[Historical development of arthrodesis of pes cavus]. / Korrigierende Arthrodesen des Klauenhohlfusses aus historischer Sicht.

In contrast to the present, the diagnosis and treatment of pes cavus was a major subject of research at the beginning of last century. This was due to the high incidence of certain neurological disorders (poliomyelitis, myelodysplasia) which led to the development of this foot deformity. Advances in anaesthetic technique and the establishment of antisepsis contributed largely to the development of the surgical treatment of pes cavus. Ladislaus Leo Freiherr von Lesser performed the first surgically induced ankylosis of the ankle by denuding the joint surfaces of cartilage followed by fixation with a metal nail. This procedure was then introduced as arthrodesis; a word derived from the Greek meaning "binding of the joint". Numerous methods and modifications of arthrodesis have been developed for the correction of foot deformities. With increasing knowledge of the pathogenesis of pes cavus, soft tissue and tendon transfer procedures were added to the surgical treatment. Today, the philosophy of arthrodesis in the treatment of foot deformity is the same, but the development of fixation techniques and implant materials could improve postoperative care and outcome.

[Complications of vertebroplasty]. / Komplikationen in der Vertebroplastie.

Percutaneous vertebroplasty was first introduced in 1984 by Galibert et al. for the treatment of hemangiomas in the spine. The current indications for vertebroplasty also include compression fractures due to osteoporosis as well as osteolytic metastases and spinal myeloma lesions. With the numbers of percutaneous vertebroplasty performed by orthopedic and trauma surgeons, neurosurgeons, and radiologists steadily increasing, complications have also risen. Over the last 3 years an increasing number of cases with varying complications, their genesis, and their management have been reported in the literature. Complications include asymptomatic cement leakage, cardiovascular effects, embolism with lethal outcome as well as severe neurological deficits. This article presents a review of the complications reported in the literature, strategies for preventing possible complications as well as current concepts in therapy management. Several of our cases with cement leakages are presented.

[Experiences with lumbar disc herniations in adolescents]. / Erfahrungen mit lumbalen Bandscheibenvorfällen bei Jugendlichen.

AIM: Lumbar disc herniation is rare in adolescents and often misread. The difference of etiology, symptoms and therapy in comparison to adults were investigated and the long-term outcome of conservative and surgically treatment evaluated. METHOD: We analysed informations obtained from the medical records of 51 patients younger than 20 years with 79 lumbar disc herniations. For the long-term follow-up we prepared a questionnaire composed of general questions about the patient's lifestyle, pain level and remaining symptoms. RESULTS: The average period from the beginning of the symptoms to the finding of the right diagnosis took about 14,3 months. We compared disc herniations in adolescents with the current literature of disc herniations in adults and found differences in etiology and symptoms. In 16 % of our patients the beginning of the pain was associated with a trauma, in 12 % the pain began during sports activity (microtrauma). In 49 % we found radiological signs of spinal aberrations. Low back pain and monoradicular sciatica were the main complaints, but findings of neurological deficits were rare. 27 patients were managed conservatively and 24 surgically. On the day of discharge 94 % of patients reported excellent or good results. The outcomes of the follow-up period were similar in both treatment groups. Almost all patients were able to attain a normal activity level and few reported restrictions of their daily life. The success rate of the pain frequency was 85 % and pain intensity was 81 %. CONCLUSION: The etiology of lumbal disc herniations in adolescents has a multifactoral basis. Conservative treatment should be pursued as a mainstay of treatment. Only if conservative treatment fails, surgical treatment should be considered.

Hyperbaric oxygenation as a successful therapeutic approach in oral wound dehiscence after operative stabilization of an unstable post-traumatic odontoid non-union.

The non-operative treatment of unstable traumatic Anderson's type II odontoid fractures has a high risk potential to develop non-unions. Even after operative stabilization literature reveals non-union rates up to 20%. Acute life threatening complications are tetraplegia and apnoea. Long-term complications induce chronic myelopathy resulting from persistent myeloradicular compression. We report the case of a patient with a 17-year-old post-traumatic pseudarthrosis of the dens axis following conservative treatment of an unstable type II fracture. By that time, the female patient, then 37 years old, was admitted to our hospital with early signs of cervical tetraplegia. After initial reposition and short-term immobilization with a halothoracic vest we performed a ventrodorsal atlantoaxial spondylodesis. Failure of anterior cervical plate stabilization and autologous graft resorption without a solid segmental fusion instigated a secondary surgical intervention. Postoperative therapy-resistant oral wound dehiscence showed an exposed autograft and osteosynthetic material. The reported positive effect of hyperbaric oxygenation on wound healing in problem cases led us to attempt this means of therapy. With a daily exposure to hyperbaric oxygenation, the dehiscence closed within 25 days. As a result of our experience in this case, hyperbaric oxygenation should be considered as a therapeutic option in postoperative complication management in orthopaedic surgery.

[The German Orthopedic History and Research Museum. A museum for research and public health]. / Das Deutsche Orthopädische Geschichts- und Forschungsmuseum. Ein Museum für Forschung und Offentlichkeit.

The German historical museum of orthopaedic surgery was founded 1959 in Würzburg. The main task of this institution is the furtherance of science in medical-history. Since the beginning, 41 years ago, the number of books and exhibits increased continuously. The library of the museum is the biggest public collection in Germany and contains more then 6000 books and publications in orthopaedics. Furthermore the museum includes a big amount of exoprostheses of the upper and lower limb, alloarthroplasties of hip- and knee-joints, traumatologic implants and instruments of orthopaedic surgery. A big number of bone-preparations with pathologic alterations and variations will also be presented. The exhibition and the library is open to the public and is available to those people in the history of orthopaedic surgery. Local requirements in Würzburg were one of the reasons to transfer the place of the museum to Frankfurt/Main. The museum was reopened at 6th of June 1998 at the university of Frankfurt/Main, department of orthopaedic surgery.

