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Biomedical subjects

W R Obermann

Publications and source records attributed to W R Obermann.

18 recordsLinked to original sources
PubMed1992

A surgical approach in total shoulder arthroplasty.

The long deltopectoral approach promoted by Neer is the standard for performing a total shoulder arthroplasty. However, this exposure is inadequate for preparation and bone grafting of the glenoid cavity or repairing an associated large rotator cuff tear. In the anatomy laboratory we looked for an alternative approach to the glenohumeral joint which would accommodate these difficulties. Afterwards we used this approach in 7 of 13 patients in whom a Biomet Bio-modular shoulder arthroplasty was planned. The study is prospective with a 1-year follow-up of 12 cases.

Aged↗
PubMed1991

Pseudarthrosis of the scaphoid treated by the Matti-Russe operation. A long-term review of 77 cases.

We report the long-term results of the Matti-Russe operation for pseudarthrosis of the scaphoid in 100 cases, reported previously by Mulder in 1968. Clinical results for 77 patients and radiographic data for 74 were reviewed at 22 to 34.8 years after surgery. In general, there was satisfactory relief of pain and stiffness but some patients had limitation of motion and reduced grip-strength, with usually slight osteoarthritic changes. There was poor correlation between subjective, objective, and radiographic results but 88% of the patients were satisfied with their results.

Activities of Daily Living↗
PubMed1990

Intertrochanteric corrective osteotomy in slipped capital femoral epiphysis. A long-term follow-up study of 26 patients.

The results of intertrochanteric corrective osteotomy in a series of 26 hips with moderate to severe chronic slipped capital femoral epiphysis are reported from follow-up studies in 1976 and 1986. In hips with a slippage of less than 40 degrees (ten hips), arthrosis was present in one hip. In the remaining 16 cases in which slippage exceeded 40 degrees, osteoarthrosis was present in 15, even though correction was adequate. From these observations it can be concluded that intertrochanteric corrective osteotomy does not prevent degeneration in cases with the most severe slip. On the basis of the present observations on treated and untreated cases, the authors advocate treatment by fixation without realignment, accepting the deformity in moderate and severe chronic slips. Rotational osteotomy may be considered in the event of hip joint contracture.

Adolescent↗
PubMed1989

Knee arthrography: comparison of iotrolan and ioxaglate sodium meglumine.

Arthrographic image quality and relative morbidity resulting from use of the nonionic dimer iotrolan and the ionic dimer ioxaglate sodium meglumine were compared in a prospective double-blind study performed in 80 patients. Radiographs obtained 2, 5, 10, 15, 20, and 25 minutes after injection of contrast agent were graded for diagnostic quality. Relative morbidity was evaluated by the physician during the examination and later by the patient by means of a questionnaire. Iotrolan demonstrated better image quality on serial radiographs in knee joints without previous effusions. Most differences were not significant. The mean duration of diagnostic-quality images for both contrast media was about 23 minutes. Iotrolan and ioxaglate caused equal postprocedural pain (in about 50% of patients). Other types of discomfort were less when iotrolan was used, but the differences were not significant. With regard to long-lasting image quality, both contrast media are suitable for arthrography.

Adolescent↗
PubMed1988

Rotator cuff impingement syndrome: MR imaging.

Ten patients with clinically suspected rotator cuff impingement syndrome were evaluated with magnetic resonance (MR) imaging, double contrast arthrography, and conventional radiography. An area of increased signal intensity in the tendinous portion of the rotator cuff was seen in eight of ten patients on images obtained with a short repetition time (TR) and short echo time (TE) and those obtained with a long TR and long TE with spin-echo sequences. Microscopic findings, available in five patients, indicated that these areas of increased intensity corresponded to degeneration and inflammation of the rotator cuff. A previously injected long-acting steroid preparation combined with a local anesthetic, which also produces an area of increased signal intensity on long TR, long TE images, can cause problems with image interpretation. No tears of the rotator cuff were detected with MR imaging. However, a full-thickness cuff tear was detected with arthrography in three patients. Although based on a relatively small group of patients, these preliminary findings suggest that MR imaging is capable of demonstrating rotator cuff abnormalities in patients with impingement syndrome.

Humans↗
PubMed1988

Magnetic resonance imaging in congenital dislocation of the hip.

A study of structures which obstruct reduction of hip dislocation was performed on 15 hips by magnetic resonance imaging (MRI). Before treatment started, MRI studies were performed on 10 patients, six of whom were treated conservatively, after which further MRI studies helped to establish a concentric reduction. In the other four conservative treatment failed and they were operated on; in them the MRI studies were compared with arthrographic and surgical findings. In all but one of these 10 patients, MRI enabled us to differentiate between an everted and an inverted limbus. In five other patients with unsatisfactory development of the hip following closed reduction, MRI was compared with earlier arthrographic studies. MRI provided accurate anatomical information which would not have been obtained by arthrography. It clearly has great potential in assisting the surgeon to select the appropriate form of treatment.

