[Pain prevention in the primary care setting : Facts for resident physicians]. / Schmerzprävention in der Grundversorgung : Fakten für niedergelassene Ärzte.

Based on health insurance data, approximately 37.4 million patients (46%) in Germany are diagnosed with "pain". The prevalence of patients with debilitating chronic pain is around 7.3%. From the health care perspective, and given the high socioeconomic relevance of chronic pain, effective preventive measures represent useful therapeutic approaches. In the context of pain medicine, primary prevention aims to avoid acute pain. Secondary prevention is targeted at preventing acute pain from turning into chronic pain. Tertiary prevention comprises measures to diminish pain-associated disability and impairment to everyday life. Finally, quaternary prevention focuses on avoiding medically non-indicated or unhelpful medical interventions. In addition to general approaches of pain prevention, such as detecting and treating of chronification factors (yellow, black and blue flags), the present article also describes educational and disease-specific approaches in musculoskeletal and neuropathic pain syndromes as well as headaches.

Implant salvage in infected total knee arthroplasty.

In a retrospective study of 60 infected total knee arthroplasties (TKAs), attempted implant salvage of 39 knees was performed with surgical debridement and antibiotic therapy. In seven of the 39 knees (17.9%), infection was successfully eradicated, with a mean follow-up examination of 4.1 years. In comparing knees with successful salvage to those with persistent infection, the following factors strongly correlated with successful salvage: (1) short duration of symptoms of infection (less than 2 weeks); (2) susceptible gram-positive organism (Streptococcus or Methicillin-sensitive Staphylococcus aureus); (3) absence of prolonged postoperative drainage or the development of a sinus tract; and (4) no prosthetic loosening or roentgenographic evidence of infection. Only five knees in this series satisfied all these criteria, and in each case, implant salvage with eradication of infection and maintenance of good knee function was achieved. Although a higher salvage rate was obtained with the less-constrained prostheses, an infected hinge prosthesis did not preclude successful implant salvage. No patient with a draining sinus tract (0/17), infection with a virulent organism (0/9), or earlier revision arthroplasty (0/9) had successful salvage of the infected implant. Of the 22 knees with postoperative drainage for longer than two weeks or failure of primary wound healing at the time of TKA, only two were successfully salvaged and both required a local muscle flap. Therefore, early aggressive management of persistently draining wounds after TKA is imperative. In TKA complicated by infection, implant salvage with aggressive surgical debridement and antibiotic therapy should be strongly considered, provided that these strict criteria for attempted salvage are adhered.

A cadaveric study of the anatomic variations of the recurrent motor branch of the median nerve.

Anatomic dissections were performed in 72 cadaveric upper extremities from 36 cadavers to determine the incidence of anomalous variations in the course of the median nerve and its branches. The classic recurrent motor branch anatomy was demonstrated in 86% of the dissections (62/72). Of the 10 variations noted (14% of all upper extremities), all were transretinacular branches that pierced the transverse carpal ligament 2 to 6 mm proximal to the distal edge. Of the six cadavers with anomalous branching, four (67%) had bilateral anomalies and two (33%) had unilateral branching.