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European Journal of Orthopaedic Surgery... May 2024Intra-articular distal femur fractures in patients with a lower extremity amputation can present a technical challenge for the treating surgeon in what may be otherwise...
PURPOSE
Intra-articular distal femur fractures in patients with a lower extremity amputation can present a technical challenge for the treating surgeon in what may be otherwise considered a routine procedure in non-amputees. Difficulties with positioning, fracture reduction, limb contractures, and stump osteoporosis can present challenges with treatment. Here, we describe the surgical technique and outcome of a case series of amputee patients with AO/OTA 33C femur fractures.
METHODS
Retrospective case series of five patients with a comminuted supracondylar distal femur fracture with intercondylar extension proximal to a below-knee amputation treated with retrograde intramedullary nail at a single Level 1 trauma center from January 1, 2021, to January 1, 2023. Baseline demographic and clinical data were recorded. Rate of bony union and complications were documented.
RESULTS
Five patients (three females and two males) with a mean age of 48 years who were treated for a comminuted supracondylar distal femur fracture with intercondylar extension proximal to a below-knee amputation were identified. At the time of final follow-up (mean 109.3 days, range 29-183 days), all patients had healed their incisions and were progressing to return of function with their prosthesis. All patients were treated with the surgical technique described in this article, and no postoperative complications were reported.
CONCLUSION
This is an effective and safe technique for surgical treatment of comminuted intra-articular distal femur fractures in patients with an ipsilateral below-knee amputation. We believe that this technique can be utilized by any orthopedic surgeon taking trauma call and can avoid unnecessary transfers or delays to care.
Topics: Humans; Femoral Fractures; Female; Male; Fracture Fixation, Intramedullary; Middle Aged; Retrospective Studies; Adult; Fractures, Comminuted; Amputation, Surgical; Bone Nails; Treatment Outcome; Fracture Healing; Aged
PubMed: 38530503
DOI: 10.1007/s00590-024-03899-6 -
Prosthetics and Orthotics International Mar 2024Amputation is a major life-changing event and is regarded as one of the loading causes of permanent disability. However, amputation often causes changes in painful and...
Effect of pain on activity and participation in individuals with unilateral lower-extremity amputation based on the International Classification of Functioning, Disability, and Health.
BACKGROUND
Amputation is a major life-changing event and is regarded as one of the loading causes of permanent disability. However, amputation often causes changes in painful and nonpainful sensory experiences. Pain after amputation has been shown to increase functional limitations caused by limb loss and lower quality of life.
OBJECTIVE
This study aimed to examine the effect of pain on activity and participation in individuals with unilateral below-knee amputations according to the International Classification of Functioning, Disability, and Health.
STUDY DESIGN
Cross-sectional study.
METHODS
In the study, 64 individuals were divided into 2 groups: those who experienced pain and those who did not. Group 1 included 33 below-knee amputees who experienced pain (27 males, mean age 43.9 ± 12.6 years) and Group 2 included 31 below-knee amputees who did not experience pain (25 males, mean age 47.4 ± 12.1 years). The McGill Pain Questionnaire and visual analog scale were used to assess pain, the Prosthetic Limb Users Survey of Mobility was used to assess activity, and the Reintegration to Normal Living Index was used to assess participation.
RESULTS
Demographic characteristics of the 2 groups were statistically insignificant (P > 0.05). The nonpainful group had significantly higher activity and participation scores than the painful group (P < 0.001).
CONCLUSIONS
It was found that phantom pain and stump pain in below-knee amputees limited activity and participation. It was also shown that phantom pain has a more negative effect on the activity level of individuals than stump pain.
PubMed: 38517384
DOI: 10.1097/PXR.0000000000000342 -
Handchirurgie, Mikrochirurgie,... Jun 2024Robotic microsurgery is an emerging field in reconstructive surgery, which provides benefits such as improved precision, optimal ergonomics, and reduced tremors....
