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E. Brug - One of the best experts on this subject based on the ideXlab platform.
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Die gedeckte Ruptur der M.-Tibialis-Anterior-Sehne
Der Unfallchirurg, 1998Co-Authors: M. Neuber, B. Vennemann, E. BrugAbstract:Closed rupture of the Anterior Tibial tendon is rare. Fewer than 50 cases have been reported in the literature, perhaps because the symptoms are often neglected by the patient as well as by the doctor. Most often the rupture occurs as a consequence of a sudden plantar flexion of the ankle and pre-existing degenerative changes of the tendon tissue due to systemic disease or iatrogenic local corticoid injections. Clinically, the tendon rupture presents as acute weakness of the ankle extensors without reddening, swelling or neurological signs. Differential diagnoses such as Anterior Tibial Syndrome and peroneal nerve palsy can thus be excluded. During the clinical examination the distal stump and the discontinuity of the Anterior Tibial tendon are often palpable. The clinical diagnosis can be confirmed by an ultrasound examination. An operation may be undertaken up to 3 months after the injury. Preferred procedures are end-to-end anastomosis and transosseous refixation of the tendon, followed by a plaster cast for 6 weeks post-operatively. High-risk patients can be treated conservatively, but the functional results are less satisfactory. We describe a case of an acute closed rupture of the Anterior Tibial tendon. A yet unpublished method of osseous reinsertion of the tendon is presented.
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Closed rupture of the Anterior Tibial tendon
1998Co-Authors: M. Neuber, B. Vennemann, E. BrugAbstract:Closed rupture of the Anterior Tibial tendon is rare. Fewer than 50 cases have been reported in the literature, perhaps because the symptoms are often neglected by the patient as well as by the doctor. Most often the rupture occurs as a consequence of a sudden plantar flexion of the ankle and pre-existing degenerative changes of the tendon tissue due to systemic disease or iatrogenic local corticoid injections. Clinically, the tendon rupture presents as acute weakness of the ankle extensors without reddening, swelling or neurological signs. Differential diagnoses such as Anterior Tibial Syndrome and peroneal nerve palsy can thus be excluded. During the clinical examination the distal stump and the discontinuity of the Anterior Tibial tendon are often palpable. The clinical diagnosis can be confirmed by an ultrasound examination. An operation may be undertaken up to 3 months after the injury. Preferred procedures are end-to-end anastomosis and transosseous refixation of the tendon, followed by a plaster cast for 6 weeks postoperatively. High-risk patients can be treated conservatively, but the functional results are less satisfactory. We describe a case of an acute closed rupture of the Anterior Tibial tendon. A yet unpublished method of osseous reinsertion of the tendon is presented.
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Die gedeckte Ruptur der M.-Tibialis-Anterior-Sehne
Der Unfallchirurg, 1998Co-Authors: M. Neuber, B. Vennemann, E. BrugAbstract:Die gedeckte Ruptur der M.-Tibialis-Anterior-Sehne ist ein seltenes Unfallereignis. Bisher wurden weniger als 50 Fälle beschrieben, möglicherweise auch als Resultat der häufig von Patient und Arzt vernachlässigten Symptomatik. In der Regel ist die Zerreißung als Folge eines akuten Plantarflexionsstresses und bereits präexistenter degenerativer Vorschädigung des Sehnengewebes durch verschiedene Systemerkrankungen resp. iatrogener Kortikoidbehandlung zu sehen. Klinisch imponieren eine akute Fußheberschwäche bei fehlender Rötung bzw. Schwellung oder neurologischer Symptomatik. Damit wird die differentialdiagnostische Abgrenzung zum Tibialis-Anterior-Syndrom bzw. der Peroneusparese möglich. Bei der Untersuchung lassen sich häufig der distale Sehnenstumpf sowie die entstandene Kontinuitätsunterbrechung der Sehne palpieren. Die diagnostische Sicherung kann sonographisch erfolgen. Günstigenfalls operativ sollte bis zum 3. posttraumatischen Monat vorgegangen werden. Dabei werden die End-zu-End-Anostomose bzw. die transossäre Refixation bevorzugt. Es erfolgt die sechswöchige postoperative Gipsruhigstellung. Risikopatienten sind auch einer konservativen Therapie mit schlechteren funktionellen Ergebnissen zugänglich. Es wird