Surgical Treatment of Proximal Humerus Unicameral Bone Cyst: A Case Report.

Unicameral bone cysts (UBCs) are noncancerous, fluid-containing sacs commonly seen in the metaphysis of long bones among young individuals, mainly affecting the proximal humerus and femur. Since they are painless, 80% of patients do not experience any symptoms from UBCs unless it is complicated by a pathological or stress fracture. These patients usually present with no history of trauma, with mild pain, local tenderness, and occasionally swelling. The diagnosis of UBCS can either be an incidental finding or can be made with the help of clinical features, radiographs, and differential diagnoses of UBCs like aneurysmal bone cyst, fibrous dysplasia, enchondroma, eosinophilic granuloma, and intraosseous ganglia can be ruled out. While identifying these cysts is often straightforward, there is ongoing debate regarding the optimal management approach. We report a case of a 16-year-old female with proximal humerus UBC who presented with a pathological fracture of the right proximal humerus. The patient was initially managed conservatively. However, she sustained a refracture at the same site twice over four years. Due to fracture recurrence and residual deformity, it was treated surgically with curettage, bone grafting, and internal fixation. The normal alignment and function of the right upper limb were restored postoperatively.

Arthroscopic shoulder surgery for gouty long head of biceps tendinitis: a case report.

OBJECTIVE: The objective of the case report is to analyze the clinical manifestations and imaging features of gouty long head of biceps tendinitis, and to summarize the methods and effects of shoulder arthroscopic surgery. CLINICAL PRESENTATION AND INTERVENTION: The clinical data of a 39-year-old Han Chinese female with gouty long head of the biceps tendinitis was retrospectively analyzed, and the clinical manifestations, imaging features, and diagnosis and treatment were analyzed. The patient presented with pain and limited movement of right shoulder joint. Computed tomography showed irregular high-density shadows above the glenoid and adjacent to the coracoid process of the right shoulder. Magnetic resonance imaging revealed superior labrum anterior and posterior injury with edema in the upper recess and axillary sac. After arthroscopic surgery, the "tofu residue" tissue of the long head of the biceps was removed, and the postoperative pathological examination proved that it was gout stone. CONCLUSION: Gouty long head of the biceps tendinitis is a rare disease. Arthroscopic surgery can probe the structural lesions of shoulder cavity in all aspects, improve the surgical accuracy, and reduce the trauma.

Surgical Treatment of Central Type Mirror Foot Associated with Eight Toes: A Case Report.

Introduction: Mirror foot is an extremely rare type of foot malformation and is characterized by the duplication of toes and metatarsals around a centrally located hallux toe. It can be part of a generalized congenital dysplasia or an isolated one. The central type is the less frequent form of the mirror foot. Case Report: We present an isolated type of central mirror foot with eight toes, seven metatarsals, and four cuneiforms. The isolated toe was medially located. The child presented no other deformities. Surgical management was performed at the age of 1 year, consisting of central-ray removal, using a dorsal and plantar incision. The approximation of the remaining metatarsals was reinforced using a suture that enwrapped the bones. We achieved an appropriate reduction in the width of the foot. A year after the procedure, the foot had a normal shape. Conclusion: Our manuscript presents the case of a central mirror foot that was treated surgically with adequate restoration of the proximity of the remaining rays.

Solitary Fibrous Tumor Requiring Abdominal Aortic Vessel Replacement.

Solitary fibrous tumors (SFTs) are mesenchymal tumors, and retroperitoneal occurrence is rare. It has been identified in a variety of soft tissues and organs, such as the pleura, peritoneum, and meninges. In this case, the tumor was in contact with the abdominal aorta, and the invasion was difficult to judge preoperatively. Intraoperatively, it was revealed that the tumor could not be completely removed without aortic replacement. Although SFTs have a generally good prognosis, certain factors, such as tumor incomplete resection, have been reported to increase the risk of recurrence and metastasis. We were able to completely remove the tumor by performing a combined resection of the aorta. The specimens were microscopically disorganized proliferation of spindle-shaped cells. Immunostaining was positive for cluster of differentiation 34 (CD34) and signal transducer and activator of transcription 6 (STAT6). The tumor cells infiltrating into aortic adventitia were observed. This is a valuable case in which artificial blood vessel replacement was able to reduce the risk of recurrence and metastasis due to tumor remnants. We report a rare case of SFT resected with artificial blood vessel replacement.

