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Trauma Case Reports Apr 2023We present the case of a patient who sustained a displaced intertrochanteric fracture proximal to an above-the-knee amputation. Reduction was obtained using 2 AO femoral...
We present the case of a patient who sustained a displaced intertrochanteric fracture proximal to an above-the-knee amputation. Reduction was obtained using 2 AO femoral distractors placed anteriorly and laterally, spanning the hip joint. Fracture fixation was achieved using a sliding hip screw and side plate. Intertrochanteric fractures proximal to an above-the-knee amputation are challenging to manage because of the difficulty in obtaining sufficient skin traction on the stump to effect reduction. Using two femoral distractors anteriorly and laterally can help obtain length and alignment in these difficult cases.
PubMed: 36874952
DOI: 10.1016/j.tcr.2023.100806 -
Journal of Functional Morphology and... Feb 2023Individuals with lower-limb amputations may have a significant strength deficit. This deficit may be related to the stump length and can lead to changes in gait, reduced... (Review)
Review
Individuals with lower-limb amputations may have a significant strength deficit. This deficit may be related to the stump length and can lead to changes in gait, reduced energy efficiency, walking resistance, altered joint load, and increased risk of osteoarthritis and chronic low back pain. This systematic review used the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA) guidelines to examine the effects of resistance training in lower limb amputees. Interventions with resistance training and other training methods were sufficient to achieve muscle strength gain in muscles of the lower limbs, improved balance, and improvements in gait pattern and speed when walking. However, it was impossible to determine from the results whether resistance training was mainly responsible for these benefits or even whether the positive effects presented would be observed with only this training method. When combined with other exercises, interventions with resistance training made possible gains for this population. Accordingly, it is noteworthy that the main finding of this systematic review is that the effects may be different according to the level of amputation, with mainly transtibial and transfemoral amputations studied.
PubMed: 36810507
DOI: 10.3390/jfmk8010023 -
Polski Przeglad Chirurgiczny Apr 2022<b>Introduction:</b> Negative pressure wound therapy (NPWT) has been suggested as a gold standard for managing complex wounds and to reduce the time of...
<b>Introduction:</b> Negative pressure wound therapy (NPWT) has been suggested as a gold standard for managing complex wounds and to reduce the time of healing and overall morbidity and mortality of the patient. </br></br> <b>Aim:</b> We have done a retrospective study to observe the outcome in patients managed with negative pressure wound therapy for varied etiologies. </br></br> <b> Methods:</b> Patients with complicated wounds including lower limb wounds post-debridement, upper limb wounds post-debridement, postoperative abdominal wound dehiscence, abdominal and chest abscess wounds post-debridement and amputation stumps, managed with negative pressure wound therapy were studied on the basis of wound outcome, total hospital stay, days of NPWT application and pressure and mode of NPWT. </br></br> <b>Results:</b> A total of 42 patients with complicated wounds were included in the study. Mean hospital stay was 16.2 days and mean NPWT application time was 8.29 days with NPWT being applied on average for 3.91 days post-procedure like debridement or amputation or after wound dehiscence in which debridement was not done. As many as 41.5% of wounds were closed with suturing, 48.8% healed by secondary intention and 9.8% were covered with split-thickness skin grafts. A significant observation was made for lower pressure being used for abdominal wound dehiscence (75 mmHg) compared to other wounds on limbs (mean 98.33 mmHg) (P < 0.001). Re-debridement after the 1st cycle of NPWT was needed in 40% of wounds managed with intermittent mode compared to 6.2% in continuous mode (P = 0.028). </br></br> <b>Conclusion:</b> NPWT can reduce and manage wound complications with improvement in the quality of life of patients when used at an appropriate time with knowledge of its mechanism and functionality.
Topics: Humans; Negative-Pressure Wound Therapy; Quality of Life; Retrospective Studies; Neurosurgical Procedures; Postoperative Complications; India
PubMed: 36806166
DOI: 10.5604/01.3001.0015.8170 -
Journal of Reconstructive Microsurgery Sep 2023Reconstruction of the mutilated hand is one of the most difficult challenges for hand microsurgeons. When multiple digits are amputated, orthotopic digital... (Review)
Review
BACKGROUND
Reconstruction of the mutilated hand is one of the most difficult challenges for hand microsurgeons. When multiple digits are amputated, orthotopic digital replantation of the available remnants may not adequately restore the hand function. In such cases, heterotopic digital replantation may provide a more functional reconstruction.
