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Cureus May 2024Introduction Managing open lower extremity fractures is challenging, with potential complications such as amputation and infection. The aim of the study was to determine...
Introduction Managing open lower extremity fractures is challenging, with potential complications such as amputation and infection. The aim of the study was to determine whether the time delay and initial treatment of the patients treated in a non-specialized hospital before being transferred to a dedicated level I trauma center led to a worse outcome. Methods Retrospective data from 44 patients (37 males and seven females) undergoing free tissue transfer for lower extremity open fractures from January 2017 to December 2022 were analyzed. Group A received primary care externally and was later transferred for definitive treatment (n=17, 38.6%), while group B received initial care at a level I trauma center (n=27, 61.4%). Surgical outcomes, complications, the duration of the hospital stay, and assessment times were compared. Various demographic variables, co-morbidities, prior interventions, and flap types were analyzed. Results Average age (A: 55.1±16.7; B: 38.7±19.8 years; p=0.041), overall hospitalization (A: 55.7±22.8; B: 42.8±21.3 days; p=0.041), and time to soft tissue reconstruction differed significantly between groups (A: 30.7±12.2; B: 18.9±9.3 days; p=0.013). Overall, 31.8% had multiple injuries without statistical differences between groups A and B (29.4% vs. 33.3%; p>0.05). There were no statistical differences between the groups in terms of major and minor complications and bone healing characteristics. Limb salvage was successful overall in 93.2% (A: 94.1%; B: 92.6%; P>0.05). Major complications occurred in 9.1%; three patients underwent major amputation (A: n=2; B: n=1). Minor complications were observed in 43.2% of patients (partial flap necrosis, wound dehiscence and non-union; A: 41.2%; B: 44.4%; p>0.05). Overall, 65.9% of patients (A: 64.7%; B: 66.7%; p>0.05) experienced uneventful bone healing, while 18.2% of patients (A: 23.5%; B: 14.8%; p>0.05) experienced delayed healing. Flaps used were mostly musculocutaneous (71.7%). Various assessed demographic characteristics, including age and presence of polytrauma, showed no significant influence on complications (p>0.05). Conclusion Although there is a significant difference in the time course of externally treated patients with open fractures, prolonged treatment is not associated with a higher complication rate or compromised bone healing outcome. Despite the findings, it is important to avoid delays and strive for interdisciplinary collaboration.
PubMed: 38883017
DOI: 10.7759/cureus.60380 -
The Journal of Arthroplasty Jun 2024Little is known about the resumption of sporting activities following megaprosthetic reconstruction of the distal femur and proximal tibia after resection of a bone...
Patients Regularly Return to Medium- and Low-Impact Types of Sporting Activities Following Distal Femoral or Proximal Tibial Replacement After Resection of a Primary Bone Sarcoma.
BACKGROUND
Little is known about the resumption of sporting activities following megaprosthetic reconstruction of the distal femur and proximal tibia after resection of a bone sarcoma. Thus, the aims of our study were: (1) to assess the functional outcome; (2) to evaluate pre- and postoperatively performed sporting activities; and (3) to identify potential beneficial and limiting factors.
METHODS
Between 1993 and 2015, a total of 230 patients underwent distal femoral replacement (DFR), and 96 patients underwent proximal tibial replacement (PTR). Exclusion criteria were death, amputation, living overseas, and a congenital disability. Functional outcome and sporting activities were assessed using the Musculoskeletal Tumor Society Score (MSTS), Toronto Extremity Salvage Score (TESS), Forgotten Joint Score (FJS), Subjective Knee Value (SKV), the Tegner Activity Score (TS), and the modified Weighted Activity Score (WAS).
RESULTS
There were 93 patients who had a median follow-up of 182 months (interquartile range (IQR) 130 to 260) after DFR with the following median scores: MSTS 18 (IQR 12 to 23), TESS 75% (IQR 60 to 84), FJS 25 (IQR 8 to 40), SKV 53% (IQR 40 to 70), TS 3 (IQR 3 to 4), and WAS 4 (IQR 0 to 8). There were 42 patients who had a median follow-up of 193 months (IQR 137 to 244) after PTR had the following median scores: MSTS 17 (IQR 15 to 22), TESS 78% (IQR 68 to 88), FJS 32 (IQR 20 to 46), SKV 60% (IQR 40 to 70), TS 3 (IQR 3 to 4), and WAS 4 (IQR 1 to 10). Postoperatively, 61% of DFR and 76% of PTR patients participated in at least one sporting activity.
