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At least 253 records · Page 14Linked to original sources
PubMed1981

The fasciocutaneous flap: its use in soft tissue defects of the lower leg.

The fasciocutaneous flap is very useful in the repair of soft tissue defects on the lower leg. It is easy to design and construct large flaps that are safe because of the good circulation. The operating time is short for an experienced surgeon and no extra equipment is needed. It is perfectly possible to carry out surgery on the underlying bones at the same time. The postoperative treatment is simple for both the patient and the staff. The surgical technique is described and the results of 23 flaps are critically reviewed.

Adolescent↗
PubMed1982

One-stage random-pattern de-epithelialised "turn over" flaps in the leg.

One-stage random-pattern de-epithelialised "turn over" flaps in the lower third of the leg appear to be as useful and successful as in the upper third of the leg. The blood supply to these flaps and their advantages are briefly discussed. The clinical details of 20 "turn over" flaps done over a period of 18 months are listed and two typical examples are presented.

Achilles Tendon↗
PubMed1999

Combined injuries to the lower limbs.

Several patterns of severe lower limb injuries are presented. They all indicate high energy trauma and affect the immediate care of the patient. The improvement of evacuation systems and resuscitating methods in intensive care create many reconstruction challenges for the orthopaedic surgeon. Awareness of the different combinations which are presented can serve as a tool that may be helpful in these demanding injuries. Guidelines for management of combined injuries are essential to improve the outcome of these life-threatening situations.

Femoral Fractures↗
PubMed2005

[Physeal distraction for limb length discrepancy and angular deformity].

PURPOSE OF THE STUDY: Physeal distraction or chondrodiastasis uses the growth plate as a zone of least resistance. Application of force thus provokes distraction and opening of the plate (Salter and Harris type I epiphyseal detachment). Progressive lengthening allows room for regenerate bone and enables limb lengthening and correction of angular deformations. MATERIAL AND METHODS: Twenty chondrodiastasis procedures were performed in fifteen patients. Mean age was 14.4 years (10.3-15.7). The underlying causes were trauma (n = 6), constitutional deformation (n = 8), infection (n = 2, distal lateral femoral epiphysiodesis), and malformation (n = 4). The localizations were: proximal tibia (n = 11), distal tibia (n = 4), distal femur (n = 4), distal radius (n = 1). The surgical procedure involved installation of an external fixator on either side of the physis after planification of the desired correction and taking into account the remaining growth potential of the physis. The distraction was performed by the patient at the rate of 1 mm per day. A one-sided external fixator was used for eleven patients (distal femoral correction and proximal tibial hemichondrodiastasis for angular deformation) and a circular fixator (to control 3D correction) in nine. Complications were noted according to the four grades of severity described by Caton. RESULTS: Mean follow-up was 26.1 months. Epiphyseal detachment was achieved in all patients, even in the presence of an epiphysiodesis bridge, in 7.7 days on average (2-15 days). Mean lengthening was 4.75 cm, mean angular correction was 22.2 degrees (mean preoperative angle 20.5 degrees ). For chondrodiastasis (symmetrical physeal distraction), the mean duration of correction was 4.6 months (1-9), mean time to healing was 8.3 months (4-13) and mean healing index was 55.6 days/cm (Verone). For hemichondrodiastasis (asymmetrical physeal distraction), mean duration of correction was 1.3 months (1-3), and mean time to healing was 2.7 months (2-5). The healing index was different and was 3 days per degree. Complications were studied using the Caton classification. There were 17 (85%) benign complications (not requiring revision under anesthesia) and 6 (30%) serious complications (requiring anesthesia and unplanned revision). There were 2 (10%) severe complications (knee flexion, ankle equinus). DISCUSSION: Chondrodiastasis has specific complications, mainly involving the distal femur (stiff knee, risk of septic arthritis). It provides rapid in situ correction resulting from epiphysiodesis bridges. The resection step proposed by Bollini is not necessary, but the growth plate is definitively sterilized. This implies that the procedure be used for preventive lengthening, depending on the predicted limb length discrepancy. This notion limits indications to older children. Besides the fact that several deformations can be corrected simultaneously, this technique does not require osteotomy and respects vascular supply to the regenerative tissue. It involves the physis responsible for the angular deformation or limb length discrepancy. It does not require internal fixation nor bone grafting and can be performed with weight bearing. Finally, the procedure can be adjusted as needed during the correction phase, with the patient in the standing position.

