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PubMed1995

[Results of treatment after traumatic shoulder dislocation. Thoracic abduction plaster case or Desault dressing].

In 80 patients with primary traumatic shoulder dislocation treated at the Heidelberg Orthopaedic University Hospital we had a follow-up examination. We wanted to know about age and sex of the patients, the number of redislocations in correlation to time and way of fixation. We had 70% male and 30% female patients with 97.5% of anterior dislocation. The minimum age was 16 and the maximum 87 years with an average of 44 years. 48 patients had a Desault bandage for 2 weeks and 32 had a shoulder-arm plaster cast for 3 weeks. There was no difference between both ways of fixation. We also could not see any better results after more than a 3 weeks' fixation. The most important fact for redislocation is the age and activity of the patients. A young man has a very high risk of redislocation within the first year.

Adolescent↗
PubMed1993

[Early functional conservative therapy of fresh fibular capsular ligament rupture from the socioeconomic viewpoint].

The expected direct and indirect costs following a fresh fibular rupture of the capsular ligament, and hence the socioeconomic burden on the patient, was investigated by a prospective randomised study comprising 120 males and females between 18 and 45 years of age. A comparison of three different conservative treatment methods A (immobilisation in a plaster cast for three weeks, followed by mobilisation with the aircast splint), B (mobilisation with the aircast splint) and C (Unna's paste dressing for two weeks with subsequent tape dressings and in each case immediate mobilisation) showed a significantly better stability after 6 months in the groups B (2.6 +/- 2.3) and C (3.6 +/- 3.8) than in A (4.8 +/- 3.5). The direct subsequent costs were also significantly lower in the groups B (DM 175.-) and C (DM 206.-) than in A (DM 340,-). Taking an average daily hospital care fee of DM 319.- (1991 in West Germany) as basis, the direct costs sequential to early functional treatment are the lowest also in comparison with surgical treatment in a hospital. The indirect sequential costs due to loss of working hours are mainly dependent on professionally conditioned physical stress but increase with the period of immobilisation after a fresh fibular rupture of the capsular ligament.

Adolescent↗
PubMed1986

Morphology of immobilized skeletal muscle and the effects of a pre- and postimmobilization training program.

The hind limbs of mice were immobilized with plaster cast for different periods of time, and the atrophy of the anterior tibial muscle was examined by measuring fiber cross sections. In a second series of experiments, mice were trained on a treadmill before and after immobilization. The most pronounced decrease in fiber diameters was observed during the 1st week; during prolonged immobilization, only a moderate atrophy occurred. Red fibers were found to be more susceptible to immobilization atrophy than white fibers. The ultrastructural observations extended to loss and fragmentation of myofibrils, mitochondria, and the sarcotubular system. Some fibers split and appeared to undergo segmental necrosis, which was followed by invasion of leucocytes into the muscle. Still while immobilized, the muscles exhibited a regenerative capacity; satellite cells differentiated to myoblasts, which fused to myotubes, being the precursors of new muscle fibers. This was already observed during the 1st week of immobilization. The effect of training after immobilization was documented by an increase of fiber diameters. The ultrastructural alterations, however, in these muscles were severe; it was concluded that a postimmobilization training has to be undertaken very carefully. When the muscles were trained before immobilization, the atrophy was almost negligible. A preimmobilization training can probably prevent the muscle from developing severe atrophy.

Animals↗
PubMed1981

Fiber type area and metabolic potential of the thigh muscle in man after knee surgery and immobilization.

The muscle atrophy of the quadriceps muscle was investigated in patients after knee operations and immobilization in a long leg plaster cast. Muscle biopsies were taken before operation and after 5 weeks immobilization. The activity of oxidative (SDH) and glycolytic (PFK) enzymes was determined. The fiber area of the different fiber types were measured and enzyme activities in single characterized fibers were analyzed. A selective type 1 atrophy was found with a reduced cross-cut area of the type 1 fiber, and a reduced oxidative enzyme activity occurred in the slow-twitch type 1 fibers. The effect of the muscle tension in the immobilized leg and the inhibiting role of the postoperative pain is discussed.

Adult↗
PubMedDate not supplied

[Early diagnosis of postoperative discitis].

This study demonstrates that infection of the retro- and intradiscal space is probable, when the temperature rises above over 37 degrees and CRP exceeds 2.0 mcg/ml 5 days postoperatively. MRI of 4 patients confirmed a retrodiscal infection that was indicated by a hyperintense band shaped structure in PS-sequences and which was space occupying with respect to the dural sac. Discitis was demonstrated by intradiscal hyperintensity in STIR images and by enhancement in T1 weighted images following the application of Gadolinium DTPHA. Diagnosis is simplified by comparison of pre- and postoperative MR-examination. Infection can be cured by treatment with antibiotics (Tobramycin and Clindamycin) bedrest and plaster cast.

