Zeitschrift für Orthopädie und ihre Grenzgebiete
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Z Orthop Ihre Grenzgeb · Jul 2006
Controlled Clinical Trial[Treatment of chronic plantar fasciitis with botulinum toxin A--an open pilot study on 25 patients with a 14-week-follow-up].
The conservative and operative treatments of plantar fasciitis tend to be tedious. Unsatisfactory results are common in chronic cases. This study was performed in order to test the hypothesis that the analgesic and anti-inflammatory effect of a single injection of Botulinum toxin A (BoNT A) induces a significant reduction of symptoms. ⋯ This pilot study shows the efficacy of a single application of 200 units BoNT A as a treatment option for chronic plantar fasciitis.
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Z Orthop Ihre Grenzgeb · Jul 2006
Clinical Trial[Limb lengthening with a fully implantable mechanical distraction intramedullary nail].
The morbidity of fixator-assisted distraction osteogenesis should be reduced by intramedullary lengthening devices. The ISKD (intramedullary skeletal kinetic distractor) is a new, fully implantable mechanical lengthening nail. In a prospective cohort trial the possibilities and limitations of the device used on femur and tibia are examined. ⋯ The ISKD reduces fixator-associated problems but incorporates its own difficulties which are mainly based on the guidance of the device. Careful patient advice in monitoring the lengthening process is mandatory. At the femur 8 cm of lengthening can be achieved but the nail tends to "block". Proper reaming and osteotomy techniques are important. A lengthening of more than 1 mm/day is recommended to prevent early consolidation. At the tibia weak callus formation and soft tissue contractures occur, therefore not more than 4 cm lengthening should be planned, the distraction speed has to be reduced noticeable below 1 mm/day and the initial immobilisation should be for more than a week.
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Z Orthop Ihre Grenzgeb · May 2006
Controlled Clinical Trial[Multidisciplinary orthopedic rehabilitation program in patients with chronic back pain and need for changing job situation -- long-term effects of a multimodal, multidisciplinary program with activation and job development].
According to a recent review by Hüppe and Raspe effects of multidisciplinary treatment programs for patients with chronic low back pain in Germany seem to be rather weak and not to have persisting effects. Factors which could counteract possible benefits of treatment are, among others, psychic and job-related stresses and strains persisting after treatment. A multidisciplinary, in-patient treatment program for patients with chronic low back pain, therefore, was amended by multidisciplinary diagnosis and assignment and measures to support vocational solutions. ⋯ We attribute these persisting and superior effects in the treatment group to an efficient treatment of occupational and psychic problems as well as to more homogeneous treatment groups attained by a multidisciplinary diagnosis and team-based assignment. They also show the significance of in-patient-treatment which is effective, when -- based on multidisciplinary diagnosis -- differential treatment groups can be formed.
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Z Orthop Ihre Grenzgeb · May 2006
[Standardised postoperative analgesic system in orthopaedic surgery].
In order to treat patients with postoperative acute pain effectively, we have developed a standardised algorithm for analgesia. This process includes three levels and the appropriate supply of medication. The therapy level is defined based on the scale of the operation. ⋯ The standardised supply medication can be applied in those cases with pain levels > or = 4 (VAS). It is possible to up- or down-grade the level within the system depending on the actual pain experienced by the patient. With this structured pain therapy algorithm we now have a guideline for the consistent postoperative analgesic treatment of patients.
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Z Orthop Ihre Grenzgeb · May 2006
Clinical Trial[Rupture of the pectoralis major muscle: classification of injuries and results of operative treatment].
Classification of pectoralis major muscle injuries and results of operative treatment in the Sportsklinik Stuttgart between 1998 and 2004 are analysed. ⋯ From our results on pectoralis major muscle injuries there are 3 types of rupture: type 1: rupture at humeral insertion, type 2: rupture of musculotendinous junction, type 3: rupture of muscle belly. This classification is essential for planning the operative technique and the incision. We recommend, after classification of the rupture, primary operative reconstruction of the pectoralis major muscle.