Traumatic epiphysiolysis of the proximal femur.

PURPOSE OF THE STUDY: Several former studies show the treatment of slipped epiphysis of the femoral head (SEFH). Its reason is rather unknown. On the other hand the rare traumatic SEFH takes place due to a real accident. According to the literature these injuries are treated like chronic SEFHs. The aim of this study is to show the differences in pathology and treatment of an acute traumatic SEFH in relationship to the chronic SEFH. PATIENTS AND METHODS: In 8 patients dislocated traumatic SEFHs were reduced anatomically and stabilized by the means of 3 to 4 Kirschner- (K-) wires or two cancellous screws. Each patient got a plaster-cast fixation for about 6 weeks of the ipsilateral hip and leg and was mobilized with two crutches and partial weight bearing for 12 weeks. The implants were removed 24 weeks after surgery. Four patients with not dislocated SEFHs were immobilized or mobilized with two crutches without weight bearing according to their pain sensation. The final examination of both groups took place 2 Vz to 15 years after the initial treatment. RESULTS: Four patients primarily under 10 years of age showed no or minimal radiological signs of a dislocated femoral head and were without any further inconvenience--the suspected SEFHs revealed as hip contusions. 8 children aged 10 years or older at the time of trauma were treated by closed reduction and internal fixation. Complications occurred in three cases--one necrosis of the femoral head because of a perforating K-wire, one subtrochanteric femur fracture after implant removal of a prophylactically stabilized contralateral femoral head and one minimally dislocated femoral head after postoperative too early full weight bearing. DISCUSSION: The traumatic SEFH is very different to the chronic one regarding the pathology and acute treatment. Technical challenges must be solved. Unilateral K-wiring or screwing for 24 weeks and reduced weight bearing for the first 12 weeks after surgery is a sufficient way of treatment of the traumatic SEFH. CONCLUSIONS: In the case of a traumatic SEFH it needs to be reduced anatomically and stabilized by surgical means in the acute phase. A prophylactic stabilization of the opposite intact side is usually not required.

[The use of sonography in muscular injuries of the lower leg]. / Die Anwendung der Sonographie bei Muskelverletzungen des Unterschenkels.

BACKGROUND: Over one third of all sports related injuries affect the muscle-tendon apparatus. Therefore an easy, quick and cost effective method for diagnosis and follow up is necessary. METHODS: We studied 50 patients with muscle strain injuries divided in two groups. The patients of group A received an elastic bandage, within the next 24 hours the first sonography of the affected limb was performed. The next check up was after 7 to 14 days and after 4 to 6 weeks. The average duration of use was registered. The visual analogue scale (VAS) was used to register pain, and the reduction of activity and motion was classified in three grades. In the patients of group B a tape bandage was applied to the injured leg. The same schedule was used for these patients. In all patients a cooling therapy was started as soon as possible. The two groups of patients were checked regularly using ultrasonography and compared to each other due to the different parameter. RESULTS: In 36 patients a muscular injury was detected sonographically during the first check up. In 13 patients on day 7 to 14, still a lesion was detectable. And in one patient 6 weeks after injury a lesion was still detectable. The 37 patients of group A reported an average of 6.9 points on VAS on day one, after 7 to 14 days 3.3 points and 0.8 points after the last check up. The 13 patients of group B reported an average of 6.7 points on VAS on day one, after 7 to 14 days 3.8 points and 2.0 points after the last check up. CONCLUSIONS: The clinical symptoms show good correlation to the sonographic results.

High resolution spatiotemporal analysis of the contingent negative variation in simple or complex motor tasks and a non-motor task.

