Medial and lateral meniscus root tears are clinically relevant lesions that if left untreated are biomechanically equivalent to a functional total meniscectomy. Therefore, after making the diagnosis, surgical treatment is often indicated; however, the treatment decision should always consider individual factors such as the degree of osteoarthritis, lower limb alignment and body mass index (BMI), especially in posteromedial meniscus root tears. The main surgical techniques include side-to-side sutures and transosseous pull-out sutures. Lateral root tears often show favorable healing rates as they are usually occur as traumatic injuries in younger patients.

Technological progress in orthopedic trauma surgery is increasingly shifting from implant refinement to the digital augmentation and representation of the entire treatment pathway, the "patient journey" in order to be able to depict this longitudinally and to detect complications and negative influencing factors at an early stage. This narrative review explores new opportunities and developmental trends along this "patient journey", specifically focusing on the preoperative and postoperative treatment phases.

With an incidence of approximately 74 per 100,000 people per year, ankle fractures are among the most frequent fractures in adults and are considered a major cause of posttraumatic ankle osteoarthritis. Reliable long-term data (≥ 10 years) are scarce. The aim of this study was to review the existing literature regarding long-term treatment outcomes following surgical management of ankle fractures. A narrative literature review was conducted. Studies were identified that reported on the treatment outcomes of surgically managed ankle fractures with a follow-up period of at least 10 years. A total of 20 studies with a mean follow-up period of 12.9 years were identified. On average the long-term outcomes were good to very good; however, depending on the patient population and scoring system 11-30% of patients reported only moderate to poor outcomes. Moderate to severe osteoarthritis was radiologically found in 18-100% of cases, although it was often asymptomatic. The conversion rate to arthrodesis or endoprosthesis ranged from 0-3% across all studies. Across the studies, only fracture complexity, development of osteoarthritis over time and depression had an impact on the outcome. In our own cohort, the number of fractured malleoli was the only significant influencing factor. Overall, the quality of the studies was at times unsatisfactory and, above all, comparability was limited. In the future, a standardization of the parameters collated would be valuable in order, for example, to evaluate the effectiveness of different surgical procedures across multiple studies.

Artificial intelligence (AI) is increasingly being integrated into clinical radiology workflows and has the potential to make a significant contribution to patient care in the future. Although there is currently insufficient evidence to enable a definitive assessment, it is nonetheless worthwhile to gain experience with AI software in the context of imaging in traumatology. While impressive performance can already be observed in clinical practice, users must remain aware of the regulatory framework and critically evaluate AI results with a vigilant eye.

Orthoplastic surgery combines the expertise of trauma and orthopedic surgery with plastic and reconstructive surgery for the management of complex musculoskeletal injuries associated with extensive soft tissue defects. Its primary aim is to provide early, coordinated interdisciplinary care to restore skeletal stability, achieve durable soft tissue coverage, and maximize long-term function. An acute orthoplastic patient is defined as an individual with complex musculoskeletal and soft tissue injuries requiring close interdisciplinary collaboration between trauma, plastic, and, where appropriate, additional surgical specialties. Furthermore, associated factors such as vascular injuries, infection, or relevant comorbidities may necessitate an orthoplastic treatment approach. The following recommendations were agreed upon: Patients who are hemodynamically stable and without an acutely threatened limb should be transferred to an orthoplastic competence center as early as possible, ideally within 24 h after injury. If immediate transfer is not feasible, early structured telemedical consultation with standardized transmission of clinical information, imaging, and photographic documentation of the soft tissue injury is recommended. Management should follow a standardized treatment pathway including prompt initiation of empirical antibiotic therapy, interdisciplinary radical debridement, restoration of bone stability, early vascular assessment, and timely definitive reconstruction. Whenever feasible, definitive fracture fixation and soft tissue reconstruction should be performed simultaneously or within a short time interval. These consensus recommendations provide the first structured framework for defining, triaging, and managing acute orthoplastic patients and aim to promote standardized orthoplastic care in specialized centers.

