[Proximal humeral fractures in the elderly : Quality of life, clinical results and institutionalization following primary reverse fracture arthroplasty]. / Proximale Humerusfraktur im fortgeschrittenen Lebensalter : Lebensqualität, klinische Ergebnisse und Institutionalisierung nach primärer inverser Frakturprothesenimplantation.

BACKGROUND: Treatment of humeral head fractures in the elderly remains a challenge. Within the framework of demographic change the incidence as well as the direct and indirect consequences of injuries will rise. The analysis of an optimal treatment should include functional parameters as well as global health parameters, e.g. quality of life. OBJECTIVE: The aim of this study was the evaluation of functional outcome, institutionalization (necessity of placement in a residential care home for the elderly, even if temporary), the influence of cognitive deficits, quality of life and the pattern of complications after primary reverse shoulder arthroplasty. MATERIAL AND METHODS: The study included a total of 34 patients (mean age 79.8 ± 6.7 years, 29 female) after implantation of a reversed modular fracture arthroplasty. The mean follow-up was 23 ± 10.6 months). The functional Constant-Murley score (CS), radiology results as well as the extent of institutionalization and quality of life as measured by the EQ-5D questionnaire were collated. RESULTS: The clinical examination showed good results in the CS (54 points, SD ± 9). In comparison to the age and gender-related CS according to Gerber the patient scores amounted to 78.9 %. The comparison of patients with and without cognitive deficits did not show any differences (53 vs. 54 points, p = 0.6525). The rate of institutionalization after treatment of humeral head fractures by reversed fracture arthroplasty was 2.94 %. The quality of life measured with EQ-5D showed a health-related quality of life (HRQoL) of 0.801. The rate of complications was 2.94 % involving an incomplete lesion of the radial nerve which was in regression. CONCLUSION: The results of this study showed good to moderate functional results, very low rates of complications and institutionalization and very good results according to the HRQoL. In comparison to conservative treatment or plate osteosynthesis, better results were achieved in this study with respect to HRQoL.

[Representatives of orthopaedic and trauma surgery residents in Germany]. / Assistentensprecher in Orthopädie und Unfallchirurgie in Deutschland.

In most German hospitals there are resident representatives to stand in for the rights and interests of residents. The precise number of representatives in orthopaedic and trauma surgery is unknown, as well as the field of duty and the rights of this position.The Junges Forum O&U presents survey data, which were collected from members of the German Society for Trauma Surgery (DGU), the German Society for Orthopaedics and Orthpaedic Surgery (DGOOC) and the German Society for Orthopaedics and Trauma (DGOU). All had an age below 40 years. The Survey was carried out in a period between 27th of January 2015 and 26th of March 2015.These data allowed the Junges Forum O&U to analyse the duties and numbers of representatives for residents in orthopaedic and trauma surgery in Germany. Questionnaires from 316 representatives were fully analysed. Of these, 92 % work at university hospitals. The conditions of election and the duties are not defined. The activity as representative was mainly fulfilled in spare time. The major aspect was conflict resolution between colleagues.The Junge Forum O&U presents the recommendation for election, field of duty and meetings on a regular basis with the other residents or even the first-line management.

[Aseptic acetabular necrosis with recurrent luxation of a bipolar hemiarthroplasty into the retroperitoneum]. / Aseptische Azetabulumnekrose mit rezidivierender Luxation eines Duokopfs in das Retroperitoneum.

In comparison to aseptic osteonecrosis of the femoral head, the occurrence of aseptic acetabular osteonecrosis is extremely rare. This article reports the case of a 77-year-old woman with a large defect of the posterior acetabular wall (type 3 AAOS/D'Antonio score). We present an option for treatment in cases of a combination of osteonecrosis with implanted bipolar hemiarthroplasty.

[Epilepsy and transverse sternum fractures: sternum fractures in drug-induced osteopenia]. / Sternumfraktur bei medikamenteninduzierter Osteopenie: Epilepsie und Sternumquerfraktur.

Fractures of the sternum are a very rare injury. The combination of indirect trauma and transverse fracture in case of an epileptic seizure has been described only in one case. A sternal fracture in a 32-year-old woman was treated by plate osteosynthesis because of progressive pain. In the current literature, there are no clear recommendations for the treatment of such fractures. Plate osteosynthesis, as an alternative to conservative treatment of such fractures, is presented and discussed.

[Safety culture in orthopedics and trauma surgery : Course concept: interpersonal competence by the German Society for Orthopaedics and Trauma (DGOU) and Lufthansa Aviation Training]. / Sicherheitskultur in Orthopädie und Unfallchirurgie : Kurskonzept: Interpersonal Competence by Deutsche Gesellschaft für Orthopädie und Unfallchirurgie (DGOU) and Lufthansa Aviation Training.

Patient safety has become a central and measurable key factor in the routine daily medical practice. The human factor plays a decisive role in safety culture and has moved into focus regarding the reduction of treatment errors and undesired critical incidents. Nonetheless, the systematic training in communication and interpersonal competences has so far only played a minor role. The German Society of Orthopaedics and Trauma (DGOU) in cooperation with the Lufthansa Aviation Training initiated a course system for interpersonal competence. Several studies confirmed the reduction of critical incidents and costs after implementation of a regular and targeted human factor training. The interpersonal competence should be an essential component of specialist training within the framework of a 3­column model.

