Biomedical subjects

P Ritschl

Publications and source records attributed to P Ritschl.

69 records · Page 4Linked to original sources

PubMedDate not supplied

[Hallux valgus: a therapy concept and its outcome from 1993 to 1996].

INTRODUCTION: Aim of this study is to present the treatment concept and the results of hallux valgus surgery of our department. PATIENTS AND METHODS: The criteria for decision making are 1st intermetatarsal angle, congruency of the first metatarsophalangeal joint and sesamoid position. According to our concept we performed between 1993 and 1996 42 Chevron osteotomies for mild, 138 Chevron with lateral soft tissue release (Chevron + LSR) for moderate and 93 basal crescentic (Mann) osteotomies with lateral soft tissue release for severe hallux valgus deformities. RESULTS: 31 Chevron, 118 Chevron with lateral soft tissue release and 80 basal crescentic osteotomies (Mann) were seen at an average follow up of 19 months (12-29) after a Chevron, respectively. 16 months (12-43) after Chevron with lateral soft tissue release and 18 months (12-32) after a basal crescentic osteotomy. 83% of all patients classified the results of the surgery as "very satisfactory" and "satisfactory". The average hallux valgus angle was corrected from preoperatively. 25.3 degrees (Chevron), 29.9 degrees (Chevron + LSR) and 41.8 degrees (Mann) to 16.5 degrees (Chevron), 12.1 degrees (Chevron + LSR) and 14.1 degrees (Mann) at final follow up, the average first intermetatarsal angle was corrected from preoperatively 12.1 degrees (Chevron), 14.0 degrees (Chevron + LSR) and 17.4 degrees (Mann) to 7.9 degrees (Chevron), 5.8 degrees (Chevron + LSR) and 7.8 degrees (Mann) at final follow up. CONCLUSION: Our analysis of the three osteotomies revealed that with this differentiated concept we were able to achieve excellent and good results in more than 80% of our patients. Only with a treatment plan that includes different procedures to address the various stages of hallux valgus can one achieve the optimum result for the patient.

Adult↗

PubMedDate not supplied

[Correction of high-grade sesamoid bone dislocation in hallux valgus using Austin's osteotomy with and without lateral soft tissue release].

INTRODUCTION: Aim of this study was to analyze if, using the Austin technique for correction of hallux valgus deformity, the additional soft tissue procedure is capable to achieve better correction of the sesamoid subluxation, the hallux valgus angle and the intermetatarsal angle. PATIENTS AND METHODS: 19 patients with 20 feet operated according to the original Austin technique and 26 patients with 28 feet operated according to a modified technique with lateral soft tissue release both with a preoperative sesamoid subluxation grade 3 were compared with the help of a standardized questionnaire in respect to clinical and radiological results. RESULTS: Analyzing the clinical outcome of the two procedures, there was no statistical difference. Comparison of the radiological results revealed a significantly better correction of the sesamoid position and a better correction of hallux valgus and intermetatarsal angle by using the additional soft tissue procedure. DISCUSSION: The lateral soft tissue procedure with release of the adductor hallucis, dissection of the deep transverse plantar ligament and mobilisation of the sesamoids is capable of a significantly better correction of the sesamoid position. Only a combination of osseus and soft tissue correction is capable to correct the pathomechanism and to guarantee long lasting results.

Adult↗

PubMedDate not supplied

[KMFTR (Kotz Modular Femur Tibia Reconstruction System) modular tumor endoprosthesis system for the lower extremity].

206 patients with tumorendoprosteses of the KMFTR-type at the lower extremity were operated at the Institute Rizolli Bologna and at the University Clinic of Vienna. The minimum follow up was 2 years (mean 3.2, max. 8 years). In order to bridge the defect caused by tumor resection the proximal femur was replaced in 42 cases, the distal femur in 119 cases and in 6 patients a total femur prosthesis was used. The proximal tibia was replaced in 35 cases and in 4 cases a total knee prosthesis was implanted. Clinical evaluation according to Enneking revealed 71.6% excellent and good results. In 83.4% the radiological score was higher then 20. We saw deep infections in 8.2% (17 patients), breakage of the prosthesis in 6.8% and aseptic loosening in 5.8%. 3 patients had to be amputated due to infection. In the remaining cases of infection in 66% of the patients healing was observed. All cases of aseptic loosening or breakage could be revised successfully by an exchange of the prostheses and therefore salvage of the leg was achieved.

