1
|
Grifka J, Schiegl Geb Götz J, Fenk-Mayer A, Benditz A. [Injection treatment for cervical and lumbar syndromes : Special infiltration techniques]. Orthopadie (Heidelb) 2024; 53:147-160. [PMID: 38078937 DOI: 10.1007/s00132-023-04458-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/30/2023] [Indexed: 02/06/2024]
Abstract
Minimally invasive injection treatment is indicated particularly in cases of treatment-resistant, painful degenerative alterations of the cervical and lumbar spine, intervertebral disc displacement and radicular syndrome. Through the injections and the supplementation with further conservative, e.g., physical therapy and activating measures, the vicious circle of neural irritation and muscle tension and sympathetic nerve reactions can be interrupted.
Collapse
Affiliation(s)
- J Grifka
- Orthopädische Klinik für die Universität Regensburg, Asklepios Klinikum Bad Abbach GmbH, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Deutschland.
| | - J Schiegl Geb Götz
- Orthopädische Klinik für die Universität Regensburg, Asklepios Klinikum Bad Abbach GmbH, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Deutschland
| | - A Fenk-Mayer
- Orthopädische Klinik für die Universität Regensburg, Asklepios Klinikum Bad Abbach GmbH, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Deutschland
| | - A Benditz
- Klinikum Fichtelgebirge Marktredwitz, Schillerhain 1-8, 95615, Marktredwitz, Deutschland
| |
Collapse
|
2
|
Grifka J, Götz J, Fenk-Mayer A, Benditz A. [Injection treatment for cervical and lumbar syndromes: principles, indications and general performance]. Orthopadie (Heidelb) 2023; 52:1017-1024. [PMID: 38015212 DOI: 10.1007/s00132-023-04449-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/15/2023] [Indexed: 11/29/2023]
Abstract
An intensive conservative treatment that exhausts all treatment options should fundamentally be carried out before every surgical intervention in the region of the spinal column. The therapeutic measures are determined by the extent of the cervical or lumbar syndrome. As a rule, in cases of local complaints symptomatic measures with physiotherapy or digital healthcare applications are indicated. In cases of referred cervical and lumbar syndromes targeted injections can be employed. Before targeted injection treatment a detailed orthopedic clarification with respect to the intensity of local, radicular or pseudoradicular complaints must be carried out. When carrying out minimally invasive injection treatment specific prerequisites with respect to spatial, personnel and technical conditions must be fulfilled. The indications and contraindications must be strictly controlled.
Collapse
Affiliation(s)
- J Grifka
- Orthopädische Klinik für die Universität Regensburg, Asklepios Klinikum Bad Abbach GmbH, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Deutschland.
| | - J Götz
- Orthopädische Klinik für die Universität Regensburg, Asklepios Klinikum Bad Abbach GmbH, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Deutschland
| | - A Fenk-Mayer
- Orthopädische Klinik für die Universität Regensburg, Asklepios Klinikum Bad Abbach GmbH, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Deutschland
| | - A Benditz
- Klinikum Fichtelgebirge Marktredwitz, Schillerhain 1-8, 95615, Marktredwitz, Deutschland
| |
Collapse
|
3
|
Schuh A, Koehl P, Sesselmann S, Goyal T, Benditz A. INCIDENTAL INTRAOSSEOUS CALCANEAL LIPOMA IN A PATIENT SUFFERING FROM PLANTARFASZIITIS. Georgian Med News 2022:37-39. [PMID: 36427838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Intraosseous calcaneal lipoma is a rare benign bone tumor. The incidence of intraosseous lipoma involving the calcaneus has been noted to account for fewer than 8-15% of all intraosseous lipoma. The etiology of the lesion is unknown. A post-traumatic secondary bone reaction, healing bone infarct, and benign neoplasm have been discussed. The symptoms can be nonspecific, varying from dull, intermittent pain to activity-related plantar pain. This pain can predictably be misdiagnosed as plantar fasciitis. We present the case of a 49-year-old male patient suffering from plantar fasciitis for three months and incidental asymptomatic intraosseous calcaneal lipoma, which was diagnosed by x-ray and CT scan. As the patient was out of complaints, the typical CT findings we saw no indication for biopsy but recommended regular CT and MRI controls.;
