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PubMed1998

Reconstruction of soft tissue and bone defects in lower extremity with free flaps.

This article reports our experiences treating soft tissue and bone defects in the lower extremity with free flaps. One of the most common causes for lower extremity wounds are high-energy injuries. These kinds of injuries contain soft tissue and bone defects beyond neurovascular complications. The rate of infection and nonunion is very high in these injuries. Between 1988 and 1996, we applied 33 flaps to 28 patients. The numbers and kinds of the free flaps are as follows: 12 latissimus dorsi, nine radial forearm, seven lateral arm, three vascularised fibula grafts with skin, one gracilis, and one medial plantar flap. Three free flaps were lost (12%). The success rate is 88%. The advantage of free flaps is that they allow the reconstruction of the large defects in one-session operations. Thus, they decrease the rate of infection and increase that of nonunion. The patient returns to his active life at an earlier stage.

Adolescent↗
PubMed1999

A rare case of polyostotic fibrous dysplasia assessed by bone scintigraphy with Tc-99m methylene diphosphonate (MDP).

A 66-year-old man affected by polyostotic form of fibrous dysplasia in consequence of worsening of lower extremity bone pain aggravated by walking and concomitant increase of serum alkaline phosphatase and osteocalcin, was subjected first to a radionuclide study. Bone scan demonstrated a pathological uptake of the radiotracer in the craniofacial bones, right scapula, left and right posterior ribs, right hemipelvis and lower extremities confirming the diagnosis but establishing especially the extent of bone involvement, greater than expected on the basis of symptoms and X-ray findings, underlying the importance of nuclear medicine imaging in the assessment and follow-up of this rare disease.

Aged↗
PubMedDate not supplied

Function and upright time following limb salvage, amputation, and rotationplasty for pediatric sarcoma of bone.

We wished to determine the relative physical and psychosocial merits of limb-sparing reconstruction, above-knee amputation, and rotationplasty in survivors of childhood and adolescent lower extremity bone sarcoma. In comparing minimum 5-year disease-free survivors, we found that outcome was somewhat dependent on the measuring tool administered. A superior score of statistical significance on the system of evaluation of the Musculoskeletal Tumour Society and a trend toward higher Toronto Extremity Salvage Scores were found among patients with a limb-sparing reconstruction compared with those with an above-knee amputation. Short-Form 36 results and the amount of time spent in the upright position (uptime), as assessed with a remote activity monitor, were similar between these groups. Uptime was highest in patients who had undergone rotationplasty, although statistical assessment of this group was not feasible. Psychosocial outcome was similar between all groups. This information may be useful in discussing reconstruction with patients and their families.

Activities of Daily Living↗
PubMed2006

[Lower extremity nerves injuries in bone fractures and joint dislocations--etiopathogenesis, treatment].

Lower extremity nerve injuries accompanying bone fractures and joint dislocations lead to serious disturbances at the lower limbs and caused significant prolongation of the treatment time. Clinical material consisted of 73 patients treated surgically with lower extremity nerve injuries due to bone fractures and joint dislocation. Based on this material we analysed the most frequent localisations of the nerves lesions and the mechanism of injury. The indications to surgical treatment were also described.

Adolescent↗
PubMed1982

Prosthetic replacement of tumour-destroyed diaphyseal bone in the lower extremity.

A description is given of a prosthesis for replacement of tumour-destroyed diaphyseal bone in the lower extremity. It can be used in a salvage procedure and as an alternative to intramedullary nailing or plating procedures. The method is not complicated provided that mechanically sound devices are used and technical errors are avoided. The operation time is short and the patients can be mobilized early.

Adenocarcinoma↗
PubMed2004

One-stage reconstruction of composite bone and soft-tissue defects in traumatic lower extremities.

