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During the last decade there have been significant changes in the perioperative management of total hip replacement patients. This process begins in the preoperative phase. Many patients are much better informed and standardized preoperative patient programs improve patient outcome and optimize the clinical pathways. The techniques in perioperative pain management have also significantly improved. The surgeon should not only rely on the anesthesiologist but should also use the options available during surgery. Postoperative weight bearing is handled in a much more progressive way than previously. In a standard primary hip replacement pain-adapted full weight bearing is possible if there are no patient-specific problems. There has also been a shift in the postoperative capability of performing athletic or recreational activities. In general patients can perform those activities that were performed before the surgery, which also includes, for example downhill skiing.

Aim: Prosthetic replacement in the hand must address such unique challenges as preservation of the collateral ligaments, tendon balancing,and Stability. Surface replacement arthroplasty can be an alternative to other current implants. The purpose of this study was to evaluate the metacarpophalangeal joint kinematics after surface replacement arthroplasty., Method: The kinematics of pyrolytic carbon as a surface replacement implant for the metacarpophalangeal joint (MCP) was compared with the intact MCP joint in eight fresh cadaver long fingers by means of an electromagnetic tracking system (Polhemus, Colchester, VT). The eight human cadaver MCP joints were tested before implantation, after implantation, after collateral ligaments resection, and after collateral ligaments reconstruction., Results: The kinematics of the MCP joint is reproduced by the joint surface replacement arthroplasty when normal ligament tension was present. The maximum angular displacement of the pyrocarbon implant was 378 for lateral deviation and 338 for rotation during the passive flexion and extension motion. The instantaneus center of rotation (ICR) after implant insertion was nearly identical to the center of rotation of the normal joint. The results also indicated that the collateral ligaments provide the primary stability of the MCP joint. No significant differences in lateral and rotational stability after surface replacement arthroplasty were noted. While collateral ligaments resection significantly affected the stability of the MCP joint., Conclusion: The ICR of the pyrocarbon implant most closely matched that of the intact MCP joint. The pyrocarbon implant provides suitable stability to radio-ulnar deviation and rotational stresses as a resurfacing implant and it simulates the kinematics of the intact MCP joint. By using new materials and taking the anatomical and biomechanical requirements into consideration, the endoprosthesis of the finger joints has created an option to achieve good long-term results. The inadequate results of earlier and current prostheses are a consequence of their mechanical construction and their materials. The success of the new implants could be proven by preferably long-term, controlled studies.

During the German championships in parachuting 78 paratroopers were asked about acute injuries and chronic pain using a questionnaire. A total amount of 131 injuries was described. These were evaluated in terms of dimension and localisation. Upper and lower parts of the body were injured with a comparable frequency. Bruises (42%), fractures (19%), sprainings (16%) and dislocations (10%) were most often described. The overall injury rate according to the total number of descents (0.09%) was lower than that reported by previous literature. Therefore it can be concluded that parachuting for experienced jumpers is less dangerous than assumed until today.

Purpose: purpose of this study was to evaluate paediatric feet and to document possible problems., Material and Methods: In 345 high school pupils of the 5th and 6th class aged 10 to 13 the feet as well as leg alignment were evaluated with a standardised protocol., Results: Only 36.5% showed regular feet. In almost 2/3rd of the pupils malalignements or even deformities were present. The valgus foot showed the highest incidence with 39.4% followed by a flat foot with 19.1%. 17.1% of the children showed a hallux valgus. There was no correlation between body weight, body height, leg alignment and foot deformity. However, a significant correlation could we found between hallux valgus and splay foot., Conclusion: The presented data underlines the necessity for paying attention on the problems of the paediatric feet. During sport lessons in school a special foot training for children should be performed.

