ABSTRACT
Forequarter amputation is a rare procedure, performed mainly for patients with malignant bone and soft tissue tumors. The present case involved a 59-year-old man with left scapula chondrosarcoma. Rehabilitation began on the second day after amputation for a left shoulder chondrosarcoma. We performed early mobilization, wound management, mirror therapy for phantom pain, strength training for the remaining muscles, and activities of daily living (ADL)/instrumental ADL (IADL) training for only the remaining upper limb. In addition, we made a shoulder disarticulation prosthesis. Six months after the operation, the International Society of Limb Salvage-Musculoskeletal Tumor Society functional score was 36.7％ for 6 items and 73.3％ for 3 items, while the Disability of Arm, Shoulder and Hand score was 31.7. The patient-reported outcome had a low score because of the lack of an upper limb, including the scapula. However, when he was discharged from the hospital, he gained self-care independence with only the remaining upper limb and resumed fishing as a hobby. We suggest that rehabilitation after forequarter amputation requires careful intervention based on a deep evaluation of the patient's ADL/IADL, hobbies, and quality of life, in accordance with the patient's lifestyle.
ABSTRACT
Forequarter amputation is a rare procedure, performed mainly for patients with malignant bone and soft tissue tumors. The present case involved a 59-year-old man with left scapula chondrosarcoma. Rehabilitation began on the second day after amputation for a left shoulder chondrosarcoma. We performed early mobilization, wound management, mirror therapy for phantom pain, strength training for the remaining muscles, and activities of daily living (ADL)/instrumental ADL (IADL) training for only the remaining upper limb. In addition, we made a shoulder disarticulation prosthesis. Six months after the operation, the International Society of Limb Salvage-Musculoskeletal Tumor Society functional score was 36.7％ for 6 items and 73.3％ for 3 items, while the Disability of Arm, Shoulder and Hand score was 31.7. The patient-reported outcome had a low score because of the lack of an upper limb, including the scapula. However, when he was discharged from the hospital, he gained self-care independence with only the remaining upper limb and resumed fishing as a hobby. We suggest that rehabilitation after forequarter amputation requires careful intervention based on a deep evaluation of the patient's ADL/IADL, hobbies, and quality of life, in accordance with the patient's lifestyle.
ABSTRACT
Chondrosarcoma is the third most common primary tumour of the bone, after myeloma and osteosarcoma. Most of the chondrosarcoma grow slowly and rarely metastasize, and they have an excellent prognosis after adequate surgery. However most of them are chemo or radio-resistant. We report a case of primary chondrosarcoma of proximal humerus in a 36-year-old female who presented with a six years history of left shoulder swelling and restricted range of motion. Trucut biopsy showed a well-differentiated chondrosarcoma. The patient underwent forequarter amputation of left upper limb and was started on chemotherapy following operation.
Subject(s)
ChondrosarcomaABSTRACT
Fundamento: el sarcoma de Ewing es una neoplasia de alta malignidad que afecta a niños y adolescentes en mayor grado. R epresenta el 9 % de las neoplasias de hueso. La quimioterapia, radioterapia y cirugía combinadas o solitarias son los tratamientos disponibles. Objetivo: familiarizar a los residentes con una técnica quirúrgica poco utilizada de amputación interescapulotoráxica empleada en un paciente con diagnóstico de sarcoma de Ewing. Presentación del caso: e scolar femenina de 9 años de edad, con aumento de volumen del hombro izquierdo y tercio proximal del brazo ipsilateral de 12 semanas de evolución. La paciente presentó diagnóstico histopatológico de sarcoma de Ewing con infiltración al músculo deltoides. El tratamiento inicial consistió en quimioterapia por 10 semanas y después se le realizó tratamiento quirúrgico definitivo consistente en amputación interescapulotoráxica por vía posterior mediante la técnica de Littlewood. Conclusiones: la amputación interescapulotoráxica de Littlewood es un procedimiento que permite incrementar la supervivencia de los pacientes oncológicos, por lo que estar familiarizado con esta técnica es necesario en la formación de los especialistas en ortopedia y traumatología en la aplicación de la buena práctica médica.
