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At least 19 recordsLinked to original sources
PubMed2006

Megaprostheses for the treatment of malignant bone tumours of the lower limbs.

Lower limb salvage surgery remains a challenge in orthopaedic oncology. Both cemented and cementless, modular, endoprosthetic systems are widely used to treat defects of different sizes. The systems have changed over the years, and each major orthopaedic company offers a modular tumour and revision system for the lower extremities. All systems have worse long-term results compared to conventional total hip or total knee systems. This is due to the large defects that need to be bridged with a more difficult fixation in the diapyhsis of the femur and tibia and a more complex restoration of joint biomechanics. This article summarises the results of several clinical studies with different systems. Newer systems without clinical follow-up are described. We previously reported a prospective study of 50 consecutive patients treated with the MUTARS endoprostheses. The follow-up was 2-7 years. Clinical evaluation showed good results compared to other systems. The review of the literature and our own results do not validate the support or favouring of one specific system. The surgeon should choose a system with which he/she is familiar and that provides the modularity needed intraoperatively to bridge any defect in the lower limbs.

Adult↗
PubMed2004

Comparison of the effect of two different doses of 0.75% glucose-free ropivacaine for spinal anesthesia for lower limb and lower abdominal surgery.

We compared the clinical efficacy and safety of two doses of ropivacaine for spinal anesthesia in Chinese patients undergoing lower limb and lower abdominal surgery. In this randomized, open-label study, 40 patients were divided into two groups: group A received 3.5 mL (26.25 mg) of 0.75% glucose-free ropivacaine, and group B received 4.5 mL (33.75 mg). Sensory and motor blocks were assessed during and after surgery through to complete recovery. Seven standard measurements were taken: time to onset of sensory blocks; maximum sensory cephalad spread; time to maximum sensory block; maximum number of blocked segments; duration of sensory block at L3; time to onset of complete motor block; and duration until complete motor block recovery. Vital signs and any adverse effects related to spinal anesthesia were also recorded. No significant differences were found between the two groups: time to onset of sensory block at L3 in group A vs B (2.1 +/- 9.6 vs 1.7 +/- 7.3 minutes), maximum cephalad spread [T4-5 (C3-T11) vs T4 (C3-T8)], maximum number of blocked segments (18.0 +/- 3.4 vs 19.8 +/- 3.7), time to maximum sensory block (34.0 +/- 22.9 vs 26.8 +/- 17.9 minutes), duration of sensory block at L3 (251.2 +/- 34.7 vs 277.3 +/- 51.1 minutes), time to onset of complete motor block (13.4 +/- 6.4 vs 10.3 +/- 3.4 minutes), and time for complete recovery from motor block (264 +/- 52.1 vs 292.5 +/- 64.5 minutes). No significant differences in global hemodynamic changes were found during and after the operation. While shivering was more frequent in group B during the operation, the difference was not significant. Otherwise, there were no differences in adverse effects during and after surgery. We conclude that both doses of 0.75% glucose-free ropivacaine, 26.25 mg (3.5 mL) and 33.75 mg (4.5 mL), have the same efficacy and safety in Chinese patients undergoing spinal anesthesia for lower limb and lower abdominal surgery.

Abdomen↗
PubMedDate not supplied

Sectional neuroanatomy of the lower limb I: lower back and hip.

This series of two articles is structured to provide anatomically accurate functional schematics of the motor and sensory innervation of the lower back, hip, and lower limb. This first paper provides radiographically oriented schematic axial sections of the lower back and hip in which the muscles are appropriately color-coded to match the peripheral nerves. A companion color-coded summary table allows prediction of unique patterns of denervation from 25 lesion sites. These are divided into three categories (roots T12 to S4, four plexal quadrants, and 11 sectional levels). Correlation between an imaging abnormality at one of these lesion sites and the predicted denervation pattern ensures the lesion is, in fact, clinically significant. The next article will continue this color-coded approach into the lower limb.

Electromyography↗
PubMed2006

Delay in initiation and termination of tibialis anterior contraction in lower-limb hemiparesis: relationship to lower-limb motor impairment and mobility.

