Zeitschrift für Orthopädie und Unfallchirurgie
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Gluteal tendinopathy as well as partial and full-thickness tears of gluteal tendons (gluteus minimus and/or medius tendon) were underestimated as a cause of chronic pain in the past, and treatment was most commonly based on the diagnosis of trochanteric bursitis. Tendinous pathologies can either stay asymptomatic or cause pain and muscular dysfunction, not necessarily being associated with osteoarthritis of the hip 1. As the terminus "rotator cuff tear of the hip" was published in 1997 2, its aetiopathogenesis was reconsidered, resulting in improvements in diagnosis and treatment. ⋯ The effectiveness of extracorporeal shock wave therapy has also been proven 14. Surgical intervention is necessary in case of non-responsiveness to treatment or loss of gluteal muscular function. Hereby, the open gluteal repair always represented the method of choice, whereas recently, users of endoscopic systems reported similar or even better outcomes 15, 16, 17, 18, 19, 20, 21.
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Optimal treatment of injuries to the thoracolumbar spine is based on a detailed analysis of instability, as indicated by injury morphology and neurological status, together with significant modifying factors. A classification system helps to structure this analysis and should also provide guidance for treatment. Existing classification systems, such as the Magerl classification, are complex and do not include the neurological status, while the TLICS system has been accused of over-simplifying the influence of fracture morphology and instability. ⋯ The neurological damage is graded in 5 steps, ranging from a transient neurological deficit to complete spinal cord injury. Additional modifiers describe disorders which affect treatment strategy, such as osteoporosis or ankylosing diseases. Evaluations of intra- and inter-observer reliability have been very promising and encourage the introduction of this AOSpine classification of thoracolumbar injuries to the German speaking community.
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The ideal treatment for massive rotator cuff tears is influenced by the morphology and chronicity of the tear, tissue quality, the degree of concomitant osteoarthritis, and patient-specific factors. Traditionally, massive rotator cuff tears have wrongly been equated with irreparable tears. ⋯ This study provides an overview of the current treatment options for large and massive rotator cuff tears, including their expected outcomes. Finally, a possible treatment algorithm is suggested.
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The incidence of fractures among epileptics is frequent and mostly occurs by direct trauma due to falls caused by seizures. The risk of fractures is estimated to be 50 % higher in epileptics than in the general population. Most of the fractures affect the proximal femora and the hip joint. ⋯ If they occur bilaterally, this is pathognomonic for seizuring. Besides this, shoulder dislocation and bilateral dislocation fractures of the humeral head, however, are far more rare even among epileptics but pathognomonic for seizure. In this case report we present a female patient with bilateral dislocation fracture of the humeral head due to first clinical manifestation of a tonic-clonic seizure without direct trauma.
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By 2030, 30 % of German residents will be over 70 years of age. In 2009, we conceptualised a TÜV (German Technical Inspection Authority) certified interdisciplinary centre for geriatric trauma care. All treatment pathways were agreed upon by all disciplines. Complex geriatric therapy was established, and patients were seen by trauma surgeons, geriatricians, therapists, and a pharmacist. Cases were discussed in team meetings. Morbidity and mortality conferences were conducted. In 2014, supplementary DGU (German Society for Trauma Surgery) certification was achieved. ⋯ Interdisciplinary geriatric-trauma therapy for older patients resulted in improved measurable outcomes. Interdisciplinary geriatric trauma care with implementation of complex therapy benefits both patients and hospitals.