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New communication technologies allow patients to communicate with their physicians from anywhere using computer or smartphone. Adding video to the mere phone call optimizes the personal contact between patient and physicians regardless of distance. Legal and reimbursements requirements must be taken into account, especially only certified software products must be used. In addition, patient consent is needed and confidentiality must be assured. The video patient consultation can be reimbursed by the health insurance companies. As with all new technologies, the introduction of these video consultations faced some challenges. Although patients and physicians have expressed great interest in this technology, it has been rarely used so far. The current COVID crisis increased the need for video consultations resulting in an increasing use of video patient consultation. It can be expected that this demand will still exists after the COVID crisis.

The recently ratified Digital Healthcare Act – DVG – has paved the way, among other issues, for the prescription of health apps. The German DVG creates an entitlement to health apps for the very first time. However, this entitlement is initially limited to low-risk medical devices that have been included in the publicly accessible Register for Digital Health Applications by the German Federal Institute for Drugs and Medical Devices. Listing in the register is granted, if the manufacturer has submitted a health app and verified that it meets basic requirements for medical devices and data security as well as positive health care effects. It is questionable, whether the DVG will lead to sustainable improvements in future patient care. In order to pursue this question and align the DGOUCʼs digitization strategy closely with its basis, an online survey was conducted among the respective members on the DVGʼs content and its associated opportunities and risks. A total of 461 German-speaking, predominantly male, experienced and elderly physicians in leading positions took part in the survey. In this study, it was shown that the majority of the participating German orthopaedic and trauma surgeons is not familiar with the DVGʼs contents. Despite a fundamentally positive attitude towards digitization, scepticism about the use of “apps on prescription” and potential risks still prevails at present. The closing of ranks between medicine, IT and the legislature via interdisciplinary expert groups and the involvement of medical societies might be obligatory.

This article deals with the current state mid-2020 in the clinical and practical aspects from the perspective of orthopedics and trauma surgery. The risks, difficulties, potentials and options are discussed in detail. The following topics are specifically debated: infrastructure of telematics, apps and mobile health, online video consultation, electronic medical records and data protection. The advantages and disadvantages and the current state of each topic in the special case of orthopedics and trauma surgery are discussed. Additionally, seven meaningful examples from the field of digital applications are named. A survey of members of the Professional Association of Orthopedic and Trauma Surgeons (BVOU) is described and analyzed. In a concluding perspective the current hurdles and future topics that need clarification are addressed.

Mit der digitalen Agenda hat sich die Bundesregierung das ehrgeizige Ziel gesetzt, digitale Kompetenzen zu fordern sowie digitale Lehr- und Lernprozesse zu erforschen. Erhebliche Investitionen sollen auf Zukunftsfahigkeit von Bildung, Hochschulen, Forschung und Digitalisierung konzentriert werden. „Digitalisierung“ in Bezug auf universitare Lehre sowie die Fort- und Weiterbildung nicht nur in der Orthopadie und Unfallchirurgie (O und U) lasst sich in digitale Organisation, digitale Kompetenzen und digitale Werkzeuge gliedern. Mit neuen Formaten wie dem Wahlpflichtfach „Digital Health“ der Charite Berlin lassen sich digitale Kompetenzen multimodal und interdisziplinar vermitteln. An der Universitat Essen konnen Lehrende und Lernende mit einer neuen App sowohl organisatorische als auch inhaltliche Informationen zu Lehrveranstaltungen mobil und flexibel abrufen. Das digitale Logbuch fur die Weiterbildung verspricht insbesondere durch Transparenz, hohere Rechtssicherheit und Planbarkeit fur den Weiterzubildenden eine echte Neuerung in der Weiterbildungsreform. Augmented und Virtual Reality spielen bei der Vermittlung praktischer Fertigkeiten eine immer grosere Rolle und verbinden Hightech mit klassischem Handwerk. Digitale Fortbildungsformate haben zuletzt immens an Bedeutung gewonnen und sind mittlerweile als „Werkzeuge“ fur eine effiziente medizinische Fortbildung gut etabliert. Wenn Orthopaden und Unfallchirurgen eine aktive Rolle im Digitalisierungsprozess der Lehre einnehmen, konnen sie ihn mitgestalten und die Kollegen von morgen vorbereiten, die Patientenversorgung angepasster gestalten, Innovationen fordern und somit das Fachgebiet insgesamt noch besser machen.

