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Biomedical subjects

M Schiltenwolf

Publications and source records attributed to M Schiltenwolf.

At least 37 records · Page 2Linked to original sources
PubMed1997

Sheet plastination of the vascularity of the lunate bone--a morphological study.

Using the method of sheet plastination, the vascularity of the lunate bone can be investigated and analyzed. By intraosseous injection, the deep and superficial venous systems are visualized. Transparent sheets with slices of embedded specimens show a three-dimensional presentation of the vascularity of the human carpus different in functional aspects. Comparing hands with a normal and extended wrist position, three mechanisms of impairment of the venous drainage are observed. The anatomical results of this investigation support the hypothesis that venous congestion, resulting from intraosseous hypertension, plays a role in the development of the necrosis of the lunate bone.

Drainage↗
PubMed1996

Further investigations of the intraosseous pressure characteristics in necrotic lunates (Kienböck's disease).

To confirm the hypothesis that venous congestion plays a role in idiopathic lunate necrosis (Kienböck's disease), intraosseous pressure in 12 normal and 12 necrotic lunates was measured. Intraosseous pressure in the capitate of 12 healthy subjects served as reference measurement. The intraosseous pressure was recorded in neutral position and 60 degrees extension of the wrist under normotensive conditions and during venous stasis. In all groups, the mean intraosseous pressure rose significantly with extension of the wrist, with the largest increase being 92.3 mmHg for necrotic lunates, followed by 40.3 mmHg for normal lunates, 6.9 mmHg for normal capitates and during venous stasis, 26.6 mmHg for necrotic lunates, 26.1 mmHg for normal lunates, and 5.9 mmHg for normal capitates. In some necrotic lunates, the intraosseous pressure during extension exceeded the arterial blood pressure, which can be explained by mechanical deformation of the bone. In neutral position, no significant differences in pressure were found between normal lunates and capitates. A significant difference was found for venous stasis and extension. The intraosseous pressure rise in the normal lunate in extension was slightly higher than the pressure found during venous stasis. The intraosseous pressure differed significantly (by 56.9 mmHg) between normal and necrotic lunates in extension. These data support the hypothesis that impairment of venous drainage plays a role in lunate necrosis and that the lunate can be considered as a venous bone at risk.

Adult↗
PubMed1996

Late results after subtrochanteric angulation osteotomy in young patients.

Young patients with painful congenital dislocation of the hips need surgery if conservative treatment is unsuccessful. A total of 24 patients after 28 subtrochanteric angulation osteotomies without resection of the femoral head were followed up (mean, 17 years) to evaluate long-term results. Most patients maintain improved function: 20 hips showed persistent gain of abduction, 14 patients showed improvement of gait, and 18 patients described less pain. The degree of angulation must equal the inclination of the pelvic wall to influence hip stability as well as hip range of motion. Osseous reactions of support-seen in 10 hips-are not proof of operative success. Angulation osteotomy does not exclude later surgical procedures such as total hip replacement.

Adolescent↗
PubMed1996

[Significance of intraosseous pressure for pathogenesis of Kienböck disease].

Femoral head necrosis is thought to be the consequence of decreased venous drainage. To confirm this pathogenetic model in lunatomalacia, the intraosseous pressure in 16 necrotic, 16 normal lunates and 16 normal capitates was measured. Intraosseous pressure was recorded in different functional positions: neutral position, extension, flexion, venous stasis, and exsanguinated conditions. Both in extension and in flexion, the intraosseous pressures of all bones exceeded those in neutral position; this corresponded to the increase in pressure during venous stasis. The increase in pressure in normal lunates and capitates could not be explained by mechanical deformation. Lunates showed a much higher increase in pressure than did capitates. Some necrotic lunates showed an intraosseous pressure during extension which exceeded the systolic blood pressure. This implies that mechanical deformation contributed to increased intraosseous pressure in necrotic lunates. The variation of intraosseous pressure suggests a physiological but unstable balance. An increase in pressure reduces the bloodflow and in addition to other promoting influences can lead to pathological conditions. The daily load of the wrist in extension is in accordance with the model of the origin of osteonecrosis on the venous side. The model that lunate necrosis is the consequence of impaired venous outflow can be accepted.

Adult↗
PubMed1995

[A prospective study of early diagnosis of lunate necrosis by means of MRI].

AIM: Early recognition of lunate necrosis by means of MRI. METHODS: 49 patients with typical symptoms and normal radiographs were examined. Coronary T1 and T2 weighted images were obtained. In addition, an attempt was made to quantify fluid shift and measure of bone marrow oedema by means of extreme T2 weighting (TR 5950 ms, TE 150 ms). RESULTS: Three instances of necrosis were found; in two cases it was possible to demonstrate marrow oedema. Oedema preceding necrosis could not be demonstrated by quantifying a grey scale. CONCLUSIONS: The pattern of pain in the region of the lunate is not typical and is usually not of bone origin. Early MRT will show lunate necrosis only rarely; nevertheless, the therapeutic consequences justify the examination if pain persists for several weeks. Extreme T2 weighting for quantifying a grey scale to demonstrate early marrow oedema has not proved useful. Our experience suggests that T2 weighting is adequate and is the method of choice for the early recognition of necrosis of the lunate.

