Treatment management and outcome of polytraumatized patients in a German certified trauma center - comparing standard versus maximum care.

German hospitals are classified as basic, standard and maximum care facilities within the German trauma networks. The Municipal Hospital Dessau was upgraded in 2015 as a maximum care provider. The aim of this study is to investigate whether a change in treatment management and outcome of polytraumatized patients has occurred afterwards. The study compared polytraumatized patients, treated in the Dessau Municipal Clinic as a standard care facility (DessauStandard) from 2012-2014 vs. those treated in the Dessau Municipal Clinic as a maximum care facility (DessauMax) from 2016-2017. Data of the German Trauma Register were analysed using the chi-square test, t-test and odds ratios with 95% confidence intervals.In DessauMax (238 patients; Ø 54 years, SD 22.3; ♂ 160, ♀ 78), the shock room time with 40.7 min (SD 21.4) was shorter than in DessauStandard (206 patients; Ø 56.1 years, SD 22.1; ♂ 133, ♀ 73 ) with 49 min (SD 25.1) (p=0.001). The transfer rate of 1.3% (n=3) to another hospital was lower in DessauMax (p=0.01). DessauStandard had 9 (4%) thromboembolic events and DessauMax 3 (1.3%) (p=0.7). Multiorgan failure was more common in DessauStandard, (16%) than in DessauMax (1.3%; p=0,001). DessauStandard showed a mortality of 13.1% (n=27), and DessauMax 9.2% (n=22) (p=0.22; OR=0.67, 95% CI, 0.37-1.23). The GOS in DessauMax (4.5, SD 1.2) was higher than in DessauStandard (4.1, SD 1.3) (p=0.002).The Dessau Municipal Clinic as a maximum care facility has achieved improved shock room time, fewer complications, lower mortality and an improved outcome.

[Etiology, pathogenesis, clinical features, diagnostics and conservative treatment of adult flatfoot]. / Ätiologie, Pathogenese, Klinik, Diagnostik und konservative Therapie des adulten erworbenen Plattfußes.

BACKGROUND: On average, one in six adults is affected by an acquired flatfoot. This foot deformity is characterized by its progression of stages and in 10% of cases causes complaints that require treatment. Untreated, the loss of walking ability may result in the final stage. Correct staging is crucial to being able to offer a specific course of therapy including a wide spectrum of conservative and operative treatments. MATERIAL AND METHODS: This review is based on pertinent publications retrieved from a selective search in PubMed and Medline and on the authors' clinical experience. DIAGNOSTICS: The loss of function of static (spring ligament complex) and dynamic (tibialis posterior tendon) stabilizers causes the characteristic deformity with loss of the medial arch, hind foot valgus and forefoot abduction. In the late stage, severe secondary osteoarthritis in upper and lower ankle joints occurs and impedes walking ability. The essential physical examination is supplemented by weight-bearing dorsoplantar and lateral radiographs, which provide further information about axial malalignment (Meary's angle, Kite's angle). The long axis hind foot view allows analysis of the hindfoot valgus. MRI provides further information about the integrity of the tibialis posterior tendon, spring ligament complex and cartilage damage. THERAPY: The therapy aims to reduce pain, regain function and avoid development of secondary osteoarthritis and degenerative tendon disorders. Progress of the deformity should be stopped. Therefore, the main aspects of the deformity-loss of medial arch, hindfoot valgus and forefoot abduction should be addressed and corrected. In the acute phase, tendovaginitis of the tibialis posterior tendon can be treated sufficiently by anti-inflammatory measures, relieving mechanical loads on the tendon and muscle and physiotherapy.

[Slowly progressive joint destruction in an older man as expression of hydroxyapatite disease. Case report and literature review]. / Langsam progrediente Gelenkzerstörung bei einem älteren Mann als Ausdruck einer Hydroxylapatiterkrankung. Fallbericht und Literaturübersicht.

This article reports the case of a 75-year-old male patient presenting with arthralgia of the large joints that had existed for 10 years. Clinically, bursitis of the right elbow joint was found. Laboratory tests showed elevated inflammatory markers and imaging revealed erosive joint destruction. A surgical bursectomy was performed. Histologically, hydroxyapatite crystals were detected in alizarin red S staining and a crystal arthropathy was diagnosed. The diagnostics are difficult since crystals can only be detected by electron microscopy or special staining methods.

