Zeitschrift für Orthopädie und Unfallchirurgie
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Comparative Study
[Posterior and transforaminal lumbar interbody fusion (PLIF/TLIF) for the treatment of localised segment degeneration of lumbar spine].
Chronic intractable low back pain is one of the most common orthopaedic diagnoses, with an enormous socioeconomic impact. The surgical treatment by posterior transpedicular instrumentation and interbody fusion of the affected segments is an established procedure after exhaustion of conservative therapies. Due to different study data on the clinical and functional results after posterior (PLIF) and transforaminal (TLIF) interbody fusion, our own patient population was analysed retrospectively. ⋯ The data of this study indicate that both TLIF and PLIF techniques are possible surgical treatment methods for patients with resistant chronic low back pain. With both techniques a clear benefit regarding quality of life and function for the operated patients is achievable, if the correct surgical indication is given.
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Anterior screw fixation is a standard treatment procedure in the case of an uncomplicated Anderson-D'Alonzo type II odontoid fracture in younger patients. Insufficient bony screw hold can cause severe procedure-related complications and result in screw breakouts with secondary fracture dislocation. Hence, the procedure is limited to patients with an adequate bone mineral density. ⋯ Two patients with odontoid fractures of Anderson-D'Alonzo type II were operated using anterior screw fixation and additional vertebroplasty of C2 to increase the screw hold. During follow-up a regular bony healing without screw complication was observed. In conclusion, cement-augmented anterior screw fixation of odontoid fractures type II according to Anderson-D'Alonzo and persistent severe osteoporosis can be an alternative to posterior C1/2 spondylodesis in individual cases.
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In the last years, German hospitals have implemented different measures to increase patient safety. Special importance has been attached to near miss reporting systems (critical incident reporting system, CIRS) as instruments for risk identification in health care, instruments that promise high potential for organisational learning. To gain insight into the current status of critical incident reporting systems and other instruments for clinical risk management, a survey among 341 hospitals was carried out in 2009. Questions covered a process of six steps: from risk strategy to methods for risk identification, to risk analysis and risk assessment, to risk controlling and risk monitoring. ⋯ While identification of clinical risks with near miss and other incident reporting systems meets increasing acceptance, the learning potential based on incident reporting is not yet appropriately being used. There is a deficit regarding systematic and comprehensive risk assessment and controlling; this will have to be met by improving the organisational framework for clinical risk management.
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Controlled Clinical Trial
[Results of single stage vs. two-stage total knee arthroplasty].
The total knee arthroplasty (TKA) is a successful procedure. In cases of bilateral knee osteoarthritis, advantages of single stage TKA vs. two-stage TKA as well as the gap between the procedures in case of two-stage TKA are discussed controversially. The aim of the present study is to compare the clinical and radiographic results of single stage bilateral TKA and two-stage bilateral TKA. In cases of two-stage TKA the dependency on the gap between surgeries was determined. ⋯ Analysis of clinical and radiological results shows only marginal differences between the two groups. In two-stage procedures functional results were best when the second surgery was done 4 to 6 months after the first procedure. Single stage TKA had a significantly higher complication rate. However, patient and surgeon should make the decision for single or two-stage bilateral TKA individually.