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At least 1,333 records · Page 74Linked to original sources
PubMed2002

Lower extremity traction pins: indications, technique, and complications.

The placement of pins in the lower extremity for the purpose of skeletal traction is a basic skill required by an orthopedic surgeon. These pins are primarily used for the management of fractures and dislocations. Although simple, the insertion and care of these pins can be accompanied by severe complications including damage to neurovascular structures, physeal injury, ligamentous insult, fracture, and infection. We review the techniques of pin insertion at the distal femur, proximal tibia, and calcaneus to provide a foundation for residents and attendings alike so that unnecessary complications may be avoided and proper placement ensured.

Bone Nails↗
PubMed2006

Prophylactic implantation of inferior vena cava filter during interventional radiological treatment for deep venous thrombosis of the lower extremity.

The purpose of this study was to evaluate the filtering effect of the Gunther tulip retrievable vena cava filter (GTF) during treatment of deep venous thrombosis (DVT) in the lower extremity using various interventional radiological procedures. Subjects of the study were all 17 consecutive patients (8 women, 9 men; age range 18-87 years; mean age 55.9 years) with symptomatic lower limb DVT referred for interventional radiological treatment between February 2001 and September 2004. In all of these patients, the GTF was implanted during interventional radiological treatment. Trapped thrombus in the filter was evaluated with venocavography performed repeatedly during the treatment for DVT. Implantation of a total of 29 GTFs was successfully performed in the 17 patients. In 10 (58.8%), more than 2 filters were subsequently implanted to prolong implantation time. Also in 10 patients, the DVT resolved after therapy and retrieval of the final GTF was successful with one exception. Worsening of or new formation of pulmonary embolism was avoided in all patients. In 8 (47.1%) of the 17 patients, a trapped thrombus in the GTF was observed during treatment for DVT. In six patients the trapped thrombus was large, filling more than half the height of the filter. In conclusion, we found that the GTF is effective in filtering the relieved thrombus from DVT in the lower extremity and in protecting against movement of the thrombus to the pulmonary artery during therapies with interventional radiological procedures.

Adolescent↗
PubMed1989

[Disability and arthrotic changes in the lower extremity].

From a sample of occupationally disabled persons who had retired because of a disease of the locomotive system 48 men and 22 women with pronounced arthrotic changes in lower extremities were selected for the study. A comparative group, which was matched to the experimental one by age (53.8 +/- 4.2 years) and sex, consisted of occupationally disabled persons who had rheumatic complaints, but no arthrotic changes in the lower extremities. All the subjects in the study were given a questionnaire to answer and underwent a clinical examination and an X-ray of the locomotive system. Marked symptoms of arthrosis were manifest in those aged 46 +/- 6 years. Besides occupation (coxarthrosis and gonarthrosis occurred more frequently among unskilled (54.2%) and skilled (25%) workers) a major risk factor were injuries (37.1% as against 5.7% in the comparative group). At clinical examination men complained much more often of spontaneous pain in the hip joints (60% as against 22.3% in women), whereas women more often complained of painful movements (63.6% as against 45.8% in men). The objective symptoms of gonarthrosis, crepitations and restricted movements in the first place, were present in men and women alike. The relative body mass (RBM), expressed as percentage of decline from ideal was, particularly among women, a significant risk factor for the occurrence and development of coxarthrosis and gonarthrosis. As much as 50% of the women with arthrosis had RBM higher than 140%, and another 40% had RBM between 120 and 140%. In the comparative group the respective percentage was 27.3% (P less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Disability Evaluation↗
PubMedDate not supplied

The nerves of the upper and lower extremities which are at a greater risk of compressive pathology. Anatomical topographical correlations. Our experience.

The experience of numerous cases of surgical operations carried out over the ten years from 1990-2000, has meant we have been able to reflect on the fact that the median, ulnar, radial (upper extremity), tibial and external popliteal sciatic (lower extremity) nerves are more greatly exposed to compressive pathology. This is due to certain anatomical topographical relationships with canals, semi-canals, tunnels in well-defined and unchanging sites. From this point of view, a pathology with an etiopathogenic topographical tendency is emerging.

Arm↗
PubMed1999

Deep venous thrombosis and pulmonary embolism in bilateral lower-extremity amputee patients.

OBJECTIVE: To determine the incidence of deep venous thrombosis and pulmonary emboli and the value of an inferior vena cava filter in patients with bilateral lower-extremity amputations, and to determine the incidence of pulmonary emboli after filter placement. DESIGN: Retrospective study with a follow-up of 3 to 64 months. SETTING: Inner-city university hospital. PATIENTS: Twenty-seven consecutive patients with bilateral lower-limb amputation. RESULTS: Age, sex, and race were assessed, and had no impact on the incidence of pulmonary embolus in these patients with lower-extremity amputation. CONCLUSION: No clinical objective evidence of pulmonary emboli occurred after placement of an inferior vena caval filter.

