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At least 19 recordsLinked to original sources

PubMed2003

Pirogoff ankle disarticulation as an option for ankle disarticulation.

Eleven patients (12 ankles) who had Pirogoff ankle disarticulation were followed up for an average of 5.6 years (range, 2.1-8.9 years). After disarticulation of the Chopart joint, the talus was removed and the calcaneus was cut off in the coronal plane. The heel then was rotated 90 degrees to the tibial plafond. The postoperative result was evaluated using a scoring sheet. Excellent results were seen in four feet: two in patients with trauma, one in a patient with a metastatic tumor, and one in a patient with osteomyelitis. Good results were seen in two feet: one in a patient with trauma and one in a patient with diabetes mellitus. A fair result was seen in one foot in a patient with diabetes mellitus. Poor results were seen in four feet in three patients with arteriosclerosis and one foot in a patient with diabetes mellitus. In Pirogoff ankle disarticulation, the leg-length discrepancy is compensated for by using the calcaneus. The patients only had a leg-length discrepancy of 2.8 cm on average, which enabled them to walk outdoors wearing only a shoe orthosis. The postoperative results were unfavorable in patients with vascular diseases and were satisfying in patients without vascular diseases.

Adolescent↗

PubMed1987

Disarticulation of the knee in children. A functional assessment.

We assessed the functional abilities of six patients who had had disarticulation of nine knees during childhood by analyzing their gait using electrocardiographic telemetry. Those who were more than five years old were further studied by timing them as they ran the fifty-yard (45.7-meter) dash and by testing the strength of the musculature of the hip girdle using a Cybex dynamometer. The physiological cost-index of Butler et al. was used to assess energy consumption. Three patients had had unilateral disarticulation and three had had bilateral disarticulation. Kinematic studies showed persistent bilateral abduction of the hip throughout the gait cycle in all six patients. The flexion-extension arc of the hip was decreased in the three who had had bilateral disarticulation. Increased flexion of the hip was noted on the normal side and decreased flexion, on the affected side in those who had had unilateral disarticulation. Phase reversal of pelvic obliquity was noted in the amputees who had had bilateral disarticulation. The prosthetic knee showed good flexion during the swing phase. All patients showed a mild decrease in the velocity of gait and in the length of step and stride. The patients who had had unilateral disarticulation showed decreased duration of the bilateral stance and single stance phases and increased duration of the swing phase. Those who had had bilateral disarticulation of the knee had a normal distribution of the components of the gait cycle: bilateral stance, single stance, and swing. The physiological cost-index for all six was within the normal range, indicating minimum energy handicap.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1996

[The CT of calcaneal fractures: 3-D reconstructions with electronic disarticulation].

PURPOSE: To evaluate the clinical value of 3-D-reformations with and without electronic disarticulation of calcaneal fractures compared to axial CT and sagittal reformations. MATERIAL AND METHODS: 25 patients with intra-articular calcaneal fractures underwent diagnostic CT-examinations. Axial slices, sagittal and 3-D-reformations with and without electronic disarticulation were performed. The sagittal and both types of 3-D-reformations were compared to the axial slices with regard to the diagnostic criteria: involvement of articular facets, number of fragments, and traumatic changes of the hindfoot. RESULTS: The best proof of involvement of articular facets is found in axial slices and 3-D-reconstructions after disarticulation followed by sagittal reconstructions. Usually on 3-D-reconstructions without disarticulation articular facets cannot be identified because of overlapping bones. The number of fragments is clearly demonstrated by axial slices and sagittal reconstructions followed by 3-D-reconstructions after disarticulation. Traumatic changes of the hindfoot can be diagnosed in all four forms of visualisation. CONCLUSION: The decisive diagnosis for treatment planning is made based on the axial slices supported by sagittal reformations. In unclarified cases 3-D-reformations after electronic disarticulation may provide further information. 3-D-reformations without disarticulation are useless.

Adult↗

PubMed2002

Disarticulation resections of the mandible: a prospective review of 16 cases.

