[Increasing Number of Road Traffic Fatalities in Germany - Turnaround or Snap-Shot]. / Warum wieder mehr Menschen im Straßenverkehr sterben ­ Trendwende oder Ausreißer?

Introduction: For the first time since 20 years, the number of road accident fatalities in 2011 increased on German roads compared to earlier periods. Methods and Results: The presented paper submitted by the expert group for accident prevention investigates and discusses possible reasons for the observed increase in road traffic fatalities. Results: Climate changes as well as changes in economic environment, and technological progress in car and passenger safety are identified as possible reasons for the observed increase. Discussion: Mentioning the "Decade of Action for Road Safety" initiated by the UNO and coordinated by the WHO, the overall goal is a worldwide reduction of accident related road fatalities. But prognostic calculations predict an asymptotic approximation to a limit of road fatalities. To achieve a reduction by half until 2020 intense collaboration and disproportional expenditure are necessary. Conclusion: From the authors' point of view the current increase of traffic fatalities in Germany is rated as a snapshot rather than a turnaround.

[Intercalary reconstruction for diaphyseal bone defects with a modular replacement system: Clinical results]. / Interkalare Rekonstruktion diaphysärer Knochendefekte mit einem modularen Diapyhsenersatzsystem: Klinische Ergebnisse.

OBJECTIVE: Reconstruction and long-term stabilization of segmental diaphyseal bone defects of the humerus, femur, and tibia. INDICATIONS: Segmental bone defects due to aggressive benign or primary malignant bone tumors, trauma, pathological fractures, osteomyelitis, or failed osteosynthesis. CONTRAINDICATIONS: Acute or chronic local infections, large metadiaphyseal bone defects preventing adequate anchorage of the prosthesis, very short life expectancy (<3 months). SURGICAL TECHNIQUE: Exposure and resection of the bony defect according to the preoperative planning. Reaming of the intramedullary canals proximally and distally followed by implantation of the stems (cemented or noncemented). Reducing sleeves can be used to bridge the difference in diameter between the nail and the spacer. Mounting of the spacer half shell with the threaded holes from underneath after adjusting for alignment and rotation. Assembling of the other half shell by guided pins to ensure proper alignment. Tightening of the clamping screws using a torque screwdriver. Connection of two spacers is possible. POSTOPERATIVE MANAGEMENT: Active physiotherapy and full weight bearing; antibiotic prophylaxis. RESULTS: The results of 14 consecutive patients treated with 15 modular intercalary endoprostheses (Osteobridge™, Merete, Berlin, Germany) between January 2007 and January 2012 with a mean follow up of 24 ± 12 months (range 12-51 months) were evaluated retrospectively. One patient had a primary malignant bone tumor, while all the other patients underwent resection for metastatic disease. The mean age at surgery was 65.9 ± 15.7 years (range 25-83 years). The mean diaphyseal reconstruction length was 110 ± 50 mm (range 50-190 mm). Three patients (20%) required revision of the distal stem due to aseptic loosening. Evaluation of the functional outcome using the MSTS score by Enneking revealed 3 very good (22%), 7 good (50%), 4 fair (28%), and no poor results.

[Accidents, illness and injuries involved in road haulage : consequences for medical care and prevention]. / Unfälle, Erkrankungen und Verletzungen im Güterkraftverkehr : Konsequenzen für die medizinische Versorgung und Prävention.

This article reviews basic characteristics of road traffic crashes of heavy vehicles and the current health status of truck drivers. It summarises previous findings from research with a focus on orthopaedic diseases and injuries. These findings comprise a risky health behaviour and high prevalence of associated diseases which can be attributed to both the occupational framework and personal risk-taking behavioural patterns. These are of major importance given the increasing number of drivers and the consequences for acute care and prevention. On the other hand there is a substantial lack of medical care for the drivers on the road. Therefore this article presents the"DocStop Initiative" for medical care on the road, an initiative that runs an international network of care providers (http://www.docstop-online.eu).

[Prevention of road accidents involving non-motorized traffic participants (pedestrians and cyclists) in Germany]. / Prävention von Verkehrsunfällen äußerer Verkehrsteilnehmer (Fußgänger und Fahrradfahrer) in Deutschland.

