Auswahl der wissenschaftlichen Literatur zum Thema „Fixation of Seniority“

Loss of reduction remains an important problem after treatment of distal radius fractures, whatever the type of bone fixation. We assessed retrospectively the rate of secondary displacement after external fixation of distal radius fractures in order to identify possible risk factors for instability. We reviewed the pre-operative and serial post-operative radiographs of a retrospective series of 35 distal radius fractures treated by bridging external fixation. When classified according to the Société Française d’Orthopédie et Traumatologie (SOFCOT) criteria, the rate of secondary displacement was 48.5%. At final follow up, the reduction was anatomical in 12% and acceptable in 83%. There was malunion in 5%. The loss of reduction concerned primarily the distal radius palmar tilt and was moderate. No correlation was found with age, gender, type of fracture, degree of initial displacement, associated ulnar fracture, or seniority of the treating surgeon.

Introduction Surgical procedures to manage trauma to the wrist, forearm and elbow in children are very common. Image intensifiers are used routinely, yet studies/guidelines that quantify expected radiation exposure in such procedures are lacking. Methods Information on demographics, injury type, surgeon grade and dose area product (DAP) of radiation exposure per procedure was collected prospectively for 248 patients undergoing manipulation/fixation of injuries to the elbow, forearm or wrist at a paediatric hospital over 1 year. Results DAP exposure (in cGycm2) differed significantly across different procedures (p<0.001): wrist manipulation under anaesthesia (MUA; median, 0.39), wrist k-wiring (1.01), forearm MUA (0.50), flexible nailing of the forearm (2.67), supracondylar fracture MUA and k-wiring (2.23) and open reduction and internal fixation of the lateral humeral condyle (0.96). Fixation of a Gartland grade-3 supracondylar fracture (2.94cGycm2) was associated with higher exposure than grade-2 fixation (1.95cGycm2) (p=0.048). Fractures of the wrist or forearm necessitating metalwork fixation resulted in higher exposure than those requiring manipulation only (both p<0.001). For procedures undertaken by trainees, trainee seniority (between year-5 and year-8 and clinical fellow, p≥0.24) did not affect the DAP significantly. Conclusions The spectrum of radiation exposures for common procedures utilised in the management of paediatric upper limb trauma were quantified. These findings will be useful to surgeons auditing their practice and quantifying radiation-associated risks to patients. Our data may serve as a basis for implementing protocols designed to improve patient safety.

In a recent paper, Schaefer (2007) considered Neomegalotomus simplex (Westwood, 1842: 18) and Neomegalotomus parvus (Westwood, 1842: 19) (Hemiptera: Alydidae) as subjective synonyms – although no specific reason for this was given, except the following statement, after commenting he had seen both types: “I find that N. parvus and N. simplex are the same species, and synonymize them here” (Schaefer 2007: 320). Nevertheless, Schaefer (2007) explicitly invoked a non-existent rule under the International Code of Zoological Nomenclature (hereafter referred to as the Code) to justify his choice of N. simplex as senior synonym (because both names were published in the same work): “by page priority, Neomegalotomus simplex has seniority over N. parvus” (Schaefer 2007: 320). The above interpretation is wrong according to the Code. There is no “page priority” in any article of the Code. When two or more names, spellings, or nomenclatural acts are published on the same date, priority among them, according to the Code, is given either by date or by First Reviser action, not by page number (Articles 24.2.1 and 24.2.2). The only mention to a “page priority” in the Code is Recommendation 69A.10, in Article 69.4, which deals with fixation of type species. This recommendation (the last one in a rank series of 10) states that “all other things being equal, preference should be given to the nominal species cited first in the work, page or line (‘position preference’).” Nonetheless, it does not deal with seniority of synonyms, homonyms, spellings or nomenclatural acts.

