Biomedical subjects

R Windhager

Publications and source records attributed to R Windhager.

At least 73 records · Page 4Linked to original sources

PubMed1993

Knee function after operation for malignancy of the distal femur. Quadriceps muscle mass and knee extension strength in 21 patients with hinged endoprostheses.

We evaluated quadriceps muscle mass and knee extension strength in 21 patients after resection and endoprosthetic replacement of the distal femur for malignant bone tumor. In all cases, a modular cementless, hinged prosthesis had been used. The mean follow-up period was 4 (2-9) years. Muscle mass was measured ultrasonographically, and strength isokinetically with a Cybex 6000 dynamometer. All the data for the operated side are given as percentage of the non-operated side. The average quadriceps mass was 48 (27-70) percent. The average peak torque was 31 (14-48) and 36 (18-55) percent at the speed of 30 degrees/s and 90 degrees/s, respectively. The reduction in extension strength became greater with increasing flexion. There was a moderate correlation between muscle mass and muscle strength. Most of the patients who had kept more than 40 percent of the quadriceps mass had more than 30 percent peak torque. Patients with excellent function (Enneking 1987) had more quadriceps muscle mass and higher strength than those that were merely good with the borderline at about 40 percent muscle mass.

Adolescent↗

PubMed1993

[The radiologic clinical picture of primary bone lymphoma].

Primary lymphoma of bone is a rare form of non-Hodgkin lymphoma which involves a single bone and has a relatively good prognosis following radiation therapy. We observed 17 histologically verified cases and found 97 cases in the literature. This rare tumour may occur at any time in adults and usually affects the metaphyses of long bones. It produces osteolytic changes and usually only mild periosteal reactions. Radiologically as well as histologically, differentiation from other highly malignant bone tumours is extremely difficult and sometimes impossible. A correct diagnosis can only be made from an accurate knowledge of the radiological appearances, localisation of the tumour and age of the patient.

Adolescent↗

PubMed1992

Polygonal triple osteotomy of the pelvis. A correction for dysplastic hip joints.

A new triple osteotomy, polygonal pelvic osteotomy (PPO), is described for use in dysplastic hips. The hip joint must be congruous with a centre-edge (CE) angle between +20 degrees and -10 degrees. Templates are used before and during operation which allow precise correction of the position of the acetabulum. The geometry of the osteotomy and a special compression plate achieve sufficient stability to permit early mobilisation. Surgery is indicated in adolescents and young adults if pain persists for at least two months. The surgical exposure, operative technique and postoperative management are presented, with the two-year results in nine cases.

Acetabulum↗

PubMed1991

Chiari pelvic osteotomy for osteoarthritis secondary to hip dysplasia. Indications and long-term results.

Of 142 Chiari pelvic osteotomies for osteoarthritis in dysplastic hips, most performed by Chiari himself, we were able to review 82 and obtain information about 18 by questionnaire. All patients were over 30 years of age at operation; follow-up averaged 15.5 years. Twenty hips had undergone secondary total hip replacement. The outcome was good in 75%, fair in 9% and poor in 16%. High osteotomies all gave good results, and the result also depended on adequate medialisation. Statistics were worse for patients over 44 years of age at the time of operation. For osteoarthritis secondary to hip dysplasia, the Chiari pelvic osteotomy is an alternative procedure to early hip replacement. In contrast to intertrochanteric osteotomy, it has the advantage of facilitating the implantation of an acetabular prosthesis should arthroplasty become necessary at a later stage.

Adult↗

PubMed1991

Chiari osteotomy for congenital dislocation and subluxation of the hip. Results after 20 to 34 years follow-up.

