Biomedical subjects

C J Wirth

Publications and source records attributed to C J Wirth.

At least 199 records · Page 11Linked to original sources

PubMedDate not supplied

[Secondary operations for improving shoulder function after brachial plexus lesion].

UNLABELLED: The results of an integrated concept of therapy are presented including a description of indications and the various operative procedures to compensate insufficient shoulder muscles following brachial plexus lesion. PATIENTS AND METHODS: To improve stability and function of the shoulder in case of deltoid and supraspinatus paralysis 12 patients (1 female; 11 male; average age 29.4 years, range 17 to 56 years) underwent a shoulder arthrodesis. In 54 patients (11 female; 43 male; average age 30.3 years, range 18 to 69 years) a trapezius transfer was performed. The indication for a rotation osteotomy of the humerus to improve loss of external rotation due to paralytic infraspinatus muscle was determined in 4 male patients (average age 29.8 years, range 16 to 42 years). Our results are based upon an average follow-up of 2.0 (0.5-7.5) years after shoulder fusion, 1.9 (0.5-4.5) years after trapezius transfer and 1.6 (0.5-3.5) years after rotation osteotomy of the humerus. RESULTS: The trapezius transfer resulted in increased function of abduction of 6.2 degrees to 37.1 degrees (5 degrees-80 degrees) and forward flexion of 15.1 degrees to 36.2 degrees (10 degrees-90 degrees). A more stable condition of multidirectional shoulder instability was experienced by 50 patients (92.6%) and 49 patients (90.7%) were subjectively satisfied with the outcome of the operation. The strength and extent of functional improvement was, on average, greater following shoulder arthrodesis: abduction of 9.6 degrees to 65 degrees (40 degrees-90), forward flexion of 15.4 degrees to 59.2 degrees (30 degrees-90 degrees). 10 patients (83.3%) were subjectively satisfied with the outcome. Patients who had undergone external rotation osteotomy showed an average deficiency of external rotation of 20 degrees before operation. After osteotomy an improvement of 32.5 degrees to 12.5 degrees external rotation was achieved. All patients were satisfied with the increase of function. CONCLUSIONS: In patients with brachial plexus palsy, secondary operations according to the individual pattern of paralysis result in an improvement of shoulder function and stability as well as patients satisfaction.

Adolescent↗

PubMedDate not supplied

[A modified Viernstein and Kelly surgical technic for correcting chronic recurrent peroneal tendon dislocation].

An operative technique modified after Viernstein and Kelly for the treatment of chronic, recurrent peronal tendon dislocation is presented, which has been performed successfully in 15 cases. Principal elements of this technique are an improvement of the bony containment of the tendons within the shallowed, malleolar sulcus and the use of the outer layer of the dislocation pouch as superior retinaculum. This is achieved by inserting the outer layer underneath a dorsally displaced, bony lamella of the outer malleolus.

Adolescent↗

PubMedDate not supplied

[Dislocation of total hip endoprosthesis with special reference to various techniques].

1238 primary total hip replacements for arthritis were performed in our hospital from 1980 until 1988. 26 dislocations (2.1%) were registered during this period. No differences became obvious regarding age, sex, type of prosthesis and different concepts of postoperative treatment. After the posterior approach dislocations occurred in 18 (3.1%) of the cases, 8 dislocations (1.2%) were found after the transgluteal approach. The dislocation rate was significantly higher for the posterior approach. Derotation braces were not able to decrease the risk of redislocation. Most of the dislocations happened during the first postoperative week. The most frequent occasions were rotation of the operated leg while lying in bed and deep sitting positions. Performing the posterior approach for primary total hip arthroplasty the surgeon has to realize the higher dislocation rate.

Aged↗

PubMedDate not supplied

[Comparison of knee ligament scores and rating systems].

The results of the treatment of knee instabilities are evaluated by different scoring systems including subjective and/or objective criteria. Because of their number and their different criteria a comparison between the scoring systems is still a problem. The aim of this study was to analyze 14 different scoring-systems and prove the comparison of the commonly used rating scales. 116 patients with anterior or anterior-medial knee instabilities were followed up at least 2 years postoperatively. The evaluation was performed according to the criteria of the used rating-scales. The Lysholm I scoring system showed the highest mean total score (92 points). The scales that gave the highest correlation were the Cincinnati and ARPEGE scoring system (r = 0.97). The Lysholm I Scale and the Barrack Scale correlated least well (r = 0.711). This study documents that a transfer of results from one scoring system to another is not possible. A comparison between these scoring systems is only possible after adjusting the total points, the quality and the quantity of each criterion and component of the scoring system. This can done by using a standardized rating scale like the IKDC-score.

