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At least 451 records · Page 25Linked to original sources
PubMed1995

Lower extremity injuries in drivers of airbag-equipped automobiles: clinical and crash reconstruction correlations.

OBJECTIVE AND DESIGN: To determine the relationship between airbags and lower extremity injuries, 10 drivers admitted to a level-I trauma center with substantial lower extremity trauma incurred in crashes involving airbag-equipped vehicles were studied in depth with regard to their injuries, the circumstances of the crashes, and the medical charges for the acute management of those injuries. MATERIALS AND METHODS: During the clinical investigation portion of this study, we photographed lower extremity injuries, both soft tissue and radiographs, and performed a detailed surgical exploration during the debridement of open wounds or fracture fixation to treat them appropriately and to define the mechanism of injury, the fracture pattern, the pattern of soft-tissue insult, and the extent of periosteal stripping. We recorded the hospital and professional charges associated with the acute management not only of these injuries, but of the other injuries as well. The analysis performed for each case included a detailed crash reconstruction, including force, contact point, and vehicle intrusion data. Particular attention was paid to the dashboard and toe pan areas to determine deformation and intrusion and their association with thigh, leg, and foot injuries. Pertinent deformation and trajectory information was entered into the Calspan Reconstruction of Accident Speeds on the Highway (CRASH) computer program to generate a delta V or change in velocity measurement used as a measure of collision severity. When field data were incompatible with the limitations of the CRASH program, manual calculations such as "slide to stop" and conservation of momentum formulas were used. RESULTS: The seven male and three female drivers had a mean age of 39.4 years. Only four used seatbelt restraints. The mean delta V was 28.3 mph and the mean maximum crush was 32.4 inches. The mean Injury Severity Score of 13.2. Musculoskeletal injuries included 11 foot/ankle fractures, 6 tibial fractures, 2 patellar fractures, 6 femoral fractures, and two acetabular/pelvic fractures. Other trauma included abdominal, thoracic, head and upper torso injuries, it seems that these safety devices do not prevent injuries to the lower extremity.

Accidents, Traffic↗
PubMed1989

Prosthetic usage following major lower extremity amputation.

There were 157 patients following major lower extremity amputation who were evaluated to determine functional prosthetic ambulation. Twenty-eight patients were evaluated in the amputee clinic and found not to be candidates for prosthetic fitting. Forty-one patients were fit with a prosthesis but did not become functional prosthetic ambulators. Eighty-eight patients became functional prosthetic ambulators. Of all above-the-knee amputees, 46% became functional prosthetic ambulators. Only 19% of bilateral lower extremity amputees became functional prosthetic ambulators. Of all below-the-knee amputees, 66% became functional ambulators. The presence of coronary artery disease decreased the ambulatory potential in above-the-knee or bilateral amputees but not in below-the-knee amputees. A screening method for elderly, dysvascular amputees should be instituted prior to prosthetic fitting.

Aged↗
PubMed2001

Capture-recapture method to estimate lower extremity amputation rates in Rio de Janeiro, Brazil.

