The authors describe a new method for measuring the flexibility of the shoulder. They have designed a device consisting of two electrical goniometers to measure the horizontal and the vertical position of the humerus. A computer registers these signals, calculates the region of mobility as a sperical segment centered to the shoulder joint (caput humeri). This region is displayed in a map, called arthrogram. Slightly modified, the arthrograph measures the rotation of the humerus and depicts the rotation angle into the map, at the site of the measurement. First results are reported. The procedure is reproducible with an error less than 5 degrees. Arthrograms of sound persons are compared to those of different pathological symptoms. Arthrograms show more information than single angular values. They can be viewed easily, e.g. to control the success of a treatment.

Biomechanical Phenomena↗

PubMedDate not supplied

[The treatment of congenital foot abnormalities].

With the exception of club foot, flat foot and claw foot, this paper gives a review of principal foot malformations at birth, proceeding from the available radiographical and clinical findings, and also from the facts found during surgery. In addition, there is suggested a classification of various deformities, and there are defined major guidelines and instructions for treatment. As far as the rather frequent polydactylies are concerned, the author distinguishes between a distal phalanx type, an interphalanx type, a proximal phalanx type, a metatarsal type and a tarsal type, depending on the "level", each, where distal/proximal web separation between the fingers stops. It is possible to include also rather particular forms, such as the rudimentary type and the so-called multiplications in this classification. The major indications for the surgical treatment of polydactylies are problems in finding adequate shoes, and also the aesthetic appearance. The principal concern of surgical treatment is to remove additional toes. When there is in parallel a syndactyly or a congenital hallux varus, this may require great skill in the applied surgical technique. Various approaches of surgical treatment are demonstrated by a few examples. Feet oligodactylies are primarily encountered with fibula dysplasia or aplasia, or in cleft feet. In very severe cases it is possible to find just one toe. The actual deformities alone rarely require surgical treatment, but they often "hint at" further malformations in the reach of the root of the foot (synostosis) and of the lower limb. Cleft feet are also frequently impaired in form and function, with these deformities including less severe hypoplasia of a middle toe, e. g. with a somewhat deeper web separation, toe aplasia, metatarsus hypoplasia and aplasia, synostosis, and transversal bones, and even monodactylies with only ray V existing. Additional toes in the cleft foot is one of the rare exceptions. However, the combination of cleft feet and cleft hands is rather frequently encountered. Many cleft feet are nevertheless highly efficient, even without any surgical treatment. That is why there are only indications for a surgical treatment when there are severe foot deformities or most inconvenient misalignments of peripheral toes. Some of the "lobster like" feet are so wide that it is just not possible to wear normal shoes. In this case it is recommended to have surgical correction and to close the cleft. Feet of congenital giant growth are extremely rare, but they raise most complex problems as to adequate treatment. In many cases, an amputation of the additional parts cannot be avoided.(ABSTRACT TRUNCATED AT 400 WORDS)

Child↗

PubMedDate not supplied

[Pollex flexus congenitus].

The authors report on the incidence, clinical picture, etiology, pathogenesis and treatment of congenital pollex flexus, and communicate the results of surgery on 52 thumbs. The permanent flexion anomaly in the interphalangeal joint and a hard, palpable knot in the long flexor tendon of the thumb over the metacarpophalangeal joint are typical for the deformity. Although these changes are sometimes observed immediately post partum, delayed diagnosis and treatment are more common. The hypothesis that it is a hereditary, endogenous condition is supported by observations in twins, relatively frequent bilateral occurrence and a high familial incidence. Constriction of the synovial sheath over the basal joint of the thumb is a key pathogenetic factor, although little is known about its causes; anatomical factors, influences affecting the growth of the sesamoid bones, and mechanical causes have been postulated. A more plausible hypothesis was first advanced by Jeannin. Like Hueston and Wilson 100 years later, he compared the tendon to a thick thread which had to be passed through a narrow eye of a needle: as a result, the "thread" would be frayed and compressed. The knot in the tendon is held to be a secondary phenomenon. The pathologicoanatomical picture varies. Lymphocyte and monocyte infiltration, and metaplasias to fiber cartilage have been detected in specimens excised from the tendon and the synovial sheath. However, pathologic changes have not been found in all cases. In the first year of life conservative therapy may be attempted, with temporary splinting of the thumb following manual correction of the flexion anomaly in the interphalangeal joint.(ABSTRACT TRUNCATED AT 250 WORDS)

Child↗

PubMedDate not supplied

[Hallux varus congenitus in polydactyly patients].

