[Quality assurance].
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Evidence-Based Medicine↗
Biomedical subjects
F U Niethard
Publications and source records attributed to F U Niethard.
[Surgical treatment of hip dislocation in patients with infantile cerebral palsy].
The results of 63 operations on 52 patients with cerebral palsy, which were performed between 1978 and 1988 to correct a subluxation or dislocation of the hip, were reviewed. The innominate pelvic osteotomy was preferably combined with intertrochanteric femoral osteotomy and soft tissue release. The average age at time of surgery was 7 years/2 months. Surgical intervention was indicated irrespective of the severity of neurologic involvement. The mean follow-up period is 3 years/4 months. The results show, that by a combinations of these surgical procedures a permanent stability of the hip joint can be achieved. Retrospectively the 5 cases of reluxation can be explained by insufficient surgical technique. The postoperative development of the CE-angle and the acetabular index reveal, that after adequate reduction of the femoral head the acetabulum is able to remodel its dysplasia. From a functional point of view actually patients with diplegia gained the most benefit from a stable hip joint, because they showed the most progress in motor activity. In tetraplegic patients the long-term success of these surgical procedures must be seen in the prevention of a painful hip in adult life, the maintenance of sitting-stability and the improvement of perineal care condition.
Adolescent↗
[Deformation in conservative treatment of vertebral fractures].
The indication for functional or operative treatment of fractures of a vertebral body depend on the additional injury, on the stability of the fracture and on the amount of deformity. In a retrospective radiological study on 74 patients we analysed the behavior of secondary deformation in stabile fractures of thoraco-lumbal vertebral bodies under treatment with a 3-Points-Corset. The average initial sagittal deformity was 12.5 degrees. After three months an average increase of 1.5 degrees was measured resulting in an average increase of total kyphosis of 2.5 degrees during fracture consolidation. No further secondary changes were seen after a period of three months following the injury.
Adolescent↗
[Chondromalacia of the patella and intraosseous pressure. A study of 43 patients].
There are some hints concerning a relationship between the intraosseous pressure and degenerative changes in hyaline cartilage. With a specially constructed cannula we evaluated the intraosseous pressure in 43 patients in relation to the joint position (Extension/Flexion). In two groups we compared patients with and without degenerative changes in the hyaline cartilage, diagnosed by arthroscopy. Our results show, that patients with a chondromalacia have an increase of intramedullary pressure. These changes were discussed in the possible role of the pathology of chondromalacia patellae and retropatellar arthrosis.
Adult↗
[Primary osteotomy of the fibula in the treatment of post-traumatic tibial pseudoarthrosis].
In a retrospective study 32 case histories of patients with primary osteotomies of the fibula were evaluated to find out the reliability of this method in the treatment of tibial pseudarthroses. The influence of the osteotomy level and extent was taken into account as well. In 23 cases the pseudarthroses resulted from tibial and fibular fractures. Causative for the pseudarthroses were the blocking effects of healed fibula, tibial infection and loose osteosynthetic materials. 22 tibial pseudoarthroses healed by fibular osteotomy and postoperative immobilisation only, healing time was 25 months on average, in case of proximal fibular osteotomies even longer. The extent of fibular resection was between 5 and 30 mm. In contrast to "modern" methods of treatment, primary osteotomies in the treatment of tibial pseudarthroses take a rather long time to heal.
Adult↗
[Transient hip joint inflammation (coxitis fugax)].
The transient coxitis is the most common hip disease in the childhood. Etiology is unknown. Questioning the history you will often find an infection in the neck, nose, ear area. Clinical, radiological findings and serological testing are unspecific. In the arthrosonography normally you will find an effusion. The positive diagnosis of the transient coxitis is only possible by observing the mostly benign course of the disease. The treatment is bed rest and non weight bearing. The most important differential diagnosis is the Perthes disease. The principal aspects of the transient coxitis are described and discussed in literature and by own experience.
