scholarly journals Rotationplasty Salvage Procedure as an Effective Alternative to Femoral Amputation in an Adult With a History of Osteosarcoma: A Case Report and Review

2022 ◽  
Vol 8 ◽  
Author(s):  
Jean Gaillard ◽  
Alban Fouasson-Chailloux ◽  
Dominique Eveno ◽  
Guillaume Bokobza ◽  
Marta Da Costa ◽  
...  
Keyword(s):  
Lower Limb ◽  
Bone Sarcoma ◽  
Functional Results ◽  
Limb Salvage Surgery ◽  
Salvage Procedure ◽  
Non Union ◽  
Curative Therapy ◽  
Professional Activities ◽  
Proprioceptive Deficit ◽  
History Of

Rotationplasty or Borggreve-Van Ness surgery is lower limb salvage surgery, indicated mainly in the management of femoral bone sarcoma and congenital femur malformations in children. It can also be an interesting surgery option for managing chronic osteoarticular infections, or in cases of non union when curative therapy is no longer an option, as an alternative to femoral amputation. The principle of this surgery is to remove the affected knee and to apply a rotation of 180° to the distal part of the lower limb in order to give the ankle the function of a neo-knee. With the help of an adapted prosthesis, the aim is to allow patients to resume their social and professional activities by keeping most of their lower limb, thus avoiding the known complications of amputation (ghost limb pain, proprioceptive deficit, psychological disorders). Nevertheless, this surgery is complex and exceptional, with vascular, infectious, and psychological risks - the chimeric aspect of the lower limb may cause significant ill-being for the patient. This article reports the case of a 38-year-old patient consulting for management of a complex septic distal femoral non-union following osteosarcoma considered as being in remission. The patient underwent rotationplasty surgery on his left lower limb, with very good functional results and no surgical revision to date. In light of this particular case, we propose a didactic overview of the literature data concerning this surgery, especially in adulthood.

scholarly journals Single-Cut Single-Screw Capitate-Shortening Osteotomy for Kienbock's Disease

2020 ◽  
Vol 09 (04) ◽  
pp. 276-282
Author(s):  
Gregory I. Bain ◽  
Sathya Vamsi Krishna ◽  
Simon Bruce Murdoch MacLean ◽  
Parth Agrawal
Keyword(s):  
Wrist Joint ◽  
Functional Results ◽  
Salvage Procedure ◽  
Kienböck’S Disease ◽  
Kienböck's Disease ◽  
Single Screw ◽  
Diagnostic Arthroscopy ◽  
Central Column ◽  
History Of ◽  
Kienbock’S Disease

Abstract Background Kienbock's disease, in spite of an uncertain natural history, is known to cause lunate compromise, leading to central column collapse, carpal instability, and degenerative arthritis of the wrist. Joint leveling procedures are performed in the early stages of Kienbock's disease to “unload” the lunate. Capitate shortening is the preferred procedure in Kienbock's patients with positive ulnar variance. Description of Technique We describe the rationale and a simplified technique of capitate shortening in early Kienbock's disease. This is a single-cut osteotomy with single-screw stabilization. Patients and Methods We have performed this technique in three cases. We present a case of a 26-year-old male who presented with a 1-year history of pain in his right wrist. Radiology performed demonstrated lunate sclerosis. Diagnostic arthroscopy revealed healthy articular surfaces. Single osteotomy capitate shortening was performed with an oscillating saw and fixed with a single cannulated compression screw. A shortening of 1.5mm was obtained with this technique. Results At 1- to 2-year follow-up, all three patients had considerable pain relief but did not have a complete resolution of pain. There was a significant improvement in function and grip strength. There have been no cases with infection, nonunion, avascular necrosis or a need for a salvage procedure. Conclusion The simplified technique of capitate shortening is easy to perform, less traumatic to the capitate vascularity, and leads to good short-term functional results.

‘I Fight Anyone Who Doesn’t Act as a Communist Should...’ Letter of F. A. Zemit to N.N. Krestinsky on Financial Work in Siberia. January 5, 1920.

