Limp Research Articles

AKT answer relating to limp in a child

AKT answer relating to limp in a child

AKT question relating to limp in a child

AKT question relating to limp in a child

The child with a limp

The child with a limp

Limp and difficulty weight bearing in a child with autism spectrum disorder: Scurvy as a mimicker of osteomyelitis

Introduction: Often thought of a disease of the past, scurvy remains a disease of the present. Recent cases have been described in an infant fed exclusively almond beverage, in a child receiving peritoneal dialysis and in the context of neurodevelopmental disability. Children with autism spectrum disorder (ASD) may be at higher risk of scurvy, and other micronutrient deficiencies, because of restricted diet and limited food repertoire. Nevertheless, because of the perceived rarity of these conditions, diagnosis may be delayed and may only come after unnecessary, invasive investigations. Case Report: A 10-year-old boy with ASD presented to the …

New Forms of Lithium Metal Anode

A polymer-assisted and solution-processed approach was employed to prepare and extract high-purity lithium metal microparticles (Li MPs) and lithium metal nanoflakes (Li NFs) at gram-scale. Two forms of metallic lithium anode were prepared based on the Li MPs and Li NFs – (1) CNT/lithium solid composite (CLSC) and (2) liquid-like polymer/lithium slurry (LPLS). The CLSC was integrated with commercial carbonate based electrolytes and showed dramatically improved overpotential and stability in both symmetric cell and LFP-based full cell compared to typical lithium foil. The LPLS was paired with ceramic electrolyte Li6.4La3Zr1.4Ta0.6O12(LLZTO) and ran at 1 mA/cm2and 1 mAh/cm2in a symmetric cell for 400 hours with overpotential as low as 150 mV. The facile method of preparing Li micro/nano-structures and the new forms of metallic lithium anodes are of great academic and industrial values.

Limp and Fever Leading to a Surprising Diagnosis

Limp and Fever Leading to a Surprising Diagnosis

Analysis of the causes and the countermeasures for the serious complications after perforating pedicle flap of lower leg

Objective To analysis causes of the serious complications after the operation of the lower leg perforator pedicle screw flap, and to explore the corresponding countermeasures. Methods From June, 2012 to August, 2016, 60 cases of soft tissue defect of ankle and foot were repaired with propeller flaps pedicled with perforator of lower legs. with the area were soft tissue defect ranged from 3.0 cm×2.0 cm to 19.0 cm×9.0 cm, and all with bone exposure. Two cases of traumatic tissue defect, 7 cases were chronic osteomyelitis of the distal tibia, 13 cases were incision infection and necrosis after the operation of ankle joint fracture and Pilon fracture, 10 cases were simple incision necrosis after calcaneal fracture, 18 cases were calcaneal osteomyelitis, 1 case were soft tissue defect after the ankle tumor operation, 6 cases were soft tissue necrosis after the Achilles tendon rupture, and 3 cases were soft tissue defect of the dorsum with infection. The posterior tibial artery perforator pedicled propeller flap was used in 18 cases. The pedicle of the vascular pedicle was 6.0-18.0 cm from the medial malleolus, the flap rotation was 135°-180°. There were 42 cases of the perforator pedicle propeller flap of the peroneal artery, 5.0-18.0 cm from the pedicle of the vascular pedicle and 120°-180° rotation in the flap. The area of the flap was 9.0 cm×3.0 cm-34.0 cm×18.0 cm. There were 32 cases of direct suture in the donor site and 28 cases of free skin grafting. Results The color, swelling, elasticity, capillary reaction and healing of donor site were observed after operation. There was no flap ischemia occurred in 60 patients. Fourteen cases had venous reflux obstruction, all of which had swelling above II degree, 8 cases had swelling above III degree with obvious purple blood stasis, resulting in partial flap necrosis in 4 cases, all necrosis in 1 case, including 4 cases of free skin grafting, 1 case of flap transplantation and repair. There were 3 cases of necrosis after skin grafting in the flap area, all of which were partial necrosis. There was case of necrosis of the wound surface after direct suture of the donor site and 1 case of skin disintegration after disassembly, and all wounds healed after the replacement of the wound and the external use of the dried blood powder. All the 60 patients were followed-up for 12 to 30 (mean, 24.5)months. The flaps survived and the donor site scars healed well. The range of motion of the ankle was from -10°to 10°(mean, 5.6 °) and the flexion of the plantar was from 20 °to 50 °(mean, 37.8 °). Fourteen patients with venous reflux disorder were followed up for 15 to 28(mean, 22.3)months. The flap and skin graft survived well. Ankle dorsiflexion ranged from -10° to 10 °(mean, 2.4 °) and plantar flexion from 20° to 45 °(mean, 35.6 °). There was no obvious limp in walking. Conclusion Although the overall effect of the lower leg perforator pedicle propeller flap to repair the soft tissue defect of the foot and ankle is satis-factory, there are still various serious complications, which are mainly due to iatrogenic. Doctors should strictly follow the basic principles of skin flap surgery from preoperative to postoperative, and during operation and postoperative man-agement, so as to reduce the incidence of complications. Key words: Lower leg; Perforator vessel; Propeller flap, perforator flap; Ankle and foot; Complication

