Zeitschrift für Orthopädie und Unfallchirurgie
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Volar locked plate fixation of distal radius fractures has become an established procedure in the past decade, although reports of flexor tendon injuries due to volar plating have been increasing. The aim of the present study is to identify the risk factors which produce irritations of flexor tendons using the locking palmar 3.5 mm T-plate, with special emphasis placed on the watershed line and the pronator quadratus muscle. ⋯ Stabilisation of distal radius fractures with dorsal and volar displacement by the locked palmar 3.5 mm T-plate produces positive results. A careful reconstruction of the pronator quadratus is more important than respecting the watershed line in that it achieves muscular coverage, and thus provides a greater distance of the plate to the tendon compartment. We recommend sonography after bony healing to identify functional plate prominence or tendon irritations under functional conditions (dorsal wrist flexion) and, if necessary, plate removal. Further systematic sonographic examinations should be undertaken including other locked plate systems.
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The aim of this study was to evaluate the functional results and determine/record the complications after treating distal humerus fractures with an anatomically precontoured and angular-stable double plate system (LCP Distal Humerus Plates, Synthes GmbH, Umkirch). ⋯ By using the anatomically precontoured and angular-stable LCP distal humerus plates system a stable osteosynthesis allowing early physiotherapy is achieved in the majority of patients. Due to early initiation of physical therapy the functional results might be improved. Despite using the LCP system complications at the distal humerus fracture side were seen frequently, emphasising the challenging surgical procedure and demonstrating the need for further implant and surgical procedure improvement.
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Nowadays, complex arthroscopic procedures of the knee joint, such as ACL reconstruction, are routinely carried out on an outpatient basis. The reduced time spent with the patient places high demands on the surgeon with regard to the management of such cases. The aim of this study was to evaluate the current standards of perioperative management following outpatient arthroscopic surgery of the knee in Germany. ⋯ DVT prophylaxis with LMWH, general anaesthesia, postoperative cryotherapy and personal availability by phone can be considered part of the standard perioperative management following outpatient knee arthroscopy in Germany. However, a wide variety of treatment options can be found regarding topics such as analgesia, antibiotic prophylaxis, tourniquet, knee drainage and physiotherapy.
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Academic careers often place the burden of research on top of clinical work. This conflict denotes a demanding task especially in surgical disciplines, such as orthopaedics and traumatology. Driven by changes in the social system, concerning, e.g., leisure and parentship, the future organisation of the academic workplace needs to address these individual issues. With the aim to evaluate individual motivation towards combining research, clinical work and private life and to receive suggestions for improvement we conducted a survey addressing residents employed in the orthopaedic and traumatological departments of German university hospitals. ⋯ Individual solutions seem to be necessary to achieve a scheduled efficiency of clinical and research careers. This includes structural developments (like a professionally headed lab) and the establishment of dynamic clinical structures. It seems possible that the clinical organisation of physicians in teams might offer solutions to cope with the demands of surgical training and clinical care on the one hand and research on the other hand.
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Displaced midclavicular fractures in children are generally treated non-operatively. But there is a lack of age-related data concerning the functional and cosmetic results following conservative treatment and patients' content with the treatment. ⋯ The method of choice in children under the age of ten with a displaced clavicular fracture is the non-surgical treatment supported by sufficient pain medication. Older children reach good results but suffer from more pain and are dissatisfied by the cosmetic results and immobilisation. Because of this, active older children and adolescents with a displaced clavicular fracture benefit from elastic stable intramedullary nailing.