Zeitschrift für Orthopädie und Unfallchirurgie
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Multicenter Study
[Subsequent treatment following proximal femoral fracture - who, when, where? Assessment of the current situation in Germany].
Geriatric fractures are an increasing challenge for the German health-care system. While the acute care for patients with proximal femoral fractures is already standardised, differences remain in the further treatment and rehabilitation. A survey was conducted in cooperation with the section of geriatric trauma (AG Alterstraumatologie) of the German Association of Trauma Surgery (DGU) to point out existing problems in this group of patients. ⋯ The questionnaire confirms that there are problems in the aftercare service of geriatric patients all around Germany. A further improvement of collaboration between acute and aftercare hospitals is required.
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Comparative Study
[Comparison of results after primary and secondary shoulder arthroplasty for proximal humeral fractures].
The purpose of this retrospective cohort study was to evaluate, compare and discuss the results and complications after primary and secondary shoulder arthoplasty in proximal humeral fractures. ⋯ In summary, the functional results did not differ significantly between primary and secondary shoulder arthroplasty after proximal humeral fractures. The relatively low expectation of elderly patients is reflected in a high rate of patient satisfaction in spite of moderate functional results. The primary humeral head replacement showed higher rates of complications and revisions compared to secondary arthroplasty.
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Tendinosis of the Achilles tendon is a degenerative-reparative structural change of the tendon with microdefects, increases in cross-section due to cicatricial tendon regeneration, neoangiogenesis and reduction of elasticity. The previously used term tendinitis is only rarely used for the chronic form since signs of inflammation such as redness and hyperthermia or elevated levels of inflammatory parameters on laboratory testing are generally absent. Duplex sonography with visualization of the neovascularization has become a valuable supplement not only for diagnostics but also for therapy planning. ⋯ When compared with conservative functional therapy the minimally invasive repair has the advantage of being less dependent on the compliance of the patient since, in the early phase of tendon healing the suture prevents a separation of the tendon ends upon controlled movements. However, not every patient with a ruptured Achilles tendon should be treated with a minimally invasive repair. Open tendon reconstruction and functional conservative therapy are still justified when the correct indication is given.