der Fall einer akut-gedeckten Sehnenruptur beschrieben und diskutiert. Dabei wenden wir ein bisher noch nicht publizierte Form der knöchernen Reinsertion an. Closed rupture of the Anterior Tibial tendon is rare. Fewer than 50 cases have been reported in the literature, perhaps because the symptoms are often neglected by the patient as well as by the doctor. Most often the rupture occurs as a consequence of a sudden plantar flexion of the ankle and pre-existing degenerative changes of the tendon tissue due to systemic disease or iatrogenic local corticoid injections. Clinically, the tendon rupture presents as acute weakness of the ankle extensors without reddening, swelling or neurological signs. Differential diagnoses such as Anterior Tibial Syndrome and peroneal nerve palsy can thus be excluded. During the clinical examination the distal stump and the discontinuity of the Anterior Tibial tendon are often palpable. The clinical diagnosis can be confirmed by an ultrasound examination. An operation may be undertaken up to 3 months after the injury. Preferred procedures are end-to-end anastomosis and transosseous refixation of the tendon, followed by a plaster cast for 6 weeks postoperatively. High-risk patients can be treated conservatively, but the functional results are less satisfactory. We describe a case of an acute closed rupture of the Anterior Tibial tendon. A yet unpublished method of osseous reinsertion of the tendon is presented.
M. Neuber - One of the best experts on this subject based on the ideXlab platform.
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Die gedeckte Ruptur der M.-Tibialis-Anterior-Sehne
Der Unfallchirurg, 1998Co-Authors: M. Neuber, B. Vennemann, E. BrugAbstract:Closed rupture of the Anterior Tibial tendon is rare. Fewer than 50 cases have been reported in the literature, perhaps because the symptoms are often neglected by the patient as well as by the doctor. Most often the rupture occurs as a consequence of a sudden plantar flexion of the ankle and pre-existing degenerative changes of the tendon tissue due to systemic disease or iatrogenic local corticoid injections. Clinically, the tendon rupture presents as acute weakness of the ankle extensors without reddening, swelling or neurological signs. Differential diagnoses such as Anterior Tibial Syndrome and peroneal nerve palsy can thus be excluded. During the clinical examination the distal stump and the discontinuity of the Anterior Tibial tendon are often palpable. The clinical diagnosis can be confirmed by an ultrasound examination. An operation may be undertaken up to 3 months after the injury. Preferred procedures are end-to-end anastomosis and transosseous refixation of the tendon, followed by a plaster cast for 6 weeks post-operatively. High-risk patients can be treated conservatively, but the functional results are less satisfactory. We describe a case of an acute closed rupture of the Anterior Tibial tendon. A yet unpublished method of osseous reinsertion of the tendon is presented.
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Closed rupture of the Anterior Tibial tendon
1998Co-Authors: M. Neuber, B. Vennemann, E. BrugAbstract:Closed rupture of the Anterior Tibial tendon is rare. Fewer than 50 cases have been reported in the literature, perhaps because the symptoms are often neglected by the patient as well as by the doctor. Most often the rupture occurs as a consequence of a sudden plantar flexion of the ankle and pre-existing degenerative changes of the tendon tissue due to systemic disease or iatrogenic local corticoid injections. Clinically, the tendon rupture presents as acute weakness of the ankle extensors without reddening, swelling or neurological signs. Differential diagnoses such as Anterior Tibial Syndrome and peroneal nerve palsy can thus be excluded. During the clinical examination the distal stump and the discontinuity of the Anterior Tibial tendon are often palpable. The clinical diagnosis can be confirmed by an ultrasound examination. An operation may be undertaken up to 3 months after the injury. Preferred procedures are end-to-end anastomosis and transosseous refixation of the tendon, followed by a plaster cast for 6 weeks postoperatively. High-risk patients can be treated conservatively, but the functional results are less satisfactory. We describe a case of an acute closed rupture of the Anterior Tibial tendon. A yet unpublished method of osseous reinsertion of the tendon is presented.
