Biomedical subjects
W Blauth
Publications and source records attributed to W Blauth.
[Cleft foot with Y-shaped deformity of the third metatarsus. A case history.].
GOAL OF SURGERY: Correction of the deformity of the third metatarsus and of the malposition of the toes to improve form and function of the foot. INDICATIONS: Problems with shoe wear. Aesthetic appearance. (Limitation of function.) CONTRAINDICATIONS: None. PREOPERATIVE WORK UP: Drawing of surgery to be performed. POSITIONING AND ANAESTHESIA: Supine. General anaesthesia. SURGICAL TECHNIQUE: Excision of the distal half of the hypoplastic second metatarsus through a curvilinear dorsal incision. Osteotomy of the third metatarsus at the Y-junction and implantation of the mediodistal part into the proximal half of the second metatarsus. Corrective osteotomy of the third metatarsus at the Y-junction. Internal fixation of both metatarsi with transosseous, transarticular Kirschner wires. Four weeks later correction of the hallux valgus using the technique recommended by Kramer. POSTOPERATIVE MANAGEMENT: Below knee plaster of Paris. Removal of K'wires after consolidation of osteotomies. Progressive increase in weight bearing. Arch supports. POSSIBLE COMPLICATIONS: Injury to nerves, vessels or tendons. Wound infection. Delayed consolidation. Nonunion. Growth disturbances. RESULTS: 30 months postoperatively, when the patient was 13 years of age, both osteotomies had healed in good position: the foot looked nearly normal. At 21 years of age the patient has no problems. She is involved in sports and is satisfied with the result.
[A new motorized dynamic splint for the hip joint].
The authors present a new mechanical exercise splint for the hip. The appliance carries out movements in three dimensions and is used early in the postoperative period following surgical treatment of the hip and surrounding structures for continuous passive motion (CPM) treatment. When the hip is flexed, the knee bends at the same time. It is possible, however, for the part of the leg cradle that holds the lower leg to be locked in the extended position to avoid any problems for patients with arthrodesis in the knee. It is also advisable for knee movement to be blocked when the patient does exercises involving spreading and closing of the legs and inward and outward rotation. In this case the leg concerned should be bent about 10 degrees at the hip to avoid friction losses against sheets and mattress. The main indications for use of the new splint are internal fixation following acetabular fractures, periacetabular fractures, dislocation, joint fractures with dislocation of the same joint and fractures or pseudarthrosis at the upper end of the femur. Other appropriate forms of treatment are synovectomy, surgery to improve the form of the cup, including pelvic osteotomy, all kinds of transformation osteotomy, especially for hip necrosis or osteochondrosis dissecans, soft tissue surgery such as capsulotomy, tenotomy or resection following ectopic bone formation and flaccid paralysis.(ABSTRACT TRUNCATED AT 250 WORDS)
[Motion characteristics of motorized knee splints].
The authors have tested the qualities of eight different motor devices. The following aspects were examined: Correspondence between motion of the motor device and of the limb placed on it. Actual transformation of the range of motion set on the motor device onto the knee joint. Changes in contact forces of the limb during passive motion. With aid of a special measuring device the X- and Y-coordinates of hip-, knee- and ankle joints of the probationer and the motor device are determined. From these coordinates the distances between the centres of rotation of hip-, knee- and ankle joint of the motor device and of the probationer are calculated; so are the degrees of hip- and knee flexion of the motor device and of the limb. For better representation and comparison of the results the authors introduce the notion of the "device quotient" (DQ). This value states which percentage of the amplitude of motion of the motor device is transformed onto the limb and at the same time takes into account the differences of centres of rotation between device and limb. The bigger DQ the better the congruence of device- and limb motion. Only two of the eight examined motor devices guarantee a next to harmonic motion (DQ of 65 to 100 for the knee and 27 to 63 for the hip). They differ from the other devices in that they have the possibility to adjust the centre of rotation of the hip joint to the anatomic centre of rotation of the hip.(ABSTRACT TRUNCATED AT 250 WORDS)
The surgical treatment of partial tibial deficiency and ankle diastasis.
In cases of congenital partial tibial aplasia or so-called diastases of the lower leg, very good results are to be expected from tibia/fibula fusion in association with a repositioning of the foot. Form and function of the limb are significantly improved, with ortho-prosthetic fitting being considerably facilitated.
[Hinge endoprosthesis of the knee joint. Long-term results based on the Blauth prosthesis].
Knee prostheses of the condylar or hinge type have constructional features that have both advantages and disadvantages. Both types are compromises as a result of different demands. Here we report long-term results with the Blauth prosthesis as an example of the efficiency of the hinge concept. The Blauth prosthesis is constructed according to the low-friction principle without a weight-bearing axis. Load transmission to the bone is accomplished by large interface areas. The sliding bearing of the patella is oriented perpendicular to the transverse axis of rotation. A prospective multicentric study reports on 511 prosthesis with a follow-up between 1 and 15 years. Aseptic loosenings were confirmed in 1.2% of the patients, deep infections in 3.3%. The survival analysis showed a probability of 89% that a prosthesis would not have a deep infection or loosen. A hinged knee prosthesis shows positive long-term results even compared with the condylar types if the relevant principles of construction are adequately considered.
