Aktuelle interdisziplinäre Behandlung von Knochenmetastasen

Eine Vielzahl an Krebspatienten entwickelt im Verlauf Knochenmetastasen. Die daraus folgenden Symptome wie Schmerzen, Funktionsverlust sowie neurologische Symptome können rasch zu einem onkologischen oder auch chirurgischen Notfall werden, es besteht in vielen Fällen rascher Handlungsbedarf. Ziel dieser Arbeit ist die Darstellung der aktuellen, evidenzbasierten interdisziplinären Behandlung von Knochenmetastasen. Grundsätzlich ist die interdisziplinäre Zusammenarbeit und die Abstimmung aller Disziplinen der Goldstandard zur optimalen Behandlung ossärer Metastasen

Initial intramuscular perfusion pressure predicts early skeletal muscle function following isolated tibial fractures

<p>Abstract</p> <p>Background</p> <p>The severity of associated soft tissue trauma in complex injuries of the extremities guides fracture treatment and decisively determines patient's prognosis. Trauma-induced microvascular dysfunction and increased tissue pressure is known to trigger secondary soft tissue damage and seems to adversely affect skeletal muscle function.</p> <p>Methods</p> <p>20 patients with isolated tibial fractures were included. Blood pressure and compartment pressure (anterior and deep posterior compartment) were measured continuously up to 24 hours. Corresponding perfusion pressure was calculated. After 4 and 12 weeks isokinetic muscle peak torque and mean power of the ankle joint in dorsal and plantar flexion were measured using a Biodex dynamometer.</p> <p>Results</p> <p>A significant inverse correlation between the anterior perfusion pressure at 24 hours and deficit in dorsiflexion at 4 weeks was found for both, the peak torque (R = -0.83; p < 0.01) and the mean power (R = -0.84; p < 0.01). The posterior perfusion pressure at 24 h and the plantar flexion after 4 weeks in both, peak torque (R = -0.73, p =< 0.05) and mean power (R = -0.7, p =< 0.05) displayed a significant correlation.</p> <p>Conclusion</p> <p>The functional relationship between the decrease in intramuscular perfusion pressures and muscle performance in the early rehabilitation period indicate a causative and prognostic role of early posttraumatic microcirculatory derangements and skeletal muscle function. Therapeutic concepts aimed at effective muscle recovery, early rehabilitation, and decreased secondary tissue damage, should consider the maintenance of an adequate intramuscular perfusion pressure.</p

Navigation in der muskuloskelettalen Tumorchirurgie

Die 97. Arbeitstagung der AG Knochentumoren konnte vom 8. bis 9. Oktober 2021 in Dresden am UniversitätsCentrum für Orthopädie, Unfall- und plastische Chirurgie erstmals wieder als Präsenztagung unter 3G-Regeln bei 7-Tage-Inzidenzwerten von 88 stattfinden.</jats:p

Current concepts review: Fractures of the patella

Fractures of the patella account for about 1% of all skeletal injuries and can lead to profound impairment due to its crucial function in the extensor mechanism of the knee. Diagnosis is based on the injury mechanism, physical examination and radiological findings. While the clinical diagnosis is often distinct, there are numerous treatment options available. The type of treatment as well as the optimum timing of surgical intervention depends on the underlying fracture type, the associated soft tissue damage, patient factors (i.e. age, bone quality, activity level and compliance) and the stability of the extensor mechanism. Regardless of the treatment method an early rehabilitation is recommended in order to avoid contractures of the knee joint capsule and cartilage degeneration. For non-displaced and dislocated non-comminuted transverse patellar fractures (2-part) modified anterior tension band wiring is the treatment of choice and can be combined – due to its biomechanical superiority – with cannulated screw fixation. In severe comminuted fractures, open reduction and fixation with small fragment screws or new angular stable plates for anatomic restoration of the retropatellar surface and extension mechanism results in best outcome. Additional circular cerclage wiring using either typical metal cerclage wires or resorbable PDS/non-resorbable FiberWires increases fixation stability and decreases risk for re-dislocation. Distal avulsion fractures should be fixed with small fragment screws and should be protected by a transtibial McLaughlin cerclage. Partial or complete patellectomy should be regarded only as a very rare salvage operation due to its severe functional impairment

Aktuelle interdisziplinäre Behandlung von Knochenmetastasen

ZusammenfassungEine Vielzahl an Krebspatienten entwickelt im Verlauf Knochenmetastasen. Die daraus folgenden Symptome wie Schmerzen, Funktionsverlust sowie neurologische Symptome können rasch zu einem onkologischen oder auch chirurgischen Notfall werden, es besteht in vielen Fällen rascher Handlungsbedarf. Ziel dieser Arbeit ist die Darstellung der aktuellen, evidenzbasierten interdisziplinären Behandlung von Knochenmetastasen. Grundsätzlich ist die interdisziplinäre Zusammenarbeit und die Abstimmung aller Disziplinen der Goldstandard zur optimalen Behandlung ossärer Metastasen.</jats:p