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B Heimkes

Publications and source records attributed to B Heimkes.

At least 19 recordsLinked to original sources
PubMed2000

Neuromuscular function and radioanatomical form of the myelomeningocele hip.

The aim of this study was to describe variants in neuromuscular function and radioanatomical form of the myelomeningocele hip based on the level of spinal paralysis. For this purpose, 84 hip joints of 44 children with myelomeningocele age 1 to 10.75 years were classified into five spinal paralysis groups. Using anteroposterior pelvic radiographs, the position of the capital epiphysis, represented by the epiphyseal angle, and the position of the greater trochanter apophysis, represented by the apophyseal angle, were evaluated. The epiphyseal angle of the five paralysis groups showed three categories of average values. The thoracic/thoracolumbar group had an average of 0 degree, groups 2 (distal L1/L2) and 3 (distal L3/L4) had average values of 5 degrees to 6 degrees, and groups 4 (distal L5) and 5 (distal S1) had average values of 13 degrees to 14 degrees. The average values of the apophyseal angle showed a characteristic curve: the values dropped from group 1 (67 degrees) to groups 2 (45 degrees) and 3 (34 degrees) and then rose in groups 4 (44 degrees) and 5 (52 degrees). The authors concluded that the insufficiency of the hip abductors leads to a reduction of the epiphysis angle, and the relative insufficiency of the small glutei compared with the knee extensors leads to a reduction of the apophysis angle.

Child↗
PubMed1998

[Not Available].

Explore the source record for details and available documents.

Journal Article↗
PubMed1998

[Bilateral congenital radio-ulnar synostosis with hyperpronation--findings and surgical therapy].

Congenital proximal synostoses of the ulna and radius do not require surgery in most of the cases, since the proximal synostosis can be sufficiently compensated by the wrist joint. In cases of considerable functional deficit, the synostosis has to be separated to enable re-ossification in a more advantageous position. We report on a patient with bilateral synostosis and a significant functional deficit due to the grotesque hyperpronation of the forearms. Following operative longitudinal separation and redressive casts, a good correction was obtained. X-ray imaging in lateral view documented the improved forearm position.

Child, Preschool↗
PubMed1997

[Peroneus tertius tendon repair following old traumatic rupture of the anterior tibial tendon (casuistry)].

The etiology of anterior tibial tendon rupture and the results after secondary operation are described in one patient. A new operative technique using his peroneus tertius tendon as a free graft was performed. Follow-up after only 5 months showed almost normalized function in comparison to the uninjured leg. No additional loss of function owing to the operative method was noted. Ultrasound is of the highest diagnostic value in detecting the injury and in controlling the course of healing.

Adult↗
PubMed1994

A combined bony and soft-tissue tarsal stabilization procedure (Grice-Schede) for hindfoot valgus in children with cerebral palsy.

This study deals with a combined bony and soft-tissue procedure (Grice-Schede) for the treatment of pes (equino) planovalgus in children suffering from cerebral palsy. Results of 43 treated feet in 28 children were assessed clinically and radiologically at a mean follow-up time of 6.7 years (range from 0.6 years to 13.8 years). In all, 58.1% excellent or good results, 14.0% satisfactory and 27.9% poor results were found. The procedure can be recommended for patients with hemiplegic and diplegic conditions. It is not suited for patients with total body involvement.

Adolescent↗
PubMed1993

Stress transfer at the femoral bone/bone cement interface as a function of the cement thickness.

When a cement canal prosthesis is used as the femoral component in total hip replacement (THR), the penetration depth of the bone cement can be varied according to the cement implantation pressure. Using experimental data which give a relation between the pressure applied to the cement at implantation and the resulting shape of the cement layer, a three-dimensional finite element study was performed to calculate the stress distribution at the bone/bone cement interface. The calculations show that the interface stresses increase with increasing depth of penetration by the cement layer. The explanation of this effect is that as the bone cement penetrates further into the cancellous bone, the cancellous bone is stiffened and can no longer act as a soft interposition between cortical bone and bone cement. From these results and from the clinical requirement that as little bone as possible be destroyed in any kind of allo-arthroplasty, we conclude that the penetration depth of bone cement into cancellous bone in THR should be minimized to the depth necessary in order to achieve sufficient initial stability of the implant. The results show that a cement-canal prosthesis meets these requirements if a cement implantation pressure of 1.0 bar is used.

