[A scaphoid fracture overlooked in CT in a combination injury of the wrist]. / Im CT übersehene Kahnbeinfraktur bei Kombinationsverletzung des Handgelenks.

A case of a patient with a combined wrist injury is presented, where a scaphoid fracture was overlooked in the computed tomography scan. The case emphasizes the value of the x­ray control in ulnar abduction for all wrist lesions which need to be operatively stabilized.

[Diagnostically Approach to Pediatric Carpal Fractures: a Retrospective Analysis]. / Diagnostisches Vorgehen bei Handwurzelknochenfrakturen im Kindesalter: eine retrospektive Analyse.

INTRODUCTION: Carpal fractures in children are rare, but can be missed, as their clinical symptoms are unspecific and discrete. Even X-ray diagnosis is difficult. Timely diagnosis and consistent therapy are especially important for scaphoid fractures, as they can help to avoid complications such as non-union or avascular necrosis. A diagnostic approach to paediatric carpal fractures will be discussed on the basis of the following group of patients. METHODS: Retrospective analysis of children under 14 years treated in our institution between 09/2010 and 02/2012 for clinically suspected carpal fracture. In the primary evaluation, all children underwent standard X-rays of the hand and/or wrist. All patients were treated by cast immobilisation until complete clinical recovery. All patients with clinical signs of carpal fracture were treated by cast immobilization, even with normal X-rays. The clinical follow-up examination was after 10 to 14 days. In patients with persistent complaints, MRI was performed. We retrospectively evaluated the records of all patients: the fractured carpal bone, and X-ray and MRI-diagnosis were stated. We calculated the mean difference between first presentation and MRI and the mean period for total recovery, in patients with fracture or non-fracture. RESULTS: 61 children (27 boys and 34 girls, mean age 11.5 y) were included in our study. The mean delay between accident and time of first presentation to our paediatric ED was 0.6 days. In primary X-rays, a carpal fracture was demonstrated in only in 2 (3.3 %) patients, but was suspected in only 6 (9.8 %) of patients. In 53 (87.9 %) patients, there was no radiographic evidence of carpal fracture. 14 patients underwent additional scaphoid views, but scaphoid fracture was confirmed in only 1 (7 %) of these patients. In 3 (21.4 %) patients, a scaphoid fracture was suspected and in 10 patients a carpal fracture could be excluded. After a mean time of 11.8 days, all patients underwent a clinical follow-up examination. 32 (54 %) patients had persistent symptoms and MRI was done after a mean time of 17 days. Carpal fracture was then excluded in 12/32 (37 %) patients and was diagnosed in another 20/32 (63 %) children. There were 14 scaphoid fractures, including 3× bone bruise lesions, 4 capitate fractures, 3 triquetral fractures, including 1× bone bruise lesion and 1 bone bruise lesion of the trapezoid. In patients with proven carpal fracture, it took a mean time of 56 days for complete recovery, in comparison with 15 days in patients with excluded carpal fracture. Surgical therapy was unnecessary in any of the patients, and there were no complications. CONCLUSION: In children with clinical and radiographic carpal fracture, diagnosis is difficult and often unsuccessful at first. Even in discrete clinical complaints, generous cast immobilization is essential and clinical follow up is recommended not later then 14 days. In patients with persistent clinical symptoms, MRI is the imaging method of choice, as it is capable of detecting carpal fractures and even bone bruise lesions with high sensitivity, thereby avoiding unnecessary diagnostic or therapeutic stress for the patients.

[Sonographic fracture diagnostics]. / Sonographische Frakturdiagnostik.

BACKGROUND: In clinically suspected fractures taking radiographs is the standard procedure but the indications should be strictly limited. Ultrasound offers a safe and radiation-free alternative for fracture diagnostics. OBJECTIVES: Sensitivity and specificity of sonographic fracture diagnostics and safety of sonographic algorithms for fracture evaluation. METHODS: Presentation of useful applications for sonographic fracture evaluation and establishment of sonographic algorithms for safe fracture diagnosis. RESULTS: In children distal forearm fractures can be diagnosed solely by ultrasound (sensitivity 96 % and specificity 97 %). The sonographic fat pad sign (SOFA) has been proven to be a useful primary screening tool for occult fractures of the pediatric elbow. A positive fat pad sign (SOFA+) is indicative of a fracture and radiographic diagnostics are necessary (sensitivity 97 % and specificity 91 %). Ultrasonography is also useful to exclude subcapital humeral fractures (sensitivity 94 % and specificity 100 %) and for correct estimation of displacement when present. CONCLUSIONS: Sonographic algorithms for fracture evaluation (SAFE) offer a safe diagnosis and guidance of the therapeutic course of certain pediatric fractures, thereby reducing unnecessary radiation exposure.

