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PubMedDate not supplied

Gunshot wounds to the lower extremity: principles and treatment.

Gunshot wounds to the lower extremity consist of three types: 1) low velocity, 2) high velocity, and 3) shotgun wounds. High velocity wounds are generally seen in military practice, whereas low velocity wounds are of concern in civilian practice. Adequate management of the gunshot wound necessitates a rigid protocol consisting of history and detailed physical examination. It is the purpose of this article to describe in detail the proper protocol for gunshot wound evaluation.

Humans↗

PubMed1980

Liposarcoma of the lower extremity.

Twenty patients with primary liposarcoma of the lower extremity were treated over a 25-year period. The adequacy of the initial surgical procedure and histological grade of malignancy both influenced survival rates. In addition local recurrence was noted only in patients who had undergone "inadequate" initial excision. Inguinal lymph nodes were uninvolved by tumor in all cases. In general, patients with liposarcomas of myxoid and/or round cell type survived for long periods of time. However, even patients with myxoid lesions occasionally exhibited evidence of early blood-borne metastases. This study suggests an important relationship between an inadequate primary resection, local recurrence, and eventual retroperitoneal spread. In the majority of cases, this may have resulted from failure to control the primary distal extremity tumor, with subsequent contiguous spread of metastases into the ipsilateral retroperitoneal space. If feasible, radical soft part resection should be performed as the primary surgical therapy of these neoplasms. Tumors contiguous to the knee or ankle joint should be treated by primary amputation. Failure to control local disease may result in blood-borne dissemination or local spread along musculoaponeurotic planes to involve proximal groin or retroperitoneal space.

Histiocytoma, Benign Fibrous↗

PubMed1994

Surgical techniques useful in the treatment of complex periarticular fractures of the lower extremity.

Treatment of complex periarticular fractures of the lower extremity is guided by the principle of soft-tissue preservation. A skin incision through the subcutaneous tissue to incise the periosteum, followed by judicious application of implants will incur the least amount of iatrogenic damage. The concept of "sufficient stability" can replace the need for "rigid fixation" in many instances. Operative treatment should be considered a complementary extension to the well-founded principles of nonoperative treatment rather than the antithesis. In the final analysis, the approach of a biologist or gardener will yield better results than a strictly mechanical or saw bone laboratory approach.

Ankle Injuries↗

PubMed1998

[Rehabilitation program for children and adolescents with limb defects or amputations of the lower extremity].

In rehabilitation of children and adolescents with lower limb deficiencies it is very important that the medical team taking care of the patient works out a treatment plan. Responsible cooperation with the parents is of utmost importance, the focus of all efforts is, of course, the handicapped child. The aims of rehabilitation are illustrated by examples demonstrating the course of successful rehabilitation of children and adolescents with damaged limbs. Equally, the psychological situation of the parents and child is taken into consideration. Children with limb deficiencies or amputation of the lower extremities should be enabled to stand and walk according to their state of development, because standing and walking in particular are among the most important preconditions for the best possible integration. Provision with a prosthesis, orthosis and orthoprosthesis is therefore indispensable for rehabilitation. While a prosthesis replaces parts of an extremity, an orthosis stabilizes the existing extremity. Orthoprostheses compensate longitudinal malformations, have a supporting effect, allow growth to be controlled, and compensate for shortening. Just as important as these technical aids is early medical treatment. The sooner the treatment starts, the better the results.

Adolescent↗

PubMed1988

Treatment of adult lower extremity lymphedema with the Wright linear pump: statistical analysis of a clinical trial.

Seventy-three adult lymphedema patients with 78 affected lower extremities were treated with the Wright Linear Pump. All patients were admitted for a 48-hour clinical trial. Comparison of circumferential limb measurements before and after a 48-hour treatment period using a repeated measures analysis of variance showed statistically significant improvement (p less than 0.00005). Although the improvement appeared to be somewhat more pronounced for men than for women, both sexes experienced an important reduction in leg circumference after therapy. Other factors such as age, etiology, previous use of the Jobst pump, or duration of lymphedema did not appear to influence the extent of improvement. These data clearly indicate that the Wright Linear Pump is an effective treatment for lower extremity lymphedema in adults.

Adolescent↗

PubMedDate not supplied

Digital angiography using hand-operated table movement for vascular disease of the pelvis and lower extremities.

