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Biomedical subjects

D Tönnis

Publications and source records attributed to D Tönnis.

At least 19 recordsLinked to original sources
PubMed2003

[Computerized tomography in evaluation of decreased acetabular and femoral anteversion].

Computerized tomography has received a new importance. It has been shown that decreased anteversion of femur and acetabulum, when both have decreased angles, are causing pain and osteoarthritis of the hip joint. Operative treatment should be performed before osteoarthritis develops. Exact measurements therefore are necessary. The investigation should be performed in prone position to have the pelvis lying in a defined and normal position. Femoral torsion is measured between the transverse axis of the knee and the femoral neck. The transverse axis for measurement of the femoral anteversion is defined by a rectangular line to the sagittal plane. For evaluation of the femoral anteversion in total the angle of the condyles has to be added to the femoral neck angle when the knee is found in internal rotation. Acetabular anteversion should be measured at the level where the femoral head is still in full contact and congruence with the anterior margin of the acetabulum.

Acetabulum↗
PubMed2001

Therapy in unilateral sirenomelia: report of one case.

A 17-month-old male infant was referred to us with a unilateral sirenoid malformation in 1970. Besides urogenital and lumbosacral vertebral defects, the right knee was flexed 160 degrees, and the hip externally rotated and abducted. The thigh and calf were connected by a soft tissue bridge with the heel fixed to the ischial region. Arteriography showed that the foot and lower leg were supplied by the profunda femoris artery through the soft tissue bridge. The lower leg had only a very small supply from the popliteal artery. Therefore, an amputation by disarticulation at the knee joint was performed. A few months later, in addition, the hip flexion contracture was released. The boy was taught to walk with a prosthesis. At the age of 31 years, he has a sedentary job and is more troubled by his urogenital than his orthopaedic defects. He prefers to walk with crutches and for a few years has no longer used his prosthesis.

Amputation, Surgical↗
PubMed1998

[Acetabular rotations y triple pelvic osteotomy by the Tönnis method].

Lesions of the acetabular labrum should be treated by correcting the causes. In a steep acetabulum where the femoral head brings the acetabular labrum under tension and traction, the acetabulum should be rotated by triple pelvic osteotomy to slightly over-corrected acetabular measurements. Severely diminished acetabular and femoral anteversion can also lead to tears and impingement of the labrum. Then rotation of the femoral neck and/or rotations of the acetabulum by triple osteotomy to 15-20 degrees of anteversion are indicated. Our triple osteotomy technique differs from that of others mainly in the ischial osteotomy. It is performed from the posterior approach between the sciatic notch next to the ischial spine and the obturator foramen and is directed 20-30 degrees anteriorly from the frontal (coronal) plane. The osteotomies therefore are placed close enough to the acetabulum to allow free rotation, but they do not interfere with the circulation of the acetabulum, and the ligaments between the sacrum and ischium are left in normal tension. Our normal values of the acetabular position were tested by correlating the measurements with the absence of pain. The optimum is reached with a CE angle and a VCA angle of 30-35 degrees, an angle of the weight-bearing zone of +5 to -5 degrees and a migration index of 10-15%. Overcorrections again caused pain and should be avoided. Diminished anteversion of femur and acetabulum towards 0 degree also caused pain and should be corrected by triple and femoral osteotomy to 15-20 degrees of anteversion. In earlier follow-ups of 216 hips 5-10 years postoperatively, 82.3% of the joints showed no change in the degree of osteoarthrosis. Survival rate curves regarding the absence of pain demonstrated that pain was experienced again when joints were corrected insufficiently or overcorrected, while in good corrections the joints were free of pain in about 75%.

Acetabulum↗
PubMed1997

[Roentgen studies and arthrography of the hip joint in infancy].

