Der Unfallchirurg
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The rehabilitation of patients with diseases of the musculoskeletal system and injuries has a high priority in Germany. The costs are essentially borne by the statutory health insurance companies (reha before nursing), pension schemes (reha before pension) and German statutory accident insurance. ⋯ Maintaining the ability to work and independence results in an increase in the need for rehabilitation; however, this also necessitates an adaptation of processes and structures in order to be able to meet these challenges.
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Sports injuries and their treatment have become increasingly more important in recent years due to the leisure behaviour of our society. Besides the aspects of acute care and medical treatment there often remains the question of optimal rehabilitative care and return to sports. Overall, the correct early planning of rehabilitation has a great influence on the prognosis of sports injuries and the date of resumption of sporting activities. ⋯ A multidisciplinary and interdisciplinary, phase-dependent, individual treatment plan that also complies with the biopsychosocial background of the athlete must be created for this purpose. Increasingly relevant is also the sport psychological support during all phases of rehabilitation, including the use of cognitive behavioral therapy. Before an athlete returns to sports and competition, objectified sport-specific criteria must be met.
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Review
[Exoskeletons for rehabilitation of patients with spinal cord injuries : Options and limitations].
Mobile exoskeletons are increasingly being applied in the course of rehabilitation and provision of medical aids to patients with spinal cord injuries. ⋯ Although exoskeletons are not yet an established tool in the treatment of spinal cord injuries, the systems will play a more important role in rehabilitation of patients with spinal cord injuries in the future. Neurologically controlled exoskeletons show beneficial effects in the treatment of acute and chronic spinal cord injuries and might therefore evolve to be a useful alternative to conventional locomotion training.
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Osteoporosis-associated fractures represent a risk factor for developing further fragility fractures. Therefore, guideline-oriented osteoporosis intervention is of utmost importance during inpatient fracture treatment. ⋯ The majority of elderly patients with fractures also suffer from osteoporosis, independent of gender. Even nowadays, osteoporosis is predominantly not diagnosed until the incidence of a fracture. Therefore, the trauma surgeon is in a key position to initiate diagnosis and treatment of osteoporosis.
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Anatomical reconstruction of acetabulum fractures and rigid osteosynthesis are required to achieve good postoperative results. In the 7(th) decade of life changes of bone quality impair stability of fixation devices in bone. ⋯ Primary implantation with alloarthroplasty of the hip joint in case of a complex fracture of the acetabulum can be recommended for elderly patients if an anatomic or good reconstruction of the hip joint cannot be achieved.