Der Orthopäde
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Most fractures of the proximal humerus with significant displacement are best treated surgically. The range of surgical treatment varies from closed reduction and pinning to hemiarthroplasty depending on the degree of displacement, age of the patient, and bone quality. Determining whether or not the individual fractured bone segments are displaced to a significant degree requires high quality x-rays which can be difficult to obtain from acutely injured patients. ⋯ Furthermore, several studies indicate that a significant number of complications can occur following early and late prosthetic replacement. Humeral head replacement as a salvage procedure after malunions or failed open reduction and internal fixation is technically demanding with a relatively high rate of complications. Newer implant designs and instruments may improve the clinical results.
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Video rasterstereography has been developed for optical back shape measurement and for biomechanical analysis of spinal and pelvic geometry. Analysis of one single measurement permits 3-dimensional reconstruction of the back surface and calculation of shape parameters including pelvis tilt and torsion. In addition, estimates of the lateral deviation of the spinal midline and of vertebral rotation are provided. ⋯ If this effect is taken into quantitative consideration, an improved accuracy of measurements is obtained by reference to a standardised, mathematically defined posture. The resulting rms-error of kyphosis/lordosis measurement is then reduced from 3.10 degrees/2.95 degrees to 1.65 degrees/1.40 degrees. These figures open up new applications in the follow-up of kyphotic and lordotic deformities.
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Public and private accident insurance companies have in common that the insurance risk is the damage to health caused by trauma. Otherwise, they are fundamentally different. ⋯ Private accident insurance as part of civil law is an insurance of fixed sums anchored in the agreement. It is completely unrelated to the consequences of trauma-induced limitation of function.
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The aim of this study was to compare the results of different treatment strategies for osteochondral defects (OCD) of the talus. Electronic databases from 1966 to June 2000 were systematically screened. Thirty-nine studies fulfilled our inclusion criteria. ⋯ From the results of this systematic review we conclude that nonoperative treatment and excision alone are not to be recommended for treatment of talar OCD. Excision, curettage and drilling produced a high percentage of good or excellent results. Further randomized, controlled trials are required to compare the outcome of these two surgical strategies for OCD of the talus.
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Review Comparative Study
[Approach to open treatment of osteochondral lesions of the talus].
Arthroscopic techniques still represent the treatment of choice in osteochondral lesions of the talus (OLT). Open techniques may be used as an alternative or may be complementary to arthroscopic treatments. They are especially indicated in cases of large osteochondral lesions, difficult localisations and in cases of recurrent interventions. ⋯ Osteotomy of the (medial) malleolus offers good visualisation of the medial talar dome. With the introduction of new techniques of osteochondral transplantations, the use of this approach is becoming more popular. However, it is an invasive technique and the risk of secondary osteoarthritis after malleolar osteotomy still needs to be determined.