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Die gedeckte Ruptur der M.-Tibialis-Anterior-Sehne
Der Unfallchirurg, 1998Co-Authors: M. Neuber, B. Vennemann, E. BrugAbstract:Die gedeckte Ruptur der M.-Tibialis-Anterior-Sehne ist ein seltenes Unfallereignis. Bisher wurden weniger als 50 Fälle beschrieben, möglicherweise auch als Resultat der häufig von Patient und Arzt vernachlässigten Symptomatik. In der Regel ist die Zerreißung als Folge eines akuten Plantarflexionsstresses und bereits präexistenter degenerativer Vorschädigung des Sehnengewebes durch verschiedene Systemerkrankungen resp. iatrogener Kortikoidbehandlung zu sehen. Klinisch imponieren eine akute Fußheberschwäche bei fehlender Rötung bzw. Schwellung oder neurologischer Symptomatik. Damit wird die differentialdiagnostische Abgrenzung zum Tibialis-Anterior-Syndrom bzw. der Peroneusparese möglich. Bei der Untersuchung lassen sich häufig der distale Sehnenstumpf sowie die entstandene Kontinuitätsunterbrechung der Sehne palpieren. Die diagnostische Sicherung kann sonographisch erfolgen. Günstigenfalls operativ sollte bis zum 3. posttraumatischen Monat vorgegangen werden. Dabei werden die End-zu-End-Anostomose bzw. die transossäre Refixation bevorzugt. Es erfolgt die sechswöchige postoperative Gipsruhigstellung. Risikopatienten sind auch einer konservativen Therapie mit schlechteren funktionellen Ergebnissen zugänglich. Es wird der Fall einer akut-gedeckten Sehnenruptur beschrieben und diskutiert. Dabei wenden wir ein bisher noch nicht publizierte Form der knöchernen Reinsertion an. Closed rupture of the Anterior Tibial tendon is rare. Fewer than 50 cases have been reported in the literature, perhaps because the symptoms are often neglected by the patient as well as by the doctor. Most often the rupture occurs as a consequence of a sudden plantar flexion of the ankle and pre-existing degenerative changes of the tendon tissue due to systemic disease or iatrogenic local corticoid injections. Clinically, the tendon rupture presents as acute weakness of the ankle extensors without reddening, swelling or neurological signs. Differential diagnoses such as Anterior Tibial Syndrome and peroneal nerve palsy can thus be excluded. During the clinical examination the distal stump and the discontinuity of the Anterior Tibial tendon are often palpable. The clinical diagnosis can be confirmed by an ultrasound examination. An operation may be undertaken up to 3 months after the injury. Preferred procedures are end-to-end anastomosis and transosseous refixation of the tendon, followed by a plaster cast for 6 weeks postoperatively. High-risk patients can be treated conservatively, but the functional results are less satisfactory. We describe a case of an acute closed rupture of the Anterior Tibial tendon. A yet unpublished method of osseous reinsertion of the tendon is presented.
B. Vennemann - One of the best experts on this subject based on the ideXlab platform.
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Die gedeckte Ruptur der M.-Tibialis-Anterior-Sehne
Der Unfallchirurg, 1998Co-Authors: M. Neuber, B. Vennemann, E. BrugAbstract:Closed rupture of the Anterior Tibial tendon is rare. Fewer than 50 cases have been reported in the literature, perhaps because the symptoms are often neglected by the patient as well as by the doctor. Most often the rupture occurs as a consequence of a sudden plantar flexion of the ankle and pre-existing degenerative changes of the tendon tissue due to systemic disease or iatrogenic local corticoid injections. Clinically, the tendon rupture presents as acute weakness of the ankle extensors without reddening, swelling or neurological signs. Differential diagnoses such as Anterior Tibial Syndrome and peroneal nerve palsy can thus be excluded. During the clinical examination the distal stump and the discontinuity of the Anterior Tibial tendon are often palpable. The clinical diagnosis can be confirmed by an ultrasound examination. An operation may be undertaken up to 3 months after the injury. Preferred procedures are end-to-end anastomosis and transosseous refixation of the tendon, followed by a plaster cast for 6 weeks post-operatively. High-risk patients can be treated conservatively, but the functional results are less satisfactory. We describe a case of an acute closed rupture of the Anterior Tibial tendon. A yet unpublished method of osseous reinsertion of the tendon is presented.
