Medical studies in times of a pandemic - concepts of digital teaching for Orthopaedics and Trauma at german universities.

BACKGROUND: Due to the Covid-19 pandemic, on-site classroom teaching became limited at most German medical universities. This caused a sudden demand for digital teaching concepts. How the transfer from classroom to digital teaching or digitally assisted teaching was conducted was decided by each university and/or department individually. As a surgical discipline, Orthopaedics and Trauma have a particular focus on hands-on teaching as well as direct contact to patients. Therefore, specific challenges in designing digital teaching concepts were expected to arise. Aim of this study was to evaluate medical teaching at German universities one year into the pandemic as well as to identify potentials and pitfalls in order to develop possible optimization approaches. METHODS: A questionnaire with 17 items was designed and sent to the professors in charge of organising the teaching in Orthopaedics and Trauma at each medical university. A differentiation between Orthopaedics and Trauma was not made to allow a general overview. We collected the answers and conducted a qualitative analysis. RESULTS: We received 24 replies. Each university reported a substantial reduction of their classroom teaching and efforts to transfer their teaching to digital formats. Three sites were able to switch to digital teaching concepts completely, whereas others tried to enable classroom and bedside teaching at least for students of higher edcuational levels. The online platforms used varied depending on the university as well as the format it was supposed to support. CONCLUSION: One year into the pandemic significant differences concerning the proportions of classroom and digital teaching for Orthopaedics and Trauma can be observed. Simultaneously huge differences in concepts used to create digital teaching are present. Since a complete suspense of classroom teaching was never mandatory, several universities developed hygiene concepts to enable hands-on and bedside teaching. Despite these differences, some similarities were observed: the lack of time and personnel to generate adequate teaching material was reported as the leading challenge by all participants of this study.

Clinical and Patient-Related Outcome After Stabilization of Dorsal Pelvic Ring Fractures: A Retrospective Study Comparing Transiliac Fixator (TIFI) and Spinopelvic Fixation (SPF).

Purpose: Aim of this retrospective cohort study was the comparison of the transiliac fixator (TIFI) and spinopelvic fixation (SPF) for fixation of dorsal pelvic ring fractures in terms of clinical outcome, complications, and quality of life. Methods: Thirty-eight patients (23 men, 15 women; mean age 47 ± 19 years) with dorsal pelvic ring fractures (type-C-injuries after AO/OTA) that have been stabilized by either TIFI (group TIFI, n = 22) or SPF (group SPF, n = 16) between May 2015 and December 2018 were retrospectively reviewed. Outcome measurements included demographic data, perioperative parameters, and complications and were obtained from the medical information system. Quality of life was assessed using the German version of the short form 36 (SF-36) and short muskuloskeletal function assessment (SMFA-D). Clinical results were assessed using Merle d'Aubigné-Score, Iowa Pelvic Score, and Majeed Pelvic Score. Results: Both groups show relatively good post-operative results, which has previously been reported. Quality of life was comparable in both groups. Group TIFI was slightly superior regarding complication rates, cutting/suture time, and fluoroscopy time. Group SPF seemed to be superior regarding pain and pelvic scores. Conclusion: None of the methods could demonstrate significant superiority over the other. Management of pelvic injuries remains a highly individual challenge adapted to the individual patients' condition. Nevertheless, if fractures allow for stabilization with TIFI, the use of this method should be taken into consideration as a less invasive and more tissue-conserving approach.

"Quod licet Chefarzt  ": The Impact of Perceived Hierarchy on Working Atmosphere and Quality of Work in Orthopaedic and Trauma Surgery. Results of a Survey Among 799 Orthopaedic and Trauma Surgeons in Germany. / "Quod licet Chefarzt  ": Der Einfluss der empfundenen Hierarchie auf Arbeitsklima und Arbeitsqualität in O und U. Ergebnisse einer Umfrage unter 799 Orthopäden und Unfallchirurgen in Deutschland.

INTRODUCTION: Surgical departments are discredited as guardians of traditional structures of hierarchy. Hierarchy and working climate have a large share in human factor, being made responsible for 70% of avoidable errors in medicine. Aim of this study was the assessment of these topics amongst physicians in the field of orthopedics and traumatology. MATERIAL AND METHODS: A questionnaire of 10 questions was digitally handed to DGOU members. 799 questionnaires were answered. RESULTS: We found significant differences in the assessment of hierarchy and working atmosphere amongst the physician groups. Working atmosphere was perceived as not appreciative by registrars only. All groups were in favor of a hierarchy rather close to, but nut absolutely on equal terms. All groups attach high influence of working atmosphere on quality of daily work. DISCUSSION: Literature shows that hierarchic differentiation can increase performance of a team, while rigid hierarchy structures can lead to mistakes. Although hierarchy in orthopedics and traumatology seems to be less pronounced than assumed, hierarchy has great influence on daily work. CONCLUSION: In order to achieve a safety oriented medical environment, it will be of great importance to define hierarchy structures in clinics and to utilize them efficiently as a part of safety culture.

Atypically Located Osteoid Osteoma: Characteristics and Therapeutic Success After Image-Guided Thermal Ablation. / Das atypisch lokalisierte Osteoidosteom: Charakteristiken und Therapieerfolg nach bildgesteuerter Thermoablation.

PURPOSE: While ostoeid osteomas (OO) are typically located in long tubular bones, OO occurring elsewhere are referred to as "atypical". Aim of our study was to review the characteristics of atypically located OO, course of symptoms and therapy, as well as clinical outcome, safety, and patient satisfaction of radiofrequency ablation (RFA). MATERIALS AND METHODS: In the period from 04/01 to 07/13, 33 patients were treated using thermal ablation (RFA or laser), partly with low temperature and short duration technique. Clinical records were analyzed. Additionally, 23 patients were interviewed via telephone. Primary endpoints were technical success, clinical success (recurrence rates), and adverse events. Secondary endpoints were course of symptoms and therapy as well as patient satisfaction. RESULTS: Mean follow-up was 22.1 ±â€Š21.5 months. Average patient age was 31.7 ±â€Š16.3 years. Localization: Most atypical OO (61 %) were located in the lower extremity, followed by axial skeleton (26 %) and upper extremity (13 %). Pain anamnesis: 74 % of patients stated that their pain occured predominantly at night and responded to NSAID, as typical for OO. Diagnostics: Patients consulted on average 4 different doctors and in 52 % patients, ≥ 3 different radiologic imaging techniques where used before the diagnosis "OO" was made. OUTCOME: Technical success of thermal ablation was 100 %. Primary clinical success was 91 %. Patient satisfaction was 100 %. No major complications occurred. CONCLUSION: In » of cases, atypical OO did not show the typical pain characteristics of OO. Image-guided thermal ablation is a promising and safe therapy also for patients with atypical OO. KEY POINTS: · Atypical OO are challenging regarding diagnostics and therapy. · Image-guided thermal ablation is a safe and effective procedure also for patients with atypical OO. · Image-guided thermal ablation shows high patient satisfaction. CITATION FORMAT: · Seemann RJ, Märdian S, Schwabe P et al. Atypically Located Osteoid Osteoma: Characteristics and Therapeutic Success After Image-Guided Thermal Ablation. Fortschr Röntgenstr 2020; 192: 335 - 342.