Biomedical subjects
Publications and source records attributed to A Reichelt.
A case of a completely absent posterior tibial artery discovered during a procedure for congenital clubfoot correction in a 6 month old male infant is reported. Anomalies of the anterior tibial artery associated with the clubfoot-deformity are common, the absence of the posterior tibial artery is, however, very rare.
Postoperative wound infections develop in approximately 2-5% of all patients after orthopedic surgery. After urinary tract infection and pneumonia, such wound infections (15%) are the third most frequent type of hospital-acquired infection. In this review we summarize all proven and unproven hygiene measures available in orthopedics, giving special attention to those implemented with the aim of preventing and controlling postoperative wound infections. Routine application only of hygiene procedures of proven efficacy will be an important contribution to economic and ecological quality assurance in hospital.
Since the advent of operative ankle arthroscopy and magnetic resonance imaging (MRI) specific treatment of osteochondritis dissecans of the talus has progressed rapidly. Drilling is still the treatment of choice in early stages of osteochondritis dissecans of the talus. Rear-entry guides and preoperative planning with MRI have led to better results with this kind of treatment. Within 5 years, 42 patients (26 male and 16 female) underwent arthroscopic treatment of osteochondritis dissecans of the talus, 22 underwent percutaneous drilling, 13 cancellous bone grafting, 4 refixation, and 3 curettage. The average age of the patients was 28 years (range, 11 to 53 years). A clinical score system was used in a clinical and MRI follow-up of 19 of the patients with K-wire drilling. Up to 100 points are given in the categories pain, stability/insecurity, efficiency/pain-free walking distance, gait, differences in circumference, range of motion, and power. There was a history of trauma in 31 of the 42 patients. The majority of lesions (24 cases) were localized at the lateral talus, and these patients all had trauma. In 11 of the 18 lesions at the medial talus, there was no evidence of trauma. The 19 patients in the follow-up achieved an average of 87 points. K-wire drilling represents the chief component of early stages with intact or partially fractured cartilage surface, whereas arthroscopically controlled cancellous bone grafts after curettage are used in grade II stages only. Results of K-wire drilling are not worse than those of cancellous bone grafts; this is attributable to a generous perforation of the sclerosis. This has contributed to an improved preoperative diagnosis with MRI.
OBJECTIVE: The high clinical and socio-economical impact of cartilage defects and chondral degeneration is well-known. After trauma or without a known etiology, often young patients suffer from pain and a loss of function leading into a decrease of physical activity and, more severe, into long term disability and unemployment. The clinical use of autologous chondrocyte transplantation was introduced in 1994 reporting the data of a pilot study. The objective of this study is to evaluate the efficacy of this method of surgery. METHODS: Autologous chondrocyte transplantation has been established in our department since 1995 for the treatment of large, full thickness cartilage defects which can be completely covered with hyaline-like cartilage without harming the subchondral bone plate. Our first patients (n=24) all showed Grade IV lesions and an average defect size of 6.27 cm2. All but 4 of the patients had at least 1 cartilage defect related operation on the knee. RESULTS: The patients and the clinicians rating indicated an increase of a modified Cincinnati Knee score from 3.6 point pre-operation to 6.9 points after 6 months and 8.1 points at 12 months on a scale from 1 (bad) to 10 (excellent). These results support the data of an international multicenter study with almost 2000 patients. The 5 year results described by the originate authors are good to excellent in 85%-95% with an adverse event rate of 5%. CONCLUSION: Autologous chondrocyte transplantation has to be considered a safe and effective method for the treatment of large full thickness cartilage defects. Alternative treatments are symptomatical: drilling, abrasion, lavage, chondroplasty, or osteotomies. The short term results are promising but a lot of patients have to be treated for osteoarthritis as a consequence of failure with total joint arthroplasty. Osteochondral transplantations have the disadvantage of limited harvesting sites and the impairment of the subchondral bone plate.
