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Biomedical subjects

H Zollinger

Publications and source records attributed to H Zollinger.

At least 19 recordsLinked to original sources
PubMed1999

Morton neuroma: effect of MR imaging findings on diagnostic thinking and therapeutic decisions.

PURPOSE: To determine the effect of magnetic resonance (MR) imaging results on diagnostic thinking and therapeutic decisions by orthopedic surgeons in cases of a possible Morton neuroma. MATERIAL AND METHODS: Orthopedic surgeons completed a questionnaire before and after MR imaging for 54 feet in 49 patients thought to have Morton neuroma. Clinical diagnosis (Morton neuroma, differential diagnosis), location, diagnostic confidence, and therapeutic decisions were noted before and after MR imaging. The influence of the size of the neuroma on therapeutic decisions was analyzed. MR imaging diagnoses were compared with surgical results for 23 revised intermetatarsal spaces. RESULTS: After MR imaging, the clinical diagnosis of Morton neuroma was withdrawn in 15 of 54 (28%) feet. In 14 of 39 maintained diagnoses, the location or number of neuromas was changed after MR imaging. Confidence levels for Morton neuroma increased substantially after MR imaging. In 31 (57%) feet, a change in treatment plan resulted after MR imaging. Diameters of neuromas on MR images were significantly larger (P = .003) in surgically treated feet than in conservatively treated feet. MR imaging diagnoses were correct in all 23 revised intermetatarsal spaces. CONCLUSION: MR imaging has a major effect on diagnostic thinking and therapeutic decisions by orthopedic surgeons when Morton neuroma is suspected, especially because MR imaging helps in localization and size assessment of Morton neuromas.

Adult↗
PubMed1999

Outcomes after partial neurectomy of Morton's neuroma related to preoperative case histories, clinical findings, and findings on magnetic resonance imaging scans.

Our purpose was to evaluate the reliability of preoperative case histories, clinical findings, and magnetic resonance imaging (MRI) scans in substantiating the diagnosis of Morton's neuroma and in predicting clinical outcomes after surgical intermetatarsal neurectomy. We studied 19 consecutive patients with histologically proved Morton's neuroma. All had preoperative MRI of the forefoot. Partial neurectomy was performed when there was forefoot pain with transmetatarsal compression and positive findings on MRI scans. Case histories, clinical findings, and findings on MRI scans were correlated with clinical outcomes. Preoperative clinical findings including localization correlated with intraoperative findings in 11 of 19 patients (58%), and MRI scans correlated in 16 of 19 patients (84%). Of the 19 patients, 74% achieved satisfactory outcomes. Neither reliable clinical findings or findings on MRI scans nor confirmation of clinical findings by MRI correlated with a superior result, but 77% of patients with neuromas measuring more than 5 mm in transverse measurement on MRI scans had good outcomes; only 17% with neuromas measuring 5 mm or less had good outcomes. Preoperative localization and diagnosis of Morton's neuroma is better achieved with MRI than through clinical findings. A more favorable clinical outcome can be expected after surgical intermetatarsal neurectomy when a Morton's neuroma has a transverse measurement larger than 5 mm on MRI scans.

Adult↗
PubMed1998

[Subtalar arthrodesis--minimal resection technique].

