A clinical evaluation of stumps in lower limb amputees

A study was carried out on 93 consecutive unilateral below-knee (BK) and 62 above-knee (AK) amputees. The dimensions of the amputation stumps were measured and the general condition and contralateral limb assessed at the time of prosthetic fitting. After one postoperative year, follow-up information for 124 (89%) of the surviving patients was obtained by personal contact. The observations were based on the standard formula for stump classification constructed by the International Society for Prosthetics and Orthotics. The 93 BK stumps had a mean length of 16.0 cm and the 62 AK stumps a mean length of 28.0 cm. The scar on the stump was adherent in 13% of BK and 2% of AK stumps. The scar was deeply wrinkled in 7% of BK stumps and 10% of AK stumps. The scar on the stump was most frequently adherent or deeply wrinkled in trauma patients (33%). The skin was undamaged in 93% of all the patients at the first visit and in 94% at the time of follow-up. The mobility of the stump in the proximal joint was limited at the time of prosthetic fitting in 15% of cases. Phantom pain was reported by 59% and stump pain by 5% of patients at this time. Although the phantom pain was mild in most cases, it was usually still present after one year, and 53% of the surviving patients suffered from phantom pain. At the first visit, 20% of patients had problems in their contralateral leg. During the first postoperative year, 6 contralateral BK amputations were performed in the BK group and one contralateral AK amputation in the AK group. Thus, along with examination of the stump, attention must be paid to the contralateral limb with a view to preserving it. The study supports the usefulness of the standard form and classification of amputation stumps.

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P099: Extending the trimodal distribution of death; trauma patients die at increased rates after discharge. Linking trauma registry data to vital statistics and hospital datasets identifies opportunities to save life

CJEM ◽

10.1017/cem.2020.305 ◽

2020 ◽

Vol 22 (S1) ◽

pp. S100-S100

Author(s):

J. French ◽

C. Somayaji ◽

D. Dutton ◽

S. Benjamin ◽

P. Atkinson

Keyword(s):

Mortality Rate ◽

Cause Of Death ◽

Causes Of Death ◽

Trauma Registry ◽

Vital Statistics ◽

Trauma Patients ◽

Age Group ◽

Post Discharge ◽

One Year

Introduction: The New Brunswick Trauma Registry is a database of injury admissions from eight hospitals throughout the province. Data tracks individuals in-hospital. By linking this information with vital statistics, we are able to observe outcomes post-discharge and can model health outcomes for participants. We want to know how outcomes for trauma patients compare with the general population post discharge. Methods: Using data from 2014-15, we followed over 2100 trauma registry observations for one year and tracked mortality rate per 1,000 people by age-group. We also compared the outcomes of this group to all Discharge Abstract Database (DAD) entries in the province (circa. 7500 total). We tracked mortality in-hospital, at six months, and one year after discharge. We truncated age into groups aged 40-64, 65-84, and 85 or older. Results: In-hospital mortality among those in the trauma registry is approximately 20 per 1,000 people for those age 40-64, 50 per 1,000 people for those aged 65-84, and 150 per 1,000 people aged 85 or older. For the oldest age group this is in line with the expected population mortality rate, for the younger two groups these estimates are approximately 2-4 times higher than expected mortality. The mortality at six-month follow-up for both of the younger groups remains higher than expected. At one-year follow-up, the mortality for the 65-84 age group returns to the expected population baseline, but is higher for those age 40-64. Causes of death for those who die in hospital are injury for nearly 50% of observations. After discharge, neoplasms and heart disease are the most common causes of death. Trends from the DAD are similar, with lower mortality overall. Of note, cardiac causes of death account for nearly as many deaths in the 6 months after the injury in the 40 -64 age group as the injury itself. Conclusion: Mortality rates remain high upon discharge for up to a year later for some age groups. Causes of death are not injury-related. Some evidence suggests that the injury could have been related to the eventual cause of death (e.g., dementia), but questions remain about the possibility for trauma-mitigating care increasing the risk of mortality from comorbidities. For example, cardiac death, which is largely preventable, is a significant cause of death in the 40-64 age group after discharge. Including an assessment of Framingham risk factors as part of the patients rehabilitation prescription may reduce mortality.

