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At least 793 records · Page 44Linked to original sources
PubMed1994

Below knee stump reconstruction by turn-up technique. Report of 2 cases.

In cases of persistent recurrence of tumor or intractable infection affecting the proximal half of the tibia, knee disarticulation or short below knee amputation is sometimes inevitable. If the knee joint is lost, rehabilitation is very difficult and sometimes impossible to attain in terms of active normal daily living. A new technique was designed for reconstruction of the stump following below knee amputation after en bloc resection of the proximal 2/3 of the tibia that included turn-up of the distal composite graft to 180 degrees and rigid fixation. It was applied to 2 cases. The followup showed excellent results in both cases.

Adult↗
PubMed1994

Use of an ultrasonic Doppler flow detector for determining tissue viability in a dog.

An 8-month-old sexually intact female Boxer was examined because of an almost complete disarticulation of the right thoracic limb at the level of the proximal phalanges. Viability of the tissue distal to the injury was considered questionable. An ultrasonic Doppler flow detector was used to determine that circulation to the portion of the digits distal to the injury had been preserved on the palmar aspect of the foot. Orthopedic repair of the fractures of the third and fourth digits and primary skin closure of the wound was performed. Infection and instability at the fracture sites resulted in pseudoarthrosis and a valgus deformity of the digits distal to the injury. The ultrasonic Doppler flow detector provided a simple noninvasive method for determining tissue viability in the severely traumatized foot of this dog.

Animals↗
PubMedDate not supplied

Anatomical variation of the tibial plafond: the anteromedial tibial notch.

An investigation of 77 intact foot and ankle specimens (21 fresh frozen and 62 preserved) was conducted to determine normal anatomical variation of the anteromedial region of the tibial plafond. Lower extremity specimens were obtained and carefully disarticulated at the ankle joint. Care was taken to observe anterior joint capsule attachments along with plafond surface anatomy. Specimens that exhibited signs of previous trauma or significant degenerative arthritic changes were not included in the study. All of the specimens were photographed with a millimeter scale, and the photographs were later evaluated to quantify anatomical variations of the anterior medial tibial plafond. The results of this investigation demonstrated a normal variant of articular notching of the anteromedial tibial plafond. The notching appears to function as a joint capsule anchor. In the more well developed notches, a fold, apparently of synovial tissue, was found. The notching increases the surface area for capsular attachment, is variable in size, and may assist in synovial fluid movement across the joint during ambulation. This articular notching, although often encountered arthroscopically, should be considered a normal anatomical variant unless localized degenerative processes are identified.

Aged↗
PubMed1994

[Stress on the ligamentum transversum acetabuli in physiological stress on the hip joint].

We investigated the strain on the transverse acetabular ligament (TAL) and the labrum close to the anterior and posterior horn of the lunate surface using Omega strain gauges [5] while increasing loads were applied to the hip joint. Two fresh hip joint specimens and four specimens fixed in 3.7% formalin were examined. The two components of the joint were disarticulated and soaked in physiological saline and then placed in a material-testing machine (Zwick) in the neutral position of the joint. The strain on the TAL and the labrum was measured at loads of 10 N, 350 N, 700 N, 1050 N, 1400 N, 2100 N and 2800 N. Finally, the contact areas were measured at a load of 350 N using a polyether casting method. Depending on load, the length of the TAL increased by up to about 3.2% at a load of 2800 N, but the length of the labrum increased by only 0.5% at the same load. Following rotation of the femoral head to positions corresponding to 15 degrees extension and 15 degrees and 30 degrees flexion, only slight differences of about 0.2% for the TAL and even less for the labrum were measured. The contact areas are all located in the anterior and posterior horn of the lunate surface. The measured changes in strain on the TAL confirm the widening of the acetabular notch and a subsequent stretching of the TAL as the load on the hip joint increases.(ABSTRACT TRUNCATED AT 250 WORDS)

Acetabulum↗
PubMed1976

Massive homogenous osteo-articular bone grafts. Long term results.

The authors present a long term review of thirty cases of massive homogenous bone grafts carried out at the Istituto Ortopedico Rizzoli between 1967 and 1971. Thirty one of these were either complete or partial diaphyseo- articular grafts. The lesions for which the operations were performed were: twelve giant cell tumours; one Ewing's tumour; two reticulosarcomas; eight osteosarcomas; six chondrosarcomas; one loss of bone substance from trauma, one echinococcosis of the femur and one aneurysmal bone cyst. In some of these cases amputation or disarticulation had been advised but refused by the patient. Follow up three and a half to five years after operation showed complete incorporation of the graft in eight cases, partial incorporation in live, and resorption in four. In the remaining fifteen cases the follow up was terminated by early death, recurrences, infection or intolerance with rejection. In conclusion, the authors recommend that massive osteoarticular homogenous grafts should be confined to the substitution of unicondylar lesions as these offer greater contact with the host bone and therefore a greater possibility of incorporation. The same indications exist in cases involving only diaphyseal substitution where osteogenetic invasion of the graft can occur from both ends. In all the other cases, they recommend either resection arthrodesis or prosthetic replacement.

