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Biomedical subjects

A K Martini

Publications and source records attributed to A K Martini.

At least 19 recordsLinked to original sources
PubMed2003

[Kapandji-Sauvé procedure for chronic disorders of the distal radioulnar joint with special regard to the long-term results].

We present the preliminary results of a retrospective study on 56 patients who underwent the Kapandji-Sauvé procedure for chronic disorders of the distal radioulnar joint (DRUJ). Outcome was assessed with special regard to the long-term results. The average follow-up was 5.9 years (1 to 12 years). 15 of the 56 operations were performed before 1996. Most procedures were performed because of secondary arthrosis or chronic dislocation of the DRUJ after distal radius fracture. Patients were assessed for pain, range of motion of wrist and forearm and radiological features. The DASH score and Mayo wrist score were used. Pain was improved in 94 % of the patients, but only 53 % were free of symptoms during heavy manual labour concerning the operated site. In four cases symptoms of ulnar impingement were found. Improvement in range of motion of wrist and forearm was significant. The post-operative DASH score was 22.6 +/- 20.0 and the Mayo wrist score was 79.5 +/- 14.6. One non-union of the DRUJ with consecutive fracture of the fixation screw and an algodystrophy in another case were found as postoperative complications. The only long-term complication consisted of a beginning humeroradial arthrosis ten years after the operation. The results demonstrate high patient satisfaction and reliable improvement in range of motion. Our results confirm the Kapandji-Sauvé procedure to be a reliable salvage procedure for arthrosis or chronic dislocation of the DRUJ even after long-term follow up.

Adult↗
PubMed2003

[Proximal row carpectomy in carpal collapse].

Proximal row carpectomy (PRC) is a generally accepted procedure in the treatment of an advanced radiocarpal arthrosis. The aim of this retrospective study was the evaluation of individual, functional and radiological results after proximal row carpectomy. Seventeen patients (15 male, two female) who had undergone proximal row carpectomy between 1991 and 1999, were reviewed. The most common indication was degenerative arthrosis secondary to carpal collapse associated with chronic scaphoid nonunion (SNAC), scapholunate advanced collapse (SLAC) deformity, late Kienböck's disease or perilunate dislocations. Clinical and subjective results were assessed using different scores (DASH-, modified Mayo wrist-score) and evaluating the individual wrist range of motion. Anteroposterior and lateral X-rays were obtained for radiological analysis. At follow-up evaluation (mean 65.4 months), the majority of patients reported pain relief and a significant increased range of motion for the operated wrist. Radiographical analysis showed degenerative changes at the radiocapitate articulation in ten patients. The intermediate-term results of this review would suggest that proximal row carpectomy is an effective procedure providing pain relief and a satisfactory range of motion in a variety of pathologic wrist disorders. Because of eventual radiocapitate arthrosis, we suggest PRC only in patients without significant degenerative changes at the proximal pole of the capitate or the lunate fossa.

Adult↗
PubMed2002

[Mantel transplant for defect reconstruction after resection of malignant bone tumors of the lower extremity].

We treated 11 patients with primary sarcoma and 1 patient with enchondroma of the femur or tibia. Bridging the osseus defect we used an intercalary allograft shell and contralateral fibula as described by Capanna et al. [7]. The median bone defect after resection of the tumor was 15.7 (9.0-28.5) cm, average follow up was 29.2 (13-56) month. Anastomosis of the autologous fibula was successful in 8 cases. There were 3 cases necessitating later amputation. The other cases showed good clinical (Enneking-score) and radiological (ISOLS-score) results. These results indicate the described technique as a suitable method for defect reconstruction with good functional outcome.

Adolescent↗
PubMed2001

[Hand surgery in German orthopedics].

The intention of this report is to present an overview of the development of hand surgery and its status in German orthopedics. An important role was played by orthopedics in the development of hand surgery: many insights and classifications in this field originate from orthopedic surgeons and retain their validity in this century. In the past few decades, traumatologists and plastic surgeons have become increasingly active in the field of hand surgery and have added to their surgical repertoire some fields formerly regarded as part of classic orthopedics, e.g., correction of malformations of the hand. Although microsurgical techniques of hand surgery were primarily developed by plastic surgeons, the past should nevertheless motivate all orthopedists to continue considering hand surgery the "pearl of orthopedics" in the future.

Germany↗
PubMed1999

[Wrist joint arthrodesis. Technique and outcome].

