[Haemophilia and knee function: are there differences between haemophilic and healthy children?]. / Hämophilie und Kniefunktion - Gibt es Unterschiede zwischen hämophilen und gesunden Kinder?

With early prophylactic treatment our haemophilic children grow up in good health. Nevertheless, we cannot prevent every bleeding. Those bleedings may be just subclinical but they could lead to overloading of the knee and more and more of the ankle joint in the long term. Motion analysis can help to understand this process and prevent it. A comparison of the gait function of haemophilic and healthy children of the age 3-18 years showed distinct functional differences especially in the youngest age group (3-6 years). Apparently, the coordination skill gait rhythm was significantly worse in the heamophilic group. All measured functional deficits can be treated with physiotherapy. Possible reasons for these early functional differences are overprotection and/or early subclinical bleedings.

[Ultrasound topometric measurements of thoracic kyphosis and lumbar lordosis in school children with normal and insufficient posture]. / Ultraschalltopometrische Erfassung des Brustkyphose- und Lendenlordosewinkels der Wirbelsäule bei haltungsschwachen und haltungsnormalen Schulkindern.

AIM: The posture of school children was examined in order to establish whether possible differences in clinically normal and insufficient posture can be detected by means of ultrasound topometry. METHOD: 105 healthy school children (56 female, 49 male) with an average age of 8 years (+/- 0.9) were examined. To classify the children as having sufficient or insufficient posture the Matthiass posture test was used. While the child stood in a relaxed position, the profile of the spine was measured with a topometric digitiser, recording each spinal processus from C7 to L5. RESULTS: 42 children (22 female, 20 male) showed an insufficient posture during the Matthiass test. The topometrically measured angles of kyphosis and lordosis were significantly smaller in these children, corresponding to a clinically greater thoracic kyphosis and lumbar lordosis. No significant differences in the lateral and anterior-posterior trunk deviation, nor in the range of trunk sway in the relaxed standing position could be observed. CONCLUSION: Using ultrasound topometry, the posture of children with sufficient and insufficient posture can be differentiated by measuring, the angles of kyphosis and lordosis. This quantification could be used for objective monitoring of the posture.

Intra-articular hyaluronic acid in the treatment of haemophilic arthropathy of the knee. Clinical, radiological and sonographical assessment.

Hyaluronic acid has been used successfully in the treatment of osteoarthritis since 1989. There is no experience in haemophiliacs in larger study groups. In a prospective study, 20 patients (21 knees) with haemophilic arthropathy of the knee received 20 mg hyaluronic acid by intra-articular injection for 5 consecutive weeks. Assessment included clinical scores, X-ray, magnetic resonance imaging (MRI) and biomechanical motion analysis before and 3 months after the first injection. The score of the WFH advisory committee and the Aichroth score for special evaluation of the knee were used. After an average period of 26 months, the World Federation of Hemophilia (WFH) score, the Aichroth score and the visual analogue scale were evaluated again. All patients had pain caused by their arthropathy, nine of them had positive antibodies to human immunodeficiency virus, and 15 had chronic hepatitis C. The mean WFH score was 8.1 points, the Petterson score was 7.3 points and the Aichroth score was 38 points (maximum 55 points). The WFH score decreased to 7.3 points, the Aichroth score improved to 40 points and the subjective assessment measured with a visual analogue scale improved from 5.3 to 3.7 points. No differences from MRI controls were detected. After 3 months, 14 of 20 patients improved subjectively, particularly in longer walking distance, stair-climbing or initial pain. These positive aspects were limited by arthropathy in adjacent joints. After 26 months 10 patients still are benefiting for up to 31 months follow-up. The average WFH score was 7.3 points, the Aichroth score 39 points, the visual analogue scale 4.0 points. We recommend hyaluronic acid for haemophilic arthropathy of the knee when regular conservative therapy has failed and operative treatment is not feasible.

[Measurement of spinal anteflexion in school children by ultrasound topometry]. / Erfassung des Anteflexionsverhaltens der Wirbelsäule bei Schulkindern mittels Ultraschalltopometrie.

