[Whiplash injury of the cervical spine].
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Cervical Vertebrae↗
Biomedical subjects
J Grifka
Publications and source records attributed to J Grifka.
[A technique for imaging stretch of human back musculature with ultrasound for supporting the diagnosis of post-discectomy syndrome].
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Biomechanical Phenomena↗
[Motion analysis in whiplash injuries].
Motion analysis of the cervical spine is a sensitive tool in the fields of preventive and clinical biomechanics of whiplash. In the field of preventive biomechanics motion analysis contributes to validation and optimisation of dummy based crash test experiments and simulations. In the clinical field motion analysis up to now is of restricted value. Data exist about restrictions and pathologies of movement and motion of the cervical spine, coordinative disturbances, postural control, TMJ-function and oculomotor disturbances after whiplash. The standardisation of technical and clinical set-ups is necessary to establish a well proven biomechanical model of whiplash and whiplash related biomechanical dysfunction. Without this model the value of motion analysis for clinical use will be restricted due to lack of comparable data on sensitivity and specificity although motion analysis of the cervical spine is neither cost- nor time consuming and free of adverse effects. Within a prospective series of 28 patients (14 m/14 f) with a follow-up to six weeks we were lucky to describe numerically two different types of reaction to low energy (delta v < 20 km/h) rear end collision: Type I with disturbances in complex movements only, Type II with overall restriction of movement. Control of angular velocity during cyclic movements of the head was disturbed by oscillations of higher frequency in all patients. Recovery from whiplash within 6 weeks could be monitored.
Head↗
[The effect of lumbar relief orthoses with abdominal compression on esophago-gastrointestinal motility].
OBJECTIVE: To investigate the effect of lumbar ortheses with abdominal compression on gastro-oesophageal reflux and gastrointestinal transit. PATIENTS AND METHODS: In a prospective study 20 consecutive patients with lumbar syndrome treated with lumbar orthesis (10 female, 10 male, median age 54.6 years) were investigated for gastro-oesophageal reflux, mouth-to-cecum transit time (MCT), and whole-gut transit time. Gastro-oesophageal reflux was assessed performing an ambulatory pH metering of the distal oesophagus over a period of 10 h with and without ortheses on two separate study days. After positioning of the pH catheter patients ingested a liquid-solid test meal labelled with 10 g lactulose and 750 g indigocarmine to determine MCT with the hydrogen breath test and whole-gut transit by the first appearance of indigocarmine in the stool. Dyspepsia was assessed by using a standardized questionnaire. RESULTS: Lumbar ortheses induced a significant increase in reflux time (pH < 4) (8.1 vs 4.1%), total number of reflux episodes (102.5 vs 69.5) and duration of longest reflux episode (6.0 vs 3.7 min) (P < 0.05). 12 patients with ortheses revealed an increase in relative reflux time (2.1-24.5%, median: 8.2%) more than two standard deviations compared to previously obtained normal values. In these patients during ortheses dyspeptic symptoms correlated significantly with reflux time (r = 0.6; P < 0.05). In contrast, MCT and whole-gut transit time in patients with and without ortheses did not differ significantly (85 vs 85 min; 10.2 vs 9.6 h). CONCLUSION: Lumbar ortheses with abdominal compression, nowadays frequently used in the lumbar syndrome, produce gastro-oesophageal reflux associated with dyspepsia. Gastrointestinal transit time is not affected, though.
Adult↗
[Injection therapy in cervical syndromes].
Injection therapy is highly significant in the treatment of cervical syndromes. Following the differential diagnosis and analysis of the symptoms, injection treatment leads to a worthwhile degree of pain relief as a result of the anaesthetic effect on the nerve. This paper describes the general criteria for such treatment and also the various injection techniques in use.
Anesthetics, Local↗
Diagnosis of knee instability using sonography.
OBJECTIVE: A sonographic method has been developed to diagnose knee joint instabilities and to gain exactly quantifiable and reproducible measurements. DESIGN: Based on biomechanical considerations, a new positioning device to analyse knee instabilities sonographically has been developed and tested in in vivo studies. BACKGROUND: Common instrumental testing techniques are difficult to reproduce and show a lack of reliability. METHOD: Using sonography the cortical line of the femur and tibia are observed. At the same time a translation of these two partners at the knee joint is provoked in a defined position using the special holding device and under a defined amount of stress. Using this method 142 healthy people, placed in different age groups, were tested to establish standard values for the physiological knee joint translation. A prearthroscopic stability analysis was performed on 101 patients. RESULTS: This study proves that the special device developed, together with the technique used, provides reliable and exact measurements for knee instability in different translation directions. In healthy subjects the lateral compartment always showed a larger translation than the medial compartment. A gradual increase in translation was determined in the age groups over 30 years. A significant difference of 0.0001 was shown between knee stability and instabilities. Moreover, a further differentiation between partial and total ACL ruptures and chronic instabilities was determined. This provides an important advantage not offered by usual instrumental testing techniques. CONCLUSIONS: The ability to diagnose even a very low extent of instability and to differentiate between different kinds of instabilities enables exact controls to be carried out for both conservative and operative treatment.
