Zeitschrift fur Orthopadie und Unfallchirurgie最新文献

A painful reduction in shoulder mobility, known as "shoulder stiffness", can occur both as a primary idiopathic condition and as a secondary condition, for example, following surgical procedures. Various factors can contribute to the development of primary shoulder stiffness. In this review we summarize the pathophysiological mechanisms, genetic influences, endocrine disorders, metabolic conditions, as well as other diseases and medical-therapeutic approaches that might have an impact on the development of primary shoulder stiffness.

The ankle fracture - the most common fracture of the lower extremities - is usually due to pro- and supination trauma and is commonly challenging for junior doctors of orthopaedics and traumatology. To accomplish sufficient surgical results, it is necessary to have surgical experience, not only because of the surrounding fragile soft tissue, but also due to the specific anatomical structures surrounding the ankle joint and the postsurgical biomechanical stress to osteosynthesis. In the following video, the most relevant steps of surgery as well as some useful tips and tricks are mentioned. The intention of the video is to convey to junior orthopaedic surgeons the most important surgical steps for their clinical daily routine.

Up to 80% of patients after amputation are affected by phantom limb pain. This may be due to various mechanisms of cortical reorganisation. Non-surgical treatment of the neuropathic phantom limb pain involves mirror therapy. Thereby, the use of a mirror should induce the illusion that the extremity has been preserved. This illusion should initiate processes to restore the original organisation of the somatosensory and motor cortex and thus to reduce pain. Evidence of mirror therapy to treat lower extremity phantom limb pain is rare. Therefore, the aim of this systematic review is to qualitatively analyse the efficacy of mirror therapy for treatment of phantom limb pain in adult patients after unilateral amputations of the lower extremity.The databases Medline (PubMed), Physiotherapy Evidence Database (PEDro), Cochrane Library (Central), and OPENGREY were systematically searched until 26th November 2020, followed by continued searches in these databases to provide a review of updated literature. Study selection, data extraction, and risk of bias evaluation (Risk of Bias Tool [RoB]) of included studies were conducted by two reviewers independently. The primary outcome was pain intensity, and secondary outcomes were pain frequency, pain duration, activities of daily life (ADL), and quality of life. The methodology of this review follows the recommendations of Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) and the Cochrane Handbook for Systematic Reviews of Interventions.The search revealed 234 articles. Four articles were included in the analysis. A reduction in pain intensity due to mirror therapy was reported in all studies, however, in only 2 studies there were significant differences between mirror therapy and the comparison after 4 weeks of treatment (p < 0.001; p < 0.05). This significant difference was maintained after 3 and 6 months follow-up in one of those studies (p < 0.001). The outcomes pain frequency, pain duration, and ADL were decreased after 4 and 10 weeks of mirror therapy compared to comparison, but with no statistical significance (p > 0.05). After 6 months, there was a significant improvement in the duration of pain and in ADL after mirror therapy compared with the control group (p < 0.05). Differences in the results quality of life between the intervention group and comparison were observed in 2 studies.Mirror therapy of high frequency and duration is an effective intervention to reduce phantom limb pain in patients after unilateral lower extremity amputation. The superiority of mirror therapy to other interventions cannot be concluded, as the evidence was of low quality.

