Trapezius-transfer for shoulder paralysis: 6 patients with brachial plexus injuries followed for 1 year.
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Brachial Plexus↗
Biomedical subjects
O Rühmann
Publications and source records attributed to O Rühmann.
The value of scintigraphy in the diagnosis of pseudarthrosis after spinal fusion surgery.
The utility of planar bone scintigraphy was evaluated for discerning bony union after spinal fusion surgery, especially in cases of clinically and radiologically suggested pseudarthrosis. Between 1991 and 1996, the authors performed bone scintigraphy on 42 patients (21 women, 21 men; mean age, 42 years) after spinal fusion surgery (32 posterolateral, 10 combined) and just before their admission to the hospital for material removal. The fusions consisted of 29 lumbosacral, 6 thoracolumbar, 3 lumbar, 2 thoracolumbosacral, 1 thoracic, and 1 cervical. The mean fusion spanned four segments, and the mean time between spinal fusion and material removal was 27 months. The scintigraphy was performed using the tracer Tc-99m. Based on the scintigraphy data, the radiologist suspected pseudarthrosis in five patients (12%), and the condition was confirmed in four patients during operation (10%), two diagnosed and two undiagnosed. The accuracy of the method was 88%; sensitivity, 50%, specificity, 93%; positive predictive value, 40%; and negative predictive value, 95%. The sensitivity and positive predictive value of bone scintigraphy are low for possible instability after spinal fusion. The method is not sufficient to reliably diagnose pseudarthrosis after spondylodesis.
Adult↗
[Ultrasound hip joint screening in newborn infants. Is twin pregnancy a risk factor for dysplasia?].
PURPOSE: This study aimed at investigating whether twin pregnancy is a risk factor for congenital dysplasia of the hip. METHOD: From 1987 until 1994 the hips of 3739 (1902 male, 1837 female) newborn were examined by ultrasound (screening) according to Graf's technique. We compared the results of twins and the other newborn (non-twins). The examinations were performed by 19 physicians. 73 (2%) of the newborn were twins (29 male, 44 female). RESULTS: In the group of 3666 non-twins we found the types of hip IIa (alpha < 55 degrees) to IV (Graf's classification) in 237 (6.5%) newborn: 136 (3.7%) right side/183 (5.0%) left side. Only 2 (2.7%) of the 73 twins showed these types of hip. We found 4% (149/3739) breech presentations at birth in the entire group. 3.9% (141/3666) in the group of non-twins and 11% (8/73) cases in the twin group. 5.2% (190/3666) of the non-twins and 2.7% (2/73) of the twins required a treatment with abduction orthosis or Pavlik harness. CONCLUSION: This report shows that the types of hip IIa (alpha < 55 degrees); IIc; D; IIa, IIb and IV according to Graf and a required treatment in twins was significantly not more frequent than in the other newborn (non-twins), although twins showed more often a breech presentation at birth. The different kind of breech position in twins (hips and knees in flexion, legs and feet parallel) and non-twins (hips in flexion, knees in extension) could be one reason for these results. Besides, non-twins assume their breech position earlier than twins with a consecutively longer period of time of mechanical stress on the hips.
Breech Presentation↗
[Ultrasound imaging of congenital knee joint dislocation. Value in diagnosis and therapy].
Congenital dislocation of the knee is a uncommon malformation. Frequently there is an association with other congenital deformities including congenital dislocation of the hip. The classification of Leveuf and Pais into three separate groups (Type A, Type B, Type C) is now widely accepted. Between October 1989 and April 1995 we evaluated ten children (five girls and five boys) with twelve dislocated knees. Clinical, radiographic and different ultrasonography examinations were carried out on both knees. The sonographic classification showed Type A in 3, Type B in 5 and Type C in 4 cases. The sonographic examination revealed the essential anatomic structures and their pathomorphology. The anterior and the posterior cruciate ligament could be demonstrated in the majority of the cases. Three dislocated knees showed an obliteration of the recessus suprapatellaris and fibrotic changes in the m. quadriceps. These cases required operative treatment. With conservative treatment we achieved a satisfactory result in eight children with nine disease knees. There was a good functional result with an average flexion of 106 degrees. Early conservative treatment recommend as the therapy of choice. Ultrasonography imaging offers the possibility of reliable differentiation into one of the three groups of the classification of Leveuf and Pais. Radiographic documentation during the therapy has become the exception. Ultrasonography imaging helped substantially in the decision making and the timing of operative treatment.
Female↗
Trapezius transfer after brachial plexus palsy. Indications, difficulties and complications.