CONCLUSION
Functional outcome is overall good with a regular resumption of sporting activities. Patients' age at surgery and higher preoperative sporting levels were associated with better functional outcomes and higher postoperative sporting activity.
PubMed: 38880406
DOI: 10.1016/j.arth.2024.06.014 -
BMC Musculoskeletal Disorders Jun 2024Traumatic proximal tibiofibular fracture and dislocation (PTFD) have been rarely studied and are easily missed in clinical practice. PTFD is considered a marker of...
BACKGROUND
Traumatic proximal tibiofibular fracture and dislocation (PTFD) have been rarely studied and are easily missed in clinical practice. PTFD is considered a marker of severely traumatized knees. The purpose of this study was to retrospectively analyze the incidence and impact of PTFD in traumatized knees with vascular injury.
METHODS
Patients with knee trauma and vascular injury were included from January 2022 to October 2023. X-rays and CT scans of included patients were retrospectively analyzed to determine the presence of PTFD. Patients were further divided into PTFD group and non-PTFD group for further comparative analysis.
RESULTS
A total of 27 patients (28 limbs) were included. Incidence of PTFD was 39.3% (11/28) in traumatic knee with vascular injury, including 8 anterolateral dislocations and 3 posteromedial dislocations. PTFD group had significantly more limbs with open injuries compared with non-PTFD group (10/11 VS 7/17, p<0.05). Amputation rate of PTFD group was as high as 40% (4/10), compared to 23.5% (4/17) in non-PTFD group. However, the difference between two groups was not statistically significant (p>0.05).
CONCLUSIONS
PTFD was easily overlooked or missed. In traumatized knees with vascular injury, incidence of PTFD was high. The presence of PTFD might indicate severe knee trauma and the possibility of open injury. Although there was no significant difference compared with non-PTFD group, PTFD group had a relatively high amputation rate of 40%.
Topics: Humans; Male; Female; Retrospective Studies; Adult; Middle Aged; Tibial Fractures; Knee Dislocation; Fibula; Incidence; Young Adult; Tomography, X-Ray Computed; Vascular System Injuries; Amputation, Surgical; Aged; Knee Injuries; Adolescent
PubMed: 38879480
DOI: 10.1186/s12891-024-07577-w -
Age and Ageing Jun 2024Peripheral artery disease (PAD) is the lower limb manifestation of systemic atherosclerotic disease. PAD may initially present with symptoms of intermittent... (Review)
Review
Peripheral artery disease (PAD) is the lower limb manifestation of systemic atherosclerotic disease. PAD may initially present with symptoms of intermittent claudication, whilst chronic limb-threatening ischaemia (CLTI), the end stage of PAD, presents with rest pain and/or tissue loss. PAD is an age-related condition present in over 10% of those aged ≥65 in high-income countries. Guidelines regarding definition, diagnosis and staging of PAD and CLTI have been updated to reflect the changing patterns and presentations of disease given the increasing prevalence of diabetes. Recent research has changed guidelines on optimal medical therapy, with low-dose anticoagulant plus aspirin recommended in some patients. Recently published randomised trials highlight where bypass-first or endovascular-first approaches may be optimal in infra-inguinal disease. New techniques in endovascular surgery have increased minimally invasive options for ever more complex disease. Increasing recognition has been given to the complexity of patients with CLTI where a high prevalence of both frailty and cognitive impairment are present and a significant burden of multi-morbidity and polypharmacy. Despite advances in minimally invasive revascularisation techniques and reduction in amputation incidence, survival remains poor for many with CLTI. Shared decision-making is essential, and conservative management is often appropriate for older patients. There is emerging evidence of the benefit of specialist geriatric team input in the perioperative management of older patients undergoing surgery for CLTI. Recent UK guidelines now recommend screening for frailty, cognitive impairment and delirium in older vascular surgery patients as well as recommending all vascular surgery services have support and input from specialist geriatrics teams.
Topics: Humans; Peripheral Arterial Disease; Aged; Endovascular Procedures; Risk Factors; Chronic Limb-Threatening Ischemia; Vascular Surgical Procedures; Age Factors; Practice Guidelines as Topic
PubMed: 38877714
DOI: 10.1093/ageing/afae114 -
The Journal of Foot and Ankle Surgery :... Jun 2024The risk of above-ankle reamputation following a transmetatarsal amputation is around 30%. Patient selection may be crucial to achieve good outcomes, and to avoid futile...
