Biomedical subjects

H Grasshoff

Publications and source records attributed to H Grasshoff.

At least 19 recordsLinked to original sources

PubMed2006

[The femoral neck prosthesis CUT. Three- to six-year results].

BACKGROUND: As the number of younger patients undergoing total hip arthroplasty is growing steadily, bone-saving implantation techniques are increasingly gaining in importance. METHODS: Fifty-six femoral neck prostheses (type CUT, ESKA Implants, Lübeck, Germany) were implanted in 50 patients between 1999 and 2002 (average age 49 years). After a mean follow-up of 4.9 years (min.: 3.2, max.: 6.5), we determined the state of all the prostheses. Forty-four patients with 50 prostheses were examined clinically with the Harris hip score and were assessed radiologically. RESULTS: The average Harris hip score improved from 48 points preoperatively to 93 points at the most recent follow-up examination. Of the 56 CUT prostheses, 6 (10.7%) had been revised. Four of these six cases (7.1%) required revision because of aseptic loosening. The radiological evaluation of these four cases revealed in three cases progressive horizontal migration with varization of the prosthesis, although the stem had been correctly positioned in primary surgery, with the femoral neck resected too widely or completely. After 4.9 years, the survival rate of the CUT prostheses is 88.4% according to Kaplan-Meier for a necessary exchange of the CUT prostheses as an endpoint. CONCLUSION: The use of the CUT prosthesis can lead to good clinical and radiological results, but shows a higher loosening rate as compared with cementless standard stems. Further studies are necessary to determine if the CUT prosthesis is a real alternative to cementless standard stems.

Adult↗

PubMed2005

Proximal focal femoral deficiency -- a rare entity in the sonographic differential diagnosis of developmental dysplasia of the hip,.

In the present study, we will describe the differential diagnosis of the rare hip anomaly of proximal focal femoral deficiency (PFFD), based on an analysis of 12,488 ultrasound images of the hips of 6244 neonates, examined in our orthopaedic clinics between 1988 and 1998. The clinical manifestations and ultrasound features of PFFD will be characterised and compared with those of the normal, the mildly dysplastic, and the severely dysplastic hip. Two cases of PFFD (0.032 %) were detected during the investigation period. Both neonates had been referred to the orthopaedic clinic for further evaluation after the initial ultrasound findings suggested an anomaly in the coxal-femoral region. Correct identification of anatomical structures in the acetabular region (acetabular labrum and lower edge of the ilium) was not possible, but the iliac line, femoral head, and greater trochanter could be reliably visualised. Because of these findings, a deformity in the coxal-femoral region was suspected, and further diagnosis was recommended. PFFD was subsequently diagnosed, and specific treatment was initiated. PFFD should be suspected in any neonate with suspicious clinical findings and failure of ultrasound to clearly visualise anatomical landmarks in the region of the acetabulum (acetabular labrum, lower edge of the ilium, cartilage-bone interface) despite the use of a sufficient imaging technique. Radiographs should then be obtained to confirm or refute the tentative diagnosis. Infants with PFFD can then receive proper treatment without unnecessary therapeutic trial and error.

Diagnosis, Differential↗

PubMed2004

[Visualization of a solitary myeloma of the sternum by ultrasonography].

We report on a 32-year-old patient with a 9 month history of pain of the mid-third of his sternum. The laboratory results as well as other diagnostical methods (MRI and bone scintigraphy) were negative. The ultrasound examination revealed an interruption of the corticalis reflex beneath the sternal synchondrosis of a length of 4 cm. Under suspicion of an osteolysis we performed an open biopsy. The histological analysis made the diagnosis of a solitary myeloma. Therefore ultrasonography is able to depict tumerous infiltrations of the sternum if the anterior corticalis is involved and allows therapeutical consequences.

Adult↗

PubMed2003

[Spondylitis due to Salmonella typhimurium].