Collapse
Affiliation(s)
- A Schuh
- 1Hospital of trauma surgery, Department of musculoskeletal research, Marktredwitz Hospital, Germany
| | - P Koehl
- 2Hospital of trauma surgery, Marktredwitz Hospital, Germany
| | - S Sesselmann
- 3Institute for Medical Engineering, OTH Technical University of Applied Sciences Amberg-Weiden, Germany
| | - T Goyal
- 4Department of Orthopaedics, All India Institute of Medical Sciences, Bathinda, Punjab, India
| | - A Benditz
- 5Hospital of trauma surgery, Department of orthopedics. Marktredwitz Hospital, Germany
| |
Collapse
|
4
|
Schuh A, Koehl P, Sesselmann S, Goyal T, Benditz A. INTRAMUSCULAR MYXOMA OF THE BUTTOCK- A CASE REPORT. Georgian Med News 2022:40-42. [PMID: 36427839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Intramuscular myxoma (IM) is a benign, soft tissue neoplasm of mesenchymal origin. IM is rare, with an incidence of between 0.1 and 0.13 in every 100,000 individuals. Onset is usually between the fourth and seventh decades of life, predominantly in women (70%). The thigh is the common site of involvement seen in 51% patients, followed by upper arm (9%), calf (7%), and rarely in buttocks. We present the case of a 63-year-old female patient with a 6-month history of a growing IM of the right buttock. Due to rapid tumor growth resection of the tumor was indicated to obtain histopathological examination and to rule out malignancy. Marginal surgical removal was performed. Histopathological examination brought the diagnosis of a big intramuscular myxoma. There is no recurrence at latest follow-up.
Collapse
Affiliation(s)
- A Schuh
- 1Hospital of trauma surgery, Department of musculoskeletal research, Marktredwitz Hospital, Germany
| | - P Koehl
- 2Hospital of trauma surgery, Marktredwitz Hospital, Germany
| | - S Sesselmann
- 3Institute for Medical Engineering, OTH Technical University of Applied Sciences Amberg-Weiden, Germany
| | - T Goyal
- 4Department of Orthopaedics, All India Institute of Medical Sciences, Bathinda, Punjab, India
| | - A Benditz
- 5Hospital of trauma surgery, Department of orthopedics. Marktredwitz Hospital, Germany
| |
Collapse
|
5
|
Abstract
The X‑ray image-guided injection methods are an important tool for the treatment of cervical and lumbar pain syndromes. For the application of these methods it is necessary to have a differentiated consideration of cervical and lumbar pain syndromes. This leads to a decoding of complaints to assignable pain generators, which enables a targeted injection method. Depending on the origin of pain, injections are placed at the nerve root or the joints. Thus, the vicious cycle of pain can be stopped. A correct technical procedure is of enormous importance. Particular attention must be paid to the pharmacological effects and special complications. A monitoring and precautionary measures are mandatory.
Collapse
Affiliation(s)
- F Faber
- Orthopädische Universitätsklinik Regensburg, Asklepios Klinikum Bad Abbach, Kaiser Karl V. Allee 3, 93077, Bad Abbach, Deutschland.
| | - A Benditz
- Orthopädische Klinik, Universität Regensburg, Bad Abbach, Deutschland
| | - D Boluki
- Orthopädische Klinik, Universität Regensburg, Bad Abbach, Deutschland
| | - J Grifka
- Orthopädische Klinik, Universität Regensburg, Bad Abbach, Deutschland
| |
Collapse
|
6
|
|
7
|
Abstract
BACKGROUND Coccygodynia is still often considered a mystery, and many patients are not taken seriously with their problems and pain. CASE A 51-year-old thin lady presented at our clinic with lifelong, persistent low back pain. The clinical examination indicated suspicion of coccygodynia. A functional X‑ray revealed a hypermobile os coccygeum with dorsal tilt. After a total coccygectomy via a y-shaped approach, she was completely pain free at the 12 months follow-up examination. No surgical site infection occurred in this period.
