0000000000132633
AUTHOR
M. Runkel
Stellenwert der MR-Tomographie bei traumatischen Patellaluxationen
PURPOSE To describe the MR imaging findings in patients with lateral patellar dislocation. MATERIAL AND METHODS The MRIs of 31 patients with patellar dislocation were evaluated retrospectively. Arthroscopic surgery was performed in 23 cases. RESULTS Hemarthrosis was found in 30/31, contusions of the lateral femoral condyle in 30/31 and of the medial patellar facet in 26/31 cases. Injury of the medial patellar retinaculum was seen in 28/31 cases. Osteochondral fractures were found in 18 patients; compared to arthroscopy there were one false-positive and 5 false-negative findings concerning loose cartilage bodies. In 7 cases, patellar dislocation was not suspected before MR imaging. CONCLUSIO…
Stellenwert der MR-Tomographie bei akuten Schulterluxationen
24 patients up to two weeks after primary traumatic shoulder dislocation were examined at 0.5 and 1.5 T. Surgical and/or arthroscopic correlation was available in 13, CT-arthrographic correlation in 16 patients. A joint effusion allowing sufficient evaluation of the capsulolabral complex was present in 21/24 (87.5%) cases. 11/14 patients with combined dislocated detachments of the glenoid labrum and capsular lesions were subsequently operated upon. Marrow edema of the humeral head was found in 16/19 Hill-Sachs lesions and in 4/5 fractures of the greater tuberosity. Two patients presented with a lesion of the long biceps tendon associated with rotator cuff tears and were also subsequently op…
Pathogenesis and prophylaxis of circulatory reactions during total hip replacement
Circulatory reactions such as a drop in blood pressure, bradycardia, cardiac arrest, and even intraoperative death after insertion of the stem are well known events during total hip replacement. The present paper reports bone marrow intravasation after rise of intramedullary pressure in the femoral cavity during insertion of hip prostheses, demonstrated by intraoperative transesophageal echocardiography. In an animal study, the ultrasound echoes were identified as "mixed emboli" consisting of a core of bone marrow surrounded by thrombus. These results suggested the use of an intramedullary plug to restrict the intravasation of bone marrow. A trial was undertaken in 60 total hip replacement …
Wandel bei der Behandlung der Unterschenkelschaftfraktur
Die Behandlung offener Unterschenkelschaftfrakturen wahrend 2 verschiedener Zeitraume (Gruppe 1: Januar 1985 bis Juli 1991 und Gruppe 2: August 1991 bis Dezember 1996) und deren Ergebnisse werden in der vorliegenden Arbeit verglichen. Gruppe 2 ist durch die Einfuhrung des unaufgebohrten Tibiaverriegelungsnagels (UTN) charakterisiert. 47 Frakturen in Gruppe 1 sowie 49 Frakturen in Gruppe 2 konnten verglichen werden. Als Osteosynthese in Gruppe 1 wurden 32 Plattenosteosynthesen (PL), 4 aufgebohrte Verriegelungsnagelungen (RTN) und 11 Fixateur-externe(FE)-Osteosynthesen durchgefuhrt, in Gruppe 2 kamen 6 PL, 2 RTN und 41 UTN zur Anwendung. Ein Implantatversagen wie Bruch oder Ausris der Platten…
Treffsicherheit der Magnetresonanztomographie zum Nachweis von Meniskusrissen
Zur Uberprufung der diagnostischen Treffsicherheit wurden prospektiv 172 Kniegelenke mittels Magnetresonanztomographie (MRT) untersucht. Nach der MRT erfolgte bei allen Kniegelenken die arthroskopische Uberprufung der bildgebenden Diagnose. Rissbildungen des Innenmeniskus fanden sich bei 102 Patienten, am Ausenmeniskus wurde 29-mal ein Riss befundet. Unter der Annahme, dass die Arthroskopie der “golden standard” diagnostischer Masnahmen am Kniegelenk darstellt, ergab sich, dass falsch-positive MRT-Befunde am Innen- und Ausenmeniskus in jeweils 3 Fallen und falsch-negative MRT-Befunde am Innenmenikus bei 2 Kniegelenken und am Ausenmeniskus 4-mal erhoben wurden. Fur den Innenmeniskus wurde ei…