STUDY DESIGN: A report of three cases of pyogenic osteomyelitis of the occipitocervical junction. OBJECTIVE: To describe the conservative management of pyogenic osteomyelitis of the occipitocervical junction. SUMMARY OF BACKGROUND DATA: The therapeutic approach to inflammation of the upper cervical spine is controversial. METHODS: Pyogenic osteomyelitis of the occipitocervical junction is rare. In the orthopedic literature, only a few case reports with variable treatment methods are available. Three patients with pyogenic osteomyelitis of the occipitocervical junction were treated nonoperatively. Intravenous antibiotic therapy was begun after direct cultures or blood cultures were obtained. Early mobilization was accomplished by application of a halo vest. RESULTS: Two patients recovered by spontaneous fusion of the occipitocervical junction. Instability developed in the spine of one patient, but she refused further treatment. CONCLUSIONS: Diagnosis of osteomyelitis of the upper cervical spine is difficult. In cases with absence of neurologic symptoms or spinal abscess formation, treatment can be nonoperative.
Periarticular ossifications of the shoulder after surgery have been described since the beginning of the century. Risk factors and the clinical impact of heterotopic bone formation have been discussed controversially. After open surgery on the shoulder, 131 patients (rotator cuff repair n = 106, acromioplasty n = 25) were included in a retrospective study if pre- and postoperative X-rays were available. The age of the 90 men and 41 women averaged 51 years (range 29-67 years). The minimum follow-up was 2 years. Also, 108 patients were interviewed by questionnaire to estimate the subjective outcome of the procedure (5 patients were reported dead). A clinical examination was carried out on 86 patients using the Constant score for evaluation of the objective outcome. Heterotopic ossifications were found in 35 cases (26.7%), 28 of them after rotator cuff reconstruction and 7 after acromioplasty. A good to excellent result was reported by 89% (n = 65) of the patients without and by 80% (n = 28) of the patients with ossifications. The Constant score averaged 69 points and 74 points (n = 60), respectively. A significant difference between the two collectives could not be calculated. As significant risk factors for the formation of heterotopic bone, the existence of osteoarthritis and the duration and complexity of the procedure could be cited. The appearance of periarticular ossifications after surgery of the shoulder seems to be of minor clinical impact. Severe cases with major functional deficits should and can be prevented by a fast and atraumatic operation technique.
RATIONALE AND OBJECTIVES: To evaluate the diagnostic utility of indirect MR arthrography of the unexercised glenohumeral joint in patients with rotator cuff tears confirmed by arthroscopy or arthrotomy as the gold standard. METHODS: Twenty-six patients underwent conventional MR imaging and indirect MR arthrography of the stationary glenohumeral joint using a wrap-around surface coil. Unenhanced T1-weighted spin echo/T2-weighted fast spin echo sequences and T1-weighted gradient echo sequences, adding spectral fat suppression after intravenous administration of contrast medium, were performed in the oblique coronal and oblique sagittal planes. Images were analyzed by three experienced radiologists in consensus. Levels of diagnostic confidence were evaluated using a four-point scale of diagnostic certainty. RESULTS: Performing indirect MR arthrography of the unexercised shoulder leads to a diagnostically efficient enhancement of joint fluid (120% at 4 minutes and 145% at 8 minutes after intravenous injection of gadodiamide). In terms of soft tissue delineation, characterization of rotator cuff tears was significantly improved by using enhanced fat-suppressed T1-weighted gradient echo sequences compared with conventional MR imaging. CONCLUSIONS: Indirect MR arthrography without glenohumeral joint exercise in the diagnosis of rotator cuff tears is feasible and represents a more convenient and less time-consuming alternative to indirect MR arthrography after joint exercise.
BACKGROUND: Osteopenia and osteoporosis are frequent complications after kidney transplantation. Data for the treatment of low bone mass after kidney transplantation are not available. METHODS: To test the efficacy of antiresorptive treatment, 46 patients with osteopenia or osteoporosis after kidney transplantation (bone mineral density < or =1.5 SD below normal) were randomly assigned to three groups cyclically treated as follows: group 1 with daily oral clodronate (800 mg) and group 2 with daily intranasal calcitonin (200 IU) for 2 weeks every 3 months. These two groups were compared with a control group (group 3). Every patient was supplemented with 500 mg of calcium per day. Bone mineral density (BMD) was measured by dual energy x-ray absorptiometry (DEXA) at the lumbar spine and femoral neck before and after the 12-month treatment period. RESULTS: BMD at the lumbar spine was increased by 4.6% in the clodronate group (n=15, P=0.005), by 3.2% in the calcitonin group (n=16, P=0.034), and by 1.8% in the control group (n=15, P=0.265). However, the differences in BMD changes among the groups were not statistically significant. During therapy, serum calcium decreased slightly in all groups by 4.6%; however, parathyroid hormone values increased significantly in the treatment groups by 116%. Therapy was well tolerated without impact on graft function. CONCLUSIONS: Cyclical therapy with clodronate or calcitonin appears to induce a gain in BMD at the lumbar spine in patients with low bone mass after kidney transplantation. This treatment had no adverse impact on graft function but may aggravate preexisting secondary hyperparathyroidism.