Radiographic examination of infants' hips is still indicated sometimes in addition to the sonographic examination. The legs have to be kept in a neutral position. The pelvis should not be turned to the side or tilted. Hilgenreiner's acetabular index is preferred in the diagnosis of hip dysplasia. Long-term follow-ups of critical values show spontaneous improvement in some cases, but also joints with increasing dysplasia. Critical values between one and two standard deviations of our material and somewhat above have to be followed. The axial orthograde view of the hip as a lateral view of the femoral head is recommended in Perthes' disease to determine the Catterall groups more exactly than in the Lauenstein position. Arthrography is still indicated in dislocated hips that cannot be reduced into the socket because of a narrow cartilaginous inlet. Here the risk of avascular necrosis is high and traction is indicated.

Acetabulum↗
PubMed1997

Early conservative and operative treatment to gain early normal growth in proximal femoral focal deficiency.

In three children with proximal femoral focal deficiency (PFFD), arthrography of the hip was performed at the respective ages of 9 days, 4 weeks, and 5 weeks. Between the unossified part of the femoral neck and the cartilaginous femoral head, there was moderate flexibility in the first child and lysis with some displacement of the femoral neck and mobility in the other two children. After the children's immobilization in a squatting cast for 3 months, consolidation was achieved and the growth plate developed normally. All three had marked coxa vara and retroversion. The earlier they were treated by valgus osteotomy and rotation to normal anteversion, the earlier normal growth started. Diagnosis at birth and immediate conservative and early operative treatment is therefore indicated in such cases. Only a few centimeters of femoral lengthening is then necessary, and resection of the unossified part of the femoral neck can be avoided.

Bone Diseases, Developmental↗
PubMed1990

Surgical treatment of congenital dislocation of the hip.

The results of two collective studies on congenital dislocation of the hip (CDH) from a number of hospitals are reported here, including general trends in the Federal Republic of Germany and the author's personal methods and preferences. In the first collective study group, the rate of ischemic necrosis in open reductions was 8.2% for anterolateral approaches, 9.6% for inguinal, 16.7% for Ludloff's operation, and only 5.5% when shortening osteotomy was combined with open reduction. A simultaneous Salter osteotomy or acetabuloplasty increased the rate to 10.3% and a concomitant varus osteotomy to 22.2%. The author prefers an inguinal approach to the hip joint, first laterally and then medially of the iliopsoas muscle and femoral nerve, for optimal visualization of the acetabulum. Stability of the joint is increased by a girdle-like flap from the dorsolateral capsule, which is drawn anteriorly and prevents dorsal redislocation. Acetabuloplasty should also be used, even during the first year of life, in joints in which stability may only be guaranteed by extreme abduction and internal rotation. Salter's and Pemberton's osteotomies are used in Germany with good results. However, the author prefers a lateral Albee-Lance acetabuloplasty modified to a complete osteotomy for lateral levering of the acetabular roof. Long-term results show measurements between 82% and 93% of normal and slightly pathologic values. Simultaneous or single varus osteotomies lead to subcapital coxa valga and should no longer be used routinely. In adolescents and adults up to 45 years of age, as long as osteoarthritis is not too advanced and the femoral head is not too deformed, triple pelvic osteotomy with the author's type of modification has a number of advantages.

Adolescent↗
PubMed1990

Ischemic necrosis as a complication of treatment of C.D.H.

