Minimal Invasive Ostheosintesis For Treatment Of Diaphiseal Transverse Humeral Shaft Fractures

Objective: To evaluate patients with transverse fractures of the shaft of the humerus treated with indirect reduction and internal fixation with plate and screws through minimally invasive technique. Methods: Inclusion criteria were adult patients with transverse diaphyseal fractures of the humerus closed, isolated or not occurring within 15 days of the initial trauma. Exclusion criteria were patients with compound fractures. Results: In two patients, proximal screw loosening occurred, however, the fractures consolidated in the same mean time as the rest of the series. Consolidation with up to 5 degrees of varus occurred in five cases and extension deficit was observed in the patient with olecranon fracture treated with tension band, which was not considered as a complication. There was no recurrence of infection or iatrogenic radial nerve injury. Conclusion: It can be concluded that minimally invasive osteosynthesis with bridge plate can be considered a safe and effective option for the treatment of transverse fractures of the humeral shaft. Level of Evidence III, Therapeutic Study.2229498Angelini, A.J., Livani, B., Flierl, M.A., Morgan, S.J., Belangero, W.D., Less invasive percutaneous wave plating of simple femur shaft fractures. A prospective series (2010) Int Orthop., 41 (6), pp. 624-628Heitemeyer, U., Claes, L., Hierholzer, G., Körber, M., Significance of postoperativestability for bony reparation of comminuted fractures. An experimental study Arch Orthop Trauma Surg., 1990 (3), pp. 144-149Gerber, C., Mast, J.W., Ganz, R., Biological internal fixation of fractures (1990) Arch Orthop Trauma Surg., 109 (6), pp. 295-303Miclau, T., Martin, R.E., The evolution of modern plate osteosynthesis (1997) Injury., 28 (SUPPL. 1), pp. A3-6Farouk, O., Krettek, C., Miclau, T., Schandelmaier, P., Guy, P., Tscherne, H., Minimally invasive plate osteosynthesis and vascularity: preliminary results of a cadaver injection study (1997) Injury, 28 (SUPPL. 1), pp. A7-12Farouk, O., Krettek, C., Miclau, T., Schandelmaier, P., Guy, P., Tscherne, H., Minimally invasive plate osteosynthesis: does percutaneous plating disrupt femoral blood supply less than the traditional technique? (1999) J Orthop Trauma., 13 (6), pp. 401-406Perren, S.M., Evolution of the internal fixation of long bone fractures. The scientific basis of biological internal fixation: choosing a new balance between stability and biology (2002) J Bone Joint Surg Br., 84 (8), pp. 1093-1110Livani, B., Belangero, W.D., Bridging plate osteosynthesis of humeral shaft fractures (2004) Injury., 35 (6), pp. 587-595Apivatthakakul, T., Arpornchayanon, O., Bavornratanavech, S., Minimally invasive plate osteosynthesis (MIPO) of the humeral shaft fracture. Is it possible? A cadaveric study and preliminary report (2005) Injury., 36 (4), pp. 530-538Apivatthakakul, T., Patiyasikan, S., Luevitoonvechkit, S., Danger zone for locking screw placement in minimally invasive plate osteosynthesis (MIPO) of humeral shaft fractures: a cadaveric study (2010) Injury., 41 (2), pp. 169-172Livani, B., Belangero, W.D., Castro de Medeiros, R., Fractures of the distal third of the humerus with palsy of the radial nerve: management usingn minimally- invasive percutaneous plate osteosynthesis (2006) J Bone Joint Surg Br., 88 (12), pp. 1625-1628Ziran, B.H., Belangero, W., Livani, B., Pesantez, R., Percutaneous plating of the humerus with locked plating: technique and case report (2007) J Trauma., 63 (1), pp. 205-210Schwarz, N., Windisch, M., Mayr, B., Minimally Invasive anterior plate osteosynthesis in humeral shaft fractures (2009) Eur J Trauma Emerg Surg., 35 (3), pp. 271-276Concha, J.M., Sandoval, A., Streubel, P.N., Minimally invasive plate osteosynthesis for humeral shaft fractures: are results reproducible? (2010) Int Orthop., 34 (8), pp. 1297-1305Hudak, P.L., Amadio, P.C., Bombardier, C., Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder and hand) [corrected]. The Upper Extremity Collaborative Group (UECG) (1996) Am J Ind Med., 29 (6), pp. 602-608Thompson (1918) e Henry (1924 e 1966) - The humerus (2003) Surgical Exposures in Orthopaedics, pp. 67-103. , in: Hoppenfeld S., De Boer P., The anatomic Approach 3rd Ed;Charpter 2Livani, B., Belangero, W.D., Osteossíntese de fratura diafisária do úmero com placa em ponte: apresentação e descrição da técnica (2004) Acta Ortop Bras., 12 (2), pp. 113-117Gustilo, R.B., Anderson, J.T., Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: retrospective and prospective analyses (1976) J Bone Joint Surg Am., 58 (4), pp. 453-458Gustilo, R.B., Mendoza, R.M., Williams, D.N., Problems in the management of type III (severe) open fractures: a new classification of type III open fractures (1984) J Trauma., 24 (8), pp. 742-746Benegas, E., Amódio, D.T., Correia, L.F.M., Malavolta, E.A., Ramadan, L.B., Ferreira Neto, A.A., Estudo comparativo prospectivo e randomizado entre o tratamento cirúrgico das fraturas diafisárias do úmero com placa em ponte e haste intra medular bloqueada (analise preliminar) (2007) Acta Ortop Bras., 15 (2), pp. 87-92Kobayashi, M., Watanabe, Y., Matsushita, T., Early full range of shoulder and elbow motion is possible after minimally invasive plate osteosynthesis for humeral shaft fractures (2010) J Orthop Trauma., 24 (4), pp. 212-216Hunsaker, F.G., Cioffi, D.A., Amadio, P.C., Wright, J.G., Caughlin, B., The American academy of orthopaedic surgeons outcomes instruments: normative values from the general population (2002) J Bone Joint Surg Am., 84 (2), pp. 208-21

