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Biomedical subjects

H J Refior

Publications and source records attributed to H J Refior.

At least 91 records · Page 5Linked to original sources
PubMed1992

[Results of the surgical therapy of distal biceps tendon rupture].

The rupture of the distal tendon of the biceps brachii is a relatively uncommon but severe injury of the upper extremity. Different techniques for surgical reattachment are described with a small number of patients. The purpose of this study was to show whether the surgical technique modified after Max Lange leads to good clinical results in the number of eleven patients who underwent physical examination between six months and eight years after surgical repair. Three patients showed a small deficit in the range of motion. Six patients had ossifications in the distal tendon, no patient had an osteoarthritis of the elbow. Strength and endurance, tested by the Cybex-II isokinetic dynamometer, showed no significant difference between operated and healthy extremity. The surgical technique modified after Max Lange is a safe and effective way for reattaching the distal tendon of the biceps brachii.

Adult↗
PubMed1992

[Results of surgical treatment of proximal biceps tendon rupture].

During a 9-year period we operated on 19 patients in whom the proximal tendon of the biceps brachii muscle had been disruptured. Various surgical techniques were employed, such as refixation at the processus coracoideus, tenodesis in the sulcus intertubercularis, keyhole operation, in combination with an intraarticular inspection, revision, or if necessary widening of a narrow passage ("defile"). Follow-up was possible in 15 patients for an average period of 3 years after the operation, in respect of clinical, roentgenological and isokinetic findings. Results were mainly good while employing a variety of different surgical techniques; in only 3 patients the shoulder function remained restricted, painful and/or weakened. The isokinetic maximum torque was either increased on the operated side (after coracoid refixation) or reduced (after tenodesis in the sulcus). The underlying biomechanical causes are explained. Good results can be obtained in surgical treatment of the rupture of the proximal biceps tendon provided the procedure is accurately executed while taking into consideration, at the same operation stage, the associated pathology of the rotatory cuff. For biomechanical reasons, preference should be given to the operations according to Hitchcock and Bechtol in respect of refixation, and to the keyhole operation method.

Adult↗
PubMed1990

Destructive changes of the spine in magnetic resonance imaging.

Twenty-nine patients were examined by magnetic resonance imaging for various lesions of the spine. The results of these scans were compared with those of plain radiographs, computertomographs, and radionuclide bone scans. The findings were substantiated by intraoperative or histological findings in 18 cases. The MRI scans proved to be very sensitive in the detection of a wide spectrum of morphological changes of the bone marrow of vertebral bodies. Characteristic changes of the signal patterns for inflammatory and tumorous lesions were not observed. The differentiation of these lesions will presently continue to have to be based on morphological criteria.

Adolescent↗
PubMed1990

The importance of functional magnetic resonance imaging (MRI) in the planning of stabilizing operations on the cervical spine in rheumatoid patients.

Chronic inflammatory diseases, such as chronic polyarthritis or spondylarthritis ankylopoietica, can occasionally lead to vertebral instabilities of the occipitoatlantal or atlantoaxial level, requiring some form of stabilizing operation. By means of functional magnetic resonance imaging, i.e., with the cervical spine at its maximal range of flexion and extension, performed on 11 patients suffering from an instability at the above level, it was possible to demonstrate not only the extent of synovial tissue, but also how this sometimes excessive soft-tissue growth hinders an adequate reduction of the subluxated vertebrae. The importance of this investigation lies in the fact that the necessary operation can be planned appropriately. As such, three patients required a decompressing operation entailing resection of the posterior arch of the atlas, widening of the foremen magnum, or both.

Aged↗
PubMed1990

[Patellar dislocation as a cause of osteochondral fracture of the femoro-patellar joint].

Acute traumatic dislocation of the patella may be associated with osteochondral fractures. Clinical examination invariably shows a tense effusion. A detailed radiographic examination including antero-posterior, lateral and skyline views of the patella is usually necessary to establish an exact diagnosis. Once diagnosis is made open reduction and fixation of the osteochondral fracture should be carried out if it is possible. Out of 78 patients of our own with patella dislocation 24 cases suffered an osteochondral fracture. In ten cases refixation of the osteochondral fragment was achieved. Intraoperatively the alignment of the patella was controlled in any case. In cases of lateral subluxation lateral release and medial reconstruction was performed. In two cases medial transfer of the tibial tuberosity was carried out. Osteochondral fractures of the femoro-patellar groove represent an important injury in the course of acute patellar dislocation. With exact diagnosis and correct treatment congruity of the femoro-patellar joint can be restored in many cases.

Bone Transplantation↗
PubMed1990

[The treatment of post-traumatic recurrent anterior shoulder dislocation using Du Toit's operation].

From 1.4. 1986 to 31.12. 1987 we operated 21 patients with a recurrent anterior dislocation of the shoulder with the Du Toit staple capsulorrhaphy. 20 patients we followed clinically and radiologically for an average period of one year and four months. By using a rating sheet 17 patients had an excellent and three patients a good result. There was, against other operation techniques, a minimally limiting of external rotation. We had no recurrents of dislocation. We concluded that the Du Toit staple capsulorrhaphy makes necessary only short postoperative immobilisation and renders an early return of motion and that a good function can be expected.

Adult↗
PubMed1990

[Scintigraphic control and x-ray findings following the cement-free implantation of the PM shaft in connection with hip joint allo-arthroplasty].