Behandlung und Ergebnisse nach Rupturen des Ligamentum patellae
Die vergleichsweise seltenen Rupturen des Ligamentum patellae werden im jungen Erwachsenenalter durch ein direktes Trauma ausgelost; beim alteren Menschen fuhrt ein inadaquates Ereignis zur Spontanruptur. Im eigenen Krankengut der Jahre 1980 bis 1990 stehen acht traumatische Rupturen (Durchschnittsalter: 26,5 Jahre) elf Spontanzerreisungen (Durchschnittsalter: 57,5 Jahre) gegenuber. Zur operativen Wiederherstellung der zerrissenen oder ausgerissenen Patellarsehne gibt es keine Alternative; Sehnennaht und entlastende Drahtschlaufe ermoglichen unter fruhrunktioneller Nachbehandlung ein gutes funktionelles Resultat mit leichteren bleibenden Muskelverschmachtigugen und geringen Bewegungseinschr…
MRT des Kniegelenkes: Fehleranalyse bezüglich der Meniskus- und Kreuzbanddiagnostik an einem arthroskopisch kontrollierten Patientenkollektiv
PURPOSE To categorise discrepancies in findings of the menisci and anterior cruciate ligament (ACL) between arthroscopy and MRI. MATERIALS AND METHODS The MRIs of 236 patients were retrospectively analysed by an experienced radiologist without knowledge of clinical and/or operative findings. Discrepancies in arthroscopic findings were reevaluated together with the arthroscopist to determine their cause of error. RESULTS The diagnostic accuracies for injuries of the medial and lateral meniscus and the ACL were 92.4%, 92.4%, and 94.1%, respectively. For the menisci, causes for discrepancies in findings (n = 31) were: overinterpretation of central signal intensities with contact to the menisca…
Parosteal osteosarcoma of the talus.
A case of parosteal osteosarcoma in the very rare location of the talus is presented. The radiological, pathological, and clinical characteristics of parosteal osteosarcoma are described and the differential diagnosis discussed.
Wissenschaftliche Grundlagen der aufgebohrten und unaufgebohrten Marknagelung
A comparative investigation of differences in new bone formation and cortical remodelling after reamed and unreamed nailing was carried out in a standardized animal model. An oblique osteotomy of the tibia was created in 19 sheep, followed by intramedullary nailing. The medullary cavity was reamed ¶in 10 of the animals, while in 9 sheep unreamed nailing was performed. After an observation period of 10 weeks, microradiographical assessment indicated more intensive bone regeneration and better bridging of the osteotomy in the animals with unreamed nailing. In addition, fewer aseptic bone sequestra were identified in the “unreamed” group. Morphometric measurements of the specimens by fluoresce…
MR-Tomographie bei Innenbandverletzungen des Kniegelenkes
Frequency and characteristics of lesions of the medial collateral ligaments (MCL) were studied by MRI in 155 patients with trauma to the knee. There were abnormalities of the MCL in 38% of cases with ligamentous injuries and in 27% these were combined with meniscal tears. 11% of these patients showed isolated rupture of MCL and as a result of the MRI findings were treated conservatively. By means of T2*-weighted images the individual lesions could be accurately localised. Characteristic findings have been defined.