Bone Cements↗
PubMed1993

Investigations on mechanism of Salter-1-fractures of the greater trochanter.

This study aims at clarifying why the apophysis of the greater trochanter very rarely separates, in contrast to other apophyses of the hip region. The inclination and area measurement of the greater trochanteric growth plate and the mode of insertion of the muscles on the apophysis were analyzed on the basis of 16 anatomic femoral specimens from newborn to children of 14 years of age. The physiological muscle cross section Q of the muscles inserting at the greater trochanter was determined on 6 specimens. In a cross-sectional radiological study, carried out on 1350 hip joints of healthy children, the inclination of the greater trochanter growth plate was measured. The anatomical and radiological findings show that the nearly plane-shaped greater trochanter growth plate remains inclined at a 50 degree angle to the horizontal body line and is loaded from a diagonally craniolateral direction throughout the total growth period. The lateral surface of the apophysis is covered by a fibrous connection which joins the insertion areas of the gluteus medius, minimus and vastus lateralis muscles. The vastus lateralis muscle is intimately bound to the vastus intermedius muscle by fibrous tissue. According to the results of the physiological muscle cross sections these four muscle groups can form a counteracting muscle sling, which transforms the traction forces at the surface of the greater trochanter into pressure forces in line with a tension band effect.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1992

Bone-cement removal with the excimer laser in revision arthroplasty.

The excimer laser was thought to be an appropriate tool for the removal of bone cement without damaging the bone. However, due to its low ablation rate, its clinical use in total hip revision arthroplasty proved to be impossible. This experimental study was designed to evaluate the maximal ablation rate by adjusting the laser's parameters. Energy density, frequency, pulse duration, radiation area, quantity of pulses, and environmental conditions were varied in the experimental setup. Even with the best set of parameters the excimer laser was about ten times slower than, e.g., the carbon dioxide laser. The removal of 10 g bone cement takes about 1 h. Thus, complete cement removal by means of the excimer laser alone is not possible. However, selective application of the excimer laser in combination with other techniques could be discussed.

Arthroplasty↗
PubMed1992

The transgluteal approaches to the hip.

The transgluteal approach to the hip, first described by Bauer et al. in 1979, has since become a recognized routine method. Its longitudinal incision of the fibers of the gluteus medius and minimus and the vastus lateralis muscles takes advantage of the tendinous junction of these muscles over the greater trochanter. This paper describes the modifications of the transgluteal approach described in the literature and compares them to the original procedure. In 52 hip specimens, including attached muscles, the insertions and different variations of the junction of the gluteus medius, minimus and vastus lateralis muscles over the greater trochanter are described and statistically analysed. In 59.6% of all specimens there proved to be a united tendinous junction of all the muscles referred to above, while in 40.4% autonomous insertions of the gluteus medius and/or gluteus minimus were seen. In accordance with the anatomical results, the form of incision described by the original authors can be considered the most favourable. In roughly one-third of all hip operations, autonomous insertions of gluteus medius and minimus must be taken into account, since otherwise total or partial upward displacement of the autonomous muscle insertions could occur.

Adult↗
PubMed1992

[Surgical treatment concepts of deformities of the upper extremities in infantile cerebral palsy].

To correct the most frequent deformity of the spastic hand, muscle release and transfer operations, such as distal slide of hand and finger flexors (according to Scaglietti and Göb), release of the adductor pollicis and flexor pollicis brevis muscle (Matev), and transposition of the flexor carpi ulnaris muscle to the dorsal aspect of the hand, should be performed. These basic operations on the spastic hand can be supplemented by release or transposition of additional muscles of the fingers or hand. Bony procedures should be done to stabilize and augment the grip between thumb and second finger. In selected cases arthrodesis of the wrist can be performed to stabilize the hand in a functional position. The outcome of operations on the spastic hand depends on the application of correct indications as well as on postoperative physiotherapy. A slight functional gain, or even a purely cosmetic improvement, may mean a lot to the patient. In respect of professional rehabilitation of adolescents, operative correction of a deformed hand can help to improve manual skills and thereby increase job chances.