Arthroplasty of the hip has become one of the most successful surgical interventions and has seen significant advancements over the last century. With these developments, patient expectations have shifted from merely achieving pain-free daily mobility to anticipating a full recovery, including the ability to participate in sports. This shift has driven innovations in prosthetic materials and surgical techniques, such as the development of wear-resistant materials like highly cross-linked polyethylene and the adoption of minimally invasive procedures to enhance recovery.However, concerns persist among patients about the risks of resuming sports postoperatively, particularly the fear of prosthesis-related accidents or failures. A survey of 300 German surgeons identified periprosthetic fractures as the greatest risk, followed by polyethylene wear and implant loosening. The study also examines osteoporosis as a risk factor, suggesting that while sports can help prevent periprosthetic osteoporosis, high-energy trauma may increase the severity of injuries. Although modern prosthetic materials have reduced wear and improved durability, the type and intensity of physical activity continue to influence prosthesis longevity.Therefore, it is recommended that low-impact sports be resumed 3-6 months postoperatively, while high-impact sports should be approached with caution, particularly during the first year after surgery, to minimize the risk of complications. Coordination training before and after surgery is also emphasized to reduce the risk of falls and injuries. In summary, the study highlights that high-impact sports cannot be generally recommended, as coordination deficits may persist for up to 12 months following total hip replacement. Such activities should only be considered later-on and only by patients who are experienced in these specific sports.

Despite open growth plates, reconstruction of the medial patellofemoral ligament (MPFL) is recommended for the treatment of patellar dislocation in children and adolescents. However, the open physis on the medial distal femur requires a tailored surgical approach with an essential knowledge of the anatomical relationship of the femoral MPFL insertion to the physis. This video illustrates the technique of MPFL reconstruction using an autologous pedicled quadriceps tendon graft with femoral drill channel fixation distal to the epiphyseal growth plate.

This article describes the technique of a multidimensional, V-shaped, and self-centering osteotomy of the tibial tuberosity with cortical bone block support, which enables combined distoanteromedialisation of the tibial tubercule.

We report on an 18-year-old female who sustained complete loss of her knee extensor mechanism (patella, quadriceps and patellar tendon) due to a motorbike injury with severe soft tissue loss of the ventral aspect of the knee and subsequent infection. After infection control and successful latissimus dorsi free flap surgery, reconstruction of the knee extensor mechanism was performed using a fresh frozen extensor mechanism allograft with patella, quadriceps- and patellar tendon and integrated tibia tuberosity fragment. After a follow-up of 18 months, there was infection free integration of the allograft with a range of motion 0-0-90° (extension/flexion) and pain free gait.

Pertrochanteric femoral fractures are among the most common injuries in geriatric patients. Intramedullary implants are used to restore patient mobility. We report coil embolisation of an aneurysma spurium of the profunda femoral artery as a complication after distal nail locking of a proximal femoral nail.

The aim of this study was to develop a simple and reliable score which supports decision making between non-operative and operative treatment in patients with osteoporotic pelvic fractures.Between 2018 to 2020, the OF Pelvis Score was developed during a total of 5 meetings of the Working Group on Osteoporotic Fractures of the Spine Section of the German Society of Orthopaedics and Trauma. The OF Pelvis Score as a decision aid between non-surgical and surgical treatment was developed by expert consensus after analysis of numerous geriatric sacral and pelvic ring fractures from several hospitals. Subsequently, retrospective evaluation of the score was performed on consecutive patients from three hospitals.The following parameters were considered relevant to decision making between non-surgical and surgical treatment and were incorporated into the score: fracture morphology using the OF Pelvis Classification, pain status, level of mobilisation, fracture-related neurological deficits, health status, and the modifiers already integrated into the OF Pelvis classification. If the score is < 8, non-surgical therapy is recommended; if the score is > 8, surgical therapy is recommended; if the score is 8, there is a relative indication for surgery. The OF Pelvis Score was then evaluated retrospectively in a total of 107 patients, according to records. The OF Pelvis Score was 8 points in 4 patients (3.7%), all of whom received surgical treatment. Of the remaining 103 patients, 93 received score-compliant therapy (90.3%). Among these, 4 of the patients who did not receive score-compliant care refused the recommended surgery, so the actual therapy recommendation was score-compliant in 94.2%.The OF Pelvis Score can be used to derive a therapy recommendation in many patients in clinical practice. Because of the possible change of clinical parameters during the course of the disease, the score has a dynamic character. In the retrospective evaluation, the recommendations from the OF Pelvis Score were in close accordance with the therapy actually performed.