Adult↗
PubMed1995

[Changes in the wrist joint in spontaneous course of scaphoid pseudarthrosis].

Scaphoid non-union always leads to carpal arthrosis. What is the natural history and course and sequence of development of arthrosis in scaphoid bone pseudarthrosis and what factors play a role in this? Forty-nine patients with scaphoid non-union were followed up; the period of observation was between three and 39 years. For comparison, 55 patients in whom a Matti-Russe reconstruction had been carried out successfully in the same period were followed up. Both the clinical and the radiological appearance seemed to be better in the operated patients than in the unoperated patients. The time factor, the position and form of the fracture appeared to be crucial for the development of arthrosis. No patient was free of arthrosis after ten years. The arthrosis begins in the radial part of the radiocarpal joint and progresses to the mediocarpal joint. The development of mediocarpal arthrosis takes about 20 years. Unstable and displaced fractures accelerate the development of arthrosis. Proximally located non-unions are unfavorable because of the danger of osteonecrosis of the proximal fragment. These non-unions should be treated surgically as soon as possible.

Adolescent↗
PubMed1994

[Natural course in lunate necrosis].

Reconstruction of the natural course of lunate necrosis is difficult because of incomplete findings, especially in the initial stages. The necrosis progresses steadily from initial lunate oedema with a normal X-ray appearance to condensation, fragmentation and collapse of the lunate within months. The collapse of the whole carpus means a dramatic deterioration in therapeutic possibilities not much later. In order to start treatment successfully in the initial stage, suspicious findings should be repeatedly followed up by X-ray films and magnetic resonance imaging. The development of degenerative changes often takes years. The clinical findings are not helpful in judging the course of the disease as pain varies and only the collapse of the lunate and late arthrosis accentuate pain.

Adolescent↗
PubMed1993

[Intermediate results in treatment of scaphoid pseudarthrosis and fracture with the Herbert screw].

The Herbert screw is a self-cutting headless screw that is designed to effect interfragmentary compression on being screwed in and is suitable for scaphoid surgery besides being useful also for other purposes. Although the Herbert screw is biomechanically inferior in many respects to the spongiosa screw, prognosis is impressively improved in scaphoid surgery (in pseudarthroses and fractures) by implanting the Herbert screw. It replaces the Matti-Russi plasty and is used in proximal, dislocated medium-positioned and unstable fractures. 73 scaphoid pseudarthroses and 27 fractures were treated with the Herbert screw between 1989 and 1991 at the Dept. of Orthopaedics at the University of Heidelberg. In 46% of problematic indications successful healing was achieved in more than 90% of the cases. However, surgical technique is complicated, requiring a certain amount of practice to keep iatrogenic traumatisations as low as possible. In the treatment of pseudarthroses special attention must be paid to careful and extensive sclerosis resection. Although the Herbert screw is screwed in through the articular surface, the procedure does not necessarily imply an accelerated development of arthrosis.

Adolescent↗
PubMed1992

[Myelomeningocele--what can be done? Aids for evaluating rehabilitation from the orthopedic viewpoint].

Shortly before or shortly after the delivery of a child suffering from congenital paraplegia (myelomeningocele or spina bifida) the obstetrician is obliged to give advice as to what will follow after neurosurgical closure of the cele and shunting of the hydrocephalus. The parents' understanding of therapy and integration of the patient is developed to assess and utilise the future chances of the disabled child. Integration of children with congenital paraplegia is performed by an interdisciplinary team of therapists. However, the obstetrician's advice is of great value in preparing the parents for their decision for or against total care post partum. They must in fact be fully aware of the chances, that the disabled child actually has with regard to integration in life, and of what can be done in this respect. Besides the neurological, paediatric and urological care, it is the task of the orthopaedist to preserve or even to improve verticalization and mobility in paraplegic patients. In this manner he exercises an influence on the quality of life of the disabled children and on their social integration. Improvement and further development of physiological orthoses for walking enable even children suffering from a thoracic level of paralysis to walk independently and to achieve integration into society. Orthopaedic aspects of integration must be part of the information given to the parents by the obstetrician, so that they may be able to assess in what way their disabled children can participate in the future at various levels of everyday life.

Child↗
PubMed1991

Results of orthotic treatment in children with myelomeningocele.

The level of paralysis in children with myelomeningocele is not necessarily the only factor determining whether they will be able to walk. If children, even with a high level of paralysis, have an appropriate motivation to walk they should be enabled to do so by surgically correcting their hip and knee flexion contraction and/or high degree of scoliosis. 106 children with spina bifida were provided with walking orthosis and were examined concerning their walking speed, walking distance, stepping distance, and how long they used their orthosis. We found that hip and knee flexion contraction as well as scoliosis substantially influenced their mobility. Therefore those handicaps should be surgically corrected if patients show an appropriate motivation to walk.

