Pneumatic compression with foot pumps facilitates early postoperative mobilisation in total knee arthroplasty.

Deep-vein thrombosis (DVT) and pulmonary embolism (PE) represent life-threatening postoperative complications frequently responsible for in-hospital mortality following total knee arthroplasty (TKA). Mechanical prophylaxis in the form of a foot pump offers an alternative to pharmacological and physical therapy. The aim of this prospective and randomised study was to examine the clinical efficacy of the A-V Impulse (AVI) system in reduction of soft-tissue swelling of the lower limb following a TKA. A total of 80 patients undergoing cemented TKA between September 2005 and December 2006 were randomised into two groups of 40 patients (n¹ = 40, n² = 40) during the 16-month study period. All patients received a subcutaneous dose of low molecular weight heparin (LMWH) (Enoxaparin/Clexane® 40 mg) once daily beginning 24 hours prior to the operation. The mean age for the groups n¹ and n² were 68.93 and 68.15 years, respectively. The reduction of soft-tissue swelling in the n¹ group was significantly higher (p < 0.05) compared with n². Evaluation of body mass index (BMI) with regard to the average reduction of soft-tissue swelling showed no significant influence (p < 0.05). The better function of the operated knee in group AVI was a significant predictor for improved agility and mobility (p < 0.01). No complications were reported for the application of the AVI. No ultrasonographic evidence of DVT or PE was found in any of the 80 patients during the investigative time period of eight days. After three months, there was no evidence of a symptomatic DVT.

In vivo measurement of polyethylene wear in cementless total hip arthroplasty.

PURPOSE OF THE STUDY: Recent years have seen an increase in cementless total hip endoprosthesis (THP) implantations. Easy radiological measurement of wear in cups coated with X-ray dense material, such as metal or ceramics, is not applicable. An alternative technique has thus been developed to radiographically measure wear on cementless spherical implants. MATERIAL AND METHODS: The authors present a method in which the center of the head of the prosthesis relative to the center of the cup was defined by graphical extrapolation. Changes between the two centers on subsequent images allowed the estimation of wear. Data from 148 randomly selected patients with cemented THP were compared with that from 50 with cementless THP (head diameter always 32 mm). RESULTS Within the cemented group metal heads showed significant more wear than ceramic heads (1.244 mm vs. 0.504 mm). However, calculating the wear rate per year showed no significant difference. No significant differences were observed comparing cemented and cementless group. A comparison of the own results with those of the literature revealed analogous values. DISCUSSION: Data of the cementless group were comparable with those obtained from conventional wear measurements on cemented hip cups thus validating the technique. CONCLUSION: The method offers the potential to define wear of metal cups with a polyethylene inlay or with X-ray dense components such as ceramic or metal inlays.

Press fit fixation of cementless cups: how much stability do we need indeed?

INTRODUCTION: Using screws for a better primary and secondary fixation has been discussed in the literature of the recent years, although the principle of press fit has been explained as the principle of a push-button. The authors wanted to compare their own results in patients using X-rays from the postoperative course to decide if it is really safer to use screws or not. MATERIALS AND METHODS: Two hundred and twenty one consecutive, not selected patients were treated with total hip arthroplasty using a cementless cup type Duraloc. They were followed up over a time of 5 years for radiological changes of the bony acetabulum around the cup ("acetabular zones" according to De Lee and Charnley). One hundred and ten cups were additionally fixed with one to three screws at the upper part in region C1, 101 cups were implanted without the use of screws. RESULTS: Periprosthetic changes visible on the radiographs (immediate postoperative gaps, subsequent sclerosis and radiolucent lines) were assessed according to the time of their appearance. A gap in zone C2 was seen more often immediately after operation within the group without screws (17.8% vs. 7.3%) and disappeared within the following 25 months. Within the group with screws significantly more often a gap was found in zone C1 and C3 compared to the group without screws (7.3% vs. 1.9%). In the group with screws a sclerosis of the bone in zone C1 developed in 32.7% mostly within the first 5 months. It was followed by a radiolucent line in zone C3 in 28.2% mainly within 5-25 months postoperatively and in zone C1 in 20.9% within 16 months. Significantly less seldom were these phenomena seen at the cups without screw fixation. There was no correlation between lateral or medial positioning and deviations from the ideal inclination to the bony changes around the cups. No signs of loosening occurred in either group. CONCLUSION: Less radiological changes around the cup if no screws were used and no disadvantages within this group led to the conclusion that an additional screw fixation in principle is not necessary in press-fit cups.

