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PubMed1978

The effect of electric fields on osteoporosis of disuse.

An experiment originally done by McElhaney et al. was repeated to obtain additional information about the effects of electrical fields on osteoporosis of disuse. The right femurs of 35 male rats were immobilized in plaster casts. Sixteen rats were treated with transcutaneous electrical fields of 30 Hz and approximately 100 V/cm for periods of 2 or 8 h a day. While the right femurs of the untreated rats were found to be atrophic with respect to the opposite limb, in the treated rats the immobilized femur was made larger than the opposite bone. Longer daily treatments exaggerated this effect. The tumors found in the previous study were not seen in our experiments. Other similarities and differences in the 2 studies are discussed.

Animals↗

PubMed1993

[The interrelationships between dental parameters and electronic axiographic findings. A study on subjects with nonphysiological incisor relations].

The purpose of the present study was to discern possible relationships between dental parameters and the horizontal inclination of the condyle path. Two test groups of orthodontically untreated individuals with non-physiological incisor relationships, one group with enlarged and the other with reverse overjet, were selected for the study. An opto-electronic apparatus was employed to measure the horizontal inclination of the condyle path. The dental parameters were set by clinical examination and by measuring plaster casts. Both groups exhibited significant distribution deviations in the inclination of the condyle path and in the following parameters: "occlusal contacts of the front teeth during protrusion", "overbite", "resulting overjet", and "sagittal and vertical distance of the incisal edge of the lower incisors to the zero point of the upper incisors". Statistically no correlation between the dental parameters and the inclination of the condyle path was discerned. The influence of muscular guidance is in large measure the determining factor for the large variations in the TMJ registrations, and especially in their quantitative evaluation. The results were the same even when tracings were repeated a number of times with the same patient.

Adult↗

PubMed1989

[Findings in the main developmental stages of the bite in dysgnathic patients].

In this study dental plaster casts of 31 male and 45 female subjects were measured using the Berlin measurement system and evaluated with the aid of a computer. The parameters of subjects with class III malocclusion, crossbite, open bite and class II/1 malocclusion were compared. The changes were studied longitudinally in the main developmental stages, namely the deciduous, mixed and permanent dentitions. Significant differences were found also following treatment between the malocclusion groups.

Child↗

PubMed1992

[The functional treatment of deep bite--the results of a long-term study].

The amount of overbite reduction and the stability of the results three to 14.5 years post-retention were analysed in a follow-up study of 60 patients who had been treated with functional appliances. To establish therapeutic and posttherapeutic changes in dento-facial relationships, plaster casts and lateral cephalograms were evaluated at the beginning, at the end of treatment and at the follow-up examination. Posttherapeutic deepening of the overbite (> 0.8 mm) was found in 54.2% of the cases, while overbite reduction remained stable in 39%. A number of skeletal and dental factors were found to be involved in overbite reduction and posttreatment deepening. In this connection, changes in the ML-NSL angle, the ML-NL angle and the gonion angle were found to be just as important as the therapeutic and posttherapeutic changes in anterior and posterior facial height and changes in the skeletal pattern. It is emphasized that strict application of retention is of the greatest importance to minimize vertical relapse.

Adolescent↗

PubMed1992

[The orthodontic treatment of deep bite in adults--a comparison of the straight-wire appliance and the segmented arch technic].

The purpose of the study was to analyse and compare deep overbite correction in adult patients carried out by a straight wire appliance and the segmented arch technique as recommended by Burstone. The sample comprised 50 adult, deep bite patients, 25 each treated with straight wire appliance and segmented arch technique. Plaster casts and lateral cephalograms made before and immediately after finishing treatment were analysed. Both techniques were successful in overbite correction; overbite reduction amounted to 3 to 3.5 mm. The straight wire appliance group demonstrated predominantly molar extrusion and as a result posterior mandibular rotation. A slight intrusion of 1 mm was seen in the lower incisor area. The segmented arch technique resulted in an incisor intrusion of 1.5 mm in the upper and 1.7 mm in the lower jaw. No substantiate extrusion in the molar area was found. The advantages of this technique are discussed.

Adult↗

PubMed1993

[The accuracy of holograms compared to other model measurements].

