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Stefanou N, Mylonas T, Angelis FA, Arnaoutoglou C, Varitimidis SE, Dailiana ZH. Upper extremity vascular injuries: Etiology, management and outcome. World J Crit Care Med 2024; 13:91558. [DOI: 10.5492/wjccm.v13.i2.91558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 01/28/2024] [Accepted: 03/04/2024] [Indexed: 06/03/2024] Open
Abstract
BACKGROUND Vascular injuries of the upper extremities are considered relatively rare injuries affecting mostly the young population. They often are complex injuries accompanied by other musculoskeletal trauma or trauma in other anatomic locations. Their management is challenging since they can lead to disabilities with major socioeconomic effects.
AIM To analyze data about the mechanism of injury, the management algorithm and functional outcomes of vascular injuries of the upper extremity.
METHODS One hundred and fifteen patients (96 males and 19 females) with arterial injuries of the upper extremity treated in a tertiary trauma center from January 2003 to December 2022 was conducted. Mean patients’ age was 33.7 years and the mean follow up time was 7.4 years. Patients with Mangled Extremity Severity Score ≥ 7 and Injury Severity Score ≥ 20, previous upper limb surgery or major trauma and any neuromuscular or psychiatric disease were excluded, from the study.
RESULTS A penetrating trauma was the most common cause of injury. The radial artery was the artery injured in most of the cases (37.4%) followed by the ulnar (29.5%), the brachial (12.1%) and the axillary (6%). A simultaneous injury of both of the forearm’s arteries was in 15.6% of the cases. In 93% of the cases there were other concomitant musculoskeletal injuries of the extremity. Tendon lacerations were the most common, followed by nerve injuries. The postoperative functional scores (full Disabilities of the Arm, Shoulder, and Hand and VAS) had very satisfactory values.
CONCLUSION Although vascular injuries of the upper extremity are rare, they may occur in the context of major combined musculoskeletal trauma. Although a multidisciplinary approach is essential to optimize outcome, the ability of trained hand surgeons to repair all injuries in combined vascular and musculoskeletal upper extremity trauma, excluding isolated vascular injuries, ensures shorter operative times and better functional outcomes.
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Affiliation(s)
- Nikolaos Stefanou
- Department of Orthopaedic Surgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, University Hospital of Larissa, Larissa 41500, Greece
| | - Theodoros Mylonas
- Department of Orthopaedic Surgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, University Hospital of Larissa, Larissa 41500, Greece
| | - Fragkiskos A Angelis
- Department of Orthopaedic Surgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, University Hospital of Larissa, Larissa 41500, Greece
| | - Christina Arnaoutoglou
- Department of Orthopaedic Surgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, University Hospital of Larissa, Larissa 41500, Greece
| | - Sokratis E Varitimidis
- Department of Orthopaedic Surgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, University Hospital of Larissa, Larissa 41500, Greece
| | - Zoe H Dailiana
- Department of Orthopaedic Surgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, University Hospital of Larissa, Larissa 41500, Greece
- Department of Hand, Upper Extremity and Microsurgery, IASO Thessalias, Larissa 41500, Greece
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Dunn JA, Gomez NG, Wong B, Sinclair SK, Henninger HB, Foreman KB, Bachus KN. Transhumeral prosthesis use affects upper body kinematics and kinetics. Gait Posture 2024; 112:59-66. [PMID: 38744022 DOI: 10.1016/j.gaitpost.2024.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 05/03/2024] [Accepted: 05/08/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND Transhumeral (TH) limb loss leads to loss of body mass and reduced shoulder range of motion. Despite most owning a prosthesis, prosthesis abandonment is common. The consequence of TH limb loss and prosthesis use and disuse during gait may be compensation in the upper body, contributing to back pain or injury. Understanding the impact of not wearing a TH prosthesis on upper body asymmetries and spatial-temporal aspects of gait will inform how TH prosthesis use and disuse affects the body. RESEARCH QUESTION Does TH limb loss alter upper body asymmetries and spatial-temporal parameters during gait when wearing and not wearing a prosthesis compared to able-bodied controls? METHODS Eight male TH limb loss participants and eight male control participants completed three gait trials at self-selected speeds. The TH limb loss group performed trials with and without their prosthesis. Arm swing, trunk angular displacement, trunk-pelvis moment, and spatial-temporal aspects were compared using non-parametric statistical analyses. RESULTS Both TH walking conditions showed greater arm swing in the intact limb compared to the residual (p≤0.001), resulting in increased asymmetry compared to the control group (p≤0.001). Without the prosthesis, there was less trunk flexion and lateral flexion compared to the control group (p≤0.001). Maximum moments between the trunk and pelvis were higher in the TH group than the control group (p≤0.05). Spatial-temporal parameters of gait did not differ between the control group and either TH limb loss condition. SIGNIFICANCE Prosthesis use affects upper body kinematics and kinetics, but does not significantly impact spatial-temporal aspects of gait, suggesting these are compensatory actions. Wearing a prosthesis helps achieve more normative upper body kinematics and kinetics than not wearing a prosthesis, which may help limit back pain. These findings emphasize the importance of encouraging at least passive use of prostheses for individuals with TH limb loss.
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Affiliation(s)
- Julia A Dunn
- Department of Biomedical Engineering University of Utah, 36 S Wasatch Dr, Salt Lake City, UT 84112, USA; Department of Orthopaedics University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA
| | - Nicholas G Gomez
- Department of Physical Therapy and Athletic Training University of Utah, 520 Wakara Way, Salt Lake City, UT 84108, USA; College of Health, Human Services & Nursing California State University, 1000 E. Victoria Street, Carson, CA 90747, USA
| | - Bob Wong
- College of Nursing University of Utah, 10 2000 E, Salt Lake City, UT 84112, USA
| | - Sarina K Sinclair
- Department of Orthopaedics University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA; Department of Veterans Affairs, 500 Foothill Boulevard, Salt Lake City, UT 84148, USA
| | - Heath B Henninger
- Department of Biomedical Engineering University of Utah, 36 S Wasatch Dr, Salt Lake City, UT 84112, USA; Department of Orthopaedics University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA
| | - K Bo Foreman
- Department of Orthopaedics University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA; Department of Physical Therapy and Athletic Training University of Utah, 520 Wakara Way, Salt Lake City, UT 84108, USA
| | - Kent N Bachus
- Department of Biomedical Engineering University of Utah, 36 S Wasatch Dr, Salt Lake City, UT 84112, USA; Department of Orthopaedics University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA; Department of Veterans Affairs, 500 Foothill Boulevard, Salt Lake City, UT 84148, USA.
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3
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Dunn JA, Wong B, Sinclair SK, Henninger HB, Bachus KN, Foreman KB. Extended physiological proprioception is affected by transhumeral Socket-Suspended prosthesis use. J Biomech 2024; 166:112054. [PMID: 38513398 DOI: 10.1016/j.jbiomech.2024.112054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 01/30/2024] [Accepted: 03/17/2024] [Indexed: 03/23/2024]
Abstract
The objective of this study was to define targeted reaching performance without visual information for transhumeral (TH) prosthesis users, establishing baseline information about extended physiological proprioception (EPP) in this population. Subjects completed a seated proprioceptive targeting task under simultaneous motion capture, using their prosthesis and intact limb. Eight male subjects, median age of 58 years (range 29-77 years), were selected from an ongoing screening study to participate. Five subjects had a left-side TH amputation, and three a right-side TH amputation. Median time since amputation was 9 years (range 3-54 years). Four subjects used a body-powered prosthetic hook, three a myoelectric hand, and one a myoelectric hook. The outcome measures were precision and accuracy, motion of the targeting hand, and joint angular displacement. Subjects demonstrated better precision when targeting with their intact limb compared to targeting with their prosthesis, 1.9 cm2 (0.8-3.0) v. 7.1 cm2 (1.3-12.8), respectively, p = 0.008. Subjects achieved a more direct reach path ratio when targeting with the intact limb compared to with the prosthesis, 1.2 (1.1-1.3) v. 1.3 (1.3-1.4), respectively, p = 0.039 The acceleration, deceleration, and corrective phase durations were consistent between conditions. Trunk angular displacement increased in flexion, lateral flexion, and axial rotation while shoulder flexion decreased when subjects targeted with their prosthesis compared to the intact limb. The differences in targeting precision, reach patio ratio, and joint angular displacements while completing the targeting task indicate diminished EPP. These findings establish baseline information about EPP in TH prosthesis users for comparison as novel prosthesis suspension systems become more available to be tested.