Osteointegration of hydroxyapatite-titanium implants coated with nonglycosylated recombinant human bone morphogenetic protein-2 (BMP-2) in aged sheep.

Osteointegration of metal implants into aged organisms can be severely compromised due to reduced healing capacity of bone, lack of precursor cells for new bone formation, or osteoporosis. Here, we report on successful implant healing in a novel model of aged sheep in the presence of nonglycosylated bone morphogenetic protein 2 (BMP-2). Ewes of 8 to 12 years with significant radiologic and histologic signs of osteoporosis and adipocytic bone marrow received a cylindrical hydroxyapatite-titanium implant of 12 x 10 mm. BMP-2 has been produced as a bacterial recombinant fusion protein with maltose-binding protein and in vitro generation of mature BMP-2 by renaturation and proteolytic cleavage. A BMP-2 inhibition ELISA was developed to measure the in vitro release kinetics of bioactive human BMP-2 from immersed solid implant materials by using Escherichia coli expressed and biotinylated recombinant human BMP-2 receptor IA extracellular domain (ALK-3 ECD). The implants were placed laterally below both tibial plateaus, with the left leg implant carrying 380 microg BMP-2. Both implant types became integrated within the following 20 weeks. The control implant only integrated at the cortical bone, and little new bone formation was found within the pre-existing trabecular bone or the marrow cavity. Marrow fat tissue was partially replaced by unspecific connective tissue. In contrast, BMP-2-coated implants initiated significant new bone formation, initially in trabecular arrangements to be replaced by cortical-like bone after 20 weeks. The new bone was oriented towards the cylinder. Highly viable bone marrow appeared and filled the lacunar structures of the new bone. In mechanical tests, the BMP-2-coated implants displayed in average 50% higher stability. This animal model provided first evidence that application of nonglycosylated BMP-2 coated on solid implants may foster bone healing and regeneration even in aged-compromised individuals.

Prophylaxis of heterotopic bone formation by radiotherapy -- a comparison between pre- and postsurgical activity.

INTRODUCTION: Heterotopic bone formation after total hip replacement is estimated to occur in about 30% of all patients. It may develop into restriction of mobility and persisting pain. MATERIAL AND METHODS: From 1991 to 1998, 90 patients with uncemented total hip replacement and known risks to develop heterotopic bone formation were treated by radiotherapy (14 patients received 5 x 3 gy between the first and the fifth postoperative day, 13 patients received 1 x 7 gy between 24 hours postoperative, 63 Patients received 1 x 7 gy between 24 hours preoperative) using gamma ray or high-energy photons. The distance between radiation and surgical procedure was never more than 24 hours. Clinical and radiological assessment was carried out 3, 6 and 12 month after surgery. RESULTS: Independent of the method of radiotherapy no clinically relevant ossification was noticed on the follow up in any of the 90 patients. CONCLUSION: The results of this study show the efficiency of radiotherapy in the prophylaxis of heterotopic bone formation, independent of the three applied methods. It seems to be important, that the interval between radiation and surgery is not longer than 24 hours. Because of possible risks and logistic problems preoperative radiation should be preferred over postsurgical treatment.

Radiological changes around the stem after cementless hip implantation in case of the anatomic medullary locking hip system -- five years results.

