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Biomedical subjects

F U Niethard

Publications and source records attributed to F U Niethard.

At least 163 records · Page 9Linked to original sources
PubMedDate not supplied

[Experiences with surgical therapy of scoliosis in patients with myelomeningocele].

This study reports about the experiences in surgical correction of scoliosis, which were performed between 1984 and 1989 in 32 children with myelomeningocele. The average age at time of surgery was 14 years, 1 month; the average degree of scoliosis was 96 degrees preoperatively. 6 different types of surgical techniques were used. In comparison the best results were obtained by a combination of ventral osteodiscectomy with or without instrumentation and dorsal CD-instrumentation; an improvement of 56% was found. Furthermore we sent questionnaires to all patients, who were operated more then one year ago. The majority of them judges the improved sitting stability of the trunk to be the greatest advantage. There is a high rate of postoperative complications. Beside one death, which occurred intraoperatively, especially pseudarthroses of the lumbosacral junction must be mentioned. These pseudarthroses and a to short selected area of fusion are the main reasons for the loss of correction, which was noticed after a mean follow-up period of 24.6 months. The necessity of postoperative bracing was not reduced by using CD-instrumentation.

Adolescent↗
PubMedDate not supplied

[Proton spin tomography in children and adolescents with so-called idiopathic scoliosis].

Somato-sensory evoked potentials (SSEP) were found to be pathological mostly in the lower extremities in 26 out of 45 children suffering from so called idiopathic scoliosis. We examined the vertebral spine and the spinal cord of 8 of them (with controlled SSEP-findings) by use of conventional MR-imaging and (where necessary) 3-dimensional-data-set following the Fournier-procedure. 6 of the 8 children showed alterations as follows: 1. A lipoma spreading partly extra-, partly intraspinally. 2. Subligamentous protrusions of the intervertebral disc (2 patients). 3. Dysraphic processes (2 patients). 4. An abnormally cranial ending myelon surrounded by a widened spinal channel. The findings are demonstrated and discussed concerning the questions whether the pathological SSEP and, furthermore, the deformity of the vertebral spine could be explained thereby. We are at least able to prove that some of the children with so called idiopathic scoliosis show pathological evoked potentials and MRI-findings.

Adolescent↗
PubMedDate not supplied

[Morphological and biochemical studies of the cartilage in the diabetic rat--a model for metabolism-induced arthritis].

Because of its general effects on connective tissue metabolism diabetes mellitus is becoming more and more important in the orthopaedic field. For investigation of morphologic changes in the cartilage a model of streptozotocin-induced diabetes was used in 80 rats. Studies were performed by light-, scanning- and transmission-electron microscopy and by biochemical analysis of proteoglycan and collagen metabolism. Three months after onset of diabetes the chondrocytes show increased metabolic activity and at the same time first stage regressive changes. The morphologic changes correlate with a significant decrease of hexosamine content in the cartilage. There is no evidence for any disturbance of collagen metabolism at that time. After seven months the cartilage is widely necrotic, the collagen fibers are swollen and show almost total loss of their microstructure. There is no sign for reparation of the necrotic zones at this time. It is most remarkable that in many specimen crystal deposits are found just below the cartilage surface which from the TEM-findings look very much like calciumpyrophosphate crystals. The morphologic and biochemical results show that in the rat diabetes leads to a special type of cartilage changes with crystallic arthropathy which seems to be a valuable model for the study of metabolic osteoarthrosis.

Animals↗
PubMedDate not supplied

[Osteochondrosis and osteochondronecrosis of the roof of the acetabulum].

Osteochondritis of the centers of ossification is a frequent condition during pubertal growth spurt. The ossification of the acetabulum is completed during that period by fusion of the primary and secondary ossification centers (Os acetabuli etc.). During that time of maximal longitudinal growth the pressure within the hip joint can impair the formation of the acetabulum. Usually the acetabular roof is involved to a lesser degree and spontaneous healing of the changes is observated (grade I). Under biomechanically disadvantageous conditions (e.g. coxa valga et antetorta) marginal defects of the acetabular roof (grade II) or even secondary dysplasias of the acetabulum are possible. From long term observations we come to the conclusion, that the pubertal growth spurt is a critical period for the development of the adolescent hip joint.