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Affiliation(s)
- Julia A Dunn
- Department of Biomedical Engineering University of Utah, United States; Department of Orthopaedics University of Utah, United States
| | - Bob Wong
- College of Nursing University of Utah, United States
| | - Sarina K Sinclair
- Department of Orthopaedics University of Utah, United States; Department of Veterans Affairs, Salt Lake City, UT, United States
| | - Heath B Henninger
- Department of Biomedical Engineering University of Utah, United States; Department of Orthopaedics University of Utah, United States
| | - Kent N Bachus
- Department of Biomedical Engineering University of Utah, United States; Department of Orthopaedics University of Utah, United States; Department of Veterans Affairs, Salt Lake City, UT, United States
| | - K Bo Foreman
- Department of Orthopaedics University of Utah, United States; Department of Veterans Affairs, Salt Lake City, UT, United States; Department of Physical Therapy and Athletic Training University of Utah, United States.
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Schulz RN, Jannace KC, Cooper DB, Sparling TL, Luken ML, Pasquina PF. Health Care Utilization After Major Limb Loss in Adults (18-64) Receiving Care in the Military Health System From 2001 to 2017. Arch Phys Med Rehabil 2024; 105:335-342. [PMID: 37722649 DOI: 10.1016/j.apmr.2023.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 08/02/2023] [Accepted: 08/14/2023] [Indexed: 09/20/2023]
Abstract
OBJECTIVE To characterize and quantify health care utilization of Military Health System beneficiaries with major limb loss. DESIGN Retrospective cohort study. SETTING Military treatment facilities and civilian health care facilities that accept TRICARE insurance across the United States. PARTICIPANTS A total 5950 adult Military Health System beneficiaries with major limb amputation(s) acquired between January 1st, 2001, and September 30th, 2017 (N=5950). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES This study was an exploratory analysis designed to identify common care specialties, services, and devices utilized by Military Health System beneficiaries with major limb loss. RESULTS Most beneficiaries were retirees/dependents (63.3%), men (73.1%), and had a single amputation (88.7%), with a mean age of 42 years. Differences between beneficiary categories were found. Active-duty service members used a larger proportion of inpatient, emergency, primary care, physical and occupational therapy, prosthetics and orthotics, physical medicine and rehabilitation, and psychiatry services than retirees/dependents. Most common procedures included "revision of amputation stump" (57.2%) for the active-duty population and "other amputation below knee" (24.3%) for the retirees/dependents. CONCLUSIONS These findings highlight the rehabilitation trajectories of beneficiaries receiving treatment for major limb loss in military and civilian care settings. The results could inform staffing decisions and training programs for military treatment facilities, American trauma centers, rehabilitation hospitals, and outpatient health care providers treating individuals with amputation.
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Affiliation(s)
- Rebecca N Schulz
- Walter Reed National Military Medical Center, Bethesda, MD; Uniformed Services University of Health Sciences, Bethesda, MD; The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD.
| | - Kalyn C Jannace
- Walter Reed National Military Medical Center, Bethesda, MD; Uniformed Services University of Health Sciences, Bethesda, MD; The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD
| | - Daniel B Cooper
- Walter Reed National Military Medical Center, Bethesda, MD; Uniformed Services University of Health Sciences, Bethesda, MD; The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD
| | - Tawnee L Sparling
- Walter Reed National Military Medical Center, Bethesda, MD; Uniformed Services University of Health Sciences, Bethesda, MD
| | - Michelle L Luken
- Walter Reed National Military Medical Center, Bethesda, MD; Uniformed Services University of Health Sciences, Bethesda, MD; The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD
| | - Paul F Pasquina
- Walter Reed National Military Medical Center, Bethesda, MD; Uniformed Services University of Health Sciences, Bethesda, MD
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Cifuentes-Cuadros AA, Romero E, Caballa S, Vega-Centeno D, Elias DA. The LIBRA NeuroLimb: Hybrid Real-Time Control and Mechatronic Design for Affordable Prosthetics in Developing Regions. SENSORS (BASEL, SWITZERLAND) 2023; 24:70. [PMID: 38202932 PMCID: PMC10780857 DOI: 10.3390/s24010070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 12/15/2023] [Accepted: 12/19/2023] [Indexed: 01/12/2024]
Abstract
Globally, 2.5% of upper limb amputations are transhumeral, and both mechanical and electronic prosthetics are being developed for individuals with this condition. Mechanics often require compensatory movements that can lead to awkward gestures. Electronic types are mainly controlled by superficial electromyography (sEMG). However, in proximal amputations, the residual limb is utilized less frequently in daily activities. Muscle shortening increases with time and results in weakened sEMG readings. Therefore, sEMG-controlled models exhibit a low success rate in executing gestures. The LIBRA NeuroLimb prosthesis is introduced to address this problem. It features three active and four passive degrees of freedom (DOF), offers up to 8 h of operation, and employs a hybrid control system that combines sEMG and electroencephalography (EEG) signal classification. The sEMG and EEG classification models achieve up to 99% and 76% accuracy, respectively, enabling precise real-time control. The prosthesis can perform a grip within as little as 0.3 s, exerting up to 21.26 N of pinch force. Training and validation sessions were conducted with two volunteers. Assessed with the "AM-ULA" test, scores of 222 and 144 demonstrated the prosthesis's potential to improve the user's ability to perform daily activities. Future work will prioritize enhancing the mechanical strength, increasing active DOF, and refining real-world usability.
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Affiliation(s)
| | | | | | | | - Dante A. Elias
- Biomechanics and Applied Robotics Research Laboratory, Pontificia Universidad Católica del Perú, Lima 15088, Peru; (A.A.C.-C.); (E.R.); (S.C.); (D.V.-C.)
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Gordon EJ, Gacki-Smith J, Kuramitsu BR, Downey M, Vanterpool KB, Nordstrom MJ, Riggleman T, Cooney CM, Jensen S, Dumanian G, Tintle S, Levan M, Brandacher G. Ethical and Psychosocial Factors in the Decision-Making and Informed Consent Process for Upper Extremity Vascularized Composite Allotransplantation: A Mixed-Methods Study. Transplant Direct 2023; 9:e1515. [PMID: 37492079 PMCID: PMC10365204 DOI: 10.1097/txd.0000000000001515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 05/27/2023] [Indexed: 07/27/2023] Open
Abstract
Although upper extremity (UE) vascularized composite allotransplantation (VCA) aims to improve quality of life, relatively few have been performed worldwide to support evidence-based treatment and informed decision-making. Methods We qualitatively examined factors contributing to anticipated and actual decision-making about UE VCA and perceptions of the elements of informed consent among people with UE amputations, and UE VCA candidates, participants, and recipients through in-depth interviews. Thematic analysis was used to analyze qualitative data. Results Fifty individuals participated; most were male (78%) and had a mean age of 45 y and a unilateral amputation (84%). One-third (35%) were "a lot" or "completely" willing to pursue UE VCA. UE VCA decision-making themes included the utility of UE VCA, psychosocial impact of UE VCA and amputation on individuals' lives, altruism, and anticipated burden of UE VCA on lifestyle. Most respondents who underwent UE VCA evaluation (n = 8/10) perceived having no reasonable treatment alternatives. Generally, respondents (n = 50) recognized the potential for familial, societal, cultural, medical, and self-driven pressures to pursue UE VCA among individuals with amputations. Some (n = 9/50, 18%) reported personally feeling "a little," "somewhat," "a lot," or "completely" pressured to pursue UE VCA. Respondents recommended that individuals be informed about the option of UE VCA near the amputation date. Conclusions Our study identified psychosocial and other factors affecting decision-making about UE VCA, which should be addressed to enhance informed consent. Study participants' perceptions and preferences about UE VCA suggest re-examination of assumptions guiding the UE VCA clinical evaluation process.
