Der Orthopäde
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Thirteen out of 17 patients with a hip prosthesis according to the Girdlestone procedure were studied at a follow-up time of 26 months to 10 years. Seven patients were found to be satisfied with the total prosthesis, while the others complained about pain, walking disability and an insufficient range of motion. The implantation of a prosthesis using the Girdlestone procedure is technically difficult and should be restricted, as the results are superior to the Girdlestone hip in only a carefully selected group of patients with good abductor muscles and unsatisfactory results after the Girdlestone operation.
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The historical development of the treatment of shaft fractures is outlined. Nowadays there is a number of possibilities for the treatment of shaft fractures: conservative and surgical methods. ⋯ The advantages and risks of the various methods are explained. We should now no longer ask what the best method is for any fracture, but rather what method will provide the best prospects of healing in a particular pattern of injury.
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The derangement of posture in advanced flexion deformity due to ankylosing spondylitis, as well as operative correction procedures are analysed. The "Dorsal Lordosating Spondylodesis", DLS, according to Zielke is introduced. This method of polysegmental correction and transpedicular fixation via USIS implants allows the recreation of a balanced upright posture by restoration of smooth lumbar lordosis. ⋯ Since the total amount of correction is split into 5-7 osteotomy sites, complication rates are substantially lower than in the monosegmental methods. Besides the gain of body height and immediate pain relief, the restoration of a horizontal axis of vision could be achieved. The latter, for all patients the most important feature, was maintained as up to 5 years follow-up's show.
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The syndrome encompassing failed back-surgery is a relatively uniform combination of complaints caused by a variety of pathological changes in the lumbar spine, alone or in various combinations. The MRI's capability of detecting these factors is described. MRI can detect recurrent disc herniations and separate them from intradural and/or extradural scar formation. ⋯ The same applies to the diagnosis of cases of spinal stenosis. The size of the spinal canal can be measured by MRI as well as by other modalities. These results just point out the risk of disease - not the disease itself.
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Hip dysplasia and treated dislocations of the hip can lead to deformity of the proximal femur with shortening of the femoral neck and proximal displacement of the greater trochanter. Shortening the femoral neck causes a reduction in the leg length and insufficient performance of the abductors in the hip. Furthermore, the mechanical axis of the knee joint is lateralized. ⋯ We used three osteotomies: one at the greater trochanter, one at the proximal, and the third an oblique osteotomy at the level of the distal femoral neck. In our group of 15 patients with 16 operated hip joints, the results were satisfactory in 14 of the 16 hips. This technique is recommended in young patients with little or no degenerative changes.