[Indirect humerus fracture in sports]. / Die indirekte Humerusfraktur im Sport.

The humeral spiral fracture as a result of violent muscle activity is not uncommon in throwing sports. Two cases of this injury (in a javelin thrower and in a handball player) are described. The complex mechanical reasons are discussed.

[Isokinetic measurements in adolescent runners]. / Isokinetische Messungen bei jugendlichen Läufern.

The aim of the investigation was to study the course of the isokinetic parameters--peak torque, time range of tension development and fatigue index--in an age range from 13 to 19 years and to compare the results with those of competitive athletes of the same age specifically trained in running. For this purpose measurements of the flexors and extensors in the upper ankle joint, knee and hip were taken. The average for the six muscle groups correlated significantly in all three parameters not only with the age development but also with the degree of training. The individual muscle groups, however, differed widely. An increased frequency of injuries by certain ratios of peak torques between flexors and extensors was not found. Instead already in the physiological age development occurred relations that were connected with an increased frequency of injuries. Prospectively this suggests that the time range of tension development has additional influence here.

[The importance of isokinetic measurement of force in sports and rehabilitation]. / Die Bedeutung isokinetischer Kraftmessung in Sport und Rehabilitation.

The musculature serves as motor of the human body and hence promotes our movement within our environment. Its organ-specific performance is the translation of force into movement. This force can be described by means of different qualities - maximal force, speed and endurance. These properties are essential for sports activities and also set limits for the achievement of athletic records. Muscular force can be evaluated by different means. Measurement of force via isokinetic systems enables quantitative measurement of effective muscular forces in various body positions which are frequently comparable under conditions specific to different types of sports. The relevance of these measurements in sports and rehabilitation is documented in this article. Two different groups of subjects (72 sportsmen and 73 patients after capsular ligament reconstruction in the knee joint) were examined. The measurement values: dynamic maximal force, energy of acceleration, average performance and the hamstring/quadriceps ratios (H/Q quotient) are measured at different speeds. The maximal force shows intraindividual differences depending on the speed. These differences are due to different conditions of training and different distribution of muscle fibre types. The acceleration energy enables assessment of differences in the ability to exercise force. Likewise, the different muscle performances can be described by means of the appropriate individual performance maximums. In rehabilitation, muscle atrophy caused by immobilization can be measured and described. Measurement of force by means of isokinetic systems enables the analysis of muscular forces with their different properties, and hence to give advice in training matters and to supervise and control popular recreational sports and competitive sports activities.(ABSTRACT TRUNCATED AT 250 WORDS)

[Immobilization damage]. / Der Immobilisationsschaden.

Prolonged immobilization can threaten the surgical result. The reduction of the muscle diameter is reported to be between 10 and 60% after four weeks of immobilization depending on the different muscle groups. Particularly the oxidative type-1 fibers, the "slow twitch fibers" are concerned. However, the sequelae of immobilization of muscle are reversible, which is in contrast to the detrimental effects immobilization has on the bone. Inactivity osteoporosis is occurring in three stages with bone loss as much as five to twenty times that of other calcipenic disorders. The physiological coupling of bone resorption and bone remodeling is lost. Immobilization leads to arthrosis changing the cartilage matrix composition quantitatively and qualitatively as well as cartilage morphology histologically and electron-microscopically. The result of immobilization is shortening of all fibrous tissues. The loss of the ligament-specific orientation of fibrils leads to significant reduction in tensile strength. The sequelae of immobilization emphasize the importance of early functional therapy. Continuous passive motion speeds up wound healing, and the tissue-structure is improved.

[Current status of the therapy of anterior cruciate ligament injuries]. / Aktueller Stand in der Therapie der vorderen Kreuzbandverletzungen.

