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

Clinical and functional outcomes of the saddle prosthesis

BACKGROUND:The implantation of a saddle prosthesis after resection of a pelvic tumor has been proposed as a simple method of reconstruction that provides good stability and reduces the surgical time, thus limits the onset of intraoperative complications. There are no studies in the literature of patients evaluated using gait analysis after being implanted with a saddle prosthesis. The present study is a retrospective case review aimed at illustrating long-term clinical and functional findings in tumor patients reconstructed with a saddle prosthesis. MATERIALS AND METHODS:A series of 15 patients who received pelvic reconstruction with a saddle prosthesis were retrospectively reviewed in terms of clinical, radiographic, and functional evaluations. Two patients were additionally assessed by gait analysis. RESULTS:Long-term functional follow-up was achieved in only 6 patients, and ranged from 97 to 167 months. Function was found to be rather impaired, as a mean of only 57 % of normal activity was restored. Gait analysis demonstrated that the implant had poor biomechanics, as characterized by very limited hip motion. CONCLUSIONS: Though the saddle prosthesis was proposed as advance in tumor-related pelvic surgery, the present study indicates that it yields unsatisfactory clinical and functional results due to both clinical complications and the poor biomechanics of the device. The use of a saddle prosthesis in tumor surgery did not provide satisfactory results in long-term follow-up. It is no longer implanted at our institute, and is currently considered a "salvage technique.