Acromioclavicular (AC) joint dislocation is a frequent injury in sports. A minimally invasive flip-button technique, MINAR (minimally invasive acromioclavicular joint reconstruction), will achieve good clinical and radiographic results in the surgical treatment of high-grade AC joint dislocations. Case series; Level of evidence, 4. In this study, 96 patients with AC joint dislocation grades III through V and minimally invasive flip-button repair were identified. Radiographic assessment was performed by use of the Alexander view and by anteroposterior stress radiograph. Clinical outcomes were assessed with the Constant and Taft scores. Factors that influenced outcomes, such as age, time from trauma to surgery, and degree of dislocation, were evaluated. Of the 96 patients, 83 (86.4%; 3 women and 80 men) were able to participate in clinical and radiographic follow-up. The average age of the participants was 39 years (range, 17-80 years). At a mean follow-up of 39 months (range, 12-78 months), clinical assessment revealed excellent results with a mean Constant score of 94.7 (range, 61-100). Clinical and radiological assessment using the Taft score also showed excellent results, with a mean score of 10.8 (range, 3-12). The mean time period from trauma to surgery was 6 days (range, 0-22 days), and mean duration of surgery was 48 minutes (range, 24-98 minutes). Nine patients (10.8%) underwent revision surgery due to recurrent dislocation (n = 8) or wound infection (n = 1). Radiological assessment showed that 18 patients had sustained a loss of reduction defined as subluxation of 50% of the clavicle shaft width in the vertical plane. However, there was no significant correlation (P = .254) with clinical outcome. Patient age was a relevant factor influencing outcome, as significantly higher outcome values were detected for younger patients (P = .024). No significant influence was shown for the time period from trauma to surgery (P = .336) or degree of dislocation after trauma (P = .987). The MINAR technique is a safe procedure and achieves good to excellent clinical and radiographic results in the surgical treatment of high-grade AC joint dislocations. Despite the simplicity of this technique, the surgeon has to overcome the learning curve to minimize the risk of recurrent dislocation.

Megaprosthetic reconstruction of segmental bone defects following sarcoma resection is a frequently chosen surgical approach in orthopedic oncology. While the use of megaprostheses has gained popularity over the last decades and such implants are increasingly used for metastatic reconstructions and in non-tumor cases, there still is a high risk of long-term complications leading to revision surgery. This article investigates current implant survivorship, frequency and types of complications as well as functional outcomes of upper and lower limb megaprosthetic reconstructions.

Zusammenfassung: Hintergrund: Chirurgische Fachdisziplinen kämpfen mit einem kritischen und sich zuspitzenden Nachwuchsproblem. Potenzielle Berufsanfänger zählen zur Generation Y, die Chefärzte und Personalabteilungen regelmäßig vor große Herausforderungen stellt. Ziel dieser Arbeit ist die Analyse verschiedener Maßnahmen der Personalakquise unter Berücksichtigung erhobener Motivationsfaktoren junger Medizinstudenten.Material und Methoden: Umfrage unter Medizinstudenten des 1. und 9. Fachsemesters (FS) einer medizinischen Fakultät zu individuellen Motivationsfaktoren, der angestrebten Facharztweiterbildung und der gesammelten Berufserfahrung in der Chirurgie.Ergebnisse: Ergebnisse von 179 der 269 befragten Medizinstudenten (66,5 %) konnten ausgewertet werden. Das Interesse an einer chirurgischen Facharztweiterbildung ist im 1. FS hoch (21 %) – fällt jedoch bis zum 9. FS deutlich ab (13 %;p = 0,23). Medizinstudenten, die im 9. FS „Aufstieg und Anerkennung“ gegenüber „flexible Arbeitszeiten“ präferieren, zeigen ein signifikant höheres Interesse an einer chirurgischen Weiterbildung (p = 0,022). Erworbene chirurgische Berufserfahrung wird mit einer durchschnittlichen Schulnote von 2+ bewertet.Schlussfolgerung: Das hohe Grundinteresse an einer chirurgischen Facharztweiterbildung zu Studienbeginn ist ein Wettbewerbsvorteil der Chirurgie. Die vielfältigen Rekrutierungsanstrengungen setzen jedoch oft erst gegen Ende des Studiums an. Zur langfristigen Nachwuchsbindung haben sich insbesondere frühzeitige Programme mit „Hands-on“-Charakter im chirurgischen Kernarbeitsbereich – dem Operationssaal – als erfolgreich erwiesen.

Purpose: Megaprosthetic distal femoral reconstruction (DFR) is a limb‐salvage procedure to address bone loss following two‐stage revision for periprosthetic knee joint infection (PJI). The purpose of this study was to analyze the survival of DFR compared to hinged total knee arthroplasty (TKA). It was hypothesized that DFR was associated with a poorer survival.Methods: In this retrospective single‐center study, 97 subjects who underwent two‐stage revision of chronic knee PJI were included. Among these, 41 were DFR. The diagnosis of PJI was established using the Musculoskeletal Infection Society (MSIS) criteria. Implant survival was calculated using Kaplan–Meier method and compared with the log‐rank test as well as multivariate Cox regression at a minimum follow‐up period of 24 months.Results: The median follow‐up period was 59 (interquartile range (IQR) 45–78) months. Overall, 24% (23/97) of patients required revision surgery for infection. The infection‐free survival of rotating hinge revision TKA was 93% (95% Confidence Interval (CI) 86–100%) at five years compared to 50% (95% CI 34–66%) for DFR. In multivariate analysis, the risk factors for reinfection were DFR reconstruction (HR 4.7 (95% CI 1–22), p = 0.048), length of megaprosthesis (HR 1.006 (95% CI 1.001–1.012), p = 0.032) and higher BMI (HR 1.066, 95% CI 1.018–1.116), p = 0.007). 10% (4/41) of patients undergoing DFR underwent amputation to treat recurrent infection. Conclusion: Megaprosthetic DFR as part of a two‐stage exchange for PJI is a salvage treatment that has a high risk for reinfection compared to non‐megaprosthetic TKA. Patients must therefore be counseled accordingly. Level of evidence: Retrospective observational study, Level IV.