Hypervascular spinal tumors: influence of the embolization technique on perioperative hemorrhage.

BACKGROUND AND PURPOSE: Corporectomy is an effective treatment for vertebral metastases; however, massive perioperative hemorrhage is often associated with this procedure. We compared preoperative particle, particle-coil, and coil embolizations of hypervascular spinal tumors prior to vertebral body replacement to determine which prevented perioperative hemorrhage most effectively. METHODS: The vertebral tumors of 59 patients were embolized prior to corporectomy. In 26 cases, only coils were used for the proximal occlusion of feeding segmental arteries. Twenty-four patients received a combination of polyvinyl alcohol (PVA) particles and coils, and nine tumors were embolized with particles alone. We compared intraoperative blood loss between the three groups and 10 other patients who did not undergo embolization prior to corporectomy. RESULTS: Estimation of intraoperative hemorrhage showed a median value of 4350 mL in patients without embolization, 2650 mL in cases of coil embolization, 1850 mL in cases of particle-coil embolization, and 1800 mL in cases of particle embolization. The difference between unembolized patients and those who underwent coil embolization was not statistically significant. Particle and particle-coil embolizations showed very similar results, and reduced hemorrhage significantly as compared to unembolized and proximal coil occlusion cases. Residual bleeding came from the venous system and the neighborhood of the embolized region. CONCLUSION: Particle embolization prior to corporectomy can reduce perioperative hemorrhage. The additional benefit of proximal coil occlusion of arterial feeders is questionable.

[Three-dimensional computer reconstruction of the pelvic and hip area in the preoperative planning of orthopedic interventions and surgical simulation]. / Dreidimensionale Darstellung der Becken- und Hüftregion am Computer zur präoperativen Planung von orthopädischen Eingriffen und Operationssimulation.

RESEARCH QUESTION: Osteotomies are elective operations which require exact pre-operative planing. Computer assisted three-dimensional planning of orthopedic procedures requires a three-dimensional reconstruction of the region of interest. To be applicable, such a three-dimensional reconstruction must be an accurate mathematical description of the region of interest, and not only a 3-D-image. The purpose of this study was to create such an accurate 3-D reconstruction. METHODS: We describe a method to create an exact reconstruction from CT-data, from the data acquisition, contour determination by an algorithm, triangulation of the resulting data and reconstruction of the region of interest. CONCLUSION: The described method is a useful tool to obtain exact individual three-dimensional reconstructions of any skeletal region of interest. This makes pre-operative planning and simulation of the results of orthopedic procedures at the computer possible.

[Natural course in lumbar disk prolapse]. / Spontanverlauf beim lumbalen Bandscheibenvorfall.

This study reports on 74 patients with lumbar nucleus prolapse (NP) and nerve root symptoms. In all patients the clinical diagnosis was confirmed using a CT-Scan. After 1.7 y a clinical follow-up was performed. Four patients have required surgery in the meantime. Ninety percent of the patients treated conservatively experienced marked pain relief and generally appreciated the results of conservative treatment. Nevertheless, 67% had some complaints. The neurological findings showed essential improvement even in cases of severe paresis. Follow-up CT scans performed in 35 of these patients and in a control group of 23 patients showed partial regression of the prolapse at an average of 48.3% and 50.4%, respectively. The NP disappeared in 3 with no regression in 2 cases. If regression occurred, it apparently took place during the first 6 months. Regression of NP and clinical improvement showed no positive correlation. The investigation demonstrated fair results with conservative therapy even in cases with minor regression.

[Computer-assisted analysis of the kinematics of the upper ankle joint]. / Computergestützte Analyse der Kinematik des oberen Sprunggelenks.

Usually the upper ankle joint is described as a typical hinge though it had been often remarked that the axis of rotation moves considerably with regard to the angular adjustment between the tibia and the trochlea tali. In the present study the relation between the movements in the upper ankle joint and the geometry of the lateral ligaments was analysed. The contours and elected landmarks of 6 dissected ankle joints were measured using a digitizer which allowed the computerized scanning of motion x-rays. In addition the proximal and distal insertion planes of the lateral ligaments were registered. Mathematical procedures were applied on the experimental data to predict the kinematic principles. The model of an hinged joint could not reproduce the motion curve which was actually found. Using the model of a link chain with four pivots, which was determined by the course of the talofibular and the calcaneofibular ligament, a good correlation with the experimental results was evident. This model implies a rotary and gliding component in the movement of the tibia against the trochlea tali. Beside the correspondence with the data of the present study the model allows an easy explanation of many other well known morphologic phenomena of the upper ankle joint for which a stringent interpretation was not yet available.

[Results of treatment of Perthes' disease by intertrochanteric adduction osteotomy with and without postoperative splint relief (author's transl)]. / Behandlungsergebnisse beim Morbus Perthes durch varisierende intertrochantere Osteotomie mit und ohne postoperative Schienenentlastung.

Opinions differ on the desirability of postoperative relief following intertrochanteric adduction osteotomy in Legg-Calvé-Perthes' disease. We therefore undertook an analysis of our patients who were given postoperative relief with a Thomas splint up to 1974. Subsequently, patients were allowed to load the joint normally after the osteotomy had knitted. Comparison of the results in the two groups of patients indeed makes it questionable whether postoperative relief with Thomas splints is desirable. If adduction is performed in Stage I of Perthes' disease, relief appears neither beneficial nor detrimental. However, in Stage II there appears to be a detrimental tendency.