INTRODUCTION: This is a prospective clinical and radiological study of the treatment of talocalcaneal deformity or degeneration by a modified technique of isolated talocalcaneal fusion. METHODS: Thirty-six patients were evaluated with clinical examination, plain dorso-plantar and oblique x-rays and CT-scan or magnetic resonance imaging in a follow-up of 32.5 months (range: 20-62). In 12 cases a posterior tibial tendon rupture with secondary osteoarthritis and in 24 cases a posttraumatic secondary osteoarthritis (18 calcaneal fractures, 3 talar fractures, 2 axial traumas with secondary talar necrosis and 1 rheumatoid arthritis with calcanear and talar fracture) were the indications for arthodesis. RESULTS: On a visual analog pain scale the patients graded their pain preoperatively at 4.4 and postoperatively at 1.1. The subjective results showed in 12 cases (33.3%) complete satisfaction, in 10 cases (27.7%) satisfaction with minor reservation, in 11 cases (30.5%) satisfaction with major reservation and in 3 cases (8.5%) dissatisfaction. The overall objective results were excellent in 17 (47.2%), good in 11 (30.5%), fair in 6 (16.8%) and poor in 2 (5.5%) cases. A further advantage of this type of talocalcaneal fusion is the remaining range of motion in the neighbouring joints, at the ankle (in 75.7% the same or better ROM than preoperatively) and at Chopart joint (in 69.4% the same or better ROM than preoperatively). The fusion rate was high with 94.5%. CONCLUSION: The modified isolated talocalcaneal fusion without disruption at the Chopart joint is a simple surgical technique in the hand of the experienced surgeon. The subjective and objective mid-term results of this prospective follow-up study are comparable to other technique described in literature.

Adolescent↗
PubMed1997

Magnetic resonance imaging of injuries to the ankle joint: can it predict clinical outcome?

OBJECTIVE: To predict clinical outcome after ankle sprains on the basis of magnetic resonance (MR) findings. DESIGN AND PATIENTS: Twenty-nine consecutive patients (mean age 32.9 years, range 13-60 years) were examined clinically and with MR imaging both after trauma and following standardized conservative therapy. Various MR abnormalities were related to a clinical outcome score. RESULTS: There was a tendency for a better clinical outcome in partial, rather than complete, tears of the anterior talofibular ligament and when there was no fluid within the peroneal tendon sheath at the initial MR examination (P = 0.092 for either abnormality). A number of other MR features did not significantly influence clinical outcome, including the presence of a calcaneofibular ligament lesion and a bone bruise of the talar dome. CONCLUSION: Clinical outcome after ankle sprain cannot consistently be predicted by MR imaging, although MR imaging may be more accurate when the anterior talofibular ligament is only partially torn and there are no signs of injury to the peroneal tendon sheath.

Adolescent↗
PubMed1997

Morton neuroma and fluid in the intermetatarsal bursae on MR images of 70 asymptomatic volunteers.

PURPOSE: To determine the prevalence and size of presumed Morton neuromas and fluid in the intermetatarsal bursae on magnetic resonance (MR) images. MATERIALS AND METHODS: In 70 asymptomatic subjects, transaxial T1-weighted spin-echo and T2-weighted turbo spin-echo images were obtained of the right forefoot. The prevalence and size of presumed Morton neuromas (diagnosed with MR imaging criteria) were evaluated, and the sizes were compared with those of 16 symptomatic, surgically proved Morton neuromas. The prevalence and diameter of fluid collections in the intermetatarsal bursae were evaluated on the T2-weighted images. RESULTS: Twenty-four Morton neuromas were diagnosed in 21 subjects (prevalence, 30%). The transverse diameter of the neuromas was 3-7 mm (mean, 4.5 mm) versus 4-8 mm (mean, 5.6 mm) in symptomatic subjects; this difference was significant (P = .0075). The prevalence of fluid in the intermetatarsal bursa was 20%, 47%, 49%, and 0% for the first through fourth intermetatarsal spaces. The transverse diameter of the fluid collection was 1-4 mm. CONCLUSION: The diagnosis of Morton neuroma at MR imaging may be relevant only when the transverse diameter is 5 mm or more and can be correlated to clinical findings. Fluid collections in the first three intermetatarsal bursae with a transverse diameter of 3 mm or less can be considered physiologic.

Adult↗
PubMed1997

Isolated talocalcaneal interposition fusion: a prospective follow-up study.

