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Biomedical subjects

K Klaue

Publications and source records attributed to K Klaue.

At least 37 records · Page 2Linked to original sources
PubMed1994

Clinical, quantitative assessment of first tarsometatarsal mobility in the sagittal plane and its relation to hallux valgus deformity.

Today, bunion surgery is still controversial. Considering that a bunion deformity in fact may be a result of multiple causes, the rationale of the currently applied techniques of surgical treatment has not been conclusively demonstrated. In view of the known hypermobility syndrome of the first ray that results in insufficient weightbearing beneath the first metatarsal head, the relationship between this syndrome and hallux valgus deformity has been investigated. The results suggest a direct relationship between painful hallux valgus deformity and hypermobility in extension of the first tarsometatarsal joint. A pathological mechanism of symptomatic hallux valgus is proposed that relates this pathology with primary weightbearing disturbances in the forefoot where angulation of the first metatarsophalangeal joint is one of the consequences. The alignment of the metatarsal heads within the sagittal plane seems to be a main concern in many hallux valgus deformities. As a consequence, treatment includes reestablishing stable sagittal alignment in addition to the horizontal reposition of the metatarsal over the sesamoid complex. As an example, first tarsometatarsal reorientation arthrodesis regulates the elasticity of the multiarticular first ray within the sagittal plane and may be the treatment of choice in many hallux valgus deformities.

Adult↗
PubMed1993

Extra-articular augmentation for residual hip dysplasia. Radiological assessment after Chiari osteotomies and shelf procedures.

The Chiari osteotomy and various shelf procedures are used to augment the weight-bearing area in dysplastic acetabula. The new articular surface derives by metaplasia from the acetabular rim and joint capsule, and is therefore of poorer quality than congruous hyaline cartilage. We reviewed 32 patients after augmentation procedures, using conventional radiographs and three-dimensional reconstruction from CT scans. We showed that Chiari osteotomy and shelf procedures generally achieve less than complete cover, especially over the posterolateral quadrant of the femoral head. Our results suggest that alternative methods which reorientate the whole of the acetabulum are the treatment of choice. Augmentation procedures remain as a salvage option when reorientation is inappropriate or the original hyaline cartilage surface is absent, as in subluxed joints with a secondary acetabulum. Computerised assessment is recommended before operation to assess existing cover and the possible extent of provision of new cover.

Adolescent↗
PubMed1991

Internal fixation with a self-compressing plate and lag screw: improvements of the plate hole and screw design. 1. Mechanical investigation.

For a number of years, self-compressing plates, with oval holes and using special drill guides, have been in use. Recently, the advantages offered by lag screw interfragmentary compression inserted through the plate have gained prominence. Often such screws are inserted in an inclined position toward the fracture plane for better efficiency. It has also become evident that inclined screws placed into oval holes undergo a displacement toward the fracture. Efforts to improve the effect of this technique have led to a new plate and screw interaction that is described herein. The result is versatility and efficiency of the fracture fixation.

Biomechanical Phenomena↗
PubMed1991

Internal fixation with a self-compressing plate and lag screw: improvements of the plate hole and screw design. 2. In vivo investigations.

A mechanically improved design of bone plate and screw was compared in vivo with conventional plate fixation. This method was investigated biologically in a standardized osteotomy model on sheep tibiae. It was found that maintenance of reduction of an osteotomy was facilitated and there was no adverse effect of this fracture fixation system on bone remodeling. The modified implant permits the reduced surgical approach to the bone through one plane and optimal fixation of the fracture or osteotomy.

Animals↗
PubMed1991

The acetabular rim syndrome. A clinical presentation of dysplasia of the hip.

The acetabular rim syndrome is a pathological entity which we illustrate by reference to 29 cases. The syndrome is a precursor of osteoarthritis of the hip secondary to acetabular dysplasia. The symptoms are pain and impaired function. All our cases were treated by operation which consisted in most instances of re-orientation of the acetabulum by peri-acetabular osteotomy and arthrotomy of the hip. In all cases, the limbus was found to be detached from the bony rim of the acetabulum. In several instances there was a separated bone fragment, or 'os acetabuli' as well. In acetabular dysplasia, the acetabular rim is subject to abnormal stress which may cause the limbus to rupture, and a fragment of bone to separate from the adjacent bone margin. Dysplastic acetabuli may be classified into two radiological types. In type I there is an incongruent shallow acetabulum. In type II the acetabulum is congruent but the coverage of the femoral head is deficient.