Ischemic necrosis is seen after both closed and open reduction. Its causes have been clarified during the last two decades. The position of the immobilized hip after reduction is an important factor; the method of reduction is another. There are other factors such as development of the epiphyseal nucleus and the degree of dislocation. In a collective series of 20 hospitals our study group on hip dysplasia investigated 3316 hip joints reduced by different techniques. It was shown that methods working with the Lorenz position of immobilization have an average rate of 27% ischemic necrosis. Lange's position of abduction with internal rotation, without flexion of the hip joint, has a 17% necrosis rate. Pavlik's harness, as a more functional method, had a 7% rate. Methods reducing bij increased flexion and less abduction, such as that of Fettweis, Hanausek and Krämer, had 2% on the average. The percentage of necrosis was increased with the degree of dislocation. The length of time of immobilization had no influence. These findings correspond with the investigations on the femoral blood circulation in different positions of the femoral head and under pressure that have been published by Schoenecker et al. and Law et al. The cartilaginous epiphysis may be squeezed so much that the circulation is interrupted. Another cause is direct pressure to epiphyseal vessels in extreme Lorenz and Lange positions (Ogden and others). There has been a question as to what degree the reduction itself is the cause of ischemic necrosis. The method of reduction was determined by arthrography. If it seemed possible, a cast in squatting position according to the method of Fettweis was applied immediately. In the beginning we even allowed the joints to reduce themselves slowly against a narrow introitus of the joint. In other joints traction was applied first, and in a few older patients open reduction was performed immediately. A total of 388 joints was evaluated. There was an increasing rate of ischemic necrosis from open acetabular inlets (3.6% necrosis) to constricted joints (8.5%) and those with an inverted upperlabrum (31%). The width of the acetabular introitus, as measured between the upper and lower labrum (ligamentum transversum), also showed a correlation with ischemic necrosis. When the degree of reduction is classified as "deeply seated", there is a definite correlation with ischemic necrosis. Also when the distance of the femoral head from the acetabular floor is measured, the same increase in incidence of necrosis is noted.(ABSTRACT TRUNCATED AT 400 WORDS)

Child, Preschool↗
PubMed1990

Technique and long-term results of acetabuloplasty.

Acetabuloplasty with lateral osteotomy of the pelvis in combination with intertrochanteric derotation-varus osteotomy was performed in our hospital between 1970 and 1976. Ninety hip joints have been reexamined recently after cessation of growth. Measurements of the acetabula show normal results in more than 80% of the cases. Measurements of the femoral neck and head, however, were normal in many fewer cases. Revalgization to a "head-in-neck position" or "subcapital coxa valga" was found in 40% of the joints, while the position of the acetabuloplasty remained without significant change if the technique was correct. Additional varus osteotomy was no longer performed after 1978 with consequent improvement in the results of acetabuloplasty.

Acetabulum↗
PubMed1986

[Skewfoot ].

The deformity, congenital metatarsus adductus, has been given different names in various countries by different authors. In addition, there are both mild and severe forms, and some authors subdivide the deformity by degree. The severe form is also called skewfoot or serpentine foot, but to us these terms only appear to represent differences in degree. With regard to etiology, it has been found that a narrow uterus, for various reasons, seems to play a role, and that the foot and lower leg is rotated internally. If not treated early, the internal rotation of the lower leg increases and is frequently misdiagnosed. Conservative treatment consists, first of all, of plaster casts, with the lower leg rotated externally, the forefoot abducted, and the hindfoot supinated. The deformity itself consists of the adducted metatarsal bones and--to different degrees--a subluxation of the Chopart joint. In extreme cases there is a vertical medially directed talus and the navicular bone is displaced laterally. Different surgical procedures are discussed. We have found that the tendon of the anterior tibial muscle inserts more distally than usual at the base of the first metatarsal bone and winds itself towards the plantar side. For treatment, it is transferred to the dorsal side of the first cuneiform bone. In one child with severe serpentine feet, the posterior tibial muscle did not insert at the navicular bone but only inserted at the plantar side of the middle part of the foot. During the operation, the Chopart joint is reduced and a part of the posterior tibial tendon is led to the navicular bone.

Casts, Surgical↗
PubMed1981

[A new technique of triple osteotomy for turning dysplastic acetabula in adolescents and adults (author's transl)].

