Objective To investigate the risk of transmission among potentially infectious SARS-CoV-2-positive football players while participating in training or matches at amateur, youth and professional levels. Methods Between August 2020 and March 2021, football players who tested positive for SARS-CoV-2 and participated in matches or training during the period of potential contagiousness were identified through media search (professional level) and a nationwide registry in Germany (amateur and youth level) to determine symptoms, source of infection and hygiene measures adopted. The definition of potentially infectious players was based on the time of a positive PCR testing and symptom onset. Transmission-relevant contacts on the pitch were evaluated through doubly reviewed video analysis. Results Out of 1247 identified football matches and training sessions (1071 amateur and youth level, 176 professional level), 104 cases (38 training sessions, 66 matches) with 165 potentially infectious players were detected. Follow-up PCR testing at the professional level (44 cases) revealed no transmission. At the amateur and youth level, the combination of partial PCR testing (31 of 60 cases) and symptom monitoring within 14 days post-exposure (46 of 60 cases) identified 2 of 60 matches in which follow-up infections occurred that were attributed to non-football activities. This is consistent with the video analysis of 21 matches demonstrating frontal contacts were <1 per player-hour (88%, 30 of 34 players), each lasting no longer than 3 s. Conclusion On-field transmission risk of SARS-CoV-2 in football is very low. Sources of infections in football players are most likely not related to activities on the pitch.

Purpose: War injuries are characterized by a high incidence of bone and soft tissue infections caused by multidrug-resistant (MDR) pathogens. We analyzed the influence of infections with MDR pathogens on the course and outcome of 17 Ukranian patients within the first three years of surgical therapy. Methods: To assess the clinical course of Ukrainian war-wounded patients treated in our tertiary care hospital between June 2022 and May 2025, the characteristics of hospital stay, number of operations, bacterial spectrum of wound infections and antibiotic therapies were analyzed retrospectively. Results: Patients had sustained mostly severe extremity injuries several months (105.3 ± 25.1 days) prior to admission. The average length of hospital stay was 165.6 ± 29.6 days. An average of 13 ± 3 operations were performed per patient during this time. Secondary limb amputation was required in 3/17 patients (18%). MDR bacteria were detected in 11/17 cases (65%). The most common pathogen (in 9/17 patients (53%)) was carbapenem-resistant Klebsiella pneumoniae . The most frequently detected carbapenemase was New Delhi metallo-beta-lactamase. Due to multiple resistance, antibiotic therapy with ‘last-resort’ antibiotics such as aztreonam/avibactam or cefiderocol was initiated in 12/17 cases (71%). Conclusion: MDR pathogens and high rates of carbapenem resistance are commonly detected in war-injured patients. Traumatized patients should be given special importance in an interdisciplinary treatment concept, given the long hospital stays in a foreign country, MDR pathogens, and imminent amputation of a limb. A successful treatment frequently requires the individualized use of novel antibiotics in combination with radical surgical debridement. Level of Evidence: III, Retrospective/Cohort analysis

Patients suffering from fractures are often required to take simvastatin during the bone healing phase due to co-morbidities. However, the impact of simvastatin on fracture healing under ischemic conditions remains unclear so far. Therefore, we analyzed in this study the effect of simvastatin on fracture healing in an established murine ischemia model. Mild ischemia of the right hind limb and a femoral fracture was induced in CD-1 mice. After stabilization of the fracture by an intramedullary screw, the animals received either 30 mg/kg body weight simvastatin per os daily or an equivalent amount of vehicle (control). Bone healing was analyzed by biomechanical as well as radiological, histomorphometric and Western blot analyses 2 and 5 weeks postoperatively. The fractured femurs of both groups exhibited a delayed healing throughout the study period. Bone formation, as assessed by micro-computed tomography, was significantly reduced in the callus tissue of femurs in simvastatin-treated animals compared to controls. Moreover, these femurs showed histomorphometric signs of ongoing healing and a tendency towards less bone tissue at 2 weeks after surgery. Western blot analyses revealed an increased expression of CD31 and phosphoinositide-3-kinase (PI3K) after simvastatin treatment, whereas the expression of bone morphogenetic protein (BMP)-2 was significantly decreased. In conclusion, these results demonstrate that simvastatin impairs fracture healing under challenging ischemic conditions. This effect is most likely caused by an imbalance of angiogenesis and osteogenesis in the callus tissue. These findings indicate that the use of simvastatin during fracture healing under ischemic conditions warrants careful reconsideration in clinical practice.

