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PubMedDate not supplied

Three-dimensional computed tomography of the foot: optimizing the image.

The complex anatomy of the foot can be imaged using high resolution computed tomography. High resolution serial nonoverlapping CT scans of foot anatomy have a high degree of soft tissue contrast, and excellent geometrical accuracy (no magnification error). Three-dimensional surface reconstruction from CT scans of the foot were performed using specially developed computer software. These surface reconstructions display the osseous and soft tissue anatomy of the foot in a form similar to anatomic preparations. The removal of overlying skin, disarticulation of the ankle, tarsals and metatarsals was accomplished using computer methods. Major factors necessary to optimize three-dimensional images are presented and illustrated. The technique has been applied in living subjects with arthritis, carpal coalitions, osteochondritis dissecans, and fractures. These images have been useful in communicating the findings on high resolution CT scans to referring clinicians, correlating CT findings in areas of complex anatomy, and eliminating overlying or obscuring structures by mathematically disarticulating the foot and individual tarsal bones.

Cadaver↗
PubMed2004

Energy expenditure and gait characteristics of a bilateral amputee walking with C-leg prostheses compared with stubby and conventional articulating prostheses.

OBJECTIVE: To compare energy cost and stride characteristics during walking with 3 different types of prostheses in a person with bilateral knee disarticulations. DESIGN: Single-case study. Setting Pathokinesiology laboratory. PARTICIPANT: A subject with bilateral knee disarticulations and bilateral transradial amputations secondary to meningococcemia with purpura fulminans. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Energy cost, stride characteristics, and motion analysis. RESULTS: When wearing the C-Leg prostheses, the subject walked the farthest and fastest, with an overall lower rate of oxygen consumption and oxygen cost compared with walking with either of the other prostheses. Gait analysis while the patient was wearing the C-Leg prostheses revealed premature hip extension, absence of knee flexion during loading response, and a rate of swing in the referent range. CONCLUSIONS: Walking in a C-leg was the most efficient method of ambulation for our subject.

Adult↗
PubMed2006

Keeping the pieces together: comparison of mass grave excavation methodology.

Mass graves are a complex and confusing mix of bodies, body parts, soils, artifacts, and other feature evidence. Forensic investigations of these complex crime scenes should attempt to maximize the collection of evidence, which includes the mortal remains, in their best possible condition as they were deposited within the graves. Two standard methods of mass grave excavation were examined with the aim of identifying the better approach. Two experienced teams using different methodologies excavated two separate but very comparable mass graves located in the same area. Single disarticulated skeletal elements not associated with a body at the time of removal from the grave were categorized and their counts analyzed to evaluate the efficiency of the differing excavation methodologies. The methodologies used were the 'pedestal' method, which focuses on the body mass, and the 'stratigraphic' method, in which the grave feature and contents are conjointly excavated. The first grave (Grave A), excavated using the 'pedestal' method, was observed to have a disproportionately larger amount of unassociated bones than did the second (Grave B), which used the 'stratigraphic' method. Chi-square (chi2) goodness-of-fit and contingency tests were performed on the total numbers of recorded elements and different categorical groups of bones, based on size and shape, in each grave. Results demonstrate that significantly greater numbers of unassociated elements resulted from the excavation of Grave A using the pedestal method, both in total number of disarticulated bones as well as within 'large' and 'medium' categories. Conversely 'small' skeletal elements were recovered at a higher rate in Grave B. The lower 'large' and 'medium' bone production rates from Grave B indicate that the stratigraphic method better maintained the provenience and articulation of remains than did Grave A, while the higher 'small' bone recovery rate may point to better recovery techniques of Grave B's excavation team.

Archaeology↗
PubMedDate not supplied

Biomechanical evaluation of pedicle screws versus pedicle and laminar hooks in the thoracic spine.