Most brachial plexus palsies are due to trauma, often resulting from motorcycle accidents. When nerve repair and physiotherapy are unsuccessful, muscle transfer may be considered. Paralysis of the deltoid and supraspinatus muscles can be addressed by transfer of the trapezius. Between March 1994 and June 1997 we treated 38 patients with brachial plexus palsy by trapezius transfer and reviewed 31 of these (7 women, 24 men) after a mean follow-up of 23.8 months (12 to 39), reporting the clinical and radiological results and subjective assessment. The mean age of the patients was 29 years (18 to 46). The operations had been performed according to the method of Saha described in 1967, involving transfer of the acromion with the insertion of the trapezius to the proximal humerus, and immobilisation in an abduction support for six weeks. Rehabilitation started on the first postoperative day with active exercises for the elbow, hand and fingers, and electrical stimulation of the transferred trapezius. All 31 patients had improved function with a decrease in multidirectional instability of the shoulder. The average increase in active abduction was from 7.3 degrees (0 to 45) to 39 degrees (25 to 80) at the latest review. The mean forward flexion increased from 20 degrees (0 to 85) to 44 degrees (20 to 90). Twenty-nine of the 31 were satisfied with the improvement in stability and function. Trapezius transfer for brachial plexus palsy involving the shoulder improves function and stability with clear subjective benefits.
Adolescent↗
[Trapezius transfer in deltoid paralysis].
In most cases the genesis of brachial plexus palsy is traumatic, often because of bike accidents. If physiotherapy and neurosurgical procedures such as nerve repair do not have the desired outcome, muscle transfer operations are possible. The results of our favored transfer of the trapezius muscle to compensate paralysis of the deltoid muscle will be presented. Preoperatively radiological, clinical and electromyographic examinations are necessary. Our results are based upon the clinical and radiological check ups and the subjective assessment of the patients. Thirty-one patients (7 female, 24 male) underwent a trapezius transfer between March 1994 and December 1996. The average age was 29 years (range 18-46 years). We performed the operations using a modification of Saha's technique. With the patient in lateral decubitus position and protection of the opposite plexus, a sagital skin incision is the first step, followed by the preparation of trapezius and deltoid muscle as well as the bony parts of the shoulder (acromion, clavicle, scapular spine). The deltoid origin is cut from the lateral third of the clavicle, the acromion and the lateral half of the scapular spine. The next step is transection of the roof of the acromion and the lateral clavicle. After elevation of the remaining trapezius insertions from the clavicle and scapular spine, the proximal humerus is exposured by splitting the partly detached deltoid muscle longitudinally. Then the acromion fragment and humerus are prepared for the bone-to-bone contact. In 90 degrees of abduction the acromion fragment with its trapezius insertion is transferred and fixed to the humerus with two 4.5-mm screws. Finally the deltoid is sutured on the top of the trapezius and the skin is closed over two suction drains. Postoperatively we immobilize the operated arm in an abduction support for 6 weeks. The physiotherapy program starts on the first postoperative day with active training of elbow, hand and fingers and electrostimulation of the transferred trapezius muscle. Six weeks after the procedure we take an X-ray and start with progressive adduction of the arm. The preoperative subluxation of the humeral head was abolished in all cases. We achieved an average increase of active abduction from 7.3 degrees (range 0-45 degrees) preoperatively to 39.2 degrees (range 25 degrees-80 degrees) 1 year after the operation; the increase of forward flexion was from 20 degrees (range 0 degrees-85 degrees) to 43 degrees (range 20 degrees-90 degrees). All patients were satisfied with the improvement of stability and function of the operated shoulder. Finally we can conclude that the trapezius transfer for flail shoulder gives a satisfactory outcome regarding shoulder function and stability as well as the subjective situation of the patients.
Adolescent↗
[New approaches to 3D-ultrasonographic imaging of infant hips].
Ultrasound of the infant hip is an established method in the diagnosis and monitoring of the treatment of congenital dysplasia of the hip (CDH). Its use as a screening method for CDH, early diagnosis and start of therapy results in a high success rate and reduces the length of the therapy. According to Graf's technique, the examination findings are taken from a standard plane. Assessment of the examined hip joint is based on information obtained from this standard intersection plane, which has to be representative for the whole joint configuration. Furthermore, the method according to Graf requires a very expert examiner. We report on a new approach to three dimensional ultrasound of the infant hip for covering and demonstrating the complete dimensions of CDH. A maturity disorder of the infant hip located outside the standard plane should be recognized by 3D ultrasound. In contrast to already existing 3D ultrasound systems with specially constructed transducers, we use a position sensor which, in conjunction with a video tape recorder, an external computer and the corresponding software, is able to support normal ultrasound equipment. A common 7.5 or 5 Mhz linear transducer can be used. During the examination, the form and size of the femoral head is automatically analysed. The result is placed as a virtual sphere into the 3D data set. The quality of the examination should be independent of the examiner's skill.