During a 1-day workshop organized by the German Society of Orthopaedics and Traumatology (DGOU) 15 German accident researchers used different approaches to improve the effectiveness of accident prevention for pedestrians and bicyclists on German roads. The main results of this analysis show: Fatal injuries of pedestrians have been significantly reduced by 82% between 1970 (n=6.056) and 2007 (n=695). Similarly, fatalities of bicyclists have been reduced during the same time period from 1,835 to 425 which amount to almost 80%. However, the total number of injured cyclists increased almost twice, i.e. from 40,531 (in 1979) to 78,579 (in 2007) a fact that needs to be analyzed in more detail. Although scientifically proven to provide protection against severe head injuries, helmets are worn less frequently by adolescents and women as compared to younger children and men. Fatalities of bicyclists might be reduced by using Dobli mirrors which allow the truck driver to see the bicyclist when turning right. Recently developed sensors are able to detect pedestrians walking closely (<2.5 m) and warn the truck driver acoustically. Bicycle lanes should be planned for one direction only, separated from the pedestrian way and large enough (2.0 m are safer than 1.6 m). Traffic education for school beginners and younger children should be repeated to be effective. Training for elderly bicyclists in cities with heavy traffic would also be reasonable. Active security systems in cars like ESP (electronic stability program), BAS (brake assist system), special light systems for curves, and night vision utilities are most effective to prevent collision with pedestrians and bicyclists. TV spots for bicyclists could help to point out dangerous situations and the proven benefits of wearing a helmet in the same way as previous campaigns, e.g."The 7th Sense" for car drivers.

[Enhanced automatic collision notification system. First field experience]. / Automatische Unfallmelder. Erste Erfahrungen aus der Anwendung.

Motor vehicle accidents are the leading cause of severe injuries. Outcome of these victims is substantially influenced by rescue time and primary trauma centre care. Nowadays, automatic crash notification systems (ACN) are available offering the major possibility of immediate initiation of the rescue chain and thereby shortening rescue time up to 50%. According to the EU commission a nationwide equipping of motor vehicles with automatic crash notification systems could save up to 2,500 lives per year. Therefore, all new vehicles should be equipped with an automatic crash notification system by 2014. BMW is the first manufacturer to install an enhanced automatic crash notification system (eACN), which could optimize the rescue triage by estimating the risk for severe injuries (MAIS3+) based on telemetric transmitted accident data.

[Is the structure of surgical clinics in Germany changing? A current investigation into the structure of surgical clinics in the Federal Republic of Germany]. / Gibt es einen Wandel in der Struktur chirurgischer Kliniken in Deutschland? Eine aktuelle Untersuchung zur Struktur chirurgischer Kliniken in der Bundesrepublik Deutschland.

Medical developments have led to extensive specialization in the field of surgery. This has already been reflected for many years in altered structure and organization forms of surgical clinics. Indispensable quality standards, statutory general conditions, increasing competition in service providers and health insurance with transparency of the service procedure all intensify this trend. The aim of this investigation was, therefore, to determine how far this differentiation of service supply in the field of surgery is also reflected in the area and in surgical departments and clinics of basic and routine supply. To achieve this, all available published information on the structure and organization of surgical clinics in the Federal Republic of Germany was classified according to current departmentalization into "undivided" or general/visceral surgery facilities compared to orthopedic/trauma surgery departments.

[Treatment of femoral bony defects with a modular hip prosthesis and distal interlocking]. / Der Einsatz einer modularen Hüftprothese (MHP) mit distaler Verriegelungsmöglichkeit bei Knochendefektsituationen des Femurs.

Patients with bony defects of the proximal femur after trochanteric fracture, implant failure (cut-out), periprosthetic fracture or aseptic loosening of prosthesis are difficult to treat with primary or revision endoprosthesis. Modular femoral hip prosthesis (MHP) with stems of different length and the possibility of distal interlocking screws are an operative solution for those patients. In a prospective study from January 1996 to January 2002 all patients treated with a MHP because of proximal and / or distal femoral bony defect or fracture were included. Follow-up after 6 to 30 months was evaluated clinically and radiologically in hospital. Change of modified Harris Hip Score and radiological signs of loosening (radiolucent line, migration of MHP, breaking interlocking screw) were documented. 106 patients with a follow-up of 58.5 % were included in the study. At time of follow-up clinical and radiological outcome after trochanteric fracture was good. Harris Hip Score was comparable to the situation of patients before fracture, only one MHP was loose. However in patients after revision arthroplasty 25 % of MHP were loose and in many patients the interlocking screw was broken. Distal interlocking screw in MHP prevents stability after trochanteric fracture to achieve osseointegration. However in case of periprosthetic fracture or revision arthroplasty MHP shows insufficient stability in many cases.

