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Biomedical subjects

R Krauspe

Publications and source records attributed to R Krauspe.

At least 37 records · Page 2Linked to original sources
PubMed2003

[Nonoperative treatment in Legg-Calvé-Perthes disease].

There is still discussion about the indication for and modalities about treatment of Perthes'disease. The main objective of treatment in Perthes'disease is prevention of deformation and malalignment of the hip joint. Most important for the evaluation of any therapy is the long term outcome, therefore we present this retrospective study on nonoperative treatment of perthes disease with orthoses compared to the natural history. 54 Patients with 59 involved hips, treated between 1945-1975 were clinically and radiologically evaluated. We divided the patients into two subgroups: Group 1 with nonoperative therapy. Group 2 with no therapy. The outcome shows correlation of the results with the degree of malalignment and necrosis. There was no statistically significant correlation between the two groups, but a slightly better outcome in the non-operative group compared to the natural history. The use of orthosis may be justified if there is improvement of the containment and reduction of the femoral head, otherwise surgical treatment like pelvic- and hip osteotomies to realign the hip joint should be considered.

Adolescent↗
PubMed2003

[Ultrasonographic evaluation of the rotator cuff after shoulder arthroplasty].

AIM: Ultrasonography of the rotator cuff tendons is a standard imaging technique. Although increasing numbers of shoulder arthroplasty are performed, there is no available data concerning the use of ultrasound after shoulder replacement. Our experimental study was performed to analyse the value of ultrasonography after shoulder arthroplasty a) in an ex-vivo-setting and b) in a retrospective analysis of our patients after shoulder hemiprothesis. METHOD: After defrosting, anatomic modular humeral head replacement was performed in four fresh-frozen specimens with intact rotator cuffs. The supraspinatus and subscapularis tendons of each specimen were either detached to simulate a cuff defect or reattached anatomically (four times per specimen). Two experienced examiners then performed ultrasonography to evaluate the two tendons to be either intact or deficient. In a retrospective study, 22 patients with 25 hemiprotheses of the shoulder underwent clinical and sonographic examination. For documentation of the clinical findings, the Constant score was used. RESULTS: In the cadaver study, the reliability of the method was slightly higher for the subscapularis tendon (13 correct, 3 false results) than for the supraspinatus tendon (12 correct, 4 false results). In our patients, rotator cuff defects and effusions around the biceps tendon and in the subdeltoid bursa could be detected. Normal sonograms correlated with good clinical results. CONCLUSION: In the cadaver study, we found a good reproducibility of in-vivo conditions. We believe that ultrasonography is beneficial in follow-up evaluation after shoulder arthroplasty.

Arthroplasty↗
PubMed2003

Influence of different culture solutions on osteoblastic differentiation in cord blood and bone marrow derived progenitor cells.

Mesenchymal progenitor cells derived from cord blood (unrestringated somatic stem cells, USSC) and bone marrow (mesenchymal stem cells, MSC) are able to differentiate under defined culture conditions into at least bone, cartilage, adipose and muscle cells in vitro. The culture media and other in vitro conditions influence the osteogenic differentiation potency of both cell types. To increase and expand the number of osteoblasts in vitro an optimization of culture conditions is required. The aim of this study was to evaluate different culture media toward their osteogenic promoting capacity on human USSCs and MSCs in vitro. Immunohistochemical stainings against osteonectin (ON), osteopontin (OP) served as markers for an osteoblastic differentiation. Cellular morphology was analysed by light microscopy technique. We found significant differences between bone marrow and cord blood derived stem cells towards an osteoblastic differentiation. Considering the number of osteoblasts MesenCult seems to have advantages in bone marrow progenitor cells, whereas low glucose DMEM and HAMS-F12 promoted an osteoblastic differentiation in cord blood derived cells more than other tested media.

Cell Culture Techniques↗
PubMed2002

The value of ultrasound after shoulder arthroplasty.

