Doerte Matziolis

Nachwuchsmangel in der Unfallchirurgie und Orthopädie

ZusammenfassungDie Gründe des Nachwuchsmangels in chirurgischen Disziplinen sind vielfältig diskutiert worden. Als Ursachen des Attraktivitätsverlusts werden exemplarisch eine arztfremde progrediente Arbeitsbelastung, ungünstige Arbeitszeiten und unzureichender Ausgleich für Bereitschaftsdienste erwähnt. Auch eine zunehmende Feminisierung des ärztlichen Berufs mit Abkehr vom chirurgischen Fach bei Unvereinbarkeit von familiärer Planung und den Ansprüchen der chirurgischen Weiterbildung wird häufig genannt. Umfragen, die Wahl des Facharztes thematisierend, bezeugen einen großen Einfluss auf die Sicht für die eigene Zukunft als Ärztin oder Arzt durch die individuellen Erfahrungen der Befragten im Verlauf ihres Studiums. Um dennoch die Attraktivität und Vielfältigkeit unserer Fachdisziplin zu verdeutlichen, initiierte man Programme für Studenten durch die Leiter der Konvente der Hochschullehrer für Orthopädie und Unfallchirurgie und dem Geschäftsführenden Vorstand der DGOU, die großen Anklang fanden. Um dem enormen Zuspruch gerecht zu werden, bat man um Unterstützung an weiteren Universitäten. Infolge dessen fand am 16.02.2010 der „Unfallchirurgische und Orthopädische Tag für Studenten“ an der Charité Berlin statt. Ziel dieses Tages war, die fehlende Präsenz praktischer Ausbildungsinhalte im regulären Studiengang zu minimieren und inhaltliche Anregungen für die Wahl dieses Facharztes zu geben.AbstractThe 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.

Influence of the Position of the Fibular Head After Implantation of a Total Knee Prosthesis on Femorotibial Rotation

A gold standard for the correct rotation of the tibial component has not been established in total knee arthroplasty (TKA). The target parameter of correct rotation is the facilitation of femorotibial rotation over the entire range of motion with no implant overhang. Although the origin of the lateral collateral ligament is a recognized landmark for determining the rotation of the femoral component (epicondylar axis), the attachment of the lateral collateral ligament has not been taken into consideration for adjusting tibial rotation until now. The objective of the current investigation was to examine whether the position of the fibular head, as the attachment of the lateral collateral ligament, influences femorotibial rotation. Seventy patients who underwent TKA were enrolled in this retrospective study. Computed tomography (CT) of the operated knee was performed 6 months postoperatively in all cases and the position of the lateral facet of the fibular head and the tibial tuberosity, and the geometric center of the tibia and the femoral epicondyles were determined. The angle between the lateral facet of the fibular head, the geometric center of the tibia, and the tibial tuberosity was 45.7°±6.9°. The angle between the surgical epicondylar axis and the line from tibial tuberosity to tibial center was 69°±8.3°. This close correlation (R=.73; P<.001) shows that the position of the fibular head determines femorotibial rotation. The fibular head may become a helpful landmark for establishing the rotation of the tibial component; it could be useful in interpretation of postoperative CT scans in knees suspected of tibial malrotation.

Treated Hypertension has No Influence on the Efficacy of Alendronate in the Therapy of Postmenopausal Osteoporosis: A Non-Randomized, Non-Blind, Controlled Prospective Study.

Changes in hormone metabolism during menopause are involved in the development of osteoporosis and arterial hypertension. A mutual influence of these two clinical pictures is evident on the basis of pathophysiological factors. In this study, we investigated whether a drug therapy of hypertension influences the efficacy of a bisphosphonate (alendronate) in the treatment of postmenopausal osteoporosis. For this purpose, 60 female patients were enrolled in the study, 30 of them on drug treatment for hypertension in addition to requiring treatment for osteoporosis, while the control group was only suffering from osteoporosis. Bone density was measured at the start of the study and 6 months after therapy (QCT). A significant increase in bone density was demonstrated in both groups, while a difference between the groups could not be seen. Treated arterial hypertension does not have a negative influence on the treatment of postmenopausal osteoporosis with alendronate. Rather, the concomitant treatment of these two clinical pictures would appear to make sense, in order to reduce morbidity and mortality.

Lack of new trainees in trauma surgery and orthopedics. An approach to a solution

