A novel minimally invasive and press-fit method for symphysiodesis - a biomechanical analysis

Purpose Does the cylindrical shaped bone block allow a stable construct for the arthrodesis of the pubic symphysis compared to a rectangular shaped bone block. The cylindrical shaped bone block stabilized by a 3.5 symphyseal plate is inferior to the stabilization with an internal fxator. Methods This study analyzed the arthrodesis of the pubic symphysis on 24 synthetic pelvises, using a rectangular shaped bone block (control group) or a cylindrical shaped bone block, stabilized with a symphysis locking plate (n=8) as the standard clinical procedure. Additionally we analyzed the stability using an internal fxator. Results This study showed that utilizing a cylindrical shaped synthetic bone graft results in a signifcant higher contact area and compression force compared to the classical rectangular shaped graft. Furthermore, the stabilization with an internal fxator had the tendency for increases of compression force and contact area, yet without a statistical signifcance, when compared to the plate fxation. Conclusion The novel method of cylindrical symphysis resection and cylindrical bone block implantation allowed an increased biomechanical stability compared to using a classical rectangular bone graft, also resulting in higher contact area. Moreover, this technique would also allow a minimally invasive approach for this purpose, which in turn could preserve perisymphyseal ligaments, thereby improving healing in a clinical context

COVID-19: a catalyst for the digitization of surgical teaching at a German University Hospital

Background: The summer semester 2020, had to be restructured due to the SARS-CoV-2 pandemic and the associated contact restrictions. Here, for the frst time, the established lectures in lecture halls and small group seminars could not be conducted in presence as usual. A possible tool for the implementation of medical teaching, ofers the use of eLearning, online webinars and learning platforms. At present it is unclear how the SARS-CoV-2 pandemic will afect surgical teaching, how digitization will be accepted by students, and how virtual teaching can be expanded in the future. Methods: The teaching, which was previously delivered purely through face-to-face lectures, was completely converted to digital media. For this purpose, all lectures were recorded and were available to students on demand. The seminars were held as a twice a week occurring online webinar. The block internship was also conducted as a daily online webinar and concluded with an online exam at the end. At the end of the semester, a survey of the students was carried out, which was answered by n=192 students with an anonymized questionnaire. The questionnaire inquires about the previous and current experience with eLearning, as well as the possibility of a further development towards a purely digital university. Results: There were n=192 students in the study population. For 88%, the conversion of classes to web-based lectures represented their frst eLearning experience. For 77% of all students, the digitization of teaching led to a change in the way they prepare for class. 73% of the participating students are of the opinion that eLearning lectures should continue to be ofered. 54% of the students felt that eLearning lectures made more sense than face-to-face lectures. A purely virtual university could be imagined by 41% of the students. Conclusion: The conversion of teaching represented the frst contact with eLearning for most students. Overall, the eLearning ofering was experienced as positive. Due to the new teaching structure, the way of learning had already changed during the semester. Based on the new eLearning content, the already existing formats can be further expanded in the future. Nevertheless, it turned out that the practical-surgical contents and skills cannot be adequately represented by purely online ofers; for this, the development of hybrid practice-oriented teaching concepts is necessary

A novel press-fit minimally-invasive symphysiodesis technique

Objective: Instability of the pubic symphysis often results in a poor outcome and reduced mobility of the patient. In some cases, an arthrodesis of the pubic symphysis is required. Until today, there is no data published how many of these procedures are performed annually and there is also no data about the outcome after this extensive surgery. Methods: We developed a novel surgical technique to address the arthrodesis of the pubic symphysis in a minimally invasive approach. Therefore, we used for this purpose modified instruments and performed the transplantation of a cylindrical bone substitute into the pubic symphysis, without an extensive approach or dissecting the anterior or posterior symphyseal ligaments. Results: Using this novel technique, a minimally invasive symphysiodesis was achieved in radiological findings, after the procedure. Conclusion: Thus, this actually minimally invasive surgical technique seems to be a promising advancement for the arthrodesis of the pubic symphysis

Does the implant make the difference ? – Prospective comparison of two different proximal femur nails

