German Society Research Articles

Citizen Views on an Opt-Out Approach to National Electronic Health Records in Germany: A Small-Scale Qualitative Study.

Electronic health records (German: elektronische Patientenakte - ePA) are an important healthcare tool. However, in Germany, current participation remains low for their national ePA. To rectify this, the German government recently adopted an opt-out approach to their national ePA system. The objective of this study is to investigate and provide a brief overview of German public attitudes towards this approach to inform policymakers with evidence-based insights. Four public focus groups were conducted with 12 German citizens to discuss their opinions on the German governments new opt-out approach to the ePA. Three major thematic categories were identified (Contributors to Opt-Out Implementation, Barriers to Opt-Out Implementation, and Contingent Factors) to describe citizen views on the opt-out approach for the ePA. The public is generally supportive of an opt-out approach to ePAs in Germany, as they see the benefits ePAs can provide to German society; but they are skeptical on how successful this approach might be due to extant issues that policymakers must be aware of in order to successfully implement an opt-out approach for Germany's national ePA system.

Vascular surgery in Germany: results from a survey and analysis of quality reports of the German Society for Vascular Surgery and Vascular Medicine

Vascular surgery in Germany: results from a survey and analysis of quality reports of the German Society for Vascular Surgery and Vascular Medicine

The S3 Guideline on the Treatment of Language Development Disorders: Summary of Recommendations

The S3 Guideline on the Treatment of Language Development Disorders: Summary of Recommendations Abstract: The German S3 Guidelines on the Treatment of Developmental Speech and Language Disorders (AWMF: No. 049-015) were published on the AWMF homepage at the end of 2022. The German Society for Phoniatrics and Paedaudiologie coordinated the work and developed the guideline text together with linguists and speech and language therapists. Many scientific medical societies consented to the respective recommendations. For the first time in the German-speaking area, the guideline group reviewed international research results on the treatment of various speech and language disorders and formulated evidence- or consensus-based recommendations for clinical care. The present article summarizes these recommendations and evaluates the guidelines from the perspective of child and adolescent psychiatry and psychotherapy.

Diagnosis and treatment of venous leg ulcers: S2k Guideline of the German Society of Phlebology and Lymphology (DGPL) e.V.

This S2k guideline on venous leg ulcers was created on the initiative and under the leadership of the German Society of Phlebology and Lymphology (DGPL). The guideline group also consisted of representatives from the German Society for Phlebology and Lymphology, German Dermatological Society, German Society for General Medicine, German Society for Angiology, German Society for Vascular Surgery and Vascular Medicine, German Society for Surgery, German Society for Dermatosurgery, German Society for Wound Healing and Wound Treatment, Professional Association of Phlebologists and Lymphologists and Initiative Chronische Wunden. The aim of this guideline is to combine the different approaches and levels of knowledge of the respective professional groups on the basis of consensus, so that a basic concept for the best possible treatment of patients with venous leg ulcers can be provided. A total of 70 specific recommendations were formulated and agreed upon, divided into the subject areas of diagnostics, therapy, prevention of recurrences, and everyday challenges. The guideline thus reflects the current state of scientific knowledge and is intended to be widely used as the best available document for the treatment of patients with venous leg ulcers in everyday clinical practice.

Current Diagnostic and Therapeutic Approaches in May-Thurner Syndrome in Children, Adolescents, and Young Adults: A Survey among Thrombosis Experts of the German Society of Thrombosis and Haemostasis.

May-Thurner syndrome (MTS) is a pelvic venous disorder involving compression of the left common iliac vein by the right common iliac artery, which results in predisposition for deep vein thrombosis. Although MTS is increasingly recognized in young patients, specific guidelines on diagnosis and management for children, adolescents, and young adults do not exist so far. The aim of this study was to assess current diagnostic and therapeutic practice in Germany, Austria, and Switzerland in children and young adults with thrombosis and MTS.We designed an online survey with 11 questions, which we sent via a mailing list to all members of the German, Austrian, and Swiss Society of Thrombosis and Haemostasis Research. Between July and October 2022, 33 specialists answered the questionnaire. Most participating specialists worked at pediatric hospitals (61%). Numbers of annually treated thromboses ranged from <5 (26%) to >30 (13%). Most specialists used venous ultrasound to diagnose deep vein thrombosis, 53% magnetic resonance imaging. Only 25% of specialists systematically screened for MTS in deep vein thrombosis. MTS was managed with anticoagulation (65%), iliac vein stent placement (32%), or balloon angioplasty (13%). In total, 31% of specialists reported to use more than one therapeutic method. Diagnostic and therapeutic approaches for MTS differed between specialists. Lack of standardization resulted in individualized and highly diverse management. Prospective observational clinical studies investigating the outcome of different management strategies including long-term follow-up on outcome and incidence of postthrombotic syndrome will help in defining patient groups who benefit most from revascularizing interventional strategies and developing standardized guidelines.

