[Lifting osteotomy of the acromion as a new principle in treatment of impingement syndrome, especially in correlation with reconstruction of large rotator cuff lesions]. / Die Aufrichteosteotomie des Akromions (AAO) als neues Prinzip in der Behandlung des Impingementsyndroms, insbesonders im Zusammenhang mit der Rekonstruktion von grossen Rotatorenmanschettenläsionen.

There are many different causes leading to impingement lesions of the shoulder (e.g., architecture of the acromion, arthritis of the acromioclavicular joint, bursitis subacromialis, chronic instability). There are also different ways of treating it. Neer described his technique of anterior acromioplasty in 1972. With this technique there is sometimes a limitation in the amount of resection possible because of the anatomical findings (i.e., very curved or small acromion). We developed a new technique: the lift-up osteotomy of the acromion (LOA). This technique allows us to gain as much subacromial space as needed (e.g., for large anterior deltoid flaps). Osteotomy of the acromion gives an excellent view of the rotator cuff. Even large lesions can easily be repaired. After the cuff repair is done, the acromion is refixed with two canulated screws. So far, we have used this LOA technique in more than 100 patients in impingement operations, cuff repairs and anterior deltoid flaps all with good results.

[Reconstruction of chronic symptomatic acromioclavicular joint dislocation (Rockwood III-V) using the modified Weaver-Dunn method. 24 operated patients (1988-95), surgical technique, results]. / Rekonstruktion der alten symptomatischen AC-Gelenksluxation (Rockwood III-V) nach modifizierter Methode von Weaver-Dunn. 24 operierte Patienten (1988-95), Operationstechnik, Resultate.

In literature there is a great controversy about the treatment of acute acromio-clavicular (AC) joint dislocations. Nevertheless some patients continue to suffer from chronic pain due to the persistent instability of the AC-joint. This can even lead to an impingement syndrome, going as far as tearing the rotator cuff. In 1972 Weaver and Dunn described a new procedure for the treatment of instable AC-joints. From 1988 to 1995 we used a modified version of this technique on 24 patients suffering from chronic AC-joint dislocation (Rockwood III-V). After the resection of the AC-joint and the preparation of the coraco-acromial ligament, we transposed the acromial end of this ligament together with a small piece of bone from the acromion tip to the lateral end of the clavicle. The results of this modified method were excellent. All patients had no pain anymore, regained a full shoulder movement, could participate in sport again and returned to work after an average of 3.3 months. This new procedure seems to be the treatment of choice for chronically instable AC-joint dislocations.

[The anterolateral deltoid muscle flap-plasty: the procedure of choice in large rotator cuff defects]. / Die anterolaterale Deltoideuslappenplastik: das Verfahren der Wahl bei grossen Rotatorenmanschettendefekten.

We analysed the results of shoulder reconstruction using an anterolateral deltoid muscle flap plasty in 101 patients with large rotator cuff lesions. This method was first described in Apoil and Augereau in 1985. We modified and extended their technique. Regular follow-up examinations were possible in 100 patients (27 females, 73 males, age 61.3 +/- 8.7 years). One patient died of sepsis of unknown aetiology during the hospital stay. All patients suffered from severe pain and sleepless nights prior to the operation. They also had long histories of unsuccessful and frustrating treatment. The rotator cuff lesions found intraoperatively were at least 5 x 5 cm in size. We used an anterolateral deltoid muscle flap to reconstruct these large defects. Physical therapy was started on the 1 postoperative day and was continued for about 6 months (6.8 +/- 2.6 months). The average hospital stay was 10.9 +/- 5.3 days. After the treatment 90% of all patients were subjectively satisfied or very satisfied with the result, while 12% had moderate and 5% unsatisfactory results. No pain was felt at all by 75% of the patients, and 21% showed decidedly less pain. Severe pain attacks were found in only 4% of the patients, but their pain was less intense than preoperatively. The shoulder function improved significantly, and 72% recovered their strength completely. Most of the patients were able to work after 6 months. The overall result was good to very good in 83%. This high percentage of good shoulder function and patient satisfaction makes this the operation technique of choice for large rotator cuff lesions.

[The deltoid flap-plasty. Therapy of choice in large rotator cuff ruptures?]. / Die Deltoideus-Lappen Plastik. Therapie der Wahl bei der grossen Rotatoren-Manschetten-Ruptur?

Rotator cuff tear is an extremely common and important disease. An extensive rotator cuff tear is an incapacitating event and remains a major problem which forces to respect to the management. The late outcome of majors ruptures of such tears are often a defect-arthropathy with a complete destroy of the shoulder and a loss of flexibility caused by pain. The deltoid muscle plasty, as the logical reconstruction method and relatively easy to perform, lead to better results in compare to all the variety of surgical treatments of restoring the anatomical continuity. This article reviews the clinical manifestations, operative technique and the results associated with the treatment by deltoid muscle plasty. Based on the results. Based on the results of flexibility, and postoperative pain in shoulder we conclude that the early results in our group of the first 20 patients are excellent. 84% of the patients were subjectively very satisfied and free of pain.

[Post-traumatic impingement syndrome caused by a displaced tuberculum majus fragment]. / Das Posttraumatische Impingement-Syndrom durch hochgestiegenes Tuberculum-majus-Fragment.

The posttraumatic impingement-syndrome caused by displacement and retraction of the entire great tuberosity with the bony insertions of the supraspinatus or infraspinatus muscle is often diagnosed with delay. Two types are distinguished: 1. The fracture of great tuberosity with proximal and dorsal dislocation of the fragment impairs motion by impinging under the acromion and against the posterior glenoid wall. 2. The multi-fragment bony fracture at the rotator cuff insertion, usually finish in rotator cuff deficiency. The analysis of the last 22 operated patients demonstrates the important preoperative complaints, commonly during a long time before reconstruction. The excellent postoperative results show the importance of the early and generous management of proximal humeral fractures.

[Ischemic-granulomatous colitis: a new differential diagnosis from Crohn's colitis?]. / Ischämisch-granulomatöse Kolitis: eine neue Differentialdiagnose zur Crohn-Kolitis?

In patients with inflammatory bowel disease the presence of epitheloid cell granuloma is considered to be the most reliable single criterion for the presence of Crohn's disease. We report on 6 patients (5 female, 1 male, mean age 73.5 years) with acute onset of inflammatory bowel disease, in whom the presence of epitheloid cell granuloma led to the diagnosis of Crohn's disease. However, concomitant major bleeding (4/6), absence of small intestinal involvement, and absence of extraintestinal manifestations suggested the presence of ischemic colitis. Histologic findings including thrombosed vessels (6/6), mucosal (5/6) and submucosal (3/4) hemorrhage, and mucosal (3/6) and submucosal (3/4) fibrosis supported this diagnosis. A review of the literature suggests that many clinical features of assumed Crohn's disease in elderly patients are atypical and would be most consistent with an ischemic pathogenesis: rarity of fistula, low recurrence rate, low rate of small intestinal involvement and extra-intestinal manifestations, and increased incidence of major colonic bleeding would best fit with an ischemic pathogenesis in at least some of these patients. We suggest that in elderly patients with "Crohn's colitis", even in the presence of epitheloid cell granuloma, an ischemic etiology should be considered.