Benulic team BildCrt Benulic from Slovenia spent 2 months at Septic Surgery Ward at Charité - University Medicine Berlin.

 

"Spitzenmedizin! Even if you do not speak German, at the end of your future observership at the Center for Musculosceletal Surgery (CMSC) at the Charite you will know what I am talking about.

Since I am interested in Orthopaedic/Trauma Surgery I decided to visit this renowned clinic, because I wanted to learn more about infections of the musculoskeletal system.

A field, which is becoming, due to the rapidly increasing numbers of implanted joint prosthesis and use of osteosynthetic materials in fracture treatment, a very important challenge in everyday clinical practice. However, despite the severity of this complications and the devastating effects they can potentially have on the quality of life of our patients, their treatment, until today, varies greatly in different parts of the globe.

The team at the Center for Septic Surgery at the Charite, which I had the honor to join, is at the very vanguard in developing and perfecting diagnostic tools and protocols for effective treatment of periprosthetic and implant-associated infections. The basic principle of the latter is the formation of biofilm on foreign surfaces (e.g. artificial joints) from bacteria, in which they persist in a low metabolic state, safe from our immune system and antibiotics. They are therefore up to 1000x more resistant as bacteria in high metabolic states (planctonic bacteria). What makes this department so special and effective are the combined efforts from a specialized orthopaedic surgical team and a team for infectious diseases, which oversees the adequate antibiotic therapy. Only when surgery works together with a carefully planned antibiotic therapy, can a synergistic effect be achieved and thus, a success rate of over 90% in the treatment of infections of the musculoskeletal system.

From the start, the team accepted me as one of their own. The environment has always been towards expending knowledge and perfecting patient care, all in a supportive and friendly way. A contagious feeling, which stimulates ones curiosity and brings out the best in every member of the team. My daily routine consisted of work on the word, where I was able, through rounds and clinical case conferences, to follow the path of the patients from admission to discharge and thus acquire the knowledge of various diagnostic procedures, surgical treatment strategies and adequate antibiotic coverage. Besides that, I assisted with surgeries from a broad spectrum of septic pathologies, from knee, hip, shoulder to long bones implant-associated infections. Having taken part in the everyday care of the patients as well as the surgical treatment itself gave me a broader picture and a good overlook on what infections of the musculoskeletal system are and how many pieces of the jigsaw must be fitted together to produce an optimal clinical outcome. A lot of time patient do not have just an orthopaedic and infectious problem, but also many other comorbidities which need to be taken into account and that is where the true interdisciplinary nature of this field comes into the forefront.

To sum up, an amazing experience is behind me and time has just flown pass, as it always does when one is having a good time. I have learnt a lot from this team, not just about medicine, but also about the importance of a good working environment, team spirit and friendship.
On top of that I had the chance to explore Berlin, the multicultural center of Europe, with its fascinating history, colorful present and an even brighter future.

At this point I wish to thank everyone at the Center for Musculoskeletal Surgery (CMSC) of the Charite for making this observership an absolute pleasure. It was an honor to work and learn beside you. I would, without hesitation, highly recommend a clinical fellowship at the CMSC to everyone with interest in Infectious diseases and/or Orthopaedics."

 

Črt Benulič, University of Ljubljana, Slovenia

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