2018 ◽  
pp. 1137-1148
Author(s):  
Dmitrii I. Petin ◽  
Keyword(s):  
Civil War ◽  
Soviet Society ◽  
Difficult Situation ◽  
Professional Activities ◽  
Regional Finance ◽  
Difficult Time ◽  
History Of ◽  
Source Study ◽  
The One ◽  
Major Impediment

The article offers a source study of the letter of the head of the Financial Department at the Siberian Revolutionary Committee F. A. Zemit to the People's Commissar of Finance of the RSFSR N. N. Krestinsky. Its text analysis clears up the issue of creation of Soviet regional governing bodies in the financial–economical sphere in Siberia at the final stage of the Civil War. The published source allows to outline major impediment to restoration of the Soviet finance system in Siberia after the Civil War: shortage of financial workers, their low professional qualifications, lack of regulatory documentation for organizing activities, etc. Key methods used in the study are biographical and problematic/chronological. Biographical method allows to interpret the document and to link it with professional activities of F. A. Zemit in Omsk. The problematic/chronological method allows to trace the developments in regional finance and to understand their causes by placing them into historical framework. The letter was written by F. A. Zemit in early January 1920 – at a most difficult time in his career in Siberia. The author considers this ego-document unique and revealing in its way. On the one hand, it is an official appeal of an inferior financial manager to the head of the People's Commissariat of Finance; its content is practical and no-nonsense. On the other hand, its style indicates a warm friendly and trusting relationship between the sender and the addressee; F. A. Zemit was, apparently, able to report personally to the People's Commissar of Finance of the RSFSR on the difficult situation in the region and to do so with great frankness. This publication may be of interest to scholars in history of Russian finance, Russia Civil War, Soviet society, and Siberia of the period.

Sacral plexus disorder caused by a wooden toothpick in the rectum

2021 ◽  
Vol 14 (1) ◽  
pp. e238690
Author(s):  
Takuro Endo ◽  
Taku Sugawara ◽  
Naoki Higashiyama
Keyword(s):  
Lower Limb ◽  
Spinal Nerve ◽  
Leg Pain ◽  
Sacral Plexus ◽  
Lateral Recess ◽  
Lateral Recess Stenosis ◽  
Preoperative Ct ◽  
History Of ◽  
History Of Pain ◽  
The Right

A 67-year-old man presented with a 2-month history of pain in his right buttock and lower limb. MRI depicted right L5/S1 lateral recess stenosis requiring surgical treatment; however, preoperative CT showed an approximately 7 cm long, thin, rod-shaped structure in the rectum, which was ultimately determined to be an accidentally ingested toothpick. It was removed surgically 6 days after diagnosis, because right leg pain worsened rapidly. The pain disappeared thereafter, and the symptoms have not recurred since. The pain might have been localised to the right buttock and posterior thigh in the early stages because the fine tip of the toothpick was positioned to the right of the anterior ramus of the S2 spinal nerve. Although sacral plexus disorder caused by a rectal foreign body is extremely rare, physicians should be mindful to avoid misdiagnosis.

Objectivization of vacuum-compression therapy effects on micro- and macrovascular perfusion in type 2 diabetic patients

2020 ◽  
Vol 65 (4) ◽  
pp. 469-476
Author(s):  
Jaroslav Prucha ◽  
Vladimir Socha ◽  
Lenka Hanakova ◽  
Andrej Lalis ◽  
Karel Hana
Keyword(s):  
Lower Limb ◽  
Compression Therapy ◽  
Neurological Complications ◽  
Diabetic Patients ◽  
Type 2 Diabetic Patients ◽  
Therapeutic Procedures ◽  
History Of ◽  
Injury Recovery ◽  
Type 2 Diabetic

AbstractThe present study aimed to evaluate the characteristic influence of physical therapeutic procedures of vacuum-compression therapy (VCT) on microvascular perfusion (MiP) and macrovascular perfusion (MaP) of the lower limb in diabetic patients. A sample of nine patients with a medical history of type 2 diabetes was used for the purpose of this study. Most of the subjects’ medical conditions included venous and neurological complications of the lower limb, whereas the rest of the subjects entered the treatment due to injury recovery or their phlebological disease. The PeriFlux System 5000 (Perimed, Sweden) diagnostic device was used to measure MiP. The MaP was evaluated based on the perfusion index (PI) using the Extremiter monitoring device (Embitron, Czech Republic) designed to perform VCT procedures. The study found that MiP and MaP increase as an effect of VCT procedures and at the same time PI clearly reflects the effect of the applied vacuum and compression phases, verifying the method’s vital influence on peripheral perfusion disorders.