Arthrodesis of the wrist joint is indicated in degenerative joint desease, instability and restricted and painful range of motion. Further indications are: failed reconstruction, partial arthrodesis or arthroplasty/total joint replacement. The surgical technique depends mainly on the quality of bone substance and degree of joint degeneration. Differences can be made concerning the type of bone graft and osteosynthesis being used. The aim is to create, a stable joint in a good functional position. The position of arthrodesis depends on the patients needs. In patients with rheumatoid arthritis a straight position is generally accepted, where as in patients with degenerative joint desease, a slight wrist extension and ulnar deviation is preferred. A stable osteosynthesis with plates is reliable and allows early rehabilitation. We present 28 cases of arthrodesis with intramedullary rods and 61 cases of arthrodesis with plates. The complication rate was low, the functional results were good. We saw significant reduction of pain, increase of strength and handfunction. Arthrodesis of the wrist joint has proven to be a long term reliable and safe procedure. Loss of motion is accepted to obtain sufficient pain relief.

Arthritis, Rheumatoid↗
PubMed1999

[Long-term outcome of partial prosthesis management of proximal scaphoid pseudarthroses with a comparison of different follow-up protocols].

Replacement of the proximal scaphoid pole with a silicone implant is a possible surgical treatment in cases of avascular necrosis of the proximal pole after scaphoid nonunion despite the possible development of silicone induced synovialitis. Based on six scores, the results of this procedure are discussed and scoring systems compared. After an average follow-up of 6.5 years, eleven patients with proximal scaphoid silicone implant were evaluated personally. The results were excellent in three patients, good in two and satisfactory in six patients. There were no poor results. In the six scores results were good or satisfactory. Mostly, satisfied patients with poor radiological results were seen. Number and weighting of the different criteria influence the results. We conclude that scaphoid silicone arthroplasty is an useful procedure for avascular necrosis of the proximal scaphoid pole. Patients may have a painless wrist and good range of motion for years. In some patients, silicone synovialitis is found. Before arthrodesis becomes inavoidable, some years of better mobility can be gained.

Adolescent↗
PubMed1998

[A new classification of semilunar bone necrosis].

The currently accepted classifications of Kienböck's disease by Decoulx and coworkers (1957) as well as Lichtman and coworkers (1977) resp. Lichtman and Degnan (1993) do not take into account early changes in MRI or changes in carpal architecture. A recent publication by Lichtman and Ross (1994) did not solve the problems of precisely describing the disease. This necessitates a new, reliable classification based on the true nature course of the disease. In a prospective study with 49 patients and in a retrospective review of 125 cases of lunate necroses, the regular natural course of the disease was analysed. It begins with normal X-ray appearance but a typical extinguished T1-signal in MRI; a fracture line is part of the later course and not seen in the beginning. Later, collapse of the lunate and the carpus can be observed. A new classification based on the natural course of the disease is proposed. This classification divides the natural course of Kienböck's disease into four stages, subdividing stage I, II and III by A and B. The disease commences with pathology only detectable by MRI (extinguished signal in T1-weighted sequence-stage I A), followed by first changes in the X-ray (condensation or mosaic-like appearance), while the outer form remains preserved (stage I B); the disease proceeds with partial deformation of the lunate with proximal or radial indentation (stage II A), later with a fracture line, while the lunate index of Ståhl remains normal (stage II B); the collapse of the lunate follows, and Ståhl's lunate index becomes pathologic (stage III A); the subsequent collapse of the carpus is characterized by a pathologic Youm-index (stage III B); Kienböck's disease, finally, leads to arthrosis of the wrist.

Follow-Up Studies↗
PubMed1998

[Late outcome of Kapandji-Sauvé distal radio-ulnar arthrodesis].

In a retrospective study the outcome of patients treated by the Kapandji-Sauvé procedure was evaluated. In the period from 1989 to 1993, 18 patients were operated. The arthrodesis of the distal radioulnar joint was performed by a dorsoulnar incision using one screw. A 2 cm long segment of the ulna was resected. Indications for Kapandji-Sauvé procedures were in 12 cases deformities subsequent to wrist fractures, in three cases osteoarthrosis of the distal radioulnar joint, in two cases Madelung's deformity and in one case Kienböck's disease. The mean follow-up time was 5.1 years (range 3 to 7 years). There was one case of reossification, which required reoperation. No other complications were seen. An excellent result was obtained in seven patients, a good result in nine patients, one patient showed satisfactory and one poor results. Grip strength was normal in six cases, reduced up to 20% in seven cases and reduced up to 50% in five cases. 13 patients returned to their previous occupation. 12 patients showed a range of pronation-supination of more than 150 degrees. There was no correlation between X-ray findings and clinical outcome in patients.

Adolescent↗
PubMed1996

Further investigations of the intraosseous pressure characteristics in necrotic lunates (Kienböck's disease).