Enhancing ultrasound education in obstetrics and gynecology in Germany: insights and innovations from postgraduate training

BackgroundUltrasound (US) has become integral to obstetrics and gynecology (Ob/Gyn), necessitating proficient training during residency. Despite its clinical importance, there is a perceived gap in the quality and structure of postgraduate ultrasound education in Germany.MethodsA cross-sectional survey was conducted among Ob/Gyn residents in Germany from October 2023 to March 2024, using the LimeSurvey platform. The survey, distributed via email, social media, and physical flyers, garnered 211 participants, with 115 completing all sections. The questionnaire covered demographic details, US training experiences, and the perceived importance of US in clinical practice.ResultsAlthough US was highly valued by respondents, with an average of 26.1% of their clinical activity devoted to it, there was significant dissatisfaction with the training quality. Key issues included inadequate supervision, the necessity of self-training, and low participation in certification courses. Despite 93.0% awareness of professional US organizations like the German Society for Ultrasound in Medicine (DEGUM), engagement with structured training programs was minimal.DiscussionThe study highlights a critical need for standardized US training protocols and curricular reform in Ob/Gyn residencies in Germany. The discrepancy between the recognized importance of US and the quality of training indicates a pressing need for improvements. Addressing these gaps through comprehensive, structured educational reforms could significantly enhance the proficiency and confidence of future Ob/Gyn specialists, ultimately improving patient care.

Questioning ‘Man’ in Joana Tischkau’s Colonastics: Black Feminist Identity Politics in Contemporary German Theater

In my contribution to this volume on Responsive Bodies I want to take a closer look at recent Black feminist identity politics in German theater in order to think about what the Caribbean philosopher Sylvia Wynter calls ‘Man.’ In this regard later in this text I will focus on the video clip series Colonastics (2020) by Joana Tischkau. I will do so in relation to the colonial roots of post-war racism in Germany, more precisely the time after its reunification in 1989. In front of this background my claim is that Afro-German feminist theater makers in the last couple of years have been responding to a certain white dominant culture in the country I am living in as a white German, where right-wing political parties like theAlternative für Deutschland (AfD) are getting stronger again right now unfortunately. The responsiveness corresponding with the aesthetic practices of the theater makers being discussed here questions, I am claiming with Wynter, ‘Man’ as a dominant genre of being human and thereby brings forth a true pluralization of German society.

The use of botulinum toxin in hernia surgery: results of a survey in certified hernia centers

Botulinum toxin application into the abdominal wall prior to major hernia repair can reduce the complexity of surgery and has been increasingly used in recent years, even if it is an off-label use. To what extent is botulinum toxin used in hernia surgery in German-speaking countries and what is the current evidence in the literature? In avoluntary online survey of German Society for General and Visceral Surgery (DGAV)-certified competence centers and reference centers for hernia surgery, aspects of botulinum toxin application were surveyed and the results analyzed. A total of 57centers took part in the survey, of which 27(47%) use botulinum toxin. The main reasons for not using it were lack of experience and reimbursement. Of the centers 85% have treated less than 50patients with botulinum toxin. The main indications were midline hernias (M2-4 according to the EHS classification) with ahernia gap > 10 cm (W3according to EHS classification) and loss of domain situations. The application was predominantly ultrasound-guided by designated hernia surgeons with 100-200 Allergan or 500 Speywood units 4-6weeks preoperatively and without complications related to the botulinum toxin application. Botulinum toxin injections in hernia surgery appear to be safe and effective. Ultrasound-guided preoperative bilateral administration is supported by the available data. Specific course and information formats should be offered by the hernia surgery institutions.