Magnetresonanztomographie des Kniegelenks mit einem Niederfeldsystem
Ziel der vorliegenden Untersuchung ist die Evaluierung der Niederfeldmagnetresonanztomographie an einem offenen System unter Berucksichtigung des Erfahrungsstands des Untersuchers. In einer prospektiven Studie wurden von August 1995 bis Mai 1997 75 Patienten der Klinik fur Unfallchirurgie der Universitat Mainz mit einem akuten Trauma des Kniegelenks nach klinischer und konventionell-radiologischer Diagnostik magnetresonanztomographisch untersucht und anschliesend diagnostisch und therapeutisch arthroskopiert. Die Auswertung der MRT-Untersuchungen erfolgte hierbei durch 2 unabhangige Untersucher unterschiedlichen Erfahrungsstands ohne Kenntnis der Anamnese bzw. des klinischen Befunds. Sensit…
Injuries of the lateral collateral ligaments of the ankle: assessment with MR imaging.
The aim of this study was to evaluate the ability of MRI to display injuries of the lateral collateral ligamentous complex in patients with an acute ankle distorsion trauma. The MR examinations of 36 patients with ankle pain after ankle distorsion were evaluated retrospectively without knowledge of clinical history, outcome and/or operative findings. The examinations were performed on a 1. 5-T whole-body imager using a flexible surface coil. The signs for ligamentous abnormality were as follows: complete or partial discontinuity, increased signal within, and irregularity and waviness of the ligament. The results were compared with operative findings in 18 patients with subsequent surgical r…
Treatment of femoral fractures after hip prosthesis
Im Zeitraum von 1995 bis 1997 wurden in unserer Klinik 24 huftprothetische Operationen durchgefuhrt mit Implantation eines Prothesenspezialschaftes aufgrund erheblichen Knochenverlustes sowie aufgetretener Frakturen des proximalen Femurs. Bei sechs Patienten erfolgte ein primarer Prothesenwechsel, sechsmal lag bereits praoperativ eine Femurfraktur bzw. eine Fraktur der bisherigen femoralen Prothesenkomponente vor, bei funf Patienten war es im Rahmen der Wechseloperation zu Frakturen gekommen. Pathologische Frakturen lagen funfmal vor, einmal erfolgte beim Prothesenwechsel eine femorale Korrekturosteotomie, einmal wurde eine Pseudarthrose bei implantierter Prothese behandelt. Defekte des Ace…
Experimentelle Untersuchungen zur Schwächung der Stabilität des Trochanter major durch laterale Fensterung
Ubliche 130°-Winkelplatten zur Versorgung huftgelenknaher Femurfrakturen haben den Nachteil, das durch das breite Einschlagfenster die laterale Femurkortikalis an biomechanisch wichtiger und hoch beanspruchter Stelle weitgehend unterbrochen wird; dies fuhrt haufig zu Komplikationen wie Abris des Trochanter major, mangelnde Stabilitat usw. Bei anderen Osteosyntheseverfahren, zum Beispiel der dynamischen Huftschraube, wird ein rundes Loch gebohrt. An zehn Femurpaaren wurde experimentell die Minderung der Stabilitat objektiviert, die durch die laterale Fensterung fur eine Osteosynthese entsteht, wobei die rechteckige Fensterung fur Winkelplatten und die kreisrunde Fensterung fur die dynamische…
Die “durchgeschobene” Kondylenplatte
Zwolf langstreckige Stuck-und Trummerfrakturen des Oberschenkels, die den metaphysaren (siebenmal proximal, funfmal distal) und gleichzeitig auch den diaphysaren Bereich betrafen, wurden mit extrem langen Kondylenplatten (16 bis 20 Loch) osteosynthetisch versorgt. Die Kondylenplatten wurden uber einen proximalen und einen distalen Zugang eingebracht, der Musculus vastus lateralis in allen Fallen im Frakturbereich vollstandig unversehrt belassen. Nach typischer Vorbereitung des Klingenlagers mit dem Plattensitzinstrument wurden die Kondylenplatten mit der Klinge auf den Operateur zeigend hinter dem Musculus vastus lateralis eingeschoben, und anschliesend unter Drehung der Platten um 180° sow…