Background: Ewing's sarcoma is a highly malignant neoplasm which mainly affects children and teenagers. It represents a 9 % of bone tumors. Chemotherapy, radiotherapy and surgery combined or alone are the available treatments. Objective: to familiarize residents with a less practiced surgical technique of forequarter amputation used in an Ewing's sarcoma case. Case presentation: a nine year old scholar female, complaining of volume increasing of the left shoulder and the proximal third of the ipsilateral arm of twelve weeks duration. The patient presented a histopathology diagnostic of Ewing's sarcoma with deltoid muscle infiltration. The early treatment included chemotherapy for ten weeks and afterwards a forequarter amputation was practiced by a posterior approach through Littlewood technique. Conclusions: Littlewood forequarter amputation is a procedure which allows increasing the survival, mainly in oncologic patients, that is why to be familiarized with the technique is necessary in the formation of orthopedics and traumatology specialists for good medical practice.
Subject(s)
Sarcoma, Ewing , Neoplasms, Bone Tissue , Amputation, Surgical/methodsABSTRACT
Foram avaliados o desempenho e as características de carcaça de 36 novilhos Brahman (Bh), Brangus (Bg) e Hereford adaptado (He), terminados em pastejo com suplementação (PSu) ou em confinamento (Conf). Os animais foram abatidos quando apresentavam espessura de gordura maior do que 4mm. Na dieta do Conf, a relação volumoso:concentrado foi de 60:40 (com base na matéria seca), continha 13 por cento de proteína bruta (PB) e 62 por cento de nutrientes digestíveis totais (NDT). O capim-mombaça continha, em média, 7 por cento de PB e 54 por cento de NDT, e o suplemento 24 por cento de PB e 76 por cento de NDT. Foi observada diferença (P<0,05) no sistema de terminação para o ganho de peso médio diário, com 1,200kg/cab/dia para Conf e 0,675kg/cab/dia para Psu. Os novilhos Bh e Bg pesaram, em média, 445,8kg, e o rendimento da carcaça quente foi de 58,4 por cento, valores maiores que os 399,1kg e 55,4 por cento obtidos pelos animais He. A área de olho de Longissimus foi maior para os animais Bg, 76,42cm². A maciez, 3,71 vs 4,89, e a espessura de gordura subcutânea, 4,64 vs 3,39, foram melhores nos animais terminados em Conf do que nos animais em Psu, respectivamente.
The productive performance and carcass of the 36 Brahman (Bh), Brangus (Bg) and adapted Hereford (He) steers finished on feedlot (FD) or on rotational grazing with supplementation system (GS) were evaluated. The animals were slaughtered when the subcutaneous fat thickness was over 4mm. The feedlot diet had a forage: concentrate of 60:40 (in dry matter) 13 percent crude protein (CP), 62 percent of NDT. The mombaça gras CP level was 7 percent and 54 percent of NDT. The supplement had supplied 24 percent of CP and 76 percent of NDT. A significant difference was observed for the average daily gain, being 1,200kg/head/day for FD steers and 0.675kg/head/day for GS steers. The effect of breed on slaughter weight was observed, being 445.8kg for Bh and Bg and 399.19kg for He. The hot dressing percentage was higher for Bh and Bg than for He, 58.4 percent vs 55.4 percent. The rib eye area was higher for Bg, 76.42cm² and tenderness measured by the shear force was lower for FD steers, at 3.71 than for GS steers, at 4.89. The subcutaneous fat thickness was higher for FD steers, at 4.64 than for GS steers, at 3.39mm.
Subject(s)
Animals , Cattle/classification , Meat , Food Analysis , Weight GainABSTRACT
Traumatic forequarter amputation is an extremely rare and life-threatening injury. It is caused by blunt trauma or tremendous traction force, and the prognosis is very poor because of the involvement of massive associated injury. Traumatic forequarter amputation has been rarely reported in the English language clinical literature, but has never been reported in Korea. We report a case of traumatic forequarter amputation caused by a conveyor belt that was treated with emergency resuscitation and surgery, with an accompanying review of the literature.