Adolescent↗
PubMed2000

Injuries and special concerns of female figure skaters.

Figure skaters are often young athletes involved in an extremely stressful, structured environment that is focused solely on skating. These athletes are at risk for a multitude of psychologic concerns, including poor communication skills, performance anxiety, stress, and family issues. Helping athletes develop self-awareness, techniques to control stress and anxiety, motivational strategies, ability to maintain concentration, and emotional balance is best done with the guidance of a sports-trained counseling professional. Communication among the athlete, parents, and coaches is extremely important. Often, coaches tell the athlete how and what to feel, and the athlete falls into a routine of trying to please coaches and parents instead of developing her own persona. The communication between pairs skaters and ice dancers is integral to their success. Excellent interpersonal skills among members of pair teams are advantageous in creating a lasting relationship. Honesty, respect, clarity, consistency, and sincerity are essential components of outstanding teammates and should be cultivated. On the other hand, sarcasm, disrespect, castigation, and ridicule should be addressed immediately and should be discouraged strongly.

Biomechanical Phenomena↗
PubMedDate not supplied

Radiology of sports-related injuries.

Participation in organized sports and fitness activity continues to increase in the United States. As a result, more acute bone and soft-tissue injuries are occurring in this patient population. Chronic overuse syndromes are also more common today. It is important for radiologists to understand the mechanism of injury so that they can properly approach the imaging of these patients. Although magnetic resonance imaging (MRI) is frequently the technique of choice, other imaging methods are also important and may, in certain cases, be preferred to MRI. In this review, we discuss extremity injuries by anatomic region. The spine is not included. A tailored imaging approach to each anatomic region and type of injury is discussed.

Ankle Injuries↗
PubMed2002

Leg length discrepancy.

The role of leg length discrepancy (LLD) both as a biomechanical impediment and a predisposing factor for associated musculoskeletal disorders has been a source of controversy for some time. LLD has been implicated in affecting gait and running mechanics and economy, standing posture, postural sway, as well as increased incidence of scoliosis, low back pain, osteoarthritis of the hip and spine, aseptic loosening of hip prosthesis, and lower extremity stress fractures. Authors disagree on the extent (if any) to which LLD causes these problems, and what magnitude of LLD is necessary to generate these problems. This paper represents an overview of the classification and etiology of LLD, the controversy of several measurement and treatment protocols, and a consolidation of research addressing the role of LLD on standing posture, standing balance, gait, running, and various pathological conditions. Finally, this paper will attempt to generalize findings regarding indications of treatment for specific populations.

Age Factors↗
PubMed1995

A 17-year follow-up of replantation of a completely amputated leg in a child: case report.

With special reference to skeletal growth, a 17-year follow-up study of a lower-leg replantation in a four-year-old boy is reported. The patient maintained good cosmesis and function; however, foot size on the affected side was 1.5 cm smaller than the contralateral side, and leg length was 1.2 cm shorter than on the normal side. A Cybex II study disclosed that the patient had almost half-standard strength of the evertors at 30 deg/sec and of the plantar flexors at 20 and 120 deg/sec on the involved side. According to these findings on late follow-up of a replanted foot in a child, replantation in a growing child apparently has adverse influences on skeletal growth and muscle strength around the ankle joint, even when the original procedure has been carried out under almost ideal conditions.

Adult↗
PubMed1992

Successful replantation of the lower leg after 42-hour ischemia: case report.

A case of right lower-leg replantation after 42-hr ischemia is presented. Revascularization of the other foot with circulatory decompensation after 36-hr ischemia was carried out simultaneously. The replanted lower leg survived. Following its shortening in replantation by 12 cm, right lower-leg lengthening by 8 cm was carried out 1.5 years after replantation with the aid of a distraction apparatus. The locomotor function in both lower extremities recovered.

