[Massive arthrofibrosis of the knee joint after carbon fibre rod implantation. Two cases]. / Massive Arthrofibrose des Kniegelenks nach Karbonfaserstift-Implantation. Zwei Fallbeschreibungen.

Summary. In the treatment of cartilage damage the use of carbon rods is getting more and more popular. The papers are promising. There are no reports about significant complications. The following cases show a post operative enormous increasing discomfort.

[Histopathological investigations in soft tissue surrounding metallic orthopaedic implants by extravasated eosinophil leukocytes]. / Histozytologische Untersuchungen der lokalen Weichteilreaktionen auf Metallimplantate anhand eosinophiler Granulozyten.

INTRODUCTION: The amount of extravasated eosinophil leukocytes in soft tissue surrounding a metallic orthopaedic implant indirectly allows conclusions about the allergenicity of the implant. As yet the implications of the distance of the biopsy from the implant have not been studied. METHODS: In a prospective study we histocytologically evaluated soft tissue biopsies gained during routine removal of orthopaedic implant material in 81 patients. By means of a quantitative and semiquantitative method, material directly adjacent to and 1 cm distant from the implant was examined for eosinophil leukocytes. RESULTS: In respect to the number of eosinophil granulocytes, the two groups showed no significant discrepancies (p = 0.55). lnterestingly, correlation analysis revealed a significant difference in the number of eosinophiles between implant-adjacent and -distant tissue in some individuals. Consecutive semiquantitative analysis could show that there was no correlation concerning the number of eosinophiles between results gained at 1 cm distance from the implant and material in the direct vicinity of the biomaterial. CONCLUSION: Our results suggest that when utilising a histocytological method to determine metal sensitivity of a biomaterial on surrounding soft tissue, not only material directly adjacent to the implant but also at a distance of approximately 1 cm should be evaluated.

A new MRI technique for imaging scoliosis in the sagittal plane.

The purpose of the present study was to introduce a new magnetic resonance imaging (MRI) procedure showing the whole spine in a coronal and sagittal plane, and to study the assessment of sagittal Cobb angle measurements using this technique. Prospectively we studied 32 patients (average age 14.8 years) with idiopathic scoliosis (mean thoracic Cobb angle 33 degrees on radiograph) and 18 patients (average age 14.5 years) without scoliosis. The MRI investigation was carried out in a standard supine position. The cervical and upper thoracic spine and the lower thoracic and lumbar spine were measured on a 1.5-T Gyroscan ACS-NT Powertrak 6000 system. An algorithm was developed to combine the results of the cranial and caudal scans into a coronal and a sagittal image of the whole spine (MR total spine imaging). Measurement of the sagittal Cobb angle conducted ten times by four independent investigators revealed an intraobserver variance of 1.6 degrees and an interobserver variance of 1.8 degrees. In the group with scoliosis the mean sagittal Cobb angle from T4 to T12 was 12 degrees (range -3 degrees to 24 degrees) and in the group without scoliosis 22 degrees (range 16 degrees to 30 degrees), which was a significant difference. MR total spine imaging makes it possible to image scoliosis in the sagittal plane. On these MR projections, idiopathic thoracic scoliosis was identified by a reduced sagittal Cobb angle. MR total spine imaging would allow monitoring of scoliosis in the sagittal plane, which can reveal relevant clinical data without radiation exposure.

[Treatment of borderline D/IIIa hip in newborn infants with the Graf-Mittelmeier abduction harness under close ultrasound control]. / Die Behandlung der grenzwertigen D/IIIa-Hüfte beim Neugeborenen mit der Graf-Mittelmeier-Aktivspreizhose unter engmaschiger sonographischer Kontrolle.

