[New assessment recommendations for disability in private accident insurance, part 4 : An interdisciplinary consensus approach-Disability outside the compensation scheme]. / Neue Bemessungsempfehlungen zur Invalidität in der PUV, Teil 4 : Ein fachübergreifend konsentierter Ansatz ­ Invalidität außerhalb der Gliedertaxe.

The following article is an element of a 4-part series on the presentation and discussion of new design recommendations for disability compensation in the private accident insurance. The introduction to the topic and the associated basics as well as the concept of the new draft of the design recommendations for the upper and lower extremities have already been published in Die Unfallchirurgie (formerly Der Unfallchirurg) on 17 February, 18 July and 18 November 2022 [2-4]. The topic of the fourth and final part published here is the assessment recommendations for disability outside the compensation scheme.

[New assessment recommendations for disability in private accident insurance part 3 : An interdisciplinary consensus approach-Lower extremities]. / Neue Bemessungsempfehlungen zur Invalidität in der PUV, Teil 3 : Ein fachübergreifend konsentierter Ansatz ­ untere Extremitäten.

The following article is an element of a 4-part series on the presentation and discussion of new assessment recommendations for disability compensation in the private accident insurance. The introduction to the topic and the associated basics as well as the concept of the new draft of the assessment recommendations of the upper extremities have already been published in Die Unfallchirurgie (previously Der Unfallchirurg) on 17 February and 31 August 2022 [2, 3]. The topic of the third part published here is the assessment recommendations for disability in the lower extremities within the compensation scheme.

[New assessment recommendations for disability in private accident insurance, part 2 : An interdisciplinary consented approach-upper extremities]. / Neue Bemessungsempfehlungen zur Invalidität in der PUV, Teil 2 : Ein fachübergreifend konsentierter Ansatz ­ Obere Extremitäten.

The following article is one component of a four-part series on the presentation and discussion of new assessment recommendations for disability compensation in private accident insurance. The introduction to the topic and the associated basics as well as the concept of the new draft of the assessment recommendations have already been published in the Der Unfallchirurg on 17 February 2022. The topic of the second part published here is the assessment recommendations for disability of the upper extremities within the compensation scheme.

[New assessment recommendations for disability in private accident insurance, part 1 : An interdisciplinary consented approach-Basics]. / Neue Bemessungsempfehlungen zur Invalidität in der PUV, Teil 1 : Ein fachübergreifend konsentierter Ansatz ­ Grundlagen.

The centerpiece of a private accident insurer is the benefit promise in cases of disability, which must be determined by a doctor in due time. The insurer specifies the rates of the compensation scheme for loss or inability to function and the medical expert must then fall back on generally recognized, revised or updated assessment recommendations in order to be able to apply the given framework to the specific, individual situation of the insured person. In four steps (basics, upper and lower extremities [disability within the compensation scheme] and disability outside the compensation scheme) interdisciplinary consensus benchmarks for disability assessment are presented, which should form the basis of a uniform medical assessment of accident-related functional disorders in private accident insurance compensation.

[Joint arthrodesis in functionally favorable position : Considerations on measurement of disability in private accident insurance]. / Gelenkversteifung in gebrauchsgünstiger Stellung : Überlegungen zur Invaliditätsbemessung in der privaten Unfallversicherung.

If an accident results in a functional disorder that persists and permanently restricts physical and/or mental capacity, this is referred to as a disability. In private accident insurance it is the task of the medical expert to assess this disability by examining the medical findings and produce an assessment taking account of the literature and comparing against generally acknowledged guidance values. The priority dismemberment disability rating schedule initially provides loss values. For the "next lowest" disability levels for arthrodesis of extremity joints, the assessment recommendations are based on a functionally favorable position although this functionally favorable position is not more precisely defined.In this article the authors have defined these functionally favorable positions based on the information available in the literature. In particular, the operatively favorable settings for arthrodesis of the affected joint that are stated in the literature on trauma and orthopedic surgery were consulted. Of course, the functional perspective has been especially emphasized.A difficulty in achieving this was that the literature on arthrodesis is now almost only of historical value due to modern endoprosthetics. The knowledge gained was checked against medical experience and is expounded here.