Very little is known about Salmonella typhimurium as an agent of spondylitis. Only single cases have been described in the international literature over the last years. We report on three patients suffering from spondylitis with Salmonella typhimurium being isolated as the triggering agent and point out the subtly differentiated diagnostic and therapeutic procedures, especially the possible complications of a Salmonella spondylitis. For one of the patients, we diagnosed a concomitant abdominal aortic aneurysm. Another patient sustained an infection of a known aortic aneurysm, which had been operated on 3 years ago. The source of the infection could be either the aneurysm or the spine, with the other structure being infected subsequently. We also discuss possible pathogenesis.

Aged↗

PubMed2002

[Heparin-induced thrombocytopenia as a complication of postoperative prevention of thromboembolism with unfractionated heparin/low molecular weight heparin after hip and knee prosthesis implantation].

AIM: With this prospective study we analysed the occurrence of a heparin-induced thrombocytopenia type II (hit type II) using unfractioned heparin (UFH) or low-molecular-weight heparin (LMWH) as postoperative thrombosis prophylaxis after primary total hip or knee replacements. Furthermore the postoperative course of the platelet count with UFH and LMWH was investigated. MATERIAL AND METHODS: In a prospective study we looked at the platelet count of 504 primary endoprothesis patients until the 9. postoperative day. 252 patients got UFH (3-mal 5000 IE Liquemin), 252 patients got LMWH (Clexane 40 opd) as thrombosis prophylaxis. RESULTS: 5 patients of the UFH-group developed a HIT type II (incidence 2%; 95%-confidence interval 0.7-4.5) after 9.8 (7-16) days. Within the LMWH-group we saw just one case (incidence 0.4%; 95%-confidence interval 0-2.1). The drop of the platelet count was on average 64% (40.9-81.6). Within the 498 patients without a HIT type II just 2 patients had a drop of the platelet count between the 5. and 9. postoperative day of more than 15% referring to the preoperative value (24% and 33%). CONCLUSION: The incidence of a HIT type II after the use LMWH seems to be lesser than after the use of UFH. The postoperative platelet count shows a typical course after a total joint replacement. With deviations of that a HIT type II must be excluded.

Aged↗

PubMed2002

[Clinical and radiological results of surgical removal of periarticular ossifications after hip prosthesis implantation].

The occurrence of heterotopic ossification (HO) is a well-recognized problem after total hip replacement. In a retrospective study, we investigated 32 patients who had undergone surgical excision of symptomatic HO followed by radiation with 7 Gy and nonsteroidal anti-inflammatory drug therapy between 1994 and 1999. The mean follow-up was 20 months (range: 12-60). Clinical and radiographic follow-up examinations included Harris hip score and classification according to Brooker. The preoperative Brooker class was III in 16 cases and IV in 16 patients. Comparison of the Brooker classification at follow-up revealed a statistically significant improvement (p < 0.0001; class 0:3, class I: 14, class II: 8, class III: 7 patients). In one case with symptomatic Brooker class III ossification, surgical reexcision of HO was necessary. A statistically significant increase (p < 0.05) in mean range of motion (ROM) was observed in flexion [preoperative: 57 degrees (+/- 26), follow-up: 83 degrees (+/- 21)], in abduction [preoperative: 17 degrees (+/- 12), follow-up: 24 degrees (+/- 9)], and in rotation (preoperative: 16 degrees (+/- 17), follow-up: 31 degrees (+/- 18)]. Comparison of preoperative Harris hip score (60 +/- 11) and Harris hip score at the time of follow-up examination (73 +/- 17) revealed a statistically significant increase (p < 0.0001) after treatment. At the time of follow-up examination, 18 patients (56%) assessed their pain symptoms as low but 6 patients (19%) reported strong pain symptoms. Nevertheless, the score at the time of examination (35 +/- 10) was statistically improved (p < 0.02) when compared to the preoperative score (30 +/- 8). Surgical excision of Brooker class III or IV heterotopic ossification with limited ROM followed by irradiation and anti-inflammatory prophylaxis results in significant improvement in flexion, abduction, and rotation arc and significant reduction of HO in radiographic examination at follow-up, but pain relief was only satisfactory.

Aged↗

PubMed2002

[Spondylodiscitis in childhood].

