[Influence of tourniquet ischemia on perioperative blood loss after total knee arthroplasty]. / Einfluss der Blutleere auf den perioperativen Blutverlust nach Knietotalendoprothesenimplantation.

The purpose of this study was to evaluate the effect of tourniquet use with constant pressure until wound closure on perioperative blood loss in total knee arthroplasty (TKA). Sufficient patients were included in the study to produce statistically relevant conclusions. In this retrospective case control study 547 patients who were treated with TKA because of osteoarthritis of the knee joint were included and of these 262 patients were operated with the use of a tourniquet (300 mmHg) and 285 without. The perioperative blood loss was calculated using patient height, body weight and preoperative and postoperative hematocrit values. The patient collectives were comparable in mean age, gender distribution and ASA classification. In the group with an operation using a tourniquet, 24 patients (9.2%) received erythrocyte transfusions compared to 36 patients (12.6%) in the group without tourniquet use (not significant). The average perioperative blood loss without tourniquet use was 1.5±0.6 l (range -0.2 to 4.3 l). In contrast patients treated with the use of a tourniquet lost on average only 1.2±0.5 l (range -0.2 to 3.4 l) (p<0.001). The use of a tourniquet reduces the perioperative blood loss in TKA if it is kept tight during the operation.

[Lack of new trainees in trauma surgery and orthopedics. An approach to a solution]. / Nachwuchsmangel in der unfallchirurgie und orthopädie. Ein lösungsansatz.

The reasons for a shortage of young people in trauma surgery and orthopedics have often been discussed. Atypical progression of medical operating levels, antisocial working hours and an inadequate financial compensation for on-call duties have been given as the reasons for a lack of interest in the discipline. Additionally a progressive feminization of the medical profession and rejection of surgical disciplines because of a mismatch with family interests and the demands of advanced surgical training have also been named. Surveys on the choice of medical specialization reveal that experiences during the course of studying have a great influence on future prospects and are immensely important for the further focusing on the future as a medical doctor. In order to increase the attractiveness of the specialization, programs for students were initiated by the heads of the Conventions of Higher Education Lecturers for Orthopedics and Trauma Surgery and the management of the German Society for Orthopedics and Trauma Surgery. Due to the enormous popularity auxiliary projects were demanded. Consequently a "Trauma Surgery and Orthopedic Day for Students" was organized on 16th February 2010 in the Musculoskeletal Centre of the Charité in Berlin. The aim was to convey practical skills and to inspire the choice of this specialization in the future.