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PubMed1995

Nerve conduction velocities in the lower extremities among patients with vibration syndrome.

In order to clarify the effect of vibration syndrome (VS) on the peripheral nervous system (PNS) in the lower extremities, 59 patients with VS (age 58.5 +/- 5.1 years) and 49 age-matched controls (age 57.0 +/- 5.1 years) were examined for sensory nerve conduction velocities (SCV) in the sural nerve (SSCV) and the medial plantar nerve (PSCV) in the summer of 1993 and 1994. They had not been suffering from diseases and injuries which might have affected the SCV in the lower extremities. These patients were divided into two subgroups, one with past vibration exposure to chainsaw (N = 22) and the other with past vibration exposure to rock drills and other tools (N = 37). SCVs corrected by skin temperature were subjected to statistical analysis. In PSCV a significant reduction among all patients (40.8 +/- 4.24 m/s, p < 0.01) including two subgroups (chainsaw, 39.7 +/- 4.7 m/s, p < 0.01; rock drill and others, 41.0 +/- 4.6 m/s, p < 0.01) was observed compared with those of the controls (43.2 +/- 4.31 m/s), but there was no significant reduction in SSCV. Significantly more subjects with PSCV below the standard of PSCV (ten percentile value of those of the controls) were observed among all patients (17/59, 28.8%, p < 0.05) including two subgroups (chainsaw, 7/22, 31.8%, p < 0.05; rock drill and others, 10/37, 27.0%, p < 0.05) than in the controls (4/49, 8.2%). These findings suggested that VS affected the PNS function in the lower extremities and that its mechanism was considered to mediate a circulatory disturbance, and to differ from SCV reduction in the finger.

Case-Control Studies↗

PubMed1998

Humorally mediated thrombocytosis in major lower extremity trauma.

Thrombocytosis in patients undergoing free tissue transfer for coverage of posttraumatic lower extremity defects may be associated with an increased incidence of microvascular thrombosis. Patients with isolated lower extremity trauma have an elevated platelet count that peaks approximately 2 weeks after injury. It is our theory that a humoral component of trauma sera is responsible for the induction of this thrombocytosis. Eight patients with isolated soft-tissue and bony trauma were included in the study. Serum was collected at baseline and throughout the study period. Platelet count, leukocyte count, hemoglobin concentration, and hematocrit were determined. Immunoassay for human interleukin-3 (IL-3), IL-6, and IL-11 as well as granulocyte macrophage colony stimulating factor (GM-CSF) were performed by solid-phase enzyme-linked immunosorbent assay. Balb-C mice were then injected intraperitoneally with the human trauma sera from all time points. Blood was collected at baseline and throughout the study period for determination of platelet count, hemoglobin, and hematocrit. Mean initial platelet count in the 8 human subjects was 152,000 per cubic millimeter with an average peak to 642,000 per cubic millimeter. IL-3, IL-11, and GM-CSF were not detectable in the serum of any patient. Elevated levels of IL-6 were detected in all patients in a nonspecific pattern. In the murine model, an early and late thrombocytosis was elicited. The early peak averaged 78.6% over baseline whereas the late peak average 81.0% over baseline. The induction by human trauma sera of an early and late thrombocytosis in this mouse bioassay supports the theory of humoral mediators. The humoral mediators are yet to be determined but may include IL-6.

Adult↗

PubMed2000

Pelvic and lower extremity veins: contrast-enhanced three-dimensional MR venography with a dedicated vascular coil-initial experience.

