Der Orthopäde
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Surgical site infections are the most common nosocomial infections in orthopedic surgery. Strategies to prevent these infections are of enormous relevance. ⋯ Only the consequent implementation of evidence-based procedures can help prevent surgical site infections.
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Posterior fusion procedures (posterior lumbar interbody fusion, PLIF; transforaminal lumbar interbody fusion, TLIF) are long-established surgical techniques for lumbar interbody fusion. They differ from anterior lumbar interbody fusion (ALIF) and extreme lateral interbody fusion (XLIF) procedures by approach and associated complications. ⋯ The PLIF and TLIF procedures are almost equivalent posterior fusion procedures with high fusion rates, good long-term clinical outcomes, and low risk of complications. The TLIF procedure is slightly advantageous: lower nerve irritation rates, shorter operative times, and less extensive operation. Thus, the TLIF procedure is available for cases with single-sided pathologies and the PLIF procedure is available for bilateral compressions.
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Groin pain in athletes is a common problem and can have extensive consequences for professional athletes. The anatomical and functional complexity of the groin as well as radiating pain from remote anatomical regions can make the differential diagnostic a challenge and requires special attention. As there are a wide variety of possible causes for groin pain, a multidisciplinary approach is required. ⋯ By a meticulous patient history and identification of the pain character, followed by clinical, sonographic and radiographic investigations, a differential diagnosis can usually be achieved. Besides typical orthopedic causes pathological findings particularly in the area of the groin need to be considered, clarified and adequately treated; therefore, a clear terminology of the different diseases is necessary. Sportsmen's groin is not a hernia but should be perceived as a separate entity due to its typical pain character and detection of a measurable protrusion of the posterior wall of the inguinal canal by ultrasound.
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Complaints in the region of the hips and pelvis are often difficult to classify. This is due to the fact that pain projection and overlapping can occur; therefore, the complete region of the lumbar spine, pelvis and hips must be considered as a single entity in which alterations can result in radiation throughout the whole region. There are many different anatomical structures within the pelvic region so that the function of various muscle components can be impaired and cause pathological alterations to positional relationships of bony structures or even alterations to other soft tissues, such as ligaments, tendons and labra. ⋯ Therefore, a detailed and targeted medical history, functional testing and specific examinations and tests are necessary to narrow down the pathology in question and reach a definitive diagnosis. Orthopedic surgeons must know which conspicuous features can lead to which problems and which anatomical structures are likely to be affected by irritation. The results of the clinical examination are the basis for targeted imaging diagnostics and subsequent therapy.