Anchoring flap suture technique to repair a wound with exposed bone after hip disarticulation: a case report and brief review of the literature.

BACKGROUND: In specific clinical scenarios characterized by poor tissue conditions surrounding a wound, achieving stable flap fixation with standard sutures can be challenging. The anchoring flap suture technique, which is commonly used for soft tissue-to-bone attachment in cases of injury, may be an alternative and effective approach. CASE REPORT: This report describes the successful application of the anchoring flap suture technique to repair a wound with exposed bone in a 39-year-old female patient. She presented with a 7% TBSA wound of the left trunk following hip disarticulation. After 4 operations, a wound with exposed iliac bone remained. Given the compromised condition of the tissues surrounding the exposed bone, the authors opted to anchor a local flap directly to the exposed bone. Steady flap fixation was achieved using the anchoring flap suture method, resulting in complete healing of that wound. Remarkably, no short- or long-term complications associated with the flap were observed. Three months after hospital discharge, the patient regained mobility, walking on 1 leg with the assistance of a 4-legged walker. CONCLUSION: The anchoring flap suture technique seems to be a reliable and effective treatment option, particularly in cases in which inadequate soft tissue precludes the use of traditional flap fixation using standard sutures.

Surgical Techniques for Performing a Through-Knee Amputation: A Systematic Review and Development of an Operative Descriptive System.

BACKGROUND: Through-knee amputation (TKA) carries potential biomechanical advantages over above knee amputation (AKA) in patients unsuitable for a below-knee amputation. However, concerns regarding prosthetic fit, cosmesis and wound healing have tempered enthusiasm for the operation. Furthermore, there are many described surgical techniques for performing a TKA. This frustrates attempts to compare past and future comparative data, limiting the opportunity to identify which procedure is associated with the best patient centered outcomes. The aim of this systematic review is to identify all the recognized operative TKA techniques described in the literature and to develop a clear descriptive system to support future research in this area. METHODS: A systematic review was performed, searching the OVID, PubMed, and Cochrane Library databases, according to Cochrane and PRISMA guidelines. Papers of any design were included if they described an operative technique for a TKA. Key operative descriptions were captured and used to design a classification system for surgical techniques. RESULTS: A total of 906 papers were identified, of which 28 are included. The most important distinctions in operative technique were the level of division of the femur (disarticulation without bone division, transcondylar amputation, with or without shaving of the medial, lateral, and posterior condyles and supracondylar amputation), management of the patella (kept whole, partially preserved, completely removed), use of a muscular gastrocnaemius flap, and skin incisions. A 4-component classification system was developed to be able to describe TKA operative techniques. A suggested shorthand nomenclature uses the first letter of each component (FPMS; Femur, Patella, Muscular flap, Skin incision), followed by a number, to describe the operation. Patient outcomes were poorly reported, and therefore outcomes for different types of TKA are not addressed in this review. CONCLUSIONS: A novel descriptive system for describing different techniques for performing a TKA has been developed. This classification system will help in reporting, comparing, and interpreting past and future studies of patients undergoing TKA.

User-relevant factors influencing the prosthesis use of persons with a transfemoral amputation or knee-disarticulation: A meta-synthesis of qualitative literature and focus group results.

OBJECTIVE: Persons with a transfemoral amputation or knee-disarticulation are heavily reliant on an adequate set of components for their prosthesis. To improve the process of adjusting the specific prosthetic properties to the expectations of the prosthesis users, it is of importance to first identify which factors have an influence on prosthesis use. Therefore, we aimed to identify factors that influence prosthesis use in adults with a transfemoral amputation or knee-disarticulation. METHODS: A qualitative meta-synthesis was conducted by searching five databases (last update January 20th 2022). Studies were considered eligible if they contained qualitative data about adult persons with a transfemoral amputation or knee-disarticulation with experience in using a prosthesis and focused on the users' opinions. All eligible studies were independently screened by two reviewers. The results sections of the included studies were entered in Atlas.ti software (v8) and coded using the framework approach. The quality of the included studies was assessed using the Critical Appraisal Skills Program (CASP) qualitative research checklist. Results of the meta-synthesis were validated with prosthesis users (n = 8) in a focus group. RESULTS: Out of 5757 articles, 14 studies were included. An overview of seven themes ('prosthesis related'; 'rehabilitation, costs and prosthetist'; 'mental'; 'physical'; 'social'; 'activities and participation' and 'walking') containing 84 factors was created. Ten factors were added during the focus group, resulting in an overview of 94 factors that may influence the prosthesis use of lower-limb prosthesis users. Participants would like more user-involvement from the rehabilitation team. The development of a patient decision aid could help this process in the future. CONCLUSION: The large number of factors demonstrates that there is a great variety between prosthesis users and the factors that influence their prosthesis use. Therefore, it is important to take individual preferences into account for the selection of a new prosthesis.