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Comparative study of functional outcome of dynamic compression plating and interlocking intramedullary nailing for fructure shaft of humerus

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20173938 ◽

2017 ◽

Vol 3 (5) ◽

pp. 1038

Author(s):

Aminul Islam Mamood ◽

Ajay Kumar Mahto

Keyword(s):

Comparative Study ◽

Dynamic Compression ◽

Humeral Shaft ◽

High Rate ◽

Trauma Patients ◽

Humeral Shaft Fractures ◽

Shaft Fractures ◽

One Year ◽

Compression Plating

Background: Fracture of the diaphysis of humerus and its complications are a major cause of morbidity in trauma patients. Fracture of the humeral shaft account for 20% of humeral fractures & about 3% of all fractures. There is a debate between the choices of operation in humeral shaft fractures.Methods: A comparative study of management of acute humeral shaft fractures treated by Dynamic Compression Plate (DCP) and Intra Medullary Interlocking Nail (IMILN) fixation over a period of one half years. 18 patients of IMILN and 20 patients of DCP were included after considering inclusion and exclusion criteria. Functional scoring criteria were used for postoperative assessment & the average follow up period was one year.Results: A high rate of excellent & good results & a tendency for early union was seen with the plating group than nailing group.Conclusions: Plating shows better results than nailing.

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Orthogeriatric Combined Management of Elderly Patients With Proximal Femoral Fracture: Results of a 1-Year Follow-Up

Geriatric Orthopaedic Surgery & Rehabilitation ◽

10.1177/2151458517698536 ◽

2017 ◽

Vol 8 (2) ◽

pp. 109-114 ◽

Cited By ~ 7

Author(s):

Stefan Förch ◽

Reiner Kretschmer ◽

Thomas Haufe ◽

Johannes Plath ◽

Edgar Mayr

Keyword(s):

Nursing Home ◽

Functional Outcome ◽

Femoral Fracture ◽

Epidemiological Data ◽

Proximal Femoral Fracture ◽

Trauma Patients ◽

Barthel Score ◽

One Year ◽

The Moment

Introduction: According to the expected demographical changes, the number of elderly trauma patients will increase exponentially over the next decades. Different models of an interdisciplinary orthogeriatric care have been developed. But there is only limited evaluation of their benefit without clear and evidence-based results. In 2011, we monitored the results of our orthogeriatric combined management by conducting a 1-year follow-up. Methods: We treated 231 patients presenting a proximal femoral fracture on our orthogeriatric ward. We obtained the epidemiological data and the geriatric assessments from all these patients. One year after discharge, we sent them a written questionnaire. Primary end points were the mortality and the functional outcome, measured by Barthel score, the requirement of care, and the residential status. Results: One hundred sixty-seven (72%) of the 231 patients completed the follow-up. The average age at admission was 81.5 years (70-99 years). The mortality rate was 2.4% during hospital stay and 31.4% after 1 year. The average Barthel score was 44 points at the time of admission, 55 points at discharge, and 72 points after 1 year. Forty-five percent of the patients were in requirement of care at the time of their admission. At the 1-year follow-up, 63% of the patients had some form of care, thus showing an increase of 18%. At the moment of the fracture, 77% of the patients were living in their own home and 23% in a nursing home. After 1 year, the surviving patients show nearly unchanged conditions (75% own home vs 25% nursing home). Eighty-six percent of the patients coming from their own home were able to continue living there independently. Conclusion: The orthogeriatric care is successful in reducing the short-time mortality without showing any effect on 1-year mortality. But the surviving patients seem to benefit from an improved functional outcome.

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Health related quality of life in trauma patients. Data from a one-year follow up study compared with the general population

Scandinavian Journal of Trauma Resuscitation and Emergency Medicine ◽

10.1186/1757-7241-19-22 ◽

2011 ◽

Vol 19 (1) ◽

pp. 22 ◽

Cited By ~ 50

Author(s):

Kirsti Tøien ◽

Inger S Bredal ◽

Laila Skogstad ◽

Hilde Myhren ◽

Øivind Ekeberg

Keyword(s):

Quality Of Life ◽

General Population ◽

Trauma Patients ◽

Health Related Quality ◽

Follow Up Study ◽

Related Quality ◽

Health Related ◽

One Year

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Phantom Pain—Psychological Conceptualization and Treatment: A Case Report

Behavioural and Cognitive Psychotherapy ◽

10.1017/s1352465800015125 ◽

1996 ◽

Vol 24 (3) ◽

pp. 275-281

Author(s):

Marteinn Steinar Jonsson ◽

Keren Fisher

Keyword(s):