[Injury prevention as the physician's challenge]. / Prävention von Verletzungen als ärztliche Aufgabe.

In Germany, more than 9 million individuals yearly sustain injuries and more than 30,000 fatal injuries. Based on estimations, preventive measures could avoid more than one half of all accidents and could influence the other half of the accidents such that the injuries caused are minor. The aim of an initiative of the Study Group on Injury Prevention of the German Trauma Society (DGU) is a complete inventory of all prevention programs from different expert groups in Germany. A synopsis of the gathered knowledge should serve as a basis for further interdisciplinary preventive measures. The consistent interdisciplinary orientation of this program is a special characteristic including trauma surgery, orthopedics, pediatric surgery, pediatrics, sociology, legal medicine, psychology, sports medicine, geriatrics, anesthesiology, and others. Special attention was also directed to the age groups of children/adolescents and the elderly.

[Has anything changed in the quality of continuing education in orthopaedic/trauma surgery? Evaluation 1 year after implementation of a new code of practice for resident training in orthopaedic/trauma surgery in Bavaria]. / Hat sich etwas in der Qualität der orthopädischen/unfallchirurgischen Weiterbildung geändert? Umfrage zur Weiterbildung zum Facharzt für Orthopädie/Unfallchirurgie 1 Jahr nach der Einführung einer neuen Weiterbildungsordnung in Bayern.

OBJECTIVE: It was the aim of this study to evaluate any changes in the quality of orthopaedic/trauma training 1 year after implementation of the new code of practice for resident training in Bavarian clinics. METHODS: A questionnaire was prepared by the Educational Committee and the Junges Forum of the German Trauma Society and sent to all 120 instructors (and their medical staff) for resident training in Bavaria for general surgery, trauma surgery as well as orthopaedic/trauma surgery on July 26 2005. RESULTS: While 56% of the chairmen claimed to perform a structured, curricular training, only 18% of the residents could verify this. In a similar manner, the majority of chairmen were satisfied with the new code of practice for resident training, while the majority of residents and attendings were not. CONCLUSION: One year after implementation of a new code of practice for resident training in Bavaria, surgical training structures are not well established. There is a large discrepancy in the evaluation of training quality between chairmen and residents. It is therefore imperative to develop recommendations for structuring orthopaedic/trauma training.

Biomechanical evaluation of a bioabsorbable expansion bolt for hamstring graft fixation in ACL reconstruction: an experimental study in calf tibial bone.

INTRODUCTION: The purpose of our study was to evaluate and compare the primary fixation strength of a novel bioabsorbable two shell expansion bolt (EB) with that of a well-established interference screw-fixation technique in hamstring reconstruction of the anterior cruciate ligament. MATERIALS AND METHODS: Thirty calf tibia plateaus (age 5-6 months) were assigned to three groups: In group I (n = 10) triple-stranded hamstring grafts were fixed with titanium interference screws (7 mm thread / 8 mm head x 25 mm). Specimens of group II (n = 10) received bioabsorbable poly-L-lactide interference screws (8 x 23 mm). In group III (n = 10), the grafts were fixed using bioabsorbable poly-D,L-lactide expansion bolts (5.8/8.5/10 mm x 35 mm). The tensile axis was placed parallel to the bone tunnel. The construction was then loaded until failure under a displacement rate of 1 mm per second. RESULTS: There were no significant differences concerning the maximum pullout force (group I: 357 N +/- 61; group II: 326 N +/- 92; group III: 343 N +/- 55). In case of the expansion bolt, we found the stiffness to be higher (61 N/mm) when compared to group I (48 N/mm), and group II (52N/mm) (P < 0.01 I vs. III). Using interference screws, we were able to demonstrate a strong correlation between torque and pullout forces (group I: r2 = 0.7; group II: r2 = 0.92). Ruptures of the suturing material occurred only in groups I and II. CONCLUSION: We conclude that hamstring graft fixation, using the presented expansion bolt, demonstrates fixation strength similar to the established screw fixation and can therefore be regarded as a reasonable alternative fixation method. Especially, since some specific disadvantages of screw fixation can be prevented by application of the bolt fixation.

