Konservative Therapie der männlichen Belastungsinkontinenz

The majority of male patients affected by stress incontinence developed this disturbance after radical prostatectomy or less frequently after TURP. Urodynamic evaluation shows sphincter insufficiency in more than 90% of the patients. The conservative therapy of postprostatectomy stress incontinence relies on physical methods, namely, pelvic floor muscle training with or without electrical or magnetic stimulation. However, evidence in favor of one or the other approach is limited. Since publication of the positive results with duloxetine in women, interest in medical therapy for men reporting postoperative stress incontinence has increased. Conclusive evidence in favor of duloxetine for prostatectomy-associated incontinence however is still missing.     

Diagnostik und Therapie der isolierten proximalen Bizepsläsion

Pathologies of the long head of the biceps tendon are a frequent cause of pain and restricted shoulder function. In most cases the anamnesis and clinical examination with a combination of specific tests for the biceps tendon lead to the diagnosis. Magnetic resonance imaging (MRI) especially with intraarticular contrast medium enables differentiation of the different biceps pathologies and additional disorders, such as rotator cuff tears. Radiological examination can rule out other bone pathologies. In cases of unclear persistent shoulder disability, diagnostic arthroscopy remains the gold standard which allows a precise diagnosis as well as direct operative treatment of the underlying pathologies. Conservative treatment consists of adaptation of physical activity, anti-inflammatory drugs as well as injections with local anesthetics. Physical therapy can further address concomitant contractures of the capsule or dyskinesia of the scapula. After failed conservative treatment, the surgical procedure depends on the underlying pathology including debridement or refixation of the biceps anchor, tenotomy or tenodesis of the biceps tendon as well as treatment of concomitant pathologies, such as rotator cuff tears.     

Häufigkeit der traumatischen und chronischen skapholunären Bandläsion bei distaler Radiusfraktur

BACKGROUND: Early diagnosis and appropriate treatment of acute scapholunate dissociation (SLD) is crucial for obtaining a favorable result in fractures of the distal radius. The aim of this study was to determine the incidence of acute SLD in a prospective study and to differentiate this entity from chronic SLD. PATIENTS AND METHODS: A total of 120 patients with unilateral distal radius fractures were prospectively evaluated for SLD. Stress radiographs were obtained for all patients on the injured side after fixation of the distal radius fractures. In cases of SLD the unaffected side was examined to rule out chronic, bilateral SLD. RESULTS: Acute SLD was detected in 13 patients (11%), 11 (9.1%) of whom had stage 3 injury. Chronic SLD with bilateral asymptomatic instability was seen in three patients (2.5%). CONCLUSION: When treating fractures of the distal radius, acute SLD has to be ruled out and to be discriminated from chronic SLD. While acute SLD requires appropriate treatment, immediate treatment of chronic SLD is not indicated.     

Konservative Therapie der „frozen shoulder“

Die Unfallchirurgie - Die idiopathische Schultersteifigkeit (Frozen shoulder, FS) ist eine häufige Pathologie des Glenohumeralgelenks, die durch ein plötzlich einsetzendes Schmerzsyndrom...     

Konservative und operative Therapie der suprakondylären Humerusfraktur im Kindesalter

Aim

The supracondylar fracture of the humerus is a common fracture in children. The aim of this study was to record complications and to evaluate functional outcome of the children with dislocated fractures who had been operated on in the Catholic Children’s Hospital Wilhelmstift in Hamburg.

Patients and methods

A total of 191 patients with 194 dislocated supracondylar fractures of the humerus underwent operation between July 1, 2004 and June 30, 2009. All children were operated on promptly, and the fractures were stabilized the day of the accident. An open surgical reduction was needed in 17 patients (9%). In 92%, the fractures were stabilized by crossed Kirschner wires. After 4 weeks, the wires and splint were removed. A follow-up of 185 patients between 3 months and 3 years after the fracture was possible; the axis, function, mobility, and nerve alteration were evaluated.

