scholarly journals Technique of Papineau in the Management of Chronic Osteomyelitis in a Low Setting Area. A 12 Years’ Experience

2020 ◽  
Vol 5 (2) ◽  
pp. p19
Author(s):  
Stanislas Ntungila Nkama ◽  
Michel Lelo Tshikwela
Keyword(s):  
Upper Limb ◽  
Low Income ◽  
Lower Limb ◽  
Chronic Osteomyelitis ◽  
Central Africa ◽  
Economic Cost ◽  
University Hospital ◽  
Limb Injuries ◽  
Dead Bone ◽  
Drying Up

Introduction: Chronic osteomyelitis, a bone infectious pathology is difficult to treat. The authors report their experience in a series of patients treated in a low-income country.Methods: We report a prospective study of 53 patients suffering of chronic osteomyelitis for a long time, covering our experience between January 1998 to December 2010 at the Kinshasa University Hospital in central Africa. We used the technique described by Papineau with success, until the consolidation of the bones and the drying up of the wounds.The following elements were analyzed and taken into account: age and sex of the patients, sites involved, germs, surgical technique, length of stay in the hospital and estimated cost of the treatment.Result: The majority of patients were between 26 and 35 years old with extremes between 15 and 80 years old, with 34 males and 19 females with a sex ratio of 1.7/1. Upper limb was involved with 7 humerus, 6 radius, 6 cubitus and the lower limb with 14 femurs and 20 tibias. Staphylococcus aureus was the germ most found in cultures from dead bone from intraoperative technique. Stay in hospital on average was 17 weeks for upper limb and 28 weeks for the management of lower limb injuries. The average cost for the treatment was estimated for 700 to 800 dollars. Conclusion: Chronic osteomyelitis is a tenacious condition for long-term evolution, but it is nevertheless encouraging to dry up foci, which were the toughest challenges for orthopedics and plastic surgeons. In a low setting region, the management of the disease remains a condition with a high economic cost and it is absolutely useless to begin a Papineau treatment if the patients do not have enough money.

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.

scholarly journals Analysis of Limb Injury Patterns in Victims of Two Wheeler Accidents

2010 ◽  
Vol 1 (1) ◽  
pp. 14-15
Author(s):  
Anish Sam George ◽  
Murali Poduval
Keyword(s):  
Upper Limb ◽  
Lower Limb ◽  
Traffic Accidents ◽  
Road Traffic ◽  
Road Traffic Accidents ◽  
Lower Limb Injuries ◽  
The Road ◽  
Limb Injury ◽  
Limb Injuries ◽  
Two Wheeler

Objectives: A retrospective study was carried out to analyse the two wheeler accidents that presented over a one year period to a single institution and to study the pattern of limb injuries according to zones assigned to the limb. The mode of injury in the two wheeler accidents and the differences in limb injuries between the driver and the pillion riding passenger were also studied.Methods: All the road traffic accidents that could be attributed to two wheelers were obtained with the help of trauma records and the nominal registers and ward records. Limb injuries were then assigned to various anatomical zones that were created for the purpose of the study. The upper limb and lower limb injuries were separately analysed for differences between the driver and the pillion rider.Results: There were 242 two wheeler accidents seen between 1st jan 2008 to 31st dec 2008, of these 110 had limb injuries. 96 cases were eventually included and of these 67 were drivers. The most common mode of injury was a skid and fall of the vehicle ( 42%). Pillion riders were injured more often in collisions between two and four wheelers. The commonest injury in drivers was in wrist and hand regions of the upper limb and the tibia and ankle regions of the lower limb. In the pillion rider, lower limb injuries were commonest in the tibia and ankle whereas in the upper limb shoulder and wrist injuries predominated.Conclusion: Two wheeler accidents cause significant morbidity in both the driver and pillion rider, the tibia and ankle are commonly injured in both the populations whereas minor differences in upper limb injury are seen between the two groups.Keywords: Road traffic accidents; epidemiology; pattern of injuries.DOI: 10.3126/ajms.v1i1.2794Asian Journal of Medical Sciences Vol.1(1) 2010 p.14-15

scholarly journals 298 Review of Rapid Implementation of Virtual Hand Therapy Clinics During COVID-19