The meniscoid lesion is a frequent but not well known cause of persistent pain in the anterior part of the upper ankle in sports traumatology. It has been described as portions of hyalinized tissue following an inversion sprain of the ankle. Trapping of this formation between the lateral cheek of the talus and the fibula is supposed to be responsible for pain and other symptoms reported by the patient. In 59 arthroscopic procedures on the ankle joint in athletes, meniscoid lesions were seen in 19 cases. Only 1 of these 19 patients showed lateral and anterior instability, and frequent clinical symptoms were swelling and trapping. Intraoperatively, all meniscoid lesions were combined with synovitis. Chondromalacia and osteophytes were seen several times. After an average follow-up period of 12 months, 14 patients could be examined. Twelve of the athletes returned to full sports activity; 10 were very satisfied, 2 satisfied, and 2 unsatisfied. Nine patients did not complain of any swelling, 4 did so on rare occasions, and 1 complained persistently. No pain was reported 10 times, improvement of pain 3 times, and continuing persistent pain 1 time, probably because of simultaneous chondromalacia and osteophytes. These were found more frequently in patients with a longer case history and unsuccessful conservative treatment, so that early arthroscopic surgery is recommended.
The treatment of ligament injuries of the knee has undergone rapid progress, especially with the improvement of arthroscopic reconstruction of the anterior cruciate ligament (ACL). Since the advent of magnetic resonance imaging (MRI) after knee trauma with ligament injuries, interest has focussed on the clinical significance of concomitant articular and osseous lesions. In 48 of 141 MRIs, different types of these lesions were found; in 38 cases an arthroscopy was performed and 34 times the patients could clinically and radiologically be examined after at least 6 months. Bone bruise was found 26 times, in 16 cases associated with ACL-tears. Eleven patients had subchondral fractures, 7 osteochondral fractures, and in 4 patients, stress fractures were found. They were attributed to various mechanisms of trauma, in different percentages associated with ligament tears and in different dimensions visible or progressive on follow-up MRIs. Obviously some of the different lesions of subchondral and spongeous bone can indicate later degenerative arthritis, so that we find hints for a modification of rehabilitation, e.g., open versus closed kinetic chain or orthosis with relief of single compartments.
INTRODUCTION: Since the advent of operative ankle arthroscopy specific treatment of osteochondritis dissecans of the talus underwent rapid progress. Besides optimizing well-known methods as drilling, spongeous plastic, curettage or refixation of dissecates new trends go to transplantation of cultivated cartilage and osteochondral allografts. Previous follow-up examinations suffer on the one hand from partially small numbers of cases, on the other hand comparisons are difficult because so far no rating system of the function of the upper ankle does exist. MATERIAL AND METHODS: Within three years 34 patients underwent arthroscopic treatment of osteochondritis dissecans of the talus, 16 with percutaneous drilling, 12 spongeous plastics, three refixations and three curettages. The average age of the 22 men and 12 women was 25 years (11-48 years). A newly developed score system and a follow up MRI was used in a follow-up of 29 of the patients. Up to 100 points are given in the categories pain, stability/insecurity, efficiency/painfree walking distance, gait, differences in circumference, motility and power. RESULTS: 27 of the 34 patients had a trauma history. 20 lesions were localized at the lateral talus, they all had a trauma history. In 7 of the 14 lesions at the medial part of the talus there was no evidence of trauma. The 29 patients in the follow-up achieved an average of 87 points, the 16 patients after K-wire drilling 85 points and the 12 patients after spongeous plastic 90 points. Deductions were noted likewise in the subjective and objective parameters. 100 points were reached by 4 patients. DISCUSSION: Cultured chondrozytes and osteochondral grafts are new trends in treatment of osteochondritis dissecans while arthroscopically controlled spongeous plastic after curettage and K-wire drilling represent the main component of early stages with intact or partially fractured cartilage surface. Results of K-wire drilling are negligible worse than those of spongeous plastic, which is attributed to a generous perforation of the sclerosis. This is contributed to an improved preoperative diagnosis with MRI.
