Trauma Surgery In Germany Research Articles

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.

Optimizing Interhospital Transfers in Orthopedics and Trauma Surgery: Challenges, Insights, and Proposals for Standardized Care in Germany.

Germany's high density of under-equipped hospitals and anticipated surge in orthopedic and trauma surgery-related diseases by 2030, combined with personnel shortages, are expected to increase patient transfers between hospitals, an issue that urgently needs standardized protocols. Despite some existing cooperative agreements, such as between joint-replacement centers or within the Trauma Network DGU®, these measures do not adequately address the full range of patient-transfer cases, including those due to a lack of specialization or staff shortages, resulting in delayed treatment and potential health risks. This study aims to dissect the intricacies of interhospital transfers in orthopedics and trauma surgery across Germany, focusing on understanding the underlying reasons for transfers, comparing the operational structures of small and large hospitals, and laying the groundwork for future standardized protocols to enhance patient care. A cross-sectional study was conducted in the form of an online survey via SoSci Survey, which was directed at orthopedic surgeons and trauma surgeons working in hospitals in Germany. The 22-question survey gathered information on participants' clinic roles, departmental details, transfer processes, frequent diagnoses, perceptions of transfer quality, and improvement areas. The survey was sent to orthopedic and trauma surgeons in Germany by the specialist society. The data were analyzed using descriptive and inferential statistics to ensure a comprehensive insight into interhospital transfer practices. The study involved 152 participants from various hospital ranks and located in different hospital sizes and types across rural and urban areas. A significant difference was observed between the care structures of basic/regular care and central/maximum care hospitals, especially regarding the available facilities and specialties. These findings suggest improvements such as better patient documentation, increased digital communication, optimized patient distribution, and standardization of transfer requests, among others. This study highlights the urgent need for improved protocols and resource allocation to eliminate inequalities in transfers between hospitals in orthopedics and trauma surgery in Germany.

Proximal humeral fractures in children - controversies in decision making

BackgroundProximal humeral fractures in children are rare and usually treated non-operatively, especially in children younger than ten. The decision between operative and non-operative treatment is mostly based on age and fracture angulation. In the current literature, diverging recommendations regarding fracture angulation that is still tolerable for non-operative treatment can be found. Besides, there is no consensus on how fracture angulation should be determined. This study aimed to determine whether leading experts in pediatric trauma surgery in Germany showed agreement concerning the measurement of fracture angulation, deciding between operative and non-operative treatment, and choosing a treatment modality.MethodsTwenty radiographs showing a proximal humeral fracture and the patient’s age were assessed twice by twenty-two senior members of the “Section of Pediatric Traumatology of the German Association for Trauma Surgery”. Experts determined the fracture angulation and chose between several operative and non-operative treatment modalities. The mean of individual standard deviations was calculated to estimate the accuracy of single measurements for fracture angulation. Besides Intra-Class Correlation and Fleiss’ Kappa coefficients were determined.ResultsFor fracture angulation, experts showed moderate (ICC = 0.60) interobserver and excellent (ICC = 0.90) intraobserver agreement. For the treatment decision, there was fair (Kappa = 0.38) interobserver and substantial (Kappa = 0.77) intraobserver agreement. Finally, experts preferred ESIN over K-wires for operative and a Gilchrist over a Cuff/Collar for non-operative treatment.ConclusionsFirstly, there is a need for consensus among experts on how fracture angulation in PHFs in children should be reliably determined. Our data indicate that choosing one method everybody agrees to use could be more helpful than using the most sophisticated. However, the overall importance of fracture angulation should also be critically discussed. Finally, experts should agree on treatment algorithms that could translate into guidelines to standardize the care and perform reliable outcome studies.Level of evidenceIII.

Impact of the COVID-19 pandemic on maxillofacial trauma surgery in Germany - implications from the national DRG database

