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PubMed2003

[Replantation at lower leg level].

INTRODUCTION: Replantation in reconstructive surgery is an established procedure due to microsurgical techniques. It can be routinely performed in unilateral lower leg amputation. In some cases of bilateral amputation, in which orthotopic replantation is not possible due to the complex trauma, heterotopic replantation is a therapeutic option. This avoids prosthetic fitting. METHODS: We report five cases of orthotopic and two of heterotopic lower limb replantations. Functional outcome concerning sensibility, mobility, pain, and aesthetic result were assessed clinically and using a questionnaire. RESULTS: Functional outcome and patient satisfaction were good. The psychological situation of the patients as well as mobility and stability of the replanted limbs were satisfying. Heterotopically replanted patients found the replanted legs superior to the prostheses. CONCLUSIONS: We conclude that, in lower leg amputation, attempts should be made to replant the extremity. In bilateral lower leg amputations, at least one limb should be reconstructed, even if "only" a heterotopic replantation can be performed.

Accidents, Occupational↗
PubMed1994

Functional outcome following traumatic upper limb amputation and prosthetic limb fitting.

Nineteen consecutive patients underwent traumatic upper limb amputation for nonreconstructible or replantible upper limb injury at a Level I trauma center over a 9-year-period. Eleven amputations were at the transradial level, five were transhumeral, and three were shoulder disarticulation. Eighteen patients underwent prosthetic limb fitting. Fifteen of the 18 initially underwent preparatory prosthetic limb fitting within 30 days following amputation with a body-powered, cable-driven prosthesis. Seventeen of the 18 achieved sufficient proficiency with their prostheses to allow them to return to work. Of these, 15 maintained daily functional prosthetic use of at least 8 hours daily at a followup examination of 12 to 110 months. Use of prosthetic limb following traumatic upper limb amputation carries a high probability for functional rehabilitation if limb fitting and prosthetic training are instituted as soon as the residual limb can tolerate the prosthetic socket as opposed to waiting for the residual limb to "mature".

Adolescent↗
PubMed2004

Houghton Scale of prosthetic use in people with lower-extremity amputations: Reliability, validity, and responsiveness to change.

OBJECTIVE: To evaluate the responsiveness to change and the floor and ceiling effects of the Houghton Scale. DESIGN: One-week and 3-month test-retest to evaluate reliability, validity, and responsiveness to change. SETTING: Amputee rehabilitation program. PARTICIPANTS: Persons (N=125) with unilateral or bilateral lower-extremity amputation who were wearing a prostheses: 1 group (n=49) for the reliability component and another group (n=76) for the responsiveness and validity component. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Responsiveness to change, ceiling and floor effects, and reliability and convergent validity. RESULTS: Evaluation of responsiveness to change (n=76) showed that the total score increased from a mean +/- standard deviation of 6.14+/-2.40 at discharge to 7.70+/-2.62 (P<.001) at follow-up 3 months later. Floor and ceiling effects were not detected for the overall score but were noted for the individual subscales. The internal consistency was moderate at discharge (Cronbach alpha=.71) and follow-up (Cronbach alpha=.70). The Houghton Scale correlated significantly, although moderately, with the physical composite score of the Medical Outcomes Study 36-Item Short-Form Health Survey (r=.393, P<.01) and the 2-minute walk test at admission (r=.620, P<.01) and discharge (r=.653, P<.01). The reliability (intraclass correlation coefficient=.96) of the Houghton Scale was high (n=49). CONCLUSIONS: The Houghton Scale is appropriately responsive to change in prosthetic use in individuals with lower-limb amputation after rehabilitation.

Activities of Daily Living↗
PubMed1987

The management of severe compound war injuries of the extremities in paediatric patients.

Twelve children suffering from severe multiple injuries following mine explosions and extensive crush to the locomotor system are described. An aggressive therapeutic approach in which surgical debridement followed by soft tissue repair was combined with external fixation and hyperbaric oxygen, resulted in the salvage of six limbs. Eleven limbs, crushed beyond repair, were amputated. All children made a surprisingly quick functional recovery.

Amputation, Surgical↗
PubMed2000

New concepts in lower limb orthotics.

Lower limb orthotics is in the process of a default transformation because of its association with lower limb prosthetics, a mechanical discipline that has translated component and material innovations into balance and velocity function gains to achieve a level of ambulation not possible a generation ago. This article discusses the fundamental mechanical similarities and differences of lower limb orthotics to prosthetics and their application to orthoses designed to improve the gait outcome of patients requiring orthotic intervention.

