Restructuring the final year of the model study programme MaReCuM at the Medical Faculty Mannheim: the academic quarter in ambulatory medicine.

Introduction: To reflect the ever-growing importance of outpatient care in medical education, MaReCuM - a reformed curriculum, also referred to as a model study programme - was introduced at the Medical Faculty Mannheim in 2006. It divided the final year of medical study into quarters and added a mandatory quarter dedicated to ambulatory medicine. This project report presents our experiences, the costs and the evaluation results connected with making specific changes to the final year of undergraduate medical study. Project description: The final-year quarter in ambulatory medicine, taught at the Medical Faculty's outpatient teaching placements, allows final-year medical students to gather practical experience in one of four elective areas in outpatient care. The parallel coursework encompasses interactive case presentations and practical reviews. Relevant curricular content on ambulatory medicine is then tested in the oral/practical section of the M3 medical examination. Results: Students are very satisfied with the academic quality of the final-year quarter in ambulatory medicine. Restructuring the final year, generating the concept and recruiting teaching placements at outpatient facilities required additional full-time positions in the beginning. Discussion: The processes of reforming MaReCuM have not only contributed to a stronger recognition of ambulatory medicine in the final year and in the clinical phase of study, but have also enabled broader opportunities for focussing individual choices during medical education. A high caliber of academics in the quarter in ambulatory medicine can be achieved with a calculable amount of organisational effort. Conclusion: Anchoring a curriculum on ambulatory medicine in medical education is possible through restructuring the final year and is received positively by students. The success of MaReCuM demonstrates the feasibility of the recommendations made by the German Council of Science and Humanities (Wissenschaftsrat).

> 10-year outcome of dislocated radial fractures with concomitant intracarpal lesions as proven by MRI and CT.

To clarify the role of concomitant carpal lesions in dislocated distal radius fractures (DRF), 104 consecutive patients with DRF underwent a preoperative morphological examination using CT and MRI. The study was performed between 2004 and 2006 with the aim of recording all types of concomitant carpal lesions as well as their consequences after 1 year. Carpal lesions of different types were found in all treated cases of dislocated DRF. A clinical follow-up 1 year (13.9 ± 6.5 months) after surgical treatment showed no correlation between the carpal lesions and the treatment outcome (previously described by Gologan et al. 2011). A second follow-up study ( > 10 years postoperative, range 11.2 ± 0.9 years) was initiated to find suspected later decompensations of the concomitant carpal lesions. A total of 37 of the original 104 patients could potentially be followed up: 22 patients had passed through both follow-ups and 15 could only be contacted with restrictions. 27 patients had died, 24 patients were excluded due to the presence of dementia or explicit rejection, and 16 patients could no longer be found. Using the Castaing score, the first follow-up after 1 year resulted in an average of 4.95 ± 3.1 points (range 0-12; "good result") and the second follow-up after 10 years in an average of 5.91 ± 2.9 points (range 2-14; "good result"). Again, there were no correlations with the primarily recognized carpal lesions [comparable groups 22 vs 22 (identical patients in both follow-ups); lost to follow-up rate 15.4%]. These results suggest that concomitant carpal lesions are primarily prevalent and detectable in (nearly) all dislocated DRF cases. However, with the usual protection of the wrist and the carpus after surgical treatment of DRF, these lesions often do not decompensate or require treatment, even after 10 years.

[Teaching in orthopaedic and trauma surgery]. / Lehre in Orthopädie und Unfallchirurgie.

The scramble for available places to study medicine in Germany continues. One of the core points within the "Master Plan 2020", which has been recently adopted, is the reform of teaching concepts at German medical faculties. In the future, students of human medicine are to be trained primarily based upon competence-oriented, integrated curricula. The present paper is intended to present modern teaching concepts and methods, as well as current examination formats, which play a special role in student training in orthopaedics and traumatology. Knowledge in the field of medical and evidence-based treatment strategies, clinical examination techniques, diagnostic/therapeutic procedures and hygienic working conditions are especially important. Individual courses with a focus on research-, practice- and competence-orientation are intended to help the students grasp the depth of the subject.

[Practical Year - Surgery in the Reformed Curriculum MaReCuM (Mannheim)]. / PJ Chirurgie im Modellstudiengang MaReCuM (Mannheim).