OBJECTIVE: To estimate rates of lower extremity amputations (LEAs) in persons with peripheral vascular disease, diabetes mellitus, trauma, neoplasm, osteomyelitis, or emphysematous gangrene. METHODS: Regional amputee registries were used to estimate the rate of lower extremity amputations with the capture-recapture (CR) technique. Data were extracted from three amputee registries in Rio de Janeiro: source 1, with 1,191 cases from 23 hospitals; source 2, with 157 cases from a limb-fitting center; and source 3, with 34 cases from a rehabilitation center. Amputee death certificates from source 1 identified 257 deaths from 1992 to 1994. Three CR models were evaluated using sources 2 and 3. In order to avoid an overestimation of the rate of LEAs, two models were applied for the data analysis: in one case, deceased patients listed in source 1 were excluded from the model, and in the other case, deceased patients were included as well. RESULTS: Excluding the 257 deaths, the estimated number of amputations in the municipality of Rio de Janeiro from 1992 to 1994 was 3,954, for a mean annual incidence rate of 13.9 per 100,000 inhabitants. Among persons with diabetes, the annual incidence rate of lower extremity amputations was substantially higher (180.6 per 100,000 persons per year), representing 13 times the risk of individuals without diabetes. The yearly rate of LEAs according to the routine surveillance system was estimated at 5.4 and 96.9 per 100,000 in the general population and in diabetics, respectively. If data from the three registries are added, 1,382 patients with LEAs were identified, with the reasons for the amputations distributed as follows: peripheral vascular disease = 804 (58.1%); diabetes mellitus = 379 (27.4%); trauma = 103 (7.4%); osteomyelitis = 44 (3.1%); gangrene = 36 (2.6%), and neoplasm = 16 (1.1%). CONCLUSIONS: These findings show a high incidence of LEAs in Brazil, when compared to countries such as Spain, that is attributable mainly to peripheral vascular disease and diabetes mellitus.

Amputation, Surgical↗
PubMedDate not supplied

Catheter-directed thrombolysis of acute deep vein thrombosis in the lower extremity of a child with interrupted inferior vena cava.

We present the case of a 14-year-old girl who developed acute deep vein thrombosis (DVT) in her right lower extremity. Laboratory testing revealed protein S deficiency, and the patient's father also had this abnormality with a history of lower extremity DVT. Manual thromboaspiration followed by catheter-directed thrombolysis resulted in total clearance of all thrombi. Computed tomography and later venography revealed an interrupted inferior vena cava. Catheter-directed thrombolysis is an established treatment for adults with acute DVT. To the best of our knowledge, this report is the first to describe catheter-directed thrombolysis in a pediatric patient with lower extremity DVT. Our results suggest that catheter-directed thrombolysis is safe and effective for use in selected older children and adolescents with acute DVT in the lower extremity.

Acute Disease↗
PubMed1991

Juvenile rheumatoid arthritis. Aquatic exercise and lower-extremity function.

This pilot study investigates the effects of aquatic therapeutic exercise on lower-extremity range of motion, gait, balance, and functional mobility in children with juvenile arthritis. Eleven patients, aged 4-13, with lower-extremity joint involvement, diagnosed as functional class I-III, completed a 6-week program of aquatic exercise aimed at increasing lower-extremity range of motion and strength. Despite the small sample size and short duration of the study program, significant improvement was noted in external and internal hip rotation, bilaterally (p < 0.05). Improvement was noted in the median scores for most other parameters; however, these did not reach statistical significance. Aquatic exercises performed in a group setting can serve as an enjoyable and beneficial part of therapy for children with arthritis. Further investigation is recommended to determine fully the effects of aquatic therapeutic exercise on mobility and fitness in children with juvenile arthritis.

Adolescent↗
PubMed1996

[Pelvic fracture with shock-inducing retroperitoneal bleeding and concomitant lower extremity ischemia syndrome: discussion of management exemplified by a case report].

BACKGROUND: Initial treatment of severe pelvic fracture consists of appropriate resuscitation and early pelvic reposition and stabilization. Concomitant retroperitoneal arterial bleeding in a hemodynamically unstable patient in combination with lower extremity ischemia make early management decisions very difficult and the mortality rate of this entity of injuries is extremely high. CASE REPORT: We report on a successful treatment of a 36 year old skier, referred in hemorrhagic shock, who had sustained a severely displaced both column fracture of the right acetabulum, an unstable pelvic ring injury on the left and a retroperitoneal bladder rupture. He developed complete ischemia of the right lower extremity. Angiography revealed an obliteration without extravasation of the external iliac artery and allowed treatment of a right superior gluteal artery disruption by embolization. The right lower extremity ischemia was revascularized with a subcutaneous femoro-femoral bypass graft. Delayed internal fixation of the right acetabulum and exploration of the iliac vasculature was done through an ilio-inguinal approach. Simultaneously, the cross-over bypass could be removed. After 18 months, the patient recovered without any ischemic symptoms, but continues with a mixed sciatic nerve lesion. DISCUSSION AND CONCLUSIONS: The combination of severe retroperitoneal arterial bleeding and total ischemia of the lower extremity requires immediate surgical therapy. Direct exploration of the retroperitoneum, however, can be fatal and should be avoided if the iliac vessels are angiographically intact or if a hemorrhage is controllable by an embolization procedure. Extraanatomic temporary revascularization of the lower extremity should be envisaged when a lower leg ischemia due to obliteration or compression of major intrapelvic vessels cannot be directly and immediately treated.

