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Biomedical subjects

R Hertel

Publications and source records attributed to R Hertel.

84 records · Page 5Linked to original sources
PubMedDate not supplied

Lag signs in the diagnosis of rotator cuff rupture.

We assessed the relative value of lag signs for the evaluation of rotator cuff rupture in a prospective study of 100 consecutive painful shoulders with impingement syndrome, stages 1 to 3. Lag signs were compared with the Jobe and lift-off signs. Three tests were designed to assess the main components of the rotator cuff: the external rotation lag sign (ERLS) for the supraspinatus and the infraspinatus tendons, the drop sign for the infraspinatus, and the internal rotation lag sign (IRLS) for the subscapularis tendon. For assessment of the supraspinatus and infraspinatus the ERLS was less sensitive but more specific than the jobe sign. The drop sign was the least sensitive but was as specific as the ERLS. Partial ruptures of the supraspinatus remained concealed to the ERLS. For assessment of the subscapularis the IRLS was as specific but more sensitive than the lift-off sign. Partial ruptures of the subscapularis tendon could be missed by the lift-off sign but were detected by the IRLS. The magnitude of the lag correlated with the size of the rupture for both the ERLS and the IRLS. Clinical testing for lag signs was efficient, reproducible, and reliable. In patients with little or no restriction of motion it enhanced the accuracy of clinical diagnosis in rotator cuff lesions.

Adolescent↗
PubMedDate not supplied

Operative management of the stiff elbow: sequential arthrolysis based on a transhumeral approach.

Between December 1990 and September 1993, 26 consecutive patients (27 elbows) were treated for elbow contractures. We used a modified transhumeral approach supplemented by a limited lateral approach with or without a limited medial approach according to the correction gained after each step of the procedure. Eleven posttraumatic, 6 degenerative, and 10 miscellaneous contractures were evaluated. The mean follow-up was 30 months. Statistically significant improvement in the range of motion was obtained for all groups of patients; the mean flexion-extension arc of motion increased from 66 degrees to 100 degrees for the posttraumatic contractures, from 79 degrees to 102 degrees for the degenerative contractures, and from 85 degrees to 121 degrees for a miscellaneous group of contractures. Relief of pain was not an issue in the posttraumatic group; it was not significant for the degenerative group but was significant for the miscellaneous group. Flexion and extension force were maintained, and no joint was made unstable. Complications included three transient ulnar neuropathies and one tardy ulnar nerve palsy. The technique presented offers the advantage of virtually unlimited exposure of the joint in a stepwise manner, dictated by the intraoperative assessment of joint motion combined with preservation of the medial and lateral collateral ligament complexes and all relevant muscle insertions and origins. The concept is applicable to contractures of differing cause and can be adapted to the specific needs of the patient.

Adolescent↗
PubMedDate not supplied

Decortication and plate osteosynthesis for nonunion of the clavicle.

Between 1968 and 1995, 37 patients with ununited fractures of the clavicle were treated by decortication and plate osteosynthesis. Thirty-two (86%) were failures of union of fractures of the middle third. Thirty-four (92%) patients had post-traumatic nonunion or delayed union. Sixteen (43%) patients had undergone primary operative treatment. Autogenous cancellous bone graft was used in 24 (65%) patients with atrophic nonunion. Nine tricortical, iliac crest, intercalary grafts were used for segmental bone loss equal to or greater than 15 mm. At the end of treatment, union had been achieved in 35 (95%) cases. At a mean follow-up of 8.6 years (range 13 months to 17 years), 32 (86%) patients had no symptoms and had a full range of motion of the shoulder. Decortication with plate osteosynthesis is a reliable, durable technique for the management of symptomatic, ununited fractures of the clavicle.

Adolescent↗
PubMedDate not supplied

Transacromial approach to obtain fusion of unstable os acromiale.

The purpose of this study was to identify possible causes for the low union rate for surgically stabilized os acromiale. Between February 1990 and November 1995, fusion of an os acromiale was attempted in 15 shoulders in 12 patients at our institution. All patients were men. The mean age was 54 years (range 37 to 63 years). All shoulders had an os mesoacromiale considered too large for simple resection. An associated lesion of the rotator cuff ranging from partial-to full-thickness tear was present in all patients. Eleven had an unfused acromial epiphysis in both shoulders. Two different surgical approaches were used. Seven shoulders were approached through an anterior deltoid-off approach, thus potentially devascularizing the os acromiale. Eight shoulders were approached transacromially, preserving the deltoid origin and hence the terminal branches of the thoracoacromial artery. The technique of internal fixation (tension band wiring) was the same for both groups. The mean follow-up was 44 months (range 13 to 72 months). Union, as demonstrated by axial radiographic views, occurred in 3 out of 7 cases with a devascularized os acromiale and in 7 out of 8 shoulders with a perfused os acromiale (P = .017), respectively. Patients with a united os acromiale had a significantly better functional outcome as measured by the Constant score (P = .0169). In conclusion, aiming at a stable fusion of a sizable and hypermobile os acromiale is probably desirable because it enhances the overall functional result. Obtaining consolidation was possible when the vascularity of the acromial epiphysis was respected.