PURPOSE: This article provides a review of the disarticulation resection of the mandible for various benign and malignant tumors and non-neoplastic processes. In so doing, the author proposes a classification to describe extension of pathology into the condylar region, thereby requiring its sacrifice. Recommendations are also proposed for preservation versus sacrifice of the meniscus when performing a disarticulation resection of the mandible. Finally, complications are evaluated in this type of mandibular resection. PATIENTS AND METHODS: This review is based on the author's accumulated clinical data obtained from performing disarticulation resections on 16 patients who presented with 10 different pathologic diagnoses. Disarticulation resections are performed for 3 different patterns of extension of pathologic processes into the condylar region, designated as type I, type II, and type III by the author. These designations reflect the radiographic involvement of the condyle or subcondylar region of the mandible by the pathologic entity. The designations of type II and type III extensions are diagnosis dependent, whereas type I extension is independent of diagnosis. RESULTS: Five patients in this series presented with type I condylar extension, 2 patients presented with type II condylar extension, and 9 patients presented with type III condylar extension. The meniscus required sacrifice in 3 of the 16 patients. Complications occurred in 3 of 16 patients and included 1 dislocation of the plate into the middle cranial fossa, 1 dislocation of the plate inferiorly and posteriorly to the mastoid process, and 1 cutaneous exposure of the plate. CONCLUSIONS: Disarticulation resections are rarely required variants of segmental resection of the mandible, and they are required by a variety of pathologic processes of the jaws and contiguous structures. The placement of a reconstruction bone plate with an affixed condylar prosthesis is well tolerated by patients and is associated with few complications. These reconstruction bone plates favorably support facial form, symmetry, and occlusion such that many patients delay their definitive bony reconstruction. Because these condyles are temporary prostheses, the surgeon should consider their removal with bony reconstruction of the disarticulation defect as soon as possible after the ablative surgery.

Bone Plates↗

PubMedDate not supplied

Total hip disarticulation prosthesis with suction socket: report of two cases.

A majority of hip disarticulations are performed in young people, with malignancy being the most common cause. The exoskeletal Canadian Hip Disarticulation prosthesis had been widely used as a standard total hip disarticulation prosthesis until recently when an endoskeletal modular version became the prosthesis of choice. However, the "basket-shaped" socket provided by the standard total hip disarticulation prostheses has been a source of discomfort and a reason for prosthetic rejection by many patients. This report concerns two patients with true lower limb disarticulation at the hip joint. Both of the patients failed to adapt to the standard total hip disarticulation prosthesis but successfully used a new total contact suction socket design. This new prosthesis provided improved suspension, better patient compliance, and enhanced prosthetic acceptance and mobility.

Activities of Daily Living↗

PubMed1991

Hip disarticulation: factors affecting outcome.

Hip disarticulation, especially in patients with peripheral vascular disease, has been associated with high morbidity and mortality rates. This report describes patient characteristics that influence the clinical outcome of hip disarticulation. The medical records of all patients undergoing hip disarticulation from 1966 to 1989 were reviewed for surgical indication, perioperative wound complications, and postoperative deaths. Fifty-three patients underwent hip disarticulation for limb ischemia (10), infection (12), infection and ischemia (14), or tumor (17). The overall incidence of wound complications was 60%, and no significant differences were found among the groups. Prior above-knee amputation and urgent/emergent operations were significantly associated with increased wound complications (p less than 0.05). The overall mortality rate was 21%, ranging from 0% (tumor) to 50% (ischemia) and differed significantly among the groups (p less than 0.02). Mortality was significantly associated with urgent/emergent operations (p less than 0.01). Age, diabetes mellitus, and previous inflow procedures did not influence mortality rates. The presence of limb ischemia influenced mortality rates to a greater extent than did infection, and a history of cardiac disease was statistically predictive of death. Wound complications frequently accompanied hip disarticulation, regardless of operative indication, and were significantly increased by urgent/emergent operations and prior above-knee amputation. Hip disarticulation can be performed with low mortality rates in selected patients. Both limb ischemia and infection substantially increase operative mortality rates.

Adult↗

PubMed1995

A semiautomatic three-dimensional segmentation method for disarticulation of bone structures on spiral computed tomography images.

The use of binary thresholding for segmenting bone structures on spiral computed tomography images is negatively influenced by partial volume effects (PVEs) induced by the image acquisition. PVE leads to mixed voxels, making the binary decision "bone" or "nonbone" a difficult one to take. As a result, two distinct bone structures that are close to each other will often appear to be connected by this method. A typical example consists of "acetabulum/femural head" pairs in the pelvic region. To separate them, a clinical user must interactively draw a disarticulation line. This procedure is time consuming (often interaction in 50 slices is needed) and leads to unsmooth visualization of the disarticulated areas (by three-dimensional [3D] rendering techniques). We developed a semiautomatic cutting algorithm that leads to smooth disarticulated surfaces and considerably decreases the amount of user interaction. A sheet detection operator is applied to automatically separate bone structures. Detected sheets are used as disarticulation lines. Postprocessing ensures that sheets not relevant for the application do not influence the resulting image. Our approach is encapsulated in an interactive segmentation environment based on thresholding and 3D connected-component labeling. Results are shown for pelvic region, wrist, and foot bone disarticulations.