Blood Sedimentation↗
PubMedDate not supplied

[Treatment of fibular capsular ligament rupture. A multicenter study].

The treatment of lateral ankle ligament tears has been by conservative and by operative means. 483 patients treated by a number of orthopaedic surgeons, general surgeons and trauma surgeons in Germany over a 2 1/2 year period were questioned one year after the injury. Treatment had been conservatively in 325 patients (tape bandage, elastic bandage, plaster cast, ankle brace, Aircast brace, others) and operatively in 158 patients (primary ligament repair, ligament reconstruction). A 100 point subjective ankle score was used for the 420 patients who responded. The mean score was 90.5 points. The average score of all patients undergoing surgery was 88.2 points, the mean score of all conservatively treated patients was 91.7 points. However, instability on stress radiographs after the injury was less in the conservative group. There was no clear correlation between the initial radiographic instability and the follow-up result. Young patients did better than older patients. The authors recommend conservative, early functional treatment for lateral ankle ligament tears.

Adolescent↗
PubMedDate not supplied

[The hip joint in arthrogryposis].

In a retrospective review of 70 hips in 35 patients with arthrogryposis 56 of all hips studied were affected by the disorder. Clinically 4 types of arthrogrypotic hip deformity could be distinguished. In 19 hip joints not only a deformity and a restriction of movement but also a dislocation was found. Based on the results of this study a one-stage open reduction combined with a varus shortening, femoral derotation osteotomy for unilateral hip dislocations is recommended. In cases of bilateral dislocations the above mentioned surgical procedure is indicated only if there is a less severe generalized involvement of AMC. For correction of hip deformities type II during neonatal period conservative treatment by traction or by plaster cast redression has proved be successful. The authors experience is compared with reports of other authors and guidelines for clinical classification and treatment are presented.

Arthrogryposis↗
PubMed1991

Supracondylar fractures of the humerus in children.

Supracondylar fractures of the humerus in children were studied in Kuopio University Central Hospital during 1974-1984. The total number of the fractures was 86. Fifty-two patients were examined 13 months to 11 years after the accident. Only severe cases (grade 3 and 4 after Holmberg's classification) were included. Twenty patients were treated operatively, 17 with traction and 15 conventionally with reposition and plaster cast. The age of the patients at the time of the accident was from 21 months to 12 years and at follow-up from five to 23 years. The purpose of this study was to evaluate late results of these three methods. There was no statistical difference between the late results of the treatment groups. Regardless of treatment method careful reposition and controlling retention for both varus, flexion and extension and rotation deformities are essential for good end results.

Casts, Surgical↗
PubMed1990

Growth disturbance following metaphyseal bending fractures of the proximal tibia--an experimental study in the mini pig.

Based on our clinical experience, we postulate that the unilateral "posttraumatic genu valgum" develops on the grounds of an unreduced primary valgus deformity. This induces a disturbance of the consolidation on the medial aspect of the fracture. Subsequently, a partial medial stimulation of the epiphyseal plate develops resulting in a secondary valgus deformity. We succeeded in proving experimentally this postulate using the Mini Pig as an experimental model. We investigated 33 tibiae of 17 Mini Pigs. With radiological follow-up studies we were able to show that the operatively created primary valgus deformity induces an increased valgus deformity of functional significance. This is a model of the unreduced fracture in men. However, the transection of the pes anserinus and the periost per se did not provoke a significant valgus formation. Based on these experimental results and our clinical findings we postulate the following treatment for the metaphyseal bending fractures of the proximal tibia in men: 1. Accurate, usually conservative, reduction of any primary valgus malposition of the fracture. 2. Retention of the corrected position of the tibia in a plaster cast. 3. Compression of the medial aspect of the fracture to prevent disturbance of consolidation and subsequent development of valgus deformity.

Animals↗
PubMed1990

[Results of conservative treatment of ligament lesions of children's ankle joint--a prospective study].

There is disagreement in the literature about the ideal treatment of ligamentous injuries of the ankle in children. We examined the results of controlled conservative treatment by means of a prospective study in 28 children, each with a fresh ligamentous ankle injury. In all patients the supinatory talus tilt was between 7 and 15 degrees as compared with the noninjured side. The children were treated with a plaster cast for 6 weeks. The results of the present study were compared with results of two other earlier investigations from our department. In one group the patients had been treated not uniformly conservatively for 1-5 weeks. In another group, patients were treated by operative ligamentous repair (5, 8). At the follow-up examination 82% of the children of the present study showed ligamentous stability, which is approximately the same percentage as it was found in operatively treated children (84%), but lies significantly higher than in inconsequentially conservatively treated patients (74%), (p greater than 0.05). 50% of the children in the present study complained about some discomfort, a number that is significantly higher than that found after operative treatment (30%), (p greater than 0.05). We assume that conservative treatment of fibular ankle lesions is justified in children with supinatory talus tilts between 7-15 degrees as compared with the noninjured side. Ligamentous stability can be expected in 80% of the patients.