[Change of daily life activity after femoral hip fracture in elderly patients]. / Veränderung der Lebenssituation des alten Patienten nach koxaler Femurfraktur.

Hospital mortality after hip fracture in elderly patients has decreased significantly in previous years. However, patients often show reduction of daily life activity. The aim of the following study was to assess clinical and radiological results nine months after operation of hip fracture. A total of 127 patients (mean age 77.2 years) were stabilized by arthroplasty because of femoral neck fractures or by gamma locking nail because of trochanteric fractures. Modified Harris-Hip-Score as well as social situation at time of follow-up compared to pretrauma situation were evaluated. Hospital mortality was 3.2 percent. Follow-up could be performed in 78 patients clinically and radiologically by examination in the hospital. At time of follow-up 19.7 percent of patients had already died independent of the operative procedure. Only 65 percent of patients were able to live at home. Modified Harris-Hip-Score at follow-up was decreased significantly by 16 points compared to the situation before the trauma. The reduction of the score was caused mainly by deterioration of hip function and less by femoral or hip pain. In future the main scope after hip fracture must be an improvement of rehabilitation of elderly patients.

Bioabsorbable expansion bolt fixation in anterior cruciate ligament reconstruction.

The current study evaluated initial fixation strength of a bioabsorbable expansion bolt compared with interference screw fixation in anterior cruciate ligament reconstruction using a bone-patellar tendon-bone graft. Thirty calf tibial plateaus with adjacent patella and extensor ligaments were used. Bioabsorbable poly-L-lactide interference screws were used for graft fixation in Group I, titanium screws in Group II, and bioabsorbable poly-DL-lactide expansion bolts were used in Group III. The mean force-to-failure (+/- standard deviation) in the three groups was 487 +/- 205 N, 713 +/- 218 N, and 594 +/- 224 N, respectively. The differences between Groups I and II were significant. No statistical differences were found regarding stiffness. Graft damage was significantly less in Group III compared with screw fixation. The fixation concept of an expansion bolt shows similar fixation strength and less graft damage compared with the established interference screw fixation. Because of the total absence of torque forces in contrast to bioabsorbable screws, the risk of implant breakage is minimized.

[Injury prevention in the elderly population]. / Prävention von Verletzungen im Alter.

Injuries in the elderly population have more considerable consequences (more difficult treatment, higher costs,worse outcome) than in the younger population. Therefore, the prevention is especially important. The majority of the injuries are caused by traffic accidents and falls. TRAFFIC ACCIDENTS: An analysis of the current injury situation in elderly road users (65 years and older) involved in road traffic accidents was intended to allow conclusions regarding future prophylaxis. FALLS: Falls are mostly caused by numerous factors. The most important predictors for falls are dementia,Parkinson-Syndrome and neurologic deficits after cerebrovascular insults. The most important symptoms, that indicate an increased risk for fall are gait abnormalities, balance lack and underweight. The most important anamnestic indications are more than one falls in the recent 90 days, need for assistance in daily living and prevailing medication. Another important factor is the residential setting (lighting, stairs, floor conditions,bath installations). The most affective protective interventions involve multiple factors. The incidence of falls could be reduced by 30%. The hip protector is an effective protection against proximal femur fractures. which is the most frequent fracture in the elderly population that requires treatment as an inpatient. Injury prevention in the elderly population is an interdisciplinary task as for example shown by the successful fall clinics in the anglo-american area.

[The femoral neck fracture in the elderly patient - cemented or cementless hip arthroplasty?]. / Die Schenkelhalsfraktur des alten Menschen - zementierte oder unzementierte endoprothetische Versorgung?