Acetabulum↗
PubMed1991

[Post-traumatic hindfoot reconstruction--principles and selected examples].

Besides rheumatoid diseases, fractures are the most frequent cause of painful static problems about the hindfoot. Even when the ankle, the subtalar or the midtarsal joints are not involved directly in the fracture, they likely degenerate secondarily because of the malalignment. The aim is to restore normal morphology of the foot with reorienting arthrodeses using stable internal fixation by screws and cortico-cancellous autologous bone grafts which allow early partial weight bearing. There are three surgical approaches which can be used alone or in combination: antero-medial along the medial column, lateral (Ollier), and postero-lateral along the heel cord.

Adult↗
PubMed1991

[Soft tissue preservation and reconstruction in non-supporting foot parts].

The foot has two skin surfaces which differ on a morphological and functional basis. The plantar skin is a highly specialized organ which has a dash-pot-like effect in weight bearing. The skin which does not participate in weight bearing covers tendons and a very rich syndesmotic complex. The internal soft tissue is segmented in tiny compartments and therefore ist not extensible. The skin and the rather thin subcutaneous layer are not extensible either because of the proximity and the rigidity of the underlying structures. In consequence, trauma to the soft tissue of the foot may cause compartment syndromes and skin defects, or secondary unstable scars which impede function. Compartment syndromes must be recognized early and treated by immediate release. Fresh skin defects need early coverage when tendons and joints are exposed. There is a variety of local flaps which are evenly good for replacement of retracting scars.

Foot Injuries↗
PubMed1991

[Current surgical therapy of congenital clubfoot].

The operative treatment of congenital club foot deformity in childhood consists of a release of soft tissues which are retracted in fibrous "knots" at the hindfoot and midtarsus. This release is more or less extensive, depending on the importance of the contracture and allows reduction of the triple deformity i.e. varus and equinus of the hindfoot and adduction at the midtarsus. Surgery is performed preferably before walking commences in order to take advantage of the functional self-treatment by bearing weight after removal of the cast. During the last several years, the different operative procedures employed for release have gained in precision and efficiency by addressing the deformity at their precise location. The difficult aim of the surgical procedure is to avoid insufficient release causing pseudo-recurrencies or overcorrection.

Clubfoot↗
PubMed1991

[Rupture of the degenerated posterior tibial tendon--symptoms and therapy].

The tibialis posterior muscle is a powerful flexor and supinator of the hind foot. Considering the plantar extension of its distal tendon, it represents a true antagonist of the short peroneal muscle. It works as a dash-pot for foot pronation under load. Actually, dorsal extension of the foot happens in the tibiotarsal joint but this movement can be increased partially by the subtalar and midtarsal joint, together with pronation. The latter is damped by the posterior tibialis muscle. Its tendon may rupture suddenly, through e.g. a sports accident; it can also rupture insidiously, through a long degenerative process. The rupture causes a chronic overload of the ligaments about the mid foot and a progressive deviation of the talus in flexion and adduction ensures. This may induce osteoarthrosis, especially of the subtalar joint. Treatment depends upon the stage of the lesion. Reconstruction may be performed by augmentation with the flexor digitorum longus tendon. Palliative treatment by triple arthrodesis may be performed in more advanced cases.

Ankle Injuries↗
PubMed1991

[Hallux valgus and hypermobility of the first ray--causal treatment using tarso-metatarsal reorientation arthrodesis].

