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J Pfeil

Publications and source records attributed to J Pfeil.

At least 19 recordsLinked to original sources
PubMed2006

Posteromedial approach to proximal tibia for corticotomy in callus distractions.

Corticotomy of the tibia using Ilizarov's anterolateral approach is used routinely for callus distraction. This method is associated with impaired callus formation and delayed healing because of marginal soft tissue covering and blood supply to the proximal tibia. We presumed a newly designed posteromedial approach would result in less callus defects and improved healing. In this prospective, randomized study, 31 patients had callus distraction using an anterolateral approach or the newly designed posteromedial approach. Callus formation was assessed radiographically and histologically. Callus defects were classified using serial radiographs. Biopsy specimens were taken from high-grade defect (Grades 3-4) zones to examine the osteogenic potential. Radiographic evaluation showed 13 callus defects; 12 occurred after the anterolateral approach and only one occurred after the posteromedial method. Although low-grade defects (Grades 1-2) healed spontaneously, biopsy specimens taken from Grades 3-4 defects revealed no osteogenic potential and requiring operative revision. Because of low soft tissue covering and impaired blood supply to the anterior tibia during surgical exposure for corticotomy, less callus formation occurred after the anterolateral approach compared with the posteromedial approach. We recommend the less invasive posteromedial approach to reduce callus defects and impaired healing in callus distraction of the proximal tibia.

Adolescent↗
PubMed2005

[Early results of one-stage septic revision arthroplasties with antibiotic-laden cement. A clinical and statistical analysis].

BACKGROUND: Periprosthetic infections will generally require revision arthroplasty. The one-stage revision arthroplasty with antibiotic-laden cement is hence an attractive therapeutic option, since it only requires one operation, has a low morbidity and, if successful, is cost-efficient. MATERIALS AND METHODS: We performed one-stage revision arthroplasties. The exchanged prostheses were fixed with antibiotic-laden cement after biotic resistance was determined. All patients were treated with postoperative systemic antibiotics. RESULTS: After a mean postoperative examination period of 18.4 months, we confirmed eradication of infection in 14 of 15 knee joints and in 15 of 16 hip joints. The mean duration of hospital stay was 23 days. Patients' satisfaction was high (93.55%) and the clinical results were satisfactory. CONCLUSION: Our analysis shows that our low early reinfection rate (6.45%) is within statistical expectation. Furthermore, we have showed that there is evidence to suggest that the rate of successful outcomes in one-stage revision arthroplasties, at least at the hip, is not different from the rate of two-stage revision arthroplasties and that the difference may be interpreted as stochastic deviation (p=0.264494). According to existing studies, an analogy to knee arthroplasties can be assumed. We demonstrated that one-stage revision is an adequate therapeutic option if patients are carefully selected and under the supervision of an experienced surgeon.

Anti-Bacterial Agents↗
PubMed2005

[Frequency and severity of callus defects. Dorsomedial vs ventrolateral approach for corticotomy in performing callus distraction of the tibia].

BACKGROUND: The purpose of this study was to compare a dorsomedial to the ventrolateral approach for corticotomy in performing callus distraction of the proximal metaphyseal tibia. PATIENTS AND METHODS: A total of 31 callus distractions were performed in 28 humans. The ventrolateral approach was used for 18 and the dorsomedial approach for 13 corticotomies. A scale of four severity grades was used to classify callus defect zones based on their extent as evidenced on serial X-rays. Biopsies were taken from higher-grade defects (grades 3-4). RESULTS: A total of 13 radiological evaluations revealed 12 defects using the ventrolateral approach. Seven defects (grades 1-2) healed spontaneously, whereas six defects (grades 3-4) required operative intervention as histological tissue examination showed no osteogenic potential. CONCLUSION: To prevent callus defects of the proximal tibia in the future and to ensure maximal osteogenic potential in the distraction zone, a minimally invasive dorsomedial approach appears to achieve favorable results.

Adolescent↗
PubMed2005

Topiramate 100 mg/day in migraine prevention: a pooled analysis of double-blind randomised controlled trials.