PURPOSE: To assess the performance of three-dimensional (3D) magnetic resonance (MR) venography of the pelvis and lower extremities in patients without acute deep venous thrombosis by using a lower extremity vascular coil and pedal injection of paramagnetic contrast material. MATERIALS AND METHODS: Conventional and MR venography were performed in 35 legs in 25 patients referred for evaluation of varicosities (n = 8) and postthrombotic changes (n = 7) and assessment of the great saphenous veins prior to bypass surgery (n = 10). Injection of 120 mL of diluted (1:15) gadopentetate dimeglumine into a pedal vein was performed manually at a rate of 1 mL/sec, and 3D gradient-recalled echo data sets of the upper and lower veins were collected. Conventional and MR venographic images were analyzed separately in a blinded fashion. RESULTS: MR image quality was comparable to that of conventional venograms. Varicose changes of the great and small saphenous veins (sensitivity, 94% [44 of 47]; specificity, 96% [89 of 93]) were assessed as reliably as their status before bypass surgery (sensitivity, 98% [53 of 54]; specificity, 92% [47 of 51]). Postthrombotic changes were diagnosed with a sensitivity of 100% [13 of 13] and a specificity of 98% [88 of 90]. CONCLUSION: Direct 3D MR venography comprehensively displays the lower extremity venous system and permits assessment of postthrombotic and varicose changes and the bypass suitability of the saphenous vein.

Adult↗

PubMed2001

Lower extremity salvage using a free flap associated with the Ilizarov method in patients with massive combat injuries.

Nine patients with massive combat injuries of the lower extremities were treated with Ilizarov bone transport in conjunction with free muscle flap coverage. In 4 patients soft-tissue coverage was applied first, and distraction osteogenesis was initiated 4 to 6 weeks later. In 3 patients both methods were applied simultaneously, and in 2 patients soft-tissue coverage occurred after distraction. The bones healed well, and all flaps survived. The segmental defects ranged from 8 to 16.5 cm in greatest dimension. The total disability time from initial injury ranged from 16 to 25.5 months. In all patients, full union of the tibia was achieved, and no osteomyelitis occurred. However, in 2 patients the applied flap became depressed, necessitating another flap operation. Despite late treatment in all 9 patients, successful results were obtained. Maintaining the original length of the tibia and providing timely, definitive treatment offer the best outcome for repair of massive injuries of the lower extremities. The Ilizarov transport method, used in combination with muscle flap coverage, represents an effective therapy for repair of massive injury of the lower extremities.

Adult↗

PubMed2003

[Chronic venous insufficiency. Results of duplex scanning of 205 lower extremities with varices: 106 not previously operated and 99 previously operated for varicose veins].

INTRODUCTION: The aim of this study was to establish the value of color-duplex scanning in a group of patients with varicose veins and another group of patients with with recurrent varicose veins. MATERIAL AND METHODS: During a 6-month period, 170 patients with varicose veins were examined: one group of 106 lower extremities and another group of 99 lower extremities previously operated for varicose veins. The material included 102 women and 68 men with a mean age of 48 years. The patients were classified according to oedema, lipodermatosclerosis, healed and active ulcer. A Diasonic Gateway 2 and 5 MHz scanner head were used for the examination of the patients in a standing position in the groin, midthigh and in the popliteal fossa. Reflux in the superficial and deep venous system, obstruction in the deep system and insufficient operation were recorded. RESULTS: In the non-operated group 84% of the varicose veins were classified as primary. Three of four ulcers belonged to that group. In the operated group 42% of the cases were due to insufficient treatment. In 33% new sites with reflux were classified. Five of six ulcers could be ascribed to deep venous insufficiency. DISCUSSION: Color-duplex scanning is applicable for the determination of the anatomic placement of the chronic venous insufficiency in patients with varicose veins, previously operated or non-operated. In this material 80% of lower extremities could be selected to a possible operation. Operation of the remaining cases would be worthless.

Adult↗

PubMed1981

Fatal myocardial infarction following lower extremity revascularization. Two hundred seventy-three patients followed six to eleven postoperative years.

