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Annals of the Royal College of Surgeons... Oct 2020Following open reduction and internal fixation for a proximal humerus fracture a 71-year-old man re-presented with wound changes consistent with infection and elevated...
Following open reduction and internal fixation for a proximal humerus fracture a 71-year-old man re-presented with wound changes consistent with infection and elevated inflammatory markers. No significant improvement was seen with concomitant intravenous antibiotics and multiple debridement procedures. This case was further complicated by soft tissue breakdown at the site of a left thigh haematoma also requiring debridement. Surgical site infections represent the most common cause of morbidity postoperatively. This case highlights the importance of considering a number of differential diagnoses. A diagnosis of pyoderma gangrenosum prompted systemic corticosteroid therapy giving rapid clinical improvement.
Topics: Aged; Debridement; Diagnosis, Differential; Fracture Fixation, Internal; Humans; Humeral Fractures; Male; Open Fracture Reduction; Pyoderma Gangrenosum; Thigh
PubMed: 32347737
DOI: 10.1308/rcsann.2020.0091 -
Knee Surgery, Sports Traumatology,... Feb 2013Identification of the most relevant diagnostic and prognostic factors of physical examination and imaging of hamstring injuries in (elite) athletes. (Review)
Review
PURPOSE
Identification of the most relevant diagnostic and prognostic factors of physical examination and imaging of hamstring injuries in (elite) athletes.
METHODS
A literature search was conducted in MEDLINE and EMBASE for articles between 1950 and April 2011. A survey was distributed among the members of the European Society of Sports Traumatology, Knee Surgery and Arthroscopy, which focused on physical examination, prognosis, imaging and laboratory tests of hamstring injuries in (elite) athletes.
RESULTS
Medical history, inspection and palpation of the muscle bellies and imaging are most valuable at the initial assessment according to the literature. Experts considered medical history, posture and gait inspection, inspection and palpation of muscle bellies, range of motion tests, manual muscle testing, referred pain tests and imaging to be most important in the initial assessment of hamstring injuries. Magnetic resonance imaging (MRI) is preferred over ultrasonography and should take place within 3 days post-trauma. Important prognostic factors are injury grade, length of the muscle tear on MR images, MRI-negative injuries and trauma mechanism.
CONCLUSIONS
Posture and gait inspection, inspection and palpation of muscle bellies, range of motion tests, manual muscle testing and referred pain tests within 2 days post-trauma were identified as the most relevant diagnostic factors.
LEVEL OF EVIDENCE
Literature review and expert opinion, Level V.
Topics: Athletic Injuries; Humans; Muscle, Skeletal; Physical Examination; Prognosis; Thigh
PubMed: 22622781
DOI: 10.1007/s00167-012-2055-x -
Radiology Oct 2022Background Longitudinal data on the association of quantitative thigh muscle MRI markers with knee osteoarthritis (KOA) outcomes are scarce. These associations are of...
Background Longitudinal data on the association of quantitative thigh muscle MRI markers with knee osteoarthritis (KOA) outcomes are scarce. These associations are of clinical importance, with potential use for thigh muscle-directed disease-modifying interventions. Purpose To measure KOA-associated longitudinal changes in MRI-derived muscle cross-sectional area (CSA) and adipose tissue and their association with downstream symptom worsening and knee replacement (KR). Materials and Methods In a secondary analysis of the Osteoarthritis Initiative multicenter prospective cohort (February 2004 through October 2015), knees of participants with available good-quality thigh MRI scans at baseline and at least one follow-up visit were included and classified as with and without KOA according to baseline radiographic Kellgren-Lawrence grade of 2 or higher and matched for confounders with use of propensity score matching. An automated deep learning model for thigh MRI two-dimensional segmentation was developed and tested. Markers of muscle CSA and intramuscular adipose tissue (intra-MAT) were measured at baseline and 2nd- and 4th-year follow-up (period 1) and compared between knees with and without KOA by using linear mixed-effect regression models. Furthermore, in knees with KOA, the association of period 1 changes in muscle markers with risk of KR (Cox proportional hazards) and symptom worsening (mixed-effect models) during the 4th to 9th year (period 2) was evaluated. Results This study included 4634 matched thighs (2317 with and 2317 without KOA) of 2344 participants (mean age, 62 years ± 9 [SD]; 1292 women). Compared with those without, knees with KOA had a decrease in quadriceps CSA (mean difference, -8.21 mm/year; = .004) and an increase in quadriceps intra-MAT (1.98 mm/year; = .007). Decreased CSA and increased intra-MAT of quadriceps during period 1 was predictive of downstream (period 2) KOA symptom worsening (Western Ontario and McMaster Universities Osteoarthritis Index total score: odds ratio, 0.24 [negative association] [ < .001] and 1.38 [ = .012], respectively). Quadriceps CSA changes were negatively associated with higher future KR risk (hazard ratio, 0.70; < .001). Conclusion Knee osteoarthritis was associated with longitudinal MRI-derived decreased quadriceps cross-sectional area and increased intramuscular adipose tissue. These potentially modifiable risk factors were predictive of downstream symptom worsening and knee replacement. Clinical trial registration no. NCT00080171 © RSNA, 2022
Topics: Disease Progression; Female; Humans; Knee Joint; Magnetic Resonance Imaging; Middle Aged; Osteoarthritis, Knee; Prospective Studies; Quadriceps Muscle; Symptom Flare Up; Thigh
PubMed: 35727152
DOI: 10.1148/radiol.212771 -
Lymphatic Research and Biology Dec 2021The primary purpose of this study was to clarify the occurrence of sites of edematous changes using the measured circumferences of the thigh and lower leg via...