OBJECTIVES: Since the characteristics of the Bereitschaftspotential (BP) - voluntary movement paradigm of internally-driven movements - have been established recently by our group using high resolution DC-EEG techniques, it was of great interest to apply similar techniques to the other slow brain potential--contingent negative variation (CNV) of externally-cued movements--with the same motor tasks using the same subjects. METHODS: The CNV for simple bimanual sequential movements (task 1), complex bimanual sequential movements (task 2) and a non-motor condition (task 3) was recorded on the scalp using a 64 channel DC-EEG in 16 healthy subjects, and the data were analyzed with high resolution spatiotemporal statistics and current source density (CSD). RESULTS: (1) The CNV was distributed over frontal, frontocentral, central and centroparietal regions; a negative potential was found at the frontal pole and a positive potential was found over occipital regions. (2) CNV amplitudes were higher for task 2 than for task 1, and there was no late CNV for task 3. (3) A high resolution spatiotemporal analysis revealed that during the early CNV component, statistical differences existed between the motor tasks (tasks 1 and 2) and the non-motor task (task 3), which occurred at frontocentral, central, centroparietal, parietal and parieto-occipital regions. During the late CNV component, additional significant differences were found not only between the motor tasks and the non-motor task but also between motor task 1 and task 2 at frontocentral, central and centroparietal regions. (4) Comparison of the CNV between the frontomesial cortex (situated over the supplementary/cingulate areas, SCMA) and both lateral pre-central areas (situated over the primary motor areas, MIs) showed that there was no statistically significant difference between the two cortical motor areas except for the early CNV. (5) Comparison of the CNV between the 3 tasks over the cortical motor areas showed that there were significant differences between the motor tasks and the non-motor task regarding the auditory evoked potential (AEP) and the early CNV component, and between all 3 tasks in the late CNV, the visual evoked potential (VEP(2)) and the N-P component. (6) The ranges and the densities of the CSD maps were larger and higher for complex than for simple tasks. The current sinks of the AEP and the early CNV were located at Fz, the late CNV at FCz and surrounding regions. As to be expected, current sources of the VEPs were located at the occipital lobes. The CNV was a current sink (negative) except for the VEP's main component which was a current source (positive). CONCLUSIONS: (1) The CNV topography over the scalp varied with the complexity of motor tasks and between motor and non-motor conditions. (2) The origin of the early CNV may rest in the frontal lobes, while the late CNV may stem from more extensive cortical areas including SCMA, MIs, etc. (3) The late CNV component is not identical with the BP.

High resolution DC-EEG mapping of the Bereitschaftspotential preceding simple or complex bimanual sequential finger movement.

The present set of experiments investigated the Bereitschaftspotential (BP) preceding voluntary bimanual sequential simple (task 1) and complex movements (task 2) in supplementary/cingulate and primary motor areas (SCMA, MIs) using 64-channel direct current electroencephalography analysis in 16 right-handed healthy subjects. The results showed that: (1) onset times of BPs preceding the two tasks were significantly earlier at Cz than at C3 and C4, (2) the complex task induced significantly larger amplitudes than the simple task over the SCMA 1.1 s before EMG onset (BPI period), over the SCMA and both MIs for the BP2 period, extending from the SCMA and MIs to all frontocentral, central, centroparietal, and frontal areas during the motor potential period, (3) task difference prior to 0.96 s mainly appeared in the SCMA rather than in either MI, (4) the BP had a significantly larger amplitude in the SCMA than in the MIs, the differences being asymmetric between the left and the right hemisphere motor areas, and (5) the sinks of BP current source density (CSD) preceding the two tasks were found in the frontocentral midline; and the regions and intensities of CSD maps were larger and stronger in task 2 than they were in task I at the same times of the epoch. The results suggested that: (1) the SCMA and MIs participate in bimanual sequential simple or complex movements, (2) the SCMA appears to not only serve as a trigger command for voluntary movement but also seems to design the different motor modes, (3) the amplitude, duration, onset time, CSD region, and intensity of BP all increase with the level of complexity of the movement, (4) the greater the complexity of the action, the earlier the preparation and the larger the extent of activated neuronal populations in the SCMA, (5) activation of the SCMA occurred prior to that of the MI, and (6) the activation suggests an asymmetry between left and right MIs in simultaneous bilateral finger movement, but this asymmetry seems to be less pronounced for complex movements.

Reduced activation of midline frontal areas in human elderly subjects: a contingent negative variation study.