Collapse
Affiliation(s)
- A Benditz
- Orthopädische Klinik für die Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V-Allee 3, 93077, Bad Abbach, Deutschland.
| | - M A König
- Orthopädische Klinik für die Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V-Allee 3, 93077, Bad Abbach, Deutschland
| |
Collapse
|
8
|
Benditz A. [Surgical techniques for the lumbar spine-an update and overview]. Orthopade 2018; 48:3-4. [PMID: 30511159 DOI: 10.1007/s00132-018-03660-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- A Benditz
- Orthopädische Klinik für die Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V-Allee 3, 93077, Bad Abbach, Deutschland.
| |
Collapse
|
9
|
Schwarz T, Benditz A, Springorum HR, Matussek J, Heers G, Weber M, Renkawitz T, Grifka J, Craiovan B. Assessment of pelvic tilt in anteroposterior radiographs by means of tilt ratios. Arch Orthop Trauma Surg 2018; 138:1045-1052. [PMID: 29651575 DOI: 10.1007/s00402-018-2931-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Indexed: 11/24/2022]
Abstract
INTRODUCTION In anteposterior (AP) radiographs, cup position in total hip arthroplasty and acetabular anatomy in hip-preserving surgery are highly influenced by pelvic tilt. The sagittal rotation of the anterior pelvic plane is an important measurement of pelvic tilt during hip surgery. Thus, correct evaluation of cup position and acetabular parameters requires the assessment of pelvic tilt in AP radiographs. METHODS Changes in pelvic tilt inversely change the height of the lesser pelvis and the obturator foramen in AP radiographs. Tilt ratios were calculated by means of these two parameters in simulated radiographs for ten male and ten female pelvises in defined tilt positions. A tilt formula obtained by exponential regression analysis was evaluated by two blinded investigators by means of 14 simulated AP radiographs of the pelvis with pelvic tilts ranging from + 15° to - 15°. RESULTS No differences were found between male and female tilt ratios for each 5° step of simulated pelvic tilt. Pelvic tilt and tilt ratios correlated exponentially. Using the tilt formula, the two blinded investigators were able to assess pelvic tilt with high conformity, a mean relative error of + 0.4° (SD ± 4.6°), and a mean absolute error of 3.9° (SD ± 2.3°). Neutral pelvic tilt is indicated by a tilt ratio of 0.5 when the height of the lesser pelvis is twice the height of the obturator foramen. CONCLUSION The analysis and interpretation of cup position and acetabular parameters may be improved by our method for assessing pelvic tilt in AP radiographs.
Collapse
Affiliation(s)
- T Schwarz
- Department of Orthopedic Surgery, University Medical Center Regensburg, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Germany.
| | - A Benditz
- Department of Orthopedic Surgery, University Medical Center Regensburg, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Germany
| | - H-R Springorum
- Department of Orthopedic Surgery, University Medical Center Regensburg, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Germany
| | - J Matussek
- Department of Orthopedic Surgery, University Medical Center Regensburg, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Germany
| | - G Heers
- Department of Orthopedic Surgery, University Medical Center Regensburg, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Germany
| | - M Weber
- Department of Orthopedic Surgery, University Medical Center Regensburg, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Germany
| | - T Renkawitz
- Department of Orthopedic Surgery, University Medical Center Regensburg, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Germany
| | - J Grifka
- Department of Orthopedic Surgery, University Medical Center Regensburg, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Germany
| | - B Craiovan
- Department of Orthopedic Surgery, University Medical Center Regensburg, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Germany
| |
Collapse
|
10
|
Abstract
The wrist and hand form a highly complex organ that is of great importance in almost all daily activities. The hand serves as a tool and an organ of sense. Injuries of the hand and wrist as well as mechanical, neurological or systemic inflammatory changes are common. Taking a detailed history can already lead to a diagnosis. Almost all structures of the hand are easily accessible for clinical examination, i. e. inspection, palpation and clinical tests, including dynamic testing. Diagnostic imaging completes the examination procedure.
Collapse
Affiliation(s)
- H R Springorum
- Orthopädisches Fachzentrum, Seehauser Straße 2, 82418, Murnau, Deutschland.