[Complete rupture of the peroneal nerve by knee distortion]. / Komplette N.-peronaeus-Ruptur bei Kniedistorsion.

This report describes a case of complete rupture of the peroneal nerve as a consequence of low velocity trauma. A 54-year-old physically fit patient suffered a complex trauma with complete nerve discontinuity as a result of knee joint distortion without external force. The initial medical findings were unremarkable, in particular neither the accident medical history nor the initial sensitivity impairment suggested the presence of serious knee damage; however, during clinical diagnostics a complex trauma with rupture of the peroneal nerve was found. Accordingly, an extensive revision with nerve suturing was carried out.

[Taking the anamnesis with a questionnaire - safe and effective]. / Die Anamneseerhebung mittels Fragebogen - sicher und effektiv.

INTRODUCTION: The anamnesis is essential for the treatment of any patient. On the other hand, the data are often of poor quality. The aim of the study was to work out whether a questionnaire which is filled out by the patient him-/herself is a reasonable tool for data acquisition. METHODS: In a level-IV trauma centre the data acquisition of 50 consecutive patients was performed with a questionnaire which was checked by a doctor. Excluding criteria were an age < 18 years, previous treatment in the clinic, a transfer from an external clinic or a caring institution and a dementia. The results were compared with the data of the 50 patients prior to the study start. RESULTS: We collected data about the general doctor, diseases, allergies, tobacco usage, drugs, operations and the familial situation. In all 7 fields the questionnaire raised more data than the oral survey; in 4 sections the difference was significant, in 3 (p > 0.05). DISCUSSION: A questionnaire is a reasonable, time-sparing tool for data acquisition of the individual anamnesis in a surgical clinic.

[Comparison of stability of plate fixateurs with parallel and oblique screw directions]. / Vergleich der Ausbruchfestigkeit winkelstabiler Plattensysteme bei paralleler und divergierender Schraubenlage.

INTRODUCTION: One of the main failure mechanisms of modern plate fixateurs is the tearing of the whole plate-screw construct out of the osteoporotic bone. The aim of this study was to show whether an oblique screw placement can improve the fixation of the plate to the bone. METHODS: A steel probe was fixed to a synthetic bone (Fa. Sawbones) with standard titanium fixed-angle screws in parallel and 55° oblique positioning. We tested the static tear force and the dynamic stability (force distance 1.4 or 1.6 mm, 610 and 900 N, frequency of force shift of 560 or 380/min). Endpoint was a visible tear of the artificial bone. In addition we performed a morphological analysis of the torn fragments. RESULTS: The maximal tear force was 2.04 kN (1.95-2.13) for oblique and 2.66 kN (2.55-2.77) for parallel placement (p < 0.05). With a parallel positioning a higher number of force shifts were performed before a visual tear appeared. With parallel positioning the screw canal was torn with an intact surrounding corticalis; in oblique positioning the threads remained intact, the corticalis was torn out with a wedge. DISCUSSION: An oblique screw positioning does not result in a higher tear force in modern plate fixateurs.

[Sonographic fracture diagnosis in children]. / Fraktursonografie im Kindesalter.

X-rays are the standard imaging procedure for the diagnosis of pediatric long bone fractures. Recent studies show that ultrasound (US) imaging is also qualified to diagnose pediatric long bones fractures. Thus, the diagnosis and decision-making for the treatment of metaphyseal forearm fractures in children can be performed by solely using US. The sonographic fat pad sign has been proven to be a useful primary screening tool for pediatric elbow injuries. If there is a negative fat pad sign, a fracture is unlikely and taking additional radiographs is dispensable at this time. If there is a positive fat pad sign, a fracture is likely and radiographs should be taken. US is also useful to exclude subcapital humeral fractures and to estimate fracture displacement. If a fracture of the subcapital humerus is present, additional radiographs are necessary to avoid overlooking of pathologic fractures. For reliable sonographic fracture diagnosis in childhood, a detailed history und exact clinical examination are required.

Ultrasound diagnosis of supracondylar fractures in children.

