[Loading and performance capacity after immobilization operations of the spine]. / Belastbarkeit und Leistungsfähigkeit nach Versteifungsoperationen der Wirbelsäule.

BACKGROUND: The results of spondylodesis depend on various medical and non-medical factors. Prerequisites for a good functional result are a well-founded assessment of the indications and a technically successful execution of the intervention. Furthermore, non-medical factors also play an important role. APPRAISAL: Attention must be paid to personal context factors and environmental conditions. In addition to psychological disorders and social background conditions, the economic considerations of the patient and expected pension payments influence the desire and willingness to return to gainful employment. ASESSMENT: Based on the physical findings, the criteria for assessment of the suitability for old-age pension insurance, the reduction in earning capacity for the obligatory social insurance and establishment of the severity of the resulting impairment/handicap according to the Social Compensation Act and the Act for the Severely Handicapped (Social Act IX) in Germany are systematically presented.

[Structure, contents and findings of an expert report prepared by a medical professional (I)]. / Das professionelle medizinische Gutachten: Struktur, Inhalt, Aussage (I).

The second section in this report on accident-related injuries is concerned with the development and result of the report. Criteria which are generally valid for the preparation of the expert report are developed. The priorities here are the previous history obtained from the medical files, the accident report, description of injuries and pain, determination of the result, evaluation of diagrams and procedures and the diagnoses emerging from the overall picture. Results are assessed in line with the scientific reference literature. The standardised method of result determination and the assessment improve the quality of the expert report. The second section is intended for experts and insurance company employees.

[Preparation and assignment of medical reports: basis for settlement of compensation claims]. / Medizinische Gutachten vorbereiten und vergeben: Grundlage der Regulierung von Personenschäden.

Medical reporting represents an essential element in the settlement of personal claims. Moreover, the report prepares the basis for determing the compensation which is appropriate to the injury. The practice of instructing the expert medical assessor to obtain the medical documents required has proved a failure and causes delays in completion of the report. The doctor who is the expert medical assessor is often unsuccessful in obtaining these vital documents. In doubtful cases the expert will deliver his report without access to the vital documents. Incomplete reports affect the settlement adversely and promote unnecessary legal disputes. Many errors can be avoided if the officials of the relevant insurance company prepare the report assignment carefully. Such preparation includes clarification of the accident circumstances, requests for copies of the primary diagnosis and requests for hospital and medical reports, including full details of surgery carried out. Printouts of the daily reports by the doctors involved are also required. Of course these doctors must be released from the obligation to treat medical records confidentially. Furthermore, if the original documents are used, results of the injury which may seem insignificant will not be overlooked. The report assignment and primary medical documents should be sent to the medical assessor at the same time. The report assignment contains a detailed questionnaire which takes into account the particular aspects of the individual claim.

[Expert appraisal of spinal injuries]. / Begutachtung von Wirbelsäulenverletzungen.

Appraisals and expert opinions of clearly identified injuries of the spine, ranging from fractures and dislocations to intervertebral disc ruptures and haemorrhage into soft tissue are generally unproblematic. The residual functional deficit is commensurate with the extent of damage. However, differences between the patient's symptoms and objective findings can be unrelated to the injury, and are often explained by the actual compensation process or other psychological/psychosocial factors. The current article discusses a basis for providing expert medical opinions, as well as a number of practical tips on the German medical insurance system. Particular attention is paid to expert opinions on causality. The article also includes information on the evaluation of structural injuries to the spine on the basis of assessment criteria that have proven to be reliable and authoritative in recent decades.

[Deformities following spinal injury at the thoracolumbar junction]. / Fehlstellungen nach Wirbelsäulenverletzungen im thorakolumbalen Ubergang.

Due to anatomical characteristics, posttraumatic deformities following spinal injury occur in particular at the transition from the flexible lumbar spine to the rigid thoracic spine. Incorrectly classified vertebral body fractures can lead to the development of posttraumatic kyphosis due to incorrect treatment. It is likewise important to evaluate the integrity of adjacent discs and assess the sagittal index. Management of kyphosis is difficult and requires radiological evaluation following exact planning. Reconstruction of the sagittal anatomical contour is crucial to prevent stress in the compensatory curves. Performing a dorso-ventral or dorso-ventro-dorsal approach, pedicle subtraction osteotomy or an eggshell procedure is also helpful to achieve good correction without anterior reconstructive surgery. The clinical result is not dependent on correct repositioning alone; poor results can be expected in cases with pseudarthrosis, neurological deficits and severe kyphotic deformities. This article gives an overview of pathogenesis, diagnostic steps and therapeutic options for corrective spinal surgery.

["Isolated injury" of the alar ligaments: MRI diagnosis and surgical therapy]. / "Isolierte Verletzung" der Ligamenta alaria : Kernspintomographische Diagnostik und operative Therapie.

UNLABELLED: Spinal distortions caused by traffic collisions play a large role in medical expert opinions. Prolonged or chronic conditions present particular difficulties. The radiologist E. Volle developed and published a system for the classification of isolated injuries of the alar ligaments. As a result, surgery on the craniocervical junction was carried out in a large number of patients and the results published on multiple occasions. This article describes the anatomy of the alar ligaments, complicated injuries, the concept of the isolated lesion of the alar ligaments and their surgical management. German and international publications are evaluated. RESULT: It was impossible to substantiate isolated injuries to alar ligaments. According to current knowledge, the published results are based on a misinterpretation of MRI findings. These results are to be considered as artefacts. There is no anatomical correlation for the classification of isolated injuries to alar ligaments. Surgical stabilisation due to an allegedly isolated injury to the alar ligaments is therefore not indicated. This statement does not apply to injuries sustained in high-speed trauma in combination with complex injuries of the atlanto-occipital and atlanto-dental-joint (joint capsules, atlanto-occipital membrane) with clear signs of instability.