Robotic microsurgery is an emerging field in reconstructive surgery, which provides benefits such as improved precision, optimal ergonomics, and reduced tremors. However, only a few robotic platforms are available for performing microsurgical procedures, and successful nerve coaptation is still a challenge. Targeted muscle reinnervation (TMR) is an innovative reconstructive procedure that rewires multiple nerves to remnant stump muscles, thereby reducing neuroma and phantom limb pain and improving the control of bionic prostheses. The precision of surgical techniques is critical in reducing axonal sprouting around the coaptation site to minimise the potential for neuroma formation. This study reports the first use of a microsurgical robotic platform for multiple nerve transfers in a patient undergoing TMR for bionic extremity reconstruction. The Symani robotic platform, combined with external microscope magnification, was successfully used, and precise handling of nerve tissue and coaptation was easily feasible even in anatomically challenging environments. While the precision and stability offered by robotic assistance may be especially useful for nerve surgery, the high economic costs of robotic microsurgery remain a major challenge for current healthcare systems. In conclusion, this study demonstrated the feasibility of using a robotic microsurgical platform for nerve surgery and transfers, where precise handling of tissue is crucial and limited space is available. Future studies will explore the full potential of robotic microsurgery in the future.
Topics: Humans; Microsurgery; Robotic Surgical Procedures; Nerve Transfer; Bionics; Male; Nerve Regeneration; Phantom Limb; Artificial Limbs; Amputation Stumps; Muscle, Skeletal; Plastic Surgery Procedures; Neuroma
PubMed: 38513691
DOI: 10.1055/a-2241-5678 -
Fukushima Journal of Medical Science Apr 2024In foot amputation, Chopart amputation is considered to have a high risk of deformity, and can result in poor function. We experienced a case in which Chopart amputation...
BACKGROUND
In foot amputation, Chopart amputation is considered to have a high risk of deformity, and can result in poor function. We experienced a case in which Chopart amputation combined with tendon transfer and tendon lengthening was performed, and the patient was eventually able to walk independently with a foot prosthesis without experiencing deformity of the foot. We investigated walking speed and plantar pressure after Chopart amputation with and without a foot prosthesis.
CASE
A 78-year-old man underwent Chopart amputation with tendon transfer and tendon lengthening. As a result, he was able to stand up and walk, both while bearing weight on the heel of the affected foot, but he was unable to push off the ground using that foot. When a foot prosthesis was introduced, the patient's walking speed increased from 0.6 m/s without the prosthesis to 0.8 m/s with the prosthesis, which was an increase of 33%. The plantar pressure at the stump decreased from 129.3 N/cm on average without the prosthesis to 51.6 N/cm with the prosthesis, which was a 59% decrease. Wearing a foot prosthesis improved the patient's walking speed and decreased plantar pressure at the amputation stump.
Topics: Humans; Male; Aged; Pressure; Amputation, Surgical; Foot; Walking Speed; Artificial Limbs; Walking
PubMed: 38494732
DOI: 10.5387/fms.23-00003 -
Handchirurgie, Mikrochirurgie,... Feb 2024The upper extremity and particularly the hands are crucial for patients in interacting with their environment, therefore amputations or severe damage with loss of hand...
BACKGROUND
The upper extremity and particularly the hands are crucial for patients in interacting with their environment, therefore amputations or severe damage with loss of hand function significantly impact their quality of life. In cases where biological reconstruction is not feasible or does not lead to sufficient success, bionic reconstruction plays a key role in patient care. Classical myoelectric prostheses are controlled using two signals derived from surface electrodes in the area of the stump muscles. Prosthesis control, especially in high amputations, is then limited and cumbersome. The surgical technique of Targeted Muscle Reinnervation (TMR) offers an innovative solution: The major arm nerves that have lost their target organs due to amputation are rerouted to muscles in the stump area. This enables the establishment of cognitive control signals that allow significantly improved prosthesis control.
PATIENTS/MATERIALS AND METHODS
A selective literature review on TMR and bionic reconstruction was conducted, incorporating relevant articles and discussing them considering the clinical experience of our research group. Additionally, a clinical case is presented.
