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PubMed1988

A case report of malignant mesenchymoma with discussion of musculoskeletal tumor staging: the Enneking system.

A 54-year-old black man presented with a soft-tissue sarcoma of the left anterior thigh. Surgical staging studies and initial biopsy results identified the lesion as a grade IIB pleomorphic liposarcoma. After radical hip disarticulation, follow up pathologic studies of the disarticulated limb showed the tumor to be confined to the anterior compartment of the left thigh without extracompartmental extension. The post-excisional surgical pathology report identified at least four different malignant mesenchymal elements: liposarcoma, myosarcoma, chondrosarcoma, and extraosseous osteogenic sarcoma. The sarcoma was therefore reclassified as a malignant mesenchymoma. The fact that the tumor was found to be intracompartmental at the time of surgery changed the staging of the tumor to stage IIA. A radical surgical margin, as recommended by Enneking, remained the treatment of choice. Three months postoperatively, the patient had chest pain and dyspnea. Chest films revealed multiple pulmonary nodules and the patient died of pneumonia 3 months later.

Femur↗
PubMed2003

Chronic osteomyelitis in a Ugandan rural setting.

OBJECTIVE: To determine the incidence pattern and outcome of chronic osteomyelitis in a rural setting. DESIGN: A prospective descriptive study where a proforma was drafted to study all consecutive patients with features of chronic osteomyelitis over a period of six years, Clinical findings on presentation, treatment, duration of symptoms, initial treatment sought, operative treatment, post operative outcome and demographic data were all documented. SETTING: Mityana hospital, a rural 120 hospital bed, located in Mubende District. It serves Mubende district and the neighbouring districts of Mpigi, Sembabule, Kyenjojo, Kibale and Kiboga. The majority of the population in these districts are mainly peasants involved in cattle keeping and agriculture. PATIENTS: One hundred and twenty patients with chronic osteomyelitis were treated between June 1996 - June 2001. RESULTS: One hundred and twenty patients with chronic osteomyelitis seen in a period of six years, involving various bones of the body. Forty five percent were females, the highest incidence occurred in the age range of 10 - 19 years. The commonest a etiological history was by pricks. The bones most frequently affected were phalanges (43.3%) followed by the tibia (21.6%). Forty four percent of these patients first used local herbs before going to hospital. Fifty five percent of the patients were found to have a big spleen of not less than 12cm below the costal margin and the best treatment option was sequestrectomy and curretage with imperical administration of antibiotics. Complications observed on follow up were: cosmetically bad fingers where curretage and sequestrectomy were done. Distortion of the foot arches where the matarsals were disarticulated and persistent discharging sinuses. CONCLUSION: Chronic osteomyelitis is a debilitating dirty disease endemic in the peasantry communities. It persists because of delay in seeking medical treatment because the first line of treatment is mainly herbs where the terminal phalanges were involved. Sequestrectomy and curettage were a better option to disarticulation because the function of the finger is not interfered with. The biggest number of cases seen involved the phalanges (45.3%) followed by the tibia 21.6% because of the nature of occupation of the rural communities.

Adolescent↗
PubMed1999

Amputations and prosthetics.

The author presents in a condensed way an overview of the principles of limb amputations and further treatment of patients who underwent such a procedure. The metabolic cost of walking, load transfer, and wound healing are reviewed in a concise manner. Particular attention is given to blood supply to the wound and methods to determine adequate perfusion with a clear analysis of the pro and cons of the Doppler method. Pediatric amputations, because of their specificity, are considered apart. Disarticulation of limbs is the method of choice in children, because of it retains growth potential of the bone and prevents bony overgrowth of the stump. The article discusses the main indications for limb amputations: trauma, peripheral vascular disease, musculoskeletal tumors and gas gangrene. In every case the specificity of the amputation is considered by the author. Postoperative care is also presented, with a short description of possible complications. Pain is the most common and treatment strategies should be similar to those used in treating patients with major reflex sympathetic causalgia. Edema, joint contracture, wound failure and dermatologic problems are all shortly reviewed. The last part of the article treats with the principles of prosthetics in both the upper and lower limb. These principles are presented basing on the level of amputation: for the upper limb hand, transradial, transhumeral amputations and shoulder disarticulation. For the lower limb foot and ankle, transtibial and transfemoral amputations are considered.

