Early orthopedics in Munich around 1860]

Case histories and patient photographs have recently been discovered from the private "Orthopaedic and Physiotherapeutic Clinic of the Licensed Orthopaedist Ludwig Hugo Krieger", which was located in Munich from 1857 to 1888 under the directorship of the surgeon Johann Nepomuk Nussbaum. The photographs include the oldest existing patient photographs in Germany. The documents reveal the early successes in Orthopaedics, which at the time was not a subject of academic study. Orthopaedics was primarily practised by interested amateurs, who were frequently quite talented, such as the bandage-specialist Krieger, ideally in co-operation with medical physicians.     

The hospital service misuse problem in orthopedics]

In a representative study for all German acute hospitals the amount of inappropriate (medically not necessary) patient care was estimated. The data material, sampling design, weighting technic and the appropriateness expert rating (retrospective, consent judging) was controlled. An overall proportion of inappropriate days of care of 18.45% were found but for orthopedic diseases this rate was 31.9% and even 37.7% for the younger than 60 orthopedic patients. Similar high rates for orthopedic diseases were found in US hospital studies of inappropriateness and should lead to an analysis of their reasons.