Journal Article↗
Endoscopic therapy in epicondylitis radialis humeri.
After making an exact diagnostic verification of tennis elbow and after intensive conservative treatment has been used without any signs of improvement, the Hohmann operative procedure involving the incision of the proximal extensor tendon has distinct advantages as far as the pathophysiological aspects are concerned. This operative treatment can be safely carried out using endoscopy. A normal 30 degrees endoscope, nonelectrolyte fluid, an exploratory probe, and an electrotome are necessary. The procedure is described in detail.
Arthroscopes↗
Significance of laser treatment in arthroscopic therapy of degenerative gonarthritis. A prospective, randomised clinical study and experimental research.
To ascertain the efficiency of different techniques of arthroscopic therapy for gonarthritis and establish the relevance of the extent of chondromalacia, clinical and experimental studies were performed. In principle, the process of chondromalacia determines the course of the disease. Treatment of additional meniscus lesions temporarily leads to better clinical results, but after only a few months the symptoms caused by the arthritic process reappear. Compared with the temporary relief of complaints after debridement and lavage, smoothing with a xenon chloride excimer laser in grade II chondromalacia leads to statistically significantly better clinical results. Scanning electron microscopic studies confirm the extremely good smoothing. These studies permit clear statements as to the various methods of treatment and their application in the different grades of chondromalacia, thus leading to differentiated arthroscopic treatment of degenerative gonarthritis.
Arthritis↗
[Clinical and sonographic meniscus diagnosis].
Clinical examination still plays an important role in diagnosing meniscal tears. The types of sensitive nerves in the knee joint are responsible for nonspecific pain, which is often correlated with too little specificity in meniscal tests. Ultrasound examination of meniscal structures of the knee joint has been debated extensively in recent years. Criticism of this noninvasive technique was due to small patient groups, improper technical and inaccurate manual standards. Since 1988 ultrasound of the tibial meniscus has become a standard technique in our Department of Orthopaedic Surgery with defined criteria of the intersecting plane and evaluation of ultrasound images. A prospective follow-up study during 6/1988 and 5/1993 including 1186 ultrasound examinations before arthroscopy, was performed. The sensitivity for ultrasound of the lateral meniscus was 58% and for the medial meniscus 83%. Specificity with 98% for the lateral and 90% for the medial meniscus was good. Sonographic detection of meniscal tears depends on the shape and location of meniscal tears. This has been shown by experimental studies in cadavers. A follow-up study including 113 knee joints was performed to prove the value of clinical and ultrasound examination in relation to arthroscopy. The sensitivity of sonography for medial meniscus was 81% and 40% for the lateral meniscus. Although the sensitivity of the clinical examination was 81% (medial) and 47% (lateral), the low specificity of 70% for meniscus tears indicated that it was because of false-positive clinical evaluation of meniscal disorders. In young patients with reflectory muscle spasm and those with acute trauma of the knee joint, clinical examination of the meniscal structures showed poor results. In these cases, too, ultrasound examination showed advantages. Ultrasound of the knee joint meniscus is noninvasive, reproducible and low cost. In cases of uncertain clinical results, ultrasound offers a good opportunity to visualize meniscal disorders.
Adolescent↗
[Osteochondral fracture of the lateral tibial pilon].
In this paper we report a case of osteochondral fracture of the lateral tibial pilon. A young man fell while he was playing soccer. In the following months the ankle was swollen and painful. Later the reason for his ankle pain was clearly visible on the X-ray pictures, which revealed a severe osteochondral fracture of the lateral tibial pilon. We describe the arthroscopic and X-ray grading of osteochondral fractures of the ankle and their treatment.
Adult↗
[Instrumental and technical prerequisites for arthroscopic surgery of the knee joint].
The continuous improvement of intrumentation and equipment is the reason for the steady increase in arthroscopic operations. As the technical equipment is becoming increasingly complicated, attention must be paid to training and standardized procedures in order to ensure that the arthroscopic operative procedure is fast, safe, and without complications. Special operative techniques and instruments have been approved for clinical use, depending on the arthroscopic operation.
