Search

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.)

The centerpiece in private accident insurance is the compensation in cases of disability, which must be determined by a physician within a certain time limit. The insurer contract specifies the compensation rate for loss or inability to function. In cases of insurance the medical expert has to refer to generally accepted revised or updated assessment recommendations in order to be able to apply the given framework to the specific individual disability situation of the insured person. This article deals with the interdisciplinary consensus benchmarks for the assessment of disability, which form the principles of a uniform medical assessment of accident-related functional disorders in the private accident insurance.With the publication of these new assessment recommendations developed under the guidance of the Specialist Society of Interdisciplinary Medical Expert Opinion (FGIMB), the recommendations published by Schröter and Ludolph in 2009 [12] are withdrawn, so that these are now replaced as the authoritative version by the assessment recommendations of the FGIMB., (© 2024. The Author(s).)

Flatfoot deformity is characterized by a multiplanar hindfoot malalignment. Although the etiology remains unclear, the deformity is mainly attributed to ligamentous laxity and dysfunction of the posterior tibial tendon. Obesity is thought to be a risk factor that additionally impairs hindfoot stability. Performing a retrospective clinical and radiological study, we compared two groups, each with 75 patients. One group included patients with a flatfoot deformity stage 2, while the other group showed no hindfoot malalignment. Reviewing the weight and calculating the body mass index revealed significantly increased values for those patients with flatfoot deformity (P=0.034 and P>0.001, respectively). This correlation should be considered during the decision-making process on surgical strategies. In obese patients with flatfoot deformity, stage 2 soft tissue reconstruction and hindfoot osteotomies should be combined with hindfoot arthrodeses, i.e. subtalar fusion, to maintain sufficient and durable stability.

In Germany foot surgery was established in the late nineteenth century. To correct foot deformities due to paralytic disorders, i.e., poliomyelitis, and congenital deformities, different types of tenotomies and arthrodeses were developed to obtain plantigrade weight-bearing and to avoid external orthosis. A description of surgical techniques during the last century is presented in detail. During those years resection arthroplasties for hallux valgus were common, although some authors recommended osteotomies of the first metatarsal as joint-sparing techniques. Nowadays, further knowledge in etiology, pathology, and biomechanics have effected the therapeutic algorithm in hallux valgus. Nevertheless, discussion about this topic has not come to an end. In 1991 the German Foot and Ankle Society (D.A.F.) was founded. Educational courses to improve surgical skills as well as clinical workshops were successfully established. A marked increase in membership and a broad international acceptance confirm these activities.

A survey of the 2000 statistics about the existing geriatric care structures in Germany showed that the number of inpatient geriatric care centers rose from 84 in 1993 to 318 in 2000. The number of day clinics rose in the same timeframe from 13 to 136. However, there are serious deficits in the area of ambulant geriatrics; in 2000 there were only 11 such institutions. The question is discussed as to why there are three different care structures for acute geriatrics, neurological early rehabilitation, and general early rehabilitation in hospitals. It is suggested how the existing care structures could be sensibly integrated.

Although it has long been undisputed that successful rehabilitation outcomes require early-onset, comprehensive rehabilitative intervention, research findings show that major shortcomings exist concerning the provision of rehabilitative care in hospitals. Contrary to the statutory premises at hand, a majority of hospitals continue to consider rehabilitation a treatment phase scheduled to set in only after completion of acute care. "Rehabilitation of the first day", a long-standing demand among the professional community, is hardly taking place at all. The rank of hospital-integrated early rehabilitation has now been confirmed in the framework of a model facility supported by the Federal ministry of labour and social order, with the recently completed scientific follow-along of the Ingolstadt Klinikum department for transdisciplinary early rehabilitation having made available research evidence of the effectiveness and efficiency of early-onset, comprehensive rehabilitation interventions in the hospital, and presented in this article for the first time.

Medical rehabilitation measures continue to be delivered nearly exclusively on an inpatient basis. A graded treatment concept comparable to those in place for instance in the acute or long-term care fields, is non-existent, while the medical need for a community-based ambulatory rehabilitation system is uncontested. Not least before a background of ever scacer financial resources among the rehabilitation agencies involved, non-inpatient rehabilitation has been gaining significance as it is generally hoped to achieve greater economy of service delivery. As a logical consequence, the demand for greater flexibility in delivering medical rehabilitation services and benefits is a focus of attention in the current rehabilitation policy debate. Greater flexibility in medical rehabilitation delivery means replacing portions of rehabilitation measures currently provided on an inpatient basis by partial-hospitalization or ambulatory service delivery; or continuing and complementing inpatient rehabilitation measures by non-inpatient ones; or using non-inpatient measures to provide aftercare post-discharge from inpatient rehabilitation. Moreover, ambulatory rehabilitation is intended to reach the population unamenable to attending far-away inpatient programmes. It is of utmost significance for the future evolution of ambulatory rehabilitation that the various financially responsible agencies involved in rehabilitation take a joint position on the subject of non-inpatient rehabilitation. Several proposals are submitted in this respect; for indications in the fields of neurology, orthopedics, cardiology, and geriatrics, catalogues of degrees of severity considered suitable for ambulatory rehabilitation are first presented.

The majority of patients with severe craniocerebral damage can be enabled to return to a relatively independent life if early rehabilitation measures are provided. The number of beds currently available for early rehabilitation, however, covers little more than 10 percent of the demand at hand. Expanding the number of beds available hence is a pressing need. The present article contains pertinent information in view of qualitative and quantitative implementation of related efforts.