UNLABELLED: By retrospective analysis we investigated the treatment of "congenital" dysplasia of the hip (D/IIIa-type according to Graf) in newborn infants with the Graf-Mittelmeier-Aktivspreizhose (abduction harness). METHOD: Between 1990 and 1997 twenty of twenty-three newborn infants with the IIIa-type were treated with the abduction harness by short-term ultrasound monitoring. We started the therapy in the first days of life, if we could identify a IIIa-type with an alpha-angle close to type D and with only minor tendency to decentration. RESULTS: Eighteen infants (90%) treated by abduction harness developed "mature" hips. At the beginning the mean-value of the alpha-angle was 41 degrees. In the first weeks a rapid hip maturation was observed. The alpha-angles of the 25 and 75 percentiles crossed the 60 degrees at the control of twelve weeks. A modification of the treatment by cast application was necessary in one case only. CONCLUSIONS: The results show, that dysplastic hip joints of newborn infants show a rapid maturation under therapy. Initial treatment with an abduction harness can improve decentered D/IIIa-hips.

Evaluation of chronic tears of the rotator cuff by ultrasound. A new index.

The diagnosis of chronic lesions of the rotator cuff is challenging. We have developed a new index to improve the sonographic diagnosis of chronic tears of the cuff. In a pilot study, we examined 50 asymptomatic healthy volunteers by ultrasound to establish the diameter of the rotator cuff in relation to the tendon of the long head of biceps. Subsequently, the index was calculated in 64 patients who had had shoulder pain for more than three months caused by clinically diagnosed lesions of the rotator cuff. The compensatory hypertrophy of the biceps tendon was quantified sonographically in relation to the diameter of the cuff. Comparison with the contralateral shoulder revealed a significantly higher biceps rotator-cuff ratio (p < 0.05) for patients with torn rotator cuffs. A ratio greater than 0.8 was considered pathological (index positive); the mean ratio in the control group was 0.43. The sensitivity of a positive index was 97.8%, the specificity 63.2%, the positive predictive value 86.3%, and the negative predictive value 92.4% in comparison with surgical findings. Use of the index improves sensitivity in the diagnosis of chronic tears of the cuff by ultrasound.

[Extra-articular localization of nodular synovitis: a case report]. / Die extraartikuläre lokalisierte noduläre Synovialitis--ein Fallbericht.

INTRODUCTION: The extra-articular nodular synovitis is regarded as a rare case of the common pigmented villonodular synovitis. The following report points out a case with wide extension in a young man's proximal lower leg. CASE-REPORT: A 24-year-old man complained about a non-painful tumor at his left proximal lower leg without any clinical handicap. Some years before he got a fracture of the proximal left tibia caused by an adequate sports trauma. So he had to undergo two operative investigations. The radiographs showed a transparent soft tissue tumor, which displaced the corticalis of the bone for some centimeters. The magnetic resonance imaging did not hint at a malignant process. After operative treatment the diagnosis was confirmed by histology. CONCLUSION: By operative and histological investigation advice could given to a benign tumor. The etiology of the extra-articular nodular synovitis is to be regarded as unknown. In our case a dislocation of synovial cells to extra-articular should be discussed.

The fetal spinal canal--a three-dimensional study.

The size of the lumbar spinal canal was evaluated in a prospective cross-sectional ultrasound (US) study to determine normal size values for lumbar part of the vertebral canal. A total of 88 patients undergoing routine obstetric US were studied between 16-41 weeks gestation. Structural anomalies or growth restriction were excluded. Area and volume of the vertebral canal in L1, L3 and L5 were calculated by three-dimensional (3-D) US. The size of the spinal canal correlated well with gestational age and no major differences could be found between upper and lower lumbar spine. By 3-D US, in vivo assessment of the spinal canal becomes possible. Further studies are needed to confirm our findings.

[Clinical and nuclear magnetic resonance tomography diagnosis of glenoid labrum injuries]. / Klinische und kernspintomographische Diagnostik von Labrum-glenoidale-Verletzungen.