Ergebnisse nach primärer ungebohrter Tibianagelung von Unterschenkelfrakturen mit schwerem offenem oder geschlossenem Weichteilschaden
Primary stabilization was performed in 72 tibial fractures with sever open (n = 37) or closed (n = 35) soft tissue injury using unreamed interlocking nails. In 60 (83%) cases the fractures healed without additional procedures. There were 2 cases of osteitis, but both these fractures healed after removal of the nail or after reamed nailing. In 9 patients with delayed union reamed nailing (n = 8) or bone grafting (n = 1) led to healing. In 1 patient with hypertrophic pseudarthrosis, union was achieved after substitution of a reamed nail for the anreamed nail. The infection rate was similar to that observed with external fixation. More secondary procedures, such as bone grafting or a change of…
Einsatzmöglichkeiten der MR-Arthrographie bei Erkrankungen des Schultergelenkes
In a prospective study possible indications for MR arthrography of the shoulder were evaluated. 37 patients were examined before and after intraarticular administration of a 2-mmolar solution of Gd-DTPA. MR arthrography was performed if there was no joint effusion and/or an uncertain finding concerning the rotator cuff or the capsulolabral complex on plain MR images. MR arthrography leads to a better demonstration of labrum pathology in 11/22 patients and to a superior delineation of the capsuloligamentous apparatus in 20/22 cases. In 9/15 patients with impingement lesions MR arthrography allowed a differentiation of severe tendinitis from partial and small full-thickness tears of the rotat…
MR-Tomographie versus CT-Arthrographie bei glenohumeralen Instabilitäten
In a prospective study the diagnostic value of MRI compared to CT arthrography (CT-A) was evaluated in 26 patients with 27 instable shoulder joints. Surgical and/or arthroscopic correlation was available in all cases. Both methods showed a high accuracy (96% CT-A, 94% MRI) in the evaluation of the glenoid labrum. CT-A was significantly superior to MRI in the detection of capsular lesions (sensitivity 96% vs. 44%, accuracy 96% vs. 72%, negative predictive value 96% vs. 67%). CT-A and MRI results regarding humeral head fractures were similar; fractures of the glenoid rim were better detected by CT-A, the difference, however, was statistically not significant. Overall, CT-A proved to be superi…
Niederfeld MR-Arthrographie der Schulter: Erste Ergebnisse mit einem offenen 0,2 T MR-System
PURPOSE To assess the practicability and image quality of doing MR arthrography of the shoulder using a 0.2T system. PATIENTS AND METHOD 60 patients (24 with chronic instability, 36 with impingement syndrome) were examined in an open 0.2T MR apparatus (Magnetom Open, Siemens). After the intra-articular injections of 15-20 ml of a 2 mmol Gd-DTPA solution, coronary STIR, T1-weighted, sagittal and axial T2*-weighted FLASH 2D sequences were performed. 21 patients subsequently underwent surgery. RESULTS Image quality of the T1- and T2*-weighted FLASH 2D sequences was regarded as good or adequate and movement artifacts were minor or moderate. STIR sequences were statistically significantly worse …
Konzepte zur Behandlung von Kniegelenkluxationen und Ergebnisse
Grundlagen: Luxationen des Kniegelenkes sind seltene, jedoch sehr schwere Verletzungen. Daher ist zur optimalen Behandlung ein uberpruftes Konzept notwendig.
