Escin/diethylammonium salicylate/heparin combination gels for the topical treatment of acute impact injuries: a randomised, double blind, placebo controlled, multicentre study.

OBJECTIVES: To investigate the clinical efficacy and safety of escin-containing gels in the topical treatment of blunt impact injuries. METHODS: Competitors in soccer, handball, or karate competitions were enrolled within two hours of sustaining a strain, sprain, or contusion and treated three times with the trial gel within a period of eight hours. Patients were randomised to three parallel groups consisting of two active treatment gels, containing escin (1% or 2%), 5% diethylammonium salicylate, and 5000 IU heparin, or placebo gel. Tenderness produced by pressure was measured at 0 (baseline), 1, 2, 3, 4, 6, and 24 hours after enrollment (within two hours of the injury). Tenderness was defined as the amount of pressure (measured by a calibrated caliper at the centre of the injury) that first produced a pain reaction as reported by the patient. RESULTS: A total of 158 patients were enrolled; 156 were evaluated in the intention to treat analysis. The primary efficacy variable was the area under the curve for tenderness over a six hour period. The gel preparations containing 1% and 2% escin were significantly more effective (a priori ordered hypotheses testing controlling the multiple alpha = 5% significance level) than placebo (p(1) = 0.0001 and p(2) = 0.0002 respectively). The treatment effects were 5.7 kp h/cm(2) (95% confidence interval (CI) 2.9 to 8.5) and 5.9 kilopond (kp) h/cm(2) (95% CI 2.9 to 8.8) between 1% escin and placebo and between 2% escin and placebo respectively. These results were supported by secondary efficacy variables. The time to reach the baseline contralateral tenderness value (resolution of pain) at the injured site was shorter in the treatment groups than in the placebo group (p<0.0001). Both active gel preparations produced more rapid pain relief than the placebo gel. No relevant differences were detected between the two active gels. The safety and tolerability of the escin-containing gels were excellent. CONCLUSIONS: Escin/diethylammonium salicylate/heparin combination gel preparations are effective and safe for the treatment of blunt impact injuries.

[Conservative therapy of ruptures of the medial collateral ligament of the knee. Results of a comparative follow-up study]. / Konservative Therapie der Rupturen des medialen Kollateralbandes am Knie. Ergebnisse einer vergleichenden Nachuntersuchung.

The rupture of the medial collateral ligament of the knee joint due to sports injuries is the most common lesion of ligaments of the knee in athletes. The treatment is usually non-operative. We compared in a retrospective study the conservative treatment of these ruptures by two different methods. One group of patients was immobilised in a plaster cast for six weeks, one group of patients was partially immobilised with a brace, initiating early functional therapy. The results proved that the group of early mobilisation was significantly better in late results, in shorter rehabilitation and in all other aspects regarded as important for the treatment of such an injury. Therefore we feel the treatment with plaster casting for isolated ruptures of medial collateral ligaments as the knee should be abandoned.

[Does excessive stress play a role in the development of osteochondrosis dissecans tali?]. / Spielt bei der Entstehung der Osteochondrosis dissecans tali Uberlastung eine Rolle?

At the follow-up examination of 61 patients with Osteochondrosis dissecans tali (OD) we found at 48 of them one or more injuries in the anamnesia. More than 70 percent of them had as an injury mechanism a supination trauma. In case of medial OD the possible cause of an OD is given by the ratio 34 to 12 of trauma and non-trauma. The ratio in case of a lateral OD is 14 to 1 and it almost definitely points to overstress being a cause of it. Primary reasons may be here sports, especially football.

[Ice hockey injuries. Studies of the highest West German league]. / Eishockeyverletzungen. Untersuchungen der höchsten bundesdeutschen Spielklasse.

Ice hockey is the speediest team sport and also considered to be one of the roughest of all sports. Due to the high rate of injuries and the lack of competent studies in the Federal Republic of Germany, we started recording the First League in connection with injuries and their causes via a thorough questioning of the players. The results of the hitherto evaluated 88 out of a total of 207 First League Players - i.e. 42.5% - show that head injuries are most frequent; however, lesions of shoulders and upper and lower extremities are far more portentous ++ to the affected players in many respects. The association with causes and mechanisms of the different kinds of injuries make it clear that a marked tightening of the rules and an improvement in the protective clothing would offer good possibilities to reduce the rate of injuries drastically in ice hockey a kind of sport that is steadily getting more and more popular.