Cerebral Palsy↗
PubMed1992

[Implantation technique of tumor and crutch prostheses].

Using anatomic specimens from 58 fixed femurs, we analyzed the point of insertion and junctional variations of the gluteus medius, minimus and vastus lateralis over the greater trochanter. On six specimens the physiological muscle cross-section Q was determined for the muscles inserting at the greater trochanter. The results showed that the gluteus medius and minimus, as well as the vastus lateralis generally insert at the lateral and ventral surfaces of the greater trochanter. In 59.6% of all cases these muscles form a joint tendon junction. In 21.1% the gluteus medius inserts autonomously and with 13.5% the gluteus minimus inserts independently. In 5.8% of all specimens all three muscles insert autonomously. The average physiological muscle cross-section of the gluteus medius and minimus added up to 37.83 cm2 and that of the vastus lateralis and the fibrously connected vastus intermedius came to 36.14 cm2. Accordingly the extensor muscles of the knee, together with the counteracting gluteus medius und minimus, form a muscle sling that puts a pressure load on the greater trochanter from the lateral cranial direction. An operating technique for the implantation of tumor prostheses using this muscle sling is introduced. Hereby the greater trochanter and inserted musculature remain intact and are placed hoodlike on the implanted tumor prosthesis. Postoperatively, the procedure results in good muscle function with early exercise tolerance.

Adult↗
PubMed1991

[Tarsal tunnel syndrome. Nerve compression syndrome in the foot].

Pathological changes in sensation over the sole of the foot do not always correspond to the full area of distribution of the posterior tibial nerve. Some neurologists advise separate examination of the tibial nerve, the medial and lateral plantar nerves, in order to ascertain whether either or both might be affected. 60 preparations of cadaveric feet in the Department of Anatomy were examined. Using a measuring grid, the position and size of the nerves in the tarsal tunnel were assessed and the facial band which define and divide the osteofibrous canal delineated. The corners of the measuring grid were the tip of the medial malleolus (A), the tip of the calcaneal tubercle at its greatest distance from the medial malleolus (B) and the tuberosity of the navicular bone (C). These points can also be clearly identified clinically. They define a triangle whose sides A-B and B-C are of constant equal length and whose base A-C varies little. The operative approach includes a T-shaped incision of the retinaculum. The vertical line of the T lies underneath the skin incision. The horizontal line corresponds with the upper border of the abductor hallucis muscle. The upper border of the abductor hallucis is defined and the muscle retracted medially to expose the deep fascia. This layer is removed together with the connective tissue bridge which stretches between the fascia and the calcaneus. The plantar nerves are discovered and run to the sole of the foot without further obstruction.

Diagnosis, Differential↗
PubMed1987

The proximal and distal tarsal tunnel syndromes. An anatomical study.

Clinical and electromyographic studies in the tarsal tunnel syndrome may suggest compression of only one of the two terminal branches of the posterior tibial nerve. This anatomical study demonstrates the structures which may cause isolated damage to either the medial plantar or the lateral plantar nerves. A surgical approach to the tarsal tunnel is described.

Ankle Joint↗
PubMed1987

[Tarsal tunnel syndrome].

The natural history, diagnosis, and therapy of tarsal tunnel syndrome are given. Anatomical studies corresponding to the clinical picture and electrodiagnostic findings show two different narrow points in tarsal tunnel. Operative treatment should take into account the compression of the posterior tibial nerve by the flexor retinaculum and also of the plantar nerves under the abductor hallucis.

Ankle↗
PubMedDate not supplied

[Ultrasound in the early diagnosis of congenital dislocation of the patella].

