Der Unfallchirurg
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Case Reports Comparative Study
[Prevention of epidural fibrosis. Initial experiences with non-resorbable membrane].
Scars around the neural structures after opening the spinal canal are common and severe problems in spine surgery. This paper presents the use of a special membrane to avoid epidural scarring in two cases.
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Big osteochondral defects in the weight-bearing zone of the medial respectively the lateral femoral condyle are still an unsolved problem especially in younger patients. The transfer of the posterior aspect of the femoral condyle was described as a salvage procedure. ⋯ However, the Mega-OATS procedure itself remains a salvage procedure and should only be reserved for younger patients. The results of the first series of 17 patients (average follow-up 12 (5-19) months) showed an improvement of quality of life and a significant (p = 0.003) increase in the Lysholm-score.
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Even years after having sustained multiple injuries patients often suffer from its sequelae. These comprise restrictions in physical function, but also pain, social and psychological impairments. Although the Meran Consensus Conference in 1990 defined the contents of "quality of life" (QoL) measures in surgery, still no instrument is available for the valid assessment of all relevant QoL domains in multiple injured patients. ⋯ Within three phases (phase I: generation of items, phase II: item reduction, phase III: pre-testing in 70 multiple injured and control patients) a questionnaire of 57 items was developed, which measures all relevant trauma-related aspects of QoL after acute hospital care. In combination with the Glascow Outcome Scale (GOS), the EUROQOL and the SF-36, the newly developed instrument builds the Polytrauma Outcome Chart (POLO-Chart) which will also be used as "Part E" for outcome assessment within the "Trauma registry" of the German Society for Trauma Surgery. In phase IV, the POLO-Chart will finally be validated in five trauma centres (Celle, Essen, Hanover, Cologne und Munich).
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The significance of mobilization and loading for healing ligaments and tendons is generally accepted today. Local deformation of cells thereby represents the key stimulus for the cellular response. Less is known, however, about the effects of cyclic strain on the cellular and molecular level. ⋯ We conclude that cyclic stretching causes a time-dependent, differential regulation of formation of fibronectin and collagen type I and III. This may effect the quality and thus the mechanical properties of healing tendon and ligament tissues. In order to improve current treatment protocols and to enlarge our knowledge of tissue healing, it is necessary to understand the cellular response to cyclic strain.
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Case Reports Comparative Study
[Ruptures of the subscapular tendon. A diagnostic problem?].
Isolated ruptures of the subscapularis tendon are rare injuries which are often missed initially. After recent treatment of 3 patients treated in our clinic typical courses and pitfalls are demonstrated. Due to the traumatic genesis of subscapularis tendon ruptures, lesions of the rotator cuff must be excluded generally by an adequate diagnostic concept. ⋯ The typical view in case of a subscapularis tendon rupture is a thinned tendon overlying the humeral head. In our opinion nuclear magnetic resonance imaging should not be the first diagnostic procedure. It should be reserved for such cases with unclear clinical and ultrasound results.