PURPOSE: The objective of our study was to evaluate the safety and accuracy of ultrasound (US) compared to standard radiographs in diagnosing supracondylar fractures (SCFs) of the humerus in children. PATIENTS AND METHODS: A total of 106 children (aged between 1 and 13 years) with clinically suspected SCF of the humerus were primarily examined by US followed by standard two-plane radiographs of the elbow. US was conducted with a linear scanner viewing the distal humerus from seven standardized sectional planes. US fracture diagnosis was established either by a cortical bulging or cortical gap, or by a positive dorsal fat pad (dFP) sign. X-ray diagnosis was stated by an independent pediatric radiologist and, afterwards, compared to our US findings. Sonographic and radiographic findings were collected in a contingency table. The sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) for US fracture diagnosis were calculated according to the radiographs. In addition, by identifying significant angulation and/or disrupture, SCFs were classified as non-operative/stable and operative/instable SCFs according to the AO Pediatric Fracture Classification System. RESULTS: By US, a SCF could be excluded in 43 patients and in 63 patients, a fracture was diagnosed. In contrast, by radiographs, an SCF could be excluded in 46 patients and in 60 patients, a fracture was diagnosed. For US fracture diagnosis in comparison to radiographs, we calculated a sensitivity of 100 %, a specificity of 93.5 %, an NPV of 100 %, and a PPV of 95.2 %. Thirty-nine SCFs were sonographically classified as stable grades 1/2 SCFs and confirmed in 37 patients by X-rays. All four operative/instable SCFs were correctly identified by US. CONCLUSION: By identifying a positive dFP sign and/or cortical lesions of the distal humerus, SCFs can be detected very sensitively by US. Even the estimation of fracture displacement seems to be possible. We suggest US as an applicable alternative method in the primary evaluation of suspected SCF in children, guiding further diagnostics, where appropriate. After minor injuries, if clinical assessment for an elbow fracture is low and US examination is negative for fracture, additional radiographs are dispensable. Thereby, the amount of X-ray burden during childhood can be reduced, without loss of diagnostic safety.

[Ultrasound-based treatment of proximal humerus fractures in children]. / Ultraschallbasierte Therapiesteuerung bei subkapitalen Humerusfrakturen im Wachstumsalter.

INTRODUCTION: The treatment of juvenile proximal humerus fractures is based on the extent of the deformity. The standard diagnosis with X-ray images in 2 directions is error-prone and can lead to a suboptimal treatment. The aim of this study was to evaluate if ultrasound imaging can improve the measurement of the deformity of proximal humerus fractures. MATERIAL AND METHODS: In a prospective, multicentre trial children aged 0-12 years with a suspected proximal humerus fracture were initially examined with a 10-MHz linear transducer in 4 directions and the maximum deformity was determined. Afterwards the standard X-rays were taken and the results of both methods compared. The certainty of both methods was compared with a standardised nominal scale. RESULTS: From 8/2010 to 5/2011 6 consultants in 4 hospitals examined 30 patients (16 m, 14 f, mean age 7.9 years). In 15 cases the ultrasound showed a larger deformation than the X-rays and in 2 cases vice versa. In 11 cases the measurement was identical 6 of which were undisplaced. The mean difference of the measurement of the deformity was + 8.6°, with 14.2° in the displaced fractures. The certainty of the ultrasound was rated significantly higher (p < 0.05) than that of radiography. DISCUSSION: With a correct technique the deformity cannot be overestimated by ultrasound means and the safeness is rated significantly higher in comparison to the X-ray imaging. It seems that ultrasound is a meaningful method to improve the measurement of the deformity of proximal humerus fractures in children. Deficiencies are found only in cases with massive deformities which demand a reduction and stabilisation.

[Uncertainty in the radiological evaluation of deformity in proximal humerus fractures]. / Unsicherheit bei der radiologischen Achsbestimmung proximaler Humerusfrakturen.

