Der Orthopäde
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Review Comparative Study
[Special features of procedures in paediatric orthopaedics].
To get good to excellent results in paediatric orthopaedics perioperative pain treatment is essential. Guidelines are in general similar to those for adults. Some special features should be taken into account. ⋯ Pain therapy is orientated to the reversed WHO pain treatment scheme completed by surface and regional anaesthesia. After discharge pain treatment has to be administered. This article presents concepts of perioperative analgesia.
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Review Comparative Study
[Patients with pre-existing chronic pain and/or psychological problems].
Existing pain chronification and psychological problems can affect the degree of perioperative pain and hence the postoperative outcome. Most elective surgery performed on the musculoskeletal system is indicated because of pain. To avoid perioperative complications it is therefore essential to identify patients with existing pain chronification before surgery is performed. ⋯ In line with what is known about the mechanisms of pain chronification, patients with existing chronification usually display additional psychological problems. These psychological factors ought to be established prior to surgery. A preliminary non-surgical treatment could potentially also lead to a reassessment of the indication for surgery.
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The German mandatory quality assurance programme collects data from all primary total hip and knee replacements. The quality of the indication is measured by clinical and radiological criteria. The results were analysed in terms of differences in establishing the indication subject to patient and hospital characteristics. ⋯ Further analyses are necessary to ascertain whether the differences in quality of care are deficits or only variances in medical care.
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Comparative Study
[Value of adjuvant physiotherapy in postoperative pain management].
In times of limited financial and human resources the application of adjuvant physiotherapy postoperatively in orthopaedic patients requires reevaluation. In the early postoperative course physiotherapy improves the patients' mobility. However, it is not able to reduce the need for pain medication. ⋯ In contrast, massages are of minor importance in the immediate postoperative course and are applied only in a few selected cases. Cryotherapy plays a major role especially after shoulder and knee surgery. On the other hand, transcutaneous electrical nerve stimulation (TENS) and acupuncture are applied only in selected patients after orthopaedic surgery, e.g., after limb amputation.
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Skeletal geometry, soft tissues, and neuromuscular control influence the patellofemoral gliding mechanism. Abnormal skeletal geometry - such as increased femoral anteversion, trochlear dysplasia, patella alta, increased tibial external torsion, increased tibial tubercle lateralization, and variations of combined deformities - may lead to patellofemoral complaints. ⋯ Osteotomy with soft tissue repair might be the best treatment, depending on the primary pathology. Surgery aims to eliminate the underlying pathomorphology.