Survival Rates Of The Himex Extensible Nail In The Treatment Of Children With Osteogenesis Imperfecta

Objective: To evaluate the performance of an extensible nail with hooks, named HIMEX, in osteogenesis imperfecta (OI) deformities. Methods: All child patients were operated on with HIMEX from 1990 to 2004. The number of fractures, reappearance of deformities, improvement of motor development before and after the use of HIMEX, and the incidence of the migration and nail survival were compared. Results: Fourteen patients, with ages from 2 to 18 years, including 8 females, underwent 46 procedures, 39 primary and 7 re-operations. The average age at the first fracture was 148.21 days, and there was an average of 42.6 fractures per patient prior to HIMEX placement. Of the forty-six bones affected, 28 were femurs and 18 were tibias. Average follow-up care lasted 80.21±36.71 months. There was a statistically significant decrease (0.78) in the number of fractures per patient and an improvement in walking in seven of the fourteen patients. Revision occurred in 18% of patients and migration of the nail occurred in 12% (5/39). Eighty percent of the nails remained in situ until 108 months, with femoral procedures lasting significantly longer than tibial procedures. The type of OI and the age at the procedure did not significantly affect the incidence of revision. Conclusion: HIMEX significantly reduced the number of fractures, presenting lower incidence of migration and higher survival rates than those described in literature.186343348Sofield, H.A., Millar, E.A., Fragmentation, realignment, and intramedullary rod fixation of deformities of the long bones in children. A ten-year appraisal (1959) J Bone Joint Surg Am, 41, pp. 1371-1391Williams, P.F., Fragmentation and rodding in osteogenesis imperfecta (1965) J Bone Joint Surg Br, 47, pp. 23-31King, J.D., Bobechko, W.P., Osteogenesis imperfecta. An orthopaedic description and surgical review (1971) J Bone Joint Surg Br, 53, pp. 72-89Williams, P.F., Cole, W.H., Bailey, R.W., Dubow, H.I., Solomons, C.C., Millar, E.A., Current aspects of the surgical treatment of osteogenesis imperfecta (1973) Clin Orthop Relat Res, 0 (96), pp. 288-298Tiley, F., Albright, J.A., Osteogenesis imperfecta: treatment by multiple osteotomy and intramedullary rod insertion. Report on thirteen patients (1973) J Bone Joint Surg Am, 55, pp. 701-713Li, Y.H., Chow, W., Leong, J.C., The Sofield-Millar operation in osteogenesis imperfecta. A modified technique (2000) J Bone Joint Surg Br, 82, pp. 11-16Santilli, C., Akkari, M., Waisberg, G., Andrade, A.L.L., Costa, U., Silva, A.L.M., A operação de Sofield e Millar no tratamento da osteogênese imperfeita (2004) Acta Ortop Bras, 12, pp. 226-232Bailey, R.W., Dubow, H.I., Evolution of the concept of an extensible nail accom- modating to normal longitudinal bone growth: clinical considerations and im- plications (1981) Clin Orthop Relat Res, 0 (159), pp. 157-170Rodriguez Jr., R.P., Wickstrom, J., Osteogenesis imperfecta: a preliminary report on resurfacing of long bones with intramedullary fixation by an extensible intramedullary device (1971) South Med J, 64, pp. 169-176Rodriguez, R.P., Report of multiple osteotomies and intramedullary fixation by an extensible intramedullary device in children with osteogenesis imperfecta (1976) Clin Orthop Relat Res, 0 (116), p. 261Marafioti, R.L., Westin, G.W., Elongating intramedullary