BACKGROUND CONTEXT: Pedicle screws have been shown to be superior to hooks in the lumbar spine, but few studies have addressed their use in the thoracic spine. PURPOSE: The objective of this study was to biomechanically evaluate the pullout strength of pedicle screws in the thoracic spine and compare them to laminar hooks. STUDY DESING/SETTING: Twelve vertebrae (T1-T12) were harvested from each of five embalmed human cadavers (n=60). The age of the donors averaged 83+8.5 years. After bone mineral density had been measured in the vertebrae (mean=0.47 g/cm(3)), spines were disarticulated. Some pedicles were damaged during disarticulation or preparation for testing, so that 100 out of a possible 120 pullout tests were performed. METHODS: Each vertebra was secured using a custom-made jig, and a posteriorly directed force was applied to either the screw or the claw. Constructs were ramped to failure at 3 mm/min using a Mini Bionix II materials testing machine (MTS, Eden Prairie, MN). RESULTS: Pedicle claws had an average pullout strength of 577 N, whereas the pullout strength of pedicle screws averaged 309 N. Hooks installed using the claw method in the thoracic spine had an overwhelming advantage in pullout strength versus pedicle screws. Even in extremely osteoporotic bone, the claw withstood 88% greater pullout load. CONCLUSION: The results of this study indicate that hooks should be considered when supplemental instrumentation is required in thoracic vertebrae, especially in osteoporotic bone.

Biomechanical Phenomena↗
PubMed2005

[Stewart-Treves syndrome].

Lymphangiosarcoma is an uncommon vascular tumor that usually develops in longstanding lymphedema. We gathered the cases of lymphangioma observed in a hospital and attempted to analyze their characteristics: age, sex, localization, treatment and follow-up data. We studied five cases: three cases of Stewart-Treves syndrome after mastectomy and radiotherapy and two cases that developed in patients with late-onset congenital lymphedema. There were four women and one man. Radical surgery was performed in four patients. The techniques employed were: above-knee amputation (one patient), hip disarticulation (one patient), scapulo-humeral disarticulation (two patients) and gemcitabine and radiotherapy in one patient with metastatic disease at diagnosis. Three patients died in the first 14 months of follow-up, while two are disease free after 46 and 86 months respectively. This study confirms the poor prognosis of patients with Steward-Treves syndrome.

Adult↗
PubMed2003

The shape of the triangular fibrocartilage during pronation-supination.

We studied the changes in the shape of the triangular fibrocartilage (TFC: disc proper) which occur during forearm rotation in disarticulated and articulated wrists. The influence of artificial 3mm ulnar lengthening on distortion of the disc was also examined. In the disarticulated wrists, slight distortion of the central and radial portions of the TFC was observed in the ulnar neutral variance specimens. More distortion was noted in the radial and central portions of the TFC in specimens with positive ulnar variance or with the ulna lengthened. However, in the articulated wrist, the TFC demonstrated little change in shape during pronosupination even in the ulnar positive variance wrists or with the ulna lengthened. There was no significant change in palmar and dorsal peripheral lengths of the TFC in ulnar neutral, ulnar positive or ulna-lengthened specimens at three rotatory positions of the forearm. These findings suggest that changes in ulnar variance which occur during forearm rotation can produce distortion on the TFC, but the carpus helps to maintain the shape of the TFC during pronation-supination, even with positive ulnar variance.

Aged↗
PubMed1995

Prosthetic usage in major upper extremity amputations.

Patterns of use of contemporary prostheses by 135 patients with major upper extremity amputations were evaluated by questionnaire. Eighty-four percent of the patients were male and 16% were female. Amputation levels represented were below elbow, 44%; above elbow, 40%; and shoulder disarticulations or forequarter amputations, 16%. The follow-up interval averaged 12 years (range, 1-67 years). One hundred and thirteen patients were fitted with either a myoelectric or body-powered prosthesis. The overall rejection rate was 38%. Thirty-nine of 42 in the below-elbow amputation group used the prosthesis and appeared to benefit the most. Eight of 141 in the wrist disarticulation group used the prosthesis: as did 9 of 21 in the above-elbow amputation group. In contrast, all bilateral amputees used their prostheses. Stiff shoulders and brachial plexus injury were both predictors for poor prosthetic usage.

Amputees↗
PubMed1993

NdYAG laser treatment of a glomus tympanicum tumour.

Glomus tympanicum tumours are highly vascular tumours of the middle ear. Their removal by conventional surgical methods requires an extensive procedure in many cases, often with ossicular disarticulation to allow adequate exposure prior to the 'chaotic' and haemorrhagic event of tumour removal. This paper reports on the use of an NdYAG laser in a case of a large glomus tympanicum tumour. The laser facilitated a transcanal approach, avoided ossicular disarticulation and allowed accurate and almost bloodless ablation of the entire tumour. The NdYAG laser appears to be a very useful treatment modality in the management of these highly vascular tumours. Care should be taken to avoid accidental energy transmission to the cochlea.

