Der Orthopäde
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Management of soft tissue ruptures of extensor tendon lesions of zone I is both difficult and controversial. Because of their superficial position already minor injury can be sufficient for laceration. ⋯ However, this injury can cause significant hand dysfunction and has to be treated with attention in order to provide the best possible outcome for the patient. Therefore we try to evaluate the common treatment procedures and to give guidelines for management of this injury.
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Injuries to the proximal interphalangeal (PIP) joint are often discounted as trivial although they can lead to instability and even more frequently to contracture of the PIP joint. Distortion and hyperextension traumata are the most common causes of PIP joint injuries of the hand and frequently occur in conjunction with sports-related injuries. Treatment concepts demonstrate considerable agreement. ⋯ During functional assessment of the joint's stability a distinction can be made between active and passive stability. Injuries of the palmar plate with and without small bone fragments that do not exhibit subluxation after repositioning and X-ray control are immobilized during the phase of acute pain in a palmar splint in the intrinsic plus position for a maximum of 5 days. Thereafter the patient independently performs movement exercises.
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For the more than 330.000 patients/year with primary total hip replacement (THR) or total knee replacement (TKR) in Germany alone, postoperative rehabilitation either on an inpatient or follow-up outpatient basis is largely accepted as standard, despite limited financial resources. The present article discusses the necessary diagnostic and therapeutic measures in the immediate postoperative phase in the hospital or clinic, the so-called post-inpatient phase in a rehabilitation clinic or centre, as well as the subsequent outpatient phase with consistent and regular specialist follow-up.
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The cervical spine is often affected in rheumatoid arthritis. Beside destructive changes, instabilities can occur, mainly in the upper cervical spine. Typical symptoms are missing so that routine x-ray examinations are needed to prevent severe consequences up to death. ⋯ Depending on the findings, further neurological examination and MRI must be initiated. Aim is the early recognition, respectively prevention of myelopathy. Therapy includes stage dependent conservative and surgical measures.
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Surgery of the shoulder, elbow, and hand can cause considerable pain. According to data from randomized controlled trials, local or regional anesthesia is recommended for analgesia during and after surgery of the upper extremity. ⋯ For the elbow joint, a peripheral block is also recommended to allow for effective analgesia and physiotherapy postoperatively. In addition, cooling and physiotherapeutic techniques are beneficial in postoperative management.