Background: Since 2006 the practical year in the Mannheim Reformed Curriculum Medicine (MaReCuM) is divided into four quarters: the two required subjects (surgery and internal medicine), one elective and one of four offered fields in ambulatory medicine. Therefore students can more intensively focus on their preferences in the practical year. In the present article we describe the provided surgical training sites, the organisation of the practical year, the surgical training itself and the quality management. We provide answers to the following questions: does dividing the practical year into quarters have a (negative) influence on the grades of final exams; how interested, motivated and satisfied are students in the different (surgical) quarters of the practical year and in which quarter(s) can new generation staff be recruited? Methods: We used results of the final exams of three cohorts of the traditional Mannheim track and three cohorts of MaReCuM, as well as the results of the Mannheim Questionnaire of Satisfaction with Training Conditions in the Practical Year of Medical Education from the regular evaluation of three practical year cohorts within two years. Conclusions: Dividing the practical year into quarters is possible and can be organised together with the new "mandatory subject" ambulatory medicine. The introduction of quarters has no negative effects on the results of final exams. The assignment in the surgical field from students' perspectives with regard to motivation, interest, knowledge and satisfaction with training is comparable to surgical electives. Therefore recruitment of new staff is possible either in the surgical elective or in the surgical area of ambulatory medicine.

[Who Stays Loyal to Orthopaedics and Trauma Surgery? Results of a Nationwide Survey]. / Wer bleibt nach einer Famulatur in Orthopädie und Unfallchirurgie dem Fachbereich treu? Ergebnisse einer bundesweiten Umfrage.

INTRODUCTION: The general shortage of medical doctors in Germany can also be felt in the area of trauma and orthopaedics. Medical elective placements, in Germany known as "Famulatur", are sensitive interfaces between the theoretical university studies and the practical medical workplace. In this research project, the aim was to study how medical students perceive these types of placements and if it alters their decision making when planning their further career. METHODS: During the summer term of 2012, 9079 medical students answered an online questionnaire. Of these, the subgroup was evaluated that had had a placement of at least 4 weeks in the field of trauma and orthopaedics. Overall, 37 test items about this placement and further career steps were included in this study. Groups were evaluated separately by the item "I am considering a career in trauma and orthopaedics" (PJ-Ja) versus "I am not considering a career in trauma and orthopaedics" (PJ-Nein). RESULTS: Overall 397 students were included in this study; 55 % were female. 267 (67.3 %) stated: "I am considering a career in trauma and orthopaedics"; 130 (32.7 %) were not. There was no significant difference in age or sex between these groups (sex: χ²= 2.50, p = 0.114; age: F[1.93]< 1, p = 0.764). Specific and statistically significant differences between those groups were found in the items team integration, ward climate, qualification of teaching, training for specific knowledge in the field, practical aspects of the tasks performed, general planning and structure of the elective achievement of the teaching goals. DISCUSSION: Knowledge of satisfaction during medical elective placements is essential if one aims to inspire students for a specific medical profession. Instructors who can identify weaknesses and deficits in their training regime can therefore in the future increase the number of medical doctors who choose their speciality. The foundation of personal development has to be laid very early in the career of medical students.

1-Year outcome of concomitant intracarpal lesions in patients with dislocated distal radial fractures: a systematic assessment of 78 distal radial fractures.

INTRODUCTION: Ligamentous lesions are concomitant to dislocated distal radius fractures in a high percentage. The purpose of this study was to evaluate the relevance of intracarpal lesions. METHODS: Seventy eight of an original cohort of 104 distal radius fractures (74%) were studied over a follow-up period of one year after surgery with complete data (X-rays, CT, MRI, follow-up X-rays and questionnaire). RESULTS: Most of our radius fractures (AO 23 type: A 39, B 9, C 30) present additional lesions: 97%. One-year evaluation showed an average Castaing score of 4.5 ± 2.5 points, means a "good" result of a scale of 0-27. Fifty five of seventy eight had an "excellent" or "good" result (<6 points). No patient had more than 12 points ("fair"). CONCLUSIONS: The dislocated distal radial fracture implies severe and complex injury to the whole wrist, mostly concerning intracarpal concomitant lesions (MRI). Surgical therapy of dislocated radius fractures followed by 6 weeks relief through thermoplastic splint seems to be sufficient to achieve good 1-year results. MRI-detectable carpal lesions at the time of the radial fracture are common, but only a few of them seem to decompensate later, give symptoms and became of therapeutic relevance.