Abdominal Injuries↗
PubMed2003

[Alignment of lower extremity in rheumatoid arthritis patients with a history of both total hip replacement and total knee replacement].

OBJECTIVE: The following is a retrospective study on lower extremity alignment of rheumatoid arthritis (RA) patients with a history of both Total Hip Replacement (THR) and Total Knee Replacement (TKR). METHODS: From 1992 to 2000, our department had 26 rheumatoid arthritis patients who underwent both THR and TKR. We classified these patients into three groups based on radiographic alignment of the lower extremities in the standing position: Knock-knee (valgus deformity of the knees), Bowleg (varus deformity of the knees) and Windswept Deformity (one knee in severe varus alignment with the other in severe valgus alignment). Furthermore, we identified dominant weight bearing points of the hip as classified by the following new criteria: Central Shift, Lateral Shift, and Upward Shift. Mal-alignment was then evaluated based on these two classification systems. RESULTS: Of the 26 patients, 22 patients met our criteria and 4 did not. In mal-alignment, we had 11 cases in the knock-knee group, 5 cases in the bowleg group, and 6 cases in the Windswept deformity. Using the new criteria, central shift had 6 cases; lateral shift had 6 cases; and upward shift had 10 cases. The groups of Lateral shift and Central shift demonstrated deformities of the lower extremities were influenced by moving weight bearing points, pelvis obliquity, and adduction contractures of the hip joint. In upward shift, weight bearing lines did not change. Consequently, destruction of the joint in this group progressed symmetrically. Windswept deformity was asymmetric and had severe destruction on the other side of the knee and forefoot. DISCUSSION: Moving of weight bearing point, pelvis obliquity, and adduction contractures of the hip joint affected the severity of mal-alignment of the lower extremities.

Adult↗
PubMed1991

[Roentgeno-surgical treatment of vascular occlusive diseases of the lower extremities].

The methods of direct revascularization of the lower extremities in occlusive-stenotic lesion at the stage of severe ischemia were used in 144 patients. Of them in 35, simultaneously or with a several day interval, the ++roentgeno-endovascular dilatation (RED) in the several segments of the arterial bed was carried out, in 36--RED was performed in combination with 2-3 procedures of plasmapheresis, in 16 patients in occlusion to a large extent, the isolated balloon profundoplasty was performed, in 46 patients with total lesion of the vessels--isolated RED of the aorto-iliac segment. This contributed to increase in the effectiveness of the collateral blood flow in the vessels of the lower extremities. A high effectiveness of the methods employed was noted in follow-up of from 1 to 5 years. The indications for the use of RED and causes of failures are presented.

Adult↗
PubMed2006

Star Excursion Balance Test as a predictor of lower extremity injury in high school basketball players.

