Angular Deformities of the Lower Limbs in Children

Angular deformities of the lower limbs are a common clinical problem encountered in pediatric orthopaedic practices particularly in patients with osteochondrodysplasias. The varus deformity is more common than the valgus deformity in achondroplasia and hypochondroplasia patients because of the unusual growth of the fibulae than that of the tibiae. We retrospectively reviewed six patients (four patients with achondroplasia and two patients with hypochondroplsia) with relevant limb deformities due to the above-mentioned entities. All patients manifested significant varus deformity of the lower limbs. Detailed phenotypic characterization, radiologic and genetic testing was carried out as baseline diagnostic tool. We described the re-alignment procedures, which have been applied accordingly. Therefore, bilateral multi-level procedures, multi-apical planning and limb lengthening have been successfully applied. While recognition of the underlying syndromic association in patients who are manifesting angular deformities is the baseline for proper orthopaedic management, this paper demonstrates how to evaluate and treat these complex patients.

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Carbon-carbon composite nail for intramedullary osteosynthesis in rats with experimental osteoporosis

Morphologia ◽

10.26641/1997-9665.2021.3.57-61 ◽

2021 ◽

Vol 15 (3) ◽

pp. 57-61

Author(s):

O.A. Hryhorieva ◽

Yu.Yu. Abrosimov ◽

V.V. Chornyi

Keyword(s):

Tibial Fracture ◽

Bone Fractures ◽

Carbon Composite ◽

Lower Limbs ◽

Laboratory Rats ◽

Intramedullary Osteosynthesis ◽

Age Related ◽

Experimental Osteoporosis ◽

Fracture Consolidation ◽

Angular Deformities

Background. In Ukraine, there has recently been an increase in the number of limb bone fractures among the population, in particular, due to increase in the number of elderly people, which is associated with the development of age-related osteoporosis and fragility of bones. Therefore, the use of artificial implants in traumatology is becoming increasingly important. The search for new bioinert and biodegradable materials, that are capable of providing rapid fracture consolidation and do not require repeated surgical intervention, continues. Objective. To elaborate a model for the research of using carbon-carbon composite nail for intramedullary osteosynthesis in laboratory rats with fractures of femur and tibia in norm and with experimental osteoporosis. Methods. The work investigated the lower limbs of 6 groups of Wistar rats. The first part of the study involved 4 groups of rats with modeled tibial fracture with subsequent osteosynthesis in norm and with experimental osteoporosis. The second part of the research included two groups of laboratory rats with modeled femur fracture. In both parts we used metal injection needle, as well as carbon-carbon composite nail for osteosynthesis. Results. All animals underwent surgery well, stepped on the injured limb. X-ray examination after the osteosynthesis demonstrated satisfactory reposition of the fragments. One month after modeled fracture in rats with experimental osteoporosis a violation of the normal consolidation of the fracture was observed, especially in the group where carbon-carbon composite nails were used for osteosynthesis. Further, until the 180th day after the surgery there were no peculiarities, function of the limbs was restored, mainly without expressed angular deformities. Conclusion. The above mentioned model was successfully elaborated for the research of using carbon-carbon composite nail for intramedullary osteosynthesis in laboratory rats with fractures of femur and tibia in norm and with experimental osteoporosis.

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Developmental deformities of the lower limbs

10.1093/med/9780199550647.003.013016 ◽

2011 ◽

Author(s):

Andrew Wainwright

Keyword(s):

Surgical Management ◽

Growth Period ◽

Lower Limbs ◽

Functional Problems ◽

Angular Deformities

♦ Some rare angular deformities of the lower limbs must be recognized early♦ Most deteriorate with time and cause significant functional problems♦ With tibial bowing, description of the apex of the bow determines prognosis and management♦ Surgical management of these conditions can be difficult: multiple procedures may be required during the growth period.

