[Development of trauma surgery in the next 20 years].

During the last century trauma surgery became established as an independent and academically accepted surgical specialty and significant progress was achieved. A high international reputation was also gained. Nowadays health care in Germany is under increased economical pressure mostly caused by a loss of resources as a sign of decreased public appreciation of excellent trauma care. Thus it becomes more and more necessary to find new structures for delivery of trauma care as well as for development of staff, especially in times of feminization in medicine. It is beyond any doubt that the demand for musculoskeletal surgery will rise during the next 20 years especially for the elder generation but it is uncertain how excellent trauma care should be delivered without massive spending and financing of health care including research and innovative forms of trauma treatment.