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PubMed1977

Experimental investigations on hypokinesis of skeletal muscles with different functions. I. Changes in muscle weight, protein and contractile properties.

In New Zealand white rabbits the right hind limb was immobilized in full extension with a plaster cast. The free left hind limb served as control. The masses of both the tetanic m. gastrocnemius and the tonic m. soleus considerably decreased as a consequence of immobilization for 5, 10, 14, 25 or 42 days. The decrease was more marked for the m. soleus. The water content of the muscle did not change substantially in the course of the atrophy. The total protein and myofibrillar protein contents of the immobilized muscles fell significantly. The tonic m. soleus atrophised sooner and was more extensive than the m. gastrocnemius. Superprecipitation of the myofibrillar proteins of the immobilized muscles decreased by 20-25% compared to the controls. The experimental model is considered suitable for further biochemical and ultrastructural investigations relating to the development of atrophy and to regeneration.

Animals↗
PubMed1977

Experimental investigations on hypokinesis of skeletal muscles with different function. IV. Changes in the sarcoplasmic proteins.

The changes in the sarcoplasmic proteins of the m. gastrocnemius and m. soleus were examined by biochemical methods on the 5th, 7th, 14th and 28th days after plaster cast immobilization of the right hind limbs of adult rabbits. During 4 weeks the soluble/myofibrillar protein ratio increased from 0.47 to 0.75 in the m. gastrocnemius, and to 0.85 in the m. soleus. Evaluation of the relative quantities of the components identified after gel-electrophoresis separation led to the following results: (1) There was no, or no appreciable change in the glyceraldehyde-3-phosphate dehydrogenase, creatine kinase and enolase activities. (2) The enzymes lactate dehydrogenase, aldolase and the glycogenolytic enzymes showed a relative decrease in both muscles. (3) Phosphoglycerate kinase, phosphoglucose isomerase and pyruvate kinase increased in both muscles. (4) Changes of opposite directions were exhibited by myoglobin, myokinase and F-protein. These results provide new data on the biochemical characterization of these functionally different muscles, and on the mechanism of disuse atrophy.

Adenylate Kinase↗
PubMed1967

Fitting of temporary prosthetic limbs immediately after amputation.

Better fit and function of prosthetic limbs is promoted when section and closure is done with attention to the prospective use of the stump as a pad for seating the limb. Preservation of tissue, fixing muscles to bone under physiologic tension, and making sure that bone ends are well covered with tissue are important to the comfort and usefulness of the limb that is to be fitted to the stump. Immediate application of a plaster-cast to form a total-contact socket for seating a temporary prosthetic limb, then early standing, weight-bearing and walking aid in healing and in shaping the stump to the permanent prosthetic socket it will ultimately occupy.

Amputation Stumps↗
PubMed1980

[Treatment of injuries to the epiphyseal synchondrosis (author's transl)].

Treatment of epiphyseal injuries must take the pathophysiology of the epiphyseal synchondrosis into account. According to the present state of knowledge, type I and type V injuries according to Müller can be stabilized sufficiently by means of a plaster cast. All other types of epiphyseal injuries should be subjected to very accurate repositioning and stabilised in "waterproof" condition by means of osteosynthesis to avoid growth disturbance caused by periosteal interposition or callus bridge formation. Hence, surgical treatment is recommended for type II according to Müller as well. In some cases, epiphyseal synchondrosis may close even if greatest care had been exercised during surgery. In all probability, this would be attributable to crush syndrome.

Bone Nails↗
PubMed1980

[Treatment of supracondylar fractures of the humerus in children and adolescents (author's transl)].

116 supracondylar fractures of the humerus were treated from 1973 to 1979. A plaster cast was applied to 68 patients after repositioning of fractures of the type Baumann I and II. 34 children were given an extension according to v. Ekesparre (fractures according to Baumann type II, III), whereas 14 patients were given surgical treatment by fixation with Kirschner wires (type III) according to Baumann). The good results obtained encouraged us to consider the extension treatment according to v. Ekesparre as a good method. Surgery appears to be indicated only if good results cannot be expected with conservative treatment or extension, or if the circulation remains disturbed or if paralysis persists.

Adolescent↗
PubMed1981

[Fresh fibular rupture of the lateral capsular ligaments - diagnosis - treatment - results (author's transl)].

The frequent injuries of the lateral capsular ligaments of the ankle joint should be diagnosed and differentiated by an accurate case report and by physical and standardised radiological examination. Precise judgement and an adequate treatment are necessary to avoid recurrent subluxation of the ankle joint, a possible factor in the eventual development of post-traumatic arthrosis deformans. A primary suture should be preferred in all cases of fresh and severe instability, especially in young patients and in patients who are active in sports. After healing of the soft tissue and active functional treatment of the ankle joint, a plaster cast bearing the full weight of the patient is used for another four weeks. Follow-up examinations of 150 patients of a group of 552 patients, treated from 1971-1980, showed good results in 92.3% of the patients.