Adolescent↗
PubMedDate not supplied

[Pathogenesis and treatment of pes adductus].

Based on the literature and our own 143 patients the etiopathogenesis and treatment of metatarsus varus are discussed. The exact scientific proof is still lacking, whether there does exist, besides of the congenital mostly severer metatarsus varus, a slight exogen postnatal form with spontaneous healing, without or with a preceding permanent prone position of the infants. A fixed adductus position of the forefoot represents the indication for stepwise correction of the deformity by means of a plaster cast and additional wedging. It is necessary to produce a slight overcorrection including the typical valgus heel. Afterwards we are striving for strengthening of the foot abductors in order to gain an equilibrium of the musculature as in the treatment of club feet. Our own techniques of correction are demonstrated as well as the results.

Casts, Surgical↗
PubMedDate not supplied

[Long-term follow-up of 166 surgically treated patients with congenital hip dislocation].

UNLABELLED: 166 patients with congenital dislocation of the hip, ranging from 10 months to 5 years old, were operated between 1958 and 1971. 140 patients were women (84%) and 26 patients were men (16%). 96 patients had unilateral and 70 patients had bilateral dislocation; that makes a total of 236 dislocated hips. 61 patients with bilateral hip dislocation were operated simultaneously on both hips. All the patients were treated with adductor tenotomy and open reduction through Smith Petersen incision with section or elongation of the psoas tendon. The postoperative immobilization consisted in a period of one month pelvic toecast followed by 2 plaster casts with abduction rod during 3 to 5 months. The postoperatory follow-up ranged from 9 years to 26 years, 2 months; average 14 years, 5 months. The clinical evaluation comprises pain, hip mobility, gait and muscle power. RESULTS: excellent 138 (59%); good 66 (28%); fair 29 (12%); and poor 3 (1%). The radiological evaluation considered: Mose; acetabular femoral head index; Wiberg's CD-angle; cervico-diaphysiary angle and radial quotient. RESULTS: normal 5 (2%); excellent 44 (19%); good 78 (33%); subtotal 54%; fair 90 (38%), and poor 19 (8%). Complications (hips); infections 12 (5%); 3 of them deep ones (1%); residual subluxation 19 (8%); reluxation 1 (0.5%). Isquemic necrosis Grade II of Tönnis 31 (13%); Grade III 2 (1%) and Grade IV 1 (0.5%).

Adolescent↗
PubMedDate not supplied

[Personal experience using the Cloward dorsal intercorporal spondylodesis].

We herewith report on our experience with dorsal, intercorporal fusion of the lumbar spine, according to Cloward, that has been performed on twenty-five cases from 1974 to 1980. The most suitable indication for this procedure has proved to be acute herniated disc, and spinal stenosis, whereas less favourable results have been obtained in cases with spondylolisthesis and spondylitis. In ten cases a pseudarthrosis developed. The report discusses whether the period of postoperative immobilisation by means of a plaster bed or plaster cast, or other factors such as a well vascularised graft substrate, or intercorporal compression, are of prime importance in affecting successful fusion. The method is still employed but now only in combination with stabilising metallic implants.

Adult↗
PubMed1980

[Aplasia of the tibia - a case report with observation for 38 years (author's transl)].

The paper reports the result of operative treatment in a case of total congenital absence of the tibia. The boy was treated conservatively by plaster casts and apparative supports until he was six years old. Then the upper end of the fibula was set into the intercondylic fossa of the femur and two months later a talofibular fusion correcting the clubfoot deformity was performed. 32 years after this procedure the leg is now 28 cm shorter. The knee joint is absolutely stable in extended position and active flexion is possible to 45 degrees. The fibula shows a remarkable hypertrophy and has changed its form into a tibia-like bone. The patient is able to walk 15 km without any pain using a supporting apparatus. In congenital absence of the tibia or fibula we prefer orthopedic - surgical devices which preserve the dysplastic part of the limb instead of primary amputation.

Braces↗
PubMed1980

[Late results of traumatic separation of the upper femoral epiphysis as an obstetrical lesion (author's transl)].