We reviewed 236 of the 388 Chiari pelvic osteotomies performed between 1953 and 1967 at the Orthopaedic University Clinic of Vienna for the treatment of congenital dislocation and subluxation of the hip. Over 90% of the operations were performed by Chiari himself. Twenty-one hips had needed reoperation after an average of 15.4 years; the other 215 hips had been followed up for 20 to 34 years (mean 24.8). The overall clinical results were excellent or good in 51.4%, fair in 29.8% and poor in 18.3%. The results were worse with increasing age at operation. The Trendelenburg sign improved only in patients aged seven or less at operation, and range of movement decreased in all cases. Subjectively poor results were seen in patients with pre-operative signs of osteoarthritis. Radiological loss of correction during follow-up was seen only in cases with incomplete primary correction. The addition of an intertrochanteric varus osteotomy in 36 cases did not achieve either better centering or better development of the acetabular roof. Degenerative changes increased significantly during the long-term follow-up, but their progress seemed to have been slowed down by the osteotomy in the younger age groups. Indications and contra-indications for the operation are discussed.

Adolescent↗

PubMed1988

[Sonography of the Achilles tendon and its bursa].

Pain and disturbed function in the sole of the foot leads to damage of the tendo Achilles and to abnormalities in its vicinity. They are frequent consequences of some sporting activities (jogging). Differentiation between bursitis, fat necrosis, degenerative changes in tendons and their rupture and from abnormalities of the ankle joint is important for treatment. In the symptomatic patients whom we examined, the bursa was involved in 72.9% and lesions of the tendo Achilles were found in 62.1%.

Achilles Tendon↗

PubMed1987

[Importance of the ossicle and therapy of Osgood-Schlatter disease].

If ossicles occur within the disease pattern of Osgood-Schlatter disease (apophysitis tibialis adolescentium) the duration of the complaints is usually extended to twice the normally expected period. Their shape and location influences the clinical course of the disease. Surgical removal of these ossifications is the therapy of choice if the complaints persist for a relatively long time. With regard to conservative treatment it has been shown on the basis of the duration of healing that functional therapy with an expansion of the ischiocrural musculature is preferable to immobilization of the joint. We consider functional treatment to be justified even if there is an increased formation of ossicles on non-immobilization of the joint, since such ossification occurs with only 20-25% of all cases of Osgood-Schlatter disease and the duration of the complaints is markedly less enhanced than with immobilization measures. As far as the sportsman is concerned, this entails only brief loss of training and the possibility to avoid muscular atrophy of the affected leg by means of physiotherapeutic exercise.

Adolescent↗

PubMedDate not supplied

[Periprosthetic femoral fractures in total hip prosthesis implantation. Functional and radiological comparison between plate osteosynthesis and proximal femur replacement].

AIM: Clinical and radiological examinations were performed to compare plate osteosynthesis (group 1) with replacement of the proximal femur by tumor prosthesis (group 2) in patients with ipsilateral femoral fractures around a hip prosthesis. METHOD: Of 24 consecutive patients with 25 fractures, nine had died and one could be contacted by telephone leaving 14 hips (in one case only recent X-rays were available) for final review (nine patients from group 1; five from group 2). RESULTS: At the time of examination four patients of group 1 were using one cane or were walking without any support, all patients of group 2 needed one or two crutches. In 5 of 9 patients in group 1 and in 4 of 5 in group 2 a firm fit of the prosthesis was observed. CONCLUSION: Group 1 achieved better clinical results in postoperative mobility, whereas femoral replacement showed better radiological results. Survival of patients with tumor prostheses was considerably superior to that of patients with plate osteosynthesis.

Activities of Daily Living↗

PubMedDate not supplied

[Cortical strut grafts, an alternative to conventional plating in periprosthetic fractures of the femur].

