Tobias Schöbel

Background: Chest tube dislodgement is a frequent and potentially life-threatening complication after thoracic trauma. Reliable fixation is essential, particularly in emergency and combat casualty care. Several suture techniques exist, but comparative biomechanical evidence is limited. Methods: This prospective biomechanical cadaveric study compared three fixation techniques—Purse String (PS), Roman Sandal (RS), and Modified Johannesburg (JO) technique —across three tube sizes (20, 24, 28 Charrière) and two materials (polyvinyl chloride (PVC) and silicone). A total of 360 tests were performed on porcine thoracic wall specimens under standardized conditions. Specimens were subjected to vertical load-to-failure testing with continuous measurement of force and elongation. Results: The Modified Johannesburg technique consistently demonstrated the highest pull-out strength across all tube sizes and materials, significantly outperforming both RS and PS ( p < 0.0001). RS ranked second and showed significantly greater stability than PS in all conditions ( p < 0.0001). Effect size analysis revealed large differences between JO and PS ( r = 0.87) and between RS and PS ( r = 0.50), and a medium effect between JO and RS ( r = 0.36). PVC tubes provided significantly greater pull-out strength than silicone tubes (147.0 ± 54.2 N vs. 128.5 ± 42.2 N; p = 0.01071), although silicone tubes exhibited greater elongation prior to failure. Tube size had a modest influence on stability, with larger tubes tending toward higher pull-out strength, but pairwise differences did not reach significance. The predominant failure mechanism was suture rupture (78.9%), followed by tube rupture (11.1%), knot loosening (8.1%), and skin failure (1.9%). Conclusions: The Modified Johannesburg Technique offers superior biomechanical stability for chest tube fixation, regardless of tube size or material. This technique should be considered the preferred method in high-risk environments, including military and emergency care, to minimize dislodgement and enhance patient safety.

Introduction: Immersive virtual reality (iVR) simulators have been introduced for skills training in various medical disciplines. While iVR simulators have been shown to improve technical skills, they are currently not well established in curricular teaching for medical students. The aim of this study was to demonstrate the implementation of an iVR operating theater in addition to conventional bedside teaching in orthopedic and trauma surgery and to evaluate user feedback regarding expectations, acceptance and limitations. Methods: Medical students must complete a week of bedside teaching in orthopedic and trauma surgery in the fourth year. Of these students one third ( n = 56) were given the opportunity to attend an iVR operation theater using Oculus Quest 2 headsets and controllers and the PrecisionOS software. Participants were able to train several surgical procedures. User feedback was obtained before and after the obligatory course by two questionnaires and compared statistically using the Mann-Whitney-U-test or Fishers’ exact t‑test. Results: All students had high expectations regarding the implementation of iVR training in the course. The participants spent a mean time of 3.3 h per week using the iVR tool in addition to the regular course content. All students stated that iVR training was a useful addition to bedside teaching in orthopedic and trauma surgery. Most participants (87.0%) thought that VR applications will play a role in their future career. Motion sickness occurred in half of the participants. The main symptoms that were described were dizziness (37.0%), nausea (33.3%) and headaches (25.9%). Students who received an iVR tool rated the bedside course better than students who did not receive the iVR tool. Conclusion: The iVR training can be easily implemented into the curriculum of medical students. The high expectations of the participants were fulfilled and the students wished iVR to be a regular part of the obligatory courses in orthopedic and trauma surgery. Graphic

Introduction: The field of orthopedics and trauma surgery in Germany is facing an increasing shortage of young specialists. Several solutions have already been proposed to attract new residents. This study evaluates the influence of a student job in an orthopedic surgery department on the career choice and skill acquisition of medical students. Methods: A single center, cross-sectional survey was conducted among 51 medical students employed as paid student assistants in the Department of Orthopedics, Trauma and Plastic Surgery at the University of Leipzig since 2017. A total of 42 participants (response rate: 82.4%) completed an online questionnaire assessing sociodemographic data, career choices and skills acquired during their employment. Statistical analysis was performed using SPSS. Results: Half of the participants with completed medical studies chose surgical residencies, with 83.3% of these in orthopedic surgery. The experience as a student assistant was ranked as the second most influential factor for career decisions after the final practical year. Participants reported significant skill acquisition, particularly in practical ward activities (mean Likert scale: 4.40 ± 0.79), operating room skills 3.55 ± 1.14 and understanding clinical processes 3.45 ± 0.86; however, limited impact was observed on scientific motivation (2.29 ± 1.13) and conducting orthopedic-specific examinations (1.98 ± 0.79). Conclusion: Student assistantships in orthopedic surgery provide substantial practical training and positively influence career decisions, potentially countering the declining interest in surgical fields. These roles represent an effective strategy for junior staff recruitment, offering structured exposure to the surgical profession. Future research should explore broader multicenter implementations to confirm these findings. Graphic