We developed a new technique using hand-operated table movement during digital angiography (DA) for the study of vascular disease of the pelvis and lower extremities. Digital video memory (DVM) is used in this technique to digitize, record, and display fluorographic images without subtraction in real time. This allows free table movement and the imaging of a large area with a single injection of contrast medium. Forty-five examinations for vascular disease of the pelvis and lower extremities were performed by this DA technique. Good images of an extensive area from the lower abdomen to the lower leg were obtained in a single study.

Aged↗

PubMed1979

[Drug therapy of chronic arterial occlusive diseases of the lower extremities with butalamine-HCl].

In a multicentre study a total of 113 patients suffering from disturbed blood flow conditions of the lower extremities (type II Fontaine) were treated with butalamine hydrochloride tablets, each containing 80 mg of the active principle. In 96% of the cases given a daily dose of 3 x 2 tablets and in 82% of those treated with a daily dose of 3 x 1 tablet both subjective and objective clinical symptoms, such as walking distance and Ratschow's testing parameters, were found to be improved. In view of the findings that metabolic functions as well as systemic blood flow conditions were not affected and that the drug was furthermore well tolerated by the gastrointestinal system, butalamine hydrochloride proved to be an effective therapeutic in long-term treatment of patients suffering from blood flow disorders of the lower extremities.

Arterial Occlusive Diseases↗

PubMed2006

[Effectiveness of backward walking treadmill training in lower extremity function after stroke].

OBJECTIVE: To examine the effectiveness of backward walking treadmill training for restoration of motor function, balance and walking speed in patients with stroke. METHODS: Twenty-six patients with stroke, 17 males and 9 females, aged 36 - 64, with the lower extremity Brunnstrom motor recovery stage at 3 or 4, able to walk for 10 m without walking aid or orthosis, were randomly divided into two equal groups: The patients in the control group were to participate in a 60-minutes conventional training five times a week for three weeks, and the patients in the experimental group received 30-minute conventional training and then 30-minute backward walking training five times a week for three weeks. Before the training and 3 weeks after the training, Fugl-Meyer assessment was used to assess the motor function of the lower extremity (FMA-L), Berg balance scale (BBS) was used to assess the balance function, and 10 m maximum walking speed was measured. RESULTS: After the three-week training period, the FMA-L score of the experimental group was 28.0 +/- 3.3, significantly higher than that of the control group (25.5 +/- 2.3, P = 0.033); the BBS score of the experimental group was 51.4 +/- 1.8, significantly higher than that of the control group (47.3 +/- 3.7, P = 0.001, and 10 m MWS of the experimental group was 57 +/- 17, significantly higher than that of the control group (43 +/- 16, P = 0.034). CONCLUSION: A safe and feasible intervention, additional backward walking therapy helps improve the damaged motor function, balance, and walking speed of the patients with stroke.

Exercise Test↗

PubMed1989

[Injuries of major blood vessels of the lower extremities as a complication of fractures and dislocations].

Surgical treatment was applied in 46 patients with simultaneous injury of great vessels of the lower extremities and fractures of the long bones or dislocations of the knee joint. The authors have determined the best in their opinion sequence of surgical procedure. They think that external fixation gives better bone stabilization and is more favorable than internal stabilization. They also recommend lavage of the peripheral vascular bed of the ischemic lower extremity, which prevents post-traumatic insufficiency of the kidneys. They think that early fasciotomy of the crus or fibulectomy is important for the good result of the operation.

Adolescent↗

PubMed1976

Analysis and evaluation of functional status of lower extremity amputee-appliance systems: an integrated approach.

This paper introduces an integrated, objective and biomechanically sound approach for the analysis and evaluation of the functional status of lower extremity amputee-appliance systems. The method is demonstrated here in its application to the unilateral lower extremity amputee-axillary crutches system and the unilateral below-knee amputee-PTB prosthesis system, both of which are commonly encountered in day-to-day rehabilitation practice.

Amputees↗

PubMed2003

Education, employment, insurance, and marital status among 694 survivors of pediatric lower extremity bone tumors: a report from the childhood cancer survivor study.

BACKGROUND: With increasing numbers of childhood cancer survivors, direct sequelae of cancer therapy and psychosocial outcomes are becoming more important. The authors described psychosocial outcomes (education, employment, health insurance, and marriage) for survivors of pediatric lower extremity bone tumors. METHODS: The long-term follow-up study of the Childhood Cancer Survivor Study is a multiinstitutional cohort study comprising 14,054 individuals who have survived for 5 or more years after treatment for cancer diagnosed during childhood or adolescence. Baseline demographic and medical information were obtained. Six hundred ninety-four survivors had osteosarcoma or Ewing sarcoma of the lower extremity or pelvis and were classified by amputation status and by age at diagnosis. The median age at diagnosis was 14 years old with a median of 16 years of follow up since diagnosis. Demographic characteristics were used to analyze the rates of psychosocial outcomes. RESULTS: Amputation status and age at diagnosis did not significantly influence any of the measured psychosocial outcomes. Education was a significant positive predictor of employment, having health insurance, and being currently in their first marriage. Male gender predicted ever being employed and female gender predicted having health insurance and marriage. When compared with siblings, amputees had significant deficits in education, employment, and health insurance. CONCLUSIONS: Overall, no differences between amputees and nonamputees were found. However, gender and education play a prominent role. When compared with siblings, amputees in this cohort may benefit from additional supports.

