Epidemiological data and costs of burn injuries in workers in Switzerland: an argument for immediate treatment in burn centres.

A complete statistical evaluation of epidemiological data and costs of burn injuries in 1984 with a follow-up for 5 years is presented, considering a collective of 1.77 million workers in Switzerland. The majority of burns are minor injuries; only about 5 per cent of the burn victims are admitted to a hospital, 0.2 per cent died. Burn injuries at work are rare, mainly owing to strict safety measures. Only one-fifth of the costs caused by burns are due to medical treatment. All other expenses result from continuation of payments of salaries and annuities. The treatment of the few severely burned patients in burn units produces effective costs which are higher than the tariff paid by the insurance. Even so, the predominant portion of the enormous costs is taken up by wages while off work and annuities. As our conclusion we stress the importance of primary care for all severe burns including all burns of the hands in a specialized centre. Any economic effort for primary burn treatment, however high it may be, is justified if the duration of rehabilitation and invalidity can be reduced.

[Burns in workers in Switzerland: epidemiology and financial sequelae]. / Brandverletzungen bei Werktätigen in der Schwiez: Epidemiologie und Kostenfolgen.

A complete statistical evaluation of epidemiologic data and costs of burn injuries in 1984 with a follow-up for 5 years is presented, considering a collective of 1.77 million workers in Switzerland. The majority of burns are minor injuries; only about 5% of the burn victimes are admitted to a hospital, 0.2% die. Only one fifth of the costs caused by burns are due to medical treatment and rehabilitation. All other expenses result from continuation of payments of salaries and annuities. The few treatments of severely burnt patients in the burn units cause effective costs higher than the tariff paid by the insurance. Even so, the predominant portion of the enormous costs is taken up by wages while off work and annuities. As our conclusion we stress the importance of primary care for all severe burns including all burns of the hands in a specialized centre. Any economic effort for primary burn treatment, however high it may be, is justified if the duration of rehabilitation and invalidity can thus be reduced.

[The SUVA (Swiss Accident Insurance Association) statistics and quality control]. / Die medizinische Statistik SUVA und Qualitätskontrolle.

Overall quality control in medicine takes place on various levels: Physician--Hospital--Insurer--Authorities, each having different requirements. Comparative standards are rather seldom. A model for a comparative standard for insurer purposes, the medical statistics package SUMEST' is presented. This model is diagnoses oriented and includes parameters for the severity of the accident, cost of treatment and treatment outcome, all based on 5-year data pool results.

[Shoulder dislocation and periarthrosis humeroscapularis]. / Schulterluxation und Periarthrosis humeroscapularis.

1232 injuries involving shoulder luxations in 1984 were investigated on the basis of the insurance dossier. 1/3 of the injured persons have sequelae: 10.5% habitual tendency to luxation, 9% peritendinitis, 2% omarthritis and 2% a shoulder instability. 1/5 in each case still experience pain and restricted movement. The 108 cases where peritendinitis has occurred following shoulder luxations are shown divided up according to various symptoms. Peritendinitis ankylosis or frozen shoulder represents the major share in almost half of the cases. Various characteristics, complications and risk factors for the possibility of contracting peritendinitis following shoulder luxation are being worked out. In conclusion, the insurance-relevant parameters for peritendinitis after shoulder luxation are shown: in cases with peritendinitis, integrity compensation was awarded 12 times more frequently than in cases without peritendinitis; in the case of shoulder luxation with peritendinitis, the entire insurance benefits were 10 times higher than in cases without peritendinitis.

[The medical and insurance technical part of expert assessment]. / Der medizinische und der versicherungstechnische Teil des Gutachtens.