| | - C Baier
- Orthopädische Klinik der Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V. Allee 3, 93077, Bad Abbach, Deutschland
| | - J Götz
- Orthopädische Klinik der Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V. Allee 3, 93077, Bad Abbach, Deutschland
| | - T Schwarz
- Orthopädische Klinik der Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V. Allee 3, 93077, Bad Abbach, Deutschland
| | - A Benditz
- Orthopädische Klinik der Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V. Allee 3, 93077, Bad Abbach, Deutschland
| | - J Grifka
- Orthopädische Klinik der Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V. Allee 3, 93077, Bad Abbach, Deutschland
| | - G Heers
- Orthopädische Klinik der Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V. Allee 3, 93077, Bad Abbach, Deutschland
| |
Collapse
|
11
|
Abstract
Few data exist of kinematics of knees with varus and valgus deformities combined with osteoarthritis. The purpose of this study was to reveal different (1) tibiofemoral kinematics, (2) medial and lateral gaps, and (3) condylar liftoff of osteoarthritic knees with either varus or valgus deformity before and after total knee arthroplasty (TKA). For this purpose, 40 patients for TKA were included in this study, 23 knees with varus deformity and 17 knees with valgus deformity. All patients underwent computer navigation, and kinematics was assessed before making any cuts or releases and after implantation. Osteoarthritic knees with valgus deformity showed a significant difference in tibia rotation relative to the femur with flexion before and after TKA, whereas knees with varus deformity did not. Knees with a valgus deformity showed femoral external rotation in extension and femoral internal rotation in flexion, whereas knees with a varus deformity revealed femoral internal rotation in extension and femoral external rotation in flexion. In both groups, gaps increased after TKA. Condylar liftoff was not observed in the varus deformity group after TKA. In the valgus deformity group, condylar liftoff was detected after TKA at knee flexion of 50 degrees and more. This study revealed significant differences in tibiofemoral kinematics between osteoarthritic knees with a varus or valgus deformity before and after TKA. Valgus deformities showed a paradoxic movement pattern. These in vivo intraoperative results need to be confirmed using fluoroscopic or radiographic three-dimensional matching before and after TKA.
Collapse
Affiliation(s)
- C Baier
- Department of Orthopaedic Surgery, University of Regensburg, Regensburg, Germany
| | - A Benditz
- Department of Orthopaedic Surgery, University of Regensburg, Regensburg, Germany
| | - F Koeck
- Department of Orthopaedic Surgery, University of Regensburg, Regensburg, Germany
| | - A Keshmiri
- Department of Orthopaedic Surgery, University of Regensburg, Regensburg, Germany
| | - J Grifka
- Department of Orthopaedic Surgery, University of Regensburg, Regensburg, Germany
| | - G Maderbacher
- Department of Orthopaedic Surgery, University of Regensburg, Regensburg, Germany
| |
Collapse
|
12
|
Benditz A, Auer S, Spörrer JF, Wolkerstorfer S, Grifka J, Suess F, Dendorfer S. Regarding loads after spinal fusion, every level should be seen separately: a musculoskeletal analysis. Eur Spine J 2018; 27:1905-1910. [PMID: 29352353 DOI: 10.1007/s00586-018-5476-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2017] [Revised: 01/05/2018] [Accepted: 01/12/2018] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The number of spinal fusion surgeries is steadily increasing and biomechanical consequences are still in debate. The aim of this study is to provide biomechanical insights into the sagittal balance of the spine and to compare spinal load before and after spinal fusion. METHOD The joint reaction forces of 52 patients were analyzed in proximo-distal and antero-posterior direction from the levels T12-L1 to L5-S1 using musculoskeletal simulations. RESULTS In 104 simulations, pre-surgical forces were equal to post-surgical. The levels L4-L5 and T12-L1, however, showed increased spinal forces compression forces with higher sagittal displacement. Improved restauration of sagittal balance was accompanied by lower spinal load. AP shear stress, interestingly decreased with sagittal imbalance. CONCLUSION Imbalanced spines have a risk of increased compression forces at Th12-L1. L4-L5 always has increased spinal loads. These slides can be retrieved under Electronic Supplementary Material.
Collapse
Affiliation(s)
- A Benditz
- Department of Orthopaedics, University Medical Centre Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V-Allee 3, 93077, Bad Abbach, Germany.