The challenging transformation of medicine in the twenty-first century, involving robotics, artificial intelligence (AI) and the digitalization of daily work routines, is hampered by bureaucratic hurdles, a shortage of skilled workers and socioeconomic pressures within an aging healthcare system. This article provides an overview of current possibilities and applications of AI in the (peri)operative care of trauma patients. Even before surgeons enter the operating room, preoperative AI planning tools could increase efficiency in the future. Intraoperatively, navigation and robotics are already well-established and improve precision. In the future, ambient AI and digital twins can be expected to also link perioperative data as well as optimizing workflows and making decisions. The AI-supported surgical documentation increasingly relieves the workload for physicians but it still poses risks and interoperability issues. Key hurdles for AI in the operating room remain data heterogeneity, a lack of standardization and costs. It is also important, especially in the operating room, that the ethical responsibility for controlling (semi)autonomous systems remains with humans.

Fracture nonunion is a multifactorial complication of fracture healing. A solely time-based definition does not adequately reflect the underlying disturbances in healing and provides an insufficient basis for treatment decisions. Instead, management should be guided by a systematic assessment of the factors preventing osseous union. These include fracture-related infection, mechanical deficits, impaired biological healing potential, and patient-related risk factors. Occult infection should also be considered in clinically presumed aseptic nonunion. Mechanical instability requires restoration of adequate stability, whereas biological deficits may necessitate targeted augmentation. Modifiable patient-related risk factors should be optimized in parallel. As several contributing factors may coexist, treatment should not be based solely on temporal or morphological criteria but should address the individual causes of impaired fracture healing. A systematic, cause-directed approach therefore enables targeted treatment and, in multifactorial cases, the appropriate combination of therapeutic strategies.

The idea of establishing certified trauma networks to ensure nationwide, high-quality care for severely injured patients emerged in the early 2000s. Since then, it has been continuously developed. Currently, 278 local, 240 regional, and 122 supraregional trauma centers in 48 trauma networks are certified in Germany. An increasing number of other countries are adopting the TraumaNetwork within their own structures. The far-reaching changes currently taking place in German health policy, the integration of other countries with different healthcare systems into the TraumaNetwork, and the growing need to focus on care structures in terms of disaster, crisis, and war are creating new challenges.

The management of pilon fractures presents major challenges for both the treating team and the patient. As these fractures are often caused by high-impact forces, it is not uncommon for the injury patterns to result in considerable damage to the bone, cartilage and soft tissues. Despite competent and prompt treatment, these fractures are characterized by a relatively high complication rate. Classical early and late complications can be distinguished. Various complications, such as impaired wound healing, infections, non-union and osteoarthritis, along with their risks and possible treatment strategies, are explained in this article. The aim is to raise awareness of complications and potential errors in the management of pilon fractures, thereby reducing their incidence through preventive measures and facilitating treatment.

There is a high demand within our society for resilient, sustainable and efficient trauma and orthpedic surgery (TOS). The shortage of young professionals threatens the provision of comprehensive care in TOS. Alongside factors, such as payment, working hours and work-life balance, the perceived attractiveness of the role is a key determinant of personal job satisfaction and fulfilment. The relationship between the perception of one's own role, the associated variety of tasks and the resulting job satisfaction, has scarcely been investigated among specialists in TOS. This study examines the self-perception and external perception of the role as well as the attributed job satisfaction, in relation to clinical practice and the stage of specialist training. The study was based, amongst other things, on Hackman and Oldham's 5‑dimensional job characteristics theory. A quantitative online survey was conducted among 8946 members of the German Society for Orthopaedic and Trauma Surgery (DGOU). The results show that job satisfaction is lowest amongst those at the start of their careers. The group comprising junior doctors and specialists describe task variety, the holistic nature of the role and feedback as important for their own satisfaction. At the same time, doctors and specialists in training associate career progression with an increase in scores across all five dimensions. In contrast, senior doctors attribute higher scores to the tasks of doctors and specialists in further training across all dimensions than those perceived by the trainees themselves. Feedback and interaction are crucial for how they interact and communicate with one another. The group of doctors and specialists in training regard feedback, diversity of tasks, the holistic nature of the role and autonomy as important and a lack of feedback as demotivating. Action is required, amongst other things, to strengthen mutual understanding in line with the activities perceived in the workplace. Key tools are communication and feedback. The authors identify shortcomings and propose solutions in this article.