Routine preoperative coronary angiography has been recommended to all patients scheduled for elective lower extremity revascularization at the Cleveland Clinic since 1978. Patients found to have severe, correctable coronary artery disease (CAD) have been advised to undergo myocardial revascularization prior to surgical management of lower extremity ischemia in an attempt to reduce the incidence of fatal postoperative myocardial infarction. In order to provide an historic standard with which the results of this approach may eventually be compared, complete follow-up information has been obtained for 95% of 273 consecutive patients who underwent lower extremity revascularization between 1969 and 1973. Fatal myocardial infarction accounted for 52% of early postoperative deaths and occurred in 3.3% of the entire series. Among the patients who survived operation, the five-year mortality rate was 20% and the 11-year mortality rate was 40%. Complications of CAD caused 50% of the deaths that occurred within five years postoperatively and 55% of the deaths that have occurred within 11 years. The incidence of fatal myocardial infarction within five years after operation among patients who had preoperatively evidence of CAD was statistically significant (p less than 0.01).

Adult↗

PubMed1993

Effects of arch height of the foot on angular motion of the lower extremities in running.

It has been suggested that a relationship exists between the height of the medial longitudinal arch of the foot and athletic injuries to the lower extremities. However, the functional significance of arch height in relation to injury is not well understood. The purpose of this study was to determine the influence of arch height on kinematic variables of the lower extremities that have been associated with the incidence of injury in running in an attempt to gain some insight into a functional relationship between arch height and injury. The three-dimensional kinematics of the lower extremities were measured during running for 30 subjects using high-speed video cameras. A joint coordinate system was used to calculate the three-dimensional orientation of the ankle joint complex for a single stance phase. Simple, linear regression analyses showed that arch height does not influence either maximal eversion movement or maximal internal leg rotation during running stance. However, assuming that knee pain in running can result from the transfer of foot eversion to internal rotation of the tibia, a functional relationship between arch height and injury may exist in that the transfer of foot eversion to internal leg rotation was found to increase significantly with increasing arch height. A substantial (27%), yet incomplete, amount of the variation in the transfer of movement between subjects was explained by arch height, indicating that there must be factors other than arch height that influence the kinematic coupling at the ankle joint complex. Additionally, the transfer of movement is only one factor of many associated with the etiology of knee pain in running.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1997

Lower extremity muscle activation during horizontal and uphill running.

To provide more comprehensive information on the extent and pattern of muscle activation during running, we determined lower extremity muscle activation by using exercise-induced contrast shifts in magnetic resonance (MR) images during horizontal and uphill high-intensity (115% of peak oxygen uptake) running to exhaustion (2.0-3.9 min) in 12 young women. The mean percentage of muscle volume activated in the right lower extremity was significantly (P <0.05) greater during uphill (73 +/- 7%) than during horizontal (67 +/- 8%) running. The percentage of 13 individual muscles or groups activated varied from 41 to 90% during horizontal running and from 44 to 83% during uphill running. During horizontal running, the muscles or groups most activated were the adductors (90 +/- 5%), semitendinosus (86 +/- 13%), gracilis (76 +/- 20%), biceps femoris (76 +/- 12%), and semimembranosus (75 +/- 12%). During uphill running, the muscles most activated were the adductors (83 +/- 8%), biceps femoris (79 +/- 7%), gluteal group (79 +/- 11%), gastrocnemius (76 +/- 15%), and vastus group (75 +/- 13%). Compared with horizontal running, uphill running required considerably greater activation of the vastus group (23%) and soleus (14%) and less activation of the rectus femoris (29%), gracilis (18%), and semitendinosus (17%). We conclude that during high-intensity horizontal and uphill running to exhaustion, lasting 2-3 min, muscles of the lower extremity are not maximally activated, suggesting there is a limit to the extent to which additional muscle mass recruitment can be utilized to meet the demand for force and energy. Greater total muscle activation during exhaustive uphill than during horizontal running is achieved through an altered pattern of muscle activation that involves increased use of some muscles and less use of others.

Adult↗

PubMedDate not supplied

Comparison of two-dimensional MR digital subtraction angiography of the lower extremity with x-ray angiography.