INTRODUCTION: The accurate measurement of the deformity of proximal humerus fractures is essential for a proper treatment, particularly in the growing bone. Due to the local pain the correct projection in standard X-rays is difficult to achieve and, in contrast to other joints, cannot be verified in the X-ray. Even with the correct projections a mismeasurement can occur when the rotation is 45° to both planes. The aim of this study was to objectify the error sources and reveal starting points for an improvement. MATERIAL AND METHODS: In a three-step study we initially developed a mathemathical formula in cooperation with the faculty of mathematics of the University of Duisburg-Essen. This formula was proved with X-ray imaging of a steel rod which was bent 120°, simulating a 60° deformity. X-ray images with different rotation and tilt were taken and compared with the values calculated with the above-mentioned formula. In the third step X-rays of a healthy shoulder in different rotation and tilt positions were presented to 2 orthopaedic and 3 radiological consultants. The aim was to determine the direction and amount of rotation and tilt. RESULTS: The first theoretical step resulted in a mathematical formula which describes the optical deformation based on real deformation, tilt and rotation. The evaluation showed a mean difference of 0.5° (0-1.2°) between the calculated and the measured values. In the third step, evaluation of the X-rays of a shoulder showed that two in 50 (4 %) of the values were correct, in additional 28 cases (56 %) the tendency of the direction of the rotation was correct, the extent of the rotation was missed by 19.6° (0-60°). Ante- and retroversion were evaluated correctly in nine cases (18 %), the extent was missed by a mean of 23° (0-50°). In seven cases (18 %) the tendency for rotation and ante-/retroversion was correct, in 11 cases (22 %) one or both aspects could not be evaluated, in additional 8 cases (16 %) the extent could not be estimated. DISCUSSION: Our results show that rotation and tilt of the proximal humerus cannot be estimated in shoulder X-rays and therefore a reliable measurement of the deformity of proximal humerus fractures is extremely unsafe. This problem is relevant for clinical practice because of the high likeliness of unaccurate projections in shoulder X-ray imaging after trauma. Especially for the growing bone the problem is evident, so that new ways of determining the deformity are mandatory.

[Proximal cut-out of the hip screw: cement augmentation as a minimally invasive rescue procedure]. / Zementaugmentation als minimalinvasive Rettungsoperation bei proximalem Cut-out von Hüftnägeln.

BACKGROUND: Cemented augmentation of osteosynthesis for the treatment of peritrochanteric fractures in elderly patients has been under discussion for years. We propose this option as a salvage procedure in cases of instability after standard osteosynthesis. MATERIAL AND METHODS: After reduction and optional re-osteosynthesis a Jamshidi needle is placed transcutanously or through the open wound cranio-lateral of the tip of the hip screw. Cement augmentation can be performed under fluoroscopic control. The patients were monitored for at least 7 months postoperatively to rule out a redislocation. RESULTS: From 1/2009 to 1/2011 we treated 6 patients (5 female, 1 male, age 83.8 [79-94] years). We performed 4 augmentations and 2 augmentations with additional re-osteosynthesis. OP time was 26.8 (13-45) minutes. The revision was performed 9.7 (4-14) days after the osteosynthesis. Within 14.7 (7-28) months no redislocation and no surgical complication occurred. CONCLUSION: Even with a small patient number the good results show the potential of this minimally invasive technique. In our opinion this option allows a fast and technically easy salvage procedure without blocking of further treatment options like a prosthesis.

[Ultrasound as a viable alternative to standard X-rays for the diagnosis of distal forearm fractures in children]. / Die Sonografie als sichere Alternative zur konventionellen Röntgendiagnostik bei distalen Unterarmfrakturen im Kindesalter.

AIM: Distal forearm fractures are very common in childhood. Radiography of the wrist is the standard diagnostic procedure. But because of higher sensitivity of growing bones to ionising radiation the diagnostic use of X-rays should be minimised as much as possible. Recent studies have shown that distal forearm fractures in children can be safely and reliably diagnosed using only ultrasound. The aim of our study was to evaluate and confirm the safety and applicability of the ultrasound diagnostic procedure in comparison to X-ray diagnosis under routine conditions of our paediatric emergency department. PATIENTS AND METHODS: We investigated 115 patients aged 2-14 years. After clinical assessment patients with suspected forearm fractures first underwent ultrasound examination of the metaphyseal forearm followed by standard two view radiographs of the wrist. Ultrasound and radiographic findings were then compared and sensitivity and specificity for ultrasound were calculated. In 9 patients with suspected displacements, sonographic and radiographic axis measurement were done and also compared. RESULTS: Radiologically we found 62 patients with 78 distal forearm fractures. By ultrasound we also diagnosed 52 fractures. All patients with no fractures were correctly diagnosed as well. Referring to X-rays we calculated for ultrasound a sensitivity of 94.9 %, a specificity of 98 %, a negative predictive value of 97.4 % and a positive predictive value of 96.1 %. The mean difference of the deformities of the radius in the sagittal section measured sonographically and radiologically were 1.7° (SD 1.6°). CONCLUSION: We confirm ultrasound is an applicable, rapid and safe alternative to X-rays in diagnosing metaphyseal forearm fractures in children. Even sonographic axis measurement seems to be a viable method. Thereby ultrasound potentially reduces the X-ray burden in children and additionally accelerates the diagnostic procedure.

