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Outcome evaluation is of major importance to provide data to analyze the value of the chosen treatment concept. Despite an increasing effort of analyzing outcome after treatment of different pelvic ring injuries, a mixture of different outcome parameters is in use. The Majeed score is most frequently used for mid- to long-term evaluation and the quality of life is analyzed using the SF-36 score. The lack in nearly all studies is that different treatment concepts are used, and only selected evaluation parameters are reported. Until today, no well-accepted standardized measurement instruments are available to analyze the clinical and radiological results after pelvic ring injuries. Overall, stability-based long-term sequelae can be expected with increasing complaints from stable type A injuries to completely unstable type C injuries. Beside a fracture-type specific treatment, concomitant injuries of other injury regions and associated local pelvic injuries (complex pelvic trauma) seem to additionally influence the results. Results of treatment of specific fracture types are sparse as a wide range of different injury types and different treatment concepts are analyzed within these analyses. A sufficient pelvic outcome instrument which addresses relevant pelvic outcome parameters is still missing. Thus, future evaluation of long-term results after pelvic ring. injuries should include prospective, multicenter outcome studies with comparable parameters. [ABSTRACT FROM AUTHOR]

Objective: The aim was to provide epidemiological and clinical data on patients with orofacial clefts in Lower Saxony in Germany. Materials and methods: The records of 404 patients with orofacial clefts treated surgically at the University Medical Center Goettingen from 2001 to 2019 were analyzed in this retrospective study. Prevalence of orofacial clefts in general, orofacial clefts as manifestation of a syndrome, sex distribution, and prevalence of different cleft types was evaluated and associated with the need for corrective surgery, family history, pregnancy complications, and comorbidities. Results: The prevalence of orofacial clefts for Goettingen in Lower Saxony was 1:890. 231 patients were male and 173 were female. CLP was most common (39.1%) followed by CP (34.7%), CL (14.4%), CLA (9.9%), and facial clefts (2%). The left side was more frequently affected and unilateral cleft forms occurred more often than bilateral ones. Almost 10% of the population displayed syndromic CL/P. 10.9% of all patients had a positive family history regarding CL/P, predominantly from the maternal side. Pregnancy abnormalities were found in 11.4%, most often in the form of preterm birth. Comorbidities, especially of the cardiovascular system, were found in 30.2% of the sample. 2.2% of patients treated according to the University Medical Center Goettingen protocol corrective surgery was performed in form of a velopharyngoplasty or residual hole closure. Conclusions: The epidemiological and clinical profile of the study population resembled the expected distributions in Western populations. The large number of syndromic CL/P and associated comorbidities supports the need for specialized cleft centers and interdisciplinary cleft care. [ABSTRACT FROM AUTHOR]

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Copyright of Der Pneumologe is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

In most cases periprosthetic fractures of the acetabulum are complex injuries and are extremely challenging for the treating medical team. Over the years the frequency of this overall rare entity has increased due to demographic changes. In recent years several treatment algorithms were published and provided the possibility of developing standardized treatment concepts. The classification of the fractures and a dedicated preoperative strategy are highly important for the quality of patient-centered care. In the literature the frequency of intraoperative fractures was initially given as 0.4%; however, several studies have been published in which a far higher rate of intraoperative fractures was detected by computed tomography (CT), often referred to as so-called occult fractures. The causes are multifactorial and there is significant association with whether cement-free press-fit acetabular cups were used or cemented forms. In approximately 75% of the cases a low energy impact was the cause of the fracture. In these patients systemic processes, such as osteoporotic alterations of the bony substance or the possible presence of low-grade infections should be considered. This article gives an overview of the diagnostics, planning, challenges and osteosynthetic treatment options for periprosthetic fractures of the acetabulum. [ABSTRACT FROM AUTHOR]

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The paradigm shift in the treatment concept for acute appendicitis is currently the subject of intensive discussions. The diagnosis and differentiation of an uncomplicated from a complicated appendicitis as well as the selection of an adequate treatment is very challenging, especially since nonoperative treatment models have been published. The laparoscopic appendectomy is still the standard for most cases. Guidelines for the treatment of acute appendicitis do not exist in Germany. Therefore, a group of experts elaborated 21 recommendations on the treatment of acute appendicitis after 3 meetings. After initial definition of population, intervention, comparison and outcome (PICO) questions, recommendations have been finalized through the Delphi voting system. The results were evaluated according to the current literature. The aim of this initiative was to define a basic support for decision making in the clinical routine for treatment of acute appendicitis. [ABSTRACT FROM AUTHOR]

