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PubMedDate not supplied

[Technical surgical possibilities for preserving an end-bearing knee exarticulation stump in skin necrosis].

Disarticulation of the knee results in an excellent end-bearing stump. Operative technique is easy, fast and gentle. The muscular balance in the femur is not disturbed. The shape of the stump provides excellent rotation control in the prosthesis. New socket designs and prosthetic knee mechanisms have eliminated the former cosmetic problems concerning this amputation level. Nevertheless--because of external rotation of the femur, poor skin quality or wound closure under tension skin necrosis can occur, most of the times concerning the lateral condyle region. Several operative possibilities to get a satisfactory wound closure while preserving the advantages of this stump are presented.

Artificial Limbs↗
PubMed2002

Influence of rotators on the kinematic adaptations in stubby prosthetic gait.

We report on the results of gait analysis in a patient with bilateral knee disarticulation amputations who used short nonarticulated prosthetic limbs (stubbies) to meet his ambulation needs over an extended period. To compensate for the loss of knee and ankle articulations, exaggerated pelvic obliquity (hip hiking), transverse pelvic rotation, and hip abduction were needed to ensure limb clearance and a functional step length. The addition of rotators to the prostheses improved gait velocity and reduced the perceived exertion of walking by favorably altering center of mass energetics.

Adult↗
PubMed1996

Clonazepam for the treatment of lancinating phantom limb pain.

OBJECTIVE: To propose clonazepam for use in the empiric treatment of shooting/shocking phantom limb pain. SETTING: Outpatient pain clinic associated with a university hospital. PATIENTS: Two patients with phantom limb pain after total hip disarticulation. INTERVENTIONS: Treatment with clonazepam. RESULTS AND CONCLUSIONS: Clonazepam provided effective relief for > 6 months in two patients with shooting/shocking phantom limb pain. Although clonazepam therapy is not new, it appears to have been omitted from current pain texts and journals as a treatment option for phantom limb pain.

Aged↗
PubMed2006

Effect of physical fitness on prosthetic ambulation in elderly amputees.

OBJECTIVE: To evaluate the physical fitness and prosthetic ambulation ability of high-level (hip disarticulation, transfemoral) lower-limb amputees aged 60 and above, and to investigate the level of fitness required for successful prosthetic ambulation. DESIGN: The test subjects were 49 amputees aged 60 and above. Subjects were permitted to use any necessary ambulatory aids and were asked to walk at their most comfortable walking speed for evaluation of prosthetic ambulation ability. An incremental exercise test was performed to evaluate physical fitness. RESULTS: The average %VO(2max) value for the successful user group was 64.4%, and the average %VO(2max) value for the failed user group was 44.8%, a statistically significant difference (P < 0.01). Of the amputees with %VO(2max) > or =50, 93.7% were in the successful user group. Of the amputees with %VO(2max) <50, only 23.5% were in the successful user group. CONCLUSION: This study showed that the ability to sustain an exercise intensity of > or =50%VO(2max) can be regarded as a guideline value for the level of fitness required for successful prosthetic ambulation in elderly amputees.

Aged↗
PubMedDate not supplied

Fibular transfer for congenital absence of the tibia: a reassessment.

Six children (nine limbs) underwent fibular centralization for complete paraxial tibial hemimelia. The preoperative, intraoperative, and postoperative criteria as described by Brown (J Bone Joint Surg [Am] 1965; 47:695-704) were strictly met. At initial postoperative evaluation, three limbs had active knee extension, and five limbs had minimal flexion contractures. However, at final follow-up, 20-123 months later, all knees had ligamentous instability and poor active range of motion; eight had significant flexion contractures. All were classified as poor results. Based on this series and other reports, it is recommended that knee disarticulation instead of fibular centralization be performed for complete paraxial tibial hemimelia, preferably within the first year of life.

Child, Preschool↗
PubMedDate not supplied

Focal scleroderma in children: an orthopaedic perspective.

Focal scleroderma is a connective-tissue disorder manifested by fibrosis of the skin and subcutaneous tissues. Consequently, it may be associated with joint contractures, extremity deformity, and impairment of extremity function. It has a variable clinical course, with both remissions and recurrences. In resistant cases of extremity involvement, treatment considerations should include physical and occupational therapy, medical treatment, bracing, serial casting, and surgical intervention. We reviewed seven patients treated between 1960 and 1990 with significant joint contractures secondary to focal scleroderma. Serial casting was found to be useful for contractures about the wrist, knee, and ankle. Soft-tissue release was an effective treatment for contractures at the wrist, hip, and ankle. Knee disarticulation was performed on one patient with a severe knee-flexion contracture. Epiphysiodesis and femoral shortening osteotomy were effective treatments for leg-length equalization in a case of hemiatrophy.

