Zeitschrift Fur Orthopadie Und Unfallchirurgie最新文献

{"title":"Video Based Assessment of Treatment Urgency in Outpatient Orthopaedic and Trauma Patients - a Pilot Trial.","authors":"Matthias D Wimmer, Kristian Welle, Martin Gathen, Sebastian Scheidt, Alexander Markowetz, Dieter Christian Wirtz, Christof Burger, Max Jaenisch, Koroush Kabir","doi":"10.1055/a-1696-2433","DOIUrl":"10.1055/a-1696-2433","url":null,"abstract":"<p><strong>Introduction: </strong>When consulting a specialist in orthopaedics and trauma surgery, personal assessment and manual clinical examination by the doctor on site are essential. Nevertheless, implementation of video consultation hours has been made legally easier in Germany. The present pilot study examines the possibility of video-based assessment of the urgency of treatment in outpatient orthopaedic and trauma patients.</p><p><strong>Materials and methods: </strong>Within an ex ante study design, 40 patients with an orthopaedic clinical picture for trauma surgery with elective, urgent or emergency indication were selected from consultation hours. A short questionnaire was filled in based on the information provided and a medical colleague simulated a movement sequence based on the patient information. After modification to the \"red flags\" and \"yellow flags\" established in spinal orthopaedics, nine short questions were recorded, which inquire about the urgency of a medical consultation. The video-based movement sequence is based on a 60 s long instruction video in which motor tests and movement sequences are demonstrated: Cervical spine movement in all levels, elevation of the upper extremity, test of the finger-floor distance when \"bending forward over-bending\", possibility of crouching from standing and getting up again, standing on heels and toes.</p><p><strong>Results: </strong>In 91.1% (n = 328) of the cases, the diagnosis was associated with the same joint or the same pathological entity. In 37.5% (n = 135) of the cases an emergency indication was seen, in 10.8% (n = 39) of the cases an urgent indication and in 51.6% (n = 186) of the cases it was seen to offer an elective indication. 12.5% (n = 45) of the cases were evaluated as \"false positives\" with regard to an emergency or urgent presentation. This means that the test persons were classified as \"emergency\" or \"urgent\", although there was no preventable dangerous course or medical emergency. 18 cases (5%) were evaluated as \"false negative\".</p><p><strong>Discussion: </strong>The screening questionnaire presented and the short video assessment are technically feasible and practicable method for the initial evaluation in video-based online medical consultation. In addition, the questionnaire presented in combination with the short video assessment was suitable as an instrument for assessing the urgency of the consultation and selecting preventable dangerous processes and acute emergencies.</p><p><strong>Conclusion: </strong>The questionnaire, in combination with the short video assessment, is a suitable method for the social distancing requirements during limited accessibility of the medical system. Nevertheless, a false negative rate of 5% is too high to implement the questionnaire presented into daily clinics without further optimisation.</p>","PeriodicalId":51219,"journal":{"name":"Zeitschrift Fur Orthopadie Und Unfallchirurgie","volume":"161 4","pages":"434-438"},"PeriodicalIF":1.0,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9899090","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cementless Short Stems in Total Hip Arthroplasty: Chances and Limits.","authors":"Yama Afghanyar, Karl Philipp Kutzner, Joachim Pfeil, Philipp Drees, Philipp Rehbein, Jens Dargel","doi":"10.1055/a-1678-7684","DOIUrl":"10.1055/a-1678-7684","url":null,"abstract":"<p><p>In recent decades, a large number of cementless short stems have been introduced to the market. The concept aims at saving soft tissue using minimally invasive surgery and at the same time preserving as much bone as possible. In particular, the latest generation of short stems, which are implanted using a calcar-guided round-the-corner technique, are attracting increasing attention. An individualised resection level allows individual stem alignment and thus an ideal reconstruction of the hip anatomy. The early clinical results of short-stem total hip arthroplasty (THA) are promising and have led to an expansion of the indications and limitations for the use of short stems. In particular, the individual positioning in valgus or varus and the resulting individual metaphyseal or metadiaphyseal anchorage offers various possibilities to reconstruct even abnormal joint morphologies. Consequently, short stems are increasingly used in patients with complex anatomical variations or in cases of osteonecrosis of the femoral head. In some various cases, they can also be used in revision or conversion arthroplasty. In some patients, short stems can also be used after femoral neck fracture. Currently, scientific data on those areas of indication of short-stem THA is scarce.