Posterolateral plate fixation with Pantalarlock® is more stable than nail fixation in tibiotalocalcaneal arthrodesis in a biomechanical cadaver study.

BACKGROUND: Despite the promising results of ankle joint arthroplasty, the tibiotalocalcaneal (TTC) arthrodesis remains an established procedure in treatment of combined pathology of the ankle and subtalar joint. Despite the promising results in biomechanical investigations, nonunion rates of up to 24% are described in recent studies. The objective of this work was a comparative study of the biomechanical properties of the posterolateral plate fixation with retrograde intramedullary nail fixation. METHODS: Twenty four fresh-frozen human lower leg specimens (12 pairs) were used for the comparative biomechanical testing. Every specimen was preconditioned with 100 N over 200 cycles. After every 250 cycles the force was increased by 50 N from 200 to 600 N. This was followed by cyclic loading in dorsi-/plantiflexion with 800 N for 3000 cycles. All specimens were subjected to bone densitometry (DXA) and computed tomography. RESULTS: Significantly higher number of spacimens with nails (4) failed during the cycling testing in dorsi-/plantarflexion and futher two during the cyclic testing with 800 N. Two specimens with plates failed during the cyclic testing with 800 N. Statistical analysis showed that the specimens with the plate were significantly more stable in each test direction. The Pearson correlation demonstrated for the specimens with plate a linear relationship between the stiffness and the determined bone density. CONCLUSIONS: The results demonstrate a significantly superior stiffness of the Pantalarlock®-plate in all testing directions compared with the HAN nail. Probably the position of the plate on the tension side of the joint and the combination of locking and lag screws provide the higher stiffness of the plate system. The correlation of the stiffness with bone density leads to more predictable results of the plate arthrodesis. We hope for a reduction of the pseudarthrosis rate and shorten the postoperative treatment phase. The authors expect advantages in the treatment of high risk patients with severe deformity of the ankle, bone defects, neuropathic deformity, poor bone quality and osteoporosis.

Biomechanical results of percutaneous calcaneal osteotomy using two different osteotomy designs.

BACKGROUND: Percutaneous osteotomy of calcaneus has been proposed to reduce the complication rate and became more and more popular. The bone cut can be performed as a straight or chevron-like (V) osteotomy using a Shannon burr. Comparative studies of straight or V-osteotomy as like as one or two screws in percutaneous calcaneal osteotomies are missing in the literature. We hypothesize that the V-osteotomy will result in a higher stiffness in biomechanical testing as the straight osteotomy using single screw for fixation. METHODS: The straight osteotomy (9 fresh-frozen specimens) and V-osteotomy (9 fresh-frozen specimens) was performed and the calcaneal tuberosity was moved 10mm medially and slightly rotated. One 6,5mm cancellous compression screw was used for osteosynthesis. Specimens were preconditioned with 100N over 100 cycles. The force was increased after every 100N by 100N from 200 to 500N. This was followed by cyclic loading with 600N for 500 cycles. RESULTS: Despite the higher mean values of the group with V-osteotomy, no significant difference was registered between the two groups regarding the stiffness at all force levels. A higher failure rate was observed in the group with straight osteotomy. CONCLUSION: The moderate correlation of bone density and stiffness in the V-group, and significantly lower failure rate with no secondary dislocation in fluoroscopy indicates the superiority of the V-osteotomy in the present study. Whether the demonstrated advantages can be reflected in clinical practice should be investigated in further studies. LEVEL OF CLINICAL EVIDENCE: 5.

Preliminary results of a plantar plate for Lapidus arthrodesis.

The TMT I arthrodesis is an established procedure for the correction of hallux valgus deformity associated with the instability of the TMT-I joint. A risk of transfer metatarsalgia is reported in the literature associated with persistant elevation of MT-I. Detailed information for ideal positioning of the arthrodesis is missing so far. Clinical, radiological and padobarografical results and their correlations were analyzed with special consideration of the elevation position of the MT-I in a TMT-I arthrodesis using the plantar plate osteosynthesis. Postoperative changes in plantar pressure and force distribution occured after TMT-I arthrodesis. A postoperative increase of the load under the medial forefoot and the dependence on the positioning of MT-I in the sagittal plane has been shown. The authors suggest, that increased load of the medial forefoot and constant pressures and forces under the central forefoot may lead to a relative relief of the area, which might explain the postoperative reduction of metatarsalgia.

Posterolateral plate fixation with Talarlock® is more stable than screw fixation in ankle arthrodesis in a biomechanical cadaver study.