OBJECTIVE: This study was undertaken to evaluate whether sonography is a useful tool in the diagnosis of soft tissue disorders as a possible cause for discomfort and/or pain after shoulder arthroplasty. DESIGN AND PATIENTS: Static and dynamic ultrasound examinations were performed in the standard sectional planes on 22 patients with 25 hemiprostheses and the results were correlated with the clinical outcome. The stability was determined in the transverse and frontal planes and the clinical results were evaluated according to the Constant and Swanson scores. RESULTS: Several pathological changes were detected: rotator cuff lesions, subdeltoid bursitis, changes around the long biceps tendon as well as an increase in intra-articular volume due to effusion and/or synovitis. The correlation of sonographic and clinical results demonstrated that patients with an excellent clinical result showed no or only a few pathological findings on sonography compared with those with a moderate or poor result. CONCLUSION: Pathological changes of the periarticular tissue in the direct neighbourhood of the implant can be detected by sonography, which can be recommended as a valuable examination technique to evaluate the soft tissue in patients after shoulder arthroplasty.

Adult↗
PubMed2002

[Acute low back pain with progressive sensorimotor paralysis. Differential diagnosis and therapy of acute decompression disease].

HISTORY AND CLINICAL FINDINGS: A 38-year-old man presented with acute low back pain and paraesthesia in dermatome S1. 4 hours before onset of symptoms he had finished the last of three scuba dives with a maximum depth of 30 m and a total diving time of 3 hours. No alcoholic beverages were taken during or before diving. The patient was complaining of local pain in the thoracic and lumbar spine and showed a 3/5 weakness of the big toe and impaired sensitivity in the S1 dermatome. 90 minutes later the patient developed a hemiparesis of the right side including hypaesthesia and additional meningism (stiff neck). INVESTIGATIONS: The X-rays of the thoracic and lumbar spine in two standard planes, cerebrospinal fluid examination, a cranial spiral-computer tomographie (CCT) and laboratory investigations showed no pathologic values. DIAGNOSIS: Acute decompression sickness (DCS) type II. TREATMENT AND COURSE: The patient received an intravenous infusion, antiinflammatory prophylaxis with dexamethasone and an immediate submission to hyperbaric oxygenation therapy. Complete recovery of neurological symptoms appeared after 4 decompression sessions in a hyperbaric chamber. CONCLUSIONS: In patients presenting low back pain as common symptoms the differential diagnosis needs to be worked out and DCS should be included especially if progressive neurologic deficits are present. Only emergency hyperbaric oxygen therapy can compromise a sufficient therapy of these patients.

Acute Disease↗
PubMed2002

A new technique for the surgical management of deformities in the growing spine.

The Luque procedure was developed to correct the deformity without the need of bracing and maintaining that correction with growth. However many authors are disappointed by their results and the complications which appear in the management of infantile scoliosis with Luque trolley alone. Besides failed implants, pseudarthrosis, modest spinal growth and protuberant rods and wires, the major problem of the Luque systems is the high incidence of loss of correction by postoperative rotation. Therefore a new application technique is recommended. A standard posterior extraperiostal approach is chosen. Sublaminar titanium cables are passed at each level except the caudal lamina. Then the rods are precontoured in shape of the planed curve correction. We use a low profile titanium instrumentation with 5.0 mm diameter rods and 4.2 mm pedicle screws. In contrast to the conventional use of two antiparallel "L"-rods we recommend the use of one reversed "U"-rod securing the laminae with sublaminar titanium cables of the upper end vertebrae. For fixation of the lower spine a dual-opening pedicle screw system is used. Using a holding forceps the distal rods are introduced and fixed into the side opening of the screws then secured by sublaminar wires. In addition both single rods are stabilized by a low profile cross link bar. This technique allows to correct pelvic obliquity and a stable anchorage of two screws reduces risk of postoperatively rotation or caudal rod slippage due to gravity forces.