[Wiplash injury and "railway spine"]. / Schleudertrauma und ,,railway spine" (I). Die Verantwortung von Arzten und Psychologen: Versicherungsmedizinische Bedeutung somatofomer Störungen und ihre Abgrenzung zur posttraumatischen Belastungsstörung.

Although post-traumatic stress disorder was only recently admitted into the international classification systems, psychological reactions to traumatic incidents have been frequently described for more than 100 years. The article deals with the mental reactions to a trauma in different historical situations. Included are the "railway spine" injuries of the 19th century, victims of accidents where third party liability could be claimed, accident insurance, the psychological consequences of National Socialism and whiplash injury. The analysis suggests that different reactions don't describe an identical disorder. It seems that reactions to injuries are mainly influenced by the historical and social background and the fact of beeing insured.

[Pain and its treatment reflected in time]. / Der Schmerz und seine Therapie im Spiegel der Zeit.

This article describes the history of pain therapy and anesthesiology with respect to the field of surgery. The history of this part of medicine is dependent upon the development of the appropriate medication groups, which were of great importance in the field of pain therapy and anesthesiology. Specifically the development of nitrous oxide, ether, morphine and the first local anesthesiologic substances will be described and discussed. The above mentioned developments combined with the knowledge of physiology of pain and new results from psychological studies led to the modern pain therapy in recent perioperative treatment concepts. Modern pain therapy is a multimodal therapy concept with a variety of specialties working as a team to optimize an individualized therapy plan which respects the needs of every single patient under different circumstances (acute, perioperative and chronic pain).

[History of 1906 census of handicapped patients]. / Die Geschichte der Reichskrüppelzählung von 1906.

The census of cripples ("Reichskrüppelzählung") in the German Reich plays a central role in the development of orthopaedic surgery. Local censuses conducted by protestant ministers had already pointed out the great number of disabled children without appropriate care. It was the achievement of Konrad Biesalski, who was an orthopaedic surgeon, and of Eduard Dietrich, a Prussian government official, that a nation-wide census for disabled people was conducted. The concerns of the Reich-health-administration, which had complained about the way the survey was to be made, were neglected. These concerns were not all unjustified. Both the planning of the census itself and the technical interpretation of the obtained numbers were full of errors. The number of cripples in need of a place in an asylum were very exaggerated. Biesalski is to be held responsible for this systematic error. For him the census was only a way to influence the public opinion and had no scientific value. The public was worried by the great numbers of cripples in need of medical care and the foundation of asylums for cripples was added to the social political agenda. Along with these asylums came the promotion of orthopaedic surgery. The law, which laid the foundation for these institutions, the "law for the welfare of the cripples in Prussia" of 1920, would have never been passed, if it had not been for Biesalski's manipulated numbers. One can say that the artificially inflated numbers of the "Reichskrüppelzählung" were a lie for a good cause.

[100 years Zeitschrift für Orthopädie, Z. Orthop. 131 (1993) 195-207]. / 100 Jahre Zeitschrift für Orthopädie, Z. Orthop. 131 (1993) 195-207.

The historical review of 100 years of the Zeitschrift für Orthopädie could create the impression that the Nazi era did not have any significant impact on orthopedics in Germany. In this commentary it is shown that the Prevention of Heredopathic Offspring Act of 1933 resulted in an uncritical overemphasis on hereditary factors. This decisively influenced concepts of, research into and therapy for hip dislocation, both in Germany and other countries.

[100 years of Zeitschrift für Orthopädie]. / 100 Jahre Zeitschrift für Orthopädie.

The article affords insight into the one hundred years' history of the Journal of Orthopedics. The existing 130 volumes reflect the change in the orthopedic spectrum of illness, diagnostic investigation and treatment. Already in its first few years of existence, the journal was a forum for international exchange. Investigation of various epochs showed that the editors applied strict scientific standards in selecting the publication, despite basis changing historical conditions. They were able to prevent political interventions appreciably influencing the character of the journal. At the same time, the negative effects which the two world wars and National Socialism had on the further development of orthopedics become evident. The extent to which, as a result of these, the development of orthopedics fell behind international development could only be overcome in the last few decades.

[A modern textbook is 100 years old. Albert Hoffa and the "Textbook of Orthopedic Surgery"]. / Ein modernes Lehrbuch wird 100 Jahre alt. Albert Hoffa und das "Lehrbuch der orthopädischen Chirurgie".

The appearance of Albert Hoffa's "Textbook book of orthopaedics" in 1891 saw the young special discipline enter a new phase of professionalisation in the German-speaking countries. Hoffa defined in this work the scope and methodology of orthopaedics in a sense that is still valid today. By including operative and conservative forms of treatment, he created the foundation for a continued scientific development of the subject. Only with the appearance of Hoffa's work did orthopaedics gain acceptance as a special area by many physicians. The far-reaching influence and significance of the textbook for orthopaedics is portrayed with the aid of historic sources.