Adolescent↗

PubMed1995

Results of transcutaneous electrical stimulation (TES) in cure of lower extremity arterial disease.

The results of the treatment of 24 subjects--10 of them diabetic--with peripheral obstructive arterial disease of the lower limbs by transcutaneous electrical stimulation (TES) have been studied. The chronic ischemia of the lower extremities was complicated with ulceration in 12 and initial or advanced gangrene in 6 patients. All patients had been treated with antiplatelet drugs, pentoxifylline, and vasodilating drugs for many years. The drug therapy was continued, and TES was given daily for twenty minutes. The results were estimated after four to eight weeks of hospitalization and during a one-year follow-up in numerous cases. Except for 4 patients the improvement was very significant in all cases: the pain disappeared, the gangrenous process of the toes stopped, regression or complete healing of the ulceration could be observed, and the painfree walking distance increased. The oxygen saturation measured on the toes increased significantly during electrical stimulation. The blood pressure measured in the tibial artery showed very different changes. According to these observations TES appears to be a useful method superior to drug therapy in curing arterial circulatory disturbances of the lower extremities.

Aged↗

PubMed1998

Electromyographic biofeedback to improve lower extremity function after stroke: a meta-analysis.

OBJECTIVE: To examine the efficacy of electromyographic (EMG) biofeedback compared with conventional physiotherapy for improving lower extremity function in stroke patients. DATA SOURCES: A literature search covering the years 1976 to 1995 in MEDLINE, CINAHL, and EXCERPTA MEDICA. STUDY SELECTION: Studies of adults after stroke, in which the treatment group received biofeedback alone or with conventional physical therapy and the control group received conventional physical therapy. Outcomes included functional measures related to the lower extremity. The study design criterion was that all must be randomized controlled trials. DATA EXTRACTION: Study quality was assessed independently by two observers-using eight criteria. Data for analysis were extracted by two observers to ensure accuracy. DATA SYNTHESIS: For outcomes that were analyzed in more than one study, meta-analyses were done. Seventy-nine studies were identified as potentially relevant and eight studies met the selection criteria. The mean effect sizes were: for ankle dorsiflexion muscle strength, 1.17 (95% CI, .50-1.85; p = .0006); for gait quality, .48 (95% CI, -.06-1.01; p = .08); for ankle range of motion, .07 (95% CI, -.42-0.57; p = .78); for ankle angle during gait, .52 (95% CI, -.18-1.21; p = .14); for stride length, .09 (95% CI, -.56-.73; p = .80); and for gait speed, .31 (95% CI, -.16-.78; p = .20). CONCLUSIONS: The results indicate that EMG biofeedback is superior to conventional therapy alone for improving ankle dorsiflexion muscle strength.

Adult↗

PubMed2006

Long-term results of microscopic lymphatic vessel-isolated vein anastomosis for secondary lymphedema of the lower extremities.

PURPOSE: To evaluate the effectiveness of microscopic lymphatic vessel-isolated vein anastomosis in patients with secondary obstructive lymphedema of a lower extremity, refractory to nonoperative management. METHODS: Nine women suffered from nonpitting edema of one or both legs (11 limbs) after radical hysterectomy with postoperative irradiation for uterine cancer. The indications for this operation were repeated cellulitis and severe nonpitting edema impairing limb function. Under microscopy of 3.2 on average, the identified lymphatic vessels were anastomosed to an isolated saphenous vein using the pull-through technique with modifications. RESULTS: The follow-up period ranged from 21 to 87 months and the operation achieved excellent reduction, of more than 5 cm, in six limbs; good reduction, of 2-5 cm, in two limbs; and poor reduction, of less than 2 cm, in three limbs. The frequency of cellulitis decreased from 2.4 infections per patient per year to 0.2 infections per patient per year. CONCLUSION: These results show that microscopic lymphatic vessel-isolated vein anastomosis is a minimally invasive operation, with good long-term effects, making it the treatment of choice for intractable secondary lymphedema of the lower extremities refractory to physiotherapy.

