Biomedical subjects

F Gohlke

Publications and source records attributed to F Gohlke.

45 records · Page 3Linked to original sources

PubMedDate not supplied

[Primary synovial chondromatosis of the shoulder].

AIM: To demonstrate the various patterns of primary synovial chondromatosis (PSC) around the shoulder and to discuss a therapeutic algorithm. METHOD: In this retrospective study, 6 patients with histologically proven PSC were operated on. The diagnosis was based on clinical examination, plain X-rays, ultrasonography and MRI in 5/6 patients. Also, a histological examination was done in all cases. According to the localisation of the disease, surgery was done by endoscopy alone, endoscopy together with open surgery or direct open surgery. RESULTS: In one case each, we saw an isolated disease of the subacromial bursa or the gleno-humeral joint. In two cases, we found an intraarticular affection together with the biceps tendon sheath. The other two patients showed a massive periarticular deposition of loose bodies together with a defect of the rotator cuff. All patients with intraarticular disease (5/6) showed different stages of chondromalacia. In 5 of 6 patients all bodies could be removed at surgery. At follow-up after 36 months the patients subjectively rated the result as satisfactory to excellent. In the patients with total removal of the bodies, no recurrences were seen on plain X-ray or ultrasonography. CONCLUSION: PSC around the shoulder appears with a variable pattern. According to the possible late complications described in the literature (i. e., secondary osteoarthritis, involvement of the rotator cuff and secondary malignant transformation), we find operative treatment justified. Surgery addressing removal of loose bodies and partial synovectomy allows good results. The operative approach (endoscopy or open surgery) is related to the localisation and severity of the condition.

Adult↗

PubMedDate not supplied

[Long-term results (5 - 13 years) after surgical local repair and deltoid muscle flap for massive rotator cuff tears].

AIM: The functional long-term results of reconstructions of massive rotator cuff tears (Bateman IV) were evaluated and analyzed. METHODS: 38 patients (6 female/32 male) had a clinical and sonographical assessment and an evaluation of the Constant score after a follow-up of 81 (60 - 160) months. Operative procedures were direct transosseous refixation in 16, local tendon shifts in 17 and deltoid flaps in 5 patients. RESULTS: The average age and sex related Constant score was 77 %. The 5 patients with the deltoid flap achieved a Constant score of 60 %, all had a sonographically detected re-tear and 4 of them rated their result as only moderate. 25/33 patients with reconstruction (76 %) rated their result as good or excellent, 5 (15 %) as satisfactory, 1 (3 %) as moderate and 2 (6 %) as poor. 12 (36 %) of the 33 patients met the sonographic criteria of a re-tear. These patients had a Constant score of 71 %, whereas 21 (64 %) patients with intact reconstruction achieved a score of 85 %. CONCLUSION: The reconstruction of massive rotator cuff tears achieves good clinical long-term results if the tendons remain intact. But even with a recurrent defect, the results have been better than in patients treated with a deltoid flap. In massive rotator cuff tears a thorough selection of the operative procedure regarding atrophy and fatty infiltration of the rotator cuff muscles as well as the tendon retraction and quality is mandatory.

Adult↗

PubMedDate not supplied

[Rotator cuff tear--an occupational disease? An epidemiological analysis].

BACKGROUND: In literature there are only few data which describe the influence of occupation on the development of rotator cuff disease. METHODS: In a retrospective study, 760 open rotator cuff repairs were analysed and related to the profession and occupational load. Exclusion criteria were traumatic tears and sports injuries. All male persons were statistically analysed and the data compared with occupational patterns of the region, obtained from the Federal Statistical State Office. RESULTS: Rotator cuff repairs were performed in 472 males who had no evidence for a traumatic origin. After statistical analysis (p < 0.001) we found significantly more patients working in agriculture and forestry (6.38% versus 1.07% in Bavaria) and in the building industry (35.11% versus 13.40% in Bavaria). CONCLUSIONS: Our data suggest that working exposure increases the risk or leads to the clinical manifestation of rotator cuff tears. Although a detailed analysis of individual physical exposure is not available yet, the statistical results indicate that rotator cuff tears must be taken into consideration as a result of ergonomic exposure.

Adult↗

PubMedDate not supplied

[Comparison between low-molecular and unfractionated heparin in the prevention of thrombosis in patients with total endoprosthetic replacement of hip and knee joint].

PURPOSE: Thrombosis-prophylaxies with heparins after total hip arthroplasty (THP) and total knee arthroplasty (TKA) is well accepted. The aim of this study was to compare the low molecular weight heparin (Enoxaparin) with PTT adjusted unfractionated heparin (Na-heparin). METHODS: In a prospective study of 226 patients after THA and TKA, we performed physical examination and ultrasound in compression and duplex technique one day before surgery and at the 7th and 14th day after surgery. 120 patients received Enoxaparin 1 x 40 mg per day in fixed dosage. 106 patients received Na-heparin 3 x 5000 IE. Since PTT did not reach 40 seconds, Na-heparin dosage was increased to 3 x 7500 IE. RESULTS: The overall thrombosis rate was 4% (n = 9), in the Enoxaparin group 2.9% for the 70 THA and 10% for the 50 TKA. Thrombosis occurred in the group of unfractionated heparin (PTT adjusted) in 1.8% after THA and in 2% after TKA. In TKA, there is statistical difference between the two heparin groups. CONCLUSION: In the thrombosis prophylaxis of TKA, PTT adjusted unfractionated heparin is superior to low molecular weight heparin in fixed dosage.

Aged↗

PubMedDate not supplied

[The stabilizing function of the glenohumeral joint capsule. Current aspects of the biomechanics of instability].