Algorithms↗

PubMed2005

Outcome after disarticulation of the hip for sarcomas.

AIMS: To review the oncological and functional outcome in 80 patients who underwent disarticulation of the hip as part of their treatment. METHODS: Eighty patients had disarticulation, of whom 46 had a bone sarcoma and 34 a soft tissue sarcoma. In 42 patients the operation was done as the first definitive surgical procedure for that patient. In 38 patients the disarticulation followed local recurrence after unsuccessful limb salvage, three of these patients had palliative amputations already having metastatic disease. All patients had adjuvant therapy when appropriate. RESULTS: The overall survival of the patients following the amputation was 56% at 1 year, 39% at 2 years, 27% at 5 years and 21% at 10 years. The 5-year survival of patients having the amputation as a primary procedure was 32%, for those with local recurrence it was 25% whilst for those with a palliative amputation it was nil. Local recurrence developed in 10 patients following the amputation, and was related to close margins of excision; all of these patients subsequently died. Function was on the whole poor, with only one surviving patient regularly using an artificial limb. CONCLUSION: Disarticulation of the hip remains a disabling procedure usually carried out for high grade sarcomas with extensive involvement of bone and soft tissues in the thigh. Long term survival is possible if wide margins of excision can be achieved.

Adolescent↗

PubMed2000

North American experience with knee disarticulation with use of a posterior myofasciocutaneous flap. Healing rate and functional results in seventy-seven patients.

BACKGROUND: A method for closure of a knee disarticulation wound with use of the posterior calf skin and gastrocnemius muscle bellies as an integral flap, without destruction of the perforating vessels, was described by Klaes and Eigler in 1985. The purposes of the present study were to report our experience with use of this technique in a prospective series of knee disarticulations and to determine the healing rate and the functional result after use of the flap. METHODS: Eighty knee disarticulations, performed with use of the flap described by Klaes and Eigler, in seventy-seven patients were evaluated in a prospective manner. The patients ranged in age from nineteen to ninety-two years (mean, sixty-four years). Thirty-one patients had diabetes mellitus with peripheral vascular disease, and twenty-nine had peripheral vascular disease alone as the primary cause of gangrene. Fourteen patients had a traumatic injury, two had a sarcoma, and one had Ollier disease. RESULTS: Five patients died in the early postoperative period, leaving seventy-five stumps available for evaluation. A total of sixty-seven stumps (89 percent) healed; sixty-three (84 percent) of them healed primarily. Major wound dehiscence occurred in seven stumps (9 percent), requiring revision to the transfemoral level. Six of those patients had a serum albumin level of less than thirty millimoles per liter. Twenty-two (81 percent) of the twenty-seven patients who could walk before surgery were able to walk with a prosthesis after it. CONCLUSIONS: This simple technique offers reliable healing of knee disarticulation wounds in properly selected patients with a variety of conditions. It also provides comfortable end-bearing for prosthesis wearers because the distal flap is thick and mobile.

Diabetic Angiopathies↗

PubMed1987

Therapeutic value of scapular and pelvic girdle disarticulations in sarcoma.

The authors have reviewed 22 cases of proximal disarticulations with the aim of assessing the therapeutic value, taking into account previous radio- and chemotherapy. The following criteria were especially examined: recurrences, survival, quality of life. There were 13/22 soft tissue sarcomas, 9/22 bone sarcomas. In 10 instances, the tumour was primary and treated for the first time whilst, in 12 cases, it was recurrence. Eighteen patients had been previously treated by non radical surgery, 11 by radiotherapy and 10 by chemotherapy. For upper limb tumours, six patients underwent an inter-scapulo-thoracic disarticulation and three an inter-scapulo-thoracic resection according to Tykhor-Lindberg. For lower limb tumours, seven patients were submitted to inter-ilio-abdominal disarticulation, three to coxo-femoral disarticulation and one to internal hemipelvectomy according to Eilber. Mean disease free interval has been 34.5 months and mean survival 38.5 months. Three out of 20 evaluable patients (15%) recurred locally although most of them benefited from second surgery. Quality of life has been excellent in general despite the fact that only seven patients accepted wearing a prosthesis. Karnofsky index ranged between 60 and 100%. No significant difference was seen, whether or not previous radiotherapy and/or chemotherapy had been administered.

Bone Neoplasms↗

PubMed1995

Syme ankle disarticulation in peripheral vascular disease and diabetic foot infection: the one-stage versus two-stage procedure.