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Affiliation(s)
- Elisa J. Gordon
- Department of Surgery, and Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, TN
| | - Jessica Gacki-Smith
- Center for Health Services and Outcomes Research, Northwestern University, Chicago, IL
| | - Brianna R. Kuramitsu
- Center for Health Services and Outcomes Research, Northwestern University, Chicago, IL
| | - Max Downey
- Department of Surgery, NYU Grossman School of Medicine, NYU Langone Health, New York, NY
| | - Karen B. Vanterpool
- Department of Surgery, NYU Grossman School of Medicine, NYU Langone Health, New York, NY
| | - Michelle J. Nordstrom
- Center for Rehabilitation Sciences Research, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD
| | - Tiffany Riggleman
- Center for Rehabilitation Sciences Research, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD
| | - Carisa M. Cooney
- Department of Plastic and Reconstructive Surgery, School of Medicine, Johns Hopkins University, Baltimore, MD
| | - Sally Jensen
- Department of Medical Social Sciences and Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Gregory Dumanian
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Scott Tintle
- Department of Orthopaedic Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD
| | - Macey Levan
- Department of Surgery, NYU Grossman School of Medicine, NYU Langone Health, New York, NY
- Department of Population Health, NYU Grossman School of Medicine, New York, NY
| | - Gerald Brandacher
- Department of Plastic and Reconstructive Surgery, School of Medicine, Johns Hopkins University, Baltimore, MD
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Atallah H, Qureshi AZ, Msechu Z. Satisfaction of individuals with partial-hand amputations after they were fitted with cosmetic silicone prostheses. Prosthet Orthot Int 2023; 47:288-292. [PMID: 36705663 DOI: 10.1097/pxr.0000000000000196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 09/08/2022] [Indexed: 01/28/2023]
Abstract
BACKGROUND Partial-hand amputations are the most common level of upper-limb amputations which can lead to cosmetic and functional problems. Partial-hand amputations can be acquired or congenital. Cosmetic silicone prostheses are used in the management of partial-hand amputation; however, a literature review shows that most of the studies are on the fabrication of prosthesis, and data remain deficient on the satisfaction of users with silicone prostheses. OBJECTIVES To assess the satisfaction of individuals after they were fitted with cosmetic silicone prostheses for partial-hand amputations. STUDY DESIGN Cross-sectional study. METHODS Fifty-four participants with partial-hand amputations and who received cosmetic silicone prostheses participated in the survey using the validated Arabic version of the Client Satisfaction with Device (CSD-Ar). RESULTS Nearly half of the participants were using their silicone prosthesis daily. Most of the patients reported satisfaction with durability and donning, whereas most of the patients were dissatisfied with comfort. The mean of CSD-Ar total score was 16.8 ± 4.7 of 32. The CSD-Ar total score was significantly associated with the side of amputation ( p -value = 0.014) and usage of prosthesis ( p -value < 0.001). CONCLUSION The satisfaction of individuals with partial-hand amputations can be enhanced by fitting them with cosmetic silicone prostheses. However, these prostheses should meet certain criteria including fitting, weight, comfort, donning, appearance, durability, skin abrasion and irritation, and pain. Individuals' expectations and concerns should be considered as well.
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Affiliation(s)
- Huthaifa Atallah
- Rehabilitation Technology Department, Rehabilitation Hospital, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
- Department of Prosthetics and Orthotics, School of Rehabilitation Sciences, The University of Jordan, Amman, Jordan
| | - Ahmad Zaheer Qureshi
- Physical Medicine and Rehabilitation Department, Rehabilitation Hospital, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Zidikheri Msechu
- Rehabilitation Technology Department, Rehabilitation Hospital, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
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Reddy AK, Norris GR, Nayfa R, Sajjadi NB, Checketts JX, Scott JT, Hartwell M. The presence of person-centered language in orthopedic-related amputation research: a cross-sectional analysis. J Osteopath Med 2022; 123:235-242. [PMID: 36520046 DOI: 10.1515/jom-2022-0181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 11/08/2022] [Indexed: 12/23/2022]
Abstract
Abstract
Context
Amputations are routine in orthopedics, specifically during trauma and when patients have recurrent surgical site infections. When undergoing amputations, patients must combat the psychosocial factors associated with the loss of an extremity, including stigmatization.
Objectives
This study analyzes the presence of person-centered language (PCL) within amputation-related orthopedic publications in the top orthopedic journals.
Methods
We conducted a cross-sectional analysis with a database search on February 14, 2021 utilizing PubMed. Utilizing a previously published search string, we isolated studies that were published in the top 20 orthopedic journals based on the Google h5-index. In addition to the top 20 orthopedic journals, we included the top two hand and foot & ankle journals in our search to incorporate more amputation literature. Our search yielded 687 returns. The sample was then randomized, and the first 300 studies that fit our inclusion criteria were examined for prespecified non-PCL terminology.
Results
Our results show that 157 (52.2%) studies were adherent to PCL according to the American Medical Association’s Manual of Style 10th Edition (AMAMS). Of the 143 (47.7%) studies that were not adherent to PCL, 51 studies (35.7%) had more than one type of non-PCL language. The term “amputee,” which is being labeled as identity-first language (IFL), was found in 101 articles (33.7%). Further investigation found that 73.3% (74/101) of the studies containing IFL were found to have other non-PCL terms. Of the other studies in the sample, non-PCL was found 34.7% (88/199) of the time. This analysis was done due to the discrepancies in stigmatization of the term “amputee.” No statistical association was found between adherence to PCL and study characteristics.
Conclusions
Our findings show that amputation literature within the top orthopedic journals has limited adherence to PCL. Additionally, the use of the term “amputee,” which is widely accepted by the amputation community, resulted in a greater rate of non-PCL terminology within orthopedic amputation literature. Efforts should be implemented within orthopedics to avoid the use of stigmatizing language, regarding individuals that underwent amputations, to minimize psychosocial stressors.
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Affiliation(s)
- Arjun K. Reddy
- Department of Orthopedic Surgery , Oklahoma State University Medical Center , Tulsa , OK , USA
- Office of Medical Student Research , Oklahoma State University Center for Health Sciences , Tulsa , OK , USA
| | - Grayson R. Norris
- Department of Orthopedic Surgery , Oklahoma State University Medical Center , Tulsa , OK , USA
| | - Rob Nayfa
- Department of Orthopedic Surgery , Oklahoma State University Medical Center , Tulsa , OK , USA
| | - Nicholas B. Sajjadi
- Office of Medical Student Research , Oklahoma State University Center for Health Sciences , Tulsa , OK , USA
| | - Jake X. Checketts
- Department of Orthopedic Surgery , Oklahoma State University Medical Center , Tulsa , OK , USA
| | - Jared T. Scott
- Department of Orthopedic Surgery , Oklahoma State University Medical Center , Tulsa , OK , USA
| | - Micah Hartwell
- Office of Medical Student Research , Oklahoma State University Center for Health Sciences at Cherokee Nation , Tahlequah , OK , USA
- Department of Psychiatry and Behavioral Sciences , Oklahoma State University Center for Health Sciences , Tulsa , OK , USA
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Muacevic A, Adler JR, Ghodasara K, Patel SH, Cheriyath P. A Rare Case of Acute Compartment Syndrome (ACS) Involving the Upper Limb in a Patient on Warfarin. Cureus 2022; 14:e31916. [PMID: 36579252 PMCID: PMC9792250 DOI: 10.7759/cureus.31916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2022] [Indexed: 11/28/2022] Open
Abstract
Acute compartment syndrome (ACS) is an acute event characterized by increased pressure in the extremities where fascia encloses muscles, vessels, and nerves, leading to complications in tissue perfusion and, eventually, tissue necrosis and death. This is usually seen after trauma, crush injuries, and fractures. Similar events can also happen in the abdomen and lead to impaired perfusion in the abdominal organs. Hypovolemia, medications, and repeated or suboptimal diagnostic tests tend to worsen a pre-existing ACS, and the mainstay of its management is fasciotomy to prevent ischemic necrosis and rhabdomyolysis. Here we discuss a 64-year-old female with ACS involving the left upper limb, secondary to anticoagulation on warfarin and aspirin for atrial fibrillation. Her history was significant for peripheral vascular disease, above-knee amputation, and congestive heart failure. This article emphasizes the importance of early recognition and management of ACS to salvage limbs.