Adult↗
PubMed1995

Acute injuries in orienteerers.

The aim of this study was to characterize the type and severeity of acute injuries occurring in Finnish orienteerers in 1987 to 1991. The study is based on the orienteering license insurance records accounting for 2189 orienteering injuries during 69268 person-years of exposure in active orienteerers. Of these orienteerers, 73.0% were male; 73.5% (N = 1608) of all injuries occurred in males, so the injury rate was similar in males and females. The rate was highest in orienteerers 20 to 24 years of age and lowest in children. Injuries occurred most commonly during May to September (78.9% or all injuries), the months which include the orienteering competition season, and were more common during competitions (59.8%) than during training. A high number of the injuries occurred during weekends (58.9% of injuries) including 68.1% of all competition injuries and 44.9% of all training injuries. The lower limbs were involved in 1611 (73.6%) of cases, the ankle (28.7%) and the knee (23.2%) being the two most common injury locations. Sprains, strains and contusions were the most common injuries. Wounds were proportionally more common in males than in females while ankle sprains were more common in females. Fractures, seven open and 94 closed, accounted for 4.6% of injuries; they were most common in the hand/wrist/forearm (N = 44) and ankle (N = 16), and were more frequent during competition (62.3%) than during training. The most important areas for preventive measures seem to be the ankle and the knee.

Adolescent↗
PubMed1983

Lower limb injuries in parachuting.

Parachuting injuries commonly result from inaccurately performed landing. Alteration of the vertical force absorption pattern to a rotational one is suggested as their major cause. Special attention to the flexed body position and adduction of the lower limbs while gliding and landing can prevent those injuries.

Adult↗
PubMed1992

[Computed tomographic torsion-angle and length measurement of the lower extremity. The methods, normal values and radiation load].

Complex corrective osteotomies in the lower extremities require precise preoperative planning. Fifty patients (37 male, 13 female) with an average age of 31 years (13 to 61 years) who had suffered fractures of the lower limbs and had been treated by osteosynthetic or conservative methods were studied, using a GE 9800 Quick CT; accurate and reproducible measurements of the angles of torsion of the femur and tibia were obtained. Digital images were produced to standardise the planes of measurement and to measure the length of the limb. The normal extremities of patients older than 18 years showed internal torsion of -20.4 +/- 9 degrees of the femur and external torsion of 33.1 +/- 8 degrees of the tibia. The most important clinical measurement is the intra-individual difference of the torsional angles. Amongst normals this is 4.3 +/- 2.3 degrees in the femur and 6.1 +/- 4.5 degrees in the tibia. Consequently, only angles greater than 9 degrees in the femur and 15 degrees in the tibia should be regarded as abnormal. Radiation exposure was measured by a LiF-thermoluminescence dosimeter on an Alderson phantom. Skin dose was 6.3 +/- 1.2 mGy and gonadal dose for females was 2.5 +/- 0.3 mGy and for males 0.7 +/- 0.1 mGy.

Adolescent↗
PubMed1997

Permutations of combined free flaps using the subscapular system.

Over five dozen permutations of free-flap combinations based on the subscapular system are possible. Although this has been the most common single flap donor site in the author's overall experience (38.5 percent), the use of a combined flap has been required in only seven cases, representing only 10 percent of all free flaps selected from this region, indeed implying that their indications are limited. When muscle flaps per se were specifically desired, the latissimus dorsi and serratus anterior muscles could be simultaneously transferred, while requiring only a single microanastomosis to their common subscapular pedicle. Additional advantages of using this most common form, or with other combined flaps, are not only augmentation of available surface area for wound coverage, but also disparate sites can be closed individually: microanastomoses are easily protected by the second flap; circumferential gliding surfaces are provided to minimize tendon adhesions; and dynamic restoration of multiple paralyzed muscles is achieved, while violating but a single donor site.

Adult↗