With the new licensing regulations and the National Competence-Based Learning Objectives Catalogue for Medicine (NKLM), the learning objectives and certificates of achievement are no longer assigned to specific subjects. In addition to the opportunity for the subject of orthopaedics and trauma surgery to present itself more prominently and at an earlier stage, there is also a need to identify the relevant subject-related learning objectives in order to integrate them into the curricula and prepare for internal faculty discussions on teaching assignments. At present, it remains unclear whether the new licensing regulations will be accompanied by the initially planned complete restructuring in the form of the so-called Z-curriculum, but the new learning objectives of the NKLM will become part of the training for future doctors.The learning objectives contained in the current draft of the NKLM from December 2023 were screened and evaluated by two teaching coordinators using the dual control principle. The learning objectives that should and can be meaningfully taught by the O & U were selected from the 2646 formulated contents. A total of 276 (10.32%) learning objectives were detected for the teaching of O & U and 2399 (89.68%) were excluded. The selected learning objectives were then assigned to the existing courses and the institute’s own teaching was optimised accordingly in preparation.In this study, the learning objectives of the NKLM were compared with the current learning objectives of O & U at Leipzig University and the learning objectives of the NKLM were integrated into the curricula. Of the NKLM, 10.32% of the learning objectives relate to the subject O & U, which underlines its importance. In addition, the approach presented here shows that the learning objectives of the NKLM can be quickly implemented in an existing curriculum.

Background: Virtual reality (VR) simulators have been introduced for skills training in various medical disciplines to create an approximately realistic environment without the risk of patient harm and have improved to more immersive VR (iVR) simulators at affordable costs. There is evidence that training on VR simulators improves technical skills but its use in orthopedic training programs and especially in curricular teaching sessions for medical students are currently not well established. The aim of this study was to describe the implementation of a VR operating theater as an elective course for undergraduate medical students and to evaluate its effect on student learning. Methods: An elective course for 12 students was implemented during the summer semester of 2023. Using Oculus Quest 2 headsets (Reality Labs, Meta Platforms, USA) and controllers and the PrecisionOS platform, they were able to train five different surgical procedures. The courses were accompanied by weekly topic discussions and instructional videos. Students were assigned to two groups: group VR vs. group non-VR. The groups were switched after 5 weeks. User feedback and performance development (theoretical and procedural surgical knowledge) after VR training were assessed using three questionnaires. Results: The students highly appreciated the implementation of VR training into their curriculum and 91% stated that they would opt for further VR training. All students stated that VR training improved their understanding of surgical procedures and that it should be obligatory in surgical training for undergraduate medical students. After 5 weeks of training, students in the VR group achieved significantly better results (100 out of maximum 180 points) than the non-VR group (70 points, p = 0.0495) in procedural surgical knowledge. After completion of the VR training the VR group achieved 106 points and the non-VR group 104 points (p = 0.8564). The procedural knowledge for non-VR group after 5 weeks significantly improved after VR training from 70 to 106 points (p = 0.0087). Conclusion: The iVR can be easily integrated into the curriculum of medical students and is highly appreciated by the participants. The iVR statistically improves the procedural knowledge of surgical steps compared to conventional teaching methods. Further implementation of iVR training in curricular teaching of medical students should be considered. Graphic

Traumatic lacerations of the prepatellar (PB) and olecranon bursa (OB) are common injuries. The aim of this study was to gain descriptive data and to identify risk factors associated with complications that made revision surgery after primary bursectomy necessary. In this retrospective monocentric study at a level I trauma center, all patients with traumatic lacerations of the PB or OB who were treated with primary surgical bursectomy from 2015 to 2020 were analyzed. 150 consecutive patients were included. In 44% of cases, the PB was affected (n = 66), in 56% the OB (n = 84). The reoperation rate after surgical bursectomy was 10.7% (n = 16). The main cause of reoperation was wound infection (50%; n = 8). The most common pathogen of postoperative infections was Staphylococcus aureus (87.5%). Several comorbidities have been identified as risk factors for reoperation after primary surgical bursectomy, such as heart diseases, arterial hypertension, the use of antihypertensives and anticoagulation. In contrast, surgical expertise, use of drains, postoperative immobilization, and postoperative antibiotics had no statistically significant effect. A significantly higher postoperative infection rate (17.6%) was observed in patients who were operated more than 48 h after initial trauma. Given the limited recommendations for therapy of these common injuries, further investigations should focus on standardized therapeutic options for lacerations of the PB or OB. Delayed surgical interventions after trauma were associated with higher complication rates. Therefore, urgent surgery within 48 h after trauma may help to prevent revisions. Level of evidence IV.