Adolescent↗
PubMed2002

[Fracture analysis of a ceramic liner. Is in hip endoprosthesis replacement of ceramic on ceramic components with only one of the corresponding partners justified?].

The good biomechanical and tribological properties, together with the excellent biocompatibility, of ceramic-on-ceramic components, make them a preferential choice for total hip replacement surgery, at least in Europe. We report on a man admitted as an outpatient with painless grating in the hip one year after replacement of a ceramic femoral head, but not of the ceramic inlay. Clinical and radiological findings were indicative of a broken liner. This was confirmed during revision surgery, during which it was replaced by a polyethylene inlay; although the ceramic head appeared intact, it was replaced by a metal head. Inspection of the surface of the broken liner in the scanning electron microscope (SEM) revealed signs of material failure. We recommend careful inspection of ceramic-on-ceramic articulating components during total hip revision surgery and if there is any uncertainty, replacement of both so as to avoid premature failure.

Aged↗
PubMed2002

The effect of limited interlaminar decompression versus complete laminectomy on intrathecal volume in degenerative lumbar spinal stenosis.

INTRODUCTION: There is a controversial discussion about the adequate surgical procedure for degenerative lumbar spinal stenosis. Due to the observation that the degenerative lumbar spinal stenosis takes place predominantly at the interlaminar region on the level of the disc involving facets and bulging of the ligamentum flavum, resection of the whole lamina might not be necessary. A biomechanical study was designed to assess the effect of different decompression techniques using cadaver lumbar spine models. METHODS: Twelve cadaver spines with CT verified degenerative lumbar spinal stenosis were dissected in order to measure the volume of the dural sac at different flexion and extension angles. Each segment (L3/4, L4/5) was decompressed first by limited interlaminar decompression and second by complete laminectomy. Intrathecal volume measurements were taken initially, after limited interlaminar decompression and after complete laminectomy. RESULTS: Before surgical procedure, the cadaver spines showed an increase of the intrathecal volume in flexion and decrease in extension. After limited interlaminar decompression, there was a significant reduction of volume loss in extension. There was no significant additional reduction of volume loss in extension after complete laminectomy in comparison to limited interlaminar decompression. CONCLUSION: The results allow to conclude that limited interlaminar decompression is efficient for decompression in degenerative lumbar spinal stenosis.

Aged↗
PubMed2001

Secondary intra-articular dislocation of a broken bioabsorbable interference screw after anterior cruciate ligament reconstruction.

We report a case of intra-articular migration of the proximal part of a broken polylactic acid screw from the tibial site of anterior cruciate ligament-reconstruction with quadrupled semi-tendinosus tendon. Five months after initially successful ACL surgery the patient felt a sudden locking of the knee without another injury. MRI showed intra-articular migration of one-half of the polylactic acid screw, and standard radiographs a widening of the proximal tibial tunnel. At revision arthroscopy the broken part was easily removed. The patient had full recovery. This case demonstrates the problem of "bioscrew" breakage in ACL surgery.

Absorbable Implants↗
PubMed2001

Treatment of congenital spondyloptosis in an 18-month-old patient with a 10-year follow-up.

STUDY DESIGN: Case report. OBJECTIVES: To present the case of a patient with congenital spondyloptosis treated and followed over 10 years. SUMMARY OF BACKGROUND DATA: The surgical management of spondyloptosis in children is variably reported in the literature. Some authors propose that posterior fusion in situ is a safe and reliable procedure, whereas others suggest that reduction of the slipped vertebra may prevent some of the adverse sequelae of in situ fusion, which include nonunion, bending of the fusion mass, and persistent lumbosacral deformity. Many investigators advocate a combined anterior and posterior fusion using instrumentation. METHODS: At the time of the first symptoms an 18-month-old boy with congenital spondyloptosis of L5-S1 was referred to the authors' institution. Because of the progression of pain, neurologic disturbance, mild foot deformity, muscle contractures, and lumbosacral kyphosis, surgical intervention was undertaken. Operative intervention began with a resection of the L5 lamina and wide bilateral L5 nerve root decompression. This was followed by anterior subtotal resection of L5 and interbody bone graft of the morcelized vertebral body for fusion from L5 to S1. The next step was reduction of the spondyloptosis and stabilization by posterior instrumentation L2-S1 with a sacral Cotrel-agraffe device. RESULTS: The procedure achieved almost complete reduction of the spondyloptosis with near-normal restoration of lumbar lordosis allowing more physiologic lumbar spinal biomechanics. There were no neurologic complications. After surgery there was no suggestion of back pain or gait disturbance and no progression of any deformity. CONCLUSION: In the treatment of severe congenital spondylolisthesis a staged procedure of decompression, reduction, and instrumented fusion is recommended for those cases in which intervention is indicated.