Acromion↗
PubMedDate not supplied

The deltoid extension lag sign for diagnosis and grading of axillary nerve palsy.

The deltoid extension lag sign has been developed to avoid the pitfalls confounding the diagnosis of an axillary nerve lesion. The physician elevates the arm into a position of near full extension. The patient is asked to attempt active maintenance of this position. If the deltoid is weak, the arm will drop. In five patients with traumatic axillary nerve palsy after anterior dislocation of the shoulder, the deltoid extension lag sign was used to evaluate the functional status of the deltoid muscle. The magnitude of the angular drop, or lag, of the arm was a precise indicator of the functional status and recovery of the deltoid. The sign proved to be objective and reproducible, allowing confident assessment of deltoid function and when repeated over time allowed precise follow-up of deltoid recovery.

Adolescent↗
PubMedDate not supplied

[Diagnosis of rotator cuff rupture: correlation of clinical findings and magnetic resonance tomography with intraoperative findings].

The diagnosis of rotator cuff tears may be based on clinical examination and MRI. The aim of this study was to define the relative value of these methods. Clinical and MRI diagnoses of 88 shoulders were compared with the intraoperative findings. The correct diagnosis of a posterosuperior rotator cuff rupture was made in 79% of the cases by clinical examination and in 91% of the cases by MRI. For the subscapularis tendon clinical examination corresponded to the intraoperative findings in 73% of the cases versus 59% for MRI. MRI was superior to clinical examination in diagnosing a posterosuperior rotator cuff rupture. For the evaluation of ruptures of the subscapularis tendon, clinical examination was more reliable than MRI. Diagnosis of rotator cuff rupture can most often be obtained by a simple physical examination.

Adult↗
PubMedDate not supplied

[Arthroscopic capsulo-labral repair and refixation with Mitek anchor in anterior shoulder instability].

From May 1992 to September 1995, 38 patients with recurrent anterior shoulder instability underwent arthroscopic stabilization. The arthroscopic stabilization was performed by capsular shifting and labral refixation using Mitek anchors, based on the Wolf procedure. Immediately after operation active assisted shoulder mobilization was initiated (elevation 60 degrees, external rotation 20 degrees less than contralateral shoulder). After a mean follow-up of 24 months (12-42 months) 30 patients were evaluated by means of the Rowe Score. Excellent and good results were achieved in 90% (n = 27) of patients and 80% had no restriction in sports activities. In 4 of the patients (13%) redislocation occurred. Analysis of the recurrence revealed no adequate trauma in two patients with preoperative multidirectional laxity. One had a trauma and the fourth showed no compliance in the early postoperative period. Compared to the open Bankart operation the described procedure shows a slightly higher rate of redislocations. However, the approach is less invasive and the subscapularis tendon with its proprioception remains intact.

Adolescent↗
PubMedDate not supplied

Surgical landmarks to determine humeral head retrotorsion for hemiarthroplasty in fractures.

Malrotation has been suggested as a cause of failure of hemiarthroplasty of the proximal humerus. Placing a shoulder prosthesis in relationship to the bicipital groove might reproduce individual anatomy more reliably than using a standardized retrotorsion. The purpose of this study was to determine criteria for accurate adjustment of retrotorsion even when the proximal bicipital groove is destroyed, as is the case in fractures. The distance of the humeral head equatorial plane to the center of the bicipital groove was measured by high-resolution computed tomography at 4 levels (proximal and distal with 2 intermediate levels). The distal distance was considered to correspond to available references in fracture cases. The mean proximal distance was 8.0 mm (10th percentile, 6.2 mm; 90th percentile, 9.8 mm), and the mean distal distance was 8.5 mm (10th percentile, 7.1 mm; 90th percentile, 9.9 mm). As to the clinical relevance, there was no statistically significant difference between distances. For practical purposes in fracture indications, it is adequate to adjust the retrotorsion of the prosthetic component to the distal bicipital groove.