[Retrospective calculation of the workload in emergency departments in case of a mass accident. An analysis of the Love Parade 2010]. / Retrospektive Abschätzung der Belastung einer Notaufnahme beim MANV. Eine Analyse am Beispiel der Loveparade 2010.

BACKGROUND: For the clinical planning of mass events the emergency departments are of critical importance, but there are still no data available for the workload in these cases. As this is essential for an effective medical preparation, we calculated the workload based on the ICD codes of the vicitims at the Loveparade 2010 in Duisburg. MATERIAL AND METHODS: Based on the patient data of the Loveparade 2010 we used a filter diagnosis to estimate the number of shock room patients, regular admittances, surgical wound treatments, applications of casts or splints, and diagnosis of drug abuse. In addition every patient was classified to a Manchester Triage System category. This resulted in a chronological and quantitative work-load profile of the emergency department, which was evaluated by the clinical experiences of the departmental medical staff. RESULTS: The workload profile as a whole displayed a realistic image of the real true situation on July 24, 2010. While only the number, diagnosis and chronology of medical surgical patients was realistic, the MTS classification was not. The emergency department had a maximum of 6 emergency room admittances, 6 regular admittances, 4-5 surgical wound treatments, 3 casts and 2 drug abuse patients per hour. CONCLUSION: The calculation of workload from the ICD data is a reasonable tool for retrospective estimation of the workload of an emergency department, the data can be used for future planning. The retrospective MTS grouping is at present not suitable for a realistic calculation. Retrospective measures in the MTS groups are at present not sufficiently suitable for valid data publication.

The long-term outcome of hepatic artery thrombosis after liver transplantation in children: role of urgent revascularization.

Hepatic artery thrombosis (HAT), one of the most severe complications of pediatric orthotopic liver transplantation (OLT), often compromises graft and/or child survival. Of 590 OLT performed in 516 children over a 20-year period, 45 were complicated by early HAT, during the first 2 weeks after transplantation. Systematic Doppler ultrasonographic detection of HAT allowed successful surgical revascularization in 19 instances, resulting in a 20-year graft survival rate of 77% versus 24% of cases when revascularization was not attempted or failed. A combination of surgical emergency revascularization, biliary interventional radiology, biliary surgery and/or retransplantation resulted in an 80% 20-year patient survival rate, identical to that of transplanted children who did not experience early HAT. The majority of long-term survivors with their initial graft had normal liver tests, no biliary dilation on ultrasonography and minimal or moderate fibrosis on liver histology. A failed attempt at revascularization did not significantly alter patient survival. Despite these encouraging results, for the children and their parents to overcome the entire process in terms of reoperations, repeated radiological interventions, number of hospitalizations and emotional stress, remains an ordeal of such magnitude that it justifies renewed efforts to progress in the prevention of this complication.

[2010 Love Parade in Duisburg: clinical experiences in planning and treatment]. / Loveparade 2010 Duisburg - klinische Erfahrungen in Vorbereitung und Versorgung.

BACKGROUND: Tragic incidents at the 2010 Love Parade attracted significant public attention. As the frequency of similar events increases, more hospitals and practitioners will face the necessities of planning and response to unforeseeable occurrences. Obligatory guidelines for physicians do not exist, so that essential aspects are repeatedly discussed for each new event. This paper summarizes the experience of hospitals and emergency departments and draws conclusions, allowing recommendations for reasonable proposals for hospitals and practitioners. METHODS AND MATERIAL: A structured analysis of data concerning planning, patient flow and injury statistics led to a profile determining personnel, rooms and material which have to be provided by the hospitals. In a consensus conference afterwards and personal interviews with clinical coordinators the preparation of hospitals was evaluated to separate reasonable from needless efforts. RESULTS: We describe various measures concerning staff, logistics and rooms from the viewpoint of actual application. Reasonable measures for preparation and management of mass panic are analysed and described in detail. Problems are explained and solutions discussed. The result is a qualitative catalogue, which supports the organization of future events. CONCLUSION: Knowledge and reflection on the experience of the 2010 Love Parade optimizes local emergency guidelines and planning for similar events. A coordinated cooperation of all involved is essential.

[Modfied technique for intramedullary femur nail removal]. / Modifizierte Technik zur Entfernung von Oberschenkelnägeln.