Status quo of operative training in emergency surgery in Germany – results of a survey

BackgroundEmergencies and emergency surgeries are a central part of everyday surgical care in Germany. However, it is unclear how emergency surgery is practically trained in clinics on a daily basis and what training concept is underlying. Therefore, the aim of this survey study was to capture the status quo of emergency surgical training of German general and visceral surgeons.MethodsThe members of the German Society for General and Visceral Surgery were surveyed online (n = 5281). The questionnaire included demographic data and expertise in surgery and assistance in emergency surgery regarding common emergency surgical operations. In addition, further training measures in emergency surgery and their support by employers were queried.ResultsOnly complete questionnaires (n = 184, response rate 3.5%) were included in the analysis. Most participants were in training (n = 69; 38%), followed by senior physicians (n = 52; 29%), specialists (n = 31; 17%) and chief physicians (n = 30; 17%). 64% of the participants were employed at university hospitals or maximum care hospitals. Regarding further training opportunities, in-clinic shock room training was most frequently used. Outside of their own clinic, the ATLS course was most frequently mentioned. Operations for cholecystitis and appendicitis as well as emergency stoma procedures are the most common emergency procedures. There was a strong difference in the frequency of operated cases depending on the level of training. For operations to treat acute abdominal traumas (hemostasis of liver and spleen, packing) as well as outside of visceral surgery, only low competence was reported. Over 90% of survey participants consider emergency surgery to be an indispensable core competence. Neither in the old (76%) nor in the new training regulations (47%) is emergency surgery adequately represented according to the participants’ assessment. There was a significantly lower prevalence of the “sub-steps concept” in emergency surgery at 38% compared to elective surgery (44%). Important elements of imparting skills in emergency surgery are simulation and courses as well as operative sub-steps, according to the majority of survey participants.ConclusionThe results show that general and visceral surgeons in Germany are introduced to emergency surgery too little structured during further training and at specialist level. The survey participants had, as expected, hardly any experience in emergency surgery outside of visceral surgery but surprisingly also little experience in visceral surgical trauma care. There is a need to discuss the future organization of emergency surgical training. Adequate simulation structures and extracurricular courses could contribute to an improvement in this respect.

Development and Future Prospects of Online Educational Lectures of the German Society for Radiation Oncology (DEGRO)

Development and Future Prospects of Online Educational Lectures of the German Society for Radiation Oncology (DEGRO)

Arbitrariness of bibliometric parameters: a case study on leading scientists in the German Society for Experimental and Clinical Pharmacology and Toxicology (DGPT)

Bibliometric rankings of researchers are increasingly important for academic hiring and for making grant application decisions in the biomedical sciences. As a case study, we performed a comprehensive bibliometric analysis of German pharmacology and toxicology. The 42 members of the German Society for Experimental and Clinical Pharmacology and Toxicology (DGPT) represented in the German ‘best scientist’ ranking in biology and biochemistry on www.research.com for the year 2022 were analyzed according to various aspects. The scientist ranking on Research.com is based on the Hirsch Index (h-Index). In the comparatively small field of pharmacology, which accounts for only 4.2% of the scientists in the ranking on Research.com, there are only two women. This shows that female pharmacologists are highly underrepresented in elite pharmacology. To achieve a high h-Index, a pharmacologist must publish more papers than a biochemist or biologist. Furthermore, German elite pharmacology was compared in the three sub-societies of the DGPT. There are no significant differences between elite pharmacologists and toxicologists in terms of productivity. Two large German pharmacology schools (Günter Schultz and Franz Hofmann) are similar in all bibliometric parameters except for number of total publications. Age-specific factors were also defined for the analysis: ‘academic age’ and the quotient of the h-Index by ‘academic age’. Any given bibliometric parameter (or combination of parameters) yielded different ranking results. This became even more evident when additionally considering the highly popular and widely used Laborjournal ranking of top pharmacology and toxicology researchers with only very few DGPT members listed. We unmasked 7 types of publication patterns of pharmacologists, an age-dependent publication peak at around 55 years and different trajectories for high- and low-volume publishing pharmacologists. In the future, less emphasis should be paid to bibliometric parameters in academic hiring and grant decisions than to the authentic societal and scientific impact of the research. Bibliometric parameters are very arbitrary within a very large segment of pharmacologists. Studies according to the paradigm of this account should be made for other countries, other learned societies, and other scientific fields. The different cultures among related scientific fields must be considered in bibliometric analyses as exemplified here for pharmacology versus biochemistry. Conversely, the bibliometric similarities between pharmacology and toxicology show that both fields belong together and have a very similar culture.