PURPOSE: To perform a preliminary evaluation of the diagnostic accuracy of contrast-enhanced, two-dimensional (2D) magnetic resonance (MR) digital subtraction angiography (DSA) of the lower extremity by comparison with x-ray angiography (XRA). MATERIALS AND METHODS: Forty lower extremities in 22 patients were imaged at multiple levels with both XRA and 2D MR DSA. Images were retrospectively analyzed by three radiologists in a randomized blinded manner. Seventeen vascular segments were graded as an insignificant lesion, a significant lesion, or as an occlusion. With the use of segments well depicted with XRA as the gold standard, the sensitivity, specificity, and accuracy of 2D MR DSA, as compared with XRA, were evaluated. The McNemar-Stuart-Maxwell test was performed to determine the significance of any differences found. RESULTS: Three hundred eighty-three arterial segments were evaluated with both techniques. Three hundred one segments were well depicted with XRA. There was no significant difference between 2D MR DSA and XRA for assessing the degree of occlusive disease in these 301 segments (.25 < P < .5). The sensitivity, specificity, and diagnostic accuracy of 2D MR DSA were found to be 90%, 98%, and 93%, respectively. CONCLUSION: Two-dimensional MR DSA is an accurate method for assessing arterial lesions in the lower extremity.

Adult↗

PubMed2001

[Statins in the treatment of patients with arterial occlusive disease of the lower extremities].

In patients with advanced atherosclerosis manifested by arterial occlusion in the lower extremities without a baseline blood lipid disorder statin treatment caused improvement of the efficiency, i.e. prolongation of the claudication interval, while in a comparable control group without statins the efficiency deteriorated further. In patients with arterial occlusion of the lower extremities with baseline dyslipidaemia statin treatment proved protective, i.e. at least it retarded the patients' complaints. The authors recorded improvement of the prooxidation state which followed after the dynamics of improvement of the impaired blood lipid spectrum. The results admit a possible part played by the pleiotropic effect of statins.

Adult↗

PubMed1990

Visualization of the bone/bone marrow of lower extremities in Ga-67 whole-body images.

Patients whose Ga-67 whole-body images showed increased uptake by the bone/bone marrow of the lower extremities were selected and classified into three types according to the extent and the grade of the visualization. These types were then compared with their serum iron levels, iron-binding capacities, and the results of several other serum biochemical tests. Of 374 consecutive whole body 72-hr images reviewed, 59 (15.8%) showed increased uptake of the tracer by the bone/bone marrow of the lower extremities. The three classified types were as follows: type T--visualization of both tibiae and femurs; type S--strong visualization of the femurs; and type W--weak visualization of the femurs. The serum iron concentration was significantly high in type T and low in type S. In conclusion, the pattern of Ga-67 uptake by the bone/bone marrow of the lower extremities fairly closely reflects the status of iron metabolism.

Adolescent↗

PubMed2002

Development of THOR-FLx: A Biofidelic Lower Extremity for Use with 5th Percentile Female Crash Test Dummies.

A new lower leg/ankle/foot system has been designed and fabricated to assess the potential for lower limb injuries to small females in the automotive crash environment. The new lower extremity can be retrofitted at present to the distal femur of the 5th percentile female Hybrid III dummy. Future plans are for integration of this design into the 5th percentile female THOR dummy now under development. The anthropometry of the lower leg and foot is based mainly on data developed by Robbins for the 5th percentile female, while the biomechanical response requirements are based upon scaling of 50th percentile male THOR-Lx responses. The design consists of the knee, tibia, ankle joints, foot, a representation of the Achilles tendon, and associated flesh/skins. The new lower extremity, known as THOR-FLx, is designed to be biofidelic under dynamic axial loading of the tibia, static and dynamic dorsiflexion, static plantarflexion and inversion/eversion. Instrumentation includes accelerometers, load cells, and rotary potentiometers to capture relevant kinematic and dynamic information from the foot and tibia. This paper will describe the performance requirements for THOR-FLx, the methodology used in its' development, results of component tests, and the biofidelity tests conducted on the full assembly.

