Search PubMed⌕ Search

Biomedical subjects

H J Refior

Publications and source records attributed to H J Refior.

At least 181 records · Page 10Linked to original sources
PubMedDate not supplied

[Experimental studies of the effect of surgical technical errors on primary stability of cementless hip endoprosthesis shafts].

For quantified evaluation of the primary stability of cementless femoral stem prostheses the operative faults: too low sized stem, distally short-lined anchoring with proximally surpassing stem and fissure or fracture of the femur shaft were simulated in autoptical test series. By inductive displacement transducers the micromotion between stem and proximal bone layer were measured in medio-lateral and ventro-dorsal direction under static load conditions before and after a dynamic loading of 50,000 cycles. The underdimensioned stem showed its instable anchoring by obviously increased micromotions in all measure plains. The proximally excelling only distally anchored prosthesis demonstrated immense amounts of motion. The fissure doesn't seem to decrease the primary stability of the stems too much. These results of the autoptical test series can only be directly transferred to the conditions of the first weeks after implantation, because the influence of later bone integration could not be considered.

Biomechanical Phenomena↗
PubMedDate not supplied

[Preferential sites for rupture of the long head of the biceps tendon].

The extreme stress on the long head of the biceps tendon is defined by its specific anatomical situation with near contact to the rotator cuff, to the sulcus intertubercularis and to the acromion. We took 74 specimens from cadavera and studied the macromorphological and cross-sectional anatomy to analyze changes preceding rupture of the biceps tendon. Degenerative tendon alterations with disorganized collagen fibers and large mucoid deposits occurred especially at the distal sulcus bicipitalis and near the origin of the tendon at the superior part of the glenoid labrum. The found degenerative histological alterations are possibly precursor of tendon rupture near to the distal sulcus or precursor of the so called "SLAP"-lesions.

Adult↗
PubMedDate not supplied

[Thermo-elastic stress analysis of human bones].

The Thermoelastic Stress Analysis (THESA) is a widely used procedure in motorcar- and airplane engineering. This study investigated the reliability of THESA for stress analysis of human bone. A human femur was cyclic stressed and the resulting stress pattern was scanned from the surface of the bone by means of the thermoelastic stress measuring instrument SPATE 9000. To proof whether the scan of SPATE 9000 is equivalent to the stress distribution of human femur surface, strain gauges are used to control the results at two different regions of the femur diaphysis under equal but static conditions. It could be shown, that both measuring methods lead to corresponding results of stress pattern on human femur surface.

Adult↗
PubMedDate not supplied

[Radiologic changes of the bones following cement-free implantation of hip joint prosthesis in inflammatory rheumatic diseases].

The postoperative x-rays of 34 patients with rheumatoid arthritis or spondylitis who had received a cement-free fixed total hip endoprosthesis were examined. The postoperative period ranged from 3 months to four years. In the region of the acetabular component an increasing rate of osseous integration in relation to the postoperative time was observed. Adaptive modeling changes in the area of the femoral stem were found as radiolucent lines parallel to the implant. Also a densification of cancellous bone and cortical hypertrophy as well as cortical rarefaction was noticeable. The bone in rheumatoid arthritis or spondylitis reacts to the implantation of a cementless fixed total hip prosthesis similar as the bone in osteoarthritis.

Adult↗
PubMedDate not supplied

[Indications and results of fusion operations of the upper cervical spine in chronic polyarthritis and psoriatic arthritis].

12 patients suffering from rheumatic or psoriatic instabilities of the upper cervical spine underwent operations by a dorsal approach from September '83 until October '86. They were examined 3 months to 3 years after operation. Different operative procedures were chosen depending upon the extent of the instabilities. Differential indications are discussed on the basis of clinical and x-ray features. Results were good in 10 patients, 1 was satisfactory, 1 patient died one week postoperatively. Rheumatoid and psoriatic instabilities of the upper cervical spine should receive early operative treatment while extent and risks of operative procedures are low.

Arthritis↗
PubMedDate not supplied

[Reconstruction technics for ruptured rotator cuff].

The principal signs for the diagnosis of a ruptured rotator sheath are a painful arch and painful, restricted movement of the shoulder joint. The diagnosis is confirmed by arthrography. Surgical reconstruction is indicated only if prior conservative treatment has been unsuccessful. A variety of approaches to the rotator sheath are advocated. Of these, the posterior-superior incision described by Debeyre et al. is particularly worthy of consideration. This approach is especially suitable for more extensive ruptures. It is described here with modifications, including the various fixation methods used for rupture of the rotator sheaths in the authors' own patients. The results obtained by the authors are classified and compared with opinions expressed in the literature. It is emphasized that the procedure described is particularly suitable for reconstruction of ruptured rotator sheaths.

Adult↗
PubMedDate not supplied

[Comparative light and scanning electron microscopy studies of the morphologic structure of ligament insertions into the bone].

