Biomedical subjects
Publications and source records attributed to F U Niethard.
Seven hundred and five radiographs of the knee were examined and 17.6% showed a so-called Haglund imprint on the patella. The incidence was the same in patients with chondromalacia and in a control group. There was no statistical difference regarding age, sex and body weight. Haglund's imprint is a variation from the normal and is of no diagnostic value.
The articular cartilage and synovial membrane of immature and mature chicken knee joints were studied by light, scanning and transmission microscopy. The findings differed from human articular cartilage and we conclude that the chicken knee joint is not suitable as a model for human joint degeneration.
Questionnaires were sent to 1000 parents of children with myelomeningocele in order to get a better knowledge of the present state of prenatal diagnosis of this disease. 566 parents answered; 488 responders, in whom the pregnancy took place 1982 and later, were evaluated in detail. 85% of the parents reported having been checked by ultrasound 2 times and more during pregnancy: however, only 27% of the myelomeningoceles were detected before delivery. 83% were diagnosed between the 30th and 40th week of pregnancy. The rate of discovery rose from 0% and 37% between 1982 and 1990. As a consequence of this result, one should make every effort by using ultrasound and alpha-foetoprotein-screening to verify or to exclude a myelomeningocele in an early phase of pregnancy. The delivery should take place in a specialised centre, and the knowledge of life expectancy and life quality of these patients should be improved, for the obstetricians as well as for the parents.
In the case presented here we demonstrate the history of a 31-year old woman who had been known to be diabetic for more than 10 years. In the beginning she complained of an isolated fracture of the first metatarsal bone. Because of incomplete immobilisation, but without major trauma, fracture of the metatarsal I-V developed. On an outpatient basis diagnosis was delayed for 6 months because of a misinterpreted scintigraphy without performing x-ray examination. In our clinic treatment consisted of immobilisation in a cast and non-weightbearing. The update knowledge diabetic osteopathy and osteoarthropathy and the consequences for treatment are discussed.
We have used a new technique of epoxy resin injection to examine the blood supply of the Achilles tendon. The posterior distal part showed poor vascularisation, as did the middle part of the tendon. Ruptures occur in the middle part, but only rarely in the distal part. We therefore suggest that there is no direct relationship between blood supply and the frequency of rupture.
The aetiology of chondromalacia patellae and especially the importance of the subchondral space have not been clarified to date. However, clinical findings yielded pointers to a connection between degenerative changes of the articular cartilage and an influence exercised by the subchondral space. In our experiments we performed an operative ischaemia of the patella with interruption of the vascular inflow and outflow on 40 adult rabbits for exactly defined times (2 weeks, 6 weeks, 3 months, 6 months). The examinations were carried out using the plastination method, histology, transmission electron microscopy, and scanning electron microscopy. Marked changes can be seen from the third month onwards: disappearance of the tidemark, degeneration of the cartilaginous cells (formation of clusters) and onset of trachomatous keratitis. These degenerative changes progress further in the animals of 6 months of age. The results indicate that metaplasia of the tidemark plays a significant part in the pathogenesis of degenerative changes of the cartilage. Hence, chondromalacia patellae can be caused by subchondral vascularisation disorders.--This is, therefore, a new concept for the aetiopathogenesis of chondromalacia patellae, a disease pattern that is of great importance in sports orthopaedics.
In 21 children with myelomeningocele who underwent kyphectomy for congenital kyphosis of the lumbar spine, aortography revealed no case in which the aorta followed the spinal curvature. Many anomalies of the intercostal and segmental arteries were demonstrated which were only in part associated with deformities of the respective vertebral bodies. The kidneys, which were frequently malformed, often lay within the kyphosis and were therefore at risk of operative damage. We conclude that the aorta is not at risk and that aortography is not usually necessary before kyphectomy, except in patients who have undergone prior abdominal surgery. Non-invasive methods (ultrasound, CT or MRI) should be used to detect malpositions and malformations of the kidneys.
A prospective experiment was carried out in 40 rabbits in which the blood supply to the patella was interrupted for defined periods from 2 weeks to 6 months. With prolonged ischaemia, there were clear changes in the articular cartilage which were comparable with those seen in human osteoarthritis.
