Zeitschrift für Orthopädie und Unfallchirurgie
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Randomized Controlled Trial Comparative Study
[Clinical-practical Examination in Orthopaedic Teaching: Who is the "Ideal" Examiner?]
Background Medical curricula require an increasing amount of integrated clinical practical skills education. German medical faculties are increasingly implementing the OSCE (objective structured clinical examination) to test students' practical as well as communication skills. Teaching and assessment tools for practical skills include simulators and simulated patient scenarios, where peer-assisted teaching (PAT) is applied. ⋯ Conclusion The analysis shows only one significant evaluation difference between the two assessors, with the PAT student tutor's evaluation being stricter. The authors conclude that a point difference of 0.8 out of 25 in the average overall evaluation and an interrater reliability of 0.95 in an orthopaedic OSCE station examining practical skills as well as communication skills justifies employing PAT student tutors as assessors in this context. The obligatory requirements for this are a detailed PAT student tutor training, the development of a well-structured and valid checklist, as well as continuous quality assurance of the overall OSCE.
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Arthrodesis of the shoulder joint is a radical event, so it is difficult to explain its significance to patients. It has been the last resort in hopeless cases. Knowledge of long-term results and evaluation of advantages and disadvantages seems to be helpful in this regard. ⋯ Plate arthrodesis in the technique used achieves high fusion and a low complication rate. Relief of pain and functional improvement are astonishing. Analysis of our results indicates that correction of the positions mentioned above is necessary: i. o. arthrodesis position for abduction 25° (by means of pre-bending plate of 105°), forward flexion 20° and internal rotation 30° are suggested.
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Practice Guideline
[Subaxial Cervical Spine Injuries: Treatment Recommendations of the German Orthopedic and Trauma Society].
In a consensus process during four sessions in 2016, the working group "lower cervical spine" of the German Society for Orthopedic and Trauma Surgery (DGOU), formulated "Therapeutic Recommendations for the Lower Cervical Spine", taking into consideration the current literature. Therapeutic goals are a permanently stable, painless cervical spine and the protection against secondary neurologic damage while retaining the greatest possible amount of motion and spinal profile. Due to its ease of use and its proven good reliability, the AOSpine classification for subaxial cervical injuries should be used. ⋯ In certain cases, an additive posterior or pure posterior instrumentation might be possible or even mandatory. In most of these cases, lateral mass screws are sufficient; when pedicle screws are applied in C3 to C6, a 3D-navigation system is recommended. Injuries in an ankylosing spine (M3-modifier) should be treated preferably from posterior with long-segment instrumentation.
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People who have become victims of domestic or public violence often suffer long-term physical, psychological and social impairment. Due to physical injury, the first contact with the health care system is frequently an A & E Department. Thus, physicians and especially surgeons play a key role in detecting victims of domestic or public violence. The specific needs of victims are adequate medical treatment of injuries, forensic documentation, as well as interdisciplinary medical support to prevent further morbidity and violence. To take this into account, so-called expertise centres for victims of violence have been established at several locations in Germany in recent years. In this study: I. We tried to define the characteristics of victims of domestic and public violence to ensure better identification by physicians/surgeons. II. We elucidate the acceptance and effectiveness of such an expertise centre one year after its implementation and for a period of three years (2007 - 2009) and for a follow-up period of three years (2014 - 2016) after establishment. ⋯ Physicians and especially trauma surgeons are responsible for identifying victims of domestic or public violence and ensuring further treatment. Accordingly, it is crucial that the expertise centre should characterise the victims of violence and be aware of their different needs, if the expertise centre is to be accepted. The results of this study indicate that interdisciplinary training and close cooperation between traumatology and legal medicine are the main prerequisites for continuous improvement in the treatment of victims of violence.
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Background The posterior tibial plateau is often affected in intra-articular tibial fractures. Moreover, treating these posterior fractures is recognised as an important prognostic factor. Open reduction and internal fixation of lateral and posterior two column tibial plateau fractures can be achieved via a combined reversed L-shape approach and an anterolateral approach in the floating position without intraoperative repositioning of the patient. ⋯ At the 3 to 4 month postoperative CT control, 10 of 14 patients showed successful reduction with restored alignment, whereas in 8 of 14 patients there was a congruent articular surface without significant articular steps (< 2 mm). Conclusion We have demonstrated that the surgical treatment of two column fractures of posterior and lateral tibial plateau fractures is technically possible via a combined posterior reversed L-shaped and anterolateral approach in a floating position without the necessity of intraoperatively repositioning of the patient. Although the number of patients was limited, the clinical and radiographic outcome was rather good.