Child With Autism and a Limp

Child With Autism and a Limp

Overdosed

You find me,Sprawled across the cold, dark asphalt.Incoherent, incompetent, "incapable".Hypotensive, bradycardic, cyanotic. Overdosed. For a moment, you pity me.So young, likely to succumb to the effectsof the chemical concoction that I consciouslyforced through my veins. Overdosed. Your pity subsides.It makes way for disgust.For judgement.How could I have elected to end up this way? Overdosed. You walk around my limp, virtually lifeless body.Assessing the patient,As you have spent an eternity learning to do.Through it all, my eyes stare right through you. Overdosed. Perhaps, fentanyl isn't solely responsible for my state.Perhaps, it was neglect, a faulty system.But, judge as you may,I overdosed. Help.

Preliminary research of combining LARS and semi-joint replacement for malignant tumor around the knee in children

Objective To study the preliminary effect of combining ligament advanced reinforcement system (LARS) and semi-joint replacement for malignant tumor around the knee in children. Methods 9 cases of malignant tumor around the knee (5 boys and 4 girls) from February 2015 to May 2017 were analyzed respectively. The average age was 9.2 years old (ranged from 5 to 12 years). The follow-up time was 6 to 28 months, with an average of 13.5 months. The preoperational biopsy diagnosis respectively were Ewing sarcoma (3 cases) and osteosarcoma (6 cases). According to Enneking staging system, all 9 cases were staged as IIB. The planned courses of standardized preoperative neoadjuvant chemotherapy were successfully given to all patients on time. All patients were given tumor extensive resection and modular prosthesis replacement. Suitable length prosthesis were prepared according to CT and MRI. LARS were annularly bundled to the prosthesis. Then residual patella ligaments, cruciate ligaments, collateral ligaments, capsules and muscles were tightly sutured to LARS. Adjuvant chemotherapy and functional exercise were given after operation. Bone healing, limb discrepancy, and complications were regularly recorded. Functional outcomes were assessed by the system of the Musculoskeletal Tumor Society (MSTS) and the range of motion (ROM) of both knee joints. Results All patients successfully received standardized chemotherapy. In all courses of chemotherapy, bone marrow all restored. No other major complications occurred during chemotherapy. Primary healing of incisions were obtained. No obvious limb discrepancy. The average limb length discrepancy was 2.9±1.8 cm (0.5~6.4 cm), the femur was 1.9±1.0 cm (0.6~3.9 cm), the tibia was 0.8±0.5 cm (0.2~2.0 cm). The distance between the lower limb alignment and the center of the knee was 0.3±0.1 cm (0.2~0.6 cm). MSTS score was 24.6±3.2 of the last follow-up, and 21.4±1.9 of preoperation, the difference was statistically significant (t=2.71, P=0.03). ROM of the knee were 71.7°±18.2° at the last follow-up, and 69.1°±17.9° before operation, and the difference was statistically significant (t=3.261, P=0.01). No infection, snapping knee, limp, dislocation, periprosthesis fractures, prosthetic broken or loosening. 2 case had lung metastasis and still survived. NO local recurrence or other metastasis cases. Conclusion LARS combined with semi-joint replacement for the treatment of malignant tumor around the knee in children have a satisfactory postoperative joint function recovery and simple surgical technique and fewer complications, and preserve the contralateral osteophytes to minimize the occurrence of limb inequality, but the long-term efficacy needs further follow-up. Key words: Sarcoma; Arthroplasty, replacement, knee; Knee prosthesis; Ligaments

