Osteopathie in der Orthop?die

Osteopathic medicine is a healing modality applied with the doctor's two hands that is similar to but goes far beyond the Manual medicine/chirotherapy which is well known in Germany. Founded in 1874 by Dr. A.T. Still in Kirksville, Missouri in the USA, osteopathic medicine is in addition to the M.D. degree in allopathic medicine a fully accepted and regulated medical profession ending in the granting of the D.O. (doctor of osteopathic medicine) degree. In 2009 the German Medical Council presented a position paper on osteopathy and osteopathic medicine which has ignited controversial discussions about the possible integration of this modality into the German medical health care system. There is currently an enormous interest in osteopathy and osteopathic medicine in Germany and the demand for this modality is continuously increasing. Although this modality is over 140 years old there are few solid studies that conclusively show its effectiveness.     

Akupunktur in der Orthop?die

Large randomized controlled trials have shown the effectiveness of acupuncture in comparison to various control treatments for low back pain, osteoarthrosis, shoulder pain, tension type headache, and migraine. For most of these diseases the cost-effectiveness of acupuncture has been proven. A few smaller controlled trials exist for tennis elbow and osteoarthrosis of the hip. The use of acupuncture for other locomotive disorders is based on textbook literature and expert opinion. Current data show that acupuncture is a relatively safe method. Internationally several guidelines for chronic low back pain have integrated acupuncture. In Germany acupuncture has been reimbursed by the state insurance system for chronic low back pain and osteoarthritis since 2007 and the estimated costs are between EUR?300-700 million annually. Acupuncture is offered by at least 12,000 medical doctors and acupuncture is mostly used for locomotive disorders.     

Komplexe operative Prozeduren in der Orthopädie und Unfallchirurgie

Since the DRG system was introduced in 2003/2004 the system for remuneration has been continually modified in conjunction with input from specialized medical associations. As part of this development of the payment system, the criteria for classification of a diagnosis-related group were further expanded and new functions were added. This contribution addresses the importance of the complex surgical procedures as criteria for subdivision of the DRG case-based lump sums in orthopedics and trauma surgery.     

Psychosomatische Aspekte in der Orthop?die

Psychosomatic disease patterns are a common differential diagnosis for orthopedic symptoms. Furthermore, mental factors, such as the method of disease processing or mental comorbidities, such as depression or somatization disorders have a great influence on the chronification of orthopedic complaints and the outcome following orthopedic interventions. The aim of this article is to present the psychosomatic pathomechanisms and disease patterns relevant for orthopedics and to derive recommendations for physician-patient communication, diagnostics, therapy and assessment.     

Konservative und operative Orthopädie

Ohne Zusammenfassung     

Strahlenschutz in der Orthopädie

In 2001 or 2002, the legislator made substantial alterations to the “Röntgenverordnung” [regulations governing use of roentgen ray radiation] and “Strahlenschutzverordnung” [regulations governing radiation protection]. This was done to bring German law in line with EU Directives 96/29/Euratom (basic safety standards for the protection of the health of workers and the general public against the dangers arising from ionizing radiation) and 97/43/Euratom (health protection of individuals against the dangers of ionizing radiation in relation to medical exposure). Proper use of radiation in medicine requires that those involved in its application are aware of the biological effects of radiation. When staff and others are protected good organization and appropriate technology at the workplace can achieve a great deal. In the new directives, the radiation protection for the patient is quantified and the responsibility of the physician is clearly pointed out. The most important aim is uniform quality throughout Europe in radiological diagnosis and radiation protection.     

Präoperative Eigenblutspende in der Herzchirurgie

BACKGROUND: Preoperative autologous blood donation is an effective method to reduce allogeneic transfusion requirement. However, this method is only rarely utilized in cardiac surgery. Besides economic concerns one essential argument against predonation is the lack of sufficient time due to the short waiting lists. The aim of the present study was to investigate the efficacy of autologous predonation to reduce allogeneic blood transfusion in routine cardiac surgery on a center without longer preoperative waiting lists. PATIENTS AND METHODS: A total of 2,626 cardiac surgery patients were included. Primary endpoint of the study was the perioperative incidence of allogeneic packed cell transfusion. If time between diagnosis and admission to the hospital was >10 days, predonation was offered to the patients. Data were stratified for preoperative risk score. Logistic and linear regression analysis tested the influence of different variables on the incidence of allogeneic blood transfusion and the total amount of allogeneic blood. RESULTS: Of all patients 267 (11.2%) underwent predonation. The incidence of allogeneic packed cell transfusion was reduced from 53% to 19% by autologous predonation (p<0.001). The total amount of allogeneic blood transfused was significantly different between the groups (2.2+/-4.2 vs. 0.84+/-6.3 units; p<0.001). DISCUSSION: Autologous predonation in cardiac surgery was effective in reducing blood transfusions even in the absence of longer preoperative waiting times. It is a safe and effective method to minimize blood transfusion in cardiac surgery.     