Angiography, Digital Subtraction↗
PubMed1996

Middle and Late Cambrian sponge spicules from Hunan, China.

Abundant and well-preserved assemblages of disarticulated sponge spicules occur in Middle and Late Cambrian platform carbonates of western Hunan, China. Assemblages recovered from 11 stratigraphic horizons include calcisponges, demosponges, and hexactinellids. Hexactinellida, in particular, are both abundant and diverse in Upper Cambrian carbonates. Comparison with spicule assemblages from Australia indicates that many of these taxa have long stratigraphic ranges, limiting their use in correlation. The morphological diversity of these spicules exceeds that known for living siliceous sponges, supporting the observation that during the Cambrian radiation, sponges, like other metazoans, evolved a variety of architectural forms not observed in later periods. Like conodonts, individual sponges can produce more than one spicule form; thus, an "apparatus genus" concept based on multiple co-occurring elements may eventually prove useful in the biostratigraphic and paleobiological interpretation of disarticulated sponge spicules. Four distinctive forms are recognized as new taxa: Australispongia sinensis new genus and species, Flosculus gracilis new genus and species, Pinnatispongia bengtsoni new genus and species, and Nabaviella paibiensis new species.

Animals↗
PubMed2000

Does literacy have an effect on stick construction tasks?

Since constructional apraxia is often concomitant with brain lesions, the study of constructional tasks in the non-brain-damaged population might be useful in helping to disentangle other causal factors. This paper explores the performance of illiterate individuals (N = 29) as compared to that of semiliterates (N = 21) and literates (N = 23) in order to see the effect of reading and writing abilities on constructional tasks. Each participant was asked to construct 4 figures based upon models having varying degrees of complexity. A global criterion of lack of fidelity and several analytic criteria (related to distortion, rotation, and disarticulation errors) were used to evaluate performance. Although illiterates generally made more errors than semiliterates and semiliterates more than literates, only some of these differences were statistically significant. Significant differences were found for lack of global fidelity and disarticulation errors when all 4 figures were considered together. Subtler data emerged with respect to single figures.

Adolescent↗
PubMed2000

Biochemical evidence of cannibalism at a prehistoric Puebloan site in southwestern Colorado.

The existence of cannibalism is one of the most controversial issues in the archaeology of the American Southwest. Disarticulated, cut-marked and heat-altered human remains from non-burial contexts at prehistoric Puebloan (Anasazi) archaeological sites in the Four Corners region of the American Southwest have been interpreted by some scholars as evidence of cannibalism. Osteological studies indicate that many of the disarticulated bodies found at these sites were processed in a manner consistent with food preparation. Opponents of this interpretation point out that non-cannibalistic practices such as secondary interment, corpse mutilation and ritualized witch executions might account for the assemblages. Osteological evidence alone does not document the actual ingestion of human flesh. Here we show consumption of human flesh did occur as demonstrated in preserved human waste containing identifiable human tissue remains from a site with osteological evidence of cannibalism.

Adolescent↗
PubMed2001

Rehabilitation of the geriatric vascular amputee patient: a population-based study.

OBJECTIVES: To determine the rate of successful prosthetic fitting in geriatric vascular amputees in the community and to determine predictors of successful fit. DESIGN: Epidemiologic survey. SETTING: General community, Olmsted County, Minnesota. PATIENTS: All Olmsted County residents more than 65 years old who had a major lower extremity amputation (below knee amputation [BKA] or higher) for peripheral vascular disease between 1974-1995, of whom 199 were identified. Median age at amputation was 79.7 years with a median survival of 1.5 years. INTERVENTION: A retrospective chart review. MAIN OUTCOME MEASURE: Successful prosthetic fit. RESULTS: Amputation levels were: 64% BKA, 4.5% knee disarticulation, 31% above knee amputation (AKA), and 0.5% hip disarticulation. Only 36% of the population was successfully fitted, compared with 74% of patients referred to the Amputee Clinic. Major reasons for not being fitted included death, reamputation, cerebrovascular disease, and cognitive deficits. Increased age (p < .001), cerebrovascular disease (p < .001), dementia (p = .002), and AKA (p < .001) were associated with failure to fit. CONCLUSION: The high probability of successful prosthetic fitting reported among referral practices cannot be generalized to unselected elderly individuals. However, selected individuals can successfully be fitted with a prosthesis; knowledge of predictors of prosthetic fitting may facilitate setting of realistic goals during presurgical counseling in this age group.