The purpose of the study was to determine the influence of rotation torques on superior-inferior and anterior-posterior translation in various degrees of abduction in the glenohumeral joint. 16 cadaveric shoulders were tested using a specifically designed four-degrees-of-freedom mounting apparatus and a 6-degrees-of-freedom tracking system which allowed of dynamic and static measurements by means of ultrasound (Zebris) Internal/external rotation torques and translation forces in the inferior-superior and anterior-posterior plane were applied in 0 degrees, 45 degrees, 75 degrees and 85 degrees of abduction. Shoulders were tested intact, vented, after severing of the acromion and coracoid (7 shoulders) and after subsequent division of the anterior capsule at the glenoid margin including a T-shaped incision (8 shoulders). Venting of the capsule resulted in a significant increase in ap-translation only in abduction of less than 45 degrees. Rotation torques and an abduction of more than 45 degrees effected a centering of the humeral head against translation-forces in the anterior-posterior and superior-inferior direction. The weakening of the anterior capsule by a T-shaped incision, in which circular fibers were also severed, significantly increased the anterior translation in comparison to that obtained after an incision along the glenoid margin.(ABSTRACT TRUNCATED AT 250 WORDS)

Acromion↗

PubMedDate not supplied

[The value of meniscus sonography--a study with reference to clinical and arthroscopic findings].

In a prospective study the sonographic findings of 250 patients were compared with the results of their clinical and arthroscopic examinations, in order to test the value of ultrasonography of the meniscus. At the same time the influence of interfering factors and the value of certain sonographic criteria were investigated. Diagnostic sensitivity of sonography proved to be 71% for the medial meniscus and 85% for the lateral meniscus. The division into parts made us realize that there was a high rate of errors. Sonography did not provide us with an essentially greater degree of information, except in certain cases such as ganglions, for example. Errors in diagnosis were evident in radial tears and in certain parts of the meniscus (Pars intermedia, Pars anterior and lateral meniscus). There is insufficient imaging especially in radial tears and cases of adiposis and osteoarthritis.

Adolescent↗

PubMedDate not supplied

[Experiences with an ankle joint motion device in prevention of thrombosis in patients after total endoprosthesis knee replacement].

PURPOSE: Thromboprophylaxis with heparins after total joint replacement is well accepted. The aim of this prospective randomized study was to evaluate the thrombo-prophylactical efficiency of an ankle joint moving device (Artroflow) after total knee arthroplasty. METHOD: In this prospective study 160 patients were examined who had undergone total knee arthroplasty (TKA). All of the 160 patients received Enoxaparin 1 x 40 mg subcutaneously per day. In addition to this, 90 patients received Artroflow three times a day for 30 minutes. The passive movements of the ankle joint lead to an emptying of the foot and calf veins. Except for the daily routine, we performed physical examination and ultrasound in colour, compression and duplex technique one day before surgery and at the 7th and 14th day after surgery. If a thrombosis was suspected, an ascending phlebography was carried through. RESULTS: The overall thrombosis rate was 6.3% (n = 10). 11.4% (n = 70) deep vein thromboses (DVT) could be observed in the group without Artroflow. Thrombosis occurred in the group with Artroflow in 2 cases (2.2%, n = 90). A statistical difference was found between the two patient groups (p < 0.05, Chi-Square-test). One patient was excluded from the study because of pain in the ankle joint at the fourth day of treatment. CONCLUSION: In addition to heparins, this ankle joint moving device can be recommended as a physical way to prevent DVTs in the thromboprophylaxis of total knee arthroplasty.

Adult↗

PubMedDate not supplied

Primary synovial chondromatosis of the elbow.

Very few cases of primary synovial chondromatosis of the elbow have been reported in the literature. This is a study concerning the late outcome of primary synovial chondromatosis in the elbows of 12 patients, 10 men and 2 women, with a mean follow-up of 16 years 10 months. The average age at the time of the initial complaint was 29 years. The histories of 10 patients revealed elbow strain as a consequence of work-related activities. Surgery included removal of loose bodies and partial synovectomy in all patients. A moderate to severe osteoarthritis was found preoperatively in 5 of 12 patients and during follow-up in 7 of 10 patients. The degree of osteoarthritis deteriorated after surgery in 5 of these cases, depending on patient age, length of presurgical history, length of follow-up, and strenuous activities. However, the functional deficiencies were usually moderate and had little significance with respect to the activities of daily living. No recurrence of primary synovial chondromatosis was found.

Activities of Daily Living↗

PubMedDate not supplied

The stabilizing sling for the long head of the biceps tendon in the rotator cuff interval. A histoanatomic study.

A histoanatomic study of the rotator cuff interval was done in 13 cadaveric specimens to investigate the relation of its ligamentous structures to the long head of the biceps tendon, with a special focus on revealing a stabilizing function. After macroscopic evaluation, the lateral half of the rotator cuff interval capsule was cut into three sections: medial, middle, and lateral. These sections were embedded in methacrylate, and then serial sections were made and stained for polarized light microscopy. The superior glenohumeral ligament was seen to form a fold having the macroscopic appearance of a U-shaped anterior suspension sling for the long head of the biceps tendon. Microscopic evaluation revealed an important role of the fasciculus obliquus in the roof of this sling. Fibers of the supraspinatus tendon join the posterosuperior part of the sling. The subscapularis tendon is not involved in this suspensory mechanism. As a result of these observations, we determined that the superior glenohumeral ligament and the fasciculus obliquus are the most important ligamentous reinforcements of a stabilizing sling for the long head of the biceps tendon in the rotator cuff interval. Their histologic appearance indicates they function to protect the long head of the biceps against anterior shearing stress. A lesion of this sling might lead to anterior instability of the biceps tendon.

Adult↗