Zeitschrift für Orthopädie und ihre Grenzgebiete, Mar 18, 2008
ABSTRACT The aim of this study was to evaluate the response of the femoral head to intraosseous p... more ABSTRACT The aim of this study was to evaluate the response of the femoral head to intraosseous pressure increases and to document blood flow of periarticular soft tissue after infusion of vasoactive substances. Beside that the value and imagery of native MRI after induced intraosseous pressure increase should be estimated for early detection of femoral head necrosis. The alteration of intraosseous pressure and peripheral blood flow of the femoral head of beagle dogs was examined after administration of bradykinin as a vasoactive substance followed by subsequent magnetic resonance imaging (MRI). Bradykinin was injected into the arteriae circumflexae femoris lateralis and medialis of six beagle dogs. The administrations were made using a standard protocol with simultaneous measurement of venous blood flow and intraosseous pressure distribution in the epiphysis of the femoral head. Bradykinin was applied in regular time intervals followed by MRI. At a mean epiphyseal pressure 14.66 mmHg (sigma: 2.42) in the femoral head, a mean flow of 91.6 ml/min (sigma: 16.08) was measured in the vena femoralis. After an administration of a defined concentration of bradykinin an increased epiphyseal pressure was recorded in the measured area. An average increase blood flow of the vena femoralis was observed at the beginning of the bradykinin-injection, followed by a circulatory volume reduction. The post-experimental MRIs showed massive oedema in the femoral musculature after bradykinin-application, however without osseous signal alterations in T1- or STIR-weighted images. Our results indicate that acute intraosseous pressure increases are not accompanied by signal alterations in MRI. Obviously more extensive pressure induced lesions are necessary for detectable signal alterations, as these have already been demonstrated in patients with diagnosed femoral head necrosis.
Zeitschrift Fur Orthopadie Und Unfallchirurgie, Apr 14, 2015
Tripolar cups can be separated into constrained and unconstrained dual-mobility cups. The latter ... more Tripolar cups can be separated into constrained and unconstrained dual-mobility cups. The latter show better survival and revision rates. The main problem is the polyethylene wear. Therefore modern types of polyethylene are used in these cups. The indications for dual-mobility cups are recurrent dislocation and situations where the risk of dislocation is increased.
Summary Reconstructive surgery with an ankle prosthesis for a painful ankle joint is of extreme ... more Summary Reconstructive surgery with an ankle prosthesis for a painful ankle joint is of extreme benefit for the rheumatoid patient. In contrast to ankle fusion, ankle arthroplasty maintains mobility with early remobilisation of the patient. The success of ankle arthroplasty depends on indication, implant design and surgical technique as well as postoperative treatment. The performance of the first ankle prosthesis generation,
Archives of Orthopaedic and Trauma Surgery, Dec 1, 1996
In this study 17 patients with recurrent dislocation of the patella were followed up 10 years aft... more In this study 17 patients with recurrent dislocation of the patella were followed up 10 years after their Goldthwait operation. The subjective and clinical findings were excellent or good in 70%. X-radiographs indicated osteoarthritis of the femoropatellar joint in 60%. Concerning the aetiopathological factors, we found an increased external torsion of the afflicted extremity (measured by computed tomography).
Experimental animal studies and clinical investigations show three processes going on during extr... more Experimental animal studies and clinical investigations show three processes going on during extremity lengthening with the Ilizarov-method. At first degenerative changes including cell necroses in the muscles, the nerves and the tendons [corrected] occur as well as denervation of muscle fibers resulting in neurogenous muscle atrophies. These alterations are followed by reperative and regenerative processes as well as the reinnervation of the denervated muscle fibers. Secondly histoneogenesis occur which leads to a high increase of tissue-specific cells and a growth of the muscles, tendons and vessels. Therefore tensile-stress is an important factor of tissue growth. Thirdly adaptive processes proceed during leg lengthening. For example the high biosynthetic activity during tissue growth seems to indicate an increase of vasa vasorum.