PURPOSE: Clinical and radiological evaluation of labral tears remains challenging. It has been shown that intravenous administration of contrast agents produces an MR arthrographic effect without the need for intraarticular injection. This is the first study evaluating this new technique of indirect MR arthrography in diagnosis of glenoid labrum tears. METHODS: 28 patients with clinically suspected labral injuries were prospectively investigated (1.5 Tesla, flexible surface coil). A native MR exam of the shoulder (transverse and oblique-coronar orientation, T1-weighted spin-, proton density- and T2*-weighted gradient echo sequences) and indirect MR arthrography (transverse and oblique-coronar orientation, fat-suppressed T1-weighted spin-echo sequences, intravenous injection of gadopentetate dimeglumine [0.1 mmol/kg], followed by 10-15 min of joint movement) were performed. Results were confirmed by arthroscopy and/or open surgery. Additionally sensitivity evaluation of clinical tests for investigation of labral tears were performed. RESULTS: Indirect MR-Arthrography improved delineation of the glenoid labrum and hyaline cartilage significantly (p < 0.05). Sensitivity and specificity of indirect MR arthrography in diagnosis of labral injuries were 90% and 89% respectively, compared to 79% and 67% of the native MR exam. The reliability of the checked clinical tests is not sufficient enough to determine labral lesions (predictive value between 50 and 70%). CONCLUSION: Indirect MR-arthrography is a promising non-invasive technique in the evaluation of the glenoid labrum.

[Reference values for development of the iliac crest apophysis (Risser sign)]. / Referenzwerte zur Entwicklung der Beckenkammapophyse (Risser-Zeichen).

PURPOSE: Actualization of the standard values for the maturation of the iliac bone apophysis by Risser. METHODS: The study analysed retrospectively 515 data from 154 patients of german descent with idiopathic scoliosis. The study group included 312 X-rays of 82 female and 203 X-rays of 72 male patients, born between 1970-1985 and within the age of 10 and 20 years at the time of the evaluation. The middle chronological age, the standard deviation, the difference between female and male patients as well as the t-value were calculated for each stage. In addition the intervals with the corresponding t-values were calculated. RESULTS: The middle chronological age calculated for the stages of Risser shows significant differences. Because of acceleration the ossification begins earlier and finishes later. As assumed, the standard values were different for female and male patients. CONCLUSION: The necessity of a new and complete investigation was given because of the acceleration of the maturation and the incomplete existing standard values. CLINICAL RELEVANCE: This study contains current standard values for maturation of the iliac bone, which could be applied for analysing the skeletal maturation.

[Lipoatrophia semicircularis--an orthopedic diagnosis?]. / Lipoatrophia semicircularis--eine orthopädische Diagnose?

INTRODUCTION: Lipoatrophia semicircularis (LAS) represents an isolated fatty atrophy usually located at the lower extremity. The atrophy is circular and painless and usually resolves without therapy. The skin modifications occur within a few days or weeks. The etiology is unknown. CASE: In the following we present a case of LAS with a segmental dysfunction of the third ipsilateral lumbal root of a 43-year-old women. It was possible to provoke a referred pain into the area of atrophy by passive motion of the lumbal spine into the plane of resistant. CONCLUSION: LAS is rare and slightly known among orthopedists. Knowledge of the typical morphological modifications will lead to diagnosis. In most of the cases further diagnostic measures are not necessary. We recommend a segmental investigation of the spine in the case of secured diagnosis.

[Effect of birth weight on hip maturation in the newborn infant]. / Der Einfluss des Geburtsgewichts auf die Hüftreifung des Neugeborenen.

In 2018 consecutive newborn ultrasound examination of the hip was performed according to the method of Graf within the first 14 days of life (average 4th day). Typ IIa was seen as normal in newborn child. Birth weight was classified according to standards of Lubchenco and Hohenauer. Newborn with high birth weight (LGA) revealed an incidence of CDH (Typ IIc according to Graf or worse) nearly twice as high as in normal weighted newborn (AGA) (6.11% vs 3.51% [Lubchenco] and 7.95 vs 3.09 [Hohenauer]). Even in children with birth weight between 75th and 90th percentile we found a CDH incidence of 5.54%. Ultrasound examination of the hip is suggested in newborn children with high birth weight because of a higher risk for development of a CDH. Other risk-factors like breech position or of CDH.

[The biceps-/rotator cuff-index in ultrasound diagnosis of chronic rupture of the rotator cuff]. / Der Bizeps-/Rotatorenmanschetten-Index in der sonographischen Diagnostik der veralteten Rotatorenmanschettenruptur.