Primer reporte de una cirugía ortopédica en Cienfuegos, historia de un caso del siglo XIX / First Report Of An Orthopedic Surgery In Cienfuegos, History Of A Case Of The XIX Century

En el trabajo se describe una desarticulación escápulo-humeral y probablemente la primera cirugía ortopédica realizada en Cienfuegos. La operación fue dirigida por Luis Perna de Salomó en un período con grandes avances en la rama de la medicina. En el estudio se emplean métodos de la investigación histórica como el heurístico, para la búsqueda de información documental relacionada con el suceso; el histórico-lógico, junto al inductivo-deductivo y el analítico-sintético, entre otros. Esta intervención quirúrgica fue de relevancia local por el alto nivel científico que precisaba su ejecución y confirma la necesidad de estudiar las técnicas y prácticas médicas empleadas en Cienfuegos durante el siglo XIX(CU)

The paper describes the performance of what was probably the first orthopedic surgery in Cienfuegos: a scapulo-humeral disarticulation. The surgery was performed by a group of doctors headed by Luis Perna de Salomó, in a period in which great advances were taking place in the branch of medicine. In this study, historical research methods are used, such as the heuristic -in search of locating primary and secondary documentary information related to the event-, the historical-logical, together with the inductive-deductive and the analytical-synthetic, among others. The surgical intervention carried out, due to its local relevance and the high scientific level that needed to be mastered to perform it, evidences the need to study the medical techniques and practices used in Cienfuegos on that date, which, as can be seen, were at the height of those carried out in the capital of the island. Due to the local relevance it had, and the high scientific level that needed to be mastered to perform it, this surgical intervention evidences the need to study the medical techniques and practices used in Cienfuegos on that date, which, as can be seen, were at the height of those made in the capital of the island(CU)

Protetización temprana y seguimiento de paciente pediátrico con hemimelia tibial / Early Fitting and Follow-Up of A Pediatric Patient with Tibial Hemimelia

Introducción: La hemimelia tibial es una entidad poco frecuente, presente hasta en 1:1.000.000 nacidos vivos. Tiene una asociación genética autosómica recesiva, y se presenta con cambios en la morfología del miembro inferior con una tibia ausente o presente parcialmente, además de cambios en peroné, rodilla y pie. Según su clasificación se puede manejar con reconstrucción quirúrgica de la extremidad o amputación. La posibilidad de una prótesis temprana favorece el resultado funcional del paciente y su adaptación protésica. Objetivo: Presentar el caso de una entidad poco común tratada con desarticulación a nivel de la rodilla y prótesis por su grado de compromiso. Presentación de caso: Paciente femenina de tres años con compromiso del miembro inferior derecho. Los primeros años usó una prótesis artesanal fabricada por su familia. Fue valorada por la Junta Médica de rehabilitación y ortopedia que decidió intervención quirúrgica para desarticulación de la rodilla. Se realizó protetización temprana en busca de beneficios de cicatrización, control del edema y adaptación postquirúrgica. Se realizan controles posteriores con ajustes a la prótesis de acuerdo con las necesidades propias de la edad de la paciente. Conclusiones: Se muestra una adecuada evolución postquirúrgica, sin dolor o neuropatía, con un reinicio temprano de la marcha y progreso adecuado de su neurodesarrollo e integración social, lo que da una pauta de manejo en paciente pediátrico con este tipo de deformidades(AU)