BACKGROUND: A number of studies report on limitations of the screw arthrodesis in severe malalignment of the hindfoot, neuropathic deformity, poor bone quality and osteoporosis. METHODS: Fourteen anatomically correct polyurethane foam models of the right leg (Sawbones Europe, Malmö, Sweden) and eighteen fresh-frozen human lower leg specimens (9 pairs) were used for the comparative biomechanical testing. RESULTS: The statistical analysis of the stiffness of the fixation developed a significant difference in favor of the plate in all test directions. CONCLUSIONS: The excellent biomechanical results are very promising and we hope for a reduction of the pseudarthrosis rate and shorten the postoperative treatment phase.

Experimental Arthritis in the Rat Induced by the Superantigen Staphylococcal Enterotoxin A.

The pathogenesis of rheumatoid arthritis (RA) is incompletely understood. Human endogenous retroviruses (HERVs) and their superantigenic envelope protein (env) have been implicated in the pathogenesis of RA. In the present investigation, the arthritogenic potential of the superantigen staphylococcal enterotoxin A (SEA) has been investigated. In the present investigation, the bacterial superantigen staphylococcal enterotoxin A (SEA) was injected into the right knee joint of 15 Lewis rats. Further nine animals received saline. Animals were sacrificed one, five and 10 days after the injection, respectively. The antigens CD3, CD4, CD8, MHC class I, MHC class II, Pax5 and CD138 were investigated by immunohistochemistry on cryo-sections. After intra-articular SEA injection, the inflammation was initially dominated by CD8+ T cells. In the course of the investigation, the numbers of CD4+, Pax5+, CD138+ and MHC class II+ cells increased. CD3 was expressed in low numbers as compared to CD8. After saline injection, no similar inflammatory response has been detected. The arthritis induced by the superantigen SEA may be a novel model for inflammatory joint diseases, that is rheumatoid arthritis or juvenile idiopathic arthritis.

[Influence of external pelvic stabilization on hemodynamically unstable pelvic fractures]. / Einfluss der externen Beckenstabilisierung bei hämodynamisch instabilen Beckenfrakturen.

BACKGROUND: In the treatment of complex pelvic fractures hemorrhage control is of primary importance; however, studies regarding the localization of bleeding are contradictory so that various treatment approaches are recommended. The primary aim of external pelvic compression applied in the trauma room is to reduce the pelvic volume and counteract blood loss through self-induced tamponade. This study examined the influence of external pelvic compression on mortality and outcome in cases of hemodynamically unstable pelvic fractures in a larger number of cases. MATERIAL AND METHODS: The current study used the TraumaRegister DGU® (TR-DGU) to retrospectively evaluate the records of 104 patients treated between 2002 and 2011. All patients suffered severe injury with an injury severity score (ISS) of at least 16 points. In addition, the patients were hemodynamically unstable with confirmed relevant isolated pelvic injuries. To evaluate the effectiveness of external pelvic compression, patients with and without external pelvic stabilization were compared. RESULTS: Of the investigated patients 26.9 % died of their injuries and of these the mortality was 78.6 % within the first 6 h of admission to the trauma room. External pelvic stabilization was performed in 45.2 % of patients. The mortality was 19.1 % in patients with external pelvic stabilization and in contrast, the mortality in the group of patients without external pelvic stabilization was 33.3 %. During the course of hospitalization, surviving patients with external pelvic stabilization were significantly more likely to develop sepsis or multiple organ failure and required longer periods of intensive care. CONCLUSION: External pelvic stabilization seems to be an important instrument for the initial treatment of hemodynamically unstable pelvic fractures and showed a positive effect on patient mortality.

[Prehospital assessment of injury type and severity in severely injured patients by emergency physicians : An analysis of the TraumaRegister DGU®]. / Präklinische Einschätzung der Verletzungsart und ­schwere beim Schwerverletzten durch den Notarzt : Eine Auswertung des TraumaRegister DGU®.

