Der Orthopäde
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There is clinical evidence that a standardized management of trauma patients in the emergency room improves outcome. ATLS is a training course that teaches a systematic approach to the trauma patient in the emergency room. The aims are a rapid and accurate assessment of the patient's physiologic status, treatment according to priorities, and making decisions on whether the local resources are sufficient for adequate definitive treatment of the patient or if transfer to a trauma center is necessary. ⋯ SOPs and training courses increase the process and result quality in the treatment of the trauma patient in the emergency room. These programs should be based on the special demands of the physiology of the trauma as well as the structural specifics of the hospital. ATLS does not equal an SOP but it qualifies as a standardized concept for management of trauma patients in the emergency room.
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Case Reports
[Vertebral fractures due to osteoporosis. Kyphoplasty and vertebroplasty vs conservative treatment].
Vertebral compression fractures are among the most common forms of manifestations of osteoporosis. Conservative treatment comprises adequate analgesia, osteoporosis medication and individualized physiotherapy or braces. Nevertheless, vertebral compression fractures frequently lead to persisting pain and decrease daily activity and quality of life. ⋯ There is broad clinical experience with both procedures. For kyphoplasty, randomized controlled trials showed significant improvements in pain and quality of life in patients undergoing kyphoplasty. However, cement leakages lead to rare but severe complications such as pulmonary embolism and nerve palsies.
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Osteoporosis is characterized by a reduction of bone mass and changes in bone micro-architecture. The resulting reduction in bone strength leads to the well recognized increase in the risk of fracture, particularly at the radius, hip, and spine. The treatment of osteoporotic fractures is challenged by the reduced mechanical capacity of osteoporotic bone, reflected in reduced holding power and increased fragility. ⋯ Modifications in implant design and techniques enable the surgeon to apply and combine the essential components of the basic principles for the treatment of mechanically impaired bone. The key components employed in modern implants include integrated compression techniques, multidirectional angular stability, expandable support surfaces, as well as multiple augmentation options. However, despite modern implant technology, osteoporotic bone fractures remain a significant challenge for the orthopaedic surgeon and require meticulous planning and implementation of the basic principles.
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Due to the high incidence of concomitant neurological lesions, standardized clinical and radiologic diagnostic procedures in cervical spine injuries are mandatory. Magnetic resonance imaging or a stress X-ray should be performed when discoligamentous injuries are suspected. ⋯ However, despite prompt and appropriate therapy many of these injuries lead to permanent functional impairment depending on the type of fracture. This article summarizes the most frequent fracture types of the cervical spine, as well as the corresponding therapeutic options and outcome.