[The Summer School of the German Society for Orthopaedics and Traumatology - A Success Story]. / Die Summer School der Deutschen Gesellschaft für Orthopädie und Unfallchirurgie ­ eine Erfolgsgeschichte.

Background: It has been known for several years that orthopaedic and trauma clinics suffer from a shortage of young people, due to the substantial loss in attractiveness. The Youth Forum OU has been addressing this problem for many years, by initiating many projects such as the Summer School to counteract this trend. The purpose of this research is to evaluate the success of Summer Schools since 2009. Methods: The Youth Forum OU performed a survey in December 2014 to answer the research question on the basis of an internet-based poll of the student participants in all Summer Schools between 2009 and 2014. Following data cleansing, 121 students and former students were included in the survey. Results: Seventy-two completed questionnaires were collected and included in the evaluation. The survey included 40 % of Summer School participants, with a mean age of 27.3 years (SD ± 2.95); 50 % were female. Participation in the Summer School helped 50 % of the respondents to decide to start advanced study in orthopaedics and/or traumatology (OU). One third of these Summer School participants had already finished a university degree; 100 % are now residents in orthopaedics and/or traumatology. Regardless of prior plans, 87.2 % of participants are now residents in OU. Thirty-three are still students: 78.8 % have already decided to work in OU. The survey also served to identify the factors positively and negatively associated with OU. Unfavourable factors included the reputation of OU, and the difficulty of reconciling family and work. Favourable factors included surgical work and personal experience during university studies. Discussion: The aim of this study was to evaluate whether the efforts of the Youth Forum OU, the German Society for Orthopaedics and Traumatology (DGOU) and the local hospitals lead to increased interest in OU. The answer to this question is positive. This is particularly true for those students who did not plan to become an orthopaedic or trauma surgeon before participating in a Summer School. In conclusion, the efforts to recruit residents for OU by using Summer Schools were successful. Moreover, this research offers approaches to counteract the loss of attractiveness of OU.

Gender influence on the outcome of an unisex total knee arthroplasty system.

BACKGROUND: Controversy exists on whether gender-specific anatomic differences in the human knee have to be taken into account by gender-specific design in total knee replacement (TKR). We evaluated total knees that were implanted in both genders. OBJECTIVE: This paper will describe the influence of gender on the outcome after a unisex total knee arthroplasty. METHODS: 52 total knee prostheses (mobile bearing Brehm Precision Knee®, BPK) were implanted in 48 patients (16 male, 32 female, 4 bilateral). Median follow-up was 15 months. HSS score, KSS score, ROM, VAS, and radiologic axis were used as outcome measures. We also obtained preoperative scores of these parameters, creating difference parameters respectively. All surgeries were performed by a single surgeon. RESULTS: No significant difference could be determined between genders for postoperative parameters and difference between preoperative and postoperative parameters between both groups. Women scored higher on HSS score preoperatively and postoperatively with 50.0 and 91.0 points versus 47.0 and 88.0 points in the male group. On KSS score, the female group scored higher preoperatively and postoperatively as well, with 79.0 and 174.0 points versus the male group with 74.0 and 168.0. CONCLUSION: As the results obtained with this unisex prosthesis system were not statistically significant when compared for gender, we conclude the BPK currently addresses gender-specific anatomic differences sufficiently.

[Daily routine in orthopedics and traumatology - results of a nationwide survey of residents]. / Der klinische Alltag in Orthopädie und Unfallchirurgie - Ergebnisse einer nationalen Umfrage unter Assistenzärzten in O und U.

BACKGROUND: The subject orthopedics and traumatology suffers by a loss of attractiveness which results in a lack of young blood. The aim of this study of the Youth Forum of the German Society of Orthopedics and Traumatology (DGOU) is to register the working conditions of residents in orthopedics. MATERIAL AND METHODS: In the months September and October 2013 we performed a survey on members of the following German societies: German Society of Orthopedics and Traumatology (DGOU), German Society of Traumatology (DGU) and the German Society of Orthopedics and Orthopedic Surgery (DGOOC), (age < 40). Our questionnaire includes 15 questions. RESULTS: We achieved 28,9 % (n = 331) answered questionnaires. The mean working time per week is 55 hours. 73 % of all participants do more than 5 emergency services per month. 52 % are more than 3 times on duty for 24 hours. Only 13 % of all residents have well ordered working hours. Normally working time is divided into three parts: one third for bureaucracy, one for operation theatre and the last for other activities (e.g. ward round). 35,6 % do only one surgery per week, 12 % do not perform any surgeries. An annual report is performed only in 45 %. A structured concept of training only exists in 16 % of all hospitals. In addition to clinical work 45 % are involved in scientific projects, mostly in their spare-time. Finally 58 % of all surgeons would still recommend orthopedics and traumatology. CONCLUSION: In order to maintain orthopedics and traumatology as an attractive it is necessary to implement flexible working time models and to reorganize and improve training-concepts.