BACKGROUND: Prehospital assessment of injury type and severity by emergency medical services physicians impacts treatment including appropriate destination hospital selection, especially in (potentially) life-threatening cases. Injuries which are underestimated or overlooked by the emergency physician can delay adequate therapy and thus significantly influence the overall outcome. The current study used data from the TraumaRegister DGU® to evaluate the reliability of prehospital injury assessments made by emergency physicians. MATERIAL AND METHODS: Data of 30,777 patients from the TraumaRegister DGU® between 1993 and 2009 were retrospectively evaluated. Using the abbreviated injury scale (AIS), subjective prehospital assessments of injury severity by emergency physicians were correlated with objectively identified injuries diagnosed after admission to hospital. For this evaluation, prehospital injury assessments rated moderate or severe by the emergency physician as well as injuries diagnosed in hospital with an AIS score ≥3 points were deemed relevant. RESULTS: The 30,777 patients with an injury severity score (ISS) ≥ 9 suffered a total of 202,496 injuries and of these 26 % (51,839 out of 202,496) were considered relevant with an AIS ≥3 points. The most frequent relevant injuries were to the head (47 %) and chest (46 %). Of the 51,839 relevant injuries, the prehospital assessment by the emergency physician was accurate for 71 % and in 29 % of the cases relevant injuries were underestimated. Relevant injuries were unrecognized or underestimated in prehospital assessments for almost 1 out of every 7 cases of head trauma, almost 1 out of every 3 thoracic trauma and almost 1 out of every 2 abdominal and pelvic trauma. CONCLUSION: The assessment of injury severity by emergency medical services physicians based on physical examination at the scene of the trauma is not very reliable. Thus, mechanisms of injury and overall presentation as well as identifiable injuries and vital parameters should be recognized by the emergency physician when considering treatment strategies and choice of appropriate destination hospital. The patient should be re-evaluated in a priority-oriented manner at the latest on arrival in the trauma room to avoid the consequences of unrecognized or underestimated injuries.

[Fast Response Training in Youth Soccer Players]. / Hochreaktives Training bei jugendlichen Fußballspielern.

BACKGROUND: Injuries of the knee and ankle joint are a serious ongoing problem in soccer. Although there is a variety of prevention programmes, a significant reduction of severe knee injuries has not been observed. Therefore, current strategies for diagnostics and training need to be re-evaluated. OBJECTIVE: Our study aimed to test a totally new intervention strategy (fast response training on the SpeedCourt). The efficiency of this method was evaluated with youth soccer athletes. MATERIALS AND METHODS: 24 young male class A athletes (mean age 18.0 ±â€Š0.7 years) of a local soccer team underwent SpeedCourt training for 7 weeks (1 training session per week = TS) during the regular season of competition. TS contained life-kinetic elements (time of exercise: 15 - 30 seconds, break: 2 minutes) and included a warm-up phase (15 minutes) and fast response training on the SpeedCourt (30 minutes). The players were tested on the SpeedCourt with different tests (Counter Movement Jump (CMJ), shuttle run, tapping, 10-second sprint) before and after the training programme. RESULTS: The univariate single-factor analysis of variance showed significant improvements in all test parameters (η(2)> 0.10). The range varied between η(2) = 0.106 (time of ground contact right leg) und η(2) = 0.730 (reaction time right leg). We did not find any relevant correlations between the tests and parameters. The number of injury-related accidents involving the lower extremities was reduced by about 50 % during defined periods of time. CONCLUSION: Our data revealed that training with fast responses at the SpeedCourt system clearly improved speed and speed strength performance of young soccer athletes, which is remarkable given the low intensity of influences (one TS per week). The increase in performance was accompanied by a significant reduction of the injury rate.

[How Valid is the Performance Diagnostic in Soccer?]. / Wie valide ist die Leistungsdiagnostik im Fußball?

BACKGROUND: Assessments of physical and physiological performance tests in soccer sports are still unspecific yet. There is also a lack of scientific validation using those as a "golden standard". Concerning match performance a large deficit also exist in sports and medical science. OBJECTIVE: The aim and purpose of this multicentric and prospective diagnostic study was to evaluate the validity of current established and recommended diagnostic tests for endurance and match performance (golden standard: real time of playing) in soccer. MATERIALS AND METHODS: In a prospective study protocol two German soccer teams from the fourth (n = 22) and third (n = 24) national league first underwent different tests of performance and diagnostics ahead of the competition season (tapping, drop jump, counter movement jump, speed dribbling, treadmill running test). Afterwards, match performance of each athlete was assessed by real time of playing (as a surrogate parameter) during the half season (14 and 25 matches). We finally compared test parameters with the match performance in a linear regression analysis. RESULTS: Our analysis showed no statistical relevant relationship between test parameters and match performance (r(2) < 0.10). Only the assessment in maximum of relative oxygen uptake during the treadmill test for endurance was associated with a higher amount of variance (12%). CONCLUSIONS: According to the study results there is no relevant and valid correlation between current established diagnostic tests in soccer sport and sport-specific performance. The time of real engagement during a match might be associated with a quality of performance for the single athlete. Therefore, the assessment of this match activity is the most important parameter for improving diagnostic tests in soccer. The existence of a "golden standard" is essential for validation of any tests and parameters and the development of new specific assessments. At the moment, physical performance tests have no scientific evidence in soccer sports.

