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Biomedical subjects

R A Fuhrmann

Publications and source records attributed to R A Fuhrmann.

At least 19 recordsLinked to original sources
PubMed2005

[The acquired buckling-flatfoot. A foot deformity due to obesity?].

Flatfoot deformity is characterized by a multiplanar hindfoot malalignment. Although the etiology remains unclear, the deformity is mainly attributed to ligamentous laxity and dysfunction of the posterior tibial tendon. Obesity is thought to be a risk factor that additionally impairs hindfoot stability. Performing a retrospective clinical and radiological study, we compared two groups, each with 75 patients. One group included patients with a flatfoot deformity stage 2, while the other group showed no hindfoot malalignment. Reviewing the weight and calculating the body mass index revealed significantly increased values for those patients with flatfoot deformity (P=0.034 and P>0.001, respectively). This correlation should be considered during the decision-making process on surgical strategies. In obese patients with flatfoot deformity, stage 2 soft tissue reconstruction and hindfoot osteotomies should be combined with hindfoot arthrodeses, i.e. subtalar fusion, to maintain sufficient and durable stability.

Adult↗
PubMed2005

[Metatarsalgia. Differential diagnosis and therapeutic algorithm].

Metatarsalgia is explained as localized or more diffuse tenderness beneath the metatarsal heads. The pain may be attributed to various etiologies. Pathological changes affecting the positional relationship of the metatarsals in the sagittal plane can cause increased pressure and friction forces during weight bearing. Since the length of the metatarsals displays a wide range of disparity only a few pathological settings, i.e., brachymetatarsia, require surgical correction. Beside those disorders of positional relationship, metatarsalgia may be due to lesser toe deformities, osteonecrosis of a lesser metatarsal head (Koehler's disease), and neurological disorders (Morton's neuroma). Apart from the etiology increased load, which is transferred to the central metatarsals, can be treated successfully with orthotic devices. If conservative measures fail, surgical treatment can be indicated. Prior to any operative therapy it is mandatory to perform a detailed analysis of the underlying pathology to avoid persistent pain or recurrence of the deformity.

Algorithms↗
PubMed2004

[Lesser toe deformities].

Lesser toe deformities often lead to painful calluses and metatarsalgia. Depending on the different underlying etiologies it is mandatory to perform a meticulous clinical assessment including the whole foot and the entire lower limb. Prior to any surgical interventions it is necessary to evaluate the deformity at all three joint levels. The metatarsophalangeal joint acts as a key joint. Any dorsal subluxation or dislocation has to be addressed first. This may include various soft tissue procedures and shortening osteotomies of the metatarsals. After successful realignment contractures of the distal joints have to be corrected. Since function of the lesser toes mainly depends on stability of the distal joints arthrodeses of the proximal and distal interphalangeal joints are superior to any resection arthroplasties.

Arthrodesis↗
PubMed2002

[The treatment of rheumatoid foot deformities].

Rheumatoid hindfoot deformity presents with hindfoot eversion, flattening of the longitudinal arch and abduction of the forefoot. Splayfoot, as the typical rheumatoid forefoot deformity, is mostly associated with various toe malformations, i.e. hallux valgus,hammer toe and claw toe,which may either be attributed to hindfoot malalignment or develop as a separate entity. The algorithm of treatment, comprising clinical assessment of both lower limbs, includes both orthotic shoe devices and surgical treatment. In rheumatoid flatfoot, arthrodesis of the hindfoot with lengthening of the lateral column and reorientation of joint congruency represent the gold standard of treatment. Despite this principle, the ankle joint should be kept mobile to facilitate standing and walking. Therefore, total ankle prosthesis is thought to be superior. Methods involving the preservation of the lesser metatarsophalangeal joints may be of benefit in providing sufficient ground contact with the toes. Nevertheless, resection arthroplasties are frequently required in cases of arthritic joint destruction. Arthrodesis of the first metatarsophalangeal joint may provide an adequate push-off for the big toe which can not be expected from resectional arthroplasties.

Arthritis, Rheumatoid↗
PubMed2001

[Foot surgery in Germany. Historical burden or scientific challenge?].