The aim of this study was to compare two proximal femur nails with regard to the complication rate and midterm clinical outcome: the InterTAN nail (ITN) versus the third generation gamma nail (GN).78 patients older than 60 years with an unstable intertrochanteric femoral fracture (AO/OTA 31 A2/A3) were randomised over a 20 month period into either ITN (n=39) or GN (n=39). The outcomes of interest were the perioperative implant-related complications and the functional status (Harris Hip Score) at 6 months postoperatively.In 14 of the ITN and in two of the GN procedures the surgeons rated the implant as cumbersome (p=0.002). Functional outcome and complication rate did not differ between both groups. The mechanical failure correlated with the positioning of the lag screw independent on the used implant.The surgeon´s technique (closed reduction, positioning of lag screw) and not implant configuration, is of crucial importance in achieving successful outcome

Case-based learning can improve the teaching quality in trauma surgery education : A survey analysis among medical students

Hintergrund Medizinische Lehre ist seit jeher eine Herausforderung für Studierende und Dozenten. Die Förderung des Zusammenhangswissens und ein Wissenstransfer von der Theorie auf die Praxis gewinnen in den letzten Jahren an Bedeutung. Um dieses Ziel zu erreichen, werden zunehmend studierendenzentrierte Lehrkonzepte in der Literatur eingesetzt. Fragestellung Kann durch ein fallbasiertes Lehrkonzept das unfallchirurgische Seminar verbessert werden? Material und Methoden Den Studierenden und Dozenten wurden standardisierte Fallbeispiele und dazugehörige Unterrichtsmaterialien wie Klassifikationshilfen und Versorgungsstrategien zur Verfügung gestellt. Durch eine zweizeitige Evaluation konnten die Auswirkungen dieser Modifikationen des Lehrdesigns erfasst und statistisch ausgewertet werden. Ergebnisse Das Seminar wurde als prüfungsrelevanter empfunden. Die Lehre durch die Dozenten wurde als kompetenter und motivierter empfunden. Insgesamt wurde das Seminar durch die Studierenden besser bewertet. Schlussfolgerungen Ein fallbasiertes Lehrkonzept kann daher, richtig und gezielt eingesetzt, die unfallchirurgische Lehre signifikant verbessern.Background Medical education has always been challenging for students and teachers. Of growing importance is the promotion of knowledge of correlations and knowledge transfer from theoretical aspects into clinical practice. In order to achieve this aim, student-centered teaching concepts are increasingly being employed in the literature. Objective Can a trauma surgery practical seminar be improved by a case-based teaching concept? Material and methods For this purpose, standardized case studies and corresponding teaching materials, such as classification aids and treatment strategies, were made available to the students and lecturers. Using a two-staged evaluation the effects of the modified teaching design could be recorded and statistically analyzed. Results The seminar was considered to be relevant for the examinations. The teaching by the lecturers was found to be more competent and appeared more motivated. Overall, the seminar was rated better by the students. Conclusion A case-based teaching concept can significantly improve the education in trauma surgery, when correctly and specifically implemented

What are predictors for patients' quality of life after pelvic ring fractures?

Background Our knowledge of factors influencing mortality of patients with pelvic ring injuries and the impact of associated injuries is currently based on limited information. Questions/purposes Weidentified the (1) causes and time of death, (2) demography, and (3) pattern and severity of injuries in patients with pelvic ring fractures who did not survive. Methods We prospectively collected data on 5340 patients listed in the German Pelvic Trauma Registry between April 30, 2004 and July 29, 2011; 3034 of 5340 (57%) patientswere female. Demographic data and parameters indicating the type and severity of injury were recorded for patients who died in hospital (nonsurvivors) and compared with data of patients who survived (survivors). The median followup was 13 days (range, 0–1117 days). Results A total of 238 (4%) patients died a median of 2 days after trauma. The main cause of death was massive bleeding (34%), predominantly from the pelvic region (62% of all patients who died because of massive bleeding). Fifty six percent of nonsurvivors and 43% of survivors were male. Nonsurvivors were characterized by a higher incidence of complex pelvic injuries (32% versus 8%), less isolated pelvic ring fractures (13% versus 49%), lower initial blood hemoglobin concentration (6.7 ± 2.9 versus 9.8 ± 3.0 g/dL) and systolic arterial blood pressure (77 ± 27 versus 106 ± 24 mmHg), and higher injury severity score (ISS) (35 ± 16 versus 15 ± 12). Conclusion Patients with pelvic fractures who did not survive were characterized by male gender, severe multiple trauma, and major hemorrhage