Age Factors↗
PubMedDate not supplied

[Surgical amputation and prosthetic management in congenital fibrosarcoma of the lower extremity].

The concept of surgical amputation and the problems of prosthetic management in a girl with congenital fibrosarcoma of left distal thigh, knee and shank is described. After failed polychemotherapy (EICESS 92) and expansion of the tumor a radical knee disarticulation and intended marginal resection of the tumorous soft tissue area of the distal thigh was performed at the age of eleven months and two weeks. The femur was shortened by osteotomy of the diaphysis and removing a fragment in order to protect the distal femoral epiphyseal growth plate and to be able to close the soft tissue of the stump primarily. Prosthetic fitting and rehabilitation started at the beginning of statomotorical development at the point when four feet standing changed into two feet standing. In present, at the age of two years and six months, this girl is independent mobile and well fitted with a knee disarticulation prosthesis.

Amputation, Surgical↗
PubMedDate not supplied

[Amputation in the growth period].

Amputations during childhood and juvenile age differ from those in adults: Osseous over-growth can be expected especially in trans-humeral and trans-tibial stumps,--to be prevented by stump-capping. After loss of a growth-plate transosseous stumps will reduce growth; therefore it is crucial to preserve the distal femoral growth-plate and a weight-bearing knee-disarticulation stump with respect to future prosthetic function and appearance. Besides predominantly traumatic origin of acquired amputations in the growth-period longitudinal deficiencies present at birth have to attract utmost attention when decision-making for surgical conversion--e.g. of a missing tibia to a knee-disarticulation stump or severe fibular deficiency to a weightbearing Symeor modified Pirogoff-/Boyd-stump. The multiple limb-deficient child and adolescent depends on a holistic approach towards therapy provided by specialised centers.

Adolescent↗
PubMed2006

Eliminating cardiac contamination from myoelectric control signals developed by targeted muscle reinnervation.

The electrocardiogram (ECG) artifact is a major noise contaminating the myoelectric control signals when using shoulder disarticulation prosthesis. This is an even more significant problem with targeted muscle reinnervation to develop additional myoelectric sites for improved prosthesis control in a bilateral amputee at shoulder disarticulation level. This study aims at removal of ECG artifacts from the myoelectric prosthesis control signals produced from targeted muscle reinnervation. Three ECG artifact removal methods based on template subtracting, wavelet thresholding and adaptive filtering were investigated, respectively. Surface EMG signals were recorded from the reinnervated pectoralis muscles of the amputee. As a key parameter for clinical myoelectric prosthesis control, the amplitude measurement of the signal was used as a performance indicator to evaluate the proposed methods. The feasibility of the different methods for clinical application was also investigated with consideration of the clinical speed requirements and memory limitations of commercial prosthesis controllers.

Adult↗
PubMed1987

Anatomy and development of the pterygopalatomaxillary region, studied in relation to Le Fort osteotomies.

An understanding of the anatomy and postnatal development of the pterygomaxillary region is needed as a basis for timing and completion of Le Fort osteotomies. The present study included a macroscopic and microscopic study of human skull and autopsy material, both materials representing different developmental stages. Finally, Le Fort I procedures were completed on adult cadavers and the pterygomaxillary region studied histologically. The skull material demonstrated an increasing association between the palatine bone and adjacent bones. Disarticulation was possible only in the infantile period; in the late juvenile and the adolescent stages, disarticulation was accompanied by fractures of the heavily interdigitated osseous surfaces. The histological studies confirmed the marked complexity of the suture, and our findings suggest that the palatine bone acts as a buffer between these areas with their differing intrinsic growth patterns. The remodeling processes in the area seem to reflect different functional demands of the bony pharynx and the maxillary complex. These findings, in conjunction with the significant variations in the gross anatomy of the pterygomaxillary area combined with the location of the actual osteotomy in simulated Le Fort I procedures, force consideration of placement of the posterior osteotomy through the maxillary sinus rather than through the pterygomaxillary fissure in adults. If Le Fort procedures are to be completed in children, probable interference in facial growth is of major concern. Therefore the timing of Le Fort procedures before adolescence must be reconsidered.