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Treatment of Ischemic Ulcers of the Lower Limbs With Alprostadil (Prostaglandin E1)

Yearbook of Plastic and Aesthetic Surgery ◽

10.1016/s1535-1513(08)70452-1 ◽

2006 ◽

Vol 2006 ◽

pp. 210-211

Author(s):

W.L. Garner

Keyword(s):

Prostaglandin E1 ◽

Lower Limbs ◽

Ischemic Ulcers

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Mid-aortic syndrome: computed tomography angiography depicting extensive collateral circulation in an 11-year-old patient with thoracoabdominal aortic coarctation

VASA ◽

10.1024/0301-1526/a000176 ◽

2012 ◽

Vol 41 (2) ◽

pp. 132-135 ◽

Cited By ~ 2

Author(s):

Krohn ◽

Gebauer ◽

Hübler ◽

Beck

Keyword(s):

Computed Tomography ◽

Computed Tomography Angiography ◽

Collateral Circulation ◽

Intestinal Ischemia ◽

Clinical Presentation ◽

Lower Limbs ◽

Upper Body ◽

Descending Aorta ◽

Before And After ◽

Blood Pressures

The mid-aortic syndrome is an uncommon clinical condition characterized by severe narrowing of the descending aorta, usually with involvement of its renal and visceral branches, presenting with uncontrollably elevated blood pressures of the upper body, renal and cardiac failure, intestinal ischemia, encephalopathy symptoms and claudication of the lower limbs, although clinical presentation is variable. In this article we report the case of an eleven-year-old patient with the initial diagnosis of a mid-aortic syndrome and present the computed tomography angiography pictures and reconstructions before and after surgical therapy.

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Comparison of standardised lymphoscintigraphic function test and high resolution sonography of the lymphoedema of legs

Phlebologie ◽

10.1055/s-0037-1622238 ◽

2008 ◽

Vol 37 (05) ◽

pp. 247-252 ◽

Cited By ~ 4

Author(s):

V. S. Brauer ◽

W. J. Brauer

Keyword(s):

Lower Leg ◽

Clinical Findings ◽

Lower Limbs ◽

Fatty Tissue ◽

Qualitative And Quantitative ◽

Function Test ◽

Unreliable Method ◽

Negative Conclusion ◽

Fine Disperse

SummaryPurpose: Comparison of qualitative and quantitative sonography with the lymphoscintigraphic function test and clinical findings in legs. Patients, methods: In 33 patients a lymphoscintigraphic function test of legs combined with measurement of lymph node uptake was performed and subsequently compared with sonography. Sonographic criteria were: Thickness of cutis, thickness of subcutanean fatty tissue and presence of liquid structures or fine disperse tissue structure of lower limbs, foots and toes. Results: In 51 legs uptake values lie in the pathologic area, in four legs in the grey area and in ten legs in the normal area. The cutis thickness in the lower leg shows no significant correlation with the uptake. The determination of the thickness of the subcutanean fatty tissue of the lower leg and of the cutis thickness of the feet turned out to be an unreliable method. In 47% of the medial lower legs and in 57% of the lateral lower legs with clinical lymphoedema sonography is falsely negative. Conclusion: Early lymphoedema is only detectable with the lymphoscintigraphic function test. In the case of clinical lymphoedema clinical examination is more reliable than sonography.

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Untersuchungen zur Quantifizierung der Änderung der Skelettmuskeldurchblutung nach Gefäßrevaskularisationen mit einem 99mTechnetiummarkierten Tracer

Nuklearmedizin ◽

10.1055/s-0038-1629534 ◽

1990 ◽

Vol 29 (05) ◽

pp. 215-220 ◽

Cited By ~ 1

Author(s):

R. Benning ◽

K. Nagel ◽

M. Jugenheimer ◽

S. Fischer ◽

S. Worthmann ◽

...

Keyword(s):

Transluminal Angioplasty ◽

Lower Limbs ◽

Surgical Patients ◽

Treadmill Test ◽

Negative Results ◽

Clinical Observations ◽

Before And After ◽

Comparative Results ◽

First Time ◽

Percutaneous Transluminal

A new 99mTc-labelled tracer (99mTc-Sestanriibi) was used for the first time to demonstrate the perfusion of the skeletal muscle. In 16 patients with obstructive atherosclerosis of the lower limbs the change of perfusion of thigh and lower leg was studied with SPECT before and after vascular surgery (n = 11) or percutaneous transluminal angioplasty (n = 5). Comparative results of scintigraphic measurements and clinical observations (ancle-arm pressure, treadmill test) in 10 surgical patients (14 operated legs) showed correct positive or negative results in 86% (12/14).

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A Plasma Clot Lysis Assay Based on the Release of Fibrin Degradation Products: Application to the Diagnosis of Hypofibrinolytic States

Thrombosis and Haemostasis ◽

10.1055/s-0038-1645690 ◽

1990 ◽

Vol 63 (01) ◽

pp. 076-081 ◽

Cited By ~ 2

Author(s):

Pascale Gaussem ◽

Sophie Gandrille ◽

Pascale Molho-Sabatier ◽

Loïc Capron ◽

Jean-Noël Fiessinger ◽

...