Immediate fullweightbearing after tarsometatarsal arthrodesis for hallux valgus correction--Does it increase the complication rate?

BACKGROUND: The arthrodesis of the first tarsometatarsal joint has a high correction potential in the treatment of hallux valgus deformity. Compared to distal correction procedures, a pseudarthrosis rate of 12-20% is quoted, however. In a prospective study the results of two different treatment procedures after correction arthrodesis were compared. METHODS: In 17 cases the patients were mobilised with a short arthrodeses shoe with floor contact (NWB group) and in 17 cases in a short arthrodeses shoe with immediate fullweightbearing (FWB group). Clinical and radiological evaluation was done preoperatively, six weeks and one year postoperatively, including visual analogue pain scale and AOFAS score pre- and one year postoperatively. RESULTS: There was no increased complication rate in the group with FWB group. The patients in the FWB group were significantly earlier fit for work. CONCLUSION: Immediate fullweightbearing after TMT I arthrodesis using a plantar plate should be established as a standard posttreatment.

Three-dimensional virtual simulation and evaluation of the femoroacetabular impingement based on "black bone" MRA.

INTRODUCTION: Femoroacetabular impingement (FAI) is a recognised cause of secondary osteoarthritis of the hip. Several imaging methods have been used to analyse the pathologic signs. Because of the lack of precise pre- and intraoperative overview and the difficulty locating osseous pathologies, arthroscopic and minimal invasive treatment is still challenging, even for trained surgeons. This paper describes a procedure that is based on magnetic resonance arthrography (MRA) and is used to virtually verify the range of motion (ROM) of the hip. It enables the evaluation of FAI and the preoperative simulation of adequate surgical manoeuvres. METHODS: Each MRI was completed on a 3.0 T system using a flexible transmit/receive surface body coil with the patient in the supine position. An axial three-dimensional (3D) gradient-echo (VIBE, volume interpolated breathhold examination) sequence was performed. For the generation of 3D bone models, semiautomatic segmentation of the MRA data was accomplished using Amira(®) visualisation software version 5.2. The self-developed software "HipProject", written in C++, computes the maximal ROM of the hip. The virtual colliding regions were visualised for verification and simulation of osseous trimming. RESULTS: In addition, for necessary information about damage to the cartilage and labrum, "black bone" MRA was used to generate extremely precise 3D reconstructions of the hip joint to automatically calculate the preoperative osseous ROM. Furthermore, the acetabular and femoral locations of the impingement zone were individually visualised and quantified. CONCLUSIONS: The described procedure is a useful tool for the preoperative investigation of impinging hips. It enables appropriate planning of required surgical interventions.

Frequency, severity and predictors of playing-related musculoskeletal pain in professional orchestral musicians in Germany.

Playing-related musculoskeletal disorders (PRMD) in professional musicians are common. Existing literature demonstrates that up to 86 % of musicians are affected. The aim of the study was to evaluate the frequency of musculoskeletal pain in professional orchestral musicians with regard to their instrument affiliation. Of special interest were pain intensity and its association with predictors such as gender, instrument group, age or stage fright. Professional orchestra players completed a self-report questionnaire to assess playing-related musculoskeletal pain and its frequency and intensity in various body regions on a numeric rating scale (NRS). Relative frequencies and prevalence ratios for different instrument groups were estimated. Out of 720 approached musicians, 408 were included in the sample (response rate 57 %); overall, 89.5 % had been affected by current or past playing-related musculoskeletal pain, 62.7 % reported pain in the previous 3 months, and 8.6 % reported current pain. Pain distribution and frequency varied between instrument groups. For all instrument groups, the neck was the most common pain region. About 43 % of musicians presented more than five pain regions, in particular violin players. Approximately 40 % of musicians indicated frequent or permanent pain. Average pain intensities increased from NRS 3.8 up to a range of 5.9 and 7.4 for frequent and permanent pain, respectively. Female gender and stage fright were proven to be predictors for musculoskeletal pain. Professional orchestral musicians are greatly affected by PRMD, often experiencing frequent or permanent pain, high pain levels and pain in various body regions. As PRMD might contribute considerably to performance disability, sick leave and the possibility of premature termination of a musicians' career, this study highlights the necessity for tailored therapeutic and preventive strategies in performing arts medicine.