147 bone scans with 99mTc-MDP following 60 cementless hip arthroplasties were analysed at 3 to 160 weeks after operation. Results are compared to clinical evaluation according to Merle d'Aubigné. X-ray changes in a number of patients are included. In uncomplicated cases, bone scan activity decreased quickly within 26 weeks postoperatively. Decrease of scintigraphic activity was markedly delayed in patients with low Merle d'Aubigné values or persisting pain. In 4 cases, bone scan activity increased again. In these cases, reoperation revealed rotational instability of the shaft endoprostheses. Unusual x-ray phenomena such as development of a bony cup at the tip of the prosthesis or seams were found mainly in patients with less satisfying results. We consider nuclear imaging an important additional examination to evaluate bony integration of PM shaft endoprostheses after hip replacement, especially as interpretation of x-ray features alone is still doubtful.

Adult↗
PubMed1990

[Use of a capacitive measuring mat for recording inter-fragment pressures and pressure distribution in ventral inter-corporal spondylodesis].

With respect to ventral interbody fusion, rates of pseudarthrosis of up to 30% are reported. With the aim of reducing this figure, the use of dorsal fixation systems to stabilise the fused spinal units is recommended by a number of authors. The aim of these osteosynthetic procedures is to elevate the interfragmentary compression between the ventral bone block and the adjacent vertebrae. In order to measure the pressure achievable, and its local distribution, an experimental investigation involving the use of a capacitive measuring mat has been designed. The system of capacitive measurement and its application to the spine is described. The simple mode of measurement and mechanical stability, combined with high accuracy, are the specific advantages of capacitive systems of measurement. Especially in the documentation of interfragmentary pressure and pressure distribution, capacitive measuring mats are superior to comparable systems.

Biomechanical Phenomena↗
PubMed1989

Micromotions in the primary fixation of cementless femoral stem prostheses.

Thirty cementless femoral stems of six different types of hip endoprostheses were implanted in femurs taken at autopsy and underwent static loading and afterwards dynamic loading of 50,000 cycles to simulate walking during the early months after implantation. After that, the static load tests were performed again. During both static load series a certain amount of micromotion between stem and implantation bed occurred in the frontal and sagittal planes and also during rotation. The six prostheses exhibited clearly differing results. The influence of dynamic load on the extent of micromotion was small.

Bone Cements↗
PubMed1988

Special problems of cementless fixation of total hip-joint endoprostheses with reference to the PM type.

The success of cement-free hip endoprosthetics is largely dependent on precise surgical techniques and primary stability of the anchorage, in which favorable biomechanical conditions as well as the quality of the stabilizing bone are of considerable importance. Information gathered from more than 1500 cementless hip-joint endoprosthesis implantations is presented with biomechanical solutions and indications regarding operating techniques, and a correlation between clinical symptoms and radiological signs of complications is discussed. In close coordination with material-specific factors, design and surface characteristics are decisive in the function and quality of anchorage of the endoprosthetic replacement. In the case of the PM total hip endoprosthesis, these widely variable values were governed strictly by biomechanical considerations, with particular reference to the resulting bone reactions. Results so far, including those relating to stable integration of the implant, must be regarded as absolutely positive and confirm the design characteristics on which this model was based. Avoiding the disadvantages of bone cement, cementless hip-joint replacement, particularly in operations for the exchange of cemented prostheses after loosening, can be regarded as a step forward in hip-joint surgery.

Biomechanical Phenomena↗
PubMed1987

A study of the synovial and ligamentous structure of the anterior cruciate ligament.

The synovial and ligamentous structure of 16 human anterior cruciate ligaments (ACL), removed at autopsy, were examined by light microscopy with special regard to their topographical relationships. The soft tissue support of the ACL consists of fibrous, areolar and areolo-adipose synovial tissue. The subsynovial layer comprises a tight fibrous peripheral part and an element of loose connective tissue containing some tight connective tissue strands, vessels and nerves. The collagenous ligamentous part of the ACL is the proper functional tissue and contains approximately 1500 fascicles measuring an average of 250 micron in diameter. These fascicles are composed of bundles of collagen fibres, fibrocytes and deposits of proteoglycans. The synovial and ligamentous structures are attached by the second part of the subsynovial layer, which radiates into the ligamentous tissue and envelops the fascicles like a sheath. By this means the biological connection between these two structures is guaranteed. The relevance of these findings to operative reconstruction of recent ligamentous injuries is discussed.

Adult↗
PubMed1987

Examinations of the pathology of the rotator cuff.

We performed autopsies on 195 shoulder joints in order to check the differing opinions as to the pathogenesis and incidence of tendinopathia calcarea and rupture of the rotator cuff that have been expressed in literature. There was a rupture rate of 11%. Intratendinous calcific deposits could be observed by radiology in 22% of the cases. The simultaneous presence of intratendinous calcification and rotator cuff rupture could be proved in 13 of 22 cases with a rupture of the rotator cuff. On the basis of our results we conclude that tendinopathia calcarea and rupture of the rotator cuff have an identical pathogenesis.

Adolescent↗
PubMed1986

[The wrist joint].

The wrist joint is involved in a great majority of cases of rheumatoid arthritis. Tenosynovitis and synovitis can lead to severe destruction of the joint and to spontaneous ruptures of the tendons. Therefore, early tenosynovectomy and wrist-joint synovectomy are required. At the advanced stage of the disease, arthroplasty is necessary. Arthrodesis is rarely indicated in the treatment of severe wrist destruction in rheumatoid arthritis.

Arthritis, Rheumatoid↗