Artificial Limbs↗
PubMed1976

Congenital longitudinal deficiency of the fibula: follow-up of treatment by Syme amputation.

Congenital longitudinal deficiency of the fibula presented two major problems in management: severe shortening of the limb and equinovalgus deformity of the ankle and foot. When the deformity was severe, our attempts at reducing the deformities of the foot and ankle with soft-tissue procedures and our attempts at achieving limb-length equality with various lengthening procedures were unsuccessful. Our best results in these patients were achieved with an early Syme amputation. The pattern of the deformity and the determination of the growth inhibition factor in the involved limb now enable us to make an early estimate of the deformity and plan appropriately. Syme amputation is definitive and allows the patient to have nearly normal function of the limb and a prosthesis of excellent appearance.

Abnormalities, Multiple↗
PubMed1992

Multidisciplinary preoperative assessment and late function in dysvascular amputees.

During a three-year period, 95 adults were treated by lower-extremity amputations for peripheral vascular insufficiency. A multidisciplinary team for presurgical evaluation determined all to be potentially independent walkers with a prosthesis. Patients were graded for level of independent walking before amputation and again at a minimum two-year follow-up examination using a seven-level functional grading system. Seventy-six of 90 patients (84%) ambulated within one functional level of their preamputation status. This return to preamputation level of function was maintained whether comparing preamputation functional level or surgical amputation level. Prosthetic use increased and the use of walking aids decreased with increased functional ambulation levels, but did not correlate with surgical levels. Peripheral vascular insufficiency patients can maintain walking independence. Multidisciplinary presurgical evaluation helps selection of the amputation level and correct prosthetic limb fitting.

Adult↗
PubMed1988

Resection of the proximal humerus and I.O.R. modular prosthesis in the treatment of metastatic lesions.

The authors report a series of 20 patients affected with metastatic lesions of the proximal humerus (19 cases) or scapula (one case) treated by intra-or extra-articular resection of the humerus and successive reconstruction with an I.O.R. type shoulder modular prosthesis. This method is indicated for the treatment of patients with extensive destruction of the epiphysis and cortical bone and limited invasion of the surrounding soft tissues. Prosthetic implant does not contraindicate the use of postoperative radiotherapy, and the cement used to anchor the endomedullary shaft contributes to the sterilization of any metastatic microfoces present by means of an intense esothermic polymerization reaction. The results obtained were satisfactory, with regression of pain and good functional recovery of the limb. There were no postoperative complications.

Adult↗
PubMed1988

[Extensive coxo-femoral resection with preservation of the thumb for prosthesis. An alternative to disarticulation at the hip].

To avoid the severe mutilation of a hip disarticulation and to improve limb-fitting, a method of partial limb preservation is proposed. Two cases of septic arthritis of the hip with neurological and atrophic lesions sufficient to justify disarticulation are described. Disarticulation was avoided by partial conservation of the thigh with an extensive resection of the upper end of the femur, a through-knee amputation and a large posterior musculo-cutaneous flap including the triceps surae whose muscle provided a good cover for an end-bearing myoplasty. The stump obtained was of good quality which, though a little unstable, was firm and well provided with muscle which allowed early mobilization with a temporary prosthesis and later limb-fitting with much more satisfactory function than that in a hip disarticulation.

Adult↗
PubMed2004

Prescription of prosthetic ankle-foot mechanisms after lower limb amputation.

BACKGROUND: A correct prosthetic prescription can be derived from adapting the functional benefits of a prosthesis to the functional needs of the prosthetic user. For adequate matching, the functional abilities of the amputees are of value, as well as the technical and functional aspects of the various prosthetic ankle-foot mechanisms. There seems to be no clear clinical consensus on the precise prescription criteria for the various prosthetic ankle-foot mechanisms related to the functional abilities of amputees. OBJECTIVES: To obtain information about aspects of prosthetic ankle-foot mechanisms and daily functioning of amputees with a prosthesis, for appropriate prosthetic prescription criteria. SEARCH STRATEGY: We searched the Cochrane Musculoskeletal Injuries Group specialised register of trials (April 2003), the Cochrane Central Register of Controlled Trials (The Cochrane Library issue 1, 2003), MEDLINE (1966 to April 2003), EMBASE (1983 to April 2003), CINAHL (1982 to April 2003) and reference lists of articles. No language restrictions were applied. SELECTION CRITERIA: All randomised controlled trials and quasi-randomised controlled trials comparing different prosthetic devices for lower limb amputation in adults. No language restrictions were applied. DATA COLLECTION AND ANALYSIS: Two reviewers independently identified potential articles from the literature search. Methodological quality was assessed using a checklist comprising 13 criteria. The reviewers extracted data using pre-defined extraction forms. MAIN RESULTS: Twenty-three trials were included, with a total of 217 participants. The methodological quality was moderate. Only one study was of high quality. No classical RCT's were identified, yet, all included studies used cross-over designs allowing sufficient control for confounding. In high activity transfemoral amputees, there is limited evidence for the superiority of the Flex foot during level walking compared with the SACH foot in respect of energy cost and, gait efficiency. This benefit has only been confirmed in transtibial amputees during decline and incline walking and increased walking speeds. REVIEWER'S CONCLUSIONS: There is insufficient evidence from high quality comparative studies for the overall superiority of any individual type of prosthetic ankle-foot mechanism. In high activity transfemoral amputees, there is limited evidence for the superiority of the Flex foot during level walking compared with the SACH foot in respect of energy cost and, gait efficiency. This benefit has only been confirmed in transtibial amputees during decline and incline walking and increased walking speeds. In prescribing prosthetic-ankle foot mechanisms for lower-limb amputees, practitioners should take into account availability, patient functional needs, and cost.