Case Report ◽

Cognitive Strategy ◽

Phantom Pain ◽

Review Of The Literature ◽

Single Session ◽

Cognitive Work ◽

Treatment Gains ◽

One Year ◽

Attention Diversion

This paper describes a case concentrating on the psychological conceptualization and treatment of phantom pain. A single session of cognitive work, teaching an “attention diversion’ strategy, was effectively utilized for the treatment of below knee phantom pain in an elderly lady. A follow-up, approximately one year later, revealed that the treatment gains had been maintained. Although a review of the literature (Sherman, Sherman and Gall, 1980) presents a rather murky picture as regards treatment prospects, the results nevertheless illustrate how a very simple cognitive strategy was successfully employed to alleviate a long standing debilitating phantom pain.

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Outcome of Surgical Treatment of Tarsal Tunnel Syndrome

Foot & Ankle International ◽

10.1177/107110070302400205 ◽

2003 ◽

Vol 24 (2) ◽

pp. 125-131 ◽

Cited By ~ 61

Author(s):

G. James Sammarco ◽

Laurette Chang

Keyword(s):

Average Length ◽

Symptom Duration ◽

Tarsal Tunnel ◽

Trauma Patients ◽

Tarsal Tunnel Syndrome ◽

Duration Of Symptoms ◽

Preoperative Symptom ◽

Tunnel Syndrome ◽

One Year

One hundred and eight ankles in 72 patients were evaluated from July 1986 to July 1997 with clinical findings and positive electrodiagnostic studies of tarsal tunnel syndrome. Clinical data included physical findings, subjective complaints, duration of symptoms, trauma history, steroid injections, nonsteroidal use and workman's compensation involvement. Associated medical conditions included diabetes, back pain and arthritis. Sixty-two patients underwent tarsal tunnel release, with 13 of them bilateral. There were 44 females and 18 males, 35 right feet and 40 left feet. The average age was 49 years. Preoperative symptom duration was 31 months. Average length of follow-up was 58 months. Average time for return to usual activity was nine months. All patients had at least a 12-month follow-up, and compared with both (Maryland Foot Score) MFS and AOFAS postoperative scores. Preoperative MFS scores obtained prior to 1994, were 61/100 (average), and postoperative MFS scores were 80/100 (average). Postoperative AOFAS scores were 80/100 (average). Patients with symptoms less than one year had postoperative MFS/AOFAS scores significantly higher than those with symptoms greater than one year. The most common surgical findings included arterial vascular leashes indenting the nerve and scarring about the nerve. Varicosities and space occupying lesions were present also. The outcome of surgery was not affected by the presence or absence of trauma. Patients with tarsal tunnel syndrome warrant surgery when significant symptoms do not respond to conservative management. Meticulous surgical technique must be followed. Improvement in foot scores is predictable even when a discrete space-occupying lesion is not present and when symptoms have been present for periods of greater than one year.

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Prosthetic use and functional and social outcome following major lower limb amputation

Prosthetics and Orthotics International ◽

10.3109/03093649009080326 ◽

1990 ◽

Vol 14 (2) ◽

pp. 75-79 ◽

Cited By ~ 87

Author(s):

T. Pohjolainen ◽

H. Alaranta ◽

M. Kärkäinen

Keyword(s):

Lower Limb ◽

Lower Limb Amputation ◽

Social Adaptation ◽

Limb Amputation ◽

Personal Contact ◽

Social Outcome ◽

Home Help ◽

Prosthetic Fitting ◽

One Year ◽

Old People's Homes

A total of 175 consecutive below and above-knee amputees sent to the prosthetic workshop in Helsinki for prosthetic fitting from 32 hospitals were reviewed to determine their functional ambulation and social adaptation. The average age of the patients was 62.2 years at the time of the prosthetic fitting. The mortality was 11% (19) during the first postoperative year. One-year postoperative information was obtained for 141 of the surviving patients (90%) by personal contact. At the time of the review, 68% of the amputees (96 patients) who had been fitted with a prosthesis made extensive and regular use of it. Half of all the above-knee amputees and 79% of the below-knee amputees used their prosthesis throughout the day or over seven hours a day. A total of 72% of the above-knee amputees (33/ 46) and 85% of the below-knee amputees (67/ 79) had useful ambulation, at least indoors. Of the 141 patients contacted, 124 (88%) lived in their own homes. The remaining 16 patients (11%) lived in apartment houses for the aged or old people's homes, A total of 48 amputees (34%) needed a regular home help.

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