The primary purpose of this study was to clarify the occurrence of sites of edematous changes using the measured circumferences of the thigh and lower leg via three-dimensional (3D) body scanning. The secondary purpose was to determine the relationship between the volume changes using 3D body scanning and the resistance changes as indicator of extracellular water (ECW) via segmental-bioelectrical impedance spectroscopy (S-BIS). Fifteen healthy women participated. Limb circumferences were measured using 3D body scanning at 10% intervals between 50% and 80% in the thigh circumference and between 0% and 80% in the lower leg circumference. The resistance of the ECW component (R) and total body water (R) was measured using S-BIS in the thigh and lower leg segments. These measurements were conducted at baseline and 6 hours postobservation. A paired -test was conducted for the differences in these parameters, and the effect sizes (ESs) were calculated using Cohen's . Correlations between changes in segmental volume and R were analyzed. Measurement-site circumferences and segmental volume significantly increased in the lower leg at postobservation but not in the thigh. The ES of circumference changes in the lower leg's central region were larger (ESs were 0.40-0.71 at 30%-50%) than in other regions. A significant correlation was observed between changes in segmental volume and R of the lower leg (ρ = -0.79, < 0.001). Assessing the circumference using 3D body scanning, we found the edematous changes to be significant in the lower leg's central regions. Moreover, volumetry using 3D body scanning can detect edematous change in the lower leg.
Topics: Body Composition; Body Water; Electric Impedance; Female; Humans; Leg; Spectrum Analysis; Thigh
PubMed: 33605789
DOI: 10.1089/lrb.2020.0087 -
Journal of Anatomy Apr 2021Although the number of Ultrasound (US) imaging studies investigating the fascial layers are becoming more numerous, the majority tend to use different reference points...
Although the number of Ultrasound (US) imaging studies investigating the fascial layers are becoming more numerous, the majority tend to use different reference points and terminology to describe their findings. The current work set out to compare macroscopic and microscopic data of specimens of the fascial layers of the thigh with US imaging findings. Specimens of the different fascial layers of various regions of the thigh were collected for macroscopic and histological analyses from three fresh cadavers and compared with in vivo US images of the thighs of 20 healthy volunteers. The specimens showed that the subcutaneous tissue of the thigh is made up of three layers: a superficial adipose layer, a membranous layer/superficial fascia, and a deep adipose layer. The deep fascia is composed of an aponeurotic fascia, which envelops all the thigh muscles and is laterally reinforced by the iliotibial tract and an epimysial fascia, which is specific for each muscle. The morphometric measurements of the thickness of the superficial fascia were different (anterior: 153.2 ± 39.3 µm; medial: 128.4 ± 24.7 µm; lateral: 154 ± 28.9 µm; and posterior: 148.8 ± 33.2 µm) as were those of the deep fascia (anterior: 556.8 ± 176.2 µm; medial: 820.4 ± 201 µm; lateral: 1112 ± 237.9 µm; and posterior: 730.4 ± 186.5 µm). The US scans showed a clear picture of the superficial adipose tissue, the superficial fascia, and the deep adipose tissue, as well as the deep fasciae. The epimysial and aponeurotic fasciae of only some topographic areas could be independently identified. The US imaging findings confirmed that the superficial and deep fascia have different thicknesses, and they showed that the US measurements were always larger with respect to those produced by histological analysis (p < 0.001) probably due to shrinkage during the processing. The posterior region (level 1) of the superficial fascia had, for example, a mean thickness of 0.56 ± 0.12 mm at US, while the histological analysis showed that it was 148.8 ± 33.2 µm. Showing a similar pattern, the thickness of the deep fascia was as follows: 1.64 ± 0.85 mm versus 730.4 ± 186.5 µm. Study results have confirmed that US can be considered a valid, non-invasive instrument to evaluate the fascial layers. In any event, there is a clear need for a set of standardised protocols since the thickness of the fascial layers of different parts of the human body varies and the data obtained using inaccurate reference points are not reproducible or comparable. Given the inconsistent terminology used to describe the fascial system, it would also be important to standardise the terminology used to define its parts. The difficulty in distinguishing between the epimysial and aponeurotic/deep fascia can also impede data interpretation.