The expert's demands careful exploration including consideration of psychological factors. Furthermore, to establish their final reports the insurance companies involved need detailed answers to specific questions in regard to the impairment. The medical expert finds himself in an area of conflict between doctor-patient relationship (which requires mutual trust) and his duty as an expert. His task will be made easier if he clearly separates the first part of his report dealing with the medical aspects from the second part referring to the more technical problems of the insurer. It is only after clarification of the medical situation that the questions relating to the insurance as such can be clearly answered. Factors which do not seem to relate directly to the medical aspects of the accidental sequels (e.g. psychosomatic), but which the Swiss Insurance Court does take more and more into account, may be mentioned, however, their evaluation is best left to the insurance company which ordered the expert's report.

[The importance of ADP for medical statistics]. / Die Bedeutung der EDV für die medizinische Statistik.

Recent german articles concerning medical statistics give priority to data acquisition. This contribution describe the statistical analysis and presentation of the results of the Swiss accident insurance Company (SUVA) with 1.9 million of insured workers. This documentation covers per year approximately 450,000 accidents at work and in free time. The documentation include primarily the insurance-data, for medical purposes we use the adjacent diagnoses (up to 20 per accident). The new medical statistic (SUMEST) begins with the accidents of the year 1984, updated until 1988, this means, that we have a statistic of the outcome of accidents. For the analysis we use properties of the personality, details of what happened, injury, expenses for healing and results. The primary presentation is a collection of tables for every diagnosis (total 417) with the most important criteria for the cases. It is provided to publish results of special problems like time of disability, influence of algodystrophy etc. The possibility to analyse a big documentation (25 MBytes) with a personal computer give to the physician the possibility to perform the statistical analysis himself and to select the significant results immediately.

[Occupational diseases of the musculoskeletal system of the SUVA (Swiss Accident Insurance Institute)]. / Die Berufskrankheiten des Bewegungsapparates der SUVA.

First there is given a definition of occupation related diseases of the musculoskeletal system as a subject to the Swiss federal law of social insurance. As a relation to age and sex, the incidence, the following time of work incapacity and the financial consequences of disability are reported within a period from 1970 to 1983. Although the results are highly specific to Swiss legislation, the international comparison might be of interest.

[Back injuries and the work site]. / Rückenschäden und Arbeitsplatz.

Payments through obligatory accident insurance for back injuries as a result of an accident in the legal sense are common. In contrast, the acceptance of back injuries as an occupational illness is associated with such strict legal prerequisites that, considering the early appearance and frequency of degenerative back diseases in the general population, the condition whereby a back injury must have been caused exclusively or predominantly, i.e. at least three quarters, by the occupational activity is satisfied only in rare cases. Epidemiological studies show that back conditions occur more frequently in certain types of exposed occupation. The high degree of causality required by the legislature is, however, not demonstrated so that back injuries could therefore be recognized as occupational illnesses only in rare cases. Because of this, prevention at the place of work is all the more important.

Differential diagnosis of ruptures of the lateral ligaments of the ankle joint.

Ruptures of the lateral ligaments of the ankle joint occur very frequently in young persons and this subject is therefore one which deserves more attention. Once a fracture or avulsion of a ligamentary insertion has been excluded the nature and extent of the ligamentary lesion should be precisely assessed. The only objective criterion of rupture of a ligament is demonstrable instability of the joint. Since the anterior talo-fibular ligament is always found to be torn immediately following supination-inversion injury to the ligaments the talar drawer sign will be demonstratable both clinically and radiologically in such cases. This test causes almost no pain and can be carried out without anesthesia. The radiological visualization of ligamentary instability with the aid of a simple jig which stresses the ankle joint provides diagnostic information which is definitely superior to that obtained from an a-p roentegenogram of the stressed joint. This conclusion was reached by statistical analysis of 384 roentgenograms.

[Mineral content of the skeleton in chronic kidney insufficiency treated with dialysis and after kidney transplantation. Results of isotope densitometry]. / Mineralgehalt des Skeletts bei chronischer Niereninsuffizienz, unter Dialysebehandlung sowie nach Nierentransplantation. Resultate der Isotopendensitometrie.