Results

In 8 cases (4.3%), a deviation between 11° and 15° in the frontal and sagittal plane persisted. No correction osteotomy was performed. According to the Mayo performance score, 182 patients (98.4%) achieved the maximum number of points. Traumatic nerve injuries were recorded in 15 cases (8%), iatrogenic injuries in 6 cases (3%). Vascular operations were necessary in 5 cases (2.5%).

Conclusions

Dislocated supracondylar fractures of the humerus have to be treated as an emergency by closed reduction and stabilization. Good results have been achieved using the well-established percutaneous Kirschner wire fixation. In comminuted fractures, residual deviations may occur. Iatrogenic ulnar nerve lesions may be reduced by the use of a small medial incision. Alternative treatment methods, e. g., applying elastic intramedullary nailing or external fixators, may reduce the complication rate even further.

     

Diagnostik und Therapie der frischen und chronischen hinteren Kreuzbandläsion

Zusammenfassung. Rupturen des hinteren Kreuzbandes geh?ren zu den schwerwiegenden Bandverletzungen des Kniegelenks. Problematisch ist hier eine oft unzureichende Einsch?tzung und versp?tete Diagnostik der Verletzungsschwere als auch der Begleitverletzungen. Zus?tzlich ist die Versagerquote der bisherigen Rekonstruktionsverfahren unbefriedigend hoch. Das Ziel dieser übersichtsarbeit ist es, auf der Basis der eigenen Erfahrungen und dem Wissen aus dem internationalen Schriftum, einen umfassenden Einblick in die Anatomie und Biomechanik, die Unfallmechanismen und die Pathobiomechanik zu geben. Ein weiterer Schwerpunkt liegt in der Kl?rung diagnostischer Schwierigkeiten. Zur ad?quaten Berücksichtigung der Begleitverletzungen, wie z. B. der posterolaterale rotatorische Instabilit?t oder zus?tzlichen Verletzungen des vorderen Kreuzbandes wird ein differenziertes Therapiekonzept vorgestellt, um das konservative und perioperative Management zu optimieren, mit dem Ziel die hohe Quote unbefriedigender Ergebnisse weiter zu reduzieren.      

Konservative Therapie bei Knorpelschäden am oberen Sprunggelenk

Cartilage defects of the upper ankle joint reflect the problem that great force is transmitted and balanced out over a relatively small surface area. As a pathophysiological factor, cartilage-bone contusions play a significant role in the development of cartilage defects of the upper ankle joint. Physiotherapeutic procedures belong to the standard procedures of conservative therapy. The use and selection of the type of therapy is based on empirical considerations and experience and investigations on effectiveness of particular therapies are relatively rare. At present a symptom-oriented therapy of cartilage defects of the upper ankle joint seems to be the most sensible approach. It can be assumed that it makes sense that the symptomatic treatment of cartilage defects or initial stages of arthritis also includes the subsequent symptoms of pain, irritated condition and limited function. This leads to starting points for physiotherapy with respect to pain therapy, optimisation of pressure relationships, avoidance of pressure points, improvement of diffusion and pressure release. In addition to the differential physiotherapeutic findings, the determination of a curative, preventive or rehabilitative procedure is especially important. In physical therapy special importance is placed on a scheduled serial application corresponding to the findings, employing the necessary methods, such as physiotherapy, sport therapy, medical mechanics, manual therapy, massage, electrotherapy and warmth therapy. From this the findings-related therapy is proposed as a practical therapy concept: locomotive apparatus pain therapy, optimisation of pressure relationships, improvement of diffusion and decongestion therapy. Therapy options have been selected base on the current literature and are summarised in tabular form. The art of symptomatic therapy of cartilage defects of the upper ankle joint does not lie in the multitude of sometimes speculative procedures, but in the targeted selection of a therapy regime based on the therapeutic goal, a corresponding application dose and serial design.     

