[Bicycle accidents in the aged]. / Fahrradsturzverletzungen im Alter.

Between January 1st, 1998 and May 31st, 2000 the total of 7852 patients were treated at the Klinik Lindenplatz. 36 of them (14 male and 22 female) received an orthopedic rehabilitation after an operative treatment of a fracture due to a bicycle accident. 57% of them were older than 60. In 81% of the injuries the lower extremities were affected. Main injuries were medial fractures of the neck of the femur and fractures of the proximal femur. Skidding bikes had most frequently caused the accidents (44%). With the elderly patients one of the common causes of an injury was their falling from the bike or their failing attempt of getting on or off. Most of the patients had fallen without hitting or colliding with another biker, car or other extraneous influence. As the most serious fractures have occurred to elderly people, it is worth discussing the use of a hip protector, which could avoid these severe injuries.

[Orthopedic traumatologic rehabilitation--a superfluous anachronism?]. / Die orthopädisch-traumatologische Rehabilitation--ein überflüssiges Relikt?

In orthopaedic-traumatologic rehabilitation, muscular atrophies, joint contractures, bone loss and other restrictions of the locomotor system can be prevented or at least diminished. After an operation in particular, decreases in physical capacity of the locomotor and cardiopulmonary systems are common, which can be countered by special training therapies. Therefore, an effective rehabilitation programme is necessary including specific therapy forms and training concepts based on scientific findings in sports medicine, performance physiology and training sciences, in orthopaedics and traumatology as well as further medical disciplines. Determination of the load on the locomotor system and examination of cardiopulmonary capacity are important basic elements of rehabilitation training. Rehabilitation should include intense muscular and regular endurance training where loads must be tuned to the patient's individual capacity. Overuse syndromes can be avoided by planning regeneration breaks between training units and by continuously controlling the individual parameters of the patient. The costs of intense rehabilitation may at first seem high; however, one year after an operation the financial expenditures in those patients who did not receive intense rehabilitation exceeded all costs incurred for an operation and additional rehabilitation.

[Medical aspects of selecting a new high performance olympic sail boat]. / Medizinische Aspekte bei der Auswahl des neuen olympischen Segelbootes.

For the 2000 Olympic Sailing-Regatta the Medical Commission of the International Sailing Federation (ISAF) analysed different high performance dinghy boats from the medical point of view. The hull of the boats and the modern styled sails increase the forward force. Special outriggers compensate the shearing forces, by which different weights of the sailors make no longer a difference in case of moderate winds. The high distance between boat and boom is favorable to prevent head injuries. But in some boats many clips, rollers, ropes, hooks are installed in those areas, where the helmsman and the foredeck hand are active. The area between the outrigger tube should be covered with fabric being pervious to water: in case of a sailor's slip off or an overturn of the boat no part of the body can be squeezed. The foot straps mostly enclose the metatarsus: At manoeuvres or capzising a foot-fracture could happen. The selected boat for the Olympic Games was the 49er.

[Intermittent painattacks: a typical sign of a vascular leiomyoma]. / Intermittierende Schmerzattacken. Ein typisches Symptom des Angioleiomyoms.

A 54-year-old women reported on intermittent attacks of pain attacks in the tibia, that she had for the first time during her pregnancies 24 years and 17 years before, disappearing with the birth of her children. Nevertheless the pain recurred at the beginning of the climacteric and became more frequent in the subsequent years. The pain attacks were often triggered by a soft touch but they also arose spontaneously: nearly every night the patient was awakened between 1:00 and 4:00 a. m. by a pain attack lasting about 20-40 min. Special diagnostic methods such as phlebography, computed tomography, scintiscan did not show any pathologic findings, except a residual bone deformation of the tibia as a consequence of a tibia fracture 20 years before. The woman was treated continuously for about 7 years with injections and different medical and paramedical methods, with no improvement. She started to write a diary about the times and the frequency of the pain attacks. This was diagnosed as a neurotic behaviour and several sessions of psychological analysis revealed many problems in her life. Finally, an operation was performed in the painful region, revealing a white elastic tumour 0.6 cm in size, which was diagnosed on histological examination as a vascular leiomyoma. The patient was instantly free of pain and still felt well 6,5 years later. According to the literature, vascular leiomyoma is the only tumour of the soft tissue except glomus tumour that usually produces severe pain attacks.

[Software and system-induced errors in isokinetic force measurements]. / Software- und systembedingte Fehler bei isokinetischen Kraftmessungen.

In the literature a good reliability of isokinetic measurements is reported. In spite of these reports high variations of the peak torque and work values were registered when testing 24 patients with low back pain, using a CYBEX TR isokinetic trunk rotation apparatus. After a 3 week's training the patients force (peak torque) increased in the average between 10.7 p.c. (SD +/- 26.4) and 23.2 p.c. (SD +/- 63.8), corresponding to the test-velocity. Seven of the 24 patients improved or deteriorated more than 30 p.c. Analysing the parameters which could interfere with the results there was found a discrepancy between the original CYBEX software and the German Iso-Kin 4.0 software. The Isokin 4.0 does not warm up and calibrate the isokinetic apparatus daily. Investigations with definite weights showed that the values for peak torque are 40-50 m higher when using the Iso-Kin 4.0 software in comparison to the original CYBEX software. Furthermore there are a lot of other parameters such as acceleration of the body, psychological alterations, pain, motivation, learning effects, and artificial oscillations of the registered curve, which can affect the results even when using the original CYBEX software.