Arthroscopes↗
[Tissue toxicity of antiseptics].
AIM: Local antiseptics are used for desinfection of skin and for lavage of wounds. The aim of this study was to determine the tissue toxicity of different antiseptics and to measure the irritation score (IS) and the irritation threshold (IT) for each substance. METHOD: The tissue compatibilities of Dibromol, Kodan, Jodobac, Octenisept, Lavasept 0.2 %, hydrogen peroxide, chlorhexidindigluconate 0.5 % and 2-propanol 60 % were evaluated in the in vivo hens eggs chorion-allantoic membrane test (HET-CAM). RESULTS: We found the most severe tissue toxicity for chlorhexidin digluconate 0.5 % (IS 20) and Kodan (IS 18). Irritating values were found for Dibromol (IS 14), Octenisept (IS 14) and 2-propanol 60 % (IS 13). Moderate vascular injuries were caused by Jodobac (IS 2). In the HET-CAM test Lavasept 0.2 % (IS 0) and hydrogen peroxide (IS 0) showed no tissue toxicity. CONCLUSION: Our results show that some of the tested antiseptics might cause severe vascular injuries as a sign of tissue toxicity. The tissue compatibility of Lavasept 0.2 % and hydrogen peroxide is much better than the compatibility of the other tested substances. With focus on the literature and our results, Lavasept 0.2 % can be recommended as the local antiseptic of choice.
Allantois↗
[Symptoms and signs in cleidocranial dysplasia (CCD)].
AIM: Occurrence of main symptoms and the rate of spontaneous mutations in patients with cleidocranial dysplasia. METHOD: 24 patients with variable phenotypic expression of CCD were examined symptomatically. The main focus was placed on findings in the shoulder girdle, craniofacial symptoms and alterations in radiologic opacity. RESULTS: The average age of the patients was 18.3 years. In our patient cohort, 58.3% were spontaneous mutations. Abnormal apposition of the shoulders were found in 88% of the patients. Craniofacial symptoms were diagnosed in 88%. An increase of the radiologic skull density was apparent in 95%. CONCLUSION: The expression of this rare disorder is variable and its symptomatology not always apparent. Spontaneous mutations occur frequently. Due to the high prevalence of the considered symptoms, the diagnosing physician should focus on the facial appearance and shoulder abnormalities. In cases of ambiguous findings we recommend a consultation of an experienced clinician as well as genetic counseling.
Adolescent↗
[Total knee arthroplasty and high tibial osteotomy in osteoarthritis--results of a survey in traumatic surgery and orthopedic clinics].
AIM: Knee arthroplasties, both total (TKA) and unicondylar, as well as high tibial osteotomy (HTO) represent the main treatment options in severe osteoarthritis of the knee. The aim of this study was to collect detailed information regarding the current treatment strategies in Germany. METHODS: 220 departments of orthopaedic surgery and 250 departments of trauma surgery were asked about their treatment strategies in an anonymous nation-wide survey regarding the different operative procedures in HTO, TKA, revision TKA and related issues. Univariate analyses were performed and means, medians and rates were calculated. RESULTS: Questionnaire forms were answered by 54 % of the departments. The survey represents 31 138 TKA for the year 2002. In the mean 137 TKA were performed in each department. Posterior cruciate ligament retaining components were used in 67 %, resurfacing of the patella was performed in 19 % of cases. The incidence of revision TKA is about 10 % compared to the primary TKA cases. In comparison to a different survey from the year 1995, the absolute number of primary and revision TKA has increased by a factor of nearly three. Compared to the number of TKA, the proportion of HTO has declined to 12 % and the number of unicondylar knee arthroplasties represents 7 % of all cases. CONCLUSION: In the surgical treatment of severe osteoarthritis, TKA shows a highly increasing number, whereas HTO is decreasing. An increasing number of revision TKA can be observed. There is trend towards the cemented implantation technique. Patella resurfacing is not performed routinely in most German hospitals.
Arthroplasty, Replacement, Knee↗
[Current treatment modalities for cartilage defects at the knee--results of a nation-wide survey of surgical trauma and orthopaedic clinics in Germany].
