Biomedical subjects

O Rühmann

Publications and source records attributed to O Rühmann.

48 records · Page 3Linked to original sources

PubMedDate not supplied

[Shoulder arthrodesis with plate fixation. Special features in cases of resection and defects].

AIM: Shoulder arthrodesis following prosthesis explantation or resection of the acromion has not often been described in the literature. The presented article analyses the special features and problems of these preoperative circumstances in 4 cases and discusses them within the entire group. PATIENTS AND METHOD: Between 06/1987 and 02/2001, a total of 30 shoulder arthrodeses using plate fixation were performed in our clinic and then analysed after an average of 2.7 (0.5 - 8.7) years. Surgery was carried out on 5 (17 %) females and 25 (83 %) males with a mean age of 37 (17 - 82) years. Two patients underwent shoulder arthrodesis as a salvage operation following unsatisfactory arthroplasty, or after trapezius transfer with corresponding reduced bony conditions, respectively. RESULTS: The active extent of movement following arthrodesis was 56 degrees (20 degrees - 90 degrees ) abduction, and 60 degrees (20 degrees - 105 degrees ) anteversion. The most frequent complications following arthrodesis included pseudarthroses (3/10 %), infections (4/13 %), and fractures of the humerus (4/13 %). The rate of complications was especially high in the cases after explantation of a shoulder prosthesis and resection of the acromion. In two of the four patients, three or five revision operations, respectively, were necessary. Two of the three pseudarthroses of the entire group occurred in these two cases. CONCLUSION: Complications of shoulder arthrodesis after resection of the acromion or the proximal humerus are especially frequent. To avoid pseudarthrosis in such cases, primary spongioplasty is advantageous. A fixation with plates is superior to a simple screw arthrodesis. For postoperative immobilization a plaster cast instead of an orthotic device should be taken into consideration.

Adolescent↗

PubMedDate not supplied

[Influence of the postoperative activity level on tibial bone tunnel enlargement and functional treatment results following anterior cruciate ligament reconstruction using a patellar tendon autograft].

AIM: This study was performed to evaluate the influence of the postoperative activity level on tibial bone tunnel enlargement following anterior cruciate ligament reconstruction using a mid-third patellar tendon autograft. METHODS: A clinical and radiological assessment was performed on 50 patients (21 male, 29 female, mean age 32 years, range 18 to 57 years) following ACL reconstruction using a patellar tendon autograft. The average follow-up examination was performed 18 (12 to 30) months after the operation. RESULTS: 33 patients (66 %) developed a tibial bone tunnel enlargement > 1 mm. We found a positive correlation (+ 0.59) of the grade of activity and the muscle status (+ 0.56) to the tibial bone tunnel enlargement. Patients with a major tibial bone tunnel enlargement performed at a higher (p < 0.05) postoperative activity grade (5.2 versus 4.1 in the Tegner grading), rated higher in the Lysholm (88 versus 77 points) and IKDC scores (p < 0.05) and reported a better subjective functional outcome (p < 0.05). There was no significant correlation of the results of the knee stability tests and the age of the patients to the grade of tibial bone tunnel enlargement. CONCLUSIONS: In ACL reconstruction using a patellar tendon autograft we recommend early rehabilitation as the concomitant tibial bone tunnel enlargement does not significantly influence the clinical outcome or knee stability.

Adolescent↗

PubMedDate not supplied

[Comparison of clinical examination with NMR spectroscopy in the diagnosis of meniscal lesions in daily practice].

INTRODUCTION: We investigated the value of Magnetic Resonance Imaging compared to the clinical examination for meniscal lesions. MATERIAL AND METHODS: From 1991 to 1995 we did arthroscopic evaluation at 824 patients with the diagnose "meniscal lesion". 73 of them had an MRI-examination elsewhere before surgery. RESULTS: During arthroscopy we found 473 lesions of the medial meniscus and 160 of the lateral meniscus. The MRI-examination had an accuracy of 70% for the medial meniscus (sensitivity 79%, specificity 63%, positive predictive value 64%, negative predictive value 78%) and 78% for the lateral meniscus (sensitivity 50%, specificity 86%, positive predictive value 50%, negative predictive value 86%). The clinical examination had an accuracy of 73% for the medial meniscus (sensitivity 98%, specificity 39%, positive predictive value 69%, negative predictive value 88%) and 87% for the lateral meniscus (sensitivity 67%, specificity 92%, positive predictive value 65%, negative predictive value 93%). CONCLUSIONS: We conclude, that by an experienced examiner a meniscal lesion can be diagnosed adequately by clinical examination alone. The different radiologists who did the MRI examination in our study belong to different outward departments and used different apparatus with sometimes insufficient quality of the pictures. Therefore the sensitivity and specificity of the MRI for meniscal lesions is markedly lower than in other studies of departments where a close cooperation between the radiologist and the orthopedic surgeon is performed.