INTRODUCTION: We present radiological results regarding the development of stress shielding around the stem of the AML hip endoprosthesis and discuss the clinical significance of it and preventive measures against stress shielding. MATERIAL AND METHODS: 391 patients (216 female and 122 male) with an AML-hip-endoprosthesis between 1991 and 1992 were followed clinically and radiologically during 5 years postoperatively. It was searched for a statistical correlation of stress shielding with a pre-existing osteoporosis of the proximal femur (Barnett-Nordin index), the diameter of the stem, a varus position of the stem and thigh pain. RESULTS: Stress shielding occurred in only 13.5 % of all patients. Atrophy of the proximal femur was detectable within 1 year, in 5 cases already after 3 weeks. Distal sclerosis reached its maximum after 1-2 years. Remarkably, women showed a tendency to more frequent stress shielding. In women more often than in men, a pre-existing osteoporosis of the proximal femur occurred. Cases with osteoporosis of the proximal femur experienced more often stress shielding. The same was seen in prostheses with diameters >13.5 mm. A slight varus position of the stem also favoured stress shielding, but it indicated an incomplete canal fit of the stems, too. Patients with stress shielding more often were suffered from thigh pain. CONCLUSION: Stress shielding is a result of the discrepancy between the elasticity of the bony femur and the stiffness of the stem. The AML-hip-prosthesis rarely shows this phenomenon. An osteoporosis of the proximal femur (coupled with an thinning of the cortex and generating higher elasticity of the bone), stems with higher diameters (what means higher stiffness) and incomplete canal fit more likely predisposed patients to stress shielding. To prevent stress shielding, the AML prosthesis should not be implanted in cases with known severe osteoporosis of the proximal femur. This prosthesis should be taken preferable in cases with diameters of the femoral canal smaller than 15 mm. Fully canal fit has to be achieved. The frequency of thigh pain, which occurs more often in patients with stress shielding, could be reduced by considering those factors.

The operative management of a malignant proximal humerus tumor represented by secondary Paget's osteosarcoma.

PURPOSE: Malignant tumors at the proximal humerus are an operative challenge. Radical removal is a principal of tumor surgery but as much functionality as possible should be retained. These conditions often conflict so a compromise has to be reached. This paper proposes a solution to this dilemma, introducing an operative approach, with a new modular prosthesis, to a secondary Paget's osteosarcoma in the proximal humerus. METHODS AND RESULTS: A recently developed humerus modular prosthesis is described, which has been implanted into a patient with Paget's osteosarcoma. In these, mostly elderly, patients, successful operative therapy should combine radical removal with early mobilization. Paget's osteosarcoma is a recognized complication of the disease, and its prognosis is poor. In our patient, the implanted humerus prosthesis allowed a limb-saving procedure to be combined with radical removal of the tumor and postoperative early mobilization. A 3-month follow-up yielded good results with no recurrence of the disease and the patient had satisfactory movement. She was able to resume normal daily life shortly after the operation. CONCLUSION: Implantation of a modular prosthesis of the humerus may allow radical removal of a malignant tumor in that area while achieving early motion. In the literature, amputation is often advocated, as radical treatment with chemotherapy is not a successful option in this elderly patient group. We think the alternative use of a modular prosthesis of the humerus is possible in selected cases. We have encountered no other case in the literature where a limb-saving procedure attempts to preserve as much functionality as possible in Paget's osteosarcoma.

Salvage of the upper extremity in cases of tumorous destruction of the proximal humerus.

Malignant bone tumours or metastasis of the upper humerus may cause significant loss of function especially in those patients with resectional arthroplasty of the shoulder. One method for achieving functional reconstruction of the humerus concerned is replacement with a modular endoprosthesis. Little is known about clinical and radiological results in these rare circumstances. Between 1993 and 1997 we treated 21 patients (22 shoulders) with enlarged osteolytic destructions of the proximal humerus caused by metastatic spread or primary malignant tumours. Patients with additional involvement of the glenoid were excluded from this study. The average follow-up was 3.9 years. Every 3 months all patients were followed-up clinically and radiographically. Prior to surgery, diagnosis was established by incisional biopsy and the outcome determined the therapeutic algorithm (radiotherapy, chemotherapy, surgery). In most cases of metastatic lesions, surgery was the first treatment. According to the regional spread of the tumour, various amount of bone and soft tissues had to be removed. The distal stem of the prosthesis was inserted in a cementless way and secured to bone with two interlocking screws. The length of the diaphyseal part depended on the site of osteotomy. Soft-tissue coverage of the large implant was achieved in all patients. Early complications were lymphogenic oedema and superficial wound dehiscence. One patient developed a deep infection, which had to be managed surgically. According to the functional rating system of the Musculoskeletal Tumour Society for the upper extremity the overall results were inversely proportional to the extent of resection. None of our patients achieved unrestricted motion of the shoulder concerned. The most important finding was a proximal migration of the prosthesis causing a painful subacromial impingement, mainly a consequence of the resection of the deltoid muscle and the rotator cuff. In summary, a modular endoprosthesis cannot be recommended generally as the method of choice. If the muscular balance of the shoulder is too weak to act as a joint centralizer the endoprosthesis has no advantage over a simple diaphyseal spacer.

