Biomedical subjects

G U Exner

Publications and source records attributed to G U Exner.

At least 55 records · Page 3Linked to original sources

PubMed1994

Fractures about the knee: growth disturbances and problems of stability at long-term follow-up.

The aim of this study was to collect information about the incidence of leg-length discrepancy, axis deviation and instability resulting from fractures about the knee in childhood. We reviewed 43 patients with a clinical and radiological examination after a mean follow-up period of 13 years. The fractures were divided into four subgroups, each one presenting typical problems. Growth disturbance (shortening and axis deviation) making secondary procedures necessary was seen in 5 out of 14 (36%) distal femoral epiphyseal fractures. Complex instability was observed in 3 out of 7 (43%) proximal tibial epiphyseal fractures. In the tibial spine fractures anatomical reduction often did not prevent moderate cruciate ligament insufficiency; and in the metaphyseal fractures 2 of the 7 cases showed leg-lenghtening. In conclusion, the Salter classification seems to be of little prognostic value at the knee as Type-II fractures are frequently followed by asymmetric growth arrest. Open reduction is not reliable in avoiding this complication. Associated ligament injuries are not rare and deserve more attention.

Adolescent↗

PubMed1994

[Natural course of mild hip dysplasia from young childhood into adulthood].

For radiometric evaluation of hip development in children, Hilgenreiner's acetabular index is one of the most important parameters. In order to assess the prognostic value of the acetabular index to separate healthy from pathologic hip joints, follow-up studies of untreated mildly dysplastic hips were undertaken. When 48 hips classified as mildly dysplastic at the age of 1-4 years were followed up when the patients were adult, 90% had normal hip scores according to Tönnis, 81% a normal acetabular angle according to Ullmann and 71% a normal acetabular coverage according to Wiberg. From the data presented there is no clear-cut delineation between healthy and pathologic hips during childhood. Therefore, the developmental dynamics of the hip during longer time intervals have to be taken into consideration.

Adult↗

PubMed1992

[Rickets due to vitamin D deficiency--a reminder].

Vitamin D deficiency, because of prophylactic supplementation, has become a rare disorder in Switzerland and therefore is usually not considered in the clinical routine. In the few cases we could diagnose, the affected children either have been of East-Mediterranean origin with insufficient nutrition and vitamin supplementation, or were raised in families who, for philosophical or other reasons, refuse any "non-biological" measure including vitamin supplementation. For the orthopedic surgeon the challenging task is to screen out of the many children presented with physiologic gait "disturbance", bow-legs or flat feet the few children with true disorders. An important point is the history of vitamin D prophylaxis; in selected cases X-ray and laboratory findings are indicated. Finally the response to the treatment with vitamin D will confirm the diagnosis of rickets due to vitamin D deficiency.

Bone and Bones↗

PubMed1992

[Complex disorders of radius and ulna in childhood].

Treatment of congenital or acquired disturbances of the radius or ulna always requires recognition of the complex biomechanics of the forearm. In particular trauma, seemingly restricted to one of the bones, should caution against concomitant lesions to the other bone. The typical example is unfortunately the often missed dislocation of the capitulum radii in Monteggia-type lesions. Additional examples are deranged growth of the distal epiphysis of the radius after a fracture of the ulna, in association with multiple osteochondromas and of the proximal epiphysis of the radius in presumptively congenital dislocation of the capitum radii. Lesions encountered in children have to be analyzed carefully with respect to dynamics of maldevelopment. Corrections that have implications for neighbouring articulations should be undertaken with the intent to fully exploit the potential for remodelling by forthcoming growth processes.

Adolescent↗

PubMed1992

[Hip diseases in children].

In the orthopedic practice, the hip joint is of special importance at all ages. For the general practitioner and the pediatrician are those disorders of the hip of high importance, for which early diagnosis and initiation of treatment is critical for prognosis. The following disorders should be looked for in priority, if symptoms indicate a possible affection of hip: congenital dysplasia and dislocation of the hip, coxitis, slipped capital femoral epiphysis, and tumors. One should always be aware that especially in children disease of the hip need not necessarily present with symptoms directly located within the region of the hip. Especially the child often complains only about knee or vague leg pain, while having a disorder of the hip; therefore, the cause of any pain should always also be looked for proximal to the structure, where the pain may be localized by the patient.

Bone Neoplasms↗

PubMed1992

[Early diagnosis of hip dysplasia--arguments for a general ultrasonographic screening].

We propose a systematically performed ultrasonographic screening of the infant's hip in Switzerland. This demand is based on shorter treatment of dysplastic or dislocated hips, if the diagnosis is established before the age of three months. In addition, the costs of treatment are remarkably reduced if treatment can begin at an early age. In order to avoid late surgery causing high costs, an early treatment of the dysplastic hip is indispensable.