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Gacki-Smith J, Kuramitsu BR, Downey M, Vanterpool KB, Nordstrom MJ, Luken M, Riggleman T, Altema W, Fichter S, Cooney CM, Dumanian GA, Jensen SE, Brandacher G, Tintle S, Levan M, Gordon EJ. Information needs and development of a question prompt sheet for upper extremity vascularized composite allotransplantation: A mixed methods study. Front Psychol 2022; 13:960373. [PMID: 36132190 PMCID: PMC9484522 DOI: 10.3389/fpsyg.2022.960373] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 07/20/2022] [Indexed: 11/24/2022] Open
Abstract
Background People with upper extremity (UE) amputations report receiving insufficient information about treatment options. Furthermore, patients commonly report not knowing what questions to ask providers. A question prompt sheet (QPS), or list of questions, can support patient-centered care by empowering patients to ask questions important to them, promoting patient-provider communication, and increasing patient knowledge. This study assessed information needs among people with UE amputations about UE vascularized composite allotransplantation (VCA) and developed a UE VCA-QPS. Methods This multi-site, cross-sectional, mixed-methods study involved in-depth and semi-structured interviews with people with UE amputations to assess information needs and develop a UE VCA-QPS. Qualitative data were analyzed by thematic analysis; quantitative data were analyzed by descriptive statistics. The initial UE VCA-QPS included 130 items across 18 topics. Results Eighty-nine people with UE amputations participated. Most were male (73%), had a mean age of 46 years, and had a unilateral (84%) and below-elbow amputation (56%). Participants desired information about UE VCA eligibility, evaluation process, surgery, risks, rehabilitation, and functional outcomes. After refinement, the final UE VCA-QPS included 35 items, across 9 topics. All items were written at a ≤ 6th grade reading level. Most semi-structured interview participants (86%) reported being ‘completely’ or ‘very’ likely to use a UE VCA-QPS. Conclusion People with UE amputations have extensive information needs about UE VCA. The UE VCA-QPS aims to address patients’ information needs and foster patient-centered care. Future research should assess whether the UE VCA-QPS facilitates patient-provider discussion and informed decision-making for UE VCA.
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Affiliation(s)
- Jessica Gacki-Smith
- Center for Health Services and Outcomes Research, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Brianna R. Kuramitsu
- Center for Health Services and Outcomes Research, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Max Downey
- Center for Surgical and Transplant Applied Research, Department of Surgery, NYU Langone Health Transplant Institute, New York University Grossman School of Medicine, New York, NY, United States
| | - Karen B. Vanterpool
- Center for Surgical and Transplant Applied Research, Department of Surgery, NYU Langone Health Transplant Institute, New York University Grossman School of Medicine, New York, NY, United States
| | - Michelle J. Nordstrom
- Center for Rehabilitation Sciences Research, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, United States
| | - Michelle Luken
- Henry M. Jackson Foundation, Center for Rehabilitation Sciences Research, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, United States
| | - Tiffany Riggleman
- Henry M. Jackson Foundation, Center for Rehabilitation Sciences Research, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, United States
| | - Withney Altema
- Henry M. Jackson Foundation, Center for Rehabilitation Sciences Research, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, United States
| | - Shannon Fichter
- Henry M. Jackson Foundation, Center for Rehabilitation Sciences Research, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, United States
| | - Carisa M. Cooney
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Greg A. Dumanian
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Sally E. Jensen
- Department of Medical Social Sciences and Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Gerald Brandacher
- Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Scott Tintle
- Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, United States
| | - Macey Levan
- Center for Surgical and Transplant Applied Research, Department of Surgery and Department of Population Health, NYU Langone Health Transplant Institute, New York University Grossman School of Medicine, New York, NY, United States
- Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Elisa J. Gordon
- Department of Surgery-Division of Transplantation, Center for Health Services and Outcomes Research, Center for Bioethics and Medical Humanities, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- *Correspondence: Elisa J. Gordon,
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11
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Dunn JA, Taylor CE, Wong B, Henninger HB, Bachus KN, Foreman KB. Testing Precision and Accuracy of an Upper Extremity Proprioceptive Targeting Task Assessment. Arch Rehabil Res Clin Transl 2022; 4:100202. [PMID: 36123975 PMCID: PMC9482043 DOI: 10.1016/j.arrct.2022.100202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objective To develop and test an assessment measuring extended physiological proprioception (EPP). EPP is a learned skill that allows one to extend proprioception to an external tool, which is important for controlling prosthetic devices. The current study examines the ability of this assessment to measure EPP in a nonamputee population for translation into the affected population. Design Measuring precision and accuracy of an upper extremity (UE) proprioceptive targeting task assessment. Participants completed 2 sessions of a targeting task while seated at a table. The targeting was completed with the dominant and nondominant hand and with eyes open and eyes closed during the task. Participants completed 2 sessions of the clinical test with a 1-week washout period to simulate reasonable time between clinical visits. Setting Research laboratory. Participants Twenty right-handed participants (N=20) with no neurologic or orthopedic deficits that would interfere with proprioception, median age of 25 years (range, 19-33 years), completed the assessment (10 men, 10 women). Interventions Not applicable. Main Outcome Measures Precision (consistency in targeting) and accuracy (distance between the intended target and participant result) in UE targeting task using EPP; test-retest repeatability between sessions. Results Both precision and accuracy were significantly decreased in the eyes-closed condition compared with the eyes-open condition regardless of targeting with dominant or nondominant hand (all P<.001). In the eyes-open condition, there was a dominance effect relating to the accuracy; however, in the eyes-closed condition, accuracy between dominant and nondominant hands was statistically equivalent. Based on minimum detectable change with 95% confidence, there was no change in either metric between the first and second sessions. Conclusions The results of this study support the feasibility of using this assessment to measure EPP-based on the definition of EPP as a learned skill that indicates control over an external, simple tool-because they demonstrate reliance on proprioception in the eyes-closed condition, symmetry in proprioceptive accuracy between hands for within-participant control, and test-retest reliability for longitudinal measurements. The results also establish normative values for this assessment in young, healthy adults. Further research is required in a clinical population to evaluate the UE proprioceptive targeting task assessment further and collect objective data on EPP.
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Affiliation(s)
- Julia A. Dunn
- Department of Orthopedics, University of Utah, Salt Lake City, UT
- Department of Biomedical Engineering University of Utah, Salt Lake City, UT
| | - Carolyn E. Taylor
- Department of Orthopedics, University of Utah, Salt Lake City, UT
- Department of Biomedical Engineering University of Utah, Salt Lake City, UT
| | - Bob Wong
- College of Nursing, University of Utah, Salt Lake City, UT
| | - Heath B. Henninger
- Department of Orthopedics, University of Utah, Salt Lake City, UT
- Department of Biomedical Engineering University of Utah, Salt Lake City, UT
| | - Kent N. Bachus
- Department of Orthopedics, University of Utah, Salt Lake City, UT
- Department of Biomedical Engineering University of Utah, Salt Lake City, UT
- Department of Veterans Affairs, Salt Lake City, UT
| | - Kenneth B. Foreman
- Department of Orthopedics, University of Utah, Salt Lake City, UT
- Department of Veterans Affairs, Salt Lake City, UT
- Department of Physical Therapy and Athletic Training University of Utah, Salt Lake City, UT
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12
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Liston JM, Forster GL, Samuel A, Werner BC, Stranix JT, DeGeorge BR. Estimating the Impact of Postamputation Pain. Ann Plast Surg 2022; 88:533-537. [PMID: 35443269 DOI: 10.1097/sap.0000000000003009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Neuromas, neuralgia, and phantom limb pain commonly occur after lower-extremity amputations; however, incidence of these issues is poorly reported and understood. Present literature is limited to small cohort studies of amputees, and the reported incidence of chronic pain after amputation ranges as widely as 0% to 80%. We sought to objectively investigate the incidence of postamputation pain and nerve-related complications after lower-extremity amputation. METHODS Patients who underwent lower-extremity amputation between 2007 and 2017 were identified using a national insurance-based claims database. Incidence of reporting of postoperative neuroma, neuralgia, and phantom limb pain were identified. Patient demographics and comorbidities were assessed. Average costs of treatment were determined in the year after lower-extremity amputation. Logistic regression analyses and resulting odds ratios were calculated to determine statistically significant increases in incidence of postamputation nerve-related pain complications in the setting of demographic factors and comorbidities. RESULTS There were 29,507 lower amputations identified. Postoperative neuralgia occurred in 4.4% of all amputations, neuromas in 0.4%, and phantom limb pain in 10.9%. Nerve-related pain complications were most common in through knee amputations (20.3%) and below knee amputations (16.7%). Male sex, Charlson Comorbidity Index > 3, diabetes mellitus, diabetic neuropathy, diabetic angiopathy, diabetic retinopathy, obesity, peripheral vascular disease, and tobacco abuse were associated with statistically significant increases in incidence of 1-year nerve-related pain or phantom limb pain. CONCLUSIONS Given the incidence of these complications after operative extremity amputations and associated increased treatment costs, future research regarding their pathophysiology, treatment, and prevention would be beneficial to both patients and providers.
