Background: Reconstruction of limbs with extensive bone loss often requires complex surgical procedures, which can be technically demanding, time-consuming, and physically and psychologically burdensome for patients. Historically, the lack of alternatives for large bone defects often led to primary amputation. Modern musculoskeletal practice allows for reconstruction using autologous or allogeneic bone grafts, or through more complex procedures such as the Masquelet technique or distraction osteogenesis. However, these methods share a common challenge: the need for a docking site procedure in cases of insufficient bony fusion of the transport segment. The aim of this study was to identify predictive factors for the need for a docking site procedure. Methods: A retrospective analysis was conducted on 93 patients treated for lower extremity bone defects between January 2013 and June 2023. Of these, 39 patients (41.9%) underwent segmental bone transport and formed the study cohort for the predictive model analysis. Patients of all ages and both genders were included, regardless of the etiology and size of the defect. The need for a docking site procedure was analyzed using logistic regression, ROC analysis, and ANOVA. Results: The study included 93 patients (73 male, 19 female) aged 7 to 83 years. The mean defect size was 76.46 mm (range: 12.1 to 225.1 mm). The mean transport duration was 149.97 days, with a mean transport speed of 0.61 mm/day. Among the 39 segmental transport patients, a docking site procedure was performed in 64.1% (n = 25). Logistic regression and ROC analysis were performed on this subgroup (n = 39, with 25 events). Significant predictors for the need for a docking site procedure were age (p = 0.024), vascular injury (p = 0.009), transport duration (p = 0.001), and transport speed (p < 0.001). ROC analysis demonstrated that transport speed (AUC = 0.931) and transport duration (AUC = 0.911) showed strong discriminative ability for predicting docking site procedure necessity, suggesting potential utility as clinical decision-support parameters. Conclusions: The study identified transport duration and speed as potentially valuable predictive factors in this retrospective cohort for the need of a docking site procedure, though prospective validation is required. A transport duration exceeding 290.5 days significantly increased the likelihood of requiring a docking site procedure. These findings can help optimize treatment planning and improve long-term limb preservation.

Purpose: Hidden blood loss (HBL) is an underrecognized contributor to total perioperative blood loss after hip fracture surgery. This study aimed to quantify HBL during the first three postoperative days following proximal femur fracture fixation and to assess the impact of preoperative anticoagulant therapy on blood loss and transfusion requirements. Methods: A retrospective cohort study was conducted including patients aged ≥ 65 years who underwent surgical fixation of proximal femur fractures at a level I trauma center between January 2020 and December 2022. Total blood loss was estimated from perioperative hemoglobin changes and calculated blood volume. Patients were stratified according to anticoagulant use, and logistic regression analysis was performed to identify independent predictors of increased blood loss. Results: Among 260 patients analyzed, median total blood loss was 1184 ml, and 25% experienced losses exceeding 1675 ml. High blood loss correlated significantly with anticoagulant use, higher BMI, and longer operative time ( p < 0.001). In multivariate analysis, anticoagulant therapy (particularly direct oral anticoagulants) remained an independent predictor of high blood loss (OR 3.06; 95% CI 1.47–6.37; p = 0.003). Patients in the highest quartile required significantly more transfusions, though short-term mortality did not differ. Conclusion: Hidden blood loss after proximal femur fracture surgery is frequent and clinically relevant. Anticoagulant use, elevated BMI, and prolonged operative duration independently increase bleeding risk. Awareness of these predictors may support optimized perioperative management and transfusion planning in elderly fracture patients.

Introduction: Posterior wall (PW) fractures are common acetabular fractures and are most often treated by open reduction and internal fixation. The gold-standard of surgical stabilization is screw fixation of large wall fragments with additional buttress plating. Some reports focussed on screw fixation alone presenting adequate results. Material and methods: From a total of 208 PW-fracture treated between 1972 and 2008, 57 patients were identified with open reduction and internal fixation (ORIF) using isolated screw fixation. These patients were analyzed regarding demographical data (patient age, sex), type of accident, injury mechanism, Injury Severity Score (ISS), concomitant pelvic ring injuries, associated injuries, perioperative parameters and long-term results. Results: 44 patients were male and 13 were female with a mean age of 36.8 years. More than 90% sustained high-energy trauma with 34 sustaining multiple injuries or polytrauma. The mean Injury Severity Score was 11.5 points. All patients had fracture dislocations, which were reduced within 24 h after admission except one patient with secondary transfer. 11 patients presented with an initial sciatic nerve deficit. 29 patients had a single PW-fragment, 16 presented with two PW-fragments and in 12 patients marginal impactions were present. Surgery was performed in average after 7 days using the Kocher-Langenbeck approach. 24.6% femoral head lesions and 19.3% acetabular lesions were detected. All hips could be reconstructed anatomically. One patient died after severe head injury. 41 patients had follow-up of at least 12 months: 80.5% reported none or slight pain and 90.2% had good to excellent clinical results. 78% had no post-traumatic hip joint changes. Conclusion: Screw fixation alone can be considered as a rare but adequate treatment modality in selected posterior wall fractures, especially minor comminuted fractures with predominantly a large single posterior wall fragment.

Periprosthetic joint infection (PJI) remains one of the most serious complications after total joint arthroplasty. This retrospective 1:1 matched case–control study investigated preoperative predictors and patient phenotypes associated with PJI in 182 patients (91 cases, 91 controls) undergoing hip or knee arthroplasty between 2013 and 2024. Variables with skewed distributions were log-transformed, and multivariable logistic regression with LASSO regularization identified independent risk factors. Unsupervised K-means clustering was applied to perioperative features to explore data-driven patient phenotypes. Preoperative anemia (OR 5.91, p = 0.026), higher ASA score (OR 1.77, p = 0.033), and surgical delay (OR 1.67, p = 0.024) independently predicted infection, while age and CRP showed non-significant trends. The resulting five-variable preoperative model achieved an AUC of 0.718 (optimism-corrected AUC of 0.661) for infection prediction. Clustering analysis revealed three phenotypes: anemia-dominated, elderly but short-procedure, and high surgery duration with significantly different infection rates (χ² = 23.5, p < 0.001) but similar mortality (p = 0.068). This integrative approach combining regression-based prediction and phenotype discovery enables clinically interpretable, preoperatively applicable risk stratification. The findings identify anemia, comorbidity burden, and surgical delay as key modifiable targets for preventive optimization before arthroplasty. External validation and recalibration to population-level incidence are warranted before clinical implementation.