Adolescent↗
PubMed1990

Plexiform neurofibromatosis: a difficult surgical problem.

A severe case of plexiform neurofibromatosis with elephantiasis neuromatosa involving the right lower limb and pelvis, leading to a right hip disarticulation, is reported. Abnormal vasculature can make surgical intervention hazardous.

Adult↗
PubMed1993

Arrhythmogenic right ventricular dysplasia: an uncommon cause of ventricular tachycardia in young and old?

Right ventricular dysplasia is a little understood condition and is almost certainly underdiagnosed as an important cause of recurrent ventricular tachycardia and sudden death. This report describes two patients with right ventricular dysplasia. Their clinical presentation reflects the remarkable diversity of the disease while the potentially life-threatening nature of their arrhythmias and their lack of response to medical treatment justified the antiarrhythmic surgical procedure of right ventricular disarticulation.

Adolescent↗
PubMed2003

A feasibility trial of a prefabricated immediate postoperative prosthetic limb system.

In this feasibility trial, 32 consecutive patients undergoing transtibial or knee disarticulation amputation had application of a prefabricated immediate postoperative prosthesis in the operating room following lower extremity amputation. Partial weightbearing was initiated on the first postoperative day. Twenty-nine underwent primary amputation as a consequence of nonsalvageable gangrene or diabetic foot infection. Others were performed at the time of wound closure following traumatic amputation for a crushed extremity and one was performed for an infected nonunion of the tibia and fibula. Seventeen of the 29 patients with diabetes were insulin dependent. Nine patients required renal dialysis and were diagnosed with concurrent malnutrition. Twenty were male and 12 were female, with an average age of 61.6 (range, 42-90) years. The average time to custom prosthetic limb fitting was 8.1 (range, 4-16) weeks. This preliminary experience with a commercially available pneumatic immediate postoperative prosthetic limb system supports its role in the early rehabilitation of lower extremity amputees.

Adult↗
PubMed1980

Local recurrence after amputation for osteosarcoma.

Two hundred and forty-eight high-grade central osteosarcomata were treated by amputation or disarticulation; in 5.2 per cent the tumour recurred at the amputation site. The following causes may be responsible for local recurrence: the level of the amputation is too close to the tumour; there is an unrecognised intramedullary extension of the tumour; during a previous block resection tumour cells may have been seeded in the soft tissues; the primary tumour was too extensive even for radical surgery; "skip" metastases may have been present; iatrogenic tumour implantation may have occurred while a biopsy was being performed during the course of an amputation. Treatment of the primary osteosarcoma should take all these possibilities into account. In our experience adjuvant chemotherapy has not significantly changed the frequency of local recurrences which should be treated by radical operation or, if this is not possible, by irradiation; chemotherapy may be used as an adjuvant. The prognosis of local recurrences is bad.

Adolescent↗
PubMed1994

Limb salvage compared with amputation for osteosarcoma of the distal end of the femur. A long-term oncological, functional, and quality-of-life study.

The outcome of treatment of nonmetastatic high-grade osteosarcoma in the distal part of the femur was studied in 227 patients from twenty-six institutions. Eight of the seventy-three patients who had had a limb-salvage procedure and nine of the 115 patients who had had an above-the-knee amputation had a local recurrence, but there was no local recurrence in the thirty-nine patients who had had a disarticulation at the hip. There were no significant differences in the rate of survival or in the duration of the postoperative disease-free period between the three groups. One hundred and nine patients (48 per cent) were alive at an average of eleven years after the operation, and ninety patients (40 per cent) remained continuously disease-free. An additional operation on the limb was necessary more often for patients who had had a limb-salvage procedure than for those who had had an amputation. Function in seventy-eight living patients was assessed with the system of the Musculoskeletal Tumor Society for evaluation of function and by the functional assessment portion of the 1989 scoring system of the Knee Society; the scores were higher for the patients who had had a limb-salvage procedure than for the two groups of patients who had had an amputation. No difference was identified between the groups with regard to the patient's acceptance of the postoperative state, the ability to walk, or the amount of pain. The quality of life was evaluated for twenty-nine patients with a series of complex questionnaires.(ABSTRACT TRUNCATED AT 250 WORDS)

Adaptation, Psychological↗
PubMed1977

Muscle blood flow after amputation with special reference to the influence of the amputation level. Assessed by 133 xenon and histamine. An animal experiment.

