A modern-day solution to a 100-yearold problem: the use of a bespoke offloading brace in the rehabilitation of ‘Deck-Slap’ and other high-energy lower limb injuries

2014 ◽  
Vol 100 (3) ◽  
pp. 337-343
Author(s):  
MA Osborne ◽  
HL Jarvis ◽  
N Bennett ◽  
RD Phillip
Keyword(s):  
Axial Loading ◽  
Cost Effective ◽  
Armed Forces ◽  
High Energy ◽  
Lower Limbs ◽  
Limb Amputation ◽  
Activity Levels ◽  
Prosthetic Devices ◽  
Functional Benefit ◽  
Limb Injuries

Abstract‘Deck-Slap’ is an injury pattern first described at the Battle of Jutland; it is still relevant today, with anti-vehicle mines a significant threat to Coalition troops. The effect of a device exploding beneath a vehicle produces a wave of high energy that is rapidly transmitted through the steel floor; this causes significant axial loading of lower limbs often resulting in severe fractures (notably of the calcaneum). Recent advancements in orthopaedic surgery have allowed for limbs that were destined for immediate amputation following significant trauma to be salvaged. However, despite intense rehabilitation, many of these salvaged limbs have subsequently gone on to delayed amputation, as functional outcomes are often poor. Technologically advanced prosthetic devices are available that afford good quality of life and allow for increased activity levels; these devices are, however, expensive to procure and maintain. This report describes a United Kingdom (UK) Armed Forces soldier who suffered a typical ‘deck-slap’ injury in Afghanistan with subsequent limb salvage. The use of the Bespoke Off-loading Brace (BOB) is discussed. The results presented here indicate that the biomechanical function of a patient with this type of injury improves when wearing the BOB. Further studies are needed to assess long-term clinical outcomes and the functional benefit of the device as a viable and cost-effective alternative to delayed limb amputation.

Computed tomography angiography and microsurgical flaps for traumatic wounds: What is the added value?

2021 ◽  
pp. 1-9
Author(s):  
Lucas Sousa Macedo ◽  
Renato Polese Rusig ◽  
Gustavo Bersani Silva ◽  
Alvaro Baik Cho ◽  
Teng Hsiang Wei ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Upper Limb ◽  
Computed Tomography Angiography ◽  
Lower Limb ◽  
High Energy ◽  
Lower Limbs ◽  
Added Value ◽  
Vascular Lesions ◽  
Limb Injuries ◽  
Significant Difference

BACKGROUND: Microsurgical flaps are widely used to treat complex traumatic wounds of upper and lower limbs. Few studies have evaluated whether the vascular changes in preoperative computed tomography angiography (CTA) influence the selection of recipient vessel and type of anastomosis and the microsurgical flaps outcomes including complications. OBJECTIVE: The aim of this study was to evaluate if preoperative CTA reduces the occurrence of major complications (revision of the anastomosis, partial or total flap failure, and amputation) of the flaps in upper and lower limb trauma, and to describe and analyze the vascular lesions of the group with CTA and its relationship with complications. METHODS: A retrospective cohort study was undertaken with all 121 consecutive patients submitted to microsurgical flaps for traumatic lower and upper limb, from 2014 to 2020. Patients were divided into two groups: patients with preoperative CTA (CTA+) and patients not submitted to CTA (CTA–). The presence of postoperative complications was assessed and, within CTA+, we also analyzed the number of patent arteries on CTA and described the arterial lesions. RESULTS: Of the 121 flaps evaluated (84 in the lower limb and 37 in the upper limb), 64 patients underwent preoperative CTA. In the CTA+ group, 56% of patients with free flaps for lower limb had complete occlusion of one artery. CTA+ patients had a higher rate of complications (p = 0.031), which may represent a selection bias as the most complex limb injuries and may have CTA indicated more frequently. The highest rate of complications was observed in chronic cases (p = 0.034). There was no statistically significant difference in complications in patients with preoperative vascular injury or the number of patent arteries. CONCLUSIONS: CTA should not be performed routinely, however, CTA may help in surgical planning, especially in complex cases of high-energy and chronic cases, since it provides information on the best recipient artery and the adequate level to perform the microanastomosis, outside the lesion area.

