The 2010 Austrian-Swiss-German (ASG) Traveling Fellowship Tour took place between April 5 and May 2, 2010. As is customary, all stops on the tour included visits to the operating rooms and clinics, scientific exchange programs, and time for sightseeing and socializing. The tour began in Munich, Germany, and proceeded to Würzburg, Germany; Salzburg and Vienna, Austria; Berlin, Cologne, Bonn, Düsseldorf, and Heidelberg, Germany; and Basel, Switzerland. It culminated at the Annual Meeting of the Southern German Orthopaedic Association in Baden-Baden, Germany. Traditionally, there have been two American fellows, one British fellow, and one Canadian fellow. This year, the Canadian Orthopaedic Society chose not to send a fellow. Because of unforeseen circumstances, including the eruption of the Icelandic volcano that interrupted European air traffic for several weeks, one of the American fellows, Scott Steinmann, MD, a shoulder and elbow specialist from the Mayo Clinic in Rochester, Minnesota, was able to participate only in the last week of the tour. So, for the initial three weeks of the trip, there were just two traveling fellows, Raghuram Thonse, MD, a total joint arthroplasty specialist currently practicing in Oxford, England, and the author, Susan Scherl, MD, a pediatric orthopaedist at the University of Nebraska in Omaha (Fig. 1).
Our first stop was Munich, Germany, where we were hosted by Dr. R. Gradinger of the Technical University of Munich (TUM) and Dr. A. Imhoff of Ludwig Maximillian University (LMU). Dr. Thonse arrived the evening of April 5, a day before I did, and spent April 6 in the operating room at TUM. On my arrival, I was taken directly to TUM for the first of the tour's many scientific sessions. I presented "Pediatric Orthopaedic Problems Related to Childhood Obesity," and Dr. Thonse presented "Antibiotic Cement-Coated Nails in the Treatment of Infected Nonunion." (We each brought five to seven talks with us, but found that the local hosts all tended to request the same two to three talks, so we ended up repeating them each several times.) After a brief walking tour of the inner city, and a stop at the famous Hofbräuhaus, we met with the faculty of both institutions for dinner at a typical Bavarian restaurant. The next day, we visited LMU. Dr. Thonse went to the operating room to observe total joint replacements, and I went to the pediatric orthopaedic clinic of Dr. Utzschneider. After a tour of LMU's impressive biomechanics laboratory, we attended another scientific session, where I spoke on "Pediatric Elbow Fractures" and Dr. Thonse spoke on "Ultrasound Screening for Developmental Dysplasia of the Hip." After hearing interesting presentations from our hosts on polyethylene wear and the "cluster-pillar" model of the proximal part of the femur, and enjoying some lively discussion, we headed back to the train station and on to Würzburg.
We had a wonderful visit in Würzburg (April 7, 8, and 9), with a perfect combination of time at the hospital and sightseeing. On April 8, we visited the operating rooms, where we had the opportunity to observe a wide variety of cases, including a shoulder arthroplasty and bunion reconstruction. We also gave our lectures; Dr. Thonse presented "Antibiotic Cement-Coated Nails for the Treatment of Infected Nonunion," and I presented "Musculoskeletal Infections in Children." We had a great tour of the molecular biology laboratory. In the evening, our hosts, Drs. Rudert, Noeth, and Luedemann, took us to Rothenburg, a medieval walled city that dates to the 1300s. We had a guided tour by the town "executioner," and learned a lot about life in the middle ages. We then had dinner at a local hotel restaurant. On April 9, it was back to the operating rooms in the morning, where I observed a complicated forefoot reconstruction performed by the chief, Dr. Rudert, as well as ankle ligament and acromioclavicular joint ligament reconstructions. In the afternoon, we took a guided tour of the Residenz, a baroque palace that features a ceiling fresco by Tiepolo, and then took in the beautiful view from the Festung, a medieval fortress overlooking Würzburg. Finally, we went to dinner at the restaurant of a vineyard and sampled the local Sekt (champagne), wine, and cuisine. There, we also had the opportunity to meet Dr. Eulert, one of the first German ASG fellows.
