Der Orthopäde
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Since 1996 we have gained experience in the development and clinical application of the OATS technique in 167 cases. Operative management, technical demands and early results of osteochondral cylindrical autograft plugs at the talus are presented. Between April 1996 and November 2000 we treated 39 patients (21 male, 18 female) with an average age of 28.4 years (range: 16-57 years) for osteochondral defects with an average size of 8 x 15 mm-20 x 15 mm at the medial (n = 31) and lateral (n = 6) talar dome as well as at the distal tibia (n = 2) with an OATS technique. ⋯ Because of the mostly posterior localization of the defect zone, osteotomy of the malleolus is necessary in most cases. Harvesting the donor cylinders from the ipsilateral knee joint by mini-arthrotomy shows a low mortality. The OATS technique is a suitable, causal and cost-effective therapy, which can possibly prevent and at least delay the development of an arthrosis.
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Osteochondritis dissecans of the talus is a particular form of osteochondral lesions of the talus. A trauma with subsequent osteochondral defect detected immediately by radiology has to be differentiated from osteochondritis dissecans of the talus. Osteochondritis dissecans (o.d.) is primarily a disease of the subchondral bone and can affect almost every joint in the human organism. ⋯ Periarticular swelling, hydrarthrosis, reduced range of motion and sometimes joint locking are the most common clinical signs. Differentiation of o.d. from posttraumatic osteochondral lesions of the talus is sometimes difficult or even impossible. In contrast, other entities of the tibiotalar joint (such as talar necrosis or subchondral ganglion) can be easily distinguished.
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The term orthopaedics was first used by a French physician named Nicolas Andry in 1742. Since then the meaning of the term has changed dramatically. Starting as the planned title of a guidebook for parents it developed to become the name of a new medical discipline. ⋯ Until world war II mostly children were treated by orthopaedic surgeons. After world war II orthopaedic surgeons have adjusted to the demographic change and have increasingly been treating elder patients. The development and the spread of prostheses display the increasing importance of age related illnesses.
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Historical Article
[From sciatica to intervertebral disk displacement. On the history of a disease concept].
Since antiquity low back pain spreading down to the buttock and the leg with or without neurological symptoms has repeatedly been described by medical authorities. To extract well defined nosological entities out of the medley of "sciatica" was a demanding process within a labyrinth of often misleading clues. ⋯ The critical appraisal of pathomorphological lesions in patients suffering from sciatica was, as it still is, a challenging task even for experienced physicians. Key texts and their authors recall the main steps towards our modern concept of lumbar intervertebral disk displacement to the readers mind.
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Gender inequality in all areas of life remains a global problem despite efforts over the past twenty years in particular to address the situation. In physical activity and sport the inequality between women and men is particularly pronounced in almost all countries, although it differs in degree. Two of the main reasons why inequality between women and men physical activity and sport is more extreme than in many other areas of social life are the result of the close association between the attributes required for sport and those associated with traditional concepts of stereotypical, hegemonic masculinity, and a lack of understanding of the difference between sex and gender. ⋯ An understanding of gender and of the construction of gender relations is an important pre-requisite to addressing the inequality between women and men in physical activity and sport and in developing policies and programs which include, and are of equal benefit to both sexes. While more research on the benefits of participation in physical activity is needed, there is currently sufficient information available to identify the health related and social value of participation to both women and men. What is now needed to ensure equality between women and men in physical activity and sport is the adoption of a gender-relations approach to policy and program planning by governments, civil society and specifically by those "experts" in the field who have the power to advocate and to influence decision makers at all levels.