rods in the treatment of osteogenesis imperfecta (1977) J Bone Joint Surg Am, 59, pp. 467-472Rodriguez, R.P., Bailey, R.W., Internal fixation of the femur in patients with osteo- genesis imperfecta (1981) Clin Orthop Relat Res, 0 (159), pp. 126-133Lang-Stevenson, A.I., Sharrard, W.J., Intramedullary rodding with Bailey-Dubow extensible rods in osteogenesis imperfecta. An interim report of results and complications (1984) J Bone Joint Surg Br, 66, pp. 227-232Gamble, J.G., Strudwick, W.J., Rinsky, L.A., Bleck, E.E., Complications of intramedulla- ry rods in osteogenesis imperfecta: Bailey-Dubow rods versus nonelongating rods (1988) J Pediatr Orthop, 8, pp. 645-649Ryöppy, S., Alberty, A., Kaitila, I., Early semiclosed intramedullary stabilization in osteogenesis imperfecta (1987) J Pediatr Orthop, 7, pp. 139-144Stockley, I., Bell, M.J., Sharrard, W.J., The role of expanding intramedullary rods in osteogenesis imperfecta (1989) J Bone Joint Surg Br, 71, pp. 422-427Nicholas, R.W., James, P., Telescoping intramedullary stabilization of the lower extremities for severe osteogenesis imperfecta (1990) J Pediatr Orthop, 10, pp. 219-223Porat, S., Heller, E., Seidman, D.S., Meyer, S., Functional results of operation in os- teogenesis imperfecta: elongating and nonelongating rods (1991) J Pediatr Orthop, 11, pp. 200-203Jerosch, J., Mazzotti, I., Tomasevic, M., Complications after treatment of patients with osteogenesis imperfecta with a Bailey-Dubow rod (1998) Arch Orthop Trauma Surg, 117, pp. 240-245Luhmann, S.J., Sheridan, J.J., Capelli, A.M., Schoenecker, P.L., Management of lower- extremity deformities in osteogenesis imperfecta with extensible intramedullary rod technique: a 20-year experience (1998) J Pediatr Orthop, 18, pp. 88-94Wilkinson, J.M., Scott, B.W., Clarke, A.M., Bell, M.J., Surgical stabilisation of the lower limb in osteogenesis imperfecta using the Sheffield Telescopic Intramedullary Rod System (1998) J Bone Joint Surg Br, 80, pp. 999-1004Zionts, L.E., Ebramzadeh, E., Stott, N.S., Complications in the use of the ailey-Dubow extensible nail (1998) Clin Orthop Relat Res, 0 (348), pp. 186-195Janus, G.J., Vanpaemel, L.A., Engelbert, R.H., Pruijs, H.E., Complications of the Bailey- Dubow elongating nail in osteogenesis imperfecta: 34 children with 110 nails (1999) J Pediatr Orthop B, 8, pp. 203-207Karbowski, A., Schwitalle, M., Brenner, R., Lehmann, H., Pontz, B., Wörsdörfer, O., Experience with Bailey-Dubow rodding in children with osteogenesis imper- fecta (2000) Eur J Pediatr Surg, 10, pp. 119-124Mulpuri, K., Joseph, B., Intramedullary rodding in osteogenesis imperfecta (2000) J Pediatr Orthop, 20, pp. 267-273Sillence, D., Osteogenesis imperfecta: an expanding panorama of variants (1981) Clin Orthop Relat Res, 0 (159), pp. 11-25Shapiro, F., Consequences of an osteogenesis imperfecta diagnosis for survival and ambulation (1985) J Pediatr Orthop, 5, pp. 456-462Hoffer, M.M., Bullock, M., The functional and social significance of orthopedic rehabilitation of mentally retarded patients with cerebral palsy (1981) Orthop Clin North Am, 12, pp. 185-191Root, L., The treatment of osteogenesis imperfecta (1984) Orthop Clin North Am, 15, pp. 775-790Gerber, L.H., Binder, H., Weintrob, J., Grange, D.K., Shapiro, J., Fromherz, W., Rehabilitation of children and infants with osteogenesis imperfecta (1990) A program for ambulation. Clin Orthop Relat Res., 0 (251), pp. 254-26