Arthroplasty↗
PubMedDate not supplied

Treatment of tibial plateau fractures with small fragment internal fixation: a preliminary report.

OBJECTIVE: To evaluate the use of small fragment implants for fractures of the proximal tibia. DESIGN: Retrospective. SETTING: Level I trauma center. PATIENTS/PARTICIPANTS: Seventeen patients with AO Classification Type B and C fractures of the proximal tibia. Two patients were lost to follow-up. INTERVENTION: After atraumatic dissection and open reduction, fracture stabilization was accomplished with the use of the AO/ASIF small T-plate (3.5-millimeter system). In two patients a medial uniplanar external fixator was applied as additional fixation. In six patients a cancellous autograft was performed. MAIN OUTCOME MEASUREMENTS: At an average follow-up of forty-two months (range, 24 to 75 months), all patients were evaluated radiographically and functionally. The incidence of local complications was specifically recorded. RESULTS: Postoperatively, the radiographs showed 86.7 percent anatomic or near anatomic reduction with respect to the articular joint surface. In three separate patients condylar widening, condylar narrowing or varus deformity was evident. In one patient, a minimal secondary displacement of less than two millimeters was observed before bony healing. All fractures healed within twelve weeks. At the latest follow-up, there were 53.3 percent excellent, 33.3 percent good, and 13.3 percent fair results. There were no infection or soft tissue complications. CONCLUSIONS: The use of small fragment implants combined with atraumatic soft tissue dissection potentially offers good results for the treatment of fractures of the proximal tibia. These initial results suggest that this technique may have the advantage of anatomic reduction while comparing favorably with less invasive methods regarding radiologic and functional outcome as well as incidence of complications.

Adolescent↗
PubMedDate not supplied

Exercise-induced compartment syndrome in the flexor-pronator muscle group. A case report and pressure measurements in volunteers.

Compartment syndrome is caused by an increase in intracompartmental pressure above the capillary level, preventing capillary flow. The acute onset of symptoms occurs after events such as fracture, soft tissue trauma, and revascularization and usually necessitates prompt fasciotomy to avoid loss of function or even necrosis of the enclosed muscle. Compartment syndromes in athletes are of a recurrent nature and are usually referred to as chronic. Nonoperative treatment is often successful. Although compartment syndromes can occur in several anatomic regions, the most commonly seen in athletes involve the leg. Chronic compartment syndromes of the upper extremity are rare, and only a few cases have been reported in the literature. The intracompartmental pressures causing chronic symptoms in these cases ranged between 22 mm Hg at rest and 40 mm Hg after 30 minutes of exercise. Under maximal contraction, a pressure of 58 mm Hg has been recorded. The object of this paper is to report a case of a tennis player where much higher flexor-pronator muscle intracompartmental pressures than those noted above were recorded. We compared the intracompartmental pressure data of this patient with intracompartmental pressures measured in six symptom-free volunteers.

Adult↗
PubMedDate not supplied

Total elbow replacement with the GSB III prosthesis.

Fourteen consecutive elbows have been treated for rheumatoid arthritis (9 elbows) and for post-traumatic osteoarthrosis (5 elbows) by total elbow replacement with the GSB III implant. The elbows were reviewed retrospectively after a mean follow-up of 6 years (2 to 9 years). Ten of 14 elbows had a functioning GSB III implant at follow-up; 7 of them were rated satisfactory and 3 unsatisfactory with the Mayo elbow performance score. In 5 of these 10 cases, the patients had significant pain relief with no or only mild pain at follow-up, whereas 5 had moderate to severe pain. With a functioning implant the range of motion averaged 140 degrees of flexion, 19 degrees of lack of extension, 65 degrees of pronation, and 84 degrees of supination. Six (43%) elbows had major complications requiring 1 to 8 additional operations. Aseptic loosening requiring revision occurred in 4 (29%) elbows. Two of them were treated by a resection arthroplasty, and 2 were revised with another hinged semiconstrained device. Three further elbows had radiolucent lines involving more than 50% of the cement-bone interface of either the humeral or the ulnar component. However, in 8 elbows the cementing technique was considered marginal or inadequate. Poor cementing (marginal or inadequate) was associated with loosening (P = .008). The GSB III total elbow prosthesis can restore function and reduce pain. The rate of aseptic loosening in this series was higher than previously reported. Based on this observation, we conclude that the GSB III implant seems to be sensitive to the insertion technique and does not tolerate suboptimal cementing.

Aged↗