Der Unfallchirurg
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Despite today's good diagnostic and therapeutic options for osteoporosis, the number of unidentified cases is very high and therapy is therefore usually inadequate. Frequently, the diagnosis of osteoporosis is made only after the occurrence of a fracture. The reason for this, apart from the costs incurred as well as the additional radiation exposure of the diagnostics, is certainly the limited availability of dual energy X‑ray absorptiometry (DEXA) as well as quantitative computed tomography (q-CT). ⋯ In addition to osteoporosis diagnostics, the calculated HU may also provide better preoperative planning as well as predicting the further course of the disease. Thus, the risk for vertebral body fractures, screw loosening and cage sintering after ventral fusion operations can be sufficiently predicted. In this way, preoperative modifications to the surgical procedure can be made to reduce the risk of implant failure.
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Review Meta Analysis
[Physical treatment options with impact on bone healing].
The impact of physical stimulation of a fracture remains unsolved because of the complexity of this process. Differences in the localization and the morphology of the fracture, soft tissue injury, pretreatment and risk factors have an influence on study results, leading to problems in evaluation of physical modulation concerning fractures and nonunions. Extracorporeal shock wave therapy (ESWT) is technically demanding and often associated with local complications including bone and soft tissue stress; however, it is still applied in some centers for the treatment of nonunions. ⋯ For the treatment of delayed unions, a highly rated RCT showed a significantly improved consolidation of midshaft tibial fractures using LIPUS. A systematic review and meta-analysis of nonunions showed positive effects in biologically active lesions, e.g. in hypertrophic pseudarthrosis, leading to a fusion rate of 80%. The consolidation process was better in patients without surgical revision 3-6 months prior to LIPUS.
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Due to demographic changes in the population and the development of novel immunosuppressive agents, an increasing number of trauma and orthopedic patients are taking concomitant immunosuppressive medication. These drugs might interfere with the healing process and can possibly retard or prevent wound and fracture healing and lead to a higher risk of infections. In these complex situations a structured and interdisciplinary process during hospital admission should preoperatively evaluate the possibility of interrupting immunosuppressive medications for the perioperative treatment period without risking a relapse of the underlying disease and which surgical approach should be individually selected for the patient.