Intraoperative Incidental Finding of Meckel's Diverticulum: A Report of Two Cases.

Meckel's diverticulum (MD), a prevalent congenital gastrointestinal anomaly affecting about 2% of the population, arises from the incomplete closure of the vitelline duct. It encompasses all layers of the small intestine and can lead to various complications like obstruction, hemorrhage, and perforation. When symptomatic, it presents challenges in diagnosis due to the low sensitivity of imaging techniques. Comprehensive understanding and accurate diagnosis are crucial for managing the complications associated with MD and forming the scientific rationale for publishing this case report. We present two cases, one of them being the case of a 73-year-old male who presented for an ileostomy closure procedure. Intra-operatively, a 4.5 cm diverticulum was identified 10 cm from the stomatal opening on the efferent limb. This finding led to segmental resection of the intestines. Later, pathology was compatible with MD, which didn't contain any malignant cells or heterotopic tissue. The second case was that of a 40-year-old female who presented for severe abdominal pain, abdominal distention, and obstipation for two days. Radiographic imaging was suspicious of a foreign object compatible with fish bone with local inflammation in the small bowel. Laparoscopic exploration showed an inflamed MD with fish bone lodged inside. In front of an incidental MD, the decision to resect is still controversial. Those who are against resection of uncomplicated believe that complications from resecting an uncomplicated MD are higher than the complications that arise if resection is not performed. Those who support resection say that the complications that arise following the resection of a complicated MD are worse than those after resecting an incidental one. Criteria have been put in place to help guide the decision for resection.

Hip Osteoarthritis-Clinical-Statistical Study and Surgical Treatment.

Osteoarthritis (OA) of the hip, also known as coxarthrosis, is a degenerative disease marked by gradual biomechanics alterations cause by articular cartilage damage in the coxofemural joint. The goal of this study was determining the incidence of patients with hip osteoarthritis who undergo surgery (hip arthroplasty) within the Department of Orthopedics and Traumatology of the Emergency County Hospital of Drobeta-Turnu Severin, hospitalized between January 2014 and December 2019. Furthermore, we proposed gathering details about incidence, distribution according to age group, gender, living conditions, and type of arthroplasty used in studied patient group. The study included 485 patients with hip OA mainly diagnosed in elderly patients, 87.83% being over 60 years old. In terms of gender, the disease primarily impacted women, with a female/male ratio of 2/1.

Surgical treatment delay in patients with headache disorders and neuralgia correlates with poor postoperative outcome.

INTRODUCTION: Although nerve decompression surgery has proven to be effective in reducing symptoms in patients with head and neck neuralgia and headache disorders, it is currently not part of the treatment algorithms for headache disorders. Therefore, patients wait an average of 20 years from the onset of symptoms to surgery, resulting in high conservative treatment costs ($989,275.65 per patient) and patient morbidity. This study evaluated the clinical impact of treatment delays on surgical outcomes. METHODS: Overall, 282 patients who underwent nerve decompression surgery at Weill Cornell Medicine and Massachusetts General Hospital between September 2012 and January 2024 were enrolled. Information regarding demographics, onset of symptoms, and headache characteristics was collected using patient surveys. The treatment outcome was evaluated by the percentage of symptom reduction in terms of frequency, duration, and pain intensity. An area under the receiver operating characteristic analysis was performed to determine the optimal timepoint to undergo surgery. RESULTS: Postoperative symptom reduction and time between the onset of symptoms and surgery were negatively correlated (r = -0.22; p < 0.001). The most significant difference in outcome was found at 2.9 years from symptom onset; patients who underwent surgery before this timepoint reported an average improvement of 79 ± 23% versus 67 ± 35% in those who were treated after the timepoint (p = 0.021). CONCLUSION: Our results indicate that delays in undergoing nerve decompression surgery beyond 2.9 years from symptom onset leads to less favorable postoperative outcomes, underscoring the need for timely referral to peripheral nerve surgeons when conservative management fails. Nonetheless, even with delays in surgical intervention, patients continued to experience significant symptom reduction.