Background Surgical hand rub and healthy skin are basic requirements to prevent surgical site infections. Nevertheless, there is little knowledge about the current practice of skin protection and/or skin care products (SP/SC) using among surgeons as well as a lack of data pertaining to the influence of SP/SC on the antimicrobial efficacy of surgical hand rub. Methods A 10 weeks-survey among German surgeons as well as an experimental crossover study involving 26 participants were conducted. The immediate and sustainable efficacy (IE/SE) of surgical hand rub and participants’ hand moisture were measured after an 8-day usage of SP/SC, as well as the influence on micro-perforations on surgical gloves. Results The questionnaire was available to 16,000 German surgeons. Thereof, 1,771 surgeons accessed the questionnaire, representing a total participation rate of 11%. As 19% (n = 338) of questionnaires were incomplete, a total of 1,433 completed questionnaires were available for further analysis. More than 75% of the participants stated not to use any SP/SC, yet, almost 50% suffered from skin irritation or discomfort. Only 5% used SP/SC at the beginning of their shift. 10% refused to use SP/SC because of concerns that SP/SC may reduce the antimicrobial efficacy of surgical hand rub. After usage of SP/SC over 8-days, skin moisture was significantly higher (P Conclusions Following the results of this largest questionnaire base survey among German surgeons on skin care, there is a need to educate and inform surgeons on the correct application and the concept of SP/SC strategies. In the present study, the combination of selected SP/SC products and one alcohol-based hand rub formulation did not show a negative interaction with surgical hand rub or surgical glove perforation. However, it is advisable to ascertain the compatibility of SP/SC products with the used hand disinfectant prior to purchase.

Although appendectomies are frequently performed and new procedural techniques have emerged, no nationwide analysis exists after the cessation of the German quality control in 2004. One thousand eight hundred seventy surgical hospitals in Germany were asked to answer questions anonymously concerning the size of the department, applied procedural techniques, various technical details, as well as the approach to the intraoperative finding of an inconspicuous appendix. We received 643 questionnaires (34.4 %) for evaluation. Almost all hospitals (95.5 %) offer laparoscopic appendectomy (LA), 15.4 % offer single-port (SPA), and 2.2 % (hybrid-) NOTES technique (NA). LA is the standard procedure in 85.2 % of male and in 89.1 % for female patients. In an open procedure (OA), the appendix and mesoappendix are mostly ligated (93.8 and 91.5 %). A Veress needle and open access are employed equally for LA. In 66.6 % of LA, the appendix is divided using an Endo-GIA, the mesoappendix in 45.5 % with bipolar coagulation. Almost half of the hospitals routinely flush the site in OA and LA. In open surgery with an inconspicuous appendix but a pathological finding elsewhere in the abdomen, it is resected “en principe” in 64.7 % and in the absence of any pathological finding in 91.2 %. For laparoscopic procedures, the numbers are 54.8 and 88.4 %. Most German hospitals perform appendectomies laparoscopically regardless of patients’ gender. Usage of an Endo-GIA is widely established. SPA has not gained much acceptance, nor is NA widely used yet. In the absence of any pathological findings in particular, the macroscopically inconspicuous appendix results in an appendectomy “en principe” in most German hospitals.

Stapling device/endo-GIA 3.6 66.6 Endoloop only n.a. 24.2 Endoloop with purse string/Z-suture n.a. 2.6 Resorbable clips 2.2 3.8 Nonresorbable clips 0.3 1.2 Mesoappendix Ligation 91.5 n.a. Bipolar coagulation 6.1 45.5 Stapling device 1.2 12.5 Resorbable clips 0.9 15.1 Nonresorbable clips 0.3 9.2 Monopolar coagulation n.a. 6.4 Lavage routinely Yes 48.1 49.9 No 51.9 50.1 Abdominal drain Always/mostly 9.5 8.3 Rarely/never 21.4 34.5 Depending on intraoperative finding 69.1 57.2 Subcutaneous Redon drain Always/mostly 4.5 n.a. Rarely/never 75.6 n.a. Depending on intraoperative finding 19.9 n.a. Subcutaneous suture Always/mostly 42.6 n.a. Rarely/never 42.4 n.a. Depending on intraoperative finding 15 n.a. Skin closing Intracutaneous and resorbable 36.5 48.3 Interrupted sutures 35.2 44.8 Staples 14.1 3.1 Intracutaneous and non resorbable 10.3 3.8