Prosthetic reconstruction for tumours of the distal tibia and fibula.
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We have carried out prosthetic reconstruction in six patients with malignant or aggressively benign bone tumours of the distal tibia or fibula. The diagnoses were osteosarcoma in four patients, parosteal osteosarcoma in one and recurrent giant-cell tumour in one. Five tumours were in the distal tibia and one in the distal fibula. The mean duration of follow-up was 5.3 years (2.0 to 7.1). Reconstruction was achieved using custom-made, hinged prostheses which replaced the distal tibia and the ankle. The mean range of ankle movement after operation was 31 degrees and the joints were stable. The average functional score according to the system of the International Society of Limb Salvage was 24.2 and five of the patients had a good outcome. Complications occurred in two with wound infection and talar collapse. All patients were free from neoplastic disease at the latest follow-up. Prosthetic reconstruction may be used for the treatment of malignant tumours of the distal tibia and fibula in selected patients. (+info)
Lengthening of congenital below-elbow amputation stumps by the Ilizarov technique.
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Patients with short congenital amputations below the elbow often function as if they have had a disarticulation of the elbow. We have reviewed the results in six patients who had lengthening of such stumps by the Ilizarov technique to improve the fitting of prostheses. The mean lengthening was 5.6 cm (3.4 to 8.4), and in two patients flexion contractures of the elbows were corrected simultaneously. Additional lateral distraction was used in one patient to provide a better surface on the stump. There were no major complications. All six patients were able to use their prosthesis at the latest follow-up after 39 to 78 months. (+info)
Quadrilateral shaped brims made from high-density polyethylene for long leg calipers.
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Quadrilateral shaped brims made of high-density polyethylene have been used with satisfactory results on more than 120 patients who needed ischial-bearing long leg calipers. At first the fitting technique was the same as that used for thigh amputees. Subsequently it has been possible to fit most patients from a range of pre-formed brims. The properties of high-density polyethylene allow the caliper side irons to be riveted directly to the brim which, with the use of ready-made brims, allows a patient to be fitted rapidly with a comfortable and effective caliper. (+info)
Prosthetic ambulation in a paraplegic patient with a transfemoral amputation and radial nerve palsy.
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Great importance and caution should be placed on prosthetic fitting for a paraplegic patient with an anesthetic residual limb if functional ambulation is to be achieved. The combination of paraplegia with a transfemoral amputation and radial nerve palsy is a complex injury that makes the rehabilitation process difficult. This article describes a case of L2 paraplegia with a transfemoral amputation and radial nerve palsy on the right side. Following the rehabilitation course, the patient independently walked using a walker at indoor level with a transfemoral prosthesis with ischial containment socket, polycentric knee assembly, endoskeletal shank and multiaxis foot assembly and a knee ankle foot orthosis on the sound side. The difficulties of fitting a functional prosthesis to an insensate limb and the rehabilitation stages leading to functional ambulation are reviewed. (+info)
Left tactile extinction following visual stimulation of a rubber hand.
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In close analogy with neurophysiological findings in monkeys, neuropsychological studies have shown that the human brain constructs visual maps of space surrounding different body parts. In right-brain-damaged patients with tactile extinction, the existence of a visual peripersonal space centred on the hand has been demonstrated by showing that cross-modal visual-tactile extinction is segregated mainly in the space near the hand. That is, tactile stimuli on the contralesional hand are extinguished more consistently by visual stimuli presented near the ipsilesional hand than those presented far from it. Here, we report the first evidence in humans that this hand-centred visual peripersonal space can be coded in relation to a seen rubber replica of the hand, as if it were a real hand. In patients with left tactile extinction, a visual stimulus presented near a seen right rubber hand induced strong cross-modal visual-tactile extinction, similar to that obtained by presenting the same visual stimulus near the patient's right hand. Critically, this specific cross-modal effect was evident when subjects saw the rubber hand as having a plausible posture relative to their own body (i.e. when it was aligned with the subject's right shoulder). In contrast, cross-modal extinction was strongly reduced when the seen rubber hand was arranged in an implausible posture (i. e. misaligned with respect to the subject's right shoulder). We suggest that this phenomenon is due to the dominance of vision over proprioception: the system coding peripersonal space can be 'deceived' by the vision of a fake hand, provided that its appearance looks plausible with respect to the subject's body. (+info)
Intermediate rehabilitation outcome in below-knee amputations: descriptive study comparing war-related with other causes of amputation.
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AIM: To asses the intermediate rehabilitation outcome of patients with war-related below-knee amputations and compare it with the patients with other causes of amputation. METHOD: The study comprised 74 patients with below-knee stumps admitted for rehabilitation at the Department of Physical Therapy and Rehabilitation, Split University Hospital, Croatia, in 1994. They were fitted with a preliminary prosthesis, a donation from the Finish Red Cross. The rehabilitation was performed by a professional team and included regular bandaging of the stump, exercises to prevent knee and hip joint contracture, general fitness exercises, standing-up, falling and walking exercises, and electrostimulation of the thigh muscles. The time to reach each rehabilitation phase (walking with 2 crutches, walking with 1 crutch, walking with no crutches) was measured. The satisfaction of the patients with the prosthesis was also assessed at the end of rehabilitation. RESULTS: Among 74 patients with below knee amputation, war trauma was the cause for amputation in 31 patients, and in 6 of them the amputations were bilateral. Patients with war-related below-knee amputations were younger than the patients with amputations related to vascular disease, including diabetes. The rehabilitation time was significantly shorter in patients with war-related amputations (61.1+/-11.4 days to walking with no crutches) compared with patients with vascular disease-related amputations (80.9+/-8.1 days; p<0.001). The satisfaction with the prosthesis was more variable in patients with war-related amputations than in other patients. CONCLUSION: Early physical rehabilitation and replacement of the lost extremity with a preliminary prosthesis is an optimal intervention in below-knee amputations due to war-injury. Special attention should be paid to the psychological support to these patients during rehabilitation therapy. (+info)
Problems with excessive residual lower leg length in pediatric amputees.
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We studied six pediatric amputees with long below-knee residual limbs, in order to delineate their functional and prosthetic situations, specifically in relation to problems with fitting for dynamic-response prosthetic feet. Three patients had congenital pseudoarthrosis of the tibia secondary to neurofibromatosis, one had fibular hemimelia, one had a traumatic amputation, and one had amputation secondary to burns. Five patients had Syme's amputations, one had a Boyd amputation. Ages at amputation ranged from nine months to five years (average age 3 years 1 month). After amputation, the long residual below-knee limbs allowed fitting with only the lowest-profile prostheses, such as deflection plates. In three patients, the femoral dome to tibial plafond length was greater on the amputated side than on the normal side. To allow room for more dynamic-response (and larger) foot prostheses, two patients have undergone proximal and distal tibial-fibular epiphyseodeses (one at age 5 years 10 months, the other at 3 years 7 months) and one had a proximal tibial-fibular epiphyseodesis at age 7 years 10 months. (All three patients are still skeletally immature.) The families of two other patients are considering epiphyseodeses, and one patient is not a candidate (skeletally mature). Scanogram data indicate that at skeletal maturity the epiphyseodesed patients will have adequate length distal to their residual limbs to fit larger and more dynamic-response prosthetic feet. (+info)
Surgical experiences in Nepal.
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Some examples of surgical problems presenting to the authors during a 2-year attachment to the British Military Hospital, Dharan, Nepal, are described. (+info)