Adolescent↗
PubMed1981

[Comparative examinations on diagnosis and therapy of fresh injuries of the exterior ligaments (author's transl)].

We are conducting a standardized investigation of injuries of the exterior ligaments, using X-ray films taken in forced extreme joint position in two planes. The advantage of this method is the comparison of the X-ray films taken while exerting a constant force. The X-ray films must be taken in two planes to permit a clear statement about the severity of the injury. It is necessary to exclude a hypermobile ankle joint by means of a comparative X-ray of the healthy limb. Adequate therapy with an elastic bandage, plaster cast or surgery based on this diagnostic method will ensure good results.

Adolescent↗
PubMed1982

[The crossed-leg flap with the fixateur externe technic].

As an introduction statements from literature and own experience are used to show and evaluate the present possibilities for the coverage of skin and soft tissue defects. As a routine operation the stemmed cross-leg flap is further on indicated on the lower leg. For the immobilisation of the legs wer use the fixateur externe. This kind of fixation has got advantages compared to plaster casts: optimal position of the two lower legs to each other, a local and general handling of the nursing with only few problems and a subjective relief for the patient. Moreover, flaps and transplant base can be connected permanently and without tension during the operation by fine adjustment of the fixateur externe, while postoperative functional strains of the neighbouring joints are possible to a certain degree. The technique of assembling the fixateur externe, i.e. immobilisation of the legs by Schanz screws and the AO-tubular system is described in detail. The results of a collective of 21 patients with mostly infectious soft tissue defects after an osteomyelitis of the tibia were checked by control examinations. There were no disadvantages for the donor leg following the use of Schanz screws. According to the presented results the settling of cross-leg flaps has been improved by the fixateur-externe-technique. Together with other authors we can recommend this method.

Adolescent↗
PubMed1982

Procedures performed by family physicians, internists, and a Medex in a small group practice.

Encounter forms for all patient visits to a small group practice (two internists, three family physicians, and one Medex) were examined retrospectively for October 1979 and January, April, and July 1980. A total of 5,694 patient encounters (2,327 male, 3,367 female) were recorded during the four months studied. Diagnostic and therapeutic procedures were performed on 592 patients (9.6 percent), 321 male and 271 female. The family physicians performed fewer procedures on their patients (6.1, 7.5, and 8.6 percent of the total patients seen). The Medex did 18.4 percent of all office procedures for that time period. The ten most commonly performed procedures included electrocardiogram (ECG), rhythm strip or ambulatory ECG, splint application, suture removal, pulmonary function test, suturing, exercise treadmill test, wart removal, removal of skin lesion or punch biopsy, application or removal of plaster cast, and application of ace wrap, sling, or collar. The majority of the procedures performed by the family physicians were also done by the Medex; however, the diversity of the procedures performed by the family physicians was comparable with that of the internists. There were large economic differences between groups, with the internists having the highest total billings and the Medex the lowest average charge per procedure performed.

Adolescent↗
PubMed1982

[Results of treatment of fresh traumatic dislocation of the shoulder].

This is a report about the treatment and the results of 100 patients with primary traumatic dislocations of the shoulder. Dependent on the age of the patient the shoulder was kept in place after the reduction either by a shoulder-arm-plaster-cast for 3 weeks or by Desault's bandage for 4-7 days. 68 patients were controlled clinically and roentgenologically 1-6 years after the dislocation. The sight was kept on the function of the joint, on the development of calcifications of the capsule and on the occurrence of recurrent dislocations.

Adolescent↗
PubMed1983

[Conservative therapy of isolated radius head fracture--immobilization or early functional movement treatment?].

We reviewed 95 patients with isolated fractures of the radial head. 33 of them were treated by plaster cast fixation for three weeks, 62 by immediate active motion. No difference in frequency of arthrosis and periarticular ossification in both groups could be observed. Examination of the patients two to four years after trauma showed excellent functional results in 61% of the 33 patients and in 77% of the 62 patients. The average duration of treatment is shorter by two weeks in the group of immediate active motion. The clinical results of this group, although not statistically significant, seem to be better than after immobilization.

Adolescent↗
PubMed1977

The effect of inactivity on reactive hyperaemia in the human calf: a study with strain gauge plethysmography.

In order to study the influence of muscular inactivity on reactive hyperaemia, postischaemic blood flow was measued with strain gauge plethysmography in the calf of twenty-nine patients, who had been treated with a plaster cast for a trauma of the lower limb. The contralateral leg served as a comparison. In all but two patients postischaemic maximal flow was lower in the immobilized calf. A negative correlation existed between maximal flow and the duration of immobilization. In the course of 6 weeks after removal of the cast, the difference in maximal flow between both sides became insignificant. Venous volume and venous emptying were not different in the two limbs. The effect of inactivity on reactive hyperaemic response may be explained by an effect of inactivity on the arterioles, muscle atrophy, a decrease in capillarization and in oxidative capacity of the muscle fibres. It is concluded that inactivity and atrophy of the lower limb musculature in patients with peripheral arterial disease may be a contributing factor to the low reactive hyperaemic response in the calf of such patients.