Anatomical conditions of the posterior pelvic ring regarding bisegmental transverse sacroiliac screw fixation: a 3D morphometric study of 125 pelvic CT datasets.

INTRODUCTION: Sacroiliac (SI) screws are used for osteosynthesis in unstable posterior pelvic ring injuries. In the cases of "sacral dysplasia", in which the elevated upper sacrum does not allow a secure SI screw insertion into the S1 level, the S2 segment must be used to achieve stable fixation. The bone quality of the S2 segment is thinner compared to that of the S1 vertebra and may cause biomechanical weakness. An additional SI screw insertion into the S3 level may improve stability. With respect to the anatomical conditions of the posterior pelvic ring, there have been no anatomical investigations to date regarding SI screw placement into the third sacral segment. MATERIALS AND METHODS: CT raw datasets from 125 patients (ø59 years, ø172 cm, ø76 kg) were post-processed using Amira 5.2 software to generate 3D pelvic models. A program code implemented in C++ computed a transverse bone corridor for the first, second and third sacral segments for a typical SI screw diameter of 7.3 mm. Volume, sagittal cross-section, iliac entrance area and length of the determined screw corridors were measured. A confidence interval of 95 % was assumed (p < 0.05). RESULTS: The fully automatic computation revealed a possible transverse insertion for one 7.3-mm screw in the third sacral segment in 30 cases (24 %). The rate (60 %) of feasible S3 screw placements in the cases of sacral dysplasia (n = 25) is significantly higher compared to that (15 %) of "normal" sacra (n = 100). With regard to the existence of transverse iliosacroiliac corridors as a function of sacral position in between the adjacent iliac bone bilaterally, a new classification of three different shape conditions can be made: caudad, intermediate minor, intermediate major, and cephalad sacrum. Gender, age, body height and body weight had no statistically significant influence on either possible screw insertion or on the calculated data of the corridors (p > 0.05). CONCLUSION: SI screw insertion into the third sacral level deserves discussion in the cases of sacral dysplasia. Biomechanical and practical utility must be verified.

[Intraobserver reliability of the Handball-specific complex test (HBKT)]. / Intraobserverreliabilität des handballspezifischen Komplextests (HBKT).

BACKGROUND: There are clearly no complex and sports-specific tests in handball. So far, no specific complex test has been developed and verified for its intraobserver reliability (IR). OBJECTIVE: The aim of this study was to determine the IR of the Handball-specific complex test (HBKT). METHODS: The HBKT was applied twice at an interval of two days to two teams of the German Third League (n = 30; age 25.7 ±â€Š3.9 years, range: 19 - 33 years). Within the HBKT, the stress parameters lactate and heart rate as well as the loading parameters time, throwing velocity and number of errors were collected. RESULTS: Overall, 23 % (3/13) of the stress parameters showed a high relative [intraclass correlation coefficient (ICC) > 0.75] and absolute [coefficient of variation (CV) ≤ 5 %] IR. On average, a sufficient absolute (∅CV = 11.3 %) and relative (∅ICC = 0.67) IR was observed. Without the parameters "missed throws" and "technical errors" in both rounds, the IR increased significantly (∅ICC: from 0.67 to 0.72 & ∅CV from 11.3 to 6.3 %). The heart rate was comparatively more reliable than lactate (∅ICC = 0.71 & ∅CV = 4.23 % vs. ∅ICC = 0.65 & ∅CV = 15.1 %). With respect to load parameters in round one, 50 % (5/10) showed a high IR; in round two, these values decreased to 40 % (4/10). The mean IR of the parameters in round one was higher than in round two (∅ICC = 0.71 & ∅CV = 12.2 % vs. ∅ICC = 0.60 & ∅CV = 14.3 %). Overall, there was an improvement of the athletes in most stress and load parameters from session one to session two. CONCLUSIONS: The HBKT can be attested with a sufficient intraobserver reliability. When the parameters "missed throws" and "technical errors" were excluded, the IR further increased significantly. Therefore, these parameters should be recorded in order to standardized the HBKT, but not be included in the statistical analysis. There are discrete adaptation and learning effects. For this reason, it is essential to familiarise trainers and players with the HBKT test procedure before the first measurement. Otherwise training effects can be easily overrated. Moreover, the test concept of HBKT can be used as a blueprint for the development of sport-specific tests in other team sports (e. g., soccer, basketball). For example, we generated a complex soccer-specific field test 1 based on the HBKT.

