[The triphalangy of the large toe-a contribution to the metric variations of the foot].
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Child, Preschool↗
Biomedical subjects
H J Refior
Publications and source records attributed to H J Refior.
[Comparative studies on the problem of the further development disorders of the vertebral column in children with dysmelia syndrome and children with peromelia].
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Abnormalities, Drug-Induced↗
[Contribution on the occurrence and form of congenital hand deformities].
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Berlin↗
Long tendon of the biceps brachii: sites of predilection for degenerative lesions.
The extreme stress on the long head of the biceps tendon is defined by its specific anatomic course, with its proximity to the rotator cuff, the intertubercular groove and the acromion. We studied the morphologic and cross-sectional anatomy of the long head of the biceps tendon in 104 cadavers to analyze degenerative lesions. Degenerative changes in the tendon (disorganized collagen fibers and large mucoid deposits) occurred mainly in the distal bicipital groove and near the origin of the tendon from the superior part of the glenoid labrum. The results of histologic examination identified sites that possibly have a predilection for tendon rupture.
Acromion↗
The role of the bicipital groove in tendopathy of the long biceps tendon.
Long biceps tendon disease is often underrated but plays an important role in anterior shoulder pain. We studied prospectively the anatomy of the bicipital groove and its relationship to clinical symptoms. Sixty-seven consecutive patients were investigated by mutual ultrasonography and radiographs of the intertubercular groove. All images were scrutinized for biceps tendon status (ultrasonography) and groove anatomy (radiography). Thirty-seven patients (21 male, 16 female, average age 48 years) had chronic anterior shoulder pain, and 30 patients (16 male, 14 female, average age 46 years) served as a control group. In 28 shoulders we found sonographic signs of tendovaginitis, and in 14 we found degenerative changes. The mean age of patients with pathologic conditions of the long biceps tendon was 40 years, significantly lower than that of the complete study group. The x-ray films revealed a great variation in the medial and total opening angle of the groove, whereas width, depth, and humeral head diameter showed sex-related differences. Radiologic signs of groove degeneration correlated in 43.6% with biceps tendon disease on the sonogram. Our study revealed statistically significant correlations between groove anatomy and long biceps tendon disease, which should be considered more while shoulder problems are evaluated.
Adult↗
[Analgesic effect of low energy extracorporeal shock waves in tendinosis calcarea, epicondylitis humeri radialis and plantar fasciitis].
PURPOSE OF THE STUDY: Is there a pain reduction at the application site after extracorporeal shockwave application for tendinitis calcarea, epicondylitis radialis and plantar fasziitis? METHODS: In a prospective study 85 patients were observed. Shockwave application was performed three or five times using low energies (0.09-0.18 ml/mm2). Before and after shockwave application pain was evaluated using SF-36 score and Visual Analog Scale (VAS). RESULTS: After 5 months for all three indications a significant improvement of the pain situation could be reached. Patients with plantar fasziitis demonstrated the highest decrease of pain, followed by tendinosis calcarea and epicondylitis radialis. The number of applications had no influence to the clinical result of the ESWT. RELEVANCE: In the present study the analgetic effect of ESWT after repeated low-energy application was described for the standard indications.
Adolescent↗
[Open surgical procedures in calcifying tendinitis of the shoulder - concomitant pathologies affect clinical outcome].
AIM OF THE STUDY: Open surgical removal of calcifications in chronic courses of calcifying tendinitis of the shoulder can be combined with acromioplasty. Independent of the surgical procedure not all patients achieve satisfactory surgical results. The aim of the study was to investigate whether preoperatively known epidemiologic, social, clinical and radiologic factors or intraoperative findings might influence the therapeutic outcome. METHODS: Following diagnostic arthroscopy, open removal of the calcifications was done as an isolated procedure (group A, n = 12) or combined with open acromioplasty (group/B, n = 24). Follow-up was 33 months for both groups. RESULTS: Clinical outcomes were comparable in both groups (Group A, 74.9 points; Group B 73.4 points, Constant-Murley score) and independent of gender, age, profession, duration of anamnesis, hospital-stay period, follow-up period, dominance of arm, preoperative Constant-Murley score, calcification morphology and size and acromial type. 20 patients in total achieved a clinical outcome of </= 75 points (Constant-Murley score). 12 of these demonstrated lesions of the rotator cuff and joint cartilage combined with synovialitis. In 6 patients an adverse preoperative Constant-Murley score or the wish to receive a pension was recorded. CONCLUSION: Both surgical procedures lead to overall good and satisfactory clinical results. Below average clinical outcomes are associated with pathologic findings of the glenohumeral joints, adverse preoperative clinical situation or the wish to receive a pension.
Acromion↗
[Macerated human hip bone preparation as a substitute for fresh frozen preparations for testing the primary stability and frictional torques of cementless hip cups].