To confirm the hypothesis that venous congestion plays a role in idiopathic lunate necrosis (Kienböck's disease), intraosseous pressure in 12 normal and 12 necrotic lunates was measured. Intraosseous pressure in the capitate of 12 healthy subjects served as reference measurement. The intraosseous pressure was recorded in neutral position and 60 degrees extension of the wrist under normotensive conditions and during venous stasis. In all groups, the mean intraosseous pressure rose significantly with extension of the wrist, with the largest increase being 92.3 mmHg for necrotic lunates, followed by 40.3 mmHg for normal lunates, 6.9 mmHg for normal capitates and during venous stasis, 26.6 mmHg for necrotic lunates, 26.1 mmHg for normal lunates, and 5.9 mmHg for normal capitates. In some necrotic lunates, the intraosseous pressure during extension exceeded the arterial blood pressure, which can be explained by mechanical deformation of the bone. In neutral position, no significant differences in pressure were found between normal lunates and capitates. A significant difference was found for venous stasis and extension. The intraosseous pressure rise in the normal lunate in extension was slightly higher than the pressure found during venous stasis. The intraosseous pressure differed significantly (by 56.9 mmHg) between normal and necrotic lunates in extension. These data support the hypothesis that impairment of venous drainage plays a role in lunate necrosis and that the lunate can be considered as a venous bone at risk.

Adult↗
PubMed1996

[Significance of intraosseous pressure for pathogenesis of Kienböck disease].

Femoral head necrosis is thought to be the consequence of decreased venous drainage. To confirm this pathogenetic model in lunatomalacia, the intraosseous pressure in 16 necrotic, 16 normal lunates and 16 normal capitates was measured. Intraosseous pressure was recorded in different functional positions: neutral position, extension, flexion, venous stasis, and exsanguinated conditions. Both in extension and in flexion, the intraosseous pressures of all bones exceeded those in neutral position; this corresponded to the increase in pressure during venous stasis. The increase in pressure in normal lunates and capitates could not be explained by mechanical deformation. Lunates showed a much higher increase in pressure than did capitates. Some necrotic lunates showed an intraosseous pressure during extension which exceeded the systolic blood pressure. This implies that mechanical deformation contributed to increased intraosseous pressure in necrotic lunates. The variation of intraosseous pressure suggests a physiological but unstable balance. An increase in pressure reduces the bloodflow and in addition to other promoting influences can lead to pathological conditions. The daily load of the wrist in extension is in accordance with the model of the origin of osteonecrosis on the venous side. The model that lunate necrosis is the consequence of impaired venous outflow can be accepted.

Adult↗
PubMed1995

[Changes in the wrist joint in spontaneous course of scaphoid pseudarthrosis].

Scaphoid non-union always leads to carpal arthrosis. What is the natural history and course and sequence of development of arthrosis in scaphoid bone pseudarthrosis and what factors play a role in this? Forty-nine patients with scaphoid non-union were followed up; the period of observation was between three and 39 years. For comparison, 55 patients in whom a Matti-Russe reconstruction had been carried out successfully in the same period were followed up. Both the clinical and the radiological appearance seemed to be better in the operated patients than in the unoperated patients. The time factor, the position and form of the fracture appeared to be crucial for the development of arthrosis. No patient was free of arthrosis after ten years. The arthrosis begins in the radial part of the radiocarpal joint and progresses to the mediocarpal joint. The development of mediocarpal arthrosis takes about 20 years. Unstable and displaced fractures accelerate the development of arthrosis. Proximally located non-unions are unfavorable because of the danger of osteonecrosis of the proximal fragment. These non-unions should be treated surgically as soon as possible.

Adolescent↗
PubMed1995

[Long-term outcome of Matti-Russe-plasty with special reference to late arthrotic damage of the wrist joint].

Corticocancellous grafting was considered the therapy of choice for treating scaphoid bone pseudarthrosis. However, there has been more criticism recently, since this method neither prevents nor stops arthrosis of the wrist in the long term. Ligamental damage with carpal instability often remains untreated. The malposition and shortening of the scaphoid bone also remains uncorrected. Fifty-five patients in who Matti-Russe reconstruction was carried out to treat schaphoid non-union were followed up. The inclusion criteria were that there had been no preoperative arthrosis and no previous operations. The mean period of observation was 10.7 years. The results of the clinical and radiological investigation were compared with the preoperative findings; in addition, there was a control group with untreated scaphoid non-union. It was shown that arthrosis is demonstrable in 69% of the operated patients; in the unoperated patients, this was the case in 95%. Carpal instability was present in 47.1% of the operated patients. However, it does not affect the development of arthrosis. The time interval between accident and operation is crucial for this. The results of this investigation indicate that scaphoid non-union should be treated as soon as possible even if it is asymptomatic.

Adult↗
PubMed1995

[Surgical and conservative therapy of scaphoid pseudarthrosis].