Acetabulum↗
PubMedDate not supplied

[Hereditary progressive arthro-ophthalmopathy (Stickler syndrome)].

The hereditary arthro-ophthalmopathy (Stickler-Syndrome) is a relatively frequent dominantly inherited disorder of connective tissue. The main symptom is strong congenital myopia, which develops often to blindness. On the other hand there is a dysplasia of the meta- and diaphysis of the tubular bones, which varies in form and expression. Within difficulties with differential diagnosis to near syndromes it is important to get a clear diagnosis by ophthalmologic, radiologic and family investigations. Within three members of a family the orthopaedic symptomatology is shown. In case of Stickler-Syndrome surgery in the skeleton system should be prevented.

Abnormalities, Multiple↗
PubMedDate not supplied

[Pathogenesis of pediatric spondylolisthesis].

62 children with spondylolisthesis were examined. Functional anatomical studies on 25 growing human spines were performed to analyse their macro morphological behavior before and after spondylolisthesis. The progression of spondylolisthesis is explained as growth disturbance. The high incidence of spina bifida occulta in spondylolisthesis is a mechanical induced osteochondrosis of the dorsal arc. The different morphology of the spondylolisthesis in children depends mostly of the age of the beginning of this disease. The differentiation between the dysplastic and spondylolytic isthmic type of spondylolisthesis is not indicated. Pour prognosis is expected in young children with kyphosis and high ventral dislocation in the involved segment.

Adolescent↗
PubMedDate not supplied

[Retrosomatic spondylolysis of the 5th lumbar vertebra with segmentation disorder of the corresponding spinal arch].

Retrosomatic spondylolysis is a very rare type of neural arch defects. In typical cases the defect is a vertical cleft of the pedicle, which is thought to be the result of two ossification centers. The authors present a case of retrosomatic spondylolysis with a segmentation defect of the corresponding vertebral arch structures. The follow-up of this child from age 7 to 12 seems to be proof for this defect to be a fatigue fracture quite similar to those in isthmic spondylolysis.

Child↗
PubMedDate not supplied

[Accuracy of length and angle measurements in the roentgen image and sonogram of the pediatric hip joint].

The results of measurement of length and angles in the x-ray and ultrasound image of the infantile hip joint are dependent on the different shape of the joint but also on different x-ray projections, on a limited accuracy and incorrect technique in measurement. From our investigations on the accuracy of measurement a differentiation between normal and pathological infantile hip joints is not possible by measuring geometrical data in the x-ray resp. ultrasound image. In the x-ray the greatest possible error of the acetabular angle is +/- 3 degrees, that of the so-called "AMC-angle" +/- 5 degrees and of the Alpha- and Beta-angle in the ultrasound image +/- 10 degrees. Thus the collection of geometrical data in the x-ray and ultrasound image of the infantile hip joint is not more reliable than a qualitative assessment orientated on the osseous resp. cartilaginous corner of the acetabulum.

Acetabulum↗
PubMedDate not supplied

[Hip ultrasound screening within the scope of U3--initial experiences].

OBJECTIVE: After introduction of hip sonographic screening in Germany in the year 1996 we are interested in its organisational features and the results on a national level. It has to be scrutinized in how far the medical consequences are oriented and in accordance with the national guideline of hip sonographic screening. METHODS: Our study includes all 191.000 documentation sheets of hip sonographic screening in the year of 1996 in Germany. RESULTS: In the year 1996 pediatricians were responsible of 70% of all hip sonographic screening which were performed on the 36. day (median). About 80% of the examined infants showed alpha-angles > 56 Grad, about 1.7% only reached < 51 Grad. 27% of all cases were recommended a second sonographic examination and 7.7% should get a therapy. For 73% of all examined infants the consequences were compatible with the national guidelines for hip sonography screening. Orthopaedists more often showed deviations than other professional groups. CONSEQUENCES: There is the case for a more binding consensus regarding the adequate consequences in the cases of sonographic alpha-ankles between 51 to 56 degrees. In the light of an unexpected high proportion of infants with therapy recommendations there is to establish an informational feedback which covers results from the monitoring of the hip sonographic screening as well as results from the national outcome study.