Child, Preschool↗
PubMed1988

The lever arm in glenohumeral abduction after hemiarthroplasty.

Fourteen cases of hemiarthroplasty for four-part fractures of the proximal humerus were reviewed. Pain relief was satisfactory, but function was limited, mainly due to loss of glenohumeral abduction despite electromyographic proof of actively contracting abductors in all cases. Analysis of special radiographs of nine cases showed a direct relationship between the clinical results and the "humeral offset", or distance between the geometric centre of the humeral head and the lateral aspect of the greater tuberosity. This offset affects the lever arms of the glenohumeral abductor muscles. The implications for surgical technique and for the design of shoulder prostheses are discussed.

Adult↗
PubMed1988

MR imaging of recurrent anterior dislocation of the shoulder: comparison with CT arthrography.

Posttrauma damage due to anterior glenohumeral joint dislocation may result in recurrent dislocation. Currently CT arthrography is the method of choice to evaluate the extent of osseous and soft-tissue changes before reconstructive surgery. This study was undertaken to determine if MR was able to depict postdislocation abnormalities and if MR is a possible replacement for CT arthrography. Thirteen patients with recurrent anterior shoulder dislocation were evaluated with conventional radiography and MR; CT arthrography was performed in 10. Twelve patients underwent surgery, and the findings of MR and CT arthrography were verified. MR and CT arthrography showed the integrity of the glenoid labrum equally well. All humeral head defects, detected in nine patients with plain film radiography and CT, were easily identified with MR. Information about anterior joint capsule abnormalities is difficult to obtain with MR. However, separation of the capsule from the bony glenoid can be detected if a joint effusion is present to adequately distend the joint. Preliminary results of this study indicate that MR is useful in the assessment of postdislocation abnormalities and may possibly replace CT arthrography in the evaluation of patients with recurrent shoulder dislocation.

Humans↗
PubMed1988

Histopathologic evaluation in failed Gerard double cup arthroplasty.

Fifteen femoral head remnants were removed at revision of an uncemented double cup arthroplasty and were investigated by histological methods. Nine showed resorption of the head, partly due to osteoporosis by stress protection, preexistent pseudocysts, or osteonecrosis. Necrosis was frequently seen in the apicocranial area, and in six cases extended into deeper areas. One failure was attributed to synovitis caused by polyethylene debris. A smooth collagenous membrane developed at both the femoral head and the acetabular interfaces. In some cases metaplasia into cartilage and osteophytes developed at the cup rim.

Adult↗
PubMed1987

Magnetic resonance imaging of glenohumeral joint diseases.

Through the application of oblique planes and flexible surface coil techniques, magnetic resonance imaging (MRI) promises to be of great clinical value in the evaluation of a variety of pathologic conditions affecting the shoulder. In patients with joint effusions, the tendinous portion of the rotator cuff, glenoid labrum, and bicipital tendon can be readily visualized. This capability has particular relevance in patients with inflammatory disease and traumatic conditions. Rotator cuff atrophy and impingement of the coracoacromial arc upon the supraspinatus muscle and tendon can also be demonstrated. MRI is also useful in the evaluation of shoulder instability.

Humans↗
PubMed1987

Knee arthrography: a comparison of iohexol, ioxaglate sodium meglumine, and metrizoate.

The arthrographic image quality and relative morbidity resulting from use of Omnipaque 300 (iohexol), Hexabrix 320 (ioxaglate sodium meglumine), and Isopaque Coronar 370 (metrizoate) were compared in a prospective double-blind study performed with 120 patients. Radiographs obtained 2, 5, 10, 15, 20, and 25 minutes after injection were judged for diagnostic quality. Relative morbidity was evaluated by the physician during the examination and later by the patient via a questionnaire. Hexabrix demonstrated the best and most persistent diagnostic quality over serial radiographs (P less than .05). Omnipaque caused significantly less postprocedural pain (P less than .05). The other types of discomfort measured did not indicate statistically significant differences in morbidity resulting from the three contrast agents.

Adolescent↗
PubMed1986

Normal shoulder: MR imaging.