Topics: Adult; Aged; Fascia Lata; Female; Humans; Male; Middle Aged; Thigh; Ultrasonography; Young Adult
PubMed: 33219512
DOI: 10.1111/joa.13360 -
Dermatology Online Journal Oct 2002
Topics: Abdomen; Aged; Aged, 80 and over; Female; Humans; Pemphigoid, Bullous; Scleroderma, Localized; Skin Diseases, Vesiculobullous; Thigh; Ultraviolet Therapy
PubMed: 12546766
DOI: No ID Found -
BMC Geriatrics Nov 2020We assessed the quantitative changes in muscle mass and strength during 2 weeks of hospitalization in immobile and mobile acutely ill hospitalized older adults. (Observational Study)
Observational Study
BACKGROUND
We assessed the quantitative changes in muscle mass and strength during 2 weeks of hospitalization in immobile and mobile acutely ill hospitalized older adults.
METHODS
Forty-one patients (82.4 ± 6.6 years, 73.0% females) participated in this prospective longitudinal observational study. Mobility status was defined according to walking ability as described in the Barthel-Index. Functional status, including handgrip strength and isometric knee-extension strength, and mid-thigh magnetic resonance imaging (MRI) measurements of cross-sectional area (CSA) were conducted on admission and at discharge.
RESULTS
Twenty-two participants (54%) were immobile and 19 (46%) mobile. In all, 54.0 and 12.0% were at risk of malnutrition and malnourished, respectively. The median time between baseline and follow-up for MRI scans were 13 days in mobile and immobile participants (P = 0.072). Mid-thigh muscle and subcutaneous fat CSA significantly decreased by 3.9cm (5.0%, P = 0.002) and 5.3cm (5.7%, P = 0.036) during hospitalization whereas intermuscular fat remained unchanged in immobile subjects. No significant changes were observed in mobile patients. In a regression analysis, mobility was the major independent risk factor for changes in mid-thigh muscle CSA as a percentage of initial muscle area (P = 0.022) whereas other variables such as age (P = 0.584), BMI (P = 0.879), nutritional status (P = 0.835) and inflammation (P = 0.291) were not associated with muscle mass changes. There was a significant decrease in isometric knee extension strength (P = 0.002) and no change in handgrip strength (P = 0.167) in immobile patients whereas both parameters increased significantly over time in mobile patients (P = 0.048 and P = 0.012, respectively).
CONCLUSIONS
Two weeks of disease-related immobilization result in a significant loss of thigh muscle mass and muscle strength in older patients with impaired mobility. Concomitantly, there was a significant reduction of subcutaneous adipose tissue in immobile older hospitalized patients whereas no changes were observed in intermuscular fat among these patients. These data highlight the importance of mobility support in maintaining muscle mass and function in older hospitalized patients.
Topics: Aged; Female; Hand Strength; Humans; Male; Muscle Strength; Muscle, Skeletal; Prospective Studies; Thigh
PubMed: 33238889
DOI: 10.1186/s12877-020-01873-5 -
Annals of the Royal College of Surgeons... Mar 2023Reconstruction of a surgical defect is an important part of the management of oral cancers. Microvascular free flap construction provides better functional and cosmetic...
INTRODUCTION
Reconstruction of a surgical defect is an important part of the management of oral cancers. Microvascular free flap construction provides better functional and cosmetic outcomes.
METHODS
Between 2014 and 2020, some 524 patients underwent microvascular reconstruction. Comorbidity variables were scored using the Charlson Comorbidity Index (CCI). Complications were recorded using Clavien-Dindo criteria.
RESULTS
Eighty-three (15.84%), 339 (64.69%) and 102 (19.47%) patients underwent free radial forearm flap, free anterolateral thigh flap and free fibula osteocutaneous flap (FFOCF), respectively. Clavien-Dindo complications of grade III and above were seen in 39 (7.44%) patients. Total flap loss was seen in 18 patients and of these, 16 were salvaged using alternative free flaps or pedicled flaps. On univariate analysis, overall and major complication rates were higher in FFOCF (=0.171). Major complications significantly more common in patients with a CCI score >4 (=0.001). Patients aged >65 years had higher rates of complications (=0.03).
