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Biomedical subjects

B Hintermann

Publications and source records attributed to B Hintermann.

At least 37 records · Page 2Linked to original sources
PubMed1999

Lengthening of the lateral column and reconstruction of the medial soft tissue for treatment of acquired flatfoot deformity associated with insufficiency of the posterior tibial tendon.

We analyzed our results of surgery for acquired flatfoot deformity after dysfunction of the posterior tibial tendon. This included lengthening the proximal lateral column by calcaneal osteotomy and reconstructing the medial soft tissue. Nineteen patients (9 women and 10 men; average age, 52.9 years [range, 24-72 years]) were treated for stage II and stage II-III insufficiency of the posterior tibial tendon. The medial soft tissue surgery included 18 reconstructions of the tendon, 11 transfers of the flexor digitorum longus tendon, 13 repairs of the deltoid ligament, and 3 repairs of the spring ligament. At follow-up (mean, 23.4 months), all patients had satisfactory restoration of their medial longitudinal arch, reduction of abduction in the forefoot, and restored height in the arch. All patients were able to bear weight fully on the foot that underwent surgery, and all but one were satisfied with the result achieved. The clinical result was rated as excellent in 6, good in 11, and fair in 2 cases. In all but one case, no loss of achieved correction in the foot was found. In one case, the calcaneocuboid joint had to undergo arthrodesis after 5 months because of painful degenerative joint disease. In the pes planovalgus and abductus deformities occurring in stage II disease, calcaneal osteotomy and reconstruction of the medial tendon and ligament seem to play a significant role in operative management. This was the case only when degenerative joint disease and significant subluxation of the subtalar or talonavicular joint or both had not already occurred. They seem to function by restoring more normal biomechanics, which allows reconstructed or transferred tendon to function successfully.

Adult↗
PubMed1999

[Lateral column lengthening by calcaneal osteotomy combined with soft tissue reconstruction for treatment of severe posterior tibial tendon dysfunction. Methods and preliminary results].

The purpose of this paper is to present principle and technique of proximal lateral column lengthening by calcaneal osteotomy and to critically analyze our preliminary results. 16 patients (7 female, 9 male; average age 52.3 years [24-72 years]) were treated for stage II to III posterior tibial tendon insufficiency by calcaneal osteotomy and medial soft tissue reconstruction (tendon reconstruction, 15; tendon transfer, 8; deltoid ligament repair, 10). When the AOFAS Ankle-Hindfoot Rating Scale was applied, these patients were shown to have significantly increased their scores from an average preoperative value of 49.1 to a mean postoperative value of 91.1 after a mean follow-up of 24.6 months. In all but one case no loss of achieved foot correction was noted. In one case, a fusion of the calcaneocuboid joint had to be performed after 5 months due to painful degenerative joint disease. At follow-up, all patients had satisfactory restoration of their medial longitudinal arch, reduction of forefoot abduction, and restored arch height. All patients were able to fully weight-bear the operated foot, and all patients were satisfied with the achieved result. In the pes planovalgus deformity occurring in stage II to III (as significant degenerative joint disease has not already occurred), osteotomies appear to have a significant role in the operative management and to function by restoring more normal biomechanics, thus allowing tendon reconstruction and tendon transfers to return to successful function.

Adult↗
PubMed1999

[Anatomic reconstruction of the lateral ligaments of the ankle using a plantaris tendon graft in the treatment of chronic ankle joint instability].