AIM: In periprosthetic fracture therapy plating has a failure rate between 30 to 50 %. Cortical allografts proved to unite constantly in revision surgery of the femoral shaft. The hypotheses to be answered in this study was whether the use of cortical allografts increases the success rate in contrast to plating. METHOD: A retrospective case control study has been done analysing the results in periprosthetic fractures of the femur around or below the tip of a stable femoral component (Vancouver B1, Mont III + IV). RESULTS: In 12 plating cases an average of 2.67 units of blood was transfused (0 - 6). In the follow-up two refractures, one loosening of the femoral component and one varus deformity greater than 10 degrees occurred. In 6 patients a total of 9 reoperations had to be done. According to the classification of Mont the results were excellent in 50 %, good in 16.7 % and poor in 33.3 %. 7 patients with strut grafts received an average of 1,43 units of blood transfused (0 - 3). In one patient with a 16 degrees varus deformity of the femur, due to multiple previous operations, a deformity of 21 degrees had to be accepted. Until now, no further operation had to be done in this group. The results were classified as excellent in 5 cases (71.4 %) and good in the other 2 (28,6 %). There was no poor result. The difference between the groups was statistically significant in the number of reoperations (p < 0. 05). CONCLUSION: In this study, with a low number so far, the strut graft group reached better results in every single variable, with a significant reduction of reoperations.

Aged↗

PubMedDate not supplied

[Osteosarcoma and Ewing's sarcoma--The most frequent malignant bone tumors in children--therapy and outcome].

BACKGROUND: Osteosarcoma and Ewing's sarcoma are the most frequent malignant bone tumors in children and young adults with relatively poor overall survival rates. METHODS: Between January 1980 and December 1994, 175 children with osteosarcoma and 64 children with Ewing's sarcoma were treated at the author's institution. 22 children had synchronous metastases, 19 patients had a pathologic fracture. Both groups were treated systemically with chemotherapy regimens (COSS and CESS). Local therapy was amputation or tumor resection and endoprosthetic replacement or biological reconstruction with wide or radical resection margins. In case of Ewing's sarcoma in 35 patients postoperative radiation therapy was done. RESULTS: Five-year overall survival rate for osteosarcoma and Ewing's sarcoma patients is about 63 %, ten-year survival rate for osteosarcoma patients is 60.2 %, for Ewing's sarcoma patients 54.5 %. Prognostic factors significantly influencing overall survival rates are tumor response to chemotherapy (p values = 0.0056 and 0.013, respectively), surgical treatment with adequate resection margins (p value = 0.0001 for osteosarcoma patients) and development of postoperative metastases (p value = 0.0001 for both groups). CONCLUSION: For both groups of malignant bone tumors systemic chemotherapy as well as adequate surgical therapy are necessary to reduce the rates of local recurrences and to achieve better survival rates.

Adolescent↗

PubMedDate not supplied

[Analysis of two different techniques of osteosynthesis in high tibial osteotomy].

AIM: High tibial osteotomy is an accepted method for varus osteoarthritis. This study intended to compare the technique of plate osteosynthesis with the technique of staple osteosynthesis, as a less invasive procedure. METHOD: 61 patients (65 knees) were included in this retrospective study evaluating the HSS score, patient's satisfaction, non weight bearing period, radiological stage of osteoarthritis, bone healing and complications after a follow up period of 5.7 (5 - 9) years. 26 patients (27 knees) were treated with plates and 37 patients (38 knees) with staples after osteotomy. RESULTS: Patients treated with plates showed 62.2 % excellent and good, 27.8 % moderate and poor results in the HSS score, 77.8 % were very satisfied and satisfied, 22.2 % less or not satisfied. Patients who received staple osteosynthesis showed 80.8% excellent and good, 19.2 % moderate and poor results in the HSS score and were very satisfied and satisfied in 86.9 %, less and nor satisfied in 13.1 %. The periods of non weight bearing and bone healing were slightly longer for patients treated with staples. There was no significant difference in complications. CONCLUSION: The data of the present study suggest that staples as a less invasive osteosynthesis after high tibial osteotomy seem to be justified compared to plate osteosynthesis having no significant difference in clinical results.

Aged↗

PubMedDate not supplied

[Surgical treatment of osteoid osteoma of the extremities].