[Kyphoplasty combined with intraoperative radiotherapy (Kypho-IORT). Alternative therapy for patients with oligometastatic spinal metastases]. / Kyphoplastie kombiniert mit intraoperativer Radiotherapie (Kypho-IORT). Therapiealternative für den oligometastasierten Patienten mit Wirbelsäulenmetastasen.

BACKGROUND: Due to a more effective systemic therapy the survival of patients suffering from malignant tumors has been significantly improved but a longer life span is often associated with a higher incidence of osseous metastases. The majority of these metastases are localized in the spine causing pain, instability and neurological impairments. The interdisciplinary management of spinal metastases previously consisted of stabilization followed by fractionated external body radiation therapy. A reduction in procedural severity and morbidity as well as consideration of self-sufficiency and hospitalization time are important target parameters for these palliative patients. METHOD AND RESULTS: Kyphoplasty combined with intraoperative radiotherapy (Kypho-IORT) is one of several modern treatment options, which involves a minimally invasive procedure with local high-dose transpedicular irradiation of the spine with low-energy (50 kV) X-rays. Immediately following irradiation, stabilization of the spine is carried out using kyphoplasty via the same access route so that a single stage procedure with excellent pain reduction and good local tumor control can be achieved. This article presents clinical data for this procedure and the different fields of indications are critically reviewed and compared to other therapy options. Methodological improvements and options for further individualization of therapy are demonstrated. CONCLUSION: The Kypho-IORT procedure is a safe, feasible and beneficial modern treatment option for instant stabilization and local tumor control in patients with spinal metastases. More than 100 operations have been successfully performed so that the method can be deemed suitable for inclusion in the clinical routine. A phase II dose escalation study has now been completed and submitted for publication and a 2-arm non-inferiority trial (phase III study) for comparison with conventional irradiation is in progress.

Association between students' personality traits and hand hygiene compliance during objective standardized clinical examinations.

BACKGROUND: Although the need for hand hygiene (HH) is generally accepted, studies continue to document inadequate compliance. Medical students are taught about the importance of HH to prevent nosocomial infections, and receive training in the correct procedures for HH. However, personality traits (social orientation and achievement orientation) may influence HH compliance. People with high social orientation feel socially responsible and act cooperatively, and people with high achievement orientation are ambitious and competitive. AIM: To evaluate the relationship between HH compliance and personality traits of medical students. METHODS: The HH compliance of 155 students was observed during objective standardized clinical examinations (OSCEs). Social orientation and achievement orientation were measured using the corresponding scales of the Freiburg Personality Inventory - Revised. FINDINGS: Social orientation did not differ between students with high HH compliance and students with low HH compliance [F(1) = 3.87, P = 0.052, η(2) = 0.045]. For achievement orientation, a moderate effect was found between low and high HH compliance [F(1) = 11.242, P = 0.001, η(2) = 0.119], and students with high HH compliance were found to be more achievement orientated than students with low HH compliance. CONCLUSION: Achievement orientation plays a major role during OSCEs, while social orientation is less emphasized. To the authors' knowledge, this is the first study to show that HH compliance is associated with achievement orientation in achievement situations.

[Fractures of the neck of the femur in younger patients (15-50 years old). Outcome 4 years after surgery]. / Die Schenkelhalsfraktur bei jüngeren Patienten (15-50 Jahre). Klinisch-radiografisches Outcome 4 Jahre nach operativer Therapie.

INTRODUCTION: Traumatic fractures of the neck of the femur are rare injuries in younger patients between 15 and 50 years old. The short-term and long-term complications may cause substantial problems, in particular non-union and avascular necrosis (AVN) of the head of the femur. In the literature (and from some experts) the impression is occasionally given that there might be "proven" successful therapeutic procedures. METHODS: For this purpose we retrospectively analysed follow-up-data from our own patients in the years 2003-2007 and compared them with the literature. We identified 23 of a total of 376 patients with a femoral neck fracture as a cohort being younger than 50 years. 17 of those 23 patients were treated with an internal fixation. We were able to collect and analyse complete clinical and radiological data of 11 of these 17 patients 4.2 years after surgery. RESULTS: The mean interval between accident and surgery was 22 hours. Only one of the patients developed an AVN after internal fixation of the fracture and was implanted a total hip replacement 18 months postoperatively. There was no non-union of the femoral neck The clinical outcome after 4.2 years was very good. The mean Harris Hip Score was 95 points (of a max. of 100 pts.). CONCLUSIONS: The osteosynthesis of femoral neck fractures in younger patients showed good results and a low risk of AVN and non-union. Therefore the internal fixation of the femoral neck fracture should be preferred for the younger patients instead of a primary total hip replacement.

