Der Unfallchirurg
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Osteoporosis is a multifactorial disease resulting in reduced bone strength and increased bone fragility. The cause of osteoporosis is underexplored. The manifestation of osteoporosis makes a significant contribution to the development of bone fractures. ⋯ At the current time there is no possibility to indicate the level of contribution in 10% or 20% steps. Taking the total picture, including clinical and radiological findings into consideration, it seems possible to assess the contribution only in larger percentage steps (e.g. 0%, 50% or ≥80%). The mere diagnosis of osteoporosis does not justify a participation rate unless its effects can be pathomorphologically proven.
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Medical emergency teams (MET) were implemented in many hospitals worldwide in order to identify patients at risk on normal wards and to initiate diagnostics and therapy without delay. Ideally, the implementation leads to prevention of cardiac arrests and unexpected deaths on normal wards, reduced rates of admissions to intensive care units and hospital mortality. ⋯ Whether the implementation of an MET generally leads to an improvement of treatment on normal wards or to a reduction in mortality in hospitals has not been finally clarified. Mortality and morbitidy (M&M) conferences can help to analyze if an individual clinic is likely to profit from the introduction of a MET.
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Surgery in metastatic bone disease is currently the most frequent type of surgery in orthopedic oncology. Improved survival rates and an increasing incidence of bone metastasis have led to an increase in complications caused by metastatic disease, such as pathological fractures or hardware failure after operative treatment. ⋯ Therefore, prognosis-tailored treatment requires an experienced team and should be performed in a multidisciplinary tumor center. The current article provides an overview of recent therapy concepts for the surgical treatment including endoprosthetic reconstruction, internal fixation with either intramedullary nailing or plate fixation devices, often augmented with bone cement.
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The dynamization of fracture fixation is a frequently used method to improve the fracture healing process; however, the term dynamization is used for different methods of altering the fixation of fractures during the bone healing process. The dynamization of intramedullary nail fixation by removing the interlocking screws is the most frequently applied method. This method can cause a telescopic movement between the nail and tubular bone that closes gaps in bony continuity and potentially compresses the fracture fragments. ⋯ For reverse dynamization, which starts with a flexible fixation and is later stabilized, no significant advantages could be shown. The aim of fracture treatment should be stable fixation from the beginning. If the fracture fixation is unstable, it should be stabilized as soon as possible.
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Since 2005, when the Diagnosis-Related Group (DRG) system was introduced, an increasing number of surgical procedures have been reported in Germany. In particular, the numbers of elective arthroplasty and spinal surgery procedures have been controversial. ⋯ Despite generally increasing volume growth, the numbers of hip and knee arthroplasty cases decreased. In addition to an ageing population and potential economic incentives, technical innovations and new implant systems should be considered when discussing increasing case numbers.