Should an asymptomatic scaphoid pseudarthrosis be eliminated by surgery? Two patient populations were followed up in order to be able to answer this central question. The first group comprised 49 unoperated patients and the second group 55 patients in whom Matti Russe reconstructive surgery had led to healing of the bone and in whom the operation had been carried out at least three years previously. The period of observation was up to 25 years. The study yielded the following findings: 1. The spontaneous course automatically terminates in radiocarpal arthrosis. It begins after five to ten years in the radiocarpal joint and also affects the intracarpal joint after a further ten years. Besides an increasing shortening of the scaphoid bone, an exacerbating carpus collapse can also be observed. 2. Neither the position of the fracture, left- or righthandedness nor the patient's occupation affect the course. Only necrosis of the proximal fragment favors the development of arthrosis. 3. The operated patients have much better results both clinically and radiologically. The development of arthrosis is slowed down (but not stopped) by the operation. 4. A DISI deformity left behind after the operation does not affect the development of arthrosis. 5. The earlier the operation is carried out, the more favorable the course. 6. We attribute the relatively high rate of arthrosis in Matti-Russi reconstructive operation (69%) to an excessively long immobilization. For this reason, we prefer internal fixation with a Herbert screw.

Adolescent↗
PubMed1994

[Natural course in lunate necrosis].

Reconstruction of the natural course of lunate necrosis is difficult because of incomplete findings, especially in the initial stages. The necrosis progresses steadily from initial lunate oedema with a normal X-ray appearance to condensation, fragmentation and collapse of the lunate within months. The collapse of the whole carpus means a dramatic deterioration in therapeutic possibilities not much later. In order to start treatment successfully in the initial stage, suspicious findings should be repeatedly followed up by X-ray films and magnetic resonance imaging. The development of degenerative changes often takes years. The clinical findings are not helpful in judging the course of the disease as pain varies and only the collapse of the lunate and late arthrosis accentuate pain.

Adolescent↗
PubMed1994

[Natural course in pseudarthrosis of the scaphoid].

Knowledge of the natural history of scaphoid nonunion is important for establishing the indication for surgery. The late results after the Matti-Russe operation reveal carpal arthrosis in a relatively high percentage of cases. On the other hand, we see patients who have engaged in sports and have continued working without symptoms for years despite scaphoid nonunion. We now address the question as to the nature and time of the development of arthrosis and the factors affecting it. Forty-one patients with pseudarthrosis were followed up over a period of 3-39 years. For comparison, 55 patients in whom a Matti-Russe operation had been successfully performed were followed up for the same period. Both the clinical and radiological appearance seem to be better in patients operated on than in those who were not operated on. The time factor, the location and the form of the fracture determine the development of arthrosis. No patient was free of arthrosis after 10 years. Arthrosis begins in the scaphostyloid joint and progresses to the scaphotrapezoid, scaphocapital and scapholunar joint. Development of midcarpal arthrosis takes place over about 20 years. Unstable and displaced fractures accelerate the development of arthrosis. Proximally located pseudarthroses are unfavorable because of the danger of osteonecrosis of the proximal fragment. These pseudarthroses should be eliminated as soon as possible by surgery.

Adult↗
PubMed1993

[Intermediate results in treatment of scaphoid pseudarthrosis and fracture with the Herbert screw].

The Herbert screw is a self-cutting headless screw that is designed to effect interfragmentary compression on being screwed in and is suitable for scaphoid surgery besides being useful also for other purposes. Although the Herbert screw is biomechanically inferior in many respects to the spongiosa screw, prognosis is impressively improved in scaphoid surgery (in pseudarthroses and fractures) by implanting the Herbert screw. It replaces the Matti-Russi plasty and is used in proximal, dislocated medium-positioned and unstable fractures. 73 scaphoid pseudarthroses and 27 fractures were treated with the Herbert screw between 1989 and 1991 at the Dept. of Orthopaedics at the University of Heidelberg. In 46% of problematic indications successful healing was achieved in more than 90% of the cases. However, surgical technique is complicated, requiring a certain amount of practice to keep iatrogenic traumatisations as low as possible. In the treatment of pseudarthroses special attention must be paid to careful and extensive sclerosis resection. Although the Herbert screw is screwed in through the articular surface, the procedure does not necessarily imply an accelerated development of arthrosis.

Adolescent↗
PubMed1993

[A new external fixator for treatment of unstable distal radius fracture].

Unstable distal radius fractures cannot be immobilized in a plaster cast: mal-unions (and later arthrosis of the wrist) are the result. Most symptoms are attributable to the shortening of the radius. Retention by means of an external fixator is the therapy of choice in such cases. Various fixator systems have become known. In this paper, a new fixator is presented which has the following advantages: It is very mobile and adaptable, and corrections are possible after attachment of the fixator. The screws can be inserted depending on the anatomical situation. The fixator is handy and light. The fixator has proved its effectiveness for a long time and is also suitable for complicated wrist injuries.

Bone Wires↗