Topiramate has been shown to be effective as a preventive treatment for migraine in three large placebo-controlled, dose-ranging trials. Because the protocols were similar in design using the same primary and secondary endpoints, data from these studies were pooled to evaluate the consistency of efficacy, efficacy by gender and tolerability of topiramate 100 mg/day (n = 386) versus placebo (n = 372). Topiramate was superior to placebo as measured by the reduction in mean monthly migraine frequency, monthly migraine days and monthly migraine duration. The responder rates, defined as at least 50% reduction for the respective parameters, were significantly in favour of topiramate (p < 0.001), for example 46.3% of patients on topiramate achieved at least 50% reduction in monthly migraine period frequency compared with 22.8% on placebo (p < 0.001). Use of medication to treat the acute migraine attack was significantly reduced by topiramate compared with placebo (p < 0.001). The therapeutic effect was consistent throughout the different studies and independent of gender. The most common adverse effect was paraesthesia, mostly of mild-to-moderate severity. The findings confirm that, at a dose of 100 mg/day, topiramate is an effective and well-tolerated drug for migraine prevention.

Adolescent↗
PubMed2002

[Spinal growth under physiological and pathological conditions].

Spinal growth is developing analogously to extremity growth. As the vertebral spine is built by 25 "vertebral units" there are much more possibilities of compensatory growth in short parts of pathologic alterations than there are in cases of affected extremities that only show epiphyseal compensations in metaphyseal or diaphyseal deformities (such as juvenile fractures). The dynamics of growth is different in the spine. The neurocentral epiphysis, basis to seize of spinal channel, shows very strong dynamics in embryonal and early childhood growth corresponding to the development in central nerve system. Whereas, enchondral height growth of vertebral bodies does not end after puberty, in male sex even at about the age of eighteen. Enchondral growth of the spine is much more sensible to affections than periostal growth. This is analogous in the extremities. Spinal growth is determined genetically, but especially in puberty it can be influenced by the child's posture. This is a therapeutic hint especially for the period of fast vertebral growth in puberty. The strong straightening tendency of spine is fascinating. Thus, in the period of growth all spinal deformities are compensated by the vertebral segments below and above, so that the axis appears in horizontal line and the spine altogether in perpendicular position.

Adolescent↗
PubMed2000

[Percutaneous epiphyseodesis. Correction of leg length inequalities and frontal plane deformities].

The percutaneous epiphysiodesis is recommended as a save and reliable technique. We have performed 21 distal femoral, 17 proximal tibial and 3 proximal fibular percutaneous epiphyseodeses on 25 patients. On 11 patients the epiphysiodesis was caused by an average leg length discrepancy of 2,7 cm (1-4 cm). 13 patients had angular deformity near the knee joint in frontal plane (6 valgus and 7 varus deformities). One patient suffered from a combined deformity with 3, 5 cm shortened leg and varus deviation of 10 degrees. The average deformity angle of the knee was 7,4 degrees (4 degrees -16 degrees ). 9 patients have reached maturity. On 3 patients the deformity could be corrected incompletely with residual deformity of 3 degrees, 4 degrees and 6 degrees as a direct result of late referral. On 1 patient an imminent over-correction could be avoided by hemiepiphysiodesis of the residual epiphysis. Till the present follow up the other patients have been corrected as calculated preoperatively. No complications like epiphysiolysis, infection, stiff knee or angular deformities occurred. We prefer the percutaneous epiphysiodesis as a save and minimal invasive technique instead of the open Phemister-technique to tread leg length discrepancy and angular deformities of the knee in frontal plane.

Adolescent↗
PubMed2000

[Principles of deformity correction around the knee].

Lower limb frontal and sagittal plane alignment and joint orientation have significant consequences for function and wear on the hip, knee and ankle. There is a normal range for the orientation of these joints relative to the mechanical and anatomic axis of the femur and/or tibia. We can use the normal joint orientation to accurately plan realignment of a deformed femur or tibia. In the frontal plane we use both anatomic and mechanical axis lines for planning. In the sagittal plane, the mechanical axis has less relevance and, therefore, only the anatomic axis is used for planning.

Ankle Joint↗
PubMed2000

[Unilateral external fixators in the correction of deformities of the extremities].

The introduction of joints in unilateral fixators enables these for multiple deformity corrections. Lengthening and shortening is achieved by changing the length of the fixator telescope. Axial corrections are performed by additive or subtractive techniques using uniplanar joints or by angulation procedures. Translation is done by direct movements of the bone fragments or by metaphyseal "double angulation". Derotation preferably is done as an acute procedure or in the "ring part" of a hybrid frame. Unilateral fixators are used to correct and temporarily stabilize until the correction is held by the intramedullary nail.

Adult↗
PubMed2000

[Lengthening osteotomies in leg length inequality].