Spondylitis is a rare disease in childhood and atypical symptoms frequently retard the diagnosis. From 1968 to 1988, 25 children with a diagnosis of spondylitis were treated in our orthopedic hospital. Anamneses, clinical symptoms, roentgenograms, and differential diagnoses are described for these cases. Spondylodiskitis represents a mild course of the disease in childhood. Tuberculous spondylitis was not present in any of the cases. The prognosis of childhood spondylitis is favorable, and surgical interventions were not necessary in our patients. Spondylitis healed with an ankylosis of one segment of the spine without essential disturbance of spinal function.

Age Factors↗

PubMed2002

[Results after resection of juxta-facet-cysts - Which role does a segmental instability play?].

This study demonstrates the results after operative treatment of patients suffering from a lumbar Juxta-Facet-Cyst. We point out diagnostical aspects, possible concomitant problems and deriving therapeutical consequences. Between 01. 01. 1998 and 31. 03. 2001 9 patients were operated on a synovial cyst or a ganglion of the facet joint at our department. 5 patients were female, 4 patients male with a mean age of 61 (45-70) years. The average clinical and radiological follow up was 11 (5-18) months postoperatively. The clinical examination revealed in 5 out of 9 patients a sensible deficit, in 3 out of 9 patients motoric disturbances. There was no positive sign of Lasegue. The resection of the cyst or ganglion was performed in all cases via a dorsal approach. 8 patients underwent for a spinal stenosis and/or an existing instability a laminectomy and a spondylodesis with an internal fixateur. The histological findings showed a synovial cyst in 6 cases and a ganglion cyst in 3 cases. At the follow up all preoperative sensible or motorical deficits had resolved. Juxta-Facet-Cysts are discovered in some cases intraoperatively by chance, the radiological methods (CT, MRT) are especially in case of a concomitant spinal stenosis uncertain. During all operations, which are performed for a spinal stenosis, one should look for a cyst. The resection of the cyst leads to good functional results, a possible instability should by addressed by a spondylodesis.

Aged↗

PubMed2001

[History of orthopedics in East Germany 1949-1990].

The following article deals with the essential aspects of the history of German orthopedics between 1949 and 1990 in the German Democratic Republic (GDR). Starting from the prevailing situation after World War II, the growth of orthopedic care in the GDR is described and the development of national orthopedic centers in the former GDR is summarized. In this context, reference is made to those public figures who played a leading role in this process, in particular F. Löffler, P.F. Scheel, and P.F. Matzen. In addition, the influence of social conditions in the GDR on the development of orthopedics and the resultant constraints are presented. Moreover, this contribution depicts the progress of orthopedic science in the former GDR and describes such salient aspects as the appearance of the specialized journal Beiträge zur Orthopädie und Traumatologie (Essays on Orthopedics and Traumatology), the Gesellschaft für Orthopädie der DDR (Association for Orthopedics in the GDR), and the annual conferences held by the this association.

Congresses as Topic↗

PubMed2001

[Single intervention for treatment of Salmonella typhimurium-induced symptomatic abdominal aortic aneurysm with spondylitis].

Simultaneous treatment of Salmonella typhimurium-induced symptomatic abdominal aortic aneurysm with associated spondylitis. Bacterially infected aneurysms associated with local spondylitis, while representing a potentially fatal clinical picture, are an operative challenge for vascular surgeons and orthopaedic surgeons alike. In this context, the concurrent occurrence of an infection with Salmonella typhimurium as a causative agent is a rare observation. The case report gives an outline of the simultaneous vascular and orthopaedic surgical procedure. The subrenal mycotic aneurysm was removed in a first step. The continuity of the aorta was restored centrally through an autogenic aortic graft with caudal anastomosis to a dacron vascular prosthetic tube. Initially, the latter was chosen of excessive length so as to facilitate the orthopaedic surgeon's approach. Upon completion of stabilising surgery of the vertebral column, the dacron tube was reduced in length as necessary and the surgical area was enclosed with an omentum majus plastic mesh. No complications were noted during the 18-month follow-up period.

Aneurysm, Infected↗

PubMed2001

[Diskography findings and results of percutaneous laser disk decompression (PLDD)].

