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At least 991 records · Page 55Linked to original sources
PubMed1989

Major amputation in a defined population: incidence, mortality and results of treatment.

Medical records of all patients, from a defined population of 88,000 inhabitants, who underwent major lower limb amputation during 1980-82 were retrospectively scrutinized. The records showed 131 amputations were performed in 106 patients at the district hospital and 22 amputations on 17 patients at the local university hospital, referral centre, altogether 57 men and 66 women. This gave an amputation incidence of 46 per 10(5) inhabitants per year. Of the amputees 47 per cent were older than 80 years. Only two patients underwent reconstructive vascular surgery (at the university hospital) before surgery. Final amputation level was above-knee in 61 per cent of the patients treated at the district hospital. Mortality rates at 30 days and 2 years after the amputation were 23 and 56 per cent, respectively, and the age-corrected survival after 2 years was 55 per cent. For patients who came from and eventually returned to their own homes the mean hospital stay amounted to 184 days (postoperative deaths excluded). After amputation 26 patients were trained to wear a prosthesis and 16 of these used the prosthesis 2 years after amputation. The present study underlines the need for prospective and parallel studies of vascular surgery and amputation as well as analyses of the risk factors involved in lower limb ischaemia in defined populations.

Adult↗
PubMed2004

A comparison of two prosthetic feet on the multi-joint and multi-plane kinetic gait compensations in individuals with a unilateral trans-tibial amputation.

OBJECTIVE: To determine the effects of two different prosthetic feet on the three-dimensional kinetic patterns of both the prosthetic and sound limbs during unilateral trans-tibial amputee gait. DESIGN: Eleven individuals with a unilateral trans-tibial amputation participated in two walking sessions: once while using the conventional SAFE foot, the other while using the dynamic Flex foot. BACKGROUND: Despite the wide variation in the design of prosthetic feet, the benefits of these prostheses remain unclear. METHODS: During each test session, peak joint moments and powers in the sagittal, transverse and frontal planes were examined, as subjects walked at a comfortable speed. RESULTS: The majority of the kinetic differences that occurred due to the changing of prosthetic foot type were limited to ankle joint variables in the sagittal plane with greater peak moments and power during propulsion for the Flex foot compared to the SAFE foot. However, effects were also found at joints proximal to the prosthesis (e.g. knee) and differences were also found in the kinetics of the sound limb. CONCLUSION: The dynamic Flex foot allowed subjects to rely more heavily on the prosthetic foot for propulsion and stability during walking with minimal compensations at the remaining joints. RELEVANCE: Determining the biomechanical differences between the conventional and dynamic prosthetic feet may advocate the use of one prosthetic foot type over another. This information, when used in conjunction with subjective preferences, may contribute to higher functioning and greater satisfaction for individuals with a lower limb amputation.

Adult↗
PubMed1996

Automated hexahedral mesh generation from biomedical image data: applications in limb prosthetics.

A general method to generate hexahedral meshes for finite element analysis of residual limbs and similar biomedical geometries is presented. The method utilizes skeleton-based subdivision of cross-sectional domains to produce simple subdomains in which structured meshes are easily generated. Application to a below-knee residual limb and external prosthetic socket is described. The residual limb was modeled as consisting of bones, soft tissue, and skin. The prosthetic socket model comprised a socket wall with an inner liner. The geometries of these structures were defined using axial cross-sectional contour data from X-ray computed tomography, optical scanning, and mechanical surface digitization. A tubular surface representation, using B-splines to define the directrix and generator, is shown to be convenient for definition of the structure geometries. Conversion of cross-sectional data to the compact tubular surface representation is direct, and the analytical representation simplifies geometric querying and numerical optimization within the mesh generation algorithms. The element meshes remain geometrically accurate since boundary nodes are constrained to lie on the tubular surfaces. Several element meshes of increasing mesh density were generated for two residual limbs and prosthetic sockets. Convergence testing demonstrated that approximately 19 elements are required along a circumference of the residual limb surface for a simple linear elastic model. A model with the fibula absent compared with the same geometry with the fibula present showed differences suggesting higher distal stresses in the absence of the fibula. Automated hexahedral mesh generation algorithms for sliced data represent an advancement in prosthetic stress analysis since they allow rapid modeling of any given residual limb and optimization of mesh parameters.

Artificial Limbs↗
PubMed1991

Loading of the contralateral foot in peripheral vascular insufficiency below-knee amputees.

