Zeitschrift für Orthopädie und ihre Grenzgebiete
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Z Orthop Ihre Grenzgeb · May 2005
Review Comparative Study[How can I assess the back pain status in my patients? The Mainz chronic disease staging method and its prognostic value].
Chronification of pain is not just a simple matter of duration, although many publications still pretend that this is so. Chronification is more a spread of pain on the physical level, on duration and even more on the psychological and social levels. We present different models to explain this process. ⋯ Results of different inquiries have shown the correlation between chronicity of pain and measurements of quality of life and effectiveness of medical treatment. Also the MPSS has a prognostic value about the effect of further treatment. To get a differentiated view on the results of examinations and treatment outcome, an evaluation of the chronification process of the patient's pain is a necessity.
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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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Z Orthop Ihre Grenzgeb · Jan 2004
Review Case Reports[Posteromedial bowing of the lower leg and neuroblastoma with possible neurofibromatosis type I: a case report and literature review].
The posteromedial bowing of the tibia is a rare condition that is not yet known to be related to neurofibromatosis. The case of a three month-old boy with the tentative diagnosis of neurofibromatosis is described. He developed paraplegia due to an abdominal neuroblastoma at the age of 9 months. This led us to a review of the literature. ⋯ The posteromedial bowing of the lower leg seems to affect more boys as well as the left side. As far as described in all but one case it was the first delivery. Regularly, a limb shortening and pes calcaneovalgus is to be found. 99 children were treated conservatively, 21 got an operation of the affected side. In 19 performed osteotomies no pseudarthrosis occurred. One case of a fracture due to an adequate trauma without healing problems is described.
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Z Orthop Ihre Grenzgeb · Jan 1999
Review[Corrective osteotomies of the lower extremities following posttraumatic deformities].
As part of a retrospective analysis of posttraumatic malunions of the lower extremity, the causes for deformity, as well as indications and methods for corrective osteotomies are reviewed. ⋯ The review of the literature, as well as of our own results, shows that deformities in the frontal plane should be corrected if they exceed 10 degrees of varus or 15 degrees of valgus. Malunions of more than 15 degrees in the sagittal and 15-20 degrees in the transverse plane should also be considered for correction, while a shortening of more than 3 cm represents an indication for corrective osteotomy. Callus distraction techniques have proven valuable in the correction of posttraumatic malunions of the lower leg, especially when soft tissue compromise is evident.
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Z Orthop Ihre Grenzgeb · Sep 1997
Review[The physician's professional responsibilities, especially the responsibility for patient education].
With increasing numbers of disputs between patient and doctor the interest in correct enlightenment is rising. ⋯ The knowledge for correct enlighten can reduce the number of disputes between patient and doctor.