[Complex Regional Pain Syndrome (CRPS) - State of the Art in Diagnostics and Therapy]. / Complex Regional Pain Syndrome (CRPS).

The complex regional pain syndrome (CRPS) usually occurs within a few weeks in 2-5% of all patients after trauma or surgery or subsequent measures of the distal extremities. There are certain risk factors for its occurrence but no "CRPS personality", instead there are factors that negatively influence the course. The prognosis is generally good ("rule of thirds"), but remaining limitations are common. The diagnosis is clinically possible according to the "Budapest criteria". Additional examinations are possible in case of doubt but are neither conclusive nor exclusive. Corticoids and bisphosphonates are used alongside drugs that have an effect on neuropathic pain. Invasive therapies do not have good evidence and have therefore lost their importance. The rehabilitative therapy is carried out actively and with a lot of self-exercises at an early stage. Invasive anesthetic, passive therapies are obsolete. Special forms of treatment are "graded exposure" (GEXP) in the case of dominant anxiety and, e.g., "graded motor imagery" (GMI) in case of neglect-like symptoms. In addition to educational and behavioral therapy elements, psychotherapy for CRPS also includes participation as part of graded exposure.

C-Nail versus plate osteosynthesis in displaced intra-articular calcaneal fractures-a comparative retrospective study.

BACKGROUND: Locking plate osteosynthesis via an L-shaped lateral approach is the gold standard in treating displaced intra-articular calcaneal fractures. High complication rates are known for this approach. The most frequent complications are wound edge necrosis and superficial wound infections. To reduce complication rates, a locking intramedullary nail (C-Nail) was developed that can be implanted minimally invasively via a sinus tarsi approach. We compared the postoperative complication rate and the outcome of plate osteosynthesis versus C-Nail in displaced intra-articular calcaneal fractures. METHODS: All patients with calcaneal fractures who received osteosynthesis with either plate or C-Nail between January 2016 and October 2019 in our institution were retrospectively analyzed. A subgroup analysis was performed with matched pairs (matching Sanders type, age, Böhler's angle postoperative in normal range, 33 pairs). Endpoints were postoperative complication rate, bone healing, full weight-bearing and functional outcome. Treatment groups were compared using Fisher's exact test for binary data, and Mann-Whitney U-test for continuous data. A p-value < 0.05 was considered statistically significant. RESULTS: One hundred and one calcaneal fractures were included (C-Nail n = 52, plate n = 49). Patients with C-Nail developed significantly less postoperative complications (p = 0.008), especially wound edge necrosis (p < 0.001). Screw malposition was found more often in the C-Nail group. The rates of achieving full weight-bearing as well as bone healing were comparable in both groups, but in each case significant faster in the C-nail subgroup. The results of the matched-pairs analysis were comparable. CONCLUSIONS: The postoperative complication rate was significantly lower in the C-Nail group. The C-Nail appears to be a successful alternative in the treatment of calcaneal fractures, even in Sanders IV fractures because of the minimal-invasive implantation as well as the high primary stability. Long-term analysis of this new implant including elaboration on functional outcome is planned. TRIAL REGISTRATION: Deutsches Register Klinischer Studien (DRKS) DRKS00020395 . Date of registration 3 January 2020.

Aetiology of severe demarcated enamel opacities--an evaluation based on prospective medical and social data from 17,000 children.

During the 1970s dentists reported an increasing prevalence of a "new" type of enamel disturbance.The disturbance was very specific, with areas of demarcated hypomineralised enamel, and was mostly found in permanent first molars and incisors. Several studies have tried to reveal the aetiology behind the enamel disturbance but sofar no clear factors correlated have been found. The aim of the present study was to evaluate aetiological factors to severe demarcated opacities (SDO) in first permanent molars in a large cohort of children enrolled in the "All Babies in Southeast Sweden" (ABIS) project. ABIS is a prospective study of all children in five Swedish counties born between Oct 1, 1997 and Oct 1, 1999, in all about 17,000 children.They have been followed from birth with recording of a large number of factors on nutrition, diseases, medication, infections, social situation etc. With help from 89 Public Dental Service clinics in the same area preliminary examinations of the children, born between Oct 1,1997 and Oct 1,1999, reported 595 children with severe demarcated opacities (SDO) in first molars.These children and a randomly selected age matched group of 1,200 children were further invited to be examined by specialists in paediatric dentistry. At these examinations 224 severe cases were identified as well as 253 children completely without enamel disturbances among children registered in ABIS.These two groups were analysed according to any correlation between SDO and variables in the ABIS databank. The analyses showed no association between SDO and pre-, peri-, and neonatal data. However, we found a positive association between SDO and breastfeeding for more than 6 months (OR 1.9; 95% CI 1.1-3.2), late introduction of gruel (OR 1.9; 95% CI 1.1-2.9), and late introduction of infant formula (OR 1.8; 95% CI 1.2-2.9). A combination of these three variables increased the risk to develop SDO by more than five times (OR 5.1; 95% CI 1.6-15.7). No significant associations were found to other environmental, developmental, or medical factors. We conclude that nutritional conditions during first 6 months of life may influence the risk to develop severe demarcated opacities in first permanent molars.