The effect of a flexible pylon system on functional mobility of transtibial amputees. A prospective randomized study.

BACKGROUND: Prosthetic component selection strongly influences the functional mobility of transtibial amputees. Until now, little attention has been paid to the connection between the prosthetic socket and the foot component. AIM AND DESIGN: Aim of this study was to compare a novel flexible with a conventional rigid pylon system in a prospective randomized trial in transtibial amputees to determine effects on gait and mobility. SETTING: The study was performed in a rehabilitation centre for geriatric amputees. POPULATION: Twenty-eight geriatric unilateral transtibial amputees (8 female, 20 male) with low degree of mobility were included. METHODS: At admission to the rehabilitation centre objective and subjective parameters were assessed including demographic data and levels of daily activity using standardized questionnaires. Three months after prosthetic fitting a follow-up was performed and additional parameters such as walking speed, step length and vertical ground reaction forces were examined using a dynamic gait analysis. RESULTS: The study revealed a significant improvement in step length (P=0.03), in using mobility aids (P=0.04) and benefits concerning the self-selected gait speed, the mobility and gait disorders using the flexible device. CONCLUSION: The results demonstrate advantages for the flexible system, resulting in a positive effect on the patient's gait accomplishments in a geriatric population. CLINICAL REHABILITATION IMPACT: The advantages of the dynamic pylon may improve clinical rehabilitation, especially for geriatric patients with vascular disorders, as it provides comfort and better prosthetic performance during gait as a short-term benefit and thus gives a better quality of life in the long-term.

Coping with amputation and phantom limb pain.

Phantom limb pain is a common, distressing phenomenon that can occur after the amputation or denervation of a part of the body. No conclusive etiological models or theories have emerged, although the problem was identified some time ago. This empirical-diagnostic study deals with correlations between coping with limb loss, body image, and the occurrence of phantom limb pain. It is based on Melzack's concept of a neuromatrix. Coping strategies were evaluated using semistructured interviews and analysis of patients' drawings of their body images. The results of the study, based on 43 amputees, show a significant association between coping strategies and pain. Patients who cope better with the loss suffer less from phantom limb pain. A difference can also be noted in subjective representation of the body image: patients suffering from phantom limb pain tend to have an image of their bodies as a complete and undamaged entity.

Silicone soft socket system: its effect on the rehabilitation of geriatric patients with transfemoral amputations.

OBJECTIVE: To report the effect of supplying new transfemoral amputee patients with a prosthesis with a silicone suspension/interface system. PATIENTS AND DESIGN: Fifty-eight new transfemoral amputee patients were supplied with a contoured adducted trochanteric-controlled alignment method (CAT-CAM) socket (CCS) with a silicone suspension/interface system. This system is called the Icelandic roll-on silicone socket, or the ICEROSS system (IRS). A second group of 18 new amputee patients were supplied with an unlined CCS (uCCS), ie, without silicone sleeve suspension. MEASURES: The IRS group was followed up at 1 year, the uCCS group at 9 months. Ambulatory capacity was investigated by first categorizing patients' prosthetic mobility into four different groups based on the distances patients were able to ambulate: 0 m (wheelchair ambulation only), <100 m, 100 to 500 m, and >500 m. The change in distance ambulated was then determined for each group for the three time intervals between admission, discharge, and follow-up. RESULTS: Between discharge and follow-up patients with the IRS had a significantly greater improvement (p<.001) in distance traversed than patients supplied with the uCCS. Distance traversed had been longer in the uCCS group before they were supplied with the prostheses (p<.05). Inpatient stay in the rehabilitation center was 5 days less in the group supplied with IRS (p<.05). Adjustments to the new socket had to be carried out for 67% of the uCCS group during the observation period, compared with only 21% for those using the IRS system. Satisfaction, average duration of daily use, and the use of assistive devices for gait did not differ significantly. CONCLUSIONS: New patients with transfemoral amputations fitted with a silicone suction socket showed greater gains in distances ambulated, and adjustments to their prostheses were significantly fewer. Therefore, it is preferable to provide these sockets to geriatric amputee patients rather than CAT-CAM sockets without silicone suspension sleeves.

[Surgical amputation and prosthetic management in congenital fibrosarcoma of the lower extremity]. / Amputationschirurgisches Management und Prothesenversorgung bei kongenitalem Fibrosarkom der unteren Extremität.