Experimental study on repairmen of high deep peroneal nerve injury by nerve transposition methods using different proximal tibialnerve muscular branches

Objective To study the effect of using different tibial nerve proximal muscle branchs to repair deep peroneal nerve injury in animal experiment, and to screen out the most optimal donor nerve branch. Methods From June, 2016 to August, 2016, 64 adult female SD rats were randomly divided into 4 groups, which were LHG (using lateral head of gastrocnemius to repair peroneal nerve) , MHG (using medial head of gastrocnemius to repair peroneal nerve) , SNB (using soleus nerve branch to repair peroneal nerve) , and blank. There were16 rats in each group. At 4 and 8 weeks after surgery, each group were tested on behavior, electrophysiology, muscle tension, muscle wet weight and histology, to evaluate function recovery of the muscles controlled by deep peroneal nerve in each group, and to compare recovery of the deep peroneal nerve repaired by different tibial nerve branches. Results Eight weeks after surgery, right foot of the rats in LHG, MHG and SNB group can be extended, toes can be completely opened. Rats in blank group showed limping gait, whose right foot can not be extended, right toe can not be opened, and muscle atrophied. At 4 and 8 weeks after the operation, the recovery rate of LHG, MHG, SNB group (at 4th weeks, 33.60 ±2.22) % , 33.07 ±2.38% and 35.91 ±2.02% ; at 8th weeks, 67.16 ±5.74) % , 66.56 ±3.18% and 73.17 ± 5.33%, respectively) was higher than blank group (7.71±1.05% and 7.84±0.78%, respectively) on CMAP amplitude, tibialis anterior muscle contractility, tibialis anterior muscle cell area, muscle cell area. SNB group was superior to the LHG group and LHG group. And the difference was statistically significant (P < 0.05) . Conclusion All the proxi- mal tibial nerve muscle branchs can be used to repair the deep peroneal nerve injury, and the soleus nerve branch is the preferred donor nerve. Key words: Nerver transposition; Common peroneal nerve injury; Tibial nerve; Lower extremity nerve function reconstruction; Rats

Cementless Mallory Head HA-coated femoral prosthesis in primary total hip arthroplasty: Clinical and radiological results of a four to nine year prospective study.

We prospectively studied 152 hips in 126 patients with a proximally porous and hydroxyapatite coated double tapered straight femoral prosthesis. The follow-up period was 4.2 to 9.6 years. All but two prostheses showed osseo-integration. The mean Harris hip score (HHS) increased from 40 to 92 points and 97% of the patients had no or only mild pain. Limping and the use of walking aids decreased substantially after the operation. The morphology of positive bone remodelling with either endosteal bone formation or periosteal bone formation was correlated with the stem fit in the medullary canal (p=0.0001). Negative bone remodelling features could not be demonstrated. There was no correlation between the clinical parameters and the radiological phenomena. (Hip International 2002; 4: 345-56).