National challenges for trauma surgery in Germany due to violence and war

Due to the war in Ukraine and the treatment of patients with war wounds in the hospitals of the TraumaNetworks of the German Society for Trauma Surgery (TraumaNetzwerke DGU®), injuries from life-threatening mission situations (LebEL), terrorism, violence and war have become a matter of daily professional life. Furthermore, the societal and global feeling of security has fundamentally changed. The much-cited term "turning point in history", the reorientation of the Armed Forces and the investigation of the resilience of the healthcare system with respect to the "fitness for war", approximate to the description of the current challenges for trauma surgery (UCH) in Germany. Based on the developments following the terrorist attacks in Paris in 2015 and in Brussels in 2016, a clarification is given as to which adaptations have already been successful and how quickly an improvement could successfully be achieved. In this context, the concept of tactical care and the course on Terror and Disaster Surgical Care (TDSC), for example, have been game changing. The main challenge currently lies in overcoming the structural alterations in the German healthcare system and professionally in the treatment of war wounded personnel from Ukraine. The knowledge gained from these two national tasks must be analyzed for the future development and adaptation of established treatment structures, e.g., of the TraumaNetzwerke DGU®, under the requirements of the increased resilience against war, terrorism and violence. The aim is to name that which has already been achieved with respect to the national challenges for UCH and at the same time to outline or discuss further necessities for improvements and elimination of possible gaps in capabilities.

Diagnosis and treatment of Parkinson´s disease (guideline of the German Society for Neurology)

IntroductionThe aim of this German national guideline is to optimize the clinical care of patients with Parkinson's disease (PD) in terms of diagnostics, drug and surgical treatment and care.Summary or definition of the topicThis guidance was prepared for the German Society of Neurology (DGN) in collaboration with the Austrian Society of Neurology (ÖGN) and the Swiss Neurological Society (SNG) for German-speaking countries. The guidelines for the diagnosis and treatment of PD have been revised by a national expert group and the guideline commission of the DGN at S2k level. The main objective of these guidelines is to optimize the clinical care of PD patients regarding diagnosis, including early detection, technical diagnostic examinations, and pharmacological as well as invasive treatment options.RecommendationsThe updated PD diagnosis and treatment guidelines are emphasizing optimized clinical care. Key revisions include preferring the name "Parkinson's disease" over previous terms and adopting International Parkinson and Movement Disorder Society (MDS) diagnostic criteria. Recommendations cover genetic and imaging diagnostics, initial pharmacotherapy considering efficacy and patient factors, and tailored pharmacological combinations for complications. Guidelines extend to managing cognitive, affective, psychotic, and autonomic symptoms, along with non-oral therapies like pump therapy and deep brain stimulation. Special situations like akinetic crisis, driving ability, and care concepts are addressed, ensuring comprehensive management for PD patients at various stages and conditions.ConclusionsThis guidance reflects the state of the art at the beginning of 2024.

A retrospective identification of severely injured patients using ICD 10 diagnoses codes : Part of the project "Quality of life and ability to work after severe trauma" (LeAf Trauma)

Due to continuous improvements in treatment, more and more severely and seriously injured patients are surviving. The complexity of the injury patterns of these patients means that they are difficult to map in routine data. The aim of the data exploration was to identify ICD 10 diagnoses that show an association with an injury severity score (ISS) ≥ 16 and could therefore be used to operationalize severely injured patients in routine data. The coded four-digit ICD 10 S diagnoses and the calculated ISS of trauma patients from the Armed Forces Central Hospital Koblenz (BwZKrhs) and the University Hospital Düsseldorf (UKD) were analyzed using statistical association measures (phi and Cramer'sV), linear regressions and machine learning methods (e.g., random forest). The S diagnoses of facial, head, thoracic and pelvic injuries, associated with an ISS ≥ 16 were identified. Some S diagnoses showed an association with an ISS ≥ 16 in only 1 of the 2 datasets. Likewise, facial, head, thoracic and pelvic injuries were found in the subgroup of 18-55-year-old patients. The current evaluations show that it is possible to identify ICD 10 S diagnoses that have asignificant association with an ISS ≥ 16. According to the annual report of the trauma register of the German Society for Trauma Surgery (TR-DGU®), injuries with an abbreviated injury scale (AIS) ≥ 3 are particularly common in the head and thoracic regions.