Limb salvage surgery for primary bone sarcoma of the lower extremities: Long-term consequences of endoprosthetic reconstructions

1998 ◽  
Vol 5 (5) ◽  
pp. 423-436 ◽  
Author(s):  
S. John Ham ◽  
Heimen Schraffordt Koops ◽  
René P. H. Veth ◽  
Jim R. van Horn ◽  
Willemina M. Molenaar ◽  
...  
Keyword(s):  
Limb Salvage ◽  
Salvage Surgery ◽  
Lower Extremities ◽  
Bone Sarcoma ◽  
Limb Salvage Surgery ◽  
Primary Bone Sarcoma ◽  
Primary Bone ◽  
Long Term Consequences

scholarly journals Alkaptonuria with extensive ochronotic degeneration of the Achilles tendon and its surgical treatment: a case report and literature review

2021 ◽  
Vol 15 (3) ◽  
pp. 129-136
Author(s):  
Nesrin Mwafi ◽  
Ali Alasmar ◽  
Monther Al-Momani ◽  
Sattam Alazaydeh ◽  
Omar Alajoulin ◽  
...  
Keyword(s):  
Case Report ◽  
Surgical Treatment ◽  
Achilles Tendon ◽  
Tendon Repair ◽  
Functional Results ◽  
Sudden Onset ◽  
Flexor Hallucis Longus ◽  
History Of ◽  
Complete Disruption ◽  
Collagenous Tissues

Abstract Background Alkaptonuria is a rare genetic metabolic disorder due to deficiency of homogentisate 1,2-dioxygenase (HGD), an enzyme catalyzing the conversion of homogentisate to 4-maleylacetoacetate in the pathway for the catabolism of phenylalanine and tyrosine. HGD deficiency results in accumulation of homogentisic acid and its pigmented polymer. Ochronosis is a bluish-black discoloration due to the deposition of the polymer in collagenous tissues. Extensive ochronotic involvement of the Achilles tendon in alkaptonuria and its surgical treatment is rarely reported. Case report A 43-year-old man presented to our clinic in March 2019 with sudden onset of left Achilles tendon pain with no history of prior trauma. Surgical exploration revealed a complete disruption of the tendon at its attachment to the calcaneus. Black pigmentation was extensive and reached the calcaneal tuberosity, extending about 7 cm from the insertion. Discussion Achilles reconstruction was performed using flexor hallucis longus tendon transfer. The patient experienced uncomplicated healing with satisfactory functional results. Conclusion Orthopedic surgeons should be aware of the progressive nature of alkaptonuria. Extensive degenerative changes of the ruptured tendon should be suspected so that physicians can plan tendon repair and facilitate prompt surgical intervention.

scholarly journals APPROACH TOWARDS DEVELOPING AN ALGORITHM FOR GAP NONUNION

2020 ◽  
pp. 1-6
Author(s):  
Nirjhar Maji
Keyword(s):  
Tertiary Care ◽  
Functional Results ◽  
Time Frame ◽  
Activity Level ◽  
Treatment Modalities ◽  
Long Bone ◽  
Care Hospital ◽  
Non Union ◽  
Formidable Challenge ◽  
Back Ground

Back ground and objectives The treatment of Gap or Defect non-union presents a formidable challenge to Orthopaedic surgeons. Not only a union but also good functional outcome is the target of modern-day Orthopaedics. The objective of this study is to consider knowledge of all treatment modalities, time frame, and functional results of long bone defects and develop an algorithm. Summary The study is designed as retrospective, prospective observational study. It is conducted in tertiary care hospital (MIOT Hospitals, Chennai). Initial evaluation of all cases were done by Maurizio Catagni’s Classification. Type of surgeries, time spent in hospital, union time were calculated. Patients were followed up for a period of 1year. Patients with average defect size of 6.29cm on an average underwent 4.47 procedures and for an overall time of 17.8 weeks with around 83.80 % of individuals were able to return to their preinjury activity level. Analysis of all data was done and algorithm developed.

