Der Orthopäde
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Within the past 100 years, shoulder and elbow surgery has developed into a highly sophisticated specialty. Technical advancements now allow operative treatment of most shoulder and elbow disorders. Shoulder arthroplasty is able to accurately reproduce normal anatomy and function. ⋯ The operative technique in proximal humerus fractures is particularly demanding, due to osteoporosis and the risk of avascular necrosis. Magnetic resonance imaging is the preferred imaging technique at the shoulder, often combined with intravenous or intra-articular contrast injection. Elbow joint replacement is mostly used in rheumatoid arthritis and has achieved a high technical standard.
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In the realization that the cause of and thus an appropriate curative systemic therapy for rheumatoid arthritis did not and does not exist, surgical treatment of this usually destructive disease emerged as a major field in orthopedics in collaboration with internists specialized in rheumatology. The establishment of working groups within the scientific society initiated by the German Association for Orthopedics and Traumatology (DGOT) in 1971 to improve efficiency was a decisive factor for the further development in the German-speaking countries. A significant role was played by the fact that the Swiss N. ⋯ It is significant that in the German-speaking countries a treatment plan focused solely on the joints has thus far not gained general acceptance as is the case in Anglo-American countries. Preference is given to working as a team with subspecialties for upper and lower extremities and the spinal column. This guarantees that the priorities of the patients who usually present with multiple joint alterations can be dealt with by one group.
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Nonunions and malunions around the elbow are often due to incorrect initial treatment of a fracture. We have to differentiate between nonunions and malunion of adults and children. There are general principles for the treatment of nonunions and malunions of the distal humerus. ⋯ It can be carried out, if necessary, on removal of implants. If these principles are followed, then the operation is usually successful and the patient satisfied. If treatment fails, the possibility of a joint replacement or an arthrodesis should not be forgotten.
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Magnetic resonance imaging (MRI) is the leading diagnostic procedure for disk pathology and has overtaken other imaging modalities in frequency of use. However, one must be cautious not to overinterpret small abnormalities that are also frequent in asymptomatic subjects. There is conflicting evidence about the correlation of high-intensity zones with clinical symptoms. ⋯ Contrast-enhanced MRI is well suited to differentiate a recurrent disk extrusion from epidural fibrosis. In all cases suspicious of tumor or infection, MRI is indicated as a first-line investigation. The indications and pitfalls of the state of the art of MRI are delineated in this article.