The extremely rare Werner syndrome (tibial hemimelia, foot polydactyly, triphalangeal thumbs) is represented by an own case: a 21 year old female has been treated since her birth in the orthopedic department of Homburg/Saar university clinic. First, during several operative sessions, there was the correction of the bilateral completely webbed fingers and the resection of the supernumerary toes. Because of tibial hypoplasia there was need of bilateral operative club-foot-correction, too. Presentation of the course over 20 years with clinical and roentgenological late results. In several publications we find different classifications of the collective name, tibial hemimelia'; the symptom-triade congenital tibia-defect/foot-polydactyly/triphalangeal thumb was of special interest.

Adolescent↗

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[Simple and valid ICD9-/10- and IKPM coding using an electronic data-assisted coding system "do it"--experiences after one years use].

UNLABELLED: Question by introducing "Fallpauschalen" and "Sonderentgelte" in German health system the coding of diagnoses and therapies gains a new momentum. Therefore, a new computer based coding-system for ICD- and ICPM- digits is presented. The physician gets enabled for simple and valid classification within his documentation routine. METHODS: Development of a hierarchic menue system, whose first part represents the anatomic region. The second part is reserved for the most common diagnosis rsp. therapies within its special anatomic region. By further sub-menues all other ICD numbers in the orthopedic and traumatologic field may be coded (selection related by frequency). This coding-system has been in clinical use since jan. 1st. 1995. RESULTS: Control of the efficiency of this coding-systems by 1316 patients with 1551 operations within one year. By using ICD-10, the representation of orthopedic-traumatologic diagnosis inhanced by factor 1.8 versus ICD-9. According to ICPM, 3560 therapies were coded, making it 2-3 actions per operation. "Fallpauschalen" were found in 21.9%, in 27.7% there were "Sonderentgelte". Within one year the coding error rate was reduced from 25% to 5%. CONCLUSIONS: Because of its easy handling the coding system "do it" represents a good alternative to conventional coding rsp. clear text analysis.

Data Collection↗

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[Endoprosthetic joint replacement in Morquio-Brailsford syndrome].

Morquio-Brailsford's disease belongs to the mucopolysaccharidoses, it shows growth-retarding with dysproportional dwarfism. Due to bone deformations and joint dysplasias very early severe arthritic changes arise with serious functional disabilities, especially in the loaded lower extremities; this may lead to early alloplastic joint replacement surgery. By means of two patients with respective bilateral THR and singular total knee replacement intraoperative complications and postoperative follow up (up to 12 years) are represented casuistically. Unfavourable anatomic properties (dysplasia, size of joints) were the main technical surgery problem; the use of individually manufactured implants might be recommended in some of these cases. The achieved subjective and objective functional results of our cases were-compared to the preoperative situation-altogether quite satisfactory.

Female↗

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[Medium-term results of cement-free autophor hip endoprosthesis].

Representation of middle-term observations of cementless ceramic THR (type Autophor) in a period of now nearly 18 years with altogether 1974 primary arthroplasties. The design of the conical shaped screwed ceramic socket proved to be very successful, its aseptic loosening rate amounted to 1.8% at last. We could confirm the favourable biocompatibility and wear behaviour of ceramic/ceramic joint pairing. The stem design had to be improved twice during the observation period due to upcoming aseptic loosening problems; the femoral component 900 S with macro- and microprofile, which has been in clinical use since 1984, shows an aseptic failure quote of less than 2% after 8 years. The very low average age of our patients with cementless THR at time of operation (48.9 years) proves, that--when using wear resistant biomaterials and surface enlarged prosthetic components to be implanted without bone cement--Charnley's strict age indication of THR may be abandoned.

Adolescent↗

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[Replacement of the hip joint in young patients under 40 years of age. Clinico-statistical report of experiences].