Comparison of surgical and conservative therapy in older patients with distal radius fracture: a prospective randomized clinic al trial.

INTRODUCTION: The distal radius fracture is considered the most common fracture in humans. For fractures classified as Arbeitsgemeinschaft für Osteosynthese (AO) 23-C1 + C2, there is no consensus on treatment in older patients due to inconsistent study results. The aim of this study was to compare conservative and surgical treatment in relation to wrist function and satisfaction in patients older than 65 years. METHODS: In this prospective randomized clinical trial, patients aged older than 65 years who suffered an isolated AO-classified C1 or C2 distal radius fracture were randomized to surgical treatment using palmar plate osteosynthesis or conservative treatment. Patient-rated wrist evaluation (PRWE) score and disabilities of arm, shoulder, and hand (DASH) was assessed 3, 6 and 12 months post-interventionally. Satisfaction, range of motion (ROM) and pain scores were evaluated at 6 weeks and 3, 6 and 12 months post-interventionally. RESULTS: A total of 80 patients with a mean age of 77.3 years (± 6.1 years) in the conservative group and 72.5 years (± 5.3 years) in the surgery group were included. Both the PRWE score, and the DASH score showed a statistically significant difference between the two groups after 3 months, 6 months and 12 months (p < 0.001). Patients in the surgical cohort showed a statistically significant higher satisfaction at the 6-week, 6-month and 12-month follow-up (p < 0.001 6 weeks + 12 months; p = 0.004 6 months). CONCLUSION: In this prospective randomized study, surgical treatment proved to be superior to conservative treatment in terms of the primary outcome variable PRWE score. Satisfaction was significantly better in the surgical group.

Tactics of surgical treatment of recurrent glomus tumors of the skull base: A clinical case.

AIM: The purpose of the study is to build effective tactics of surgical treatment of pathology, and to increase the effectiveness of surgical treatment of patients with this diagnosis by optimising preoperative preparation, and the correct sequence of actions that will help prevent relapse. METHODS: The leading approach to the study is the description of a clinical case, which will help to carefully consider this issue from all angles, analyse the methodology of patient examination, and build highly effective tactics of surgical intervention to eliminate tumour-like masses, minimising the risks of recurrence. The second clinical case was also considered, and a comparative analysis was carried out on certain parameters. RESULTS: The paper presents a clinical case with a practical aspect of surgical treatment of the pathology. The issue of detailed symptoms and manifestations of the disease is disclosed, and the course of surgical interventions is described in stages, in which no nerve is damaged, no complications are caused, and the desired result is achieved. The peculiarity of this case is the recurrence of the disease, and the ineffectiveness of previous treatment methods, including embolisation of the neoplasm and antromastoidotomy. CONCLUSIONS: The results obtained in the course of this study and the formulated conclusions are of great importance for surgeons who are faced with patients with the stated diagnosis.

Analyzing Risk Factors for Delayed Extubation Following Posterior Approach Surgery for Congenital Scoliosis: A Retrospective Cohort Study.