In Germany foot surgery was established in the late nineteenth century. To correct foot deformities due to paralytic disorders, i.e., poliomyelitis, and congenital deformities, different types of tenotomies and arthrodeses were developed to obtain plantigrade weight-bearing and to avoid external orthosis. A description of surgical techniques during the last century is presented in detail. During those years resection arthroplasties for hallux valgus were common, although some authors recommended osteotomies of the first metatarsal as joint-sparing techniques. Nowadays, further knowledge in etiology, pathology, and biomechanics have effected the therapeutic algorithm in hallux valgus. Nevertheless, discussion about this topic has not come to an end. In 1991 the German Foot and Ankle Society (D.A.F.) was founded. Educational courses to improve surgical skills as well as clinical workshops were successfully established. A marked increase in membership and a broad international acceptance confirm these activities.

Foot↗
PubMed2001

The long-term results of resection arthroplasties of the first metatarsophalangeal joint in rheumatoid arthritis.

We performed a retrospective study in 188 patients (254 feet) with rheumatoid arthritis and compared the late results of Keller's procedure with those of Hueter-Mayo's technique after 7.9 years. More than 60% of the Keller group and 30% of the Hueter-Mayo group were suffering from persistent metatarsalgia due to increased forefoot pressure as well as experiencing pain around the great toe. Plantar callosities, recurrent hallux valgus deformity, lack of plantar flexion and weakened push-off were more frequent after Keller's procedure.

Adult↗
PubMed2000

Salvage of the upper extremity in cases of tumorous destruction of the proximal humerus.

Malignant bone tumours or metastasis of the upper humerus may cause significant loss of function especially in those patients with resectional arthroplasty of the shoulder. One method for achieving functional reconstruction of the humerus concerned is replacement with a modular endoprosthesis. Little is known about clinical and radiological results in these rare circumstances. Between 1993 and 1997 we treated 21 patients (22 shoulders) with enlarged osteolytic destructions of the proximal humerus caused by metastatic spread or primary malignant tumours. Patients with additional involvement of the glenoid were excluded from this study. The average follow-up was 3.9 years. Every 3 months all patients were followed-up clinically and radiographically. Prior to surgery, diagnosis was established by incisional biopsy and the outcome determined the therapeutic algorithm (radiotherapy, chemotherapy, surgery). In most cases of metastatic lesions, surgery was the first treatment. According to the regional spread of the tumour, various amount of bone and soft tissues had to be removed. The distal stem of the prosthesis was inserted in a cementless way and secured to bone with two interlocking screws. The length of the diaphyseal part depended on the site of osteotomy. Soft-tissue coverage of the large implant was achieved in all patients. Early complications were lymphogenic oedema and superficial wound dehiscence. One patient developed a deep infection, which had to be managed surgically. According to the functional rating system of the Musculoskeletal Tumour Society for the upper extremity the overall results were inversely proportional to the extent of resection. None of our patients achieved unrestricted motion of the shoulder concerned. The most important finding was a proximal migration of the prosthesis causing a painful subacromial impingement, mainly a consequence of the resection of the deltoid muscle and the rotator cuff. In summary, a modular endoprosthesis cannot be recommended generally as the method of choice. If the muscular balance of the shoulder is too weak to act as a joint centralizer the endoprosthesis has no advantage over a simple diaphyseal spacer.

Adult↗
PubMed1997

Furcation involvement: comparison of dental radiographs and HR-CT-slices in human specimens.

In this in vitro study we compared dental radiographs and high resolution computed tomography (HR-CT) regarding identification and classification of the degree of horizontal and vertical furcation involvement. After removal of the soft tissue and metallic restorations of 18 dentate upper and lower jaws in the interradicular furcation region of 28 molars, bony defects of different dimensions were experimentally produced. The specimens were examined radiographically with standardized dental radiographs and 1.0 mm thick contiguous axial CT-scans. After identification of molars with artificial furcation involvement in the dental radiographs and axial CT-scans, the horizontal and vertical grades of furcation involvement were classified. Radiological identification and classification were compared with the macroscopic findings in the specimens. For quantitative histological-radiological comparison, corresponding microsections were prepared in the same plane as the axial CT-scans. In the dental radiographs the artificial furcation involvement in 6 of 28 (21%) molars was identified. In contrast, all 28 molars with involved furcations (100%) were identified in the axial CT-scans. The horizontal and vertical grades of furcation involvement were classified in the same way as the macroscopic findings, permitting comparison of histological sections and axial CT-scans. The HR-CT technique offers 3-dimensional assessment of the interradicular bone morphology in furcation involvement without overlying structures. The periradicular alveolar bone can be assessed on all sides of the roots. HR-CT scanning thus permits a high identification rate and classification of molars with involved furcations.