Costs and Cost Analysis↗

PubMed1992

["Congenital" dislocation of the radial head. A bilateral case developing around the age of ten].

Dislocation of the head of the radius has important repercussions on pronation-supination, elbow stability and on the wrist joint. In the absence of a history of trauma, this anomaly is generally considered to be "congenital". Few authors have described the progressive acquisition of this dislocation during growth. The case of a 20 year old man is presented, corresponding to initial subluxation which gradually evolved towards dislocation of the head of the radius at about the age of 11 years. This type of dislocation appears to be related to abnormal growth of the proximal radial epiphysis, responsible for repercussions on the humero-radial articular relations and on the anatomy of the upper extremity of the radius. The patient was treated by ulnar osteotomy at the age of 17 years according to Hirayama's technique, when he was probably already too old. Surgical correction of the subluxation of the head of the radius at an earlier age would probably have been preferable.

Age Factors↗

PubMed1991

[Experiencing and coping with the diagnosis and therapy of a malignant bone tumor and the survival time afterwards].

UNLABELLED: Six patients who had been treated for osteosarcoma of the lower extremity report their experience and how they mastered diagnosis and therapy as well as the time thereafter. They give information regarding especially the following points: psychological stress during different phases of their disease, aspects of the information they received during treatment, how they felt during therapy and how and where they have received support, wishes, etc. RESULTS: In order to master the disease as well as the sequelae they need sufficient time and opportunities to express their feelings to others and sufficient understandable informations about examinations, therapy and prognosis. There are large variations in how the individual patient responds to the threat by the disease. The whole period of time with repeated hospitalizations that extends over about one year in retrospect has been judged to be very burdening. Most of the patients feel to be strongly challenged during chemotherapy; physically, they are reduced, are oversensitive and need sensitivity and support by the persons taking care of them. The informations given by the patients allow us to improve treatment and support of patients in the future.

Adaptation, Psychological↗

PubMed1991

[Reconstruction of large segmental defects of the lower extremities following resection of malignant and locally aggressive bone tumors].

The chances to be cured from a primary malignant musculoskeletal tumor have improved dramatically during the last two decades with the introduction of adjuvant chemotherapy. The cure rate e.g. for osteosarcomas and Ewing sarcomas has improved in this period from about 20% to 75%. Furthermore instead of amputations for local tumor control local resections have become possible in most cases when the rules of oncologic surgery for such tumors beginning with the biopsy are strictly followed. With the improved long term survival of patients afflicted by musculoskeletal malignancies the demands upon reconstructions after large resections have significantly increased. Techniques actually available for different localizations of tumors of the femur and tibia with trends for 'more biologic' procedures with arthrodeses and massive allografts are demonstrated besides new endoprosthetic material.

Adolescent↗

PubMed1991

[Imaging techniques in the diagnosis and therapy of hip dysplasia and hip dislocation].

With the introduction of sonography and computed and magnetic resonance tomography into the diagnostic procedures of congenital dysplasia and congenital dislocation of the hip more detailed anatomic imaging has become available and has brought new insights and dynamics to the therapy of this frequent orthopedic problem. The techniques are discussed with representative illustrations and compared with each other as well as the 'classic' roentgenogram and arthrogram.

Computer Simulation↗

PubMed1991

Fibular aplasia. Early surgical correction in two cases.

Two infants with bilateral fibular aplasia are described. They were operated on at 1 1/2 years and 8 months respectively in order to obtain a stable axial position of the foot beneath the tibia. The procedures consisted of soft tissue releases together with angulation osteotomies of the tibiae in one, and splitting the distal tibial epiphysis in the other. Both patients are now able to walk well barefoot or in custom-made shoes; no orthotic devices are needed. This type of conservative approach should be considered rather than amputation in selected cases.

Fibula↗

PubMed1991

Zürich experience with preoperative, high dose methotrexate-containing chemotherapy in patients with extremity osteosarcomas (OSA).

From 1979 to 1990, 37 patients with extremity osteosarcomas, 22 of them males and 15 females, median age 19 years, received pre- and postoperative chemotherapy. The period of observation, calculated from after the primary operation, ranged from 1-114 months, median 25 months. After preoperative chemotherapy, 9 (24%) underwent a primary amputation, in 28 (76%) a limb salvage procedure was possible, 4/29 (14%) later developed local recurrences, metastases were diagnosed in 8/9 amputees and 5/28 after limb-sparing surgery. The five-year disease-free and overall survivals after amputation are 11% and 33%, respectively, compared to 68% and 75%, respectively (p = 0.001 and 0.018, respectively, for long rank). Results of histologic assessment after preoperative chemotherapy are of significant prognostic impact. The earlier prognostic groups of 0%-49% necrosis versus 50%-100% necrosis were statistically no longer suitable for distinguishing useful prognostic groups. In this second analysis, patients with 0%-79% necrosis versus 80%-100% necrosis had 5-year disease-free survivals of 81% versus 44% (p = 0.032) and 5-year overall survivals of 88% In summary, 24% of our patients with extremity osteosarcomas, most of them with large primaries close to joints, had to undergo primary amputation and had only a 33% 5-yr-survival, whereas limb salvage procedures with pre-and postoperative chemotherapy were associated with a 5-yr survival of 75% and thus had no adverse impact. Careful selection of patients for successful management of osteosarcomas is important; necrosis of 80% and more after preoperative chemotherapy is a prerequisite for a favourable outcome.

