[Orthopedic-traumatologic observations]. / Orthopädisch-traumatologische Begutachtung.

This article focuses on the problems encountered when giving an expert opinion on the results of slight distortion of the cervical spine after low-velocity rear-end collisions. Special attention is paid to the non-medical reasons for discontent of injured (innocent) passengers due to the current system of compensation.

Five-year results of conservatively treated tears of the anterior cruciate ligament.

Follow-up examinations of 35 patients with an arthroscopically confirmed isolated fresh tear of the anterior cruciate ligament were conducted after an average period of 5 years. After arthroscopy and immobilization of the knee in a plaster cast for 2 weeks, all 35 patients had been conservatively treated with neurophysiological physical therapy. Twenty-four of the tears were complete; the remaining 11 were partial. The results of the follow-up examination are based on subjective scores (O'Donoghue score, Lysholm score), an objective score (objective O'Donoghue score) and clinical examination. With the partial tears, good to satisfactory results were achieved, and surgery was needed less often. In these patients, it was largely possible to maintain the original level of athletic performance. Those patients with complete, isolated tears generally had satisfactory to poor results on the objective scores. There was a high rate of revision surgery, especially in the case of meniscus tears, and they were largely unable to regain their original level of athletic performance.

[Criteria for legal assessment of rotator cuff rupture]. / Beurteilungskriterien zur Begutachtung der Rotatorenmanschettenruptur.

The judgement of the correlation between an accident and a rotator cuff tear has an important role in legal and private accident insurance. Owing to the high morbidity of degenerative alterations and ruptures of the rotator cuff tendons, the causality of an acute traumatic rupture can be difficult to demonstrate, which means assessments are often controversial. In a retrospective study we evaluated 25 orthopaedic assessments and tried to find rules for an objective estimation. The judgement of correlation between trauma and rotator cuff tear should be based on four pillars: history, trauma mechanism, initial findings and course of the functional deficit. Possible mechanisms of traumatic rupture are discussed from various angles. Important clinical findings, e.g. a functional supraspinatus deficit, should be fully documented. X-Rays of both shoulders can lead to indirect demonstration of preexistent changes in the rotator cuff. Sonographic evaluation can show up the rotator cuff tear and demonstrate signs of acute injury. After persistent pain and functional deficit, in a few cases operative and microscopic findings will lead to a correct estimate of causality. Because of the diagnostic uncertainty a 20-point score is introduced for retrospective assessment of the history (2 points), trauma mechanism (3 points), initial clinical, radiological and sonographic findings (10 points) and course of functional deficit (5 points) to evaluate the role of trauma in rotator cuff tears. Using this score trauma can be classified as the main or partial cause or as irrelevant to the pathogenesis of rotator cuff tears.

[Results of follow-up of conservatively treated isolated fresh anterior cruciate ligament rupture]. / Nachuntersuchungsergebnisse nach konservativ behandelter isolierter frischer vorderer Kreuzbandruptur.

35 patients with an arthroscopically confirmed isolated fresh anterior cruciate ligament rupture were subjected to follow-up examination after an average period of four years. In all the 35 patients a conservative treatment schedule had been followed post-arthroscopically, with a physiotherapy on a neurophysiological basis. Of the 35 isolated anterior cruciate ligament ruptures, 24 were complete and 11 partial ruptures. The follow-up examination results are based on subjective scores (O'Donoghue Score, Lysholm Score) and on one objective score (objective ODonaghue Score), as well as on the Lachman Test and the Pivot Shift Sign. In the partial anterior cruciate ligament ruptures we obtained mostly good to satisfactory results with the subjective and objective scores and a lower incidence of surgery; the original performance ratings at sports were largely maintained. On the other hand, the complete isolated anterior cruciate ligament ruptures yielded mainly satisfactory to poor results with the objective scores and a high rate of repeat surgery especially in the case of meniscus tears, and a major setback in the original sports performance ratings.

[Postoperative infections and wound healing disorders in patients with infantile cerebral palsy]. / Postoperative Infektionen und Wundheilungsstörungen bei Patienten mit infantiler Cerebralparese.

As part of a retrospective study including 569 patients with ICP and a group of 405 controls, the risk of postoperative wound healing disorders and wound infections was investigated in surgically treated children with cerebral palsy. The higher rate of wound healing disorders in ICP patients could not be attributed to factors such as excessively long duration of operation, secondary interventions, or a high number of interventions per operation. Rather, the causes of the increased risk of infection have to be seen in connection with the symptoms of ICP itself, such as immunological weakness, increased tendency to sweat, reduced circulation in the affected extremity and disturbances of sensitivity and perception. A direct link between these parameters and increased risk of postoperative infection can only be established by prospective studies.

[Legal evaluation of bone tumors]. / Begutachtungsfragen bei Knochentumoren.

Three topics are of major importance in the legal evaluation of bone tumors: The questions of medical liability, of causality and of medical evaluation. Concerning medical liability, the legal consequences of proven cases of malpractice are stressed. A causal connection between an accused trauma and the occurrence of a malignant bone tumor can be denied in nearly all circumstances. Due to the well known occurrence of a secondary sarcoma, the irradiation of a benign bone tumor or tumorlike lesion is strongly disfavored. In cases of medical evaluation, patients with malignant bone tumors should be judged by the same criteria as patients with any other diseases and impairments.