AIM: The anteflexion of the spine in normal schoolchildren was examined by 3D real-time ultrasound topometry to see if differences in the form of restrictions of anteflexion could be detected. METHODS: 102 schoolchildren at the age of 7 to 9 years volunteered to the study. We measured the spinal anteflexion by recording the row of the spines (C7-L5) in a maximally flexed position with a topometric digitiser. By computer-aided data analysis the curvature of the spinal line was reproduced by lined up radii. RESULTS: In the sagittal plane the spinal line in anteflexed position showed a single curvature in 8 cases. In 94 cases the spinal line was subdivided into three curvatures (X1, X2, X3) with less mobility of the region from the middle to the lower thoracic segments. For these less mobile segments we calculated a mean relative anteflexion (X2/[(X1 + X3)/2]) of 0.36 (+/- 0.18). In seven children (6.8%) with clinically indirect signs of scoliosis the anteflexion was reduced and in 4 cases out of the standard deviation. For the relative anteflexion the Pearson's correlation coefficient of the measurement 1 and the direct control-measurement was 0.86 (p < 0.001). CONCLUSION: By ultrasound topometric measurement of the spinal anteflexion in schoolchildren we are able to identify cases with less ability of anteflexion. Because a restriction of anteflexion is discussed in the pathogenesis of idiopathic scoliosis, a follow up of these children seems to be usefully.

[Three-dimensional ultrasonography and intraoperative navigation:a new application of ultrasonograms in osteotomy of the proximal femur]. / Dreidimensionaler Ultraschall und intraoperative Navigation: ein neuer Einsatz des Ultraschalltopometers bei Umstellungsosteotomie des proximalen Femurs.

AIM: As precise operative control is difficult to achieve, the accuracy of femoral osteotomies can only be estimated. Therefore, a computer-assisted ultrasound navigation system was developed in order to apply an on-line control for femoral osteotomies. METHOD: Three ultrasound emitters were fixed on a triangle. The exact position of triangles could be determined by measuring the time the ultrasound beam takes to reach microphones positioned in a frame. With a reference triangle fixed distally to the osteotomy and a second triangle fixed on the surgical chisel the exact correction angle can be determined three-dimensionally. RESULTS: A high degree of accuracy was found in both laboratory trials and in simulation trials using pig femurs. The deviation of measured values compared to a laser beam control was less than 0.5 degrees. CONCLUSION: The system was introduced into our operating theatre as an optimised control device that can provide excellent support to the surgical procedure.

Gait analysis of the hemophilic ankle with silicone heel cushion.

Shock absorption becomes very important in damaged joints with destroyed cartilage and progressive muscular imbalance as occurs in hemarthropathy. The effects of silicone heel cushioning on the ankle motion of hemophilic patients in different stages of hemarthropathy of the ankle joints was measured using an ultrasound motion analysis system. It is concluded that silicone heel cushioning has no influence on ankles in the late stage of hemarthropathy. Silicone heel cushioning will lead to uncontrolled changes of the ankle joint in the early hemarthropathic ankle, involving the tibiotalar and the subtalar joints. The angular velocity of the ankle is increased producing higher acceleration at the ankle joint. The higher angle acceleration is related to higher joint loading uncontrolled by the muscles. The resulting uncoordinated motion can cause ligamentous overloading, strains, and a higher probability of joint bleeding. Therefore, silicone heel cushioning or other shock absorbing devices that return the energy immediately to the foot are not useful for prevention and treatment of chronic hemophilic synovitis and may cause additional deterioration of the joint.

[Intraoperative evaluation of surgical correction. Reconstructive interventions on the skeleton with ultrasound topometry]. / Intraoperative Korrekturüberprüfung. Wiederherstellende Eingriffe am Skelett mittels Ultraschall-Topometrie.

We present a new 3 D analysis system which allows us to control axial correction in the skeletal system during operation. The method is based on the measurement of the transit time of ultrasound impulses from transmitters to receivers. With a gas sterilised digitiser we are able to record anatomical landmarks within a few seconds and with a high reliability. The results are reproducible with a precision of less than 1 mm. The duration of the whole measurement, including the positioning of the frame for the receivers and the computer aided data analysis, lasts 3 to 5 minutes. This technology enables us to analyse the 3 D body geometry and optimises operative procedures on the musculoskeletal system. Therefore, it is an addition to intraoperative x-ray control.

[Follow-up problems in scoliosis patients]. / Problematik der Verlaufskontrolle bei Skoliosepatienten.

With reference to 4 different methods - theoretical derivation, computed model, recent radiological analysis based on 120 scoliosis patients and measurement of the posterior median line in 40 scoliosis patients - the unreliability of follow-up in scoliosis patients is illustrated. The results are compared with previous publications by other authors and discussed. A method of determining spinal geometry three-dimensionally by means of topometric methods (5) is described. The validity of this measuring method is demonstrated in the patient by geometrical measurement of the posterior median line without treatment, under halo gravity extension and in movement.

