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Background: Approximately 30 % of all bone injuries are foot metatarsal fractures. Metatarsal V basis fractures occur most frequently. The classification is done into the tuberosity avulsion fractures, Jones fractures and stress fractures of the proximal diaphysis. The treatments of non-displaced fractures are generally conservative. The indication for surgical treatment depends on the load and the associated refracture rate. There are different types of treatment of these fractures. We present a possible approach to conservative treatments and show how different therapies affect healing of metatarsal V basis fractures and social reintegration of patients., Methods: A retrospective study consisted of 68 patients analysed during a 9-year period, whereas for a prospective analysis 18 patients were included for a period of 3 years. The treatment was performed using either a splint, closed bandage of the ankle or special Göttinger Anklesplint bandage, with immediate pain-oriented full load in all groups. The subjective and objective treatment results were analysed accoding the Göttinger Phillips score., Results: In retrospect, the fracture consolidation was observed after 8.1 weeks full load-bearing was achieved after 6.3 weeks on average. In the prospective analysis, the osseous consolidation occurred after 6.2 weeks, and the full load was applied after 1.7 weeks. After 10 weeks the treatment with the Anklesplint bandage was assessed with 105 points of a maximum 110 points of the Phillips score. The Anklesplint bandage was also the cheapest option in the cost comparison., Conclusion: Using the immobilisation of the metatarsal supination with the Anklesplint bandage the metatarsal V basis fractures can heal in a regular way. The functional outcome is better in comparison to the that with other treatments and it is a cost-effective treatment., (© Georg Thieme Verlag KG Stuttgart · New York.)

Over a period of one year, all accidents associated with in-line skating (ILS) were surveyed. Sport-specific data was recorded with a standardized questionnaire. The study comprised 66 patients with 75 injuries (48 upper limb, 16 skull, eight lower limb, three trunk). We were looking after 42 male and 24 female patients with an average age of 20 years (5-53 years). Twenty-seven patients (40%) had to be treated as inpatients. Overall, the most frequent injury (one third of all injuries) was forearm fracture close to the wrist (21 radius fractures, four radioulnar fractures). It had to be reset in 20 cases. Additional internal fixation was required in 10 cases (Kirschner wire osteosynthesis, intramedullary nailing or plate osteosynthesis). Only five patients could be treated with plaster cast fixation alone. Most patients with injuries in the vicinity of the wrist were not wearing a wrist protector at the time of the accident. The most frequent reasons given for not wearing protectors was forgetfulness or the high price of protectors. However, there were also two distal radius fractures and a disc injury in the wrist in patients who had been wearing wrist protectors. In most cases, ILS accidents lead to appreciable damage requiring a healing period of several weeks to months (average period of loss of work 41 days). The bfu (advisory center for accident prevention) reckons with 60,000 ILS cases annually in Switzerland. These injuries are thus of great socioeconomic importance. In the future, better risk behavior must be achieved by informing the population (wearing protectors, especially for the wrist and head, attendance of training courses).

In the discussion of limiting the growth of medical spending there are intentions to exclude the costs of sport injuries from coverage by the public health insurance system. The aim of this study is to analyse typical sport injuries and to compare them with injuries from other fields of accidents and thus to deliver arguments in the discussion of costs in public health system.

All these data suggested, that rehabilitation can be more quickly effected and may have a better outcome using the EAP, than has been achieved with traditional therapies. Because the treatment is so new, it will be some time before the data become statistically significant. It is expected that confirm development of EAP may in the future lead to still better outcomes. Ambulatory rehabilitation is only available at large center, making the necessary daily units difficult for patients who live in outlying areas.

The epidemiology of skiing accidents is described and discussed on the basis of SUVA statistics. This is followed by an analysis of the frequency of the various types of injuries and a summary of the social consequences (cost of treatment, daily sickness allowance, compensation for pension and integrity compensation). To conclude, there is a discussion on the prevention of skiing accidents and, in particular, the presentation of "warm-up!", SUVA's prevention campaign. This campaign has been designed to the very latest advertising principles to prevent skiing accidents. It addresses the question of the correct warming-up procedures at pan-Swiss level prior to undertaking a downhill skiing run.

The expected direct and indirect costs following a fresh fibular rupture of the capsular ligament, and hence the socioeconomic burden on the patient, was investigated by a prospective randomised study comprising 120 males and females between 18 and 45 years of age. A comparison of three different conservative treatment methods A (immobilisation in a plaster cast for three weeks, followed by mobilisation with the aircast splint), B (mobilisation with the aircast splint) and C (Unna's paste dressing for two weeks with subsequent tape dressings and in each case immediate mobilisation) showed a significantly better stability after 6 months in the groups B (2.6 +/- 2.3) and C (3.6 +/- 3.8) than in A (4.8 +/- 3.5). The direct subsequent costs were also significantly lower in the groups B (DM 175.-) and C (DM 206.-) than in A (DM 340,-). Taking an average daily hospital care fee of DM 319.- (1991 in West Germany) as basis, the direct costs sequential to early functional treatment are the lowest also in comparison with surgical treatment in a hospital. The indirect sequential costs due to loss of working hours are mainly dependent on professionally conditioned physical stress but increase with the period of immobilisation after a fresh fibular rupture of the capsular ligament.

The range of payments by health insurance companies in case of accident and illness is presented and possible deficits of reimbursement are explained. The discussion of benefits and possible negative effects of physical activity leads--with a side-glance to professional sport--to the claim for a more reasonable use of our physical structure. Finally, abuses of our social network and financial consequences from our behavior are quoted as examples.

In spite of increased efforts in the prevention of recreational accidents the SUVA has to state that, as before, there is a steady increase in non-occupational accidents. 33% of all non-occupational accidents are caused through sport. Preventive measures and optimum patient treatment are effective moves to limit the costs. Shortening the financial benefits in heavy-risk sports (hazardous ventures) or in grave infringement of elementary cautionary obligations (gross negligence) should aim less at a cost saving than at an overall preventive effect.