Eigene tierexperimentelle und klinische Studien zeigten, daû in den Weichgeweben bei der Extremit... more Eigene tierexperimentelle und klinische Studien zeigten, daû in den Weichgeweben bei der Extremitätenverlängerung nach dem Ilizarov-Prinzip 3 verschiedene Prozesse nebeneinander ablaufen: 1. treten Weichteilschädigungen mit degenerativen Prozessen bishin zu Zellnekrosen in den Muskeln, den Nerven und den Sehnen sowie Denervierungen der Muskelfasern mit daraus resultierenden neurogenen Muskelatrophien auf. Diese werden von Regenerationsbzw. Reparationssowie von Reinnervationsprozessen gefolgt. 2. finden Histoneogeneseprozesse statt, die so ausgeprägt sind, daû sie zu einem Gewebewachstum mit Vermehrung der gewebespezifischen Zellen in der Muskulatur, den Sehnen und Gefäûen führen. Hieraus kann gefolgert werden, daû ein kontinuierlicher, kleinschrittiger Zugreiz ein wichtiger Stimulator für das Gewebewachstum darstellt. 3. kommt es zu adaptiven Prozessen. Hierzu zählen die Vermehrung der Vasa vasorum, die der Anpassung an einen erhöhten Sauerstoffbedarf bei Wachstumsprozessen dienen dürfte.
Zeitschrift für Orthopädie und Unfallchirurgie, 2017
ZusammenfassungFür die Behandlung von periprothetischen Infektionen von Schulterendoprothesen exi... more ZusammenfassungFür die Behandlung von periprothetischen Infektionen von Schulterendoprothesen existieren verschiedene therapeutische Konzepte. Bei akuten periprothetischen Infektionen kann das Implantat belassen werden, alle mobilen Teile (Inlay) sollten bei einem offenen Débridement gewechselt werden und Spülungen mit antibakteriellen Lösungen wie Octinedin oder Polyhexanid durchgeführt werden. Bei Spätinfektionen sind die therapeutischen Optionen nach der Entfernung des infizierten Implantats: Einlage eines permanent verbleibenden Spacers, die Resektionsarthroplastik, einzeitige und zweizeitige Wechsel mit und ohne temporären Spacer. Die funktionellen Ergebnisse sind beim einzeitigen Wechsel am besten und die Eradikationsrate vergleichbar mit derjenigen beim zweizeitigen Wechsel. Voraussetzung für den einzeitigen Wechsel ist die Identifizierung des Keimes, um zielgerichtete Antibiotika in den Zement beizumischen und systemisch zu verabreichen.
Zeitschrift für Orthopädie und ihre Grenzgebiete, Mar 18, 2008
ABSTRACT The aim of this study was to evaluate the response of the femoral head to intraosseous p... more ABSTRACT The aim of this study was to evaluate the response of the femoral head to intraosseous pressure increases and to document blood flow of periarticular soft tissue after infusion of vasoactive substances. Beside that the value and imagery of native MRI after induced intraosseous pressure increase should be estimated for early detection of femoral head necrosis. The alteration of intraosseous pressure and peripheral blood flow of the femoral head of beagle dogs was examined after administration of bradykinin as a vasoactive substance followed by subsequent magnetic resonance imaging (MRI). Bradykinin was injected into the arteriae circumflexae femoris lateralis and medialis of six beagle dogs. The administrations were made using a standard protocol with simultaneous measurement of venous blood flow and intraosseous pressure distribution in the epiphysis of the femoral head. Bradykinin was applied in regular time intervals followed by MRI. At a mean epiphyseal pressure 14.66 mmHg (sigma: 2.42) in the femoral head, a mean flow of 91.6 ml/min (sigma: 16.08) was measured in the vena femoralis. After an administration of a defined concentration of bradykinin an increased epiphyseal pressure was recorded in the measured area. An average increase blood flow of the vena femoralis was observed at the beginning of the bradykinin-injection, followed by a circulatory volume reduction. The post-experimental MRIs showed massive oedema in the femoral musculature after bradykinin-application, however without osseous signal alterations in T1- or STIR-weighted images. Our results indicate that acute intraosseous pressure increases are not accompanied by signal alterations in MRI. Obviously more extensive pressure induced lesions are necessary for detectable signal alterations, as these have already been demonstrated in patients with diagnosed femoral head necrosis.
Zeitschrift Fur Orthopadie Und Unfallchirurgie, Apr 14, 2015
Tripolar cups can be separated into constrained and unconstrained dual-mobility cups. The latter ... more Tripolar cups can be separated into constrained and unconstrained dual-mobility cups. The latter show better survival and revision rates. The main problem is the polyethylene wear. Therefore modern types of polyethylene are used in these cups. The indications for dual-mobility cups are recurrent dislocation and situations where the risk of dislocation is increased.