Adolescent↗
[Neurophysiologic aspects of the etiology and pathogenesis of congenital hip dislocation].
Till today the meaning of neuromuscular factors in etiology and treatment of congenital dislocation of the hip is not quite clear. Our observation in 62 children with 78 dislocated hips show that neurophysiological mechanisms play of very important role in the development and upkeep of CDH. The neurological examination in 17 children pointed to the typical asymmetries of the children which correlated with the side of the dislocated hip. The knowledge of neurophysiological disturbances on the dislocated hip is of great value for the diagnosis of CDH and even more for the exercise treatment in hips with severe adduction contracture.
Cerebral Palsy↗
[Preliminary treatment of congenital hip dislocation using physical therapy based on neurophysiology].
Adductor tightness is a typical symptom in CDH. In cases of subluxation and complete dislocation even a rigid abduction contracture can occur, preventing reduction and favouring redislocation. The contracture of the hip joint is the result of neurophysiological disorders, which can be treated by an exercise program on a neurophysiological basis. 62 children with 73 severely contracted and 5 hypotonic hip dislocations have been treated by the so-called "Vojta-program" before reduction. In a prospective study over 5 years this kind of treatment has been very successful: the incidence of necrosis of the femoral head could be reduced to 4%, long-lasting traction was not necessary anymore and the rigid hip joints required open reduction only in 2 cases.
Cerebral Palsy↗
[In pact with the impact factor?].
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Bibliometrics↗
[Cause of pain in early dysplasia coxarthrosis. A case report].
The case of a 48 year old woman with a synovial cyst of the hip joint and arthrosis secondary to dysplasia is presented Rheumatic disease could be excluded. During an arthrography, which showed the communication of the cyst with the hip joint, the formerly existing pain could be elicited. In this case the pain in beginning hip dysplasia is not directly related to arthrosis.
Diagnosis, Differential↗
[Symphysis injury--clinical and ultrasound follow-up].
We report about the sonography as a non-invasive method for diagnosis and control of a postpartal injury of the symphysis.
Adult↗
[Radiographic study of the hip in infancy and early childhood].
In the age of sonography, there is increasing disapproval of radiologic examination of the hip in infancy and early childhood. Justifiably, the sonogram has replaced the X-ray in many examinations of the hip joint in infants and small children, thus sparing them radiation exposure. It must be remembered, however, that sonography is primarily a screening method for detecting congenital hip dislocation and dysplasia in infancy. There is still no substitute for radiologic examination of hip joints which require treatment or have been treated. Performance of survey radiograms, and if necessary arthrography, with a specific diagnostic goal permits an interpretation of all pathomorphologic changes associated with hip dislocation in infancy and early childhood. There is no place for computerized tomography in this context. It is still impossible to predict the extent to which, in the future, magnetic resonance imaging, with new coil configurations and shorter examination times, will open a new chapter in hip joint examination.
Child, Preschool↗
[Virtual reality in orthopedics: principles, possibilities and perspectives].
Virtual Reality is a new form of human-machine interface. Virtual Reality integrates the human into the virtual world of the computer. Concerning existing Virtual Reality programs and 3D-graphics in medicine this article shows possibilities and perspectives for orthopedic surgery. Using Virtual Reality the orthopedic specialist is able to improve the diagnosis, the planning and supporting of operations just as new ways of teaching and training. Virtual Reality (VR) assists disabled individuals in improving the quality of life an working with computers. Principles will be discussed in respect to the four categories Immersive VR, Desktop VR, Pseudo VR and Inverse VR.
Arthroscopy↗
[Definition of patellar chondropathy and patellar chondromalacia].
In the course of a review of the literature the definition, etiology, diagnosis and treatment of the disease entities chondropathy and patellar chondromalacia are compared. Without exception, the descriptions found are inconsistent and inaccurate. A new classification--chondromalacia, patellar and peripatellar syndrome--is proposed. Possible causes of these diseases in the subchrondral vascular system are mentioned explicitly ("patellar migraine", "patellar claudication").