</p>","PeriodicalId":51219,"journal":{"name":"Zeitschrift Fur Orthopadie Und Unfallchirurgie","volume":"161 4","pages":"396-404"},"PeriodicalIF":1.0,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9880703","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health Care for Inpatients with a Proximal Humeral Fracture - an Analysis of Health Insurance Data.","authors":"Nikolaus von Dercks, Pierre Hepp, Jan Theopold, Ralf Henkelmann, Dennis Häckl, Nils Kossack","doi":"10.1055/a-1716-2218","DOIUrl":"10.1055/a-1716-2218","url":null,"abstract":"<p><p>The proximal humeral fracture is one of the most common fractures in the elderly. While epidemiological factors have been well studied, the influence of a proximal humeral fracture on morbidity, mortality and associated costs has not yet been adequately analysed.On a basis of 4.1 million insurance holders of the German public health insurance (GKV), patients with (study population, SP) and without (comparison group, VG) a proximal humeral fracture (pHF) were compared with regard to comorbidity, rehospitalisation, mortality, drug and aid needs as well as number of physician contacts. Study period was between 2012 and 2016.6068 patients of the SP met the inclusion and exclusion criteria (age 69.4 ± 14.3 years; male : female = 28.2% : 71.8%). 4781 patients (78.8%) received surgical, 1287 patients (21.2%) conservative treatment of the pHF. Rehospitalisations and visits to the general practitioner occurred more frequently in the SP vs. VG (p < 0.01). Contacts with specialists after pHF varied according to specialty, as did newly occurring diseases. Typical specialities for preventive examinations were significantly less common (gynaecology p < 0.01, pathology p < 0.01, dermatology p < 0.01). According to pHF, the costs of SP for drugs (2490.76 ± 1395.51 € vs. 2167.86 ± 1314.43 €; p = 0.04), medical therapies (867.01 ± 238.67 € vs. 393.26 ± 217.55 €; p < 0.01) and aids (821.02 ± 415.73 € vs. 513.52 ± 368.76 €; p < 0.01) were significantly above the VG. The two-year survival after pHF is lower in the SP than in the VG (p < 0.01).The results show increased morbidity and mortality as well as medical costs after a proximal humeral fracture. Preventive examinations and treatments are rarer. In the future, care concepts for patients with proximal humeral fractures should not only be optimised with regard to functional scores and reduced complication rates, but also with regard to quality of life and preservation of general health.</p>","PeriodicalId":51219,"journal":{"name":"Zeitschrift Fur Orthopadie Und Unfallchirurgie","volume":"161 4","pages":"439-446"},"PeriodicalIF":1.0,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9892513","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Shoulder-specific Outcome after Proximal Humerus Fracture Influences Medium-term Overall Quality of Life.","authors":"Ralf Henkelmann, Paul-Vincent Link, Peter Melcher, Jan Theopold, Pierre Hepp","doi":"10.1055/a-1666-9231","DOIUrl":"10.1055/a-1666-9231","url":null,"abstract":"<p><strong>Background: </strong>Surgical treatment of proximal humerus fracture is an established procedure. Postoperative complications have been shown to have a significant impact on shoulder-specific outcome. Little is known to date about an influence on injury-independent quality of life.</p><p><strong>Aim of the work: </strong>The aim of this retrospective study is to analyse whether patients with a poor functional outcome after surgically treated proximal humerus fracture also show a reduced general quality of life in the medium term. Emphasis is placed on the analysis of patients with poor functional outcome due to postsurgical complications.</p><p><strong>Material and methods: </strong>Evaluation of all patients operated at one level 1 trauma centre with a proximal humerus fracture in the period 01.01.2005 to 31.12.2015 and follow-up using validated scores (Constant-Murley Score [CMS], EQ-5D). Two groups, group A with good outcome (∆CMS ≤ 15P.) and group B with poor outcome (∆CMS ≥ 16P.), were defined. Furthermore, descriptive variables including definition of a complication were defined in advance.