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1.
Acta Chir Orthop Traumatol Cech ; 87(5): 340-345, 2020.
Article in English | MEDLINE | ID: mdl-33146602

ABSTRACT

PURPOSE OF THE STUDY Subacromial impingement is one of the most common reasons for shoulder pain. The surgical management of this condition has recently become the focus of criticism because of the rising number of surgical procedures and the lack of superiority of surgical over conservative treatment. In this prospective comparative study, we compared standardised conservative care with surgical treatment and placed special emphasis on the patients' ability to work. MATERIAL AND METHODS A total of 106 patients (25 women, 81 men; mean age: 45.4 12.3 years) were included in this prospective comparative clinical study. Patients in the non-operative arm (n = 42) received standardised physiotherapy. Patients in the surgical arm (n = 38) underwent arthroscopic subacromial decompression. All patients were followed up at 3, 6 and 12 months. Shoulder function (Constant score), pain (Numerical Rating Scale), and the duration of inability to work were assessed. RESULTS Shoulder function and pain improved significantly with both kinds of treatment. At no time of follow up we detected significant differences between the two treatment options. An analysis of the patients' ability to work showed that conservative treatment was superior to surgical treatment at 3-month follow-up (0.3 versus 5.0 weeks; p < 0.001) and between 4 and 6-month after intervention (0.2 versus 1.6 weeks; p = 0.032). DISCUSSION In the study presented here, significant improvements in function (Constant score) and pain (NRS) were achieved in both the non-operative and the surgical arm. There were no significant differences between the two groups at any time point. These results are similar to those reported by other authors in recent studies. Unlike other research work, however, our study demonstrated a major difference in the development and duration of inability to work. CONCLUSIONS Conservative and surgical treatment of subacromial impingement syndrome led to similar outcomes for shoulder pain and function at 3, 6 and 12 months after intervention. However, patients who were managed conservatively returned to work significantly earlier than patients who underwent surgery. Key words: subacromial impingement, shoulder, constant score, pain, ability to work.


Subject(s)
Shoulder Impingement Syndrome , Arthroscopy , Conservative Treatment , Decompression, Surgical , Female , Humans , Male , Middle Aged , Prospective Studies , Shoulder Impingement Syndrome/surgery , Shoulder Pain/etiology , Shoulder Pain/therapy , Treatment Outcome
2.
Unfallchirurg ; 113(2): 114-21, 2010 Feb.
Article in German | MEDLINE | ID: mdl-20107761

ABSTRACT

Casualties in military conflict produce patterns of injuries that are not seen in routine surgical practice at home. In an era of increasing surgical sub-specialization the deployed surgeon needs to acquire and maintain a wide range of skills from a variety of surgical specialties. Improvised explosive devices (IEDs) have become the modus operandi for terrorists and in the current global security situation these tactics can be equally employed against civilian targets. Therefore, knowledge and training in the management of these injuries are relevant to both military and civilian surgeons. To create this kind of military surgeon the so-called "DUO-plus" model for the training of surgical officers (specialization general surgery plus a second specialization either in visceral surgery or orthopedics/trauma surgery) has been developed in the Joint Medical Service of the German Bundeswehr. Other relevant skills, such as emergency neurotraumatology, battlefield surgery with integrated oral and craniomaxillofacial surgery and emergency gynecology, are integrated into this concept and will be taught in courses. Log books will be kept in accordance with the training curricula. On successful completion of the program medical officers will be officially appointed as Medical Officer "Einsatzchirurg" by their commanding officers for a maximum of 5 years and it will be necessary to renew it after this period. These refresher programs will require participation in visiting physicians programs in the complementary surgical disciplines in order to retain the essential specific skills.


Subject(s)
Education, Medical, Graduate , Military Medicine/education , Specialties, Surgical/education , Blast Injuries/surgery , Clinical Competence , Curriculum , Education, Medical, Continuing , Germany , Humans , Terrorism , Wounds, Gunshot/surgery
3.
Langenbecks Arch Surg ; 386(7): 507-11, 2002 Jan.
Article in English | MEDLINE | ID: mdl-11819108

ABSTRACT

An experimental in vitro study involving ten hand-sutured, ten biofragmentable anastomotic ring (BAR) and ten stapled anastomoses was conducted to compare current anastomotic techniques on the basis of early bursting pressure. The 30 fresh human colon segments used in the study were harvested from patients who had undergone elective oncologic resection. Following the construction of in vitro anastomoses, the pressure required to burst these specimens was measured. The results showed no significant differences among the three techniques. Since hand-sutured anastomoses proved to be as effective and reliable as the other methods and can offer the advantage of cost savings, they should remain standard procedure in colorectal surgery.


Subject(s)
Anastomosis, Surgical , Carcinoma/physiopathology , Carcinoma/surgery , Colon/physiopathology , Colon/surgery , Colonic Neoplasms/physiopathology , Colonic Neoplasms/surgery , Tensile Strength/physiology , Adult , Aged , Female , Humans , In Vitro Techniques , Male , Middle Aged , Prospective Studies , Random Allocation , Surgical Stapling , Suture Techniques
4.
Unfallchirurg ; 98(9): 493-9, 1995 Sep.
Article in German | MEDLINE | ID: mdl-7481837

ABSTRACT

A questionnaire was mailed to the heads of 400 German orthopaedic departments listed by the "Deutsche Gesellschaft für Unfallchirurgie", with the aim of evaluating the diagnostic and therapeutic approaches to chronic ankle instability that were current in 1994. The questionnaire was structured to focus on diagnostic imaging techniques, conservative and surgical management, and postoperative treatment. Evaluable questionnaires were returned from 267 hospitals (66.7%). The number of ligament reconstructions performed per institution ranged from 1 to over 100 (mean 17.5). Radiographic stress investigations and clinical examination were considered by 71.6% of the surgeons to be the most important criteria for surgical therapy. The methods most frequently used for primary reconstruction of the ligaments were: periosteal flaps (45.3%), anatomical repair (23.6%), different tenodeses (20.6%), and free anatomical implants of autologous or exogenous material (10.5%). Half the respondents used reconstruction procedures involving secondary repair of the injured ligament without augmentation or with periosteal flaps. The other half of the German surgeons preferred tenodeses or various other procedures. Conservative management of chronic ankle instability was considered by surgeons to be less appropriate for young active patients. Postoperative treatment includes casting and orthosis. The duration varied from 2 weeks to 8 weeks. The results of the nationwide survey demonstrate that more objective clinical methods of diagnosis are needed to allow preoperative differentiation between functional and mechanical instability. With better knowledge of the function of individual ligaments and more frequent exposure of the ligaments for simple overlap and direct suture, a lower rate of primary non-anatomical reconstructions may be possible in the future.


Subject(s)
Ankle Injuries/surgery , Collateral Ligaments/injuries , Joint Instability/surgery , Adult , Ankle Injuries/diagnostic imaging , Ankle Injuries/physiopathology , Collateral Ligaments/diagnostic imaging , Collateral Ligaments/physiopathology , Female , Follow-Up Studies , Germany , Humans , Joint Instability/diagnostic imaging , Joint Instability/physiopathology , Male , Radiography , Range of Motion, Articular/physiology , Treatment Outcome , Weight-Bearing/physiology
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