Der Unfallchirurg
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Due to the new general data protection regulations (GDPR), the requirements for correct patient information on the documentation of pseudonymized data in a registry have increased enormously. In particular, written consent applies to the TraumaRegister DGU® as it is not always possible to get written permission from severely injured patients in acute situations. Therefore, the study aimed to investigate the influence of undocumented cases due to a lack of clarification on the standardized mortality rate (SMR). ⋯ Due to the lack of written consent from surviving patients, only about 75% of all patients at Leipzig University Hospital could be documented for the TraumaRegister DGU®. On the other hand, since the local legal situation permits registry documentation of deceased patients, this has a detrimental effect on the standardized mortality rate (SMR), which is about 10% higher in our collective than it actually is.
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The arthroscopic treatment of arthritis of the ankle joint is very limited and is only indicated for early stages of arthritis with impingement, strictly localized forms and more for young patients. The most important aim of arthroscopy is to improve the range of motion (ROM) of the ankle by removal of bony projections (dorsal and ventral) and an extensive synovectomy with debridement. ⋯ This is independent of the localization of the narrowing, especially if the complete joint is affected. If necessary, arthroscopy can then be carried out as an additional intervention in cases of conversion osteotomy in order to improve the ROM.
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Review
[Conservative treatment options for arthritis of the ankle : What is possible, what is effective?]
In this article the causes of arthritis in the region of the ankle are introduced and the conservative treatment options are described and discussed more extensively. The risks of treatment with nonopioid analgesics (NOPA) are presented in detail. ⋯ If contraindications for oral NSAIDs are present, intra-articular treatment is a meaningful option. The best evidence is currently available for viscosupplementation but the study situation for the use of platelet-rich plasma (PRP) is still not sufficiently comprehensive and there are only a few case reports on the use of mesenchymal stem cells..
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The gold standard in operative treatment of end-stage ankle osteoarthritis remains controversial even now. Endoprosthetic treatment, which has undergone significant improvements in recent years competes with arthrodesis, which can achieve excellent results particularly in the arthroscopically assisted technique. Both procedures offer specific advantages and disadvantages so that the decision about indications for treatment should always be made individually, taking specific needs and the individual constellation of findings of the patient into consideration.
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Due to the change in the age structure in Germany and the steadily increasing number of fractures, arthrosis of the upper ankle joint, mainly caused by posttraumatic conditions, is becoming more and more relevant in routine trauma surgery and orthopedics. Patients suffer from reduced functionality and quality of life as well as immobilizing pain. In addition to an ankle joint prosthesis arthrodesis of the upper ankle joint offers an alternative for the treatment of advanced arthrosis. ⋯ Comparative studies to date have shown an advantage of the arthroscopic technique in terms of complication rate, length of hospitalization, proportion of ossification and functional outcome. The indications for arthroscopic fusion should be strictly considered, especially in the case of malalignment, as major axis corrections are difficult to perform. In such cases, open fusion of the upper ankle joint still seems superior to the arthroscopic method.