PurposeThe COVID-19 pandemic has affected the personal and social lives of millions of people and also impacted the etiological factors of midfacial trauma such as falls, interpersonal violence or traffic accidents. The aim of this study was to analyze the influence of the COVID-19 pandemic on maxillofacial trauma surgery in the German healthcare system.MethodsNationwide data regarding the national diagnosis-related-group (DRG) inpatient billing system used in all German hospitals was received from the German Federal Statistical Office. Various trauma-associated procedures of the Operation and Procedure Classification System (OPS), a German modification of the International Classification of Medical Procedures (ICPM), were statistically associated with different epidemiological factors between 2012 and 2021.ResultsA statistically significant decrease (p < 0.05) in surgeries regarding maxillofacial fractures was registered during the years 2020 and 2021. Young male patients had the largest decline in maxillofacial trauma surgeries during this period (p < 0.05). In contrast. elderly patients 80 years and older showed a dramatic increase in the frequency of fractures in both the midface and the mandible (p < 0.05).ConclusionsDuring the COVID 19 pandemic there has been a shift in the number, composition and etiology of maxillofacial fracture surgeries. Measures of social distancing and personal risk avoidance had a societal positive effect on the frequency of facial injuries. This stands in contrast to the drastic increase in fractures of elderly people who should be protected primarily by the measures taken. These results can help to understand these influences better in future pandemics.Trial registrationGerman Clinical Trials Register No: DRKS00032778.

Orthopaedics and Trauma Surgery in Germany in 2023 - Will We Have Sufficient Doctors in the Future?

There has been a growing shortage of physicians in Germany in recent years. In this study, we analyse the situation facing orthopaedic hospitals and trauma centres.Between 22 November and 5 December 2022, a web-based questionnaire was sent out by the Academy of the German Trauma Society (AUC) and by the Society of Leading Orthopaedic and Trauma Surgeons (VLOU).The questionnaire was answered by 185 heads of department. Of the responses, 20% came from university hospitals or major trauma centres, and a third from regional or local clinics. More than half of the hospital departments (55%) had a median of 2.7 vacant doctor positions. Among those hospitals, 47% had a vacant position for a consultant, 33% for a board-certified specialist, and 89% for a junior doctor. Within the university hospitals, only one third had vacant doctor positions. The responding heads of department gave negative feedback regarding the number of applications, the qualifications of young doctors, and their motivation for scientific work (in university hospitals).More than half of the responding hospitals had vacant doctor positions. If we are to counteract the growing shortage of doctors in orthopaedics and trauma surgery, the number of clinical doctors in general and the working conditions in hospitals have to be improved. Teaching hospitals should try to improve the training of medical students with a view to inspiring greater motivation to work in orthopaedics and trauma surgery.

Scientific Productivity of University Orthopaedics and Trauma Surgery in Germany, Austria, and Switzerland.

Despite major achievements, such as the development of hip prostheses, scientific productivity in orthopaedics and trauma surgery has hardly been investigated. Our study's aim therefore was to analyse the correlation between the leading physicians' h-index and their academic rang, in order to determine whether this objective measure of scientific accomplishments correlates with clinical position. All physicians in leading positions at university hospitals' orthopaedics or trauma surgery departments in Germany, Austria, and Switzerland were included. Year of habilitation, number of publications and citations as well as h-index were collected from September to November 2020. A total of 844 leading physicians at 46 university hospitals were included. Professors had the highest number of total publications (117.4±124.8, p<0.001) and highest h-index (20.1±10.1, p<0.001). We found significant differences in the total number of publications (p=0.001), publications in the last three years (p<0.001), and h-index (p<0.001) between the three investigated nations, with all parameters being highest in Switzerland. Our study shows that increasing scientific productivity is correlated with academic success. The country-specific differences indicate significant differences in the value of scientific activity in daily clinical routine.

Effects of the SARS-CoV‑2 pandemic on residency training in orthopedics and traumatology in Germany : Anationwide survey.

BackgroundThe spread of the coronavirus disease has impacted healthcare systems worldwide; however, restrictions due to the SARS-CoV‑2 (severe acute respiratory syndrome coronavirus 2) pandemic are particularly drastic for physicians in residency training. Imposed restrictions interrupt the standard educational curricula, and consequently limited residents to meet mandatory requirements.AimThe aim of this study was to evaluate the effects of the SARS-CoV‑2 pandemic on residency training in orthopedics and trauma surgery in Germany.MethodologyAn online-based, voluntary, and anonymous survey of physicians in residency training for orthopedics and trauma surgery was conducted. Through email lists of junior physician organizations the survey was sent to 789 physicians. Participation was possible between October and November 2021.ResultsA total of 95 participants (female 41.1%) with a mean age of 31.3 ± 2.8 years were analyzed. In the everyday clinical practice and care 80% of participants thought that they were set back in time of their general training due to the pandemic. There was an average reduction of 25.0% in time spent in the OR and 88.4% agreed that their surgical training was delayed due to the pandemic. Of the respondents 33.6% were able to attend external continuing education courses. Only 4.2% were able to invest more time in research and 55.8% of participants agreed that their residency training will be extended due to the pandemic.ConclusionThe COVID pandemic has had a significant impact on the residency training in orthopedics and trauma surgery in Germany. In almost all areas of training, residents had to accept restrictions due to the imposed restrictions, which potentially negatively affected their training.Supplementary InformationThe online version of this article (10.1007/s00132-022-04295-w) contains the german and english version of the survey.