48 patients with an acute lateral and/or medial epicondylitis of the elbow, induced by sporting activities, were treated in a prospective, controlled, double-blind, and randomised clinical study over a period of one to two weeks in a standard manner, either with taping and the oral NSAID proglumetacine b.i.d. (26 patients: 8 women, 18 men; mean age of 37.8 years) or with taping and an oral placebo b.i.d. (22 patients: 11 women, 11 men; mean age of 40.0 years). The course of complaints was followed on the basis of a functional index (created according to Lequesne). Taking into account the prior definition of efficacy, at the end of the 1st week of all 22 NSAID group patients, enrolled and treated according to the protocol, there were already 21 responders and of all 19 corresponding placebo group patients, there were 12 responders. The difference is statistically significant (p = 0.0157). The rate of efficacy was 95.5% in the verum (plus taping) group and 63.2% in the placebo (plus taping) group with a further amelioration in both groups at the end of the study. Safety was comparably good in both the verum as well as the placebo group.
PURPOSE: Shoulder lesions are usually examined with the joint in only one or two positions. We examined the shoulder with the joint in a variety of positions. We also assessed the application of cine-MR to the detection of instability and impingement. MATERIAL AND METHODS: The cine-MR examinations were performed in 30 patients and 15 healthy volunteers. We used an open 0.2 T system and a closed 1.0 T system. Spoiled gradient echo 2D T1-weighted images and turbo spin-echo T1- and T2-weighted images were obtained with a field of view of 180 mm. The examinations were videotaped and evaluated later. RESULTS: Normal variations of the glenohumeral joint were easy to recognize. Sub-luxations and luxations of the humeral head as well as rupture of the labrum were identified. It was also possible to identify the labrum with a signal change after arthroscopic refixation. And we were able to objectively assess distances between the osseous structures during dynamic movement. CONCLUSION: Unlike static MR, cine-MR would appear to be useful in visualizing the capsular ligament complex of the gleno-humeral joint in impingement and instability. It also provides information on dynamic changes and may thus prove to be an important tool for shoulder diagnostics. The method may provide an early diagnosis in the sub-acromial impingement syndrome.
The authors report their experiences with the percutaneous transforaminal approach to the epidural space. 85 patients were treated endoscopically for non-contained lumbar herniated discs. Very good and good results of 20 patients (learning curve) were obtained in 65%. However, reoperation rate was 25% versus 3% for the last 65 patients. The first 50 patients were treated under local anaesthesia, the last 35 patients under general anaesthesia. Operative technique is described in detail. Laser application in the epidural space is helpful for tissue ablation and to obtain hemostasis. No complications were observed. The main advantages of this new minimal invasive technique are, besides reduced morbidity, less epidural scarring and removal of the sequestered tissue under visual control while retaining disc tissue in the intervertebral space. Thus, the disadvantages of open nucleotomy with possible instability and abundant scarring may be avoided.
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We reviewed the results of seven transtrochanteric rotational osteotomies done for painful avascular necrosis of the femoral head. The results tended to deteriorate over the time. Despite the overall unsatisfactory results at final follow-up, the procedure was valuable as it delayed the necessity for total hip arthroplasty. Six patients underwent total hip arthroplasty an average of 6.7 years following the osteotomy. The procedure is technically difficult and is associated with a high risk of late complications, mainly progressive collapse, further necrosis and increased osteoarthritic changes.
If strict indications are adhered to, shoulder arthrodesis is a valuable method in the operative treatment of restoring function to a chronically painful joint in a physically hard-working patient. Functional failure, especially because of rotation loss occurs often and is frequently the cause of unsatisfactory results. The main problem is the position of the arthrodesis. After numerous contradictory proposals, the most favorable approach is an abduction of 20-25 degrees and flexion of 30 degrees with an internal rotation of 45 degrees. Of all of the previous methods of fixation, today compression arthrodesis with one or two AO plates is preferred.