A prospective randomized trial compared performing a Syme ankle disarticulation using a one-stage versus Wagner's two-stage technique. Surgery was performed at two University Medical Centers where patients underwent amputation surgery for gangrene or nonsalvageable diabetic foot infection. Those undergoing surgery subsequent to trauma or congenital anomaly were eliminated. Initially, 21 patients were randomized into one-stage and two-stage surgery. The randomization was stopped for ethical reasons when the results of both procedures appeared to be similar. The next 22 consecutive patients underwent 23 Syme ankle disarticulations in one-stage surgery. Selection of amputation level was based on clinical examination, transcutaneous oximetry as a measure of vascular inflow, serum albumin as a measure of tissue nutrition, and total lymphocyte count as a measure of immunocompetence. As a total group, 31 of 44 amputations progressed to amputation wound healing and prosthetic limb fitting. In the randomized group, 9 of 13 one-stage and 5 of 8 two-stage surgeries healed. In the subsequent consecutive group, 17 of 23 healed. In all, 26 of 36 one-stage and 5 of 8 two-stage surgeries healed successfully. We concluded from this study that Syme ankle disarticulation may be performed as safely in one stage as in two stages in properly selected patients and, therefore, recommend the one-stage Syme ankle disarticulation in those patients suitable for this level amputation.

Adult↗

PubMed2003

Syme ankle disarticulation in patients with diabetes.

BACKGROUND: Syme ankle disarticulation is an amputation level that minimizes disability and preserves function, but it has been used sparingly in patients with diabetes mellitus. Surgeons have avoided this level because of the perceived high risk for wound failure, wound infection, or migration of the heel pad, which makes prosthesis use difficult. METHODS: Ninety-seven adult patients with diabetes mellitus who underwent Syme ankle disarticulation because of a neuropathic foot with an infection or gangrene, or both, during an eleven-year period were studied retrospectively. Selection of the amputation level was made on the basis of clinical examination and an assessment of the wound-healing parameters, i.e., vascular inflow, tissue nutrition, and immunocompetence. The average age of the patients was 53.2 +/- 17.5 years. RESULTS: Eighty-two patients (84.5%) ultimately achieved wound-healing. When threshold levels for vascular inflow (ultrasound Doppler ischemic index of 0.5 or transcutaneous partial pressure of oxygen between 20 and 30 mm Hg) and tissue nutrition (serum albumin of 2.5 g/dL) were met, an overall success rate of 88% was achieved. Total lymphocyte count (an absolute lymphocyte count of 1500) and the smoking of cigarettes during the study period did not appear to impact wound-healing rates. The overall infection rate was 23%, and it was three times greater in smokers. Most infections were managed with local wound care and antibiotic therapy. At a minimum follow-up of two years, all but two patients were able to walk with a prosthesis. Thirty of the ninety-seven patients died at an average of 57.1 months following surgery. CONCLUSIONS: The results of this retrospective review support the value of Syme ankle disarticulation in diabetic patients with infection or gangrene. This function-sparing amputation can be successfully performed with a reasonable risk. Patients managed with a Syme ankle disarticulation appeared to remain able to walk better and to survive longer than similar patients who had a transtibial amputation and served as historical controls. In diabetic patients with dysvascular disease who have adequate vascular inflow to support wound-healing (an ultrasound Doppler ischemic index of 0.5 or a transcutaneous partial pressure of oxygen between 20 and 30 mm Hg), the threshold for the wound-healing parameter of serum albumin appears to be as low as 2.5 g/dL.

Amputation, Surgical↗

PubMed1988

[Extensive coxo-femoral resection with preservation of the thumb for prosthesis. An alternative to disarticulation at the hip].

To avoid the severe mutilation of a hip disarticulation and to improve limb-fitting, a method of partial limb preservation is proposed. Two cases of septic arthritis of the hip with neurological and atrophic lesions sufficient to justify disarticulation are described. Disarticulation was avoided by partial conservation of the thigh with an extensive resection of the upper end of the femur, a through-knee amputation and a large posterior musculo-cutaneous flap including the triceps surae whose muscle provided a good cover for an end-bearing myoplasty. The stump obtained was of good quality which, though a little unstable, was firm and well provided with muscle which allowed early mobilization with a temporary prosthesis and later limb-fitting with much more satisfactory function than that in a hip disarticulation.

Adult↗

PubMed2004

Hip disarticulation--the evolution of a surgical technique.