By means of a photon densitometer utilizing a 125I-source, bone mineral content was measured in 15 chronic renal failure patients on conservative management, 46 patients on maintenance hemodialysis and 20 patients after renal transplantation. The determinations were made at 4 sites in both radius and tibia. In patients with chronic renal failure on conservative treatment the bone mineral content did not differ significantly from that in normals. Patients on hemodialysis showed a low bone mineral content in 61 percent of females and 53 percent of males. Especially low values were obtained from 5 females who had undergone bilateral nephrectomy. After renal transplantation all female patients showed low values, whereas 50 percent of male patients showed decreased values. No correlations were found between bone mineral content and serum parameters (calcium, phosphate, alkaline phosphatase, creatinine), duration of renal failure, hemodialysis treatment or steroid medication.

[Analysis of gait in hemiplegics (author's transl)]. / Ganganalyse beim Hemiplegiker.

The gait of 31 hemiplegics is analyzed with a multiplecomponents force-plate. The healthy and paretic side differ in 5 of 7 parameters. The difference betwen the left and right side is bigger in the right hemiplegic, because in the left hemiplegic, the healthy side is more disturbed as in the right hemiplegic. That makes less differences between healthy and paretic side. The variability of the single steps is bigger in subjects with a bad gait. The method is suitable to screen the change of the gait and its progress.

[The porosity of bone cement (author's transl)]. / Untersuchungen zur Porosität von Knochenzementen

This paper describes a method of measuring the porosity, shape, distribution and formation of cavities in acrylic cement. We distinguish between big spherical cavities greater than 60 mu and small cavities less than 60 mu which form a variable "basic porosity" with a large number, but a minor volume of bubbles. The bubbles are formed in two different ways. The first is through introduction of air bubbles in the mixing phase by stirring the cement before the working time. These bubbles expand little by temperature rise. The second method of formation is through neoformation of bubbles by evaporation of the monomer at about 100 degrees C. This neoformation of porosity expands the cement. The rise of volume through the neoformation and expansion of bubbles is able to compensate the shrinking of cement due to the polymerization. This effect, however, cannot be currently controlled. Cement strength is influenced by the degree of porosity.

[Biomechanics of the hip joint. I. A new model for the calculation of the forces in the hip joint]. / Studien zur Biomechanik des Hüftgelenkes I. Ein neues Modell für die Berechnung der Hüftbelastung

After a short review of the theory of the forces acting in the human hip joint we develope a new model for the calculation of the forces R acting on the head of the supporting femur, of their direction phi and of the maximal pressure of the femoral head. The new concept is the determination of a fixed point A, the attachement of the resultant muscle force M at the pelvis, and the insertion T of this muscle force at the trochanter. After determination of this points in a single standard radiography of the pelvis and hips, the model calculate the resultant force R at the hip joint. The pressure in the articulation is calculated also by the same proceeding. The influence of the choice of the point A is discussed.

[Volume changes of bone cements]. / Die Volumenänderungen von Knochenzementen whrend der Härtung

The volume changes of hardening cements are measured with the buoyancy method. During hardening the polymerisation shrinkage runs through distinguished phases, totaling from setting in the bone to the final state 2 to 4 volume percents. Expansion and contraction because of temperature changes superimpose the measurements by a rate of 0, 21%/10 degrees C. - Factors influencing the volume changes are discussed.

[Working time of bone cements]. / Die Verabeitungszeit von Knochenzementen

The period of applicability during polymerisation of four well introduced bone cements (Sulfix-6, CMW, Simplex, Palacos) was measured by a subjective method in function of room respectively conditioning temperature. Simultaneously temperature in the cement and mechanical admittance (transfer of oscillation of 750 Hz) were registered. The duration of working-up period and plymerisation period depends considerably from the room temperature. An increase of 10 degree C accelerates polymerisation by a factor of 1.5 to 2.0. The working time of the products differs widely. Increased room temperature means also increasing maximum polymerisation temperature. Mechanical admittance is an interesting measure for the objectivation of the working period. Discussing new ISO standards a proposal is made for more accurate determination of the end of the working-up period (set time).