Arthroscopy↗

PubMedDate not supplied

[Secondary operations for improving shoulder function after brachial plexus lesion].

UNLABELLED: The results of an integrated concept of therapy are presented including a description of indications and the various operative procedures to compensate insufficient shoulder muscles following brachial plexus lesion. PATIENTS AND METHODS: To improve stability and function of the shoulder in case of deltoid and supraspinatus paralysis 12 patients (1 female; 11 male; average age 29.4 years, range 17 to 56 years) underwent a shoulder arthrodesis. In 54 patients (11 female; 43 male; average age 30.3 years, range 18 to 69 years) a trapezius transfer was performed. The indication for a rotation osteotomy of the humerus to improve loss of external rotation due to paralytic infraspinatus muscle was determined in 4 male patients (average age 29.8 years, range 16 to 42 years). Our results are based upon an average follow-up of 2.0 (0.5-7.5) years after shoulder fusion, 1.9 (0.5-4.5) years after trapezius transfer and 1.6 (0.5-3.5) years after rotation osteotomy of the humerus. RESULTS: The trapezius transfer resulted in increased function of abduction of 6.2 degrees to 37.1 degrees (5 degrees-80 degrees) and forward flexion of 15.1 degrees to 36.2 degrees (10 degrees-90 degrees). A more stable condition of multidirectional shoulder instability was experienced by 50 patients (92.6%) and 49 patients (90.7%) were subjectively satisfied with the outcome of the operation. The strength and extent of functional improvement was, on average, greater following shoulder arthrodesis: abduction of 9.6 degrees to 65 degrees (40 degrees-90), forward flexion of 15.4 degrees to 59.2 degrees (30 degrees-90 degrees). 10 patients (83.3%) were subjectively satisfied with the outcome. Patients who had undergone external rotation osteotomy showed an average deficiency of external rotation of 20 degrees before operation. After osteotomy an improvement of 32.5 degrees to 12.5 degrees external rotation was achieved. All patients were satisfied with the increase of function. CONCLUSIONS: In patients with brachial plexus palsy, secondary operations according to the individual pattern of paralysis result in an improvement of shoulder function and stability as well as patients satisfaction.

Adolescent↗

PubMedDate not supplied

[Dislocation of total hip endoprosthesis with special reference to various techniques].

1238 primary total hip replacements for arthritis were performed in our hospital from 1980 until 1988. 26 dislocations (2.1%) were registered during this period. No differences became obvious regarding age, sex, type of prosthesis and different concepts of postoperative treatment. After the posterior approach dislocations occurred in 18 (3.1%) of the cases, 8 dislocations (1.2%) were found after the transgluteal approach. The dislocation rate was significantly higher for the posterior approach. Derotation braces were not able to decrease the risk of redislocation. Most of the dislocations happened during the first postoperative week. The most frequent occasions were rotation of the operated leg while lying in bed and deep sitting positions. Performing the posterior approach for primary total hip arthroplasty the surgeon has to realize the higher dislocation rate.

Aged↗

PubMedDate not supplied

[Perthes disease--results of a containment-oriented therapy concept].

INTRODUCTION: In a retrospective study a treatment concept for Perthes' disease dependent on the containment was applied. PATIENTS/METHODS: 49 hips of 41 children (9 female, 32 male) were treated between 01. 01. 1990 and 31. 12. 1995. In our concept of treatment a varus femoral osteotomy was performed in 28 cases with not contained hips or less than 4/5 coverage of the femoral head (X-ray/MRI). The other 21 well contained hips with 4/5 coverage or more were treated conservatively with physiotherapy and in case of joint effusion and pain additionally with the use of crutches (partial weight bearing) and anti-inflammatory medication. The average age in the non-operative group at the time of first investigation was 4 years and 9 months (3 y./1 m. to 7 y./1 m.) and 6 years and 3 months (4 y/2 m. to 10 y/0 m.) at our last examination (mean follow up 17.7 months, range of 6 to 72 months). At the time of indication for a varus femoral osteotomy the patients had an average age 6 years and 1 month (3 y./6 m. to 10 y./2 m.), the mean age at the last postoperative examination was 7 years and 11 months (4 y./8 m. to 12 y./5 m.) with an average follow up of 21.5 months (6 to 77 months). RESULTS: For the conservatively treated children we achieved good results (still well contained hips with 4/5 coverage, no decrease of function, no increase of pain) in 85.7% (18 of 21 cases). In 85.7% (24 of 28 cases) we found good results (well contained hips, increase of coverage, no decrease of function, no increase of pain) in the operation group. CONCLUSIONS: The presented concept of therapy in Perthes' disease was practicable for all patients and included the possibility of decision for operative or non-operative treatment. In both groups we achieved good results in 85.7% of the cases.