Activities of Daily Living↗

PubMedDate not supplied

["Primary" shoulder stiffness: illness duration and therapeutic comparison].

AIMS: Etiology, natural history and therapy of the frozen shoulder still remains obscure. Therefore observation of natural history is of interest. METHOD: In a retrospective study 140 patients with different therapies were followed-up. RESULTS: 28 (20%) patients were not considered as healed because of persisting complaints during the whole follow-up period with an average duration of 49 months. Mobilisation under anaesthesia (27 patients) showed an less improval in range of motion with a shortening of complaint period. CONCLUSION: The existence of a subgroup of patients with no response on regular therapy is assumed.

Adult↗

PubMedDate not supplied

[Perthes disease--results of a containment-oriented therapy concept].

INTRODUCTION: In a retrospective study a treatment concept for Perthes' disease dependent on the containment was applied. PATIENTS/METHODS: 49 hips of 41 children (9 female, 32 male) were treated between 01. 01. 1990 and 31. 12. 1995. In our concept of treatment a varus femoral osteotomy was performed in 28 cases with not contained hips or less than 4/5 coverage of the femoral head (X-ray/MRI). The other 21 well contained hips with 4/5 coverage or more were treated conservatively with physiotherapy and in case of joint effusion and pain additionally with the use of crutches (partial weight bearing) and anti-inflammatory medication. The average age in the non-operative group at the time of first investigation was 4 years and 9 months (3 y./1 m. to 7 y./1 m.) and 6 years and 3 months (4 y/2 m. to 10 y/0 m.) at our last examination (mean follow up 17.7 months, range of 6 to 72 months). At the time of indication for a varus femoral osteotomy the patients had an average age 6 years and 1 month (3 y./6 m. to 10 y./2 m.), the mean age at the last postoperative examination was 7 years and 11 months (4 y./8 m. to 12 y./5 m.) with an average follow up of 21.5 months (6 to 77 months). RESULTS: For the conservatively treated children we achieved good results (still well contained hips with 4/5 coverage, no decrease of function, no increase of pain) in 85.7% (18 of 21 cases). In 85.7% (24 of 28 cases) we found good results (well contained hips, increase of coverage, no decrease of function, no increase of pain) in the operation group. CONCLUSIONS: The presented concept of therapy in Perthes' disease was practicable for all patients and included the possibility of decision for operative or non-operative treatment. In both groups we achieved good results in 85.7% of the cases.

Child↗

PubMedDate not supplied

[Perioperative cost analysis of cemented versus uncemented total hip endoprostheses for clinical and economic management. Postoperative follow-up study over one year].

QUESTIONS: Are there and what are the differences between in-patient and out-patient costs for cemented or noncemented hip prosthesis? How to make it possible to keep in-patient costs within the limit of the a special global amount ("Fallpauschale")? METHODS: In this study we compared in-patient and out-patient costs of 30 patients with cemented and 30 patients with noncemented hip prosthesis during the first year after surgery. We developed a perioperative management in order to keep the costs in the limits of the "Fallpauschale". RESULTS: The average in-patient cost for the cemented prosthesis group was DM 19.644,89 and for the non-cemented group DM 20.485,33. In both groups these costs went beyond the "Fallpauschale" (DM 18.643,80). Comparing the two groups we found significant differences in costs for the endoprosthesis and for laboratory costs. We discovered a suitable perioperative management to keep costs below the "Fallpauschale". CONCLUSION: Using an appropriate perioperative management it is possible to keep costs in the given limits.

Aged↗

PubMedDate not supplied

[10 years follow-up of athrodeses of the hindfoot joints and upper ankle joint].

PURPOSE: What is the clinical and radiographic outcome of arthrodeses at the hindfoot and at the ankle more than 10 years postoperatively? METHODS: Between 1968 and 1988, 155 arthrodeses (ankle joint, triple arthrodeses, subtalar, pantalar and talonavicular arthrodeses) were performed on 147 patients. Indications for arthrodesis were posttraumatic arthritis, congenital deformity, idiopathic degenerative arthritis and rheumatoid arthritis. A variety of internal fixation devices or no internal fixation were used. 79 patients with 82 arthrodeses were reexamined clinically and radiographically, after 11.1 years on average. Static and dynamic foot print measurements were recorded with a capacitive sensor system. Another 26 patients with 27 arthrodeses replied to a questionnaire. RESULTS: Subjectively, the average pain score improved significantly. The overall function score improved only slightly. Results were inferior in the talonavicular arthrodesis. Radiographic evaluation revealed bony union in only 59 percent of the arthrodeses, one third at the talonavicular joint. Secondary degenerative arthritis of the foot and ankle occurred in 107 joints of the 82 feet. Evaluation of dynamic foot pressure measurements revealed an overall prolonged weightbearing on the midfoot region. CONCLUSION: An unacceptably low rate of bony union in some locations, a high incidence of secondary degenerative changes at neighboring joints, and a persistent abnormality of the plantar weightbearing pattern in the operated feet demonstrate unsatisfactory results with the techniques used more than 10 years ago. We now recommend stable internal fixation with optimum adaptation of the bone surfaces of the arthrodesis.

