Background: As patient volumes rise and the workforce ages, medical specialties face mounting pressure to attract and retain new talent. Despite women making up the majority of medical students in Germany, their representation in surgical fields, especially orthopaedics and trauma surgery (O&T), remains comparatively low and has shown little improvement over the past decade. To ensure the future of surgical care, it is essential to understand how medical students – particularly women – perceive O&T and what factors shape their specialty choices. Methods: In this prospective cross-sectional survey, 676 medical students from 32 medical faculties in Germany and Austria completed a questionnaire to assess specialty preferences, career motivations, educational experiences, and attitudes toward potential reforms in specialty training. Descriptive statistics, group comparisons, and regression analyses were used to examine gender differences and trends across stages of medical education. Results: O&T was selected as a preferred specialty by 11.5% of respondents, with no significant gender difference at baseline ( p = 0.213). However, female interest declined significantly throughout medical school, while male interest remained stable ( p = 0.028). The most important influencing factors were subject-related interest, work environment, and practical clinical experiences. Female students rated work–life balance, part-time options, and gender representation significantly higher than male peers (all p < 0.01). Only 67.9% of students considered O&T a suitable field for women. More than half reported having been actively discouraged from entering the field—frequently by O&T physicians themselves (accounting for 30% of reported discouragement). Conclusion: This study reveals a persistent gap between early interest in O&T and the structural realities that may shape students’ long-term career decisions. This disconnect does not appear to stem from a lack of interest or ability but may be linked to perceived barriers such as rigid hierarchies, limited female representation, and exclusionary workplace cultures. Supporting future talent may therefore require attention to sustainable career paths, inclusive leadership, and visible efforts toward structural change.

Purpose: Ruptures of the posterior cruciate ligament (PCL) are often accompanied by posterolateral corner (PLC) and posteromedial corner (PMC) injuries. This study investigates the incidence and impact of PMC and PLC injuries on posterior tibial translation (PTT). It was hypothesized that PMC injuries are more common and impactful than previously reported.Methods: In this retrospective study, all patients with a PCL injury between January 2016 and December 2023 and received magnetic resonance imaging (MRI) within 30 days of trauma were included. Patients with atraumatic PCL instability, missing MRI or additional anterior cruciate ligament (ACL) rupture were excluded. Posttraumatic MRI was analyzed for peripheral injuries. Preoperative stress radiographs for PTT were measured, and the side‐to‐side difference was calculated. The statistical significance level was set at p < 0.05.Results: Ninety‐two patients were included, predominantly male (71.7%) with a mean age of 35.8 ± 15.6 years at injury. The mean time from injury to MRI was 7.3 ± 7.9 days. There were 16 patients (27.4%) with isolated PCL injuries. The prevalence of medial injuries (37.0% superficial medial collateral ligament [sMCL], 66.3% deep medial collateral ligament and 51.1% posterior oblique ligament [POL]) was comparable to lateral injuries (22.8% LCL, 55.4% PLC and 13.0% popliteus tendon). Injuries of the PMC (sMCL ± POL) occurred in 53 patients (57.6%) and of the PLC (POP ± PLC ± LCL) in 59 (64.1%) patients. PTT was significantly increased in the presence of a peripheral‐associated injury compared to isolated PCL injury (p < 0.01). With a combined injury of PMC + PLC the PTT was significantly larger than in the case of a unilateral injury (p < 0.05 compared to PLC; p < 0.05 compared to PMC).Conclusion: PCL injuries are commonly associated with PMC and/or PLC injuries. A PTT of >10 mm is equally caused by PLC and PMC‐associated injuries. Knowledge about the severity and localization of peripheral‐associated injuries is therefore essential for therapeutic decision‐making.Level of Evidence: Level III retrospective cohort study.

Platelets are attributed an increasing role in the post-traumatic immune response. The exact mechanisms, particularly the link between immune response and hemostasis, have not been conclusively established. This study aimed to investigate the activity marker CD63 on platelets after polytrauma and its significance for hemostasis. A non-interventional, prospective clinical study was conducted, in which the blood of 20 polytraumatized patients was analyzed at nine time points within 10 days following trauma. Peripheral blood platelets were analyzed using flow cytometry to determine CD63 expression and rotational thromboelastometry (ROTEM^®) for hemostatic platelet function. Additionally, the clinical parameters of age, gender, and injury severity were correlated to the experimental outcomes. During the observation period, an increase in platelet count and CD63 expression was observed. Simultaneously, a hemostasiological dysfunction with reduced platelet maximum clot firmness (MCF) was observed. The factors of age, gender, and injury severity showed no significant influence on immunological activation or coagulation function. These results suggest that polytrauma induces a platelet response and CD63 activation while simultaneously impairing hemostasis. This reveals a novel perspective on post-traumatic coagulation disorders, indicating that immunologically active platelets may lose their ability to contribute effectively to blood clotting. Consequently, these findings emphasize the critical role of platelet immunology in hemostatic regulation.