Background: To evaluate the level of documentation as an instrument of ongoing quality management in arthroplasty, a questionnaire was created on this subject, which concentrated on structural and process indicators., Methods: A total of 908 questionnaires was sent to orthopedic and trauma departments in Austria, Germany and Switzerland and were evaluated anonymously., Results: The quota of return was 54% in Switzerland, 47% in Austria and 25% in Germany. The waiting period for an arthroplasty is much less in Switzerland and in Germany than in Austria. Only 40% of patients receive forms for informed consent. Documentation is seldomly standardized thus making comparison virtually impossible. Surgical planning is usually done with templates in Germany and Austria, in Switzerland with drawings. Prosthesis passports are predominately used by orthopedic departments. The data regarding complication rates and infections are not analyzed at regular intervals (max. 30%) and corrective measures are rarely implemented., Conclusion: Documentation is the basic instrument of quality management and requires completeness (totality) and plausibility of the datas. It is of great importance that evaluated data are analyzed and consequences are taken. The primary aim of quality assurance is to identify problems that adversely affect quality in order to develop and implement process sequences for the improvement of patient care and management.

The local independence of students and teachers is accepted to be one of the main advantages of teleteaching. New techniques allow to use the Internet protocol similar to video conferences, thus giving premises to link specialties which have to operate in different environments. Synchronous communication can be established with students even over long-distances. In a pilot study a three-directional lecture between an operating theatre, the dissection laboratory of the institute of anatomy, and a lecture hall was given. During the lesson students discussed problems with any lecturer. We were able to demonstrate a sufficient transmission capability for this real-time application provided by the available internet technology. On the other hand, great technical and personnel effort for this computer aided MOT is necessary. However, although it is often difficult to reconcile the timetable of surgeries and lectures MOT provides new potentialities in interdisciplinary medical education.

In a field study the injury pattern as well as the active and passive injury prophylaxis of 1036 inline skaters were evaluated. Of them, 60% had already been injured. Every 124 h an injury occurred during inline skating. While 61% of the injuries affected only soft tissue, 31% were joint distorsions, and 8% were fractures. Altogether 37% of the 626 injured skaters required medical treatment. The upper extremities are especially at risk: 78% of the fractures and 48% of the distorsions affected the fingers, wrist, forearm or elbow. It is obvious that the inline skaters' passive prophylaxis measures are still unsatisfactory. Only 17% of the questioned used complete protection, whereas 16% were wearing no protective gear at all. Of the rest, 49% were skating with wrist guards, 66% were using knee pads, and 31% elbow pads. A high percentage of injuries is due to the lack of basic knowledge and techniques. The survey revealed that only 24% can stop immediately. While 51% had only slight problems with braking, 16% admitted having great difficulties, and 7% were not able to brake at all. These numbers reveal that there are still large deficits regarding braking techniques and education on the risks of injury. Therefore, athletes who use this equipment for the first time should learn the basic techniques of skating, braking and falling with the help of a qualified instructor. Most of all those questioned wanted to have more information, and half would be interested in special educational programmes.

The object of the study was to evaluate the management of patients with acute or recurrent shoulder instabilities. Therefore all trauma, general surgery, and orthopaedic departments in Germany were asked to complete a standardized evaluation form; completed questionnaires were returned from 880 institutions treating shoulder instabilities. Questions were asked about the diagnostic imaging techniques used and about conservative and operative treatment. In addition, the treatment regimens that would be followed for two typical patients were asked for. In patients with shoulder instabilities the following diagnostic imaging techniques were used: X-ray (97.1%), ultrasound (61.3%), CT (29.1%), arthro-CT (26.2%), MRI (13.3%), arthrography (24.1%), and arthroscopy (30.6%). After the first traumatic dislocation the average period of immobilization was 2.2 weeks. Immobilization was achieved with a sling in 2.0%, with a Desault bandage in 38.8%, with a Gilchrist bandage in 72.7%, and with a cast in 4.2% of cases. Open surgical stabilization was performed according to Bankart (30%), Eden-Hybinette (28.6%), Weber (Osteotomy) (27.1%), Lange (15.5%), Putti-Platt (13.6%), and other procedures (Magnusson-Stack, Bristow) only occasionally. The average period of immobilization after open surgery was 3.0 weeks. Arthroscopic stabilization techniques were applied by 7.5%. In a 19-year-old handball player stabilization would be performed immediately after the first traumatic dislocation in 9.2% of the institutions; in 34.4% the patient would not be operated on, and in 56.3% the shoulder would be stabilized after the third redislocation.(ABSTRACT TRUNCATED AT 250 WORDS)