Cardiac biomarkers prior to noncardiac surgery

Cardiac biomarkers, such as high-sensitivity cardiac troponin (hs-cTn) and brain natriuretic peptide (BNP) or N‑terminal prohormone of brain natriuretic peptide (NT-proBNP) are measured perioperatively to improve the prognosis and risk prediction. The European Society of Cardiology (ESC), European Society of Anesthesiology and Intensive Care (ESAIC) and the German Society of Anesthesiology and Intensive Care Medicine (DGAI) have recently published guidelines on the use of cardiac biomarkers prior to surgery. This article provides an overview of the available evidence on perioperative troponin and BNP/NT-proBNP measurements. Current guideline recommendations are presented and discussed. MEDLINE, Cochrane and google.scholar were searched for relevant keywords. Titles and abstracts of identified papers were checked for relevance and published results were summarized. Guideline recommendations from the ESC, ESAIC and DGAI are presented, compared and evaluated based on the available literature. In addition, the significance of new perioperative cardiac biomarkers is discussed based on the existing evidence. The definitions, diagnosis and management of cardiovascular events in the perioperative context differ from those in the nonsurgical setting. The evidence for the measurement of hs-cTn and BNP/NT-proBNP is evaluated differently in the guidelines and the resulting recommendations are partly contradictory. In particular, recommendations for changes in perioperative management based on biomarker measurements diverge. The ESC guidelines propose an algorithm that uses preoperative biomarkers as the basis for additional cardiac investigations. In particular, invasive coronary angiography is recommended for patients with stable chronic coronary syndrome who have no preoperative cardiac symptoms but elevated biomarkers. In contrast, the ESAIC guidelines emphasize that the available evidence is not sufficient to use perioperative biomarker measurements as abasis for achange in perioperative management. Treating physicians should coordinate interdisciplinary (surgery, anesthesiology, cardiology) recommendations for clinical practice based on the aforementioned guidelines. If cardiac biomarkers are routinely determined in high-risk patients, this should be done in accordance with the ESC algorithm.

S3-Guideline Chronic Tinnitus - Update

Chronic tinnitus is a symptom of disturbed auditory perception. More than 90% of tinnitus patients suffer from hearing loss. Many people experience tinnitus and seek for treatment, but suffering and actual burden of tinnitus is individually very different, sometimes it disappears after a certain time even without treatment. This process is called habituation. The actual suffering from tinnitus depends on stress symptoms and other psychosomatic comorbidities like depression, anxiety and sleeping disorders.Up-to-date there is no therapy that can completely switch off tinnitus, mainly because the origin and expression of tinnitus are individual and very different. This educational publication summarizes and evaluates scientific therapeutic approaches for chronic tinnitus, based on the newly elaborated S3-Guideline "Chronic Tinnitus", under the lead management of the German Society of ENT, Head and Neck-Surgery, published in 2021. It focusses on recommendations for counselling, interventions against hearing loss and psychotherapy, mainly cognitive behavioural therapy.

Migration and Cultural Integration in Germany

Purpose: The aim of the study was to analyze the migration and cultural integration in Germany. Methodology: This study adopted a desk methodology. A desk study research design is commonly known as secondary data collection. This is basically collecting data from existing resources preferably because of its low cost advantage as compared to a field research. Our current study looked into already published studies and reports as the data was easily accessed through online journals and libraries. Findings: Migration and cultural integration in Germany present both achievements and hurdles. Successful integration hinges on factors like language skills, education access, and job opportunities. Yet, challenges persist due to cultural disparities, discrimination, and social exclusion. Though progress is evident, ensuring migrants' seamless integration remains a continual and intricate endeavor in Germany. Unique Contribution to Theory, Practice and Policy: Social identity theory, multiculturalism theory &amp; transnationalism theory may be used to anchor future studies on analyze the migration and cultural integration in Germany. Community-based organizations, educational institutions, and government agencies should collaborate to provide tailored support services and resources that empower immigrants to fully participate in German society while preserving their cultural identities. Policymakers should enact policies that promote inclusive societies and remove barriers to immigrant integration in Germany.

DACH-PRINCIPLE IN THEORY AND IN PRACTICE AND THE PLACE OF THE AUSTRIAN VARIETY OF THE GERMAN LANGUAGE IN BULGARIAN SCHOOLBOOKS

This paper focuses on the pluricentricity of the German language and the pluricentric approach in the German course books used in Bulgaria. In the first part, basic terms like pluricentricity and DACH principle are defined. The DACH principle views the cultural diversity as normal and uses the diversity of the German language in the different countries as an opportunity for multidimensionality in teaching German as a foreign language. The second part is dedicated to the most important lexical, phonetic, morphological and syntactic specifics of the Austrian variety of the German language which, in my opinion, should be presented in the course books used in Bulgarian secondary schools. The third part contains the results of my study whose aim is to examine the pluricentric approach focusing on the presence of the Austrian German language in selected schoolbooks, approved by the Bulgarian Ministry of Education and Science. The results show that the pluricentric approach is barely implemented on a cultural level and the specifics of Austrian German language are totally neglected. Austria is mainly portrayed as one single tourist attraction – in this context, almost every information is limited to the capital Vienna. As opposed to Germany, the limited representation of Austria and its variety of the German language, culture and society is only a superficial “glimpse” in the Bulgarian schoolbooks, which has a significant impact on the students’ general perception of the German speaking countries.

