[Treatment and late results in para-articular femoral fractures].
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Biomedical subjects
Publications and source records attributed to K J Villiger.
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Surgical replacement of the anterior cruciate ligament (Lindemann's procedure) is recommended for recent intraligamentary lesions as well as for chronic lesions of the anterior cruciate ligament, since very favourable results had been obtained from 260 cases. That assessment is based on questionnaire interviews with patients and on objectivated conclusions from post-surgical follow-up checks. Additional reconstruction proved to be necessary in many instances. The patient's cooperation and surgical after-care are of crucial importance.
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The diagnostic steps and the indications for the treatment of chronic instability of the knee joint due to rupture (lesion) of the anterior cruciate ligament are discussed. After briefly mentioning the surgical technique we report on 250 dynamic surgical replacements of the anterior cruciate ligament by the proximally based gracile (semitendinous) tendon. For the operations performed between 1976 and 1983 a technique similar to Lindemann's was used. We would like to stress the importance of the reconstruction of injured synergistic stabilizators. The results of a control 1 to 8 years (mean 38 months) after the operation were very good in 21.2%, good in 66.8%, moderate in 9.2%, unsatisfactory in 1.6% and poor in 1.2% of the cases, although strict standards had been applied. We therefore recommend this technique for the treatment of lesions of the anterior cruciate ligament. Thorough after-treatment is of utmost importance for its outcome.
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Fibromatosis plantaris, also called Ledderhose disease, is presented on the basis of the limited literature available. The possible causes are mentioned. Two cases are reported of patients suffering from fibromatosis palmaris (Dupuytren) on both hands and fibromatosis plantaris (Ledderhose) on both feet simultaneously. It is suggested that more attention be paid to examination of the soles of the feet, especially after a period of immobilization and plaster fixation of the shank. On diagnosis of Ledderhose disease, surgery should be performed before the often irreversible deformation of the toes develops.
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We describe a plasty for stabilization of the slipping Patella. The elimination of the Anti-Bandi-Effect and the simultaneous discision of the distal insertion of the Musculus vastus lateralis and the lateral retinaculum apparatus is of importance. The results 5 months till 5 years after intervention are excellent. By none of the 59 knee joints occurred a reluxation even all 46 patients have taken up their work and their sports. Except 1 all patients are subjectively satisfied. We can recommand this technique for treatment of slipping Patella, if not a deformity outside of the patellofemoral joint caused this affection. This operation can also be performed on adolescents with open proximal tibial epiphyseal cartilage.
Of 1039 patients, 1300 knee joints were operated on for chondropathia patellae or patellofemoral osteoarthrosis; the results are arranged in tabular form. The basic operation was proximal medialization of the patella by indent operation. Additional interventions like retropatellar should be indicated by an experienced surgeon. The excellent results found 6, 12, 40, and 60 months after the operation recommmend this procedure for the treatment of chondropathia patellae or osteoarthrosis.
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