STUDY DESIGN: Prospective cohort. OBJECTIVE: To determine if Star Excursion Balance Test (SEBT) reach distance was associated with risk of lower extremity injury among high school basketball players. BACKGROUND: Although balance has been proposed as a risk factor for sports-related injury, few researchers have used a dynamic balance test to examine this relationship. METHODS AND MEASURES: Prior to the 2004 basketball season, the anterior, posteromedial, and posterolateral SEBT reach distances and limb lengths of 235 high school basketball players were measured bilaterally. The Athletic Health Care System Daily Injury Report was used to document time loss injuries. After normalizing for lower limb length, each reach distance, right/left reach distance difference, and composite reach distance were examined using odds ratio and logistic regression analyses. RESULTS: The reliability of the SEBT components ranged from 0.82 to 0.87 (ICC3,1) and was 0.99 for the measurement of limb length. Logistic regression models indicated that players with an anterior right/left reach distance difference greater than 4 cm were 2.5 times more likely to sustain a lower extremity injury (P<.05). Girls with a composite reach distance less than 94.0% of their limb length were 6.5 times more likely to have a lower extremity injury (P<.05). CONCLUSIONS: We found components of the SEBT to be reliable and predictive measures of lower extremity injury in high school basketball players. Our results suggest that the SEBT can be incorporated into preparticipation physical examinations to identify basketball players who are at increased risk for injury.

Adolescent↗
PubMed2006

Gait symmetry and walking speed analysis following lower-extremity trauma.

BACKGROUND AND PURPOSE: Gait has been shown to be a major determining factor of function following limb-salvage surgery. However, little is known regarding the measures associated with gait recovery for this patient population. The purpose of this study was to identify clinical measures associated with impaired walking speed and gait asymmetry in patients with lower-extremity reconstruction. SUBJECTS: Study subjects were 381 patients from the Lower Extremity Assessment Project (LEAP) who had undergone reconstruction following severe lower-extremity trauma. METHODS: The LEAP study was a longitudinal study of outcomes following lower-extremity reconstruction. The present study used 24-month clinical follow-up data. A combined outcome measure of reduced walking speed and gait deviation was chosen to provide a comprehensive measure of impaired physical mobility. RESULTS: The most significant clinical factors associated with decreased walking speed and gait deviation were impaired ankle plantar-flexion range of motion, knee flexion strength, and a nonreciprocal stair-climbing pattern. DISCUSSION AND CONCLUSION: The findings provide clinicians with specific clinical measures associated with functional recovery in patients with lower-limb reconstruction. These measures, in turn, can be considered to inform treatment decision making and to prioritize interventions.

Adolescent↗
PubMed1989

Diagnosis of arteriosclerosis obliterans by impedance technique with special reference to relative blood flow of the lower extremity.

Simultaneous recordings of impedance cardiography of the chest and impedance plethysmography of the lower extremity were performed on 105 limbs with or without arteriosclerosis obliterans (ASO) documented by angiography. The ratios of blood flow to the lower extremity--leg stroke volume/cardiac stroke volume--(LSV/CSV) were 11.2 +/- 3.3% in normal male subjects, 11.1 +/- 5.5% in normal female subjects, and 3.1 +/- 1.2% in lower extremities with ASO, respectively. The normal value (range) for LSV/CSV calculated from the normal groups by the percentile method was between 4.9% and 17.8%, and the diagnostic accuracy of this value was 100% for sensitivity and 97.5% for specificity. LSV/CSV is a good index for the diagnosis of ASO and makes it possible to minimize error when expressed as an absolute value.

Arteriosclerosis Obliterans↗
PubMedDate not supplied

Assessment of lower extremity nerve block: reprise of the Four P's acronym.

BACKGROUND AND OBJECTIVES: Successful performance of lower-extremity regional anesthesia includes sensory and/or motor block assessment of up to 4 major peripheral nerves. This brief report describes a methodology for the rapid evaluation of lower-extremity anesthesia before surgical incision. METHODS: Illustrations highlight the techniques for evaluation of sciatic, obturator, lateral femoral cutaneous, and femoral nerve anesthesia. This methodology is based on a Four P's acronym: push, pull, pinch, punt. CONCLUSIONS: Accurate assessment of lower-extremity regional anesthesia can be achieved rapidly using The Four Ps evaluation tool.

Femoral Nerve↗
PubMed1981

Rehabilitation for lower extremity amputation.