OBJECTIVE: To assess the relationship between delays in initiation and termination of tibialis anterior contraction in the hemiplegic lower limb and clinical measures of lower-limb motor impairment and mobility. DESIGN: Cross-sectional correlational study. SETTING: Outpatient rehabilitation clinic of an academic medical center. PARTICIPANTS: Convenience sample of 22 chronic stroke survivors with lower-limb hemiparesis. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Delays in initiation and termination of tibialis anterior electromyographic activity during isometric contraction, lower-limb Fugl-Meyer Assessment (FMA), and Modified Emory Functional Ambulation Profile (mEFAP). RESULTS: The affected lower limb exhibited significantly longer delays in initiation and termination of tibialis anterior contraction relative to the unaffected limb. Delay in termination of 3-second tibialis anterior contraction of the affected limb correlated significantly with the FMA and mEFAP. However, delay in initiation of tibialis anterior contraction did not correlate with clinical measures. CONCLUSIONS: Delay in termination of muscle activity in the hemiparetic lower limb may have important clinical implications, but delay in initiation did not correlate with clinical measures. Controlled, interventional trials are needed to demonstrate a cause and effect relationship.

Adult↗
PubMed1990

Upper-limb and lower-limb exercise training in patients with chronic airflow obstruction.

We designed a randomized controlled study to evaluate the benefit of upper-limb exercise training, alone and in combination with walking training, in patients with severe CAO. In an outpatient department supervised by a physiotherapist, we evaluated 28 patients with severe stable CAO (FEV1, 32 percent of predicted). Patients were randomly allocated to either a control (eight), upper-limb (six), lower-limb (seven), or combined (seven) exercise group. The upper-limb group trained with a circuit of upper-limb exercises, the lower-limb group by walking, and the combined group with both. Exercise was for one hour three times per week for eight weeks. Assessment before and after training included pulmonary function, mouth pressures, respiratory muscle endurance, maximal bicycle exercise test, maximal and submaximal arm ergometer, six-minute walking distance, and a scale of well-being (Bandura scale). Twenty-six patients completed the program. There was a significant improvement (Wilcoxon rank sum test) in the following: six-minute walking distance in the lower-limb (p less than 0.005) and combined (p less than 0.003) groups; arm ergometer in the upper-limb (p less than 0.005) and combined (p less than 0.04) groups; and the scale of well-being in the combined (p less than 0.005) group. There was no significant change in any other parameter measured. We conclude that exercise training improves exercise performance in severe CAO, that the training is specific for the muscle group trained, and that upper-limb exercises should be included in training programs for these patients.

Aged↗
PubMed2001

Lower limb amputations: registration of all lower limb amputations performed at the University Hospital of Trondheim, Norway, 1994-1997.

The authors consecutively recorded all lower limb amputations performed at the University Hospital of Trondheim from January 1st, 1994 to January 1st, 1997. A total of 215 primary lower limb amputations were carried out in the study period: 40 partial foot amputations, 2 ankle disarticulations, 51 trans-tibial amputations, 68 knee disarticulations, 50 transfemoral amputations and 4 hip disarticulations. Seventy-four (74) (34%) of the amputees had diabetes mellitus, 113 (53%) had peripheral vascular disease and 28 (13%) of the amputees had various diagnoses. In those who were amputated due to diabetic and peripheral vascular disease the overall reamputation rate was 19% and 20%, respectively. The rates of reamputation at the trans-tibial and knee level were similar. In the city of Trondheim the annual incidence of primary amputations was 34 per 100,000 and 4.4 per 1,000 diabetic subjects. The incidence of lower limb amputations was 25 times higher in diabetic subjects compared to non-diabetic subjects.

Adolescent↗
PubMed2006

Factors influencing outcome following limb-threatening lower limb trauma: lessons learned from the Lower Extremity Assessment Project (LEAP).

The Lower Extremity Assessment Project (LEAP) is a multicenter study of severe lower extremity trauma in the US civilian population. At 2- and 7-year follow-ups, the LEAP study found no difference in functional outcome between patients who underwent either limb salvage surgery or amputation. However, outcomes on average were poor for both groups. This study and others provide evidence of wide-ranging variations in outcome following major limb trauma, with a substantial proportion of patients experiencing long-term disability. In addition, outcomes often are more affected by the patient's economic, social, and personal resources than by the initial treatment of the injury--specifically, amputation or reconstruction and level of amputation. A conceptual framework for examining outcomes after injury may be used to identify opportunities for interventions that would improve outcomes. Because of essential differences between the civilian and military populations, the findings of the LEAP study may correlate only roughly with combat casualty outcomes.

