Der Orthopäde
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Multicenter Study Comparative Study Clinical Trial
[The evaluation of balloonkyphoplasty for osteoporotic vertebral fractures. An interdisciplinary concept].
Patients with osteoporotic vertebral compression fractures frequently complain of pain and a loss of function and mobility. Such fractures are associated with an increased mortality. The common treatment with bed rest, bracing or osteosynthesis does not lead to satisfying results. With two new surgical techniques, vertebroplasty and kyphoplasty, an internal stabilisation of osteoporotic vertebral fractures is possible. ⋯ Kyphoplasty is a reliable and minimally invasive method for stabilizing fractured osteoporotic vertebral bodies. Improvement of pain and function and a regain in height of the treated vertebral body can be accomplished.
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Children with congenital thoracic scoliosis associated with fused ribs and unilateral unsegmented bars adjacent to convex hemivertebrae will invariably have curve progression without treatment. It is assumed that the unilateral unsegmented bars do not grow and therefore early spinal fusion has been performed in the past with consecutive short thoracic spines and loss of lung volume. A new surgical technique is based on an indirect deformity correction and enlargement of the thorax via a longitudinal implant, the vertical expandable prosthetic titanium rib (VEPTR). ⋯ Using a 3-D analysis of computed tomography, a significant growth of the concave (7.9 mm/7.1% increase per year) and convex (8.3 mm/6.4%) side of the thoracic spine was found with no significant difference between sides. Unilateral unsegmented bars showed significant growth as well. Contrary to common knowledge, we were able to demonstrate the growth of the concave side of the thoracic spine and of the unilateral unsegmented bars after expansion thoracoplasty and VEPTR implantation.
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Reduction of the depressed joint surface in tibial plateau fractures often leaves large cancellous bone defects. These metaphyseal voids are typically filled with autogenous bone grafts that can cause a significant donor site morbidity. The use of injectable bone cement offers the opportunity to support the reduced joint surface without bone grafting. ⋯ The results show that Norian SRS can be used to fill metaphyseal bone defects in tibial plateau fractures. Clinical and radiological results are comparable to those of fractures treated with autologous bone graft. The high compression strength allows early full weight bearing without the risk of secondary loss of reduction.
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Pharmacologic treatment options for complex regional pain syndrome (CRPS) type I are discussed and drug effectiveness is graded according to the level of evidence available. Various drug strategies in the treatment of CRPS type I, i.e. NSAIDs, corticosteroids, free radical scavengers, antidepressants, anticonvulsants, local anesthetics, opioid analgesics, clonidine, capsaicin, NMDA receptor antagonists, calcitonin, bisphosphonates, GABA(B)-agonists, alpha-blockers, IVRA (bretylium/ketanserin), IVRA (clonidine), IVRSB, local anesthetics sympathetic blockade, GLOA and iloprost are discussed.
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Delayed lesions of the femoral or sciatic nerve are a rare complication after total hip arthroplasty. Several cases in association with cement edges, scar tissue, broken cerclages, deep hematoma, or reinforcement rings have been published. We report about a 62-year-old female who developed a pure motor paresis of the quadriceps muscle 2 weeks after total hip arthroplasty. ⋯ Electrophysiological evaluation revealed several nerve conduction blocks in physiological entrapments and the diagnosis of hereditary neuropathy with liability to pressure palsies (HNPP) was established. Hereditary neuropathy with liability to pressure palsies (HNPP) is a rare disease with increased vulnerability of the peripheral nerve system with mostly reversible sensorimotor deficits. It should be taken into consideration in cases of atypical findings of compression syndromes of peripheral nerves or delayed neuropathy, e. g., after total hip arthroplasty.