[Further training in the faculty of orthopedics and trauma surgery. Outstanding, average or insufficient?]. / Weiterbildung im Fach Orthopädie und Unfallchirurgie. Mustergültig, mittelmäßig oder mangelhaft?

A well structured and executed and practical residency program is important to secure a sufficient number of well trained orthopedic surgeons in the future. Some of the residents, however, see substantial shortcomings here. Additionally, orthopedic residency programs struggle to be a valid alternative for graduated medical students when comparing them to residency programs in other medical specialities or alternative job options. In improving the current situation program directors as well as residents must play a key role. A rapid improvement of structural shortcomings of German residency programs does not only provide an advantage in recruiting new residents now, but may also help to maintain the high quality in orthopedic health care in the future.

[Promoting the next generation - what can we improve?]. / Nachwuchsförderung - Was können wir besser machen.

The surgical faculties are threatened by a shortage of junior staff which also applies to orthopedics and traumatology. This article explains which concepts the Young Forum of the German Society of Orthopedics and Traumatology (DGOU) already actively promotes to get students enthusiastic about musculoskeletal surgery and what additional efforts are needed to ensure that the measures are successful.

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

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

[6 years after reformation of the specialty training reglementation--is there still room for improvement?]. / 6 Jahre nach Reform der Weiterbildungsordnung--gibt es noch Verbesserungspotenzial?

AIM: The specialty training reglementation in Germany is defined by a clear framework and aims regarding the obtainable specialty qualification. But its implementation is often difficult. The aim of the present study was to evaluate the demands of the new specialist qualification on the part of the trainers in Germany. METHOD: An e-mail questionnaire was distributed via the offices of DGU (German Society of Traumatology) and DGOOC (German Society of Orthopaedics and Orthopaedic Surgery) to 954 head physicians. Questions referred to abilities that are subject to concrete specialty training. Questions 1-3 referred to basic knowledge of the trained specialty. Questions 4 and 5 focused on self-reliant work, questions 6 and 7 touched aspects of conservative orthopaedics and multiple trauma management whereas questions 8-10 referred to the achieved surgical skills. RESULTS: 220 questionnaires were evaluated overall in a period of 6 weeks. 132 questionnaires were returned by the DGOOC and 88 by the DGU. Questions 1-3: basic knowledge regarding diagnostics and treatment of diseases and injuries of the musculoskeletal system as well as communication in adequate medical terminology were presumed by 97% and 85% respectively. 72% of the questioned trainers expected a brand new specialist to give a detailed and qualified description of an X-ray. Questions 4 and 5: 67% postulated that a brand new specialist should be capable of indicating a routine surgical intervention correctly. But only 30% expected a specialist to manage a consultation. Questions 6 and 7: the self-reliant conservative treatment of back pain patients was assumed by 60%, whereas the organisation of the medical care of multiple trauma patients is requested by 40%. Questions 8-10: referring to the surgical skills, 52% expected that one should handle the standard surgical approaches to the large extremity joints. Only 24% expected that after completing his training, a specialist can perform standard surgical procedures, which are required in the specialty training reglementation, without supervision. On the other hand they were expected to assist. CONCLUSION: Expectations of the head physicians concerning the skills of a new specialist did not match the expected skills defined in the specialty training reglementation regarding basic knowledge, self-reliant work, surgical skills as well as conservative orthopaedics and multiple trauma management. A reasonable structuring is necessary in order to implement the requested contents of the specialty training reglementation. This can only be achieved if demands on aims are compliant.

[Correction of angular deformity of the knee in growing children by temporary hemiepiphyseodesis using the eight-plate]. / Die kniegelenksnahe Achskorrektur im Wachstumsalter durch temporäre Hemiepiphyseodese mit der eight-Plate.

