Biomedical subjects

B Heimkes

Publications and source records attributed to B Heimkes.

26 records · Page 2Linked to original sources

PubMedDate not supplied

[Biomechanics of the hip joint in children].

Based on the data derived from the examination of 16 infantile and juvenile anatomical hip specimens as well as the radiological examination of 1350 hip joints of healthy children, a biomechanical model of the developing hip was computed. This two-dimensional vector model describes the forces acting on the growth plates of the head and the greater trochanter during the one-legged stance. It could be proven that the apophysis of the greater trochanter is subject to compressive stress by lateral-cranial traction bands and therefore corresponds with a "pressure apophysis". The muscle forces acting on the trochanter apophysis can be combined as a trochanteric resultant RT. This stimulates a lateral-cranial growth of the trochanter apophysis. The direction of the hip abductors and, as a result, also the direction and the length of Pauwels' hip resultant R are influenced by this mechanism.

Adolescent↗

PubMedDate not supplied

[Course and prognosis of congenital scoliosis].

75 patients (33 male, 42 female) with congenital scoliosis, diagnosed first time between birth and 40 years were examined. Type and site of the anomaly were classified and evaluated in accordance with a standardized scheme. The prognosis of congenital scoliosis depends strongly on the type of the anomaly. The differences of progression in the site of the abnormality are therefore minor. Unilateral unsegmented bars showed the most severe progression: the yearly rate of deterioration of the curve averages 7.6 degrees. Unilateral hemivertebrae showed 1.5 degrees (upper thoracic region) and 2.3 degrees (lower thoracic region). Two contralateral hemivertebraes and block vertebraes had a yearly rate of deterioration less than 1 degree. Operation is the treatment of choice in case of unilateral unsegmented bars. A conservative treatment is sufficient in most cases of other abnormalities.

Abnormalities, Multiple↗

PubMedDate not supplied

[Treatment of congenital tibial pseudarthrosis using a free vascularized fibula transfer and plate osteosynthesis. Case report].

Congenital pseudarthrosis of the tibia is a rare disorder of unknown etiology. The free vascularized fibula-pro-tibia-transplant permits correction of the defect and the leg length-discrepancy during one surgical procedure. A 5 year old girl with congenital pseudarthrosis underwent a free vascularized fibular-pro-tibia-transplant. At a follow-up examination 5 years post surgery she had no subjective complaints, she walked without external orthopaedic support, there was no leg length-discrepancy. As stated in the literature the rates of bony unions are much higher than after conventional methods.

Bone Plates↗

PubMedDate not supplied

[Recurrent Perthes disease in a 6-year-old boy].

Two episodes of avascular necrosis in the same femoral capital epiphysis have been reported in Gaucher's disease and in six cases of Legg-Calvé-Perthes disease. The present case report is an additional example of a recurrent avascular necrosis in a six years old boy two years after complete healing of the first occurrence had been documented clinically and radiologically.

Bone Wires↗

PubMedDate not supplied

[Protrusion of a calcified cervical intervertebral disk in a 5-year-old boy].

Herniation of the calcified nucleus pulposus is a complication of intervertebral disc calcification. The herniated nucleus pulposus may assume an intraspinal location which may lead to cord compression and produce alarming neurological symptoms and radiographic images. Surgical intervention is, however, rarely necessary as complete resorption of the calcified disc material will generally occur. We report the case of a five years old boy with the symptoms of an acute tortcollis, radiographs of the cervical spine revealed calcification of C5/C6 intervertebral disc and MRI narrowing of the spinal canal. With conservative treatment his symptoms resolved within three weeks, three months later X-rays and MRI showed complete resolution of the calcification and herniation.

Calcinosis↗

PubMedDate not supplied

[Value of ultrasound in differential diagnosis of pediatric hip joint effusion (Perthes disease, C. fugax, epiphysiolysis coapitis femoris].

UNLABELLED: Hip pain during infancy is frequently harmless by nature and hardly demands any therapeutic intervention. A careful differential diagnosis is of great importance. AIM: In our study we attempted to evaluate the significance of sonography as a non-radiant and economical aid in the differential diagnosis of hip diseases during infancy. METHODS: The study population consisted of children aged from 2 to 14 years, who visited our clinic with hip complaints and evident capsular distension (more than 2 mm compared to the contralateral hip joint) and without preceeding diagnosis. The study period was from 1988 to 1995. From the 82 children enrolled in this study we diagnosed Coxitis fugax (n = 54), Morbus Perthes (n = 19), Epiphysiolysis capitis femoris (n = 5), rheumatic Arthritis (n = 2), septic Arthritis (n = 1) and femoral Osteoid-Osteoma (n = 1). All patients with Coxitis fugax were scheduled for clinical and sonographic re-examination. RESULTS: Coxitis fugax is the most frequent disease of the hip during infancy. Perthes disease is the most important differential diagnosis up to the age of 10 years. Epiphysiolysis capitis femoris and rheumatic diseases proved to be most common differential diagnosis among elderly children. As a result of our study we were able to establish a diagnostic algorithm of hip diseases during infancy. Sonographic examination proves to be of great value especially in the differential diagnosis of Coxitis fugax and M. Perthes. In many cases the X-ray examinations which were previously mandatory could even be dispensed with. RELEVANCE: Although this concept requires careful supervision of the patients, it spares 60% of the children from undergoing X-ray examinations or MRI.

Adolescent↗

PubMedDate not supplied

Forces acting on the juvenile hip joint in the one-legged stance.

A two-dimensional biomechanical model of the juvenile hip joint was developed to describe the forces acting on the capital epiphysis and the greater trochanter apophysis in the one-legged stance. Based on anatomic femur specimens of 16 children, ranging from toddlers to teenagers, and radiographic studies of 1,350 hip joints of healthy children, we showed that the apophysis of the greater trochanter is a pressure apophysis. If the muscular forces acting on the apophysis of the greater trochanter are added, the unit sum may be considered a resultant force acting from a craniolateral direction. The trochanteric resultant force near the end of the growth period is equivalent to approximately 1.7 times body weight. The trochanteric resultant force stimulates craniolateral growth of the greater trochanteric apophysis. This mechanism is responsible for the direction of the forces exerted by the hip abductors and thus the direction and magnitude of Pauwels' hip-joint resultant, and finally influences the neck-shaft angle.

Adolescent↗

PubMedDate not supplied

[Results of late synovectomy of the hip in juvenile chronic arthritis].

The aim of this study was to examine the indication for total synovectomy of the hip in juvenile chronic arthritis. For this purpose, five children with six treated hips were followed up. At the time of synovectomy all patients were suffering from therapy resistance and progressive destructive coxitis, as a result of juvenile chronic arthritis. The procedure carried out must, consequently, be regarded as late synovectomy. At the time of the follow-up examination--at least 2 years after the operation--all patients had lasting relief from pain. The range of hip movement could not be improved, despite being accompanied by tenotomies and consistent rehabilitation in the postoperative years. The functional capacity in everyday life also failed to improve. During the post-operative radiographic follow-up the deterioration of the hips proceeded more rapidly than expected for this spontaneous course of treatment. The results lead to the conclusion that the relief of pain due to a late synovectomy of the hip is achieved at the expense of a rapidly progressive destruction of the joints. For this reason, the late synovectomy of the hip in juvenile chronic arthritis should be regarded as the last possibility where resistance to conservative therapy exists.

Activities of Daily Living↗