Antonius Pizanis

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.

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.

Case: In this case report, we present a novel stabilization technique of the pubic symphysis using an internal spinal fixator in a 78-year-old morbidly obese woman having a pelvic disruption type B1.1 (AO classification). We treated the disruption using an internal fixator to reduce the extent of the incision and soft-tissue damage. Conclusions: The use of an internal fixator, known from percutaneous spinal fixation, for the stabilization of the pubic symphysis in cases of disruption (“open book” injuries) may be an alternative to the standard plate fixation as a novel minimally invasive stabilization technique.

Zusammenfassung: Bei der Behandlung von Impressionsfrakturen des lateralen Tibiaplateaus gilt die offene Reposition und Osteosynthese als Methode der Wahl. Für ausgewählte Frakturen, bei denen die Impression der Gelenkfläche die Hauptkomponente darstellt, kann die Rekonstruktion des Plateaus nach der hier vorgestellten Methode jedoch auch minimalinvasiv mithilfe eines Kyphoplastieballons erfolgen, der statt konventioneller Instrumente zum Anheben der Gelenkfläche benutzt wird. Der Erfolg der Operation hängt dabei von der korrekten Indikationsstellung sowie von der Beachtung einiger Tricks und Fallstricke ab. Eigene Erfahrungen zeigen sehr gute postoperative Ergebnisse nach Tibioplastie von ausgewählten Frakturen.

Anterior bone grafts are used as struts to reconstruct the anterior column of the spine in kyphosis or following injury. An incomplete fusion can lead to later correction losses and compromise further healing. Despite the different stabilizing techniques that have evolved, from posterior or anterior fixating implants to combined anterior/posterior instrumentation, graft pseudarthrosis rates remain an important concern. Furthermore, the need for additional anterior implant fixation is still controversial. In this bench-top study, we focused on the graft-bone interface under various conditions, using two simulated spinal injury models and common surgical fixation techniques to investigate the effect of implant-mediated compression and contact on the anterior graft.

The functional results and the complications following interlocking plate fixation of displaced proximal humerus fractures should be evaluated and compared with those following minimal invasive fixation techniques. Fifty patients (30 women, 20 men, mean age 62.7 (18–91) years) were treated for a displaced proximal humerus fracture using an interlocking plate fixation (PHILOS^®) between 2003 and 2004. The mean follow-up time was 12 (9–36) months. Functional and radiographic results (Constant-Murley and Neer scores) were analyzed and compared with an equivalent historical control group of 53 patients operated for the same fracture types using minimal invasive techniques (K-wires and/or cannulated screws) between 1995 and 1997. According to the OTA/AO classification, there were 15 type A, 18 type B, and 17 type C fractures in the plate fixation group, and 23, 25, and 5 of these types in the control group, respectively. The mean Neer score was 85.9, the mean Constant-Murley score 84, whereas 82.4 and 75.4 for the control group, respectively. Good and excellent results were seen in 78 %, whereas in 70 % in the control group. The results were dependent upon the fracture’s type, sex, and patient’s age. Complications were seen in 9 patients, whereas in 16 patients in the control group. Using an interlocking plate, the indication of fixation of displaced proximal humerus fractures had been expanded to type C fractures. The implant failure rate can be reduced. The functional results achieved are better compared with those following minimal invasive techniques.