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Hintergrund: Neuromuskuläre Erkrankungen im Kindes‑, Jugend- und Erwachsenenalter sind seltene und sehr seltene Erkrankungen; bei vielen sind Prävalenz und Inzidenz nicht bekannt. Kausale Therapien kommen derzeit nur bei einzelnen Krankheitsentitäten zum Einsatz. Dennoch führen neue genetische Methoden, ein besseres Verständnis der Pathophysiologie und multidisziplinäre Behandlungskonzepte zu einer Verbesserung von Diagnostik und Therapie mit einer Steigerung von Lebenserwartung und Lebensqualität. Das führt dazu, dass Patienten mit frühem Erkrankungsbeginn häufiger als früher das Erwachsenenalter erreichen und eine Weiterversorgung in der Erwachsenenmedizin erforderlich ist. Dabei kommen insbesondere auf die Neurologie zunehmende Herausforderungen zu, es wachsen die Anforderungen an eine interdisziplinäre Zusammenarbeit in der Erwachsenenmedizin.Fragestellung: Wie kann die Transition sinnvoll gestaltet werden, wo zeichnen sich strukturelle und inhaltliche Probleme ab?Material und Methode: Anhand der Duchenne-Muskeldystrophie sollen die inhaltlichen und strukturellen Anforderungen an den Transitionsprozess dargestellt und auf Schwierigkeiten bei der Umsetzung hingewiesen werden.Schlussfolgerungen: Der Transitionsprozess ist komplex und erfordert zeitliche wie personelle Ressourcen. Das Ziel ist eine kontinuierliche spezialisierte medizinische Versorgung und eine Übernahme der Gesundheitsfürsorge durch den Patienten. [ABSTRACT FROM AUTHOR]

Ein Massenanfall von Verletzten (MANV) bedeutet nicht nur für den Rettungsdienst, sondern auch für die klinischen Versorgungsstrukturen eine erhebliche Herausforderung. Es liegt zumindest vorübergehend ein Missverhältnis von Patienten und Versorgungsressourcen bezüglich Personal und Material (insbesondere bei Medikamenten, Verbandsmaterial und OP-Ausrüstung) vor. Daher muss ggf. von der klassischen individualmedizinischen Versorgung abgewichen werden. MANV-Konzepte von Krankenhäusern, wie sie in den Krankenhausalarmplänen festgeschrieben sind, basieren auf 3 wesentlichen Säulen: 1. dem Personalmanagement, 2. einer speziellen Materialbevorratung und Nachschublogistik sowie 3. einem strikten medizinischen Damage-Control-Konzept. Zur erfolgreichen Vorbereitung für Großschadensereignisse aus Sicht eines Krankenhauses gehören neben der spezifischen Infrastruktur ein konsequent umzusetzendes Mitarbeiterschulungsprogramm sowie regelmäßige Übungen. [ABSTRACT FROM AUTHOR]

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Copyright of Pädiatrie & Pädologie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Journal of Orofacial Orthopedics/Fortschritte der Kieferorthopadie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objectives: There is no general consensus for treatment of medication-related osteonecrosis of the jaw (MRONJ). A stage-related approach that primarily aims to minimize morbidity and preserve function was prospectively evaluated. Patients and methods: Treatment goals are stable mucosal closure and absence of clinical symptoms. Patients were enrolled between March 2010 and October 2011. MRONJ lesions were treated either by conservative means or surgically by debridement or resective surgery. Results: In total, 38 patients were treated. Six patients were healed by undergoing conservative measures; nine were treated palliatively. Four patients dropped out after surgery in the recall phase. In 17 of 19 patients (89.5 %) surgical treatment was successful. After a 1-year observation period, the success rate was 92 % (23 of 25), including all patients treated as per protocol. Conclusion: In stage-related treatment, conservative means or surgical debridement can be successful at early stages. Extensive resection is solely indicated in cases of extended necrosis. Clinical relevance: The number of patients with MRONJ is steadily increasing. Guidelines to deal with this condition are helpful for both clinicians and dental practitioners. [ABSTRACT FROM AUTHOR]

Copyright of Zeitschrift für Psychodrama und Soziometrie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Treatment of acetabular fractures requires extensive knowledge of the bony anatomy, the amount of possible exposure of the bone with the selected approaches and fracture type-dependent indications of operative treatment. Classification of the fracture with detailed analysis of the fracture morphology is the basis for decision making and planning. The primary treatment aim is the anatomic reconstruction of the acetabulum which results in optimal long-term results. The basis of this overview is the presentation of standard treatment concepts in acetabular fracture surgery. Beside characteristics of the acetabular bony anatomy, biomechanical and pathomechanical principles and the relevant radiological anatomy, the treatment options, both conservative and operative and basic principles of the indications for standard surgical approaches will be discussed. The special fracture type is discussed in detail regarding incidence, injury mechanism, concomitant injuries, options for conservative and operative treatment, quality of operative reduction and long-term results. Furthermore, epidemiological data on typical postoperative complications are evaluated. [ABSTRACT FROM AUTHOR]