Assessing Telemedicine Efficiency in Follow-up Care With Video Consultations for Patients in Orthopedic and Trauma Surgery in Germany: Randomized Controlled Trial.

BackgroundTelemedicine can help mitigate important health care challenges, such as demographic changes and the current COVID-19 pandemic, in high-income countries such as Germany. It gives physicians and patients the opportunity to interact via video consultations, regardless of their location, thus offering cost and time savings for both sides.ObjectiveWe aimed to investigate whether telemedicine can be implemented efficiently in the follow-up care for patients in orthopedic and trauma surgery, with respect to patient satisfaction, physician satisfaction, and quality of care.MethodsWe conducted a prospective randomized controlled trial in a German university hospital and enrolled 60 patients with different knee and shoulder conditions. For follow-up appointments, patients received either an in-person consultation in the clinic (control group) or a video consultation with their physician (telemedicine group). Patients’ and physicians’ subsequent evaluations of these follow-up appointments were collected and assessed using separate questionnaires.ResultsOn the basis of data from 52 consultations after 8 withdrawals, it was found that patients were slightly more satisfied with video consultations (mean 1.58, SD 0.643) than with in-clinic consultations (mean 1.64, SD 0.569), although the difference was not statistically significant (P=.69). After excluding video consultations marred by technical problems, no significant difference was found in physician satisfaction between the groups (mean 1.47, SD 0.516 vs mean 1.32, SD 0.557; P=.31). Further analysis indicated that telemedicine can be applied to broader groups of patients and that patients who have prior experience with telemedicine are more willing to use telemedicine for follow-up care.ConclusionsTelemedicine can be an alternative and efficient form of follow-up care for patients in orthopedic and trauma surgery in Germany, and it has no significant disadvantages compared with in-person consultations in the clinic.Trial RegistrationGerman Clinical Trials Register DRKS00023445; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00023445

Smartphone and App Usage in Orthopedics and Trauma Surgery: Survey Study of Physicians Regarding Acceptance, Risks, and Future Prospects in Germany.

BackgroundIn the course of digitization, smartphones are affecting an increasing number of areas of users’ lives, giving them almost ubiquitous access to the internet and other web applications. Mobile health (mHealth) has become an integral part of some areas of patient care. In contrast to other disciplines, routine integration of mobile devices in orthopedics and trauma surgery in Germany is still in its infancy.ObjectiveThis study aimed to investigate physicians’ current state of opinion regarding acceptance, future prospects, and risks of medical apps in the field of orthopedics and trauma surgery in Germany.MethodsA web-based survey among orthopedics and trauma surgeons in German university hospitals on the use of medical apps in everyday clinical practice was conducted between September 2018 and February 2019. The survey consisted of 13 open- and closed-ended or multiple-choice questions. A logistic regression analysis was performed to ascertain the effects of interindividual characteristics on the likelihood of participants’ app and smartphone usage behavior.ResultsA total of 206 physicians participated in the survey. All of the participants (206/206, 100%) owned a smartphone, and 79.1% (159/201) used the device, while 64.7% (130/201) used apps regularly in everyday clinical practice. Medical apps were perceived as beneficial, given their substantial future promise, by 90.1% (181/201) of the participants. However, 62.5% (120/192) of the participants were not satisfied with the current supply of medical apps in app stores. Desired specifications for future apps were “intuitive usability” (167/201, 83.1%), “no advertising” (145/201, 72.1%), and “free apps” (92/201, 45.8%). The attributes “transparent app development and app sponsoring” (75/201, 37.3%) and the existence of an “easy-to-understand privacy statement” (50/201, 24.9%) were of minor relevance. The majority of the participants (162/194, 83.5%) considered that future apps in the field of “medical research” would provide the greatest benefit. The greatest predicted risks were “data misuse” (147/189, 77.8%), “usage of untrustworthy apps” (135/189, 71.4%), and “alienation from patients” (51/189, 27.0%). Increasing age was significantly associated with a reduction in the likelihood of regular smartphone (odds ratio [OR] 0.91, 95% CI 0.86-0.97; P=.002) and app (OR 0.90, 95% CI 0.85-0.96; P=.001) usage, while the medical profession grade had no significant impact on the usage behavior.ConclusionsThe study demonstrates that young German doctors in orthopedics and trauma surgery already use smartphones and apps in everyday clinical practice. Medical apps are considered to play an important role in the future. However, a significant discrepancy exists between the supply and demand of mHealth applications, which creates a legal and ethical vacuum with regard to data protection.