Adolescent↗
PubMedDate not supplied

[Psychosomatic aspects in orthopedic legal assessment].

AIM: Complaints in orthopaedics that are not sufficiently explainable can be caused (partly) by psychosomatic disorders. A manual psychosomatic disorders for legal assessment in orthopaedics will be supplied. METHOD: Diagnoses essential for orthopaedics are classified by DSM-IV and ICD-10 in consideration of the current literature; evaluation was performed under legal assessment criterions. RESULTS: The most important complaints that are often poorly explainable results in musculoskeletal pain. Since a sensorial perception of pain is combined with emotions, emotions and psychic disorders can be perceived as pain. The most important diagnoses for assessing not sufficiently explainable complaints by somatic cause are "somatoform pain disorder", "somatization disorder", "undifferentiated somatoform disorder", "conversion disorder", "hypochondriasis", "body dysmorphic disorder", "maior depression", "dysthymic disorder", "posttraumatic stress disorder", and "adjustment disorder". The relevance of psychosomatic comorbidity in legal assessment is possible in all affairs of civil and social law. Private accident insurances exclude psychic and psychosomatic diseases from all insurance benefits. CONCLUSION: When composing legal assessments in orthopaedics, especially on pain, the knowledge of psychosomatic (co)morbidity is necessary for meeting the different causes of the complaints. Under awareness of possible psychosomatic disorders, additional psychosomatic legal assessments can be recommended and understood as well.

Diagnosis, Differential↗
PubMedDate not supplied

[What questions are appropriate for predicting the risk of chronic disease in patients suffering from acute low back pain?].

AIM: The objective of the study was to develop a brief questionnaire to determine the risk of chronification for patients suffering from lumbar (low) back pain who are consulting a physician for the first or second time. METHOD: At the outset, and again after six months, a questionnaire with 167 valid items for chronification was distributed to patients in orthopedic offices. After six months, patients were contacted by mail to inquire whether they were still suffering from back pain. Based on outcome (persistence of back pain/absence of back pain) and by means of logistic regression analysis, those variables were determined that could predict actual chronification. RESULTS: The following items were predictive: "How strong was your back pain during the last week when it was most tolerable?" and "How much residual pain would you be willing to tolerate while still considering the therapy successful?" (Acceptance value, beta = 0.61), patient's educational level (beta = - 0.44), massage is experienced as bringing relief (beta = 0.44), 5 items of the Zung scale for depression (beta = 0.42), items of the scale for catastrophizing thoughts (beta = 0.41) and items of the scale for feelings of helplessness (beta = - 0.39) of the Kiel pain inventory; duration of the back pain for longer than 1 week (beta = 0.38), pain in other parts of the body (beta = 0.37); and female gender (beta = 0.25) CONCLUSION: Based on these questions, it was possible to predict the chronification of back pain with a probability of 78.05 %. A corresponding questionnaire and an evaluative table were developed.

Acute Disease↗
PubMedDate not supplied

[Catel-Manzke syndrome].

The leading symptom of Catel-Manzke syndrome is a characteristic deviation of index fingers. Further the patients suffer from symptoms of Pierre-Robin syndrome (micrognathia, glossoptosis, cleft palate). The survival of patients, mostly male, depends on the severeness of congenital malformation of the face skull. The rare disease is demonstrated and discussed by two own cases.

Cleft Palate↗
PubMedDate not supplied

[Hyperphalangia in Pierre-Robin syndrome].

Pierre Robins syndrome associated with symmetric hyperphalangia of the index fingers is called Catel-Manzke syndrome. Connate radial deviation of the index fingers is caused by an odd bone. The deformity is demonstrated by two personal cases. The deviation is progressive and because of increasing functional limitation the operative correction of the index fingers at the age of 2-3 years is advised. Surgical technique and success of treatment are presented.

Child, Preschool↗
PubMedDate not supplied

[Intraosseous pressure measurement in Kienboeck's disease--initial findings].

Intraosseous pressure was measured under standardized and different functional conditions in 11 necrotic lunates in different stages of the disease and in 11 viable lunates. Both the viable and the necrotic lunates show a significant increase of the pressure, if the wrist is brought into dorsiflexion. Both groups do not differ significantly, but the mean value of the necrotic group exceeds that of the viable group clearly. There might have some technical problems in measuring. Venous stasis by tourniquet provoked increase of pressure, too. The increase of pressure both in dorsiflexion and in venous stasis is evidence of venous drainage. Dorsiflexion impairs the venous drainage of the lunate, which promotes necrosis. The increase of intraosseous pressure in necrotic lunates can be understood as a failure of the physiologic regulation of the intraosseous pressure by moving the wrist and cause of necrotic changes.

Humans↗