Adolescent↗

PubMedDate not supplied

[The limits of saving the extremity--amputation versus resection].

On the basis of the extensive data contained in the Vienna Bone Tumor Register, i.e. 839 primary malignant bone tumors, as well as of 554 cases treated at the Orthopedic Department of the University of Vienna Medical School, a comparison between the methods of surgery applied at pelvis and extremities during the past two decades can be drawn. Resectional therapy had been performed in twice as much patients as amputation therapy, and barely 20%, mostly with multiple metastases, had been merely treated with palliative surgery or were just biopsied and underwent chemo- and radiotherapy. An analysis of amputations and resections, subdivided into pelvis and sacrum resections, resectional reconstructions and resectional reimplantations at the extremities, shows approximately the same low incidence of local recurrences in the groups amputation versus resection, but a significantly higher involvement of pelvis and sacrum resections as well as no local recurrences in the group of 48 resectional reimplantations. As regards the oncologic radicality of surgical margins, in cases of resections, as compared to amputations, about twice as much inadequate operations had to be accepted, though. The fact that the local recurrences did not increase to the same degree, but were approximately equilibrated, seems to be due to the new chemotherapeutic treatment which had been initiated at the same time as the frequent application of resectional therapy. The conservation of extremities contains twice as high a risk of inadequate operation, but it is, in cases of effective chemotherapy, comparable with the former results of amputations, as regards local recurrences.(ABSTRACT TRUNCATED AT 250 WORDS)

Amputation, Surgical↗

PubMedDate not supplied

[Long-term results of the treatment of Perthes' disease in the fulminant stage and after development of a coxa magna according to Chiari's pelvic osteotomy].

We report about long term follow ups of treatment of Morbus Perthes with Chiari's Pelvic Osteotomy. Average follow up time was 8 years. One of our two main indications for operating was a distinct coxa magna with lack of sufficient roofing or with secondary osteoarthritis caused by this very lack. Cases with advanced destruction or strong lateralisation of the femoral head were the second major indication. Osteotomy as near to the joint as possible and extensive dislocation with maximal medialization of the head are the decisive factors for success for this operation. Two thirds of the cases showed a marked improvement of complaints at follow-up with almost unchanged range of motion. Improvement of the CE-angle and a remarkable increase of the sclerosed parts of the acetabular roof is also noticed in all x-rays at follow up. Nine cases can be judged as excellent, two as good and three as mediocre according to the cup-head-quotient of Heyman and Herndon. A remodelling of the femoral head with a Pelvic Osteotomy is possible even after conclusion of the reconstruction stage.

Adolescent↗

PubMedDate not supplied

[Surgical amputation and prosthetic management in congenital fibrosarcoma of the lower extremity].

The concept of surgical amputation and the problems of prosthetic management in a girl with congenital fibrosarcoma of left distal thigh, knee and shank is described. After failed polychemotherapy (EICESS 92) and expansion of the tumor a radical knee disarticulation and intended marginal resection of the tumorous soft tissue area of the distal thigh was performed at the age of eleven months and two weeks. The femur was shortened by osteotomy of the diaphysis and removing a fragment in order to protect the distal femoral epiphyseal growth plate and to be able to close the soft tissue of the stump primarily. Prosthetic fitting and rehabilitation started at the beginning of statomotorical development at the point when four feet standing changed into two feet standing. In present, at the age of two years and six months, this girl is independent mobile and well fitted with a knee disarticulation prosthesis.

Amputation, Surgical↗

PubMedDate not supplied

[CT in the surgical planning in tumorous processes of the sacrum].

