Explore the vast range of titles available.

Background: In subjects with transfemoral amputation, mechanical changes are observed due to the dependence of an artificial limb for the support of body weight associated with a loss of musculature of the lower limb, leading to compensatory movements in the hip, pelvis and trunk during gait. Objective: This study aimed to analyze two models of prosthetic feet, articulated and solid ankle cushion hell (SACH), in relation to static balance. Methodology: This is an observational and interventional case study, with a quanti-qualitative character of a transfemoral amputee. The adapted Romberg test and the evaluation with the baropometer were used. This study was approved by the research ethics committee of the South Minas Foundation’s teaching and research foundation - FEPESMIG and approved according to the number of protocol 1,826,838 and CAAE 61766416.9.0000.5111. Results: Data from the evaluation of baropodometry associated with the Romberg test for the articulated foot showed a pressure of ± 50.0%, anterior quadrant pressure of 20%, posterior quadrant pressure of ± 30.0%, a posterior quadrant distribution of ± 60.0% and an anterior quadrant distribution of ± 40.0%. On the other hand, the SACH foot data showed a pressure of 50%, anterior quadrant pressure of ± 20.0%, posterior quadrant pressure of ± 30.0%, a posterior quadrant distribution of ± 60.0%, and anterior quadrant distribution of ± 40.0%. Conclusion: The choice of foot type should take into account the individuality of the patient, as well as the application of a complete program of intervention in physiotherapy.

Background Postamputation neuroma pain can prevent comfortable prosthesis wear in patients with limb amputations, and currently available treatments are not consistently effective. Targeted muscle reinnervation (TMR) is a decade-old technique that employs a series of novel nerve transfers to permit intuitive control of upper-limb prostheses. Clinical experience suggests that it may also serve as an effective therapy for postamputation neuroma pain; however, this has not been explicitly studied. Questions/purposes We evaluated the effect of TMR on residual limb neuroma pain in upper-extremity amputees. Methods We conducted a retrospective medical record review of all 28 patients treated with TMR from 2002 to 2012 at Northwestern Memorial Hospital/Rehabilitation Institute of Chicago (Chicago, IL, USA) and San Antonio Military Medical Center (San Antonio, TX, USA). Twenty-six of 28 patients had sufficient (> 6 months) followup for study inclusion. The amputation levels were shoulder disarticulation (10 patients) and transhumeral (16 patients). All patients underwent TMR for the primary purpose of improved myoelectric control. Of the 26 patients included in the study, 15 patients had evidence of postamputation neuroma pain before undergoing TMR. Results Of the 15 patients presenting with neuroma pain before TMR, 14 experienced complete resolution of pain in the transferred nerves, and the remaining patient’s pain improved (though did not resolve). None of the patients who presented without evidence of postamputation neuroma pain developed neuroma pain after the TMR procedure. All 26 patients were fitted with a prosthesis, and 23 of the 26 patients were able to operate a TMR-controlled prosthesis. Conclusions None of the 26 patients who underwent TMR demonstrated evidence of new neuroma pain after the procedure, and all but one of the 15 patients who presented with preoperative neuroma pain experienced complete relief of pain in the distribution of the transferred nerves. TMR offers a novel and potentially more effective therapy for the management of neuroma pain after limb amputation. Level of Evidence Level IV, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.

HintergrundTumorprothesen werden mit guten Langzeitergebnissen bei Kindern und Jugendlichen mit Knochentumoren implantiert und ermöglichen meist einen langfristigen Extremitätenerhalt. Ebenso finden 3‑D-gedruckte Individualimplantate zunehmend Anwendung.FragestellungMit diesem Beitrag wird eine Übersicht zu kindlichen und jugendlichen Knochentumoren und deren chirurgischer Behandlung gegeben. Aufgrund der Verteilungshäufigkeit der kindlichen und jugendlichen Knochentumoren mit einer Häufung im Bereich der unteren Extremität liegt der Schwerpunkt dieses Beitrags auf diesem Bereich.MethodikEs erfolgte die systematische Literaturrecherche bei PubMed sowie die Darstellung anhand der zentrumsinternen Erfahrungen.ErgebnisseKnochentumoren bei Kindern und Jugendlichen finden sich zumeist kniegelenknah. Die Verwendung von modularen Tumorprothesen stellt heutzutage die Therapie der Wahl dar, mit der in der Mehrzahl der Fälle ein langfristiger Extremitätenerhalt erreicht werden kann. Mittels Wachstumsprothesen kann bei jüngeren Kindern versucht werden, einer großen Beinlängendifferenz entgegenzuwirken. 3‑D-gedruckte Individualimplantate kommen zunehmend zum Einsatz. Generell haben Tumorprothesen eine höhere Komplikationsrate als primäre Endoprothesen. Die am häufigsten auftretenden Komplikationen und daraus folgende Revisionseingriffe im Langzeit-Follow-up sind periprothetische Infektionen, Prothesenverschleiß und aseptische Lockerungen.