The purpose of this work was to present our technique of anatomic reconstruction of the lateral ankle ligaments using a free plantaris tendon graft. Between 1988 and 1997, 52 ankles (48 patients) were treated for chronic ankle instability resisting to a training program of minimally 3 months. The average age was 28.6 years (16 to 46 years) at the time of surgery. There were 30 ankles in men and 22 ankles in females. 4 patients were treated on both ankles. 50 ankles were available for a follow-up investigation after a mean of 3.5 years (1 to 10 years). Based on the AOFAS-Hindfoot-Scale an average score of 97.9 points (90 to 100 points) was found. The functional result was found to be excellent in 39 ankles (78 %), good in 9 ankles (18 %), fair in 2 ankles (4 %), and poor in 0 ankle (0 %). Dorsi-/plantarflexion was not restricted in any ankle. Supination was slightly restricted in 2 ankles, but not increased in any ankle. High patient's satisfaction with respect to the achieved stability was found in all but one ankle. No deterioration with time was observed in any case. The overall good and excellent results with this method may be explained by the strictly anatomic reconstruction that did not alter the kinematics nor the mechanics of the ankle joint complex. In addition the peroneal tendons were not weakened. We feel that this procedure is a better alternative to other more complex ligament reconstructions, especially tenodesis operations by using the peroneal tendon.

Adolescent↗
PubMed1998

[Not Available].

Explore the source record for details and available documents.

Journal Article↗
PubMed1998

Arthroscopic findings in luxatio erecta of the glenohumeral joint: case report and review of the literature.

PURPOSE: We report the case of an inferior glenohumeral dislocation of the shoulder in which arthroscopic assessment showed an extensive detachment of the labral-biceps tendon complex (Bankart and superior labrum anterior posterior [SLAP] lesions). We sought to review the literature to compare our findings with the reported lesions in this type of shoulder dislocation. CASE SUMMARY: A young patient presented with an inferior dislocation of his right shoulder (erect dislocation) after having sustained a motorcycle accident. Conventional radiographs revealed the humeral shaft parallel to the scapular spine and an anteroinferior position of the humeral head with a large avulsion of the greater tuberosity. Preceding arthroscopy showed a complete detachment of the anterior labrum and ligament complex (SLAP lesion). After open reduction and internal fixation of the greater tuberosity, the capsulolabral complex was reduced and securely fixed with three bone anchors at the glenoidal rim. The patient recovered well reaching full shoulder function after 5 months and regaining the former sports activity level within 9 months after surgery. DISCUSSION: Arthroscopy identified the location and extent of an important labral detachment that, in combination with the stability testing under anesthesia, proved the need for a labral refixation. The literature regarding reported pathology in inferior glenohumeral dislocation is reviewed, and the additional information on associated soft-tissue lesions by means of arthroscopy are discussed. RELEVANCE: No prior case of arthroscopic assessment in inferior glenohumeral dislocation of the shoulder has been reported. Recognizing the extent and site of accompanying labral detachments contributing to the instability of the joint may enhance our knowledge of the full pathology in these dislocations and thus allow an adequate surgical treatment.

Accidents, Traffic↗
PubMed1998

Pronation in runners. Implications for injuries.

In spite of some significant progress in the understanding of the biomechanics of the ankle joint complex, especially the coupling mechanism between foot and leg, various mechanisms causing overuse injuries in the lower extremities are still poorly understood. Some increased pronation of the foot is often physiological, but excessive pronation is potentially harmful. Compensatory overpronation may occur for anatomical reasons. However, not only the amount of foot eversion, but also the way this eversion is transferred into tibial rotation may be crucial to the overloading stress on the knee. In other words, the individual transfer mechanism of foot eversion into internal tibial rotation may be of some predictable value for lower extremity overloading and related injuries. Further research is necessary to improve the functional understanding of anatomical and biomechanical abnormalities and their pathological value in predicting overuse injuries.

Ankle Injuries↗
PubMed1998

[Biomechanics of the ankle joint--injury mechanisms].

The complex mechanics of the ankle joint complex depends highly on the integrity of the ankle ligaments. An incomplete restoration of the antero-fibular ligament after trauma may result in a mechanical dissociation of the talus from the ankle mortise. The force that is needed to induce a non-physiological movement of the foot is determined by the individual configuration of the bony and articular structures of the hindfoot. A pes cavus is less protected to suffer of an ankle sprain than a flatfoot. As the leverarm of the peroneal muscles decreases with increasing plantarflexion of the foot, the active protection to resist against a supination stress decreases with plantarflexion. These findings have significant implications for the practice. First of all an adequate treatment of any ankle sprain is necessary to restore the mechanical interplay of the ankle joint complex. Ankle orthoses should protect the foot against supination stress and excessive plantarflexion. The prevention of ankle injury may be significantly improved by recognition of the individual mechanical disposition.