Pathologie und Therapie der Rotatorenmanschettenl?sion

The differentiation between traumatic and degenerative rotator cuff lesions is of high importance in everyday clinical practice. Knowledge of the anatomy and biomechanics are essential for the treatment of patients. In the past 15?years, increasing knowledge of the biomechanics of the shoulder joint and surgical treatment options, particularly in arthroscopic reconstructive options, has evolved. Full documentation of primary clinical findings and the close-knit follow-up documentation are of the utmost importance for an expert evaluation. The authors summarize the key aspects of treatment and possible therapeutic options of rotator cuff lesions.     

Behandlung der lateralen OSG-Instabilität

Chronic ankle joint instability often necessitates operative treatment. Operative treatment methods are classified into non-anatomical tenodesis, anatomical reconstruction and direct repair. In addition to open approaches, arthroscopic techniques are increasingly becoming established. This article describes the various operative treatment procedures, their advantages and disadvantages and in particular the arthroscopic feasibility.     

Begutachtung der SLAP-Läsion

The proximal bony part of the glenoid, the cartilaginous lip firmly attached to the glenoid, the origin of the biceps tendon and the surrounding capsular and ligamentous structures show specific recurrent injury patterns. These have been scientifically identified, analyzed and systematized under the term SLAP lesion (superior labrum anterior to posterior lesion). It is often questioned if these SLAP lesions are a result of overuse, microinjuries or major traumatic effects. In particular the specific causality requirements of the German statutory accident insurance necessitate identification of the most probable cause of such a lesion either by overuse, wear or trauma. The review of the currently available literature shows that the majority of SLAP lesions are not caused by traumatic events. The type and direction of the trauma, which can lead to an accident-linked causal contribution are discussed.     

Läsion der distalen Bizepssehne

The biceps brachii muscle of the arm fulfils a very important function in the arm due to its capacity for flexion and supination. Complete rupture of the distal biceps tendon is typically seen in physically active men. Loss of strength after conservative therapy is extensive (30–40% for flexion and >50% for supination). Refixation of the tendon at the tuberosity of the radius can hold the prospect of a good functional outcome. Chronic partial lesions of the distal biceps tendon can be painful and have to be considered in the differential diagnosis of elbow pain.     

Operative Therapie der peripelvinen Morel-Lavall��e-L?sion

Objective

Evacuation of hematoma, hemostasis, reduction of dead space by vacuum systems for minimization of secondary complications, such as full skin necrosis, deep infections, and secondary wound closure.

Indications

Morel-Lavallée lesion (MLL), all larger epifascial hematomas.

Contraindications

None.

Surgical technique

Central longitudinal incision, detection of the extent of the hematoma, transection of the full length of the lesion, hemostasis, debridement, application of vacuum systems, secondary wound closure, or splitskin coverage.

Postoperative management

Vacuum therapy must be continued until secretions are less than 30?ml/24?hours. Negative bacterial culture before wound closure is imperative. Daily change of wound dressings, frequent control of inflammation parameters. Weight bearing until consolidation of soft tissue.

Results

Operative treatment of the MLL with vacuum systems is a relatively new concept, and results on larger collectives have not been published yet. A total of 8 patients in our hospital underwent vacuum therapy after sustaining a MLL, 5 of them with concomitant instability of the pelvic ring. Emergency stabilization and initiation of vacuum therapy were performed on the day of admission. Three patients had initially positive bacterial colonialization. Duration of vacuum therapy was 8.5?days (range 4?C14?days). Dressings were changed every 2.6?days (range 1?C4?days). While 6?wounds could be closed secondarily, 2 needed split skin coverage. Complications were not observed. Vacuum therapy facilitates wound management and helps reduce bacterial colonialization. It has also been proved to have a beneficial effect on qualitative and quantitative granulation.     