Evaluation of Lower Limb Injury Mitigation Techniques for High Velocity Impacts With the Mil-LX

2011 ◽  
Author(s):  
Jennifer L. Serres ◽  
Dan V. Jones ◽  
Rabih E. Tannous ◽  
Nathan Dau ◽  
Cynthia A. Bir
Keyword(s):  
Lower Extremity ◽  
Lower Limb ◽  
Axial Loading ◽  
Critical Factor ◽  
Lower Limbs ◽  
Lower Limb Injury ◽  
Lower Extremity Injuries ◽  
Axial Forces ◽  
Limb Injuries ◽  
Mitigation Techniques

Improvised Explosive Devices (IED) and landmines present a significant threat to mounted troops currently serving in Iraq and Afghanistan. As a result of these threats, a substantial number of lower limb injuries are sustained by service members. Due to this reality, a critical factor in military vehicle design is the mitigation of lower limb trauma. Past studies have shown that the standard Hybrid III and THOR-LX are not biofidelic in military axial loading conditions (up to 12 m/s). Both of these surrogates over predict axial forces compared to Post Mortem Human Specimens (PMHS) [1]. As a result, a new surrogate was developed, Mil-LX (Military Lower Extremity), that matches the PMHS response for axial loading of the lower leg up to 12 m/s [2,3]. While injury mitigation techniques, such as energy absorbing mats, foot rests, and isolation floors, have been effective in reducing lower extremity injuries in live fire test events, there are several variants of each of these methods. Additionally, it has also been suggested that the positioning of the lower limbs may affect the load sustained by these extremities [4].

Janus – A New Approach to Air Combat Pilot Training

2019 ◽  
Vol 2019 (4) ◽  
pp. 7-22
Author(s):  
Georges Bridel ◽  
Zdobyslaw Goraj ◽  
Lukasz Kiszkowiak ◽  
Jean-Georges Brévot ◽  
Jean-Pierre Devaux ◽  
...  
Keyword(s):  
Low Cost ◽  
Cost Effective ◽  
High Energy ◽  
Training System ◽  
Embedded Sensors ◽  
Pilot Training ◽  
New Approach ◽  
Combat Aircraft ◽  
Air Combat ◽  
The Cost

Abstract Advanced jet training still relies on old concepts and solutions that are no longer efficient when considering the current and forthcoming changes in air combat. The cost of those old solutions to develop and maintain combat pilot skills are important, adding even more constraints to the training limitations. The requirement of having a trainer aircraft able to perform also light combat aircraft operational mission is adding unnecessary complexity and cost without any real operational advantages to air combat mission training. Thanks to emerging technologies, the JANUS project will study the feasibility of a brand-new concept of agile manoeuvrable training aircraft and an integrated training system, able to provide a live, virtual and constructive environment. The JANUS concept is based on a lightweight, low-cost, high energy aircraft associated to a ground based Integrated Training System providing simulated and emulated signals, simulated and real opponents, combined with real-time feedback on pilot’s physiological characteristics: traditionally embedded sensors are replaced with emulated signals, simulated opponents are proposed to the pilot, enabling out of sight engagement. JANUS is also providing new cost effective and more realistic solutions for “Red air aircraft” missions, organised in so-called “Aggressor Squadrons”.

scholarly journals What Is Currently the Role of TcPO2 in the Choice of the Amputation Level of Lower Limbs? A Comprehensive Review

2021 ◽  
Vol 10 (7) ◽  
pp. 1413
Author(s):  
Judith Catella ◽  
Anne Long ◽  
Lucia Mazzolai
Keyword(s):  
Arterial Disease ◽  
Major Amputation ◽  
Lower Limbs ◽  
Limb Amputation ◽  
Quality Of Data ◽  
Amputation Level ◽  
Increased Risk ◽  
Transcutaneous Oximetry ◽  
Peripheral Arterial