Amputation, Surgical↗
PubMed2003

Variations in lower limb venous anatomy: implications for US diagnosis of deep vein thrombosis.

PURPOSE: To retrospectively review bilateral venograms free of thrombus to evaluate the frequency and types of variations seen in venous anatomy. MATERIALS AND METHODS: A retrospective review of 404 bilateral (808 limbs) lower limb venograms obtained from medical patients participating in a thromboprophylaxis clinical trial and found to be free of thrombus was performed. Venograms were evaluated according to predetermined criteria for the presence of duplication of vessels and inter- and intraindividual variations in venous anatomy. Variations were assessed with analysis of variance and chi2 tests. RESULTS: Two vessels were seen in the popliteal fossa on 337 (42%) of 808 venograms, and 41 (5%) were true duplicated popliteal veins. There were 253 (31%) duplicated superficial femoral veins (SFVs), with 12 (1.5%) being complex duplicated systems. Of 265 duplicated SFVs, 138 (52%) began in the midthigh region and 80 (30%), in the adductor canal region. The duplicated vessel was medial to the main SFV in 122 (46%), lateral in 131 (49%), and both (ie, triplications) in 12 (4.5%). The length of the duplicated SFV ranged from 1 to 35 cm; 6-15 cm was the most common length in 162 (62%) SFVs. There was no significant association between the incidence of anatomic variations and age or sex (P >.1). The presence of multiple vessels in one leg was strongly correlated with the probability of occurrence in the other leg (P <.001). CONCLUSION: Variations in lower limb venous anatomy are common and have important implications for the US diagnosis of deep vein thrombosis.

Adult↗
PubMed2000

Steroid sex hormones for lower limb atherosclerosis.

BACKGROUND: There is accumulating evidence that steroid sex hormones have a beneficial effect on a number of risk factors for peripheral arterial disease. OBJECTIVES: The objective of this review was to determine whether exogenous steroid sex hormones are an effective treatment for patients with lower limb atherosclerosis. SEARCH STRATEGY: The Cochrane Peripheral Vascular Diseases Group trials register was searched, together with reference lists from relevant articles and reviews obtained through searches of Embase and Medline. SELECTION CRITERIA: Randomised controlled trials of steroid sex hormones in patients with lower limb atherosclerosis were selected. DATA COLLECTION AND ANALYSIS: Both reviewers extracted data and assessed trial quality independently. Whenever possible investigators were contacted to obtain information needed for the review that could not be found in published reports. MAIN RESULTS: Four trials appeared to meet the inclusion criteria, but one was excluded because of poor methodology and another is awaiting translation into English. The two remaining trials compared testosterone treatment with placebo in a total of 83 men with intermittent claudication. No trials were available which investigated the potentially beneficial effects of oestrogenic hormones in women with lower limb atherosclerosis. Testosterone therapy produced no improvement in tests of walking distance or in a variety of other objective tests for peripheral arterial disease, including venous filling time, muscle blood flow and plethysmography. The odds ratio for subjective improvement in symptoms using the combined trial results was also non-significant (odds ratio 1.28, 95% confidence interval 0.61 to 2.65). REVIEWER'S CONCLUSIONS: There is no evidence to date that short-term testosterone treatment is beneficial in male subjects with lower limb atherosclerosis. However, this might reflect limited data rather than the lack of a real effect.

Arteriosclerosis↗
PubMed1982

Volume fluctuations in the residual limbs of lower limb amputees.

This study evaluated residual limb volume fluctuations of new and mature amputees in order to better plan for definitive limb prostheses. A measurement system based on a water displacement technique was used to measure cross-sectional area profiles of lower extremity amputation residual limbs. Reliable data were obtained for 32 of the 49 subjects participating in this study. Residual limb shrinkage cannot be characterized by any single pattern and therefore the date for fitting of a final prosthesis cannot be predicted precisely from regular volume measurements. Every amputee studied demonstrated an increase in body weight. Changes in residual limb volume early postoperatively were dictated by interaction of shrinkage and opposite effect of weight gain . Mature amputation limbs were observed to fluctuate in volume, and these fluctuations tended to correspond to body weight changes. For 3 general patterns of volume change observed early postoperatively, the best estimate of time to fit a final prosthesis appears to be about 150 days postamputation.

Adolescent↗
PubMed1996

Value of duplex scanning in evaluation of crural and foot arteries in limbs with severe lower limb ischaemia--a prospective comparison with angiography.