| | - S Auer
- Laboratory for Biomechanics, Regensburg Center of Biomedical Engineering, Galgenbergstrasse 30, 93053, Regensburg, Germany
| | - J F Spörrer
- Department of Orthopaedics, University Medical Centre Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V-Allee 3, 93077, Bad Abbach, Germany
| | - S Wolkerstorfer
- Department of Orthopaedics, University Medical Centre Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V-Allee 3, 93077, Bad Abbach, Germany
| | - J Grifka
- Department of Orthopaedics, University Medical Centre Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V-Allee 3, 93077, Bad Abbach, Germany
| | - F Suess
- Laboratory for Biomechanics, Regensburg Center of Biomedical Engineering, Galgenbergstrasse 30, 93053, Regensburg, Germany
| | - S Dendorfer
- Laboratory for Biomechanics, Regensburg Center of Biomedical Engineering, Galgenbergstrasse 30, 93053, Regensburg, Germany
| |
Collapse
|
13
|
Benditz A, Maderbacher G, Zeman F, Grifka J, Weber M, von Kunow F, Greimel F, Keshmiri A. Postoperative pain and patient satisfaction are not influenced by daytime and duration of knee and hip arthroplasty: a prospective cohort study. Arch Orthop Trauma Surg 2017; 137:1343-1348. [PMID: 28776090 DOI: 10.1007/s00402-017-2769-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Indexed: 11/26/2022]
Abstract
PURPOSE The number of total hip and knee arthroplasties (THA and TKA) is steadily increasing. Many factors that influence pain have been reported, but little is known about the correlation between the time of day and the duration of surgery and postoperative pain. On one hand, surgical interventions are performed faster due to economic pressure; on the other hand, obtaining sound surgical skills and a thorough education are most important for young surgeons, particularly at university hospitals. Amidst these different interests, it is the patient who should be the focus of all medical efforts. Therefore, our study investigated the effects of the time of day and the duration of total knee and hip arthroplasty on postoperative pain perception and patient satisfaction. METHODS 623 patients were analyzed 24 h after primary total knee or hip arthroplasty regarding pain, patient satisfaction, and side effects by means of the questionnaires of the German-wide project Quality Improvement in Postoperative Pain Management (QUIPS). RESULTS The time of day and the duration of knee or hip arthroplasty were not correlated with maximum, minimum, and activity-related pain and patient satisfaction rated on a numeric rating scale (NRS). CONCLUSIONS This study is the first to show that neither the time of day nor the duration of surgery has any influence on patient satisfaction and postoperative pain 24 h after total knee or hip arthroplasty; regarding these aspects, young orthopaedic surgeons may be trained in the operating theatre without time pressure.
Collapse
Affiliation(s)
- A Benditz
- Department of Orthopaedics, University Medical Centre Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V-Allee 3, 93077, Bad Abbach, Germany.
| | - G Maderbacher
- Department of Orthopaedics, University Medical Centre Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V-Allee 3, 93077, Bad Abbach, Germany
| | - Florian Zeman
- Centre for Clinical Studies, University Medical Centre Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Joachim Grifka
- Department of Orthopaedics, University Medical Centre Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V-Allee 3, 93077, Bad Abbach, Germany
| | - Markus Weber
- Department of Orthopaedics, University Medical Centre Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V-Allee 3, 93077, Bad Abbach, Germany
| | - Frederik von Kunow
- Department of Orthopaedics, University Medical Centre Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V-Allee 3, 93077, Bad Abbach, Germany
| | - Felix Greimel
- Department of Orthopaedics, University Medical Centre Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V-Allee 3, 93077, Bad Abbach, Germany
| | - Armin Keshmiri
- Department of Orthopaedics, University Medical Centre Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V-Allee 3, 93077, Bad Abbach, Germany
| |
Collapse
|
14
|
Abstract
BACKGROUND The number of total knee arthroplasties in elderly patients is increasing in accordance with the demographic shift in the population. OBJECTIVE Analysis of the special situation in the elderly, conservative treatment options, perioperative risk factors, preoperative preparation, special intraoperative features and outcome. METHODS Analysis of currently available scientific data and presentation of own scientific study results. RESULTS Total knee arthroplasty in elderly patients is related to an increased perioperative risk of complications. A thorough interdisciplinary preparation is required to reduce risk factors. Ligament stability of the knee does not correlate with age. The postoperative outcome after total knee arthroplasty in elderly patients is decisively influenced by the preoperative function and psychosocial parameters. CONCLUSION Total knee arthroplasty in elderly patients is particularly challenging for orthopedic surgeons and requires close interdisciplinary cooperation.
