Zeitschrift für Orthopädie und Unfallchirurgie
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In Germany, 800,000 fractures are treated per year, and up to 10 % of these patients may suffer subsequently from a delayed union or a nonunion at the fracture site. Surgical treatment of these complications is tedious and associated with high costs. ⋯ The adjuvant treatment with ultrasound has been propagated for the past years to enhance fracture healing and bony union, and has been discussed controversially. This review article demonstrates the significance of the low intensity pulsed ultrasound application in fracture treatment, on the basis of basic science results, animal experiments and the results of clinical trials.
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Total knee arthroplasty (TKA) is one of the most common procedures in orthopedic surgery and clinical success can be characterized by the revision rate and improvement of function, as well as the patients' satisfaction and pain. Despite the clinical success of primary TKA with 10-year survival rates as high as 95 %, about 20 % of the patients after TKA are not completely satisfied with their outcomes for several reasons. Obvious causes of failure might be identified with clinical examinations and standard radiographs only, whereas the unexplained painful TKA still remains a challenge for the surgeon. Failure can be classified into extra- and intraarticular disorders, the latter being divided into biological and mechanical origins. The onset of the pain after the operation and the differentiation between pain in motion and at rest are helpful to distinguish between mechanical and non-mechanical problems. An infection should be the first diagnosis to be ruled out in a painful TKA. It is generally accepted that a clear understanding of the failure mechanism in each case is required prior to considering revision surgery. ⋯ This diagnostic algorithm offers an important tool for a sufficient failure analysis in almost all patients with painful TKA.
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Review Meta Analysis
[Effect of continuous passive motion for cartilage regenerative surgery - a systematic literature review].
The aim of this systematic review was to evaluate treatment effects of continuous passive motion (CPM) after surgical cartilage repair. ⋯ Three studies described significant improvements with regard to subjective outcome such as pain, swelling, Quality Life Survey, Knee Society score, WOMAC score or rating Cincinnati due to the surgical treatment and the CPM intervention of cartilage defects in the knee. Six (case) studies suggested an enhanced cartilage quality of the patients after CPM. More high-quality randomised controlled trials are needed to provide high level evidence.
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Review Case Reports
[A rare complication of kyphoplasty is PMMA-cement loosening - case report and literature review].
For vertebral body fractures combined with strong back pain, the kyphoplasty is an established method for pain reduction. A balloon effects an excavation in the vertebral body, which will be filled up with cement. We distinguish between cements of polymethyl metacrylate (PMMA) and calcium phosphate. Their diverse chemical qualities enable different indications. ⋯ Injuries of the vertebral body frame cannot be operated exclusively with kyphoplasty. The reason for this is the instability of the vertebral body despite the injection of the PMMA cement. We advise to stabilise the spine in such cases with a dorsal internal fixator additively.
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Review Meta Analysis
[Diagnostic and therapeutic management of primary and recurrent patellar dislocations - analysis of a nationwide survey and the current literature].
Patellar dislocations are a common injury of the knee joint. During patella dislocations injuries of soft-tissue structures can occur that can destabilise the patella and lead to recurrent dislocations. There are also congenital pathologies that predispose to patella dislocations. In the current literature, diagnostics and treatment of patellar dislocations are frequently discussed. Therefore the aim of our survey was to analyse and summarise actual diagnostic and therapeutic strategies regarding primary and recurrent patella dislocations. ⋯ The results of our survey showed diagnostic and therapeutic procedures in the participating departments which are in accordance with recommendations in recent publications. The clinical importance of the MPFL reconstruction was observed for primary and recurrent patella dislocation. In addition, conservative treatment is still the most common treatment after primary dislocation of the patella.