CONCLUSION
Microvascular free tissue transfer is a reliable, safe and gold standard modality in surgical reconstruction and can be replicated in non-institutional settings.
Topics: Humans; Mouth Neoplasms; Free Tissue Flaps; Postoperative Complications; Thigh; Lower Extremity
PubMed: 35175143
DOI: 10.1308/rcsann.2021.0295 -
BMC Musculoskeletal Disorders Nov 2018Musculoskeletal models are commonly used to quantify joint motions and loads during human motion. Constraining joint kinematics simplifies these models but the...
BACKGROUND
Musculoskeletal models are commonly used to quantify joint motions and loads during human motion. Constraining joint kinematics simplifies these models but the implications of the placement and quantity of markers used during data acquisition remains unclear. The purpose of this study was to establish the effects of marker placement and quantity on lower extremity kinematics calculated using a constrained-kinematic model. We hypothesized that a constrained-kinematic model would produce lower-extremity kinematics errors that correlated with the number of tracking markers removed from the thigh and shank.
METHODS
Healthy-young adults (N = 10) walked on a treadmill at slow, moderate, and fast speeds while skin-mounted markers were tracked using motion capture. Lower extremity kinematics were calculated for 256 combinations of leg and shank markers to establish the implications of marker placement and quantity on joint kinematics. Marker combinations that yielded differences greater than 5 degrees were tested with paired t-tests and the relationship between number of markers and kinematic errors were modeled with polynomials to determine goodness of fit (R).
RESULTS
Sagittal joint and hip coronal kinematics errors were smaller than documented errors caused by soft-tissue artifact, which tends to be approximately 5 degrees, when excluding thigh and shank markers. Joint angle and center kinematic errors negatively correlated with the number of markers included in the analyses (R > 0.97) and typically showed the greatest error reductions when two markers were included on the thigh or shank segments. Further, we demonstrated that a simplified marker set that included markers on the pelvis, lateral knee condyle, lateral malleolus, and shoes produced kinematics that strongly agreed with the traditional marker set that included 3 tracking markers for each segment.
CONCLUSION
Constrained-kinematic models are resilient to marker placement and quantity, which has implications on study design and post-processing workflows.
Topics: Adult; Biomechanical Phenomena; Exercise Test; Female; Humans; Lower Extremity; Male; Models, Biological; Pelvis; Thigh; Young Adult
PubMed: 30424811
DOI: 10.1186/s12891-018-2329-7 -
Magnetic Resonance in Medicine Nov 2019To enable intrinsic and efficient fat suppression in 3D Cartesian fast interrupted steady-state (FISS) acquisitions.
PURPOSE
To enable intrinsic and efficient fat suppression in 3D Cartesian fast interrupted steady-state (FISS) acquisitions.
METHODS
A periodic interruption of the balanced steady-state free precession (bSSFP) readout train (FISS) has been previously proposed for 2D radial imaging. FISS modulates the bSSFP frequency response pattern in terms of shape, width and location of stop band (attenuated transverse magnetization). Depending on the FISS interruption rate, the stop band characteristic can be exploited to suppress the fat spectrum at 3.5 ppm, thus yielding intrinsic fat suppression. For conventional 2D Cartesian sampling, ghosting/aliasing artifacts along phase-encoding direction have been reported. In this work, we propose to extend FISS to 3D Cartesian imaging and report countermeasures for the previously observed ghosting/aliasing artifacts. Key parameters (dummy prepulses, spatial resolution, and interruption rate) are investigated to optimize fat suppression and image quality. FISS behavior is examined using extended phase graph simulations to recommend parametrizations which are validated in phantom and in vivo measurements on a 1.5T MRI scanner for 3 applications: upper thigh angiography, abdominal imaging, and free-running 5D CINE.
RESULTS
Using optimized parameters, 3D Cartesian FISS provides homogeneous and consistent fat suppression for all 3 applications. In upper thigh angiography, vessel structures can be recovered in FISS that are obscured in bSSFP. Fat suppression in free-running cardiac CINE resulted in less fat-related motion aliasing and yielded better image quality.
CONCLUSION
3D Cartesian FISS is feasible and offers homogeneous intrinsic fat suppression for selected imaging parameters without the need for dedicated preparation pulses, making it a promising candidate for free-running fat-suppressed imaging.
Topics: Abdomen; Adipose Tissue; Adult; Artifacts; Female; Healthy Volunteers; Humans; Image Enhancement; Image Processing, Computer-Assisted; Imaging, Three-Dimensional; Magnetic Resonance Angiography; Magnetic Resonance Imaging; Magnetic Resonance Imaging, Cine; Male; Phantoms, Imaging; Signal-To-Noise Ratio; Thigh
PubMed: 31197881
DOI: 10.1002/mrm.27830