Der Orthopäde
-
Review Meta Analysis Comparative Study
[Hip fractures in the elderly : Osteosynthesis versus joint replacement].
Osteoporotic fractures of the femoral neck and trochanteric region pose an ever-expanding existential problem both for the individual and for society. Despite numerous innovations and advances regarding implant design, mortality and the systemic and mechanical complication rates remain high. ⋯ In summary, there are many parameters affecting the outcome in the treatment of fragility and hip fractures. Technical features as well as surgeon characteristics play an important role and the ultimate solution has yet to be developed. Even though fracture morphology may indicate a specific treatment option, patient characteristics play an important role in decision-making. The development of centers of fragility fracture care in Germany could help to lower the complication rate and increase quality of life in hip fracture patients in the future.
-
Periprosthetic fractures represent a common and complex challenge in the clinical practice in orthopedics and trauma surgery. Due to demographic changes characterized by increased life expectancy and higher numbers of primary arthroplasties, the number of periprosthetic fractures is increasing as well. Factors such as osteoporosis, multimorbidity and a highly active aging population additionally increase the complexity of periprosthetic fractures. ⋯ The present article demonstrates the current state of open reduction and internal fixation of periprosthetic fractures with respect to biomechanical principles and furthermore provides an overview on implant augmentation.
-
Osteoporotic fractures of the ankle were observed three times more often in the year 2000 than in the year 1970 and it is predicted that this will increase another three times by the year 2030. The most important predictive values for ankle fractures in the elderly are smoking, multipharmacy and poor mobility. ⋯ Due to the increasing number of ankle fractures in the elderly particularly in postmenopausal women with osteoporosis, the insufficient diagnostics and therapy of osteoporosis and because the number of these difficult to treat fractures will increase by a factor of 3 by 2030, special surgical techniques and particularly implants are necessary for unstable ankle fractures types PA III, SE IV and PE.
-
During sports the shoulder complex is exposed to considerable load especially where throwing is important and various pathological changes can occur. In the last two decades the shoulder in athletes has become a special term in clinical sports medicine ⋯ Knowledge about sport-specific load profiles as well as about the variety of treatment options is crucial for successful treatment of these injuries.
-
Acromioclavicular joint (ACJ) dislocations represent the most frequent injuries of the shoulder girdle among athletes. Low grade injuries are more common than high grade injuries. Possible injury mechanisms are either a direct trauma to the shoulder or a fall on an adducted elbow with indirect trauma to the ACJ. ⋯ After relatively restrictive postoperative care including a 6-week immobilization period, competitive sport is normally possible after 3-4 months in cases of acute injury and after 6 months in cases of chronic injury.