Biomedical subjects
Publications and source records attributed to W Blauth.
In cases of congenital partial tibial aplasia or so-called diastases of the lower leg, very good results are to be expected from tibia/fibula fusion in association with a repositioning of the foot. Form and function of the limb are significantly improved, with ortho-prosthetic fitting being considerably facilitated.
Knee prostheses of the condylar or hinge type have constructional features that have both advantages and disadvantages. Both types are compromises as a result of different demands. Here we report long-term results with the Blauth prosthesis as an example of the efficiency of the hinge concept. The Blauth prosthesis is constructed according to the low-friction principle without a weight-bearing axis. Load transmission to the bone is accomplished by large interface areas. The sliding bearing of the patella is oriented perpendicular to the transverse axis of rotation. A prospective multicentric study reports on 511 prosthesis with a follow-up between 1 and 15 years. Aseptic loosenings were confirmed in 1.2% of the patients, deep infections in 3.3%. The survival analysis showed a probability of 89% that a prosthesis would not have a deep infection or loosen. A hinged knee prosthesis shows positive long-term results even compared with the condylar types if the relevant principles of construction are adequately considered.
The authors examined 41 shoulder joints by arthrography after the patients had undergone surgery for rotator cuff tears. In 26 cases the arthrographic findings were negative; that is to say the region of the tendon suture was tightly closed. In 10 of these 26 cases the underside of the rotator cuff had a rather irregular border. The arthrograms were positive for 12 of the other 15 patients who had undergone surgery. In 3 cases contrast medium leakage into tendinous tissue on the joint side was seen. The postoperative results, ascertained with reference to the assessment guidelines proposed by Neer and Patte, were largely unrelated to the arthrographic findings. In patients with contrast medium leakage from the rotator cuff only the muscular strength was slightly reduced. There was no correlation with the clinical symptoms. In the comparison of all patients who had undergone postoperative arthrography with the total study population a lower number in the index was striking. It may be that patients with symptoms persisting after surgery were more prepared to undergo control arthrography.
This publication consists of two parts, the first of which is concerned with the definition of arthrolysis as a mere soft tissue procedure. This is delineated from arthroplasty. In the second part, arthrolysis results are presented. Three different means of treatment are possible for knee joint stiffness: manual joint mobilization under anaesthesia, arthroscopic operation, and "open" arthrolysis. The authors concentrate on the third type of treatment because of the great amount of long-term experience they have made. In the majority of cases knee joint stiffness is caused by immobilization and posttraumatic and postoperative effects on the joint itself or in the area of the joint. Morphological findings are intraarticular adhesions in the recessus, as well as between the joint surfaces, retraction of the capsular-ligament system, and extra-articularly located impediments caused by shrinkage and scars in the muscles, tendons, and sliding laminas of the soft tissue. Open arthrolysis is indicated after failure of conservative treatment and in cases of severe stiffness of the knee joint. For operative arthrolysis many requirements must be met, which are specified in detail. The preoperative information about the treatment given to the patient is of particular interest. The operative methods, including postoperative management, are described only briefly, because the presentation of the results is the main purpose of this paper. Eighty-five patients (94%) who underwent open arthrolysis were personally examined. Information about the other patients was obtained from medical records such as the examination at discharge or the last presentation in the outpatient clinic. The average follow-up time was 5 years and 4 months ranging from 6 months to 14.25 years. The results are differentiated in many respects whereas the so-called relative improvement of joint mobility following an operation is of main interest. Well-defined criteria have been published and were applied. The results are listed according to the severity of joint stiffness. Four grades of joint stiffness are created, ranging from grade IV, the most severe form with a preoperative maximum of joint mobility of 30 degrees, to grade I with a maximum of 90 degrees joint mobility. In all, operative procedures led to an improvement in nearly 100% compared to the preoperative findings. The results are presented in relation to age, operative methods, previous operations, and different stages during the follow-up.
The trend for early mobility after surgical treatment of knee joint ligament injuries has led to the production of a large number of different braces in recent years. To allow an approximation of the very complex motion of the human knee, the use of braces with so-called physiological hinges has been recommended in the last few years. The authors report on a group of 50 patients who had sustained injuries to the cruciate ligament and had received IOWA knee braces following surgical treatment, the fit being subsequently checked by X-ray. These checks clearly demonstrated that the hinge of the brace hardly coincides with the knee axes and that there were deviations ranging from 1 to 4 cm. The authors therefore come to the conclusion that brace-fit must be checked by X-ray in all cases and that incorrectly fitted braces should be corrected before use. There is so far no evidence that so-called physiological hinges are really superior to braces with single axes. The current trends and developments cannot really be justified as long as there is no guarantee that the axes of brace and human knee coincide both in motion and during weight-bearing.