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
C Timon ◽  
B O'Ceallaigh ◽  
E Siney ◽  
N McInerney
Keyword(s):  
Patient Satisfaction ◽  
Upper Limb ◽  
Assessment Tool ◽  
Environmental Benefits ◽  
University Hospital ◽  
Trauma Patients ◽  
Hand Therapy ◽  
Social Distancing ◽  
Virtual Hand ◽  
Limb Injuries

Abstract Aim The COVID-19 pandemic led to the introduction of movement restrictions and the concept of social distancing in Ireland, beginning suddenly on March 12th 2020 (1). Following this, virtual consultation via video-call have been identified and integrated as an alternative to in-person consultation. To follow national recommendations and reduce the risk of patient attendance, video consultations were rapidly integrated by the hand therapy team at University Hospital Galway. This service provides a service to 730,513 people across eight counties (2) and was utilised for a range of upper limb injuries, providing vital care to trauma patients post-operatively and to minor injury cases. We wanted to retrospectively assess the implementation of these virtual clinics and how it affected patients. Method Patients were offered virtual hand therapy appointments. Patients were sent a link with their virtual appointment time and date via email. The patient could accept or decline the option of a virtual appointment at this stage. Patient satisfaction was measured via a bespoke survey. Functional outcomes were assessed via the QuickDASH assessment tool (3). Results 44/74 ( 59.5%) of patients responded to the survey. Subjectively, the vast found the service user-friendly, convenient and beneficial. Objectively, the QuickDash score demonstrated low disability and high upper limb function return post injury. Conclusions Implementation of virtual hand therapy was integrated into practise without major issues. Patient satisfaction was very high. Virtual health services have obvious economic and environmental benefits and are essential to providing safe patient care in a social distancing society.

Arterial Reconstruction after Mangled Extremity: Injury Severity Scoring Systems Are Not Predictive of Limb Salvage

Vascular ◽  
2005 ◽  
Vol 13 (2) ◽  
pp. 114-119 ◽  
Author(s):  
Mohamed Amin Elsharawy
Keyword(s):  
Prospective Study ◽  
Limb Salvage ◽  
Upper Limb ◽  
Injury Severity ◽  
University Hospital ◽  
Secondary Patency ◽  
Arterial Reconstruction ◽  
Mangled Extremity ◽  
Limb Injuries ◽  
A Prospective Study

The Vascular Unit at Suez Canal University Hospital in Egypt covers a wide area with high rates of severe injuries. This is a prospective study of mangled extremities to identify risk factors associated with limb loss in these patients. Between December 2000 and August 2003, a prospective study on all patients with arterial injuries in mangled extremities was undertaken. All patients were scored using the Mangled Extremity Severity Score (MESS) and the Mangled Extremity Severity Index (MESI). During this period, arterial reconstruction was performed in 62 patients. Primary patency, secondary patency, and limb salvage rates were 81%, 85.5%, and 93.5%, respectively. The only factor affecting limb salvage (statistical trend) was the site of trauma (upper limb 100% vs lower limb 89%; p = .08%). There was no significant effect related to the mechanism of trauma (blunt 90% vs stab 100%; p = .125), MESS (< 7, 100% vs > 7, 91%; p = .22), and MESI (< 20, 100% vs > 20, 90.5%; p = .154). Upper limb injuries were the least likely to lead to amputation. We recommend that all injuries, whatever their score, should be surgically explored before treatment decisions are made.

scholarly journals Injury patterns in patients with QINGQI motorcycle rickshaw related road traffic accidents presenting at accident and emergency department of Mayo Hospital, Lahore.

