Der Unfallchirurg
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Humeral head fractures generally may be treated in a non-operative concept with early physiotherapy when fragment dislocation is minor. Dislocated 2-part fractures (head and shaft fragment) may be treated with closed reduction. If the fracture persists unstable, K-wire, cerclage, intramedullary nailing or plate osteosynthesis are the eligible methods. ⋯ In 4-part fractures prosthetic replacement should be considered. Especially when old patients have severe destruction or luxation of the humeral calotte prosthetic treatment may be indicated. Early functional physiotherapy is important after all types of osteosynthesis or prosthesis.
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Comparative Study
[Femoral neck fractures in the elderly -- bipolar hemiarthroplasty in total hip replacement].
In this study surgical risk and functional outcome of bipolar hemiarthroplasty and total hip replacement in elderly patients with femoral neck fractures were compared. ⋯ In elderly patients with femoral neck fracture and high comorbidity, we recommend the implantation of hemiarthroplasty and in healthy, active patients with longer life expectancy the total hip replacement.
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Comparative Study
[Quality of life after surgical treatment of osteitis].
Although many studies have measured the functional outcome after surgical treatment of osteomyelitis, there have been few published attempts to evaluate the long-term quality of life. We therefore undertook this study to assess the quality of life in a large patient population after operative treatment for this condition. All patients who underwent operative treatment for osteomyelitis from 1993 until 1997 at our institution were included in the study. ⋯ Compared to a standard population, the investigated patients showed a significant reduction in their overall psychological well being and physical functional capacities. Surgical treatment was able to inactivate the infection in 88% of the patients. Because of persistent deficits, the psychological well being and physical functional capacities are reduced compared to a standard population.
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Comparative Study
[10-year results of bone marrow stimulating therapy in the treatment of osteochondritis dissecans of the talus].
The optimal operative therapy for the treatment of osteochondritis dissecans tali is still controversial. Beside bone marrow-stimulating techniques like abrasion arthroplasty, drilling and microfracturing, new techniques like autologous osteochondral transplantation and autologous chondrocyte transplantation are increasingly used. This study reviewed the clinical, radiological and subjective long-term outcome of bone marrow-stimulating therapy for 45 ankles with an osteochondritis dissecans tali stage 3 or 4 according to the classification by Berndt and Harty. ⋯ Obesity, age older than 40 years and preoperative osteoarthritic changes had a significant negative impact on the clinical outcome. Bone marrow stimulating therapy is an inexpensive, low invasive therapy and a good therapeutic option at least for small Berndt/Harty stage 3 and 4 ODT lesions. Autologous chondrocyte transplantation and osteochondral autografts yield encouraging 2- and 4-year results, but still have to prove their superiority in long-term follow-up studies.
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Comparative Study
[Radiation dosage in orthopedics -- a comparison of computer-assisted procedures].
Since the 1990s, computer-assisted methods have been well-established in the field of orthopedics and traumatology. In addition to the proven improvement in the field of surgical precisioncompared with conventional techniques, the decrease in the amount of emitted ionizing radiation inside of the operating room was cited to constitute an additional major advantage of computer-based navigation. The goal of this study was to quantify X-ray dose values exposed during both conventional methods and computer-assisted procedures, the latter being performed using a C-arm device SIREMOBIL Iso-C3D (Siemens Medical Solutions). ⋯ The conclusions from the clinical studies are in agreement with the results from the laboratory measurements. Computer-assisted techniques led to a significant reduction in X-ray dose exposure and drastically shortened irradiation times. The most pronounced decrease in the emission of ionizing radiation was achieved in case of the Iso-C3D-navigation, which has only recently been introduced into clinical practice, i.e. during runtime of this study.