[Morbid obesity in total knee arthroplasty: a critical case review]. / Morbide Adipositas in der Knieendoprothetik: Eine kritische Einzelfallbetrachtung.

HISTORY AND ADMISSION FINDINGS: In a 66-year-old obese woman (WHO stage III, BMI 51 kg/m2) pronounced osteoarthritis of the right knee was diagnosed. Because of progressive chronic pain of the right knee joint her walking distance was limited to a few meters. Conservative therapy was exhausted. INVESTIGATIONS: Clinical examination showed a restricted and painful range of motion of the right knee and distinctive obeseness on the trunk and the extremities including a lipedema/lymphedema. TREATMENT AND COURSE: After a complicated course of treatment lasting for 220 days the total knee replacement ended in an arthrodesis combined with a gastrocnemius muscle flap. CONCLUSION: With respect to this case the high complication-rates in obese patients should be taken into account: Total knee replacement can even lead to loss of the limb in the worst case. In addition to extended preoperative examination this indication should be critically scrutinized.

Symptoms of craniomandibular dysfunction in professional orchestra musicians.

BACKGROUND: Up to 80% of professional musicians are affected by playing-related musculoskeletal disorders, but data regarding the frequency of craniomandibular dysfunction (CMD) in professional orchestra musicians is scarce. AIMS: To evaluate the frequency of CMD and its relation to musculoskeletal pain in various body regions. METHODS: A questionnaire-based survey approach assessing CMD symptoms and musculoskeletal pain in professional orchestra players was adopted. Relative prevalence rates and prevalence ratios for different instrument groups were estimated. RESULTS: A total of 408 musicians completed the questionnaire (response rate 57%). Playing-related pain in the teeth or jaw was reported by 19-47% of musicians and TMJ pain by 15-34%, depending on the instrument group. Current pain in the face indicating a painful CMD was reported in 6-10% and related symptoms such as teeth grinding in 25-34%, jaw clenching in 33-42% and jaw locking in 11-18% of musicians. Females were 2.4 times (95% confidence intervals (CI) 1.49-3.84) more likely to report having had orofacial pain within the last month. Musicians reporting orofacial pain within the last month were 4.8 times (95% CI: 2.83-8.02) more likely to report pain in the neck and 2.5-3.8 times (P < 0.05) more likely to report pain in other body regions, including shoulders, right wrist, left fingers and the thoracic and lumbar spine. CONCLUSIONS: Symptoms suggesting CMD were common in this study of professional orchestra musicians and were associated with pain in the neck, shoulder and hands. There is a need to enhance awareness of CMD to optimize early medical diagnosis and treatment.

[Ankle arthrodesis with an posterolateral approach using a polyaxial angle stable Talarlock® plate]. / OSG-Arthrodese über einen posterolateralen Zugang mit der polyaxial-winkelstabilen Talarlock®-Platte.

OBJECTIVE: Safe arthrodesis of the ankle as well as load carrying capacity free of pain. INDICATION: Painful arthritis of the ankle joint occurring idiopathic or posttraumatic, resulting from rheumatoid arthritis or neuromuscular diseases. Extensive bony defects in varus or valgus ankle deformities and after failed prosthesis. Complex hindfoot deformities in neurological disease, paralysis and instabilities. Joint destruction after infection. CONTRAINDICATIONS: Active osteitis, extensive skin ulcers in the approach area, periphery artery occlusive disease. SURGICAL TECHNIQUE: Posterolateral skin incision. Sparing cartilage resection. Penetrating sclerosis zones. Reorientating anatomic positioning of the talus thereby correcting axis deformities. Talarlock(®) plate positioning and tibiotalar arthrodesis. POSTOPERATIVE MANAGEMENT: Full weight bearing in an arthodesis boot for 6 weeks. After bone grafting partial weight bearing (20 kg) in an arthrodesis boot for 8 weeks. Full weight bearing after 10weeks. RESULTS: Ten patients were operated on using this procedure. The follow-up time was 1 year. There were no complications requiring further surgical procedures. Ankle fusion and a good clinical outcome could be achieved in all cases.