Der Orthopäde
-
Case Reports
[A 56-year-old patient with Gaucher's disease sustaining a pathologic subcapital fracture of the humerus].
We present a case of a pathologic humerus fracture in a patient with the initial diagnosis of Gaucher's disease, which is the most frequent form of lipidosis transmitted as an autosomal recessive trait. It often results in orthopaedic complications with pain, osteonecrosis, fractures and joint infractions. If there is cause for suspicion, beta-glucocerebrosidase in white blood cells should be measured because of the important consequences for treatment. Therapy with a modified enzyme is effective in managing the disease.
-
Case Reports
[Ventral stabilization of the lumbar spine of a 2-year-old boy with an expandable cage : 7-year course].
This case report describes the first implantation of an expandable cage into the lumbar spine of a 2-year-old boy. Due to incomplete remission of a teratoma, it was necessary to replace the second lumbar vertebral body with an expandable cage implantation and subsequent dorsoventral stabilization. During the follow-up period with annual x-ray examinations, a loss of correction without increased pain or neurological deficits could be shown in the now 9-year-old boy.
-
Materials used in osteosynthesis or artificial joint replacement are usually well tolerated. Complaints after such operations are mostly related to infection or mechanical problems but may also be caused by allergic reactions. The latter encompass skin changes, e.g., eczema, delayed wound/bone healing, recurrent effusion, pain, or implant loosening. ⋯ Titanium-based osteosynthesis materials are recommended for metal allergic patients. In elective hip replacements, a ceramic/polyethylene (PE) articulation should be used, and in knee replacements "alternative materials". If a regular, potentially applicable CoCr/PE articulation is preferred, the patient must be well informed and must give his/her written consent.
-
Compared with conventional total knee arthroplasty, rehabilitation after a minimally invasive procedure is faster. Flexion to 90 degrees is reached in a few days in most patients. Coordination exercises, stair climbing, and mobilisation with one or no crutches are achieved rapidly, and patients can usually return more quickly to their activities of daily living as well as professional and leisure-time activities. ⋯ Patient education is best started weeks before surgery because a well-motivated patient supports an excellent clinical outcome. New surgical techniques give us the possibility to think about routinely used perioperative procedures and improve them. The aim is to offer a concept of minimally invasive surgical technique and optimized protocols for perioperative anaesthesia, analgaesia, and rehabilitation.
-
Case Reports Comparative Study
[Bilateral clavicular fractures occurring at different times. Conservative vs operative therapy using intramedullary nailing--a case report].
In this case report we present treatment strategies and the functional and cosmetic outcome in a case of midclavicular fractures. A 20-year-old patient suffered from nearly identical fractures of the left and right clavicle with a time interval of 2 years following snowboard falls. The first fracture was treated conservatively leading to an unsatisfactory course and result. ⋯ The functional and cosmetic outcome of this treatment was excellent. In cases of clavicular fractures elastic stable intramedullary nailing (ESIN) is a minimally invasive technique leading to fast analgesia resulting in a high level of mobility and ultimately a pleased patient. If the indication is right, intramedullary nailing can be a helpful operation technique which complements the already established procedures (conservative and plate osteosynthesis) in cases of dislocated clavicular fractures.