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Biomedical subjects

F Grill

Publications and source records attributed to F Grill.

At least 55 records · Page 3Linked to original sources
PubMed1990

Correction of clubfoot relapse using Ilizarov's apparatus in children 8-15 years old.

Treatment of relapsed or neglected clubfeet between the age of 8-15 years is at present unsatisfactory. Correction by triple arthrodesis with wedge osteotomies is not possible before the end of skeletal maturation. This caused us to use Ilizarov's external fixator, which made it possible to correct all components of clubfoot simultaneously by continuous guided distraction. Thirteen feet in 12 children were treated. A plantigrade foot was achieved in all cases. All patients were able to wear ready-made shoes. Complications were some slight and two severe pin track infections, temporary edema, and two relapses successfully treated by means of second procedures.

Adolescent↗
PubMed1990

[Pelvic tilt and leg length discrepancy].

Pelvic obliquity caused by leg length discrepancy is a problem facing patients with a wide variety of conditions. It is the degree of discrepancy and the growth pattern of the legs that usually govern treatment decisions, with the cause of the discrepancy having little influence. We analyzed the results recorded in 345 patients with pelvic obliquity caused by leg length inequality operated on between 1969 and 1989. In 146 patients a shortening procedure was done and in 199 patients a lengthening procedure. Biological bone growth stimulation did not prove to be predictable and effective in 65 cases. In 134 patients and 138 segments a distraction procedure was performed. In 26 segments the technique was according to Wagner; in 37 cases the Ilizarov fixator was used and in 75 the Orthofix device. Excellent results were obtained in 65% and good results in 23%; the condition became worse in 12%. Analysis of the results justifies the use of epiphysiodesis, shortening osteotomies and bone lengthening according to the biological principles investigated by Ilizarov in the presence of well-defined indications outlined in this report. Patients with a discrepancy of up to 2-3 cm are treated conservatively by shoe lift. For patients with a leg length inequality of 3-5 cm, epiphysiodesis or shortening osteotomy is still a good indication although lengthening procedures can also be performed. Discrepancies between 5 and 15 cm are treated mainly by lengthening operations. New lengthening techniques such as corticotomy and callus distraction, as well as new external fixation systems like Orthofix and Ilizarov, have made bone lengthening a less risky, easier, and more effective procedure. In a growing child, careful clinical and radiological assessment and repeated analysis of past growth in order to predict future growth can provide an exact plan for effective treatment, which often consists of bone lengthening, combined with shortening procedures on the contralateral side to establish leg length equality even in cases when there is 20 cm difference. Surgical treatment can be especially gratifying when anatomical, cosmetic and functional symmetry is restored and a lifetime of shoe lifts, braces or prostheses can be avoided.

Adolescent↗
PubMed1990

[Current concepts for surgical treatment of cerebral movement disorders].

In cerebral palsy orthopedic surgery can avoid deformity, existing deformities can be corrected, muscle imbalance can balanced and painful conditions--such as early osteoarthritis in hip dislocation--can be diminished. A tremendous functional improvement is not to be expected. In order to achieve good results the correct diagnosis is important, the natural course of the disease must be known. A team approach that includes the pediatric neurologist, physical therapist and the orthopedic surgeon is a must. The goals of therapy have to be discussed with the patient and his/her parents. If possible electromyography and gait analysis should be done but exact clinical evaluation is most important. The interactions between different groups of muscles must be known. It is important to differentiate primary and secondary, dynamic and fixed deformities. Orthopedic surgery can make life easier for a person with cerebral palsy, but cerebral palsy itself can never be over come.

Ankle Joint↗
PubMed1989

[Congenital idiopathic clubfoot. Etiology, pathomorphology, therapy and results].

The congenital clubfoot is still a challenge for any orthopaedic surgeon and a subject of controversial and unresolved aspects. In this study the technique and results of 312 clubfeet which were treated at the pediatric orthopaedics department of the Speising Hospital between 1979-1987 are reported. Conservative treatment was successful in only 15% of our patients. 85% had to be corrected by a surgical intervention, mostly by an extensive posterior release. New aspects of pathomorphology and of surgical management of the deformity are mentioned. The benefit of the Cincinnati-incision is stressed and has been proved by this study.

Casts, Surgical↗
PubMed1989

Correction of complicated extremity deformities by external fixation.