Acetylcholinesterase assay for cerebrospinal fluid using bupivacaine to inhibit butyrylcholinesterase.

BACKGROUND: Most test systems for acetylcholinesterase activity (E.C.3.1.1.7.) are using toxic inhibitors (BW284c51 and iso-OMPA) to distinguish the enzyme from butyrylcholinesterase (E.C.3.1.1.8.) which occurs simultaneously in the cerebrospinal fluid. Applying Ellman's colorimetric method, we were looking for a non-toxic inhibitor to restrain butyrylcholinesterase activity. Based on results of previous in vitro studies bupivacaine emerged to be a suitable inhibitor. RESULTS: Pharmacokinetic investigations with purified cholinesterases have shown maximum inhibition of butyrylcholinesterase activity and minimal interference with acetylcholinesterase activity at bupivacaine final concentrations between 0.1 and 0.5 mmol/l. Based on detailed analysis of pharmacokinetic data we developed three equations representing enzyme inhibition at bupivacaine concentrations of 0.1, 0.2 and 0.5 mmol/l. These equations allow us to calculate the acetylcholinesterase activity in solutions containing both cholinesterases utilizing the extinction differences measured spectrophotometrically in samples with and without bupivacaine. The accuracy of the bupivacaine-inhibition test could be confirmed by investigations on solutions of both purified cholinesterases and on samples of human cerebrospinal fluid. If butyrylcholinesterase activity has to be assessed simultaneously an independent test using butyrylthiocholine iodide as substrate (final concentration 5 mmol/l) has to be conducted. CONCLUSIONS: The bupivacaine-inhibition test is a reliable method using spectrophotometrical techniques to measure acetylcholinesterase activity in cerebrospinal fluid. It avoids the use of toxic inhibitors for differentiation of acetylcholinesterase from butyrylcholinesterase in fluids containing both enzymes. Our investigations suggest that bupivacaine concentrations of 0.1, 0.2 or 0.5 mmol/l can be applied with the same effect using 1 mmol/l acetylthiocholine iodide as substrate.

Acetylcholinesterase in lumbar and ventricular cerebrospinal fluid.

BACKGROUND: Soluble acetylcholinesterase (AChE, E.C. 3.1.1.7.) is released by neurons, glial and meningeal cells into the CSF. AChE activity in cerebrospinal fluid (CSF) is altered in various disorders of the nervous system. The objects of this study are to define a reference range for CSF AChE activity in human lumbar CSF, to prove that the enzyme activity does not depend on the blood/CSF barrier function, and to provide information about AChE in ventricular CSF. In addition, drugs used in neurosurgical care have been examined for their in vitro effects on CSF AChE activity to exclude interference with the test system. METHODS: We tested the AChE activity in 64 lumbar CSF samples collected from a clinically healthy population and in 169 ventricular CSF samples obtained from 90 neurosurgical patients. AChE activity was assayed with our inhibitor-free test procedure. RESULTS: The reference range determined for lumbar CSF AChE activity is 9.2-24.4 nmol/min per ml. Lumbar CSF AChE activity does not correlate with parameters characterising the status of the blood/CSF barrier. Ventricular puncture is only justified for underlying pathology making it impossible to provide reference data for ventricular CSF. Most measurements reveal ventricular enzyme activity below 4 nmol/min per ml. CONCLUSION: The results of this study suggest the utility of lumbar CSF AChE activity as a measure of specific secretory function in enzyme releasing cells of the nervous system.

