[Results of treatment after chemonucleolysis with reference to a special rehabilitation program]. / Behandlungsergebnisse nach der Chemonukleolyse unter Berücksichtigung eines speziellen Rehabilitationsprogrammes.

Between January 1985 and March 1987, the authors used chemonucleolysis to treat 66 patients. Patients were observed for an average of 18.2 months. Clinical and radiological follow-up examinations were performed and the results compared with those of other authors. In the present study, particular attention was paid to a program of physiotherapy which used Brunckow's modified lifting exercises. Compared with other follow-up studies, the results of treatment using this form of chemonucleolysis therapy were in the top third. Chemonucleolysis is better for treating sciatica than lumbago. Persistent lumbago can be improved successfully if subsequent physiotherapy is rigidly adhered to. Stabilization through Brunckow's modified lifting exercises is especially suitable for this purpose. There is no correlation between the alteration in the height of the intervertebral space and the clinical picture. A measurement of disk slackness does not allow any prognosis as regards success of treatment. Results have shown that a high degree of success can only be achieved where diagnosis is accurate. Where lumbago has been resistant to therapy for a long time, chemonucleolysis should be prescribed with caution.

[Metal spongiosa endoprostheses for surgical revision of the hip joint]. / Metallspongiöse Endoprothesen für Revisionseingriffe am Hüftgelenk.

On the basis of 60 revision operations which were carried out on hip joints with mainly aseptic loosened cemented endoprosthesis and which also had, to some extent, distinct macrophagic induced osteolysis zones, it could be shown that implants with a metal spongiosa surface structure offer a good chance of an enduring revitalisation in the anchorage position and, thereby, are able to achieve a permanently stable endoprosthesis fixation. The expansion defects could be filled by means of homologous or autologous spongiosa transplantation. The post-operative X-ray check-up showed a vital inward-growing healing. All the endoprosthesis remained in situ during the follow-up examination period of, on average, 12.1 months. In accordance with the Merle D'Aubigne hip evaluation scheme, 43.3% showed an excellent result; 40% a good one; 13.3% were satisfactory; and only 3.4% showed a bad result. Major complications which occurred were: two intra-operative femoral stem fractures which had to be taken care of osteosynthetically; a repeat operation which had to take place during the first post-operative week because of a dislocation of the socket cup; and a luxation which was revised under narcosis. In spite of an increased periarticular ossification's ratio in revision operations, second-class ossification only occurred in 16.7% of all cases and third-class ossification did not occur at all.

[Does technetium scintigraphy in combination with gallium scintigraphy improve the differential diagnosis of aseptic and septic endoprosthesis loosening?]. / Bringt die Technetium-Szintigraphie in Verbindung mit der Gallium-Szintigraphie eine verbesserte Aussage über die Differentialdiagnose der aseptischen und septischen Endoprothesenlockerung?

In the majority of cases, 3-phase scintigraphy using Tc99m phosphate complexes is sufficient to diagnose a septic (infective) loosening of an endoprosthesis (hip or knee). Additional Ga 67 citrate scintigraphy should be considered only if technetium scintigraphy fails to supply an unequivocal finding. This is explained by the authors in detail.

[Pre- and postoperative magnetic resonance tomography of osteochondrosis dissecans]. / Prä- und postoperative Kernspintomographie bei der Osteochondrosis dissecans.

Thirty-five patients treated surgically and three treated conservatively were examined by MRT. This proved to be an imaging method which could provide information concerning the state of the bone fragments, the continuity of the joint cartilage and the state of reintegration of the dissected fragment. This was fixed by means of fibrin, autologous spongiosa and resorbable pins.

[Follow-up studies of transosseous capsule-ligament sutures of the basal joint of the thumb using a standardized holder]. / Nachuntersuchungen von transossären Kapselbandnähten am Daumengrundgelenk unter Verwendung eines standardisierten Halteapparates.

In cases of capsular ligament lesions at the basal joint of the thumb, transosseal reinsertion has proved to be a suitable procedure for treating both old and fresh ruptures of the ligament. Primary suturing is only possible in the rare cases where the tear is straight and the ruptured ends are close. In cases of old ruptures, if no usable ligament stump or cicatricized strand can be found, plastic surgery should be performed. Roentgenograms are made under standardized conditions using a holder in order to objectify the preoperative and postoperative findings. To this end a holder has been developed which satisfies criteria for objective assessment.

[Refixation in osteochondrosis dissecans with resorbable material using magnetic resonance tomography in follow-up monitoring]. / Refixation bei der Osteochondrosis dissecans mit resorbierbarem Material unter Verlaufsbeobachtung mit der Kernspintomographie (MR).

A new method for refixation of osteochondritis dissecans and osteochondral flake fractures by using absorbable pins, fibrin adhesive and autologous spongiosa transplantation is described. The diagnostics can be improved by using MR (magnetic resonance imaging) to demonstrate the preoperative status of the defect as well as the postoperative reintegration of the flake, bone vitality and continuity of the joint cartilage. MR information is an excellent addition to the conventional radiograms for preoperative planning as well as for postoperative decision when to allow daily and sports activities. The clinical and radiological preliminary results of the described method show a complete reintegration in all cases of osteochondritis dissecans of the femur condyle.

[A holding device for standardized roentgenologic detection of ulnar, palmar and radial capsule ligament lesions of the metacarpophalangeal joint of the thumb. Hyperextensometer for the index finger metacarpophalangeal joint for determining laxity of the ligament]. / Halteapparat zum standardisierten röntgenologischen Nachweis von ulnaren, palmaren und radialen Kapselbandläsionen am Daumengrundgelenk. Hyperextensometer für das Zeigefingergrundgelenk zur Bandlaxitätsbestimmung.

A device has been designed to hold the limb for standardized radiological demonstration of lesions of the ulnar and radial collateral and palmar ligaments of the metacarpophalangeal joint of the thumb. The device also serves as a hyperextensometer of the metacarpophalangeal joint of the index finger with which to measure joint laxity. The simple mechanism allows routine application. Standardized stressed roentgenograms allow exact quantification of the extent of all lesions and consequently leads to adequate treatment.

[A holder for plain x-ray visualization of ulnar, volar and radial injuries of the capsule and ligaments of the basal thumb joint. A hyperextensometer for the determination of the ligamentous laxity of the index finger basal joint]. / Haltegerät zum standardisierten röntgenologischen Nachweis von ulnaren, volaren und radialen Kapsel-Bandläsionen am Daumengrundgelenk. Hyperextensometer für das Zeigefingergrundgelenk zur Bandlaxitätsbestimmung.

We have constructed a device for standardized radiodiagnostics of ulnar, volar, and radial capsulo-ligamentous lesions of the basal thumb joint. Used as hyperextensometer at the basal joint of the index finger, the device is of equal value in the diagnosis of ligamentous laxity.