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New therapeutic strategies for juvenile idiopathic arthritis (JIA) have evolved within the past ten years, and as a result, an update of the 2011 recommendations of the German management guidelines was initiated.A systemic literature review was performed, overarching principles were proposed and pre-selected via an online survey followed by two multidisciplinary consensus conferences. Pharmacological and non-pharmacological treatments were discussed, statements were proposed and ultimately agreed upon by nominal group technique (NGT).12 overarching therapeutic principles, as well as 9 recommendations on pharmacological and 5 on non-pharmacological treatments for JIA were agreed upon.This report summarizes the recent update of the interdisciplinary, consensus-based German guidelines on the management of JIA. The multi- and interdisciplinary participation of all caregivers was central for this patient-focused update. With these guidelines, physicians can choose an evidence-based approach, which allows better tailored treatment in this vulnerable cohort of children and adolescents.

Erkrankungen und Verletzungen peripherer Nerven fuhren zu Funktionsausfallen des Bewegungssystems. Bei Persistenz oder Progredienz konnen muskuloskelettale Veranderungen beobachtet werden, die zu einer Reduktion der Lebensqualitat fuhren und einer orthopadischen Behandlung bedurfen. Das vorliegende Kapitel beschreibt die Storungen und den naturlichen Verlauf der Pathophysiologie der Bewegungsorgane bei Erkrankungen peripherer Nerven, wie bei angeborenen und erworbenen Neuropathien, entzundlichen und traumatischen Nervenschadigungen. Die wichtigsten Grundprinzipien der neuroorthopadischen Pravention, Behandlung und Rehabilitation werden anhand einer Auflistung von bewahrten und aktuellen Therapieansatzen und Therapieverfahren dargestellt.

ZusammenfassungFußfehlstellungen im Kindes- und Jugendalter beschäftigen sowohl den Kinderarzt als auch den Orthopäden. Harmlose Fußfehlhaltungen müssen dabei von strukturellen Deformitäten unterschieden werden, bei denen eine Therapie notwendig wird. Im folgenden Artikel sollen die häufigsten Fußfehlstellungen im Kindes- und Jugendalter dargestellt werden.

Flatfoot is a severe complication of extensive clubfoot surgery. In this retrospective study, we evaluated our results following flatfoot surgery in overcorrected clubfeet. The aim was to analyze the success of different surgical techniques, including tarsal osteotomies and arthrodesis, in correcting different types of flatfeet. Between January 1, 2011 and December 31, 2015 we treated 25 severe cases of flatfeet after extensive clubfoot surgery. We classified the hindfoot deformities into rotational valgus, hinge valgus or translatory valgus based on AP standing X-rays. Tarsal osteotomies (Mitchell, Evans, Cotton) and arthrodesis were adapted based on age and severity. Age, gender, pain, hindfoot valgus and function were documented. Function and X-rays were compared pre- and postoperatively. There were 17 male and 4 female patients. Age at operation ranged from 11 to 26 years with an average age of 14.3 years. The mean follow-up was 27.6 months (7–60 months). Primary surgical treatment was a tarsal osteotomy in 19 cases and in six cases it was arthrodesis. Hindfoot valgus (O 18.6°–3.2°), calcaneal pitch (O 6.2°–14.6°), Costa Bartani angle (O155°–142°) and Meary angle (O 2.0°–8.8°) improved pre- to postoperatively. Range of motion did not improve after surgical correction. 81% were satisfied with the postoperative results. All flatfeet with translatory valgus, initially treated with a tarsal osteotomy, needed further arthrodesis due to primary undercorrection. Tarsal osteotomies are successful methods for correcting flatfeet following extensive clubfoot surgery with rotational valgus and mild hinge valgus. Tarsal osteotomies are unable to successfully correct flatfeet that have a translatory valgus. In such cases, we recommend double or triple arthrodesis. The functional outcome is limited by the preop range of motion and the appearance of talus deformities.