The authors studied 45 cleft feet from among their patients and 128 from the literature with regard to their roentgenographic morphology. An increasing degree of malformation was found, from deepening of a central interdigital commissure to a monodactylous cleft foot. These observations resulted in a classification of six groups based on the number of metatarsal bones. Types I and II are cleft feet with minor deficiencies, both having five metatarsals. The metatarsals are all normal in Type I and partially hypoplastic in Type II. As the degree of malformation increases, only four metatarsals in Type III, three metatarsals in Type IV, and two metatarsals in Type V can be identified. Type VI represents the monodactylous cleft foot. Of the 173 feet studied, 166 could be assigned to one of these types. Two additional forms were also found: four cleft feet with central polydactyly are described as polydactylous type, and three monodactylous feet with lower-leg diastasis or tibial aplasia or both are described as diastatic type. According to the distribution of syndactylies, synostoses, and aplasias, it became evident that cleft formation begins at the second or third ray. It then proceeds in a longitudinal direction from distal to proximal as well as in a transverse direction from tibial to fibular, while the first ray remains intact. The first ray is only missing in the monodactylous cleft foot, which possesses only the fifth ray. The defects are always larger distally than proximally. Synostoses are found only at the margin of the cleft. Cross-bones are rare and usually occur in mild cases of the deformity. Another rare feature is polydactyly.(ABSTRACT TRUNCATED AT 250 WORDS)
For 17 years, the Blauth total knee prosthesis has been implanted with its basic constructional features remaining unchanged. While it is true that the prosthetic components are constrained by a mechanical hinge, load transmission is actually effected in accordance with the low-friction principle through the cup-shaped condylar surfaces. Packing of the prosthesis in the bone is ensured by large load-bearing surfaces and by specific elements intended for rotational stability. In a comprehensive follow-up review, 497 implants were studied over a period of one to 15 years (average, 45 months). Aseptic loosening occurred in only 1.2% of the prostheses, and deep infection was found in 3% of the patients in the follow-up review. According to survival statistics, the probability of finding prostheses without deep infection or loosening after more than ten years is 89%. The efficiency of total knee arthroplasty (TKA) by hinged prostheses should therefore not be judged by the results obtained with the pioneer implants, which date back to the beginnings of TKA. The clinical results obtained clearly demonstrate that there is 90 degrees knee flexion in more than 88% of the implants. A subjective appraisal demonstrated substantially less pain compared with the preoperative findings. Problems originating from the patella were recorded in less than 10%. However, in 1985, an improved prosthetic design was introduced that also provided for the replacement of the posterior surface of the patella and for a proximally extended patellar bearing. The position of the hinge and implant packing remained unchanged. The results obtained so far with the modified prosthetic design are very good.
The literature on the etiology, pathogenesis, and therapy of Sudeck's atrophy is reviewed. The authors present their treatment regimen for reflex dystrophic hands that has been used successfully for more than twenty years. This program consists of a combination including drugs as well as physical and occupational therapy. Patients have to be guided psychologically. In-patient treatment is preferred. The ultimate aim of therapy is to restore the functional integrity of the affected hand. The choice of therapy depends on the stage of the disease. Removing pain and edema is the most important aim in stage I. This is achieved by immobilization of the affected extremity in an upward position, cooling the hand with ice, and careful physiotherapy supported by antiphlogistic drugs. In stage II the physiotherapy has to be intensified and should be supplemented by special balneologic (bathing) measures and functional splints. The ipsilateral shoulder can be affected and has to be treated adequately. In stage III additional surgical treatment might be helpful such as arthrolysis, arthroplasty, or arthrodesis of finger joints. The authors report on their results in seventy-seven dystrophic hands in a long-term follow-up between one and fourteen years. The results depend on the begin of the treatment in the different stages of the disease. Eighty-three percent of the patients were cured in stage I, only thirty-one percent in stage II, and no patient in stage III. The authors' experience using Calcitone shows that it has no influence on the functional results. Comparing their results to those obtained by others, the authors conclude that physical and occupational therapy are decisive in dealing with dystrophic hands.