This review presents the current concepts in the treatment of anterior cruciate ligament (ACL) injuries. Conservative treatment emphasising strengthening of the muscles to stabilise an unstable knee is discussed. The agonistic and antagonistic functions of the hamstrings and the quadriceps muscle in relation to the ACL are described. The possible mechanisms of muscular stabilisation of the knee are discussed on a neurophysiological basis. The existence of joint specific receptors is pointed out and their reflex and perceptive functions are demonstrated. Taking this into account one can deduce a two-step mechanism of joint protection: 1) via the mechanical strength of the joint capsule and ligaments and 2) via reflex muscle contractions. It follows therefrom that in an unstable knee with a lax capsule and disturbed reflex mechanisms, strengthening of muscles alone is insufficient and cannot protect the joint from progressive deterioration. Therefore, surgical treatment is necessary for an ACL deficient knee. Our indications for ACL reconstruction are described. In addition, the existing methods of surgical replacement of the ACL are critically elucidated. In our opinion, an extraarticular repair tendon transfer as the only surgical procedure to regain stability is of only historical interest. However, extraarticular repair of the medial or lateral capsule is often a necessary additional step to restore stability of the knee. The replacement of the ACL is the crucial step. Using autogenous grafts one must consider the doubtful outcome of biological response leading to necrosis and revascularization in the transplant.(ABSTRACT TRUNCATED AT 250 WORDS)

[Treatment of spondylolisthesis in adults using the dorsal approach with the fixateur interne and a special repositioning device]. / Die Behandlung der Spondylosisthesis beim Erwachsenen von dorsal mit dem Fixateur interne und einem speziellen Repositionshilfsgerät.

Fourteen patients with spondylolisthesis were operated in the Orthopaedic Clinic of Ulm (RKU) from October 1984 to December 1986. All patients suffered from low back pain, 13 had symptomes of nerve root compression, 6 had intermittent spinal claudication. All patients were treated by segmental distraction, reduction of the slipped vertebra and a ventral interbody fusion. The operative technique required first the dorsal approach for distraction and reduction using the fixateur interne (Dick) as well as a self developed special instrument for the reduction of the vertebra (repositeur). The ventral interbody fusion was performed in a one-stage procedure. The self developed special instrument (repositeur) is described and its construction principals, mechanics and its applications. Distraction and reduction of spondylolisthesis was achieved totally or nearly complete with this instrument in all but one patient. In one case the transpedicular screw ripped out. Always the foramina intervertebralia were opened to physiological width. Pain and neurological symptomes completely disappeared in all patients and no additional spinal operation was necessary. No infection and no pseudarthrosis did occur. Our clinical results are discussed in regard to other publications. Operative treatment of spondylolisthesis using the fixateur interne and a new developed special instrument for reduction.

[Recent aspects of the biocompatibility of carbon fibers. A histologic and electron microscopy analysis]. / Neuere Aspekte zur Biokompatibilität von Kohlefasern. Eine histologische und elektronenmikroskopische Analyse.

Twenty out of 36 patients who had been treated with a carbon fiber syndesmoplasty were followed up 12-19 months after surgery. Reoperation was performed on 11 patients, in 3 cases for removal of the material and in 8 because of persistent pain, although the syndesmoplasties were stable in the majority of cases. Histologic and electron-microscopic study of the explanted ligaments revealed a considerable foreign-body reaction to the carbon fibers and insufficient metaplasia of the allogenic material to connective tissue.

[Significance of the radial compression syndrome for the diagnosis and surgical therapy of so-called epicondylitis humeri radialis (Epic. hum. rad.)]. / Die Bedeutung der Radialiskompressionssyndrome (RKS) für die Diagnostik und operative Therapie der sogenannten Epicondylitis humeri radialis (Epic.hum.rad.).