STUDY DESIGN: Retrospective cohort study. OBJECTIVES: Investigate the risk factors for delayed extubation after posterior approach orthopedic surgery in patients with congenital scoliosis. METHODS: The clinical data of patients who received surgery for congenital scoliosis at the First Affiliated Hospital of Xinjiang Medical University between January 2021 and July 2023 have been gathered. Patients are categorized into the usual and the delayed extubation groups, depending on the duration of tracheal intubation after surgery. The study employs univariate and multivariate logistic regression models to examine the clinical characteristics of the two cohorts and discover potential risk factors linked to delayed extubation. In addition, a prediction model is created to visually depict the significance of each risk factor in terms of weight according to the nomogram. RESULTS: A total of 119 patients (74.8% females), with a median age of 15 years, are included. A total of 32 patients, accounting for 26.9% of the sample, encountered delayed extubation. Additionally, 13 patients (10.9%) suffered perioperative complications, with pneumonia being the most prevalent. The multivariate regression analysis revealed that the number of osteotomy segments, postoperative hematocrit, postoperative Interleukin-6 levels, and weight are predictive risk factors for delayed extubation. CONCLUSIONS: Postoperative hematocrit and Interleukin-6 level, weight, and number of osteotomy segments can serve as independent risk factors for predicting delayed extubation, with combined value to assist clinicians in evaluating the risk of delayed extubation of postoperative congenital scoliosis patients, improving the success rate of extubation, and reducing postoperative treatment time in the intensive care unit.

Investigation of the alterations in miRNA expression levels in thyroid nodules and malignancies.

The relationship between preoperative miR-146b and miR-155 expression levels and postoperative pathology results in patients operated on for nodular thyroid disease and thyroid malignancy was investigated. Sixty three patients who were operated on for thyroid nodules diagnosed as benign, malignant and atypia of undetermined significance (AUS) were included in the study. Preoperative miR-146b and miR-155 expression levels of these patients were compared according to postoperative pathology results. Twenty three of the patients were male (36.5%) and 40 patients were female (63.5%). According to the results of fine needle aspiration biopsy (FNAB) taken from the patients in the preoperative period, The number of benign patients was 26 (41.2%), the number of malignant patients was 17 (26.9%), the number of patients reported as suspicion of malignancy was 10 (15.8%), and the number of AUS patients reported was 10 (15.8%). The postoperative pathology of 58.7% (n = 37) of the patients was benign, and the postoperative pathology of 41.3% (n = 26) was malignant. Compared to the group with benign postoperative pathology results, miR-146b expression level significantly increased by 8.08-fold in the group with malignant postoperative pathology results (p < 0.01). Additionally, miR-146b expression level was significantly upregulated by 3.23-fold in AUS patients compared with benign pathology results (p < 0.01). Although a 1.88-fold increase in miR-155 expression level was detected in malignant patients compared to the benign group, it was determined that the expression level of miR-155 significantly increased by 2.36-fold in AUS patients (p < 0.001). Circulating miRNA could discriminate between patients with benign and malignant nodules. Our results suggest that both miR-146b and miR-155 expression levels increased in the group with malignant postoperative pathology results. Additionally, increased miR-155 expression level could be associated with AUS progression. Therefore, miRNAs could be used as preoperative malignancy biomarkers to determine the characteristics of nodules and the decision to undergo surgery.

Surgical outcomes and risk factors for overall mortality in brain arteriovenous malformations patients: a retrospective analysis.

Background: Brain arteriovenous malformations (AVMs) are challenging vascular lesions. Extensive follow-up studies are necessary to refine the therapeutic algorithm, and to improve long-term survival in these patients. The aim of the study was to assess surgical outcomes, and to evaluate overall long-term mortality in patients treated for brain AVMs. Methods: This retrospective single-center study included 191 patients with brain AVMs, admitted between 2012 and 2022. Clinical and angiographical particularities have been analyzed, to identify factors that might influence early outcome and overall long-term mortality. Results: Out of 79 patients undergoing surgery, 51 had ruptured AVMs with total resection achieved in 68 cases (86.1%). Deep venous drainage was associated with incomplete resection. Female sex, admission modified Rankin Scale (mRS) > 2, and eloquent location were independent predictors of poor outcomes. Multiple venous drainage was associated with a higher risk of worsened early outcome. Eloquent brain region involvement, conservative treatment, increasing age, admission mRS > 2, and comorbidities significantly decrease survival in brain AVM patients. Patients treated with interventional treatments had significantly better survival than the conservatively managed ones, when adjusting for age and admission mRS. Conclusion: The study identified female sex, poor neurologic status on admission and eloquence as independent prognostic factors for a negative outcome after surgery. Patients who received interventional treatment had significantly better survival than patients managed conservatively. We recommend employing tailored, proactive management strategies as they significantly enhance long-term survival in brain AVM patients.