At Orthopedic Department of Homburg/Saar University Clinic there were - between 1974 and 1985 - altogether 270 cementless total hip replacements by AUTOPHOR-arthroplasty in 243 patients, who were 40 years of age and younger at time of operation. The male patients mostly suffered from posttraumatic joint destructions or idiopathic femoral head necrosis, the female patients from dysplasia coxarthritis. In 43.3% there were previous hip operations in the past. 6 septic failures (5 times removal of prosthesis); 33 (12.2%) aseptic failures, mostly of the femoral component with following exchange operation. Clinical and roentgenological control of 170 cases (septic and aseptic failures excluded). Subjectively good and very good results in 82.3%. Evaluation of clinical datas acc. to the scheme of Merle d'Aubigné. Improvement of preoperative situation (5.4 points average) to 14.7 points average postoperatively. In most of the patients, a professional and social integration could be achieved; only 28 patients received a pension. With regards to the functional inferior alternatives of resection hip rsp. hip arthrodesis, THR by cementless prostheses in young patients with severe joint destructions seems to be justifiable and recommendable - according to our medium-term results.

Adolescent↗

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[Implant fractures in ceramic hip endoprostheses].

Between 1974 and 1987, a total of 2356 ceramic hip endoprostheses, both primary and secondary, were implanted at the Orthopedic University Clinic in Homburg/Saar. Strem fractures occurred in three of these patients only, which corresponds to a relative frequency of 0.13%. In two instances, these were fatigue fractures of the AUTOPHOR I (WISIL) prosthesis stem, while in the third instance the fracture, of stem type 2 (ENDOCAST), was the result of a fault during casting. Fractures of ceramic components as a result of a direct trauma of sufficient force were observed in six cases (relative frequency of 0.25%). Persistent fractures only occurred where there was recurrent knocking of a long ceramic collar against the rim of the acetabulum (eight cases, relative frequency of 0.34%), mainly as a result of primary or secondary false positioning of the acetabulum (surgical error, aseptic loosening). Ceramic fractures when using the ceramics/polyethylene combination for joints have yet to be recorded. Given the authors' 12 years of experience, and considering the large number of patients treated fractures of high quality BIOLOX ceramics are a rarity. Both persistent fractures and exaggerated ceramic abrasion were almost always the result of false positioning of the acetabulum, with the recurrent knocking of the hip head ceramic collar playing a significant role. It is evident that the extent of tolerance of ceramics as regards undue strain with a subsequent danger of fracture is lower than that of the metal-polyethylene combination.

Ceramics↗

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[Indications and complications of surgical treatment of orthopedic diseases in patients over 80].

Due to increasing life expectation the number of elder patients, who need medical care, increases, too. Orthopedic surgery of elder patients especially deals with degenerative changes of locomotor and supporting apparatus, as well as with traumatic lesions. Because of the polymorbidity the rate of complications and risks of operative treatment raises. Representation of a casuistry of 173 operative intervention in patients undergoing operative treatment between 1965 and 1984 (20 years), who where 80 years and older. Most of the cases were operations of choice without any vital indication. Concerning emergency operations traumatological cases were well to the fore. All operative interventions are classified in localisation and intra- and postoperative complications. There was rather a high mortality in these patients compared to the average mortality in our clinic. The indication for operative treatment in high aged patients needs a careful and critical examination of risks and the attainable results. Aesthetic aspects are lesser important. The interdisciplinary collaboration of internal specialists, surgeons, haemostasiologists a.o. is very important to prepare the patients for surgical treatment and to reduce the postoperative complication rate.

Aged↗

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[Technic and results of rib hump resection in thoracic scoliosis].

Description of operative procedure acc. to Naravcevic for treatment of rib hump in thoracal scoliosis (partial resection of ribs, segmental shifting) and of possible complications (injury of pleura). The indication for operation is only given by cosmetic and psychologic reasons. Report about 48 patients of Orthopedic University Hospital of Homburg/Saar who underwent operative treatment between 1975 and 1983. The average age at time of operation was 19.3 years. The most popular fixation of the resected ribs was by end-to-end connection and Mersilene-suture. There were no severe complications. The subjective results were altogether very satisfactory. The clinical control showed and average correction of the height of the rib hump of about 50%.

Adolescent↗

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[Joint saving operation procedures in idiopathic femur head necrosis].