Cross-Sectional Studies↗
PubMedDate not supplied

[Initial results of the evaluation study of ultrasound hip screening in Germany].

AIM OF STUDY: To assess the effectiveness of a universal sonographic screening of developmental dysplasia of the hip (DDH) established in Germany since 1996. METHODS: Currently a national survey is being performed in Germany to identify infants and young children who receive inpatient treatment for DDH. Between May, 1997 and October, 1997 monthly questionnaires were sent to all pediatric orthopaedic surgeons (active surveillance) and they were asked to report all inpatient cases between 10 weeks of age and 5 years with current closed or open reduction and/or osteotomies due to DDH. Information on time and results of previous ultrasound screening as well as treatment modalities was obtained in reported cases. RESULTS: 129 children (mean age at hospital admission 15.9 months, range 1.1 to 57.1 months) underwent closed reduction (n = 51), open reduction (n = 40) and osteotomies of the hip (n = 38) in the 6-month study period. Ultrasound screening has been performed too late and not at all in 45 children (35.1%). While in 18 cases (13.7%) no information could be obtained on screening results, the majority of children (n = 66, 51.2%) had completed DDH screening prior to the sixth week of life as recommended. Preliminary calculation of the unadjusted incidence of inpatient treatment for DDH in Germany was 0.33 per 1000 livebirths. CONCLUSION: DDH cases are still identified after introduction of an universal ultrasound hip screening in Germany. Continued evaluation must show, whether the incidence will decrease throughout the next few years.

Child, Preschool↗
PubMedDate not supplied

[Growth disorders of the acetabular roof after acetabuloplasty in congenital hip dysplasia].

PURPOSE: The aim of this long-term study was to evaluate whether the Lance acetabuloplasty for congenital dysplasia of the hip causes a growth disturbance of the acetabular roof during or after puberty. METHOD: 71 hips of 58 patients were followed clinically and radiologically over a maximum time of 16 years after the operative procedure of a Lance acetabuloplasty. The average age of the patients at the time of operation was 2.8 years (1-6 years). In order to assess the growth of the acetabulum in the early and long-term postoperative phase quantitative parameters (acetabular index of Hilgenreiner, CE angle of Wiberg, ACM angle of Idelberger) as well as qualitative parameters (disturbance of the ossification of the acetabulum and the femoral head) were determined in standardized X-rays of the pelvis, done routinely 6 months, 3 years, 5 years, 8 years and at an average of 11 years as the last follow-up examination after the operation. The assessment of these metrical parameters were carried out in accordance to the classification of the study-group "hip dysplasia" of the DGOT (normal--slight pathological--serious pathological) respecting the different age-groups and degrees of dysplasia. RESULTS: Although in the early postoperative phase the acetabular roof showed a positive development (65% of the CE angles could be considered normal 3 years after operation), the further growth of the acetabulum was disturbed in the period of puberty (8 years after operation only 33% of the CE angles could be considered normal, 51% were extremely pathological). And also in the last X-ray control after an average follow-up time of 11 years a significant retardation of the acetabular roof was seen in 51% of all cases. CONCLUSION: The Lance acetabuloplasty seems to damage the Ossa acetabuli, which are as centers of ossification the essential anatomic structures for the growth of the acetabular rim in adolescence. CLINICAL RELEVANCE: Other procedures such as the Salter osteotomy are to be preferred for the therapy of hip dysplasia.

Acetabulum↗
PubMedDate not supplied

[MRI-controlled outcome after core decompression of the femur head in aseptic osteonecrosis and transient bone marrow edema].