Introduction: Tibial hemimelia is a rare entity, reported in up to 1:1,000,000 live births. It has an autosomal recessive genetic association, and it presents with changes in the morphology of the lower limb with an absent or partially present tibia, as well as changes in the fibula, knee, and foot. Depending on its classification, it can be managed with surgical reconstruction of the limb or amputation. The possibility of an early prosthesis favors the functional result of the patient and his prosthetic adaptation. Objective: To report the case of a rare entity treated with knee disarticulation and prosthesis due to its degree of compromise. Case report: The case of a three-year-old female patient with compromise of the lower right limb is reported here. The first years she used a handmade prosthesis made by her family. She was assessed by the Medical Board of Rehabilitation and Orthopedics, which decided to undergo surgery for knee disarticulation. Early fittings were performed in search of healing benefits, edema control and post-surgical adaptation. Subsequent controls were carried out with adjustments to the prosthesis according to the needs of the patient's age. Conclusions: An adequate post-surgical evolution is shown, without pain or neuropathy, with early resumption of gait and adequate progress of their neurodevelopment and social integration, which provides recommendation for management in pediatric patients with this type of deformity(AU)

Knee disarticulation following oncologic total knee arthroplasty: A 5-year follow-up case report.

BACKGROUND: The present case report describes the 5-year follow-up results of an atypical knee disarticulation of a man previously treated with an oncologic total knee arthroplasty due to an Ewing sarcoma. METHODS: The patient presented an aseptic loosened tibial component of a tumor prosthesis system and requested final amputation, as he had previously suffered from five revision surgeries. To encourage the most functional outcome regarding an exoskeletal prosthesis, we decided to disarticulate the knee joint while retaining the currently fixed femoral component to create a full end-bearing stump. FINDINGS: The patient could be mobilized as a functional knee disarticulated amputee. Seven months after amputation, he showed a slightly less symmetrical gait compared to the preoperative status (preoperative mean Symmetry Index: 0.984 for kinematics and 0.940 for kinetics, 7-month postoperative Symmetry Index: 0.858 and 0.915). At the 5-year follow-up, the femoral component is still stably fixated and shows no loosening signs. In addition, the Symmetry Index increased to 0.908 and 0.949. INTERPRETATION: Even after 5 years, the presented amputation appears to be consistent with "conventional" knee disarticulation. The femoral component still withstands the altered loads and the patient shows a further improved gait pattern.

A review of through-knee amputation.

OBJECTIVES: Through-knee amputation is an umbrella term for several different surgical techniques, which may affect clinical and functional outcomes. This makes it hard to evaluate the benefits and need for a through-knee amputation approach. This article seeks to (1) determine the number of through-knee amputation performed compared with other major lower limb amputations in England over the past decade; (2) identify the theoretical concepts behind through-knee amputation surgical approaches and their potential effect on functional and clinical outcomes and (3) provide a platform for discussion and research on through-knee amputation and surgical outcomes. METHODS: National Health Service Hospital Episodes Statistics were used to obtain recent numbers of major lower limb amputations in England. EMBASE and MEDLINE were searched using a systematic approach with predefined criteria for relevant literature on through-knee amputation surgery. RESULTS: In the past decade, 4.6% of major lower limb amputations in England were through-knee amputations. Twenty-six articles presenting through-knee amputation surgical techniques met our criteria. These articles detailed three through-knee amputation surgical techniques: the classical approach, which keeps the femur intact and retains the patella; the Mazet technique, which shaves the femoral condyles into a box shape and the Gritti-Stokes technique, which divides the femur proximal to the level of the condyles and attaches the patella at the distal cut femur. CONCLUSIONS: Through-knee amputation has persisted as a surgical approach over the past decade, with three core approaches identified. Studies reporting clinical, functional and biomechanical outcomes of through-knee amputation frequently fail to distinguish between the three distinct and differing approaches, making direct comparisons difficult. Future studies that compare through-knee amputation approaches to one another and to other amputation levels are needed.

Emergency hip disarticulations for severe necrotising fasciitis of the lower limb: a series of rare cases from a rural district general hospital.