Collateral effect of COVID-19 on orthopedic and trauma surgery.

The purpose of this study was to assess the impact of the COVID-19 pandemic on orthopedic and trauma surgery in private practices and hospitals in Germany. In this cross-sectional study, an online-based anonymous survey was conducted from April 2th to April 16th 2020. The survey was conducted among 15.0000 of 18.000 orthopedic and trauma surgeons in Germany, both in private practices and hospitals. All members of the German Society of Orthopedic and Trauma Surgery (DGOU) and the Professional Association for Orthopedic and Trauma Surgery (BVOU). were invited by e-mail to participate in the survey. Out of 50 questions 42 were designed to enquire a certain dimension of the pandemic impact and contribute to one of six indices, namely "Preparedness", "Resources", "Reduction", "Informedness", "Concern", and "Depletion". Data was analyzed in multiple stepwise regression, aiming to identify those factors that independently influenced the indices. 858 orthopedic and trauma surgeons participated in the survey throughout Germany. In the multiple regression analysis, being employed at a hospital was identified as an independent positive predictor in the indices for "Preparedness", "Resources", and "Informedness" and an independent negative predictor regarding "Depletion". Self-employment was found to be an independent positive predictor of the financial index "Depletion". Female surgeons were identified as an independent variable for a higher level of "Concern". The study confirms a distinct impact of the COVID-19 pandemic on orthopedic and trauma surgery in Germany. The containment measures are largely considered appropriate despite severe financial constraints. A substantial lack of personal protective equipment (PPE) is reported. The multiple regression analysis shows that self-employed surgeons are more affected by this shortage as well as by the financial consequences than surgeons working in hospitals. The COVID-19 pandemic has a profound impact on orthopedic and trauma surgery as an unrelated specialty. Self-employed surgeons are affected especially by a shortage of PPE and financial consequences. Political and financial support can now be applied more focused to subgroups in the field of orthopedics and trauma surgery with an increased demand for support. A special emphasis should be set on the support of self-employed surgeons which are a more affected by the shortage of PPE and financial consequences than surgeons working in hospitals.

Bone transplantation or biomaterials? : An analysis of 99,863 surgical procedures in orthopedic and trauma surgery in Germany from 2018

FragestellungZiel der Arbeit war es, (1) die Gesamtzahl der operativen Eingriffe mit autologer bzw. allogener Knochentransplantation sowie Biomaterialien zu analysieren. (2) Es sollten die unterschiedlichen Arten von Biomaterialien, autologen und allogenen Knochentransplantationen untersucht und (3) die zusätzliche Anwendung eines Antibiotikumzusatzes bei Biomaterialien analysiert werden.MethodikDaten wurden vom Statistischen Bundesamt für das Jahr 2018 bezogen. Durch die Operationen- und Prozedurenschlüssel 5‑784 „Knochentransplantation und -transposition“ und 5‑785 „Implantation von alloplastischem Knochenersatz“ konnten die Prozedurhäufigkeit der Implantation von Biomaterialien, wie Kalziumphosphatkeramiken, Kalziumsulfate, Kalziumphosphatzemente und Polymethylmethacrylat, sowie autologem und allogenem Knochen zur Defektrekonstruktion an Extremitäten und Becken analysiert werden.ErgebnisseIm Jahr 2018 wurden insgesamt 99.863 Prozeduren unter Verwendung von Autografts (54.784, 55 %). Biomaterialien (23.838, 24 %) und Allografts (21.241, 21 %) durchgeführt. Sowohl bei Autografts als auch bei Allografts kamen am häufigsten Spongiosaplastiken (77 % resp. 79 %) zum Einsatz. Bei den Biomaterialien wurden Keramiken (42 %) häufiger als Knochenzemente (37 %) benutzt (sonstige Biomaterialien 21 %). Bei 16.027 (67 %) der Biomaterialien wurde kein Antibiotikumzusatz verwendet. Antibiotikumzusatz kam v. a. bei Knochenzementen zum Einsatz (6612 Fälle, 75 %).SchlussfolgerungIm Jahr 2018 wurden insgesamt bei einer beträchtlichen Anzahl von 99.863 Eingriffen zur Knochendefektrekonstruktion Knochentransplantate bzw. Biomaterialien eingesetzt. Bei mehr als der Hälfte der Fälle wurde autologer Knochen (55 %), ungefähr einem Viertel Biomaterialien (24 %) und etwa einem Fünftel (21 %) allogener Knochen eingesetzt. Als Biomaterial wurden Keramiken (42 %) öfter als Zemente (37 %) verwendet. Antibiotikumzusatz kam v. a. bei Zementen zum Einsatz (75 %).