Summary Reconstructive surgery with an ankle prosthesis for a painful ankle joint is of extreme ... more Summary Reconstructive surgery with an ankle prosthesis for a painful ankle joint is of extreme benefit for the rheumatoid patient. In contrast to ankle fusion, ankle arthroplasty maintains mobility with early remobilisation of the patient. The success of ankle arthroplasty depends on indication, implant design and surgical technique as well as postoperative treatment. The performance of the first ankle prosthesis generation,
Archives of Orthopaedic and Trauma Surgery, Dec 1, 1996
In this study 17 patients with recurrent dislocation of the patella were followed up 10 years aft... more In this study 17 patients with recurrent dislocation of the patella were followed up 10 years after their Goldthwait operation. The subjective and clinical findings were excellent or good in 70%. X-radiographs indicated osteoarthritis of the femoropatellar joint in 60%. Concerning the aetiopathological factors, we found an increased external torsion of the afflicted extremity (measured by computed tomography).
Experimental animal studies and clinical investigations show three processes going on during extr... more Experimental animal studies and clinical investigations show three processes going on during extremity lengthening with the Ilizarov-method. At first degenerative changes including cell necroses in the muscles, the nerves and the tendons [corrected] occur as well as denervation of muscle fibers resulting in neurogenous muscle atrophies. These alterations are followed by reperative and regenerative processes as well as the reinnervation of the denervated muscle fibers. Secondly histoneogenesis occur which leads to a high increase of tissue-specific cells and a growth of the muscles, tendons and vessels. Therefore tensile-stress is an important factor of tissue growth. Thirdly adaptive processes proceed during leg lengthening. For example the high biosynthetic activity during tissue growth seems to indicate an increase of vasa vasorum.
Eigene tierexperimentelle und klinische Studien zeigten, daû in den Weichgeweben bei der Extremit... more Eigene tierexperimentelle und klinische Studien zeigten, daû in den Weichgeweben bei der Extremitätenverlängerung nach dem Ilizarov-Prinzip 3 verschiedene Prozesse nebeneinander ablaufen: 1. treten Weichteilschädigungen mit degenerativen Prozessen bishin zu Zellnekrosen in den Muskeln, den Nerven und den Sehnen sowie Denervierungen der Muskelfasern mit daraus resultierenden neurogenen Muskelatrophien auf. Diese werden von Regenerationsbzw. Reparationssowie von Reinnervationsprozessen gefolgt. 2. finden Histoneogeneseprozesse statt, die so ausgeprägt sind, daû sie zu einem Gewebewachstum mit Vermehrung der gewebespezifischen Zellen in der Muskulatur, den Sehnen und Gefäûen führen. Hieraus kann gefolgert werden, daû ein kontinuierlicher, kleinschrittiger Zugreiz ein wichtiger Stimulator für das Gewebewachstum darstellt. 3. kommt es zu adaptiven Prozessen. Hierzu zählen die Vermehrung der Vasa vasorum, die der Anpassung an einen erhöhten Sauerstoffbedarf bei Wachstumsprozessen dienen dürfte.
Zeitschrift für Orthopädie und Unfallchirurgie, 2017
ZusammenfassungFür die Behandlung von periprothetischen Infektionen von Schulterendoprothesen exi... more ZusammenfassungFür die Behandlung von periprothetischen Infektionen von Schulterendoprothesen existieren verschiedene therapeutische Konzepte. Bei akuten periprothetischen Infektionen kann das Implantat belassen werden, alle mobilen Teile (Inlay) sollten bei einem offenen Débridement gewechselt werden und Spülungen mit antibakteriellen Lösungen wie Octinedin oder Polyhexanid durchgeführt werden. Bei Spätinfektionen sind die therapeutischen Optionen nach der Entfernung des infizierten Implantats: Einlage eines permanent verbleibenden Spacers, die Resektionsarthroplastik, einzeitige und zweizeitige Wechsel mit und ohne temporären Spacer. Die funktionellen Ergebnisse sind beim einzeitigen Wechsel am besten und die Eradikationsrate vergleichbar mit derjenigen beim zweizeitigen Wechsel. Voraussetzung für den einzeitigen Wechsel ist die Identifizierung des Keimes, um zielgerichtete Antibiotika in den Zement beizumischen und systemisch zu verabreichen.
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