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Affiliation(s)
| | | | | | - Brian C Werner
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA
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13
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Fitzpatrick SM, Brogan D, Grover P. Hand Transplants, Daily Functioning, and the Human Capacity for Limb Regeneration. Front Cell Dev Biol 2022; 10:812124. [PMID: 35309909 PMCID: PMC8930848 DOI: 10.3389/fcell.2022.812124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 02/08/2022] [Indexed: 11/24/2022] Open
Abstract
Unlike some of our invertebrate and vertebrate cousins with the capacity to regenerate limbs after traumatic loss, humans do not have the ability to regrow arms or legs lost to injury or disease. For the millions of people worldwide who have lost a limb after birth, the primary route to regaining function and minimizing future complications is via rehabilitation, prosthetic devices, assistive aids, health system robustness, and social safety net structures. The majority of limbs lost are lower limbs (legs), with diabetes and vascular disorders being significant causal contributors. Upper limbs (arms) are lost primarily because of trauma; digits and hands are the most common levels of loss. Even if much of the arm remains intact, upper limb amputation significantly impacts function, largely due to the loss of the hand. Human hands are marvels of evolution and permit a dexterity that enables a wide variety of function not readily replaced by devices. It is not surprising, therefore, for some individuals, dissatisfaction with available prosthetic options coupled with remarkable advances in hand surgery techniques is resulting in patients undertaking the rigors of a hand transplantation. While not “regeneration” in the sense of the enviable ability with which Axolotls can replace a lost limb, hand transplants do require significant regeneration of tissues and nerves. Regaining sophisticated hand functions also depends on “reconnecting” the donated hand with the areas of the human brain responsible for the sensory and motor processing required for complex actions. Human hand transplants are not without controversy and raise interesting challenges regarding the human regenerative capacity and the status of transplants for enabling function. More investigation is needed to address medical and ethical questions prior to expansion of hand transplants to a wider patient population.
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Affiliation(s)
- Susan M. Fitzpatrick
- James S. McDonnell Foundation, St. Louis, MO, United States
- *Correspondence: Susan M. Fitzpatrick,
| | - David Brogan
- Department of Orthopaedic Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Prateek Grover
- Division of Neurorehabilitation, Orthopaedic Surgery and Neurology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
- The Rehabilitation Institute of St Louis, St. Louis, MO, United States
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14
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Efanov J, Tchiloemba B, Izadpanah A, Harris P, Danino M. A review of utilities and costs of treating upper extremity amputations with vascularized composite allotransplantation versus myoelectric prostheses in Canada. JPRAS Open 2022; 32:150-160. [PMID: 35402680 PMCID: PMC8989691 DOI: 10.1016/j.jpra.2022.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 03/04/2022] [Indexed: 11/30/2022] Open
Affiliation(s)
- J.I. Efanov
- Corresponding author at: Plastic and Reconstructive Surgeon, Centre Hospitalier de l'Université de Montréal, 1051 Rue Sanguinet, Montréal, QC H2 × 3E4, Canada.
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15
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Ting YZJ, Tan AS, Lai CPT, Satku M. Clinical factors and mortality rates for non-traumatic upper extremity amputations. J Hand Surg Eur Vol 2022; 47:314-320. [PMID: 34472395 DOI: 10.1177/17531934211042720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Non-traumatic upper extremity amputations are an increasing concern with the rising prevalence of diabetes mellitus. To ascertain the risk factors and mortality rates for these amputations, the demographic information, amputation history, comorbidities and clinical outcomes of 140 patients who underwent non-traumatic upper extremity amputations between 1 January 2004 and 31 October 2017 were studied. Correlations were assessed using Cochran-Armitage chi-squared tests, odds ratios and multivariate binomial logistic regression as appropriate. Diabetes mellitus, coronary artery disease, end-stage renal failure, peripheral arterial disease and prior lower extremity amputation were significant risk factors for multiple upper extremity amputations. One-year, 2-year and 5-year mortality rates were 12%, 15% and 38%, respectively, following first upper extremity amputation. The risk factors for upper extremity amputations correspond with those for lower extremity amputations, comprising mainly diabetes mellitus and its related comorbidities. The mortality rates for non-traumatic upper extremity amputations highlight their significant burden on patients.Level of evidence: III.
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Affiliation(s)
| | - An-Sen Tan
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | | | - Mala Satku
- Department of Hand and Reconstructive Microsurgery, Tan Tock Seng Hospital, Singapore
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16
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Maslow JI, LeMone A, Scarola GT, Loeffler BJ, Gaston RG. Digital Nerve Management and Neuroma Prevention in Hand Amputations. Hand (N Y) 2022:15589447211065074. [PMID: 35130747 DOI: 10.1177/15589447211065074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Hand and digit amputations represent a relatively common injury affecting an active patient population. Neuroma formation following amputation at the level of the digital nerve can cause significant disability and lead to revision surgery. One method for managing digital nerves in primary and revision partial hand amputations is to perform interdigital end-to-end nerve coaptations to prevent neuroma formation. METHODS All patients with an amputation at the level of the common or proper digital nerves that had appropriate follow-up at our institution from 2010 to 2020 were included. Common or proper digital nerves were managed with either traction neurectomy or digital end-to-end neurorrhaphy. The primary outcome was the development of a neuroma. Secondary outcomes included revision surgery, complications, and visual analog pain scores. RESULTS A total of 289 nerves in 54 patients underwent hand or digital amputation in the study period. Thirteen hands with 78 nerves (27%) underwent direct end-to-end coaptation with a postoperative neuroma incidence of 12.8% compared with 22.7% in the 211 nerves that did not have a coaptation performed. Significantly fewer patients reported persistent pain if an end-to-end coaptation was performed (0% vs. 11.8%, P < .01). The prevalence of depression and workers compensation status was significantly higher in in patients with symptomatic neuromas than in patients without symptomatic neuromas (P < .01). CONCLUSIONS Digital nerve end-to-end neurorrhaphy is a method for neuroma prevention in partial hand amputations that results in decreased residual hand pain without increase complications. Depression and worker's compensations status were significantly associated with symptomatic neuroma formation.
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Affiliation(s)
- Jed I Maslow
- Vanderbilt Orthopaedic Institute, Nashville, TN, USA
| | | | | | - Bryan J Loeffler
- OrthoCarolina Hand Center, Charlotte, USA.,Atrium Musculoskeletal Institute, Charlotte, NC, USA
| | - R Glenn Gaston
- OrthoCarolina Hand Center, Charlotte, USA.,Atrium Musculoskeletal Institute, Charlotte, NC, USA
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17
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Stögner VA, Megerle K, Krezdorn N, Vogt PM. Major traumatic amputations and replantations of the upper extremity in Germany – National Quality Reports 2014 – 2018. JPRAS Open 2022; 32:98-110. [PMID: 35345616 PMCID: PMC8956841 DOI: 10.1016/j.jpra.2022.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 01/07/2022] [Indexed: 11/12/2022] Open
Abstract
The treatment of traumatic major upper limb amputation is complex and of great urgency. Loss of time often represents a majorrestriction for replantation. Thus, logistical and infrastructural developments, such as the expansion of specialised hand trauma centres, are crucial for optimizing delivery of care. Surveillance represents the fundament for a proper, demand-adapted implementation of such therapeutical improvements. However, a comprehensive database for surveillance of these injuries does currently not exist in Germany or Europe. In this study quality reports of German hospitals from 2014 to 2018 were screened retrospectively for traumatic major upper extremity amputations and replantations. A total of 329 amputations and 87 replantations were recorded, accounting for an overall replantation rate (RR) of 26%. Most of the injuries affected the level of the wrist and forearm. Treatment of these injuries experienced an increasing centralisation to medical teaching facilities, which accounted for higher RRs compared with non-teaching facilities. The cumulatively most populous federal states handled most of the amputation injures in this five-year study period. Ratio calculations on the basis of population counts, however, revealed great discrepancies to these results, with Hamburg, Rhineland-Palatinate and Saarland accounting for the highest per capita incidences. In 2018 Germany was provided with 46 specialised hand trauma and replantation centres, which performed 45% of the replantations in that year, revealing a RR of 17%, compared to an overall RR of 14% in that year. Nevertheless, there might be potential for improvement in the geographical distribution of these specialised centres. The provision of highly specialised therapy in highly specialised centres for highly complex injuries is a future challenge in replantation surgery. This data is contributing to logistical improvements for a need-adapted expansion of these specialised hand trauma centres. The study demonstrates an approach of a standardised and comprehensive injury surveillance program based on national quality reports, while underlining the importance of such a national or rather European database for optimisations in medical care. Level of evidence IV.
