Orthopade最新文献

Legal requirements surrounding medical rehabilitation are firmly anchored in German social legislation: see Sozialgesetzbuch IX - Rehabilitation und Teilhabe von Menschen mit Behinderung (Social Law Book IX-Rehabilitation and Participation of Disabled People). Disabled people, and people threatened by disability, are thus legally eligible for rehab. Medical rehab staff must deal with many socio-medical questions during the whole rehabilitation process. This process requires detailed and sound knowledge of all the relevant legal requirements, definitions and terminology.

The quadriceps tendon often ruptures spontaneously without trauma, frequently following an eccentric load on the tendon (walking down stairs) in the case of a previous degenerative injury. Rupture after endoprosthetic knee replacement is a special etiological case. Predominantly men between 50 and 65 years of age are affected. Clinical signs are suprapatellar hematoma and the inability to actively straighten the knee. A typical examination finding is the "suprapatellar gap sign". Ultrasonography is the diagnostic imaging modality of first choice as it can be reliably visualize the rupture and the resulting hematoma. Magnetic resonance imaging has a high sensitivity and specificity for detecting quadriceps tendon ruptures. However, its limited availability should not delay therapy. The treatment of choice is surgical transosseous refixation of the tendon at the upper patellar pole. Following surgery, a straight splint, partial weight bearing and limited mobility are required for 6-8 weeks.

Background: The reintegration into the social and professional environment and the achievement of the best possible quality of life after multiple injuries can often only be achieved after a lengthy rehabilitation process and belongs in the hands of experienced doctors, therapists, and rehabilitation managers.

Rehabilitation phases: Rehabilitation after serious accidents must be differentiated from "normal" orthopedic rehabilitation after elective surgery. The challenges of trauma rehabilitation require coordinated rehabilitation phases. This is the only way to avoid the so-called "rehab hole" between discharge from the acute clinic and the start of post-acute rehabilitation. A 6-phase model is described. After acute treatment (phase A) and any necessary early rehabilitation (phase B), phase C of post-acute rehabilitation places special demands on the rehabilitation facility. Phase D of the follow-up rehabilitation is established. The further rehabilitation (phase E) provides measures specifically tailored to the consequences of the accident, such as pain rehabilitation or activity-oriented procedures. Long-term follow-up care for previously severely injured patients is necessary (phase F).

Prospects: An integration of trauma rehabilitation centers into the existing trauma network remains the goal to improve the outcome after polytrauma.

Advances in medications and changes in therapeutic options have significantly reduced limitations in functional capacity and quality of life for patients with rheumatic diseases and osteoporosis, but there is still a large number of patients in whom the diseases do not take the desired course. Older rheumatic patients also often have comorbidities that require a multidisciplinary and multimodal approach to therapy. Rehabilitation measures are, therefore, an important part of the treatment concept for these patients in order to maintain their functional health, social participation, and, in the case of those who are still working, in particular their gainful employment. They can help to limit sequelae, preserve existing functions, reduce pain, and maintain the quality of life of those affected. The article aims to provide an overview of the rehabilitative therapy concept and the level of evidence for individual forms of therapy.

The rehabilitation of patients with an amputation is challenging and an example of an interdisciplinary team approach. Knowledge of the principal surgical techniques and the needs for a good prosthetic fitting is mandatory for the team members. According to the ideas of International Classification of Functioning, Disabilities and Handicaps the goal of the rehabilitation is to achieve the highest possible participation in private, work and social life of the patient. Within the team a clear definition of responsibilities is necessary, as well as an intensive communication structure. The patient himself plays a major role. This rehabilitation is complex, in terms of both personal and resource use. Depending on the level of amputation, the usual rehabilitation times range between 4 to 12 weeks for the lower extremity; for the arms, the time varies greatly from person to person. Longer rehabilitation times seem to ensure better treatment outcomes in the long term.

Background: In rehabilitation medicine, differentiated concepts of interdisciplinary multimodal pain management have existed for years, or even decades.

Objectives: What does orthopedic pain management include? How do these treatment measures carried out in the curative and rehabilitative setting differ?

Methods: In addition to the content of rehabilitative pain management, further established models such as IMST (interdisciplinary multimodal pain therapy) are discussed.

Results: The duration and intensity of the rehabilitation treatment differ from the models offered in topical medicine or in the curative sector. The treatment is also based on different questions or goals. In addition to the actual treatment, the aspect of complaint validation and socio-medical assessment is also typical for the rehabilitation sector.

Conclusions: Orthopedic rehabilitation through pain management provisos is part of a tiered and diversified system of treatment methods and models; A leap in quality was again achieved in the past few years through the introduction of behavioral medicine-oriented rehabilitation (VMO).

Background: Total knee replacement requires follow-up treatment. This can take place on an outpatient basis as part of health insurance coverage, but also as outpatient or inpatient rehabilitation.

Kind of rehabilitation: Outpatient rehabilitation provides comparable results to inpatient rehabilitation, but only for those patients who are suitable for outpatient rehabilitation. Inpatient rehabilitation should be indicated depending on general health status, general physical fitness, housing situation, accessibility of rehabilitation facilities and possibilities of social support in the home environment, as well as age and comorbidities. Physiotherapeutic procedures should focus on exercise therapy. Passive reactive measures complement the therapy. For patients of working age, the activity profile should be considered as part of the rehabilitation process. Patient education, with information on prosthesis-appropriate behavior, represents an important component in follow-up treatment.

Prospect: Demographic change requires increasing consideration of orthogeriatric aspects. Fast-track programs will not make follow-up treatment superfluous, but with accelerated processes they represent a new challenge for sectoral cooperation.