The risk of above-ankle reamputation following a transmetatarsal amputation is around 30%. Patient selection may be crucial to achieve good outcomes, and to avoid futile operations and suffering. We are aware of no previous comparison between the two largest patient groups that undergo lower extremity amputations: patients with diabetes, and patients with non-diabetic peripheral artery disease. Patients with diabetes or non-diabetic peripheral artery disease who had undergone a transmetatarsal amputation from 2004 through 2018 at our institution were included. Patient characteristics and peri-operative details were analyzed retrospectively. Subjects with diabetes were compared with subjects with non-diabetic peripheral artery disease regarding above-ankle reamputation, reamputation level, and mortality. Five-hundred-and-sixty transmetatarsal amputations in 513 subjects were included. The majority of transmetatarsal amputations (86%) occurred in diabetic subjects. Subjects with non-diabetic PAD had a higher risk of above-ankle reamputation (p = .008), and death (p < .001). At the time of data collection, only multiple-ray amputation (vs. single-ray) was an independent risk factor for above-ankle reamputation. Only age, medical comorbidity in general, and chronic heart failure were independent risk factors of death. To our knowledge, this study is the first to report marked differences in above-ankle reamputation rates and mortality following transmetatarsal amputation, comparing diabetics with non-diabetic patients with peripheral artery disease. However, the differences may be attributed to non-diabetics being older, having more medical comorbidities, and having more advanced foot ulcers at the time of transmetatarsal amputation. In patients exhibiting several of these risk factors, transmetatarsal amputation may be futile. LEVEL OF CLINICAL EVIDENCE: Prognostic Level 2: Retrospective study.
PubMed: 38876207
DOI: 10.1053/j.jfas.2024.05.017 -
Nursing Open Jun 2024To understand the experiences of individuals who undergo LEA due to DFU after disability.
AIM
To understand the experiences of individuals who undergo LEA due to DFU after disability.
DESIGN
A descriptive research design in qualitative research.
METHODS
Semi-structured interviews were used in this qualitative descriptive study. Eleven middle-aged patients (45-59 years) who underwent LEA due to DFU were purposively selected and interviewed. Qualitative data were thematically analysed.
RESULTS
Three themes and 10 subthemes were identified. The themes were (1) role function confusion, (2) self-concept stress and (3) unreasonable objective support. Subthemes included (1) weakened career role, (2) family role reversal, (3) social role restriction, (4) over-focusing on appearance, (5) immersion in patient experience, (6) living with faith, (7) polarization of independent consciousness, (8) low perceived benefits of peer support, (9) existence of treatment disruption and (10) poor participation in medical decision-making.
Topics: Humans; Qualitative Research; Middle Aged; Male; Female; China; Amputation, Surgical; Diabetic Foot; Disabled Persons; Lower Extremity; Social Support; Interviews as Topic; Self Concept
PubMed: 38875354
DOI: 10.1002/nop2.2213 -
Canadian Prosthetics & Orthotics Journal 2023The world of prosthetics has been undergoing significant changes, with the evolution of materials, design techniques, and manufacturing methodologies converging to...
The world of prosthetics has been undergoing significant changes, with the evolution of materials, design techniques, and manufacturing methodologies converging to redefine the landscape. Central to this narrative is the imperative for a holistic approach, harmonizing the trinity of materials, design, and methodologies to yield optimal outcomes. This balance is especially pivotal for the overlooked yet significant segment of those with partial hand and finger differences. Historically, this demographic has been underserved, with rehabilitation and prosthetic innovations often falling short. The sheer prevalence of partial hand differences underscores the urgency of tailored solutions. Traditional fabrication methods like wet lamination have posed challenges, particularly in aligning and efficiency. The advent of additive manufacturing has been transformative. The case of designing and printing a partial finger socket for Point Designs, LLC's Point Partial finger highlights this paradigm shift. Where conventional techniques demanded hours, digital design and 3D printing have condensed the process to mere minutes, without compromising on quality. This is not merely a win in terms of time efficiency; the implications for the end users are profound, ensuring a more customized and efficient solution. The journey underscores the potential of blending technology and traditional prosthetic knowledge, pointing towards a future where prosthetics align more seamlessly with users' needs.