Aged↗
PubMed2003

Cost-effectiveness of the bird's nest filter for preventing pulmonary embolism among patients with malignant brain tumors and deep venous thrombosis of the lower extremities.

Patients with malignant brain tumors and deep venous thrombosis (DVT) of the lower extremities are at high risk of developing pulmonary embolism (PE). We developed a Markov model to compare the cost-effectiveness of two strategies to prevent PE in such patients: intra-vena-caval bird's nest filter (BNF) with anticoagulation versus anticoagulation alone. Using the benchmark of 50,000 US dollars per quality-adjusted life year (QALY), BNF was not cost-effective in this population as it reduced the rate of PE at an incremental cost-effectiveness ratio of 198,852 dollars per QALY gained. However, after adjusting the model to reflect the 5-year mortality rate of hypothetical breast cancer patients, BNF was more effective and less expensive than anticoagulation alone. BNF was effective in reducing the rate of PE but was not cost-effective for patients with brain tumors. BNF could be cost-effective for patients with longer life expectancies.

Anticoagulants↗
PubMedDate not supplied

Transbrachial thrombolysis, PTA and stenting in the lower extremities.

We present an analysis of 37 interventions in the arteries of the lower limbs via a transbrachial arterial approach. Twenty-six patients (42-79 years) underwent 37 interventional procedures in the lower extremities (iliac n = 6, iliac + femoro-popliteal n = 1, femoro-popliteal n = 30) with a vascular approach via the brachial artery (33 left sided, 4 right sided, introducer sheath 4-7 F). The transbrachial approach was chosen to avoid puncture of femoral bypass graft material. Technical success could be achieved in 11/13 thrombolyses, 8/9 PTAs, 7/10 combinations of thrombolysis and percutaneous transluminar angioplasty (PTA) and in the placement of two stents. One patient suffered from periprocedural severe re-thrombosis due to insufficient anticoagulation during fibrinolysis, and twice thrombolysis was incomplete. One puncture-related false aneurysm of the brachial artery had to be corrected surgically. One transient ischemic attack (TIA) and four minor complications occurred. Transbrachial vascular approach for arterial interventions in iliac and femoro-popliteal pathologies is a reasonable alternative to the transaxillary access if transfemoral puncture has to be avoided. The technical success rate is comparable with the results of the transaxillary and transfemoral approach. To minimize, at least theoretically, the risk of cerebral complications, the left-sided approach should be preferred and intravenous heparin should be administered routinely.

Adult↗
PubMed1990

Head injuries coexistent with pelvic or lower extremity fractures--early or delayed osteosynthesis.

The authors compared the results of a retrospective analysis of two groups of head-injured patients who had coexistent pelvic or lower extremity fractures. One group was treated with early osteosynthesis within the first 12 hours after trauma, simultaneously with neurosurgical treatment, while the second group was treated neurosurgically and osteosynthesis was postponed for 4 to 10 days. The second group revealed a higher mortality, which was due to fat embolism. We conclude that early osteosynthesis is the treatment of choice in patients with coexistent head injury and lower extremity fractures.

Adolescent↗
PubMed1997

[Phase-contrast MR angiography of the lower extremity. Comparison of methods and clinical application].

PURPOSE: To investigate whether phase-contrast MRA is a clinically suited approach to examine arteries of the pelvis and lower extremities. METHODS: The study was divided into two parts, a volunteer study and patient study. Three MRA techniques-2D TOF with venous saturation, 3D magnitude contrast and 2D phase contrast with ECG triggering-were intraindividually compared in 15 volunteers and evaluated by three blinded readers. Subsequently, a total of 230 vessel segments of 45 MRA studies using ECG-triggered phase contrast were compared with intraarterial DSA. All vessel segments were scored by three blinded readers using a five-point scale with DSA serving as the gold standard. RESULTS: ECG-triggered phase contrast provided better image quality than the other MRA techniques as assessed by the Friedman test. Clinical studies demonstrated a significant correlation of DSA and MRA as assessed by the Spearman correlation and kappa statistics for individual readers. CONCLUSION: MRA of the pelvis and lower extremities may be performed with 2D ECG-triggered phase-contrast MRA within a reasonable time frame (< 30 min). MRA slabs provide orientation similar to that with DSA projections and good to very good correlation of vessel pathology as shown by kappa statistics.

Angiography, Digital Subtraction↗
PubMed2006

The influence of in-season injury prevention training on lower-extremity kinematics during landing in female soccer players.