PURPOSE: Diagnosis of old lesions of the rotator cuff is clinically and sonographically challenging. To improve the sonographic diagnosis of old rotator cuff tears the index was developed. METHOD: In a prospective study 100 patients were examined by ultrasound to evaluate standard measures of rotator cuff diameters in relation to the long biceps tendon. The compensating hypertrophy of the biceps tendon was sonographically quantified in relation to the rotator cuff diameter. RESULTS: The pathological study group included 50 patients with an old lesion of rotator cuff (> 3 months). The control group consisted of 50 patients without any lesions. Comparison of both groups revealed a significantly higher biceps/rotator cuff ratio (p < 0.05). Data higher than 0.8 represent a pathological ratio (Index positive), the standard is 0.5. The index is independent of sex and age. There are no significant index changes measurable in acute tears of the rotator cuff. CONCLUSION: The index helps to improve sensitivity in diagnosis of old rotator cuff tears by ultrasound.

[Intraneural ganglion of the peroneal nerve]. / Intraneurales Ganglion des Nervus peronaeus.

The intraneural ganglion of the peroneal nerve is a rare lesion. The differential diagnosis includes lesions of the knee especially the tendinopathia of the knee flexors. Clinical examination, electrophysiological investigations, ultrasound imaging and magnetic resonance tomography will establish the diagnosis. We report a case in which an artificial puncture of the ganglion caused a temporary peroneal palsy. Surgical procedure led to complete restoration of the nerve function.

Functional treatment of humeral shaft fractures: indications and results.

OBJECTIVE: To determine effectiveness of closed functional bracing for humeral shaft fractures. DESIGN: Retrospective. SETTING: University. PATIENTS: Eighty-seven patients with humeral shaft fractures. INTERVENTION: All patients were treated with closed functional bracing. MAIN OUTCOMES MEASURED: Both subjective and objective criteria were measured. Objective criteria consisted of range of motion and radiographic measurements. Subjective data were recorded using the Hannover Shoulder Score. RESULTS: Eighty-six percent of the follow-up group showed no restrictions in the movement of their shoulder and elbow joints. On the basis of subjective criteria, 95% of the patients were content with the functional treatment, 65% claimed to be pain free in their daily activities and at work, and 35% felt pain only when doing vigorous activities or heavy physical work. Although malposition with an angulation greater than 10 degrees was observed in ten patients (12.6%), functional outcome was good or excellent in two thirds of the cases followed up. CONCLUSIONS: When the correct indications are present, functional treatment of humeral shaft fractures has proven to be an excellent method that is both reliable and cost effective.

Comparative results of bracing and interlocking nailing in the treatment of humeral shaft fractures.

A comparison was made between 44 humeral fractures treated conservatively with functional bracing (Group 1) and 45 treated by operation with a locking nail (Group 2). Thirty-eight of the 44 patients in Group 1 (86%) and 22 of the 45 patients in Group 2 (47%) regained full movement of the shoulder joint. The functional end results were somewhat better in Group 1 although over 90% of patients in both groups were able to clasp their fingers behind their necks and to reach up their backs without restriction. Two patients developed a pseudarthrosis in Group 1, and 2 patients in Group 2 required operative revision due to a haematoma in 1 case and as a result of an infection in the other. There were 6 cases of primary radial nerve damage in both groups, and 6 had to be decompressed operatively. Residual sensory and motor disturbance remained in 2 patients in Group 1. Both methods are useful for the treatment of humeral shaft fractures. We advocate functional bracing as the method of choice if no contraindications exist.

[Standard values for the intrauterine ultrasonography of hip joint development]. / Sonographische Normwerte für die intrauterine Hüftgelenksentwicklung.

Although etiology and pathogenesis of congenital dislocation of the hip (CDH) is of broad interest in orthopaedics, basic questions still remain obscure. Advances in high-resolution ultrasound technology now permit investigation of the fetal hip joint in vivo. Standard values of intrauterine hip development have been established by investigating 146 fetuses (141 pregnancies) in vivo by ultrasound. Standard values describe the development from 20th weeks of gestation until birth. Prenatal Alpha- values suggest influence of intrauterine posture and spatial fetal conditions on hip development. Alpha-angles of 59.7 (SD 8.9) are achieved at the end of pregnancy. These angles meet standards of Graf's calculations for the postnatal hip development. Standard values of intrauterine hip development are of basic interest for interpretation of hip joints in premature children.