Amputation, Surgical↗
PubMed2005

CPPD crystal deposition disease in patients with rheumatoid arthritis.

The aim of this study was to assess the frequency and the outcome of patients suffering from rheumatoid arthritis in which calcium pyrophosphate dihydrate (CPPD) crystal deposits were found to coexist in synovial fluid analysis. Such association was more frequent than previously believed with CPPD crystals found in 25.8% of 93 patients with rheumatoid arthritis. As a group, a trend toward a worse outcome was suggested by more frequent prostheses of the lower limb.

Adult↗
PubMed1996

Pain memories in phantom limbs: a case study.

Pain experienced in a limb prior to amputation may influence the course of phantom limb pain many months later. Katz and Melzack (1990) found that 42% of their sample reported a 'somatosensory pain memory' which resembled the quality and location of a painful, or non-painful pre-amputation sensation. For many amputees, pain memories are vivid experiences which incorporate both emotional and sensory aspects of the pre-amputation pain (Katz 1992). Katz and Melzack (1990) suggest that sensory input will 'trigger' somatosensory pain memories while the affective component of a pain memory is generated by the intensity, quality and location of the current experience of phantom limb pain. The present case study used a diary design to examine whether 'triggers' could be identified for somatosensory pain memories. Over a 9-month period, the patient reported daily experience of ongoing phantom limb pain, generally confined to the distal part of the limb, and 5 episodes of injury-related phantom limb pain, primarily experienced in the calf of the missing limb. A 'trigger' was identified for each of the episodes of injury-related phantom limb pain, and a significant finding in this study was that two episodes of injury-related phantom limb pain were associated with cognitive and/or emotional, rather than sensory 'triggers'.

Abscess↗
PubMed2004

Use and satisfaction with prosthetic limb devices and related services.

OBJECTIVES: To examine the use and satisfaction with prosthetic limb devices and satisfaction with prosthetist services in a large and diverse sample of persons with limb loss. DESIGN: Retrospective cohort study. SETTING: General community. PARTICIPANTS: Persons aged 18 to 84 years identified from the Amputee Coalition of America registry as having a major upper- or lower-limb loss due to vascular disease, trauma, or malignancy. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Use and satisfaction with prosthetic limb devices and satisfaction with prosthetists' services, assessed via structured telephone interviews. RESULTS: Most persons (94.5%) surveyed had a prosthesis and used it extensively (71h/wk). Most persons with amputations appeared to be satisfied with the overall performance of their prostheses (75.7%). Nearly one third of them, however, expressed dissatisfaction with their prostheses' comfort. Frequency of prosthesis use and satisfaction with the device were significantly higher among those with shorter timing to first prosthesis fitting, even after controlling for a wide array of respondents' sociodemographic and amputation characteristics. Overall, persons with amputations in our sample had positive assessments of their prosthetists' quality. Less favorable ratings concerned items related to the prosthetists' interpersonal skills. Multivariate analyses showed that men and black persons with amputations were less likely than their female or white counterparts to have favorable perceptions about their prosthetists across all dimensions of provider quality. Persons with fewer years of schooling were also less likely to be satisfied with their prosthetist's interpersonal manner. There were no significant differences in prosthesis use, satisfaction, or assessment of prosthetists' quality based on amputation etiology or amputation level. CONCLUSIONS: Efforts should be directed at minimizing the interval from surgery to first prosthesis fitting and at improving communication between patients and prosthetists, to improve the quality of care provided to the growing numbers of persons with limb loss.