Effect analysis of quality control circle in the follow-up rate of upper limb functional exercise in elderly patients after permanent pacemaker implantation

Objective To explore the application and effects of quality control circle activities on the compliance rate of upper limb functional exercise in elderly patients after permanent pacemaker implantation. Methods The application of quality control circle was used to analyze the causes, so as to find out the real cause of low compliance of upper limb functional exercise in permanent pacemaker implantation elderly patient including lack of accessary for upper limp training excise, the lake of education materials pacemaker for upper limb functional training after implantation without image, the lack of upper limb function exercise knowledge after pacemaker implantation in nurses, fear of pacemaker shift and bleeding, 5 aspects of team coaching patients with upper limb functional exercise, according to it due to the development of effective countermeasures which organized the implementation of standardized management. Results After the implementation of quality control circle activities, the follow-up rate of upper limb functional exercise in elderly patients increased from 57.89% to 100.00% before permanent pacemaker implantation, and the difference was statistically significant (P<0.05) . The goal of the event rate increased to 151%, and progress rate of 72.74%. Conclusions The application of quality control circle can improve follow-up rate in permanent pacemaker implantation in elderly patients after upper limb functional exercise, the upper limb function, and the quality of life of patients, as well as the members of quality control techniques, professional knowledge, communication and coordination, team spirit, and ability to explore problems were improved. Key words: Aged; Pacemaker implantation; Quality control circle; Upper limb functional exercise; Follow-up rate

Love in the Time of Limp Dicks

Love in the Time of Limp Dicks

Van Neck-Odelberg Disease: Another Cause of Limp in Childhood

Van Neck-Odelberg Disease: Another Cause of Limp in Childhood

Automatically Recorded Performance and BehaviourParameters as Risk Factors for Lameness in Dairy Cattle

Lameness is one of the major welfare issues in dairy cattle, but because of the increasing amount of automation in modern dairy farms and consequently a decreasing surveillance rate per individual, lameness often is recognized only when a severe, very obvious change in gait can be observed. This usually occurs after a long period of time during which the animal endures suffering from pain caused by the hoof lesion, seeing as cows will try to hide signs of disease (in this case: an obvious limp) as long as possible. This study evaluated automatically recorded performance and behaviour parameters as possible risk factors for lameness that could be used for an automatic lameness alert in order to detect lameness cases earlier. The study herd consisted out of 60 Simmental cattle housed in a free stall barn. The herd was observed continuously from April 2014 to April 2015 using different sensors to measure performance (milk yield, live weight, feed intake) and behaviour (feeding behaviour, standing, lying and activity index) related parameters, adding up to a total of 27 variables. During the data collection period the whole herd was locomotion scored weekly according to Sprecher et al. (1997) (1-5, 1 = healthy, 5 = severely lame) in order to assess lameness in every individual. After dividing the data into a training and a test dataset, the training set was fitted into a regularized regression method (Elastic Net) including relevant interaction terms. The preliminary model fitted on the training dataset had an AUC (Area under the Receiver Operating Characteristic Curve) of 0.95 with a sensitivity of 0.95 (95 %-confidence interval: 0.92-0.97) and a specificity of 0.83 (95 %-confidence interval: 0.79-0.86) and the same model fitted on the training data resulted in an AUC of 0.84 with a sensitivity of 1.00 (95 %-confidence interval: 0.19-1.00) and a specificity of 0.80 (95 %- confidence interval: 0.71-0.87). The most important risk factors were ‘feeding duration (day/night ratio)’, ‘lying time (day/night ratio)’, ‘milk yield*feed intake’ and ‘milk yield*lying time’.

A 13-year-old girl with fever and limp.

A 13-year-old girl with fever and limp.