The article is devoted to the problems and perspectives of democracy as the form of organization of the social and political existence in general, as well as to the some aspects of the optimization of democracy in the context of the guaranteeing of the social welfare in particular. The real aim of the existence of the democracy was revealed. It was noted that stability is the most important elements of the value of the state. The author pays attention to the advantages of the presidential republic, of the constitutional monarchy, of the «Polybius scheme» of the ideal «mixed» state, of the two-party system, of the indirect elections, of the temporal fixation of the elections and of the absence of the snap elections in the context of the guarantee of the political stability. The optimal model of government, the rational limits of the democracy and its acceptable forms were proposed. The author says that democracy is more or less acceptable only if the laws of the state guarantee the impossibility of the election of the unworthy candidate. The system of the electoral qualifications for the members of the Electoral College as well as for the candidates to the elected positions was recommended. Also, the similar system of the qualifications for the officials of the executive power was recommended. The author says that the republican state should be built «from the below». It was noticed that citizens may make the conscious choice only inside their common during the local elections or during the elections of the members of the Electoral College, when they really know the candidates and their personal qualities. The author recommends the political model, when people elect the members of the Electoral College, and the last one form the local representative organs during the local elections, and after that the local representative organs delegate some their members to the regional representative organs, and the last one delegate some their members and form the parliament of the state. Also, the political model, when the executive power is built «from the below», was recommended. The author says that each official of the executive power should start his service from the primary position in local executive bodies, and that the filling of the vacant positions should be done exclusively on the basis of professionalism, experience, length of service and seniority of the officials, but not on the grounds of the arbitrariness of the highest officials or randomnicity. The main principles of replacing of the post of the head of the state in the parliamentary republic as well as in the presidential republic were outlined. It was noted that the professionalism, experience and the high moral qualities of the officials, and especially of the senior state officials, are the fundament of the effective governance and welfare of society, etc.

I remember so clearly when I first became a member of the American Orthopedic Foot and Ankle Society in the early 1980s. I knew everyone. It was a small organization that facilitated friendships, collegiality as well as academic and professional interaction. Now as then, these incredible friendships that we have all established over the decades define our professional life. For those of you who have been involved in the education of residents and fellows you will understand how relevant this is to your own personal growth. I have always felt strongly that you cannot be an educator unless you’re prepared to listen to your students. In the earlier years of training fellows, it was not much of an age differential, and while there was always a matter of the difference in knowledge and experience, I did not yet have the “seniority”. However, over the decades I’ve learned that some of our closest relationships emanate from these mentoring experiences. Here is a quote from Dr George Quill, a fellow in 1989: “In hindsight, I was doubly fortunate to be only the second surgeon in the world to matriculate with Mark Myerson because, in doing so, I gained a generous mentor and a dear friend for life!” Remember this: as an educator you inevitably give of yourself, but you will also receive something in return. When we share compassion with others, we are all tremendously enriched. Teaching of residents and fellows is a responsibility that we all share. During the formative training particularly of fellows, I want them “to lose their GPS”. Residents learn by repetition, but this encourages sterility without analysis. And by following the acquisition of knowledge blindly without questioning and analyzing the process does not help one grow. This is what I mean about losing your GPS, since sooner or later our fellows need to break away from the mentality of being guided by their mentor’s thinking and develop strategies of their own. I have never been afraid to push the envelope of experiences, and I have always embraced intellectual, personal, academic, and professional challenges. Many of you may have heard me saying that life begins at the edge of your comfort zone. In my practice of medicine, I’ve never felt any room for complacency. To accept everything as given, whether we read it in a prominent journal, or hear it from a colleague is meaningless until we can prove it for ourselves. This I learned from my mentor, Dr. Melvin Jahss who insisted in the early 1980’s that very few things were actually new ideas. He maintained that if one read the literature in depth, particularly in other languages, it was all there. I was reminded this many years later when I “rediscovered” what we knowas today as the Ludloff osteotomy. I was sure that I had performed a new procedure. However, sure enough, my fellow at the time Dr. Hans Trnka found this technique referred to in the German literature, and although my technique was completely different since Ludloff did not use any fixation, the rest is history. Where do new ideas come from? I’m sure that all of you have said to yourselves at one point in time or another “oh, why did I not think of that?” As long as I can remember I have derived immense satisfaction and enrichment from research and investigation, and this passion has never diminished. It has been part of my life and continues to be an integral source of stimulation for me. Many of you do not have the resources nor access to research, but I am sure that all of you wonder about outcomes and results pertaining to your own innovative thinking. Try to share these ideas with others and find like-minded individuals who want to explore new ideas. Some of the most productive times for me have been when I am sitting quietly listening to music. When I go to the symphony orchestra, I scribble research notes and ideas onto the program. Multitasking it’s something that for surgeons comes naturally. Find a quiet time for yourselves and just think, don’t do! As many of you know, I’ve devoted these past years to humanitarian service through an organization which I founded, Steps2Walk (www.steps2walk.org). This has been an extraordinary journey, and I and the others who have supported us either on our medical advisory board, or as surgeon volunteers have all been touched and blessed by this opportunity. The spectrum of deformities which we treat is indeed challenging, but when by performing humanitarian service, one experiences the deep fulfillment that can only come from improving the lives of others. I truly believe that you cannot experience your practice of orthopedic surgery nor reach your potential until you do something for someone who can never repay you. Steve Jobs said that “the people who are crazy enough to think that they can change the world are the ones who do”.