OBJECTIVES: To compare Duplex scanning with angiography for evaluation of crural and pedal arteries in limbs with lower limb ischaemia. DESIGN: The findings obtained during Duplex scanning and angiography were prospectively compared in a blinded manner. SETTING: Departments of Surgery, Diagnostic Radiology and Clinical Physiology, University Hospital. MATERIALS: Duplex scanning and selective angiography of femoropopliteal, crural and foot arteries were performed in 40 limbs (38 patients, 480 segments) with intermittent claudication (n = 6), rest pain (n = 13) and ulcer/gangrene (n = 19). Each arterial segment were graded into four categories: normal, < or = 50% diameter reduction, > 50% diameter reduction and occlusion. Pedal arteries were evaluated as patency or occlusion of dorsal pedal artery and plantar arch. CHIEF OUTCOME MEASURES: Accuracy (AC), sensitivity (SE), specificity (SP), positive predictive (PPV), negative predictive (NPV) and kappa values. MAIN RESULTS: The Duplex scanning of the tibioperoneal trunk, crural and pedal arteries had an accuracy of 80% (kappa = 0.6). The SE, SP, PPV and NPV values were 83%, 77%, 79% and 81%, respectively. The SP was relatively low for the peroneal artery (58%) compared to the others. CONCLUSIONS: The results demonstrate the feasibility and reliability of Duplex scanning in detecting crural and pedal artery lesions in lower limbs with severe ischaemia.

Adult↗
PubMed2001

Phantom limb pain and residual limb pain following lower limb amputation: a descriptive analysis.

PURPOSE: This research aimed to develop a clearer picture of the experience of residual limb pain and phantom limb pain following a lower limb amputation and to gain a greater understanding of their relationships with physical and psychosocial variables. METHOD: One hundred and four participants completed the Trinity Amputation and Prosthesis Experience Scales (TAPES), which includes a section on each of, psychosocial issues, activity restriction, satisfaction with a prosthesis and pain (incidence, duration, level and extent of interference). RESULTS: The results showed that 48.1% of the sample experienced residual limb pain and 69.2% experienced phantom limb pain. While fewer people experienced residual limb pain, those who did, experienced it for longer periods, at a greater level of intensity and with a greater amount of interference in their daily lifestyle, than people who were experiencing phantom limb pain. The experience of residual limb pain was associated with other medical problems and low levels of Adjustment to Limitation. Phantom limb pain was associated with older age, being female, above knee amputation, causes other than congenital causes, not receiving support prior to the amputation, the experience of other medical problems, low scores on Adjustment to Limitation and high scores on Aesthetic Satisfaction with the prosthesis. CONCLUSION: These findings provide a greater understanding of the issues to be taken into consideration in the rehabilitation of people with a lower limb amputation.

Adolescent↗
PubMed2004

Early fitting of artificial limbs to amputated lower limbs.

Specific rehabilitation of patients with amputated lower limbs is first of all rehabilitation to walk with a prosthesis (artificial limb). After 20 years of practice of prosthetic early fitting for lower limbs amputees using practice prosthesis, the authors suggest that this technique is still up-to-date. The taking charge of amputated patients by a specialised team is an important element if one wants to achieve a good functional result. A rehabilitation milieu, where the new amputee is with a large number of patients with the same pathology, also constitutes a framework that is reassuring as well as stimulating and allows the patient to imagine the situation in which he/she can find himself/ herself a few weeks later.

Amputation, Surgical↗
PubMed2002

Symmetrical upper limb peromelia and lower limb phocomelia associated with a de novo apparently balanced reciprocal translocation: 46,XX,t(2; 12)(p25.1;q24.1).

We report a female fetus of 20 weeks gestation with severe symmetrical deformity affecting all four limbs. These deformities were unusual in that there was upper limb peromelia and lower limb phocomelia. No additional major malformations were identified on postmortem examination. In particular there was no evidence of splenogonadal fusion or micrognathia and hypoglossia. The limb malformations in this case are associated with a de novo apparently balanced reciprocal translocation 46,XX,t(2;12)(p25.1;q24.1). The cytogenetic features of Roberts-SC phocomelia syndrome were not detected. Unfortunately, the fibroblast line died and no FISH or DNA analysis could be carried out. In spite of this, the case is presented as it may be useful to other researchers in the selection of candidate genes for mendelian forms of peromelia and phocomelia.

Amniocentesis↗