Bone regeneration presents an enduring clinical barrier, particularly with the projected rise in osteoporotic fractures exceeding 6 million annually by 2050. Autografts, allografts, and xenografts remain foundational in bone repair due to their inherent osteogenic, osteoconductive, and osteoinductive capacities. However, issues such as donor site morbidity, immunogenicity, limited graft availability, and pathogen transmission risks limit their applicability. In response, recent developments in biomaterials, including ion-doped bioceramics, bioactive glass-polymer composites, and stem cell-functionalized hydrogels, aim to replicate the hierarchical structure and biochemical microenvironment of native bone. This review surveys advancements in scaffold materials over the past five years, evaluating their physicochemical properties, immune modulation potential, and clinical readiness within the context of bone tissue engineering (BTE). Specific attention is given to strategies for selecting appropriate biomaterials based on clinical needs, considering their physical and biological properties, as well as their respective advantages and limitations. Despite this progress, clinical translation remains limited; only a few engineered scaffolds have achieved regulatory approval for routine use. To accelerate adoption, efforts must focus on scalable fabrication, quantitative immune profiling, and scaffold degradation monitoring to bridge preclinical performance with clinical efficacy.

Human papilloma virus (HPV)-positive head and neck squamous cell carcinoma (HNSCC) cells are highly radiosensitive resulting from an elevated number of DNA double-strand breaks (DSB) remaining after irradiation. Partially this effect is due to a defective homologous recombination (HR). HPV-positive cells also show pronounced instability of chromosome 3, which codes for the kinase ataxia-telangiectasia and Rad3-related (ATR) protein, a central player of HR. If there is a contribution of ATR to the radiosensitivity of HPV-positive cells remains unclear, and this in-vitro study tested a functional involvement of ATR expression. The study was performed with six HPV-negative and six HPV-positive HNSCC cell lines. Gene copy number and gene expression were determined via qRT-PCR, protein expression by Western Blot. Response of cells towards irradiation in dependence of ATR expression was tested after siRNA Knock-down (ATRKD). Clonogenic survival after photon irradiation was evaluated by colony formation assay and DSBs were visualized by γH2AX/53BP1 co-staining. ATR gene copy number and expression were not altered. Protein level was almost two-fold lower in HPV-positive compared to HPV-negative cells, but fully functional as observed by active phosphorylation in response towards irradiation. ATRKD resulted in a further increase in both, radiosensitivity as well as number of residual DSBs, but only for HPV-positive cells. Since the effect of ATRKD was compensated in HPV-negative but not in HPV-positive cells, these data revealed that the two-fold lower level of ATR in HPV-positive cells does not account for their enhanced inherent radiosensitivity, but acts additive to irradiation.

Zusammenfassung: Hintergrund: Traumaregister ermöglichen eine systematische Bewertung der Versorgungsqualität schwer verletzter Patienten. Ziel dieser Arbeit ist der Vergleich zentraler epidemiologischer, klinischer und prozessbezogener Parameter aus Deutschland, Österreich und der Schweiz anhand ihrer nationalen Traumaregister. Methodik: Es wurde eine narrative, deskriptive Analyse der aktuell verfügbaren Registerdaten durchgeführt. Für Deutschland (TR-DGU, 2023) und Österreich (TR-ÖGU, 2023) wurden ausschließlich Daten des Basiskollektivs verwendet [1, 2]. Für die Schweiz wurden mangels Jahresberichten die publizierten Daten des Swiss Trauma Registry (STR, 2015–2019; Costa et al.) ausgewertet, die ausschließlich Fälle mit einem ISS ≥ 16 und/oder AIS des Kopfes ≥ 3 umfassen [3, 4]. Aufgrund unterschiedlicher Einschlusskriterien und Zeiträume wurde kein inferenzstatistischer Vergleich durchgeführt. Ergebnisse: Deutschland dokumentierte 2023 im Basiskollektiv 31.217 Patienten, davon 28.718 primär versorgt (Ø 54,5 Jahre, 69,6 % männlich, Ø ISS 18,5). In der Outcome-Kohorte von 25.208 Patienten lag die Krankenhausmortalität bei 7,4 % [1]. Österreich erfasste im selben Jahr 1060 Fälle (Ø 50,2 Jahre, 73,8 % männlich, Ø ISS 22,6) mit einer Mortalität von 14,7 % [2]. In der Schweiz wurden in den publizierten STR-Analysen zwischen 2015 und 2019 insgesamt 13.222 Patienten erfasst (Ø 58 Jahre, 68 % männlich, Ø ISS 22) mit einer Mortalität von 11,6 % [3, 4]. Während in allen 3 Ländern stumpfe Traumata dominieren (> 90 % in DE/AT, ≈ 94 % geschätzt aus Costa et al.), unterscheiden sich die prähospitalen Strukturen: Deutschland und Österreich setzen auf ein notarztbasiertes System, die Schweiz stärker auf Paramedics. Prozessparameter wie präklinische Intubation, Schockraum-CT oder Transfusionen variieren zwischen den Ländern, zeigen jedoch insgesamt vergleichbare Versorgungsabläufe. Schlussfolgerung: Die Traumaregister im DACH-Raum zeigen insgesamt vergleichbare Strukturen in der Versorgung schwer verletzter Patienten, unterscheiden sich jedoch in Altersprofil, Fallselektion, Mechanismen und Mortalität. Da für die Schweiz ausschließlich publizierte STR-Analysen verfügbar sind, die nur schwer verletzte Patienten einschließen, ist die Schweizer Kohorte definitionsgemäß schwerer verletzt als die deutschen und österreichischen Basiskollektive. Harmonisierte Registerstrukturen und gemeinsame Auswertungen könnten künftig dazu beitragen, länderübergreifend voneinander zu lernen und die Versorgungsqualität weiter zu verbessern. Graphic