Adult↗

PubMed2003

Relationship between age and lower extremity fractures in frontal motor vehicle collisions.

BACKGROUND: Older adults (aged > or = 65 years) represent the single fastest growing segment of the United States population and will comprise one in five Americans during the third decade of this century. As this population segment rapidly expands, lower extremity fractures (LE Fx) and their associated disability will become a greater public health concern. The purpose of this study was to quantify the risk for LE Fx from motor vehicle collisions (MVCs) according to age. METHODS: The 1995 to 2000 National Automotive Sampling System data files were used. Study entry was limited to front-seat occupants involved in frontal MVCs. Risk ratios for LE Fx and age were adjusted for gender, driver versus passenger, seat belt use, airbag deployment, delta-V, intrusion, and vehicle type. RESULTS: Beginning in the fourth decade, there was a trend of higher relative risk for LE Fx with age that reached statistical significance in the seventh decade of life. CONCLUSION: This study documented an increased risk of LE Fx in older MVC occupants. Efforts to prevent these disabling injuries and to better protect occupants' lower extremities in MVCs should include improved vehicle design and reevaluation of the existing federal motor vehicle safety standards.

Accidents, Traffic↗

PubMedDate not supplied

Surgical decompression in lower-extremity diabetic peripheral neuropathy.

Peripheral neuropathy can be a devastating complication of diabetes mellitus. This article describes surgical decompression as a means of restoring sensation and relieving painful neuropathy symptoms. A prospective study was performed involving patients diagnosed as having type 1 or type 2 diabetes with lower-extremity peripheral neuropathy. The neuropathy diagnosis was confirmed using quantitative sensory testing. Visual analog scales were used for subjective assessment before and after surgery. Treatment consisted of external and as-needed internal neurolysis of the common peroneal, deep peroneal, tibial, medial plantar, lateral plantar, and calcaneal nerves. Subjective pain perception and objective sensibility were significantly improved in most patients who underwent the described decompression. Surgical decompression of multiple peripheral nerves in the lower extremities is a valid and effective method of providing symptomatic relief of neuropathy pain and restoring sensation.

Adult↗

PubMed2003

Gender differences in lower extremity mechanics during running.

OBJECTIVE: To compare differences in hip and knee kinematics and kinetics in male and female recreational runners. DESIGN: Gait analysis of 20 men and 20 women recreational runners. BACKGROUND: Female runners are reported to be more likely to sustain certain lower extremity injuries compared to their male counterparts. This has been attributed, in part, to differences in their structure and it has been postulated that these structural differences may lead to differences in running mechanics. It was hypothesized that females would exhibit greater peak hip adduction, hip internal rotation, knee abduction and decreased knee internal rotation compared to their male counterparts. It was also hypothesized that females would exhibit greater hip and knee negative work in the frontal and transverse planes compared to males. METHODS: Comparisons of hip and knee three-dimentional joint angles and negative work during the stance phase of running gait were made between genders. RESULTS: Female recreational runners demonstrated a significantly greater peak hip adduction, hip internal rotation and knee abduction angle compared to men. Female recreational runners also demonstrated significantly greater hip frontal and transverse plane negative work compared to male recreational runners. CONCLUSION: Female recreational runners exhibit significantly different lower extremity mechanics in the frontal and transverse planes at the hip and knee during running compared to male recreational runners. RELEVANCE: Understanding the differences in running mechanics between male and female runners may lend insight into the etiology of different injury patterns seen between genders. In addition, these results suggest that care should be taken to account for gender when studying groups of male and female recreational runners.

Adolescent↗

PubMed1985

Lower extremity arterial disease in young adults. A systematic approach to early diagnosis.

General and vascular surgeons are consulted occasionally to evaluate young adults with ischemia of the lower extremity. Between 1975 and 1985, 51 adults under 40 years of age who had arterial occlusive disease of the lower limb were managed. Although premature atherosclerosis was the most common problem (50%), claudication or limb-threatening ischemia also resulted from other sources (thromboembolism, popliteal artery entrapment, Buerger's disease, collagen vascular disease, and Takayasu's arteritis). Identifying the exact cause was sometimes difficult. The authors were impressed with the number of young adults who had delay in diagnosis and treatment (30 patients, 59%) before referral for a surgical opinion. In this paper, the attempt has been made to uncover the reasons for delayed diagnosis and to suggest a systematic approach that should lead to early recognition of lower extremity ischemia in this age group.

Adolescent↗