Decompression, Surgical↗
PubMed2001

Is sacral instrumentation mandatory to address pelvic obliquity in neuromuscular thoracolumbar scoliosis due to myelomeningocele?

STUDY DESIGN: Prospective study. OBJECTIVE: To evaluate the functional outcome of two-stage anterior and posterior instrumented fusion without fixation to the sacrum on 11 patients with neuromuscular scoliosis from thoracolumbar myelomeningocele. SUMMARY OF BACKGROUND DATA: To our knowledge, there are no published results of combined anterior and posterior correction and fusion without inclusion of the sacrum in neuromuscular scoliosis from thoracolumbar myelomeningocele. In this article we present our experience and critically evaluate the functional outcome on 11 patients with neuromuscular scoliosis. PATIENTS AND METHODS: From July 1, 1992 through June 30, 1995, 11 consecutive patients with severe thoracolumbar scoliosis were admitted at our hospital. The mean age at operation was 12 years 9 months (range 9 years 9 months to 14 years 6 months). All patients underwent a two-stage anterior and posterior spinal reconstruction. The patients were evaluated before surgery and after surgery. RESULTS: All patients were observed for a mean of 4 years 11 months (range 42-88 months) from the time of second stage procedure. Before treatment the mean scoliosis was 81 degrees (range 55-110 degrees ); this was reduced to a mean of 31 degrees (range 8-70 degrees ), and at the final follow-up the correction had deteriorated slightly to a mean of 35 degrees (range 12-80 degrees ). No patient had increased neurologic deficit or showed other major complication. CONCLUSIONS: Pelvic obliquity in thoracolumbar neuromuscular scoliosis from lumbosacral myelomeningocele spontaneously corrected when the scoliotic deformity is adequately addressed with instrumented fusion without inclusion of the sacrum. The correction obtained remained stable at follow-up. In the absence of a control group we believe that sparing lumbar segments from primary fusion offers these patients a better freedom of mobility.

Adolescent↗
PubMed2001

Correction of length discrepancies and angular deformities of the leg by Blount's epiphyseal stapling.

UNLABELLED: The management of leg length difference (LLD) and angular deformities of the leg remains controversial. Numerous treatment options have been proposed over the past years depending on the patient's general condition, skeletal age, function, and degree and configuration of the deformity. Our retrospective study consisted of 48 patients with 58 legs treated between 1970 and 1991 by Blount's epiphyseal stapling to equalise length or correct angular deformity. After an average follow-up of 16.5 years, all patients with idiopathic bow-legs or knock-knees (n=12) and 71% of LLD caused by overgrowth (e.g. Klippel-Trenaunay syndrome) showed good and excellent results at skeletal maturity, whereas the results of the treatment of LLD with undergrowth of the leg and angular deformities due to trauma, infection or general dysplasia and malformation were fair to poor because of the difficulty in prediction of growth development and growth potential, allowing only for partial correction of the deformity. Besides the restriction of the stapling procedure due to the aetiology of the deformity, the age of the patients at the time of surgery is important, as it determines the complication rate of this technique (loosening or dislocation of staples). Thus Blount's epiphyseodesis should not be performed before the age of 9 years in girls and 11 years in boys. CONCLUSION: Blount's epiphyseal stapling can be recommended as a safe procedure with predictably good results in idiopathic angular deformities of the leg and leg length difference caused by overgrowth.