Introduction: Percutaneous fixation techniques are increasingly used in the management of posterior pelvic ring lesions in the elderly. As the incidence of fragility fractures continues to rise, a growing number of implants and surgical techniques have been developed to address the specific challenges of this vulnerable population. The goal of this scoping review is to address the following questions: 1) What are the latest advances in percutaneous fixation of posterior pelvic ring fractures? 2) What are the clinical results and current level of evidence supporting these techniques? Methods: A systematic search using the keywords “((Percutaneous) OR (Minimal* invasive) OR (Transsacral) OR (Innovative implant)) AND ((Pelvic fragility fracture) OR (Sacral fracture))” was performed in PubMed and Cochrane Library using PRISMA-ScR guidelines. Studies published from the 11 ^th of August 2020 up to the 11 ^th of August 2025 were included and assessed independently by two reviewers. Results: A total of 334 studies were found, of which 107 were included in this review following the screening process. Of these, 22 studies pursued a biomechanical approach. Various new implants (e.g. ISG-Rod System, SI-Plate, TriFix, SACRONAIL®) and technologies (e.g. 3D computer-assisted navigation/O-arm/Robot) are described in the recent literature. Using navigation significantly reduces the rate of screw malposition. Additional cement augmentation can reduce the length of a patient’s stay in hospital. (Bilateral) transsacral fixation reduces the risk of fracture progression. Novel implants, such as curved implants and photodynamic nails, offer promising alternatives for patients with dysmorphic sacra. Conclusion: Iliosacral screw fixation is considered the gold standard for the percutaneous stabilization of the posterior pelvic ring. However, given the vast range of new implants and technologies available, decisions should always be made on a case-by-case basis. High-quality evidence studies comparing new implants with conventional SI screws are desirable.

Background/Objectives: Patients suffering from fractures are often treated with clopidogrel during the phase of bone healing due to multiple comorbidities. Studies indicate that clopidogrel suppresses osteoblast proliferation and the formation of trabecular bone. However, it is unknown whether clopidogrel also affects fracture healing under ischemic conditions, as they may occur in multimorbid patients. Methods: To test this in the present study, a murine ischemia model was performed in CD-1 mice by ligating the right deep femoral artery to induce mild ischemia of the right lower limb. A closed fracture of the femur was then stabilized by inserting an intramedullary lag screw. The animals received either 3 mg/kg body weight clopidogrel daily per os or vehicle (control). Bone healing was assessed by biomechanical, radiological, histomorphometrical and Western blot analyses 2 and 5 weeks postoperatively. Results: The fractured femurs in the clopidogrel group exhibited no increase in biomechanical stiffness throughout the observation period in contrast to controls. While the radiological analysis showed no differences between both groups, histomorphometric analyses demonstrated a significantly reduced bridging score, less bone and more connective tissue within the callus of clopidogrel-treated animals. Western blot analyses revealed a significantly reduced expression of the osteogenic marker bone morphogenetic protein (BMP)-4 and an increased expression of the blood vessel marker CD31. Conclusions: These results show that clopidogrel may impair fracture healing under challenging ischemic conditions, which is associated with a shift in angiogenic and osteogenic expression markers in the callus tissue. Therefore, clopidogrel treatment may not be recommended in fracture patients with tissue ischemia.