Adult↗
PubMed1994

Microvascular thrombosis associated with onset of acute laminitis in ponies.

The hypothesis that equine laminitis is caused by thrombosis of vessels in the laminar corium (dermis) was investigated. Hemostatic alterations were evaluated by determining platelet count, platelet survival, platelet adhesiveness to vascular subendothelium, activated clotting time, and whole blood recalcification time. Thrombosis of vessels in the hoof wall was evaluated by scintigraphic studies of the hoof wall after administration of indium-111 (111In)-labeled platelets, contrast arteriography, and histologic examination. Platelet count remained constant before and at the onset of lameness; however, survival of 111In-labeled platelets was shortened. Scintigraphy of affected feet revealed accumulation of 111In-labeled platelets distal to the coronary band. Arteriography of disarticulated saline-perfused feet revealed marked reduction in blood supply to affected hooves. Histologic examination of the laminar dermis disclosed variable numbers of microthrombi in dermal veins of affected feet from 3 of 4 ponies with laminitis. Whole blood recalcification time was shortened at 8 hours after administration of carbohydrate and was prolonged at the onset of laminitis. Activated clotting time was prolonged at 32 hours after carbohydrate administration and at the onset of lameness. Plasma endotoxin-like activity was detected in 1 of 4 affected ponies. These data confirm that microvascular thrombosis existed at the onset of lameness in ponies with carbohydrate-induced laminitis and indicate that systemic coagulopathy may have preceded development of thrombosis.

Acute Disease↗
PubMed1994

Ilizarov lengthening of a posttraumatic below elbow amputation stump. A case report.

Lengthening of a nonfunctional posttraumatic below elbow stump via Ilizarov technique is described. Preoperatively, the 5 cm ulna in the residual forearm provided an insufficient lever arm for practical use of a standard below elbow prosthesis. An additional 5 cm of ulnar length was achieved (100% increase) by distraction histogenesis, ultimately limited by impending necrosis of adherent skin covering the tip of the residual limb. Utilizing the Ilizarov technique, ulnar lengthening converted the functional level of the patient's amputation from elbow disarticulation to below elbow status.

Adult↗
PubMed1994

Revision of failed below knee amputations. Local debridement with gentamicin collagen.

OBJECTIVE: To describe our results with a new technique of revision of failed below knee amputation stumps using gentamicin impregnated collagen sponge. DESIGN: Open study. SETTING: District hospital. SUBJECTS: 31 patients who underwent below knee amputations between 1988 and 1992, compared with 31 historical controls who were operated on between 1984 and 1988. INTERVENTIONS: Two thirds of the stumps that failed to heal underwent excision of necrotic and devitalised tissue; half had shortening of tibia and fibula and a gentamicin impregnated collagen sponge was left in the wound, which was then closed. MAIN OUTCOME MEASURES: Successful wound healing and rehabilitation. RESULTS: 12 Stumps failed to heal, 8 of which were suitable for local treatment with the gentamicin sponge. All 8 healed satisfactorily, though one required revision of the scar 6 months later. Of the remainder, the stumps were converted to above knee amputations (n = 3) and one was disarticulated at the knee. In the control group 5 of the 7 stumps in which healing failed, were converted to above knee amputations and the other two healed after split skin grafting. CONCLUSION: We think that local treatment with the collagen sponge with gentamicin offers a viable alternative to conversion to above knee amputation for below knee amputation stumps that fail to heal. The treatment should now be subjected to a randomised controlled trial.

Adult↗
PubMed1993

Gait analysis in peripheral vascular insufficiency through-knee amputation.

Due to recent improvements in prosthetic limb componentry, through-the-knee (knee disarticulation) amputation has gained new interest for rehabilitation-minded amputation surgeons. Recent objective scientific studies from our gait analysis laboratory have described the walking characteristics of peripheral vascular insufficiency through-knee amputees, and have compared their function with similar patients amputated above (transfemoral), or below (trans-tibial), the knee joint. This paper provides a summary of that available information.

Amputation, Surgical↗
PubMed1993

[Autoclaved tumoral autografts. Apropos of 12 cases, 6 of which highly malignant].