Because holograms are easy to deal with, and because their information content is especially high, they will potentially play a much larger role in the future. In this study plaster casts were placed in a measuring device fabricated in our department, measured by means of a laser beam, and then the accuracy of these measurements was compared to hologram measurements taken by means of a sliding caliper. The result was that the computer-guided hologram measurements evidenced no significant differences with the measurements with a laser beam. The hologram measurements, which are regarded as having an accuracy of 0.182 mm, should therefore be significantly superior to sliding caliper measurements. When measuring the mesiodistal width of teeth, the caliper yields a pseudo-accuracy which doesn't correspond to the factual conditions. When defining the Z-coordinates, the sliding caliper's measuring deficiencies are easily circumvented, but this does not automatically imply a higher degree of accuracy.

Dental Occlusion↗

PubMed1981

Immobilization osteoporosis and active vitamin D: effect of active vitamin D analogs on the development of immobilization osteoporosis in rats.

The therapeutic effects of vitamin D analogs, 1,24(R)-dihydroxycholecalciferol [1,24(R)-(OH)2D3], 1,24(S)-dihydroxycholecalciferol [1,24-(S)(OH)2D3], and 1,25-dihydroxycholecalciferol [1,25(OH)2D3] on immobilization osteoporosis were studied in rats. The right hind limb was immobilized through application of a plaster cast following the section of the sciatic nerve. The left hind limb was intact. Vitamin D analogs were orally administered for 6 weeks at dose levels of 0.02 and 0.10 micrograms/kg/day, respectively. The mean lengths of the immobilized femurs were not significantly different from those of the intact femurs in all the experimental groups. In the immobilized femur of animals treated with 1,24(R)(OH)2D3, 0.10 micrograms/kg, dry and ash weights were heavier and calcium and phosphorus contents greater than those in the nontreated group. Furthermore, the amount of calcified bone mass and the cortical thickness of the femurs of the immobilized limb in 1,24(OH)2D3-treated animals were greater than those in the nontreated animals. Treatment with 1,25(OH)2D3 at 0.10 micrograms/kg caused an increase of the bone mass in both immobilized and intact femurs when compared with those of the control group. It was concluded that the administration of 1,24(R)(OH)2D3 diminished the effect of immobilization in the development of osteoporosis without any side effects.

Animals↗

PubMed1994

Early and late displacement of fractures of the distal radius. The prediction of instability.

One hundred fractures of the distal radius with dorsal displacement were treated by closed reduction and a plaster cast. The mean age of the patients was 55 years. Radiographs were taken after 1, 2 and 5 weeks to evaluate the frequency of early and late displacement. Dorsal angulation occurred in 71 patients, shortening of the radius in 47 and flattening of the radial angle in 32. Late displacement was more frequent than early. Statistical analysis showed a greater incidence of secondary shortening in Older's types III and IV fractures. The severity of the initial radial shortening was the most reliable indication of instability.

Chi-Square Distribution↗

PubMed1994

Sagittal fracture of the second cervical vertebral body.

We describe a patient with a sagittal fracture of the second cervical vertebral without neurological involvement. The mechanism is likely to be axial compression and lateral displacement. The fracture was treated in a Minerva plaster cast.

Adolescent↗

PubMed1982

[Injuries in the Lisfranc joint (author's transl)].

132 injuries of the Lisfranc joint were reviewed in order to show methods of diagnosis and treatment. Injuries of this joint are rare. Almost one third are open fractures and/or dislocations, mostly comminuted lesions, associated with severe soft tissue trauma and so decreasing blood supply of the foot. Most dislocations and fractures can be treated conservatively by closed reductions and following fixation by means of Kirschner wires. In cases of minimal or moderate displacement closed reduction and plaster cast proved to be sufficient. Some cases of severely dislocated fractures or fracture dislocations need open reduction. Closed reduction should never be done when it probably disrupts the blood supply and so causes ischaemia. The methods of conservative or surgical treatment should guarantee best reduction and optimal stability of weight bearing areas of the foot. Operative treatment to achieve accurate reductions does not have definite advantages over conservative methods. Open reduction is recommended in all cases of delayed treatment, if blood supply is intact and the patient is young. Inveterate cases with poor results require special shoes or an orthosis and only sometimes osteotomies and other reconstructive operations.

Adolescent↗

PubMed1982

[Post-traumatic hemarthrosis of the knee joint--determination of the cause by arthroscopy (author's transl)].

