Informaticarecht en informatietechnologie:een noodzakelijke combinatie

Informaticarecht en infor­matietechnologie: een noodzakelijke combinati

The importance of the rehabilitation program following an internal hemipelvectomy and reconstrucion with limb salvage - gait analysis and outcomes: a case study

Background: Chondrosarcomas account for approximately 20% of bone sarcomas, with the most common site being the lower limb. Hemipelvectomies that involve hindquarter amputation have previously been the treatment of choice for pelvic tumors. However, with advances in chemotherapy, radiotherapy, imaging and surgical techniques more patients are now being treated with limb salvage surgery. The rehabilitation outcomes following an internal hemipelvectomy have not been well identified and there is currently little, if any, gait analysis data on rehabilitation following hemipelvectomy in limb salvage patients. Case description: A 53-year-old male underwent an internal hemipelvectomy with limb salvage followed by a 2-year rehabilitation program. The aim of this case study is to describe temporal and spatial parameters, metabolic energy expenditure and joint kinematics of a patient with an internal hemipelvectomy who underwent a wide excision of a chondrosarcoma followed by intensive rehabilitation. Outcomes: Walking speed (1.6 m/s), stride length (1.7 m), stride width (0.13 m) and good symmetry in step length (right 0.85 m and left data 0.80 m) and stance time (right 62% and left 59%) indicate a walking pattern similar to the asymptomatic able bodied. Oxygen consumption was 16.6 ml/kg/min and oxygen cost 0.17 ml/kg/m. Discussion: Following the intensive 2-year rehabilitation program this patient’s gait pattern was similar to a control group with no statistically significant difference in the movement of the left and right knee and ankle joints. Some differences were identified against the control group in respect of the movement of the pelvis and hips, but this is partly to be expected. This case study highlights the functional outcomes that can be achieved following limb salvage surgery with intensive rehabilitation and a high level of motivation from the individual

Monitoringsrapport 2: Convenant Verzekeringssector

Second report (over 2019) by the Monitoring Committee of the International Responsible Business Conduct Agreements for the Dutch Insurance Secto

Is an Impacted Morselized Graft in a Cage an Alternative for Reconstructing Segmental Diaphyseal Defects?

Large diaphyseal bone defects often are reconstructed with large structural allografts but these are prone to major complications. We therefore asked whether impacted morselized bone graft could be an alternative for a massive structural graft in reconstructing large diaphyseal bone defects. Defects in the femora of goats were reconstructed using a cage filled with firmly impacted morselized allograft or with a structural cortical autograft (n = 6 in both groups). All reconstructions were stabilized with an intramedullary nail. The goats were allowed full weightbearing. In all reconstructions, the grafts united radiographically. Mechanical torsion strength of the femur with the cage and structural cortical graft reconstructions were 66.6% and 60.3%, respectively, as compared with the contralateral femurs after 6 months. Histologically, the impacted morselized graft was replaced completely by new viable bone. In the structural graft group, a mixture of new and necrotic bone was present. Incorporation of the impacted graft into new viable bone suggests this type of reconstruction may be safer than reconstruction with a structural graft in which creeping substitution results in a mixture of viable and necrotic bone that can fracture. The data suggest that a cage filled with a loaded morselized graft could be an alternative for the massive cortical graft in reconstruction of large diaphyseal defects in an animal model

Survival of massive allografts in segmental oncological bone defect reconstructions

Reconstructions of large segmental bone defects after resection of bone tumours with massive structural allografts have a high number of reported complications including fracture, infection and non-union. Our goal is to report the survival and complications of massive allografts in our patients. A total of 32 patients were evaluated for fracture, infection, non-union rate and survival of their massive allograft reconstructions. The average follow-up for this group was five years and three months. The total fracture rate was 13% with a total infection rate of 16%. We found a low union rate of 25%. The total survival of the allografts was 80.8% (± 18.7%) after five years. We found a five-year allograft survival of 80.8% which is comparable with other studies