Thirty-three limb segments with various deformities in 28 children were treated by external fixation. Sole bone lengthenings and trauma cases were excluded from this study. The Wagner device was used in six cases, the Ilizarov ring fixator in seven, and the Orthofix in 20. Indications, techniques, results, and complications are discussed. The results indicate that modern external fixation is an effective alternative method in the treatment of problem cases such as congenital pseudarthroses, severe relapsed or neglected clubfoot, high dislocated hips, and limb deformities with length discrepancies.

Adolescent↗
PubMed1988

The osteoporosis pseudoglioma syndrome. Update and report on two affected siblings.

Two siblings (male, 29 years, and female, 13 years) with the rate autosomal recessive osteoporosis pseudoglioma syndrome are reported in detail. All essential signs and symptoms of the full clinical picture were present and are documented by impressive X-ray pictures. Some aspects of our patients are compared with relevant findings of previous reports. Collagen studies (skin biopsies) failed to reveal any significant disorder of the main collagen types composition. Striking similarities with established genetic disorders of collagen (like the osteogenesis imperfecta group and the Ehlers-Danlos syndrome) suggest, however, that the OPS could be a primary collagen disorder. Genetic counselling and devoted socio-medical care for these handicapped children is presently the only help which can be offered.

Adolescent↗
PubMed1987

The Ilizarov distractor for the correction of relapsed or neglected clubfoot.

The correction of a relapsed or neglected clubfoot by an external distractor is an alternative to a major operation which may involve triple arthrodesis and is often associated with skin problems. We report the use of the Ilizarov method to treat nine severely deformed feet, with satisfactory results in terms of function and appearance. The distractor enables treatment to be applied before maturity and avoids the shortening of the foot that results from wedge osteotomies. We discuss the indications, technique, complications and results of the method.

Adolescent↗
PubMed1986

Experiences with the chevron (V-)osteotomy on adolescent hallux valgus.

The results of a distal chevron (V-)osteotomy in 31 adolescent patients are reported. The distal V-osteotomy of the first metatarsal appeared to provide excellent correction of hallux valgus deformities. The surgical technique and the advantages over other forms of distal osteotomy are described. The authors recommend that distal V-osteotomy be considered as an alternative to other forms of distal osteotomy when treating hallux valgus in adolescents and growing children.

Adolescent↗
PubMed1985

Chiari's pelvic osteotomy in the treatment of Legg-Calvé-Perthes disease.

Results of Chiari's pelvic osteotomy in Legg-Calvé-Perthes disease were analyzed in 37 hips of 36 patients. The mean age at surgery was nine years. The results were assessed according to both the quality of sphericity and containment of the femoral head. The results were satisfactory in 26 hips (70%), acceptable in 10 hips (27%), and poor in only one hip (3%). In cases where preoperative arthrography revealed a saddle-shaped distortion of the protruding and flattened epiphysis, the results were less satisfactory. The authors conclude that Chiari's osteotomy is needed where other kinds of containment cannot be expected to be successful. The indications are smooth flattenings of severely protruding epiphyses in patients aged seven years or more, and severe epiphyseal protrusions without flattening in patients 10 years or older.

Adolescent↗
PubMed1985

[Conservative and surgical treatment of hip dysplasia and dislocation].

Almost in any case of hip dislocation and dysplasia, diagnosed within the first 3 months of live conservative treatment is successful. Very instable hips have to be treated with plasters. Because of the danger of necrosis of the femoral epiphysis the Lorenz position of hip plasters is no more longer accepted. The only way to avoid this complication is to use the human position (110 Grad flexion, 60 Grad abduction) for hip spikas. Surgical methods are necessary in cases of late diagnosis, or of neglected conservative therapy.

Female↗
PubMed1985

[Etiology, pathogenesis and pathology of dysplastic hip dislocation].

Neonatal hip examination and early therapy of CDH proofed to be best in preventing early osteoarthritis of the hip. Nevertheless we still happen to be confronted with congenital dislocated hips and hip dysplasias diagnosed after walking age. The pathologic changes of the dislocated hip joint are described.

Child Development↗
PubMed1984

Clubfoot therapy according to Bösch: conservative and operative aspects.

