Der Orthopäde
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The aim of the study was to find the best possible methodology to evaluate the perioperative processes in the main diagnosis-related groups in an orthopaedic and trauma centre. A model in five phases was followed to develop the care pathways. Optimization potentials were derived from estimated problems and their origin. ⋯ The cost-effectiveness of treatment procedures and the costs of processes conditionally led to a change in management. The advantages of the study were increased knowledge of the processes involved in diagnosis and therapy with regard to the evoked costs. So the limited budget became more calculable.
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Osteoporosis is characterized by a reduction of bone mass and changes in bone micro-architecture. The resulting reduction in bone strength leads to the well recognized increase in the risk of fracture, particularly at the radius, hip, and spine. The treatment of osteoporotic fractures is challenged by the reduced mechanical capacity of osteoporotic bone, reflected in reduced holding power and increased fragility. ⋯ Modifications in implant design and techniques enable the surgeon to apply and combine the essential components of the basic principles for the treatment of mechanically impaired bone. The key components employed in modern implants include integrated compression techniques, multidirectional angular stability, expandable support surfaces, as well as multiple augmentation options. However, despite modern implant technology, osteoporotic bone fractures remain a significant challenge for the orthopaedic surgeon and require meticulous planning and implementation of the basic principles.
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Case Reports
[Vertebral fractures due to osteoporosis. Kyphoplasty and vertebroplasty vs conservative treatment].
Vertebral compression fractures are among the most common forms of manifestations of osteoporosis. Conservative treatment comprises adequate analgesia, osteoporosis medication and individualized physiotherapy or braces. Nevertheless, vertebral compression fractures frequently lead to persisting pain and decrease daily activity and quality of life. ⋯ There is broad clinical experience with both procedures. For kyphoplasty, randomized controlled trials showed significant improvements in pain and quality of life in patients undergoing kyphoplasty. However, cement leakages lead to rare but severe complications such as pulmonary embolism and nerve palsies.
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Due to the high incidence of concomitant neurological lesions, standardized clinical and radiologic diagnostic procedures in cervical spine injuries are mandatory. Magnetic resonance imaging or a stress X-ray should be performed when discoligamentous injuries are suspected. ⋯ However, despite prompt and appropriate therapy many of these injuries lead to permanent functional impairment depending on the type of fracture. This article summarizes the most frequent fracture types of the cervical spine, as well as the corresponding therapeutic options and outcome.