Der Orthopäde
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The altered physiology of the older patient in combination with the increased number of disease processes increases the potential risk of perioperative complications. The usual diagnostic procedures often fail to uncover the multiple problems these patients have. ⋯ Special considerations include an evaluation of the nutritional status, the functional capabilities and an assessment of the patients' cognitive and emotional status. This type of comprehensive assessment helps the physician to minimize the perioperative risks for older patients and is an excellent tool for improving the postoperative care and rehabilitation procedures.
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Following a general review of the basic principles of knee examination, the specific instability tests of the different ligaments are explained. The pathophysiology, the pathomechanic and the diagnostic evidence of these instability tests are shown. The diagnosis of meniscal and cartilaginous lesions are not discussed.
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Rupture of the Achilles tendon has become more common in recent years. Operative repair is the treatment generally used but non-surgical therapy is being accepted by an increasing number of surgeons because of the reports of good results with conservative treatment. Ultrasonographic examination not only allows an exact diagnosis to be made in muscle and tendon injuries, but also observation of the healing processes. ⋯ We observed complete healing in all patients, absence of complications and excellent functional results. The morbidity of the patients was lower than with operative treatment and no hospital stay was needed. In conclusion, in our opinion ultrasound-controlled conservative functional treatment of rupture of the Achilles tendon should be used more frequently in future.
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The most common cause of wrist pain, due to neurological disorder is carpal tunnel syndrome. In aging patients with atrophy of the hand muscles it is to be differentiated from s.c. myelopathic hand, caused by denervation of anterior horn cells in conditions such as cervical spondylosis. The referred pain affiliated with palpable bands and trigger points in the muscles has to be also considered as origin of pain.
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A total of 1566 patients with fractures of the pelvis were treated at the Department of Traumatology at the Hannover Medical School between 1972 and 1990. Of these, 1350 patients had fractures of the pelvic ring, 216 isolated acetabulum fractures, and 398 combinations of pelvic ring fractures and acetabular involvement. Of these patients, 718 were admitted with severe polytrauma. ⋯ In unstable pelvic ring fractures (Tile C), external fixation led to a significantly higher rate of posterior dislocations (over 1 cm) than did internal fixation. In these situations a combined posterior and anterior internal fixation procedure improved the result compared to posterior internal stabilizations alone. As a result, internal stabilization using a standardized technique for every fracture location is recommended for all unstable pelvic ring fractures.