scholarly journals COMPARATIVE EVALUATION OF TRAMADOL AND FENTANYL FOR EPIDURAL ANALGESIA IN LOWER LIMB SURGERIES

2020 ◽  
Vol 8 (12) ◽  
pp. 811-816
Author(s):  
Hp Singhl ◽  
◽  
Naveen Jindal ◽  
Jaspreet Singh ◽  
◽  
...  
Keyword(s):  
Lower Limb ◽  
Comparative Evaluation ◽  
Epidural Block ◽  
Epidural Fentanyl ◽  
Epidural Administration ◽  
Double Blind ◽  
Sensory Blockade ◽  
Catheter Technique ◽  
Lower Limb Surgery ◽  
History Of

Background:Epiduralandspinalblocksaremajorregionaltechniques with along history of effectiveuseforavarietyofsurgicalprocedures and pain relief. Epidural block with the catheter technique gives a better control of the level of analgesia and can be used for providingpost-operativepainreliefbyopioidsorlocalanaestheticagents.The purposeofthepresentstudywastocomparethe safetyandefficacyofepiduraltramadolversusepiduralfentanylas adjuvantstobupivacaineforlowerlimbsurgeries. Materials and methods:100 patients werer an domisedin to two groups with50 patient sineach group: Group BB-epidural administration of 20mL 0.5% plain bupivacaine with [50 mg (1 mL) tramadol + 1 mL NS= 2 mL].Group BF- epidural administration of 20 mL 0.5% plain bupivacainewith100mcg(2mL)of fentanyl.Settings and Design- Randomised double-blind trial. Results:The mean onset of sensory blockade and time for maximum sensory blockade was observed to be significantly reduced with the addition of fentanyl to bupivacaine as compared to tramadol and bupivacaine. The results showed statistically significant increase in the duration of analgesia with the addition of fentanyl to bupivacaine as compared to tramadol and bupivacaine. Conclusion:We can conclude that tramadol and fentanyl were effective adjuvants to bupivacaine when used epidurally in patients undergoing lower limb surgery. Although, epidural fentanyl with bupivacaine produces significantly faster onset of sensory blockadecompared to epiduralhowever,epiduraltramadolwithbupivacaineproducessignificantlyprolonged durationofanalgesiacomparedtoepiduralfentanyl.

scholarly journals Active Unicameral Bone Cysts in the Upper Limb are at Greater Risk of Fracture

2009 ◽  
Vol 17 (2) ◽  
pp. 157-160 ◽  
Author(s):  
Inn Kuang Tey ◽  
Arjandas Mahadev ◽  
Kevin Boon Leong Lim ◽  
Eng Hin Lee ◽  
Saminathan Suresh Nathan
Keyword(s):  
Growth Plate ◽  
Lower Limb ◽  
Pathological Fracture ◽  
Bone Cyst ◽  
Lower Limbs ◽  
Unicameral Bone Cyst ◽  
Pathological Fractures ◽  
Risk Of Fracture ◽  
History Of ◽  
Index 2

Purpose. To elucidate the natural history of unicameral bone cyst (UBC) and risk factors for pathological fracture. Methods. 14 males and 8 females (mean age, 9 years) diagnosed with UBC were reviewed. Cyst location, symptoms, and whether there was any fracture or surgery were recorded. Cyst parameters were measured on radiographs, and included (1) the cyst index, (2) the ratio of the widest cyst diameter to the growth plate diameter, and (3) the adjusted distance of the cyst border from the growth plate. Results. There were 11 upper- and 11 lower-limb cysts. 13 patients had pathological fractures and 9 did not. 20 patients were treated conservatively with limb immobilisation; 2 underwent curettage and bone grafting (one resolved and one did not). Seven cysts resolved (5 had fractures and 2 did not). The risk of fracture was higher in the upper than lower limbs (100% vs 18%, p<0.001). Fractured cysts were larger than unfractured cysts (mean cyst index, 4.5 vs. 2.2, p=0.07). Active cysts were more likely to fracture. Conclusion. Conservative management had a 30% resolution rate. Surgery should be considered for large active cysts in the upper limbs in order to minimise the fracture risk.

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