Activities of Daily Living↗

PubMedDate not supplied

[Treatment of fibular capsular ligament rupture. A multicenter study].

The treatment of lateral ankle ligament tears has been by conservative and by operative means. 483 patients treated by a number of orthopaedic surgeons, general surgeons and trauma surgeons in Germany over a 2 1/2 year period were questioned one year after the injury. Treatment had been conservatively in 325 patients (tape bandage, elastic bandage, plaster cast, ankle brace, Aircast brace, others) and operatively in 158 patients (primary ligament repair, ligament reconstruction). A 100 point subjective ankle score was used for the 420 patients who responded. The mean score was 90.5 points. The average score of all patients undergoing surgery was 88.2 points, the mean score of all conservatively treated patients was 91.7 points. However, instability on stress radiographs after the injury was less in the conservative group. There was no clear correlation between the initial radiographic instability and the follow-up result. Young patients did better than older patients. The authors recommend conservative, early functional treatment for lateral ankle ligament tears.

Adolescent↗

PubMedDate not supplied

[Shoulder stiffness and metal allergy--a possible link? A single case report].

The authors report on the link between shoulder stiffness following surgery for a traumatically recurrent dislocation of the shoulder and an allergy to the metal bone clamp used. In addition to a review of the literature on the problems of metal allergies and their verification, the relationship between metal allergy and the stiffening of a shoulder due to an allergy and the stiffening of a shoulder due to an allergy to nickel, hitherto unknown to the present authors, is discussed.

Adult↗

PubMedDate not supplied

[Stress relief of the hip joint by the Thomas splint].

The Thomas Splint is mainly administered to relieve weight from the hip joint. Theoretically the leg is bypassed by transmitting the body weight directly from the pelvis to the floor.--Load transmission via a Thomas Splint was measured with an orthosis strain gauged at the ischial interface area and at the foot plate. The results show, that about one half of the weight will bypass the joint through the orthosis. The Thomas splint ist unsuitable in cases when complete weight relief from the hip joint is necessary.--These results did not depend on whether the floor was flat or ascending, or whether stairs were climbed. The lateral bar never carried more then 25% of the force transmitted.

Adult↗

PubMedDate not supplied

[Diseases of the sesamoid bone of the large toe].

One-hundred patients with anterior foot pain were examined by tangential sesamoid x-rays and some by bone scan. Degenerative changes were present at the sesamoid joint in thirty patients. In thirty-five the sesamoids had changed position relative to the first metatarsal bone, which in all cases could be attributed to metatarsus-primus-varus. Three fractures were found. They were differentiated from congenital partitions only by bone scan. Osteomalacia of the sesamoids was observed in two patients. Operative removal was necessary in only one of all patients.

Adolescent↗

PubMedDate not supplied

[Operative treatment of congenital upward displacement of the shoulder blade].

In congenital elevation of the scapula the scapulothoracic movements and the patient's cosmetical appearance are affected. The aim of a number of operative procedures is the improvement or removal of this conditions. Between 1958 and 1978 15 patients with congenital elevation of the scapula were operatively treated by resection of the supraspinous portion of the scapula with or without relocating the scapula in a more caudal position, or in the method of König. 5 cases had a Grade-3 deformity, 9 cases a Grade-2 deformity and one case a Grade-1 deformity, measured in the technique of Rigault. By resection of the supraspinous portion of the scapula with mobilization of the scapula (6 cases) a mean caudalization of 2.7 cm. and a mean improvement in shoulder abduction of 32 degrees could be achieved. The procedure of König resulted in a mean scapular caudalization of 2.9 cm. and a mean improvement in shoulder abduction of 26 degrees. No important difference in the endresult could be found between the two operative procedures because of nearly the same pre-operative grading distribution of deformity. Only the partially unsightly surgical scars were dissatisfying.

Child↗

PubMedDate not supplied

[Resection of the acromial end of clavicula in acromioclavicular joint arthrosis].