Twelve patients presenting with a bone tumor were operated on using autoclaved bone autografts for reconstruction following carcinologic resection. According to the Enneking grading system, 6 were high malignancy tumors (3 osteosarcomas and 3 grade 2 chondrosarcomas), 4 were low grade tumors (1 paraosteal sarcoma, 1 chondrosarcoma, 1 secondary chondrosarcoma, 1 liposarcoma). One was a metastasis from a kidney tumor. The last patient had a femoral osteoid osteoma. Six local recurrences were responsible for 4 reoperations: 2 disarticulations and 2 iterative resections. With a 1-6 years range of follow-up (average follow-up 2.5 years), osseointegration of autoclaved grafts was studied. Fusion at the host/graft junction was roentgenographically observed. In three cases, proximal resorption of the humeral graft occurred. Five biopsies were obtained during reoperation after 1 year, which showed partial revascularization of autoclaved bone autografts. The authors conclude that autoclaved tumoral bone grafts, are reliable and discuss indications. They point out the main contraindication, represented by chemosensitive bone tumors, in which conservation of the removed tumor is necessary to quantify the response to chemotherapy.

Adolescent↗
PubMed1994

Complications of internal fixation of tibial plateau fractures.

All cases of displaced tibial plateau fractures treated by open reduction and internal fixation at two university hospitals over a 3-year period were retrospectively reviewed. There were 47 fractures in 45 patients. Rigid fixation to allow early motion was the goal in all cases. There were 3 AO type I (wedge) fractures, 20 AO type III (wedge/depression) fractures, and 24 AO type IV (comminuted/bicondylar) fractures. Cases were classified into three groups depending on the amount of hardware used to obtain fixation (a single buttress plate, group 1; a buttress plate and interfragmentary lag screws, group 2; or medial and lateral buttress plates with or without lag screws, group 3). In group 1, there were 20 fractures and no instances of deep-wound infection or postoperative ankylosis. In group 2, infection occurred in 6 of 19 fractures (32%), all of which also developed significant ankylosis including 1 patient who underwent arthrodesis. In group 3, 7 of 8 (87.5%) knees became infected, and the patients experienced other devastating complications, including ankylosis (n = 3), arthrodesis (n = 2), knee disarticulation (n = 1), and above-knee amputation (n = 1). Patients whose knees became infected underwent an average of five subsequent surgical procedures. These results suggest that patients with comminuted tibial plateau fractures requiring either two buttress plates or a single plate with additional interfragmentary lag screws would probably be better managed by either non-operative treatment or limited internal fixation.

Adult↗
PubMed1993

Effect of KTP laser ablation of endochondral bone on bone healing.

The advantages of using a laser to cut a hole in the ossicular chain include increased precision, decreased likelihood of disarticulation, and elimination of noise-induced threshold shift associated with conventional drills. This study was designed to determine optimal energy settings and cooling technique to minimize tissue injury. Laser ablated holes were cut in rabbit femurs with different endostat fibers at power settings of 1.6 to 5.0 watts. Comparable burr holes were cut by a high-speed drill and the animals were sacrificed at different time intervals. Specimens were evaluated microscopically for tissue injury by the amount of cell necrosis of the surrounding osteocytes, bone marrow changes, and denaturation of bone matrix. Changes in healing were assessed by the production and ossification of the granulation tissue. Laser ablated holes created with 1.6 to 2.0 watts at 2 to 7 days demonstrated thermal damage comparable to conventionally drilled holes. At 14 to 28 days these holes demonstrated advanced healing and integrated lamellar bone. In contrast, higher power (> 3.5 watts) at 2 to 7 days demonstrated Significantly more osteocyte loss, marked bone marrow fibrosis, and bone matrix denaturation. At 14 to 28 days these holes showed evidence of delayed healing and osseous plugs not integrated with the surrounding bone.

Animals↗
PubMedDate not supplied

[Gritti's amputation in vascular surgery].

Gritti's amputation was performed in 35 patients, mean age 71 years, with vascular disease of leg. There was no immediate postoperative mortality. Of twenty patients fitted with an appliance using a specific technique, only one had a poor functional result. The results obtained in this preliminary series were compared with those after amputations and knee disarticulations. They showed that Gritti's amputation should be considered for patients with arteritis when a functional knee is impossible to conserve.

Adult↗
PubMed1977

The conservative hemipelvectomy.

Conservative hemipelvectomy is the resection of the ischium, ilium and subjacent extremity. It differs from the orthodox hemipelvectomy method by retaining the ilium, which permits the patient to have normal balance, Sarcomas of the soft tissue extend toward the attachment of the pelvis. The operation has been performed upon ten patients, and the entire operative procedure can be done using the anterior approach, thus minimizing the need to turn the patient. This technique is less traumatic than either disarticulation of the hip joint or hemipelvectomy and can be performed in approximately one and one-half hours, blood loss being limited to an amount varying from 500 milliliters to 1 liter. No postoperative deaths have been recorded. Of the ten patients operated upon, none have had a local recurrence. One obese elderly woman with a liposarcoma died two years after operation from diffuse metastases. The other nine patients are alive and well from two to six years after amputation. The balance of these patients is manifested by the fact that two of them are excellent amputee-skiers.