2020 ◽  
Vol 27 (07) ◽  
pp. 1476-1481
Author(s):  
Waseem Sadiq Awan ◽  
Arslan Ahmed ◽  
Umme Bilqees ◽  
Unaiza Malik ◽  
M. Kashaf Naseer ◽  
...  
Keyword(s):  
Emergency Department ◽  
Upper Limb ◽  
Lower Limb ◽  
Soft Tissues ◽  
Road Traffic ◽  
Trauma Patients ◽  
Cross Sectional ◽  
Accident And Emergency ◽  
Limb Injuries ◽  
Accident And Emergency Department

Objectives: The objective of this study was to determine the patterns of the injuries in patients of Qingqi rickshaw related accidents. Study Design: Descriptive Cross-Sectional study. Setting: Accident and Emergency Department of Mayo Hospital, Lahore. Period: Six months from 1st of March, 2019 to 31st of August, 2019. Material & Methods: Non-probability consecutive sampling technique was used and all tri-wheeler Qingqi related trauma patients fulfilling the inclusion and exclusion criteria were included. Frequency and percentages were calculated for patterns of injuries and presented as tables. Results: A total of 356 Qingqi rickshaw related injured patients presented in six months study period. There were 243 (68.3%) males and 113 (31.7%) females and a mean age of 32.5 +2.5 years. Soft tissues injuries like subcutaneous edema, abrasions and lacerations were noticed in 206 patients (57.9%). Most common region involved was lower limb in 98 (27.5%) cases followed by upper limb trauma in 65 (18.2%) cases. Ploy trauma was present in 58 (16.3%) and head and spinal injuries were noticed in 27 (7.6%) and13 (3.7%) cases, respectively. The turning over of the rickshaw due to different reasons (47.2%) and head on collision (38.4%) were the leading cause of serious injuries. None of the Qingqi rickshaw drivers (0%) were wearing helmet. A total of 46 (12.9%) cases were pedestrians. Three patients had to undergo amputation for mangled limb injuries. Conclusion: The common pattern of injuries related to Qingqi accidents include lower limb injuries followed by upper limb and poly trauma comprising of head injuries. Males in their younger age group are most commonly injured. These accidents can result in serious morbidity and even mortality. It is now time to consider measures for safety of three-wheelers to reduce such incidents.

scholarly journals (A21) Injury Patterns of Blast Type Antipersonnel Land Mine Victims

2011 ◽  
Vol 26 (S1) ◽  
pp. s6-s6
Author(s):  
L. Dassanayake ◽  
A. Karunarathne ◽  
D. Munidasa
Keyword(s):  
Soft Tissue ◽  
Upper Limb ◽  
Lower Limb ◽  
The Body ◽  
Lower Limbs ◽  
Severe Injuries ◽  
Land Mine ◽  
Limb Injuries ◽  
Tarsal Bones ◽  
Compound Fractures

Anti-personnel land mines are deployed in many regions of conflict around the world. A large number of civilians and militants are affected regularly due to the blasts of such mines. Once set, they remain as silent concealed killers for decades and challenge the safety of the civilians even during the times of peace. A descriptive study was carried out at the Anuradhapura Teaching Hospital during a six month period starting in July 2007. The total number of anti-personal land mine injuries admitted during this period was 89. In all cases, the body part primarily in contact with the mine had been a lower limb. Except for few occasions, extensive soft tissue damage associated with compound fractures necessitated some form of an amputation for those limbs in primary contact with the blast mines. Closed fractures of the calcareous, talus, and the tarsal bones were seen in two cases. Nearly two thirds of the patients sustained either soft tissue or bone injuries to the opposite lower limb. Twelve percent of the victims had compound fractures on the opposite tibia and fibula. Injuries to external genitalia were seen in 8% of the cases. Upper limb injuries were not rare and predominantly found on the contra lateral upper limb (17%). The majority of them were soft tissue injuries. Chest wall injuries were seen among 2% of the cases. Superficial facial injuries were seen among 7% of the cases. In one occasion a gingival injury was detected. Seven percent of the victims developed deterioration in level of consciousness. None of them clinically showed any external physical trauma to the head. In some instances, the Glasgow Coma Scale (GCS) was ranked as 7 in which tracheal intubation and ventilation were needed. It was evident in this study that the majority of the affected patients sustained severe injuries in both lower limbs in contrast to some of the previous available studies.