Collapse
Affiliation(s)
- M Weber
- Orthopädische Abteilung der Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Deutschland.
| | - F Völlner
- Orthopädische Abteilung der Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Deutschland
| | - A Benditz
- Orthopädische Abteilung der Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Deutschland
| | - T Schwarz
- Orthopädische Abteilung der Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Deutschland
| | - M Wörner
- Orthopädische Abteilung der Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Deutschland
| | - B Craiovan
- Orthopädische Abteilung der Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Deutschland
| | - T Renkawitz
- Orthopädische Abteilung der Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Deutschland
| | - J Grifka
- Orthopädische Abteilung der Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Deutschland
| |
Collapse
|
15
|
Renkawitz T, Benditz A, Rüsseler M, Obertacke U, Grifka J, Weber M. Lehre in Orthopädie und Unfallchirurgie. Orthopäde 2017; 46:969-978. [DOI: 10.1007/s00132-017-3457-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
16
|
Abstract
In cervical and lumbar pain syndromes special injections are key for effective pain therapy. Depending on the origin of pain injections are placed at the nerve root or the joints. Thus, the vicious cycle can be stopped. A correct technical procedure is of enormous importance. Because pharmacological effects and special complications are possible, monitoring and precautions are mandatory.
Collapse
Affiliation(s)
- J Grifka
- Orthopädische Klinik, Universität Regensburg, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Deutschland.
| | - A Benditz
- Orthopädische Klinik, Universität Regensburg, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Deutschland
| | - D Boluki
- Orthopädische Klinik, Universität Regensburg, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Deutschland
| |
Collapse
|
17
|
Abstract
The wrist and hand form a highly complex organ that is of great importance in almost all daily activities. The hand serves as a tool and an organ of sense. Injuries of the hand and wrist as well as mechanical, neurological or systemic inflammatory changes are common. Taking a detailed history can already lead to a diagnosis. Almost all structures of the hand are easily accessible for clinical examination, i. e. inspection, palpation and clinical tests, including dynamic testing. Diagnostic imaging completes the examination procedure.
Collapse
Affiliation(s)
- H R Springorum
- Orthopädische Klinik der Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V. Allee 3, 93077, Bad Abbach, Deutschland.
| | - C Baier
- Orthopädische Klinik der Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V. Allee 3, 93077, Bad Abbach, Deutschland
| | - J Götz
- Orthopädische Klinik der Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V. Allee 3, 93077, Bad Abbach, Deutschland
| | - T Schwarz
- Orthopädische Klinik der Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V. Allee 3, 93077, Bad Abbach, Deutschland
| | - A Benditz
- Orthopädische Klinik der Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V. Allee 3, 93077, Bad Abbach, Deutschland
| | - J Grifka
- Orthopädische Klinik der Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V. Allee 3, 93077, Bad Abbach, Deutschland
| | - G Heers
- Orthopädische Klinik der Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V. Allee 3, 93077, Bad Abbach, Deutschland
| |
Collapse
|
18
|
Matussek J, Dingeldey E, Benditz A, Rezai G, Nahr K. [Conservative treatment of idiopathic scoliosis : Influence of archetypical Cheneau-Corsets on trunk asymmetry]. Orthopade 2016; 44:869-78. [PMID: 26662552 DOI: 10.1007/s00132-015-3177-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The vertical posture of the growing child requires minute central nervous control mechanisms to maintain the symmetry of the torso in its various activities. Measuring only static parameters such as the Cobb angle does not describe the dynamic changes of scoliotic deformities in gait. A constant deviation in the frontal, transverse, and sagittal planes from the dynamic symmetry of the trunk is described in motion analysis and the surface changes of the spinopelvic complex. METHODS Early intervention with effective bracing, physiotherapy and sport can reverse curve progression in growth spurts, once these are identified by screening. Modern braces have a derotating and reducing effect ("mirror effect") on asymmetric body volumes, thus influencing the growing torso and restoring lasting symmetry. These braces can be reduced for archetypical designs. Latest data support the use of braces to reverse progressing scoliosis.
Collapse
Affiliation(s)
- J Matussek
- Kinderorthopädie und Wirbelsäulenchirurgie, Orthopädische Klinik für die Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl V. Allee 3, 93077, Regensburg/Bad Abbach, Deutschland.