BACKGROUND: The indication of implant removal of intramedullary nails is a subject of much discussion. The main concern is the increased morbidity of the preparation of the proximal nail end which can cause postoperative discomfort. The aim of the present study was to develop a soft-tissue protecting extraction technique and to evaluate it in comparison to the standard procedure. MATERIAL AND METHODS: With the modified technique the proximal end of the nail is preparated by a guidewire and the standard reamer used for implantation. This allows a soft-tissue protection with reduced morbidity, especially in patients with ossification. The outcome was assessed 4-20 weeks postoperatively and the operation times compared with those of 10 patients operated with the conventional technique. RESULTS: From 5/09 to 12/10 we treated 9 patients with the mentioned technique. The operation time was reduced from a mean of 74.8 minutes to 32.0 minutes. Eight of nine patients had reduced or no discomfort postoperatively. Eight of nine patients stated that they had a benefit from the operation. CONCLUSION: The modified operation technique is capable of reducing operation time and morbidity in the implant removal of intramedullary nails.

[Efficacy of x-ray assessment in emergency surgical departments: an evaluation in a level I trauma center]. / Qualität der Röntgenbefundung im traumatologischen Bereitschaftsdienst: Eine Einschätzung anhand einer Studie an einem Krankenhaus der Maximalversorgung.

BACKGROUND: The aim of the study was to ascertain the state of the art in x-ray assessment in an emergency surgical department. METHODS: From August 2008 to February 2009 a total of 1,588 plain x-rays of 658 patients from the emergency department were included in this study. The images were assessed by 3 experienced orthopedic surgeons and 1 experienced radiologist. The incidence of missed traumatic lesions and suspected lesions and the treatment of these patients were noted. RESULTS: A total of 136 pathological cases with 238 pathological x-ray findings were found. The mean rate of missed lesions was 13% of the assessed cases. Despite the fact that the rate of missed lesions varied from 9-25% depending on the level of experience, all patients were treated adequately. The quality of x-ray assessment improved with the level of training of the individual doctors. CONCLUSION: The present situation is in need of improvement but it is not critical. Junior medical staff should undergo a special training in x-ray assessment.

[Sonographic diagnostics of proximal humerus fractures in juveniles]. / Sonographische Diagnostik der subkapitalen Humerusfraktur im Wachstumsalter.

AIM OF THE STUDY: The exact determination of the extent of deformities in juvenile proximal humerus fractures is difficult with plain x-rays. The aim of this study was to find out whether proximal humerus fractures can be diagnosed and the extent of the deformity can be detected by ultrasonography. PATIENTS AND METHODS: In a prospective, multicentre trial children aged 0-12 years with suspected proximal humerus fractures were examined. Initially a standardized sonographic evaluation was performed and the extent and the direction of the deformity were determined. The recommended treatment was noted. Afterwards standard x-rays were taken and the results of both diagnostic procedures were compared. RESULTS: A total of 33 children were examined, 14 male and 19 female, with a mean age of 7.6 years. In the ultrasound examination 17 out of 18 proximal humerus fractures were detected. In comparison to x-ray diagnostics ultrasonography proved to have a sensitivity of 94% and a specificity of 100%. In 16 cases ultrasonography gave a better result than x-ray imaging and x-ray was better in 5 cases. CONCLUSION: Ultrasonography is suitable for detection and exclusion of fractures and better than x-ray diagnosis for evaluation of the type and direction of deformations of proximal humerus fractures.

[Effective skill training by means of E-learning in orthopaedic surgery]. / Effektives Training der chirurgischen Röntgenbefundung durch E-Learning.

BACKGROUND: The effectiveness of e-learning for reporting of x-ray-findings in a prospective, randomized trial was tested. MATERIAL AND METHODS: Twenty advanced medical students were randomized into two groups. The test group practiced 4-6 hours with the newly developed software, the control group used conventional learning material. Afterwards, a test was carried out including 30 pathologic x-ray films that were randomly spread through 200 non-pathologic images. The required time, the number of correctly appraised images and the frequency of falsely suspected pathologies were recorded. In addition, we asked for an assessment of the own capabilities in evaluating x-ray films and of passing the radiology training. RESULTS: The test group showed a markedly improved efficiency in comparison to the control group in all parameters. The required time was 57.4% shorter than in the control group (p < 0.05), 18.3% more cases were evaluated correctly (p < 0.05). The frequency of falsely suspected pathologies decreased by 61% (p < 0.05). There was no significant correlation of the objective abilities of a student with his/her self-assessment or of passing the radiology course. CONCLUSION: This study shows that an effective standardized training of practical skills by means of e-learning is feasible and reasonable.