Adolescent↗
PubMed2003

Adjustments in gait symmetry with walking speed in trans-femoral and trans-tibial amputees.

The effect of increased walking speed on temporal and loading asymmetry was investigated in highly active trans-femoral and trans-tibial amputees. With increasing walking speed, temporal gait variables reduced in duration, particularly on the prosthetic limb, while vertical ground reaction force (vGRF) increased in magnitude, particularly on the intact limb. Thus, temporal asymmetry reduced and loading asymmetry increased with walking speed. The greater force on the intact limb may reflect the method by which the amputees achieve greater temporal symmetry in order to walk fast, and could possibly account for greater instances of joint degeneration in the intact limb reported in the literature.

Adaptation, Physiological↗
PubMedDate not supplied

Cost-efficacy issues in the treatment of peripheral vascular disease: primary amputation or revascularization for limb-threatening ischemia.

Controlling rising health care costs represents a major challenge to our society. Due to the aging of the population and the increasing number of patients with vascular disease, vascular specialists will be under mounting pressure by the managed care industry to provide the most cost-effective care for these patients. One particular controversy is whether to attempt revascularization in the patient with limb-threatening ischemia or to proceed directly with primary amputation. Although it has been assumed that the operative risk for revascularization procedures is high in elderly patients with a severely ischemic limb, mortality rates in the sickest patients are actually higher for amputation. It is also incorrect to assume that the duration of hospitalization is shorter for patients undergoing amputation than for patients undergoing revascularization. For both types of procedures, it is complications that prolong the length of hospital stay, and the rate of secondary amputation following a revascularization attempt is low (8.5%), compared with the rate of operative revision in patients following primary below-knee amputation (23%). The costs for revascularization and primary amputation are similar when the costs of a prosthesis and rehabilitative therapy are included in the calculations for amputation. The rationale for primary amputation assumes that patients will ambulate successfully with a prosthesis; however, many do not, and thus costs for institutionalization must be included in the equation. Long-term costs following revascularization were $28,374 in patients with a viable limb, compared with $56,809 in those undergoing secondary revascularization. The key to minimizing health care costs in this population is careful patient selection for initial revascularization, with aggressive long-term surveillance to ensure graft patency and limb viability.

Activities of Daily Living↗
PubMed2002

Body image and prosthesis satisfaction in the lower limb amputee.

PURPOSE: This study examines the relationship between prosthesis satisfaction and body image in lower limb prosthesis users, and the gendered variations within these relationships. METHOD: A total of 44 valid responses were obtained to an internet survey regarding prosthesis satisfaction, body image and phantom pain. Spearman Rho correlations were calculated for these three domains. RESULTS: Moderate to high negative correlations were observed between body image disturbance and prosthesis satisfaction. These were consistent across genders. Other relationships were also revealed, including positive correlations between prosthesis satisfaction with hours of use and negative correlations between prosthesis satisfaction and pain experience, although strong differences between genders were observed for these. The length of time for which respondents had had their prosthesis bore little relation to other variables. CONCLUSION: The present research is instructive of the close relationship between body image and prosthesis satisfaction, as well as gender variations in these relationships, in lower-limb prosthesis users. These findings have implications for targeted service provision in prosthetic rehabilitation.

Adolescent↗
PubMed1988

Upper limb amputations in southern Finland 1984-85.

There is a specific requirement for amputee statistics to facilitate the planning of prosthetic rehabilitation of amputee patients. The aim of this study was to analyse the epidemiological situation concerning upper limb amputations in southern Finland. The data on all limb amputations made in the catchment area of the Helsinki University Central Hospital were collected for the period 1984-85. During the two-year period upper limb amputations had been performed on 52 patients. A total of six major amputations had been performed on 52 patients. A total of six major amputations had been performed at a level potentially requiring a prosthesis, and 46 patients had undergone amputation distal to the carpal joint. The overall upper limb amputation rate was 2.2 and rate of major amputations 0.3 per 100,000 inhabitants per year. The ratio of men to women was 7.7 for all amputations and 10.5 for finger amputations. Of the 52 amputees, 62 per cent were in the 20-59 age group. The mean age of all amputees was 42.7 years. The typical upper limb amputee was a man of active working age. Trauma, mainly occupational accident, was the most common cause, accounting for 61 per cent of all upper limb amputations. The annual incidence of major amputations in the whole of Finland is as low as 20-30 cases. It would seem reasonable to concentrate prosthetic fitting of upper limb amputations at two or three prosthetic factories and rehabilitation centres.

Adult↗