Zentralblatt für Chirurgie
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The "gold standard" treatment modality for extra-articular and combined intra-, extra-articular fracture of the distal femur is the condylar blade plate (CP). Large exposure of the distal femur with unavoidable iatrogenic trauma to the soft tissue surrounding the fracture site and perhaps the lack of stiffness of the eccentric lateral cortical location of the CP has been suggested to play a role in the high rate of infections and pseudarthrosis reported in the literature. ⋯ The DFN is a modular system sharing many components and almost all instrumentation with the AO-UFN and it is expected that the nail is much better in axial stiffness and strength than the condylar blade plate. The treatment of supracondylar femoral fractures should be improved by providing early weight bearing and accelerated fracture healing with a reduced incidence of delayed unions and infections.
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The modern hospice movement started in St. Christopher's Hospice, London. ⋯ Until 1990 there was not much of a hospice or palliative movement in Germany. In the early nineties an increasing interest could be recognized and since May 1997 there are 34 palliative care units in existence.
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The indication for operative or conservative treatment of the anterior cruciate ligament remains still difficult. Many years of intensive basic and clinical research and a better knowledge of biology, biomechanics and pathology have not been achieved standards of therapy. Therefore varying treatment options exist. ⋯ In all other types of ruptures only a reconstruction using autologous material (lig. patellae, semitendinosous tendon) is recommended. Rehabilitation after ACL ruptures depends on the method of treatment (conservative procedure, reconstruction material, fixation technique, associated lesions) and has to be adapted to the biological healing process. Normally an immobilisation (cast, orthesis) has no benefit for ligament healing.
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Palliative care is the active total care of patients whose disease is not or no more responsive to curative treatment. Its action strategies should be applied at the time when the goals change from cure to care. Palliative care is total care of body, mind and spirit. ⋯ The general principles of treating dyspnoea and pain are the same as for any other aspect of treatment in palliative care: 1. to define and treat the underlying cause of dyspnoea wherever possible and reasonable for the patient. This includes oncological interventions such as chemotherapy and radiotherapy as far as the patient's status allows it. 2. to relieve dyspnoea without adding new problems by way of sideeffects, interactive effects, social or financial burdens. The rule of proportionality to treatment affirms that symptom control and life-prolonging treatment are contraindicated when they cause more suffering than benefit. 3. to consider whether a treatment will be worthwhile for the patient and his family bearing in mind his prognosis and adverse effects of invasive procedures. 4. to discuss all reasonable treatment options (including the decision of "no intervention") with the patient and his family, allowing them to make the final decision as far as possible by themselves.
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Posterior stabilization by internal fixator is used as a frequent procedure for the surgical treatment of thoracolumbar spine fractures. The technique of internal fixator stabilization and its results regarding the correction of spinal posture and spinal canal clearance are described. By transpedicular spongiosal filling of the reduced vertebral body, a complete consolidation can be achieved. ⋯ For spinal fractures with pronounced destruction of the anterior column and associated intervertebral disc ruptures, an interbody fusion by anterior approach should be performed. In case of additional posterior or transverse instability, a supplemental stabilization by internal fixator is necessary. For severe spinal canal encroachments at thoracic spine level with symptomatic or imminent spinal cord compression, the most efficient decompression by an anterior approach is preferred.