Callus distraction is the standard procedure for the operative treatment of leg length discrepancy. The deformity is analysed prior to surgery. Clinical assessment and imaging allow precise quantification. The procedure is performed by ring or unilateral frame and or i.m. nail in a continuous mode. The bone cut is performed percutaneously. Associated axial or rotational deformities are corrected simultaneously--acutely or in a continuous mode. Callus distraction is preferably applied during childhood. For good outcome control of the patient is important during the inpatient and outpatient treatment. Physiotherapy and orthotic treatment are mandatory, the same as the management of complications.

Child↗
PubMed1999

[Correction of leg deformities. Definition, estimation and realignment of axis deviation and misalignment].

The operative realignment of mechanical axis deviations (MAD) is necessary to prevent early joint degeneration and to reach normal load-bearing. Modern types of external fixation systems allow an alignment of the mechanical axis to exact degrees. Predominantly this are corrections of angular deformities. In some cases the analysis of the MAD does not show any angular deformity, but a parallel staggering of the mechanical axis lines of a bone. Such parallel staggering of the mechanical axis lines is defined as a translation deformity of the bone. In combined deformities with angulation and translation the centre of deformity can be established proximal or distal out of the limit of the bone. In translation deformities the realignment of the mechanical axis requires a parallel re-staggering made by a translation-osteotomy or by a counter-angulated double osteotomy. In complex deformities with angulation and translation, the translation requires a separate corrective planning. By using external fixator systems to perform acute or progressive corrective osteotomies the position of the Axis of Correction of Angulation (ACA) in relation to the n-CORA of the deformity has to be considered. If ACA position is not conform with the n-CORA position relevant geometric effects in relation of length and translation occur. These geometric effects to corrective osteotomies can be calculated by using simple trigonometric formulas or graphical methods. Possibilities to compensate translation and length effects are shown by using unilateral external fixator systems.

Bone Lengthening↗
PubMed1999

Definition, quantification, and correction of translation deformities using long leg, frontal plane radiography.

The surgical realignment of mechanical axis deviation is necessary to prevent early joint degeneration. Modern types of external fixation systems allow alignment of the mechanical axis to exact degrees. Predominately, these are corrections of angulation deformities. In some cases, the analysis of the mechanical axis deviation does not show any angulation deformity, but rather a parallel staggering of the mechanical axis lines of a bone. Such parallel staggering of the mechanical axis lines is defined as a translation deformity of the bone. In combined deformities with angulation and translation, the center of deformity can be established proximal or distal to the limit of the bone. In translation deformities, the realignment of the mechanical axis requires a parallel restaggering made by a translation-osteotomy or by a counterangulated double osteotomy. In complex deformities with angulation and translation, the translation requires separate corrective planning. In frontal plane radiographs of the standing leg, the components of angulation and translation can be established graphically or by simple trigonometric formulas. The analysis and surgical procedure to realign translation deformities or a combination of translation and angulation deformities using an unilateral fixator device are discussed.

Adult↗
PubMed1997

Quantitative assessment of callus distraction using dual energy X-ray absorptiometry.

Bone mineralisation during and after limb lengthening procedures on the femur or tibia using unilateral fixators has been monitored quantitatively using dual energy X-ray absorptiometry (DEXA). We measured the bone mineral density (BMD) prospectively in the newly formed callus, in the bone adjacent to the callus and in the proximal femur. In twenty-one patients we showed a typical course with a peak value at 4-6 weeks after beginning distraction and a minimum value at maximum distraction. In the consolidation period the BMD in the distraction gap increased until the fixator was removed. The BMD in the regenerated bone increased faster in the regions of interest (ROI) opposite the fixator compared to those near it. Dynamisation caused more homogeneous regeneration equalising VBMD in the different ROIs. The BMD in the proximal femur of the leg which was operated on decreased to 67% and in the opposite leg to 87% of the preoperative value. DEXA provides a precise and quantitative assessment of callus and bone mineralisation during limb lengthening and helps in understanding what is happening during these procedures.

Absorptiometry, Photon↗
PubMed1997

[Etiology and pathogenesis of spondylolytic spondylolisthesis].

The commonly accepted hypothesis set up by Brocher in 1950 that the dysplasia of the pars interarticularis vertebrae is an essential requirement for the occurrence of spondylolysis should be thought over in light of recent findings. Newly published investigations show that disturbed spinal growth leads to dysplasia of the vertebral arch and to spondylolysis. Disturbances that play an important role are biomechanical stress factors that result from the evolution from a quadripedal to a bipedal human locomotion as well as stress fractures of the vertebral pars inter-articularis and defects in vertebral maturation in small infants.

Adult↗