A new form of triple-osteotomy of the pelvis is described. The ischium is osteotomized from a dorsal approach, immediately behind the hip joint. The ischium is left in place, the ligaments giving stability to the sacrum remain in tension. After turning the patient a small medial incision is done for the osteotomy of the pubis. The The ilium is cut through with a Gigli saw from a small incision laterally. It should descend medially in a distance of 2-2,5 cm apart from the joint. The possibilities to turn the acetabulum are very good and correspond to the amount of abduction before operation. Injuries to the sciatic nerve are avoided by the dorsal approach. The evaluations of 32 patients with different degrees of dislocations are reported. The osteotomy may be done even in flat-shaped femoral heads, where the acetabulum is still congruent as long as it is possible to abduct the leg and turn the femoral head into the acetabulum. It has been done in high dislocations with secondary acetabulae as well. The operation may be used in children above 8 years, where the osteotomy of Salter and acetabuloplasties are not efficient any more. In contrary to Chiari's osteotomy the acetabulum is covered by cartilage and the angle of inclination usually normal. It can be used in adults and beginning arthrosis as long as the abduction is not limited.

Acetabulum↗
PubMed1981

[The "hip value" as a criterium for the operative treatment of CDH in juveniles (author's transl)].

Planimetric measuring was performed at the X-rays of the pelvis of 2027 mainly juvenile patients in order to determine the socalled "hip value". We were able to define a clear statistical difference between normal and pathological values. It was possible to use the hip value as a parameter for the displasia of the hip and with additional clinical data to give a prognosis about the development of pathological hips. In addition to this guide lines for corrective operative procedures could be established. Extreme displastic joints with a hip value of more than 30 need immediate operative treatment, severe displasia with a hip value above 20 should be treated operatively as soon as possible before the end of the growth period. In milder cases of hip displasia operative treatment can be delayed until the patient starts to feel pain in the affected hip.

Adolescent↗
PubMed1981

A modified technique of the triple pelvic osteotomy: early results.

A modification of the triple pelvic osteotomy for children over 8 years and the young adult is described. The results of the first 32 cases are reviewed. These show that the indications for the operation can be widened so that not only primary dysplasias but also subluxated or dislocated hips with secondary dysplasia can be operated on successfully. The operation is done in two stages. At first the patient is lying prone. The osteotomy of the ischial ramus is done dorsally by cutting the connection between the sciatic notch and obturator foramen immediately behind and below the acetabulum. In the second stage, with the patient lying supine, the pubic and the iliac osteotomy are performed rather circular and parallel to the hip joint. These modifications have several advantages: (a) the operator has a direct field of view at all times; (b) the osteotomy is performed close to the acetabulum, thus allowing a great amount of lateral rotation and medial displacement of the acetabulum, thereby providing good coverage of the femoral head by hyaline cartilage; and (c) the ischial ramus and its ligaments to the sacrum are left intact, leading to greater stability of the pelvis and spine.

Acetabulum↗
PubMed1980

[Examination method for identification of snapping hip (author's transl)].

An examination method is described for the identification of the snapping hip 30-40 degrees of bending, adduction and alternating anterior and exterior rotation of the hip joint. Through the maximal pre-tension of the tractus iliotibialis it is possible to definitely prove the existence even of minor snapping. In view of the fact that the examination method is a passive one, it can also be employed intra-operatively for direct control of the result of the operation.

Hip Joint↗
PubMed1979

[The growth of the juvenile hip joint. A planimetric study of x-ray films (author's transl)].

A total of 1.779 X-ray films of the pelvis done with the same technic in children and adolescents was divided into 8 different age groups between 5 and 20 years. Several planimetric parameters for the evaluation of pelvic growth were measured and statistically analysed. A growth quotient was found showing periods of limited intensive growth efforts of the human hip joint. Such growth periods were found in both sexes between 5 and 8 years, and again for girls between 9 and 12 years, for boys between 11 and 14 years. In pathologic hip joints the triradiate cartilage closes sooner. The development of the pelvic roof and the closure of the triradiate cartilage show a close relationship. By evaluating 802 normal hip joints, an acetabular form index useful for all age groups was found.

Adolescent↗