Abstract:Background Tibial lengthening is frequently associated with gastrocsoleus contracture and some patients are treated surgically. However, the risk factors associated with gastrocsoleus contracture severe enough to warrant surgery during tibial lengthening and the consistency with which gastrocsoleus recession (GSR) results in a plantigrade foot in this setting have not been well defined. Questions/purposes We compared patients treated with or without GSR during tibial lengthening with respect to (1) clinical ri… Show more
“…The main complications seen, beyond pin site infections, were related to soft-tissue and joint contractures. Including the heel in the frame construct may reduce the risk of equinus contracture, although other methods have also been described to overcome such contracture during tibial lengthening, including pre-emptive soft-tissue release 24 and temporary extra articular arthrodesis. 25 As a retrospective study between two centres, there was no set indication for including the foot in this series.…”
PurposeTo review the initial deformity and subsequent remodelling in posteromedial bowing of the tibia and the outcome of limb reconstruction in this condition.Patients and MethodsIn all, 38 patients with posteromedial bowing of the tibia presenting between 2000 and 2016 were identified. Mean follow-up from presentation was 78 months. A total of 17 patients underwent lengthening and deformity correction surgery, whilst three further patients are awaiting lengthening and deformity correction procedures.ResultsThe greatest correction of deformity occurred in the first year of life, but after the age of four years, remodelling was limited. The absolute leg-length discrepancy (LLD) increased throughout growth with a mean 14.3% discrepancy in tibial length. In the lengthening group, mean length gained per episode was 45 mm (35 to 60). Mean duration in frame was 192 days, with a mean healing index of 42.4 days/cm. Significantly higher rates of recurrence in LLD were seen in those undergoing lengthening under the age of ten years (p = 0.046). Four contralateral epiphysiodeses were also performed.ConclusionPosteromedial bowing of the tibia improves spontaneously during the first years of life, but in 20/38 (53%) patients, limb reconstruction was indicated for significant residual deformity and/or worsening LLD. For larger discrepancies and persistent deformity, limb reconstruction with a hexapod external fixator should be considered as part of the treatment options.Level of evidenceLevel IV (Case series)
“…The main complications seen, beyond pin site infections, were related to soft-tissue and joint contractures. Including the heel in the frame construct may reduce the risk of equinus contracture, although other methods have also been described to overcome such contracture during tibial lengthening, including pre-emptive soft-tissue release 24 and temporary extra articular arthrodesis. 25 As a retrospective study between two centres, there was no set indication for including the foot in this series.…”
PurposeTo review the initial deformity and subsequent remodelling in posteromedial bowing of the tibia and the outcome of limb reconstruction in this condition.Patients and MethodsIn all, 38 patients with posteromedial bowing of the tibia presenting between 2000 and 2016 were identified. Mean follow-up from presentation was 78 months. A total of 17 patients underwent lengthening and deformity correction surgery, whilst three further patients are awaiting lengthening and deformity correction procedures.ResultsThe greatest correction of deformity occurred in the first year of life, but after the age of four years, remodelling was limited. The absolute leg-length discrepancy (LLD) increased throughout growth with a mean 14.3% discrepancy in tibial length. In the lengthening group, mean length gained per episode was 45 mm (35 to 60). Mean duration in frame was 192 days, with a mean healing index of 42.4 days/cm. Significantly higher rates of recurrence in LLD were seen in those undergoing lengthening under the age of ten years (p = 0.046). Four contralateral epiphysiodeses were also performed.ConclusionPosteromedial bowing of the tibia improves spontaneously during the first years of life, but in 20/38 (53%) patients, limb reconstruction was indicated for significant residual deformity and/or worsening LLD. For larger discrepancies and persistent deformity, limb reconstruction with a hexapod external fixator should be considered as part of the treatment options.Level of evidenceLevel IV (Case series)
“…In this case, anterior and lateral compartment fasciotomies were done through small incisions at the initial surgery. Gastrocsoleus recession (GSR) may be needed to prevent or treat equinus contracture 14 during tibial lengthening. In this case, GSR was done 6 weeks after the initial surgery to treat a 20-degree equinus contracture that developed during the lengthening.…”
Summary:A new generation of internal lengthening nail is now available that has reliable remote-controlled mechanisms. This allows accurate and well-controlled distraction rate and rhythm, and early clinical results have been very positive. In this article, 2 posttraumatic cases are presented that illustrate deformity correction and lengthening using the internal lengthening nail. Surgical planning and adjuvant techniques of fixator-assisted nailing and the use of blocking screws are discussed.
“…Our statistical methodology may have potential limitations. Logistic regressions are used widely in medicine to predict dichotomous clinical outcomes related to diseases and have been specifically applied to musculoskeletal disorders; yet this is not without its shortfalls [27‐29]. Odds ratios are not intuitive, and fitting a model on an entire sample or population can result in overfitting that will reduce the model's ability to provide predictions for future cases.…”
Background
Prior studies have identified age as a factor in determining an individual’s likelihood of receiving a prosthesis following a lower limb amputation. These studies are limited to specific subsets of the general population and are unable to account for pre-amputation characteristics within their study populations. Our study seeks to determine the effect of pre-amputation characteristics on the probability of receiving a prosthesis for the general population in the United States.
Objective
Identify pre-amputation characteristics that predict of the likelihood of receiving a prosthesis following an above-knee amputation (AKA).
Design
A retrospective, population-based cohort study.
Setting
Olmsted County, Minnesota (2010 population: 144,248)
Participants
Individuals (n=93) over the age of 18 years who underwent an AKA i.e. knee disarticulation or trans-femoral amputation while residing in Olmsted County, MN between 1987 and 2013.
Methods
Characteristics affecting the receipt of a prosthesis were analyzed using a logistic regression and a random forest algorithm for classification trees. Pre-amputation characteristics include age, sex, amputation etiology, year of amputation, mobility, cognitive ability, comorbidities, and time between surgery and the prosthesis decision.
Main Outcome Measures
The association of pre-amputation characteristics with the receipt of a prosthesis following an AKA.
Results
Twenty Four of the participants received a prosthesis. The odds of receiving a prosthesis were almost 30 times higher in those able to walk independently prior to an amputation relative to those who could not walk independently. A 10-year increase in age was associated with a 53.8% decrease in the likelihood of being fit for a prosthesis (odds ratio=0.462, p-value =.030). Time elapsed between surgery and the prosthesis decision was associated with a rise in probability of receiving a prosthesis for the first three months in the random forest algorithm. No other observed characteristics were associated with receipt of a prosthesis.
Conclusions
The association of pre-amputation mobility and age with the likelihood of being fit for a prosthesis is well-understood. The effect of age, after controlling for confounders, still persists and is associated with the likelihood of being fit for a prosthesis.
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