Seven ambulatory peripheral vascular insufficiency below-the-knee amputees underwent gait analysis to determine the local pressures on seven prominent plantar regions in their remaining limb. Patients occupied significantly less stance phase time on their remaining limbs. Peak, mean, and total pressures measured at each of the seven prominent areas was decreased as compared with laboratory age and sex matched controls. The results of this study suggest that the risk of contralateral limb amputation surgery is related to systemic peripheral vascular insufficiency or local factors, and not increased loading of the remaining contralateral "limb-at-risk."

Aged↗
PubMed1985

Electrically powered prostheses for the adult with an upper limb amputation.

The value of fitting adult upper limb amputees with electrically powered prostheses is assessed. In a series of 164 amputees, complete or useful acceptance of an electrically powered prosthesis was recorded in 80% of below-elbow amputees, 69% of above-elbow amputees and 72% of high level amputees. Patients expressed satisfaction with the combination of comfort, cosmesis and function. Results indicate that, accepting the high cost, an electrically powered prosthesis can provide important function to the upper limb amputee.

Adolescent↗
PubMed2000

Pediatric prosthetics. Current trends and future possibilities.

The child's growing, ever-changing nature presents a dynamic challenge to clinics that provide pediatric prostheses for children. Over the years clinics have developed strategies for prescribing and fitting pediatric prostheses. As new components, materials, or techniques are introduced, management of children with limb deficiencies may begin to take on a new look as well.

Artificial Limbs↗
PubMed2001

Acquired limb deficiencies. 3. Prosthetic components, prescriptions, and indications.

UNLABELLED: This self-directed learning module highlights indications for prosthetic components and prescription formulation for adults with acquired limb deficiency. It is part of the chapter on acquired limb deficiencies in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. Advantages and disadvantages of specific components of upper and lower limb prostheses are discussed, and a sample prescription sheet for upper limb devices is included. Recent innovations in terminal devices for upper limb prostheses are reviewed. Special considerations for the adult with acquired multilimb deficiency are also examined. OVERALL ARTICLE OBJECTIVE: To describe indications for prosthetic components and prescription formulation for adults with acquired limb deficiency.

Adult↗
PubMed1988

The 2-stage neuroskeletal pathomechanism of developmental deformities of the limb skeleton. A contribution to the discussion on the McCredie-McBride hypothesis.

Experimental skeletal deformities produced in laboratory birds and in frog tadpoles and examined with Williams' technique (1943) suggest a selective inhibitory effect of various teratogens upon the vulnerable growth of peripheral nervous trunks. The exaggerated osteoneural growth differential resulting therefrom is compensated for by adaptive deformities (buckling, achondroplasic stunting, dislocation) of otherwise normally growing bones which, though independent of innervation under normal conditions, have to "respect" the growth insufficiency of the nervous trunks and to accommodate along them during the proximo-distal development of the limb, even at the cost of a gross deformity. The McCredie-McBride hypothesis, on the other hand, is aimed at explanation of skeletal defects by an early neuroskeletal (neurotrophic) disturbance within the limb bud. Aneurogenic limbs produced experimentally do not necessarily militate against the existence of neuroskeletal relations in the early limb bud postulated, above all, by the McCredie-McBride hypothesis. These relations have been firmly established during the phylogenetic history so that artificial aneurogenic limb, never evolved by Nature, may grow up by (phylo)genetic inertia even without any neural involvement during the individual ontogenesis.

Animals↗
PubMed2005

A quasi-dynamic nonlinear finite element model to investigate prosthetic interface stresses during walking for trans-tibial amputees.

BACKGROUND: To predict the interface pressure between residual limb and prosthetic socket for trans-tibial amputees during walking. METHODS: A quasi-dynamic finite element model was built based on the actual geometry of residual limb, internal bones and socket liner. To simulate the friction/slip boundary conditions between the skin and liner, automated surface-to-surface contact was used. Besides variable external loads and material inertia, the coupling between the large rigid displacement of knee joint and small elastic deformation of residual limb and prosthetic components were also considered. RESULTS: Interface pressure distribution was found to have the same profile during walking. The high pressures fall over popliteal depression, middle patella tendon, lateral tibia and medial tibia regions. Interface pressure predicted by static or quasi-dynamic analysis had the similar double-peaked waveform shape in stance phase. INTERPRETATION: The consideration of inertial effects and motion of knee joint cause 210% average variation of the area between the pressure curve and the horizontal line of pressure threshold between two cases, even though there is only a small change in the peak pressure. The findings in this paper show that the coupling dynamic effects of inertial loads and knee flexion must be considered to study interface pressure between residual limb and prosthetic socket during walking.

Artificial Limbs↗