[Postoperative results of arthrography following suturing of ruptured rotator cuff].
The authors examined 41 shoulder joints by arthrography after the patients had undergone surgery for rotator cuff tears. In 26 cases the arthrographic findings were negative; that is to say the region of the tendon suture was tightly closed. In 10 of these 26 cases the underside of the rotator cuff had a rather irregular border. The arthrograms were positive for 12 of the other 15 patients who had undergone surgery. In 3 cases contrast medium leakage into tendinous tissue on the joint side was seen. The postoperative results, ascertained with reference to the assessment guidelines proposed by Neer and Patte, were largely unrelated to the arthrographic findings. In patients with contrast medium leakage from the rotator cuff only the muscular strength was slightly reduced. There was no correlation with the clinical symptoms. In the comparison of all patients who had undergone postoperative arthrography with the total study population a lower number in the index was striking. It may be that patients with symptoms persisting after surgery were more prepared to undergo control arthrography.
[Arthrolysis of the knee joint].
This publication consists of two parts, the first of which is concerned with the definition of arthrolysis as a mere soft tissue procedure. This is delineated from arthroplasty. In the second part, arthrolysis results are presented. Three different means of treatment are possible for knee joint stiffness: manual joint mobilization under anaesthesia, arthroscopic operation, and "open" arthrolysis. The authors concentrate on the third type of treatment because of the great amount of long-term experience they have made. In the majority of cases knee joint stiffness is caused by immobilization and posttraumatic and postoperative effects on the joint itself or in the area of the joint. Morphological findings are intraarticular adhesions in the recessus, as well as between the joint surfaces, retraction of the capsular-ligament system, and extra-articularly located impediments caused by shrinkage and scars in the muscles, tendons, and sliding laminas of the soft tissue. Open arthrolysis is indicated after failure of conservative treatment and in cases of severe stiffness of the knee joint. For operative arthrolysis many requirements must be met, which are specified in detail. The preoperative information about the treatment given to the patient is of particular interest. The operative methods, including postoperative management, are described only briefly, because the presentation of the results is the main purpose of this paper. Eighty-five patients (94%) who underwent open arthrolysis were personally examined. Information about the other patients was obtained from medical records such as the examination at discharge or the last presentation in the outpatient clinic. The average follow-up time was 5 years and 4 months ranging from 6 months to 14.25 years. The results are differentiated in many respects whereas the so-called relative improvement of joint mobility following an operation is of main interest. Well-defined criteria have been published and were applied. The results are listed according to the severity of joint stiffness. Four grades of joint stiffness are created, ranging from grade IV, the most severe form with a preoperative maximum of joint mobility of 30 degrees, to grade I with a maximum of 90 degrees joint mobility. In all, operative procedures led to an improvement in nearly 100% compared to the preoperative findings. The results are presented in relation to age, operative methods, previous operations, and different stages during the follow-up.
[Sense and nonsense of knee orthosis].
The trend for early mobility after surgical treatment of knee joint ligament injuries has led to the production of a large number of different braces in recent years. To allow an approximation of the very complex motion of the human knee, the use of braces with so-called physiological hinges has been recommended in the last few years. The authors report on a group of 50 patients who had sustained injuries to the cruciate ligament and had received IOWA knee braces following surgical treatment, the fit being subsequently checked by X-ray. These checks clearly demonstrated that the hinge of the brace hardly coincides with the knee axes and that there were deviations ranging from 1 to 4 cm. The authors therefore come to the conclusion that brace-fit must be checked by X-ray in all cases and that incorrectly fitted braces should be corrected before use. There is so far no evidence that so-called physiological hinges are really superior to braces with single axes. The current trends and developments cannot really be justified as long as there is no guarantee that the axes of brace and human knee coincide both in motion and during weight-bearing.
Cleft feet. Proposals for a new classification based on roentgenographic morphology.