The concept of surgical amputation and the problems of prosthetic management in a girl with congenital fibrosarcoma of left distal thigh, knee and shank is described. After failed polychemotherapy (EICESS 92) and expansion of the tumor a radical knee disarticulation and intended marginal resection of the tumorous soft tissue area of the distal thigh was performed at the age of eleven months and two weeks. The femur was shortened by osteotomy of the diaphysis and removing a fragment in order to protect the distal femoral epiphyseal growth plate and to be able to close the soft tissue of the stump primarily. Prosthetic fitting and rehabilitation started at the beginning of statomotorical development at the point when four feet standing changed into two feet standing. In present, at the age of two years and six months, this girl is independent mobile and well fitted with a knee disarticulation prosthesis.

Fluorescence guided excimer laser ablation of intervertebral discs in vitro.

Laser induced fluorescence of intervertebral discs was investigated in this study for the first time in order to develop a fluorescence guided percutaneous excimer laser discectomy. For this purpose 35 human cadaveric intervetebral discs from level L1 to L5 were irradiated with a 308 nm XeCl excimer laser with a 60 nsec pulse width at 10, 20 and 30 mj/mm2. Laser light was transmitted over a 1000 microns core optical fiber. Fluorescence emitted from the irradiated tissue was transmitted back over the same fiber over a semireflective mirror to another optical fiber, coupled into a spectrograph and O-SMA optical simultaneous multichannel spectral analyzer system. The spectral lineshape of both the annulus fibrosus and the nucleus pulposus was characterized by a broadband emission between 320 nm and 616 nm with 3 peak emissions at 358, 423 and 457 nm. Relative intensities were calculated by forming two ratios of the peak intensities of the three peaks (R1 = I 423/I 358; R2 = I 423/I 457). Statistical analysis of both ratios revealed a highly significant discrimination between annulus fibrosus and nucleus pulposus (P less than 0.001). Under penetrating conditions multiple recorded spectra showed the spectral profile of subsequently ablated nucleus and annulus. The results of this study demonstrate that discrimination between annulus fibrosus and nucleus pulposus by excimer laser-induced fluorescence is feasible under laboratory conditions. Fluorescence spectroscopy could possibly be developed into a valuable guiding system for percutaneous laser discectomy.

[The incidence of recurrence of intra- and extra-lesional operated metastases of long tubular bones]. / Die Rezidivhäufigkeit von intra- und extraläsional operierten Metastasen langer Röhrenknochen.

Using a collective of 54 patients with 76 operated metastases of long bones in carcinoma of the breast and kidney the frequency of local recurrence after intralesional and extralesional (marginal, wide, radical) resection was investigated. 57 operations were done intralesional, 19 extralesional. Local recurrence was seen in 50.8% in the intralesional group on the other hand in only 15% in the extralesional group (p 0.007). Relief of pain was similar in both groups. The postoperative range of motion had worse results after extralesional resection and endoprosthetic replacement. There was no difference between both groups in the manifestation of further metastases.

[Management of the administration of leucovorin calcium in high-dose methotrexate therapy]. / Zur Handhabung der Applikation von Leucovorin-Calcium bei hochdosierter Methotrexat-Therapie.

At the Orthopaedic University Hospital Vienna, neoadjuvant chemotherapy with high-dose methotrexate (MTX) has been applied since 1975 in patients with osteosarcoma. Since 1977 the hospital has been a participant in the Cooperative German-Austrian Study on Osteosarcoma (COSS, 77, 80, 82, 85, 86). Therapeutic results and incidence of side effects are reviewed at regular intervals. Over a 2-year period (1/86 to 12/87), a total of 1999 g MTX were given to 15 patients in 102 therapeutic cycles. In patients treated with MTX in our hospital, only minor intolerance phenomena occurred, owing to careful leucovorin monitoring. Intoxications of up to grade III (modified WHO-score) have been seen in only a few patients. The management of the administration of leucovorin (leucovorin calcium, calcium folinate, INN; citrovorum factor) which is directly dependent on the serum level of MTX, is exactly shown in the discussion.

[Epicondylitis humeri radialis with special reference to the Wilhelm operation]. / Die Epicondylitis humeri radialis unter besonderer Berücksichtigung der Operation nach Wilhelm.

48 cases of epicondylitis humeroradialis were treated by means of an operation described by Wilhelm at the Orthopaedic Department of the University of Vienna between 1975 and 1979. They received a POP back slab for the upper arm for one week. Average time required to reach a pain-free state was three months (minimum two weeks, maximum six months). The follow-up examination at least five years later, taking clinical and subjective parameters into consideration, showed very good the satisfactory results in 93.2% and non-satisfactory results in the remaining 6.6% of cases.