[Shoulder arthrodesis. Possible causes of functionally poor results]. / Schulterarthrodese. Mögliche Ursachen der funktionell schlechten Ergebnisse.

Due to severe articular destruction of the glenohumeral joint with corresponding soft tissue changes arthrodesis has been performed in 24 patients since 1973. After an average period of 5.4 years (2-15) years, 22 patients were reviewed. Primary bone consolidation was achieved in all cases. During the observation period in 7 cases one of the following additional operations had to be performed on the involved shoulder: subcapital osteotomy due to excessive abduction (2 cases), resection of the acromio-clavicular joint due to painful osteoarthritis (2 cases), partial resection of an ugly acromion projecting laterally (1 case), removal of the fixation plate protruding proximally (4 cases). 18 patients experienced a marked improvement after arthrodesis. No improvement in 2 cases and a deterioration in 2 cases were the result of a not optimal positioning of the arthrodesis. A position of 20 of abduction, 20 to 30 of flexion and 45 of internal rotation proved to be functionally the most beneficial. Patients will be only painless if the optimal position of the arthrodesis was achieved. Excessive abduction and flexion was generally experienced as unpleasant. Deviation in the rotational position leads to functional restriction. The remaining function after arthrodesis is often overrated.

[The piriformis syndrome--a possible cause of sciatica]. / Das Piriformissyndrom--eine mögliche Ursache für Ischialgien.

In a 50-year-old patient with unilateral pain in the buttocks and in the sciatica, a radicular compression syndrome was diagnosed. Because conservative therapy failed, surgical intervention for herniated disc was suggested. Clinical examination revealed a painfully contracted piriform muscle and irritation of the sciatic nerve. Through specific stretch exercises, quick recovery was effected. Based on this case report, typical clinical diagnoses and therapeutical possibilities for the piriformis syndrome are discussed.

[The Haglund exostosis--a surgical indication and a minor intervention?]. / Die Haglund-Exostose--eine Operationsindikation und ein kleiner Eingriff?

From 1946 to 1985 a total of 594 patients with Haglund's disease were treated. 165 of the 266, who had been surgically treated were questioned extensively and 32 of them clinically and radiologically examined. Besides details of indication, surgical technique and perioperative issue, the subjective result as compared with the morphological state after removal of exostoses, was noted particularly. This necessitated the introduction of new X-ray quantification techniques in addition of the procedures described in literature. 73% good, and further 20% acceptable results confirm the indication. Nevertheless the success of the method depends largely on a good surgical technique and especially on the post-operative care.