The authors studied 45 cleft feet from among their patients and 128 from the literature with regard to their roentgenographic morphology. An increasing degree of malformation was found, from deepening of a central interdigital commissure to a monodactylous cleft foot. These observations resulted in a classification of six groups based on the number of metatarsal bones. Types I and II are cleft feet with minor deficiencies, both having five metatarsals. The metatarsals are all normal in Type I and partially hypoplastic in Type II. As the degree of malformation increases, only four metatarsals in Type III, three metatarsals in Type IV, and two metatarsals in Type V can be identified. Type VI represents the monodactylous cleft foot. Of the 173 feet studied, 166 could be assigned to one of these types. Two additional forms were also found: four cleft feet with central polydactyly are described as polydactylous type, and three monodactylous feet with lower-leg diastasis or tibial aplasia or both are described as diastatic type. According to the distribution of syndactylies, synostoses, and aplasias, it became evident that cleft formation begins at the second or third ray. It then proceeds in a longitudinal direction from distal to proximal as well as in a transverse direction from tibial to fibular, while the first ray remains intact. The first ray is only missing in the monodactylous cleft foot, which possesses only the fifth ray. The defects are always larger distally than proximally. Synostoses are found only at the margin of the cleft. Cross-bones are rare and usually occur in mild cases of the deformity. Another rare feature is polydactyly.(ABSTRACT TRUNCATED AT 250 WORDS)
Are unconstrained components essential in total knee arthroplasty? Long-term results of the Blauth knee prosthesis.
For 17 years, the Blauth total knee prosthesis has been implanted with its basic constructional features remaining unchanged. While it is true that the prosthetic components are constrained by a mechanical hinge, load transmission is actually effected in accordance with the low-friction principle through the cup-shaped condylar surfaces. Packing of the prosthesis in the bone is ensured by large load-bearing surfaces and by specific elements intended for rotational stability. In a comprehensive follow-up review, 497 implants were studied over a period of one to 15 years (average, 45 months). Aseptic loosening occurred in only 1.2% of the prostheses, and deep infection was found in 3% of the patients in the follow-up review. According to survival statistics, the probability of finding prostheses without deep infection or loosening after more than ten years is 89%. The efficiency of total knee arthroplasty (TKA) by hinged prostheses should therefore not be judged by the results obtained with the pioneer implants, which date back to the beginnings of TKA. The clinical results obtained clearly demonstrate that there is 90 degrees knee flexion in more than 88% of the implants. A subjective appraisal demonstrated substantially less pain compared with the preoperative findings. Problems originating from the patella were recorded in less than 10%. However, in 1985, an improved prosthetic design was introduced that also provided for the replacement of the posterior surface of the patella and for a proximally extended patellar bearing. The position of the hinge and implant packing remained unchanged. The results obtained so far with the modified prosthetic design are very good.
[Sudeck syndrome of the hand. Historical review, treatment concept and results].
The literature on the etiology, pathogenesis, and therapy of Sudeck's atrophy is reviewed. The authors present their treatment regimen for reflex dystrophic hands that has been used successfully for more than twenty years. This program consists of a combination including drugs as well as physical and occupational therapy. Patients have to be guided psychologically. In-patient treatment is preferred. The ultimate aim of therapy is to restore the functional integrity of the affected hand. The choice of therapy depends on the stage of the disease. Removing pain and edema is the most important aim in stage I. This is achieved by immobilization of the affected extremity in an upward position, cooling the hand with ice, and careful physiotherapy supported by antiphlogistic drugs. In stage II the physiotherapy has to be intensified and should be supplemented by special balneologic (bathing) measures and functional splints. The ipsilateral shoulder can be affected and has to be treated adequately. In stage III additional surgical treatment might be helpful such as arthrolysis, arthroplasty, or arthrodesis of finger joints. The authors report on their results in seventy-seven dystrophic hands in a long-term follow-up between one and fourteen years. The results depend on the begin of the treatment in the different stages of the disease. Eighty-three percent of the patients were cured in stage I, only thirty-one percent in stage II, and no patient in stage III. The authors' experience using Calcitone shows that it has no influence on the functional results. Comparing their results to those obtained by others, the authors conclude that physical and occupational therapy are decisive in dealing with dystrophic hands.
Classification of polydactyly of the hands and feet.
The authors present a new classification of polydactyly based on radiomorphological alterations. The malformations are defined in two directions, as in a system of coordinates. The longitudinal arrangement is based on the pathogenetic principle of bifurcation of a finger or a toe ray from distal to proximal. We accordingly divided polydactylies into five types: distal phalanx, middle phalanx, proximal phalanx, metacarpal or metatarsal, carpal or tarsal. The transverse arrangement indicates which rays are involved. All polydactylies, including the special forms such as rudimentary manifestations, triphalangism, and multiple duplications, can be incorporated into this simple basic scheme. Depending on their characteristics, the special forms are further subdivided, e.g., into a distal or proximal phalanx type with simple or double triphalangism, or a tarsal type with third-degree duplication and first-degree aplasia. Numerous radiological examples and schematic drawings illustrate the classification. The advantage of the classification is that it depends exclusively upon the skeletal finding and all manifestations are registered according to a simple scheme longitudinally and transversely. This makes them codifiable for the computer and suitable for multicenter studies. The special forms, the rudiment, triphalangism, and multiple duplication, can easily be further subclassified. Moreover, the nomenclature is simple and is oriented to anatomical terminology.