Der Orthopäde
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Multicenter Study Clinical Trial
[Effective pain relief facilitates exercise therapy : Results of a multicenter study with controlled-release oxycodone in patients with movement pain].
The efficacy and tolerability of oral controlled-release oxycodone in the therapy of musculoskeletal pain were analyzed in this observational study. ⋯ The therapy of pain of the musculoskeletal system with controlled-release oxycodone is efficient. An effective pain relief makes physical therapy practicable, reduces the impairment in different parts of life, and increases quality of life.
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Fractures of the distal phalanx are common. According to the histological results of Hoch et al., the term bony extensor tendon avulsion is not correct; instead, the description fracture of the dorsal distal phalanx should be used. Many therapeutic options for these fractures are described in the literature. ⋯ The mid- and long-term results of remodelled joints that are mostly not in anatomically correct positions can only be determined in prospective studies. Indications for operative treatment are dorsal distal phalanx fractures with a distal finger joint subluxation or in cases of widely rotational malposition of the bony fragment. The osteosynthesis has to respect the extensor aponeurosis.
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Management of soft tissue ruptures of extensor tendon lesions of zone I is both difficult and controversial. Because of their superficial position already minor injury can be sufficient for laceration. ⋯ However, this injury can cause significant hand dysfunction and has to be treated with attention in order to provide the best possible outcome for the patient. Therefore we try to evaluate the common treatment procedures and to give guidelines for management of this injury.
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Injuries to the proximal interphalangeal (PIP) joint are often discounted as trivial although they can lead to instability and even more frequently to contracture of the PIP joint. Distortion and hyperextension traumata are the most common causes of PIP joint injuries of the hand and frequently occur in conjunction with sports-related injuries. Treatment concepts demonstrate considerable agreement. ⋯ During functional assessment of the joint's stability a distinction can be made between active and passive stability. Injuries of the palmar plate with and without small bone fragments that do not exhibit subluxation after repositioning and X-ray control are immobilized during the phase of acute pain in a palmar splint in the intrinsic plus position for a maximum of 5 days. Thereafter the patient independently performs movement exercises.
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For the more than 330.000 patients/year with primary total hip replacement (THR) or total knee replacement (TKR) in Germany alone, postoperative rehabilitation either on an inpatient or follow-up outpatient basis is largely accepted as standard, despite limited financial resources. The present article discusses the necessary diagnostic and therapeutic measures in the immediate postoperative phase in the hospital or clinic, the so-called post-inpatient phase in a rehabilitation clinic or centre, as well as the subsequent outpatient phase with consistent and regular specialist follow-up.