25 patients with Tennis Elbow were examined after surgery (= retrospectively), 25 before surgery (= prospectively). All of the patients were operated on according to the Wilhelm and Wachsmuth method. 5-18 months after surgery (on average 10), both groups underwent clinical examinations. Those patients who still had symptoms were given neurophysiological examinations. Both groups were compared with each other. The following results were obtained from the comparison: 1) 7 patients (28%) in the retrospective group were dissatisfied with the results of surgery and still had symptoms specific to the disease. In the prospective group, only 2 patients (8%) complained of similar problems. 2) 6 of the above-mentioned 7 dissatisfied patients in the retrospective group agreed to a postoperative neurophysiological examination. This revealed in five out of six patients damage to the radialis nerve. 3) At the clinical examinations of the 25 prospective patients, 17 were suspected of having radial compression syndrome. In 9 patients, this suspicion was confirmed by the neurophysiological findings. A neurolysis of the N. radialis was performed on these nine patients during surgery. All of these patients were satisfied with the results of surgery at the follow-up examination. The above results permit the following conclusions: 1) The failures in surgical treatment of Tennis Elbow can in part be put down to radial compression syndrome. 2) A thorough clinical examination, which in particular takes radial compression syndrome into account, should be carried out on every Tennis-Elbow-patient. 3) The neurophysiological examination of the main extensors of the hand should be an obligatory part of pre-operative preparations.(ABSTRACT TRUNCATED AT 250 WORDS)

[Treatment of unreduced anterior shoulder dislocation]. / Die Behandlung der veralteten vorderen Schulterluxation.

We evaluated the results of treatment in six patients with unreduced chronic anterior dislocations of the shoulder. In three patients the dislocations had not been recognized by the initial treating physician. In the remaining three patients the dislocations initially had been diagnosed but reduction had failed and the dislocations had remained unreduced. In one of the six shoulders the dislocation was left unreduced. The dislocation existed for 3.5 years and there was absence of disabling functional impairment, pain or neurovascular disturbance. In five of six shoulders the function was severely impaired. One of five shoulders with an anterior dislocation of three weeks duration could be reduced by closed manipulation. Four shoulders underwent open reduction. In all patients the humeral head could be preserved. Associated osseous lesions of the glenoid or the humeral head (Hill-Sachs lesions, fractures) were treated by rotation osteotomies according to Weber and the Eden-Lange-Hybinette procedure. Preoperatively all shoulders were graded as poor. Postoperatively the results in one was graded as excellent, in three as good and in one (algodystrophy of the left arm) as fair.

[Causes and treatment of delayed callusformation and pseudarthrosis following fractures of the shaft of the humerus (author's transl)]. / Ursachen und Behandlung der verzögerten Heilung und Pseudarthrose nach Oberarmschaftfrakturen

In the OHH, during the years 1969 to 1974, 28 patients were operatively treated because of delayed callusformation or pseud-arthrosis, following a fracture of the shaft of the humerus. It was possible to inquire about and to re-examine 20 patients. The operative treatment had, when possible been achieved by osteosynthesis through plates (25 cases). Each of the so treated cases lead to healing of the bone, additional nerve lesion did not in one case occur because of the operation. Objectively seen, there existed in 7 patients a slight, final restriction of movements, for the abduction and outside rotation in the shoulder joint. 6 patients complained of being sensitive to weather changes. The different treatment method of the fracture of the humerus and pseudarthrosis was discussed.

Histological effects of 6-mercaptopurine on the fetal rat central nervous system: a light-microscopic study.

Wistar rats were administered single doses of 16 or 50 mg/kg 6-mercaptopurine (6-MP) on day 12 of pregnancy. Necrosis in the fetal forebrain and spinal cord was studied by light microscope 6, 12, 14, 48, 72, and 81 h and 8 days afterward. The extent of necrosis was dose dependent. The first necroses were seen after 24 h, regardless of location (brain, spinal cord) or dose; but the extent was greatest after 48 h. All necrotic cells had a typical appearance; they were ballooned and often fragmented, their nuclei were darkly colored and frequently pyknotic, and they were often karyorhexic. Necroses appeared almost exclusively at sites of beginning cellular differentiation, i.e., in the intermediate zone. In the spinal cord the ventricular zone was also necrotic and the alar plate (dorsal horn) always affected. Phagocytizing cells (macrophages) appeared in the spinal cord after 48 h and in the brain after 72 h. After 81 h all the necrotic material had been phagocytized, at which time there was a massive congestion of the extra- and intracerebral vessels. Hemorrhages appeared in defined localizations. Eight days after exposure to 16 mg/kg 6-MP fetuses no longer showed any visible deviations. Fetuses exposed to 50 mg/kg showed deviations in the cytoarchitecture of the neopallium: an extremely broadened ventricular zone, few cells in the intermediate zone, and extensive rarefaction cells in the cortical plate with no clear layer structure. In the spinal cord, cleft formations were especially noticeable in the dorsal-horn region. All fetuses showed a hydrocephalus externus after 50 mg/kg. The mechanism leading to necrosis is discussed.