scholarly journals A magyar alpesi sízők és hódeszkázók egészségkárosodásainak összehasonlító statisztikai elemzése

2017 ◽  
Vol 158 (16) ◽  
pp. 618-624
Author(s):  
Péter Felkai ◽  
Ingrid Lengyel ◽  
Miklós Szokoly ◽  
Gábor Forgó
Keyword(s):  
Upper Limb ◽  
Lower Limb ◽  
Injury Rate ◽  
International Literature ◽  
Body Parts ◽  
Insurance Company ◽  
Injury Patterns ◽  
Winter Sport ◽  
Limb Injuries ◽  
Head Neck

Abstract: Introduction and aim: There are no high mountains or any advantageous circumstances for winter sports in Hungary, yet within the 10 million population there are about half a million people (the exact number is 550,000) who tend to go for skiing or snowboarding abroad. Authors compared the injury statistical data with results described in the international literature in order to develop conclusions about the differences in the injury patterns and frequency between the Hungarian ones’ and those found in countries with plenty of winter sport possibilities. Method: Authors analysed the winter sport injury cases of an insurance company. All the injury happened abroad and the assistance provider of the insurance company has managed the patient treatment and repatriation. Three winter seasons (12 months) data was analysed from the point of view of injuries frequency at different body parts and areas. Due to the fact that only limited information was available a simple statistical method was applied. Results: Of 222 cases 90.5% were ski-related injury and 8.6% were snowboard injury. As for the skiers, the upper limb injuries accounted for 21.9%, the truncal region for 24.4% and the lower limb for 55.8%. Among snowboarders the upper limb injuries accounted for 36.9%, the truncal region for 37% and the lower limb for 26.1%. The most frequent was the knee (36.8%), the wrist (12.4) and the shoulder (11.4) injury. Skier’s thumb injury was only 1.5%. The most common snowboard injury was the wrist trauma (31.6%), the head/neck/face was accounted 15.8% of all the injuries. And the ankle was injured in 10.5% of all the cases. The head/neck and the knee injury often combined with injuries of some other body part. 29 patients (13%) had to be repatriated, the most frequent reason for the repatriation was the injury of the lower limb. Conclusions: The Hungarian sportsmen’s injury patterns do not always follow data described in the international literature, but they correspond to data of countries with similar geographical situation. The injury rate of knee and of the shoulder displays same data, the injury rate of the wrist was more frequent than in the international data, and this is true both for skiers and the snowboarders. The Hungarians’ injury of the truncal region (mainly the head) was more frequent, but on the other hand the general injury rate of other body parts proved to be a lower number. It seems that the frequent use of the protective equipment and the preventive measures applied by the Hungarians are mirrored in the lower injury figures. Orv. Hetil., 2017, 158(16), 618–624.

scholarly journals Impact of the COVID-19 Pandemic on Trauma and Orthopaedic Service in the Republic of Ireland

2020 ◽  
Author(s):  
Hany Elbardesy
Keyword(s):  
Upper Limb ◽  
Lower Limb ◽  
Respiratory Illness ◽  
University Hospital ◽  
Female Population ◽  
Patient Admissions ◽  
Limb Trauma ◽  
Novel Coronavirus ◽  
Lower Limb Trauma ◽  
The Impact