INTRODUCTION: Congenital dislocation of the patella is defined as lateral dislocation of the patella present at birth, impossibility of closed reduction and diagnosis before the age of 10 years. We report about a rare case of a bilateral congenital dislocation of the patella. CASE REPORT: Physical examination of an eight-month- old boy showed bilateral knee flexion contractures associated with moderate genu varum. On both sides the patella could not be palpated easily. Radiographic diagnosis could not show the patella as the patella normally ossifies later. Ultrasound examination located the patella lateral to the lateral femoral condyle on both sides. Closed reduction was impossible. An open reduction with division of the lateral soft tissues, lateral release, and derotation of the quadriceps femoris and refining of the medial structures was performed. After cast removal the patellae were both located in the intercondylar grooves as confirmed by clinical and ultrasound examinations of both knees. Active and passive exercises were started. CONCLUSION: Failure of internal rotation of the myotome which contains the quadriceps femoris and the patella is the etiology of congenital dislocation of the patella. The quadriceps acts as flexor, exerting a valgus stress on the knee, causing external rotation of the tibia. Diagnosis is often delayed because of the lack of pathological findings on plain radiographs. Early diagnosis is enabled by ultrasonography. Surgical treatment is necessary and results are good, as long as there are no secondary changes.

Contracture↗
PubMedDate not supplied

[Age-related force distribution at the proximal end of the femur in normally growing children].

In a group of normally developed children and adolescents the age dependent distribution of forces at the proximal end of the femur was to be described. The results should explain why the shape of the proximal end of the femur changes significantly during the time of growth and why the neck shaft angle decreases. The method applied was the biomechanical computation analyzing in the coronal plane according to Pauwels' biomechanical hip model. The necessary age relevant data was derived from 675 anteroposterior pelvis radiographs of healthy children of both sexes and of varying age. The following can be put down as a result: 1. The proximal end of the femur is stressed by two resultant forces: the hip resultant force R controls the growth of the capital growth plate, the trochanteric resultant force RT regulates the growth of the greater trochanter growth plate. 2. During the growing period the hip resultant force R adjusts itself less vertically: during the second year of life it inclines at an average of 11,6 degrees towards the vertical, towards the end of the growing period it is incident with an inclination angle of 20 degrees. With the older child the magnitude of the hip resultant force R decreases in relation to the exerting body weight. 3. During the time of growth the trochanteric resultant force RT maintains its direction stability with inclination angles of 50-52 degrees towards the vertical. Its magnitude increases significantly (in relation to the exerting body weight). 4. From age 2 to 10 the projected neck shaft angle decreases from an average of 148.2 degrees to 133.7 degrees and usually remains stable. It can be concluded that the shape of the proximal end of the femur is determined by the muscle forces stimulating the greater trochanter apophysis and by gravity. With increasing age the growth of the greater trochanter apophysis shifts the insertions of abductor muscles laterally. As a result the directions of the hip abductors and the hip resultant force R incline. The neck shaft angle decreases consecutively.

Adolescent↗
PubMedDate not supplied

[Pathogenesis and prevention of spastic hip dislocation].

Based on retrospective analysis of 82 hips of 41 patients with cerebral palsy, a pathogenetic model of spastic paralytic dislocation of the hip is introduced including recent observations of the normal hip development. According to this model the reduced activity of the gluteus maximus, medius, minimus and quadriceps femoris muscles, which normally cause a decrease of valgus and anteversion, results in an increased subluxating coxa valga antetorta with a consecutive dislocation. In order to prevent a dislocation, these muscle groups have to undergo increased activation. Since walking has to be to undergo increased activation. Since walking has to be considered the strongest stimulus for the dislocation-preventing hip abductors, hip extensors, outward rotators and knee extensors, the erect gait should be encouraged with statomotorically favored children early as possible. This can be supported by muscle relaxing surgery of the antagonistically effective hip flexors, hip adductors and inward rotators as well as the knee flexors. These muscle release operations will counteract, although to a limited extent, a dislocation even with a severely handicapped child who is unable to walk.

Adolescent↗