We traveled to Salzburg on Saturday, April 10, and had time to take a walk through the Mirabell Gardens (the setting of the "Do-Re-Mi" scene in the movie The Sound of Music) and take in a chamber music concert at the Baroque Museum. On April 11, we did more sightseeing, including a visit to the famous Festung Hohensalzburg (fortress) that sits above the city and to Mozart's birthplace, prior to meeting our host, Dr. Dorn. On April 12, we headed to the operating room, where we observed a Tönnis pelvic osteotomy expertly performed by Dr. Neumann. An interesting scientific session followed in the afternoon, where Dr. Thonse and I each gave two talks. We then proceeded to dinner at a local restaurant with Dr. Dorn and his wife. In the morning on April 13, we had a tour of the brand-new Paracelsus Medical School, including their impressive anatomy department. Another highlight was the Synthes engineering laboratory, where prototype implants can be designed and fabricated in a matter of days. After a quick lunch and final stroll through town, we headed for the train station, where we boarded a train for Vienna.
Highlights of our stay in Vienna (April 14 through 17) included two days spent at the Allgemeines Krankenhaus, the enormous hospital of the Medical University of Vienna. On April 14, we gave our talks at grand rounds, and then I went to the pediatrics outpatient clinic with Dr. Catharina Chiari and later observed a tumor case in the operating room. That evening, we went to a typical Viennese wine bar, or Heurigen, for dinner. The next day, I observed Drs. Windhager and Chiari performing a fibular hemimelia reconstruction. Afterward Dr. Chiari took us for lunch and sightseeing on a bus tour to some of the famous sights of Vienna's inner ring. That evening, we had dinner at a restaurant overlooking the Stephansplatz and the famous cathedral. On April 16, we were hosted at the Speising Orthopaedic Hospital, under the direction of Dr. Franz Grill. After our morning talks, I observed Dr. Grill performing a femoral derotational osteotomy. We then listened to presentations by Drs. Grill and Ogon, had a tour of the beautiful buildings and grounds, and then headed out with Dr. Alexander Tuschel for a visit to the Belvedere Palace and dinner at a traditional restaurant in the city center. Our last day was left free for us to explore Vienna. However, because of the Icelandic volcano's disruption of European air travel, we were concerned our flight to Berlin might be cancelled, so we spent two hours at the train station to reserve tickets for the following day. It turned out to be time well spent because our flight was indeed cancelled. We then visited the St. Stephan's cathedral, stopped at the open air Naschmarkt for lunch, and took a guided tour of the Vienna State Opera House. That evening I fulfilled a personal dream and went to a wonderful performance of Prokofiev's "Love for Three Oranges" at the less formal Volksoper.
On April 18, we took a ten-hour train ride to Berlin. Early the next morning, we headed to Charité Hospital, which has four campuses spread across the city. After x-ray rounds in the morning, I headed to Charité’s pediatric hospital with Dr. Placzek. I spent the day observing in his clinic and also in the multidisciplinary spasticity management clinic. We headed back to the main campus to give our talks and listened to interesting presentations from the faculty on low-dose key-muscle treatment with botulinum toxin for cerebral palsy, and unicondylar knee arthroplasty. Because we had missed our opportunity to sightsee the day before, Dr. Thonse and I did a very quick self-guided tour on the way to dinner. We passed by the Reichstag, the Brandenburg Gate, and the Holocaust Memorial, and ended at Gendarmenmarkt, where the restaurant was located. On April 20, we visited Auguste-Viktoria Klinikum, where I observed an adult spine decompression and fusion performed by Dr. Kienapfel.