Adult↗
PubMed1975

The Syme amputation in children.

Twenty-three children had proportionate growth of bone and soft tissue between two and eleven years after a Syme ankle disarticulation. All walked with permanent prostheses within three months after operation. Ischemic necrosis occurred twice after inadvertent ligation of the posterior tibial artery. Suture of the extensor tendons into the heel pad eliminated its posterior migration. Prosthetic realignment compensated for progressive genu valgum in ten of fourteen amputees with fibular hemimelia. On the basis of these gratifying results, the Syme ankle disarticulation is suggested as early treatment for certain congenital anomalies of the lower extremity.

Adolescent↗
PubMed1989

Rotational osteotomy for proximal femoral focal deficiency.

Thirteen patients who had a proximal femoral focal deficiency and were treated with a rotational osteotomy of the tibia (Van Nes procedure) were evaluated at an average of five years after operation. Five patients needed a repeat osteotomy of the tibia: four because the limb had spontaneously derotated toward the original position and one because the limb had had insufficient rotation at the time of operation. One patient had a disarticulation at the ankle after the first stage of a planned two-stage procedure because the mother was not happy with the child's appearance. In ten limbs, the distal femoral growth plate and epiphysis were removed and in two, the femoral epiphysis and growth plate and the tibial growth plate were removed so that the joint of the prosthetic knee would be positioned at the proper height at the completion of the child's growth. Neither growth plate was removed from one limb, the shorter one in the child who had bilateral involvement. A ten-point grading scale based on use and fit of the prosthesis, gait, range of motion of the ankle, use of external support, and final height of the ankle compared with that of the contralateral knee was used to evaluate the result, which was excellent in six patients, good in four, fair in one, and poor in one. One patient, who had a disarticulation at the ankle, was excluded from the final evaluation. Rotational osteotomy provided good function and acceptable cosmetic appearance in the patients who had unilateral involvement.

Ankle Joint↗
PubMed1986

Limb-salvage treatment versus amputation for osteosarcoma of the distal end of the femur.

A retrospective multi-institutional study of 227 patients with osteosarcoma of the distal end of the femur was done to compare rates of local recurrence, metastasis, and survival. Three cohorts of patients who had had either a limb-sparing procedure, an above-the-knee amputation, or disarticulation of the hip were compared. The results revealed prevalences of eight of seventy-three, nine of 115, and zero of thirty-nine as to local recurrence; forty-three of seventy-three, sixty-five of 115, and twenty-one of thirty-nine as to metastasis; and thirty-three of seventy-three, forty-eight of 115, and eighteen of thirty-nine as to death. Of the seventeen patients who had a local recurrence, sixteen died. In the limb-salvage group, eighteen patients required amputation, because of local recurrence in eight and other local complications in ten. The Kaplan-Meier estimates of the percentage of patients who survived and the percentage of patients without recurrent disease showed no difference among the three surgical groups (Mantel-Cox test statistic: p = 0.8) after a median length of follow-up of five and one-half years. Various covariant adjusted estimates yielded similar results. For the entire group of patients, the rate of continuously disease-free survival was 42 per cent, and the over-all rate of survival was 55 per cent at five years. It appears that, compared with above-the-knee amputation or disarticulation of the hip, the use of a limb-salvage procedure for osteosarcoma of the distal end of the femur did not shorten the disease-free interval or compromise long-term survival.

Adolescent↗
PubMedDate not supplied

Major lower extremity amputation in patients with peripheral arterial insufficiency with special reference to the transgenicular amputation.