METHODS
Between 1997 and 2018, 53 patients with mutilating hand injuries were treated with heterotopic digital replantation at our institution. A retrospective chart review was conducted to determine the details of the injury, indications for heterotopic digital replantation, and functional outcomes.
RESULTS
In total, 173 digits were amputated from 53 patients (one patient suffered from bilateral hand injuries, so totally 54 hands). Sixty-eight digits underwent heterotopic digital replantation, 30 digits had orthotopic digital replantation, and 75 stumps were terminalized. The survival rate of digits treated by heterotopic digital replantation and orthotopic digital replantation was 83.8% (57/68) and 86.7% (26/30), respectively ( = 1). Tripod grip was achieved in 83.3% (45/54) of patients following replantation and optional secondary reconstructive surgeries.
CONCLUSION
Heterotopic digital replantation is a practical and reliable method for achieving optimal hand function following mutilating hand injuries. The basic principles are to restore a functional thumb in the first instance, followed by at least two adjacent fingers against which the thumb can oppose. This method is particularly indicated when orthotopic digital replantation of the available amputated parts would yield a suboptimal result.
Topics: Humans; Finger Injuries; Amputation, Traumatic; Retrospective Studies; Fingers; Hand Injuries; Replantation
PubMed: 36720252
DOI: 10.1055/s-0043-1761288 -
Sichuan Da Xue Xue Bao. Yi Xue Ban =... Jan 2023To investigate the role of contrast-enhanced ultrasound (CEUS) in the treatment of diabetic ulcers.
OBJECTIVE
To investigate the role of contrast-enhanced ultrasound (CEUS) in the treatment of diabetic ulcers.
METHODS
The clinical data of 27 diabetic patients, who underwent CEUS examination of their ulcers in our hospital between April 2021 and July 2022 were collected. Among them, 26 patients suffered from diabetic foot ulcers, 5 of whom underwent amputation during hospitalization, and one patient suffered from hip ulcer. The 27 patients' mean age was (64.08±12.57) years. Fasting blood glucose levels of the patients were 3.36-34.61 mmol/L, with a mean of (10.62±8.77) mmol/L. Their glycosylated hemoglobin levels were 5.80%-10.70%, with an average of 7.96%±1.50%. Philips EPIQ7 ultrasound system with L9-3 linear probe of 3-9 MHz was used. First, the patients' ulcers were examined with conventional ultrasound to observe for abnormal echo. Then, 2.4 mL SonoVue (Bracco, Italy), a contrast agent, was injected intravenously through the elbow to look for effusion/pus, sinus tract, or dead space in the lesion area, and images were acquired.
RESULTS
Among the 27 patients, except for 5 with amputation stumps, 22 patients had wound areas ranging from 0.16 cm to 215 cm , all being accompanied by sinus tract formation. Ten patients underwent ultrasound examination during their treatment. The positive rate of the results of conventional ultrasound was 50% (5/10) for identifying effusion/pus and pseudoaneurysm in the deep area of ulcers, while the positive rate of CEUS results was 100% (10/10). In addition to the lesions found by conventional ultrasound, CEUS also found large sinus tracts or dead spaces in the deep surface of ulcers in 5 additional patients. Of the 27 patients, 17 underwent ultrasound examination of the healing status of sinus tracts and dead spaces in the deep areas of ulcers before discharge. No sinus tracts in the deep areas of the ulcers were found by conventional ultrasound. However, relatively small dead spaces or sinus tracts in the deep areas of the ulcers were found in 10 patients by CEUS. Conventional ultrasound and CEUS found that 1 patient had a small amount of fluid in the amputation stump. In the remaining 6 patients, no deep sinus tracts in the ulcers were found by either conventional ultrasound or CUES, and the ulcers healed completely.