ZusammenfassungDie Gründe des Nachwuchsmangels in chirurgischen Disziplinen sind vielfältig diskutiert worden. Als Ursachen des Attraktivitätsverlusts werden exemplarisch eine arztfremde progrediente Arbeitsbelastung, ungünstige Arbeitszeiten und unzureichender Ausgleich für Bereitschaftsdienste erwähnt. Auch eine zunehmende Feminisierung des ärztlichen Berufs mit Abkehr vom chirurgischen Fach bei Unvereinbarkeit von familiärer Planung und den Ansprüchen der chirurgischen Weiterbildung wird häufig genannt. Umfragen, die Wahl des Facharztes thematisierend, bezeugen einen großen Einfluss auf die Sicht für die eigene Zukunft als Ärztin oder Arzt durch die individuellen Erfahrungen der Befragten im Verlauf ihres Studiums. Um dennoch die Attraktivität und Vielfältigkeit unserer Fachdisziplin zu verdeutlichen, initiierte man Programme für Studenten durch die Leiter der Konvente der Hochschullehrer für Orthopädie und Unfallchirurgie und dem Geschäftsführenden Vorstand der DGOU, die großen Anklang fanden. Um dem enormen Zuspruch gerecht zu werden, bat man um Unterstützung an weiteren Universitäten. Infolge dessen fand am 16.02.2010 der „Unfallchirurgische und Orthopädische Tag für Studenten“ an der Charité Berlin statt. Ziel dieses Tages war, die fehlende Präsenz praktischer Ausbildungsinhalte im regulären Studiengang zu minimieren und inhaltliche Anregungen für die Wahl dieses Facharztes zu geben.AbstractThe 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.

Posterior Cortical Axis: A New Landmark to Control Femoral Component Rotation in Total Knee Arthroplasty

Rotation errors of the femoral component are held responsible for occurrences such as instability in flexion and midflexion, patellar maltracking, and arthrofibrosis following total knee arthroplasty. However, in many cases, the epicondylar axis cannot be reliably identified due to bone defects or metal artifacts on computed tomography, so alternative landmarks are necessary to evaluate the femoral component rotation. The current study sought to determine the relationship of the posterior cortical bone and the anterior cortical bone in relation to the epicondylar axis. In this retrospective study, 398 consecutive patients who had undergone magnetic resonance imaging of the knee joint were included. The average angle between the posterior cortical bone and the epicondylar axis was 7.3°±3.3°. When the posterior cortical bone was used as the reference, the average absolute error was 2.6°±2.1°. In comparison, the average angle between the anterior cortical bone and epicondylar axis was 10.4°±4.5°. When this reference was used, the average absolute error was 3.6°±2.8°. The posterior cortical bone is a more consistent landmark than the anterior cortical bone is for intra- or postoperative approximation of the epicondylar axis. This appears to be due to the flat geometry of the posterior cortical bone compared with the elliptical form of the anterior cortical bone of the distal femur. In practice, an external rotation of the femoral component of 7° in relation to the posterior cortical bone is to be recommended. [Orthopedics. 2017; 40(3):188-190.].

Patella Infera in an HIV Positive Patient Following Total Knee Arthroplasty.

A lowering of the patella after total knee arthroplasty is accompanied by pain and a restriction of the range of motion. With its etiology being unclear at present, a multifactorial genesis is under discussion. For the first time, we present a case report describing an HIV infection as a possible cause of patella infera. A 54-year-old HIV-positive woman developed patella infera (Insall-Salvati ratio 0.6) with a painful restriction of motion 18 months after implantation of a bicondylar surface prosthesis. By changing to a partially coupled endoprosthesis, distalization of the joint line and partial patellar resection, the patient was free of symptoms with a ROM of 0°/0°/110°. All risk factors known from the literature could be excluded in this case, so that the presence of an HIV infection has to be discussed as a possible cause.

Nachwuchsmangel in der Unfallchirurgie und Orthopädie@@@Lack of new trainees in trauma surgery and orthopedics: Ein Lösungsansatz@@@An approach to a solution

ZusammenfassungDie Gründe des Nachwuchsmangels in chirurgischen Disziplinen sind vielfältig diskutiert worden. Als Ursachen des Attraktivitätsverlusts werden exemplarisch eine arztfremde progrediente Arbeitsbelastung, ungünstige Arbeitszeiten und unzureichender Ausgleich für Bereitschaftsdienste erwähnt. Auch eine zunehmende Feminisierung des ärztlichen Berufs mit Abkehr vom chirurgischen Fach bei Unvereinbarkeit von familiärer Planung und den Ansprüchen der chirurgischen Weiterbildung wird häufig genannt. Umfragen, die Wahl des Facharztes thematisierend, bezeugen einen großen Einfluss auf die Sicht für die eigene Zukunft als Ärztin oder Arzt durch die individuellen Erfahrungen der Befragten im Verlauf ihres Studiums. Um dennoch die Attraktivität und Vielfältigkeit unserer Fachdisziplin zu verdeutlichen, initiierte man Programme für Studenten durch die Leiter der Konvente der Hochschullehrer für Orthopädie und Unfallchirurgie und dem Geschäftsführenden Vorstand der DGOU, die großen Anklang fanden. Um dem enormen Zuspruch gerecht zu werden, bat man um Unterstützung an weiteren Universitäten. Infolge dessen fand am 16.02.2010 der „Unfallchirurgische und Orthopädische Tag für Studenten“ an der Charité Berlin statt. Ziel dieses Tages war, die fehlende Präsenz praktischer Ausbildungsinhalte im regulären Studiengang zu minimieren und inhaltliche Anregungen für die Wahl dieses Facharztes zu geben.AbstractThe 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.