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18
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Kim S, Shin DY, Kim T, Lee S, Hyun JK, Park SM. Enhanced Recognition of Amputated Wrist and Hand Movements by Deep Learning Method Using Multimodal Fusion of Electromyography and Electroencephalography. SENSORS 2022; 22:s22020680. [PMID: 35062641 PMCID: PMC8778369 DOI: 10.3390/s22020680] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 01/09/2022] [Accepted: 01/14/2022] [Indexed: 02/04/2023]
Abstract
Motion classification can be performed using biometric signals recorded by electroencephalography (EEG) or electromyography (EMG) with noninvasive surface electrodes for the control of prosthetic arms. However, current single-modal EEG and EMG based motion classification techniques are limited owing to the complexity and noise of EEG signals, and the electrode placement bias, and low-resolution of EMG signals. We herein propose a novel system of two-dimensional (2D) input image feature multimodal fusion based on an EEG/EMG-signal transfer learning (TL) paradigm for detection of hand movements in transforearm amputees. A feature extraction method in the frequency domain of the EEG and EMG signals was adopted to establish a 2D image. The input images were used for training on a model based on the convolutional neural network algorithm and TL, which requires 2D images as input data. For the purpose of data acquisition, five transforearm amputees and nine healthy controls were recruited. Compared with the conventional single-modal EEG signal trained models, the proposed multimodal fusion method significantly improved classification accuracy in both the control and patient groups. When the two signals were combined and used in the pretrained model for EEG TL, the classification accuracy increased by 4.18-4.35% in the control group, and by 2.51-3.00% in the patient group.
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Affiliation(s)
- Sehyeon Kim
- Department of Convergence IT Engineering, Pohang University of Science and Technology, Pohang 37673, Korea;
| | - Dae Youp Shin
- Department of Rehabilitation Medicine, College of Medicine, Dankook University, Cheonan 31116, Korea;
| | - Taekyung Kim
- Department of Medical Device Management and Research, SAIHST, Sungkyunkwan University, Seoul 03063, Korea;
| | - Sangsook Lee
- Department of Rehabilitation Medicine, Daejeon Hospital, Daejeon 34383, Korea;
| | - Jung Keun Hyun
- Department of Rehabilitation Medicine, College of Medicine, Dankook University, Cheonan 31116, Korea;
- Department of Nanobiomedical Science & BK21 NBM Global Research Center for Regenerative Medicine, Dankook University, Cheonan 31116, Korea
- Institute of Tissue Regeneration Engineering (ITREN), Dankook University, Cheonan 31116, Korea
- Correspondence: (J.K.H.); (S.-M.P.); Tel.: +82-10-2293-3415 (J.K.H.); +82-10-7208-7740 (S.-M.P.)
| | - Sung-Min Park
- Department of Convergence IT Engineering, Pohang University of Science and Technology, Pohang 37673, Korea;
- Department of Electrical Engineering, Pohang University of Science and Technology, Pohang 37673, Korea
- Department of Mechanical Engineering, Pohang University of Science and Technology, Pohang 37673, Korea
- Correspondence: (J.K.H.); (S.-M.P.); Tel.: +82-10-2293-3415 (J.K.H.); +82-10-7208-7740 (S.-M.P.)
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19
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Frey S, Motawar B, Buchanan K, Kaufman C, Stevens P, Cirstea C, Morrow S. Greater and More Natural Use of the Upper Limbs During Everyday Life by Former Amputees Versus Prosthesis Users. Neurorehabil Neural Repair 2022; 36:227-238. [PMID: 34996313 DOI: 10.1177/15459683211062889] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Hand loss profoundly impacts daily functioning. Reversal of amputation through hand replantation or transplantation offers an alternative to prosthetics for some. Whether recipients exhibit more extensive and natural limb use during everyday life than prosthesis users is, however, unknown.We asked unilateral, below-elbow amputees (N = 22), hand graft recipients (transplants N = 4; replants N = 2), and healthy matched controls (N = 20) to wear wireless accelerometers distally on their forearms/prostheses and proximally on their upper arms. These units captured limb activity over 3 days within participants' natural environments.Graft recipients exhibited heavier reliance on their affected hands compared to amputees' reliance on their prostheses, P < .001. Likewise, reliance on the injured side upper arm was also greater for hand graft recipients than amputees, regardless of whether they were wearing their prostheses, P < .05 in both cases. Hand graft recipients, like healthy controls, also relied more on forearm vs upper arm movements when controlling their limbs, P < .001.Compared with conventional prosthesis users, graft recipients exhibited more extensive and natural functioning of the upper limbs during everyday activities. This information is an important addition to other considerations when evaluating risk-benefit of these treatment alternatives.
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Affiliation(s)
- Scott Frey
- Dept. of Psychological Sciences, 14716University of Missouri, Columbia, MO, USA.,Dept. of Physical Medicine and Rehabilitation, 14716University of Missouri, Columbia, MO, USA.,Dept. of Cardiovascular and Thoracic Surgery, 12254University of Louisville School of Medicine, Louisville, KY, USA
| | - Binal Motawar
- Dept. of Physical Medicine and Rehabilitation, 14716University of Missouri, Columbia, MO, USA
| | - Kelli Buchanan
- Dept. of Physical Medicine and Rehabilitation, 14716University of Missouri, Columbia, MO, USA
| | - Christina Kaufman
- Dept. of Cardiovascular and Thoracic Surgery, 12254University of Louisville School of Medicine, Louisville, KY, USA
| | | | - Carmen Cirstea
- Dept. of Physical Medicine and Rehabilitation, 14716University of Missouri, Columbia, MO, USA
| | - Sean Morrow
- Dept. of Psychological Sciences, 14716University of Missouri, Columbia, MO, USA
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20
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Cramer J, Brown G, Herrera FA. Epidemiology of Upper-Extremity Amputations Using the National Electronic Injury Surveillance System. Ann Plast Surg 2021; 86:S599-S602. [PMID: 34100819 DOI: 10.1097/sap.0000000000002856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Upper-extremity amputations can be devastating injuries that lead to lifelong disabilities. The purpose of our study was to review national data and identify populations at risk and injury patterns that could be targeted with prevention strategies. METHODS Data from the National Electronic Injury Surveillance System between years 2012 and 2018 were reviewed. Injuries affecting the upper extremity resulting in amputation were included. Patient demographics, anatomical location, mechanism of injury, level of care provided, and setting of injury were recorded. Descriptive was recorded and tabulated for each category. RESULTS There were 4,766 patients identified with amputations to the upper extremity from 2012 to 2018. The following categories are listed below: age in years, sex, race, anatomical location of injury, most common mechanisms of injury, disposition of patient, environmental location. CONCLUSIONS Our data show that male children younger than 10 years are at the high risk for finger amputations. In addition, the majority of these injuries occur in the home. This suggests that safety prevention in the home is a significant area in need of improvement. We recommend further research in areas of home safety and injury prevention to decrease the risk of the devastating injuries.