Joint fractures can interrupt the arterial and venous blood supply to the hyaline cartilage. Previous studies revealed effects of venous engorgement and hypertension in the cartilage. In this study the influence of interruption of the blood supply on the development of osteoarthritis was analysed. In a prospective, experimental study in 40 rabbits all vessels in the patella were ligated and the cartilage was investigated after 2, 6, 12, and 24 weeks by transmission electron microscopy. After 2 weeks no degenerative signs were determined. After 6 weeks there were distinct signs of cartilage injury. The degeneration of the hyaline cartilage increased with time. The endpoint of injury was the destruction of the cartilage and necrosis of the chondrocytes, determined after an ischaemic period of 24 weeks. The stages of cartilage degeneration in our trial correspond to the changes that are well known to occur in osteoarthritis. In conclusion, interruption of the blood supply of the patella results in degenerative changes to the joint cartilage. This effects is related to the duration of ischaemia. On the basis of results we recommend early and watertight repositioning of fractured joints not only for biomechanical reasons but also to avoid irrevocable effects of interrupted blood supply on hyaline joint cartilage.
We give details of seven children with the TAR syndrome, Thrombocytopenia with absence of the radius. Two of the children were siblings. The TAR syndrome is characterised by hypomegakaryocytic thrombocytopenia and bilateral absence of the radius. It is inherited as an autosomal recessive trait.
Between 1960 and 1983, 82 children were treated for Wilm's tumour at our hospital. The secondary effects and changes in the skeleton have been assessed. Radiotherapy was found to cause growth disturbances and osteochondrosis of variable degree, but not osteonecrosis. Since irradiation produces late damage, it should be applied symmetrically to the spine and the dose limited as far as is possible. A long follow up is necessary since skeletal damage can only be assessed after the end of growth.
Terminal overgrowth in transverse deficiencies and in amputations, particularly of the humerus and tibia necessitate serial trimming procedures or re-amputation. Capping using an autogenous bone graft or a titanium and polyethylene endoprosthetic cap provides a satisfactory way of avoiding these re-amputations and allowing end-bearing.
There is a tendency for malunion to occur in fractures of the knee region in children because the growth plates are often affected. Leg length discrepancies are reported in more than 50% of the children and axis deviations in 20-40%. The prognostic significance of epiphyseal lesions is described (not always accurately) by the classifications of Salter and Harris or Aitken. Treatment is mostly directed at leg-length discrepancies and axis deviations by resection of callus formations, epiphysiodeses and osteotomies. A complete bone growth history is necessary to plan the operative procedure.
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Rupture of a healthy Achilles tendon is disputed. A previous degenerative process with ischemia after recurrent microtraumas is usually held to be responsible. The vascular anatomy of eight human specimens was defined with a new method after perfusion through the femoral artery. This method allows exact analysis of the vessels even at a microscopic level. In contrast with the literature, the authors found a large number of anastomoses between the extra- and the intratendinous vessel system. The well-vascularized paratenon is therefore very important for the nutrition of the Achilles tendon. This fact must be taken into account during the surgical treatment of a rupture. The authors agree with the studies of the anatomist Lang who found a decrease of the intratendinous vascularization in an area 3 to 5 cm above the insertion in the os calcis. However a relationship between the frequency of rupture in this area and the vascular anatomy has not yet been shown.
The technique of lengthening the tibia with the Ilisarov device is explained. Different variations (bifocal or simultaneous) of the method are demonstrated, as well as the results of 53 cases of tibia lengthening in 37 patients of our hospital between 1986 and 1989. In 14 patients, a second operative procedure was necessary during treatment. In no case was internal fixation or grafting necessary. The Ilisarov ring fixator is very efficient, especially in major lengthening procedures and for simultaneous correction of deformities.
The clinical findings seen in chondromatosis (Henderson-Jones syndrome) and the treatment of this rare disease are presented. The etiology is also discussed. The authors suggest a therapy, drawing on their own experience in 40 patients with an average follow-up of 12.6 years and on numerous articles from the literature. They recommend total synovectomy with removal of loose bodies at an early stage to prevent mechanical destruction of articular cartilage.
25 patients suffering from femoral head necrosis in 30 hip joints were radiologically studied for an average of 11.6 years following intertrochanteric varus angulation osteotomy. Preoperatively only stages 2 and 3 according to Meyers were seen. The follow-up results could be distributed into 4 groups. At best the osteonecrosis was reconstructed within 6 to 9 years while the trabeculae started to become rearranged within 2 to 4 years. At worst, rapid destruction in absence of bony reaction was observed. The ability of the bone outside the osteonecrosis to react to changed circumstances following angulation osteotomy correlates with long-term results. This may indicate a general osteopathy even outside the necrotic area.