[Endoprosthetic replacement of the ankle joint]

Indikationen und Alternativen der endoprothetischen Versorgung beim jüngeren Patienten

Due to the significant risk of aseptic implant loosening, the indications for endoprosthetic treatment of young adults must be assessed critically. All conservative and surgical therapy options must always be considered cautiously. Even advanced osteoarthritis of the upper extremities (shoulder, elbow and wrist joints) can often be treated with joint sparing, non-endoprosthetic therapy that leads to good clinical results and sufficient joint function. Total joint replacement is often inevitable for regaining an acceptable gait and adequate mobility in cases of advanced joint destruction of the lower extremities (hip and knee joints). Arthrodesis of the upper ankle joint in cases of isolated osteoarthritis remains a valid therapeutic option. Replacement of the upper ankle joint should be considered in cases of bilateral affliction as well as in the event of additional osteoarthritis of the adjacent joints of the lower ankle and the tarsus.

[Trauma surgery in the elderly]

The indications for the surgical treatment of fractures in elderly patients should consider the individual's general health status, the specific pattern of injury, and the ability of the patient to actively participate in the rehabilitation process. Intramedullary systems are the gold standard for shaft and metaphyseal fractures due to the decreased operative trauma and the possibility of early weight bearing and functional treatment. Minimally invasive locking plate systems can frequently be applied, offer decreased risk of secondary fracture displacement, and have great advantages in the treatment of periprosthetic fractures with firm implants. The possible reasons for falls should be diagnosed in order to allow their prevention. An exact assessment of the severity of osteoporosis in important in allowing adequate treatment for associated pain and for decreasing the risk of future osteoporosis related fractures.