We spent the next several days (April 21 through 24) in the North Rhine Westphalia area and visited three cities in three days: Cologne, Bonn, and Düsseldorf. On April 21, we were in Cologne, where I observed a cervical vertebral resection performed by the chief, Dr. Eysel. In the evening, we took a walk along the Rhine and then went to the old town for a tapas dinner. On April 22, it was on to Bonn, where we observed some trauma cases and then headed out with our host, Dr. Kowalski, for sightseeing. Dinner was at a traditional Brauhaus with members of all three faculties. The tradition there is to order the local beer, Kölsch, which comes in small glasses, by the meter (especially for a group). They also offer various kinds of sausage by the meter. April 23 was spent at the Uniklinik Düsseldorf, where I observed a revision reconstruction of a clubfoot deformity performed by Dr. Westhoff. Then we had a lovely lunch and a great scientific session. After our presentations, we heard talks on research on Legg-Calvé-Perthes disease, navigated shoulder arthroplasty, and stem-cell therapy. On April 24, we were treated to a full day of sightseeing in Cologne, accompanied by our host, Dr. Springorum. We started with a guided tour of the famous cathedral, stopped for lunch at a Brauhaus, and then continued the walking tour through the old city. It was a wonderful way to finish off our visit to the North Rhine Westphalia region.
On April 25, we boarded an early train to Heidelberg, which traveled the scenic route next to the Rhine River. That evening, we met our local host, Dr. Gotterbarm, who took us to the famous castle ruins overlooking the city and then to dinner in the old town. On April 26, we made our way to the Heidelberg Orthopaedic Clinic for morning x-ray rounds and to present our talks. The hospital is 100 years old and has always been orthopaedics only. There is a wonderful sculpture garden on the grounds. After a morning in the operating room, where I observed a revision reconstruction to correct a clubfoot deformity performed by Dr. Wenz, we headed out for a boat trip on the Neckar River to take in the scenery and sunshine, accompanied by Dr. Egermann. That evening, Dr. Steinmann finally joined us at dinner, having made it over to Europe despite the ash cloud. The next day, Dr. Steinmann headed to the hospital for his first official visit of the trip. Interestingly, the faculty of the Heidelberg Orthopaedic Clinic are featured in "Die Knochen-Docs" ("The Bone Doctors"), a reality television show that had been filmed at the clinic over six months and was being shown on German television at the time of our visit.
We had three very busy days in Basel (April 28, 29, and 30). We spent the morning of April 28 in the operating room of the University Hospital and observed several cases. In the afternoon, we visited the Children's Hospital, where Drs. Thonse and Steinmann observed the case of a patient with scoliosis, and I had the wonderful opportunity to observe clinic with Dr. Hefti. That evening, we had a group dinner in the old town. The next day, we went to Liestal, a town outside of Basel, and spent the morning observing a total ankle replacement performed by Dr. Hintermann. After a scientific session on the research being done at Liestal, we had a tour of Augusta Raurica, the local Roman ruins, which included an amphitheater. Then we returned to Basel, where we gave our talks and finally enjoyed a dinner of traditional Swiss fondue.
On April 30, after a free morning to explore Basel, we boarded the train to Baden-Baden, the site of the Southern German Orthopaedic Congress. The next day, we gave our final presentations of the trip ("Musculoskeletal Infections in Children," by Scherl; "Treatment of Coronoid Fractures," by Steinmann; and "Antibiotic Cement-Coated Nails in the Treatment of Infected Nonunion," by Thonse). Afterward, we attended the formal Spargel (white asparagus) lunch, where we were presented with our ASG ties and scarf and heard the report of the European fellows who had recently returned from their trip to North America.
The entire experience of the ASG Fellowship was truly wonderful. We learned a lot, visited interesting places, ate fantastic meals, had fun sightseeing, and, most importantly, made good friends and professional contacts. It was an incredible opportunity for which I am so grateful, and I encourage anyone who is eligible, and considering it, to apply.