The authors report on experience gained in the surgical treatment of eight patients with congenital hallux varus associated with polydactyly of the big toe. Aside from a description of the "radiological anatomy", the paper focuses in particular on the intraoperative soft tissue findings. In addition to the supernumerary bone structures, muscle and tendon anomalies were found in all the patients. In four patients the cause of the varus malposition was found to be fibrous stands extending from the rudimentary big toe to the tarsus. In five patients the abductor hallucis muscle was found to be shortened. An analysis of the surgical results shows that these soft tissue changes must be taken into account during surgery. In addition to complete removal of the polydactylic supernumerary, fibrous strands must be resected and shortened muscles severed or elongated. In many cases, operations on the basal joint capsule and plastic surgery are also necessary.

Abnormalities, Multiple↗

PubMedDate not supplied

[The value of the anamnesis for the probability diagnosis of shoulder pain].

The response to pain of the shoulder in different diseases and injuries in this joint is uniform and this is of very little help in recognizing the cause. A detailed case history is useful in delineating the differential diagnosis. We have therefore developed a questionnaire consisting of 55 specifically aimed questions to these case histories. The acquired information was specifically rated for the 24 most frequent shoulderillnesses/injuries, and integrated in a computer program. In 55.4% of the cases the computer predicted the correct diagnosis and in 80% of the cases the right diagnosis was suggested amongst the first 3 preferences of the differential diagnosis.

Diagnosis, Computer-Assisted↗

PubMedDate not supplied

[Problems in the surgical treatment of congenital pseudarthrosis of the lower leg].

The principal aim of this study was to describe the frequent errors that are being committed when treating congenital pseudarthroses of the lower leg. The authors studied this in 25 patients. 21 of these were referred to surgery, whereas 4 were presented by colleagues seeking counsel and were then subjected to further treatment at another location. One-half of the 21 congenital pseudarthroses had already been unsuccessfully operated on in other hospitals up to as often as four times. The method of "combined plate osteosynthesis" was employed with 19 of the 21 patients; this method was originally developed by W. Blauth and used for the first time in 1969. Witt and Refior reported on a similar technique at about the same time and independently thereof. 17 of our patients were cured; 2 failures cannot be blamed on the method. The main procedural error in the previously operated patients had been a misjudgement of the disease pattern which is characterised by "biological deficiency" and lack of load-bearing capacity of the bones of the lower leg in a circumscribed region at the transition from the median to the lower third of the lower leg. Another important factor was certainly the lack of knowledge of the pathogenetic significance of the pathologically affected periosteum. In this connection the failures were certainly also conditioned by faulty osteosyntheses resulting therefrom, without using autologous osseous material for grafting; by operating too early; by immobilising the limbs postoperatively for too short a period; and by insufficient relief of the limbs before a patent medullary cavity had formed. Another error consisted in omitting to perform autologous bone chip implantation at the same time when removing osteosynthesis material. The authors conclude that congenital pseudoarthroses of the lower leg can in all probability be remedied already in early childhood if the well-tried principles of treatment of "combined plate osteosynthesis" are observed. This, however will not result in normal lower leg bones, as can be concluded from the fact that spontaneous fractures have occurred partly even in the locomotor apparatus after the pseudarthroses had healed. In future, petiolated bone grafts performed by microsurgeons should be promising and competitive. Küntscher nail osteosyntheses should also offer good chances of healing if performed from the site of the sole. Their main drawbacks might be damage of the distal tibial epiphysis and of the functions of the ankle joint and talo-calcaneonavicular joint.

Adolescent↗

PubMedDate not supplied

[Surgical treatment of isolated, congenital radio-ulnar synostoses].

