Preliminary image findings of lower limb stress fractures to aid ultrasonographic diagnoses: A systematic review and narrative synthesis
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ABSTRACT: Introduction
This systematic review investigates which image appearances are most common
SUBMITTER: Schaper M
PROVIDER: S-EPMC8579372 | biostudies-literature | 2021 Mar
REPOSITORIES: biostudies-literature
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Project description:Lower limb fragility fractures require long-term rehabilitation and are also very expensive to treat. Clinically, early weight bearing and walking stability were reported as key measures of fracture restoration. This study introduces methods to numerically quantify these performance indices for a range of ankle and knee joint fractures. As a follow-up of initial treatment, experimental data was collected using force plates from 367 subjects divided into seven groups: ankle fracture (AF), lower leg ankle fracture (AL), calcaneus foot fracture (CF), knee tibia fracture (KF), knee patella fracture (KP), kneecap rupture (KR), and normal limb (NL). For each joint, data was analysed to evaluate intralimb and interlimb weight-bearing and walking stability for all fracture conditions. These thresholds were statistically compared with normal subjects. Some advantages of evaluating fracture restoration indices over the others include:•to quantify fracture restoration (weight-bearing, walking stability, and gait symmetry) using minimum setup and signal requirements.•to provide comprehensive tools to assess and overcome fracture-associated complications through a detailed preview of fractured limb functionality during subphases of a gait cycle.•in clinical research, such assessments are important as a reference to evaluate existing or new rehabilitative interventions.
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Project description:BackgroundLimb amputation is often an inevitable procedure in the advanced condition of various diseases and poses a dramatic impact on a patient's life. The aim of the present study is to analyze the impact of lower-limb amputations on aesthetic factors such as body image and self-esteem as well as quality of life (QoL).Methods298 patients (149 uni- or bilateral lower-limb amputees and 149 controls) were included in this cross-sectional study in three centers. Demographic data was collected and patients received a 118-item questionnaire including the Multidimensional Body-Self Relations Questionnaire (MBSRQ), the Rosenberg Self-esteem (RSE) scale and the SF-36 Health Survey (QoL). ANOVA and student's t-test were used for statistical analysis.ResultsUnilateral lower-limb amputees showed a significant lower MBSRQ score of 3.07±0.54 compared with 3.41±0.34 in controls (p<0.001) and a lower score in the RSE compared to controls (21.63±4.72 vs. 21.46±5.86). However, differences were not statistically significant (p = 0.36). Patients with phantom pain sensation had a significantly reduced RSE (p = 0.01). The SF-36 health survey was significantly lower in patients with lower-limb amputation compared to controls (42.17±14.47 vs. 64.05±12.39) (p<0.001).ConclusionThis study showed that lower-limb amputations significantly influence patients' body image and QoL. Self-esteem seems to be an independent aspect, which is not affected by lower-limb amputation. However, self-esteem is influenced significantly by phantom pain sensation.
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Project description:Background and objectiveThe evaluation of both femoral and tibial torsional profiles remains a challenge in the orthopedic practice since there is no agreement on the most precise and reliable measurement method and technique. The aim of this review is to collect and critically report the most relevant and up-to-date evidence on the radiological techniques available to determine lower limb torsional deformities and to discuss the advantages and limitations of each technique to better define their optimal field of application.MethodsLiterature research on PubMed, Embase, and Google Scholar databases was performed, utilizing the following search string: "torsion" AND ("lower limb" OR "femur" OR "tibia"). Relevant clinical and preclinical studies evaluating different radiological techniques to assess lower limb torsional deformities, and possibly comparing them, were collected and critically reviewed.Key content and findingsComputed tomography (CT) is still considered the best method to measure both femoral and tibial torsional angles. Its main limitation, the radiation exposure, has been recently addressed with ultra-low dose protocols that were proven to be as accurate as standard protocols. On the other hand, magnetic resonance imaging (MRI) offers a nonionizing, radiation-free option that is now considered almost equivalent to CT. However, MRI consists in a long and expensive procedure that can be hindered by issues linked to metal implants, patient's positioning and measurement variabilities. Lastly, three-dimensional (3D) reconstructions derived from low-dose biplanar radiographies (LD-BRs) have been proposed as a low-radiating, quick and reliable solution to overcome the limitations of both MRI and CT scans.ConclusionsTo date, CT has still to be considered the gold standard for the radiological assessment of lower limb torsional deformities. Nonetheless, MRI and LD-BR have been proven to be valid and reliable alternatives, especially in specific clinical settings.
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Project description:Tendinopathy is a common disease that affects athletes, causing pain and dysfunction to the afflicted tendon. A clinical diagnose is usually combined with imaging and, among all the existing techniques, ultrasound is widely adopted. The aim of this review is to sum up the existing evidence on ultrasound as an imaging tool and guide for treatments in lower limbs tendinopathy. Using three different databases-PubMed, MEDLINE and CENTRAL-a literature search has been performed in May 2020 combining MeSH terms and free terms with Boolean operators. Authors independently selected studies, conducted quality assessment, and extracted results. Ultrasound imaging has a good reliability in the differentiation between healthy and abnormal tendon tissue, while there are difficulties in the identification of tendinopathy stages. The main parameters considered by ultrasound imaging are tendon thickness, hypoechogenicity of tendon structure and neovascularization of the tendon bound tissue. Ultrasound-guide is also used in many tendinopathy treatments and the available studies gave encouraging results, even if further studies are needed in this field.