[Effectiveness of conservative therapies in chronic backache reflected in the literature]. / Die Effektivität konservativer Therapien bei chronischen Rückenschmerzen im Spiegel der Literatur.

A review of literature concerning the conservative treatment of low back pain shows that none of the different therapies is favoured. Modern conservative treatment of chronic low back pain starts with an accurate diagnosis. As a frequent cause of low back pain the instability of a spine segment following an intervertebral disc degeneration is identified. If the pathogenesis of the pain is clear, the treatment of low back pain consists of individual positioning and extension, isokinetic training, special physiotherapy, body building, physical therapy, including parts of the back school. An intensive daily training programme which consist of training of muscle endurance and muscle strength, and includes moreover education and training regarding spine function and body mechanics, as well as psychological intervention, seems to be successful.

[Diagnosis of chronic backache in health resort patients]. / Zur Diagnostik chronischer Rückenschmerzen bei Kurpatienten.

Conservative treatment of backache requires an accurate diagnosis because sometimes such patients are suffering from a serious but unrecognised disease of the abdomen or low back region. Diagnoses like cervical syndrome, lumbar syndrome or even cervicodorso-lumbar syndrome are not sufficiently conclusive to start conservative treatment, since they convey nothing in respect of cause, prognosis or aim of treatment. Patients undergoing a course of inpatient curative treatment of, say, four weeks in a hospital, need special therapy programmes that are meaningfully based on precise data on their disorder. It is important to set great store by the physical examination (which is often performed cursorily before the patients are referred to curative inpatients treatment), including a neurological examination and in some cases also EMG, special radiographs, myelography, CT, magnetic resonance imaging and the like to gather more information on the real cause of the low back pain. This will also help the physician in arriving at a fair estimation of the patient's performance rating. A useful classification of patients into two groups would be as follows: a) without neurological symptoms, and b) with signs of a nerve-root compression or even spinal cord symptoms.

[Accident causes and prevention of injuries in Enduro-motorbike sport]. / Unfallursachen und Verletzungsprophylaxe beim Enduro-Motorradsport.

365 participants of the 64. Enduro-World Championship in 1989 reported 232 injuries within a 10-years-period of motorbike driving. The knee was most frequent (21.5 pc., mainly ligament ruptures) injured, followed by fracture of the clavicle (18.5 pc.), hand (15.5 pc.) and damages of the shoulder. Fractures are very common (55.5 pc.) in motorbike sports. Injuries often were produced by collisions with other motorbikes or trees. Driving mistakes, jumps, slipping wheels and overturn were other causes for an accident. During the championship 13 accidents were registered. In a clinical examination defects or alterations of the joints and bones were observed at 91 drivers. Important is the incidence of two malign tumours of the testicles. Preventive measures against accidents are discussed.

[Traumatology of sailing injuries]. / Traumatologie der Segelverletzungen.

In a period of 3 years 68 injuries during sailing have been registered. The hand (32.3 p.c.) and the head (17.6 p.c.) are most frequently damaged. Bleeding wounds (26.4 p.c.), contusions (22.0 p.c.) and fractures (17.6 p.c.) are very common lesions. The injuries are mainly caused by the dolorous contact with the boom, by stumbling on board a ship and by jumping on the landing-stage. An effective prevention is discussed.

[The material properties of a combined plaster-plastic cast]. / Die Materialeigenschaften eines kombinierten Gips-Kunststoffverbandes.

The treatment of patients by a combined plaster/plastic cast often is more advantageous than the application of only one of these components. Now a compression test was made to check the attributes of the plaster, plastic and combined material. There were shown clear differences in the elastic behavior and the solidity of both casts, and the combination of both materials consequently was not really stable.

[Causes and prevention of typical volleyball injuries]. / Ursachen und Prophylaxe typischer Volleyballverletzungen.

A survey conducted among 224 volleyball players in the German Federal League revealed a high number of serious injuries. The upper ankle joint (55.1% of all serious injuries) and the fingers (22.4%) were most commonly affected. The principal cause of the accidents was a collision with an opponent at the net. There is a close relationship between the player's position, the part he plays in the game and the frequency of injury. Aside from other measures a change of one of the international volleyball rules would represent a suitable method of preventing such injuries.

Cardiovascular reactions during exhausting isometric exercise while windsurfing on a simulator or at sea.

Eleven amateurs and two internationally ranked windsurfers performed isometric exercise on a windsurfing simulator to the point of exhaustion. The two professional windsurfers maintained their position during exercise two times longer than those of the other group. The following mean values (n = 11) were measured during the exercise: the blood pressure increased from 114 +/- 6.6/70 +/- 11.5 to 177 +/- 8.6/93 +/- 10.3 mmHg, the heart rate from 63 +/- 13 to 103 +/- 16 bts/min, blood flow in the forearm from 6.4 to 7.4 ml/(100 ml tissue x min), and the lactate level in the capillary blood from 0.9 +/- 0.2 to 1.9 +/- 0.4 mmol/l. The post-exercise hyperemia reached values of 28.2 ml/ (100 ml tissue X min). There was neither a significant correlation between the time of exercise and the handgrip force (MVC = maximal voluntary) nor the calculated force of the forearm. Motivation was interpreted as an exercise-prolonging factor. At sea and with high wind (7 Beaufort), the heart rate reached a maximum of 200 bts/min, but the lactate level did not reach more than 3.0 mmol/l.