AIM: It was the aim of this retrospective study to evaluate the frequency of recurrences and complications in patients treated by conventional surgical methods at our institution between 1980 and 1996 and to compare them to those observed in patients treated by minimal invasive methods reported in the literature. METHOD: 70 patients with osteoid osteomas located at the extremities were treated by conventional surgical treatment. 51 patients underwent curettage and 19 patients had en bloc resection. After curettage an additional stabilising plate was implanted in 12% of the cases, after en bloc resection in 68%. RESULTS: There are 66% event-free patients after curettage versus 47% after en bloc resection. Local recurrence rate after curettage was 7%, after en bloc resection no patient developed a recurrence. In both groups a postoperative fracture was observed. Persistent pain due to the implant was reported by 7% after curettage and by 24% after en bloc resection. CONCLUSION: The rate of complications rises with increasing invasiveness and it is necessary to balance the security concerning a local recurrence and the danger of persistent postoperative pain. Curettage is the surgical method of choice in the therapy of the osteoid osteoma, en bloc resection is justified only for recurrent lesions. Curettage is an alternative to minimal invasive methods in cases of superficially located osteoid osteomas or in cases of unfavourable locations of the nidus (near joint or growth plate, inaccessibility).

Austria↗

PubMedDate not supplied

[Percutaneous radio-frequency ablation (PRFA) in painful metastases involving bone].

AIM: The aim of the study was to determine the efficacy of PRFA in the palliative treatment of symptomatic bone metastases in regard to pain reduction, safety, and quality of life. METHOD: Over a period of 11 months, ten PRFA were performed in eight patients with painful metastases involving bone, where conventional treatment with radiation therapy, chemotherapy, and treatment with analgesics had failed to reduce the pain efficiently. Pain was measured with the visual analogue scale (VAS: 0 to 10) for the day and night before PRFA was performed, and daily for 7 days after release from the hospital via a dietary book, and at the follow-up periods of 1, 3, 6 weeks and 3 and 6 months after PRFA. Additionally, quality of life was self-assessed by the patient via the health surveys IQOLA SF-36 and EORTC QLQ-C30, and via the Karnofsky Performance Scale (KPS) by the physician at each follow-up. The patients' analgesics use was also recorded at the follow-up intervals and complications were monitored. Analysis of the primary end point was undertaken with paired comparison procedures. RESULTS: Under conventional therapy, pain was specified by the patients as VAS min of 4.1 and VAS max of 9.3. Due to PRFA a reduction of the preinterventional pain (VAS) from 7.4 (+/- 1.9 SD) and 5.0 (+/- 2.7 SD) for day and night, subsequently, to 1.8 (+/- 1.6 SD, minus 75 percent) and 0.7 (+/- 0.7 SD, minus 86 percent) was achieved within one day after admission to the hospital. This significant reduction did not change during the whole follow-up period, and was also reflected in the ability to reduce analgesics and in the improvement of specific domains of SF-36 and QLQ-C30. However, no significant change was detected in the summary scales for mental and physical health. No serious complications were observed. CONCLUSION: PRFA of symptomatic bone metastases is a safe technology to reduce pain intractable to conventional therapy, even in terminally ill patients.

Adult↗

PubMedDate not supplied

[The use of a rapid infusion system in orthopedics].

Major orthopedic surgery such as partial resection of the pelvis and subsequent implantation of a prosthesis is highly connected with massive bleeding. Therefore we tested the hypothesis that the use of a rapid infusion device, which was originally designed for liver transplantations, can prevent hypovolemic shock. We studied 20 patients: in one group (n = 10) the iv volume was given in a conventional way (37 degrees C) by use of pressure infusion bags. Patients of the second group (n = 10) received the iv volume via the Rapid Infusion system (Haemonetics Corp., Braintree, MA). We can conclude that with this new device for rapid volume replacement it is possible to keep the patient's vital functions stable even during times of excessive bleeding and to prevent from metabolic consequences following hypovolemic shock.

Adult↗

PubMedDate not supplied

[Surgical treatment of spinal metastases].