[Medical and sociodemographic aspects of domestic violence. Systematic evaluation of patient data from the emergency department of a maximum care hospital]. / Medizinische und soziodemographische Aspekte häuslicher Gewalt. Systematische Auswertung von Patientendaten einer Notaufnahme eines Krankenhauses der Maximalversorgung.

BACKGROUND: Injuries due to domestic violence are a frequent occurrence in emergency departments. Although domestic violence has been well analyzed from the sociological point of view, medical data concerning patterns of injuries are rare. METHODS: Victims of domestic violence who presented at the emergency department of a maximum care hospital were included in the study. Sociodemographic data and patterns of injuries were documented. RESULTS: Of the patients who presented at the emergency room 1.4 % suffered injuries due to domestic violence and 70 % were women who had been predominantly attacked by the (ex) partner. The male victims were predominantly attacked by friends. In 88 % the head and neck were involved. Male patients were attacked with objects (as a kind of weapon) more frequently than women. A migration background was documented in 45 % of the female and 30 % of the male patients. CONCLUSION: Patterns can be easily recognized: the victims were predominantly female and were attacked by the (ex) partner. Injuries were localized to the upper part of the body. No excessive violence with life-threatening or fatal injuries was observed.

[Carpal lesions associated with dislocated fractures of the distal radius. A systematic screening of 104 fractures using preoperative CT and MRI]. / Karpale Begleitläsionen bei dislozierter distaler Radiusfraktur. Eine systematische Erfassung durch präoperative CT- und MRT-Untersuchung.

BACKGROUND: The functional outcome of surgically treated dislocated fractures of the distal radius is limited and does not correlate with radiographic results. Additional carpal lesions are assumed to be the cause. This study has evaluated which carpal lesions are associated with dislocated fractures of the distal radius. MATERIAL AND METHODS: A total of 104 consecutive patients with dislocated fractures of the distal radius were included in the study. The injured wrist was examined by radiography, computed tomography (CT) and magnetic resonance imaging (MRI) to determine additional carpal lesions. RESULTS: Radiographically 51 of the 104 fractures presented as type A according to the AO classification, 10 as type B and 39 as type C. The CT scan detected that only 5 of the 51 type A fractures were exclusively metaphyseal fractures. All type A fractures were associated with ligamental lesions in MRI. CONCLUSIONS: The results of the study confirm the hypothesis that every dislocated fracture of the distal radius is a combined carpal trauma associated with additional osseous and/or ligamental lesions.

[Logbook of learning targets for special educational skills in orthopaedic and trauma surgery for undergraduate medical training]. / Logbuch der erreichbaren Lehrziele für die speziellen Wahlfachinhalte Orthopädie/Unfallchirurgie im Praktischen Jahr (PJ) des Medizinstudiums.

INTRODUCTION: The changes in medical licensing regulations introduced in Germany in 2012 require the development of specific catalogues, termed logbooks, that define the practical skills medical students should acquire in different specialties. In conjunction with another change in medical education, which allows medical students to freely select any German university hospital or academic teaching hospital for their one-year internship, these catalogues are a prerequisite for ensuring comparable training standards throughout Germany. The German licensing regulations provide no details regarding the contents or form of the logbooks but only mention a "training programme" in very general terms. A logbook is commonly understood to define clear learning objectives to be accomplished during a specified interval (4 months). The conference of German medical faculties proposed a basic logbook for compulsory training modules (surgery and internal medicine) that is intended to serve as a model (formally and contentwise) for those who develop similar catalogues for elective training modules. Here we present our logbook for an elective training module in orthopaedic surgery and traumatology. MATERIAL AND METHOD: The logbook presented here is based on the catalogue of learning outcomes in orthopaedic surgery and traumatology developed by an expert board of the medical teaching study group of the German Society of Orthopaedic Surgery and Traumatology (DGOU) in 2011. The objectives defined for the one-year internship are of necessity divided into orthopaedic surgery and traumatology skills that must be acquired by all medical students and those that are optional (compulsory and elective modules). Using a set of predefined criteria, the authors developed the catalogue of learning outcomes (logbook) presented here. The catalogue outlines the competencies to be acquired in an elective orthopaedic surgery and traumatology module, leaving it to each medical faculty to work out the details. Where applicable, comprehensive skills across a number of (compulsory and elective modules) learning objectives are arranged in such a way that they can be taught at different levels of complexity. RESULTS: The logbook covers 15 skill domains from different specific components of orthopaedic surgery and traumatology. Where these skills overlap with those also required in compulsory modules (e.g., surgery), the required level of complexity may be lower for students in the elective module. The text is supplemented by figures with synopses of the major issues and summaries for easy reference. CONCLUSION: With the recent changes in German licensing regulations for physicians, it has become necessary to set up a logbook of uniform learning outcomes to assist medical students and their teachers alike. The authors have developed such a logbook of elective training modules in orthopaedic surgery and traumatology to be taught during the one-year undergraduate internship of German medical students.

