Epidemiologic data of trauma-related lower limb amputees: A single center 10-year experience.

OBJECTIVE: The aim of this study is three fold: 1) to introduce epidemiologic data of patients with trauma-related amputations as a 10-year experience of a rehabitation center; 2) to determine comorbidities and secondary conditions of lower limb loss; 3) to determine the rehospitalization reasons for lower limb amputee patients. MATERIALS AND METHODS: This retrospective study was conducted in a tertiary rehabilitation center in Turkey. Clinical and demographic data of amputees including sex, age, employment status, time since amputation, time after amputation to first hospitalization, length of hospitalization, how many times the patient was hospitalized, reason for hospitalization, stump complications, comorbid conditions, amputation level and K classifacation were documented. RESULTS: Three hundred ninetynine patients with a mean age of 23,48±6,04 (4-74) years were included in this study. Mean duration after amputation was 119,71±68,86months. Patients were 3,43±2,53 times hospitalized. Landmine explosion was the most common etiology of amputation with 370 patients (92.7%). Below knee amputation was the most common amputation level with 230 (50,77%) amputations. 399 patients were hospitalized 1369 times and the most common hospitalization reason were stump complications (356 times, 26,00%). Spur formation (202 times) was the most common stump complications. Pyscologic disorders were the most common comorbidity with 68 patient (37,56%). CONCLUSION: Patients with traumatic limb amputations are likely to experience several complications and comorbidities. Prevention of secondary conditions affecting those living with the loss of a limb is an important part of amputee rehabilitation and may prevent rehospitalization.

Sonographic evaluation of the sciatic nerve in patients with lower-limb amputations.

Hypertrophy of the sciatic nerve after lower-limb amputation in patients with sarcomas has been previously reported by magnetic resonance imaging; however, sonographic evaluation of the sciatic nerve after lower-limb amputation due to nonmalignant causes has not been done before. Therefore, the aim of this study was to perform imaging of the sciatic nerve in lower-limb amputees and to find out whether sonographic findings were related to clinical characteristics. Twenty-three males with lower-limb amputations due to traumatic injuries were enrolled. Sonographic evaluations were performed using a linear array probe (Aloka UST-5524-7.5 MHZ). Sciatic nerve diameters were measured bilaterally at the same level, and the values of the normal limbs were taken as controls. Sciatic nerve width and thickness values were found to be greater on the amputated sides than the normal sides (P = 0.001). The thickness values were greater in above-knee amputees than below-knee amputees (P = 0.05). Subjects with a neuroma also had thicker sciatic nerves (P = 0.04). The diameters were found not to change between subjects with different liners (P > 0.05), but they were correlated with time after amputation (r = 0.6, P = 0.006; r = 0.4, P = 0.05, respectively). Our results clearly show that the sciatic nerves were wider and thicker on the amputated sides. Amputation level, duration, and the presence of a neuroma seem to affect the eventual diameters of the nerves.

The relationship between basal metabolic rate and femur bone mineral density in men with traumatic spinal cord injury.

OBJECTIVES: To investigate the relationship between basal metabolic rate (BMR) and hip bone mineral density (BMD) in people with spinal cord injury (SCI) and to determine whether neurologic factors contribute to this relationship. DESIGN: Cross-sectional study. SETTING: Inpatient SCI unit in a rehabilitation hospital. PARTICIPANTS: Thirty men with chronic (time since injury, >1 y) traumatic SCI with an American Spinal Injury Association Impairment Scale grade A or B. Subjects' mean age was 32 years (range, 20-45 y). INTERVENTIONS: All participants were evaluated with neurologic examination to define the level and severity of injury. BMR was determined by indirect calorimetry, and BMD was determined by dual-energy x-ray absorptiometry (DXA). Patients were allocated to osteoporotic, osteopenic, and normal bone density groups according to World Health Organization criteria. DXA was used also to estimate lean- and fat-tissue mass (in kilograms) by standard methods. DXA measurements were performed on the same day as BMR analysis. MAIN OUTCOME MEASURES: DXA and indirect calorimetry. RESULTS: BMR correlated significantly with BMD of the total femur, femur neck, trochanter, and shaft. However, there was no correlation between BMR and femur Ward's triangle. These correlations were stronger in patients with tetraplegia. There was a moderate correlation between BMR and lean tissue mass (r = .66, P < .001), although femur BMD values did not correlate with lean tissue mass in our study group (P > .05). CONCLUSIONS: BMR is closely associated with BMD in men with SCI.

Comparison of a generic and a disease specific quality of life scale to assess a comprehensive spa therapy program for knee osteoarthritis.

OBJECTIVES: To compare the differences or correlation between the results obtained from a generic and a disease-specific instrument for the study group and to assess the short-term effects of spa therapy on quality of life of patients with knee osteoarthritis. PATIENTS AND METHODS: Fifty patients with knee osteoarthritis were randomly recruited. They underwent a comprehensive spa therapy program for 21 days. Forty-six patients completed the study. The results were evaluated with Medical Outcomes Study 36-Item Short Form-36 (SF-36) and Arthritis Impact Measurement Scale 2 (AIMS2). RESULTS: Statistically significant improvement was observed in all subscales of SF-36. All subscales of AIMS2 improved too, but only half of them were significant. Correlation between matching subscales of each test was also significant, except physical activity. CONCLUSION: Comprehensive spa therapy seems to increase the quality of life of patients with knee osteoarthritis for short term.

Bone density loss after spinal cord injury: elite paraplegic basketball players vs. paraplegic sedentary persons.

OBJECTIVE: To compare the bone mineral density of elite paraplegic basketball players with the values obtained from their paraplegic sedentary counterparts. DESIGN: A total of 17 male paraplegic basketball players and 17 male paraplegic sedentary persons were included in the study. Bone mineral densities of the distal third of radius of the dominant arm, L2-L4 spine, and trochanters, Ward's triangles, and the femoral necks of both hips were measured. RESULTS: The densities of trochanters, Ward's triangles, and the femoral necks were found to be decreased in both groups, with no significant difference between them. The densities of lumbar and radial regions were found to be increased in both groups. Radial density was significantly higher in paraplegic basketball players than in paraplegic sedentary patients, whereas the groups were not significantly different for lumbar density. CONCLUSIONS: Wheelchair basketball in spinal cord-injured patients was associated with greater bone density in distal radius compared with sedentary paraplegics. However, it was not associated with greater density below the injury level.

Efficacy of isokinetic exercise on functional capacity and pain in patellofemoral pain syndrome.

OBJECTIVE: To assess the effect of an isokinetic exercise program on symptoms and functions of patients with patellofemoral pain syndrome. DESIGN: A total of 22 consecutive patients with the complaint of anterior knee pain who met the inclusion criteria were recruited to assess the efficacy of isokinetic exercise on functional capacity, isokinetic parameters, and pain scores in patients with patellofemoral pain syndrome. A total of 37 knees were examined. Six-meter hopping, three-step hopping, and single-limb hopping course tests were performed for each patient with the measurements of the Lysholm scale and visual analog scale. Tested parameters were peak torque, total work, average power, and endurance ratios. RESULTS: Statistical analyses revealed that at the end of the 6-wk treatment period, functional and isokinetic parameters improved significantly, as did pain scores. There was not statistically significant correlation between different groups of parameters. CONCLUSION: The isokinetic exercise treatment program used in this study prevented the extensor power loss due to patellofemoral pain syndrome, but the improvement in the functional capacity was not correlated with the gained power.