Management of bone loss that occurs after severe trauma of open lower extremity fractures continues to challenge reconstructive surgeons. Sixty-one patients who had 62 traumatic open lower extremity fractures and combined bone and composite soft-tissue defects were treated with the following protocol: extensive debridement of necrotic tissues, eradication of infection, and vascularization of osteocutaneous tissue for one-stage bone and soft-tissue coverage reconstruction. The mechanism of injury included 49 motorcycle accidents (80.3 percent), five falls (8.2 percent), three crush injuries (4.9 percent), two pedestrian-automobile accidents (3.3 percent), and two motor vehicle accidents (3.3 percent). The bone defects were located in the tibia in 49 patients (79 percent; one patient had bilateral open tibial fractures), in the femur in seven patients (11.3 percent), in the calcaneus bone in four patients (6.5 percent), and in the metatarsal bones in two patients (3.2 percent). The size of soft-tissue defects ranged from 5 x 9 cm to 30 x 17 cm. The average length of the preoperative bony defect was 11.7 cm. The average duration from injury to one-stage reconstruction was 27.1 days, and the average number of previous extensive debridement procedures was 3.4. Fifty patients had vascularized fibula osteoseptocutaneous flaps, six had vascularized iliac osteocutaneous flaps, and five patients had seven combined vascularized rib transfers with serratus anterior muscle and/or latissimus dorsi muscle transfers. One patient received a second combined rib flap because the first combined rib flap failed. The rate of complete flap survival was 88.9 percent (56 of 63 flaps). Two combined vascularized rib transfers with serratus anterior muscle and latissimus dorsi muscle flaps were lost totally (3.2 percent) because of arterial thrombosis and deep infection, respectively. Partial skin flap losses were encountered in the five fibula osteoseptocutaneous flaps (7.9 percent). Postoperative infection for this one-stage reconstruction was 7.9 percent. Excluding the failed flap and the infected/amputated limb, the primary bony union rate after successful free vascularized bone grafting was 88.5 percent (54 of 61 transfers). The average primary union time was 6.9 months. The overall union rate was 96.7 percent (59 of 61 transfers). The average time to overall union was 8.5 months after surgery. Seven transferred vascularized bones had stress fractures, for a rate of 11.5 percent. Donor-site problems were noted in six fibular flaps, in two iliac flaps, and in one rib flap. The fibular donor-site problems were foot drop in one patient, superficial peroneal nerve palsy in one patient, contracture of the flexor hallucis longus muscle in two patients, and skin necrosis after split-thickness skin grafting in two patients. The iliac flap donor-site problems were temporary flank pain in one patient and lateral thigh numbness in the other. One rib flap transfer patient had pleural fibrosis. Transfer of the appropriate combination of vascularized bone and soft-tissue flap with a one-stage procedure provides complex lower extremity defects with successful functional results that are almost equal to the previously reported microsurgical staged procedures and conventional techniques.

Accidental Falls↗
PubMedDate not supplied

Case report: massive osteolysis in a case of rheumatoid arthritis: clinical, histologic and biochemical findings.

A 54-year-old male with a 10-year history of seropositive rheumatoid arthritis subsequently developed generalized osteoporosis, multiple cervical spine subluxation, vertebral collapses, and massive osteolysis of the humeral and femoral heads and carpal bones. These lesions were accompanied by neurologic manifestations in both the upper and lower extremities. Bone matrix collagen and noncollagenous proteins in this rare syndrome were analyzed. The pathogenesis of this rare phenomenon is discussed.

Arthritis, Rheumatoid↗
PubMed1988

[Surgical treatment of the polyostotic form of fibrous dysplasia in children and adolescents].

The work presents an experience with the treatment of 50 patients with polyossal form of fibrous osteodysplasia on whom 99 operations were performed. A method of plasty of bone defects was elaborated and used in order to eliminate severe deformations of lower extremity bones after removal of pathological tissue in combination with epiosseous nailing osteosynthesis. In patients with short bones the compression-distraction osteosynthesis with bone alloplasty was used. Long-term results of treatment of 48 patients make it possible to recommend the methods of bone alloplasty with extraosseous and intraosseous nailing osteosynthesis as well as compression-distraction devices for practical use.

Adolescent↗
PubMed1996

Multicentric chondrosarcomas.

Multicentric chondrosarcomas, other than those from mesenchymal chondroma, are rare and difficult to differentiate from metastatic disease. Eight new patients with multicentric chondrosarcomas are reported. Five patients had chondrosarcomas that were monomelic, 3 had disseminated chondrosarcomas, 3 had synchronous involvement, and 5 had metachronous involvement; 1 patient had Ollier's disease. A bimodal age distribution was apparent: 4 patients were between 62 and 76 years old, and the remaining 4 were between 16 and 33 years old. Average duration of followup was 6 years, 4 months. Each of the patients with synchronous chondrosarcomas had single bone lower extremity involvement and presented with symptoms occurring at only 1 of the 2 sites of tumor. Each of the 5 patients with metachronous chondrosarcomas experienced involvement of a different bone when the second tumor presented. Only 1 of these metachronous chondrosarcomas was limited to the lower extremity. The second tumor occurred in all patients after excellent control of the primary tumor by wide excision. The average duration between diagnosis of the 2 tumors was 4 years, 4 months (range, 8 months-12 years, 9 months). Patients who had nonmonomelic malignancies must be viewed with a considerably more guarded prognosis than those who had monomelic chondrosarcoma because each of the 2 deaths resulting from progressive disease occurred among the 3 patients with nonmonomelic chondrosarcoma. The nonmonomelic malignancies may represent metastatic chondrosarcoma with a rare predilection to bony involvement. Monomelic chondrosarcoma simply may represent lesions analogous to the skip lesions observed in osteosarcoma.

Adolescent↗
PubMed1983

Lower extremity loads stimulate bone formation in the vertebral column: implications for osteoporosis.

