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PubMed2000

Lower limb deficient children in The Netherlands: epidemiological aspects.

Information on the characteristics of children with limb deficiencies and amputations in The Netherlands is largely lacking. The present study aimed to collect data about the prevalence of congenital deficiencies, the ratio of congenital to acquired limb deficiencies, types of lower leg deficiency or amputation and male/female ratios. Data were obtained from a regional birth defects registry for the northern part of The Netherlands (EUROCAT-NNL) and from a national survey. Inclusion criteria for the selection of the EUROCAT data were: children/foetuses with lower leg deficiencies born in 1981-1986. Inclusion criteria for the survey data were: children aged 1-18 years with congenital deficiencies or acquired amputations of the leg, excluding toe deficiencies/amputations. Both the regional birth defects registry and the national survey only yielded small numbers of children, which limits the validity of the authors' findings. The Eurocat data show a prevalence of lower leg deficiencies at birth of 2.07/10,000. Fifty-five (55) children/foetuses were included in the present study. The male/female ratio was 1:1. Of the live-born children, 30% also had defects of the upper limbs, while 38% had bilateral lower limb deficiencies. The national survey included 89 children, of whom 73% had congenital deficiencies, while the others had undergone amputations: of which 37% were due to malignancies, 29% to traumata, 13% to infections and 21% to other pathology. The male/female ratio was 7:3 for the children with congenital deficiencies versus 6:4 for the children with acquired amputations. In the group of congenital deficiencies, fibula deficiency was most frequently seen (36%), while in the group with acquired amputations trans-femoral amputation, knee disarticulation and trans-tibial amputation were seen with equal frequency (21%). In 40% of the children with congenital deficiency and in 8% of the children with acquired amputations the arm was also affected. Both legs were affected in 37% of the children with congenital deficiencies and in 8% of the children with acquired amputations.

Adolescent↗
PubMed2000

Amputees in Limburg: incidence, morbidity and mortality, prosthetic supply, care utilisation and functional level after one year.

OBJECTIVES: To describe for the province of Limburg, the Netherlands, the incidence of lower limb amputation (LLA), the demographic characteristics of the amputees, reason and level of amputation, care the amputees receive, prosthetic supply and functional level after one year. DESIGN: A prospective descriptive cohort study. METHODS: Anonymized data on all amputees in all nine hospitals were collected during 1994. Follow-up was one year. RESULTS: 191 major lower limb amputations in 164 patients. Incidence was 17.1 per 100,000. Amputation levels: 77 trans-tibial, 52 transfemoral and 43 knee disarticulation. Twenty (20) patients died during hospitalisation. Eighty-seven (87) amputees gave permission for followup, 60 could be actually followed. Twenty-two (22) patients received in-patient rehabilitation, 16 primary day-care, 21 went to a nursing home and one went home without rehabilitation. The mean duration of rehabilitation was 35 weeks. In 53 patients a functional prosthesis was indicated. Forty-three (43) of these patients walked with the prosthesis after one year, 7 of whom more than 500 metres. Nineteen (19) amputees performed the Get Up and Go Test (GUGT) safely. Amputees on average have a low level of functioning, as indicated by SIP68 and Barthel Index Scores. The ability to walk is closely related to this daily function and quality of life. CONCLUSION: After one year the majority of amputees have low walking skills and the walking distance is limited. They are often ADL-dependent and their amputation greatly limits their daily function.

Activities of Daily Living↗
PubMed2003

Prosthetic prescription in the Netherlands: an observational study.