AIM: The aim of the study was to validate macerated human acetabuli as replacement for fresh frozen preparations for testing primary stability and the screwing in moments of cementless threaded hip cups. METHOD: Three fresh frozen human pelvis were tested. One half of each pelvis was macerated whereas the other half was preserved as fresh frozen preparation. In the side of every pelvis the moments of screwing-in, the micromotions, the maximum expressing force and the maximum pull-out torque were determined. RESULTS: The screwing in moments, the maximum expressing forces and the maximum pull-out torques did not change. The micromotions were reduced to half. CONCLUSION: Considering the reduction of the micromotions, macerated human acetabuli are valid replacements for fresh frozen preparations for testing the primary stability and the screwing-in behaviour of screwed pans.
Cementation↗
[Complete rotator cuff rupture--differential surgical techniques and intermediate-term results].
QUESTIONS: What is the mid term result of open rotator cuff repair? What are the criteria for a good surgical result? METHODS: Between February 1988 and December 1993 130 patients (135 shoulders) underwent surgery for rotator cuff repair. All surgical techniques were combined with a acromioplasty--transosseous refixation, transtendinous suture, isolated or combined transfers of tendons. The retrospective analysis consisted of clinical examination including the Constant score, X-rays and sonograms of the shoulder before and after surgery. RESULTS: 95 patients (98 shoulders) were controlled 4 years and 8 months after surgery by clinical, radiological and sonographical examination. 80% of all cases showed good or very good long term results by chiefly transosseous refixation alone or in combination with tendon transfer. Analysis of all data made it possible to create simple prognostic criteria. These criteria can help preoperatively to give an idea of the expected outcome. CONCLUSION: The best preoperative criteria for a prognostic good surgical result were an acromion-humeral head distance in the native true a.p.-X-ray of more than 7 mm, a rotator cuff defect of less than 2 x 3 cm and a passive free range of motion.
Adult↗
[Alloplastic replacement of the proximal femur--indications, results and experiences].
The aim of this follow-up study was to see if, by the application of a special endoprosthesis for the replacement of the proximal femur, a radical tumour resection could be achieved and/or the function of the lower limb could be preserved or restored respectively. Between 11/1986 and 12/1992 a proximal femoral endoprosthesis was implanted in 9 patients with metastases in the proximal femur. In 21 cases this special endoprosthesis was used in the revision of conventional cemented total hip arthroplasties with loosening of the implant and extreme bone loss at the proximal femur. Twenty-three patients were seen for a follow-up examination with an average follow-up period of 20 months. In all cases the walking ability was preserved or restored respectively. The majority (22/23) of the patients had complete or, nearly complete pain relief. In those patients with skeletal metastases, were no cases of local reoccurrence. The majority problem of this endoprosthesis was the increased risk of dislocation. There is a clear indication for such a special endoprosthesis in the treatment of primary and secondary bone tumours in the proximal femur. For revision of cemented total hip prostheses with loosening and bony defects a revision prosthesis with uncemented distal fixation should be used.
Activities of Daily Living↗
[Primary leiomyosarcoma of the bone].
In a 52-year-old female patient and a 50-year-old patient with a malign tumor of the right distal femur (stage IIIb) respectively the left distal tibia (stage Ia according to Enneking), the extremely rare primary leiomyosarcoma of the bone was diagnosed. The mortality of the primary leiomyosarcoma of the bone is 50%, the mean survival time after diagnosis is 3.4 years. Diagnosis of a primary leiomyosarcoma of the bone is only possible after a secondary leiomyosarcoma has been excluded as well as by histopathological including immunohistochemical examination. The operative procedure is the therapy of choice. A neoadjuvant and/or adjuvant radio- or chemotherapy can be useful.
Angiography↗
[Nuclear magnetic resonance tomography in destructive changes of the spine].
Correct treatment of destructive lesions in the vertebral column requires exact radiological evaluation with the traditional techniques of plain films, computed tomography and radionuclide scanning. With the development of magnetic resonance imaging the possibility of visualizing pathological changes of the bone marrow became apparent. To prove the value of MRJ in detecting destructive lesions of the spine 29 patients were investigated using plain radiographs, computertomographies, radionuclide scanning and MRJ. The findings were correlated to the intraoperative aspect of the lesion and the results of the histological investigation in 18 cases. MRJ showed to be a very sensitive manner of detecting bone marrow changes of different kind. Indeed characteristic changes in signal intensity were not to be observed in pathological lesions of inflammatory or tumorous genesis. So the distinction is based on morphological criterias.
Adolescent↗
[Rupture of the distal tendon of the biceps--diagnosis and results].
The rupture of the distal tendon of the biceps brachii is a uncommon injury of the upper extremity. For this reason, the clinical patterns are quite unknown. Between 1980 and 1989 14 patients were treated operatively because of a distal biceps tendon rupture. Aetiology, diagnostic efforts and operative treatment are demonstrated as well as the results of a follow-up of 12 patients. The results of operative treatment are quite good and point out the need for operative treatment.