For child-oriented treatment of fractures it is important to consider healing processes specific to children. These healing processes necessitate early treatment and a primary definitive treatment concept in line with current standards. The parents or guardians of the child should be directly included while obtaining the anamnesis, for the diagnosis and when planning the treatment concept. Specifically, the potential of spontaneous correction of the growing bone and the necessity or avoidance of imaging procedures should be thoroughly discussed. For the treatment of shaft fractures of the long bones the method of elastic stable intramedullary nailing has found common acceptance as this method significantly reduces both the duration of inpatient treatment as well as the time of immobilization. The child-oriented treatment of fractures is still in development and demands specific knowledge of the orthopedic surgeon concerning the characteristics of the growing bones, the potential of spontaneous correction and the outcome of injuries to the growth plate on the growing skeleton. [ABSTRACT FROM AUTHOR]

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Copyright of Der Unfallchirurg is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

In the discussion on the treatment of the clinical N0 neck in head and neck cancer, the sentinel lymphonodectomy is gaining more and more in significance. Prior to a multicentre study on the value of sentinel lymphonodectomy, it seemed to be desirable to collect data on the current practice of neck dissection in German ENT departments. First a standardised questionnaire was sent to 50 hospitals in Germany. It contained questions on the respective therapeutic concepts (uni- or bilateral modified radical neck dissection versus selective neck dissection, wait-and-see policy) in histologically proven squamous cell carcinoma (G2) and defined localisation of the primary tumour (T1-T2 carcinoma of the oral cavity, the oropharynx and hypopharynx as well as larynx). Summing up the evaluation of 39 anonymously answered questionnaires, it can be stated that no uniform therapeutic concept for the treatment of the cervical lymph nodes in carcinomas of the upper aerodigestive tract based on the stage of lymphatic metastatic disease exists. It seems to be essential to elaborate such a concept in order to be able to compete in the international context. Likewise, a widespread uniform therapeutic strategy would be the basic prerequisite for the initiation and realisation of multicentric therapy studies. [ABSTRACT FROM AUTHOR]

Fractures of the carpus are frequent injuries and typically result from of a fall onto the outstretched hand. Scaphoid fractures are the second most frequent fracture type of the hand (80%). 95% of the patients with acute scaphoid fractures are male, and the average age is approximately 25 years. Conservative treatment of acute scaphoid fractures with immobilization in a plaster cast was the therapy of choice for a long time. Surgical treatment was reserved to severe dislocated fractures only. A progress could be obtained by the principle of intramedullary fixation, whose forerunner is represented by the Herbert screw, and the introduction of cannulated screws guaranteed a continuous improvement. The decision to treat the fracture by surgery requires a clear definition of the fracture type. Therefore, precise radiologic technique is mandatory to detect the fracture and to analyze the pathomorphological circumstances. In order to get an exact classification for the decision on how to proceed, three standard X-ray projections (posteroanterior [PA], lateral and Stecher projection) and a CT scan have to be performed. The most well-known classification has been defined by Herbert & Fisher which combines fracture anatomy, stability and disease history in order to derive prognostic and therapeutic criteria. Also, delayed healings and nonunions are considered. To decide on the adequate treatment, a prerequisite for conservative therapy of acute scaphoid fractures is the anatomic position of the scaphoid. Conservative therapy should be reserved to fracture types, which are stable and heal reliably in the lower-arm plaster cast within 6 weeks. All displaced and unstable acute scaphoid fractures should be operated, and whenever possible, rigid internal fixation should be achieved because of interfragmentary compression. Therefore, several intramedullary implants are available for surgical treatment of acute scaphoid fractures, e. g., Herbert screw, Mini Herbert screw, AO screw (cannulated), Acutrac screw (cannulated), or Twin-fix screw (cannulated). With improved surgical and radiologic techniques, most scaphoid fractures are amenable to minimally invasive fixation. The dorsal approach guarantees a good overview in treating proximal pole fractures. Yet, not all types of fractures can be treated in this way. Severely displaced fractures require the classic open palmar approach. In order to prevent the development of a scaphoid nonunion or an advanced carpal collapse (SNAC-wrist), an early and sufficient diagnostic algorithm is necessary. We recommend internal fixation with a cannulated Herbert screw in B1 and B2 fractures and a Mini Herbert screw in fractures of the proximal third (B3). A2 fractures can be treated conservatively. Early diagnosis and operative treatment will shorten the time off work, minimize the risk of nonunion, and reduce the costs of health care in the long term. [ABSTRACT FROM AUTHOR]

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Copyright of HNO is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)