Hip Dislocation, Congenital↗
[Robot-assisted knee endoprosthesis].
With the development of powerful computer systems, computer-assisted medical diagnosis and therapy have become common over the last 10 years. Even in the surgical field, computer- and robotic-assisted techniques are becoming practical but are not yet used on a daily basis. In the orthopaedic field, computer and robotic assistance is used in planning and performing demanding three-dimensional osteotomies, setting pedicle screws in the spine and milling the femoral medullary canal in total hip replacement. This article introduces a computer- and robotic-assisted system for performing arthroplasty in total knee replacement procedures.
Computer Simulation↗
[The use of lasers in surgical orthopedics. A current review].
In laser-assisted arthroscopic knee surgery, clinical outcome and experimental results are quite different. After laser treatment of local chondromalacia, large cartilage lesions with less tendency towards repair were more often seen than after conventional arthroscopic treatment. Therefore, laser treatment of chondromalacia cannot be recommended. Compared with conventional meniscectomy, laser-assisted meniscal surgery has some advantages, but there is also some risk of inducing gonarthrosis. Some studies show a good hemostatic effect of the laser and the feasibility of precise tissue cutting. On the other hand, laser treatment causes alteration of the tissue. The meniscal tissue becomes stiffer, which may promote the manifestation of gonarthrosis. Percutaneous laser disc decompression has been in successful clinical use since 1986 in the treatment of intervertebral disc prolapses. Studies of multiple orthopedic departments worldwide show a success rate of 75%. To guarantee the success the indications must be observed. The use of lasers in the arthroscopic treatment of outlet impingement syndrome have some advantages, too. The outcome is better than that of other arthroscopic techniques and there are fewer complications because of the hemostatic effect and the improved vision. Laser-assisted capsular shrinkage combined with arthroscopic labrum reattachment allows conventional laser use. Capsular shrinkage can be achieved with low-level laser energy. If this treatment is not successful, other operative techniques can be performed without restrictions.
Arthroscopy↗
[Historical development of muscle replacement operations in brachial paralysis].
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Brachial Plexus↗
[After-care regimen after muscle replacement operations in brachial plexus lesions].
Following augmentation of the upper extremity muscles necessitated by damage to the brachial plexus, special post-operative care programs are required to provide the patient with the best possible results. Proper care requires cooperation between the orthopedic surgeon, physical therapists and nurses. Only then can postoperative rehabilitation and functional control of the extremity improve. We describe interdisciplinary postoperative care programs for augmentation of the deltoid muscle with trapezius transfer, arthrodesis of the glenohumeral joint, biceps augmentation with the latissimus dorsi transfer, Steindler flexorplasty and augmentation of flexors/extensors muscles in the hand.
Adult↗
[May recurrent goiter be resected bilaterally? Value and results of intraoperative laryngoscopy].
Operations for recurrent goiter are considered to range among the most difficult procedures in thyroid surgery and are marked by unusually high subsequent damages of the recurrent nerve. Results from 89 patients with recurrent goiter operated over the last six years and our own experiences with intraoperative laryngoscopy are presented. This procedure is applicable in 60% of all cases with true bilateral thyroid recurrency and accounts for a realistic help in deciding whether to continue the operation with simultaneous resection of the contralateral side.
Cicatrix↗
[Surgical shortening of the Achilles tendon for correction of elongation following healed conservatively treated Achilles tendon rupture].
INTRODUCTION: Is operative shortening of the achilles tendon an adequate therapy in cases of elongation following conservative treatment of achilles tendon rupture? METHODS: From 11/89 to 12/97, 12 patients underwent achilles tendon shortening (9 male, 3 female, average age 43 years). All patients had an elongated tendon following conservative treatment of achilles tendon rupture. We were able to examine 8 patients (67%) after the operation. The average follow-up period was 35 (7-103) months with an average span between the primary trauma and surgery of 22 (8-45) months. RESULTS: Prior to surgery, all patients complained of weakness, gait disturbance and limitation of activity. At follow-up a subjective weakness of the plantar flexion remained in five and an objective weakness in all patients. We found a decrease of the isometric plantar flexion strength to 52% of the non-operated lower extremity while the maximum calf circumference was only 5% decreased. Only two patients reported of a gait disturbance and activity limitation whereas three patients were free of complaints. Using a modified Trillat score (1,967), 7 patients rated good or very good (1 poor). CONCLUSIONS: Achilles tendon shortening in case of elongation following conservative treatment of achilles tendon rupture helps to decrease gait disturbance and limitation of activity whereas a lack of the isometric plantar flexion strength persists. In our opinion an early decision for achilles tendon shortening might prevent this deficit.