Adolescent↗

PubMed1990

[Current aspects of treatment for clubfoot in infants and young children].

The congenital club-foot is one of the frequent malformations (incidence around 2%). The treatment during early childhood implies conservative measures with corrective manipulations and casting, surgical procedures with extensive soft tissue releases. The technically demanding medial release is a well established procedure; however it is often not performed because the peritalar malpositions are often underestimated in the young child. After surgical correction stabilization of the foot for prolonged time is important and follow-up is mandatory until adulthood is reached.

Braces↗

PubMed1990

Magnetic resonance imaging in malignant bone tumours.

Complete removal of the tumour without leaving microscopic disease is vital in the management of bone sarcomas. Magnetic resonance imaging now seems to be the best method of depicting the changes produced by the tumour within the bone and surrounding soft tissues. In order to define its reliability, five cases of primary bone sarcomas (Ewing's sarcoma, osteosarcoma, chondrosarcoma) are described where radiographs, bone scans and magnetic resonance images are directly compared to the pathological findings after resection. We conclude that surgical margins should be redefined with respect to the extent and borders of the tumour as depicted by magnetic resonance imaging. This will allow improvement in salvage procedures, but further experience is needed so as not to jeopardize the prognosis by incomplete removal of the tumour.

Adolescent↗

PubMed1989

Metastatic bone disease from occult carcinoma: a profile.

To assess the general profile of metastatic bone disease from occult primary carcinoma, the records of 172 patients with skeletal metastases seen between 1965 and 1985 were reviewed. In 51 patients (30%), the origin of the primary could not be identified when bone metastases were first diagnosed. This group were predominantly male with a high incidence of spinal metastases, cord compression and pathological fractures, and a significantly shorter (P less than 0.1) survival compared with bony metastases when the primary was known. The site of the primary was established in 33 patients (65%), mostly at autopsy. Lung carcinoma was by far the most common primary tumour in 52% of the cases, while it accounted for only 7% of those with a diagnosed primary. We believe that the onset of bony metastases from an occult source must initially raise the possibility of lung carcinoma. If the primary remains undetected, it appears justifiable to assume it to be in the lung, since the probability of a missed lung tumour being responsible for the metastases is high.

Adult↗

PubMed1988

Serpentine fibula--polycystic kidney syndrome. A variant of the Melnick-Needles syndrome or a distinct entity?

A 5-year-old girl is reported with small stature, unusual facial appearance, polycystic kidneys and elongated curved fibulae as the most impressive radiographic finding. From the close similarity with another girl described recently and discrepancies between these two patients and others with Melnick-Needles syndrome it is assumed that they may present a separate hitherto unreported entity or syndrome.

Body Height↗

PubMed1987

[Sonographic screening for hip dysplasia in newborn infants].

The hips of 335 unselected newborn children have been examined sonographically to evaluate the general use of ultrasound in screening programs for early recognition of hip dysplasia. Ultrasound findings indicating the need for treatment in 4% of the children were surprisingly high compared to earlier data on the frequency of hip dysplasia from purely clinical studies. However, this is to be seen in relation to the still significantly late diagnoses of dysplasias or even luxations in later childhood, adolescence and adults. Because of the importance of early recognition of hip dysplasia for treatment and outcome, it can be concluded even from the limited data available that ultrasound examination of the hips should be included in health surveillance programs of newborns.

Hip Dislocation, Congenital↗

PubMed1987

Metastatic carcinoma of the spine. A study of 92 cases.

In a retrospective study of 172 patients with disseminated carcinoma in the skeleton, 54% were shown by radiography and scintigraphy to have vertebral metastases. Breast carcinoma was the most common primary tumour, occurring in 30% of the patients, followed by lung (17%), prostate (10%) and kidney (9%). The lumbar spine was most often involved and some primary carcinomas showed a predilection for particular spinal segments. Cord compression occurred in 30% of the patients with vertebral spread and was a poor prognostic sign for long-term survival. Hypernephroma was the most common tumour to cause spinal cord involvement. The thoracic segment was the most frequent site of cord compression (43%), and pathological fracture-dislocation was the most common cause (50%).

Female↗