Zur traumatischen Entstehung der Rotatorenmanschettenläsion

The traumatic etiology of rotator cuff lesions is a matter of controversial discussed in legal assessments. Because of the relatively high prevalence of degenerative changes with increasing age, including partial and complete rotator cuff tears, it may be difficult to demonstrate the cause of an acute traumatic rotator cuff tear. This article presents a review of the literature concerning current knowledge of the anatomy, biomechanics and pathogenesis of rotator cuff pathology. According to this, a catalogue of potentially adequate and inadequate trauma mechanisms is proposed. Another focus of this work is in the post-traumatic diagnostic steps following persistent rotator cuff-deficient shoulder function. X-ray, ultrasound, MRI and operative findings in rotator cuff tears underline the criteria for distinguishing between traumatic and degenerative lesions. From a legal point of view (e.g., private accident insurance, workers compensation claims), various minor and major arguments are defined, which could help the expert in judging the cause of post-traumatic rotator cuff deficiency.     

Die erste Beschreibung der Kniegelenksmeniscusläsion

Ohne ZusammenfassungMit 2 Textabbildungen     

Therapie der akuten AC-Gelenk-Instabilität

Background

A variety of surgical procedure are desrcibed for the treatment of acute acromioclavicular (AC-) joint injuries. Beside open techniques arthroscopic assisted procedures spread widely. Each surgical technique offers advantages and disadvantages, but none is currently accepted as a gold standard. Therefore, the study aims to review the evidence for arthroscopic and open surgical procedures in the treatment of acute AC joint instabilities.

Material and methods

According to the Cochrane Handbook for Systematic Reviews of Interventions we conducted a defined search of Medline and Embase database for articles publisher over the last ten years.

Results

The search resulted in 961 studies of which 32 were included in this review and 3 studies were suitable for a meta-analysis. The functional outcome (Constant score) showed a tendency towards better results after arthroscopic procedures (weighted mean difference 5.60, 95?% confidence interval 0.36–10.64). There were no significant differences with respect to complication rates, secondary dislocation in the vertical plane, revision surgery and AC joint instability.

Conclusion

There is insufficient evidence to inform the surgical management of acute AC joint instability. Due to inconsistent study designs there is no evidence for a general superiority of any of the open or arthroscopic procedures. Randomized, controlled studies are necessary to demonstrate whether arthroscopic techniques show a potential benefit in terms of a better functional outcome.

     

Die Therapie der Epiphysenfugenschädigungen

Ohne Zusammenfassung Mit 10 Textabbildungen in 28 Einzeldarstellungen     

Konservative und operative Behandlung der Hiatushernie im Säuglingsalter

Ohne ZusammenfassungVortragender:A. Flach-Tübingen.     

Diagnostik und Therapie der frischen und chronischen hinteren Kreuzbandl?sion

Rupturen des hinteren Kreuzbandes geh?ren zu den schwerwiegenden Bandverletzungen des Kniegelenks. Problematisch ist hier eine oft unzureichende Einsch?tzung und versp?tete Diagnostik der Verletzungsschwere als auch der Begleitverletzungen. Zus?tzlich ist die Versagerquote der bisherigen Rekonstruktionsverfahren unbefriedigend hoch. Das Ziel dieser übersichtsarbeit ist es, auf der Basis der eigenen Erfahrungen und dem Wissen aus dem internationalen Schriftum, einen umfassenden Einblick in die Anatomie und Biomechanik, die Unfallmechanismen und die Pathobiomechanik zu geben. Ein weiterer Schwerpunkt liegt in der Kl?rung diagnostischer Schwierigkeiten. Zur ad?quaten Berücksichtigung der Begleitverletzungen, wie z. B. der posterolaterale rotatorische Instabilit?t oder zus?tzlichen Verletzungen des vorderen Kreuzbandes wird ein differenziertes Therapiekonzept vorgestellt, um das konservative und perioperative Management zu optimieren, mit dem Ziel die hohe Quote unbefriedigender Ergebnisse weiter zu reduzieren.