Alveolar Process↗
PubMed1996

Distal movement of premolars to provide posterior abutments for missing molars.

In 24 patients with missing molar teeth in the upper and/or in the lower jaw, 32 premolars were distalized. The mean orthodontic distalizing distance was 9.4 mm (SD 2.6). After distalization all these teeth served as posterior abutments for fixed restorations. The investigation period ranged between 2.5 to 14.1 years, average 9.6 years (SD 3.2). The clinical examination criteria were sensitivity, mobility, probing depth, sulcus bleeding index; the radiologic criteria were root resorption (lateral and apical) marginal bone level and axial position. None of the 32 premolar abutments were lost during investigation period. All the teeth maintained their vitality. The measured probing depths and sulcus bleeding indices were low. Of the teeth tested 40.6% revealed localized lateral root resorption on the pressure side; the average postorthodontic depth of root resorption was 0.7 mm (SD 0.3), and the length 2.3 mm (SD 0.6). The follow-up examination revealed a partial repair of the lateral root lesions. The extent of apical root resorption amounted to 0.9 mm (SD 1.1). The marginal bone level showed a bone loss of 0.5 mm mesially and 0.2 mm distally. The findings confirm that the distalized premolar functioning as a posterior bridge abutment represents a prognostically favorable alternative to an implant.

Adolescent↗
PubMed1995

Human histologic tissue response after long-term orthodontic tooth movement.

UNLABELLED: The maxilla of a deceased 19-year-old young woman who had been treated with an edgewise appliance was removed during autopsy. The specimen was prepared histologically in the horizontal plane. The type of tooth movement was reconstructed by comparing the treatment documents at outset (photograph of dental cast, radiograph) with the photograph and radiographs of the specimen. This permitted the histological findings to be correlated to the type of tooth movement. RESULTS: the localization and extent of tissue changes at the roots depend on the type of tooth movement and the structure of the bone. In case of an atrophied alveolar bone in front of the tooth movement direction, a partial increase of osseous tissue may be induced by bone apposition in the subperiosteal layer. After tooth movement in the maxillary sinus region, however, bone resorption was found in the subperiosteal layer in front of the roots. The histologic findings are more pronounced than the radiographs would suggest. Histologically verified bony dehiscences or fenestrations in the facial or oral cortical plate could not be diagnosed by macroscopic inspection of the specimen.

Adult↗
PubMed1995

Assessment of alveolar bone loss with high resolution computed tomography.

In this in vitro study we compared high resolution computed tomography (HR-CT) with dental radiographs regarding the interpretation of horizontal and vertical alveolar bone loss. After removal of the soft tissue and metallic restorations of 20 dentate upper and lower jaw segments 40 infra-alveolar bony defects of different dimensions were experimentally produced. The specimens were examined radiographically with standardized dental radiographs and 1.0 mm thick contiguous axial CT-scans. On the specimens, radiographs and CT-scans the bone loss was measured between the cemento-enamel junction and the adjacent alveolar bone level of 472 mesial and distal tooth surfaces; the identification, classification and vertical depth of the infra-alveolar bony defects were also compared. An average underestimation of 0.6 mm of horizontal alveolar bone loss in the dental radiographs and an overestimation of 0.2 mm in CT-scanning was shown. No significant differences between the imaging accuracy of horizontal alveolar bone loss between dental radiographs and CT-scanning could be evaluated. In the dental radiographs 24 (60%) of the infra-alveolar bony defects could be identified and the vertical depth was underestimated by a mean of 2.2 mm. In comparison, all 40 (100%) infra-alveolar defects could be identified in the CT-scans and the vertical depth was underestimated by an average of 0.2 mm. The HR-CT-technique offers a three-dimensional interpretation of the alveolar morphology without overlying structures. This permits a high identification rate and classification of infra-alveolar bone loss according to the number of surrounding bone walls into one-, two or three-walled bony pockets.

Alveolar Bone Loss↗
PubMed1995

Assessment of the dentate alveolar process with high resolution computed tomography.