Adolescent↗
PubMed1975

The surgical management of primary osteosarcoma.

Regrettably amputation remains to the present day an essential part of treatment in osteosarcoma of the limb bones. Only by its inclusion in the therapeutic regime can the present best level of about 20 per cent survival be achieved in any large group of patients. Preliminary biopsy is essential and there is no evidence that it is harmful even if followed by a delay of many days before definitive treatment. In patients treated initially by radiotherapy, selective amputation some 6 months later only in patients free of metastases, carries just as good a prognosis for the group as a whole as initial primary amputation in all patients. This method, first described by Cade, is widely practiced in the United Kingdom and spares many patients who develop early metastases following initial radiotherapy from unnecessary mutilating surgery shortly before inevitable death. Local recurrence may follow retention of a femoral stump following amputation for osteosarcoma at the most common site in the lower femoral metaphysis. There are cogent arguments in favor of hip disarticulation in such patients although they do not include evidence of greater survival. The balance between the two procedures is finely drawn but is weighted in favor of disarticulation.

Amputation, Surgical↗
PubMedDate not supplied

Extraosseous blood supply of the tibia and the effects of different plating techniques: a human cadaveric study.

OBJECTIVE: To describe the extraosseous blood supply of the tibia and how the blood supply of the distal tibia is influenced by different plating techniques. DESIGN: Microdissection of cadaveric adult hip disarticulation specimens following sequential arterial injections of india ink and Ward's Blue Latex was performed. Readily identifiable arterioles measured approximately 0.5 mm in diameter. Their artery of origin was identified, and their position along the medial, lateral, and posterior aspects of the tibia was documented relative to the tibial plafond. Additionally, six matched pairs of limbs were used to assess the effects of different plating techniques on the extraosseous blood supply along the medial aspect of the distal tibia. SETTING: University anatomy laboratory. PATIENTS/PARTICIPANTS: Nine matched pairs ( = 18) of randomly obtained, adult cadaveric hip disarticulation specimens. INTERVENTION: India ink followed by Ward's Blue Latex was injected into the superficial femoral artery at the level of the inguinal crease after cleansing of the arterial system. The skin, subcutaneous tissue, and muscles were dissected from the leg, exposing the arterial system and the extraosseous vessels of the tibia. MEAN OUTCOME MEASUREMENTS: The extraosseous blood supply of each aspect of the tibial diaphysis was determined. Each extraosseous arteriole was identified, and the locations of each documented relative to the tibial plafond. Changes in the filling of these vessels along the medial aspect of the distal tibia were documented in a separate group of specimens ( = 12), which had undergone two different plating techniques. RESULTS: The proximal metaphysis of the tibia was found to have a rich extraosseous blood supply provided primarily from vessels from the popliteal artery, the anterior tibial artery (ATA) laterally, and the posterior tibial artery (PTA) medially. In comparison, the tibial diaphysis was found to have relatively few extraosseous vessels and a considerably hypovascular region, posteriorly. Branches of the ATA were found to supply the posterior aspect of the diaphysis with these branches passing through the interosseous membrane. The diaphysis also received a variable contribution from the PTA. The lateral aspect of the diaphysis was supplied by branches of the ATA. An anastomotic network of arteries from the ATA and PTA formed the rich extraosseous blood supply of the medial distal aspect of the tibia. Open plating of the medial aspect of the distal tibia caused a statistically significant ( < 0.05) greater disruption of the extraosseous blood supply of the metaphyseal region than did percutaneously applied plates. In each specimen, open plating prevented filling of each periosteal vessel in the region as opposed to percutaneous plates, which permitted filling of the extraosseous vessels up to the edge of the plate. CONCLUSIONS: The proximal and distal metaphyseal areas of the tibia have a rich extraosseous blood supply provided primarily by branches of the ATA and the PTA. Open plating of the medial aspect of the distal tibia caused a greater disruption of this extraosseous blood supply than did percutaneously applied plates. Disruption of these extraosseous vessels following fracture and subsequent operative stabilization may slow healing and increase the risk of delayed union and nonunion. These findings support current efforts to develop less invasive methods and implants for operative stabilization of distal tibia fractures.

Adult↗