[What is the meaning of safety in hospitals?]. / Was bedeutet Sicherheit im Krankenhaus?

Patient safety in hospitals is difficult to define and is not measurable by operational safety parameters as in other fields. So-called adverse events (AE) are a collective of complications, failures, mistakes, errors and violations. Estimations of at least 9.2 % AEs in surgery with 0.1 % fatalities are given worldwide but there are no correlations between objective quantification of AEs and subjective or public perception of safety during the perioperative period. Patient safety during this period is mostly endangered by wound infections (safety 98 %) and nosocomial infections (safety 97 %). In spite of these facts, safety parameters for problems in anesthesia, blood transfusion, in retaining surgical instruments and so-called index events, such as patient and side identification errors are much higher. Patient safety is maintained in hospitals by objective means (surgical). Checklists have been proven to improve safety and critical incidence reporting, training and changing of attitudes could have further advantages but they are difficult to measure.

[Learning and teaching abilities of a newly inaugurated operation technique. Analysis of learning curves and transferability exemplified by Kypho-IORT]. / Lehrfähigkeit und Erlernbarkeit einer neu inaugurierten Operationsmethode. Analyse der eigenen Erfahrungskurve und des Weitergabeerfolgs am Beispiel der Kypho-IORT.

The Kypho-IORT procedure is a recently developed surgical technique to combine intraoperative radiotherapy with cement augmentation of the vertebra for spinal metastases. The technical feasibility and the operation principle of this new method have been described. In the following article the refinement of the standard operation procedure and the technical development of the method are described. Not only the procedural improvements but also the learning curves of the inaugurators are pointed out. Moreover, the article presents the measures which were necessary to educate trainees during surgical master classes in this new method and to transfer the method. The learning success was quantified by recording the accuracy reached by the trainees in the key procedure during hands-on cadaver exercises. Improvements of the standard operation procedure could be successfully transferred in a second master class. The method of Kypho-IORT and the demonstrated way of postgraduate education is feasible to instruct trainees. The Kypho-IORT procedure can be learnt and performed safely by running through the surgical master class.

[Kyphoplasty in combination with intraoperative radiotherapy. Technical and regulatory characteristics of a concept for treatment of vertebral metastases]. / Kyphoplastie in Kombination mit intraoperativer Radiotherapie. Technische und regulatorische Besonderheiten eines Konzepts zur Behandlung von Wirbelkörpermetastasen.

BACKGROUND: Operative and radiotherapeutic procedures are available for the treatment of symptomatic vertebral metastases. The method for treatment of vertebral metastases presented in this article involves a combination of intraoperative radiotherapy (IORT) and kyphoplasty. METHODS AND RESULTS: Kyphoplasty-IORT allows treatment of symptomatic vertebral metastases between vertebrae T3 and L5. With the patient under intubation narcosis an extrapedicular or bipedicular access to the vertebra is selected as for conventional kyphoplasty. This is followed by insertion of special sheaths of the radiation applicator and radiation therapy is intraoperatively administered via a radiation generator (Intrabeam®, Carl Zeiss Surgical, Oberkochen, Germany). The radiation dose is 8 Gy at a depth of 5-10 mm depending on the study protocol (50 kV X-radiation). Following radiation a conventional kyphoplasty procedure (Medtronic, USA) is carried out and the vertebra stabilized with cement. CONCLUSIONS: The procedure presented demonstrates a new approach to treatment of vertebral metastases and represents a valuable alternative to previously established methods.

[Competency-based medical education: National Catalogue of Learning Objectives in surgery]. / Kompetenzorientierung in der medizinischen Ausbildung: Nationaler Lernzielkatalog Chirurgie.