This is a prospective clinical and radiological study of the treatment of talocalcaneal deformity or degeneration by a modified technique of isolated talocalcaneal fusion. Thirty-six patients were evaluated with clinical examination, plain dorsoplantar and oblique radiographs, and computed tomography scanning or magnetic resonance imaging in a follow-up of 32.5 months (range, 20-62 months). Indications for arthrodesis were posterior tibial tendon rupture with secondary osteoarthritis (12 cases) and secondary posttraumatic osteoarthritis (24 cases). On a visual analog pain scale, the patients graded their pain at 4.4 before surgery and at 1.1 after surgery. The subjective results were 33% complete satisfaction, 28% satisfaction with minor reservation, 31% satisfaction with major reservation, and 9% dissatisfaction. The overall objective results were excellent in 47%, good in 31%, fair in 17%, and poor in 6% of cases. A further advantage of this type of talocalcaneal fusion is a large remaining range of motion in the neighboring joints, at the ankle (in 76% the same or better ROM than before surgery), and at Chopart's joint (in 69% the same or better ROM than before surgery). The fusion rate was high (95%).

Adolescent↗
PubMed1997

Efficacy of MR imaging in patients suspected of having Morton's neuroma.

OBJECTIVE: The purpose of our study was to evaluate the role of MR imaging in patients with suspected Morton's neuroma and to assess the value of various MR sequences in this diagnosis. MATERIALS AND METHODS: Thirty-two consecutive patients with suspected Morton's neuroma were studied using a 1.0-T MR scanner. Axial T1- and T2-weighted spin-echo, short inversion time inversion recovery, and enhanced T1-weighted fat-suppressed spin-echo images were obtained on each patient. Eighteen intermetatarsal spaces in 16 of the 32 patients were evaluated surgically. Contrast-to-noise ratios for Morton's neuroma versus surrounding fat were calculated and standardized for imaging times. RESULTS: In 15 of 18 intermetatarsal spaces, a Morton's neuroma was surgically proven. Thirteen true-positive, two false-negative, three true-negative, and no false-positive MR diagnoses were given. In six of 15 proven neuromas, the clinical examiner was not able to identify the correct intermetatarsal space. The MR diagnoses in the 16 remaining patients who did not undergo surgery were Morton's neuroma (n = 8), stress fracture (n = 1), foreign body reaction (n = 1), tendon sheath ganglion (n = 1), postoperative changes (n = 2), and no abnormality (n = 3). Standardized contrast-to-noise ratios (+/- SD) were 2.42 +/- 0.72 for T1-weighted images; 1.43 +/- 1.13 for T2-weighted images; 1.26 +/- 1.47 for short inversion time inversion recovery images; and 0.83 +/- 0.59 gadolinium-enhanced fat-suppressed images. The differences were statistically significant for the T1-weighted spin-echo images versus the three other sequences (p = .001-.018), but not among the other sequences (p = .209-.710). CONCLUSION: MR imaging is accurate in diagnosing Morton's neuroma and may be important for correct localization. A limited examination employing axial T1-weighted spin-echo images is adequate; additional sequences should be employed only for differential diagnosis.

Female↗
PubMed1996

[Juvenile hallux valgus].

Juvenile bunions have different etiologies and require specific operative approaches. Any operative procedure to correct a juvenile hallux valgus deformity should correct all the components of the deformity, i.e. pronation of the hallux, the increased hallux valgus angle, the enlarged medial eminence, the increased intermetatarsal angle, and hypermobility or obliquity of the first metatarso-cuneiform joint with the intention of decreasing the rate of recurrence.

Adolescent↗
PubMed1996

Clinical examination and magnetic resonance imaging in the assessment of ankle sprains treated with an orthosis.