The authors present a new classification of polydactyly based on radiomorphological alterations. The malformations are defined in two directions, as in a system of coordinates. The longitudinal arrangement is based on the pathogenetic principle of bifurcation of a finger or a toe ray from distal to proximal. We accordingly divided polydactylies into five types: distal phalanx, middle phalanx, proximal phalanx, metacarpal or metatarsal, carpal or tarsal. The transverse arrangement indicates which rays are involved. All polydactylies, including the special forms such as rudimentary manifestations, triphalangism, and multiple duplications, can be incorporated into this simple basic scheme. Depending on their characteristics, the special forms are further subdivided, e.g., into a distal or proximal phalanx type with simple or double triphalangism, or a tarsal type with third-degree duplication and first-degree aplasia. Numerous radiological examples and schematic drawings illustrate the classification. The advantage of the classification is that it depends exclusively upon the skeletal finding and all manifestations are registered according to a simple scheme longitudinally and transversely. This makes them codifiable for the computer and suitable for multicenter studies. The special forms, the rudiment, triphalangism, and multiple duplication, can easily be further subclassified. Moreover, the nomenclature is simple and is oriented to anatomical terminology.
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It is the intention of this study to present a more profound investigation of the morphology of cleft hands and to provide a new classification based on the results of that investigation. After a short review of the literature, which shows the different opinions regarding heredity, pathogenesis and classification of cleft hand, the authors demonstrate their own patients with 35 cleft hands: The deformities were mostly bilateral and associated with cleft feet. In unilateral cases the right side was more common. Males were in the majority. This paper puts emphasis on the analysis of X-ray morphology. The authors are able to demonstrate that the cleft hand shows several peculiarities which have not been yet sufficiently respected. It was found out, that, apart from aplasia of the bones and soft tissue, synostosis is often the origin of clefting. In 40% of our cases the cleft was caused exclusively by synostosis, in a further 34% it derived partly from synostosis of the phalanges and the metacarpal bones. In the carpus we found osseous deformities surprisingly often, a feature which has hardly been mentioned in former studies. Among the numerous associated malformations emphasis must be placed on the osseous syndactylies and the central polydactylies, because they are closely related to the cleft hand as shown by Ogino. 18 of our own cases belong to this group. Our investigations lead us to the following classification: Cleft hand type 1: Cleft hands with osseous defects (aplasias) Cleft hand type 2: Cleft hands with synostosis Cleft hand type 3: Cleft hands with aplasias and synostosis Hands with central polydactyly and synostosis as preforms of the cleft hand could be classified in type 4. These phenomena form the beginning of the teratological row towards the completely developed cleft hand. In combination with Blauth's distribution of cleft hands, who distinguished the median and medio-lateral form (1976, 1978) this new classification enables each cleft hand to be placed into one of the different types, which are analysed: Type 1 mostly shows a medio-lateral form, is always combined with cleft feet and shows heredity in 50% of the cases. It cannot be classified by the Ogino method. Type 2 mostly shows a median form, is not frequently combined with cleft feet, heredity occurs in one third of the cases. This type can very often be classified by the Ogino method. Type 3 varies from case to case because of the different items of defects.(ABSTRACT TRUNCATED AT 400 WORDS)
The authors report on congenital clubhand as a malformation of the radial parts of the upper extremities and point out that this malformation car occur as a part of various syndromes as well as in the framework of thalidomide embryopathy. From the morphological viewpoint, the radius can be completely or partially lacking or hypoplastic. Soft tissue defects include muscle and tendon aplasia as well as numerous anatomical variations thereof. Clubhand is usually treated conservatively, using manual rédressement exercise, rédressement plaster casts, correction splints, and occupational therapy. If, after corrective therapy, the function tests show no improvement in hand function, then this is an indication for operative treatment. In addition to our own technique, others are also described. Clubhand often recurs because the support of the wrist and muscular balance at the wrist joint are not always optimally established. The authors warn that operations can be prematurely evaluated as successful.
Injuries to the lateral ligament of the ankle are frequently encountered in adolescence and require just as much care in diagnosis and management as in adults. There is a strikingly high rate of tears with an avulsion of the bony or cartilaginous insertion of the anterior talo-fibular ligament in younger children. The most likely causes are the higher elasticity and strength of ligaments, as well as the special situation of ligament insertion during growth. Experience has shown operative treatment to be superior to conservative measures. Only a surgical procedure can allow exact adaptation of the ruptured ligaments and especially a reinsertion of cartilaginous or bony fragments after avulsion injury. Old tears often make a reinsertion very difficult if not impossible. In these cases, resection of the fragments and reconstruction of ligaments are suggested if necessary. For more operative and technical details, the recently edited monograph from Zwipp should be consulted; it also contains many interesting points regarding the physiology, pathology and clinical importance of injuries to the lateral ligament of the ankle.
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Two cases of osteoid osteoma in the hand are reported. One shows a rare localisation in the trapezium. Errors in the first diagnosis and the duration of the disease emphasize the difficulties one can encounter making the correct diagnosis of this tumor. The particular symptoms of osteoid osteoma when located in cancellous bone are discussed as well as the diagnostic aids of tomography and bone scan.