The results of rehabilitation for lower-extremity amputation were analyzed to assess the impact of a center that used a coordinated team combined with modern surgical and prosthetic techniques. Data for group 1 patients (amputated between July 1, 1975, and June 30, 1977) demonstrated a healing rate of 63%, a mean rehabilitation time of 128 days, a mean hospitalization time of 68 days, and a rehabilitation rate of 69% for those who could walk prior to amputation. Data for group 2 (amputated between July 1, 1977, and July 30, 1979) demonstrated an amputation healing rate of 97%, an average rehabilitation time of 30.8 days, a mean hospitalization time of 38 days, and a rehabilitation rate of 100% for those patients who could walk before amputation. There was no difference between groups 1 and 2 in surgical mortality; all other variables, however, showed significant improvement for group 2 patients. Comparison within the same institution of the results of rehabilitation for lower-extremity amputation before and after the initiation of a dedicated amputation center clearly demonstrated the superiority of the center concept.

Adult↗
PubMed1990

Vascular problems of the lower extremity in athletes.

The vascular anatomy of the lower extremity predisposes the popliteal area to traumatic injury owing to tethering at the adductor hiatus and the soleus arch. Knee dislocations should be followed with arteriography or exploration of the vessels. Epiphyseal separations of the proximal tibia and distal femur, as well as fractures about the knee, should be observed closely for 24 to 48 hours to ensure that the vascular status is intact. Traumatic pseudoaneurysms may arise from seemingly minor trauma and are treated surgically. The etiology of nonspecific claudication in the athletic population requires a careful history and physical examination and may require vascular studies in order to determine if the etiology is one of popliteal artery entrapment syndrome, adventitial cystic disease of the popliteal artery, or adductor canal outlet syndrome. Buerger's disease may be seen more frequently as the use of smokeless tobacco increases in the athletic population and may be distinguished from these other claudication-causing entities by its distribution to the upper and lower extremities in a distal fashion. A sense of alertness to these vascular entities will add to the quality of care of athletes.

Athletic Injuries↗
PubMed2002

Lower extremity injuries sustained while farming.

Today's complex farm environment can pose many threats to the lower extremities of all people especially those with chronic diseases that affect the lower extremities. The purpose of this study was to investigate the incidence of injuries to the lower extremities among farmers and to rank the importance of these incidents in order to plan prevention programs. one hundred farmers were surveyed at a large farm show in the southeastern United States. An average of 4.86 injuries per farmer were reported. Blisters from work shoes or boots, followed by injuries from animals stepping on the feet were the most common injuries. Since those with chronic illnesses are especially prone to injury and disability, regular foot assessments, evaluation, and education about the hazards of farming are mainstays of prevention.

Journal Article↗
PubMed2004

Free tissue transfer to a difficult wound of the lower extremity.

Amputation is still recommended to patients with a difficult wound of the lower extremity because limb salvage after free tissue transfer in these patients remains uncertain. During the past 3 years, the authors studied 15 patients (11 men, 4 women; age range, 17-71 years) with difficult wounds of the lower extremities who had free tissue transfers for limb salvage. Eleven patients had an extensive soft-tissue defect (nearly the entire length) of the legs or feet, and 4 had a composite-tissue defect of the legs or feet that required bony reconstruction. A total of 16 free tissue transfers (13 free muscle flaps, 2 osteomusculocutaneous flaps, and 1 adipofascial flap) were performed in 15 patients (1 patient had bilateral transfers). A saphenous vein loop or graft was used in 3 patients and a subsequent bone graft was done in 2 patients. Free tissue transfer was accomplished successfully in 14 patients (93%). Limb salvage was achieved ultimately in 12 patients (80%) who were able to ambulate during a 36-month follow-up. The authors believe that free tissue transfer for limb salvage in any patient with a difficult wound of the lower extremity is still a worthwhile procedure and should be attempted if possible. Meticulous preoperative preparation and intraoperative execution combined with the use of innovative microsurgical techniques are the keys for success.

Adolescent↗