EXOGEN ultrasound bone healing system for long bone fractures with non-union or delayed healing: a NICE medical technology guidance

Open Access. This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and the source are credited.This article has been made available through the Brunel Open Access Publishing Fund.A routine part of the process for developing National Institute for Health and Care Excellence (NICE) medical technologies guidance is a submission of clinical and economic evidence by the technology manufacturer. The Birmingham and Brunel Consortium External Assessment Centre (EAC; a consortium of the University of Birmingham and Brunel University) independently appraised the submission on the EXOGEN bone healing system for long bone fractures with non-union or delayed healing. This article is an overview of the original evidence submitted, the EAC’s findings, and the final NICE guidance issued.The Birmingham and Brunel Consortium is funded by NICE to act as an External Assessment Centre for the Medical Technologies Evaluation Programme

VIGOR: Sviluppo geotermico nelle Regioni della Convergenza

La valutazione del potenziale geotermico. Quadro normativo e iter autorizzativo per la ricerca e la coltivazione di risorse geotermiche. Accettabilità sociale della geotermia. Il caso tipo di Termini Imeres

Bridging plate osteosynthesis of humeral shaft fractures

This study was approved by the Ethics Committee of the Faculty of Medical Sciences and developed during November 2000 and July 2001 in the Orthopedic and Traumatology Department of UNICAMP. There were 15 patients, 11 mates, age between 14 and 66 years. All fractures were unilateral. Of the 15 patients eight were polytraumatised, two of them had open fractures. The others had an isolated fracture of the humerus, of which one was open. None of the patients had previous lesions of the radial nerve, but in two patients there was a lesion of the brachial plexus. All of the patients underwent a bridging plate osteosynthesis of the humeral shaft fractures using only two small incisions proximal and distal to the fracture site. We used broad or narrow D.C.P.(R) plates for large fragments mostly with 12 holes, fixed with two or three screws at each end. All cases united with an average time of 8-12 weeks, with the exception of one case with a grade III open fracture and a brachial plexus lesion on the same side. We had no major complications. All patients recovered good function of the limb without significant residual deformity. (C) 2004 Elsevier Ltd. All rights reserved.35658759

Scaphoid Fracture Nonunion: Correlation Of Radiographic Imaging, Proximal Fragment Histologic Viability Evaluation, And Estimation Of Viability At Surgery: Diagnosis Of Scaphoid Pseudarthrosis