Purpose: Medial patellofemoral ligament (MPFL) reconstruction is the most used surgical technique in the treatment of patellofemoral instability. However, the role of patient specific factors like age, sex and body mass index (BMI) at surgery is being increasingly discussed. The aim of this study was to study the influence of these factors with regards to functional outcomes and redislocation rates. Methods: All patients with patellofemoral instability, who were treated with isolated MPFL reconstruction surgery between 01/2017 to 01/2022, were included. Patients with pathologic risk factors, high‐grade cartilage damage, prior surgeries and age <14 years were excluded. Demographic information and information concerning surgery, complications and history were collected. Patient reported outcome measures (PROMs) were collected preoperatively, after 6 and 12 months postoperatively and at final follow‐up using multiple standardised scores (knee injury and osteoarthritis outcome score, International Knee Documentation Committee [IKDC], Tegner activity scale, Kujala, BANFF). Results: Of the 62 patients included in this study 42 (67.7%) were female with a mean age of 24.8 ± 7.6 years and a mean BMI of 24.5 ± 4.7 kg/m ² at the time of surgery. Final follow‐up was 42.3 ± 23.4 months. Fifty‐four (90.3%) patients were satisfied with the functional outcome, four (6.5%) patients suffered recurrent dislocation. Overall, the functional outcome was very good in our study population (e.g., Kujala 87.0 ± 10.5, IKDC 76.4 ± 13.7). In the subgroup analysis, there were no significant differences in the functional outcome between women and men (e.g., Kujala score: 87.2 ± 11.4 vs. 86.4 ± 7.8, p = 0.81) and there was no correlation with BMI at time of surgery (e.g., Kujala, r = 0.11, p = 0.53). However, statistically significant correlations were detected in functional outcome with the age at surgery. Conclusion: Older age at the time of surgery has a highly significant negative correlation with the functional outcome after isolated MPFL reconstruction. Therefore, surgeons must be highly vigilant and identify high‐risk patients even before surgery and necessary MPFL reconstruction should not be delayed. Level of Evidence: Level III, retrospective cohort study.

Fracture healing failure affects millions globally, yet early molecular mechanisms remain poorly understood. This study aimed to characterize initial fracture response through analyzing peripheral blood hematology, multiplex cytokine profiles, and microRNA (miRNA) expression in fracture hematoma within the first 5 days post-injury. In a prospective cohort of 64 patients with acute clavicle fractures, we assessed hematological parameters, cytokine levels via multiplex immunoassays, and miRNA expression through RNA sequencing, and quantitative PCR (qPCR) validation. Fracture severity and time elapsed post-injury were key drivers of molecular response variability. Severe fractures (type C) were associated with older patient age and impaired hematological parameters, including reduced hemoglobin, erythrocyte counts, and hematocrit. Leukocyte counts declined over time, reflecting evolving systemic inflammation. Severity-dependent cytokines included eotaxin, interferon alpha-2 (IFNα2), interleukin-1 alpha (IL-1α), macrophage inflammatory protein-1 (MIP-1α), whereas interferon gamma-induced protein 10 (IP-10) and MIP-1α distinguished temporal healing phases. MiRNA profiling revealed 55 miRNAs with significant time-dependent expression changes (27 downregulated, 28 upregulated). Five key miRNAs (miR-140-5p, miR-181a-5p, miR-214-3p, miR-23a-3p, miR-98-5p) showed robust temporal patterns and enrichment in cytokine signaling pathways critical for bone repair. This work presents the first detailed molecular portrait of early human fracture healing, highlighting hematological, immune cytokine, and miRNA networks orchestrating repair. These insights provide a foundation for biomarkers development to predict healing outcomes and support precision-targeted interventions in fracture management.

Introduction: Women show lower mortality and fewer complications than men after severe polytrauma, but underlying mechanisms remain unclear. In this context, reproductive hormones have gained increasing attention. In particular, oestradiol is controversially discussed: experimental studies suggest protective effects, whereas clinical studies link elevated levels to systemic inflammation and adverse outcomes. Methods: Therefore, in this prospective cohort study, patients with polytrauma(injury severity score ≥16) were enrolled. Hormones (oestradiol, progesterone, testosterone, luteinising hormone [LH], follicle-stimulating hormone [FSH]) were measured on admission and daily on days 1–5. Longitudinal changes were analysed with repeated-measures models. Associations with injury severity and clinical outcomes (organ failure, length of stay, mortality) were assessed using correlation and regression analyses adjusted for relevant confounders. Results: 128 patients, progesterone, testosterone, LH, and FSH declined significantly over time, whereas oestradiol showed an early rise with a peak around the second day followed by a decline. Sex-specific differences were observed for testosterone, LH, and FSH, but not for oestradiol. Elevated oestradiol levels and post-traumatic increases were independently associated with injury severity and adverse outcomes, including organ failure, longer stay and mortality, after adjustment for injury severity. These findings were consistent across different oestradiol metrics (peak, area under the curve, and absolute change). Discussion: be an integral component of the early systemic response to polytrauma and are associated with injury severity and adverse outcomes. These findings challenge the concept of oestradiol as a uniformly protective factor and support its role as a marker of post-traumatic stress and systemic dysregulation.