OBJECTIVE: To examine the influence of in-season injury prevention training on hip and knee kinematics during a landing task. DESIGN: Longitudinal pre-post intervention study. SETTING: Testing sessions were conducted in a biomechanics research laboratory. PARTICIPANTS: Eighteen female soccer players between the ages of 14 and 17 participated in this study. All subjects were healthy with no current complaints of lower extremity injury. INTERVENTIONS: Testing sessions were conducted prior to and following a season of soccer practice combined with injury prevention training. MAIN OUTCOME MEASUREMENTS: During each testing session three-dimensional kinematics were collected while each subject performed a drop landing task. Peak hip and knee joint angles were measured during the early deceleration phase of landing and compared between pre- and post-training using paired t-tests. RESULTS: Following a season of soccer practice combined with injury prevention training, females demonstrated significantly less hip internal rotation (7.1 degrees vs. 1.9 degrees; P = 0.01) and significantly greater hip abduction (-4.9 degrees vs. -7.7 degrees; P = 0.02). No differences in knee valgus or knee flexion angles were found post-season. CONCLUSIONS: Female soccer players exhibited significant changes in hip kinematics during a landing task following in-season injury prevention training. Our results support the premise that a season of soccer practice combined with injury prevention training is effective in altering lower extremity motions that may play a role in predisposing females to ACL injury.

Adolescent↗
PubMed1989

Intraoperative angioscopically monitored laser-assisted angioplasty in treating lower-extremity atherosclerotic occlusive disease.

As part of an ongoing multi-institutional study, our surgical center offered laser-assisted angioplasty to patients with significant, documented lower-extremity atherosclerotic occlusive disease, as an alternative to standard femoral-popliteal or femoral-tibial bypass. During the 1st 12 months of the study (September 1987 through August 1988), 31 patients had laser-assisted angioplasty in 34 limbs. The procedures were performed with an argon-powered laser probe that features a heated metallic tip and a window that furnishes 20% of the laser energy as a direct argon laser beam. Angioscopic monitoring was provided in each case. The immediate recanalization rate was 82% (28 of 34 limbs). After a follow-up period of 6 to 18 months (mean, 14 months), the patients continue to show clinical improvement of pretreatment symptoms, and noninvasive studies continue to reveal improved segmental arterial pressures. On the basis of this experience, we conclude that angioscopically monitored laser-assisted angioplasty has a role in the management of lower-extremity atherosclerotic occlusive disease.

Journal Article↗
PubMed2006

Conus medullaris syndrome without lower-extremity involvement in L-1 burst fractures: report of four cases.

Conus medullaris injury from burst fractures is known to occur in conjunction with other neurological deficits, including lower-extremity motor weakness or sensory changes. Rarely does an isolated conus medullaris injury occur from an extradural cause without other neurological deficits. The authors report four cases of L-1 burst fractures in which conus medullaris dysfunction was the sole neurological injury in the absence of lower-extremity involvement.

Adult↗
PubMed1993

Arterial sonography: efficacy for the diagnosis of arterial disease of the lower extremity.

Until recently, Doppler sonography played a minor role in the evaluation of peripheral arterial occlusive disease. Two recent developments have made sonographic evaluation of the arteries in the lower extremity more attractive. The introduction of color flow mapping significantly shortened the examination time, and the sonographic results were found to dramatically affect the treatment of patients with peripheral arterial disease. This review article describes the changing role of arterial sonography in patients with arterial disease of the lower extremity.

Arterial Occlusive Diseases↗
PubMed2004

[The results of single-stage multilevel muscle-tendon surgery in the lower extremities of patients with spastic cerebral palsy].

OBJECTIVES: We evaluated the results of single-stage multilevel muscle-tendon surgery performed for the treatment of contractures in the lower extremities of patients with spastic cerebral palsy. METHODS: The study included 23 patients (11 girls, 12 boys; mean age 6 years 3 months; range 4 to 17 years) with spastic cerebral palsy, who underwent single-stage multilevel muscle-tendon surgery for the treatment of contractures in the lower extremities secondary to spasticity. Quadriplegia, diplegia, and hemiplegia were present in five, 14, and four patients, respectively. Preoperatively, 13 patients could walk, while 10 patients lacked ambulation even with support. Evaluations were based on pre- and postoperative (mean 4 years 9 months; range 1 to 8 years) physical examination findings and on the Gross Motor Function Classification System (GMFCS) scores. The patients' mean age at the last follow-up was 11.5 years (range 9 to 19 years). RESULTS: The range of motion of all the operated joints improved postoperatively, resulting in significant improvements in posture, sitting, gait, and hygiene of the patients. Of ten patients who could not walk, five could ambulate with the use of a walker or crutches postoperatively. The mean pre- and postoperative GMFCS scores were 3.045 and 1.864, respectively (p<0.001). All the patients showed an improvement of at least one GMFCS level. CONCLUSION: Surgery for spastic cerebral palsy can be most beneficial only when all contractures of the hip, knee, and ankle have been corrected. Symmetrical and multilevel operations should be performed when necessary, for single-stage and symmetrical multilevel muscle-tendon surgical applications have definite advantages over staged interventions.