Arthroses of the acromioclavicular joint mainly occur after trauma and may be the cause of pain in the shoulder region which is difficult to treat. Other possible causes are metastases, hyperparathyroidism, tuberculosis and osteolysis whose pathogenetic mechanism is still unknown. If all conservative treatment methods have been tried without success, lateral resection of the clavicula, first described in 1941 by Gurd and Mumford, is the method of choice. Some of the results obtained by the present authors with 15 patients (of whom 11 were followed up) are presented and compared with those obtained by other authors. Since the results are altogether very good, this operation, which is technically simple to perform, is recommended for arthroses of the acromioclavicular joint of any etiology. In cases with Tossy III ruptures of the joint the procedure described by Weaver and Dunn can be performed in addition.

Acromioclavicular Joint↗

PubMedDate not supplied

[Resection of the acromial and sternal end of the clavicle].

The causes of complaints in the acromioclavicular joint include arthrosis after dislocation of the joint, metastases, polyarthritis, tuberculosis, or hyperparathyroidism. Some causes have not yet been identified. If conservative therapy is unsuccessful the condition may be treated by resection of the acromial end of the clavicular, as first described by Gurd and Mumford. The present paper reports the results obtained in 22 patients who were followed up. Complete freedom from pain was achieved in 59% of the cases and improvement in 23.7%, while in 13.6% the results had to be classified as unchanged or poor. An analysis of these results admits the conclusion that with restricted indication and in particular in post-traumatic conditions, it is certainly possible to achieve results which make this technically simple procedure the treatment of choice in arthrosis of the acromioclavicular joint; this is borne out by the literature. In much rarer cases, changes in the sternoclavicular joint have to be surgically treated. Here also, the majority of cases are post-traumatic changes, and here again most of them are conditions following anterior luxation. Analogously to resection at the acromial end of the clavicula, a resection at its sternal end may also produce successful results. With reference to three of the authors' own cases, the clinical picture is considered and the results are presented and discussed; however, since the various surgical techniques cannot be compared, a final evaluation is only possible to a limited extent.

Acromioclavicular Joint↗

PubMedDate not supplied

[Bilateral habitual fibula head dislocation].

Dislocation of the fibular head is rare. In most of the cases a trauma caused by sports activity, sometimes associated with a tibia fracture, is described. Only a few publications exist about habitual dislocation of the fibular head without history of trauma. This article reports a case of bilateral habitual anterolateral dislocation of the fibular head in a 17-year-old female. There was no information about a neurological or other disease and no sign of generalized ligamentous laxity. Because of marked symptoms with severe pain after each sensation of dislocation which appeared several times a day, the patient was treated by using a part of the biceps tendon for fixation of the reduced fibular head.

Adolescent↗

PubMedDate not supplied

[Magnetic resonance tomography in therapy follow-up after repositioning treatment of congenital hip dislocation].

INTRODUCTION: After treatment of infantile hip dislocation in terms of reduction and retention in plaster casts or splints a problem of therapy controlling exists. To assess if the femoral head is in correct position centered in the socket ultrasound is not possible, because one cannot achieve the necessary standard position. Computertomograms are associated with a hereditary taint of radiation and plain roentgenograms lack of presentation of the important cartilaginous structures. METHOD: To control infantile hips after open or closed reduction from 1990 until 1996, 43 examinations by MR imaging were performed in 34 children. RESULTS: In our series MRI was able to provide exact information about the position of the femoral head independently of its state of ossification. Also, a clearly visualisation of the different structures of the acetabular fossa, particular acetabulum, pulvinar, bony and cartilaginous acetabular rim and limbus was possible. Furthermore the MR images showed interpositioned soft tissue, intraarticular effusion and displayed cartilaginous parts of the acetabular rim. CONCLUSIONS: MRI is an exact method to assess the anatomical and pathological conditions of the childlike hip joint. Because of the disadvantages of CT and X-ray, MRI is superior in terms of controlling the results after treatment of infantile hip dislocation.

Acetabulum↗

PubMedDate not supplied

Dynamic double tendon replacement of the posterior cruciate ligament.

Reconstruction of the posterior cruciate ligament combined with medial capsular repair was performed in eight men and four women whose average age was 29 years. In an effort to simulate the tensile behavior of the two major divisions of the posterior cruciate ligament, i.e., the anterolateral and posteromedial portions, we used the gracilis and semitendinosus tendons as substitutes. Since we consider this a dynamic operation, we feel its full benefits are measured better by functional parameters than by purely objective parameters. Accordingly, followup between 1 and 4 years (averaging 32 months) revealed all patients were subjectively pleased with their operative results. Postoperative objective evaluation still demonstrated a positive posterior drawer sign (although decreased) in all cases and a diminished medial joint space opening in most cases. Thigh girth differences were found at followup in most cases, probably as a result of disproportionate activity of the contralateral extremity. We feel that our dynamic reconstruction is an excellent alternative when one is considering surgery for a torn posterior cruciate ligament.

Adolescent↗