87 patients were treated for metastatic disease of the spine between 1970 and 1992. In the majority of the patients anterior decompression and stabilization was performed. The posterior approach was chosen only in case of predominant infiltration of the dorsal parts of the vertebra or in case of inaccessibility of the tumor via an anterior approach. The most common primary tumors were cancer of the breast, kidney and thyroid. Overall survival was 15.1 months. Only patients with metastases of thyroid cancer showed a statistically significant longer survival. Clinical results showed an improvement of pain in 83% and preoperative neurologic dysfunction could be improved in 53% of the patients. Our results suggest that surgical treatment improves life quality also in patients with short life expectancy. Patients who are expected to have longer survival times should be treated according to the general principles of stabilizing spine surgery.

Bone Plates↗

PubMedDate not supplied

[Salter's pelvic osteotomy in the treatment of congenital hip dislocation and hip dysplasia with special reference to pelvic tilt].

On the basis of 63 Salter pelvic osteotomies which were performed in 57 patients with congenital dislocation and subluxation of the hip between 1970 and 1986 at the Orthopaedic University Clinic of Vienna, we tried to work out the reasons for the rate of failures of 29% in our material. The mean age at operation was 4.1 years (1.5-18), that at follow up 15.7 years (4.6-28). We based our assessments on the clinical and radiological criteria of the Commission for the Study of Hip Dysplasia of the German Society of Orthopaedics and Traumatology. The number of failures at follow up (hip value III + IV) increased from 25%, if the operation was done before the age of four years, to 41%, if it was performed at a later age. In the latter group we were not able to observe any spontaneous improvement, which was typical for the younger age group. A moderately pathologic hip dysplasia (hip value III) could be improved to a normal value at follow up in 87%, an extremely pathologic one just in 50% of the cases. In just some of the patients we found postoperatively a tilt of the distal pelvic fragment, which could be registered by the oval shape of the foramen obturatum. Above all in young children a pelvic tilt was rare because of the elasticity of the triradiate cartilage. Out of 37 evaluable cases a tilt of the distal pelvic fragment by the operation could be verified in only 12 cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMedDate not supplied

[Clinical and radiologic comparison of "idiopathic" and "neurogenic" pes cavus].

41 patients with 66 cavus feet were reviewed clinically and radiologically according to the parameters of Dennemann at an average age of 41.3 years. The etiology was a so-called "idiopathic pes cavus" in 51 per cent of the cases, in the others, a neurological basic disease (15 per cent condition after poliomyelitis, 3 per cent meningocele, 6 per cent Friedreich's ataxia, 10.5 per cent other neurological disorders) or condition after congenital club foot or trauma. Exact neurological and electrodiagnostic examination of the cavus feet primarily staged as idiopathic revealed sensory or motor loss in 74 per cent of the cases. A comparison of the "idiopathic cavus feet" with the cavus feet in neurological basic diseases with respect to the radiological parameters showed no significant differences concerning progression and osteoarthritis. Conservative and surgical measures were carried out with roughly the same success. In 36 cases (55 per cent), however, complaints on the part of the ankle joint and the talo-calcaneonavicular joint and the metatarsal head were noted.

Adolescent↗

PubMedDate not supplied

[Radiologic measurement of the behavior of lumbar intervertebral disks in idiopathic scoliosis based on so-called "bending" images].

Total disc mobility, segmental mobility, both depending upon location of the disc and upon its position within the scoliotic curve as well as the opening angle of the disc in the ap x-ray were measured in the so-called "bending-test" x-rays of the lumbar curve of 40 patients with idiopathic scoliosis. The measurements showed a maximum of mobility in the segments L2/3, L3/4 and L4/5. In no direct dependence an increased mobility of the most proximal motion segment against the next lower one of the lumbar curve was found. No direct relation between lateral flexion and degree of scoliosis was measurable. Mobility towards the convexity increases directly with the opening angle of the disc concerned while mobility towards the concavity decreases; lateral flexion remains constant altogether. The results achieved might become quite relevant in connection with the possible therapeutic progress in the treatment of lumbar scoliosis with enzymatic dissolution of nucleus pulposus.

Adolescent↗