This is a prospective clinical study of treatment of ankle sprains with an ankle brace that permits ankle dorsiflexion and plantarflexion of 20 degrees, but limits inversion and eversion for 6 weeks. The ankle brace is followed by physiotherapy for another 6 weeks. Thirty patients were evaluated with clinical examination and magnetic resonance (MR) imaging before treatment and after 12 weeks of treatment. MR imaging revealed acute tears in the anterior talofibular ligament in all 30 ankles (100%) and tears in the calcaneofibular ligament in 25 of 30 ankles (83%). At 12 weeks after injury, MR evidence of healing was present for the anterior talofibular ligament in 22 of 30 ankles (73%) and for the calcaneofibular ligament in 23 of 25 ankles (92%). Postural sway analysis after therapy was used to quantify functional stability of the ankle. There was no correlation with MR findings, but there was a correlation with the subjective impression of functional instability. Twenty-eight of 30 patients (93%) had a functionally stable ankle after 12 weeks of treatment. MR findings after ankle sprain could not predict clinical outcome.

Adult↗
PubMed1995

[The lax juvenile flexible flatfoot--disease or normal variant?].

The spectrum of normal variations of children's feet is extremely broad and often difficult to separate from pathological conditions. Especially the flexible flatfoot normally disappears during growth, and even if it persists up to adult life, it hardly has any pathological significance. The natural course taken even by severe flexible flatfoot in children leads to results that are as good, if not even better than when surgery had been performed; therefore, more reticence with surgical treatment in such cases is advocated.

Child↗
PubMed1994

Analyses of 94 consecutive spinal cord injury patients using ASIA definition and modified Frankel score classification.

Serial neurological examinations were analysed on 94 consecutive spinal cord injury (SCI) patients admitted for rehabilitation to the Swiss Paraplegic Center at the Clinic Balgrist Zurich, Switzerland between 1987 and 1992. Patients' data were examined adopting ASIA and modified Frankel definitions in order to compare the two classifications in terms of consistency and prognostic value. The modified Frankel definition was subdivided into five categories (A, B, C, D and E). On admission (discharge) 43 (37) patients were classified as Frankel A, 23 (11) patients in group B, 26 (42) patients in group C, 2 (2) patients as Frankel D and 0 (2) patients in group E. A qualitative analysis of the results on the base of a maximal score of 100 points (A = 0, B = 25, C = 50, D = 75 and E = 100 points) suggested a mean score improvement from 21.5 (+/- 22.5) to 29.0 (+/- 26.3) or 7.5 (+/- 7.1), regarding all 94 patients during follow up (admission/discharge). The median improvement was one modified Frankel grade (A/B to B/C). No detailed assessments were yielded concerning motor and sensory functions. Using ASIA definition, a continuous numerical score of motor and sensory function was observed. Recovery during follow up was determined by detailed motor and sensory function. For all 94 patients (quadriplegics and tetraplegics), the average motor recovery according to the ASIA definition was 9.4 (+/- 9.6). The mean ASIA motor score improved from 52.2 (+/- 17.3) on admission to 61.6 (+/- 17.9) on discharge.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

[Injuries in snowboarding--a prospective study].

180 patients with injuries effected through snowboarding were evaluated during a period of 2 1/2 months in both the hospitals and private surgeries of Oberwallis. This was done to determine the nature of the injuries and the risk factors that led to them. Snowboarders are on the average 21 years of age and only rarely over 40. One-third are women, and two-third are men. More than half are beginners with less than one week's training experience; one-fifth of the beginners met with the accident on the first "snowboard day". Over 80% of the injured said that riding mistakes and insufficient training and instruction were the cause; rarely were the conditions of the runway blamed. The accidents happened irrespective of snow and runway conditions. Accidents due to tearing of the fastenings always injured the lower extremity. Injuries of the upper and lower extremities take place in the same proportions. Injuries of the trunk and head are rare. Beginners usually injure the upper, while good snowboarders the lower extremities. The most common injuries are radius fractures, followed by ankle and knee distorsions. In the case of injuries to the lower extremities, the forward leg which is the "skating leg" or "standing leg", is affected more than 80% of the cases.

Adolescent↗
PubMed1994

[Foot problems in the elderly].

Foot problems in the geriatric patient are multiple and sometimes complex. The choices in treatment are frequently restricted because of contraindications for surgery. Common foot problems are common in the elderly patient, too, but in addition there is a specific pathology of this group of patients. Inexpensive, but institutionalized routine foot care is an essential medical need of the elderly to improve the quality of life.

