Zeitschrift für Orthopädie und Unfallchirurgie
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Autologous chondrocyte transplantation/implantation (ACT/ACI) is an established and recognised procedure for the treatment of localised full-thickness cartilage defects of the knee. The present review of the working group "Clinical Tissue Regeneration" of the German Society of Orthopaedics and Traumatology (DGOU) describes the biology and function of healthy articular cartilage, the present state of knowledge concerning potential consequences of primary cartilage lesions and the suitable indication for ACI. ⋯ Advanced degenerative joint disease is the single most important contraindication. The review gives a concise overview on important scientific background, the results of clinical studies and discusses advantages and disadvantages of ACI.
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As a further alternative to previously used vertebral augmentation methods, the Kiva VCF Treatment System® was clinically investigated. ⋯ On the basis of these results, the new augmentation can be described as being effective in the treatment of painful vertebral fractures.
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A 36-year-old motorcyclist sustained multiple severe injuries in a motorcycle accident. The leading injury was a type B open-book pelvic fracture, resulting in a relevant haemodynamic instability. ⋯ After repositioning of the pelvic binder in the emergency room, the pelvis was adequately stabilised, leading to a transient stabilisation of the haemorrhagic shock. This example illustrates the benefit of a simple and effective tool for the initial stabilisation of pelvic fractures in haemodynamically compromised patients and in particular the importance of the correct placement of the pelvic binder.
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To offer a correct treatment strategy for osteoporotic vertebral body fractures remains a huge challenge in modern spine surgery. ⋯ After 5 years the therapy concept seems to be of low risk and not being associated with major complications. The PCS and MCS scores are comparable to a norm group of the same age. The correction loss exceeded the operative reduction marginally but turned out to be slightly lower compared to that of an isolated kyphoplasty.
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Statistics of the Arbitration Office of the North German Medical Boards for extrajudicial claim resolution show that nearly 30 % of all panel proceedings confirm medical malpractice. In proceedings concerning fractures in children the percentage rises to 63 % with significant differences in various fracture localisations. ⋯ The evaluation of malpractice in the treatment of diaphyseal fractures in children confirms the consensus: correct assessment of fracture type, early adequate treatment and fracture control, early corrective measures after insufficient primary reduction or secondary dislocation, lead to fracture healing without any anatomic or functional deficiency. Reverse argument: fracture healing leading to anatomic and/or functional loss gives a very probable indication of malpractice.