Prosthetic prescription for lower limb amputees and the methodology used are primarily based on empirical knowledge. Clinical expertise plays an important role that can lead to an adequate prescription; however, a clear evidence based motivation for the choices made cannot be given. This can lead to local prescription variations with regard to overuse or underuse of prosthetic care and a lack of transparency for consumers and health insurance companies. Hence a clinical guideline may lead to a more consistent and efficient clinical practice and thus more uniformly high quality care. The purpose of this study was to get insight into potential similarities in prescription criteria in clinical practice in the Netherlands. Secondly, the authors were interested to know if prosthetic prescription was primarily based on the level of activity or intended use of the prosthesis. As part of the development of a consensus-based clinical guideline a multi-centred, cross-sectional study was carried out in order to observe the prosthetic prescription for a group of lower limb amputees. Therefore prescription data were collected from 151 amputees with trans-femoral amputation, knee disarticulation or trans-tibial amputation. Results of the multiple logistic regression show no relationship between the activity level and any of the variables included in the equation such as the hospital or medical doctor in Physical and Rehabilitation Medicine (MD in P&RM), prosthetic components, age of the amputee or reason of amputation. The criteria used are merely based on the clinical expertise and local experience whereas the actual prescriptions differ from location to location. In conclusion the development of a clinical guideline for prosthetic prescription in lower limb amputation is recommended. The information gained from this observational study will be used in a clinical guideline procedure for prosthetic prescription in the Netherlands.

Aged↗
PubMed2003

Lower limb proximal amputation for a tumour: a retrospective study of 12 patients.

OBJECTIVE: To analyse survival, prosthetic fitting and functional status after trans-femoral amputation or hip disarticulation for a primitive tumour. METHODS: Retrospective study of all patients admitted since 1985. RESULTS: Mean age at amputation was 55. Causes of amputation were osteosarcoma in 50%. Eight (8) patients had initial conservative surgery. Local recurrence was never observed. Nine (9) developed metastasis and required further hospitalisation. Fifty percent (50%) of patients died. Inpatient rehabilitation started 14 days after amputation (7-27), and was of a mean duration of 32 days. Prosthetic fitting was performed 13 days after admission (7 days when a liner was used). Further improvement of the prosthesis was performed in 10 patients. Among the patients who died, 5 had gone home, 4 were wearing their prosthesis all day long and 2 walked indoors with no additional support at discharge. Three (3) patients lived less than 2 months at home. Among the patients who did survive, all went home, 5 were wearing their prosthesis all day long and 2 walked indoors without aid at discharge. Two (2) patients practised sport and 4 drove. All the patients who were active have gone back to work. CONCLUSIONS: Gain due to prosthesis provision is undebatable. Good functional results can be obtained with adapted materials. Initial problems due to the synchronisation of treatments are resolved with multidisciplinary care. All patients should have a rapid and short hospitalisation in a rehabilitation unit and receive a first, simple prosthesis that can be further adapted.

Adult↗
PubMed2005

Are Canadian prostheses used? A long-term experience.

The Canadian prosthesis is indicated for the more proximal levels of amputation of the lower limb (very short trans-femoral, hip disarticulation and hemipelvectomy cases); it is frequently rejected by many patients for different reasons (awkwardness, intolerance of the socket, excessive energy expenditure to ambulate among others). The objective was to analyse the use or rejection of Canadian prostheses (n = 23) after an 8-year follow-up study (range: 2 -16 years). The sample consisted of 52% men and 48% women, and the average age at the time of amputation was 52.26 +/- 19.71 SD years (range: 1-74 years). The most frequent aetiology was malignant tumour (56.5%). Eight of the subjects continued to use the prosthesis through the entire study (34.7%). Gender, age, and aetiology were not significant determinants of use. The daily use was 12.5 h per day. The rejection of the Canadian prosthesis was after 20 months of use (range: 2-48 months), and the main reasons were death (all tumour causes), intolerance to the socket, or difficulty in ambulation. In conclusion, many years after their discharge from rehabilitation services, more than one-third of the sample (34.7%) were wearers of the Canadian prosthesis.

Adolescent↗
PubMed2006

A descriptive study of traumatic lower limb amputees from the Hospital Hel Trabajador: clinical evolution from the accident until rehabilitation discharge.