[Reproducibility of radiologic diagnosis in gonarthrosis]. / Reproduzierbarkeit der radiologischen Diagnostik bei Gonarthrose.

AIM OF STUDY: Ongoing efforts of the "German Society of Orthopaedic Surgery and Traumatology" (DGOT) to standardize diagnosis and therapy of osteoarthritis, necessitated this study, where the reproducibility of different radiographic features of knee-OA was assessed. METHODS: Three readers graded 100 antero-posterior and lateral knee radiographs for selected features (femorotibial osteophytes, joint space narrowing, sclerosis and chondrocalcinosis; patellofemoral osteophytes) and an overall-score (Kellgren and Lawrence, 1963) at two time points 3 months apart. Intra- and inter-observer-reliability were calculated by intra-class correlation-coefficient (ICC). RESULTS: Osteophytes in the femorotibial as well as in the patellofemoral joint could be assessed with a high intra- and inter-observer-reliability. While for joint space narrowing intra-observer-reliability is excellent, the inter-observer-reliability is less satisfactory, and subchondral sclerosis as well as chondrocalcinosis showed even less reproducibility. The Kellgren-Lawrence global score proofed to be highly reproducible. CONCLUSION: Based on the results of this examination, we can recommend a reliable radiographic classification of knee osteoarthritis by grading of relevant individual features (osteophytes and joint space narrowing) and overall assessment.

[Reproducibility in the roentgenological assessment of coxarthritis]. / Reproduzierbarkeit der röntgenologischen Beurteilung von Coxarthrosen.

The "German Society of Orthopaedic Surgery and Traumatology (DGOT)" is trying to support the application of standardized and reproducible criteria in diagnosis and therapy of osteoarthritis. As radiographs are a primary measure of outcome at present, the objective of this study was to investigate the reproducibility of radiologic assessment in hip osteoarthritis using different radiographic variables. 3 investigators read 100 hip joints on 50 pelvis radiographs at two time-points for the presence and severity of individual radiographic features: joint space narrowing (JSN), osteophytes, sklerosis, subchondral cysts and deformity of the femoral head. Additionally the summary grade of Kellgren and Lawrence (1963) and Scott et al (1992) was assessed. Intra- and inter-rater-reliability were calculated by intra-class-correlation-co-efficient (ICC). The results regarding intra- and inter-rater-reliability show excellent values for superior JSN, femoral head deformity and the summary score. The radiologic assessment of medial JSN, osteophytes and acetabular sklerosis depends on the level of the investigator's experience. Perifoveal osteophytes and subchondral cysts do not seem to be have sufficient reproducibility. The results of our investigation show, that a reliable radiological classification of the severity of hip osteoarthritis is possible by assessment of certain individual radiographic features or a summary grade.

Lesions of the alar ligaments. In vivo and in vitro studies with magnetic resonance imaging.

STUDY DESIGN: This study analyzed anatomic characteristics of the alar ligaments and the possibility of imaging them with magnetic resonance imaging. Also determined was whether artificial ruptures of the alar ligament can be recognized experimentally. OBJECTIVE: To determine the ability of magnetic resonance imaging to visualize normal, torn, resected alar ligaments. SUMMARY OF BACKGROUND DATA: There are no studies about computed tomography or magnetic resonance imaging findings of alar ligaments and after anatomic sections. Direct visualization of the complete ligament is not possible for computed tomography. No precise diagnostic method for showing a ruptured alar ligaments has been described. Magnetic resonance imaging seems to be the method of choice for distinguishing between normal and pathologic soft tissue. METHODS: Fifteen specimens from accident victims underwent anatomic dissection. In addition, ligaments from three groups were examined: 1) eight volunteers, 2) seven patients, and 3) 17 fresh cadaveric specimen before anatomic exploratory dissection. In seven of these specimens, one ligament was cut to simulate an artificial disruption and magnetic resonance imaging was repeated. RESULTS: Lesions of the alar ligaments were found in four of 15 prepared specimens. Using magnetic resonance imaging, the alar ligaments could be identified in all volunteers, patients, and specimen except one. No ruptures were found in the 17 specimens. Of the seven resected specimens, all cuts could be demonstrated by magnetic resonance imaging. CONCLUSION: Magnetic resonance imaging is useful for showing lesions of the alar ligaments because of a high soft tissue contrast, plane independence imaging, possibility of functional scans, and secondary reconstruction from three-dimensional data sets.