Hip disarticulation is the removal of the entire lower limb through the hip joint by detaching the femur from the acetabulum. This major ablative procedure is rarely performed for infection but may be required in severe necrotising fasciitis. We present a single centre retrospective review of all cases of emergency hip disarticulations in patients with necrotising fasciitis between 2010 and 2020. All five patients included in the review presented with acute lower limb pain and sepsis. Three patients had comorbidities predisposing them to necrotising fasciitis. Three were deemed to be high risk and two were at intermediate risk of developing necrotising fasciitis. There were two deaths in the postoperative period. Of the three survivors, two required revision surgery for a completion hindquarter amputation and one for flap closure. All three survivors had good functional outcomes after discharge from hospital. Despite its associated morbidity, emergency amputation of the entire lower limb is a life-saving treatment in cases of rapidly progressing necrotising fasciitis and should be considered as a first-line option in managing this condition.

Reviving the debate: Articular cartilage preservation during disarticulation at the lower limb? A systematic review.

BACKGROUND: The need for preservation(P) or removal(R) of articular cartilage during disarticulations remains unanswered. METHODS: Medline database was used to conduct a systematic review regarding all types of minor disarticulations and some types of major disarticulations in patients with diabetes mellitus, peripheral arterial disease or trauma related disarticulations. Fisher-exact statistical test was used to perform calculations for the entire group as for subgroups. RESULTS: A total of 444 disarticulations at the Chopart joint, ankle and knee were included (P = 255 vs. R = 189). There was no difference in wound healing, functionality and mortality. Reamputation rate was lower in the P-group (9.4% vs. 16.9%). Infection rate was not significantly different. Differences in reamputations (R = 10.6% vs. P = 1.0%) and infections (R = 4.4% vs. P = 22.6%) were only present for the ankle subgroup. CONCLUSIONS: There is no difference in wound healing, functionality and mortality between the preservation and removal of articular cartilage in the lower limb.

Severe polymicrobial and fungal periprosthetic osteomyelitis persisting after hip disarticulations treated with caspofungin in risk patients: a case series.

BACKGROUND: Periprosthetic fungal infections are considered rare and opportunistic infections. Treatment is difficult, and established standards do not yet exist. The choice of the appropriate antifungal drug might affect the patient outcome. CASES: All the three cases presented showed polybacterial recurrent infection of the revision hip arthroplasty. All patients were of younger age, had multiple revisions of the endoprosthesis, each had a large partial femoral replacement greater than 40% of the femoral length, gentamycin-loaded cement, and a long anchoring distance of the used intramedullary stem. Due to the severe life-threatening infection with deep osteomyelitis, an amputation had to be performed. However, despite surgical intervention, the fungal dominated infection persisted. Finally, only the use of caspofungin allowed permanent infection control. CONCLUSION: The polybacterial infection is driven by the symbiosis between fungi and bacteria. Therefore, eradication of the fungus is required to achieve elimination of the bacteria. Antimycotics of the echinocandin-class, such as caspofungin, may be considered as initial treatment.

Targeted muscle reinnervation following external hemipelvectomy or hip disarticulation: An anatomic description of technique and clinical case correlates.

BACKGROUND: Targeted muscle reinnervation (TMR) has been shown to decrease or prevent neuropathic pain, including phantom and residual limb pain, after extremity amputation. Currently, a paucity of data and lack of anatomical description exists regarding TMR in the setting of hemipelvectomy and/or hip disarticulations. We elaborate on the technique of TMR, illustrated through cadaveric and clinical correlates. METHODS: Cadaveric dissections of multiple transpelvic exposures were performed. The major mixed motor and sensory nerve branches were identified, dissected, and tagged. Amputated peripheral nerves were transferred to identified, labeled target motor nerves via direct end-to-end nerve coaptations per traditional TMR technique. A retrospective review was completed by our multi-institutional teams to include examples of clinical correlates for TMR performed in the setting of hemipelvectomies and hip disarticulations. RESULTS: A total of 12 TMR hemipelvectomy/hip disarticulation cases were performed over a 2 to 3-year period (2018-2020). Of these 12 cases, 9 were oncologic in nature, 2 were secondary to traumatic injury, and 1 was a failed limb salvage in the setting of chronic refractory osteomyelitis of the femoral shaft. CONCLUSIONS: This manuscript outlines the technical considerations for TMR in the setting of hemipelvectomy and hip disarticulation with supporting clinical case correlates.