Journal Article↗

PubMed2003

Gender differences in lower extremity kinematics, kinetics and energy absorption during landing.

OBJECTIVE: To determine whether gender differences exist in lower extremity joint motions and energy absorption landing strategies between age and skill matched recreational athletes. DESIGN: Mixed factor, repeated measures design. BACKGROUND: Compared to males, females execute high demand activities in a more erect posture potentially predisposing the anterior cruciate ligament to greater loads and injury. The preferred energy absorption strategy may provide insight for this performance difference. METHODS: Inverse dynamic solutions estimated lower extremity joint kinematics, kinetics and energetic profiles for twelve males and nine females performing a 60 cm drop landing. RESULTS: Females demonstrated a more erect landing posture and utilized greater hip and ankle joint range of motions and maximum joint angular velocities compared to males. Females also exhibited greater energy absorption and peak powers from the knee extensors and ankle plantar-flexors compared to the males. Examinations of the energy absorption contributions revealed that the knee was the primary shock absorber for both genders, whereas the ankle plantar-flexors muscles was the second largest contributor to energy absorption for the females and the hip extensors muscles for the males. CONCLUSIONS: Females may choose to land in a more erect posture to maximize the energy absorption from the joints most proximal to ground contact. RELEVANCE: Females may be at a greater risk to anterior cruciate ligament injury during landing due to their energy absorption strategy.

Adult↗

PubMed1977

Symposium on arthritis in older persons. Section IV. Surgery and rehabilitation. Total joint replacement: lower extremities (Summary of presentation).

In experience with total joint replacement in the lower extremity, to date, total hip arthroplasty has been the most successful. Total arthroplasty operations as applied to the knee and ankle are giving promising results. These methods offer new avenues for relief of pain and deformity and stabilization of arthritic joints in the lower extremity.

Aged↗

PubMed1995

Autogenous reconstruction with the lower extremity deep veins: an alternative treatment of prosthetic infection after reconstructive surgery for aortoiliac disease.

PURPOSE: This report evaluates the efficiency of use of the lower extremity deep vein as arterial conduits in the autogenous repair of prosthetic infection after reconstructive aortoiliac surgery. METHODS: We reviewed our records for the period 1990 to 1994 of all patients with prosthetic infection after reconstruction for aortoiliac disease, and we selected for this study all those patients who underwent autograft repair with the lower extremity deep veins. RESULTS: Included were 15 patients: 12 had previously undergone direct aorto(ilio)femoral reconstruction, and three had an extraanatomic prosthetic graft. Thirteen patients were admitted with primary graft infection, and two were admitted with secondary graft-enteric erosion. Treatment consisted of prosthetic excision and aorto(ilio)femoral reconstruction with the superficial femoral vein. In situ reconstruction was performed in 12 cases. The operative mortality rate was 7%. There were no early graft occlusions. One patient underwent an above-knee amputation because of concomitant femoropopliteal occlusion in the presence of a patent deep venous aortofemoral graft. Early postoperative limb swelling was common and was controlled with bed rest, elastic stockings, or intermittent pneumatic compression. The mean follow-up of this series was 17 months (range 4 to 33 months). Two patients died of unrelated causes. One graft occluded after 16 months. There were no reinfections, and all but one patient resumed normal daily activities. Disability from removal of the deep veins was minimal: only one patient continues to wear elastic stockings for limb swelling and shows signs of venous hypertension more than 2 years after surgery. CONCLUSION: Harvesting of the lower extremity deep veins is well tolerated. Autogenous reconstruction with these veins provides good potential for salvage of life and limbs in case of prosthetic infection. A longer period of follow-up is required to study the long-term behavior of these grafts and to allow definite comparison with more conventional approaches.