Today, bunion surgery is still very controversial. Considering that a bunion deformity is actually a result of multiple possible causes, the rationale of the currently applied techniques has not been conclusively demonstrated. Multiple techniques are still applied with uncertain outcome, as shown by the not insignificant recurrence rate. The tarsometatarsal reorientation arthrodesis addresses the deficient anteromedial buttress which is due to the most often concomittent hypermobile first ray. This is an important aspect of treating hallux valgus deformity and includes the sagittal alignment besides the horizontal reposition of the metatarsal over the sesamoid complex. Since in hallux valgus, the first metatarsal looses its position also by the insufficiency of the intrinsic musculature and the ligamento-capsular structures, the arthrodesis regulates the elasticity of the multiarticular first ray within the sagittal plane. Recurrences are less likely after this operation, even when performed on the adolescent hallux which is known as very difficult to be treated successfully.

Arthrodesis↗
PubMed1990

The limited contact dynamic compression plate (LC-DCP).

To realize the new concept of biological internal fixation the limited contact dynamic compression plate was developed. It minimizes vascular damage to the plated bone segment. It should lead to a more versatile and efficient application of internal fixation using plates.

Bone Plates↗
PubMed1990

[Peri-acetabular reorientation osteotomy].

A new technique to plan and perform a reorientation pelvic osteotomy around the hip joint in adolescents and adults is described. Planning is based on 3-dimensional reconstruction of the hip joint. The operation is simulated by computer before surgery to find the correction angles which optimize alignment both quantitatively (amount of femoral head covered) as well as qualitatively (joint congruency). These angles are then utilized at the time of surgery. A Smith-Petersen approach is always used to perform the osteotomy. The pelvic ring is not displaced, but nevertheless the acetabular fragment can be tilted without limitation around all 3 axes. Furthermore, linear displacement permits medialization of a lateralized hip joint. Stability is obtained by simple screw fixation. The posterior column remains mechanically intact, and thus no cast is required. Since 1984, about 200 peri-acetabular osteotomies have been performed. The success of correction was evaluated on plain radiographs using A P and "false profile" views as well as by CT. Conventional radiographs showed fully normalized VCE (Wiberg) and VCA (de Sèze and Lequesne) angles and well-centered joints on the CT-based reconstructions. Four types of complications occurred: there were 2 cases with intra articular extension of the osteotomy; 1 transient femoral neuropraxia; 2 non-unions and 4 cases with ectopic ossifications which limited motion of the joint. The latter problem appear to have been eliminated by the administration of prophylactic indomethacin. Symptomatic fixation screws had to be removed after union in 13 cases.

Acetabulum↗
PubMed1988

[Critical study of the repair of the anterior cruciate ligament of the knee using a pediculated flap to the Hoffa pad taken from the middle 3d of the patellar tendon. 50 surgical knees with a 2-to-4-year follow-up].

A reconstruction of the anterior cruciate ligament of the knee has been devised on the anatomical principle of an intra-articular flap taken from the middle third of the patellar tendon and based on the sub-patellar fat pad. Fifty knees have been treated and assessed after a follow-up of two to four years to provide a critical analysis of the method. The technique of the operation is described in detail in relation to the isometric reconstruction of the course of the anterior cruciate ligament. With a mean follow-up of 33 months (minimum 24 and maximum 48 months), 98 per cent of the patients had a good result as regards stability together with a good anatomical result, with complete or almost complete elimination of the anterior drawer sign and the jerk test in 96 per cent. The subjective result described by the patient was good in 92 per cent but only 54 per cent returned to the same sporting activity. The main problem encountered with this method was loss of 10 degrees of extension in 40 per cent of patients and loss of more than 10 degrees in 22 per cent. This loss of extension arose on the one hand from an impingement of the fatty pedicle in a narrow intercondylar notch and on the other from an associated postero-lateral laxity which resulted in an intra-articular transplant which was too short despite its anatomical attachments. The pedicled transplant has not given better results than free transplants and has given rise to additional iatrogenic problems even with a meticulous operative technique.(ABSTRACT TRUNCATED AT 250 WORDS)

Adipose Tissue↗
PubMed1988

CT evaluation of coverage and congruency of the hip prior to osteotomy.