Ankle Injuries↗
PubMed1997

[Primary management of comminuted humeral head fracture in the elderly patient with a humerus head prosthesis].

The purpose of this prospective study was to determine the early subjective and functional result and outcome after primary implantation of humeral endoprosthesis in severely comminuted humeral head fractures in elderly patients. From 1993 to 1995, 27 humeral head fractures (27 patients) were treated by primary implantation of a Neer II modular shoulder prosthesis. Of these, 23 patients were women, 4 patients were men. The average age of patients was 76 (48-91) years. Postoperatively, one shoulder had to be mobilized under general anesthesia. Of the 27 patients 21 could be clinically examined after 16 (3-29) months postoperatively; 4 patients had died in the meantime, 2 did not come to the control examination because of a great distance and because they were happy. The average Constant Score was 48 (25-76) points; the difference to the other shoulder was 30 (18-69) points. Of the 21 patients 19 were satisfied by the result and 20 would reaccept the same procedure. These preliminary results suggest that primary shoulder prosthesis in humeral head fractures in the elderly patient is a valuable alternative option.

Aged↗
PubMed1996

Arthroscopic assessment of the chronic unstable ankle joint.

The purpose of this study was to evaluate prospectively the findings during arthroscopy in patients with chronic instability of the ankle joint. One hundred and ten consecutive patients who had suffered at least two ankle sprains and were symptomatic for at least 6 months were included in this study. A complete rupture of the anterior talofibular ligament was found in 64%, of the calcaneofibular ligament in 41% and of the deltoid ligament in 6%. Cartilage lesions of the talus were seen in 54% of the joints, more of them medial (56%) than lateral (15%) or ventral (20%). Other frequently observed findings were synovialitis (38%), rupture of the syndesmosis (7%), and ventral scarring (6%). While cartilage damage was found independently of the lateral ligament injuries, all complete tears of the deltoid ligament were associated with cartilage injury of the talus. Medial instability was assessed in five ankles clinically and found arthroscopically in 23 ankle joints. Our arthroscopic findings show that chronic instability of the ankle joint is associated with various pathological conditions of ligaments, capsule and cartilage. It can therefore give essential information about the status of the chronic unstable joint with regard to the choice of operative or conservative treatment.

Adolescent↗
PubMed1996

[Biomechanics of the ligaments of the unstable ankle joint].

Ligament rupture occurs at the maximum breaking load. During ligament healing, contraction and remodeling of the scar is sufficiently advanced at 6 weeks to reach 60 to 70% of the initial strength. There is evidence of an early improvement in biomechanical properties of repaired ligaments. This advantage, however, may not be sustained as, after one year, sutured and unsutured ligaments have nearly equal length when measured at rest and comparable failure strength when subjected to exercise. Each of the ankle ligaments has a role in stabilizing the ankle and/or subtalar joint. Beside of maintaining lateral ankle stability, the lateral ankle ligaments have been shown to play a significant role in providing rotational ankle stability. This is especially true for the anterior talofibular ligament. A loss of this ligament does allow for an increase in foot inversion and external rotation of the leg to occur, without any tilting of the talus or subtalar gapping. It is this increase in foot inversion which may lead to a symptomatic instability. When treating ankle instability, it is therefore important for the clinician to take the alteration of hindfoot biomechanics into consideration. This is especially the case for any surgical repair of injured ankle ligaments. Unphysiological tenodesis procedures should be avoided.

Ankle Injuries↗
PubMed1996

[Diagnostic imaging of ankle joint instability].

