Der Orthopäde
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Because of its biopsychosocial factors chronic back pain is often resistant to unimodal therapy regimes. Multimodal pain programs are a promising therapy option in the management of chronic pain as they focus on functional restoration. The aim of the study was to evaluate the prevalence of psychopathology in patients with chronic back pain. ⋯ Fisher's exact test was performed to calculate the significance in the different subgroups. The results showed that there was a high prevalence of depression, anxiety disorders and adjustment disorders in patients with chronic back pain. In this cohort the prevalence of depression and anxiety disorders was significantly higher than the estimated prevalence of the normal German population.
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Deformities of the small toes often occur with complex forefoot deformities. Proximal interphalangeal joint arthrodesis is a reliable correction procedure for rigid flexed proximal interphalangeal joints. The most often performed technique by far is K-wire fixation; however, pin tract infections, malrotation due to deficient securing of the rotation and irritation of the metatarsophalangeal joints are common complications. ⋯ The follow-up time was 2 years. In all cases clinical and radiological osteotomy healing occurred 6 weeks postoperatively and there were no complications. This technically simple and cost-efficient procedure appears to be a good alternative to known proximal interphalangeal joint arthrodesis methods.