RESULTS
Bionic reconstruction combined with Targeted Muscle Reinnervation enables intuitive prosthetic control with simultaneous movement of various prosthetic degrees of freedom and the treatment of neuroma and phantom limb pain. Long-term success requires a high level of patient compliance and intensive signal training during the prosthetic rehabilitation phase. Despite technological advances, challenges persist, especially in enhancing signal transmission and integrating natural sensory feedback into bionic prostheses.
CONCLUSION
TMR surgery represents a significant advancement in the bionic care of amputees. Employing selective nerve transfers for signal multiplication and amplification, opens up possibilities for improving myoelectric prosthesis function and thus enhancing patient care. Advances in the area of external prosthetic components, improvements in the skeletal connection due to osseointegration and more fluid signal transmission using wireless, fully implanted electrode systems will lead to significant progress in bionic reconstruction, both in terms of precision of movement and embodiment.
Topics: Humans; Quality of Life; Amputation, Surgical; Upper Extremity; Amputation Stumps; Prosthesis Implantation; Artificial Limbs; Muscle, Skeletal
PubMed: 38417811
DOI: 10.1055/a-2260-9842 -
Journal of Personalized Medicine Jan 2024Lower limb trauma often results in mangled extremities, and in some cases, complete amputation may be necessary. However, limiting the extent of amputation and...
Lower limb trauma often results in mangled extremities, and in some cases, complete amputation may be necessary. However, limiting the extent of amputation and preserving the major knee joint are crucial to enhance mobility and overall functionality. By providing painless soft tissue coverage on the stump, early prosthesis use and the initiation of physiotherapy become more feasible. Soft tissue transfers hold the potential to benefit patients in two essential aspects: first, resolving soft tissue deficiencies without causing bone shortening, and second, preparing the stump to enhance overall functionality. A retrospective study conducted at Chang Gung Memorial Hospital (2009-2016) focused on lower limb amputation patients who underwent soft tissue transfers at different time periods compared to those without stump reconstruction. Out of the 2391 cases of lower limb injuries treated operatively, 117 amputations were performed in 110 patients (44 above the knee and 73 below the knee). Among them, 12 patients received soft tissue transfers for limb salvage and soft tissue deficiency after amputations. It was observed that patients in this group were typically younger, predominantly female, had longer hospital stays, and underwent a greater number of surgical procedures ( < 0.05). Through the use of soft tissue transfers, successfully preserved tibial bone length and functional knee joint in selected patients was achieved. This approach effectively resolved soft tissue deficiencies following lower limb amputations, optimizing physiotherapy and facilitating functional rehabilitation.
PubMed: 38392593
DOI: 10.3390/jpm14020160 -
Frontiers in Medicine 2024Low-grade fibromyxoid sarcoma (LGFMS) is a rare type of soft tissue sarcoma that often involves the deep soft tissue of the extremities and trunk in young and...
BACKGROUND
Low-grade fibromyxoid sarcoma (LGFMS) is a rare type of soft tissue sarcoma that often involves the deep soft tissue of the extremities and trunk in young and middle-aged adults. It is uncommon in the elderly. Here we discuss a case of LGFMS in an elderly patient who had recurrence and metastasis within 2 years of resection of the primary tumor.
CASE REPORT
A 71-year-old LGFMS patient was presented with a mass in the left forearm accompanied by pain and numbness from the left upper arm to fingers. The patient subsequently underwent 3 surgical resections, although she had 3 recurrences within 6 months after the initial diagnosis. Considering the malignant biological behavior of the tumor, an amputation at 5 cm above the elbow was eventually performed. However, recurrence in the extremity of the stump and chest wall metastasis were observed 2 years after amputation. Then resection of the metastases, radiotherapy and particle implantation therapy were performed. The patient is currently undergoing follow-up and has no evidence of recurrence.
CONCLUSION
In our case, multiple early postoperative recurrences may be associated with a positive margin at initial operation. The patient underwent a total of 5 operations including local resection of the primary tumor, twice wide resections, amputation and metastatic surgery with 4 early postoperative recurrences and metastases within 4 years, suggesting that LGFMS may have highly invasive biological behavior. Our case demonstrated that early aggressive surgical treatment is recommended for LGFMS patients with a positive margin at initial operation and patients who had recurrence even after wide resection rather than local resection. Further research is needed to develop more effective treatment options for rapidly progress and highly aggressive LGFMS.