The selection of the proper level for lower extremity amputation in patients with advanced arterial ischemia poses a multiplicity of problems with regard to operative mortality, stump healing, re-amputation rate and rehabilitation status. In a retrospective study all these parameters have been evaluated in 413 patients submitted to below-knee (bk, n = 196), transgenicular (tg, n = 93) and above-knee (ak, n = 124) amputation between 1971 and 1980. As compared to the ak resection, the bk amputation has the following advantages: lower operative mortality (9% vs. 30.5%), higher prosthetic fitting rate (85% vs. 66%) and significantly improved rehabilitation (walking with artificial limb: bk 84%, ak 22%). Regarding surgical mortality (8.5%) and prosthetic gait (66%), the tg amputation was nearly equivalent to the bk resection and turned out to be clearly superior to the ak amputation. As compared to the latter procedure, knee disarticulation and bk amputation had a greater risk of delayed wound healing and re-amputation at a higher level (ak: 13.5 resp. 1%, tg: 22.5 resp. 25%, bk: 35% resp. 16%). The patient with a bk amputation has the best prospect concerning a successful rehabilitation. Whenever the very important knee joint cannot be saved an ak amputation should be avoided in favour of a knee disarticulation.

Adult↗
PubMed1987

New bone formation at amputation sites in electrically burn-injured patients.

Sixty-one amputation sites in 43 electrically injured men were examined for significant new bone formation. Twenty-eight amputations were classified as long bone (6 above knee, 4 below knee, 4 above elbow, 14 below elbow); 28 small bone (9 hand or finger and 19 foot or toe); and 5 disarticulations. Significant new bone formation occurred at the amputation site in 23 (82%) of the 28 long bone cases, but none occurred in the small bone or disarticulation cases. This difference was significant at the 0.0001 level (chi square = 40.53, 2 df). Fourteen (78%) of upper and nine (90%) of lower extremity sites had significant new bone formation. The average time from amputation to diagnosis of new bone was 38 weeks, range from 5 to 110 weeks. Eight of these 23 patients required surgical revision of the stump and/or revision or reconstruction of their prosthesis. Clearly, the ability to predict new bone formation in electrical burn amputees has important clinical and economic applications.

Adolescent↗
PubMed1986

Experimental study of postmortem change under field conditions: effects of freezing, thawing, and mechanical injury.

Understanding the processes of postmortem change in biologic systems is important to the forensic sciences. Previous experimental studies of postmortem change in animals under field conditions made use of animal carcasses that had been incidentally exposed to the effects of freezing and thawing or mechanical damage, or both, and were limited to gross observations. The current study was designed to document intrinsic processes of postmortem change, and the effects of freezing-thawing and mechanical injury, under controlled conditions in the field, using histologic and microbiologic techniques, as well as gross observation. Insect and microbiologic succession sequences, and patterns of decomposition and disarticulation, were observable over time. Previously frozen-thawed animals showed predominantly decay (aerobic decomposition) in the field, while freshly killed animals showed predominantly putrefaction (anaerobic decomposition). Previously frozen animals showed the same sequence, but accelerated rates, of disarticulation. Mechanically injured tissues showed accelerated rates of decomposition. These findings have implications for the interpretation of results of previous studies, as well as the interpretation of human and animal remains subjected to freezing and thawing.

Animals↗
PubMed1985

[Biological characterization of a hamster osteosarcoma Os 515--development of lung metastasis].

Biological characterization of a transplantable hamster osteosarcoma Os515 which had been induced by BK virus was attempted, and usefullness of this tumor was confirmed as an experimental model of treatment of osteosarcoma. All the hamsters with this tumor died of spontaneous lung metastasis. The chest X-ray picture of a tumor-bearing hamster visualized diffuse metastasis in the whole lungs 30 days after transplantation. The development of lung metastases was monitored by chest X-ray after marginal excision of subcutaneously transplanted tumors or after radical disarticulation of a tumor-bearing hind limb. Slow-growing nodular lung metastases were seen on X-ray pictures when the subcutaneous tumors were resected 1 or 2 weeks after transplantation, whereas fast-growing diffuse metastases were seen when the tumors were not resected at all or resected 3 weeks after transplantation. Nodular lung metastases occurred in a small number of animals long after the early radical disarticulation of a tumor-bearing leg.

