[What information do we need to treat the injured shoulder of a hockey player?]. / Welche Informationen sind zur Therapie der traumatischen Schulterverletzung im Eishockey notwendig?

Successful patient care of the injured shoulder of a hockey player involves interdisciplinary cupertino. Images allow an interpretation of a static dimension but may not be sufficient enough to develop a surgical treatment strategy, since all injuries to the shoulder have its origin in a dynamic pathology with some kind of external impact. This article classifies various traumatic shoulder problems and the mechanism of injury, it outlines clinical tests and stresses key facts an imaging report should include in order to plan conservative or surgical treatment. Basic treatment options as performed in our institution for the injured shoulder of a hockey player are summarised briefly.

Classification, clinical findings and operative treatment of degenerative and posttraumatic shoulder disease: what do we really need to know from an imaging report to establish a treatment strategy?

Successful patient care involves interdisciplinary Cupertino. Images allow an interpretation of a static dimension, but may not be sufficient to develop a surgical treatment strategy, since many shoulder problems have its origin in a dynamic pathology. This article outlines dynamic clinical tests of shoulder pathology, classifies various degenerative and posttraumatic shoulder problems and stresses key facts an imaging report should include in order to plan surgery. This article conveys basic knowledge of those tests and the dynamic background of shoulder pathology. Basic surgical treatment principles are summarised briefly.

Pull-out strength and stiffness of meniscal repair using absorbable arrows or Ti-Cron vertical and horizontal loop sutures.

We tested pull-out strength and linear stiffness of meniscal repair using bioabsorbable arrows and vertical and horizontal loop sutures in fresh-frozen bovine lateral menisci. In phase I, menisci repaired either with 2-0 Ti-Cron vertical or horizontal loop suture, or 10-, 13-, or 16-mm Meniscus Arrows were loaded to failure at 12.5 mm/sec. In phase II, we examined the number of barbs engaged and angle of insertion using 10- and 13-mm arrows. Pull-out strengths of both suture repair groups were significantly higher than those of the arrow groups. Vertical loop sutures were significantly stiffer than horizontal sutures and 10-mm arrows. In phase II, the mean ultimate load to failure for the 10-mm arrows was 35.1 N, significantly stronger than in phase I (18.5 N); however, stiffness remained low (7.9 N/mm). Five arrows in the 13-mm group were inserted parallel to the tibial surface and showed no significant difference from phase I. Five arrows were inserted at more than a 30 degrees angle. This group was significantly weaker than in phase I. Single vertical loop suture showed the highest overall pull-out strength. Although weaker than sutures, arrows should provide sufficient stability for meniscal healing. The number of barbs engaged and angle of insertion are critical.

Unreamed intramedullary tibial nailing--fatigue of locking bolts.

Between January 1990 and October 1993 we investigated 72 consecutive patients who had an unreamed tibial nail inserted for fractures of the tibial shaft; 75 per cent (N = 54) were closed fractures and 25 per cent (N = 18) were open fractures. The mean follow up was 15.2 months. Of the patients 91.7 per cent (N = 66) were interlocked, 58 per cent (N = 38) statically and 42 per cent (N = 28) dynamically. Union rate was 98.6 per cent, time to union was 18.5 weeks, 17.3 weeks for closed fractures, 22 weeks for open fractures. Shortening greater than 1 cm occurred in 1.4 per cent (N = 1), varus and valgus deformity in 4.1 per cent each (N = 3). There was no rotational deformity. Of the locking bolts 30 per cent broke 8-10 weeks after partial weight bearing was allowed. Electron microscopy investigations showed that failure of the bolts was due to fatigue. It was not associated with any clinical problems with regard to union times or incidence of malunion. Bolt failure is however a problem if you try to remove the nail.

[Standardized shoulder examination with reference to computerized isokinetic strength testing (Cybex II)]. / Standardisierte Schulteruntersuchung unter Berücksichtigung der computerisierten isokinetischen Kraftmessung (Cybex II).

The complexity of shoulder movement makes it difficult to test normal or pathological shoulder function, as well as therapy results after injury. There are also problems to classify therapy results and to compare those with the results of other persons or other treatment methods. The aim of this paper is to introduce a standardised examination method of the shoulder and a standardised score regarding "subjective feelings", "clinical examination", "technical examination" such as x-ray, CT, sonogram, and "computerised isokinetic strength test", which enables us to conduct a follow-up case study of different patient groups after shoulder injury. Standardised examination programmes of the most common shoulder injuries like AC separations, rotator-cuff tears and luxations of the shoulder are given in this paper. A retrospective study of surgically treated AC separations Type III at the Staatliche Orthopädische Klinik München/Harlaching showed that therapy results can be established with the help of this score. The efficacy of different treatment methods (e.g. Bosworth and tension-band wire) can be both elucidated and compared.