Aspects of traumatology in ice hockey.

Ice hockey is the fastest team game played and is also considered to be one of the roughest of all sports, with a high injury incidence. Injuries and their causes were recorded by the questioning of players in the first league of the Federal Republic of Germany. Eighty-eight out of a total of 207 first league players were included in this study. Head injuries were found to occur most frequently: however, lesions of the shoulders and of the upper and lower extremities had a more detrimental effect. The links between causes and mechanisms of the different kinds of injuries make it clear that a marked tightening of the rules and an improvement in protective clothing would serve to reduce the incidence of injuries in ice hockey.

[Alloplastic treatment of knee ligaments. Experience using artificial support in fresh injuries of the inner ligament]. / Alloplastische Versorgung der Kniegelenksbänder. Erfahrungen mit der Kunststoffschienung bei frischen Innenbandverletzungen.

From November 1983 to July 1985 a plastic reinforcement of the collateral medial ligament was performed in 14 patients. In all cases there was an additional reconstruction of the anterior cruciate ligament and a partial resection respectively refixation of the medial meniscus. In order to confirm the collateral ligament alloplastically in 6 cases a non-resorbable plastic connection (Gore-Tex patch), in 8 cases a resorbable plastic connection (PDS) was used. All the patients could be clinically reinvestigated on an average of 13 months after the operation. The results are presented.

[Posterior defects of the patella on CT arthrograms. Detection and differential diagnosis]. / Die Defekte der Patellarückfläche im CT-Arthrogramm. Nachweis und Differentialdiagnose.

Changes of the posterior bony and cartilaginous surfaces of the patella as seen on CT arthrograms are described in the case of bipartite patellae, fractures and ossification defects. Contrary to present opinion, cartilaginous lesions are frequently seen on CT arthrograms. This is also true for discreet and partial ossification defects which are not visible on conventional x-rays and are described here for the first time. The aetiology, morphogenesis and clinical examples are discussed.

[Winter sports injuries of the hand. 3 problem injuries]. / Wintersportverletzungen im Handbereich. Drei echte Problemverletzungen.

Growing redistribution of injuries has been recordable from winter sport activities, in recent years, with the upper extremity being more often affected than in the past. This prompted the authors to undertake follow-up checks for the purpose of verifying therapeutic success of patients treated earlier for three frequent injuries which had quite often been underestimated or even overlooked, rupture of the ulnar ligament of the metacarpophalangeal joint of the thumb, fracture of the distal radius, and fracture of the scaphoid. Included in the follow-up check were 37 patients with rupture of the ulnar ligament, 34 with fracture of the distal radius, and 11 with scaphoid fracture. All of them had been treated by the authors, in 1982 and 1983. Periods between 4 and 26 months had passed from surgical treatment or beginning of conservative therapy at the time of the follow-up check.

[Assessment of cardiopulmonary functional capacity with ergospirometric parameters at a capacity of 1 w/kg body weight]. / Beurteilung der kardiopulmonalen Leistungsfähigkeit mit ergospirometrischen Parametern bei einer Leistung von 1 W/kg Körpergewicht.

A sample of 73 men and 52 women aged 20 to 59 years was examined during a work-out on a bicycle ergometer while in a reclining position in order to assess spiroergometric parameters at a power output of 1 w/kg body weight, in regard to cardiopulmonary efficiency. In the male sample, a useful correlation between the maximum O2-intake against several parameters measured at 1 w/kg was determined, especially against the respiratory equivalent, respiratory minute volume, oxygen pulse, and heart rate. In the female sample, the correlation was particularly evident against oxygen pulse, and, within certain age groups, against heart rate, respiratory equivalent, and respiratory minute volume. The results of a physical working capacity 170 did not yield a more advantageous relation to the maximum O2-intake than to the above mentioned parameters. We found the quotient of O2-intake to the product of heart rate and respiratory minute volume at a load of 1 w/kg to offer by far the most accurate correlation. These results show that the use of suitable spiroergometric parameters at the more clinically feasible 1 w/kg standard load provide useful conclusions to the actual maximum efficiency--all the more so since spirographic parameters can be used concomitantly to determine the heart rate capacity.