The present study was undertaken to determine quantitatively the accuracy of modern high-resolution computed tomography (HR-CT) in imaging periodontal defects in vitro by means of comparative radiological and histological studies. The soft tissue and metallic restorations were removed from four mandibular and maxillary jaw segments. Eighteen lingual and buccal defects of different dimensions were artificially created over the roots of the teeth. Dental radiographs and 1.0 mm contiguous axial and coronal HR-CT scans were obtained. Histological specimens were prepared in the same plane as the CT scans. A quantitative analysis of the periodontal regions on the CT scans was feasible when the alveolar bone was 0.5 mm thick. A visible periodontal ligament space was found to improve the reliability of the measurement of buccal or lingual bone plates up to 0.2 mm thick or of the artificial dehiscences. In the axial HR-CT scans, 70% of the artificial defects could be identified. and in the coronal scans, 50%. In contrast, none of the defects could be evaluated on conventional dental radiographs. It is concluded that HR-CT scanning could be useful in assessing buccal and lingual alveolar bone morphology and in diagnosing larger dehiscences.

Alveolar Bone Loss↗
PubMed1995

Three-dimensional imaging of craniomaxillofacial structures with a standard personal computer.

OBJECTIVE: To implement 3D-reconstruction of CT and MR data by a standard MS-DOS personal computer. METHODS: User-specific software has been developed for the 3D-reconstruction and quantitative evaluation of hard and soft tissues of the skull. RESULTS: The software displays a 3D-reconstruction and secondary reformatted vertical sections within 4-30 s on the monitor. The 3D-structures can be evaluated quantitatively with a freely-superimposable grid. Distances or angles between two landmarks can be measured directly. Various tools for the simulation of surgical treatment are available. CONCLUSIONS: Gross skeletal and soft-tissue malformations, topographical relations and the degree of asymmetry of severe maxillofacial deformities can be evaluated in more detail. Access to a readily available low-cost computer system for 3D-evaluation of the head will enable a larger number of clinicians to use 3D-methods in diagnosis and treatment planning. The off-line computing system permits a higher of flexibility independent of any computing centre.

Anatomy, Cross-Sectional↗
PubMed1994

Treatment prediction with three-dimensional computer tomographic skull models.

Orthodontic and surgical treatment planning in the conventional articulator is compared with three-dimensional computer tomographic (3D-CT) model surgery in an individually milled skull model. After computer tomography has been completed of the patient's skull that has a bimaxillary asymmetric disharmony, the data set is transferred to generate individually milled polyurethane foam models. The imprecisely delineated dental arches of the skull model are replaced by dental casts that allow the simulation of various orthodontic and surgical treatment procedures. Expected segment displacement, the best osteotomy lines, and the resulting skeletal and dental symmetry in relation to the orthodontic set up can be evaluated. Although the technique is both time-consuming and expensive compared with the traditional treatment planning through the articulator, we have included 3D-CT model surgery in our presurgical work-up of patients with severe dentofacial disharmonies. Especially in asymmetric cases, the individually milled skulls allow a higher precision of orthodontic and surgical treatment planning.

Centric Relation↗
PubMed1994

Periodontal conditions after facial root tipping and palatal root torque of incisors.

UNLABELLED: The maxilla of a deceased 19-year-old young woman who had been treated with a fixed appliance was removed during autopsy. The sagittal movements of the incisors could be reconstructed by using the treatment records, which were also at our disposal. The anterior segment of the specimen was prepared histologically in the sagittal plane and stained with toluidine blue. RESULTS: The tooth movements were executed in two phases: an uncontrolled tipping (root movement to vestibular) was followed by palatinal root torque. The histologic changes, induced by the palatinal root torque were (1) root resorption with apical slope from facioapical to orocoronal, and (2) pronounced subperiosteal bone apposition (palatinal) with partial protrusion of the cortical plate thinning toward coronal. No osseous perforations occurred. The extent and the localization of root resorptions were not verified in the orthoradial x-ray film of the specimen.

Adult↗
PubMed1994

B-mode ultrasound scanning of the tongue during swallowing.

The aim of the present study was to evaluate the ability of video-based dynamic B-mode ultrasound in differentiating normal from abnormal swallowing. Tongue position at rest and during the oral phase of swallowing was examined with a 5 MHz transducer placed under the chin in 60 subjects aged between 6 and 33 years. 40 patients with abnormal tongue movement or swallowing were compared with a control group of 20 adults with Angle Class I occlusion without any signs of dysfunctional tongue activity. The ultrasound sequences were videotaped and the movement of the tongue in swallowing a 2 ml water bolus analysed qualitatively. An abnormal swallowing pattern was demonstrated in 19 patients. Those with an Angle Class III malocclusion had the highest rate of abnormal swallowing. Video-based ultrasound scanning in the sagittal plane seems to be a useful screening method for the diagnosis of poor tongue coordination during swallowing, especially for the imaging of tongue thrust in children.

Adolescent↗