Der Orthopäde
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The foundation of the German Society for Orthopedics in 1901 was due to a separation from the faculty of surgery because a surgical approach alone did not adequately deal with the symptoms. Orthopedists were initially considered as a fringe group. The conservative treatment approach was initially at the forefront and operative measures were a side line. ⋯ The demographic development presents new requirements which must be dealt with. Technical solutions are often very promising especially in this field. Technical orthopedics remains an important component of the specialty of orthopedics and trauma surgery and with an increasing tendency due to more recent research and development.
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Diseases and injuries of the musculoskeletal system are the most common reasons for rehabilitation in Germany. The statutory health insurance, pension funds and the German social accident insurance are service providers for rehabilitation. Rehabilitation is based on the international classification of functioning, disability and health (ICF). ⋯ This will be a burden for the health system in acute care medicine and rehabilitation. Improving activities and participation following diseases and injuries of the musculoskeletal system will end in an increase in utilization of rehabilitation. This needs to be considered and reflected in an adjusted higher budget for costs in rehabilitation.
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In a representative survey among members of the working group for joint replacement (AE) in Germany (86.7% response) it was found that 0.6% of patients with total knee arthroplasty (TKA) and 1.2% of patients with total hip arthroplasty (THA) may have a problem due to hypersensitivity to nickel or cobalt after implantation. Only one third of them may need revision surgery. ⋯ Before a revision is performed it is recommended to perform knee arthroscopy to obtain tissue for microbiological and histopathological investigations. The second part of this questionnaire will look at the special question of how to deal with allergy patients based on constructed case examples.
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Ankle sprains are common injuries in childhood and are generally harmless. However, fractures of the ankle joint are rare, but complications (persistent rotational or axial deformity, alteration of growth of the distal tibia or fibula, or joint deformity) can lead to serious problems during growth. The clinical relevance of growth disturbances at the distal tibia or fibula depends on the age at the time of fracture more than on the fracture type, severity of dislocation, or interponated material in the fracture gap. ⋯ Valgus deformity is rare, mostly due to persistent axial deviation of an insufficiently reduced fracture. Transitional fractures always occur at the time of growth plate closure; thus, growth disturbances do not play a role. Transitional fractures could be overlooked or treated insufficiently, leading to a step or gap of the joint surface.
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Periprosthetic shoulder joint infections are encountered by orthopedic surgeons mainly as complex situations which are highlighted by difficult treatment modalities. In a confirmed infection the general therapeutic principle is a surgical procedure. Several strategies orientate on the cause of an infection, the time course of postoperative symptoms, the pathogenicity of the isolated species and the specific comorbidities of the patient. ⋯ Early recognition is of paramount importance in order to prevent further spread, sepsis or even fatal outcome. Low grade infections are challenging conditions in terms of diagnosis and treatment. This article summarizes the principles of current classification, detection and treatment strategies for periprosthetic shoulder joint infections.