Impact of the COVID-19 Pandemic on Orthopaedic and Trauma Surgery in University Hospitals in Germany: Results of a Nationwide Survey.

The purpose of the present study was to assess the impact of the coronavirus disease 2019 (COVID-19) pandemic on orthopaedic and trauma surgery departments in university hospitals in Germany in order to clarify current challenges. In this cross-sectional study, an online-based anonymous survey was conducted within the Convention of University Professors of Orthopaedic and Trauma Surgery in Germany from April 3 to April 11, 2020. A bipolar 5-point Likert scale (with possible responses of "totally disagree," "rather disagree," "neutral," "rather agree," and "totally agree") was applied. Fifty-two (69.3%) of 75 clinic directors participated. Communication and cooperation with the government, hospital administration, and other departments during the COVID-19 pandemic were mainly perceived as appropriate. However, only 7 respondents (13.7%) totally agreed or rather agreed with the statement that the authorities are supporters of orthopaedic and trauma surgery departments. Substantial financial and personnel changes in orthopaedic and trauma surgery departments of university hospitals were reported, resulting in an average reduction of 49.4% in operating room capacity and an expected 29.3% loss of revenue. In addition, 14.7% of physicians were reallocated from orthopaedic and trauma surgery to other care-delivery environments. Our study demonstrated that the COVID-19 pandemic has had a substantial impact on orthopaedic and trauma surgery departments in German university hospitals. Distinct structural and financial effects were noted. Nevertheless, the present study demonstrates the commitment of our specialty to overcome the pandemic by providing competent personnel as well as close cooperation with the hospital administration and other departments. To our knowledge, this is the first Germany-wide survey among the heads of orthopaedic and trauma surgery departments in university hospitals on the impact of the COVID-19 pandemic. The survey results may help to inform system-wide decision-making in Germany, in Europe, and beyond.

10years German Society for Orthopedics and Trauma Surgery (DGOU): trauma surgery-quo vadis?

On the occasion of the 10th anniversary of the foundation of the German Society for Orthopedics and Trauma Surgery (DGOU), the current General Secretary of the German Society for Trauma Surgery sees the need for a standpoint on trauma surgery in Germany. This manuscript outlines future options and perspectives for the development of trauma surgery in Germany.

Is DRG Coding too Important to be Left to Physicians? - Evaluation of Economic Efficiency by Health Economists in a University Medical Centre

Background: We investigated and evaluated the cost effectiveness of coding by health care economists in a centre for orthopaedics and trauma surgery in Germany, by quantifying and comparing the financial efficiency of physicians with basic knowledge of the DRG-system with the results of healthcare economists with in-depth knowledge (M.Sc.). In addition, a hospital survey was performed to establish how DRG-coding is being performed and the identity of the persons involved. Material and Methods: In a prospective and controlled study, 200 in-patients were coded by a healthcare economist (study group). Prior to that, the same cases were coded by physicians with basic training in the DRG-system, who made up the control group. All cases were picked randomly and blinded without informing the physicians coding the controls, in order to avoid any Hawthorne effect. We evaluated and measured the effective weighting within the G-DRG, the DRG returns per patient, the overall DRG return, and the additional time needed. For the survey, questionnaires were sent to 1200 German hospitals. The completed questionnaire was analysed using a statistical program. Results: The return difference per patient between controls and the study group was significantly greater (2472 ± 337 €; p < 0.05); the overall return was raised by 494,500 €. The mean additional time needed was 11.32 ± 0.8 min per case, resulting in an increase in proceeds of 218 ± 38 € per minute. 2.5 % of all cases had to be devaluated by the health economist after the initial coding by the control group. Returned sheets of 60 hospitals were evaluated. The median level of DRG case reports was 1277 (2500-62,300). Coding was performed in 69 % of cases by doctors, 19 % by skilled specialists for DRG coding and in 8 % together. Overall satisfaction with the DRG was described by 61 % of respondents as good or excellent. Conclusion: Our prospective and controlled study quantifies the cost efficiency of health economists in a centre of orthopaedics and trauma surgery in Germany for the first time. We provide some initial evidence that health economists can enhance the CMI, the resulting DRG return per patient as well as the overall DRG return. Data from the survey shows that in many hospitals there is great reluctance to leave the coding to specialists only.