CONCLUSION
By examining microvascular perfusion in diabetic wounds with CEUS, we can observe the extent of sinus tracts during treatment and whether the sinus tracts have healed or whether there are still dead spaces before patient discharge, which provides support for clinical decision-making concerning the treatment of diabetic ulcers.
Topics: Humans; Middle Aged; Aged; Diabetic Foot; Contrast Media; Inflammation; Suppuration; Diabetes Mellitus
PubMed: 36647662
DOI: 10.12182/20230160507 -
Annals of Physical and Rehabilitation... Jun 2023Individuals requiring non-traumatic Gritti-Stokes amputation or mid-thigh amputation usually have multiple comorbidities that place them at high risk of mortality. (Observational Study)
Observational Study
BACKGROUND
Individuals requiring non-traumatic Gritti-Stokes amputation or mid-thigh amputation usually have multiple comorbidities that place them at high risk of mortality.
OBJECTIVE
To determine survival rate 5 years after Gritti-Stokes and mid-thigh amputation in individuals with vascular insufficiency and to identify the predictors of survival.
METHODS
We conducted a retrospective observational study including all individuals with vascular insufficiency who underwent amputation from September 2007 to December 2015 in our University Hospital. The indication for amputation was limb necrosis in 86% of cases, infection in 10%, and complications with the stump (discomfort, neuroma or scar dehiscence) in 4%. Medical records were analysed to determine factors and comorbidities. The date of death was retrieved from the national death registry at a minimum of 5 years after amputation. Cox proportional-hazard regression was used to estimate associations between factors and post-amputation survival with hazard ratios (HR) and 95% confidence intervals (CIs).
RESULTS
We included 126 people with vascular insufficiency (83 men), mean age was 70 years [20; 97]; eighty-nine participants (71%) died during the study period. Survival rate was 68% at 1 year, 48% at 3 years and 37% at 5 years. Survival was associated with prosthetic fitting (HR 0.306 [95% CI 0.180; 0.521], p<0.001) and length of stay (HR 0.992 [95% CI 0.987; 0.997], p = 0.003). Conversely, limb necrosis was associated with a lower survival rate (HR 3.801 [95% CI 1.615; 8.949], p = 0.002). In a secondary multivariable analysis, Gritti-Stokes amputation was the only factor positively associated with prosthetic fitting (odds ratio 7.407 [95% CI 2.439; 22.489], p<0.001).
CONCLUSIONS
The survival rate at 5 years after Gritti-Stokes and mid-thigh amputation in people with vascular insufficiency was 37%. Prosthetic fitting was independently associated with better survival, and Gritti-Stokes amputation was the only factor positively related to prosthetic fitting.
Topics: Male; Humans; Aged; Thigh; Amputation, Surgical; Proportional Hazards Models; Comorbidity; Retrospective Studies; Risk Factors; Treatment Outcome
PubMed: 36645964
DOI: 10.1016/j.rehab.2022.101727 -
BJR Case Reports Nov 2022Despite the existing literature, the use of surgery to treat medical diseases in Ancient Egypt remains controversial. Regarding amputations, such procedures were...
OBJECTIVE
Despite the existing literature, the use of surgery to treat medical diseases in Ancient Egypt remains controversial. Regarding amputations, such procedures were performed in Egypt for therapeutic reasons, although they were never described in medical papyri. Here, we present the radiographic study of a possible lower limb amputation found in a recently discovered tomb in Aswan, Egypt.
METHODS
The necropolis is located on the west bank of the Nile, around the Mausoleum of the Aga Khan III. Around 45 mummies were found in the tomb, along with more than 400 mixed bones of adults and subadults. Radiographic analyses were carried out directly on-site in the proximity of the tomb using a digital portable device.Among the mixed bones, we found a mature right femur with evidence of mid-diaphyseal bone interruption and exuberant reparative callus at the broken stump with woven periosteal new bone, indicating a recent and active healing process at the time of death. The X-ray study confirmed the presence of a mid-diaphyseal transverse fracture, highlighting the relatively sharp margins which were suggestive of a transverse cut at this point. A slightly radiopaque bone callus was visible as osseous spurs with circumferential and proximal directions; the exuberant bone callus revealed an ante-mortem trauma, suggesting the hypothesis of certain types of amputation. The X-ray showed no clear signs of other bone diseases or advanced taphonomic processes. Among the commingled remains, we also found the mature distal epiphysis of a right femur with radiographic evidence of extensive bone remodeling at the proximal broken stump. However, we cannot ascertain that these two femoral pieces corresponded to the same individual.