Abstract Objective. To define clinical phenotypes of postamputation pain and identify markers of risk for the development of chronic pain. Design. Cross-sectional study of military service members enrolled 3-18 months after traumatic amputation injury. Setting. Military Medical Center Subjects. 124 recent active duty military service members Methods. Study subjects completed multiple pain and psychometric questionnaires to assess the qualities of phantom and residual limb pain. Medical records were reviewed to determine the presence/absence of a regional catheter near the time of injury. Subtypes of residual limb pain (somatic, neuroma, and complex regional pain syndrome) were additionally analyzed and associated with clinical risk factors. Results. A majority of enrolled patients (64.5%) reported clinically significant pain (pain score ≥3 averaged over previous week). 61% experienced residual limb pain and 58% experienced phantom pain. When analysis of pain subtypes was performed in those with residual limb pain, we found evidence of a sensitized neuroma in 48.7%, somatic pain in 40.8%, and complex regional pain syndrome in 19.7% of individuals. The presence of clinically significant neuropathic residual limb pain was associated with symptoms of PTSD and depression. Neuropathic pain of any severity was associated with symptoms of all four assessed clinical risk factors: depression, PTSD, catastrophizing, and the absence of regional analgesia catheter. Conclusions. Most military service members in this cohort suffered both phantom and residual limb pain following amputation. Neuroma was a common cause of neuropathic pain in this group. Associated risk factors for significant neuropathic pain included PTSD and depression. PTSD, depression, catastrophizing, and the absence of a regional analgesia catheter were associated with neuropathic pain of any severity.

Background Symptomatic neuroma occurs in 13% to 32% of amputees, causing pain and limiting or preventing the use of prosthetic devices. Targeted nerve implantation (TNI) is a procedure that seeks to prevent or treat neuroma-related pain in amputees by implanting the proximal amputated nerve stump onto a surgically denervated portion of a nearby muscle at a secondary motor point so that regenerating axons might arborize into the intramuscular motor nerve branches rather than form a neuroma. However, the efficacy of this approach has not been demonstrated. Questions/purposes We asked: Does TNI (1) prevent primary neuroma-related pain in the setting of acute traumatic amputation and (2) reduce established neuroma pain in upper- and lower-extremity amputees? Methods We retrospectively reviewed two groups of patients treated by one surgeon: (1) 12 patients who underwent primary TNI for neuroma prevention at the time of acute amputation and (2) 23 patients with established neuromas who underwent neuroma excision with secondary TNI. The primary outcome was the presence or absence of palpation-induced neuroma pain at last followup, based on a review of medical records. The patients presented here represent 71% of those who underwent primary TNI (12 of 17) and 79% of those who underwent neuroma excision with secondary TNI (23 of 29 patients) during the period in question; the others were lost to followup. Minimum followup was 8 months (mean, 22 months; range, 8–60 months) for the primary TNI group and 4 months (mean, 22 months; range, 4–72 months) for the secondary TNI group. Results At last followup, 11 of 12 patients (92%) after primary TNI and 20 of 23 patients (87%) after secondary TNI were free of palpation-induced neuroma pain. Conclusions TNI performed either primarily at the time of acute amputation or secondarily for the treatment of established symptomatic neuroma is associated with a low frequency of neuroma-related pain. By providing a distal target for regenerating axons, TNI may offer an effective strategy for the prevention and treatment of neuroma pain in amputees. Level of Evidence Level IV, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.

After transhumeral amputation, four patients had implantation of a self-contained, osseointegrated prosthesis with a neuromusculoskeletal interface that allowed intuitive control of the prosthetic hand and arm over 3 to 7 years. A video shows use of the prostheses in daily life.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.