Adolescent↗
PubMed1981

[Fracture of the odontoid process (author's transl)].

102 cases of fractures of the odontoid process have been seen by the author - 73 recent cases and 29 old ones. It was important to distinguish basal fractures (29 cases), which all united after conservative treatment by reduction and skull traction for six weeks followed by a plaster cast for six to eight weeks, and fractures of the body (44 cases). 41 body fractures were treated conservatively, of which 6 died and only 20 united. The authors consider that treatment by skull traction must always be tried. An eventual indication for surgery can be made at about the 20th day if displacement is found to be present in spite of treatment. Fusion in these cases must be limited to C1-C2. It is best obtained by a combination of wiring and grafting.

Adolescent↗
PubMed1983

Progressive resistance exercise training of the hypotrophic quadriceps muscle in man. The effects on morphology, size and function as well as the influence of duration of effort.

The effects of progressive resistance exercise (PRE) training for 4 weeks on the hypotrophic quadriceps muscle were investigated in 23 young healthy male soccer players, who had been immobilized in a plaster cast 4-6 weeks after knee ligament injuries. The subjects were allocated to two training regimes where the injured leg was trained for periods of varying duration, whereas the intensity and frequency of exercise were alike in the two groups. However no significant differences were detected between the two training groups. In the whole material the lean thigh volume of the injured leg increased from 4.09 to 4.47 litres (p less than 0.001), whereas the fat component of the thigh was unchanged. The dynamic strength (1 RM) of the injured leg increased from 14.0 kg to 27.0 kg and amounted to 87% of the control leg after 4 weeks of training. At this time the maximum isometric strength amounted to 114 Nm, which was 63% of strength in the control leg. Succinate dehydrogenase (SDH) in homogenates of muscle biopsy sample increased (i.e. 20%, p less than 0.05) to the same level as found in the control leg. No changes in phosphofructokinase (PFK) were observed. The type I fibre distribution was lower in the immobilized leg than in the control leg. These results indicate that, following muscular hypotrophy resulting from 4-6 weeks of immobilization, dynamic exercise can restore the oxidative potential, whereas the size and strength are only partly recovered.

Adolescent↗
PubMed1982

[Screwed-plate osteosynthesis and reconstruction of fractures of the calcaneus].

The authors have treated 182 fractures of the calcaneus. Ninety-nine of these were operated on and plated. The results were studied in 75 cases with a follow up of 1 to 6 years. The technique used a lateral approach; a plate was always used, sometimes with a heterogeneous bone graft (Kiel bone). The operation was followed by 3 weeks of plaster cast fixation followed by mobilisation of the foot. A good functional result was obtained in 82 p. 100 of cases, but a satisfactory anatomical reduction in only 73 p. 100. Some mobility of the subtalar joint was conserved in 73 p. 100 of cases. The indications are described. This type of operation should be performed in displaced fractures with 2, 3 or 4 fragments. In more comminuted fractures the authors consider that primary arthrodesis is advisable. Conservative treatment is indicated in slightly displaced fractures or when local conditions make operation inadvisable.

Adolescent↗
PubMed1983

[Surgical treatment of dislocated hips after 5 years of age].

Fifty dislocated hips after the age of 5 were treated between 1975 and 1980. The surgical procedures performed combined tenotomy of the iliopsoas and adductor muscles, shortening of the femur, capsulorraphy and a pelvic osteotomy usually for re-orientation (Salter procedure) and rarely for widening of the acetabulum (Chiari procedure). It is thought that tenotomies and femoral shortening were more efficient than pre-operative traction which produced osteoporosis. However post-operative traction was used. In some cases plaster cast immobilisation was not used. The advantages of this technique were an acceleration of the surgical programme, better articular stability and early mobilisation. Osteochondritis and post operative stiffness were rare. The average range of movement included 90 degrees of flexion and lumbar balance was the most significantly improved factor. This type of surgical procedure aims to slow the development of coxarthrosis but it cannot diminish the risk. The limit of age for such treatment appears to be 10 years. After that, the indications need to be assessed carefully.

Age Factors↗
PubMed1984

[Postero-internal menisco-capsular disinsertions associated with chronic instabilities of the knee caused by rupture of the anterior cruciate ligament].

Posterior menisco-capsular tears of the medial compartment of the knee can be considered as a complication of rupture of the anterior cruciate ligament and the consequent medial instability. The lesion is more a capsular lesion than a true meniscal one and it is related to an excessive stress on the oblique fibres of the ligament of Hughston attached to the meniscus. The diagnosis is based on arthrography made with meticulous technique. The lesion must be differentiated from true meniscal tears because it can be sutured. One hundred and twenty five such lesions have been operated on and reviewed after a follow-up of an average of two years. The technique must be very precise to prevent any secondary lesion due to surgery and to avoid any plaster cast immobilisation. The results have been satisfactory in 69 p. 100. They should be improved with more accurate surgical technique and with more precise indications.

Arthroscopy↗