Senile osteoporosis is a growing national health problem. The purpose of this study was to determine whether loads applied through the lower extremity would stimulate bone formation in the vertebral column, the site of most osteoporotic fractures. Female white New Zealand rabbits were divided into experimental (EG) and control (CG) groups. The right hind leg of the EG was repetitively loaded to 1.5 X body weight, 20 min/day for three weeks; the CG was "sham loaded". Bone formation in both groups was labeled using tetracycline. Labeled osteons, resorption spaces, surface bone formation, and porosity were measured in cross-sections from the right and left tibias and humeri, right femurs, and L6, L1, T12, T1, and C7 vertebrae. This experiment demonstrates that repetitive loading of the lower extremity increases osteonal bone formation in the vertebral column of rabbits extending at least up to the cervical spine, but not into the forelimbs. This finding supports the concept that exercise involving repetitive loading of the lower limbs (eg, walking) could be used to treat or prevent age-related osteoporotic changes in the vertebrae.

Aged↗
PubMed2005

Bone mineral density and the risk of peripheral arterial disease in men and women: results from Mr. and Ms Os, Hong Kong.

Previous population studies have demonstrated an association between peripheral vascular disease and bone mineral density in women, but not in men. In a large prospective cohort of 3,998 Chinese men and women aged 65 to 92 years of age in Hong Kong, the association between peripheral vascular disease and bone mineral density was explored. Demographic and lifestyle information was obtained from face to face interviews using a standardized questionnaire. This included demographic information, medical history and lifestyle factors. Physical examination measurements included anthropometry and tibial and brachial systolic blood pressures. The ratio of the posterior tibial and brachial systolic blood pressures, the ankle/arm index, was used as a measure of peripheral arteriosclerosis in the lower extremities. Bone mineral density (BMD) at the total hip and spine (L1-L4) was measured by Hologic QDR-4500 W densitometers (Hologic, Inc., Waltham, Mass.). In this cross-sectional analysis, the ankle brachial index (ABI) was positively correlated with hip BMD (correlation coefficient=0.27; P<0.001). However, after adjustment for confounders, the correlation became much weaker (correlation coefficient=0.03; P<0.05). This showed that much of the relationship between ABI and BMD could be explained by other confounders. In multiple regression analysis, an increase in ABI of 1 SD of ABI was associated with an increase of 0.5% (95% CI: 0.02%, 0.9%) in hip BMD after adjusting for age, sex, body weight, smoking status, history of diabetes, cardiovascular diseases, use of thiazide diuretics, grip strength and physical activity. Although our study shows that peripheral vascular disease in the lower extremities may be associated with decreased bone mineral density, the association is weak especially after adjustment was made for confounders. This indicates that other factors may be contributing to the association between peripheral vascular disease and osteoporosis.

Aged↗
PubMed2004

Decrease in neuromuscular control about the knee with maturation in female athletes.

BACKGROUND: Compared with male athletes, female athletes demonstrate increased dynamic valgus angulation of the knee during landing from a jump, although prior to maturation male and female athletes have similar forces and motions about the knee when they land from a jump. Our hypothesis was that musculoskeletal changes that accompany maturation result in poor neuromuscular control of the knee joint in female athletes. METHODS: One hundred and eighty-one middle-school and high-school soccer and basketball players-100 girls and eighty-one boys-participated in the study. Dynamic control of the knee joint was measured kinematically by assessing medial knee motion and the lower-extremity valgus angle and was measured kinetically by assessing knee joint torques; the values were then compared between female and male athletes according to maturational stage. Lower-extremity bone length was measured with three-dimensional kinematic analysis. RESULTS: Following the onset of maturation, the female athletes landed with greater total medial motion of the knees and a greater maximum lower-extremity valgus angle than did the male athletes. The girls also demonstrated decreased flexor torques compared with the boys as well as a significant difference between the maximum valgus angles of their dominant and nondominant lower extremities after maturation. CONCLUSIONS: After girls mature, they land from a jump differently than do boys, as measured kinematically and kinetically.

Adolescent↗
PubMed1985

An aggressive treatment approach for adult osteomyelitis.

Osteomyelitis in the adult patient has been associated with failure of eradication, late recurrence, nonunion, and prolonged hospitalization. A staged aggressive approach has been used for the past seven years to treat 53 patients with adult osteomyelitis. This approach includes: evaluation of bone necrosis and identification of the etiologic organisms by deep bone culture; radical surgical debridement of devascularized tissue; intensive systemic antibiotics; and early bone and soft tissue reconstruction. All patients have been followed at least 1 year (mean, 33 months). Lower extremity bones predominated in the series (24 tibias, 13 femurs); and 19 patients had bony instability. Thirty-seven patients had initial successful eradication of their infections with 26 of these returning to full activity status. The remaining 16 patients developed recurrent infection; however, 11 patients totally responded to further aggressive treatment. Of the five failures in the total series, three patients required amputation and two patients have persistent infection. Fifteen of the 19 patients with bony instability healed with initial treatment, and the remaining four patients healed with subsequent treatment. Six patients had primary muscle flap soft tissue reconstruction, and an additional two patients had reconstruction as a secondary procedure. In all these patients with tibial instability, bony union was accelerated compared to those patients with tibial instability not receiving muscle flaps (4 months vs 12 months). The muscle coverage provided by either pedicled flaps or transferred by microvascular anastomoses.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