PURPOSE: We evaluated the signal changes of avascular necrosis and transient bone marrow oedema before and after core decompression of the femoral head to deduce prognostic factors for this operative procedure. METHOD: 38 to 40 cases with core decompression (35 patients, medium age 44 years) were analysed with a mean follow-up time of 26 months. Preoperatively patients were staged by the ARCO classification. MR-images were judged in accordance to the criteria of Mitchell and Steinberg. The clinical outcome was analysed according to the hip index of Merle D'Aubigne. RESULTS: All hips with transient bone marrow oedema showed normal signal patterns at an average of 3 months after core decompression. In stage I and II, all patients with a preoperative necrosis area less than 30% of the femoral head showed a reduction of the necrotic zone and good clinical results. An unchanged or progressive appearance was observed in necrotic lesions with more than 30% head involvement. Because of failure a renewed operation had to be done in all patients with stage III and IV. CONCLUSION: In the case of transient bone marrow oedema, a restitutio ad integrum can be achieved with core decompression. In stage I and II of avascular necrosis, the successful outcome depends on the lesion size of the femoral head. Necrotic lesions less than 30% seem to have the best prognosis. In stage III and IV, core decompression cannot be recommended.

Adult↗
PubMedDate not supplied

[The hip joint in the frontal projection. A contribution to the roentgenologic comprehension of the femur head-acetabulum relation].

The development of hip deformities is strictly dependent on the congruence between the head of the femur and the acetabulum. The routine radiological examination shows this relationship in one plane only. The combination of the anterior-posterior and the frontal projection opens the view into the third dimension of the hip joint. The frontal projection is especially suitable for measuring the anteversion of the acetabulum which in combination with a marked antetorsion of the femoral neck leads to a reduction of the weight-bearing articular surface. As every decentration of the femoral head should be considered for operative procedures the frontal projection is of special interest in the radiological examination of the hip joint.

Acetabulum↗
PubMedDate not supplied

[Problems of posture and the locomotor system as a result of amputation of a lower extremity (author's transl)].

While it is true that partial loss of a leg regularly leads to additional stress on the remaining parts of the body, the ability of the organism to compensate for this is evidently so good that under everyday conditions with physiological stress the additional load is tolerated by the vertebral column and the remaining leg. Conversely, the residual function of the amputated leg is likely to be impaired if the prosthesis is too short, and if these are any lumbosacral defects damage will probably result. This applies in particular to cases with scoliosis due to false posture.

Amputation, Surgical↗
PubMedDate not supplied

[Using extracorporeal shockwave therapy in orthopedics--a meta-analysis].

AIM: Up to now ESWT is not a standard therapeutic technique in orthopaedics. The mechanisms of the induced analgesic effect or the mechanism of shock-waves in bony defects are still unknown. By metaanalysis successrates and indications for ESWT are worked out as well as adequate impulse- and energyrates according to actual state of knowledge. Aim of this study is to rate the published cases. METHOD: 105 papers referring to ESWT of the locomotor system are rated. Validation was performed for each paper according to the international accepted system of the American Association of Spine Surgery in Type A-E. Advise for therapy is taken only from high quality publications of Type A and B. This advise should regard scientific as well as economic aspects. RESULTS: 4825 cases from 55 publications and abstracts that underwent ESWT were evaluated. 24 papers with 1585 cases (33%) live up to the standards of a scientific investigation. Numerous studies exist about therapy of calcifying tendinitis, epicondylitis humeri radialis, painful heel, pseudarthrosis and other enthesiopathies. Especially the studies concerning pseudarthosis and other enthesiopathies do hardly live up to scientific standards. In calcifying tendinitis and painful heel ESWT achieves nearly the same results than the established methods. No serious complications were observed. Because of the high complication rate in operative treatment of heel spur ESWT seems to be justifiable. The techniques of ESWT, energy density levels, impulse rates and complications will be described. CONCLUSION: The advantages of ESWT are non-invasiveness and low rate of complications. Primary aim should be to evaluate adequate energy density levels and impulse rates for specific groups of indications using high quality studies according to evidence-based-medicine. Long term results need to be awaited to be able to compare ESWT with established methods. Recent inflationary use of ESWT especially in outpatient departments has no scientific indication in numerous cases as conservative methods are not used consequently.

Calcinosis↗