Gastric cancer and brain metastasis: A systematic review and meta­analysis.

Gastric cancer (GC) constitutes one of the most wide-ranging cancers, with brain metastasis (BM) being a markedly uncommon and unfavorable outcome. The present meta-analysis evaluated the relationship between no-surgical treatment vs. additional surgical BM resection on the patient's quality of life and potential survival using electronic databases, including PubMed (1980-April 2024), Medline (1980-April 2024), Cochrane Library, and EMBASE (1980-April 2024). After a literature search, six articles were included in the final study pool. The number of patients with BM and conservative treatment was 289 (80.05%) compared with those that underwent an additional surgical resection 72 (19.95%). The mean age was 59.2 years, and the males were 195 (73.8%) of 264 available from five studies. The findings of the present meta-analysis revealed that the curative effect of BM tumor resection on patients with GC undergoing additional treatment with stereotactic radiosurgery, whole-brain radiotherapy or chemotherapy was favorable for their survival.

A new patient-reported outcome measure for the evaluation of ankle instability: description of the development process and validation protocol.

BACKGROUND: Acute ankle sprains represent one of the most common traumatic injuries to the musculoskeletal system. Many individuals with these injuries experience unresolved symptoms such as instability and recurrent sprains, leading to chronic ankle instability (CAI), which affects their ability to maintain an active lifestyle. While rehabilitation programs focusing on sensorimotor, neuromuscular, strength and balance training are primary treatments, some patients require surgery when rehabilitation fails. A critical analysis of the patient-reported outcome tools (PROs) used to assess CAI surgical outcomes raises some concerns about their measurement properties in CAI patients, which may ultimately affect the quality of evidence supporting current surgical practice. The aim of this research is to develop and validate a new PRO for the assessment of ankle instability and CAI treatment outcomes, following recent methodological guidelines, with the implicit aim of contributing to the generation of scientifically meaningful evidence for clinical practice in patients with ankle instability. METHODS: Following the COnsensus-based Standards for the selection of Health Measurement Instruments (COSMIN), an Ankle Instability Treatment Index (AITI) will be developed and validated. The process begins with qualitative research based on face‒to‒face interviews with CAI individuals to explore the subjective experience of living with ankle instability. The data from the interviews will be coded following an inductive approach and used to develop the AITI content. The preliminary version of the scale will be refined through an additional round of face‒to‒face interviews with a new set of CAI subjects to define the AITI content coverage, relevance and clarity. Once content validity has been examined, the AITI will be subjected to quantitative analysis of different measurement properties: construct validity, reliability and responsiveness. DISCUSSION: The development of AITI aims to address the limitations of existing instruments for evaluating surgical outcomes in patients with CAI. By incorporating patient input and adhering to contemporary standards for validity and reliability, this tool seeks to provide a reliable and meaningful assessment of treatment effects. TRIAL REGISTRATION: Not applicable.

Efficacy and inflammatory responses of root canal therapy plus periodontal non-surgical treatment for periodontal-endodontic combined dental lesions.

