Biomedical subjects
Publications and source records attributed to J Koebke.
Rotation of the radius about the fixed ulna is analysed radiographically in an anatomic specimen. While rotating the styloid process of the radius migrates in relation to the ulna. Compared to the prone position supination leads to a more distal position of the styloid process.
A pronounced valgization or varization of the lower extremity leads to changes in skeletal muscle which are histologically and morphometrically demonstrable in biopsies of Mm. vastus lateralis et medialis of patients with chronically anomalous stressing of the knee joint. During chronic over-stressing, increased thickness in type I and type II muscle fibers can be observed in both Mm. vastus medialis and lateralis, whereas type II fibers demonstrate a greater variability and there is a greater occurrence in type I fibers. Our investigations show that a chronic anomalous stressing influences both the size and energy metabolism of a skeletal muscle cell in a manner which can be interpreted as a functional adaptation.
Changes in the position and structure of the patella and their importance with regard to pain patterns are described on the basis of long-term observation of the Blauth prosthesis. Examinations were performed on 206 knee prostheses on average 37.6 months (min. 12, max. 120 months) after implantation. Axial roentgenograms showed the patella to be laterally subluxated in 12% of the cases, and luxated in one. Also in 12% of the cases, osteolytic destruction of the posterior surface of the patella was found; there was a statistically significant correlation between the two groups, but they were not identical. In cases with changes in the patellar structure, initial pain on walking was significantly more frequent, though this was not so in cases where the kneecap had shifted from its normal position. The authors discuss possible connections with curvature radii and with the distances between the center of rotation and the sliding support on the femoral part of the prosthesis as causes of increased complaints in low kneecaps and for the increased incidence of structural changes in high kneecaps. The term "retropatellar pain syndrome" is applied to patients who experience pain when climbing stairs, rising from chairs and when starting to walk, in whom at least 2 of these complaints are positive: A total of 10.2% of the patients complained of considerable retropatellar pain. A patellectomy was performed in 8 of these patients. The radiological and histological analyses of 3 of the patellae removed showed evidence of arthrosis deformans at different stages, with concomitant synovitis.
Two from 59 anatomical samples of the upper cervical spine show an osseous fusion of the axis and the third cervical vertebra. Moreover, a non-osseous but very rigid union between the second and the third cervical vertebrae is observed in five cases. Generally the fusions seem to be caused by degenerative processes. For these, a more horizontal or vertical orientation of the articular facets of the vertebral joints is important. The failure of development of the dorsal part of the axis' transverse process promotes degenerative alterations.
INTRODUCTION: Particularly problematic in total hip revision arthroplasty is the cement removal out of the depth of the femoral canal; it is also costly in time and effort. The extracorporal shock wave lithotripsy proved to be an unsuitable method. With the present paper we proved experimentally a newly developed endoscopically controlled modified intracorporal lithotripter (Swiss Orthoclast) for the removal of bone cement. METHODS: We tested the efficiency on standardized cement specimens of different manufacturers in vitro. We compared both conventional removing techniques with mallet and chisel and a pneumatically powered chisel with formalin fixed human femora. During these experiments we measured the intrafemoral pressure distally to the cement layer. RESULTS: We achieved a high energy (max. 450 mJ) and a very effective fragmentation of the cement (40 mg fragments calculated on the single impulse of 350 mJ). The endoscopic control ensures a safe control of the cement removal even in the depth of the femoral canal. No bone damage occurred macroscopically and radiologically. No heat or toxic products developed. Using the Swiss Orthoclast the intrafemoral pressure was the lowest possible (7 mbar). Even with hammer and chisel or the pneumatically powered chisel the pressure was too low (max. 55 mbar with mallet and chisel) to cause a fat embolic syndrome. CONCLUSION: As a result of these experiments we started with clinical trials (with permission of the Ethic commission) to evaluate the practicability of the modified intracorporal lithotripter (Swiss Orthoclast) for cement removal.
Three patellae from patients with implanted Blauth knee joint prosthesis were investigated after patellectomy. Radiological findings on sawn sections and macroscopical and histological analysis of the retropatellar surface give evidence of osteoarthritic alterations and inflammation.
A causal correlation is proved between an outgrowing osseous spur at the Os metacarpale II and the rhizarthrosis. The midhand bone of the thumb is connected by a ligament with the base of the Os metacarpale II. High tensile stresses elongate the ligament and lead to its partial ossification. The ligament looses its essential function and the thumb subluxates radially.
Anatomical examinations of the inguinal canal exist in many forms. The preperitoneal tissue, the structure directly adjacent to the transverse fascia, was examined in 62 cadavers. The left side of the inguinal abdominal wall was studied with special interest in the transverse fascia and the adjacent preperitoneal tissue. In 75% of the cases the transverse fascia and preperitoneal tissue built a continuous layer. A differentiation was difficult in cadavers with cachexia or an average nutritive state. The tissues could be differentiated without difficulty in individuals with adipositas. In these cases no connection between the two layers was detected. In the medial part of the inguinal abdominal wall the tissue thickness was larger than in the lateral part. However in 32% of the cases the tissue thickness was reverse. As a consequence, the isolated suture of the transverse fascia in inguinal hernia repair is anatomically virtually impossible, if both tissues build one continuous layer.