Introduced in the 18th century, hip disarticulation was considered to be one of the most radical operations performed for trauma or disease of the lower limb. The high morbidity and mortality associated with it ensured that it was a rarely performed procedure. It is fortunate that it remains extremely uncommon to the present day. Since the first successful hip disarticulation was described, a number of important advances have occurred. General medical care has improved dramatically and the development of anaesthesia, analgesics, antibiotics and blood transfusions has resulted in greatly decreased morbidity associated with this dramatic operation. This review on the history of hip disarticulation outlines the surgical evolution of the operation, the indications for its use and the techniques used. It draws on the early experiences and preferred techniques of the surgeons of the 19th century, with some discussion on the methods employed to reduce intraoperative haemorrhage. Further development of techniques in the 20th century is also described together with discussion on the evolution of hindquarter amputation.

Disarticulation↗

PubMed1997

Walking pattern of midfoot and ankle disarticulation amputees.

Measurements of the vertical component of ground reaction force (ORF) and dynamic center of pressure (COP) were recorded for five subjects with midfoot level amputations and six with Syme's ankle disarticulation amputations. All of the subjects underwent amputation surgery as a consequence of peripheral vascular disease and diabetes. GRF measurement was accomplished with the F-Scan system (Tekscan, Boston, MA). Each group exhibited a consistent, reproducible pattern of gait. Subjects with Syme's ankle disarticulation initiated initial loading response, i.e., heel strike, with a concentration of GRF in the center of the anatomic heel. COP progressed along the midline to the center of the anatomic forefoot, where GRF was concentrated at push-off. Midfoot amputees initiated loading at the lateral-posterior heel. COP progressed medially to the midline, where it progressed distally to the level of the distal residual limb (proximal metatarsal metaphyses). It then shifted medially under the base of the first metatarsal, where a small concentration of GRF occurred at push-off, similar to the normal foot. These findings explain the decreased magnitude of propulsion seen in midfoot level amputees and may explain the seemingly paradoxical increased metabolic cost of walking observed in midfoot amputees as compared with Syme's ankle disarticulation amputees.

Adolescent↗

PubMed1980

Disarticulation of the hip as a result of failed arthroplasty. A series of 11 cases.

Eleven patients underwent disarticulation for infected arthroplasty of the hip. Exchange total hip arthroplasty or conversion to a Girdlestone excision arthroplasty had been undertaken previously an average of 2.9 times. The indications for disarticulation were as a life-saving measure, or as a result of severe infection of soft tissue and bone, loss of bone stock, or vascular injury. While the indications for this drastic operation were highly individual, there were instances where disarticulation could have been avoided if repeated exchange operations had been eschewed in deference to a Girdlestone procedure.

Adult↗

PubMed1999

Anterior flap for coverage following hip disarticulation for osteomyelitis.

The use of a posterior myocutaneous flap is the most common method of coverage following hip disarticulation. Other options for coverage following hemipelvectomy have been described mainly when the conventional flap is unavailable owing to tumor involvement. We report a case of hip disarticulation for a decubitus ulcer with underlying osteomyelitis of the proximal femur; coverage was obtained using an anterior myocutaneous flap. In this case, two previous unsuccessful attempts at wound coverage prior to the hip disarticulation using a lateral and a posterior flap made the anterior flap the best available option for closure. Complete healing was achieved within two months.

Diabetes Mellitus, Type 1↗

PubMed1990

Knee disarticulation with intercondylar patellofemoral arthrodesis. An improved technique.

As compared to an above-knee amputation, the knee disarticulation has several marked advantages that are well known and accepted by most surgeons. However, it has not gained popularity because it leaves a double condylar, bulbous, uneven stump, which is difficult to fit into the base of the socket. In ten patients, a modified surgical technique included moderate trimming of the femoral condylar prominences and patellofemoral arthrodesis in the intercondylar notch. This produces a conical stump with a large area for end bearing, and at the same time allows the standard suction-socket fitting without ischial weight bearing. The average age was 33.1 years (range, ten to 75 years). The indication for amputation was trauma in four cases, tumor in three cases, chronic osteomyelitis in one, ischemia of the leg in one, and congenital malformation in one. Average length of follow-up study was four years (range, one to 9.8 years). Complications were stump ulceration in one case and fistula formation in two cases. Nine patients achieved full weight-bearing ambulation with an end-bearing type of prosthesis. The remaining patient was not fitted with a prosthesis prior to his death from a systemic medical illness. Union of the patellofemoral arthrodesis was achieved in all ten cases. This procedure is recommended whenever knee disarticulation is indicated and ambulation expected. Significant improvement over standard knee disarticulation or distal above-knee amputation can be achieved.

Adolescent↗