Purpose: Implant-associated complications remain a major challenge in orthopaedic and trauma surgery, particularly among elderly patients requiring revision procedures or infection management. This study analysed nationwide trends and healthcare burden of implant-associated complications in Germany. Methods: Nationwide German hospital discharge data from 2000 to 2023 were analysed and complemented by Diagnosis-Related Group (DRG) data from 2024. Cases were identified using ICD-10-GM code T84 and its subcategories. Outcomes included temporal trends, age-standardised incidence, demographic characteristics, in-hospital mortality, length of stay (LOS), and DRG-based healthcare resource utilisation. Results: Hospitalisations for implant-associated complications increased from 45,121 in 2000 to a peak of 95,154 in 2011, followed by a decline to 72,846 in 2023. Age-standardised incidence decreased by approximately 31% between 2010 and 2023. Segmented regression identified a temporal breakpoint in 2010.6, with annual percentage changes of + 6.21% before and − 3.55% after the breakpoint. Annual hospitalisations for periprosthetic joint infection increased from 5,367 to 11,215, while osteosynthesis-associated infections increased from 2,469 to 7,059. Mean LOS decreased from 20.8 to 11.8 days, whereas in-hospital mortality remained stable. Compared with low-complexity cases, infection-related complications were associated with prolonged hospitalisation and approximately threefold higher treatment costs, while complex revision procedures generated mean costs exceeding €9,000 per case. Conclusion: Although the age-standardised incidence of implant-associated complications has declined in recent years, infection-related complications and complex revision procedures continue to impose a substantial clinical and economic burden, underlining the need for continued optimisation of prevention and treatment strategies.

Inflammatory rheumatic diseases are major contributors to morbidity and healthcare utilisation worldwide. Advances in disease-modifying antirheumatic drug therapy have substantially changed disease management and may have influenced patterns of inpatient care and orthopaedic surgical treatment. However, nationwide data on long-term hospitalisation trends remain limited. This nationwide analysis of aggregated inpatient hospital discharge data was based on data from the German Federal Health Monitoring system (GBE-Bund) between 2010 and 2023. Hospitalisations associated with rheumatoid arthritis (RA), psoriatic arthritis (PsA), ankylosing spondylitis (AS), juvenile idiopathic arthritis (JIA), and osteomyelitis were identified using ICD-10-GM codes. Orthopaedic procedures were analysed using diagnosis-related group data from the German Institute for the Hospital Remuneration System (InEK). Hospitalisation trends differed substantially across disease groups. RA hospitalisations declined from 29,775 cases in 2010 to 24,992 cases in 2023 (− 16.1%), while JIA showed the largest reduction (− 43.0%). In contrast, PsA hospitalisations increased (+ 7.6%), whereas AS remained largely stable (+ 2.9%). Osteomyelitis, included as a comparator musculoskeletal disorder, showed an overall stable pattern. A marked reduction in hospitalisations was observed across all disease groups in 2020. Age-standardised hospitalisation rates largely mirrored these findings, with RA decreasing from 40 to 30 and JIA from 7 to 4 hospitalisations per 100,000 population between 2010 and 2023. Distinct orthopaedic procedure profiles were identified, with knee and hip replacement procedures predominating in RA and spine-related interventions predominating in AS. Nationwide hospitalisation patterns in inflammatory rheumatic diseases have changed substantially over the past decade. Despite advances in medical therapy, orthopaedic surgical interventions continue to represent an important component of disease management, highlighting the continued need for integrated rheumatologic and orthopaedic care.

Bone defects caused by trauma, infection, tumour resection and impaired healing remain difficult to reconstruct because successful repair requires coordinated mechanical stability, vascularisation, immune regulation and osteogenesis. Natural-based hydrogels provide hydrated, extracellular-matrix-mimicking platforms that can conform to irregular defects and integrate local delivery of bioactive factors, cells, extracellular vesicles and mineral phases. This critical narrative review examines natural-based hydrogels for bone regeneration from a biomaterials-to-clinic perspective, focusing on material design, cell–material interactions, vascularisation, osteoimmunomodulation, controlled therapeutic delivery, injectable and stimuli-responsive systems, composite reinforcement and 3D bioprinting. Human evidence exists for selected gelatin- and hyaluronan-based systems and for clinically adjacent applications such as growth-factor-assisted fracture healing and antibacterial implant coatings; however, most multifunctional regenerative systems remain preclinical. We therefore emphasise translational maturity rather than technological novelty alone. Key barriers include insufficient load-bearing mechanics, variable in vivo degradation, vascularisation at clinically relevant scale, manufacturing and sterilisation constraints, regulatory complexity and limited comparative clinical evidence. The most credible path to clinical adoption is likely to involve indication-specific systems that provide a reproducible biological advantage while remaining surgically compatible, scalable and practically manufacturable.