This is a report on the treatment results of femoral neck fractures with a cemented (group 1) and cementless (group 2) type of hip prosthesis, resp. 72 patients were enrolled. 35 patients were treated with a cemented hip prosthesis (mean age: 78 years), and 37 patients with a cementless modular hip prosthesis (mean age: 77 years). In the cemented group we observed 5 cases of hypotension during insertion of the prosthesis in the femoral shaft. One of these patients required mechanical resuscitation during surgery. In the second group 3 cases of proximal femur fissure and one case of distal femoral fracture were recorded. One year after surgery 43 patients presented for follow up evaluation (cemented group: n = 24; cementless group: n = 19). Both groups revealed comparable results according to the Harris Hip Score (75 versus 78,3 points). No prosthesis loosening was observed in either group. In our view the cemented hip prosthesis is the treatment of choice for femoral neck fractures among the old and very old, if no stabile osteosynthesis can be performed. Patients with cardiopulmonary risk factors, however, may profit from cementless hip arthroplasty to avoid the well known cardiodepression during surgery.

[ACN (Automatic Collision Notification)--reducing fatalities in traffic accidents by automated accident reporting]. / ACN--Reduzierung von Toten im Strassenverkehr durch automatische Unfallmeldung.

To improve patient's outcome of seriously injured occupants after vehicle accident rescue should be performed as soon as possible. While the rescue-time-period after EMS alarming is well-defined the rescue-time-period before EMS-alarm is very variable from minutes to several hours. To reduce the rescue-time-period between accident occurrence and EMS-alarm the Automatic Collision Notification (ACN) was developed. The ACN is a new invehicle-equipment which detects a severe vehicle crash and alarms via cellular phone the EMS automatically. Simultaneously the exact accident location is transmitted (GPS). Official data of the European Community predict a 15% reduction of road traffic fatalities with ACN. Thereby the economical benefit of about 561 million [symbol: see text] could be calculated for Germany 2000.

[Changes in bone density of the femur after cement-free implantation of a modular hip prosthesis with a long shaft]. / Veränderung der Knochenmasse des Femurs nach zementfreier Implantation einer modularen Hüftprothese (MHP) mit langem Schaft.

Until now, no reports exist on the existence of femoral bone loss after hip arthroplasty using long-stem cementless prostheses in elderly patients. In a prospective evaluation the amount of bone loss (stress-shielding) after implantation of a long stem hip prosthesis in patients with femoral neck fractures (group A) or pertrochanteric femoral fractures (group B) was examined. Eleven patients (five from group A and six from group B) were treated with a long-stem modular hip prosthesis (MHP). Change of bone mass was evaluated using quantitative computed tomographie (QCT) immediately following and at six months (group A and B) and twelve months (group A) after implantation of the prosthesis. Clinical results, expressed with the modified Harris Hip Score, and relative changes of bone mass were compared with mean periprosthetic bone mass of the femur after operation. After implantation of the MHP, the maximum decrease of mean femoral bone mass was 19.1% at six months and 20.2% at twelve months for group A and 29.5% at six months for group B. Bone loss in the proximal periprosthetic area was higher than in the distal part. There was no correlation between baseline values of bone mass and the amount of stress-shielding or clinical outcome.

Metastatic lesions of the humerus treated with the isoelastic diaphysis prosthesis.

Between January 1, 1987, and December 31, 1997, an isoelastic polyacetal resin prosthesis was used in 50 patients with metastatic bone disease to reconstruct pathologic or impending fractures of the humeral diaphysis. Fifty-seven operations were performed, including seven revision surgeries. The patients were assessed before and after surgery for limb function and quality of life using a modified Karnofsky scale. The mean survival time was 440 days. Ninety-one percent of the operations resulted in restoration or improvement of quality of life. Limb function was good or excellent in more than 80% of the patients after surgery. Breaking of the implant (n = 3), loosening of the implant (n = 2), periprosthetic fracture (n = 1), hematoma (n = 2), infection (n = 1), and one radial nerve paralysis were the main complications. In the cases of implant failure, the prosthesis broke at the site of a locking screw that was inserted across the prosthetic shaft in the cementless implantation technique. This kind of complication could be avoided by using bone cement for implantation or additional plate osteosynthesis between the prosthesis and humeral shaft. The isoelastic diaphyseal prosthesis offers a promising method of treating patients with metastatic lesions of the humeral shaft.