Background: Early operative treatment of acetabulum fractures in geriatric patients has been suggested to reduce pain and allow for earlier mobilization. The aim of this study was to determine mortality, complications and functional outcome after operative and non-operative treatment. Methods: Patients aged ≥60 years with operative treatment of low-energy fragility fracture of the acetabulum from 2009 to 2016 and a follow-up of at least 24 months were identified. The patients were contacted by phone and a modified Merle d’Aubigné score was obtained. If patients or their relatives were not available for follow-up, mortality data was assessed using a national social insurance database. Results: One hundred seventy-six patients (mean age 78, SD 10 years; 73 female) were available for analysis of mortality data. At final follow-up (68 months, SD 26, range, 24 to 129), 99/176 patients (56.3%) had deceased. One-year-mortality was 25.0% and 2-year mortality 35.8%. Type of treatment (non-operative vs. operative) did not affect mortality at 1 and 2 years (p = .65 and p = .10). Hospital-acquired infections were observed in 31/176 cases (17.6%), thromboembolic events and delirium in 6 patients (3.4%). In-hospital mortality was 5.7%. Patients who underwent operative treatment were more likely to have an in-hospital infection (p = .02) but less likely to sustain thromboembolic events (p = .03). The mean hospital stay was 14 days (SD 10 days, range, 1 to 66). Patients with operative treatment were longer hospitalized than patients with non-operative treatment (p < .001). The rate of secondary conversions to THA was 12.4%, this was not affected by initial treatment. The mean modified Merle d’Aubigné Score of those patients available for a final follow-up (n = 47; follow-up 56 months, SD 28, range, 24 to 115) was 14/18 points, SD 3 (range 7 to 18). Functional results at final follow-up between operatively and non-operatively treated patients were without difference. Conclusions: All-cause mortality and in-hospital complications are high among geriatric patients with low-energy fractures of the acetabulum even when treated operatively. Secondary conversion rates to THA are similar to those seen in younger patients. Mid-term functional outcome in those surviving is fair.

Introduction: The field of orthopedics and trauma surgery in Germany is facing an increasing shortage of young specialists. Several solutions have already been proposed to attract new residents. This study evaluates the influence of a student job in an orthopedic surgery department on the career choice and skill acquisition of medical students. Methods: A single center, cross-sectional survey was conducted among 51 medical students employed as paid student assistants in the Department of Orthopedics, Trauma and Plastic Surgery at the University of Leipzig since 2017. A total of 42 participants (response rate: 82.4%) completed an online questionnaire assessing sociodemographic data, career choices and skills acquired during their employment. Statistical analysis was performed using SPSS. Results: Half of the participants with completed medical studies chose surgical residencies, with 83.3% of these in orthopedic surgery. The experience as a student assistant was ranked as the second most influential factor for career decisions after the final practical year. Participants reported significant skill acquisition, particularly in practical ward activities (mean Likert scale: 4.40 ± 0.79), operating room skills 3.55 ± 1.14 and understanding clinical processes 3.45 ± 0.86; however, limited impact was observed on scientific motivation (2.29 ± 1.13) and conducting orthopedic-specific examinations (1.98 ± 0.79). Conclusion: Student assistantships in orthopedic surgery provide substantial practical training and positively influence career decisions, potentially countering the declining interest in surgical fields. These roles represent an effective strategy for junior staff recruitment, offering structured exposure to the surgical profession. Future research should explore broader multicenter implementations to confirm these findings. Graphic

Zusammenfassung: Hintergrund: Das Osteosyntheseversagen nach proximaler Femurfraktur stellt eine zunehmende Herausforderung in der Alterstraumatologie dar. In diesen Fällen ist häufig eine Konversions-Hüfttotalendoprothese (K-HTEP) erforderlich. Unklar ist, ob ein einzeitiges oder zweizeitiges Vorgehen hinsichtlich Infektionsrisiko und klinischem Outcome überlegen ist. Methodik: Es wurde eine Literaturrecherche in der Datenbank PubMed für den Zeitraum 1995–2025 durchgeführt. Eingeschlossen wurden Originalarbeiten, die das ein- oder zweizeitige Vorgehen nach Osteosyntheseversagen des proximalen Femurs untersuchten. Fallberichte, Editorials und Studien ohne Bezug zur Hüftendoprothetik wurden ausgeschlossen. Insgesamt wurden 17 Publikationen in die Analyse eingeschlossen. Auf Grundlage der Ergebnisse wurde ein klinischer Entscheidungsalgorithmus zur Therapieplanung in der eigenen Klinik entwickelt. Ergebnisse: Die verfügbare Evidenz basiert überwiegend auf retrospektiven Studien mit geringer Fallzahl. Infektionsraten nach K‑HTEP variieren erheblich zwischen den Studien (0–8,6 %). Einzelne Arbeiten zeigen Vorteile des zweizeitigen Vorgehens hinsichtlich Infektionskontrolle, während andere vergleichbare Ergebnisse für beide Strategien aufzeigen. Positive mikrobiologische Befunde trotz fehlender klinischer Infektzeichen sind häufig, ihre klinische Relevanz bleibt unklar. Schlussfolgerung: Die aktuelle Datenlage erlaubt keine eindeutige Empfehlung zugunsten eines ein- oder zweizeitigen Vorgehens. Entscheidend ist eine individuelle Risikostratifizierung unter Berücksichtigung klinischer, laborchemischer und radiologischer Parameter. Der vorgestellte klinische Algorithmus bietet einen praxisorientierten Ansatz zur Entscheidungsfindung. Prospektive, multizentrische Studien sind erforderlich, um belastbare Empfehlungen abzuleiten.