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Project description: Not available
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Project description:ObjectiveTo introduce a new type of simple adjustable bilateral bidirectional polyvinyl chloride (PVC) tube traction device and discuss the value of using this device before surgery in patients with lower limb fractures.MethodsTo introduce the manufacturing process of an adjustable bilateral traction device made of PVC pipes. From August 2018 to November 2019, the data of 36 patients with lower limb fractures who were treated with this traction device were retrospectively analysed. The treatment outcomes were analysed, including length of both lower limbs, fracture reduction, lower limb mobility, visual analogue scale (VAS) score, incidence of complications, and patient satisfaction.ResultsAll patients were able to move the affected limb immediately after using the device. The patient's pain was significantly reduced, they were able to turn over freely during bed rest, and the length of the affected limb was restored to that of the healthy limb. Thirty-four (94.5%) patients were satisfied with the reduction of the fracture end, 2 (5.5%) patients with tibiofibular fractures showed angular displacement of the fractured end and satisfactory reduction after the position of the bone traction needle was adjusted; 7 (19.5%) patients developed deep vein thrombosis of the affected lower limb during traction; there was no decubitus or vascular nerve injury, and the overall complication rate was 25% (9/36). All the patients and their families were satisfied with the results of this treatment.ConclusionThe aim of this study is to introduce a new type of traction device. It is advantageous in that it is light weight, low cost, easy to assemble, promotes immediate movement of the affected limb after assembly, improves patient comfort and can be used with a titanium steel needle for MRI examination under traction. In the clinical setting, it has been shown to be suitable for the temporary treatment of patients with lower leg fractures prior to surgery, particularly patients who, for various reasons, require nonsurgical treatment in the short term.
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Project description:IntroductionIn April 2012 the John Radcliffe Hospital in Oxford became a major trauma centre (MTC). The British Orthopaedic Association and British Association of Plastic, Reconstructive and Aesthetic Surgeons joint standards for the management of open fractures of the lower limb (BOAST 4) require system-wide changes in referral practice that may be facilitated by the MTC and its associated major trauma network.MethodsFrom 2008 to 2013 a multistep audit of compliance with BOAST 4 was conducted to assess referral patterns, timing of surgery and outcomes (surgical site infection rates), to determine changes following local intervention and the establishment of the MTC.ResultsOver the study period, 50 patients had soft tissue cover for an open lower limb fracture and there was a significant increase in the proportion of patients receiving definitive fixation in our centre (p=0.036). The median time from injury to soft tissue cover fell from 6.0 days to 3.5 days (p=0.051) and the median time from definitive fixation to soft tissue cover fell from 5.0 days to 2.0 days (p=0.003). The deep infection rate fell from 27% to 8% (p=0.247). However, in 2013 many patients still experienced a delay of >72 hours between injury and soft tissue cover, primarily owing to a lack of capacity for providing soft tissue cover.ConclusionsOur experience may be relevant to other MTCs seeking to identify barriers to optimising the management of patients with these injuries.
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Project description:Case presentationA 93-year-old man living in a nursing home presented to our emergency department with altered mental status. Examination revealed hypotension and severe hypoxia. Chest radiograph showed infiltrates in the right upper lobe, and computed tomography of the abdomen and pelvis demonstrated a left femoral neck fracture. A point-of-care transthoracic echocardiogram (TTE) revealed an enlarged right ventricle, severe tricuspid regurgitation, and numerous white floating dots moving toward the right atrium from the inferior vena cava (IVC), leading to the diagnosis of fat embolism syndrome (FES).DiscussionAlthough imaging studies can facilitate diagnosis, the diagnosis of FES is typically made by clinical history and presentation, making a swift diagnosis often difficult in those who are critically ill. Recent case reports have described that TTE can detect fat emboli, seen as flowing hyperechoic particles in IVC. This image demonstrates the utility of TTE to diagnose FES.
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Project description:PITX1 is a bicoid-related homeodomain transcription factor implicated in vertebrate hindlimb development. Recently, mutations in PITX1 have been associated with autosomal-dominant clubfoot. In addition, one affected individual showed a polydactyly and right-sided tibial hemimelia. We now report on PITX1 deletions in two fetuses with a high-degree polydactyly, that is, mirror-image polydactyly. Analysis of DNA from additional individuals with isolated lower-limb malformations and higher-degree polydactyly identified a third individual with long-bone deficiency and preaxial polydactyly harboring a heterozygous 35?bp deletion in PITX1. The findings demonstrate that mutations in PITX1 can cause a broad spectrum of isolated lower-limb malformations including clubfoot, deficiency of long bones, and mirror-image polydactyly.
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Project description:Deep vein thrombosis (DVT) is a significant postoperative complication in patients with lower limb fractures, potentially leading to life-threatening outcomes such as pulmonary embolism. This study aimed to evaluate the knowledge, attitudes, and practices (KAP) of this high-risk population regarding DVT prevention. A cross-sectional study was conducted at Nanchang Hongdu Hospital of Traditional Chinese Medicine between March 2023 and May 2024. A structured questionnaire collected demographic and KAP data, analyzed using descriptive statistics and structural equation modeling (SEM). Among 442 valid respondents, SEM revealed direct effects of knowledge on attitudes (β = 0.593, P < 0.001) and attitudes on practices (β = 0.746, P < 0.001). Despite proactive practices, patients demonstrated inadequate knowledge and negative attitudes towards DVT. These findings underscore the need for targeted educational interventions to enhance patient understanding and attitudes, ultimately improving preventive behaviors and reducing DVT-related complications.
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