Renin activity and concentrations of angiotensin I and II in amniotic fluid of normal and Rh-sensitized pregnancies.

Renin activity and the concentrations of angiotensin I and angiotensin II in amniotic fluid of second- and third-trimester pregnancies were determined by radioimmunoassay. Between the 28th and 38th wk of gestation, the mean renin activity in the amniotic fluid was higher than during early pregnancy (before the 18th wk of gestation). Both renin activity and the concentrations of angiotensin I and II were increased on some cases of Rh-incompatibility. One to two weeks after the administration of betamethasone to the mother with threatened premature delivery, the intra-amniotic renin--angiotensin system was slightly suppressed. In urine samples of newborns, angiotensin concentrations were in the same range as those found in the amniotic fluid; renin activity was very low or undetectable in the urine of male neonates (1--7 days of age). Thus, angiotensin II in the amniotic fluid may be derived both from fetal urine and/or as the product of enzymatic reactions in the amniotic sac; the latter is dependent not only on the presence of renin and converting enzyme but also on the local renin substrate (angiotensinogen) concentration.

[MR tomography in the control of chemonucleolytic therapy]. / MR-Tomographie zur Therapiekontrolle nach Chemonukleolyse.

MR tomography can be used for the diagnosis of lumbar disc prolapse and provide information concerning the indications and the follow-up of injection treatment with chymopapain. It is able to distinguish various parts of the disc from their varying signal intensity. Examination of 26 patients showed the effect of chymopapain on intradiscal fluid shift based on shifts in signal intensity. The use of T2-weighted gradient echo sequences over a period of seven to ten minutes is sufficient to show significant changes in the disc following chemonucleolysis.

Oxaceprol is a well-tolerated therapy for osteoarthritis with efficacy equivalent to diclofenac.

The therapeutic equivalence and safety of treatment for 21 days with 400 mg t.i.d. oxaceprol (n = 132) and 50 mg t.i.d. diclofenac (n = 131) were assessed in a multicentre, randomised, double-blind study of a mixed population of patients with osteoarthritis of the knee and/or hip. In a per-protocol analysis of efficacy, the mean Lequesne index decreased by 2.5 points in the oxaceprol group (n = 109) and by 2.8 points in the diclofenac group (n = 109). The 95% confidence interval for the end-point difference revealed therapeutic equivalence. This was confirmed by assessments (visual analogue scale) of pain at rest, weight-bearing pain, pain on standing and pain on movement, all of which decreased to a similar extent under both treatments. The pain-free walking time increased in both groups from 10 min to 25 min by the end of the treatment period. Mobility was also increased to a similar extent by both drugs. The physicians assessed treatment as good or very good in 45-46% of patients in both groups. In all patients who received treatment, 28 and 37 adverse events were reported by 25 out of 132 (18.9%) and 33 out of 131 (25.2%) patients treated with oxaceprol and diclofenac, respectively. In 15 patients (11.4%) with 15 adverse events in the oxaceprol group and 25 patients (19.1%) with 27 adverse events in the diclofenac group, a relation to the medication was considered probable. The difference between the groups was statistically significant (p = 0.04106) for the number of these adverse events. Oxaceprol is therapeutically equivalent to diclofenac, but better tolerated than diclofenac in the treatment of osteoarthritis.

The importance of sonography and radiography in diagnosis and treatment of congenital dislocation of the hip.

The advantages of the sonography of the hip joint in the diagnosis and treatment of hip dysplasia in 1992 "policlinic" children and 1100 newborns are discussed and compared with radiological methods. The treatment concept at the Orthopädische Universitätsklinik Bonn is described as well as its modification after introduction of the sonography in the hip dysplasia screening-examination. These results confirm the necessity of making an early diagnosis. The osteonecrosis of the hip as a complication of the treatment of hip dislocation is discussed.

[Radiological evaluation of polyethyelene wear of cementless total hip endoprosthesis]. / Röntgenologische Bewertung des Polyethylen-Verschleisses zementfreier Hüfttotalendoprothesen.