Some patients still require major amputation for lower extremity peripheral arterial disease treatment. The purpose of pre-operative amputation level selection is to determine the most distal amputation site with the highest healing probability without re-amputation. Transcutaneous oximetry (TcPO2) can detect viable tissue with the highest probability of healing. Several factors affect the accuracy of TcPO2; nevertheless, surgeons rely on TcPO2 values to determine the optimal amputation level. Background about the development of TcPO2, methods of measurement, consequences of lower limb amputation level, and the place of TcPO2 in the choice of the amputation level are reviewed herein. Most of the retrospective studies indicated that calf TcPO2 values greater than 40 mmHg were associated with a high percentage of successful wound healing after below-knee-amputation, whereas values lower than 20 mmHg indicated an increased risk of unsuccessful healing. However, a consensus on the precise cut-off value of TcPO2 necessary to assure healing is missing. Ways of improvement for TcPO2 performance applied to the optimization of the amputation-level are reported herein. Further prospective data are needed to better approach a TcPO2 value that will promise an acceptable risk of re-amputation. Standardized TcPO2 measurement is crucial to ensure quality of data.

The Susceptibility of Healthy People to COVID-19 Infection and the Role of ACE2

2021 ◽  
Author(s):  
Mehdi Kushkestani ◽  
Mohsen Parvani ◽  
Bakhtyar Tartibian ◽  
Rasoul Eslami
Keyword(s):  
Risk Factors ◽  
Cost Effective ◽  
Normal Subjects ◽  
Definitive Treatment ◽  
Activity Levels ◽  
Cost Effective Approach ◽  
Increased Risk ◽  
Physical Activity Levels ◽  
Ace2 Gene

The COVID-19 virus has caused many deaths of people worldwide since the pandemic began. However, no definitive treatment for this infection has been discovered so far. It has been shown that comorbidities such as diabetes, hypertension and cardiovascular diseases are associated with an increased risk of SARS-COV-2 infection. Interestingly, SARS-COV-2, like SARS-COV, uses the ACE2 gene to enter the host cell. Also, changes or imbalance in ACE2.ACE can affect SARS-COV-2 susceptibility, related outcomes and mortality. Regarding the crucial role of ACE2 protein in COVID-19 infection, the effect of different factors such as age, BMI, physical activity levels, nutritional status, altitude, as well as blood group was assessed on the level of this protein. Further, to our knowledge, no study has been conducted to examine factors that increase or decrease the risk of COVID-19 and its related severity and outcome in normal subjects emphasizing the pivotal role of ACE2. Therefore, the primary purpose of this study was to investigate the involved mechanisms of ACE2 protein and other risk factors causing infection in different situations and finally, to introduce a safe, accurate, and cost-effective approach to prevent SARS-COV-2 infection and hard clinical outcomes in normal subjects.

scholarly journals Prospects for optimizing the drying process of Virginia 202 tobacco leaves

2021 ◽  
Vol 17 (1) ◽  
pp. 70-77
Author(s):  
E. Е. Ulyanchenko ◽  
N. N. Vinevskaya
Keyword(s):  
Quality Indicators ◽  
Raw Materials ◽  
Control Sample ◽  
Physical Method ◽  
Cost Effective ◽  
High Energy ◽  
Drying Process ◽  
Drying Time ◽  
Apply Physical ◽  
Natural Drying

Cultivation and use of Virginia 202 broadleaf skeletal variety for the production of smoking tobacco has broad prospects. Problems of post-harvest processing of large leaves with a massive midrib consist in high energy costs with an artificial drying method or the provision of facilities for long-term natural drying. The aim of the research is to apply physical method of cutting the leaf midrib to intensify drying and to determine the effect of this technique on the quality indicators of raw materials. It has been found that the technique of cutting the midrib on the Virginia 202 variety contributes to a significant optimization of the drying process without reducing the quality of raw materials. The drying time of leaves with the combined method is reduced by 2,8 times, with the natural method – by 2,3 times, and the quality indicators of raw materials improve. Commercial quality is characterized by the yield of 1 commercial grade, for combined drying the yield of 1 grade has increased in comparison with the control sample by 27% and amounted to 86,5%, with natural drying – the increase in yield is 4%. Cutting the midrib increases the fiber yield by 3–5% and contributes to an increase in the volumetric-elastic properties of the fiber, providing an economical consumption of raw materials for the production of smoking articles, the consumption is 676,8–753,8 g/1000 pcs. The gustatory quality improves, raw materials with a cut midrib have optimal values of the ratio of carbohydrate-protein balance in the range of 1,08–1,5, the strength is preserved due to the lower consumption of nicotine during the shorter drying period, in comparison with drying the leaf without cutting the midrib. Cutting the midrib in Virginia 202 is cost effective.