Child↗

PubMedDate not supplied

[Standardized sonographic investigation of the lumbar spine in 247 newborns].

Open dysraphism is generally known before birth due to prenatal screening but occult spinal malformation often remains unrecognized. Nevertheless, newborns with occult dysraphism could be easily diagnosed by ultrasound, which might be performed additionally to the neonatal screening of the hips. Early surgical treatment or close neuropediatric follow-ups could be administered as a consequence. As part of a prospective study-design, we screened the spinal cord of 247 newborns by ultrasound. Parents were interviewed about a positive family history, a folate intake during pregnancy, amniocentesis or chorionbiopsy. Clinically, cutaneous stigmata usually associated with occult spinal dysraphism were evaluated. An orthopedic and pediatric examination followed. The sonographic investigation was done in prone position using a newly designed positioning device. The sonographic examination was performed within 5 minutes and longitudinal and transversal pictures were taken for documentation. In all of the 247 examined newborns we were able to visualize the cartilageous structures of the spinal cord and the dural sack detailly. Dependent on the position of the newborn, variations of the width of the dural sack could be noted. Thus a newly designed positioning device helped to standardize the examination situation. We did not find any pathological changes of the spinal cord. Nevertheless ultrasonography provides a useful diagnostic tool in investigating the newborn where occult spinal dysraphism is expected.

Female↗

PubMedDate not supplied

[Ultrasound hip joint screening in newborn infants. Correlation of anamnestic risk factors and hip dysplasia].

BACKGROUND: Congenital dysplasia of the hip (CDH) is the most frequent inborn deformity of the locomotor apparatus. Hereditary, pelvic respectively breech presentation or abdominal delivery, premature as well as post-term birth and twin pregnancy are considered to be anamnestic risk factors for congenital dysplasia of the hip. The results of ultrasound hip screening from July 87 until December 94 are presented with special regard to the correlation of these risk factors and the occurrence of pathologic hips. PATIENTS: 19 different orthopaedic surgeons examined the hips of 3739 newborns (female: 1837-49.1%; male: 1902-50.9%) by ultrasound (screening). 96% of the examinations were performed within a period of 5 days after birth, in a few cases the babies were up to 19 days old. METHOD: The ultrasound examinations, the assessment of the echograms and classification into types of hip were performed according to Graf's technique. Two types of ultrasonographs were used: SL-1, Siemens--5 MHz scanner; LSC 7500, Picker--7.5 MHz scanner). All investigations were assessed retrospectively over the period of time with the help of documentation forms (data of newborn baby, case history, clinical and sonographical findings, kind of therapy and procedure) and statistically checked (program SPSS 7.5, Chi-Quadrate-Test, logistic regression). RESULTS: In 239 children (6.4%) we found hips required therapy respectively control investigations (type IIa, alpha < 55 degrees or worse; Graf's classification). For the entire group we achieved the following types of hips (right/left side): Ia--214 (5.7%)/224 (6.0%); Ib--2069 (55.3%)/2008 (53.7%); IIa (> or = 55 degrees)--1318 (35.3%)/1322 (35.4%); IIa (< 55 degrees)--65 (1.7%)/74 (2.0%); IIc--45 (1.2%)/71 (1.9%); D--18 (0.5%)/30 (0.8%); IIIa--8 (0.2%)/7 (0.2%); IIIb--1 (< 0.1%)/2 (0.1%); IV--1 (< 0.1%)/1 (< 0.1%). With regard to the risk factors the distribution was as follows: hereditary--302 babies (8.1%), pelvic respectively breech presentation--149 (4%), abdominal delivery--359 (6.5%), premature birth--188 (5.0%), post-term birth--164 (4.4%), twin pregnancy--73 (2%). CONCLUSIONS: In newborn babies with cases of hip dysplasia in their family (heredity) and pelvic respectively breech presentation at birth we found a significant higher rate (p < 0.05) of hips required therapy respectively control investigations (type IIa, alpha < 55 degrees or worse; Graf's classification). Also, for girls and the left hip a significant higher rate was achieved. A correlation of the other mentioned risk factors abdominal delivery, premature and post-term birth as well as twin pregnancy was not evident.

Equipment Design↗

PubMedDate not supplied

[Ultrasound neonatal screening: the effect of anamnestic risk factors on hip dysplasia].