Adolescent↗
PubMed2001

[Osteochondral shear fractures in children. A case report and critical review of the literature].

Only few articles on osteochondral flake fractures in children have been published. Diagnostic tools have been improved over the past decades, but still, diagnosis of severe osteochondral defects may be delayed. The presented case report describes the different techniques currently being available for the diagnosis of osteochondral flake fractures. The different therapeutic options for the treatment of osteochondral flake fractures in children are discussed based on the current literature. This article demonstrates the necessity to consider severe injuries, even if impressive clinical symptoms are lacking.

Arthroscopy↗
PubMed2001

[Experimental validation of DXA and MRI-based bone density measurement by ash-method].

Different methods have been established for bone density measurements such as dual energy X-ray absorptiometry (DXA), quantitative computertomography (QCT), and scintigraphy (VQ-Scan). There are hints that magnetic resonance imaging (MRI) might become a new option for the evaluation of bone density. The aim of this study was to investigate correlations between MRI vs. DXA and MRI vs. mineral content of lumbar vertebrae. Data were obtained from ten lumbar vertebral bodies of cattles. The T-1 MRI-sequences SE, PS, and the T-2 Sequence STIR were used for analysis. Total pixel numbers and a pixel per area ratio were determined. Values were compared to DXA-measurements, to the wet weight, and to separated measurements of the spongious, trabecular, and total mineral content of the vertebral body after ashing. We found correlations between DXA (g/vertebral body) vs. mineral content by ash-method (0.918; p < 0.01), DXA vs. MRI (SE-sequence) (-0.872; p < 0.01), and MRI (SE-sequence) vs. mineral content (0.775; p < 0.01). No correlations were found between PS- or STIR-sequences and the ash-method. This study shows that the determination of the bone mineral content of vertebrae is possible applying MRI in the T1-weighted SE-sequence. Without radiation, the MRI provides additionally early detection of trabecular lesions, fractures, and deformities at the spine, without other diagnostic procedures becoming necessary.

Absorptiometry, Photon↗
PubMed2001

Morbidity profile of high-performance fencers.

There are only very few data available about the morbidity of elite fencers athletes. The aim of this study was to elucidate the nature and history of the morbidity in high-performance fencers. The injury profile over 15 years of 93 fencers at a highly competitive level was analysed by clinical assessment and examination. We found a positive correlation between the injured upper extremity with the dominant fencing side while the lower extremity showed no side preference with regard to vulnerability. Achillodynia occurred more frequently at the contralateral side. The joint most affected was the knee. The dominating symptom was patellofemoral pain which occurred in 39.8 %.

Adolescent↗
PubMed2001

Biomechanical analysis of Graf's dynamic spine stabilisation system ex vivo.

The most frequent causes of chronic lumbar spine instability are of degenerative or traumatic origin. Numerous anterior and posterior stabilisation devices were developed for anatomical reconstruction of the spinal alignment and fusion of the spine to restore stability. Fusion of the spine results in increased load of adjacent segments with an increased risk of secondary degeneration which might result in instability or stenosis. To avoid the disadvantages of static devices, Graf developed a method of dynamic surgical treatment of spinal column instabilities, which is based on the principle of flexible stabilisation. This study is analysing the kinematics of discoligamentary intact motion segments compared with the experimentally destabilised human lumbar spine and the influence of Graf's stabilisation. According to our results, rotational instabilities cannot be satisfactorily stabilised by Graf's ligamentoplasty. With the present ex vivo study, it could be shown that it is possible to restore stability after discoligamentary lesion and after facetectomy using Graf's dynamic lordosis ligamentoplasty.

Biomechanical Phenomena↗