To Bösch goes the honor of having revealed the contradictions of the classical redressment treatment as early as 1950. Bösch's method was new insofar as he exerted pressure on the calcaneus from laterally and thus intuitively corrected the most important deformity, the subtalar horizontal internal rotation. Theoretical confirmation of this subtalar rotation was only made possible by computer tomography investigations, as described herein. On the grounds of these findings, the current operative concept has to be questioned and adapted to the latest scientific findings on the pathomorphology of the clubfoot. Also reported is an operation technique which permits correction of subtalar internal rotation and simultaneous complete reduction of the navicular on the talus, including the calcaneocuboid joint.

Adolescent↗
PubMed1984

Treatment of hip dislocation after walking age.

Between 1979 and 1981, 35 patients were treated at our institution. All patients were more than 18 months of age and 50 congenitally dislocated hips were treated. The average age at operation was 7 years and 3 months. Whereas children under the age of 6 were typically operated upon by open reduction and Salter, Pemberton, or Dega osteotomy partly combined with femoral osteotomy, in the group of the patients older than 6 years with high iliac hip dislocations, a method was used to avoid femoral shortening. By means of the Wagner distractor the dislocated hips were brought opposite to the acetabulum. This procedure was followed by femoral osteotomy and in most cases Chiari pelvic osteotomy. Despite a number of complications the results turned out better than expected. Compared with the preoperative X-ray classifications (Severin) the postoperative result was excellent in 10 cases, good in 20, fair in 15, and poor in 1 case.

Adolescent↗
PubMed1984

Distraction of the epiphyseal cartilage as a method of limb lengthening.

This case report presents a girl with congenital short femur and a limb length discrepancy of 12 cm. After a series of complicated operations failed to lengthen the limb, we applied distraction epiphysiolysis and succeeded in correcting the length discrepancy. This method, rarely mentioned in medical literature, is described and discussed.

Bone Lengthening↗
PubMed1984

[Early diagnosis of hip dysplasias].

Neonatal hip examination is only effective with the help of a large number of experts. Teamwork between pediatrician, pediatric orthopedic surgeon and general practitioner seems to be essential. Best results can be achieved with a hip examination during the first 4 days of life and controls with 3 months and with 12 months. The technic of clinical examination and diagnosis is described. Because of hip dysplasias without any clinical signs the importance of an x-ray of the hip with an age of 3 months is emphasized.

Child Development↗
PubMedDate not supplied

[Early results of the Ponseti method for the treatment of idiopathic clubfoot].

AIM: The Ponseti method for the treatment of congenital clubfeet has been propagated due to the sometimes disappointing functional results after surgical treatment. The aim of our study was to evaluate our early results and experiences with the Ponseti method. METHOD: Between December 2002 and December 2004 a total of 87 clubfeet in 59 patients were treated using the Ponseti method at our department. Only patients in whom treatment was initiated within the first three weeks of life were included in this study. Rate of successful correction without open release surgery, radiological findings, classification according to Pirani at the time of the last follow up, recurrence rate and duration of treatment were defined as outcome measures for this prospective study. RESULTS: Fifty-nine cases in 37 patients met the inclusion criteria. Ninety-three percent of all cases (55 feet) were corrected without open surgery. The mean duration of active treatment was 11.4 weeks (8-20 weeks). The mean tibiocalcaneal angle 3-4 weeks after the percutaneous tenotomy of the Achilles tendon was 69 degrees, the mean a.-p.-talocalcaneal angle measured 33 degrees and the lateral talocalcaneal angle 36 degrees. A recurrence was seen in one patient with bilateral clubfeet (3.6 %). CONCLUSION: Open release surgery can be averted in most cases of idiopathic clubfoot using the Ponseti method. Scarring of the soft tissue and especially of the joint capsule can thereby be avoided.

Achilles Tendon↗
PubMedDate not supplied

[Treatment of a radial club hand].

The present study includes a total of 12 patients who had a longitudinal radial deficiency which produced a club hand. 17 hands were affected. Complete radius aplasia (type C) was most frequent, followed by partial radius aplasia (type D) and radius hypoplasia (type E). 7 patients (8 hands) were treated surgically by centralisation of the ulna. Average age at surgery was 46 months. Indications for surgery were followed according to Blauth. The results were evaluated using the criteria of Hippe and Blauth. All patients were pleased with the results, and in each case there was no doubt that function and appearance could be improved. The results of this study demonstrate that correction of radial clubhand by centralisation of the ulna produces a good functional result if the criteria of Blauth are followed: functional mobility of the elbow joint of more then 90 degrees, and the possibility of passive correction of the deformity preoperatively.

Child, Preschool↗