INTRODUCTION: Hereditary, pelvic respectively breech presentation or abdominal delivery, premature as well as post-term birth and twin pregnancy are considered to be anamnestic risk factors for congenital dysplasia of the hip. The results of ultrasound hip screening of two University hospitals are presented with special regard to the correlation of these risk factors and the occurrence of pathologic hips. PATIENTS/METHODS: 24 different physicians of the orthopaedic departments examined the hips of 6617 newborns (female: 3253--49.2%; male: 3364--50.8%) by ultrasound (screening). 94.6% of the examinations were performed within a period of 5 days after birth. The ultrasound examinations, the assessment of the echograms and classification into types of hip were performed according to Graf's technique. All investigations were assessed retrospectively over the period of time with the help of documentation forms (data of newborn baby, case history, clinical and sonographical findings, kind of therapy and procedure) and statistically checked (Chi-Quadrate-test). RESULTS: In 436 children (6.6%) we found hips required therapy respectively control investigations (type IIa, a < 55 degrees or worse; Graf's classification). For the entire group we achieved the following types of hips (right/left side): Ia--724 (10.9%)/645 (9.8%); Ib--3931 (59.4%)/3892 (58.8%); IIa (> or = 55 degrees)--1733 (26.2%)/1768 (26.7%); IIa (< 55 degrees)--143 (2.2%)/181 (2.7%); IIc--55 (0.8%)/77 (1.2%); D--20 (0.3%)/39 (0.6%); IIIa--9 (0.1%)/11 (0.2%); IIIb--1 (< 0.1%)/3 (0.1%); IV--1 (< 0.1%)/1 (< 0.1%). CONCLUSIONS: In newborn babies with cases of hip dysplasia in their family (heredity) and pelvic respectively breech presentation at birth, as well as for girls and the left side we found a significant higher rate (p < 0.05) of hips required therapy respectively control investigations (type IIa, alpha < 55 degrees or worse; Graf's classification). A correlation of the other mentioned risk factors premature respectively post-term birth, twin pregnancy and cases of abdominal delivery without breech presentation was not evident.

Female↗

PubMedDate not supplied

[Bilateral habitual fibula head dislocation].

Dislocation of the fibular head is rare. In most of the cases a trauma caused by sports activity, sometimes associated with a tibia fracture, is described. Only a few publications exist about habitual dislocation of the fibular head without history of trauma. This article reports a case of bilateral habitual anterolateral dislocation of the fibular head in a 17-year-old female. There was no information about a neurological or other disease and no sign of generalized ligamentous laxity. Because of marked symptoms with severe pain after each sensation of dislocation which appeared several times a day, the patient was treated by using a part of the biceps tendon for fixation of the reduced fibular head.

Adolescent↗

PubMedDate not supplied

[Magnetic resonance tomography in therapy follow-up after repositioning treatment of congenital hip dislocation].

INTRODUCTION: After treatment of infantile hip dislocation in terms of reduction and retention in plaster casts or splints a problem of therapy controlling exists. To assess if the femoral head is in correct position centered in the socket ultrasound is not possible, because one cannot achieve the necessary standard position. Computertomograms are associated with a hereditary taint of radiation and plain roentgenograms lack of presentation of the important cartilaginous structures. METHOD: To control infantile hips after open or closed reduction from 1990 until 1996, 43 examinations by MR imaging were performed in 34 children. RESULTS: In our series MRI was able to provide exact information about the position of the femoral head independently of its state of ossification. Also, a clearly visualisation of the different structures of the acetabular fossa, particular acetabulum, pulvinar, bony and cartilaginous acetabular rim and limbus was possible. Furthermore the MR images showed interpositioned soft tissue, intraarticular effusion and displayed cartilaginous parts of the acetabular rim. CONCLUSIONS: MRI is an exact method to assess the anatomical and pathological conditions of the childlike hip joint. Because of the disadvantages of CT and X-ray, MRI is superior in terms of controlling the results after treatment of infantile hip dislocation.

Acetabulum↗

PubMedDate not supplied

[Long-term outcome of arthroplasty of the first metatarsophalangeal joint].

INTRODUCTION: Resection arthroplasty of the first metatarsal-phalangeal joint is a wellknown operation for hallux valgus. The follow-up results more than 17 years after arthroplasty are recorded and discussed. MATERIAL AND METHOD: Between 1971 and 1980, 335 arthroplasties were performed on 205 patients. The only indication for arthroplasty of the great toe was hallux valgus. The technique of arthroplasty was according to Keller-Brandes. 102 patients were reexamined clinically and radiographically, after 17.6 years on average. RESULTS: Questionnaire assessment revealed a significantly prolonged walking distance and 70% of the patients were painfree at the time of investigation, whereas 67% suffered from severe pain before operation. Clinical evaluation showed diminished weightbearing of the great toe during walking and a reduced range of motion of the partial-resected first metatarsal-phalangeal joint. Radiographically the shortening of the phalangeal bone of 37% was evident as expected. Hallux-valgus-angle was 23 degrees at the time of investigation and 34 degrees preoperatively in the mean. DISCUSSION: The high rate of hallux valgus relapse, especially due to a high intermetatarsal angle demonstrate unsatisfactory longterm results by the Keller-Brandes operation. We now recommend this operation for older patients and a differentiated approach according to the clinical and radiographical situation for younger patients.

Adolescent↗