The value of CT in the preoperative management of tumors of the sacrum is demonstrated. Essential informations for treatment planning are: involved sacral segment, infiltration of sacral foramina and nerve roots, involvement of the sacroiliac joints, ingression of the lumbar spine, infiltration of the pelvic organs and vessels, sciatic nerve and the dorsal soft tissues. In order to prove the competence of the CT in answering these questions we evaluated the CT-examinations of 30 pat. with 14 primary tumors, 9 metastatic tumors and 7 tumors involving secondary the sacrum. The CT findings were correlated with clinical symptoms and surgical reports in 11 pat., with clinical symptoms alone in 19 pat. There was good correlation in the criterias: location and number of involved segments (8/11, 17/19), infiltr. of SI-joints (11/11), infiltr. of lumbar spine (9/11, 18/19), and infiltr. of pelvic organs (10/11), worse correlation in the criterias: nerve root-involvement (2/11, 3/19), and sciatic nerve-infiltr. (7/11, 15/19). Our conclusions are that CT gives helpful preoperative informations deciding about extent of surgical procedure, and surgical approach. The major problem, however, consist in diagnosis of nerve root and sciatic nerve involvement, therefore in poor prediction of postoperative conservation of neural functions. The knowledge of CT-anatomy of sacrum- and important condition for correct segment-location of the tumor is refreshed by outlines of characteristic segmental CT-sections of the sacrum.

Adult↗

PubMedDate not supplied

[Surgical therapy of metastases of the pelvis and sacrum].

We are reporting on 42 surgical and 5 conservative treatment approaches in metastases of the pelvis and sacrum. With an average disease-free survival of 14.4 months the majority of the lesions were resected intralesionally. In the area of the ischium and the pubis resection alone was done without further stabilizing measures. If the resection was in the area of the iliac wings, stabilization was achieved by means of osteosynthesis in 50% of the cases. Periacetabular resections required reconstruction with endoprotheses in all cases. In patients with good prognosis and solitary metastases also extralesional resections were performed. Reoperated embolization was used in advanced stages of the disease or if the metastases were not easily accessible surgically. Because of the complexity of pelvic resections and the often considerable loss of function, patients with metastases are often treated with intralesional resection and osteosynthesis. In exceptional cases, if radiotherapy had failed or multiple intralesional resections were followed by recurrences, we feel however that extralesional resection should be attempted with good prognosis for the patient.

Adenocarcinoma↗

PubMedDate not supplied

[Analysis and results following replacement surgery of loose, cemented hip endoprostheses].

Between 1971 and May 1981 2380 Total Hip Replacements were performed at the Orthopedic Clinic of the University of Vienna. In 145 patients (6,1%) a revision arthroplasty had to be done, because of loosening of the prostheses. 10 of these patients had to be reoperated once more because of a second failure. All together 76% of the patients were either very or almost content with the result of the operation. Considering only patients with one revision arthroplasty we saw 87% good and very good results. The average hip movement was 93 degrees in flexion, 20 degrees in abduction and 24 degrees in adduction. They had a fairly good walking capacity and have not been reduced in their daily work. The revision arthroplasty of a loosened total hip replacement can be advised to the patients, even though the second operation is larger and of higher risk to the patients than the first one.

Adult↗

PubMedDate not supplied

[Results following spongiosa transplantation in giant cell tumor of bone].

Between 1952-1988 47 giant cell tumors of the bone were treated at the Orthopedic University Clinic of Vienna with different surgical margins: In 9 cases a radical or wide, in 3 cases a marginal and in 35 cases an intralesional resection was performed. In the cases with intralesional resections the tumors were diligently curatted and the resulting bone cavity was shaved with a rase. In addition in eleven cases a chemical cauterization was done with phenol. Afterwards the lesion was filled up with autogenous or homogeneous bone chips with or without fibrin tissucol. In the cases where phenol was used no local recurrence was observed over a mean period of 39 months (max. 91, min. 6) of follow up. Because of the subchondral joint location of the giant cell tumors of the extremities a radical or wide resection usually causes the loss of a part of the joint which is followed by poor functional results. Intralesional resections in combination with phenol cauterization not only achieved good functional results, but also succeeded in reducing the rate of local recurrencies from 25-44% in 0 as described by other authors.

Adolescent↗

PubMedDate not supplied

[The incidence of recurrence in phenol treated and non-phenol treated bone cavities following intralesional resection of non-malignant bone tumors].