Achilles Tendon↗
[Radiologic and computerized tomography evaluation of pedicle screw placement in lumbar spondylodesis].
PURPOSE: To determine the accuracy of a standard roentgenogram for the placement control of pedicle screws following spinal fusion. METHOD: From 1995 to 1997 we performed computed tomography (CT) after material removal following lumbar and lumbosacral spinal fusion in 16 patients. We compared the placement of the 76 pedicle screws in plain X-rays after spinal fusion with their appearance on CT. A correct placement was defined as no penetration of the pedicle cortex, no contact of the lateral or ventral cortex of the vertebral body or joint, and a sufficient screw length. RESULTS: We found correct placement of 58 screws (76.3%) on the standard roentgenogram, whereas by CT only 46 (60.5%) were placed correctly. The results of both radiological examinations correlated (correct/incorrect placement) for only 54 screws (71.1%). A penetration of the ventral cortex of the vertebral body in 21 cases (27.6%) was identified in only 11 screws (14.5%) on the postoperative X-rays. The two radiological methods in this instance correlated for 62 screws (81.6%). CONCLUSION: The value of postoperative standard roentgenogram for the placement control of pedicle screws following spinal fusion is low. By this method possible contact with the aorta, vena cava, dura or vertebral joint cannot sufficiently be excluded.
Bone Screws↗
[Transposition operation in paralysis of extensor muscles of the hand--intermediate-term results].
AIM: The surgical reconstruction of the dorsiflexion of the wrist and the abduction of the thumb in paralyzed radial nerve for the improvement of the useability of the hand is described. Likewise, the early functional subsequent treatment is described. Indications and contraindications are represented in detail. METHOD: Between October 1997 and May 2000 we treated 10 patients by the following method: The musculus flexor carpi ulnaris tendon is cut near the pisiform bone, transferred subcutaneously and fixed on the tendons of the extensor communis digitorum communis muscle. The tendon of the palmaris longus muscle is fixed on the tendon of the extensor pollicis longus muscle. After the swelling in the hand has subsided, the patients are supplied with a dynamic splint in order to avoid adhesions. RESULTS: According to the score suggested by Haas, 9 patients achieved a very good result (median: 30 degrees dorsiflexion), one patient had a good result (0 degree dorsiflexion). CONCLUSION: Adhesions could be avoided and the time of rehabilitation could be shortened by the operation method described. The operations result in an improvement of hand function and as well as patient satisfaction.
Adolescent↗
[Corrective bone operations for treatment of deformities caused by obstetrical brachial plexus palsy].
In an adult, a marked deformity of the upper arm and forearm with loss of function of the limb due to obstetrical brachial plexus palsy has been corrected. An external rotational osteotomy of the humerus and radioulnar arthrodesis resulted in an improved function.
Adult↗
[The influence of age on the outcome of anterior cruciate ligament reconstruction].
AIM: There is an increasing demand for a high loading capacity of the knee during exercise in the elderly patient with knee instability following rupture of the anterior cruciate ligament (ACL). The question is, if the results of an ACL reconstruction in patients over 40 years of age are as good as those in younger patients. METHOD: From 1989 to 1994 we replaced the ACL with a mid-third BPTB autograft in 397 patients following ACL rupture. A total of 309 patients (78%, 110 female, 199 male, the average age was 27 years) were followed for an average of 43 months. The results were compared relating to four groups of age (group 1: < 20 years, n = 41; group 2: 20 - 29 years, n = 175; group 3: 30 - 40 years, n = 77; group 4: > 40 years, n = 16). RESULTS: We did not find any significant differences between the groups in the different score ratings, the subjective and objective knee function and stability, the pain and the level of activity. The average Cincinnati score of the whole group was 91 points (HSS score: 78/16 % excellent/good, Lysholm score: 90 points, IKDC score: 22/31 % A/B). CONCLUSION: ACL replacement is a sufficient therapy for patients over 40 years of age with symptomatic knee instability following ACL rupture. The subjective and objective clinical outcome is comparable to the good results of ACL replacement in younger patients without any significant differences.
Adolescent↗