Hip disarticulation with pedicled total leg fillet flap for recurrent fungating sarcoma.

Soft tissue sarcomas may be treated with limb-sparing procedures in the majority of cases; however, certain cases involving significant tumor spread and fungation may call for amputation. In the thigh, hip disarticulation typically involves a pedicled gluteus maximus flap or a pedicled anterior quadriceps flap. In this case report, we describe a rare situation in which the anterior flap, posterior flap, and adductor flap musculature were contaminated with tumor; therefore, a hip disarticulation was performed applying a pedicled total leg fillet flap for closure. Eighteen months after treatment, the patient continues to have no local recurrence of disease, a stable flap site, and ambulates with a walker. We present this amputation and closure method as a potentially effective modality in treating extensive oncologic disease of the proximal lower extremity.

Extra-articular resection of shoulder joint for bone sarcomas: Oncologic and limb-salvage outcomes of 32 cases compared with shoulder disarticulation and forequarter amputation.

BACKGROUND AND OBJECTIVES: We aimed to identify the overall survival (OS), surgical complications, survival of reconstruction, and functional outcome of patients who underwent extra-articular resection of the shoulder joint for primary bone sarcomas. The OS and local recurrence rates in patients who underwent an amputation were also evaluated for comparison. METHODS: Thirty-two patients treated between 1988 and 2017 were studied. The tumours were located in the humerus in 22 (69%) and scapula in 10 patients (31%). The resection types were Malawer type IV in 6 (19%), type V in 21 (66%), and type VI in 5 patients (15%). Reconstruction was performed with endoprosthesis in 23 patients (72%) while excision arthroplasty with the suspension of the humerus to the clavicle was performed in 9 patients (28%). Surgical margins were wide in 16, marginal in 8, intralesional in 3, and not available in 5 patients. During the study period, 40 patients underwent a forequarter amputation and 11 patients underwent a shoulder disarticulation. RESULTS: The 5-year OS for patients who underwent extra-articular resection of the shoulder joint was 42% which was not statistically different compared with that of patients who underwent amputation (5-year OS = 30%; P = .091). The 5-year survival of the reconstruction was 94%, similar for endoprosthesis and excision arthroplasty. Local recurrence and complications developed in 6 (19%) and 10 patients (31%), respectively. Failures of the reconstruction requiring revision surgery occurred in two patients (6%). Limb salvage was achieved in 30 patients (94%). The median Musculoskeletal Tumour Society functional score was 61% (interquartile range, 57%-70%) and was similar in the endoprosthesis and excision arthroplasty group. CONCLUSIONS: Extra-articular resection of the shoulder joint for bone sarcomas is an effective limb-salvage method. However, local recurrence remains a principal concern.

[Severe acute limb ischemia resulting in rescue disarticulation in a patient with Nicolau syndrome following intramuscular penicillin injection: a case report]. / Ischémie aiguë de membre sévère sanctionnée par désarticulation de sauvetage dans un contexte de syndrome de Nicolau suite à une injection intramusculaire de pénicilline: à propos d'un cas.

We here report the case of a 9-year-old child suffering from Nicolau syndrome involving the left pelvic limb with severe acute limb ischemia following intramuscular benzathine penicillin injection into the buttock. Given the rarity of acute limb ischemia in children, this case of complicated Nicolau syndrome combining acute arterial thrombosis and severe rhabdomyolysis leading to rescue hip dislocation is very interesting.

Lower Extremity Surgical Treatment to Improve Function in a Patient with Gollop-Wolfgang Complex: A Case Report.

CASE: Gollop-Wolfgang Complex (GWC) includes congenital absence of the tibia with ipsilateral distal femur bifurcation associated with hand/foot ectrodactyly. A 20-month-old male presented with GWC, including left bifid distal femur with ipsilateral tibial hemimelia and absent extensor mechanism, hypoplastic bilateral thumbs, and right foot tarsal-type preaxial polydactyly. Left through-knee amputation preserving growth and contralateral polydactyly reconstruction were performed. Complications of wound infection and dehiscence were successfully treated. Patient is 44 months old and ambulating with left knee disarticulation prosthesis and right supramalleolar orthosis. CONCLUSIONS: Through-knee amputation and prosthetic fitting provides limb function for GWC patients with tibial hemimelia lacking an extensor mechanism.

