[Post-traumatic bursitis--histological expert assessment and insurance medicine aspects]

Concerning insurance medical reports on posttraumatic bursitis the histological findings hold an important position. 20 operation preparations of bursae with a known trauma have been studied. Thereby criterion for the histological characterization of posttraumatic bursitis have been set up and furthermore the findings have been correlated with the posttraumatic time interval. Sector-like fiber necrosis, defects of the top-cell layer, new erythrocyte extravasations, beginning inflammatory reactions and ensilages of foreign bodies in the histological preparation confirm the results of the medical opinion in the acute stage until 24 hours after the trauma occurred. The traumatic genesis of bursa alternations can be verified up to two weeks after the trauma through defects of the top-cell layer, fiber necrosis in all layers of the bursa wall, and erythrocyte extravasations. Preparations of which the trauma is dated back more than two weeks can be classified as posttraumatic bursitis because of their numerous chronifying processes only by their fiber continuity or by their granulation zone which reaches to the synovial surface. Four weeks after a suitable trauma it becomes more difficult to differentiate definite posttraumatic bursa findings from the morphological presentation of the so-called chronic-unspecified polyetiological bursitis. In the late posttraumatic stage the pathologic-anatomical differential diagnosis is only possible with considerable reservations. The clinical data on the course of disease gain particular importance for the insurance medical judgement in such late medical reports.