Handchirurgie in der deutschen Orthopädie

The intention of this report is to present an overview of the development of hand surgery and its status in German orthopedics. An important role was played by orthopedics in the development of hand surgery: many insights and classifications in this field originate from orthopedic surgeons and retain their validity in this century. In the past few decades, traumatologists and plastic surgeons have become increasingly active in the field of hand surgery and have added to their surgical repertoire some fields formerly regarded as part of classic orthopedics, e.g., correction of malformations of the hand. Although microsurgical techniques of hand surgery were primarily developed by plastic surgeons, the past should nevertheless motivate all orthopedists to continue considering hand surgery the "pearl of orthopedics" in the future.     

Kernspintomographische Diagnostik in der Orthopädie

Ohne Zusammenfassung     

Gutartige Weichteiltumoren in der Orthopädie

For the most part soft tissue tumors are benign. However, the clinical presentation, including radiological aspects, is not always clear. Therefore, a biopsy is necessary in some cases to detect malignant tumors at an early stage. The course of even benign tumors is sometimes complicated. A not insignificant group of local, aggressive or intermediary tumors tend to recur and in exceptional cases can be fatal. Benign soft tissue tumors are subdivided according to the current WHO classification from 2002. They are classified by the tissue they mimick. In clinical practice they are additionally grouped according to aggressiveness. Some benign soft tissue tumors occur in the context of a syndrome, leading to multiple tumors. In these cases there is the threat of a tumor becoming malignant (neurofibromatosis, Maffucci syndrome).     

Postoperative Schmerztherapie in der Orthopädie

Zusammenfassung Die systemische Analgetikatherapie der postoperativen Phase folgt dem WHO-Stufenschema. Dieses sieht die Gabe eines Basis-Nicht-Opioids (Stufe I) in Kombination mit einem schwachen (Stufe II) oder starken Opioid (Stufe III) vor. Werden in der Schmerztherapie Nichtopioid und Opioid kombiniert eingesetzt, so erfolgt zuerst die Gabe des Nicht-Opioids.Während die i.v.-Medikation aufgrund des raschen Wirkeintritts die Applikationsform der Wahl unmittelbar postoperativ ist, sollte frühestmöglich postoperativ auf eine orale Darreichung der Schmerzmedikation gewechselt werden. Bei oraler Therapie mit Opioiden sollten retardierte Präparate Anwendung finden. Intramuskuläre Applikationen sind in der postoperativen Schmerztherapie zu vermeiden. Regionale Verfahren in der postoperativen Schmerztherapie, etwa Peridural- oder Plexuskatheter, senken den Schmerzmittelbedarf und können bereits präoperativ eingeleitet werden. Ein ungewöhnlich hoher oder gar ansteigender Schmerzmittelbedarf in der postoperativen Phase weißt auf Komplikationen der durchgeführten Operation hin.Aus Sicht des Behandelnden erscheint es sinnvoller, wenige unter der Vielzahl zugelassener Substanzen einzusetzen, diese dafür aber um so besser hinsichtlich Wirkung und Nebenwirkung zu kennen.     

Die Magnetresonanztomografie in der Orthopädie

Magnetic resonance imaging (MRI) is an established diagnostic tool in orthopaedics. Superior soft tissue contrast, lack of ionised radiation and free slice orientation are the key points for optimal evaluation of joint structures, muscles and ligaments. Application of contrast agents improves the detection of inflammation and tumour tissue. However, measuring and interpretation of magnetic resonance imaging is a challenge both for orthopaedists and radiologists. Basic requirements for good diagnosis are clinical findings, plain radiographs and a clear indication. This report provides information about the method of magnetic resonance imaging, artefacts, indications, risks and drawbacks as well as limitations of this method that necessitate alternative imaging modalities.     

