The aim of the study was to assess the effects of the COVID-19 pandemic on sport practice and to identify measures adopted by individuals and sports organizations to allow a safe return to community sports. An electronic survey was launched worldwide in June 2020 in the German and English languages. The questionnaire collected anonymous data on sporting activity before, during, and after pandemic-induced confinement. Participants classified themselves as either recreational, competitive, or professional sports level athletes. A total of 1336 adults (30.5±11.7 years; 54.0% women) participated in the survey; 68.5% were active athletes, 10.1% coaches, 2.1% officials and 4.3% related medical staff, 3.6% had another function, and 11.4% indicated no regular sports activity. Most participants practiced their sport in Europe (93.8%); the majority (61.0%) was amateur athletes. During confinement, 15.7% could perform their main sport unrestricted, 43.5% stated a reduced amount of time spent on sporting activities, 46.4% a reduced intensity level. Most participants (77.5%) were neither aware of screening measures nor of guidelines for dealing with infected athletes (80.0%) or for return to sports after a coronavirus infection (88.6%). Preventive measures mentioned included basic hygiene, measures to reduce personal contacts or virus transmission, or to improve traceability of infections. During confinement, a higher age (p=0.004) and training in a club setting (p<0.001) were associated with reduced sporting activity, while the availability of online training (p=0.030) was linked to both increased extent and intensity levels. A lower age (p=0.001) and recreational sports level (p=0.005) were associated with decreased activity after confinement. Although isolation can be necessary to protect public health, it alters the amount and intensity of physical activity.

Postoperative shoulder activity after proximal humerus fracture treatment could influence the outcomes of osteosynthesis and may depend on the rehabilitation protocol. This multi-centric prospective study aimed at evaluating the feasibility of continuous shoulder activity monitoring over the first six postoperative weeks, investigating potential differences between two different rehabilitation protocols. Shoulder activity was assessed with pairs of accelerometer-based trackers during the first six postoperative weeks in thirteen elderly patients having a complex proximal humerus fracture treated with a locking plate. Shoulder angles and elevation events were evaluated over time and compared between the two centers utilizing different standard rehabilitation protocols. The overall mean shoulder angle ranged from 11° to 23°, and the number of daily elevation events was between 547 and 5756. Average angles showed longitudinal change <5° over 31 ± 10 days. The number of events increased by 300% on average. Results of the two clinics exhibited no characteristic differences for shoulder angle, but the number of events increased only for the site utilizing immediate mobilization. In addition to considerable inter-patient variation, not the mean shoulder angle but the number of elevations events increased markedly over time. Differences between the two sites in number of daily events may be associated with the different rehabilitation protocols.

Introduction The aim of this study was to evaluate the clinical and radiological outcomes of patients treated with the TFN-Advanced™ Proximal Femoral Nailing system (TFNA¸ DePuy Synthes, West Chester, PA) including intra- and postoperative complications. Materials and methods All patients with an acute proximal femur fracture consequently treated with a TFNA between September 2014 and December 2018 were evaluated. Clinical and radiological data were assessed for intra- and postoperative complications, including treatment failure. In addition, intra- and postoperative X-rays were used to determine the position of the implant, and any migration, via tip-apex-distance (TAD) and the caput-collum-diaphyseal angle (CCD). The accuracy of the fracture reduction was rated by both observers according to Baumgartners criteria. Results 275 consecutive patients (mean age 77.5 ± 14.1; 70.2% female) were included. The predominant OTA/AO fracture classification was 31A2 (140 cases, 50.7%). The average surgical time was 69 min (± 39.8). The reduction quality was good in 253 cases (92.0%) and acceptable in 22 cases (8.0%). In 18 cases, a pre-defined primary outcome parameter (6.5%) was recorded after a mean of 8.2 ± 8.0 months. During the observational period, 19 patients (6.9%) required a total of 23 additional surgeries. Implant removal was not considered a failure in the absence of pain. Significant group differences were observed with younger age (p = 0.001), lower Charlson Comorbidity Index (CCI)-score (p = 0.041) and lower rate of osteoporosis (p = 0.015) in the failure group. There were no cases of cut-out or cut-through among the patients who underwent augmentation as part of osteosynthesis. Conclusions Proximal femur fractures treated with the TFNA show low complication rates and high levels of radiological healing. Implant-related complications might be more common in patients with younger age, a lower CCI-score and lower frequency of osteoporosis. Usage of cement augmentation could potentially be beneficial to reduce postoperative cut-through and cut-out.