Der Orthopäde
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The orthopedist can choose from three classes of drugs to relieve pain. Nonsteroidal anti-inflammatory drugs (NSAID) possess sufficient analgetic efficacy, but they are hampered by often causing gastrointestinal pain and bleeding. Opioids are strong analgetics that can be successfully used against strong pain. ⋯ Because of the risk of damage to white blood cells leading to agranulocytosis with foudroyant infections their use should be strictly limited to conditions that justify such a risk like tumor or colic pain. The aniline derivative acetaminophen (= paracetamol) is well tolerated and is the drug of choice in usual common pain. Large doses are to be avoided because of liver damage, especially in children.
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Clinically relevant pain states are usually characterized as either inflammatory or neuropathic. While inflammatory pain results from tissue injury or damage, neuropathic pain results from damage or disease of nerve fibers. In either pain state, both the peripheral and the central nociceptive system contribute significantly to the generation of pain. ⋯ Central sensitization is a neuronal process that amplifies the activity from the periphery. Numerous molecular mechanisms are involved in peripheral and central nociceptive processes including rapid functional changes of signaling (increase of excitability) and long-term regulatory changes such as upregulation of mediator/receptor systems. The conscious pain is generated by thalamocortical networks that produce both sensory discriminative and affective components of the pain response.
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Limping and groin pain can issue diagnostic problems during late pregnancy. Differential diagnosis of two idiopathic syndromes, transient osteoporosis and osteonecrosis of the femoral head, is made possible by MRI in the early stages. This case is reported to demonstrate the need to distinguish between those syndromes early so as to prevent further joint damage.
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Unstable fractures of the posterior pelvic ring are frequently combined with severe hemorrhage. In 80% of cases the bleeding originates in the ruptured presacral venous plexus or the fracture itself. Arterial bleeding is less common. The pelvic clamp introduced by Ganz can make it possible to stabilise the pelvis, with subsequent compression of the fracture planes and reduction of the intrapelvic volume in such cases, so improving the prognosis. Use of the pelvic clamp can be integrated into the management in the emergency room with no problem. ⋯ In the hands of an experienced and practised user application of the pelvic clamp is a safe method for emergency stabilisation of the posterior pelvic ring in polytraumatised patients, even without blood volume control. Problems can be solved and do not generally mean the pelvic clamp cannot be used. The immediate radiological check (e.g. during the emergency CT -scan performed for primary diagnosis) is a must, however.
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Case Reports
[A complication during kyphoplasty. Cement penetration through the azygos vein into the superior vena cava].
A 59-year-old woman had a nontraumatic osteoporotic fracture of the seventh thoracic vertebral body. Despite correct operative technique, in the course of kyphoplasty cement was dislocated through the segment vein into the azygos vein and from there into the superior vena cava. The patient was free of cardiopulmonary symptoms throughout. Oral anticoagulation was administered for 3 months to prevent thromboembolism, and regular clinical and echocardiographic follow-up examinations were also performed during this period.