Free fillet lower leg flap for coverage after hemipelvectomy or hip disarticulation.

INTRODUCTION: Tumor resection is the gold standard treatment for soft tissue and bone sarcomas. In the pelvis, this may require a hemipelvectomy that can compromise primary skin closure. Flaps are essential in this context; however the vascularization of potential pedicled flaps may have been removed during tumor excision. Using healthy tissue from the amputated limb as a free flap is an excellent coverage option. HYPOTHESIS: The free fillet flap from an amputated lower limb is a simple and reliable coverage technique after hemipelvectomy or hip disarticulation. MATERIAL AND METHODS: Seven patients were operated on at three specialty centers: six transpelvic amputations (external hemipelvectomy) and one hip disarticulation. In three cases, the flap consisted of the superficial posterior compartment of the calf area and in the three other cases, the lower leg compartments with the fibula and its intact periosteum. Complications were documented. RESULTS: Clear resection margins were achieved in all patients. The mean follow-up at the final visit was 13 months (range, 6.5 to 21 months). Six patients had complications but only one resulted in loss of the flap. Four patients were able to be fitted with a hip prosthesis. DISCUSSION: The free fillet flap from an amputated lower limb is a reliable coverage technique (86%) after hemipelvectomy or hip disarticulation. In the 16 cases previously reported in the literature, there were no wound-healing failures. Local flaps are often too fragile with insufficient muscular padding. This free flap is the preferred first-line technique as it spares other potential free flaps in case of failure without increasing the morbidity of a procedure that is already extensive. This coverage technique should be one the options considered after external hemipelvectomy. LEVEL OF EVIDENCE: IV, retrospective study.

Long-term symptoms and function after war-related lower limb amputation: A national cross-sectional study.

OBJECTIVE: The aim of this study was to document long-term symptoms and functional results following war-related knee disarticulation, trans-femoral amputation, and hip disarticulation. METHODS: An observational cross-sectional study was conducted in a 7-day recreational camp in Iran. One thousand patients with unilateral hip disarticulation, trans-femoral amputation and knee disarticulation due to war-related injuries were invited to undergo a thorough physical examination. Among the invited persons, 58.7% (587 subjects) responded to our invitations. A complete examination related to phantom pain, phantom sensation, stump pain, back pain, and sound limb joints pain with a self-constructed questionnaire was performed. In addition, Amputee Mobility Predictor (AMP) instrument with a prosthesis was completed to assess the function of patients. RESULTS: The mean duration of time since amputation was 22 years. The most common symptoms reported by participants were phantom sensation (82%), back pain (69%), and phantom pain (63%). In addition, total scores of AMP with a prosthesis in persons with knee disarticulation and trans-femoral amputations were 20.8 and 28, respectively. The knee disarticulation was associated with higher scores of AMP with a prosthesis compared to transfemoral amputation (p < 0.01). CONCLUSION: The results of this study showed that patients with lower limb amputation suffer from significant clinical and functional problems. The findings may be useful to adopt new strategies in planning rehabilitation programs to improve quality of life and health status of patients with war-related lower limb amputation. LEVEL OF EVIDENCE: Level IV, Therapeutic study.

Diseño de exoesqueletos para miembro inferior / Exoskeleton design for lower limb

Introducción: La desarticulación de cadera es realizada por cirujanos para prevenir el crecimiento de enfermedades malignas en casos que no pueden ser tratados en forma conservadora. Existe la posibilidad que la desarticulación pueda ser causada por un accidente traumático que comprometa uno o los dos miembros inferiores. Objetivo: modificar el diseño de una prótesis para personas con problemas de tensión muscular, para cargas pesadas y movimientos repetitivos, para ser usada en personas con desarticulación unilateral o bilateral de cadera, partiendo de la patente de invención. Métodos: El diseño se realizó teniendo en cuenta desplazamiento similar al sistema locomotor humano, el confort, las posibles lesiones en las prominencias óseas, la repetitividad y el bajo costo. Para garantizar el menor impacto en la prominencia ósea disminuyendo el riesgo de ruptura o ulceras se usó un escáner 3D con sensores de presión para una correcta distribución de la presión sobre toda la prominencia de la cadera. Resultados: El sistema propuesto resultó en una alternativa para personas con limitaciones de movilidad en miembro inferior permitiendo un movimiento más natural y así mejorar la calidad de vida de este tipo de pacientes. La técnica permitió al usuario un alto nivel de independencia en situaciones de pérdida de los miembros inferiores. Conclusiones: El estudio se centró en la modificación de una prótesis para miembro inferior usado para personas con baja tonicidad muscular o actividades repetitivas a un sistema para personas con desarticulación bilateral de cadera o pérdida de un solo miembro inferior(AU)