Adult↗
[Lymphoma-induced imitation of knee prosthesis loosening].
Persistent pain after knee arthroplasty is often caused by aseptic loosening, implant failure, unphysiological alignment (especially of the patella), infection, scars and neuroma. In a case of a 70-year-old patient pain and swelling after knee arthroplasty persisted despite three revision procedures. Surprisingly, a non-Hodgkin's lymphoma was found in femoral bone marrow histology. A metastatic non-Hodgkin's lymphoma as cause of pain and swelling after knee arthroplasty, like in this case, is rare and has not been described up to now.
Aged↗
[Proprioception in the anterior cruciate ligament of the human knee joint--morphological bases. A light, scanning and transmission electron microscopy study].
In 21 human anterior cruciate ligaments removed with their synovial sheaths during autopsy and operation, nerves and nerve endings were demonstrated by light microscopy, scanning electron microscopy and transmission electron microscopy. Ultrastructural examination allowed a classification of nerve endings into three types: Ruffinian corpuscles, Pacinian corpuscles and free (afferent and efferent) nerve endings. The nerve endings corresponded to those characteristic of articular capsules. The anterior cruciate ligament shows evidence of a proprioceptive function besides its stabilizing function, which is based on its collagenous structure. Together, they probably represent the most important factor in the dynamic stabilization of the knee joint. At present it is only possible to speculate on the potential clinical significance of these findings, for example in development of rehabilitation programs and prevention strategies offering protection against anterior cruciate tears. This also applies to the question of whether to preserve the ligament during surgery for ruptures and knee-joint prostheses.
Adult↗
[Indications and results of intertrochanteric reconstructive osteotomy in coxa profunda and protrusio coxae].
Coxa profunda often connected with coxa vara lead to an increasing stress on the medial part of the acetabulum. Secondary degenerative alterations with painful limited motion are the result. In 20 hip joints with coxa profunda a valgus intertrochanteric osteotomy was carried out in order to modify the direction of the resulting force from the depth to the roof of the acetabulum. A relief of pain was achieved in 18 of 20 cases. Therefore the valgus intertrochanteric osteotomy has to be considered an effective method in the treatment of coxarthrosis in coxa profunda.
Adult↗
[Significance of sagittal stability in knee prosthesis implantation--an analysis of 76 cases with unconstrained joint surface replacement].
ISSUE: How does the sagittal stability influence the outcome in unconstrained knee arthroplasty? METHOD: In order to clarify this aspect, 76 arthroplasties (10 male, 66 female, 39x gonarthrosis, 37x rheumatoid arthritis) in 61 patients with unconstrained primary knee arthroplasty were examined with a mean follow-up of 4 years. The determined values were the HSS-Score, the Knee-Society-Score, the range of motion, the flexion contracture as well as the posterior and anterior drawer with the KT 1000. The laxity was defined as the sum of the anterior and posterior drawer. RESULTS: The mean values measured were 2.9 mm for the anterior drawer, 1.9 mm for the posterior drawer and 4.8 mm for the laxity. The total patient population reached 81.3 points in the Knee Score, 70.9 points in the Function-Score and 80.7 points in the HSS-Score. The medium range of motion was determined as 103.5 degrees, the medium flexion contracture as 3.5 degrees. For an anterior drawer of > 6 mm and a posterior drawer of < 1 mm the results deteriorated significantly. A laxity of 8-11 mm gave the best score results. CONCLUSION: An anterior drawer of < 6 mm, a posterior drawer of 2-5 mm and a laxity of 8-11 mm seem to be recommendable for unconstrained knee arthroplasty.
Aged↗
[Initial clinical results with heat-treated homologous bone transplants].
Several ways for HIV inactivation in bone allografts are being discussed. These methods must be efficient, but they must not compromise biologic properties of the allografts. According to animal studies, moderate heat treatment of bone allografts in a 65 degrees C waterbath has no adverse effects on osseointegration. A clinical follow-up study of 49 patients with heat treated bone allografts was conducted. 37 patients with conventional cryopreserved allografts were included in the study as controls. Average follow-up time was 27 months. Results were evaluated by clinical and X-ray examination, using a modified radiologic score. No significant differences in the two groups were detected, except for a slight retardation in bony integration of the heat treated allografts between week 39 and 52 postoperatively. Complication rates were 11.4% vs. 10.7%. In conclusion, moderate heat treatment of bone allografts appears to be a practicable and safe method to improve safety in bone transplantation in clinical practice. In addition to the known guide lines for bone banking heat treating of allografts should be further improved in order to minimize the low remaining risk of infection which exists despite of the three months test.
Acetabulum↗