Obere Labrumpathologie beim Sportler.

Since their first description several years ago, superior||| glenoid labral lesions have increasingly been blamed for shoulder problems||| associated with sports. Originally merely describing arthroscopically visible||| upper labral/biceps abnormalities, the current understanding is that often||| clinical problems such as impingement pain or even rotator cuff disease can be||| secondary to these lesions, especially in overhead athletes. Impingement in||| these cases is caused by superior shoulder instability originating from an||| unstable biceps insertion that is present for example in SLAP (superior labrum||| from anterior to posterior) lesions. Additional problems such as internal or||| posterosuperior impingement that are often found simultaneously in these||| patients are pathomorphologically located in the same anatomical region and||| therefore make exact diagnosis and thus treatment more complex. Magnetic||| resonance imaging with intra-articular contrast enhancement and particularly||| arthroscopy are the primary tools for exact diagnosis and classification of||| superior labral/biceps pathology. Therapeutically, lesions with unstable biceps||| origin (SLAP types 2 and 4) require operative refixation, as we have seen in||| our 50 cases in the last 4 years, in order to reestablish the stabilising||| effect of the biceps tendon for the shoulder joint. The arthroscopic technique||| for repair of these lesions using different devices of implantable suture||| anchors is presented. Long-term pain-free shoulder function in competitive||| athletes, throwers in particular, thus requires anatomical reconstruction of||| the originally unstable biceps, which is the causal therapy for these||| lesions.

[Superior labrum pathology in the athlete]. / Obere Labrumpathologie beim Sportler.

Since their first description several years ago, superior glenoid labral lesions have increasingly been blamed for shoulder problems associated with sports. Originally merely describing arthroscopically visible upper labral/biceps abnormalities, the current understanding is that often clinical problems such as impingement pain or even rotator cuff disease can be secondary to these lesions, especially in overhead athletes. Impingement in these cases is caused by superior shoulder instability originating from an unstable biceps insertion that is present for example in SLAP (superior labrum from anterior to posterior) lesions. Additional problems such as internal or posterosuperior impingement that are often found simultaneously in these patients are pathomorphologically located in the same anatomical region and therefore make exact diagnosis and thus treatment more complex. Magnetic resonance imaging with intra-articular contrast enhancement and particularly arthroscopy are the primary tools for exact diagnosis and classification of superior labral/biceps pathology. Therapeutically, lesions with unstable biceps origin (SLAP types 2 and 4) require operative refixation, as we have seen in our 50 cases in the last 4 years, in order to reestablish the stabilising effect of the biceps tendon for the shoulder joint. The arthroscopic technique for repair of these lesions using different devices of implantable suture anchors is presented. Long-term pain-free shoulder function in competitive athletes, throwers in particular, thus requires anatomical reconstruction of the originally unstable biceps, which is the causal therapy for these lesions.

[Endoscopically controlled division of the diaphragm. A minimally invasive approach to ventral management of thoracolumbar fractures of the spine]. / Das endoskopisch kontrollierte Zwerchfellsplitting. Ein minimal-invasiver Zugang zur ventralen Versorgung thorakolumbaler Frakturen der Wirbelsäule.

On 90 patients with 93 unstable fractures of the thoracic spine and the thoracolumbar junction we treated by a minimal invasive procedure between may 1996 and april 1998, in 46 patients an endoscopic splitting of the diaphragm was performed. The diaphragma was dissected at its attachment at the spine and the adjoining costal base. After partial corporectomy and discectomy, a tricortical bone graft has been inserted. An additional stabilization was done by using a plate and screw system. The incision of the diaphragm was closed by suturing or using an universal endostapler. Controlling the postoperative results a complete closure of the incision was documented by X-ray and CT-scan. There was no conversion to the open procedure or postoperative infection. Splitting the diaphragma opens also the thoracolumbar junction to a minimal invasive treatment and stabilization of fractures.

[Carpal tunnel syndrome in developing pseudarthrosis following isolated fracture of os capitatum]. / Carpaltunnelsyndrom bei Pseudarthrosebildung nach isolierter Fraktur des Os capitatum.

A rare case of well adapted and radiologically invisible capitatum fracture is reported resulting in a pseudarthrosis with pain and median nerve irritation 2 1/2 years following trauma. The difficulty in diagnosis of such well adapted rare fractures is pointed out and electromyography is demonstrated as a good method to diagnose a carpal-tunnel syndrome in cases of pseudarthrosis.

[Indications, technic and complications of intramedullary nailing in orthopedic view (author's transl)]. / Indikationen, Technik und Komplikationen der Marknagelung aus orthopädischer Sicht.

After short statement of the present indication and short illustrations of the technics of intramedullary nailing, 41 cases of failure (with the necessity of reoperation) are investigated with demonstrating the observed complications and their causes. Especially were seen malunions, shortening of legs, pseudarthrosis and osteomyelitis and some secondary anchylosis after fractures of metaphysis or comminuted fractures. These results were caused by use of nails with too small diameter and deficient reaming with following insufficient solidity.