AIM: Angular deformities of the lower extremity are considered as prearthrotic factors. Osteotomy is regarded as a way of corrective treatment. But this intervention is considered as complex and requires a special after-treatment. During childhood and with remaining growth, guided growth offers an elegant solution for this problem. Resulting in a temporary hemiepiphyseodesis, the eight-Plate offers an alternative technique besides the Blount staples and the definitive epiphyseodesis. We evaluated the effect of this device on the correction of angular deformities in children with different diagnoses and at different ages. METHOD: Since 04/2006 22 patients with angular deformities of the lower extremities due to different diagnoses were treated at our department with the eight-Plate (42 eight-Plates). In this study we evaluated the outcome of 13 patients (26 eight-Plates) until the completed angular correction and removal of the eight-Plate. A special treatment after plate removal was not applied. RESULTS: All patients improved their mechanical leg axis. The average age at implantation was 9.4 years (2.3-13.7 years). The average time until plate removal was 10.7 months (6-34 months). No hardware failures, extrusions, growth arrests, wound infections or other complications were observed. Two patients did not achieve the desired axis correction because of insufficient remaining growth potential. An additional surgical intervention was realised. The average correction of the study group regarding the mechanical axis deviation (MAD) was 22 mm (6-43 mm) and 10.6 degrees (5-27 degrees) regarding the angular correction of the mechanical lateral distal femoral angle (mLDFW). The mechanical medial proximal tibial angle (mMPTW) changed by 8.0 degrees (3-15 degrees). CONCLUSION: In our opinion the eight-Plate seems to be a safe and reliable device for guided growth of angular deformities around the knee. The technique is easy to learn and the complication rate low compared to the staple technique. A special after-treatment is not needed and there is only minor operative trauma. At present there are only few data on long-term follow-up after plate removal until skeletal maturity. The definition of the ideal point in time for plate removal is still open.

[Partial physeal growth arrest with increasing genu varum deformity caused by a cortical enchondroma--a case report]. / Partielle epiphyseale Brückenbildung mit zunehmendem Genu varum bei kortikalem Enchondrom--ein Fallbericht.

INTRODUCTION: Trauma or infectious diseases can cause destruction of the epiphyseal region of the knee with premature partial bridging of the physis and deviation of length and axis. There is only little information about tumorous lesions as pathogenetic factor for these deviations. We have been searching for an approach to take advantage of the particular growth potential in order to avoid further complex procedures. METHOD: We report the case of a 6-year-old girl with progredient varus deformity of the left knee and reduction of walking distance. The X-ray and MRI investigations have shown a benign lesion like osteofibroma of the mediodistal femur with an affection of the medial physis. Because of the early and rapidly progredient deformity we planned an operative intervention, including the following two steps: 1) resection of the benign lesion and arthroscopically assisted resection of the bony bar with fat-patch interposition; 2) lateral hemiepiphyseodesis with an eight-plate. The histological examination revealed a cortical enchondroma, which had caused the above-mentioned growth disturbance. During follow-up (clinical and radiological examinations every 3 months) we saw a nearly normal growth of the mediodistal femoral physis with consecutive correction of the axial deviation. RESULTS: With surgical intervention (resection and temporary lateral hemiepiphyseodesis) we achieved a complete deformity correction in reference to the opposite side within one year post operation. Removal of the eight-plate has already been accomplished. Follow-up will be continued until completion of growth. CONCLUSION: In cases of rare partial bridging of the physis induced by a benign bone tumour one can achieve early correction of axial deviation during growth with resection, interposition of a fat patch and temporary hemiepiphyseodesis. With the help of such a procedure it is possible to prevent further progression of a pre-existing deformity and later aggressive surgical intervention.

[Differential behaviour of human adult arthrotic chondrocytes under 2D- and 3D-cultivation set-ups in a collagen I gel]. / Differenzierungsverhalten humaner adulter arthrotischer Chondrozyten unter 2 D- und 3 D-Kultivierungsbedingungen in einem Kollagen-I-Gel.

AIM: The aim of this study was to assess the influence of culture conditions on the differentiation of human chondrocytes expanded in monolayer (2 D) or a three-dimensional (3 D) biodegradable collagen type I matrix, with regard to chondrocyte-specific markers. METHOD: Human arthrotic chondrocytes were taken from nine adult donors (average age 72.1 years) undergoing knee replacement. The isolated cell suspensions were split and cultivated either in a 3-dimensional collagen gel (3 D) or in a monolayer (2 D). The amounts of mRNA for collagen I and II, aggrecan and melanoma inhibitory activity (MIA) were quantified by means of real-time PCR at different times. RESULTS: The 2 D-passaged cells showed a significant increase of collagen I between P 00 and P 01 (p = 0.009), whereas the expression of collagen II decreased significantly (p = 0.022). There was no significant change for collagen I in 3 D-cultivation, whereas the collagen II expression decreased significantly after 2 to 4 weeks (p = 0.001). CONCLUSION: Human adult chondrocytes obtained from elderly patients showed a decreased expression of collagen II with increased passaging in the monolayer (2 D). The decrease was delayed in 3 D-cultivation. We thus question the assumption that the dedifferentiation of chondrocytes can be prevented or reversed by 3 D-cultivation. Based on our results, we recommend the use of freshly isolated and therefore sparsely dedifferentiated chondrocytes for transplantation.