Animals↗
PubMed1985

[Extensive resection of the hip for suppurative arthritis in the paraplegic. Evaluation of 170 cases].

Trochanteric or ischial sores in paraplegia may lead to suppurative arthritis of the hip, followed by anaerobic infection, septicaemia, gangrene and amyloidosis. In 121 patients this complication was bilateral in 49. Extensive resection of the hip and the upper quarter of the femur avoided surgical disarticulation of the limb. This type of correction makes it possible to treat hip infection and to perform muscle and skin plastic procedures. The operation was performed 170 times in the course of twenty years. Post-operative care must be very precise to allow organisation of the new arthrosis and to prevent ossification. Seven patients died. Five disarticulations had to be performed secondarily despite the resection. The results were satisfactory in the remaining patients from the point of view of suppuration and the procedure provided satisfactory adaptation to a wheelchair. Only five cases developed a disabling hip ankylosis.

Adolescent↗
PubMedDate not supplied

[Methods of treatment of tumors of the soft parts and bones of the limbs and extremities. Analysis of case records].

218 patients examined for localized cancer of the extremities (50% benign, 50% malignant) are reported. The incidence is considered by sex and age. Demolition surgery was carried out in 35 patients and 27 locoregional treatment with antiblastics and radioactive isotopes was employed. Conservative surgery was used in 158. Operative mortality was less than 1% (2 cases out of 218) and did not reach 6% if amputations and disarticulations alone are considered. There were no deaths in cases submitted to radiochemotherapy and inguinocrural hymphadenectomy. The series includes a 15-years survival for giant-cell tumour of the femur treated with radioactive microsphores, an 11-years survival for a popliteal melanoma submitted to radiocolloid infiltration, a 9-year survival for femoral osteosarcoma for which hip disarticulation was carried out and a 4-year survival for a recurrent rhabdomyosarcoma of the hip operated by hemipelvectomy.

Adolescent↗
PubMed1993

Parosteal (juxtacortical) chondrosarcoma of the humerus associated with regional lymph node metastasis. A case report.

Recurring parosteal (juxtacortical) chondrosarcoma of the humerus occurred in a 79-year-old man. Roentgenograms of the left humerus showed minimal cortical irregularity and a large soft tissue mass without calcification or periosteal reaction. Magnetic resonance imaging (MRI) showed a multilobular tumor of high intensity (T2-weighted imaging) without marrow involvement. During the left shoulder disarticulation an enlarged axillary lymph nodes was discovered and removed. Macroscopic examination of the disarticulated humerus showed a large yellow parosteal mass, which looked like cartilage, completely surrounding the humeral shaft. The marrow cavity was almost normal except for a small erosion at the site of the olecranon fossa. The histologic diagnosis of the mass was Grade 2 chondrosarcoma of parosteal (juxtacortical or periosteal) origin associated with regional lymph node metastasis. The features that made this case unique were a long history of the tumor (for 32 years), minimal cortical destruction of the bone by the tumor, and regional lymph node metastasis. This case illustrates the differential diagnosis of the parosteal chondrosarcoma from periosteal osteosarcoma and extraskeletal myxoid chondrosarcoma.

Aged↗
PubMedDate not supplied

Neonatal gangrene of the extremities.