PubMed: 38362535
DOI: 10.3389/fmed.2024.1172746 -
Medicinski Glasnik : Official... Feb 2024Aim To study the character of blood circulation in the bone stump at tight and loose closure of the medullary cavity. Methods Two series of experiments on 39 rabbits...
Aim To study the character of blood circulation in the bone stump at tight and loose closure of the medullary cavity. Methods Two series of experiments on 39 rabbits with mid-third femoral amputation and muscular plasty were carried out. In the 1st (experimental) series, the bone scapula was closed by thin cortical autograft taken from the epimetaphyseal area, and then the muscles were sutured, and in the 2nd - the scapula was closed by myoplasty only. Follow-up periods: 1st series - 7, 14, 21 days and 1, 3, 6 months, 2nd series - 1, 3, 6 months. Histological methods with infusion of vessels with ink-gelatin mixture and morphometry was used. Results In the 1st series there was a rapid restoration of the disturbed macro- and microcirculation due to the reserve sources of blood circulation and the development of extravascular ways of microcirculation. In the 2nd series, blood circulation recovery was significantly slower and occurred mainly due to the development of extravascular microcirculatory pathways. Conclusion The study established undeniable usefulness of tight closure of the bone marrow cavity during amputation.
PubMed: 38341643
DOI: 10.17392/1677-23 -
The Journal of Hand Surgery... Feb 2024Surgical reconstruction can restore length and function, but cannot adequately resolve the problem of disfigurement. Prosthetic fitting can play a complementary role in...
Surgical reconstruction can restore length and function, but cannot adequately resolve the problem of disfigurement. Prosthetic fitting can play a complementary role in enhancing the aesthetic outcomes post reconstruction. However, complex reconstruction involving flaps coupled with the surgical imperative for limb length preservation can lead to outcomes where the reconstructed stumps are challenging to fit with prosthesis. This article describes how prosthetic fitting was tackled in a case of a triple-digit amputation after reconstruction that presented with finger stumps that were bulky, long and stiff in extension contracture, compounded by the presence of substantive scar tissues. We discuss major prosthesis modifications that were unconventional but necessary to enable fitting, the techniques involved, as well as the aesthetic and functional considerations behind the modifications. The results showed that enhanced aesthetic appearance, together with a marginal improvement in hand function, was achieved post-prosthetically, meeting the patient's and the clinical team's fitting objective. Level V (Therapeutic).
Topics: Humans; Surgical Flaps; Prostheses and Implants; Amputation Stumps; Fingers; Contracture
PubMed: 38299242
DOI: 10.1142/S2424835524720032 -
JNMA; Journal of the Nepal Medical... Sep 2023Crush injury with bone loss results in shortening the length of the thumb. Most of the immediate intervention is amputation and stump closure. Revision amputation with...
UNLABELLED
Crush injury with bone loss results in shortening the length of the thumb. Most of the immediate intervention is amputation and stump closure. Revision amputation with stump closure gives loss of functional length and the patient is unable to do daily activities as before. In most of all hand functions, the opposition of the thumb plays an important role. Reconstruction of the thumb with iliac crest bone graft with its functional length is one of the major achievements for the patient. As in our case, the patient is right-hand dominant he is more concerned about the functional length of the thumb, whatever the aesthetic appearance. Here we present a case of a 24-year-old male with thumb reconstruction in a severely injured thumb with loss of bone and soft tissue just distal to the base of the proximal phalanx. Nine months postoperatively, the patient showed a great outcome with restored thumb length, function, grip strength, and a good range of motion.
KEYWORDS
case reports; injury; thumb.
Topics: Male; Humans; Young Adult; Adult; Thumb; Ilium; Groin; Amputation, Traumatic; Plastic Surgery Procedures
PubMed: 38289797
DOI: 10.31729/jnma.8264