| | - E Dingeldey
- Kinderorthopädie und Wirbelsäulenchirurgie, Orthopädische Klinik für die Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl V. Allee 3, 93077, Regensburg/Bad Abbach, Deutschland
| | - A Benditz
- Kinderorthopädie und Wirbelsäulenchirurgie, Orthopädische Klinik für die Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl V. Allee 3, 93077, Regensburg/Bad Abbach, Deutschland
| | - G Rezai
- Asklepios Klinikum Bad Abbach, Fa. Urban-Kaemmler, Bad Abbach, Deutschland
| | - K Nahr
- CCtec Deutsches Korsettzentrum GBR, Offenburg, Deutschland
| |
Collapse
|
19
|
Linhardt O, Grifka J, Benditz A. [Are There Correlations Between Disc Degeneration and the Appearance of Lumbar Disc Herniations?]. Z Orthop Unfall 2016; 154:595-600. [PMID: 27336841 DOI: 10.1055/s-0042-109568] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Background: The correlation between disc prolapse and disc degeneration is important in the evaluation of clinical and occupational disease. The present clinical radiological study investigated whether there is a correlation between disc degeneration (chondrosis) and disc prolapses. Patients and Methods: The present study is a retrospectively trial which was performed with conservatively and surgically treated patients from 2011 till 2013 in our clinic. 100 patients with disc prolapse and chondrosis in current MRI images were recruited. We classified patients into those who exhibited a prolapse and chondrosis in the same segment, those with only disc prolapse and those with only chondrosis. Statistical evaluation for the correlation between chondrosis and disc prolapse was performed with the chi-square test. Odds ratios for prolapse and chondrosis were calculated, as well as interobserver reliability (kappa-value) between the first and second observers of radiological images. Results: In all segments in our 100 patients, 119 radiological findings were made (= 100 %). 54 findings (45 %) with disc prolapse in combination with chondrosis were identified in the same lumbar segment. 43 findings (36 %) exhibited disc prolapse without chondrosis and 22 (19 %) chondrosis without prolapse. In most cases, the findings were seen in the last two segments. There was a statistical correlation between disc prolapse and chondrosis, as seen with the chi-squared test. As regards odds ratios, disc prolapse with chondrosis was 1.25-fold more frequent than prolapse without chondrosis; chondrosis with prolapse was 2.37-fold more frequent than chondrosis without prolapse. The interobserver reliability showed a kappa-value of 0.79 with disc prolapses and a kappa-value of 0.85 with chondrosis. Conclusion: For patients with disc prolapse and chondrosis in the same segment, chondrosis was mostly seen in combination with a prolapse. A causal relation was found between prolapse and chondrosis in the same segment. The interobserver reliability showed high correlation for radiological findings with disc prolapse and very high correlations with chondrosis.
Collapse
Affiliation(s)
- O Linhardt
- Wirbelsäulenchirurgie, Orthopädiezentrum Arabellapark München
| | - J Grifka
- Orthopädische Klinik für die Universität Regensburg, Bad Abbach
| | - A Benditz
- Orthopädische Klinik für die Universität Regensburg, Bad Abbach
| |
Collapse
|
20
|
Abstract
A sufficient pain management forms the foundation for a successful operative treatment of orthopedic patients. Clinical guideline standards must be provided to ensure safe and immediate pain therapy. Training in these guidelines should be held for clinical personnel on a regular basis. The visual analog scale (VAS) and the numerical rating scale (NRS) are valid instruments used for assessment of pain intensity. A sufficient pain management includes basic analgesics, analgesics on demand as well as special features, such as regional nerve blocks and patient-controlled anesthesia (PCA). The basic analgesics are primarily the groups of classical non-steroidal anti-inflammatory drugs (NSAID) and cyclooxygenase 2 (COX-2) inhibitors as well as stand by analgesics, such as metamizole. If there is further need for pain therapy, medium strong and strong opioids can be used but adverse events must be taken into consideration.
Collapse
Affiliation(s)
- T Fikentscher
- Orthopädische Klinik für die Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl V. Allee 3, 93077, Bad Abbach, Deutschland.
| | - J Grifka
- Orthopädische Klinik für die Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl V. Allee 3, 93077, Bad Abbach, Deutschland
| | - A Benditz
- Orthopädische Klinik für die Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl V. Allee 3, 93077, Bad Abbach, Deutschland
| |
Collapse
|
21
|
Matussek J, Benditz A, Dingeldey E, Völlner F, Boluki D. [Surgical treatment of scoliosis in childhood and adolescence: Age group and etiology-related indications and choice of instrumentation]. Orthopade 2016; 44:577-90; quiz 591-3. [PMID: 26156039 DOI: 10.1007/s00132-015-3133-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The indications for a corrective surgical procedure for the complex 3-dimensional deformations of the spine collectively known under the term scoliosis, essentially depend on knowledge of the underlying etiology, the time of initial diagnosis in relation to the growth curve of the child and on considerations about the general operability of the patient. An early onset of scoliosis in childhood under defined diagnostic criteria is usually associated with a fast progression of spinal curvature and requires early surgical intervention during the growth period, while scoliosis in adolescence often allows a delayed surgical intervention until all conservative means have been taken into consideration. Corrective measures in the growing spine require procedures and adjustable hardware which can be adapted to vertebral and thoracic growth and thus anticipate the threat of pulmonary insufficiency due to postural and spinal collapse. Towards the end of puberty when spinal growth slowly comes to an end, corrective spinal fusion procedures are considered in those cases of early and late onset scoliosis, where curvature progression is likely to occur.