PubMed: 38873135
DOI: 10.33137/cpoj.v6i2.42139 -
Canadian Prosthetics & Orthotics Journal 2023Victoria Hand Project (VHP) is a Canadian charity with a mission to provide 3D printed prosthetic arms to people in-need across the world, by partnering with prosthetic...
Victoria Hand Project (VHP) is a Canadian charity with a mission to provide 3D printed prosthetic arms to people in-need across the world, by partnering with prosthetic care providers. This article explores the journey of VHP, sharing insights, lessons learned, ongoing directions, and the impact of 3D printing on prosthetic care for people with upper-limb amputation. Benefits such as affordability and customization are explored, as well as the challenges encountered, including quality control and the steep learning curve associated with working in the digital 3D space. Through this article, the potential of 3D printing to continue to transform the field of assistive technology and prosthetic and orthotic applications is underscored, especially when used for collaborative, humanitarian initiatives.
PubMed: 38873134
DOI: 10.33137/cpoj.v6i2.42142 -
Canadian Prosthetics & Orthotics Journal 2023Cosmetic covers provide better aesthetic appearance and may facilitate increased acceptance of the prosthesis. Traditionally, cosmetic covers aimed to achieve an... (Review)
Review
Cosmetic covers provide better aesthetic appearance and may facilitate increased acceptance of the prosthesis. Traditionally, cosmetic covers aimed to achieve an aesthetic and realistic appearance; through time, a fresh perspective has developed on cosmetic covers where traditional/realistic covers evolved into a custom-made product, which truly promotes the patient's personality. The objectives of the study were to gather information from five well-known companies in the cosmetic cover industry (UNYQ, Limb-Art, Alleles, WillowWood and Aqua-Leg), analyse and compare their design elements using the Pugh matrix, and suggest a novel design using the best performing criteria of each design. The overall results of the Pugh matrix revealed the opportunity of a new design with improved design elements mainly in terms of "cover fit/aesthetics", "ease of attachment" and "practicality". The novel design had a vast difference in total score from the second-best design, revealing the improvement possibilities such cover design may have in the future. Although the study successfully presented a theoretical novel design, it was based on data found through literature and web resources, making the overall results of the study more objective rather than subjective. Future research is encouraged to be conducted based on a more subjective approach towards cosmetic covers.
PubMed: 38873131
DOI: 10.33137/cpoj.v6i2.42176 -
Canadian Prosthetics & Orthotics Journal 2023Major limb loss can have profound physical and psychosocial implications for individuals, impacting their quality of life and well-being. Despite the effectiveness of... (Review)
Review
BACKGROUND
Major limb loss can have profound physical and psychosocial implications for individuals, impacting their quality of life and well-being. Despite the effectiveness of peer support in improving outcomes for various chronic conditions, its impact on individuals with major limb loss remains understudied.
OBJECTIVES
This review aims to explore the existing literature on peer support for individuals with major limb loss. Specifically, exploring how the literature defines peer support; examining its implementation, identifying outcomes measured in peer support interventions, assessing the benefits for individuals with major limb loss, and identifying barriers associated with peer support provision.
STUDY DESIGN
This review followed Arksey and O'Malley's methodological framework, analysing relevant literature to identify evidence, definitions, and key factors related to peer support for individuals with major limb loss.
METHODOLOGY
A comprehensive search in January 2023 utilized databases: MEDLINE, PsychInfo, Embase, and CINAHL. After a two-phase screening process, articles meeting specific criteria were included. Thematic and descriptive numerical analyses were applied to the extracted data.
FINDINGS
Twenty-two articles were reviewed. Peer support was described as an opportunity to provide education, advice, and encouragement between individuals with lived experiences. Across the two intervention-based studies investigating peer support programs, outcome measures included physical, psychological, social, and quality of life. Qualitative studies described perceived benefits as improved psychosocial well-being and the opportunity to exchange knowledge. Perceived barriers included a lack of formal training and male-dominated groups, which deterred individuals with amputation from participating.
CONCLUSION
The evidence from the findings of the review sheds light on the current understanding of peer support for individuals with amputation. Due to the limited number of studies available, future research is necessary to develop and evaluate the effectiveness of peer support interventions tailored to this population.
PubMed: 38873011
DOI: 10.33137/cpoj.v6i1.42170