The value of the available diagnostic methods for the evaluation of the unstable ankle joint still is under discussion. This is a result of the increasing knowledge of basic biomechanics. It has been demonstrated that ankle instability is not restricted to two planes, but can be multidirectional or rotatory. There is also a trend to conservative treatment of acute unstable ankle joints. This paper presents the actual diagnostic tools for evaluation of the unstable ankle joint with regard to their efficiency. Stress views, sonography, MRI and arthrography will be discussed.

Ankle Injuries↗
PubMed1996

[Arthroscopic findings in the unstable upper ankle joint].

The purpose of this prospective study was the assessment of the chronic unstable ankle joint. With regard to cartilage and ligament lesions this was done arthroscopically. 99 consecutive arthroscopies were performed in patients with symptomatic chronic ankle instability. There were 67 complete ruptures of the anterior talofibular ligament and 45 complete ruptures of the calcaneofibular ligament. A complete rupture of the deltoid ligament was found in 6 cases, always combined with lesions of the lateral ligaments. Cartilage damage of the talus was noted in 51 cases and of the tibial pilon in 12 cases. While all complete lesions of the deltoid ligament were associated with talar cartilage damage, this was different for lateral ligament lesions. 11/22 ruptures of the talofibular ligament were associated with cartilage damage of the talus and 11/22 ruptures presented with an intact talar cartilage. Combined ruptures of the talofibular and the calcaneofibular ligament were associated with talar cartilage damage in 21 cases and presented with intact cartilage in 24 cases. This study demonstrated a near equal distribution of intact and damaged articular cartilage in the presence of lateral ligament lesions indicating that the status of the ligaments allows no conclusion with regard to the cartilage. Arthroscopy therefore can give essential information about the status of the unstable ankle joint concerning operative or conservative treatment.

Adolescent↗
PubMed1996

[Effectiveness of outer stability aids on rotational stability of the ankle joints].

The main goal in nonoperative treatment of lateral ankle ligament injuries is the reduction of the possible supination at the ankle joint complex. Complete ligament healing can only be achieved when protected from overstress. There is general agreement that talar tilt should be avoided. Recent reports, however, have shown that instability of the ankle joint is at least in one form an axial rotational one. Therefore, the reduction of tibial rotation should also be taken into consideration. The purpose of this study was to determine the effect of three commonly used ankle braces and ankle taping on rotational stability of the ankle joint complex. The Künzli stabilizing shoe was the only orthosis that stabilized sufficiently the ankle joint complex when the foot was in slight plantarflexion. The reduction of external tibial rotation was in foot flexion of 20 degrees: Künzli stabilizing shoe, 58%; Aircast, 23%; Mikros, 12%; and taping, 10%. This becomes more relevant as this foot position is the most dangerous one where most of the ligament injuries does occur. It could be that the insufficient effect of various ankle braces on rotational stability may be the reason for residual problems after ankle sprain.

Adult↗
PubMed1996

[Dwyer osteotomy with or without lateral stabilization in calcaneus varus with lateral ligament insufficiency of the upper ankle joint].

Varus deformity is a well known problem in the treatment of chronic lateral ankle instability. Surgical correction is recommended occasionally. The goal of this study was to show the effect of a calcaneal Dwyer osteotomy in patients suffering from a functional instability. We examined 6 patients, who underwent 7 calcaneal osteotomies. Postoperatively all patients maintained stability. No recurrence of a supination trauma was observed.

Adult↗
PubMed1996

Influence of ankle ligaments on tibial rotation: an in vitro study.

The purpose of this study was to clarify the role of the ankle ligaments in controlling the tibial rotation for different foot positions. A 6 degrees of freedom device was constructed for in vitro simulation of this movement transfer during the support phase of gait. Tibia rotation angle was measured for different foot positions and vertical loads, while the ligament integrity was modified. Data were collected from eight legs of four different cadavers. The results showed that vertical loading is unimportant to influence tibial rotation, while the lateral ankle ligaments have significant influence, especially during eversion. It was concluded that chronic partial or total lateral ankle instability may contribute to knee and foot injuries through abnormal tibial rotation.

Aged↗