Purpose: The purpose of this study was to correlate the pre-operative imaging, vascularity of the proximal pole, and histology of the proximal pole bone of established scaphoid fracture non-union. Methods: This was a prospective non-controlled experimental study. Patients were evaluated pre-operatively for necrosis of the proximal scaphoid fragment by radiography, computed tomography (CT) and magnetic resonance imaging (MRI). Vascular status of the proximal scaphoid was determined intra-operatively, demonstrating the presence or absence of puncate bone bleeding. Samples were harvested from the proximal scaphoid fragment and sent for pathological examination. We determined the association between the imaging and intra-operative examination and histological findings. Results: We evaluated 19 male patients diagnosed with scaphoid nonunion. CT evaluation showed no correlation to scaphoid proximal fragment necrosis. MRI showed marked low signal intensity on T1-weighted images that confirmed the histological diagnosis of necrosis in the proximal scaphoid fragment in all patients. Intra-operative assessment showed that 90 % of bones had absence of intra-operative puncate bone bleeding, which was confirmed necrosis by microscopic examination. Conclusions: In scaphoid nonunion MRI images with marked low signal intensity on T1-weighted images and the absence of intra-operative puncate bone bleeding are strong indicatives of osteonecrosis of the proximal fragment.3916772Chang, M., Bishop, A., Moran, S., The outcomes and complications of 1,2-intercompartmental supraretinacular artery pedicled vascularized bone grafting of scaphoid nonunions (2006) J Hand Surg [Am], 31, pp. 387-396Dias, J., Brenkel, I., Finlay, D., Patterns of union in fractures of the waist of the scaphoid (1989) J Bone Joint Surg, 71B, pp. 307-310Compson, J., The anatomy of acute scaphoid fractures. A three-dimensional analysis of patterns (1998) J Bone Joint Surg, 80-B, pp. 218-224Taljanovic, M., Karantanas, A., Griffith, J.F., DeSilva, G.L., Rieke, J.D., Sheppard, J.E., Imaging and treatment of scaphoid fractures and their complications (2012) Semin Musculoskelet Radiol, 16 (2), pp. 159-174. , PID: 22648431Geissler, W., Adams, J.E., Bindra, R.R., Lanzinger, W.D., Slutsky, D.J., Scaphoid fractures: what’s hot, what’s not (2012) Instr Course Lect, 61, pp. 71-84. , PID: 22301223Benis, J., Turpin, F., The role of imaging in the assessment of vascularity at hand and wrist (2010) Chir Main, 29, pp. S21-S27. , PID: 21075667Schmitt, R., Christopoulos, G., Wagner, M., Krimmer, H., Fodor, S., van Schoonhoven, J., Avascular necrosis (AVN) of the proximal segment in scaphoid nonunion: is intravenous contrast agent necessary in MRI (2011) Eur J Radiol, 77 (2), pp. 222-227. , COI: 1:STN:280:DC%2BC3M7ltFKksg%3D%3D, PID: 20965679Pao, V., Chang, J., Scaphoid nonunion: diagnosis and treatment (2003) Plast Reconstr Surg, 112, pp. 1666-1676. , PID: 14578801Alnot, J., Bellan, N., Oberlin, C., De Cheveigné, D.C., Fractures and nonunions of the proximal pole of the carpal scaphoid bone internal fixation by a proximal to distal screw (1988) Ann Chir Main, 7, pp. 101-108. , COI: 1:STN:280:DyaL1M%2FkvFarsQ%3D%3D, PID: 3190298Barton, N., Twenty questions about scaphoid fractures (1992) J Hand Surg (Br), 17, pp. 289-310. , COI: 1:STN:280:DyaK38zisFGqsA%3D%3DZaidemberg, C., Siebert, J., Angrigiani, C., A new vascularized bone graft for scaphoid nonunion (1991) J Hand Surg [Am], 