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21
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Boutrous ML, Tian Y, Brown D, Freeman CA, Smeds MR. Area Deprivation Index Score is Associated with Lower Rates of Long Term Follow-up after Upper Extremity Vascular Injuries. Ann Vasc Surg 2021; 75:102-108. [PMID: 33910047 DOI: 10.1016/j.avsg.2021.03.037] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 03/17/2021] [Accepted: 03/19/2021] [Indexed: 11/15/2022]
Abstract
The Area Deprivation Index (ADI) has been shown to be a determinant of healthcare outcomes in both medical and surgical fields, and is a measure of the socioeconomic status of patients. We sought to analyze outcomes in patients with upper extremity vascular injuries that were admitted over a five-year period to a Level I trauma center sorted by ADI. All patients with upper extremity vascular injury presenting to a level one trauma center between January 2013 and January 2017 were retrospectively collected. The patients were divided into two groups based on their ADI with the first group representing the lowest quartile of patients and the second group the higher three quartiles. Patient's demographics were analyzed as well as modes of trauma, hospital transfer status prior to receiving care, type of intervention received, follow-up rates and outcomes including both complication and amputation rates. Over this time period, a total of 88 patients with traumatic upper extremity vascular injuries were identified. The majority of injuries were due to penetrating trauma (74/88, 84%) with 41% (10/24) of patients in the lower ADI being victims of gunshot wounds compared to 27% (17/64) of those in the higher ADI (P = 0.19). Patients in the lowest ADI quartile were more likely to be African Americans (P= 0.0001), and more likely to be transferred to our university hospital prior to receiving care (P= 0.007). Arrival Glasgow Coma Scale and Injury Severity Score were similar as was time spent in the emergency room. Length of stay trended longer in the lowest ADI quartile as compared to the higher ADI (7.5 vs. 11.8, P= 0.59). The rates of long term follow-up were significantly lower in patients with the lowest ADI scores as opposed to the higher ADI group (P= 0.0098), however, there was no statistically significant difference in outcomes between the two groups including both complication and amputation rates. The ADI is associated with lower rates of long term follow-up after upper extremity vascular injuries, despite patients in both the high and low ADI groups having similar outcomes in regards to complication and amputation rates. Further study is warranted to investigate the role of the socioeconomic status in outcomes following traumatic injury.
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Affiliation(s)
- Mina L Boutrous
- Division of Vascular and Endovascular Surgery, University of Connecticut, Farmington, CT, USA.
| | - Yuqian Tian
- Division of Vascular and Endovascular Surgery, St. Louis University, St. Louis, MO, USA
| | - Daniel Brown
- Division of Vascular and Endovascular Surgery, St. Louis University, St. Louis, MO, USA
| | - Carl A Freeman
- Trauma and Surgical Critical Care Division, St. Louis University, St. Louis, MO, USA
| | - Matthew R Smeds
- Division of Vascular and Endovascular Surgery, St. Louis University, St. Louis, MO, USA
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22
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Incidence and demographic characteristics of Syrian Civil War-related amputations: A multi-center study. Turk J Phys Med Rehabil 2021; 67:48-55. [PMID: 33948543 PMCID: PMC8088804 DOI: 10.5606/tftrd.2021.5058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 12/18/2019] [Indexed: 11/21/2022] Open
Abstract
Objectives The aim of this study was to identify the causes, levels, and rates of amputations performed in civilians during the Syrian Civil War and to present epidemiological data of the amputees. Patients and methods Between August 2017 and February 2019, a total of 363 amputations of 307 amputees (266 males, 41 females; mean age 29.9±13.3 years; range, 6 to 86 years) were retrospectively analyzed in four prosthesis and orthosis centers managed by an international non-governmental organization and serving to individuals who experienced amputation during Syrian Civil War. Level, etiology, number of amputations and distribution of the amputations by years were investigated. Results Of the patients, 25.4% were under the age of 18 years. A total of 74% of all amputations were of the lower extremities. Transtibial and transfemoral amputations were the most common amputation levels. Of the amputees, 89.3% reported the cause of amputation as bombing. Conclusion Civil amputations during the Syrian Civil War are different from those in other civil wars due to the high rate of bombing-induced amputations and also the high rate of victims under the age of 18 years. Our study results show a high ratio of both lower and upper extremity amputations in these civilians.
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Lans J, Hoftiezer Y, Lozano-Calderón SA, Heng M, Valerio IL, Eberlin KR. Risk Factors for Neuropathic Pain Following Major Upper Extremity Amputation. J Reconstr Microsurg 2020; 37:413-420. [PMID: 33058096 PMCID: PMC10375759 DOI: 10.1055/s-0040-1718547] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Active treatment (targeted muscle reinnervation [TMR] or regenerative peripheral nerve interfaces [RPNIs]) of the amputated nerve ends has gained momentum to mitigate neuropathic pain following amputation. Therefore, the aim of this study is to determine the predictors for the development of neuropathic pain after major upper extremity amputation. METHODS Retrospectively, 142 adult patients who underwent 148 amputations of the upper extremity between 2000 and 2019 were identified through medical chart review. All upper extremity amputations proximal to the metacarpophalangeal joints were included. Patients with a follow-up of less than 6 months and those who underwent TMR or RPNI at the time of amputation were excluded. Neuropathic pain was defined as phantom limb pain or a symptomatic neuroma reported in the medical charts at 6 months postoperatively. Most common indications for amputation were oncology (n = 53, 37%) and trauma (n = 45, 32%), with transhumeral amputations (n = 44, 30%) and shoulder amputations (n = 37, 25%) being the most prevalent. RESULTS Neuropathic pain occurred in 42% of patients, of which 48 (32%) had phantom limb pain, 8 (5.4%) had a symptomatic neuroma, and 6 (4.1%) had a combination of both. In multivariable analysis, traumatic amputations (odds ratio [OR]: 4.1, p = 0.015), transhumeral amputations (OR: 3.9, p = 0.024), and forequarter amputations (OR: 8.4, p = 0.003) were independently associated with the development of neuropathic pain. CONCLUSION In patients with an upper extremity amputation proximal to the elbow or for trauma, there is an increased risk of developing neuropathic pain. In these patients, primary TMR/RPNI should be considered and this warrants a multidisciplinary approach involving general trauma surgeons, orthopaedic surgeons, plastic surgeons, and vascular surgeons.
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Affiliation(s)
- Jonathan Lans
- Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Yannick Hoftiezer
- Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Santiago A Lozano-Calderón
- Department of Orthopaedic Surgery, Orthopaedic Oncology Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Marilyn Heng
- Department of Orthopedic Surgery, Harvard Medical School Orthopedic Trauma Initiative, Massachusetts General Hospital, Boston, Massachusetts
| | - Ian L Valerio
- Division of Plastic Surgery, Hand Surgery, and Peripheral Nerve Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Kyle R Eberlin
- Division of Plastic Surgery, Hand Surgery, and Peripheral Nerve Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Artoni F, Tanguenza A, D'Anna E, Micera S. Somatosensory Evoked Potentials following upper limb noninvasive electrical stimulation: a case study. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2020:2881-2884. [PMID: 33018608 DOI: 10.1109/embc44109.2020.9176722] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Lack of sensory feedback is one of the main issues contributing to lack of control and embodiment for upper-limb prostheses. Noninvasive nerve stimulation may help amputees overcome such limitations by providing a degree of somatotopic feedback, however its neural correlates have been only partly characterized so far. While the effects of median nerve stimulation have been studied, little attention has been given to ulnar nerve and bipolar stimulation, which might provide a finer modulation of the somatotopic sensation. Here, monopolar and bipolar transcutaneous electrical nerve stimulation (TENS) is repeatedly applied to the ulnar and median nerves and elicited Somatosensory Evoked Potentials (SEPs) are characterized by means of electroencephalography (EEG). Clear P50, P150 and P270 SEPs were outlined, with significantly different amplitudes between configurations. In each case scalp topographies showed a strong contralateral activation in the early phase after the stimulus onset (40-100 ms), compatible with generators in the somatosensory cortex and in accordance to previous literature on actual tactile stimuli, which gives way to a frontal-central distribution at long latencies (130-190 ms). These findings, although needing further validation with a larger pool of subjects, show that bipolar TENS could have potential applications in improving prosthesis control with tactile feedback.