The purpose of the study was to describe the demographics, the causes of amputations, the amputation levels, the clinical outcomes, the durability of prostheses in unilateral lower limb amputee among workers entitled to non-state related work insurance, the ACHS, Chile, between 1974 and 2001. It was a retrospective descriptive study based on selected clinical files. One hundred files, with the minimal data required, were selected with a diagnosis of traumatic lower limb amputation, the levels ranging from Boyd's foot amputation to hip disarticulation, as defined by the Occupational Accidents Act from 1974 to December 2001. The mean age was 35.5 years, 96% were males, with an average follow-up of 7.7 years. In 50% of the cases the education level did not exceed elementary school. Ninety-eight percent were blue collar workers. The traumatic injury resulting in amputation took place during work in 89% of the cases the main causes being crushing injury (50%), traffic accident (19%), run over by car (14%) and burns (6%). The most common amputation levels were trans-femoral (40%) and trans-tibial (47%). Amputations were performed within the first 24 h in 49% of the cases. The hospitalization stay reached 8 weeks in 56.7%. Early complications were dehiscence (9.4%), superficial infection, (14.6%) and deep infection (26%). Late complications detected were soft tissue lesions (34.1%), exostosis (3.6%), painful neuroma (12.5%) and phantom limb pain (12.5%). Prostheses durability was on average 3 years. The average period to resume work was 1 year for 60% of the cases.

Accidents, Occupational↗
PubMed2004

Strength and endurance training of an individual with left upper and lower limb amputations.

PURPOSE: The purpose of this article is to describe the development of a strength and endurance training programme designed to prepare an individual with a left glenohumeral disarticulation and transtibial amputation for a bike trip across the USA. METHOD: The subject was scheduled for training three times per week over a two-month period followed by two times per week for an additional two months. Training consisted of a resistance training circuit using variable resistance machines, cycling using a recumbent stationary bike, and core stability training using stability ball exercises. Changes in strength were assessed using 10 RM tests on the resistance machines and changes in peak VO(2) were monitored utilizing the Cosmed K4b pulmonary function tester. RESULTS: The subject demonstrated a 30.3% gain in peak VO(2). The subject's 10 RM for left single limb leg press increased 36.8% and gains of at least 7.7% were seen for all other muscle groups tested. CONCLUSION: The strength and endurance training programme adapted to compensate for this subject's limb losses was effective in increasing both strength and peak VO(2). Adapting exercise programmes to compensate for limb loss may allow individuals with amputations to participate in physically challenging activities that otherwise may not be available to them.

Adult↗
PubMed1977

Atypical fibrous histiocytoma of the humerus: a light and electron microscopic study.

A unique osseous tumor, which arose in the humerus of a 44-year-old white man, is reported. The lesion was designated atypical fibrous histiocytoma because of the absence of atypical mitoses despite prominent nuclear pleomorphism of tumor cells. The tumor was composed mainly of spindle cells, tightly packed in a storiform pattern. Clear histiocytes and tumor giant cells were occasionally seen. Toward the proximal and distal ends, the tumor showed increasing fibrogenesis, and the ends were composed of areas of packed clear histiocytes and acellular myxoid matrix with focal calcification. Ultrastructurally, five cell types comprised the tumor, but fibroblast-like cells predominated. Histiocyte-like, xanthomatous, giant and undifferentiated cells were observed only occasionally. The patient has been followed for five years after disarticulation without developing evidence of distant metastasis.

Adult↗
PubMed1996

Chromoblastomycosis caused by Exophiala spinifera.

We report the second case of chromoblastomycosis caused by Exophiala spinifera; this is the first known case in the United States. Examination of biopsied tissue showed thick-walled, internally septated, chestnut brown muriform cells (sclerotic bodies) within multinucleated giant cells present in the dermis that were characteristic of chromoblastomycosis. The individual cells within the muriform cells disarticulated from the outer wall of the parent cell and from each other to form endoconidia within the outer walls of the parent cells. After fracture of the outer walls, the endoconidia were released. This unique process of endoconidial formation in vivo for the propagation of muriform cells was observed for the first time. Initial treatment with itraconazole and 5-fluorocytosine followed by treatment with itraconazole and heat resulted in marked improvement in the patient's lesions. This infection reiterates the fact that the dematiaceous fungus E. spinifera, a well-known etiologic agent of phaeohyphomycosis, can cause more than one type of infection and supports earlier observations that chromoblastomycosis and phaeohyphomycosis represent extremes of a continuum of infections.

Antifungal Agents↗
PubMed2005

MHC II+ CD45+ cells from synovium-rich tissues of normal rats: phenotype, comparison with macrophage and dendritic cell lineages and differentiation into mature dendritic cells in vitro.