[Clinical relevance of the early detection of arthrosis]. / Die Früherfassung der Arthrose aus klinischer Sicht.

In the years 1989 to 1992 615 local persons underwent yearly examinations for analysis of osteoarthrosis of the hip and knee by means of comprehensive documentation of orthopaedic health history and clinical findings. Of special interest in our investigation were the Altman ACR criteria for osteoarthrosis of the hip and knee over the years. We can show, that finding the diagnosis is as accurate with the ACR criteria as well as the far more extensive Lequesne and Tegner-Lysholm score. Analysis of the investigations over the years revealed clearly different results in the frequency of osteoarthrosis. The reason is the nature of osteoarthrosis changing between silent and active phases especially during time of onset. Our investigations show, that valuable criteria exists for detection of early osteoarthrosis, however apparent are deficits for observing its course.

[Clinical aspects of the detection of early arthrosis. Degenerative changes of the menisci of the knee joint]. / Klinische Aspekte zur Erfassung der frühen Arthrose. Degenerative Veränderungen der Menisken des Kniegelenks.

In a series of 420 persons the knee and hip joints were examined anamnestically and clinically. From this series, 146 persons were selected for further examination of one knee joint by means of magnetic resonance imaging (MRI) on a 1.5 Tesla Magnetom; there was a wide range of indications. Only four MRIs showed no pathological findings in the cruciate ligaments, cartilage surfaces, or menisci. Fifty-one menisci showed grade 3 degenerative changes. In 29 cases (57%), isolated horizontal tears were found, in 1 case (2%) an isolated vertical tear, and in 3 cases (6%) combined horizontal and vertical tears. The correlation of the degenerative changes in the medial meniscus and age was significant (P = 0.01). There was no correlation between the degenerative changes of the medial meniscus and femoral or tibial changes of the cartilage. In this series, there was no significant connection between degenerative changes of the medial meniscus and the previously accepted clinical symptomatology.

[Possibilities for early detection of arthroses using imaging procedures]. / Möglichkeiten der Früherfassung von Arthrosen durch bildgebende Verfahren.

Today early detection of osteoarthrosis (OA) must imply the recognition of initial changes of articular cartilage before radiological signs appear. A noninvasive imaging technique must meet the demands of imaging the articular cartilage layer with high contrast and surface irregularities (fibrillation) and changes within the substance. This can only be achieved by magnetic resonance imaging (MRI) with optimized conditions (3D-gradient echo sequence). In 80 patients, 62% of them without radiological signs of OA, articular cartilage of the knee joint was prospectively (70 patients) and retrospectively (10 patients) investigated with MRI and compared with the arthroscopic findings. Normal cartilage could be distinguished from pathological conditions with a specificity of more than 90% when evaluating surface morphology, signal homogeneity and, above all, signal intensity (40 patients). Full-thickness defects were identified in all cases. Cartilage fibrillation of differing depths (grades 1-3) could not be differentiated with a sufficient degree of reliability and requires a more subtle evaluation method by means of improved software. Thus, the noninvasive recognition of early pathological changes of articular cartilage in patients without radiological signs of OA has become possible.

Aseptic osteonecrosis of the humeral trochlea (Hegemann's disease).

A differential diagnosis of diseases affecting the elbow joint in children should also give due consideration to osteonecroses. They are very rare in the context of the humeral trochlea, the case with which we are concerned being one of a total of 15. In the light of this syndrome's relative rarity, we will report on the case of a 7-year-old boy. This is also the first time that a MR image of Hegemann's disease has been shown.