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Closed rupture of the Anterior Tibial tendon
1998Co-Authors: M. Neuber, B. Vennemann, E. BrugAbstract:Closed rupture of the Anterior Tibial tendon is rare. Fewer than 50 cases have been reported in the literature, perhaps because the symptoms are often neglected by the patient as well as by the doctor. Most often the rupture occurs as a consequence of a sudden plantar flexion of the ankle and pre-existing degenerative changes of the tendon tissue due to systemic disease or iatrogenic local corticoid injections. Clinically, the tendon rupture presents as acute weakness of the ankle extensors without reddening, swelling or neurological signs. Differential diagnoses such as Anterior Tibial Syndrome and peroneal nerve palsy can thus be excluded. During the clinical examination the distal stump and the discontinuity of the Anterior Tibial tendon are often palpable. The clinical diagnosis can be confirmed by an ultrasound examination. An operation may be undertaken up to 3 months after the injury. Preferred procedures are end-to-end anastomosis and transosseous refixation of the tendon, followed by a plaster cast for 6 weeks postoperatively. High-risk patients can be treated conservatively, but the functional results are less satisfactory. We describe a case of an acute closed rupture of the Anterior Tibial tendon. A yet unpublished method of osseous reinsertion of the tendon is presented.
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Die gedeckte Ruptur der M.-Tibialis-Anterior-Sehne
Der Unfallchirurg, 1998Co-Authors: M. Neuber, B. Vennemann, E. BrugAbstract:Die gedeckte Ruptur der M.-Tibialis-Anterior-Sehne ist ein seltenes Unfallereignis. Bisher wurden weniger als 50 Fälle beschrieben, möglicherweise auch als Resultat der häufig von Patient und Arzt vernachlässigten Symptomatik. In der Regel ist die Zerreißung als Folge eines akuten Plantarflexionsstresses und bereits präexistenter degenerativer Vorschädigung des Sehnengewebes durch verschiedene Systemerkrankungen resp. iatrogener Kortikoidbehandlung zu sehen. Klinisch imponieren eine akute Fußheberschwäche bei fehlender Rötung bzw. Schwellung oder neurologischer Symptomatik. Damit wird die differentialdiagnostische Abgrenzung zum Tibialis-Anterior-Syndrom bzw. der Peroneusparese möglich. Bei der Untersuchung lassen sich häufig der distale Sehnenstumpf sowie die entstandene Kontinuitätsunterbrechung der Sehne palpieren. Die diagnostische Sicherung kann sonographisch erfolgen. Günstigenfalls operativ sollte bis zum 3. posttraumatischen Monat vorgegangen werden. Dabei werden die End-zu-End-Anostomose bzw. die transossäre Refixation bevorzugt. Es erfolgt die sechswöchige postoperative Gipsruhigstellung. Risikopatienten sind auch einer konservativen Therapie mit schlechteren funktionellen Ergebnissen zugänglich. Es wird der Fall einer akut-gedeckten Sehnenruptur beschrieben und diskutiert. Dabei wenden wir ein bisher noch nicht publizierte Form der knöchernen Reinsertion an. Closed rupture of the Anterior Tibial tendon is rare. Fewer than 50 cases have been reported in the literature, perhaps because the symptoms are often neglected by the patient as well as by the doctor. Most often the rupture occurs as a consequence of a sudden plantar flexion of the ankle and pre-existing degenerative changes of the tendon tissue due to systemic disease or iatrogenic local corticoid injections. Clinically, the tendon rupture presents as acute weakness of the ankle extensors without reddening, swelling or neurological signs. Differential diagnoses such as Anterior Tibial Syndrome and peroneal nerve palsy can thus be excluded. During the clinical examination the distal stump and the discontinuity of the Anterior Tibial tendon are often palpable. The clinical diagnosis can be confirmed by an ultrasound examination. An operation may be undertaken up to 3 months after the injury. Preferred procedures are end-to-end anastomosis and transosseous refixation of the tendon, followed by a plaster cast for 6 weeks postoperatively. High-risk patients can be treated conservatively, but the functional results are less satisfactory. We describe a case of an acute closed rupture of the Anterior Tibial tendon. A yet unpublished method of osseous reinsertion of the tendon is presented.