Aged↗

PubMed1995

Lower extremity fractures in motor vehicle collisions: the role of driver gender and height.

In a previous study it was noted that there was a higher incidence of lower-extremity fractures among women drivers. Analyses were based on a linkage between trauma registry and police crash report data. The present study addresses the issue of whether the differences noted are attributed to driver gender or are merely a reflection of differences in driver height. An inverse association was noted between driver height and the incidence of lower-extremity fractures. Those shorter than average (5'7") for this population had a 64% increase in lower-extremity fracture, which can be mainly attributed to ankle/tarsal injuries. Thus, the incidence of these injuries appears to be a function of driver height, with an increase among shorter drivers, most of whom are women.

Accidents, Traffic↗

PubMed2004

Renal insufficiency and the risk of lower extremity peripheral arterial disease: results from the Heart and Estrogen/Progestin Replacement Study (HERS).

Renal insufficiency is a risk factor for coronary heart disease and stroke, but whether it predicts lower extremity peripheral arterial disease (PAD) is unknown. The authors evaluated was the association of baseline renal insufficiency with future PAD events in the Heart and Estrogen/Progestin Replacement Study (HERS) and follow-up study (HERS II). A total of 2763 postmenopausal women with known coronary heart disease were enrolled in HERS and randomly assigned to receive hormone therapy with conjugated estrogens and medroxyprogesterone acetate or placebo and followed for up to 8 yr for clinical end points. The outcome was time from randomization to first occurrence of either a lower extremity amputation, revascularization (surgical or percutaneous), or lumbar sympathectomy during follow-up. Incident lower extremity PAD event rates among women with creatinine clearances > or =60, 30 to 59, and < 30 ml/min/1.73 m(2) were, respectively, 0.55%, 0.92%, and 2.73% per year. After multivariable proportional-hazard adjustment for potential confounders and other known risk factors for PAD, women with a creatinine clearance 30 to 59 ml/min/1.73 m(2) (hazard ratio [HR], 1.63; 95% confidence interval [CI], 1.04 to 2.54, P = 0.032) and <30 ml/min/1.73 m(2) (HR, 3.24; 95% CI, 1.20 to 8.78, P = 0.021) had a significantly increased risk of PAD compared with participants with a creatinine clearance > or =60 ml/min/1.73 m(2). Renal insufficiency was independently associated with future PAD events among postmenopausal women with coronary heart disease. Future studies should determine whether this association is present in other populations and investigate its potential mechanisms.

Aged↗

PubMed2002

Goal attainment scaling in the rehabilitation of patients with lower-extremity amputations: a pilot study.

OBJECTIVE: To assess the interrater reliability, construct validity, and responsiveness of Goal Attainment Scaling (GAS) among patients who have had lower-extremity amputations. DESIGN: Pilot study comparing GAS with 2 functional measures with established reliability, validity, and responsiveness values. SETTING: Regional amputee program in southwestern Ontario. PARTICIPANTS: Ten patients (6 women, 4 men; mean age +/- standard deviation, 72.3+/-10.7 y) with unilateral lower-extremity amputations who were consecutively admitted to a regional amputee program. The ratio of transtibial to transfemoral amputations was 6:4. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Subjects were assessed by using GAS, the Barthel Index, and the Locomotor Capabilities Index (LCI) of the Prosthetic Profile of the Amputee. RESULTS: The interrater reliability of GAS was r=.67, and 63% of goals developed were identified independently by both investigators. The construct validity between GAS and the Barthel Index and the LCI was r=.44 and r=.35, respectively. GAS was more responsive than both the Barthel Index and the LCI, as indicated by the calculation of effect sizes and relative efficiencies. CONCLUSION: This pilot study suggests that GAS is a promising outcome measure for the rehabilitation of patients with lower-extremity amputations.

Activities of Daily Living↗