During the last years increasingly cementless hip endoprostheses have been implanted. Radiological wear measurement of cemented hip endoprostheses for the material couples polyethylene cup-ceramic- or metal head has been established in the literature. However, for cups encased by metal (screwing or pressfit cups), this method of measurement is not applicable. Therefore, a method has been developed to measure wear on radiographs on cementless spherical implants. The data were compared to those, obtained from conventional wear measurements on cemented hip cups. The results indicate that both techniques generate comparable results, thus validating the new technique as being suited for cementless cup implants.

Gelatin-based haemostyptic Spongostan as a possible three-dimensional scaffold for a chondrocyte matrix?: an experimental study with bovine chondrocytes.

The gelatin-based haemostyptic compound Spongostan was tested as a three-dimensional (3D) chondrocyte matrix in an in vitro model for autologous chondrocyte transplantation using cells harvested from bovine knees. In a control experiment of monolayer cultures, the proliferation or de-differentiation of bovine chondrocytes was either not or only marginally influenced by the presence of Spongostan (0.3 mg/ml). In monolayers and 3-D Minusheet culture chambers, the cartilage-specific differentiation markers aggrecan and type-II collagen were ubiquitously present in a cell-associated fashion and in the pericellular matrix. The Minusheet cultures usually showed a markedly higher mRNA expression than monolayer cultures irrespective of whether Spongostan had been present or not during culture. Although the de-differentiation marker type-I collagen was also present, the ratio of type-I to type-II collagen or aggrecan to type-I collagen remained higher in Minusheet 3-D cultures than in monolayer cultures irrespective of whether Spongostan had been included in or excluded from the monolayer cultures. The concentration of GAG in Minusheet cultures reached its maximum after 14 days with a mean of 0.83 +/- 0.8 microg/10(6) cells; mean +/-, SEM, but remained considerably lower than in monolayer cultures with/without Spongostan. Our results suggest that Spongostan is in principle suitable as a 3-D chondrocyte matrix, as demonstrated in Minusheet chambers, in particular for a culture period of 14 days. Clinically, differentiating effects on chondrocytes, simple handling and optimal formability may render Spongostan an attractive 3-D scaffold for autologous chondrocyte transplantation.

Proprioceptive skills and functional outcome after anterior cruciate ligament reconstruction with a bone-tendon-bone graft.

Several studies have shown that patients with anterior cruciate ligament (ACL) reconstruction have an improved proprioceptive function compared to subjects with ACL-deficient knees. The measurement of functional scores and proprioception potentially provides clinicians with more information on the status of the ACL-reconstructed knees. To evaluate proprioception in patients following ACL reconstruction with a bone-tendon-bone (BTB) graft, we used the angle reproduction in the sitting, lying and standing positions and the one-leg hop test. Forty-five patients between 19 and 52 years of age were investigated in a 36-month period after the operation. For functional performance measurement, the International Knee Documentation Committee (IKDC) score was used. Very good and good results were seen in 95% of cases. All patients returned to the same activity level as seen before ACL repair. There was a significant difference in the active angle reproduction test between the ACL-reconstructed knees and normal knees in the active sitting position. Tests with passive angle adjustment in the sitting, lying and active standing positions did not show any differences in proprioceptive skills. Good to very good results in the one-leg hop test we found in 95% of patients. After ACL reconstruction, deficiencies in the active angle reproduction test were very small but, nevertheless, were still observed. Overall, the functional and proprioceptive outcomes demonstrate results to recommend the procedure.

[Autologous chondrocyte transplantation in the ankle joint. Rational or irrational?]. / Autologe Chondrozytentransplantation am oberen Sprunggelenk. Rational oder irrational?