Retrograde Nailing of Humeral Shaft Fractures
The use of intramedullary nailing in the upper extremity is still controversial. Those who have experience with antegrade nailing have either great enthusiasm or strong criticism for the procedure. Criticism of the procedure is because of the trauma that can occur to the rotator cuff and possible impingement syndrome, which can occur after antegrade nail insertion. The technique of retrograde nail insertion with the unreamed humeral nail is described in detail. In a series of 190 retrograde nailings performed in a prospective multicenter study, the most frequent intraoperative problems were fissure or avulsion at the entry portal (n = 8; 4.2%) and secondary radial nerve palsy (n = 8; 4.2%).…
Minimally invasive plate fixation in femoral shaft fractures
Bridge-plating with its advantages in terms of vascularity and bone healing is a well established procedure today in the treatment of comminuted femoral fractures. Bridge-plating means that the fracture site is not interfered with during the operative procedure. This paper introduces a surgical technique in which the plate is inserted through isolated proximal and distal incisions only, behind the vastus lateralis. Alignment is secured by the plates, the fracture site remains untouched, fixation and screw insertion is restricted to the proximal and distal main fragments. Longitudinal femoral fractures extending right into the trochanteric and or condylar areas are the main indication for mi…
Indirekte MR-Arthrographie zur Verlaufskontrolle nach autologer osteochondraler Transplantation
Purpose: To evaluate the spectrum of findings in indirect MR-arthrography following autologous osteochondral transplantation. Patients and Methods: 10 patients with autogenous osteochondral homografts underwent indirect MR-arthrography at three, 6 and 12 months postoperatively. The MR protocol at 1.5 T comprised unenhanced imagings with PD- and T 2 -weighted TSE-sequences with and without fat-suppression as well as T 1 -weighted fat-suppressed SE-sequences before and after iv. contrast ad ministration and after active joint exercise. Image analysis was done by two radiologists in conference and comprised the evaluation of signal intensity (Sl) and integrity of the osseous plug and the carti…
Ergebnisse nach Implantation von zementfreien metallspongiösen Hüftprothesen
72 Huftgelenke mit zementfreier metallspongioser Huftprothese wurden zwei bis sieben Jahre (mittlere Nachuntersuchungszeit 43 Monate) nach der Implantation klinisch und rontgenologisch kontrolliert. Bei funf Patienten muste die zementfreie Prothese wegen Lockerung (ausbleibende knocherne Einheilung n=2, Pfannenlockerung infolge operationstechnischer Fehler n=3) gewechselt werden. Aufgrund der klinischen Befunde konnten 88% von 67 Huften mit sehr gut bzw. gut, 9% mit befriedigend und 3% mit unbefriedigend bewertet werden. 10% der Patienten klagten noch uber Oberschenkelschmerzen. Die typischen, rontgenologisch erkennbaren, knochernen Reaktionen des Implantatlagers werden beschrieben, eine In…
Niederfeld-MR-Tomographie des Kniegelenkes: Ergebnisse einer prospektiven, arthroskopisch kontrollierten Studie
PURPOSE To define the diagnostic accuracy of an open low-field MR unit (Magnetom Open, Siemens, Erlangen) in traumatic knee lesions. MATERIALS AND METHODS The MRIs of 150 patients were prospectively evaluated by two independent readers with different experience levels. The study protocol included a proton-density weighted SE-sequence in the sagittal, a T2.-weighted Flash-2D-sequence in the coronal, and a 3D-acquisition (DESS) in the axial plane. 75 patients were treated either conservatively or operatively. RESULTS Based on arthroscopy as the gold standard, the sensitivities, specificities, and diagnostic accuracies for lesions of the medial and lateral meniscus, the anterior cruciate ligam…
Pathogenesis and clinical relevance of bone marrow embolism in medullary nailing — demonstrated by intraoperative echocardiography
Abstract For the clarification of pulmonary impairment after medullary nailing of femoral fractures, the intramedullary pressure in the femoral cavity during the operative procedure was investigated. In addition, an intraoperative transoesophageal echocardiography was performed which revealed two phenomena occurring once the intramedullary pressure had increased: snow-flurry and configured emboli. An experimental study in sheep was performed in order to define the substrata of the sonographic echoes. The level of intrafemoral pressure which would result in bone marrow intravasation and the substrata of the echocardiographic echoes were studied in sheep by applying pressure to the femoral ca…