Introduction: Hip disarticulation is performed by surgeons to prevent the growth of malignant diseases in cases that can not be treated conservatively. There is a possibility that the disarticulation may be caused by a traumatic accident involving one or both lower limbs. Objective: to modify the design of a prosthesis for people with muscular tension problems, for heavy loads and repetitive movements, to be used in people with unilateral or bilateral hip disarticulation, starting from the patent of invention. Methods: The design was made taking into account displacement similar to the human locomotor system, comfort, possible lesions in bony prominences, repetitiveness and low cost. To guarantee the least impact on the bone prominence, reducing the risk of rupture or ulcers, a 3D scanner with pressure sensors was used to correctly distribute the pressure over the whole hip prominence. Results: The proposed system resulted in an alternative for people with mobility limitations in the lower limb allowing a more natural movement and thus improving the quality of life of this type of patients. The technique allowed the user a high level of independence in situations of loss of the lower limbs. Conclusions: The study focused on the modification of a lower limb prosthesis used for people with low muscle tone or repetitive activities to a system for people with bilateral hip disarticulation or loss of a single lower limb(AU)

Syme Amputation: A Systematic Review.

BACKGROUND: In the decision-making process toward an amputation of the lower extremity, knowledge about patient-related outcomes after amputation and rehabilitation is important. We have not found a systematic review that provides this knowledge for Syme amputation. The aim of this study was to present an overview of outcomes after a Syme amputation grouped according to the International Classification of Functioning, Disability and Health (ICF) model, focusing on body structures and functions, activities, and participation. METHODS: A systematic literature search was performed. Included studies went through 2 selection procedures by 2 independent assessors. Included were all studies concerning Syme amputation with patient-related outcomes. RESULTS: Thirty-six studies were included for data extraction, concerning 1056 patients (238 children and 818 adults). Heel pad migration was reported in 49 of 176 (28%), skin problems in 23 of 128 (18%), and bone problems in 42 of 145 (29%) children. No reamputations were reported. All children were fitted with a prosthesis, and 62 of 90 (69%) children participated in sports. Skin problems were reported in 35 of 195 (18%), ulceration or infection in 120 of 512 (23%), residual limb pain in 46 of 181 (25%), and reamputations in 180 of 919 (20%) adults. In total, 247 of 363 (68%) adults were fitted with a prosthesis. Walking aids were used by 45 of 135 (33%) adults. Employment status was unchanged in 147 of 209 (72%) adults. CONCLUSION: In children, no reamputations were necessary and few complications were reported, with good participation in daily life in the majority of children. In adults, more complications and reamputations were reported; nevertheless, most adult amputees became successful prosthesis users. LEVEL OF EVIDENCE: Therapeutic Level III, systematic review containing retrospective cohort studies.

Successful First Gait of a Child With Hip-Disarticulation Prosthesis.

An infant boy underwent hip disarticulation for infantile fibrosarcoma immediately after birth. His rehabilitation began when he was 4 mos old and involved training with his left (residual) leg. He could stand with support at 12 mos. His initial prosthesis fitting was performed at the age of 13 mos. He could stand and walk with support at 15 mos of age and could walk with no additional support and go up and down stairs at 2 yrs. A single-axis prosthetic knee joint was introduced at the age of 2 yrs 3 mos. His first gait using a hip prosthesis was successful, and his prosthesis was replaced at appropriate intervals with no major problems. The authors believe that the key to achieving a successful prosthetic gait in children is good communication among the medical team, which should comprise an orthopedic doctor, rehabilitation doctor, nurse, physical therapist, prosthetist/orthotist, and the patient's parents.