[Sternocostoclavicular hyperostosis--case reports and differential diagnosis]. / Sternocostoclaviculäre Hyperostose--Kasuistik und Differentialdiagnose.

Sternocostoclavicular hyperostosis (SCCH) is a disorder related to collagenoses. SCCH is typically characterised by the triad of swelling of the sternoclavicular and/or sternocostal joints of the first or second rib, palmar and plantar pustulosis (PPP), only limited elevation of inflammation indicating laboratory parameters. Till today the etiology is unclear and no causal therapy is known. Symptomatic treatment consists of administration of NSAID and cortisone, irradiation and even limited resection of the clavicle and rib.

[Treatment of progressive axial deformities in children by surgical measures of the growth plate]. / Die Behandlung von progredienten Achsenfehlern bei Kindern durch chirurgische Massnahmen an der Wachstumsfuge.

Report of the results of 4 surgically treated epiphyseal injuries with progressing deformities in the lower extremities (3 injuries type V, 1 epiphyseal fracture type IV according to Salter and Harris). Our Surgical procedure consisted in a resection of the posttraumatic transphyseal bony bridge with a following interposition of a silastic block to prevent again transphyseal blocking. The indications for such a surgical procedure is explained possibilities leading to failures are discussed. The results of our experimental studies being the basis for such operations are reported.

[Injuries of the distal epiphysis of the humerus in the period of growth]. / Verletzungen der distalen Humerusepiphyse im Wachstumsalter.

From 1978 to 1983 in the Orthopedic University Clinic (Oskar-Helene-Heim, Berlin) 75 children with fractures of the distal humerus received medical treatment. The results of 25 intra-articular fractures of the distal humerus in children (ten fractures of the radial condyles, eight fractures of the ulnar epicondyles, three Y-fractures of the condyles, two luxations with additional flake fractures, one fracture of the ulnar condyle) will be reported. The frequency of remaining complications like valgus and varus deformities, pseudarthroses, posttraumatic osteochondroses and "fish tail" deformities are described. The possible mechanism of such developing deformities is discussed. The resulting consequences for the surgical treatment in the future are also discussed.

[Ultrastructural investigations of the palmarfascia in M. Dupuytren (author's transl)]. / Ultrastrukturelle Untersuchungen an der Palmarfaszie beim Morbus Dupuytren (D. K.).

The palmarfascia of 30 patients with Dupuytrens disease was investigated light- and electron microscopically. As typical changes there exist an increase in cells which form noduli. Many cells contain contractile filaments in their cytoplasma are therefore described as myofibroblasts. Beside these cells active fibroblasts could be observed. Close to their cell membranes there occur filaments with a diameter of 100--300 A. In a greater distance fibrils and fibers with a diameter of 400--600 A were observed. The regular order of the connective tissue is disturbed, one often can observe "vortex" like structures. The lumina of many capillaries are collapsed. The pericytes are increased. The nerve fibers are morphologically unchanged - they are often closely surrounded by collagen fibers. Respecting the morphological findings the pathogenesis of Dupuytrens disease is discussed.

[Combined labor induction in the small hospital]. / Kombinierte Geburtseinleitung im kleinen Krankenhaus

Authors report about 504 oxytocin infusions after amniotomy or spontaneous rupture of membranes without possibility of cardiotokography. The rate of success by a 12-hour-limit is 91,9 per cent, by a 24-hour-limit 95,2 per cent. It was observed a superior rate of obstetric operations, post-partum haemorrhages and 3 cases of uterus rupture following hypersensitivity. Intravenous oxytocin infusion reduced the time of delivery. After combinating induction of labour childrens have an acceptable general condition, recorded by Apgar-score. Simultaneous induction of labour by oxytocin infusion is a high-risk proceeding in obstetric hospitals without possibility of cardiotokography. However, a renunciation of this method in default of alternatives is not accept.