Introduction When using radiation intraoperatively, a surgeon should aim to keep the radiation dose as low as is reasonably achievable to obtain the therapeutic goal. We aimed to investigate factors associated with increased radiation exposure in fixation of proximal femur fractures. Methods We assessed 369 neck of femur fractures over a 1-year period in a district general hospital. All hip fracture subtypes that had undergone surgical fixation were included. We assessed the relationship between type of fracture, implants used and surgeon level of experience with the dose–area product (DAP; cGy/cm2) and screening time (dS). We also looked at the quality of reduction and fixation and its effect on the radiation exposure. Results A total of 184 patients were included in our analysis; 185 patients who were treated with hip arthroplasty were excluded. There was a significant association between higher DAP and fracture subtype (p = 0.001), fracture complexity (p < 0.001), if an additional implant was used (p = 0.001), if fixation was satisfactory (p = 0.002) and operative time (p < 0.001). DAP was higher with a proximal femoral nail than with a dynamic hip screw, especially when a long nail was used. There was some evidence of an association between the surgeon’s level of experience and DAP exposure, although this was not statistically significant (p = 0.069). Conclusions Increased radiation in proximal femur fractures is seen in the fixation of complex fractures, some subtypes, with certain types of implants used and if an additional implant was required. Surgeon seniority did not result in less radiation exposure, which is in contrast to other published studies.

Abstract Introduction The recently developed femoral neck system (FNS) for treatment of femoral neck fractures (FNF), comprises theoretical biomechanical advantages compared to other implants. The aim of this study was to validate the safety and to report outcomes of patients treated with the FNS. Method A retrospective multicentric analysis of patients treated by FNS with a minimum of three months of follow-up. Details analysed from three medical centres were operative duration, estimated blood loss, initial hospitalisation duration, fixation quality as well as complications and reoperation rate. Patients who had revision surgery were compared to all other patients to identify risk factors for failure. In addition, a literature review was performed to analyse data on FNS clinical implementation and patient’s outcomes. The two data sets were combined and analysed. Results One-hundred and two patients were included in this study cohort with an average follow-up of seven months (range 3–27). Ten papers were included in the literature review, reporting data on 278 patients. Overall, 380 patients were analysed. Average age was 62.6 years, 52% of the fractures were classified as Gardens 1–2. Overall, the revision rate was 9.2% (14 patients diagnosed with cut-out of implant, 10 with AVN, 8 with non-union and 8 with hardware removal). For the 102 patients in the cohort risk factors for reoperation included patients age, surgeon seniority and inadequate placement of the implant. Conclusion This study shows that FNS is a safe treatment option for FNF. Intra-operative parameters and failure rates are comparable to previously reported rates for this implant and other frequently used implants.