Der Unfallchirurg
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From the perspective of trauma and orthopedic surgery interdisciplinary reconstructive surgery of the extremities encompasses different indications ranging from IIIB/Copen fractures with major segmental loss of bone and soft tissue, to arterial vessel in-jury necessitating vascular repair and to biological, plastic reconstructions following resections of musculoskeletal tumors. The interdisciplinary treatment concept including trauma-orthopedic surgery combined with vascular, plastic and neuro- as well as microsurgery has significantly decreased amputation rates and functional deficits thereby improving quality of life and long-term oncological outcome The multisdisciplinary management of both complex trauma and malignant bone/ soft tissue sarcoma of the extremity is an integral task of the surgical trauma or tumor center. Close interdisciplinary communication and expierence are the precondition for performance of a priority-adapted therapeutic strategy, low complication rates and improvement of overall prognosis.
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Surgery on the meniscus of the knee joint is one of the most frequently performed operations. The arthroscopic technique currently represents the general treatment standard and except in a few cases has completely superseded the open approach. Arthroscopy facilitates precise diagnosis and classification of all forms of meniscus lesions. ⋯ Substitution of lost meniscus tissue is possible with allograft transplantation; good results are possible especially on the lateral meniscus. A novel alternative is arthroscopic implantation of a biodegradable collagen matrix, which replaces partial defects on the medial meniscus. Long-term results of this treatment form must be awaited.
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Autografts and allogeneous bone grafts as well as cages are used for the reconstruction of the anterior column after corpectomy. Recently, expandable cages for vertebral body replacement have been developed. Based on our own experience, the purpose of this study was to summarize the available biomechanical and clinical data of expandable corpectomy cages and to compare it with established fixation techniques. ⋯ Additionally, design variations of expandable corpectomy cages did not show any significant impact on the biomechanical stability. Currently available mid-term clinical and radiological data on the treatment of fractures, metastasis and infection of the cervical, thoracic and lumbar spine demonstrated no significant difference between expandable and non-expandable cages. However, the increased stress-shielding effect of expandable cages compared to non-expandable cages might result in a deterioration of the long-term clinical outcome.
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Analgesia is one of the physician's genuine challenges. Pain makes the patient suffering and leads to unfavourable somatic effects as well, which may have negative outcome effects. Sufficient perioperative analgesia depends on well defined organizational conditions. ⋯ Special syringe pumps allow a patient controlled analgesia (PCA) under fixed conditions. Regional anaesthesia via catheter is powerful as well and avoids systemic opioid side effects. In these cases as well, a continuous or patient controlled analgesia is possible.