Der Unfallchirurg
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Tendon pathologies are a frequent cause of shoulder pain and can lead to significant decline in the quality of life. Conservative treatment is suitable for most tendon pathologies. In addition to classical conservative treatment options, such as physiotherapy, oral analgesia and infiltrations, there are a number of additive treatment options to promote structural tendon healing and clinical outcome. ⋯ The objective of this article is to give an overview of biological and regenerative therapeutic options in the treatment of tendon injuries of the shoulder. Therefore, the anatomical and molecular biological principles of the tendon structure and their importance for tendon healing are explained in order to highlight the various therapeutic options for daily practice. Biological augmentation procedures and regenerative medicine represent a promising therapeutic option for tendon injuries of the shoulder, however, the benefits are so far supported by little or no evidence at all.
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The gold standard in the treatment of scaphoid pseudarthrosis is reduction, interposition of an iliac crest graft and stabilization with a headless bone (Herbert) screw, aiming to reduce the frequently observed humpback deformity. This study correlated the extent of humpback deformity after scaphoid reconstruction to clinical and radiological postoperative parameters. ⋯ III.
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Irreparable rotator cuff tears represent a significant everyday clinical challenge. A high degree of tendon retraction and muscle degeneration means that a direct reconstruction is impossible. Patients often suffer from pain and pseudoparalysis. ⋯ Minimally invasive arthroscopic treatment approaches can lead to pain relief and slight functional improvements in selected patients; however, to restore the active movement of the joint a partial cuff repair, augmentation with a graft or replacement with muscle transfer is necessary. This article presents the various treatment options and the results reported in the literature. Through this a treatment algorithm is suggested in order to facilitate management decisions.
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Ruptures of the pectoralis major (PM) tendon are rare but have increased in recent years, especially during fitness exercising, such as bench pressing. The pathomechanism is an eccentric load under pretension of the PM (falling onto the outstretched arm, injuries during ground combat, boxing and during downward movement when bench pressing). The rupture sequence starts from superior to inferior at the insertion site with initial rupture of the most inferior muscle parts, followed by the sternal part and the clavicular part. ⋯ Surgical refixation or reconstruction (with autograft/allograft) of acute and chronic PM ruptures shows excellent clinical results with high patient satisfaction. Latissimus dorsi (LD) and teres major (TM) tendon ruptures are rare injuries but can lead to significant impairments in high-performance athletes. In contrast to PM ruptures, LD and TM injuries are primarily treated conservatively with very satisfactory results.
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A 95-year-old patient suffered bleeding that required a transfusion after closed reduction and internal fixation (CRIF) of an intertrochanteric femoral fracture with a proximal femoral nail. After mobilization of the patient the secondarily dislocated fragment of the lesser trochanter perforated a side branch of the profunda femoris artery. ⋯ A continuing decrease of hemoglobin levels despite repeated transfusion of red blood cells is indicative of active bleeding. Accurate identification of the source of the bleeding after osteosynthesis of proximal femoral fractures is decisive for the correct treatment.