The German COVID-19 rheumatism register

At the beginning of the coronavirus disease 2019 (COVID-19) pandemic in December 2019 there was no available evidence regarding the management of immunosuppressive or immunomodulatory treatment and the potential outcomes of severe acute respiratory syndrome coronavirus type2 (SARS-CoV-2) infections in inflammatory rheumatic diseases (IRD). As aresult, the Justus Liebig University of Giessen, Germany, in collaboration with the German Society for Rheumatology, established the German COVID-19 register ( www.covid19-rheuma.de ). The COVID-19 register enabled for the first time a systematic documentation and evaluation of viral infections in patients with IRD. The data collection started as early as March 2020. Currently, the register is one of the largest global registers in the field of COVID-19 and IRD. As of 18 December 2023 the register has recorded more than 7100 cases. The first scientific findings on SARS-CoV‑2 infections in IRD patients were generated from the register in 2020, showing an association between disease activity of IRD, certain comorbidities, such as cardiovascular diseases and treatment with rituximab, with an unfavorable course. The contents and construction of the database of the register were designed at the conception to allow collaboration and data exchange with other national and international registers (e.g., EULAR COVID-19 register, COVID-19 global rheumatology alliance and the Lean European open survey on SARS-CoV‑2 infected patients). In addition, other registers and surveys were initiated. A vaccination register documents the tolerability and possible adverse reactions to COVID-19 vaccination in IRD patients. The data resulted in numerous publications and formed the basis for national and international recommendations for action in the care and vaccination of IRD patients during the COVID-19 pandemic. In summary, the German COVID-19 register has made asignificant contribution to the understanding of the course of COVID-19 in IRD patients and has facilitated international collaboration for abetter understanding of COVID-19 and IRD.

Treatment of proximal humeral fractures in childhood and adolescence : Consensus report of the pediatric traumatology section of the German Society for Trauma Surgery

Proximal humeral fractures are arelatively common injury in childhood and adolescence, accounting for 0.45-2% of all fractures [2, 18]. Treatment is usually conservative but is still the subject of ascientific debate [9, 12]. In addition to the S1-LL, there are different recommendations for the diagnostics and treatment of these fractures in the literature. As part of the 10thscientific meeting of the SKT of the DGU, the existing recommendations and the relevant or current literature were critically discussed by apanel of experts and aconsensus was formulated. An algorithm for the diagnostics, therapy and treatment was integrated into this. The measurement of axial deviation and tilt is not interobserver and intraobserver reliable [3]. The age limit for when complete correction is possible was set at an age of 10years, as the correction potential changes around this age. For diagnostic purposes, well-centered X‑ray images in 2planes (true AP and Y‑images without thoracic parts) is defined as the standard. At the age of less than 10years, any malposition can be treated conservatively with Gilchrist bandaging for 2-3weeks. Surgery can only be indicated in individual cases, e.g., in the event of severe pain or the need for rapid weight bearing. An ad latus displacement of more than half the shaft width should not be tolerated over the age of 10years. Due to the variance in the measurement results, it is not possible to recommend surgical treatment depending on the extent of the ad axim dislocation. As aguideline, the greater the dislocation and the closer the child is to growth joint closure, the more likely surgical treatment is indicated. The development should be taken into account. The gold standard is retrograde, radial and unilateral ESIN osteosynthesis using two intramedullary nails. Osteosynthesis does not require immobilization. Afollow-up X‑ray is planned for unstable fractures without osteosynthesis after 1week, otherwise optional for documentation of consolidation after 4-6weeks, e.g., if sports clearance is to be granted and before metal removal (12weeks). Recommendations for surgical indications based on the extent of tilt are not reproducible and seem difficult in view of the current literature [3, 9, 12]. Apragmatic approach is recommended. The prognosis of the fracture appears to be so good, taking the algorithm into account, that restitutio ad integrum can be expected in most cases.