Between December 1977 and February 1981, a series of 70 patients was examined because of an unclear hemarthrosis, the source of hemorrhage was determined by arthroscopy. In our opinion a hemarthros of the knee joint is not clear if the lateral ligaments are stable, no drawer can be loosened at an angle of 90 degrees, and if the X-ray radiograph does not clearly show a fresh fracture. In most cases, the symptom of uncertain hemarthros was provoked by a banal trauma hardly to reconstruct. Due to the violent pain caused by the thick effusion, the patients consulted the doctor early and had partly been pre-examined by several doctors. In all cases, the joint was described to possess stable ligaments and X-ray examination did not show any clear fracture sign. The thorough examination under anesthesia made by the author resulted in a suspicion of a ligament in 43% of the examined joints, however, the subsequent arthroscopy showed a rupture of the anterior cruciate ligament in 70%. A cartilage/bone lesion was found in 30%, a rupture of the posterior cruciate ligament, however, only in 5,7%. In two cases (3%), the hemorrhage was caused by a fatty body lesion or the rupture of an adhesion. In 41% of the patients we found severe combined lesions of the anterior cruciate ligament and the meniscus or cartilage lesions. In 56 patients, i.e. 80%, the lesion was so severe that they had to be treated by surgery. In 11%, we thought an immobilization by plaster cast to be sufficient. Only six patients i.e. 9%, had neither to be operated nor immobilized. The hemarthros of the knee joint which occurs even after small accidents is caused by severe inner lesions of ligaments and cartilages. In more than 50% of all cases, these lesions cannot be diagnosed even by careful clinical examination under anesthesia and special X-ray examination methods. With adequate skill and experience, however, arthroscopy allows an exact diagnosis in almost 100% of all cases. It is therefore the patient's interest to clarify by arthroscopy every case of unclear hemarthrosis.

Adolescent↗

PubMed1982

[Results after surgical treatment of acute injuries to the lateral ligament of the ankle (author's transl)].

105 patients with acute injuries of the fibular collateral ligament were treated surgically. Diagnoses and following treatment were based on X-rays in stressed positions (talar tilt and anterior drawer sign) compared with the other side. More than fifty percent were athletic injuries. After surgical treatment patients wore a below-knee plaster cast for 6 weeks. 90 patients were seen after an average interval of 24 months; another 7 were assessed on the basis of patient's judgement. In 7 cases the X-ray control showed some instability (talar tilt greater than 5 degree and anterior drawer sign greater than 2mm). At physical examination we found in some cases minor differences in mobility, swelling and pain. 14 patients showed hypesthesia on the lateral side of the dorsum of the foot. No patient had to give up his sport activities due to the ligamentous injury, 89 (97 were asked) were content with the result.

Adult↗

PubMed1990

[New viewpoints on the clinical picture, diagnosis and pathophysiology of reflex sympathetic dystrophy (Sudeck's disease)].

Reflex sympathetic dystrophy can be elicited by various factors (e. g. trauma, herpes zoster, myocardial infarction). Independent of kind and site of a lesion, symptoms occur most often in the whole distal part of the affected extremity. There in most cases, a triad of autonomic, motor and sensory disturbances can be found clinically. For early diagnosis--beside clinical investigation--a comparative measurement of skin temperatures on both sides of finger or toe tips, respectively, is recommended. Hereby the clinical finding of a warmer or colder extremity can be proved, which supplies evidence of a disturbed skin blood flow. In case, the above mentioned triad and a disturbance of skin circulation is found, diagnosis of sympathetic reflex dystrophy can be made with great certainty. With regard to the underlying pathophysiology, symptoms can be explained at this time satisfactory only by the assumption of a vicious circle. Starting from a painful event (e.g. trauma, mark in a plaster cast, nerve lesion or myocardial infarction) a functional disturbance of the sympathetic nervous system is initiated. This results in a disturbance of the circulation in all of the affected tissues (skin, muscle, bone and joint), which finally gives rise to an abnormal excitation of afferent receptors, particularly of nociceptors. This excitation maintains the disturbance of the sympathetic nervous system at central nervous level (vicious circle). The most relevant pathomechanism in this process seems to be the occurrence of an imbalance between the activity of sympathetic vasoconstrictor neurons supplying arteries and those, supplying veins. A sympatholytic therapy, if applied in time, is able to cut off the vicious circle, which may lead to a restitutio ad integrum. Further investigations will show to what extent psychological factors are involved in developing the central nervous disturbance of the sympathetic nervous system and may also show if in addition the motor system is affected.

Diagnosis, Differential↗

PubMed1994

[Combination of Monteggia and Galeazzi injury of the same arm].