AIM: The aim of our study was to find a correlation between discographic findings and the clinical outcome of patients treated by PLDD. METHOD: At our clinic a total of 444 patients was treated by PLDD from 1992 until 1998. Of these, 100 patients were included into this study by chance. All patients had discography. We analysed the discographic results and correlated them with the objective and subjective outcome after PLDD. RESULTS: Best clinical results were found in the group of discographic stages 7 and 8 according to Krämer. In cases of epidural leak of contrast medium and in cases of total degeneration, the clinical results were significantly poor (stages 6 and 9). CONCLUSION: In cases of ruptured posterior longitudinal ligament, i.e., epidural leak of contrast medium in discography, PLDD is not indicated. The indication for an operation first of all depends on the clinical symptoms but the success of the operation depends on the discographic findings.

Adult↗

PubMed2001

[Significance and incidence of type II heparin-induced thrombocytopenia. A prospective study].

AIM: The incidence of heparin-induced thrombocytopenia (HIT type II) as a consequence of postoperative thrombosis prophylaxis after hip or knee prosthesis was investigated in this study. Furthermore the platelets count was postoperatively analysed in patients without HIT II. PATIENTS AND METHODS: Patients with knee and hip prosthesis were included in a prospective study during an 8 months period. All patients received 3 x 5,000 Liquemin (Hoffmann-LaRoche) from the day of the operation until discharge. In cases with a platelet count drop of more than 40% and in patients with clinically manifest thrombosis or embolism a HIT type II test was initiated. RESULTS: 5 of 252 patients included in this study developed a HIT type II. The platelet count drop was on average 65.7% (40.9-81.6). One patient died of a lung embolism (lethality 20%). Four patients were treated with Hirudin and 1 patient with Danaproid-Natrium. There was no drop of the platelet count between the 5th and 7th postoperative day of more than 15% in the other patients without HIT type II. CONCLUSION: In operative departments not enough attention is paid to HIT type II. Knowing the risks with an appropriate monitoring HIT type II can be early detected. Under these conditions the advantages of a heparin prophylaxis outweigh the risk of developing a HIT type II with it's life threatening sequelae.

Aged↗

PubMed2001

[Results of operative therapy of periprosthetic femur shaft fractures in total hip endoprostheses].

Periprosthetic femoral shaft fracture represents an uncommon but potentially devastating complication associated with total hip arthroplasty. The treatment should result in complete union of the fracture and at the same time guarantee stability of the implant. 15 patients treated between 1992 to 1998 were analysed. Clinical and radiographic follow-up averaged 30 months (6-79 months) in 13 cases. Two patients died regardless of the fracture. The method of treatment depended on the intraoperative stability of the prosthesis and in addition on the fracture type (Bethea). In 5 cases of intraoperative stability of the prosthesis plate fixation was performed. Plate fixation was complicated by fixation failure combined with a recurrent fracture in two cases leading to shift to a long stem prosthesis. Ten cases of fractures associated with loose stems were treated with a new prosthesis using a long stem system. In these cases an uncomplicated healing of the fracture was achieved with adequate stability in radiographic examinations. The average Harris score was 70 (26-93). For fractures near the femoral stem or in case of implant loosening we recommend the shift to a long stem prosthesis. Also in fractures distally from the femoral stem tip we prefer now long stem implants rather than plate fixation to avoid large exposure of the femoral shaft and resultant complications.

Aged↗

PubMed2001

[Value of ultrasound in diagnosis of bursopathies in the area of the Achilles tendon].

AIM: The goal of this study was to check the usefulness of ultrasonography as a diagnostic tool for a bursitis in the area of the Achilles tendon. Furthermore, we assessed the shape and size of the retrocalcaneal bursa of normal subjects. METHOD: The ultrasonograms of 28 patients with a bursitis at the Achilles tendon were analysed. In addition, we sonographically examined the region of interest in 10 normal subjects (20 Achilles tendons). We used a 5 and/or a 7.5 MHz linear transducer. The examination was done in both standard planes. RESULTS: The examination of 10 normal subjects could not reliably demonstrate a bursa in the expected location of the subachillic bursa or the subcutaneous calcaneal bursa in a single case. We could, however, depict a subachillic bursitis (echofree to hypoechoic) in 22 patients. A subcutaneous calcaneal bursitis was found in 7 cases. CONCLUSIONS: The retrocalcaneal and subcutaneous calcaneal bursa is not demonstrable by ultrasonography in healthy people. Exsudation and proliferation of the bursa, however, facilitate the detection by ultrasound. Taking that into consideration, the sign of the bursitis is not the enlargement but the fact that the bursa is demonstrable at all by ultrasonography. In the case of the peritendinitis of the achilles tendon a concurrent bursitis should be looked for. During operative explorations an existing bursitis has to be removed. Ultrasonography is the method of choice for the diagnostic evaluation of a bursitis in the area of the achilles tendon.