CONCLUSIONS
Further studies will better clarify the causes of the bony lesion, which may be related to possible amputation of fracture from high-force blunt trauma. At present, the most likely cause relies on interpersonal violence, accidental occupation trauma and/or therapeutic treatment. Our report highlights how conventional radiology can still provide important results in the field of paleopathology, thanks to the possibility of using portable radiological devices directly on archaeological sites, thus overcoming technical difficulties in transporting bone mummified remains.
PubMed: 36632550
DOI: 10.1259/bjrcr.20220090 -
Neurosurgical Focus: Video Jan 2023In the United States, an estimated 185,000 individuals undergo amputation of their upper or lower limb. This results in residual limb pain in up to 85% of cases....
In the United States, an estimated 185,000 individuals undergo amputation of their upper or lower limb. This results in residual limb pain in up to 85% of cases. Targeted muscle reinnervation (TMR) is a technique that has been shown to prevent symptomatic neuroma formation. In this video, the authors demonstrate their technique utilizing TMR at the time of above-the-knee amputation. Coaptations are made to provide motor targets for branches of the saphenous, tibial, and peroneal sensory nerves. At the featured patient's most recent follow-up visit 3 months postoperatively, she reported no stump pain or phantom limb pain. The video can be found here: https://stream.cadmore.media/r10.3171/2022.10.FOCVID2293.
PubMed: 36628094
DOI: 10.3171/2022.10.FOCVID2293 -
JBJS Case Connector Oct 2022We report the case of a 35-year-old patient who presented with a septic residual synovial cavity infection 8 weeks after a through-the-knee amputation because of a...
CASE
We report the case of a 35-year-old patient who presented with a septic residual synovial cavity infection 8 weeks after a through-the-knee amputation because of a parosteal sarcoma. An endoscopic evacuation of the turbid fluid and synovial debridement through parapatellar portals as in a standard knee arthroscopy was performed, in conjunction with appropriate antibiotic therapy. One year postoperatively, there were no signs of residual infection.
CONCLUSION
Endoscopic treatment of a septic stump infection of the residual synovial cavity after through-the-knee amputation is feasible. In our case, this approach resulted in rapid wound healing and early prosthesis mobility.
Topics: Humans; Adult; Disarticulation; Knee Joint; Surgical Wound Infection; Arthroscopy; Wound Healing
PubMed: 36574429
DOI: 10.2106/JBJS.CC.22.00313 -
Cureus Nov 2022Chronic marijuana and alcohol consumption leads to many forms of physical and physiological deterioration in the human body, mainly affecting the neurological system. A...
Chronic marijuana and alcohol consumption leads to many forms of physical and physiological deterioration in the human body, mainly affecting the neurological system. A 65-year-old male patient suffered from stroke with the involvement of middle cerebral artery of the left side. Nine years later, patient presented with gangrene due to a traumatic unhealed wound on his left leg. The patient was under the influence of alcohol when he was injured. The infection spread, causing peripheral arterial disease, which eventually led to the development of gangrene till mid-calf of the left leg, for which he was amputated. Above-knee amputation with a fish-mouth incision was performed. Physiotherapy management focused on prehension and grip exercises for right upper limb, strengthening of all the limb musculature, stump management, transfer training, gait training with walker/crutches and prosthesis, and home exercise program, retraining activities of daily living. This case study embodies a rehabilitation program for this patient who suffered from stroke followed by amputation of the left leg. It focuses on bringing the patient back to his near-normal life. Regular physiotherapy helped the patient build up confidence, helped in resolving his addictions, and provided individual structure management. We present a rare case of above-knee amputation secondary to complications of alcohol abuse where an extensive post-op care and elaborate physiotherapy program resulted in a successful recovery.
PubMed: 36561577
DOI: 10.7759/cureus.31700