Der Orthopäde
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Painful stiffness of the shoulder is an ill-defined clinical entity that is difficult to assess and delicate to treat. The nomenclature used is broad and includes terms such as frozen shoulder, adhesive capsulitis, focal algodystrophy, stiff shoulder, contracted shoulder, and others. Apart from its idiopathic form, the disease can be initiated by trauma, infection, tumour, radiation, systemic and local metabolic disturbances. ⋯ In the inflammatory phase, aggressive treatment protocols are probably contraindicated. Complications of invasive protocols are rare but deleterious and therefore have to be taken into consideration. New anti-anglogenetic agents may enhance functional results and shorten the rehabilitation phase.
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Comment Letter Randomized Controlled Trial Comparative Study Clinical Trial
[A homeopathic drug is equivalent to diclofenac?!].
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Core decompression of the necrotic area for treatment of idiopathic osteonecrosis of the femoral head was developed and published by Ficat and Arlet in 1962 within the scope of their "Functional exploration of bone". The mode of action is attributed to a reduction of the intramedullary pressure in the bony compartment of the femoral head. The possibilities of repair and bone regeneration following core decompression are still discussed controversially. ⋯ On account of the literature and our own experience, treatment by core decompression can be recommended in cases of reversible early stages of osteonecrosis (ARCO 1), as well as in those cases of irreversible early stages (ARCO 2) that show a medial or central location of the necrosis with an extent of less than 30% of the femoral head. Once the disease reaches the irreversible early stage, complete recovery cannot be expected. In these cases only reduction of pain and retardation of the natural course of the osteonecrosis are possible to gain time until total hip replacement is unavoidable.
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Every 15th case of a bone fracture in patients aged more than 65 years concerns the distal radius in Germany. This means the second rank of all geriatric fractures following fractures of the hip. According to the approved and increased apply of operative stabilisation there are arising more and more reports upon poor results of nonsurgical treatment. ⋯ Lesion of the superficial branch of the radial nerve were noted in 2 cases (2.1%), as far as we extended the surgical approach for the pin application. Technical problems from the site of the external fixateur appeared in 3 cases, two of them could be attributed to an infirmity of the fixateurs ball joints which is now eliminated by the producer. 4 patients with a type-B fracture was provided by plating, additionally 4 patients with a type-C fracture because of non-compliance. The external fixateur is an essential part of a differentiated treatment with reference to the several types of distal radius fractures in older patients.