Background: The novel coronavirus disease-2019 (COVID-19) has been identified as the cause of a rapidly spreading respiratory illness that is thought to have originated from Wuhan, China in early December 2019. Since then, the free movement of people has decreased, which has thus reduced the number of trauma-related casualties. The Irish governments initiated strict social distancing measures in response to the COVID-19 pandemic in late March 2020. It remains challenging to quantify the impact this had on reducing the spread of the virus. The viral outbreak has led to significant changes in the lifestyle of Irish citizens. The aim of this study was to examine the impact of the pandemic on activity, related to emergencies in trauma and orthopaedics departments. Methods: Patients admitted to the Trauma and Orthopaedic Department at Cork University Hospital (CUH), Cork, Ireland and South Infirmary Victoria University Hospital (SIVUH), Cork, Ireland between the 1st of March and the 15th of April 2020 were documented and compared to the patient admissions from the same time period in 2019. Results: The total numbers of lower limb trauma cases dropped by 20.44% from 137 (females: 87; males: 50) to 109 (females: 74; male: 35), (p=0.72). Of note, there was a 30.00% reduction in the number of male cases (from 50 to 35; p<0.05), in comparison to the 14.94% reduction observed in the female population (from 87 to 74; p<0.05). The total number of upper limb trauma cases increased by 0.14% from 90 (female: 44; men: 46) to 94 (female: 54; male: 40; p=0.14). The increase reported was only applicable to the female population; the number of male cases of upper limb trauma slightly decreased from 46 to 40 (p<0.005). Conclusion: The COVID-19 crisis has led to a decrease in the total numbers of lower limb trauma surgeries but an increase in the number of upper limb fractures. The main reduction was amongst the male patients, while the number of female cases increased.

Mangling upper limb injuries in industry

Injury ◽  
1999 ◽  
Vol 30 ◽  
pp. S
Author(s):  
D RING
Keyword(s):  
Upper Limb ◽  
Limb Injuries

Cardiac troponin I in patients with acute upper and lower limb ischemia

VASA ◽  
2008 ◽  
Vol 37 (4) ◽  
pp. 327-332 ◽  
Author(s):  
Koutouzis ◽  
Sfyroeras ◽  
Moulakakis ◽  
Kontaras ◽  
Nikolaou ◽  
...  
Keyword(s):  
Upper Limb ◽  
Lower Limb ◽  
Cardiac Troponin ◽  
Cardiac Involvement ◽  
Troponin I ◽  
Limb Ischemia ◽  
Elevated Troponin ◽  
Troponin Elevation ◽  
Lower Limb Ischemia ◽  
Ischemia Group

Background: The aim of this study was to investigate the presence, etiology and clinical significance of elevated troponin I in patients with acute upper or lower limb ischemia. The high sensitivity and specificity of cardiac troponin for the diagnosis of myocardial cell damage suggested a significant role for troponin in the patients investigated for this condition. The initial enthusiasm for the diagnostic potential of troponin was limited by the discovery that elevated cardiac troponin levels are also observed in conditions other than acute myocardial infarction, even conditions without obvious cardiac involvement. Patients and Methods: 71 consecutive patients participated in this study. 31 (44%) of them were men and mean age was 75.4 ± 10.3 years (range 44–92 years). 60 (85%) patients had acute lower limb ischemia and the remaining (11; 15%) had acute upper limb ischemia. Serial creatine kinase (CK), isoenzyme MB (CK-MB) and troponin I measurements were performed in all patients. Results: 33 (46%) patients had elevated peak troponin I (> 0.2 ng/ml) levels, all from the lower limb ischemia group (33/60 vs. 0/11 from the acute upper limb ischemia group; p = 0.04). Patients with lower limb ischemia had higher peak troponin I values than patients with upper limb ischemia (0.97 ± 2.3 [range 0.01–12.1] ng/ml vs. 0.04 ± 0.04 [0.01–0.14] ng/ml respectively; p = 0.003), higher peak CK values (2504 ± 7409 [range 42–45 940] U/ml vs. 340 ± 775 [range 34–2403] U/ml, p = 0.002, respectively, in the two groups) and peak CK-MB values (59.4 ± 84.5 [range 12–480] U/ml vs. 21.2 ± 9.1 [range 12–39] U/ml, respectively, in the two groups; p = 0.04). Peak cardiac troponin I levels were correlated with peak CK and CK-MB values. Conclusions: Patients with lower limb ischemia often have elevated troponin I without a primary cardiac source; this was not observed in patients presenting with acute upper limb ischemia. It is very important for these critically ill patients to focus on the main problem of acute limb ischemia and to attempt to treat the patient rather than the troponin elevation per se. Cardiac troponin elevation should not prevent physicians from providing immediate treatment for limb ischaemia to these patients, espescially when signs, symptoms and electrocardiographic findings preclude acute cardiac involvement.

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