Der Orthopäde
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In high tibial closing-wedge osteotomies (HTO), closure of an osteotomy gap after resection of a bony wedge can be associated with a fissure of the medial cortex of the tibial head (MCT). The effect of a broken MCT on the recurrence of varus deformity is disputed. In this study, serial roentgen stereometric analysis (RSA) was used to determine the fixation stability of a rigid internal "L" plate after HTO. ⋯ Twelve weeks after HTO, translations between tibial segments were below the accuracy of the RSA setup in the majority of patients. Group 1 patients demonstrated a higher initial fixation stability, less occurrence of varus deformity, and a higher HSS score compared to patients with larger wedge sizes and frequent fracture of the MCT (group 2). Before bone healing is achieved, the integrity of the MCT plays a crucial role for the clinical and radiological outcome after HTO.
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The importance of analgesic drugs in the treatment of low back pain is a matter of intense debate. Based on the current literature, a multidisciplinary approach combining drug treatment with physical and psychotherapy has proven to be the most successful treatment of back pain. ⋯ This chapter reviews the historical background of analgetic drugs and provides an overview of the current diagnostic and therapeutic options in the treatment of back pain. Recommendations are given based on the results of current randomized controlled studies.
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Review Comparative Study
[Clinical pharmacology of the selective COX-2 inhibitors].
The discovery of two isoforms of cyclooxygenases (COX-1 and COX-2) has provided a new insight into the involvement of prostaglandins in the clinical effectiveness and gastrointestinal toxicity of NSAIDs. Currently, there are four selective COX-2 inhibitors available in Germany: celecoxib, rofecoxib, valdecoxib and parecoxib. Orally administered rofecoxib, celecoxib and valdecoxib have been approved for the relief of symptoms of osteoarthritis and rheumatoid arthritis. ⋯ The incidence of gastrointestinal complications was significantly lower than that with the non-selective NSAIDs. However, the clinical relevance of these effects was, at least in some populations of patients (e.g. patients on low dose aspirin), not as high as initially expected. While not replacing less expensive classical NSAIDs, selective COX-2 inhibitors provide a marked enrichment of the spectrum of anti-inflammatory and analgesic therapeutics.
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Postoperative pain management adheres to the principles of a three-step routine according to the WHO recommendations. This routine suggests the combination of a basic non-opioid (step I) with an opioid of low potency (step II) or high potency (step III). Non-opioids are routinely administered prior to an opioid. ⋯ In order to lower the need for systemic pain medication, postoperative pain management is supplemented by regional anesthesia administered pre- or intraoperatively. Requirement for pain medication beyond normal or increasing with postoperative time is suggestive of a postsurgical complication. Among the numerous drugs available for postoperative pain management, the physician is advised to confine his selection of pain medication to a limited number in order to gain superior knowledge of effects and side effects of the drugs administered.
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The purpose of this study was to compare quality of life and subjective well-being between patients who underwent either amputation or limb-salvage procedures for lower extremity sarcomas in order to determine if this aspect can be considered in the decision on the type of surgery. Sixty-six patients were evaluated at least 1 year after surgery and systemic therapy for lower extremity sarcomas. Self-report questionnaires such as the Quality of Life Questionnaire (QLQ-C30), the Life Satisfaction Questionnaire (FLZ), and the Enneking Score (MSTS) were used. ⋯ Additionally, a correlation between subjective well-being and the location of either amputation or reconstruction ( p=0.039, r(p)=- 0.309) could be shown. These findings demonstrate that the type of surgery has no influence on quality of life and subjective well-being after lower extremity sarcomas. Thus the decision for either limb-salvage procedures or amputation cannot be based on quality of life and subjective well-being but must be determined by oncological criteria.