A computer-assisted model has been developed to improve the results of surgical techniques for reconstruction of hip dysplasia. This method assesses the coverage and congruency of the femoral head by evaluating multiple factors that may influence surgical planning. It achieves a more reliable image because the measurements are based on a three-dimensional representation, and attention is focused on the cartilaginous coverage of the femoral head. A method to simulate the operative correction helps the surgeon in planning osteotomies of the femur and pelvis. This technique clearly establishes both deficiencies of coverage and congruency of pathologic hips and thus may be used to create a more precise definition and treatment of multiple congenital abnormalities.

Hip↗
PubMed1988

A new periacetabular osteotomy for the treatment of hip dysplasias. Technique and preliminary results.

A new periacetabular osteotomy of the pelvis has been used for the treatment of residual hip dysplasias in adolescents and adults. The identification of the joint capsule is performed through a Smith-Petersen approach, which also permits all osteotomies to be performed about the acetabulum. This osteotomy does not change the diameter of the true pelvis, but allows an extensive acetabular reorientation including medial and lateral displacement. Preparations and injections of the vessels of the hip joint on cadavers have shown that the osteotomized fragment perfusion after correction is sufficient. Because the posterior pillar stays mechanically intact the acetabular fragment can be stabilized sufficiently using two screws. This stability allows patients to partially bear weight after osteotomy without immobilization. Since 1984, 75 periacetabular osteotomies of the hip have been performed. The corrections are 31 degrees for the vertical center-edge (VCE) angle of Wiberg and 26 degrees for the corresponding angle of Lequesne and de Seze in the sagittal plane. Complications have included two intraarticular osteotomies, a femoral nerve palsy that resolved, one nonunion, and ectopic bone formation in four patients prior to the prophylactic use of indomethacin. Thirteen patients required screw removal. There was no evidence of vascular impairment of the osteotomized fragment.

Acetabulum↗
PubMedDate not supplied

[Medial flexor digitorum longus tendon augmentation and lateral foot column lengthening or reorienting triple arthrodesis as surgical therapy of posterior tibial tendon dysfunction].

QUESTION: The purpose of this study was to evaluate the alignment and functional outcome after surgical augmentation of the tibialis posterior by tendon transfer and lateral column lengthening by osteotomy of the os calcis, calcaneo-cuboidal arthrodesis or reorientating triple arthrodesis. METHODS: From 1991 to 1999 41 patients with the clinical and radiological diagnosis of dysfunction of the tibialis posterior tendon underwent surgical exploration and repair. These 41 patients (22 women, 19 men) had an average age of 44.3 years (range, 19-69 years) and had been symptomatic for an average of 2.3 years (range, 6 months to 6 years). All patients had the symptoms of a painful flatfoot deformity without dynamic support along the medioplantar aspect. Flexor digitorum longus (FDL) tendon transfer as reconstruction of the tibialis posterior tendon was performed in the cases without major deformity (n = 77). Patients underwent FDL transfer and lengthening osteotomy (n = 15) of the os calcis or calcaneocuboidal (c-c) arthrodesis (n = 12) if passive correction of the foot deformity was still possible and reorientating triple arthrodesis (n = 7) when a fixed flatfoot deformity had developed. AOFAS score and radiological examination were used preoperatively and in the follow-up. RESULTS: The AOFAS score improved for stage 1 patients after a mean follow-up of 43 months with FDL transfer from a preoperative mean of 54 to 84 points, for stage II patients with FDL transfer and lengthening osteotomy (mean follow-up 36 m) from 47 to 92 points, with c-c arthrodesis (follow-up 66 m) from 48 to 86 points, and for stage III patients with triple arthrodesis from 42 to 72 points. In two patients, the deformity failed to improve (stage I) necessitating a revision surgery with a calceneo-cuboidal lengthening arthrodesis for relapsing deformity. CONCLUSION: In order to correct deformity and provide substantial relief of foot pain and dysfunction, we recommend the transfer of the FDL tendon in flexible flat foot deformity together with lengthening osteotomy. This treatment will provide optimal restoration of a dynamic support along the medioplantar aspect of the foot and is functionally superior to a c-c arthrodesis. Reorientating triple arthrodesis showed fair functional results and is recommended--for fixed flatfoot deformity.

Adult↗