Collapse
Affiliation(s)
- J Matussek
- Abteilung Kinderorthopädie und Wirbelsäulenchirurgie, Orthopädische Klinik für die Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl V. Allee 3, 93077, Bad Abbach, Deutschland, Regensburg,
| | | | | | | | | |
Collapse
|
22
|
Linhardt O, Benditz A, Grifka J. [Influence of disc degeneration on the development of disc prolapse]. Z Orthop Unfall 2014; 152:558-64. [PMID: 25531515 DOI: 10.1055/s-0034-1383021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE The present clinical-radiological study examines retrospectively the relation between lumbar disc prolapse and degenerations like chondrosis and spondylosis. METHOD Firstly the relation between disc prolapse and chondrosis was examined. 44 patients with disc prolapse and chondrosis in actual MRI scans in the same segment were recruited in our clinic. By regarding older MRI scans, we could find out which finding was first to occur. Concerning the second question, we followed patients with spondylosis to see if they could progress to a disc prolapse. RESULTS In 67% of our cases with disc prolapse and chondrosis, a chondrosis was seen before the disc prolapse. More than a half had had a spondylosis and a chondrosis in the same segment before the herniation. Only 33% of our cases showed a prolapse before chondrosis. CONCLUSION Concerning patients with disc prolapse and chondrosis in the same segment, chondrosis was seen before the herniation in most cases. Also patients with spondylosis progress to a herniation. A causal relation between both radiological findings is not possible. In a future study it must be analysed with statistical tests whether these results are generally valid.
Collapse
Affiliation(s)
| | - A Benditz
- Orthopädie, Orthopädische Uniklinik Regensburg
| | - J Grifka
- Orthopädie, Orthopädische Uniklinik Regensburg, Bad Abbach
| |
Collapse
|
23
|
Keshmiri A, Wolf T, Wiech O, Benditz A, Grifka J, Springorum H. Einfluss der intraoperativen Schallprotektion auf postoperative Schmerzen. Schmerz 2014; 28:82-9. [DOI: 10.1007/s00482-013-1368-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
24
|
Renkawitz T, Schuster T, Benditz A, Craiovan B, Grifka J, Lechler P. [What medical students want - evaluation of medical recruitment ads by future physicians]. Gesundheitswesen 2013; 75:e149-55. [PMID: 23459836 DOI: 10.1055/s-0032-1331785] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Three-quarters of all hospitals in Germany are now struggling to fill open positions for doctors. The medical job ad is a vital tool for human resources marketing and an important image factor. The present study examines the importance of information and offers in medical recruitment ads on application decisions by medical students. METHOD A total of 184 future physicians from clinical semesters participated voluntarily in an anonymous cross-sectional survey. Using a standardised questionnaire, the importance of 49 -individual items extracted from medical recruitment ads were rated with the help of a 4-point Likert Scale. Finally, the study participants prioritised their reasons for an application as a physician. RESULTS Primary influence on the application decision on medical recruitment ads by medical students had offers/information in relation to education and training aspects and work-life balance. Payment rates for physicians and work load played an important role for the application motivation. Additional earnings for, e. g., emergency calls, providing of medical expertise and assistance with housing, relocation and reimbursement of interview expenses were less crucial. In prioritising key reasons for selecting a prospective employer "regular working hours," an "individual training concept" and an "attractive work-life balance" scored the highest priority. The "opportunity for scientific work" was assigned only a small significance. CONCLUSION High importance for the application decision by future physicians on medical recruitment ads is placed on jobs with an opportunity for personal development and aspects that contribute to work-life balance.
Collapse
Affiliation(s)
- T Renkawitz
- Orthopädische Universitätsklinik Regensburg, Asklepios Klinikum Bad Abbach
| | | | | | | | | | | |
Collapse
|