Vascular insufficiency of a peripheral limb is a well-recognized and serious complication occurring in newborn infants. A 15-year review of a Level III neonatal intensive care unit at The Children's Hospital of Eastern Ontario revealed 10 infants who had a vascular insult to a limb necessitating the amputation of a portion of the limb. Predisposing factors to vascular occlusion were prematurity, polycythemia, umbilical artery catheterization, and intensive care treatment for other life-threatening illnesses. The lower extremity was most commonly affected, requiring below-knee amputations in two infants, knee disarticulation in one, and toe amputations in five. The remaining infants required an elbow disarticulation and amputation of the fingers, and one child had a massive ischemic contracture of the lower limb. Care should be taken not to amputate prematurely and await definitive demarcation of the gangrenous portion. Amputation should be designed to preserve growth plates wherever possible to ensure an adequate stump for prosthetic fitting in the older child.

Algorithms↗
PubMed1994

[Foot deformities in longitudinal ectromelia of the lower limbs].

We have studied 204 feet in 181 children with congenital limb shortening. There were 17 short femurs in 11 children in whom it was impossible to lengthen the leg. Thirteen feet were abnormal. It was necessary to adapt the foot to fit the chosen prosthesis. In 34 children it was possible to correct the length of the short femur. In 21 the feet were normal. 13 had abnormal feet associated with fibular aplasia and deformities included equinovalgus, hind foot synostosis, and deficient rays. In 72 children with congenital hypoplasia or aplasia of the fibula, 76 feet were affected. The function of the foot depends on attaining a stable position beneath the tibia. In 34 children (35 feet), the feet were in a stable position. There were 22 ball and socket ankle joints. Before carrying out leg lengthening, operation was necessary on 9 feet, and a further 13 required operation after lengthening had been carried out. In 34 children (41 feet) there was fibular aplasia. The feet lay in equinovalgus and were often narrow. Only 5 did not have a degree of synostosis. Twenty-three feet in twenty two children were operated on with early soft tissue release, tendon transfer and tibiotalar arthrodesis. This is our treatment of choice. Twenty-seven children had tibial dysplasia which affected 37 feet. The feet lay in equinovarus and in 5 there was partial diplopodia. In the absence of a tibia (19 feet) disarticulation of the knee was carried out. In 12 there was proximal shortening of the tibia which in 9 cases was treated by tibiofibular union. It was possible to retain only 2 feet in a proper position in a lengthened leg. In 30 children (33 feet) both fibular and tibial hypoplasia was present. The feet functioned well. There were 22 ball and socket ankles, 28 narrow feet and numerous synostoses. In limbs with atypical dysplasia 7 abnormal feet were noted. If it is possible to preserve or lengthen the limb it is vital that the foot is retained in a stable position beneath the tibia in order that satisfactory function be obtained. If limb lengthening is impossible, the foot must be adapted to match the prosthesis.

Adolescent↗
PubMed1988

Amputation of the little finger.

We review 17 patients who had 21 amputations of the little finger. Transmetacarpal amputations gave satisfactory results in older patients, but in young patients loss of breadth of the palm caused significant disability. Disarticulation through the metacarpophalangeal joint is recommended in younger patients.

Age Factors↗
PubMed1997

Ewing's sarcoma of the thumb.

The case of a 51-year-old man with Ewing's sarcoma of the thumb is presented. The tumor involved the distal phalanx of the right thumb, associated with an impressive extraskeletal mass. Histology revealed a round cell sarcoma with a positive immunoreactivity with monoclonal antibody O13. Five years after disarticulation at the metacarpophalangeal joint, the patient is alive without recurrence or metastasis.

Bone Neoplasms↗
PubMed2004

Concomitant double epiphyseal injuries of the tibia with vascular compromise: a case report.

A rare case of double epiphyseal injuries in the same tibia is reported. A 4-year-old child was struck by a vehicle and presented with the above fractures and vascular compromise to the extremity. Following localization of the vascular occlusion level by arteriography, popliteal vessel anastomosis was attempted. The vascular repair failed, resulting in disarticulation through the knee. Simultaneous displaced proximal and distal epiphyseal injury in the same tibia has not been previously reported in the literature. The most serious complication of injury to the proximal tibia is vascular compromise. A delay in recognition or intervention in such cases can be devastating.

Child, Preschool↗