Competency-based medical education is a prerequisite to prepare students for the medical profession. A mandatory professional qualification framework is a milestone towards this aim. The National Competency-based Catalogue of Learning Objectives for Undergraduate Medical Education (NKLM) of the German Medical Faculty Association (MFT) and the German Medical Association will constitute a basis for a core curriculum of undergraduate medical training. The Surgical Working Group on Medical Education (CAL) of the German Association of Surgeons (DGCH) aims at formulating a competency-based catalogue of learning objectives for surgical undergraduate training to bridge the gap between the NKLM and the learning objectives of individual medical faculties. This is intended to enhance the prominence and visibility of the surgical discipline in the context of medical education. On the basis of different faculty catalogues of learning objectives, the catalogue of learning objectives of the German Association of Orthopedics and Orthopedic Surgery and the Swiss Catalogue of Learning Objectives representatives of all German Surgical Associations cooperated towards a structured selection process of learning objectives and the definition of levels and areas of competencies. After completion the catalogue of learning objectives will be available online on the webpage of the DGCH.

[An educational skills programme for undergraduate training in orthopaedic and trauma surgery]. / Lehrzielkatalog im Pflicht- und Wahlbereich des Praktischen Jahres für die Inhalte des Faches "Orthopädie und Unfallchirurgie"

INTRODUCTION: Practical training on clinical cases and work with patients is one of the most important steps within the educational programme of undergraduates. Until now a general programme with specific learning targets for undergraduate training in orthopedic and trauma surgery is lacking. MATERIAL AND METHOD: In this article we present an educational skills programme developed by a national committee composed of specialists in the field of orthopaedic and trauma surgery. This programme is based on existing guidelines of German medical universities. RESULTS: The facultative and obligatory guidelines developed by the national committee are presented. CONCLUSION: The presented learning programme contains chapters regarding the increasing requirements within the field of orthopaedic and trauma surgery and provides reproducible contents with the possibility for learning control.

[Undergraduate education in orthopaedic and trauma surgery - a nationwide survey in Germany]. / Die studentische Lehre im gemeinsamen Fach Orthopädie-Unfallchirurgie - eine deutschlandweite Statuserhebung.

AIM: Musculoskeletal conditions consume enormous resources and costs, and their incidence is increasing worldwide. Therefore, an appropriate education of medical students about these conditions is required. This study examines the extent of medical education in orthopaedic and trauma surgery in Germany. MATERIAL AND METHODS: A questionnaire comprising 7 topics (curriculum design, lecture, practical training, e-learning, examination, evaluation, resources) with a total of 44 items was sent to all assistant lecturers in orthopaedic and trauma surgery at the 37 medical schools in Germany. RESULTS: The survey attained a return rate of 76 % for orthopaedic surgery and 81 % for trauma surgery, respectively. Medical training in musculoskeletal conditions represents with an average of 38.4 hours of lectures and further 55.9 hours of practical training less than 6 % of the entire undergraduate medical education. This study demonstrates a high inhomogeneity regarding the curriculum design when comparing the different German medical schools not only in total training time but also regarding its contents. E-learning as additional teaching method is only offered in 39 % of orthopaedic training and in 47 % of the trauma surgery training. Practical examinations like the OSCE are offered at 8 medical schools for orthopaedic training and 15 schools for trauma surgical training, respectively. CONCLUSION: Medical training in musculoskeletal conditions is very inhomogeneous and requires further improvement and standardisation regarding quantity and implementation.

Scintigraphic evaluation of rhBMP-2-biocoated implants reveals no ectopic bone formation.

The main objectives of the study described below were of two-fold nature: (1) to examine if rhBMP-2-biocoated implants in a pig model could lead to ectopic bone formation and (2) if quantitative and/or qualitative differences could be found between adhesively and covalently bonded BMP II using the scintigraphic method. In order to examine these central questions, 26 Göttingen minipigs were allocated to three groups with a control group (n=7) and two study groups (n=9 each) receiving one of three implant types: (a) chromosulfuric acid treated titanium surface as control, (b) non-covalently bonded BMP-2, and (c) covalently bonded and immobilized rhBMP-2. Each animal received four barbell-shaped implants, one in the proximal and distal metaphysis of each femur. The scintigraphic analyses were conducted after four, eight, and 12 weeks postoperatively. The visual (qualitative) analysis failed to show ectopic bone formation in any of the three groups. The statistical analysis of the relative values for bone formation yielded no significant differences between the groups, although the limitation in the applied methods do not enable one to draw conclusions regarding the histomophometric results.