scholarly journals Technology for monitoring everyday prosthesis use: a systematic review

2020 ◽  
Author(s):  
Alix Chadwell ◽  
Laura Diment ◽  
Encarna Micó Amigo ◽  
Dafne Zuleima Morgado Ramirez ◽  
Alexander Dickinson ◽  
...  
Keyword(s):  
Upper Limb ◽  
Lower Limb ◽  
Battery Life ◽  
Activity Levels ◽  
Everyday Activity ◽  
Prosthetic Devices ◽  
Clinical Scores ◽  
Standard Clinical Practice ◽  
The Cost

BackgroundUnderstanding how prostheses are used in everyday life is central to the design, provision and evaluation of prosthetic devices and associated services. This paper reviews the scientific literature on methodologies and technologies that have been used to assess the daily use of both upper- and lower-limb prostheses. It discusses the types of studies that have been undertaken, the technologies used to monitor physical activity, the benefits of monitoring daily living and the barriers to long-term monitoring.MethodsA systematic literature search was conducted in PubMed, Web of Science, Scopus, CINAHL and EMBASE of studies that monitored the activity of prosthesis-users during daily-living.Results60 lower-limb studies and 9 upper-limb studies were identified for inclusion in the review. The first studies in the lower-limb field date from the 1990s and the number has increased steadily since the early 2000s. In contrast, the studies in the upper-limb field have only begun to emerge over the past few years. The early lower-limb studies focused on the development or validation of actimeters, algorithms and/or scores for activity classification. However, most of the recent lower-limb studies used activity monitoring to compare prosthetic components. The lower-limb studies mainly used step-counts as their only measure of activity, focusing on the amount of activity, not the type and quality of movements. In comparison, the small number of upper-limb studies were fairly evenly spread between development of algorithms, comparison of everyday activity to clinical scores, and comparison of different prosthesis user populations. Most upper-limb papers reported the degree of symmetry in activity levels between the arm with the prosthesis and the intact arm.ConclusionsActivity monitoring technology used in conjunction with clinical scores and user feedback, offers significant insights into how prostheses are used and whether they meet the user’s requirements. However, the cost, limited battery-life and lack of availability in many countries mean that using sensors to understand the daily use of prostheses and the types of activity being performed has not yet become a feasible standard clinical practice. This review provides recommendations for the research and clinical communities to advance this area for the benefit of prosthesis users.

scholarly journals Research Progress and Key Issues of Hydrodebenzylation of Hexabenzylhexaazaisowurtzitane (HBIW) in the Synthesis of High Energy Density Material Hexanitrohexaazaisowurtzitane (HNIW)

Materials ◽  
2022 ◽  
Vol 15 (2) ◽  
pp. 409
Author(s):  
Xiaofei Tang ◽  
Rui Zhu ◽  
Tianjing Shi ◽  
Yu Wang ◽  
Xiaochen Niu ◽  
...  
Keyword(s):  
Energy Density ◽  
High Performance ◽  
Research Effort ◽  
Specific Impulse ◽  
Cost Effective ◽  
High Energy ◽  
High Energy Density ◽  
Research Progress ◽  
Fourth Generation ◽  
Key Issues

High energy density materials (HEDM) are the subject of an extensive research effort in relation to the use of these compounds as components of rocket propellants, powders, and formulations of high-performance explosives. Hexanitrohexaazaisowurtzitane (HNIW, i.e., CL-20) has received much attention in these research fields for its specific impulse, burning rate, ballistics, and detonation velocity. In this paper, the development and performances of the explosives from the first to the fourth generation are briefly summarized, and the synthesis status of the fourth-generation explosive, HNIW, is reviewed. The key issues that restrict the development of industrial amplification synthesis of HNIW are analyzed, and the potential directions of development are proposed. It is pointed out that to synthesize new and efficient catalysts is the key to making the cost-effective manufacturing of CL-20 a reality.

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