Adolescent↗
PubMed1997

Intraexaminer reliability, interexaminer reliability, and mean values for nine lower extremity skeletal measures in healthy naval midshipmen.

Physical therapists, athletic trainers, and other health care professionals commonly evaluate static postures and dynamic motions in patients with skeletal malalignments of the lower extremity. Accurate clinical evaluation of these malalignments depends on reliable and valid measures as well as established normal values. The purpose of this study was to document the intraexaminer and interexaminer reliability and mean values for nine static lower extremity skeletal measures in healthy Naval midshipmen. The measures studied were femoral torsion, ankle dorsiflexion, tibial length, leg length discrepancy, genu varus/valgus, medial talonavicular joint bulge, rearfoot angle, arch angle, and foot type classification. Intraexaminer and interexaminer reliability ICCs ranged between .65 and .97, and percentage agreements ranged between 88.8 and 94.4%. Mean absolute difference values all were within acceptable limits for clinical measurement. A foot type classification scheme was suggested. The results of this study indicate that the measures investigated are reliable when conducted on healthy Naval midshipmen by experienced examiners. Suggestions for further research are offered.

Adolescent↗
PubMed1999

The Lower Extremity Functional Scale (LEFS): scale development, measurement properties, and clinical application. North American Orthopaedic Rehabilitation Research Network.

BACKGROUND AND PURPOSE: The purpose of this study was to assess the reliability, construct validity, and sensitivity to change of the Lower Extremity Functional Scale (LEFS). SUBJECTS AND METHODS: The LEFS was administered to 107 patients with lower-extremity musculoskeletal dysfunction referred to 12 outpatient physical therapy clinics. METHODS: The LEFS was administered during the initial assessment, 24 to 48 hours following the initial assessment, and then at weekly intervals for 4 weeks. The SF-36 (acute version) was administered during the initial assessment and at weekly intervals. A type 2,1 intraclass correlation coefficient was used to estimate test-retest reliability. Pearson correlations and one-way analyses of variance were used to examine construct validity. Spearman rank-order correlation coefficients were used to examine the relationship between an independent prognostic rating of change for each patient and change in the LEFS and SF-36 scores. RESULTS: Test-retest reliability of the LEFS scores was excellent (R = .94 [95% lower limit confidence interval (CI) = .89]). Correlations between the LEFS and the SF-36 physical function subscale and physical component score were r=.80 (95% lower limit CI = .73) and r = .64 (95% lower limit CI = .54), respectively. There was a higher correlation between the prognostic rating of change and the LEFS than between the prognostic rating of change and the SF-36 physical function score. The potential error associated with a score on the LEFS at a given point in time is +/-5.3 scale points (90% CI), the minimal detectable change is 9 scale points (90% CI), and the minimal clinically important difference is 9 scale points (90% CI). CONCLUSION AND DISCUSSION: The LEFS is reliable, and construct validity was supported by comparison with the SF-36. The sensitivity to change of the LEFS was superior to that of the SF-36 in this population. The LEFS is efficient to administer and score and is applicable for research purposes and clinical decision making for individual patients.

Activities of Daily Living↗
PubMed1997

[The hemodynamic significance of normal vertical blood reflux based on dopplerographic data and in patients with primary varicose veins of the lower extremities].

Data of echophlebodopplerography on "ULTRA-PVD" (USA) were used for studying the frequency and hemodynamic significance of vertical reflux of blood in the deep veins of lower extremities in varicose patients. A group of 50 healthy men and women and 80 patients with different stage of varicose disease were studied. A comparison of the data obtained allowed determining a reliable static criterion of the retrograde wave duration when performing a test with proximal compression. It was shown that under normal conditions it should not exceed 1.5 sec. Three degrees of the retrograde blood flow were distinguished. Indications for surgical correction of the relative valve deficiency of the deep lower extremity veins must be established in each concrete case. Since 1993 200 patients with primary varicose veins have been examined and operated upon. Good and excellent results (96%) testify to the effectiveness of the correction of deep vein hemodynamics which can improve surgical treatment of this pathological condition.

Adolescent↗