Between 1955 and 1986 intralesional excisions were performed at Vienna University Orthopedic Clinic on 103 patients suffering from aneurysmatic or juvenile bone cysts, chondromyxoid fibromas or giant cell tumors. In 31 patients phenol was applied to the wall of the bone cavity after this had been carefully curetted or fraised. The chemical cauterization effect is intended to destroy any remaining tumor cell remnants. The cavity is then filled with autologous or homologous spongiosa. In a total of 72 nonphenolized bone cavities there were 21 recurrences (29.1%). By using phenol following intralesional excision of nonmalignant bone tumors in 31 patients the recurrence rate was significantly lowered (3 recurrences - 9.7%).

Adolescent↗

PubMedDate not supplied

[The incidence of recurrence of intra- and extra-lesional operated metastases of long tubular bones].

Using a collective of 54 patients with 76 operated metastases of long bones in carcinoma of the breast and kidney the frequency of local recurrence after intralesional and extralesional (marginal, wide, radical) resection was investigated. 57 operations were done intralesional, 19 extralesional. Local recurrence was seen in 50.8% in the intralesional group on the other hand in only 15% in the extralesional group (p 0.007). Relief of pain was similar in both groups. The postoperative range of motion had worse results after extralesional resection and endoprosthetic replacement. There was no difference between both groups in the manifestation of further metastases.

Adult↗

PubMedDate not supplied

[Pathogenesis of fibrous cortical defect and non-ossifying bone fibroma].

We were able to show in eighty-one cases that fibrous cortical defects or non-ossifying fibromas of the bone occur only in areas, where tendons insert into the perichondrium of the epiphyseal plate. During growth these tumor like lesions move towards the diaphysis following a cortical line, which begins at the point of insertion of the tendon and is parallel to the longitudinal axis of the bone.

Adolescent↗

PubMedDate not supplied

[Long-term results of basal wedge osteotomy in metatarsus primus varus in the young patient].

INTRODUCTION: Aim of this retrospective study was to analyse the long term results after basal closing wedge osteotomy for correction of metatarsus primus varus and hallux valgus in the younger patient. PATIENT AND METHODS: 49 patients (70 feet) were operated according to a basal closing wedge osteotomy from 1974 to 1985 at our institution. Age was under 40 years in all patients at the time of surgery. 34 patients (50 feet) were evaluated in respect to their clinical and 26 patients (37 feet) to their radiological outcome. The average age was 26 years (14-39 years). The follow-up was 12 to 22 years (Median: 18 years). Analysis was performed using the patient's record, weight-bearing X-rays, a standardized questionnaire and clinical investigation. RESULTS: 82% of the patients had very good and good subjective results. Cosmetics was rated very good and good in 78%, 88% of the patients were painfree. Radiological analysis at follow-up: Hallux valgus-angle 19,3 degrees, intermetatarsal I/II-angle 6 degrees, shortening of first metatarsale 5 mm, at average; dorsal elevation of first metatarsale 38%, degenerative arthritis of the metatarsocuneiforme joint 19%, congruency of first metatarsophalangeal joint 54%,sesamoid subluxation: 46% grade 0, 30% grade I, 14% grade II and 10% grade III. In 14 feet (28%) metatarsalgia was found. DISCUSSION: The basal closing wedge osteotomy is rather a technically demanding procedure conjuncted with a higher risk of failure. Satisfactory long term results can be obtained by an ideal operating technique. As undesirable side effects shortening of the first ray and dorsal malangulation of the first metatarsale may occur consecutively leading to metatarsalgia. Lower risk procedures like the crescentic osteotomy according to Mann or chevron osteotomy should be preferred.

Adolescent↗

PubMedDate not supplied

The results of surgical treatment for Perthes' disease.

We report the clinical and radiological results following intertrochanteric varus osteotomy and Chiari pelvic osteotomy for Perthes' disease in 70 hips with a minimum follow-up of 3 years. The indication depended on lateralization of the epiphysis of the femoral head with or without full containment in the abduction radiograph, thickening of the acetabular floor, coxa magna, and osteoarthritis. Epiphyseal quotient and sphericity showed that head deformity is mostly permanent; the acetabulum-head quotient provided good coverage. Operation in the condensation stage achieved far better results than later operations. From these and other results, the late and mild occurrence of osteoarthritis can be assumed despite deformed femoral head or acetabulum, with full coverage provided.

Adolescent↗