Der Unfallchirurg
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Problems related to the use of interference screws for fixation of bone-patellar tendon-bone grafts for anterior cruciate ligament (ACL) replacement have led to increasing interest in press-fit techniques. Most of the described techniques use press-fit fixation on either the femoral or tibial side. Therefore an arthroscopic technique was developed which achieves bone-patellar tendon-bone graft fixation by press-fit on both sides without the need for supplemental fixation material. ⋯ The presented press-fit technique avoids all complications related to the use of interference screws. It achieves primary stable fixation of the bone-patellar tendon-bone graft thereby allowing early functional rehabilitation. However, fixation strength depends on bone quality and the arthroscopic procedure is demanding. The results showed reliable stabilization of the operated knees.
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An increasing lack of young fellowship trainees in operative medicine, particularly in orthopaedics and traumatology and the various options to counteract this problem during the phases until the individual decision for residency and the fellowship program is made, were the focus of part I. The present part concentrates on residency and the fellowship phase including the individual perspectives after successful training. With respect to an attractive and highly qualified training in orthopaedics and traumatology, three essential points are to be made: a timely general framework, the establishment of a clinic-specific management of training and a general evaluation of training in the sense of a benchmarking system. ⋯ In the future the contents of fellowship training will need a well-considered adaptation to the clinical needs and realities in the light of the emerging national trauma network program. A wide field of activity will open up to specialists in orthopaedics and traumatology with a focus on special traumatology considering the rapid changing field of hospital and outpatient care. Thus a systematic and creative reorganization of the residency and fellowship phases will overcome any problem of attractiveness.
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Randomized Controlled Trial
[Anatomic anterior cruciate ligament reconstruction with hamstrings using press-fit fixation without hardware: operative technique and long-term results of a prospective and randomized study].
An innovative technique for anterior cruciate ligament (ACL) reconstruction has been developed in 1998 which allows the grafts to be fixed by press-fit to the femoral and tibial tunnel without any hardware. The semitendinosus (ST) and gracilis tendons (GT) are built into a sling by tying a knot with the tendon ends and securing the knot after conditioning by sutures. For the femoral tunnel the anteromedial porta is used. ⋯ Re-rupture rates, subjective findings, knee stability and isokinetic testing showed similar results for both grafts. This is the first level I study which demonstrates cartilage protection by ACL reconstruction as long as the meniscus is intact at index surgery, shown by bilateral MRI analysis 9 years post-operation. There was no significant difference in the average grade of chondral and meniscus lesions between BPT and HT and in comparison of the operated to the intact knee, except for grade 3-4 lesions found at the 9 year follow-up, which were significantly higher in the BPT group.
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[Six years of Advanced Trauma Life Support (ATLS) in Germany: the 100th provider course in Hamburg].
With over 1 million certified physicians in more than 50 countries worldwide, the Advanced Trauma Life Support (ATLS) concept is one of the most successful international education programs. The concept is simple, priority-orientated (ABCDE scheme) and assesses the situation of the trauma patient on the basis of vital signs to treat the life-threatening injuries immediately. With over 100 ATLS provider courses and 10 instruction courses accomplished in less than 6 years, no other land in the world has successfully established this concept in such a short time as Germany. ⋯ The individual parts of the course were marked as followed: presentations 1.6 (1.0-2.81, n=100), practical skills stations 1.46 (1.0-2.4, n=100) and surgical skills stations 1.38 (1.0-2.38, n=100). In 2009 a total of 47 ATLS courses were accomplished which will clearly increase in 2010. Other ATLS formats, such as ATCN (Advanced Trauma Care for Nurses) and refresher courses are planned for the beginning of 2010.