AIM: A local cartilage defect at the knee is mostly followed by arthritis after a period of time. Up to now there are no options to adequately regenerate hyaline cartilage in vivo. Hence, the present strategies try to create a repair tissue with hyaline-like characteristics or to repair defects by transplanting autologous osteochondral cylinders. The objective of this study was to collect data about the current treatment of local cartilage defects of the knee in Germany. METHOD: In a countrywide anonymous survey, 250 German trauma surgery and 220 orthopaedic surgery departments were asked about their diagnostic procedures and their treatment strategies when addressing a local cartilage defect of the knee. RESULTS: 230 (48.9 %) of the questionnaires were returned and evaluated. We found differences between the two specialities: the orthopaedic departments are more progressive in applying autologous chondrocyte transplantation (ACT) (28.3 % versus 13.6 %) and osteochondral transplantation (OCT) (69.1 % versus 56.3 %). Only 5.2 % of the German surgeons perform periostal grafting for local cartilage defects. CONCLUSION: There are still discrepancies about the therapy for local cartilage defects of the knee. Our survey illustrates the present status of cartilage repair strategies in Germany.
Cartilage↗
[MRI evaluation of carpal tunnel morphology after carpal tunnel release by a retinaculum lengthening technique].
AIM: The benefits of maintaining the pulley function of the flexor retinaculum in carpal tunnel release by lengthening or reconstructing it have been described. Quantitative MR imaging was used to investigate the morphological changes after open carpal tunnel release by such a retinaculum lengthening technique. METHOD: Ten patients had bilateral carpal tunnel MRI pre- and postoperatively. The MRI examinations were performed with a 1.5 Tesla imaging system and wrist coils. Carpal tunnel volume, carpal arch width, median nerve position and flexor tendon position in relation to the hamate-trapezial axis were recorded . RESULTS: Like other methods of carpal tunnel release with complete division of the flexor retinaculum, the retinaculum lengthening technique showed a significant postoperative increase of carpal tunnel volume. Carpal arch width increased only slightly. There was a significant palmar displacement of the median nerve but not of the flexor tendons. CONCLUSION: The findings support the hypothesis that maintenance of the pulley function of the retinaculum may lead to an early postoperative recovery of grip strength. In spite of some difficulties in application quantitative MR imaging may be a useful tool in evaluating the carpal tunnel morphology.
Adult↗
[Therapy of femoral head osteonecrosis: results of a national survey].
AIM: The therapy for osteonecrosis (ON) of the femoral head is controversially discussed in the literature. The aim of this study was to ascertain the current treatment concepts of ON in Germany and to compare them with the results reported in the literature. METHODS: 219 Departments of Orthopedic Surgery were asked for their treatment strategies in an anonymous country-wide survey regarding the etiology, diagnosis and therapy (conservative, operative) of ON. Univariate analyses were performed and means, medians and rates were calculated. RESULTS: 43 % of ON were idiopathic, 28 % were due to alcoholism and another 17 % were seen after steroid intake. All departments performed biplanar X-rays for diagnosis of ON and 78 % of departments obtained additional magnet resonance imaging. In the early stages of ON (stage I, II) 33 % of orthopedic clinics recommend a conservative treatment (protected weight bearing, high energy shock wave, pulsed electromagnetic fields) while 67 % prefer surgery (79 % core decompression, 15 % flexion osteotomy, 6 % total hip arthroplasty). In the later stages (stage III, IV) most clinics perform an operative treatment (11 % core decompression, 10 % flexion osteotomy, 79 % total hip arthroplasty). CONCLUSION: Results of ON of the femoral head are unsatisfactory after protected weight bearing. No randomized clinical trials and no mid-term results are available for high energy shock wave or pulsed electromagnetic fields therapy. In the early stages of ON core decompression shows good results. However, in he later stages with secondary arthritis of the hip, total hip arthroplasty remains the gold standard.
Femur Head Necrosis↗
[Acute tissue toxicity of PMMA bone cements].
AIM: Local toxic reactions are one possible reason for fibrous tissue formation at the interface between bone and PMMA bone cement. Most of the numerous in vitro studies have shown severe cytotoxicity of bone cements and their components. However, in vivo investigations of the local tissue toxicity of bone cements have so far seldom been performed. METHODS: The in-vivo hens-egg chorion-allantoic-membrane test (HET-CAM), a well established replacement procedure for experiments with higher vertebrates, is used for the testing of potentially toxic solid and fluid substances. It was performed with PMMA bone cements, their components and their monomer extracts to measure in vivo biocompatibility. RESULTS: We showed that local toxic tissue reactions occurred, especially at the beginning of the processing phase of PMMA bone cements. We also proved that certain components of PMMA bone cements have poor tissue compatibility and sometimes cause severe local tissue changes. CONCLUSIONS: In the development of PMMA bone cements and when drafting the recommendations for their use, attention should be paid to their biocompatibility as well as their mechanical properties.
Animal Testing Alternatives↗