Prostaglandins induce very probably the local intercellular communication and regulate the metabolism of bone and cartilage. They are supposed to be local mediators of mechanical stress, electric phenomena as well as of hormonal control mechanisms in cytobiologic and cytochemical reactions within the skeletal system. In-vitro prostaglandins act as potent bone and cartilage resorbing agents. In-vivo they also promote the synthesis of bone in a way that is not known as yet. Experimental investigations proved their influence on inflammatory processes, and, above all on the bone destruction in the pathogenesis of rheumatoid arthritis and osteomyelitis. It is the aim of the following review to elucidate the function and metabolism of prostaglandins with regard to their clinical importance and, particularly, to orthopaedic diseases.

Animals↗

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[Hip changes in infantile cerebral palsy].

Dislocation of the hip associated with cerebral motor disturbances differs considerably from that in children with normal motor activity. In patients with such disturbances ist is a relatively common and often serious complication. It occurs at an age when there are not usually any clear spastic signs, merely hypotonia with reflex-like movement patterns. Early dislocation is marked by early onset of acetabular dysplasia. In the final analysis, hip dislocation associated with cerebral motor disturbances is attributable to a more or less constant muscle imbalance. The prognosis for hip development is poor if there is an early tendency toward flexion and adduction postures and the course of general motor development is unfavorable. The classification proposed by Tönnis and Brunken (1968) is used for radiological assessment. The primary goal of therapy is to prevent further decentration of the hip joint. Therefore, physiotherapy plays the most important role in early treatment of impending dislocation. All other therapeutic measures are secondary to this.

Cerebral Palsy↗

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[Vertebral implant as a treatment principle in tumors and metastases of the thoracic and lumbar spine].

We report the clinical course of 31 patients suffering from primary tumors or vertebral metastases treated by osteosynthesis with vertebral body implant. Surgical treatment of vertebral tumors aims at eliminating the compression, thus relieving the myelon and the roots as well as the reestablishment of the supporting function of the involved segments. Subjective and objective improvement was found in 64.5 per cent of the 31 patients. The conditions remained the same in 22.5 per cent. New symptoms occurred in 13.0 per cent. After tumor specific evaluation of the over-all survival period, plasmacytoma were found to have a more favourable course of a little more than two years. Patients with vertebral metastases died after an average of 10 months. In nearly all cases with postoperative improvement on the initial symptoms and signs, the symptoms could be improved permanently. We thus regard ventral curettage and parallel stabilisation, may be combined with dorsal stabilisation, as a means of improving the quality of life in these patients. By using the surgical technique employed by us sufficient stabilisation of the vertebral column can be achieved in order to enable quick mobilisation of the patients.

Adult↗

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[Ventral stabilization of primary tumors and metastases of the spine with vertebral body implant and palacos].

The authors report on the clinical course of 31 patients with primary tumors or metastases of the spine which were treated with the vertebral body implant and Palacos, i.e., composite osteosynthesis. The goal of therapy is to relieve the spinal cord and the nerve roots and to restore the supporting function of the spine. Subjective and objective improvement was found in 64% of the patients; the result was unchanged in 23%, and further symptoms developed in 13%. The tumor-specific breakdown revealed that overall survival was somewhat more than two years in plasmocytoma cases and ten months in metastasis cases. In almost all cases in which an improvement in initial symptoms was achieved postoperatively, this improvement was permanent. With the surgical technique applied here spinal stability can be restored and the patients can also be mobilized quickly.

Adult↗

PubMedDate not supplied

[Initial results of the surgical treatment of scoliosis with the Cotrel and Dubousset CD instruments].

At the Orthopaedic University Hospital Muenster 50 patients were surgically treated according to the Cotrel and Dubousset technique from June 1985 to October 1986. An outstanding characteristic of this method is the three-dimensional correction of the curve without exclusive application of distraction or transverse forces, bringing about excellent stability. By means of this operation an average preoperative angle of 63.4 degrees could be diminished to 33.9 degrees, meaning a gain of correction of 46.5%. Complications occurred essentially due to insufficient experience with this technique in the first patients operated on. After sufficient training this procedure is as practicable as the Harrington technique.

Adolescent↗

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[Laceration of the vessels of the kidney hilus. A complication not previously described in halo extension treatment].

During the last years the halo traction proved to be an appropriate preoperative procedure to provide the spinal region with corrective forces, although several complications became known. As a complication unknown as yet a laceration of the renal hilus vessels is described, and the possible causes are discussed. Consequently, in case of abdominal symptoms and signs, a possible intraabdominal or retroperitoneal vascular lesion must be taken into consideration besides the well-known spinal-traction/spinal-cord-traction-syndrome.

Angiography↗

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[Results of operative treatment of Scheuermann disease].

Only rarely is a surgical intervention necessary for increased kyphosis in Scheuermann's disease. However, effective erection of fixed kyphoses is only possible with an incision of the anterior spinal ligament, removal of the discs at the vertex of the curvature, resection of the vertebral arch joints, narrowing of the considerably widened vertebral arches and stabilizing with Harrington's instrumentation. The present authors have treated 11 patients in this way. With this procedure it proved possible to erect the kyphosis on average by 53.4%. In the first postoperative year there was an average loss of correction of 1.7 degrees, though subsequent deterioration was only 0.7 degrees up to the time of the last follow-up examination. The residual correction gain was 50.4 per cent. The results in 4 other patients, in whom Schöllner's erector rods were implanted, were less favorable. The permanent correction was only 50.4 in these cases. The best postoperative results are likely to be obtained by a unilateral ventral and dorsal procedure.

Adolescent↗

PubMedDate not supplied

[Growth and development of the skeleton represented by the epiphyseal groove].

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Adolescent↗