Alfred Bollinger - One of the best experts on this subject based on the ideXlab platform.
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Chronic Anterior Tibial Syndrome
VASA. Zeitschrift fur Gefasskrankheiten, 1993Co-Authors: Johann Steurer, K Läderach, J Largiadèr, Alfred BollingerAbstract:In two young athletic men we made the diagnosis of chronic Tibialis Anterior Syndrome. Pain during strenuous exercise was localized in the anterolateral aspect of both calves. After stopping exercise the complaints disappeared within 15-20 minutes and not in 2-3 minutes as it would be typical for patients with atherosclerotic peripheral arterial occlusive disease. Diagnosis is based on patient history, normal clinical examination (systolic ankle pressure determined by Doppler-Sonography, electronic segmental oscillography) and increased intramuscular pressure at rest (> 10 mmHg) and after exercise (42 and 35 mmHg). Bilateral fasciotomy was performed in both patients. They are free of pain after 3 respectively 6 months postoperatively.
H Mau - One of the best experts on this subject based on the ideXlab platform.
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Compartment Syndromes of the lower extremities (author's transl)
Zeitschrift fur Orthopadie und ihre Grenzgebiete, 2008Co-Authors: H MauAbstract:A reduction of the arterial blood pressure of the muscles of the 4 tight fascial compartments of the shank may be initiated by: Trauma and operation of the lower extremities, spontaneous bleeding, occlusion of the arteries, general and local hypotonia due to elevation of the leg, as well as by drug abuse and increased stress of the muscles of the lower extremities. This is followed by an increased swelling and tension of the tissue with ischemia and consecutive paralyses of the nerves and muscles in the presence of almost simultaneous muscle contractures. We may encounter a double insult, a "rebound" effect, if f.i. following removal of a two thigh bandage of the shank the compartment again becomes too narrow due to a postischemic swelling. The Anterior Tibial Syndrome is frequently caused by an increased exertion in sports and in the military service. The dorsal Syndromes are often accompanied by Sudeck's dystrophy in the late stages. In treatment the early and extensive longitudinal incision of the respective fasciae is imperative in order to prevent the typical equino-varus deformity and hallux flexus.
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Kompartment-Syndrome der unteren Extremitäten
Zeitschrift Fur Orthopadie Und Ihre Grenzgebiete, 2008Co-Authors: H MauAbstract:A reduction of the arterial blood pressure of the muscles of the 4 tight fascial compartments of the shank may be initiated by: Trauma and operation of the lower extremities, spontaneous bleeding, occlusion of the arteries, general and local hypotonia due to elevation of the leg, as well as by drug abuse and increased stress of the muscles of the lower extremities. This is followed by an increased swelling and tension of the tissue with ischemia and consecutive paralyses of the nerves and muscles in the presence of almost simultaneous muscle contractures. We may encounter a double insult, a "rebound" effect, if f.i. following removal of a two thigh bandage of the shank the compartment again becomes too narrow due to a postischemic swelling. The Anterior Tibial Syndrome is frequently caused by an increased exertion in sports and in the military service. The dorsal Syndromes are often accompanied by Sudeck's dystrophy in the late stages. In treatment the early and extensive longitudinal incision of the respective fasciae is imperative in order to prevent the typical equino-varus deformity and hallux flexus.