Aged↗
PubMed1994

[Natural course of juvenile foot deformities].

The spectrum of normal variations of children's feet is extremely broad and often difficult to separate from pathological conditions. Especially the flexible flatfoot and the pes adductus normally disappear during growth, and even if they do persist up to adult life, they hardly have any pathological significance. It therefore appears proper to see foot deformities of children from the prognosis point of view, that is, to differentiate between a benign, pain-free course of development with no functional restriction even under load, and pathological deformities which systematically require conservative or surgical therapy. However, definite pathological conditions like pes equinovarus, talus verticalis, or foot deformities due to development of defects, without therapy lead in most cases to well-known deformations and often to painful functional disorders. Early detection and treatment can contribute to a favorable prognosis in many cases.

Adult↗
PubMed1992

[Biomechanics of the foot--forces in the forefoot during walking and their clinical relevance].

Pathologic conditions of the toe and metatarsophalangeal (MP) joints, such as the commonly encountered hallux valgus but also the relatively rare idiopathic necrosis of the metatarsal heads (Freiberg-Koehler's disease) and many other disorders of the foot, call for precise investigation of the kinematic and dynamic behavior of the foot during walking. The success of surgery performed on bone or soft tissues in the forefoot depends on an understanding of the biomechanics of the region. Therefore, the plantar forces acting under the metatarsal heads of the 1st, 2nd and 5th rays and under the pads of the 1st and 2nd toes were measured during walking, so that with the aid of anthropometric information pertaining to the forefoot, reaction forces in the flexor tendons and in the joints could be estimated. Particularly evident was the large share of the load taken by the big toe. This necessitates correspondingly high tension forces in the flexor tendons of the 1st ray, which simultaneously have the function of supporting the longitudinal arch of the foot. Because of this, the 1st metatarsal bone is loaded mainly in compression. In sharp contrast to this, the 2nd metatarsal bone is heavily loaded in bending, similar to a cantilever that is firmly held at its base. The high bending stress, especially when the 1st ray is no longer taking its share of the total load, leads to fatigue or march fractures, typically in the shank of the bone. A possible explanation for the pathogenesis of locally restricted necrosis of the metatarsal heads (Freiberg-Koehler's disease) is suggested and, finally, the question of dislocation of the base of the 2nd toe in the MP joint is discussed.

Adult↗
PubMed1991

[Hallux rigidus and its treatment].

Hallux rigidus is a rather frequent, painful limitation of movements in the metatarsophalangeal joint of the great toe caused by arthrosis. A mechanical limitation of dorsal flexion due to osteophytes frequently causes a progressive plantar flexion with compensatory hypermotility in the interphalangeal joint. Therapeutic measures with technical modification of shoes and physical therapy are often insufficient and operative therapy aims at arthrodesis or remobilisation of the great toe's metatarsophalangeal joint.

Arthrodesis↗
PubMed1991

The causes of subsequent arthrodesis of the ankle joint.

Between 1917 and 1984, we performed 217 arthrodesis of the ankle joint. Posttraumatic states were the cause of the osteoarthritis in 153 cases, whereas 118 of these cases were malleolar fractures. The accident X-rays were analyzed, and the fractures were classified in accordance with the classification of Weber (11). Our own system was used for the radiological classification of the degree of arthritis. The extent of malunion after the initial care was assessed. We found type-C malleolar fractures most frequently, the most striking malunion being the shortening of the fibula. In all fractures requiring subsequent arthrodesis, osteoarthritis of degree III-IV was present. In most cases the malleolar fractures treated surgically showed a shortening of the fibula and must be considered failures of initial care. The classification into types according to Weber also seems to provide prognostic information about the subsequent need for arthrodesis. Here it can be observed that C-fractures and compression fractures more often require arthrodeses.

Ankle Injuries↗