Contingent negative variation (CNV) was recorded from electrodes F7, F3, Fz, F4, F8, T7, C3, Cz, C4, T8, P7, P3, Pz, P4 and P8 in 19 young (mean age: 23 years) and 15 elderly (mean age: 66 years) healthy right-handed subjects, using a S2-choice paradigm. Young subjects showed early peak negativity shortly after the warning stimulus over mid-frontal areas, whereas for the remaining electrodes the negativity increased continuously. The amplitude of the early CNV was selectively reduced in elderly subjects over midline but not lateral frontal areas. We conclude that the activation of frontal midline areas as pre-supplementary motor area or anterior cingulate might be impaired in higher age.

Open meniscal repair: clinical and magnetic resonance imaging findings after twelve years.

The purpose of this study was to document the longterm clinical, radiographic, and magnetic resonance imaging results after open meniscal repair. Twenty-two patients, with 23 open meniscal repairs, were evaluated after a mean follow-up of 12.9 years using patient history, physical examination, KT-1000 arthrometer testing, the "Orthopaedische Arbeitsgemeinschaft Knie" knee evaluation scheme, Tegner activity score, weightbearing radiographs, and magnetic resonance imaging. Two of the 22 patients had retears and both occurred in unstable knees. Radiographs revealed no degenerative changes in 17 of the 23 compartments. Grade III and IV signal alterations were present on magnetic resonance imaging scans in more than 50% of the repaired menisci. We concluded that the longterm survival rate of repaired menisci was 91%, and that magnetic resonance imaging is unsuitable for diagnosis of the healing process of a repaired meniscus.

Cortical DC potential shifts accompanying the central processing of visually presented analogue and digital time displays.

According to studies in brain-lesioned patients, the cortical substrate subserving the reading of digitally presented time displays seems to differ from that of reading analogue displays. While the right hemisphere has been assumed to be important for reading analogue displays, reading digital displays is attributed to the left hemisphere. This study attempts to localize the cortical substrate of reading analogue versus digital time displays in the intact human brain using scalp-recorded event-related slow negative DC potential shifts. In the arithmetic tasks, subjects had to judge whether or not the time conveyed by the last out of three tachistoscopically presented (analogue or digital) slides was the exact difference between the time conveyed by the first and the second slide. In the control condition, subjects only had to attend to (analogue or digital) time displays. With analogue slides, frontolateral recording sites revealed a right hemispheric preponderance of DC shifts measured in the interval between the second and third slide. Anterior temporal recording sites revealed a right hemispheric preponderance only when calculations were performed. By contrast, there was no hemispheric lateralization with digital slides. The arithmetic versus control manipulation modulated waveforms, but did not influence hemispheric laterality.

Brain potentials with old/new distinction of non-words and geometric figures.

Event-related potentials (ERPs) were recorded in a continuous memory recognition task. Readable non-words and abstract geometric figures were presented in an alternating manner with an inter-stimulus interval of 2.1 s. Probability of item repetition was 0.25, a lag of one item lay between initial presentation and repetition. OLD/NEW distinction was indicated by the subject's motor response. Using linked-mastoid electrodes for reference, material-specific hemispheric asymmetries of ERPs started 150 ms after stimulus onset in temporo-lateral and parietal recordings with ERPs elicited by non-words being lateralized to the left and those by figures to the right. Clear OLD/NEW ERP effects were found with non-words: Starting about 200-250 ms after stimulus presentation, ERPs of formerly presented (OLD) items were more positive-going in recordings over the midline than ERPs of items that were new and to be repeated (NEW). In contrast, no local OLD/NEW ERP-difference was found with figures. In some brain regions, OLD/NEW ERP-differences were larger over the left hemisphere compared to the right. This finding, however, did not differ between non-words and figures.

Frontal DC potentials in auditory selective attention.

Selective dichotic listening during periods of 35 sec was associated with negative shifts of the cortical DC potential. Amplitudes of negative DC potentials had maxima in frontal, in particular, in anterior frontal records. The temporal pattern of negative DC potentials was different between the fronto-lateral records of the two hemispheres: in records from the right side, DC potentials declined during the 35 sec observation period, whereas they remained sustained in those of the left side. Different instructions ("attend left ear," "attend right," "attend both") and different levels of pitch separation between deviants and standards had no effects on frontal negative DC potential shifts, which are discussed in terms of higher order control of selective dichotic listening.