Determination of skeletal maturity by ultrasound: a preliminary report.

OBJECTIVE: Replacement of radiography by sonography for determination of skeletal maturity. DESIGN: Sonographic and radiographic evaluation of the maturation of the iliac bone apophysis (Risser's sign) and evaluation of the distal radial epiphyses. PATIENTS: 64 children and adolescents with idiopathic scoliosis, aged from 5 to 19 years. RESULTS: Sonograms with corresponding radiographs were available for the hand and wrist in 36 cases and for the iliac bone in 28 cases. Comparison of sonographic with radiological data revealed sonography to have a sensitivity for qualifying the status of the distal radial epiphysis of 93.1%. Specificity was 100%, accuracy 94.4% for investigation of the distal radial epiphysis. Overall accuracy for correct determination of Risser's stage by ultrasound (in comparison with the radiographic standard) was 89.2%. CONCLUSIONS: These findings suggest that ultrasound is a useful and highly acceptable tool for bone age determination in clinical routine or screening studies and will help to reduce ionizing radiation to children and adolescents.

[Ultrasound anatomy of the fetal hip joint with special reference to the blood supply]. / Sonoanatomie des fetalen Hüftgelenks unter besonderer Berücksichtigung der Blutversorgung.

AIM: Study of the anatomy of the fetal hip joint in 115 pregnancies between 13. to 40.th weeks of gestation by ultrasound. METHOD: Sonoanatomy was studied by high resolution ultrasound (Acuson 128). For investigation of vascular supply of the fetal hip, colour-coded Doppler sonography was performed. In-vivo studies on vascular supply were correlated with histological sections of 34 fetal hip specimens, according to the conceptional age of 13-35 weeks. RESULTS: Vascular studies of the proximal end of the human femur showed a supply by the lateral and medial femoral circumflex arteries branched from the femoral artery or the deep femoral artery. After 22 weeks of gestation the acetabular artery supplied by the obturator artery was visible by means of Doppler sonography. At the end of pregnancy, large numbers of intraosseous blood vessels are demonstrable within the femoral head and neck. CONCLUSION: The basic arterial pattern of the hip joint is established at birth. Proximal end of the growing femur, acetabulum, os ilium and labrum acetabulare are clearly visible by ultrasound.

[Long-term effect of brace treatment on spinal decompensation in idiopathic scoliosis. A comparison of Milwaukee brace--Chêneau corset]. / Der langfristige Einfluss der Korsettbehandlung auf die spinale Dekompensation der idiopathischen Skoliose. Ein Vergleich Milwaukee Brace--Chêneau-Korsett.

Spinal decompensation is a statistically important factor in idiopathic scoliosis. In our study we compared longterm influence of brace-treatment by Milwaukee brace and Chêneau-Orthosis. Twenty-six patients treated by Milwaukee Brace and 21 treated by Chêneau-Orthosis were followed up with an average of 7.8 (Milwaukee) and 4 (Chêneau) years. No correlation was found between spinal decompensation, expression and localisation of the major curve. Further we didn't find any correlation between spinal decompensation and development of the major curve under therapy. Chêneau-Orthosis showed better results significantly. In 61.9% of all patients decreased of spinal decompensation to 35% of the initial value was seen. With Milwaukee Brace only 38.5% of the patients did improve to 46.6% of the initial value. A prediction for development of spinal decompensation under therapy was not possible.

[Ultrasonography studies of the fetal hip]. / Sonographische Untersuchungen des fetalen Hüftgelenks.

Recent advances in ultrasound technology, especially high-resolution sonography, now permit visualisation of the fetal hip development. Since early diagnosis and treatment of congenital hip dislocation significantly influence the outcome of the disease, ultrasound screening of the newborn infants showed to be the most effective method. In our study assessment of the fetal hip has been performed on the prenatal level in order to provide basic knowledge on fetal hip development from 14th to 40th weeks of gestation. From the 20th week of gestation bony structures are clearly visible and allow the assessment of acetabular configuration. Soft tissue and chondral acetabular components are recognizable from the 21st week. For pre- and postnatal comparative measures Graf's method and standard documentation is used.