The form of surgical treatment mainly considered for treatment of radioulnar synostoses is corrective osteotomy of severe malpositions of the forearm. Opinions as to the indications for such surgery range from complete rejection to regular application in cases with pronounced contractures. In the present article, the authors consider solely isolated congenital radioulnar synostoses, referring to 40 cases in 30 patients. In 13 cases the condition was bilateral. Roentgenologically, four degrees of severity may be distinguished: in the mildest form, there are only dysplasias in the proximal radioulnar joint. Second-degree malformation is characterized by synostoses exclusively in the proximal radioulnar joint. In third-degree synostoses the bony bridges extend farther distalward. In the rare fourth-degree form of the anomaly, complete or almost complete bridges are found between the two forearm bones. On the basis of the clinical findings, the authors give their views on the question of corrective surgery, the key factor being findings deriving from carefully conducted physiotherapeutic and ergotherapeutic function tests. In view of the fact that even in cases of pronounced bilateral contracture most actions are accomplished by compensatory movement of the shoulder and wrist joints, and considering the relatively high complication rates reported in the literature, the authors are in principle against surgery. If, in exceptional cases with extreme malposition, correction is nevertheless considered following thorough function testing, 30-40 degrees pronation of the forearm on the dominant side and slight supination on the non-dominant side are recommended.

Adolescent↗

PubMedDate not supplied

[Enchondromatoses of the hand].

In the introduction the authors report on the suspected theories of origin of the enchondromas: some believe that they are the result of disintegration of islands of cartilage from the epiphyseal growth cartilage, while in the opinion of others they are brought about by disturbances of blood supply in the metaphyseal vessels during enchondral growth. No evidence of heredity has yet been established. Surgical treatment and late results are described taking the course of disease of a patient who is now 33 years old as an example. This patient had grotesque tumors on both hands; the tumors not only disfigured the limbs but also constituted a functional handicap. Surgery was indicated for both esthetic and functional reasons. For large tumors, with destruction of the substantia corticalis or regions close to the joint, cross-section or segmental resection is given as the therapy of choice, and if possible segmental resection is to be preferred, filling the defect with loosely emplaced autologous spongiosa. After this procedure the hand does not have to be immobilized for as long as after a cross-section. In this patient, after a total of 16 procedures on both hands, there have been no recurrences in the ten years of the follow-up period. The same applies to two other patients with multiple enchondromas (which were admittedly less severe) who were followed up between 3 and just under 8 years after surgery. It is stressed that growing tumors which disturb the function or appearance of the hand should be surgically treated in childhood, but that by no means every enchondroma seen in enchondromatosis requires such therapy.

Adult↗

PubMedDate not supplied

[Our knee joint prostheses with patellar replacement].

In the 13 years since the first Blauth total knee joint replacement was implanted, in August 1972, it has proved highly successful. This is borne out by the results of a prospective long-term study. Out of 488 patients who had been provided with such a prosthesis up to the beginning of 1984, 398, or 82%, were included in the study. Sixty patients had meanwhile died, and 24 could not be contacted. Six prostheses had to be removed. The follow-up quota of the surviving patients corresponded to 94%. The mean duration of observation was 40 months, with a minimum of 12 and a maximum of 144 months. Of the patients, 35% suffered from rheumatoid polyarthritis, and 61% from gonarthrosis. The mean postoperative flexion and extension values were 98-3-0 degrees. About 10% of the patients still claimed to suffer appreciable pain when starting to move and when bearing weight, as compared to approx. 95% preoperatively. Severe complications were 9 deep infections (2.3%) and 5 cases of aseptic loosenings (1.3%). There were no stress fractures or breakages of the prosthesis material in the patients follow up. A retropatellar pain syndrome was found in 8.3% of the patients, i.e., definite pain when standing up, on stairs, or when starting to move. For this reason the original design of the prosthesis was developed further and complemented, inter alia, by an artificial patella. The principal modifications are as follows: -The femoral section was given a concave shape in the sliding bearing of the kneecap and elongated proximally.(ABSTRACT TRUNCATED AT 250 WORDS)

Arthritis, Rheumatoid↗

PubMedDate not supplied

[Frontal talus cleft--talus bipartitus].

To our knowledge, only three patients with a frontal split of the talus have been reported so far. We report on a sixteen year old patient who had some discomfort and restriction of movement in the ankle joint. X-ray examination showed an articular link between the ankle and subtalar joint. As regards the etiology, trauma, avascular necrosis, accessory bones and abnormal ossification were not evident. With respect to the phylogenesis of the foot skeleton, the frontal split of the talus may represent an atavistic malformation of the human foot. This is in contrast to the current hypothesis of a duplicated ossification in the talus.

Adolescent↗