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Masood A, Danawar NA, Mekaiel A, Raut S, Malik BH. The Utility of Therapeutic Anticoagulation in the Perioperative Period in Patients Presenting in Emergency Surgical Department With Extremity Vascular Injuries. Cureus 2020; 12:e8473. [PMID: 32642377 PMCID: PMC7336685 DOI: 10.7759/cureus.8473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Extremity vascular trauma is a challenging surgical emergency in both civilian population and combat environment. It requires vigilant diagnosis and prompt treatment to minimize limb loss and mortality. A multidisciplinary team approach is required to deal with shock states, concomitant abdominal injuries, head injuries, and fractures with significant tissue loss and psychological stress. Anticoagulation is frequently used during traumatic vascular repair to avoid repair site thrombosis, postoperative deep venous thrombosis, and pulmonary embolism (PE). In this review article, we are going to search about how frequent is the use of anticoagulation in terms of limb salvage rates, and mortality rates or side effects of anticoagulation in terms of risk of bleeding episodes, and the need for future prospective studies. Extremity vascular trauma is managed by a variety of methods including open repairs, endovascular repairs, and nonoperative management. Most of the literature demonstrates the use of systemic or regional anticoagulation in the management of vascular injuries with the improvement in limb salvage rates and reduced morbidities but confounding factors lead to variable results. Some studies show an increased risk of bleeding in trauma patients with the use of anticoagulants in trauma settings without any significant effect on repair site thrombosis. More comprehensive studies and randomized controlled trials are needed to confirm the importance of perioperative anticoagulation while avoiding the confounding factors in terms of injury severity scores, ischemia time, demographics of patients, modes of injury, comorbidities, grades of shock, concomitant injuries that need anticoagulation like venous injuries or intracranial injuries that are contraindications to the use of anticoagulation, type of anticoagulation and expertise available as well as the experience level of the operating surgeon. Literature also reveals the use of new oral anticoagulants (e.g., dabigatran) to be associated with lesser bleeding episodes when compared to warfarin, so in future, we can check the feasibility of these agents to reduce the bleeding episodes and at the same time improve the limb salvage rates.
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Affiliation(s)
- Ayesha Masood
- General Surgery, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Nuaman A Danawar
- General Surgery, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Andrew Mekaiel
- Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Sumit Raut
- Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Bilal Haider Malik
- Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
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Factors Associated with Primary and Secondary Amputation following Limb-Threatening Upper Extremity Trauma. Plast Reconstr Surg 2020; 145:987-999. [DOI: 10.1097/prs.0000000000006644] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Bidirectional Control of Myoelectric Prostheses in Upper Limb Amputees: Current Results and Expectations. SERBIAN JOURNAL OF EXPERIMENTAL AND CLINICAL RESEARCH 2019. [DOI: 10.2478/sjecr-2019-0065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
The most common causes of upper-limb amputations include traumatic etiology and malignity, followed by peripheral vascular diseases. Prosthetic fitting along with conducting a rehabilitation program provide the greatest possible degree of independence to the upper-limb amputees in performing their daily tasks, occupational, recreational and work activities. Despite recent advance in strategies of design and control, the lack of sensory feedback is, according to patients, one of the most important characteristics lacked by commercial myoelectric prostheses. This reason has led to the need for the development of comprehensive prosthetic part which would provide intuitive control and realistic sensory feedback to the amputees enabling them thus to more easily accomplish the tasks which are essential for easier performance of activities of daily life. Electromyography, and recently, electroneurography signals have been used for the development of more efficacious upper-limb prosthetic control. Several recent studies have demonstrated the efficacy of homologous and somatotopic approach in upper-limb amputees, by applying implanted and surface electrodes. This work presents novel methods for effective bidirectional control of myoelectric prostheses in patients with upper-limb amputations using motor control and sensory feedback. The above-mentioned approaches are applicable and have good prospects in further clinical use. The intraneural, extraneural and surface approach can be more or less applicable depending on the etiology and the level of amputation. From a clinical point of view, various approaches should be combined for obtaining more efficient control of bidirectional prostheses and corresponding sensory feedback.
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Ro JS, Leigh JH, Jeon I, Bang MS. Trends in burden of work-related upper limb amputation in South Korea, 2004-2013: a nationwide retrospective cohort study. BMJ Open 2019; 9:e032793. [PMID: 31748310 PMCID: PMC6886917 DOI: 10.1136/bmjopen-2019-032793] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVES This study aimed to measure the burden of work-related upper limb amputation in Korea over a 10-year period and assess its trend. DESIGN Ecological study. SETTING National level data in Korea between 2004 and 2013. PARTICIPANTS 49 535 subjects who claimed Korea industrial accident compensation insurance due to upper limb amputation. MAIN OUTCOME MEASURES The disability-adjusted life years (DALYs) were calculated by sex, age and the site of amputation using annual incidence. RESULTS The burden of work-related upper limb amputations in Korea reached its peak in 2007 and decreased thereafter. Males showed a higher burden of disease. Finger amputations showed a decreasing trend from 2007, whereas arm amputations continued to show an increasing trend. An increasing trend was found among participants older than 50 years. CONCLUSIONS The decrease in the burden of finger amputations may be attributable to the lower incidence as a result of policy efforts. The increase in the burden of arm amputations was particularly noticeable among the elderly population over 50 years old. This could be attributable to the high proportion of the elderly population working in the manufacturing sector and the lack of policy efforts regarding major amputations in Korea. Future regulatory efforts are needed to prevent amputations.
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Affiliation(s)
- Jun-Soo Ro
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ja-Ho Leigh
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Rehabilitation Medicine, Korean Workers Compensation and Welfare Service Incheon Hospital, Incheon, Republic of Korea
- Institute of Public Health and Medical Service, Seoul NationalUniversity Hospital, Seoul, Republic of Korea
| | - Inpyo Jeon
- Department of Medicine, Seoul Rehabilitation Hospital, Seoul, Republic of Korea
| | - Moon Suk Bang
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
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Ngan CGY, Kapsa RMI, Choong PFM. Strategies for neural control of prosthetic limbs: from electrode interfacing to 3D printing. MATERIALS 2019; 12:ma12121927. [PMID: 31207952 PMCID: PMC6631966 DOI: 10.3390/ma12121927] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Revised: 06/03/2019] [Accepted: 06/12/2019] [Indexed: 01/28/2023]
Abstract
Limb amputation is a major cause of disability in our community, for which motorised prosthetic devices offer a return to function and independence. With the commercialisation and increasing availability of advanced motorised prosthetic technologies, there is a consumer need and clinical drive for intuitive user control. In this context, rapid additive fabrication/prototyping capacities and biofabrication protocols embrace a highly-personalised medicine doctrine that marries specific patient biology and anatomy to high-end prosthetic design, manufacture and functionality. Commercially-available prosthetic models utilise surface electrodes that are limited by their disconnect between mind and device. As such, alternative strategies of mind-prosthetic interfacing have been explored to purposefully drive the prosthetic limb. This review investigates mind to machine interfacing strategies, with a focus on the biological challenges of long-term harnessing of the user's cerebral commands to drive actuation/movement in electronic prostheses. It covers the limitations of skin, peripheral nerve and brain interfacing electrodes, and in particular the challenges of minimising the foreign-body response, as well as a new strategy of grafting muscle onto residual peripheral nerves. In conjunction, this review also investigates the applicability of additive tissue engineering at the nerve-electrode boundary, which has led to pioneering work in neural regeneration and bioelectrode development for applications at the neuroprosthetic interface.
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Affiliation(s)
- Catherine G Y Ngan
- Department of Surgery, The University of Melbourne, St Vincent's Hospital, Melbourne 3065, VIC, Australia.
- Biofab3D@ACMD, St Vincent's Hospital Melbourne, Melbourne 3065, VIC, Australia.
- ARC Centre of Excellence for Electromaterials Science, Intelligent Polymer Research Institute, Innovation Campus, University of Wollongong, Wollongong 2500, NSW, Australia.
| | - Rob M I Kapsa
- Biofab3D@ACMD, St Vincent's Hospital Melbourne, Melbourne 3065, VIC, Australia.
- ARC Centre of Excellence for Electromaterials Science, Intelligent Polymer Research Institute, Innovation Campus, University of Wollongong, Wollongong 2500, NSW, Australia.
- Department of Medicine, The University of Melbourne, Melbourne 3065, VIC, Australia.
- Department of Clinical Neurosciences, St Vincent's Hospital, Melbourne 3065, VIC, Australia.
| | - Peter F M Choong
- Department of Surgery, The University of Melbourne, St Vincent's Hospital, Melbourne 3065, VIC, Australia.
- Biofab3D@ACMD, St Vincent's Hospital Melbourne, Melbourne 3065, VIC, Australia.
- ARC Centre of Excellence for Electromaterials Science, Intelligent Polymer Research Institute, Innovation Campus, University of Wollongong, Wollongong 2500, NSW, Australia.
- Department of Orthopaedics, St Vincent's Hospital, Melbourne 3065, VIC, Australia.
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