[Long-term results following subcutaneous Achilles tendon rupture]. / Langzeitergebnisse nach subkutaner Achillessehnenruptur.

From 1972 to 1982, 132 ruptures of the achilles tendon were treated at the Orthopedics Division, University of Heidelberg. Surgical treatment was carried out in 125 cases, and seven patients were treated conservatively. The average age of the patients was 42 years. 84% of the achilles tendon ruptures occurred during sport. After an average investigation period of 6.5 years, 33 patients could be followed up. The rate of complications and the final functional results are communicated. The blood supply to the achilles tendon is described separately. Twelve cadaver achilles tendons were investigated by means of the plastination method. It could be demonstrated that a reduced blood supply to the Achilles tendon is present about 3-5 cm above the calcaneal tuber. This finding corresponds to the most frequent site of rupture. It is unclear to what extent there is a connection between the blood supply and the rupture site of typical locations.

[Unilateral finger polyarthrosis as a late sequel of frostbite]. / Einseitige Fingerpolyarthrose als Spätfolge nach Erfrierung.

Unilateral Osteoarthritis involving all interphalangeal joints are in some cases late sequelae of cold injury. Case report.

[Long-term roentgenologic studies in peak performance javelin throwers]. / Röntgenologische Langzeitbeobachtungen bei Speerwerfern der Spitzenklasse.

The example of the javelin thrower demonstrates that an unphysiological movement sequence at the elbow joint (valgus stress) leads to regular arthrotic alterations by summation of such strains: these are known as "javelin elbow". Since the new javelin introduced in 1986 requires a greater explosive force, a tendency to an increased incidence of these alterations must be reckoned with in the future. Further observations are necessary to clarify whether there will be an increase in degenerative alterations in the lumbar spine by abrupt hyperlordosis and trunk rotation in producing the bow tension of the javelin thrower; whether the above-average incidence of patients with spondylolysis amongst competitive javelin throwers is coincidental; whether the processes of remodelling in the interarticular portion of javelin throwers constitute zones of fatigue; and, finally, whether the unilateral trunk strain of the javelin thrower influences the scoliotic posture.

[Development and assessment of so-called rotator cuff ruptures]. / Die Entstehung und Beurteilung der sogenannten Rotatoren-manschettenrupturen.

The following conclusions can be drawn from our investigations: We could not find out isolated ruptures of the supraspinatus tendon, which were caused exclusively by injury. Mostly ruptures of the rotatory cuff develop spontaneously, the basic degenerative changes involve also the shoulder joint and the acromioclavicular joint. The term rupture of rotatory cuff is misleading, because it signals to the patient the existence of aftermath of injuries and for the most part the rupture is not found in the tendons of the rotatory muscles but in the supraspinatus tendon. The degenerative cuff defects with spontaneous ruptures must be differentiated in medical certificate from the rare rotatory cuff ruptures, which are caused by injury alone. Seldom exogenous mechanical stress may lead to an enlargement of a preexistent rupture with symptoms and clinical signs, which occur for the first time. On the promises, that an adequate injury has occurred, that roentgenographic changes deteriorated within 3 months after the injury and a degenerative defect of rotatory cuff with clinical relevance can be excluded for the time before the injury, the damage of the shoulder has to be accepted by the insurance as an injury after accident. In the most times occasional causes with inadequate injuries to the shoulder are brought up, to assert an old degenerative defect of the shoulder as an aftermath of injury. There are no interrelations between intraoperative findings and mechanism of injury. The anamnestic statement of the patient concerning earlier diseases and injuries are often unreliable.(ABSTRACT TRUNCATED AT 250 WORDS)

[Problems of posture and the locomotor system as a result of amputation of a lower extremity (author's transl)]. / Probleme des Haltungs- und Bewegungsapparates als Folge der Amputation der unteren Extremität.

While it is true that partial loss of a leg regularly leads to additional stress on the remaining parts of the body, the ability of the organism to compensate for this is evidently so good that under everyday conditions with physiological stress the additional load is tolerated by the vertebral column and the remaining leg. Conversely, the residual function of the amputated leg is likely to be impaired if the prosthesis is too short, and if these are any lumbosacral defects damage will probably result. This applies in particular to cases with scoliosis due to false posture.

[Expertises on growth disturbances in children seen from the aspect of private accident insurance (author's transl)]. / Die Begutachtung von Wachstumsstörungen bei Kindern in der privaten Unfallversicherung.

In private accident insurance, a degree of disability established for the insured and the insuring party for the first time in a binding manner, cannot be established as a new fact if more than 3 years have elapsed since the accident occurred. In private accident insurance for children, the right to confirm the disability as a new fact, is limited to a period of 5 years, but not beyond the age of 18. If post-traumatic disturbances in young children (following injuries of the epiphyseal cartilage, bone and articular infections etc..) do not supply sufficient pointers towards the possible or probable findings at the termination of growth, the physician writing the expertise should draw attention to this fact and should state that as far as the medical situation is concerned, determination of the first occurrence cannot be made now and is possible at the stage of termination of growth only.