A combination injury to the forearm, consisting of Monteggia- and Galeazzi lesion is described. After osteosyntheses of the fractures the dislocation of the head of radius and ulna were reduced spontaneously because of restauration of correct axes and length. Because of a simultaneous fracture of the coronoid process an above elbow plaster cast was supplied. Healing took place with free motion of all joints.

Adult↗

PubMed1992

[Bilateral tibial head epiphysiolysis in somersault jumping].

We are reporting about a rare case of a bilateral epiphyseal separation of the proximal tibial epiphysis which occurred to a 16 year old male at the time of bileged take-off when somersault diving. The X-rays at admission showed a bilateral proximal tibial epiphyseal separation of Salter-Harris type I on the right side and Salter-Harris type II on the left side. Both epiphyses showed a posterior dislocation. Stable, anatomical position on both sides was achieved by closed reduction under general anaesthesia and fixed by a plaster cast for five weeks. Healing occurred in anatomical position and no redislocation or growth disturbance was observed. The treatment for such separations is usually conservative; the prognosis is very good, provided that an optimal reposition with restoration of the anatomical situation has been achieved.

Adolescent↗

PubMed1995

[New aspects in the treatment of complete and isolated diaphyseal fracture of the forearm in childhood].

From 1984 to 1992 153 children were treated at the pediatric surgical department of the University of Mainz, of whom 19 had fractures of the radius, 9 of the ulna and 125 had a combination of both in the diaphysis of the forearm. Factors like patient's age, type of fracture and therapeutic methods were analyzed. One hundred and forty-one children were treated conservatively, 12 by operation. One hundred and one of these patients were healthy, when discharged (about 8 weeks after accident). Follow-up was possible in 69 cases. We found that occasional a remaining dislocation angle does not impair function: in 65 cases the result was "good" and "very good", but only "moderate" in 4 cases. These 4 children had been treated conservatively by reposition and plaster cast; 2 of these 4 children showed bone reconstruction without dislocation. Twenty-two of the 56 X-ray follow-up's showed persisting dislocation. To prevent functional problems (2 of our cases) it is essential to obtain a very exact reposition of diaphyseal forearm fractures. Therefore we would recommend a more generous indication for operation, preferably using elastic-stable Nancy pins.

Adolescent↗

PubMed1980

[Treatment of fresh injuries of the capsule and the ligaments of the knee joint (author's transl)].

Surgical treatment of ruptured knee ligaments is indicated, when stress roentgenograms reveal medial or lateral laxity of more than 3 degree compared with the uninjured knee. Operation is recommended on the day of injury until 2 weeks after trauma. A medial or lateral parapatellar incision on the side of laxity is used. It extends distally as far as the tibial tubercle and swings posteriorly at a 45 degree angle to the posterior border of the tibia. The skinflap is reflected including all superficial tissues down to the fascia. By this method collateral ligaments and deep capsular structures as well as cartilage, bone and menisci can be inspected. Ligaments and capsular tears are repaired with atraumatic sutures. Special surgical techniques are required to reattach the inferior margin of the posterior capsule to the tibia. Weak and split collateral ligaments or lax capsular structures are reinforced by a simultaneous tendon transfer. After surgery, the joint must be immobilized in 30 degrees of flexion by an articulated toe-to-groin plaster cast, which allows active motion between 20 and 60 degrees of flexion for 6 weeks. After removal of the cast, resistance exercises are necessary to regain stability. No sport is permitted until at least 4 months after surgery. Results in 50 cases revealed full stability of the knee joint and ability to engage in sports in 72% of patients.

Arthroplasty↗

PubMed1980

[Functional after-treatment, exercises and appraisal after lesions of the knee ligaments (author's transl)].

Lesions of the capsule and the ligaments of the knee joint require immobilization, regardless if they are treated with or without surgery. The plaster cast causes an atrophy of muscles which have an important function together with the capsule. During immobilization isometric tension exercises can work against the atrophy and are useful to regain the full mobility of the joint. The period of immobilization depends on the lesion. Active and to some extent passive exercises, gymnastics in water and combined exercises (e.g. cycling, walking in water) determine the therapy. A mobilization of the joint under anesthesia is excluded. Thermotherapy and massaging are contraindicated for an injured knee. An expert appraisal has to evaluate the injury in connection with the accident and with the degree of damage.

Bursa, Synovial↗