Der Orthopäde
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The clinical features, diagnosis and treatment of haematogenous multifocal osteomyelitis, a rare illness, are described. Of clinical note are the pain, pseudoparalyses and restriction of movement. ⋯ MR-tomography is the most reliable method for examination of proximal infected foci (spondylitis, pelvis osteomyelitis). In our view, the earliest possible removal of all infected foci by means of operation and parenteral antibiotics mare the most important treatment.
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The efficiency of ultrasound was tested in septic arthritis. A total of 259 children with hip pain, septic arthritis (n = 14), transient synovitis (n = 120), juvenile rheumatoid arthritis (n = 12), Legg-Calvé-Perthes disease (n = 92) and slipped capital femoral epiphysis (n = 21) were examined by ultrasound. By using the standard planes described by the DEGUM, it is possible to analyze the joint capsule, the surface of the femoral head and the periarticular structures. ⋯ Therefore, ultrasound cannot distinguish between septic and non-specific arthritis; capsular distention is a non-specific ultrasound sign. Immediate diagnostic puncture is necessary if septic arthritis is suspected (possible by ultrasound control). In cases with both capsular distention and osseous abnormalities, ultrasound usually allows differentiation between slipped capital femoral epiphysis/Perthes disease and septic/non-specific arthritis.
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Since the development of microsurgical methods, the timing and concepts of surgery have significantly changed in obstetrical palsies. Because of the high axon regeneration potential in children, early and successful microsurgical reconstruction of the brachial plexus provides very encouraging results. Such successful nerve regeneration is the basis for secondary surgery which aims at complete restoration of function of the upper limb.
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The precise preoperative clinical and electrophysiological evaluation of the brachial plexus as well as an exact rediological evaluation are the keystones for the treatment of traumatic injuries of the brachial plexus. Furthermore, surgical management and prognosis of traction injuries of the brachial plexus depend on the accurate diagnosis of root avulsion from the spinal cord. Myelography, myelo-computed tomography and recently magnetic resonance imaging are the main radiological methods for preoperative diagnose of cervical root avulsions. ⋯ However in 15 % of the cases preoperative exact radiological diagnosis is unfortunately not reliable. In these special cases intraspinal surgical exposure of the cervical roots will provide the accurate diagnosis of root avulsion. Accurate clinical evaluation and exact assessment of intraspinal root avulsion simplify enormously the decision concerning the choice of donor nerves for transplantation and/or neurotization during brachial plexus surgery.
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The occurrence of sever pain is one of the most disabling symptoms after the traumatic lesion of the brachial plexus. Avulsion of one or more cervical roots of the brachial plexus is the main cause of severe pain, known as deafferentation pain. Lesion of the dorsal horn of the cervical spinal cord due to root avulsion may lead to important pathological changes and scarring that are responsible for the induction of pain sensations. ⋯ In contrast to drug therapy, which usually offers only limited benefit, surgical treatment over the last years has shown positive results. Coagulation of the dorsal root entry zone (DREZ) is one of the most efficient surgical treatments for these patients. Understanding of the pathophysiological changes and different pain mechanisms induced by traumatic injury of the brachial plexus is fundamental for the planning and step-wise treatment of such patients.