The microstructure of the osseous ligament insertion was studied by light microscopy and scanning electron microscopy using the insertion of the membrana interossea antebrachii as an example. The scanning electron microscopical findings of specimens which had been prepared by freeze-fracturing confirm the typical 4-zone-structure of the osseous ligament insertion. The findings emphasize the functional importance of both zones of unmineralized and mineralized fibrous cartilage, which represent an effective shock absorbing system for the collagenous structures of the osseous ligament insertion.

Cartilage↗
PubMedDate not supplied

[Treatment of unstable dislocated hip in infancy and early childhood using the modified Fettweis method].

We report on our experiences with the application of cast immobilisation in the human position according to Fettweis in order to treat unstable luxations of the hip joint of infants. Stability of the joint was achieved and marked degrees of acetabular dysplasia were brought to cure in about 80% of the cases. However, based on this analysis, remaining instability or lasting dysplasia of the hip joint have to be anticipated in about 10% of the cases. The use of sonography in diagnostics let expect more progress in therapy for the future.

Casts, Surgical↗
PubMedDate not supplied

[Reconstruction of the iliac crest using homologous femur head transplants].

Corticocancellous bone grafts from the iliac crest are suitable for anterior fusion of the spine in various indications. The remaining defect in the iliac bone often causes pain an is mostly unsatisfactory. To repair this defect we use homologeous bone from human femoral heads. The bone is cut and a slice is well fitted in and than fixed with sutures or Kirschner wires. Complete bone remodeling and reconstruction of the iliac crest occurs within six months after this procedure, which is easy to perform.

Bone Transplantation↗
PubMedDate not supplied

[Value of passive postoperative mobilization treatment following knee joint synovectomy in chronic polyarthritis].

One group of 17 Knee joints was treated postoperatively with continuous passive motion, while the control group received cyclical changes of the Knee's position in flexion and extension. In the postoperative period the CPM-treated patients suffered less pain than the control group. Furthermore the patients of the CPM-group reached free extension and 90 degrees of flexion earlier than the control group. The amount of liquid in the suction drainage was higher in the CPM-group than in the control group. Based on the results of our examination continuous passive motion is considered to be a useful contribution to the postoperative treatment of synovectomy of the knee joint in rheumatoid arthritis.

Adult↗
PubMedDate not supplied

[Late clinical and roentgenologic results following surgical treatment of chronic shoulder dislocation using Lange's technic].

In German speaking countries the M. Lange procedure is a well known method in the treatment of recurrent shoulder dislocations. In order to study the longterm results 21 shoulder joints of 20 patients were examined clinically and radiologically after an average postoperative period of 13.5 years. According to the subjective judgment of the patients good results were obtained in 19 of the 21 cases. True recurrent dislocation occurred in 5.2%. In 57% of the cases signs of degenerative arthritis of the shoulder joints were found radiologically. Our examination shows that the M. Lange procedure is a reliable method with good longterm results. It should be used in cases of glenoidial dysplasia and in cases of a defect of the anterior glenoid rim.

Adolescent↗
PubMedDate not supplied

[Arthroscopy of the pediatric knee joint].

From April 1981 to April 1984 arthroscopy was performed on the knee joints of 33 children at the orthopedic clinic of Hanover Medical University. At the time of examination the children were aged between 5 and 14. It was found that the knee joints could be classified in two categories: Category 1: knee joints in which clinical findings were unclear and in which arthroscopy contributed to diagnosis. Category 2: knee joints in which the diagnosis had already been established, and in which arthroscopy was a help in deciding subsequent therapy. On the basis of the findings obtained in these investigations it can be stated that even in children, arthroscopy of the knee joint is a valuable diagnostic and therapeutic aid.

Adolescent↗
PubMedDate not supplied

[Primary manifestation of hepatocellular carcinoma as osteolytic hand metastasis--a case report].

Osseous metastases to the hand are very rare. Only a single case of osseous metastasis of hepatocellular carcinoma to the hand has been reported in the literature to date. We report a case of osteolytic metastasis of the right first metacarpal as first manifestation of unresectable, alpha-fetoprotein-negative hepatocellular carcinoma (pT3, Nx, M1, UICC stage IVB, Okuda's stage I). The therapy consisted of R0-resection and hormonal therapy with tamoxifen 2 x 10 mg/d orally. Generally patients with metastatic cancer to the bones of the hand have a very poor prognosis.

Bone Neoplasms↗
PubMedDate not supplied

[Bicondylar knee replacement--an intermediate term evaluation of the Genesis prosthesis].