Urologische Probleme in der Orthopädie

Zusammenfassung Die Arbeit bringt eine zusammenhängende Besprechung krankhafter und unfallbedingter Zustandsbilder, die einen hohen Prozentsatz des orthopädischen Krankengutes stellen, und deren letzte Klärung nur durch Erfassung ihrer urologischen Zusammenhänge möglich ist. Nicht allein diagnostische auch therapeutische Forderungen ergeben sich daraus. Die Gefahr, daß durch mangelnde Kenntnisse auf dem Gebiete der Urologie wertvolle Zeit versäumt, mitunter ein günstiger Zeitpunkt verpaßt wird, muß dem behandelnden Orthopäden eindringlich klar werden. Vieles ist noch unklar; doch wurde der Versuch gemacht, unter Fortlassung älterer Ansichten den gegenwärtigen Standpunkt herauszuarbeiten.     

E-Learning in der Orthopädie und Unfallchirurgie

Background

Additional internet-based learning tools (e-learning) are successfully used in the curricula of many disciplines and are highly accepted among students. However, in orthopedics and traumatology e-learning is underrepresented and scientific papers are rare. The aim of the present pilot study was to evaluate the acceptance of the e-learning module network for students in traumatology and orthopedics (NESTOR) among users and non-users and to analyze the effect of this additional learning tool on knowledge acquisition.

Material and methods

A total of 544 students were asked to complete evaluation questionnaires at the end of two semesters using different ones for NESTOR users and non-users. The gain of knowledge was analyzed by two written knowledge tests (pre-post test, 20 multiple choice questions) at the beginning and end of the semester comparing these two groups.

Results

A total of 191 students took part in the evaluation and 152 completed both written tests. The NESTOR users showed a high acceptance of the e-learning system and non-users considered e-learning beneficial as well. Reasons given for not using NESTOR were lack of time, lack of information about the existence of NESTOR and a lack of interest in this discipline and e-learning in general. Both groups significantly increased their level of knowledge during the course of the semester (p?Conclusion The presented data support the high acceptance among users and the benefit of the e-learning project NESTOR in teaching students in orthopedics and traumatology. Based on experience and these results the permanent implementation of an additional e-learning module in the curriculum can be recommended for other faculties. In this process the critical comments of the non-users determined in the present study should be addressed.     

Regionalanästhesie in der Orthopädie

Regional anesthesia has its place in the perioperative pain management of orthopedic patients. A reduction in postoperative mortality and morbidity with regional anesthesia is acknowledged for subsets of patient populations. Single shot and continuous applications are techniques for providing regional analgesia. Continuous infusion of local anesthetics with catheter techniques provides for uninterrupted postoperative analgesia. The combination of regional and general anesthesia reduces the consumption of systemic anesthetics. The side effects of opioid therapy are thereby reduced. The inhibition of intraoperative stress reaction, especially with epidural anesthesia, helps to prevent or lower unwanted metabolic changes. Patient contentment with analgesic quality differs with the technique with which the regional anesthesia is applied (PDA, PCEA, IVRA, peripheral block, i.a. injection), and the medication (LA, opioid) used.     

Nachwuchsmangel in der Unfallchirurgie und Orthopädie

The reasons for a shortage of young people in trauma surgery and orthopedics have often been discussed. Atypical progression of medical operating levels, antisocial working hours and an inadequate financial compensation for on-call duties have been given as the reasons for a lack of interest in the discipline. Additionally a progressive feminization of the medical profession and rejection of surgical disciplines because of a mismatch with family interests and the demands of advanced surgical training have also been named. Surveys on the choice of medical specialization reveal that experiences during the course of studying have a great influence on future prospects and are immensely important for the further focusing on the future as a medical doctor. In order to increase the attractiveness of the specialization, programs for students were initiated by the heads of the Conventions of Higher Education Lecturers for Orthopedics and Trauma Surgery and the management of the German Society for Orthopedics and Trauma Surgery. Due to the enormous popularity auxiliary projects were demanded. Consequently a “Trauma Surgery and Orthopedic Day for Students” was organized on 16th February 2010 in the Musculoskeletal Centre of the Charité in Berlin. The aim was to convey practical skills and to inspire the choice of this specialization in the future.