Amputation on rabbits was found to change the muscle blood flow (MBF) in the limb subjected to surgery as well as in the contralateral extremity, depending on the technique used for amputation and the level at which it was carried out. Amputation was immediately followed by a reduction in MBF in the stump. After amputation of the crus and knee disarticulation, the flow was normalized a few days later and exceeded the preoperative mean flow. After amputation of the femur such an increase in flow was not seen, but when osseous plugging of the medullary cavity was applied, the MBF in the stump was intensified even after amputation of the femur.

Amputation, Surgical↗
PubMed1979

Adamantinoma tibiae.

A case with characteristic roentgenographic and microscopic findings of adamantinoma tibiae is reported. Knee disarticulation with early ambulation is the treatment of choice and was performed on this patient. Limb ablation followed by Unna Paste Bandage to prevent oedema and permit early prosthetic fitting facilitates rehabilitation. The 1 year follow-up showed excellent prosthetic function and no evidence of residual tumour.

Adult↗
PubMed1999

[Intraoperative sectional anatomy of congenital absence of tibia type I A].

Intraoperative, angiographic and preparation findings within lower leg and foot of a child with tibial hemimelia type IA according to Jones are presented. Disarticulation at the knee has been performed bilaterally. Dysplasia of the distal femur, absence of the patellae, extensor apparatuses and cruciates were found. Amputated preparation revealed fibrotic band attached via interosseus membrane to the fibula, presence of unidentified muscle attached to the tip of the lateral malleolus, doubled tibialis anterior muscle on one side and accessory extensor digiti II. Talocalcaneal synostosis was bilateral, abnormal cuboids and accessory bones were found. Popliteal artery division was found at the mid-length of the fibula. Unidentified thick nerve passed the lateral ankle and divided at the sole of the foot.

Disarticulation↗
PubMed2000

[Syme amputation of the foot--is it appropriate for foot infections in diabetics?].

Syme ankle disarticulation for foot infections in diabetics with concomitant peripheral vascular disease is often unsuccessful. The need for re-amputation usually results from recurrent infection or ischemia of the posterior heel flap. We present 5 such cases of deep foot infections in diabetics who underwent Syme amputation after failure of local debridement. All patients needed reamputation in 4-18 days for ischemia of the flap.

Adult↗
PubMed2003

Controversies in amputation surgery.

Amputation surgery should be the first step in the rehabilitation of a patient with a nonfunctional limb, rather than the final step in treatment. When faced with a difficult decision regarding lower extremity amputation compared with attempted limb reconstruction, expectations for a reasonable outcome must be determined. After reasonable goals have been set, the surgery should be directed toward interfacing with a prosthetic limb. Current surgical techniques of lower extremity amputation, paying special attention to transosseous versus disarticulation amputation, help to optimize prosthetic limb fitting and functional rehabilitation. With the evolution of end-bearing amputation levels, there is resurgent interest in the bone bridging technique of Johann Ertl and interest in a new pneumatic immediate postoperative prosthetic limb fitting system.

Amputation, Surgical↗
PubMed2006

Orthopedic management of decubitus ulcers around the proximal femur.

Decubitus ulcers, commonly known as pressure ulcers or sores, represent localized areas of tissue necrosis. Despite increased awareness and use of preventive measures, these ulcers remain a major concern in the hospitalized and immobile patient population. When the hip joint becomes infected or the wound remains refractory to nonsurgical treatments, the orthopedic surgeon becomes involved in patient care. In this review, a brief overview of decubitus ulcers and their nonsurgical management is given, followed by a discussion of various flaps used in more extensive repairs. The major orthopedic procedures presented include proximal femoral resection (Girdlestone procedure), hip disarticulation, and hemipelvectomy. These surgeries retain an important position in managing complicated decubitus ulcers around the proximal femur.

Disarticulation↗
PubMedDate not supplied

[Lymphangiosarcoma following mastectomy: review of the literature apropos of 2 recent cases of Stewart-Treves syndrome].

Two cases of lymphangiosarcomas which arose 4 and 14 years after a mastectomy are reported (Stewart-Treves syndrome). One of the patients was treated by shoulder disarticulation and the other by chemotherapy (using Melphalan, Cyclophosphamide and 5-fluorouracil). Disseminated metastases and deaths occurred 6 and 18 months after the onset of the lesion. Stewart-Treves syndrome occurs in approximately 0.07 to 0.45% of mastectomy. Prognosis is worse: survival at five year is fewer than 10%. Early diagnosis is mandatory. Surgical resection of the lesions and adjunctive chemotherapy seem the best treatment.

Aged↗