Der Unfallchirurg
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Despite the high incidence of osteoporosis, the high risk of subsequent fractures after an initial fracture and effective treatment options, there is a substantial deficit in the diagnostics and treatment of patients suffering from osteoporosis in Germany and worldwide. The reasons for this are multifactorial and can be attributed to physicians and patients as well as mismanagement inherent to the system. This article provides an overview of the challenges in the treatment of osteoporosis patients and shows the possibilities for improvement of care in the outpatient area. With respect to the exact schedule of the diagnostics and treatment of osteoporosis, reference is made to the pocket-sized edition of the current guidelines of the Governing Body Osteology (DVO).
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Serial fractures of metatarsal bones are rare and usually caused by direct or indirect high-energy trauma; however, in cases of pre-existing diseases, such as diabetes mellitus, they also can occur spontaneously or as insidious fractures. Due to the substantial soft tissue swelling mostly associated with such injuries, minimally invasive osteosynthesis with intramedullary Kirschner-wires (K‑wires) is recommended. The antegrade technique for placement of the K‑wires is preferred as the technically simpler retrograde procedure has several significant disadvantages. The preferred operative approach is described in detail exemplified by two clinical cases.
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With the clarification by the Federal Court of Justice, the distinction between the principle of equivalence and the principle of adequacy for assessment has again come to the fore. In contrast to the equivalence principle for assessments in the German statutory accident insurance (DGUV), the principle of adequacy applies in private accident insurance. ⋯ There are so far no points of reference for the estimation of participation. With the help of the theory of equivalence from linguistics, an attempt was made to provide assistance through definitions of the extent of participation.
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With an incidence of 3% of all biceps tendon injuries, rupture of the distal biceps tendon is a rare injury but can be associated with significant functional impairment of the elbow. In case of a complete rupture, the diagnosis can be made clinically with a pronounced power deficit, in particular for supination of the forearm. ⋯ Regarding the therapeutic approach, there is general consensus in the current literature that surgical treatment with anatomical reconstruction of the tendon footprint is superior to the conservative approach. Various surgical techniques with good biomechanical and clinical results are currently available but no clear superiority of a single technique has so far been demonstrated.
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[Performance control after arthroscopic arthrolysis with capsulectomy in fresh-frozen elbow joints].
Posttraumatic or postoperative movement restrictions in elbow joints can often occur (including capsular contracture) and can generate everyday limitations. In persistent elbow stiffness, arthroscopic arthrolysis with removal of the dorsal and ventral capsule portions can be carried out. The purpose of this study was to assess the efficacy of arthroscopic capsulectomy by means of an in vitro anatomical study. ⋯ Arthroscopic arthrolysis can be performed with a high degree of radicality. The radicality must be self-critically taken into account in one's own action. The radicality of the portal change may even be higher ventrally than with an isolated column procedure. On the other hand, it must be critically considered that posteriorly, the PML cannot be adequately addressed by means of arthroscopy due to the risk of ulnar nerve injury. Portal changes might help to enable a more complete visualization of the joint capsule and may avoid leaving possibly relevant remnants of the capsule. If a release of the PML is required, this may have to be carried out in combination with an ulnar nerve release in a mini-open technique.