Synovial tissues are frequent sites of inflammatory disorders in which dendritic cells (DCs) may play an important role. This study examines potential antigen-presenting cells obtained from synovium-rich tissues (SRTs) by vascular perfusion of rat hind limbs with collagenase and further enzymatic digestion of the disarticulated hind paws in vitro. The three sub-populations of interest were: CD45+MHC IIhi, mainly CD11c+ and CD163-; CD45+MHC IIlo, mainly CD11c- and CD163+ and CD45+MHC II-, mainly CD11c- and CD163+. Expression of CD11c and CD163 correlated with ruffled cell-surface (CD11c+CD163-) and highly vacuolated cytoplasm (CD11c-CD163+), respectively. Culture of the CD45+CD163- sub-population in granulocyte macrophage colony-stimulating factor (GM-CSF) yielded CD45+MHC IIhi CD11c+CD163- cells with veiled morphology, while the large vacuolated cells that expressed CD163 resembled type A synoviocytes in both surface antigen phenotype and morphology. These results demonstrate that SRTs contain indeterminate cells that can differentiate into mature DCs in vitro in response to GM-CSF, plus mature synovial lining macrophages.

Animals↗
PubMed1986

Documentation of medial rotation accompanying shoulder flexion. A case report.

We dissected a fresh cadaver to determine which glenohumeral structures causes medial rotation of the humerus during flexion in the sagittal plane. All structures associated with both shoulders were dissected thoroughly. Both elbows were disarticulated to expose the distal end of each humerus to be used as measurement landmarks. We used a universal goniometer for measurements of shoulder flexion. To determine which structures cause passive medial rotation, the associated shoulder muscles, ligaments, and the capsule were individually reflected from the humerus. Passive shoulder flexion to the point where medial rotation started was measured after each structure was resected. The end passive glenohumeral flexion without rotation was 60 degrees after reflection of all musculature and other periarticular shoulder structures. Our results support Steindler's conclusion that during flexion of the humerus beyond the horizontal there is forced rotation caused by ligamentous tension. We also found that the bony configuration of the glenohumeral joints also plays an important role in medial rotation accompanying shoulder flexion.

Biomechanical Phenomena↗
PubMed2004

Onycholemmal carcinoma.

We report on a slowly growing malignant tumor of the nail bed epithelium in a 69-year-old male. On light microscopic examination, the tumor was composed of: (1) some small cysts filled with eosinophilic, amorphous keratin and lined by an atypical squamous epithelium devoid of a granular layer and (2) solid nests and strands of atypical keratinocytes filling the dermis and penetrating the phalangeal bone. Because the nail bed epithelium is comparable to the outer root sheath, or trichilemma of the hair follicle, and since the reported tumor showed some analogies with trichilemmal carcinoma, we suggest that this entity be designated 'onycholemmal carcinoma'. Disarticulation of the involved phalanx was performed and neither local recurrence nor distant metastasis was observed during 4 years of follow up.

Aged↗
PubMed1998

Rapid, efficient dental identification of 92% of 13 train passengers carbonized during a collision with a petrol tanker.

On September 8, 1997 (day 0), an express train in Aquitaine, France, crashed into a petrol tanker, which immediately burst into flames and set the first carriage of the train on fire. We describe the dental technique and methodology which led (day 2) to the positive identification of 92% of these very heavily carbonized remains. In only 1 case, and only to be totally certain, did the investigators have recourse to use molecular biologic techniques. The use of this specific odontostomatologic technique (craniomandibular disarticulation with bone samples) and excellent collaboration with the Identification Unit for Mass Disasters Victims (CIVC) precluded recourse to any reconstructive identification.

Accidents↗
PubMed1983

The totem pole rib graft reconstruction of the nose.

The totem pole rib bone graft for nasal reconstruction is presented as an effective way to prepare the donor bone for the correction of saddle-nose deformity. The article's title emanates from the fact that when the sculpturing of the rib is completed it has the appearance of a totem pole before the separate parts are disarticulated for insertion into the nose. The use of this technique permits an accurate, detailed sculpturing of the component parts of the subsequent reconstruction, permitting correction of each feature of the saddle-nose deformity. If these bony segments were dissected or sculptured separately, the smallness of each part would make it very difficult to carve the precise definition needed for a reconstruction that would give structural support and at the same time afford an aesthetically pleasing result. The rationale of the technique and representative cases are presented.

