[Recreational and competitive alpine skiing. Typical injury patterns and possibilities for prevention]. / Alpiner Skibreiten- und Skileistungssport. Typische Verletzungsmuster und Möglichkeiten der Prävention.

Alpine skiing is the most popular winter sport discipline in Germany and is performed by more than 4 million recreational sportsmen and ski racing athletes. Compared to other sports, however, the injury rate in alpine skiing is quite high. Especially the knee joint is the most commonly injured area of the musculoskeletal system. Knee injuries are classified as severe in a high percentage of cases. In this review article, epidemiologic data and typical injury patterns in recreational alpine skiing and in competitive alpine ski racing are compared. In addition, the potentials of preventive methods in alpine skiing are presented and evaluated with a special focus on orthotic devices and protection wear as injury prevention equipment.

Detecting submaximal effort in power grip by observation of the strength distribution pattern.

This study examined patterns of grip strength when maximal and submaximal effort are applied. Using a sensor glove, 50 healthy subjects performed two different power grips. Both maximal and submaximal gripping showed characteristic patterns of strength distribution that were independent of the degree of power applied. Significant differences were also noted in the strength distribution patterns, depending on whether the grip was performed at maximal, or submaximal, strength. The small finger plays a decisive role in this. In maximal strength gripping, the total measured strength is distributed relatively evenly over all four fingers, with each finger contributing between 23% and 27% of the total strength. In submaximal strength gripping, the little finger is involved very little and only contributes between 14% and 15% of the total strength, with the remainder of the gripping distributed relatively evenly between the index, middle and ring fingers, each of which contributes between 26% and 32% of the total.

[Predictive value of the HISS-scoring system for estimation of trauma severity and the time off work after hand injuries]. / Einschätzung der Verletzungsschwere sowie der Dauer der Arbeitsunfähigkeit bei Handverletzungen mit dem HISS-Bewertungsschema.

BACKGROUND: The estimation of the time off work depending on the injury pattern and severity is of major interest in the treatment of hand injuries. The predictive value of the HISS score (Hand Injury Severity Scoring System) was evaluated. MATERIAL AND METHODS: According to this score, 184 work-related injuries (1999 to 2002) were analyzed prospectively, excluding injuries of both hands. The median age was 37.9 years (18 to 65 years), 11 % of the patients were female. RESULTS: A significant correlation was established between the HISS score and the time off work (p < 0.0001, r = 0.51). The score also correlated with the degree of work incapacity (p < 0.0001). CONCLUSION: Our data confirm the predictive value of the HISS score for the early estimation of the time off work resulting from hand injuries. However, the estimation is limited to injuries distal to the wrist.

[Treatment of flexor tendon injuries in children]. / Die Behandlung von Beugesehnenverletzungen im Kindesalter.

In contrast to the standard therapy of flexor tendon injuries in adults, the postoperative treatment program for children remains a controversial topic. Some prefer immobilization therapy in a variety of forms and for different periods of time. Others prefer early mobilization programs. We present results for twenty-eight children with thirty-seven flexor tendon injuries. The average age was 5.8 years. After primary tendon suture in children six years and younger (group A), our postoperative program consisted of immobilization for three weeks. The older children (group B) were treated with an early passive mobilization program. Follow-up examinations were carried out on twenty six of the children at three months and at 3.7 years. Three months after surgery, the children in group A showed only average results while those in group B presented good finger motion. After 3.7 years both groups showed good results.

[Reconstruction of bone defect by vascularized fibular transfer after failed wrist arthroplasty]. / Die Rekonstruktion eines Knochendefekts nach Explantation einer Handgelenkprothese mit einem vaskularisierten Fibulatransplantat.

A bone defect of 14 cm resulted after wrist implant removal because of loosening in a 46-year-old patient. Performing wrist arthrodesis the defect was reconstructed by a vascularized fibular transfer. Solid bone fusion was complete in six weeks. Free function of the digits was seen because of length reconstruction.

[Infected animal bite injuries of the extremities]. / Infizierte Tierbissverletzungen an den Extremitäten.

The appearance of animal bite injuries varies in regard to location and extent. Injuries with puncture wounds involving the extremities carry great risk of infection. Managing the complications often requires substantial medical treatment and increased costs. The aim of this study is the evaluation of the course of disease, medical care, and treatment costs in patients with infected bite injuries. In the year 2000, 16 patients were treated for infection after bite injuries of the extremities. Fourteen patients received substandard therapy because of incorrect assessment of the extent of the bite wound. Because of infection, the average time needed for treatment before returning to work was 3 months, including 12 days of hospitalization and 16 days of out-patient treatment. The average treatment costs exceeded 6,100 Euro for the health insurance companies. Because of its increasing prevalence and inadequate treatment, this type of injury has become a serious public health problem.

Surface electromyography-verified muscular damage associated with the open dorsal approach to the lumbar spine.

The dorsal approach is increasingly preferred in the surgical treatment of vertebral fractures. However, the access and the implant's position cause muscle loss, which can lead to instability and a reduced capacity for rehabilitation. Morphological factors (bones, intervertebral discs) are typically blamed for chronic pain syndromes in the literature, while less importance is attached to functional factors (muscles). The objective of this study was therefore to investigate the isolated influence of dorsal spinal instrumentation on the back muscles by means of electromyography (EMG). A total of 32 patients with conditions after dorsal spondylodesis following the fracture of a vertebral body and 32 subjects with healthy backs were enrolled in this study. The EMG signal was recorded in three different muscle groups during isometric extension exercise. The evaluation was performed by comparing the mean rectified amplitudes of the three muscle groups in the patients and controls. The patients had significantly lower amplitudes in the multifidus muscle (MF) and significantly higher amplitudes in the iliocostal muscle (IL). Patients with severe pain were found to have lower electric muscle potentials in all investigated muscle groups than patients with mild pain. The muscle damage which was established in the multifidus muscle is compensated by increased activity in the iliocostal muscle. On the basis of anatomical considerations, the damage pattern can be identified as having been caused by surgery. It is extremely unlikely that trauma is the cause.

Soft tissue texture analysis by B-mode-ultrasound in the evaluation of impairment in chronic low back pain.

OBJECTIVE: Patients complaints in chronic low back pain do not always correspond to the results of X-ray and MRI investigations. The paraspinal muscle is very sensitive to all structural disorders of the spine. We used B-mode-ultrasound to investigate the change of the ultrasonic texture of the paraspinal lumbar muscle in people suffering from low back pain. METHODS: The quantitative texture analysis was defined by the ratio of the mean echo level of a unilateral cross-section (L2) of the paraspinal muscle and the level of a central area (L1) of the same cross-section (square 1 x 1 cm, defined by the ultrasonic device). In the lumbar spine there were five cross sections on either side starting at L1 through L5. In the first study healthy males were investigated (n=30). In the second study, 20 males with MRI controlled lumbar disc disorders were investigated. Finally screening was performed with a group of 40 male patients. The last investigation was a pathohistologic cross-check from the ultrasonic findings in five individual shortly after exitus. RESULTS: The ratio showed results >0.6 in the healthy group. The group with lumbar disc disorders showed at the affected levels ratios <0.5. All patients (with one exception) with a lumbar spinal history were detected. Pathohistology confirmed the ultrasonic findings. CONCLUSIONS: The ultrasonic texture analysis of the paraspinal lumbar muscle allows a rapid and easy to perform investigation for relating discal (actually all structural) disorders of the lumbar spine to the reported pain or disability.