65 knee arthroplasties in 60 patients (5 x both sided, 49 x female, 11 x male) with a Genesis Total Knee System (54 x cemented, 6 x cementless, 4 x tibial cemented/femoral cementless, 1 x tibial cementless/femoral cemented) were evaluated according to the Knee Society Score and the HSS Score with a medium follow up of 4 years und 5 months (3 years and 4 months to 5 years and 11 months). In 48 patients the diagnosis was gonarthrosis, in 17 patients it was rheumatoid arthritis. The medium postoperative Knee Score was 80.9 points, the Function Score was 73.7 points. The HSS Score obtained 80.9 points. 87.7% of the patients were excellent or good. The Genesis Total Knee arthroplasty has proved to be reliable for osteoarthritis and rheumatoid arthritis in medium term.

Aged↗
PubMedDate not supplied

Age-related changes of the glenoid labrum in normal shoulders.

A growing number of labral changes are described in the literature. The purpose of this study was to evaluate the glenoid and labrum of normal shoulders at different ages and characterize any apparent age-dependent changes. We analyzed 32 normal cadaveric shoulders with a mean age of 57 years (range, 18-89 years). There were 22 male and 10 female cadavers, with 14 right and 18 left specimens. The shoulders were studied macroscopically, histologically, and radiologically. The radiologic evaluation consisted of an analysis of the subchondral mineralization of the glenoid with the use of computed tomographic osteoabsorptiometry. Macroscopically, there were no statistically significant differences among the age groups. Histopathologically, the labrum showed a significant qualitative and quantitative increase (P <.01) in lesions across all regions with increasing age. In younger individuals, lesions at the 12-o'clock position were the most prevalent, with the incidence increasing with age. The anterosuperior position was the region with the next highest prevalence. This was also the area of the highest stress distribution on the glenoid. Our studies demonstrated clear histopathologic changes of the glenoid labrum that are significantly age-related at specific sites. The earliest changes are seen close to the area of highest stress distribution of the glenoid, which could explain the progressive labral changes with increasing age. Arthroscopically detected changes of the glenoid labrum should be evaluated in the context of age-related changes in normal shoulders.

Adolescent↗
PubMedDate not supplied

Long-term results of high tibial osteotomy for medial osteoarthritis of the knee.

We reviewed retrospectively the results in patients who had undergone one hundred and four high tibial lateral osteotomies. The operations were all performed between 1985 and 1993. Each one of fifty men and forty nine women demonstrated a varus deformity of the knee with a coexistent medial osteoarthritis. Results were reviewed in 49 patients (62 knees) with an average follow-up of 10.2 years (range 6-14 years). Of the remaining 42 patients, 8 were lost to follow-up, 10 had died, and 24 were subsequently treated with total knee arthroplasty at an average 4.7 years after having had a high tibial osteotomy. Clinical results were evaluated using the Hospital for Special Surgery Score (HSS) and the Knee Society Score. Radiographs were systematically analysed to evaluate osteoarthritis and leg axis. Forty four (90 per cent) of the forty nine patients stated the results met their expectations and given the same circumstances, they would have the operation once again. In these patients the knee score results were excellent. The same patients had excellent HSS and Knee Society Scores. Five patients (10 per cent) had a poor result and twenty four patients were treated later by total knee arthroplasty because of pain. The following factors set these patients apart from those with more favorable results: previous arthroscopic debridement, obesity, lateral knee osteoarthritis, insufficient valgus correction, and an age of more than 55 years. High tibial valgus osteotomy provides good pain relief and improved function in carefully selected patients. Our results support this conclusion.

Adult↗
PubMedDate not supplied

Effects of NO synthase inhibitors on the synovial microcirculation in the mouse knee joint.

Production of nitric oxide by the inducible NO synthase (iNOS) is known to be enhanced in chronic joint inflammation and osteoarthritis as well as aseptic loosening of joint prostheses. Initial studies yielded promising results after inhibition of the nitric oxide synthase (NOS). However, the effect of NOS inhibition has not been studied at the site of the primary function of NO, the microcirculation of the synovium in vivo. Using our recently developed model for the in vivo study of synovial microcirculation in the mouse knee joint, the effects of selective versus nonselective inhibition of iNOS were investigated by means of intravital fluorescence microscopy. After resection of the patella tendon, the synovial fatty tissue was exposed for intravital microscopy. Diameter of arterioles, functional capillary density (FCD), diameter of venules, venular red blood cell velocity and leukocyte-endothelial cell interaction were quantitatively analyzed before, and 10 and 60 min after intravenous injection of NOS inhibitors [selective iNOS inhibitor N-iminoethyl-L-lysine (L-NIL), and nonselective NOS inhibitor N(G)-nitro-L-arginine methyl ester (L-NAME)]. Our results demonstrate that L-NAME causes a significant decrease in the arteriolar diameter and FCD associated with an increase in the leukocyte accumulation in the synovium in vivo. In contrast, L-NIL neither altered the microhemodynamics nor the leukocyte-endothelial cell interaction in the synovium, indicating its potential use for selective inhibition of iNOS in joint inflammation. Using our method, further studies will provide new insights into the unknown effect of NOS inhibition on the synovial microvasculature in inflammatory joint disease in vivo.

Animals↗