Adult↗
PubMed1975

Surgical treatment of 297 soft tissue sarcomas of the lower extremity.

The results of surgical treatment of 297 soft tissue sarcomas arising in the lower extremity were critically examined. En bloc wide soft part resection (158 cases) yielded five and ten year survival rates of 63% and 50%. Amputation or major disarticulation (139 cases) gave corresponding survival rates of 45% and 29%. The most frequent cause of treatment failure was distant metastases, commonly in the lungs. The tissue type of sarcoma, histologic grade of malignancy, and tumor size appear to be important determinants of survival irrespective of the type of surgical treatment. Local recurrence of sarcoma occurred in 18% of the cases, more commonly after soft part resections than amputations. The proximity of a sarcoma to major vessels, bone or joint tends to compromise the margins of a wide soft part resection, thus increasing the risk of local recurrence. In appropriate cases, the scope of soft part resection can be extended by en bloc excision of the femoral vessels, with the hope of improving local control of sarcoma. Amputation should br resorted to if an adequate margin of resection cannot otherwise be obtained. This decision must be weighted against the high frequency of distant metastases in this disease. Postoperative adjuvant chemotherapy and immunotherapy offer prospects of prevention of this tragic outcome.

Adolescent↗
PubMed1989

Comparison of soft dressing and rigid dressing in the healing of amputated limbs of rabbits.

Thirty white male New Zealand rabbits underwent forelimb amputation below the elbow under sterile operating conditions. Fifteen of the amputation stumps were dressed in a soft, bulky dressing while the remaining 15 rabbits had their stumps immobilized in a rigid plaster dressing. On each of the postoperative days 3, 6, 9, 12 and 15, three rabbits from each group were killed and the amputated limb disarticulated and fixed in formalin. Then, histological examination of the suture line and subcutaneous tissue was carried out by a pathologist to determine the effects, if any, that the type of immobilization has on wound healing. Based on microscopic evaluation of wound approximation, interstitial edema and presence of granulation tissue, there was no significant difference between the stumps immobilized in a plaster dressing and those dressed with a soft, bulky dressing.

Amputation Stumps↗
PubMed1975

The implications of "skip" metastases in osteosarcoma.

A prospective study of 40 consecutive classic primary osteosarcomas employing tomography, angiography, radio-scanning, tetracycline labelling, macroscopic and microscopic study revealed that in 10 (25%) "skip" metastases were found. In 8 the "skips" were completely unsuspected prior to computation. It is evident that patients with "skips" are more prone to local recurrence and have a worse prognosis following amputation than those without such satellite lesions. Through-bone amputation entails a considered risk of leaving micro-foci of tumor; proximal disarticulation does not obviate the risk of cross joint "skips" when the lesion is in a sub-articular site. What affect such residual foci has upon the effectiveness of adjunct therapy and conversely whether such therapy will permit more conservative surgery by suppressing residual "skips" is an important but unanswered question.

Adolescent↗
PubMedDate not supplied

False aneurysm of the brachial artery complicating closed fracture of the humerus. A case report.

A 66-year-old, obese, mentally retarded man sustained a closed spiral fracture of the humerus accompanied by development of a large false aneurysm arising from a small rent in the distal third of the brachial artery. Because of the patient's body habitus, mental deficiency, and paucity of objective physical findings, the arterial injury was not suspected until expensive pressure necrosis necessitated shoulder disarticulation as a lifesaving measure. Although false aneurysms are known to complicate penetrating trauma and various surgical procedures using metallic implants, the lesion has not been previously reported with closed long bone fractures. The authors wish to alert others to occurrence of the occult arterial injury in association with a relatively common extremity fracture. The need to exercise special awareness and suspicion of subtle injuries in patients whose age, mental status, or associated trauma render communication of symptoms impossible, cannot be overemphasized.

Aged↗