Zeitschrift für Orthopädie und ihre Grenzgebiete
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Z Orthop Ihre Grenzgeb · Sep 2004
Comparative Study[Current treatment modalities for cartilage defects at the knee--results of a nation-wide survey of surgical trauma and orthopaedic clinics in Germany].
A local cartilage defect at the knee is mostly followed by arthritis after a period of time. Up to now there are no options to adequately regenerate hyaline cartilage in vivo. Hence, the present strategies try to create a repair tissue with hyaline-like characteristics or to repair defects by transplanting autologous osteochondral cylinders. The objective of this study was to collect data about the current treatment of local cartilage defects of the knee in Germany. ⋯ There are still discrepancies about the therapy for local cartilage defects of the knee. Our survey illustrates the present status of cartilage repair strategies in Germany.
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Z Orthop Ihre Grenzgeb · Jul 2004
Case Reports[Intramuscular application of diclofenac--case report and critical consideration of a therapeutic measure].
Diclofenac is a non-steroidal anti-inflammatory drug of the phenylacetic class. It is frequently given as an intramuscular injection. ⋯ Based on a short case report about a fatal complication in the context of the i.m. administration of diclofenac, the arguments for and against the intramuscular injection of the drug are critically discussed. As a result, the administration of diclofenac as an intramuscular injection should be critically reviewed and alternatives -- as suppositories are available -- should be taken into account.
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Z Orthop Ihre Grenzgeb · Jul 2004
Practice Guideline Guideline[Guidelines for the assessment of pain. Version 8.3 from 9.7.2004].
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In several prospective studies it has been demonstrated that psychological factors are better predictors of low back pain than biographical or medical factors. The most elaborate model for the development of chronic low back pain is the model of fear avoidance. The essential feature of this model is that exaggerated negative orientations towards pain ("pain catastrophizing") lead to fear of movements and the belief that movements will lead to more pain. ⋯ On the other hand, reduction of uncertainty via adequate information about the non-serious nature of back pain disorders may lead to an adequate confrontative pain behavior, less emotional arousal and more useful coping mechanisms. In particular, the uncritical use of widespread back schools has to be looked upon carefully for pronouncing avoidance learning. For chronic pain, therapy must include mechanisms from the treatment of phobias in which pain behavior is looked upon as the result of a phobic process.
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The various radiological changes after implantation of the thrust plate prosthesis (TPP) are demonstrated and, with the help of a standardized radiological classification, divided in pathological and non-pathological findings. ⋯ The radiological changes of the bony stock of the TPP can be divided into physiological adaptation processes because of changed biomechanics and signs of loosening. As a stress-shielding phenomenon we see a progressive atrophy under the thrust plate and simultaneously a sclerosis of the spongious bone above the calcar femoris. An indication for a loosening of the prosthesis is a progressive radiolucency of sector B.