At first, this report deals with the characteristics of the idiopathic necrosis of the femoral head and the possibilities of operative treatment specially in the sense of saving the hip-joint. Beside old techniques of sanitation of the focus, nowadays the femoral osteotomy, mainly in the sense of a flexion-osteotomy is well to the fore. Hereby, the necrotic area can be turned out of the main loaded part of the hip-joint. We recommend a combination of femoral osteotomy with a ventral capsulotomy and tenotomy. Furthermore, there should be a sanitation of the focus, above all by drilling. Then we report about our experience with this operative treatment. 37 cases out of 52 were controlled clinically and roentgenologically. The subjective results were very good to fair in about 85%, the functional improvement of the hip-joint was mostly good. On the other hand, there was a difference between clinical and roentgenological results, we found an improvement of the necrotic destruction of the femoral head only in 28%. We mainly noticed poor subjective and objective results in cases of too extended necrotic areas, of too advanced stage of necrosis and of secondary coxarthrosis. In those cases we refer to the differential indication of the total hip-arthroplasty.

Adolescent↗

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[Results of infection prevention in hip joint alloarthroplasty with cefamandole].

With regard to the unsatisfactory number of infections after total hip replacement operated in conventional operating rooms the problems of antibiotic prophylaxis has been discussed for years but has remained contested until today. We tested the efficiency of a peri- and postoperative prophylaxis of Cefamandole (Mandokef) on a non selected collective of 384 patients undergoing total hip replacement during a period of exactly two years. The results of these patients were compared to those of a preceded comparable collective of 319 patients who did not have a perioperative antibiotic prophylaxis. Cefamandole was given 4.6 postoperative days on the average. Compared to the collective of 319 patients there was a significant reduction of secondary healing in the "cefamandole-collective" from 3.1% to 0.8%. The number of deep infections were reduced from 3.8% to 0.8%. Allergic side effects of the antibiotic could be reduced from 12.5% ("secondary" prophylaxis sometimes applied to patients of the first collective) to 1.3% ("cefamandole-group"), the mycosis rate was reduced from 3.8% to 1.8%. There were no grave complications of the cefamandole-prophylaxis, not even effects on the microclimate of the hospital. Two of the three infected hip arthroplasties (prophylaxis-group) could be saved by a second operation when putting a through-drainage and giving a special antibiotic treatment. The prosthesis had to be removed only in one single case (0.3%). Beside the importance of a prophylactic antibiotic treatment we point out the efficiency of a clean air system, furthermore, these two procedures are economically justifiable.

Cefamandole↗

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[Surgical treatment of arthritis of the thumb saddle joint].

First the etiology, clinical signs and differential diagnosis of the basal joint of the thumb are represented. Then a short summary is given about the possibilities of conservative and operative therapy. In operative treatment, there are techniques of maintaining the flexibility of this joint as well as the arthrodesis. In our clinic we prefer operative techniques by removal of the multangulum majus or implantation of an artificial joint (Francobal-endoprosthesis). The results of our 22 patients, who had an operation of an arthritis of the basal joint of the thumb were controlled clinically and radiologically. We specially controlled the function and stability of the thumb and if the patient was able to manage his occupation. In arthritis of the basal joint of the thumb, the excision of the multangulum majus had good results and may be recommended. The arthroplasty of this joint had good early results, too. Here late results remain to be seen.

Aged↗

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[Surgical treatment of chronic recurrent patella dislocations. Surgical procedure and results].

This is a report about a simplified operative technique of discission of the lateral retinaculum and vastus and medial drawing tight of the capsule. After the end of growth there will be always a medial transfer of the tuberositas tibiae at the same time by an undermining technique of osteotomy and osteosynthesis with a traction screw. Evaluation of our own 135 cases (1964-1981) with 27 only soft-tissue-operations and 108 combined operations by longterm-observations or recent control (115 cases with average observation period of 5,9 years). The number of reluxations of the patients, who had only a soft-tissue-operation, was as high as other reports; the primary number of reluxations after the combined operation was much lower (6,7%). By further conservative treatment or sometimes second operation none of our patients had any longer reluxations of the patella.

Adolescent↗

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Brief therapy in addictions: one answer to the mental health benefit gatekeeper.

Explore the source record for details and available documents.

Humans↗

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[Fetal congestive heart failure due to nodal tachycardia: in utero digoxin therapy ].

The authors report one case of fetal congestive heart failure secondary to nodal tachycardia, revealed in the 26th week of gestation. Transplacental digoxin treatment stopped the tachycardia in a few days and allowed the pregnancy to continue to term, with delivery of a normal child. This report shows the value of fetal echocardiography in cases with arrhythmias, the possibility of in utero digoxin treatment of supraventricular tachycardia and the follow-up procedures.

Adult↗