Keyword(s):

Degradation Products ◽

Venous Occlusion ◽

Lower Limbs ◽

Clot Lysis ◽

Plasma Clot ◽

Vein Thrombosis ◽

Fibrin Degradation Products ◽

Before And After ◽

Euglobulin Clot Lysis Time ◽

Pai 1

SummaryUsing a monoclonal antibody-based assay, we measured the fibrin degradation product release in the supernatant of plasma clots obtained before and after venous occlusion (VO) in 30 patients with definite or suspected vascular thrombosis (19 definite and 2 suspected deep vein thrombosis, 6 recurrent superficial thrombophlebitis, 3 arterial occlusions of lower limbs). tPA and PAI-1 concentrations were determined using ELISA assays; the post-occlusion values were corrected for haemoconcentration. The increase in tPA during VO was correlated with haemoconcentration (r = 0.74), but 3 patients had ineffective VO (<2% increase in proteins). The fibrinolytic response to VO was evaluated using the shortening of the time necessary for the release of 200 μg of fibrin degradation products per mg of fibrinogen (Δ T 200). Two among the 27 patients with effective VO were bad responders with a Δ T 200 <3 h (whereas all the others had Δ T 200 >10 h). These patients had respectively a deficient tPA release (Δ tPA = 1 ng/ml) and an elevated PAI-1 level at rest (33 ng/ml). Several other patients were bad responders in terms of tPA release or of shortening of the euglobulin clot lysis time but they had a normal Δ T 200. This plasma clot test reflects the ability of free tPA to bind to fibrin (the amount of which depends on the level of tPA and PAI-1), and may be useful in the diagnosis of a hypofibrinolytic state.

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D-Dimer Test and Diagnosis of Deep Vein Thrombosis: A Comparative Study of 7 Assays

Thrombosis and Haemostasis ◽

10.1055/s-0038-1650615 ◽

1996 ◽

Vol 76 (04) ◽

pp. 518-522 ◽

Cited By ~ 44

Author(s):

A Elias ◽

I Aptel ◽

B Huc ◽

J J Chale ◽

F Nguyen ◽

...

Keyword(s):

Deep Vein Thrombosis ◽

Negative Predictive Value ◽

Predictive Value ◽

Latex Agglutination ◽

Lower Limbs ◽

First Episode ◽

Lower Sensitivity ◽

Vein Thrombosis ◽

Deep Vein ◽

D Dimer

SummaryThe current D-Dimer ELISA methods provide high sensitivity and negative predictive value for the diagnosis of deep vein thrombosis but these methods are not suitable for emergency or for individual determination. We have evaluated the performance of 3 newly available fast D-Dimer assays (Vidas D-Di, BioMerieux; Instant IA D-Di, Stago; Nycocard D-Dimer, Nycomed) in comparison with 3 classic ELISA methods (Stago, Organon, Behring) and a Latex agglutination technique (Stago). One-hundred-and-seventy-one patients suspected of presenting a first episode of deep vein thrombosis were investigated. A deep vein thrombosis was detected in 75 patients (43.8%) by ultrasonic duplex scanning of the lower limbs; in 11 of them the thrombi were distal and very limited in size (<2 cm). We compared the performance of the tests by calculating their sensitivity, specificity, positive and negative predictive value for different cut-off levels and by calculating the area under ROC curves. The concordance of the different methods was evaluated by calculating the kappa coefficient. The performances of the 3 classic ELISA and of the Vidas D-Di were comparable and kappa coefficients indicated a good concordance between the results provided by these assays. Their sensitivity slightly declined for detection of the very small thrombi. Instant IA D-Di had a non-significantly lower sensitivity and negative predictive value than the 4 previous assays; however its performance was excellent for out-patients. As expected, the Latex assay had too low a sensitivity and negative predictive value to be recommended. In our hands, Nycocard D-Dimer also exhibited low sensitivity and negative predictive value, which were significantly improved when the plasma samples were tested by the manufacturer. Thus significant progress has been made, allowing clinical studies to be planned to compare the safety and cost-effectiveness of D-Dimer strategy to those of the conventional methods for the diagnosis of venous thrombosis.

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