[Differentiation of functional knee movement in hemophilic patients by means of ultrasonic topometry (author's transl)]. / Differenzierung der funktionellen Kniebewegung von hämophilen Patienten mittels Ultra-Schall-Topometrie.

First experiences using UST (Ultra-Sound-Topometry) in functional analyses of the loco motor system show: The motor patterns in gait analyses can be analyses can be visualized in such high steric- and time-resolution, that even slightest disturbances can be seen and localized. The high resolution of the procedure allows exact analyses of the movement patterns within the joints. In the knee, for example, we could demonstrate, how in slight to marked pathology the stress in the cartilagenous layers is disturbed in different ways. Out of this, conclusions, concerning the intraarticular destructions and their effects on the kibernetic chain, can be made.

[Hemophilic pseudotumors]. / Hämophile pseudotumoren]

A review of the literature was made with special interest in morphology, pathogenesis and treatment of hemophilic pseudotumors. 110 reports of hemophilic pseudotumors were evaluated and compared with 25 own cases. The separation according to the inflicted site and the primarily involved anatomical structure revealed three types of hemophilic pseudotumors: 1. Intramuscular hematomas which enter secondarily into the periosteum. a) In the diaphyses of long tubular bones (femur 49, lower leg 14, humerus 4, forearm 2). b) In the iliac bone (37). 2. Intraspongious cysts in short cancellous bones (calcaneus 14, talus 5, scapula 3). 3. Direct subperiostal hematomas in the phalanges and metacarpals in the hand (thumb 5, finger 1, metacarpal 1). Concerning treatment, there is to state, that in general a conservative approach (substitution of the missing clotting factor and immobilization) is promising. The operative indications are demonstrated and determined, using case reports.

[Conclusive significance of gait analyses at the pelvis-leg skeleton (author's transl)]. / Die Aussagekraft von Ganganalysen am Becken-Bein-Skelett.

Functional analyses of the gait of healthy male volunteers show approximately identical coordination of movement under standardised conditions. In contrast thereto, marked differences can be seen if the joint functions are disturbed and if there is an associated muscular insufficiency. These changes can be seen even in very minor joint affections in pain-free condition. The standardised course of the functions is suitable for describing characteristic changes in gait and to reveal some of the causal links. If these standardised conditions are employed, they offer the only possibility of assessing normalisation or progressive degeneration of pathological movement patterns.

[Electromyographic examination of the femoral muscles in hemophilic effusion in the knee-joint and in irritated conditions of the knee-joint (author's transl)]. / Elektromyographische Untersuchung an der Oberschenkel-muskulatur bei hämophilem Kniegelenkserguss und bei Reizzuständen des Kniegelenkes.

In ten patients with acute effusion in the knee-joint due to hemophilia, or with chronic knee-joint affection, the maximal isometric contraction of the M. vastus medialis and lateralis and of the M. rectus femoris was measured by electromyography. Measurements were taken before and after puncture of the effusion, or before and after intraarticular injection of a local anesthetic. In all examined patients, the contraction tests were performed below the pain threshold. The proportionate share of energy of the quadriceps muscle was considerably enhanced by reducing the intraarticular pressure and injecting a local anesthetic. This increase differs, depending on the state of the knee-joint affection.

[Sawing and welding with ultrasonics. Experimental investigation to test the applicability of an apparatus for sawing and welding bone tissue with ultrasonics in orthopedics (author's transl)]. / Sägen und Schweissen mit Ultraschall. Experimentelle Untersuchung zur Prüfung der Anwendbarkeit eines Gerätes zum Sägen und Schweissen von Knochengewebe mit Ultraschall in der Orthopädie

An experimental investigation of a procedure for sawing and welding of bone tissue with ultrasonics in the area of orthopedics was reported. The welding of bone with ultrasonic waves, bone meal and a plastic adhesive did not product satisfactory results in terms of stability and tissue reaction. The applicability of the ultrasonic saw is limited by the thickness of the bone on which the osteotomy is to be performed. We saw no advantages over against the oscillating saws which were available to us. In our opinion, an indication for the application of the ultrasonic apparatus could be the removal of inflammatory, tumerous or necrotic bone processes.