24-25 March 2011
“Every operation is a huge responsibility for further full life of the patient”
Within the framework of the II Moscow International Congress of traumatologists and orthopedists “The Road Traffic Accidents Injuries and Their Sequels: Pitfalls, Mistakes and Complications in Treatment” that will take place on March 24-25, 2011 the press - service of the event organizes interviews and meetings with the best specialists in the fields of traumatology and orthopedics. Thus, we’ve asked several questions to one of the members of the Organizing Committee of the Congress – Dr. Pape Hans-Christoph, professor, Director of the Clinic of Traumatology and Orthopedics, Clinic of Aachen University (Germany).
Dr. Pape, what is the general line of your work and research, what are the main topics that were targeted during your professional career?
First of all, the general line, or motto, I would say, of any doctor’s work is to help those who need medical help. A man can be a very fragile creature. So, the main topics are the management of complex injuries and malunions as well as complications after injuries to the spine, pelvis and extremities. Three books were published so far. They deal mainly with difficult situations after fractures and bone malformations.
Also, I’d like to mention that the period of recovering after an operation is as important as the surgery process itself, considering psychological condition of a patient. And very often the “after- period” needs more management and attention.
How many people did you operate in total? What was the success rate of their recovery?
Well, there were about 6000 operations in the regions addressed above. We did everything that we could and had to do. And sometimes even more. We did not let anybody leave a patient’s room until we were sure that the person is fine. The rest of the recovery process is the responsibility that family and friends should take, with our help surely.
What was the most difficult operation that you had in last 10 years? How is the patient doing now?
I have to mention that every operation is a huge responsibility for further full life of the patient. The most complex cases were 2 revision surgeries, one from a spine fracture deformity and one from a pelvic deformity. Both patients have healed and are back to work right now.
Another patient with a rotational deformity of both the femur and the tibia with 6 cm shortening were submitted to an Ilizarov procedure and the patient is also back to work now. They are fine.
What are the most common methods that you use towards the patients, do all your colleagues agree on these methods? Please shortly describe the process.
There are certain things that have been proved to be the most effective method in every field. So, in femur fractures, I usually use an intramedullary nail and this is the accepted standard of care.
Do new technologies make a big difference in the way Traumatology developed in last decade? What would you name the biggest brake though in Traumatology lately?
The development of locked plating is among the major advances made in traumatology. Locked plates are indicated for high-energy fractures, those with severe comminution and in osteoporotic injuries. Historically, fractures of the tibial plateau involving both condyles have required extensile exposures, dual plating and large-fragment implants, which have led to wound dehiscence, infection, articular collapse, nonunion and malalignment. Inborder to minimise soft-tissue injury, percutaneous techniques such as the use of femoral distractors, Kirschner wire joysticks and percutaneously applied reduction forceps is indicated to manipulate the major condylar fragments. Laterally-based locking plates provide increased stability in the presence of metaphyseal or metadiaphyseal comminution, and may offer an alternative to an additional medial plate or external fixator for added support of the medial column when a non-locking plate is used for bicondylar fractures. The studies suggest that while isolated lateral locked plating may offer a more biological approach to bicondylar fractures, and may provide a viable alternative for open fractures with a medial wound or fractures with tenuous soft tissues, classical dual plating remains the most rigid construct. The surgeon must assess which fixation is best suited for the pattern of bony and soft-tissue injury and the overall medical condition of the patient.
Does Germany have a leading position in Road Traffic Trauma recovery among other European countries? What makes it possible? Could you give us some statistics and numbers?
The German system has achieved a great deal in the management and rehabilitation of these patients. There has been a reduction in mortality in patients from 28 % in 1980 to only 13 % in 2010. The logistics of trauma care and the implementation of the damage control techniques have greatly improved survival. I believe, all that would take longer to achieve without support of medical institutions and their researchers.
What do you consider an important direction in which Traumatology has to develop in the future? Where do doctors have a need for more scientific research and new ways of healing patients?
Every trauma itself is a complex of traumas later…It is quite difficult to name just one direction. The development should be a complex and integrated process. However, I think, improvement the techniques of minimal invasive surgery is the priority.
How do you see the cooperation among professionals in Russia and Germany? What should be done by governments, what should be done by doctors themselves?
There should be an exchange of doctors and of knowledge. Young specialists could learn a lot from their older colleagues. The information of certain difficult patients could be shared by email or by web conferences and common plans can be made on these patients. In this regard, organizing international events, meetings, conferences, and exhibitions is very important.
Do you think that International Congress in Moscow will help solving any of the issues?
The Congress will certainly help to share information about the complex fracture situations that we are dealing with today. I believe it will become the place for meeting outstanding professionals of the field, for implementing new ideas and technologies.
What would you say to doctors, who are coming to the Congress?
Please bring examples of difficult cases. These could be discussed while the Congress is going on – or during a special session. Most participants in previous courses have been very eager to discuss their cases with the audience and with experts in that particular field. Please discuss the questions that you have had in particular situations with your colleagues and the faculty. That would make the Congress even more special and more interesting for the participants.