Relatively poor spatial resolution has been obtained in magnetic resonance (MR) imaging of the shoulder because the shoulder can only be placed in the periphery of the magnetic field. The authors have devised an anatomically shaped surface coil that enables MR to demonstrate normal shoulder anatomy in different planes with high spatial resolution. In the axial plane, anatomy analogous to that seen on computed tomographic (CT) scans can be demonstrated. Variations in scapular position (produced by patient positioning) may make reproducibility of sagittal and coronal plane images difficult by changing the relationship of the plane to the shoulder anatomy. Oblique planes, for which the angle is chosen from the axial image, have the advantage of easy reproducibility. Obliquely oriented structures and relationships are best seen in oblique plane images and can be evaluated in detail.

Humans↗
PubMed1986

Radiographic views in recurrent anterior shoulder dislocation. Comparison of six methods for identification of typical lesions.

In a prospective study of 27 shoulders with recurrent anterior dislocation, we compared six radiographic views for demonstration of the Hill-Sachs defect and the Bankart lesion. The Hill-Sachs defect was most often identified by the Stryker notch view (25/27); it was best visualized and most easily recognized on the 45 degrees craniocaudal view (22/27). This view also had the highest diagnostic yield for demonstrating the Bankart lesion.

Adolescent↗
PubMed1986

Cortical hyperostosis and enthesopathy due to long-term etretinate administration.

Two cases are presented which show a severe ossification disorder that we observed during long-term administration of a synthetic vitamin A analogue (etretinate). The radiologic findings are discussed in relation to the skeletal abnormalities, which occur in chronic vitamin A intoxication and retinoid hyperostosis, which has been recently described in the literature as a side effect of another retinoid (isotretinoin).

Adult↗
PubMed1986

Scintigraphy of the female breast with Tc-99m-DTPA: a prospective blind evaluation.

Following a report on the use of Tc-99m-diethylenetriamine pentaacetic acid (Tc-99m-DTPA) for detection of malignant breast tumors we compared this method with other diagnostic aids such as mammography and cytology. Among 160 women referred to our department for diagnosis, 166 examinations were performed (six patients had bilateral lesions); the final diagnosis of the breast lesion was established as malignant in 62 cases and benign in 104 cases. The scintigraphic image was reported malignant if an area of focal uptake observed on the scan 30 minutes after injection of the tracer persisted or became more intense on the 2-hour scintigram. All other uptake patterns were considered benign. For this examination we obtained a sensitivity of 75% and a specificity of 91%. For mammography, sensitivity was 90% and specificity was 82%. The lower false-positive results of scintigraphy may serve to confirm the benignancy of doubtful mammographic findings, for when both examinations suggest a benign lesion, the combined imaging procedure is a useful means of excluding cancer (sensitivity 96%, predictive value 98%). It is concluded that in all other cases Tc-99m-DTPA breast scintigraphy is of limited value.

Adult↗
PubMed1983

The os supratrochleare dorsale: a normal variant that may cause symptoms.

Four patients with an os supratrochleare dorsale are presented; three had symptoms that necessitated surgical removal. One patient showed the abnormality in both elbows; three were men and one was a woman. The os supratrochleare dorsale is most likely an accessory bone; however; the location is such that it often becomes traumatized by the olecranon. Posttraumatic pathologic changes with secondary chondrometaplasia of the bone itself occurs as a consequence. Symptomatic patients show posttraumatic changes of the bone, while those without symptoms show a normal trabecular pattern. This condition seems to bear no relation to the supratrochlear septum or to bones in the coronoid fossa.

Adolescent↗
PubMedDate not supplied

Neonatal screening and staggered early treatment for congenital dislocation or dysplasia of the hip.

In 14 264 consecutive newborn babies the results of screening and early treatment for congenital dislocation and/or dysplasia of the hip (CDH) were evaluated in a prospective follow-up study. Barlow's test was done and the family history was recorded. Babies who were positive (n = 140) were immediately given abduction treatment. If the screening result was doubtful (133) or if the test was negative but the family history positive (685) the child was radiographed at 5 months and abduction treatment was started if any form of CDH was seen. Among Barlow-negative children with no family history (13,306), two reference groups were selected--at age 5 months (596) and at age 2 years (4365). Dislocation was missed at screening in 0.02%. Dysplasia was seen at 5 months in 15% of Barlow-negative children with a positive family history and in 2-3% of the reference group children. Crude estimates of the lower limits of validity indices for the screening test showed that the test is efficient in the identification of dislocation but probably has no value for dysplasia. Of the babies in whom treatment was started immediately 17% had relapse dysplasia after withdrawal of therapy, 3% had avascular necrosis, and 78% were normal at 2 years. When treatment was started at 5 months we found no relapse dysplasia, only 1% avascular necrosis, and 53-63% success at 2 years. In children with dislocatable hips we propose a wait-and-see treatment strategy, with early ultrasonography or radiography at 5 months.

Follow-Up Studies↗