OBJECTIVE: To investigate the efficacy and inflammatory responses of treating periodontal-endodontic combined lesions (PECLs) with root canal therapy (RCT) alone versus RCT combined with periodontal non-surgical treatment (PNST). METHODS: A total of 103 patients with PECLs admitted between January 2019 and January 2020 to Shenzhen Baoan Women's and Children's Hospital were divided into control (RCT alone, 50 cases) and combined (RCT + PNST, 53 cases) groups. Comparative analyses included efficacy assessment, probing depth (PD), bleeding index (BI), plaque index (PLI), gingival index (GI), serum levels of interleukin-1ß (IL-1ß), tumor necrosis factor-α (TNF-α), and high-sensitivity C-reactive protein (hs-CRP), pain severity during RCT, incidence of adverse reactions, post-treatment tooth conditions, and recurrence rates at 6 and 12 months. Univariate analysis identified factors associated with poor treatment outcome in PECL patients. RESULTS: The combined group demonstrated a higher total effective rate (90.57%) compared to the control group (74.00%) (P < 0.05). Patients receiving combined therapy showed significantly lower PD, BI, PLI, GI, IL-1ß, TNF-α, and hs-CRP levels, as well as reduced pain severity and lower recurrence rates at 6 and 12 months (all P < 0.05). The combined group also had a lower incidence of adverse (periodontal distending pain and local foreign body sensation) reactions (7.54%) compared to the control group (26.00%) (P < 0.05). After treatment, the incidence of periodontitis, percussion tenderness, and loosening of teeth in the combined group was lower than that of the control group, and the retention rate of affected teeth was significantly higher (all P < 0.05). Factors such as history of alcoholism, betel nut chewing, and treatment method (RCT) were significantly associated with poorer prognosis in PECL patients (P < 0.05). CONCLUSION: Combined RCT and PNST improves clinical efficacy, reduces pain severity and inflammation levels, decreases adverse reactions, and enhances tooth retention in PECL patients. This treatment approach should be considered the preferred option for managing PECLs.

[Prediction of papillary thyroid cancer recurrence according to preoperative data]. / Prognoz retsidiva pri papillyarnom rake shchitovidnoi zhelezy po dooperatsionnym dannym.

OBJECTIVE: To create a formalized method for predicting papillary thyroid cancer recurrence after hemithyroidectomy based on preoperative data. MATERIAL AND METHODS: At this stage of the study, we selected 101 patients with papillary thyroid cancer who underwent surgical treatment in 2017-2023. Recurrence was observed in in 47 patients. Fifty-four patients had no recurrence within 5 years after surgical treatment, i.e. these patients underwent surgery in 2017-2018. To find prediction rules, we used original classification method based on searching for subsets of variables and piecewise linear rules separating classes in pairs with subsequent voting of such rules to make a decision. RESULTS: The exam was carried out using a training sample (101 cases) and sliding control method (10 tests on 10 random cases). On the training sample, sensitivity of predictive algorithm was 91%, specificity 78% and error rate 13%. The aggregated result of 10 trials using sliding control method revealed sensitivity of predictive algorithm 86%, specificity 75% and error rate 15%. This result is close to overall sample and confirms the effectiveness of this method for predicting recurrence. CONCLUSION: The pilot experiments revealed the patterns in data for potential prediction of recurrence based on preoperative indicators. Further study of this problem may be valuable for decision-making and adjustments in the management of patients with papillary thyroid cancer.

Campanacci Grade 2 or 3 Giant Cell Tumor of the Phalanges: En Bloc Resection and Matched Nonvascularized Toe Phalangeal Transfer.