Amputation, Surgical↗
PubMedDate not supplied

Fibular dimelia with deficiency of the tibia.

Longitudinal deficiency of the tibia associated with fibular dimelia is a very rare condition. We report our experience with six patients and outline management of this anomaly. Knee disarticulation is advised in cases with an associated normal femur, and femorofibular fusion is advised in cases of associated ipsilateral proximal focal femoral deficiency (PFFD) or congenital short femur. Fibulocalcaneal fusion and Boyd type amputation provide good end-bearing stumps.

Abnormalities, Multiple↗
PubMed1993

Survivorship of healed partial foot amputations in dysvascular patients.

The results of 94 initially successful, partial foot amputations in dysvascular patients were reviewed with survivorship analysis at a minimum of 6.5 years after surgery. Partial foot amputations were divided into three types: transmetatarsal amputations, metatarsophalangeal disarticulations, and ray resections. No amputation type was more or less likely to be treated with subsequent amputation of the foot or to develop recurrent ulceration. Taking all groups together, the chance of retaining the foot after an initially healed partial foot amputation was 86% at four years after operation and 76% at eight years after operation. Of these surviving feet, however, 53.8% developed ulceration or needed local reoperation. The chance of completely avoiding any surgery after an initially healed partial foot amputation was 71% at four years after operation and 52% at eight years after operation. In properly selected patients, partial foot amputations have significant longevity.

Amputation, Surgical↗
PubMed1995

Prothrombotic events in the prodromal stages of acute laminitis in horses.

Prothrombotic changes occurring in the prodromal stages of carbohydrate-induced laminitis were investigated. Hemostatic alterations were evaluated by determining platelet counts, platelet survival, activated partial thromboplastin time, one-stage prothrombin time, and monocyte procoagulant activity. Thrombosis of vessels in the hoof wall was evaluated by contrast arteriography and histologic examination. Of 5 horses, 4 became lame between 28 and 52 hours after carbohydrate administration. Mean platelet count in laminitis-affected horses was lower throughout the prodromal stages of laminitis, compared with that in control horses, but differences were not statistically significant. However, survival of indium-111-labeled platelets was less than the value in control horses by 6 hours after carbohydrate administration. Arteriography of disarticulated feet revealed marked reduction in blood supply to hooves in laminitis-affected horses. Histologic examination of the laminar dermis disclosed microthrombi in venules of the laminar dermis in 2 of 4 affected horses. Statistically significant changes in prothrombin time were not observed, and changes in activated partial thromboplastin time were slight and occurred only at the onset of lameness. Statistically significant changes in monocyte procoagulant activity were not observed. Plasma endotoxin-like activity was not detected in laminitis-affected horses. These data indicate that platelet survival was decreased within the first 6 hours after induction of carbohydrate-induced laminitis, but systemic activation of the coagulation system was not detected.

Angiography↗
PubMed1996

[Preoperative and postoperative chemotherapy of osteogenic sarcoma of the limbs in children].

BACKGROUND: A preoperative and postoperative chemotherapy regimen was applied to nonmetastatic osteosarcoma of the extremities in patients under 16 years of age to prevent the progress to metastatic disease and reduce the volume of the primary tumor in order to assess a conservative surgery. PATIENTS AND METHODS: A modified T-10 chemotherapy regimen was used before surgery, including high dose methotrexate, vincristine, bleomycin, cyclophosphamide and dactinomycin. After surgery patients with a grade of tumor necrosis > 90% received the same regimen up to 45 weeks of treatment. For the cases with necrosis < 90%, this regimen was substituted by adriamycin and cisplatinum. Survival was studied in relation with age, sex, tumor site, levels of alkaline phosphatase and LDH, surgical treatment and tumor necrosis in the surgical specimen after preoperative chemotherapy. Uni and multivariate analysis were performed. RESULTS: Twenty seven patients with ages ranging from 5 to 15 years (median 11 years) were treated. The most common site of primary tumor was femur, followed by humerus and tibia. In 9 cases (33%) tumor necrosis was > 90%. Consecutive surgery was performed in 20 patients and 7 suffered amputation or disarticulation of the extremity. Twenty patients remain alive and disease-free at a median follow-up of 84 months. The probability of disease-free survival at 50 months is 71%. The only factor which influenced significantly the survival was the grade of tumor necrosis. Survival was 100% for the 9 patients with necrosis > 90% and 53% for the 18 cases with necrosis > 90% (p = 0.022). CONCLUSIONS: Preoperative and postoperative chemotherapy achieve disease-free survival in more than two thirds of patients with nonmetastatic osteosarcoma of the extremities and allow a non mutilating surgical treatment in the majority of them.

Adolescent↗