Ankle sprains are one the most common injuries of the lower limb. Fractures, ligamentous lesions, and cartilaginous damage are often associated. Nevertheless the injury is often misjudged and concomitant chondral lesions are assessed late. In the case of a symptomatic osteocartilaginous lesion of the talus, which can be illustrated by MRI or X-ray, operative intervention is indicated. Methods such as microfracturing, mosaicplasty, and autologous chondrocyte transplantation (ACT) are in clinical use. The latter is well known and being established as the treatment of choice for large cartilage defects in the knee. Due to the good results in the knee and the technological improvements (three-dimensional tissue constructs seeded with autologous chondrocytes) this method is being increasingly applied for cartilage lesions of the talus. In contrast to the mosaicplasty donor site morbidity is low and the size of the defect is not a limiting factor. The current studies about ACT of the talus show a stable repair of the defect with mostly hyaline-like cartilage and high patient satisfaction. Therefore, the procedure can be recommended for lesions>1 cm2. Concomitant treatment of posttraumatic deformities (malalignment), ligamentous instabilities, and especially the reconstruction of bony defects are compulsory.

[Development of a catalogue of undergraduate learning objectives for orthopaedics and traumatology]. / Entwicklung des Lernzielkatalogs "Muskuloskeletale Erkrankungen, Verletzungen und traumatische Notfälle" für Orthopädie--Unfallchirurgie im Medizinstudium.

BACKGROUND: The developments towards a combined specialty of orthopaedic and trauma surgery requires not only the consolidation and revision of the postgraduate education training programme but also the development of a catalogue of learning objectives as a uniform basis for undergraduate medical training in the new specialty at German medical schools and teaching hospitals. MATERIALS AND METHODS: Based on the Frankfurt Catalogue of Learning Objectives for Trauma Surgery and the Ulm Catalogue of Learning Objectives for Orthopaedics, a task force of experts has developed a combined catalogue of learning objectives for the new specialty. The experts of both specialties classified the learning objectives into 2 levels for knowledge, into 4 grades of competence for skills, as well as attitudes and social competence. RESULTS: The general part of the operative specialties contains 120 items classified into 39 learning objectives for knowledge and 83 for skills. Two learning objectives comprise both knowledge and skill. The part orthopaedic and trauma surgery comprises 141 learning objectives, six items for skills, 138 for knowledge, as well as three learning objectives for both knowledge and skills. In addition, 22 learning objectives deal with aspects of attitudes and social competence. CONCLUSION: In spite of the only recent alliance of orthopaedics and trauma surgery, the commission has developed not only a collection of topics, but also a usable joint catalogue of learning objectives for undergraduate training with a nationwide recommendation character. The catalogue paves the way for a forward-looking, modern education. The integrated recommendations for the prioritisation, the linkage to other subjects and specialties, and the integration of didactic methods facilitate the local implementation of the learning objectives without loosing any academic freedom.

[Development of a catalogue of undergraduate learning objectives for orthopaedics and traumatology]. / Entwicklung des Lernzielkatalogs "Muskuloskelettale Erkrankungen, Verletzungen und traumatische Notfälle" für Orthopädie-Unfallchirurgie im Medizinstudium.

BACKGROUND: The development towards a combined speciality of orthopaedic and trauma surgery requires not only consolidation and revision of the postgraduate education training programme but also the development of a catalogue of learning objectives as a uniform basis for undergraduate medical training in the new speciality at German medical schools and teaching hospitals. MATERIALS AND METHODS: Based on the Frankfurt catalogue of learning objectives for trauma surgery and the Ulm catalogue of learning objectives for orthopaedics, a task force of experts developed a combined catalogue of learning objectives for the new speciality. Experts from both specialities classified the learning objectives into two levels of knowledge and four grades of skills competence, in addition to objectives for attitudes and social competence. RESULTS: The section on general operative specialities contains 120 items classified into 39 learning objectives for knowledge and 83 for skills. Two learning objectives comprise both knowledge and skills. The section on orthopaedic and trauma surgery comprises 141 learning objectives, including six items for skills and 138 for knowledge, as well as three learning objectives for both knowledge and skills. In addition, 22 learning objectives deal with aspects of attitude and social competence. CONCLUSION: Although this alliance of orthopaedics and trauma surgery is recent, the commission has developed not only a collection of topics but a joint catalogue of learning objectives for undergraduate training that can be used nationwide. This catalogue paves the way for modern education that looks to the future. The integrated recommendations for content prioritisation, links to other subjects and specialities, and the integration of didactic methods facilitate local implementation of the learning objectives without loss of academic freedom.