Representatives of orthopaedic and trauma surgery residents in Germany

In most German hospitals there are resident representatives to stand in for the rights and interests of residents. The precise number of representatives in orthopaedic and trauma surgery is unknown, as well as the field of duty and the rights of this position.The Junges Forum O&U presents survey data, which were collected from members of the German Society for Trauma Surgery (DGU), the German Society for Orthopaedics and Orthpaedic Surgery (DGOOC) and the German Society for Orthopaedics and Trauma (DGOU). All had an age below 40 years. The Survey was carried out in a period between 27th of January 2015 and 26th of March 2015.These data allowed the Junges Forum O&U to analyse the duties and numbers of representatives for residents in orthopaedic and trauma surgery in Germany. Questionnaires from 316 representatives were fully analysed. Of these, 92 % work at university hospitals. The conditions of election and the duties are not defined. The activity as representative was mainly fulfilled in spare time. The major aspect was conflict resolution between colleagues.The Junge Forum O&U presents the recommendation for election, field of duty and meetings on a regular basis with the other residents or even the first-line management.

Pelvic and acetabular fractures.

The focus of this issue is the treatment of pelvic and acetabular fractures. The spectrum of these injuries varies, ranging from simple non-displaced fractures to highly unstable complex injuries that can be extremely challenging in terms of clinical management, surgical intervention and prevention of residual functional disability. Moreover, there has been an increase in pelvic injuries in Europe, which can be attributed to the changing age structure of the European population, with an increase of middle-aged and advancedage people. Growing age also impacts the origin and causes of those fractures; whereas previously young people suffered injury of the pelvis or acetabulum due to high-energy trauma, we see an increasing number of patients with insufficiency fractures of the sacrum or acetabular fractures after a trivial trauma. On the other hand, the progress in the treatment of pelvic fractures over the last two decades has undoubtedly led to a substantial improvement in the outcome of those patients. The following papers focus on specific aspects in the diagnosis and management of pelvic fractures. Keel et al. [1] provide an overview of some important developments in pelvic surgery. Rommens et al. [2] discuss specific aspects that arise in fractures of the pelvis in the older patient. In addition to this work, the article by Rickman et al. [3] deals with the management of complex acetabular fractures in the elderly. Lehmann et al. [4] give an overview of the handling of spinopelvic dissociations. These authors would like to take the opportunity to dedicate this issue to the 60th anniversary of Professor Johannes M. Rueger. Johannes M. Rueger was born on 28 September 1952 in Frankfurt/Main, Germany. He studied in Tubingen, Mainz and Berlin, and graduated in 1978. After a phase of orientation in which he received training in anaesthesia and urology, Professor Rueger passed, in 1979, the United States Medical Licensing Examination and started his residency in the Department of Surgery, University of Louisville, KY, USA. In 1981, he moved to the University Hospital of Frankfurt, where he received further training in the Department of Trauma, Hand and Reconstructive Surgery (Director Professor A. Pannicke). In 1990, he completed his habilitation on bone substitute materials. For this work, he was awarded several times. In 1991, he was appointed to Senior Consultant in Frankfurt. Clinically, pelvic and acetabular surgery was his particular passion early on. In 1992, he worked as a visiting physician at the University of California under Professor J. Matta. In 1998, he was appointed to the Chair of the Department of Traumatology at the University Hospital Hamburg-Eppendorf. He was the successor to Professor Jungbluth, who led the department as one of the first German Professors for trauma surgery in Germany. Under the direction of Professor Rueger, the clinic expanded constantly, especially with a focus on the treatment of pelvic injuries. He is, for many years, faculty member of the Matta Pelvic Courses in Los Angeles, CA, USA, as well as pelvic Letournel Institute Courses in Paris, France, and introduced his own European Pelvic Course in Hamburg, Germany. His passion for pelvic surgery is still ongoing. We wish Professor Rueger on his 60th Birthday optimal health and as much creative energy to Dedicated to Professor Johannes M. Rueger’s 60th Birthday.

Die studentische Lehre im gemeinsamen Fach Orthopädie-Unfallchirurgie – eine deutschlandweite Statuserhebung

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. 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. 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. Medical training in musculoskeletal conditions is very inhomogeneous and requires further improvement and standardisation regarding quantity and implementation.

Trauma Surgery in Germany

Trauma Surgery in Germany