Achilles Tendon↗

PubMed2001

[Interesting case no. 45. Pharyngeal manifestation of chondroid chordoma].

Chordomas usually occur in the axial skeleton and they arise from the remnants of notochord. Their growth is slow and they often metastase. Most frequently chordomas are situated in sacral bone (50%), in spheno-occipital region of the skull base (35%) and in the cervical and lumbar spine (15%). We reported an unusual case of chordoma of the cervical spine with participation of the parapharyngeal space. The cervical chordoma was excised by total resection of the tumor mass with partial vertebrectomy C2/C3.

Aged↗

PubMed2000

[Bilateral and simultaneous rupture of the quadriceps tendon--a diagnostic problem?].

We report about a 36 year old patient with thrombocytopenia due to Werlhof's disease, who had been diagnosed and treated as suffering from paraparesis of both legs for 10 months. The real cause of his problem--a simultaneous bilateral rupture of the quadriceps tendon--had not been detected. Only when he underwent an ultrasound scan of both of his knees as part of the examination in our outpatient department the diagnosis of a simultaneous bilateral rupture of the quadriceps tendon was made. The following operation confirmed the sonographical findings. The sonographical evaluation of the quadriceps tendon can clearly assess the extent of the lesion and lead to the necessary therapeutical consequences.

Adult↗

PubMed2000

Vertebral collapse and normal peripheral blood cell count at the onset of acute lymphatic leukemia in childhood.

Acute lymphatic leukemia presenting with bone pain and spine involvement is a recognized clinicopathologic complex that can mimic a wide range of orthopaedic conditions. Bone pain as the presenting complaint is common, with a reported incidence of 27% to 50%. Radiologic abnormalities associated with leukemia in children has been described previously. In the literature, the incidence of spinal involvement is controversial, but there is agreement that the spine is less commonly involved than are the long bones. At the onset of the disease, only 10% of children have normal peripheral blood counts. If the patient has spinal involvement and a normal leukocyte count, the diagnosis is often unclear. Only three of these patients have been described in the literature; this article adds one more patient with acute lymphatic leukemia with back pain as the main symptom, vertebral collapse, and a normal peripheral blood cell count at the time of initial presentation. It illustrates that delay in diagnosis frequently occurs, with the classic features of the disease being uniformly absent.

Blood Cell Count↗

PubMed1999

[Anterior hyperostosis of the cervical spine: diagnostic studies and surgical therapy].

BACKGROUND: Dysphagia due external compression by anterior hyperostosis of the cervical spine is rare. The diagnosis may be established by conventional X-ray of the spine, esophagogram, and CT. PATIENTS: We operated on three patients with large anterior osteophytes from C3 to C7. In two cases morphologic changes of the cervical spine were the main cause of dysphagia. One patient with progressive hypopharynx cancer had hyperostosis of cervical spine as secondary findings. RESULTS: The patients were asymptomatic, post-operatively. CONCLUSIONS: Cervical osteophytes can be detected in 20-30% of the population in asymptomatic patients. The therapeutic approach depends on the extent of dysphagic complaints. Painful dysphagia is a indication for surgery. The anterolateral extrapharyngeal approach is commonly preferred with anterior hyperostosis between C4 and C7. The transoral intrapharyngeal approach has been used in patients with hyperostosis of cervical vertebra C2/C3. Interdisciplinary orthopedic and ENT surgical treatment is without complications and yields good functional results.

Cervical Vertebrae↗