</p><p><strong>Results: </strong>138 patients were included in the study (group A: 91, group B: 47). The mean follow-up was 93.86 months ± 37.33 (36-167). Group B had significantly more complications. Furthermore, patients with poor outcome regarding the shoulder (group B) were also found to have significantly lower EQ-VAS (78.9 ± 19.2 [20.0-100] vs. 70.4 ± 19.5 [15.0-98.0]; p = 0.008) and EQ index (0.91 ± 0.14 [0.19-1.00] vs. 0.82 ± 0.17 [0.18-1.00]; p < 0.001).</p><p><strong>Discussion: </strong>In conclusion, in the present study, the patients with poor outcome of shoulder function in CMS have significantly lower overall quality of life after a mean of more than 6 years of follow-up. The poor outcome was due to a significantly higher postoperative complication rate. This was independent of the fracture morphology present and the surgical procedure used.</p>","PeriodicalId":51219,"journal":{"name":"Zeitschrift Fur Orthopadie Und Unfallchirurgie","volume":"161 4","pages":"422-428"},"PeriodicalIF":1.0,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10266383","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nickelbelastung bei Implantation einer nickelfreien totalen Kniegelenksendoprothese","authors":"","doi":"10.1055/a-2032-2054","DOIUrl":"https://doi.org/10.1055/a-2032-2054","url":null,"abstract":"","PeriodicalId":51219,"journal":{"name":"Zeitschrift Fur Orthopadie Und Unfallchirurgie","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2023-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47826825","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Kommentar zu: Beinsymmetrie von Athleten nach vorderer Kreuzbandrekonstruktion vs. Unverletzte","authors":"","doi":"10.1055/a-2104-4627","DOIUrl":"https://doi.org/10.1055/a-2104-4627","url":null,"abstract":"","PeriodicalId":51219,"journal":{"name":"Zeitschrift Fur Orthopadie Und Unfallchirurgie","volume":"1 1","pages":""},"PeriodicalIF":1.0,"publicationDate":"2023-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"57822850","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beinsymmetrie von Athleten nach vorderer Kreuzbandrekonstruktion vs. Unverletzte","authors":"","doi":"10.1055/a-2032-2093","DOIUrl":"https://doi.org/10.1055/a-2032-2093","url":null,"abstract":"Der Riss des vorderen Kreuzbandes (VKB) ist eine häufige Knieverletzung, die oft durch sportliche Aktivität verursacht und operativ mit einer VKB-Rekonstruktion behandelt wird. Ein Standardkriterium für die Rückkehr zum Sport ist eine ausreichende Funktion des verletzten Beins, die mit einem Symmetrieindex (LSI, verletztes Bein/gesundes Bein × 100) von mindestens 90% in einer Abfolge von Sprung- und Krafttests nachgewiesen wird.","PeriodicalId":51219,"journal":{"name":"Zeitschrift Fur Orthopadie Und Unfallchirurgie","volume":"6 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134965466","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Referenz Orthopädie und Unfallchirurgie: Becken und Hüfte","authors":"","doi":"10.1055/a-2078-3035","DOIUrl":"https://doi.org/10.1055/a-2078-3035","url":null,"abstract":"Grützner P, Hoffmann R, Rudert M, Hrsg. Referenz Orthopädie und Unfallchirurgie: Becken und Hüfte. Stuttgart: Thieme; 2023. 249,99 €, ISBN: 978-3-13-243542-1","PeriodicalId":51219,"journal":{"name":"Zeitschrift Fur Orthopadie Und Unfallchirurgie","volume":"41 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134965664","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rotatorenmanschettenrekonstruktion ohne Akromioplastik: höhere Revisionsrate","authors":"","doi":"10.1055/a-2032-2080","DOIUrl":"https://doi.org/10.1055/a-2032-2080","url":null,"abstract":"","PeriodicalId":51219,"journal":{"name":"Zeitschrift Fur Orthopadie Und Unfallchirurgie","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2023-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48984304","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Knietotalendoprothese: Kombination einer hochdosierten präoperativen und periartikulären Steroidinjektion","authors":"","doi":"10.1055/a-2032-2067","DOIUrl":"https://doi.org/10.1055/a-2032-2067","url":null,"abstract":"","PeriodicalId":51219,"journal":{"name":"Zeitschrift Fur Orthopadie Und Unfallchirurgie","volume":"1 1","pages":""},"PeriodicalIF":1.0,"publicationDate":"2023-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"57822949","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}