Cartilage Diseases↗
[The prognostic significance of clinical and radiological parameters for the revalgisation of the femoral neck following intertrochanteric derotation varization osteotomy].
This study investigates retrospectively the preoperative findings and postoperative courses of 580 children with altogether 1001 intertrochanteric osteotomies. The evaluation of on average 5 postoperative years determines criteria assisting the revalgisation of the femoral neck. Of main importance is the age at the date of operation; the younger the child is the higher is the degree of revalgisation. An also important factor is the preoperative CCD-angle, high values correlate with a high revalgisation rate. Exceptional features and alterations of femoral head, form and depth of the hip-socket also assist the revalgisation of femoral neck. Mechanical mistakes, little varization, low medialization of distal femoral fragment e.g., lead to an increase of postoperative CCD-angle; meanwhile damage of the apophyseal or epiphysial line does not affect the revalgisation.
Child↗
[Save the joint? Replace the joint? Long-term results and considerations in the treatment of femur head necroses in adults].
UNLABELLED: 65 patients with necrosis of the femoral head (not caused by a trauma) in 102 hip joints were examined at an average of 9.7 years following first operation: 1st: 30 joints underwent intertrochanteric varus angulation osteotomy (follow up 11.6 y). RESULTS: 12/30 clinically not sufficient, 13/30 radiologically worse, only 2/30 improved range of movement. 2nd: 35 hip joints were treated using an artificial hip replacement (follow up 9.1 y): 77% got loose at an average of 5 years requiring 39 follow-up operations. 3rd: 5 arthrodesis were performed (follow up 11.4 y). 60% delayed nor non bony union. The results indicate a general osteopathy overlapping the size of osteonecrosis, and causing a lot of complications. Various therapeutic concepts should be considered with respect to radiological stage and age of the patient. The results of joint saving operations depend on the ability of the femoral bony structures to react sufficiently.
Adult↗
[Spinal surgery on patients with myelomeningocele. Results 1971-1990].
Between 1971 and 1990 33 kyphectomies were performed at the Orthopaedic Hospital, University of Heidelberg. The average age at time of surgery was 5 years/5 months; the follow-up period was 5 years. The best results were obtained in the group with congenital rigid kyphosis. A marked postoperative deterioration was considered in patients with a flexible paralytic kyphosis, probably due to a too short area of fusion. In 19 patients the correction of the kyphotic deformity was the prerequisite for being provided with orthotic devices. The most serious complication was the intraoperative death of 3 patients. It can be presumed, that after transection of the spinal cord a non-functioning CSF-shunt lead to an acute elevation of the intracranial pressure. Therefore an adequately functioning shunt must be secured preoperatively.
Adolescent↗
[How idiopathic is idiopathic scoliosis? Results of neurological studies with somatosensory evoked potentials (SSEP) in children and adolescents].
UNLABELLED: About 90% of all the scolioses are called "idiopathic". Various neurological diseases (for example poliomyelitis, etc.) are frequently accompanied by deformities of the spine. The so-called somatosensory evoked potentials are at our disposal being a very sensitive and a non-problematic neurological diagnostic tool. Formation of the question: Are there clinically non-detectable neurological changes demonstrable by use of evoked potentials in children with so-called idiopathic scoliosis? 45 non-operated patients suffering from scoliosis and 21 healthy children were examined clinically, neurologically, and by use of evoked potentials. RESULTS: 26/45 children with idiopathis scoliosis showed pathological evoked potentials (right-left-side-difference concerning latency and amplitudes of the potentials and generally delayed transmission from peripheral nerves to the somatosensory cortex), mostly concerning the lower extremities. 19/45 children showed normal evoked potentials (EP). There was no correlation between EP and direction respectively degree of the scoliosis. Neurological affections mostly located caudally of the cervical spine are to be discussed (for example protrusion of the intervertebral disc, dysrhaphic processes etc.).
Adolescent↗