Publications on birth-traumatic epiphyseolysis of the head of the femur are rare. No long-term reports (the course of the disease extending over 10 years and more) have been published. We must mention the detailed paper published by Mau in 1975 on epiphyseolysis of the head of the femur in children, among which a lesion of the epiphysis in an otherwise complicationfree birth is described. In most of the cases, however, epiphyseolysis occurs with breech presentation (Michail 1958, Mortens 1964), less frequently with Caesarean sections (Baumgartner 1961) and internal versions (Lindseth 1971). If the region of the hip joint appears swollen, associated with haematoma and pain on pressure-which can also occur in the region of the proximal femur, associated with shortening of the leg-then epiphyseolysis must be suspected. Clinical examination of the hip joint is characterized by pain inhibition. X-ray examination of the pelvis ante partum will mostly show lateral and cranial dislocation of the proximal shaft of the femur. Differential diagnosis of a dislocation of the hip joint is possible since symmetrical and well developed acetabulae are present. Diagnosis is finally established by means of arthrography of the hip. Likewise, callus formation supplies proof of the reparation processes subsequent to epiphyseolysis. Treatment in congenital that prescribed by the treatment guidelines in congenital hip dislocation. Abduction-extension is the method of choice. In order to improve reposition of the fragments, an additional internal rotary traction or transverse traction in the direction of adduction is recommended. However, in view of the rapidity of callus formation (approximately 2 weeks) and consolidation of epiphyseolysis, the effectivity of prolonged therapeutic efforts must be doubted if seen in retrospect. This applies mainly to subsequent Lorenz plaster-casts followed by the application of a splint. Several months will elapse until the child begins to stand and to walk, and during this period consolidation of the lysis may have easily taken place.

Adult↗
PubMed1990

[Current status of surgical treatment of the unstable spine with special reference to neurosurgical indications].

The presently available surgical techniques will practically always allow stabilization of the vertebral column in case of injuries indicating the need for surgery. Patients can be subjected to early functional treatment and introduced to rehabilitation training without requiring the plaster casts that used to be major obstacles to mobilization. Excellent results can be obtained in injuries of the thoracic and lumbar vertebral column if surgery is performed early, using less invasive dorsal stabilization techniques. Dorsal intervention is also possible in polytraumatic and intensive-care patients whose overall condition prohibits a ventral approach because of the stress involved in such surgery. During a period of just five years traumatologic surgery of the vertebral column has advanced by leaps and bounds, while proving that in surgery of the vertebral column close cooperation of neurosurgeons and surgeons is mandatory because of the hazards involved with particular regard to neural structures. In this manner a safety factor is created from which the patient benefits because such experience is a prerequisite for achieving good overall results. Surgery of the vertebral column is not just general surgery; in fact, it usually involves a large number of personnel and technical equipment such as only well-staffed and well-equipped institutions have at their disposal, but the results achieved at Kiel university have shown that zeal and purposefulness enable the successful management even of technically complicated interventions.

Cervical Vertebrae↗
PubMedDate not supplied

[Magnetic resonance tomography in therapy follow-up after repositioning treatment of congenital hip dislocation].

INTRODUCTION: After treatment of infantile hip dislocation in terms of reduction and retention in plaster casts or splints a problem of therapy controlling exists. To assess if the femoral head is in correct position centered in the socket ultrasound is not possible, because one cannot achieve the necessary standard position. Computertomograms are associated with a hereditary taint of radiation and plain roentgenograms lack of presentation of the important cartilaginous structures. METHOD: To control infantile hips after open or closed reduction from 1990 until 1996, 43 examinations by MR imaging were performed in 34 children. RESULTS: In our series MRI was able to provide exact information about the position of the femoral head independently of its state of ossification. Also, a clearly visualisation of the different structures of the acetabular fossa, particular acetabulum, pulvinar, bony and cartilaginous acetabular rim and limbus was possible. Furthermore the MR images showed interpositioned soft tissue, intraarticular effusion and displayed cartilaginous parts of the acetabular rim. CONCLUSIONS: MRI is an exact method to assess the anatomical and pathological conditions of the childlike hip joint. Because of the disadvantages of CT and X-ray, MRI is superior in terms of controlling the results after treatment of infantile hip dislocation.

Acetabulum↗
PubMed1982

[Indication and use of the fixateur externe in childhood].

The use of the fixateur externe in childhood is an indispensable extension of all measures taken by the paediatric traumatologist to preserve the skeletal system. In recent decades external fixations by means of Kirschner wires in association with plaster casts or in the Küntscher distractor had become necessary on account of increasing severity of the injuries to the extremities. Now a reduction in size and weight as well as multidimensional applicability in conjunction with microsurgical vascular reconstructions and neurovascular grafting of soft parts have increased the indications and considerably improved the results achieved. The article demonstrates by means of own examples how the indication for internal and external stabilisation must be weighed, taking into consideration the special features of the growing skeleton, the age, the type of injury, the localisation and extension of the injury. Choosing a particular type of osteosynthesis does not necessarily exclude transition to another type. The type of fixateur externe described here (Hoffmann) represents just one possibility of a system which is possible in principle.

Adolescent↗