PURPOSE: The goal of the study was to assess the result of en bloc resection and matched nonvascularized toe phalangeal transfer in Campanacci grade 2 or 3 giant cell tumors of the phalanges. METHODS: Seven patients with Campanacci grade 2 and 3 phalangeal giant cell tumors were treated by en bloc resection and matched nonvascularized toe phalangeal transfer between June 2004 and May 2021. The patients were followed up by X-rays, Patient-Rated Hand and Wrist scores, Foot Function Index, Quick Disabilities of the Arm, Shoulder, and Hand questionnaire, and total active motion measurements. RESULTS: The minimum follow-up was 18 months (range: 18-230 months; mean: 110 ± 81). There were three males and four females, with age ranging from 13 to 48 years (mean: 24.14 ± 11.74). The right:left hand ratio was 3:4. The thumb was involved in one patient, the index finger in two, the middle finger in one, and the ring finger in three patients. The mean total active motion was 201.70 (range: 190°-240°). The mean patient-rated hand and wrist score was 15.2 (range: 10-35). The mean quick disabilities of the arm, shoulder and hand questionnaire score was 1.3 (range: 0-9). The mean foot function index on follow-up was 2.86 (range: 2-3). There was no tumor recurrence. One patient had a pathological fracture with resultant shortening of the finger on follow-up. CONCLUSIONS: In our series en bloc resection and matched nonvascularized toe phalangeal transfer resulted in a functional tumor-free digit with a low complication rate and no recurrences. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic V.

Mesenchymal Tumor Management: Integrating Surgical and Non-Surgical Strategies in Different Clinical Scenarios.

Mesenchymal tumors originate from mesenchymal cells and can be either benign or malignant, such as bone, soft tissue, and visceral sarcomas. Surgery is a cornerstone treatment in the management of mesenchymal tumors, often requiring complex procedures performed in high-volume referral centers. However, the COVID-19 pandemic has highlighted this need for alternative non-surgical approaches due to limited access to surgical resources. This review explores the role of non-surgical treatments in different clinical scenarios: for improving surgical outcomes, as a bridge to surgery, as better alternatives to surgery, and for non-curative treatment when surgery is not feasible. We discuss the effectiveness of active surveillance, cryoablation, high-intensity focused ultrasound, and other ablative techniques in managing these tumors. Additionally, we examine the use of tyrosine kinase inhibitors in gastrointestinal stromal tumors and hypofractionated radiotherapy in soft tissue sarcomas. The Sarculator tool is highlighted for its role in stratifying high-risk sarcoma patients and personalizing treatment plans. While surgery remains the mainstay of treatment, integrating advanced non-surgical strategies can enhance therapeutic possibilities and patient care, especially in specific clinical settings with limitations. A multidisciplinary approach in referral centers is vital to determine the optimal treatment course for each patient.

Conservative nonsurgical knowledge of German orthopedic and trauma surgeons-Present state of affairs.

BACKGROUND: After the fusion of the fields of orthopedics and trauma surgery in 2006 the educational content significantly increased. The acquisition of non-surgical diagnostic and treatment skills seems to fall behind in the classical operatively focused residency programs. This study presents a status quo of the non-surgical education and knowledge in the field of orthopedics and traumatology in Germany. METHODS: An online-based voluntary and anonymous questionnaire was conducted between June and August 2023. The questionnaire was distributed through the email lists of the German Society for Orthopedics and Traumatology (DGOU) and the German Professional Association for Orthopedics and Traumatology (BVOU). RESULTS: A total of 486 German orthopedic and trauma surgeons answered the online questionnaire (77.9% male; mean age 50.2 ± 11.8 years) and 11.5% were residents. Only 27.1% spent part of the residency training in the outpatient sector. In total 84.2% wish for an increased focus on non-operative treatment options during further education, 81.1% agreed that they have a good general understanding of non-operative treatment options and 81.0% felt confident to apply them in the daily clinical routine (residents 35.4% and 41.7%, respectively). The highest self-assessed competences were knowledge on the application of splints and casts and physiotherapy, ergotherapy and sports therapy, the lowest were knowledge on acupuncture, magnetic field therapy and nutritional aspects after trauma. In total, 77.7% stated non-surgical research projects are not supported at their institution. CONCLUSION: Orthopedic and trauma surgeons in Germany subjectively have solid knowledge on treatment options while resident physicians still need to strengthen their skills. Rotation into the outpatient sector and rehabilitation facilities as well as supporting research in the field could further improve the non-surgical skills.