What does the patient want?

Knee injuries during sports as well as the “unstable joint” were the focus of last summer’s 10th ZKOS. For the first time, more than 200 orthopedic specialists, sports physicians and physiotherapists gathered for the anniversary congress. Podium discussions of practical cases always dealt with how the patient wanted to live in the future.

The patient’s individual goals are central and guiding issues during treatment. This is shown in the cases that were presented. We will briefly introduce two of them:

Case 1: Open femoral shaft fracture following a car accident

Dr. med. Casper Grim, Head of the Department for Orthopedics and Trauma Surgery at Osnabrück Hospital , presented the case of a 21-year-old female patient who suffered an open femoral shaft fracture in the left leg during a car accident. It was treated abroad but became infected subsequently. The patient underwent surgery in various countries over several years. At the beginning of treatment in Osnabrück, the situation was as follows: atrophic, infected non-union of the femur with shortening, hip joint ankylosis, multidirectionally unstable knee joint due to previous dislocation, and ankylosed patellofemoral joint. The patient could neither stand nor walk.
The following questions arose from an orthopedic point of view: does the patient want to walk again? Should she be treated with a prosthesis, intramedullary nailing or a reconstruction plate? Are we sure she is free from infection? Can the femur be lengthened?
After resection of the non-union, Dr. Grim and his team carried out a segmental transport of the femur as well as orthosis stabilization of the left knee. The femur was lengthened by a total of twelve centimeters. The external fixation was removed after seven months. After a gradual increase in load-bearing over 18 months, ossification and union progressed well so that the patient could be mobilized with a full load on her leg.

Case 2: A young tennis player with back pain

The example presented by Prof. Dr. med. Wolfram Mittelmeier, Director at Rostock University Orthopedic Clinic and Polyclinic was about “sports and instability” as well as the particular aspects when treating (competitive) athletes. A 13-year-old tennis player with back pain was diagnosed with spondylolysis. Prof. Dr. Mittelmeier asked the people in the audience which treatment approach they would take. The 13-year-old is a competitive athlete and would like to continue his career. The expert audience agreed that the young man should initially take a break and be treated with targeted physiotherapy and a lot of isometric training. After successful treatment , he would be able to return to performance training with a suitable support. If, however, the vertebra was to slip too far, it would be the end of competitive sports. As a basic rule, Prof. Dr. Mittelmeier recommended to his colleagues that , when treating competitive athletes, a consistent analysis must be carried out – also focusing on the specific sport. And that the issue of doping must be considered when medication is administered.

Images: Andreas Wetzel/Bauerfeind AG