16, pp. 474-478. , COI: 1:STN:280:DyaK3MzhvVSrsA%3D%3DDerby, B., Murray, P., Shin, A., Bueno, R., Mathoulin, C., Ade, T., Neumeister, M., Vascularized bone grafts for the treatment of carpal bone pathology (2013) J Hand Surg [Am], 8, pp. 27-40Green, D., The effect of avascular necrosis on Russe bone grafting for scaphoid nonunion (1985) J Hand Surg [Am], 10, pp. 597-605. , COI: 1:STN:280:DyaL28%2FgvFCksw%3D%3DImaeda, T., Nakamura, R., Miura, T., Makino, N., Magnetic resonance imaging in scaphoid fractures (1992) J Hand Surg (Br), 17, pp. 20-27. , COI: 1:STN:280:DyaK38zkvV2lsg%3D%3DSmith, M., Using computed tomography to assist with diagnosis of avascular necrosis complicating chronic scaphoid nonunion (2009) J Hand Surg [Am], 34, pp. 1037-1043Cerezal, L., Abascal, F., Canga, A., García-Valtuille, R., Bustamante, M., del Piñal, F., Usefulness of gadolinium-enhanced MR imaging in the evaluation of the vascularity of scaphoid nonunions (2000) Am J Roentgenol, 174, pp. 141-149. , COI: 1:STN:280:DC%2BD3c%2Fpt1Smsw%3D%3DQu, G., von Schroeder, H.P., Trabecular microstructure at the human scaphoid nonunion (2008) J Hand Surg [Am], 33 (5), pp. 650-655Ribak, S., Medina, C., Mattar, R., Ulson, H., Resende, M., Etchebehere, M., Treatment of scaphoid nonunion with vascularised and nonvascularised dorsal bone grafting from the distal radius (2010) Int Orthop, 34, pp. 683-688. , PID: 19730861Sakuma, M., Nakamura, R., Imaeda, T., Analysis of proximal segment sclerosis and surgical outcome of scaphoid non-union by magnetic resonance imaging (1995) J Hand Surg (Br), 20, pp. 201-205. , COI: 1:STN:280:DyaK2MzhvVGqsA%3D%3DFondi, C., Franchi, A., Definition of bone necrosis by the pathologist (2007) Clin Cases Miner Bone Metab, 4 (1), pp. 21-26. , PID: 22460748Marcus, R., Normal and abnormal bone remodeling in man (1987) Annu Rev Med, 38, pp. 129-141. , COI: 1:STN:280:DyaL2s3htFyjuw%3D%3D, PID: 3555287McClure, J., Smith, P., Consequences of avascular necrosis of the femoral head in aluminium-related renal osteodystrophy and the role of endochondral ossification in the repair process (1983) J Clin Pathol, 36, pp. 260-268. , COI: 1:STN:280:DyaL3s7js1ertg%3D%3D, PID: 6402524Parfitt, A., Drezner, M., Glorieux, F., Kanis, J., Malluche, H., Meunier, P., Ott, S., Recker, R., Bone histomorphometry: standardization of nomenclature, symbols, and units. Report of the ASBMR histomorphometry nomenclature committee (1987) J Bone Miner Res, 2 (6), pp. 595-610. , COI: 1:STN:280:DyaL1czjvVemsQ%3D%3D, PID: 3455637Schuind, F., Prognostic factors in the treatment of carpal scaphoid nonunions (1999) J Hand Surg [Am], 24, pp. 761-776. , COI: 1:STN:280:DyaK1MznsVygtg%3D%3DBuijze, G., Ochtman, L., Ring, D., Management of scaphoid nonunion (2012) J Hand Surg [Am], 37 (5), pp. 1095-1100Waitayawinyu, T., McCallister, W., Katolik, L., Schlenker, J., Trumble, T., Outcome after vascularized bone grafting of scaphoid nonunions with avascular necrosis (2009) J Hand Surg [Am], 34 (3), pp. 387-394Dinah, A., Vickers, R., Smoking increases failure rate of operation for established non-union of the scaphoid bone (2007) Int Orthop, 31 (4), pp. 503-505. , COI: 1:STN:280:DC%2BD2snjslKqtw%3D%3D, PID: 16947049Buchler, U., Nagy, L., The issue of vascularity in fractures and nonunion of the scaphoid (1995) J Hand Surg (Br), 20B (6), pp. 726-735Bilic, R., Simic, P., Jelic, M., Stern-Padovan, R., Dodig, D., van Meerdervoort, H., Martinovic, S., Vukicevic, S., Osteogenic protein-1 (BMP-7) accelerates healing of scaphoid non-union with proximal pole sclerosis (2006) Int Orthop, 30 (2), pp. 128-134. , COI: 1:STN:280:DC%2BD287mslGrtg%3D%3D, PID: 16506027Ricardo, M., The effect of ultrasound on the healing of muscle-pediculated bone graft in scaphoid non-union (2006) Int Orthop, 30 (2), pp. 123-127. , PID: 16474939Dawson, J., Martel, A., Davis, T., Scaphoid blood flow and acute fracture healing. A dynamic MRI study with enhancement with gadolinium (2001) J Bone Joint Surg (Br), 83 (6), pp. 809-814. , COI: 1:STN:280:DC%2BD3MvnvVKjtA%3D%3DPaul, P., O’Byrne, E., Blancuzzi, V., Wilson, D., Gunson, D., Douglas, F., Wang, L.Z., Mezrich, R., Magnetic resonance imaging reflects cartilage proteoglycan degradation in the rabbit knee (1991) Skelet Radiol, 20 (1), pp. 31-36. , COI: 1:STN:280:DyaK3M7lslSgsw%3D%3DDonati, O., Zanetti, M., Nagy, L., Bode, B., Schweizer, A., Pfirrmann, C., Is dynamic gadolinium enhancement needed in MR imaging for the preoperative assessment of scaphoidal viability in patients with scaphoid nonunion? (2011) Radiology, 260, pp. 808-816. , PID: 21712471Gunal, I., Ozcelik, A., Gokturk, E., Ada, S., Demirtas, M., Correlation of magnetic resonance imaging and intraoperative punctate bleeding to assess the vascularity of scaphoid nonunion (1999) Arch Orthop Trauma Surg, 119, pp. 285-287. , COI: 1:STN:280:DyaK1Mzns1Kmsw%3D%3D, PID: 10447624Maurer, P., Sandulescu, T., Kriwalsky, M., Rashad, A., Hollstein, S., Stricker, I., Hölzle, F., Kunkel, M., Bisphosphonate-related osteonecrosis of the maxilla and sinusitis maxillaris (2011) Int J Oral Maxillofac Surg, 40 (3), pp. 285-291. , COI: 1:STN:280:DC%2BC3M3hvFyisw%3D%3D, PID: 21163624Stahl, S., Hentschel, P.J., Held, M., Manoli, T., Meisner, C., Schaller, H.E., Santos Stahl, A., Characteristic features and natural evolution of Kienböck’s disease: five years’ results of a prospective case series and retrospective case series of 106 patients (2014) J Plast Reconstr Aesthet Surg, 67 (10), pp. 1415-142

A case series featuring extremely short below-knee stumps

Background: Lower limb amputations should be evaluated carefully, especially with regard to the possibility of preserving the knee joint to enable a more physiological gait and lower energy consumption. Below-knee amputations were performed immediately below the tibial tuberosity with maintenance of the insertion of the patellar tendon, resulting in very short, but functional stumps. This case study examined whether very short below-knee stumps allow a more functional gait, as compared to more proximal amputations. Case Description and Methods: Between June 2010 and June 2011, four patients had extremely short below-knee amputations, with resection of the head of the fibula at the junction and reinsertion of the collateral ligaments and structures attached to the tibia. This was followed by placement of a prosthesis with a vacuum-assisted suspension socket. Findings and Outcome: At the end of treatment, patients that underwent transtibial amputations with an extremely short stump were considered well adapted to their prosthesis and were satisfied in relation to the acquired gait patterns. Conclusion: The extremely short below-knee amputation, despite having a short lever arm should be considered as another option for lower-limb amputations, although we cannot yet assure that other patient groups undergoing this level of amputation may have the same results of the study.36223623