Der Unfallchirurg
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Review Comparative Study
[Osteitis. Infections of the locomotive system].
Infections of the locomotive system appear in many different forms such as acute inflammation of joints or bone following injury or surgical or chronic processes, often lasting for years. They demand an exact treatment plan not only to remove necrotic tissue but also for reconstruction of defects. A special problem is infection following alloplastic reconstruction of joints or spine. Multiple surgical procedures are required to hinder reinfection, restore function, and assure acceptable patient quality of life.
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Low postoperative pain level, decreased length of hospital stay and accelerated rehabilitation are the major benefits of unicondylar knee arthroplasty. Especially in comparably young, not yet retired and still active patients with an isolated medial gonarthrosis, these prostheses offer many advantages. However, one important requirement to be treated with such implants is a well functioning stability system of the muscles and ligaments. Thus in patients with degenerated or destroyed anterior cruciate ligaments it is contraindicated to use this method. In order to still take advantage of this therapy for treatment of isolated arthrosis, reestablishment of the proprioceptive structures through simultaneous or staged ACL reconstruction is mandatory. ⋯ Preliminary results of this short-term follow-up are promising. Especially the predominant number of patients who were able to return to work soon after rehabilitation and the significantly improved score postoperatively reflect the benefits of this prosthesis system in select patients. However, long-term follow-up and larger case numbers are necessary to confirm these encouraging results in the future.
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Comparative Study
[Solid body augmentation for comminuted calcaneal fractures : development and biomechanical testing of a hybrid osteosynthesis technique].
Comminuted calcaneal fractures are a consequence of high impact trauma to the foot. Stable fixation and anatomically correct repositioning of the joint surfaces are often a problem. To improve fracture treatment, surgical techniques in combination with new augmentation materials have been tested. ⋯ This work investigated a new concept of internal support of multifragmentary calcaneal fractures. Augmentation of defect voids in the calcaneus with a mechanically stable solid body implant in combination with stable screw anchorage in this implant leads to a higher stability compared to plate-fixation and augmentation with cancellous bone under in-vitro conditions.
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The number of implanted hip prostheses is increasing constantly. At the same time the patients are becoming older and older. Thus, also patients with periprosthetic infections are older and therefore sicker. Uniform guidelines for the treatment of infected arthroplasties are controversial. Empirical studies show that the explantation of the original prosthesis and implantation of a revision may be the option with the greatest chance of success. These very aggressive procedures may overburden the old, polymorbid patient. The aim of this study was to ascertain whether or not keeping the hip prosthesis in combination with local debridement, formation of a permanent fistula and long-term administration of antibiotics is a possible option for the treatment of infected hip prostheses in old and polymorbid patients. ⋯ Restricting the indication to old, polymorbid patients, preservation of the arthroplasty in combination with local surgical debridement, permanent fistula and long-term systemic administration of antibiotics seems to be an alternative to explantation of the prosthesis with consecutive revision arthroplasty or resection arthroplasty.
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Comparative Study
[Mobile and digital documentation of inpatient treatments : use of personal digital assistants in addition with the ClinicCoach(c) software].
Documentation of the individual treatment course is essential from medical as well as economic and forensic aspects. With increasing hospital computerization the conventional hardcopy form of record keeping is seen to be associated with high outlays and restrictiveness. ⋯ The combination of PDAs and ClinicCoach(c) is a reliable and to clinical routine well adapted system that allows digital documentation at the bedside.