Comprehensive rehabilitation in the management of traumatic elbow fracture with elbow dysfunction

Objective To explore the application of comprehensive rehabilitation therapy in elbow joint dysfunction resulted from traumatic elbow fracture. Methods Sixty-eight patients with elbow dysfunction after fractures were treated in our hospital between June 2014 and June 2015. The patients were randomly divided into the comprehensive treatment group and control group with 34 patients each. Patients in the comprehensive treatment group underwent the comprehensive rehabilitation therapy (traditional Chinese herbal fumigation+fine-tuning static drawing limp+arthrosis mobilization+active training). Patients in the control group were treated with arthrosis mobilization only. Visual analogue scale (VAS) pain score and Mayo elbow performance score were assessed before and 2, 6 and 12 weeks after the treatment, respectively. Results After 2, 6 and 12 weeks of treatment, VAS pain score and Mayo elbow performance score were improved in patients of both groups compared with pre-treatment. The differences were statistically significant (P<0.05). The scores of the comprehensive treatment group were all significantly higher than scores of the control group (P<0.05). Conclusion Comprehensive rehabilitation therapy can not only improve the function of the elbow, but also greatly improve the efficacy of rehabilitation, which is worth to be popularized and applied clinically. Key words: Elbow joint; Fractures; Dysfunction; Comprehensive rehabilitation

Nursing of related complications of implanted venous port

Objective To explore the complications in the nursing work of implanted venous portand its causes, so as to explore the preventive methods. Methods We collected the clinical data and the nursing data of 102 patients with implanted venous port in our department from November 2013 to November 2015. Nursing records during the maintain period were recorded, common complications were summarized, the reasons were analyzed, and nursing interventions were explored and made. Results Among 102 patients, the following-up time was 7-31 months, and the median follow-up time was 19 months. There were 38 cases(37.25%) of complications occurred 2 weeks after operation and 11 cases(10.89%) of complications occurred during discharge maintenance, the difference was statistically significant(P<0.05). The common complications included the sweeling of neck and limps, incision complication and blochage in catheter. Conclusions The incidence of complications within 2 weeks after implanting surgery is higher than that during the maintain period. Among all the complications, catheter associated thrombosis, damaged base and ectopic catheter are the most serious and they can cause the discontinue use of port. By following the recommended operating procedures during the implementation of nursing work, bettering the health education, and improving the patients′ understanding of implanted venous port, we can reduce the incidence rate of complications, and ensure the safety use of venous port. Key words: Comprehensive prevention; Implanted venous port; Complications; Nursing measures

Feasibility of biological acetabular component with high placement technique in hip revision arthroplasty

Objective To investigate the feasibility of biological acetabular component with high placement technique in hip revision arthroplasty. Methods From March 2006 to March 2015, 34 patients (35 hips) underwent hip revision arthroplasty with biological acetabular components with high placement technique. There were 15 males (15 hips) and 19 females (20 hips) with an average of 55 years (range, 26-74 years). There were 22 hips caused by aseptic loosening and 13 hips by infection. The acetabular bone defects included Paprosky IIA in 3 cases, IIB in 4, IIC in 2, IIIA in 17, and IIIB in 9. Modular tapered stems with distal fixation were performed in most femoral sides. The height of hip center was greater than 2.5 cm for all the patients, which were divided into two groups according to the degree of placement: 2.5-3.5 cm for the high placement group, greater than 3.5 cm for the high hip center group. Harris hip score, pain visual analogue score (VAS), leg length difference, gait characteristics were compared between two groups postoperatively and at the final follow-up respectively. The height of hip center and the horizontal distance between hip center and teardrop were measured in the hip X-ray. Radiolucent lines and migrations were also recorded. Results The average operation time and blood loss was 108 min (100-220 min) and 525 ml (300-1 200 ml) in two groups respectively. All the patients were followed up for average 49.2 months (range, 12-116 months). At the final follow-up, the average Harris hip score improved from 36.52±17.17 points preoperatively to 83.46±7.63 (t=18.99, P=0.001). The average VAS score decreased from 8.06±1.24 points preoperatively to 1.91±1.62 postoperatively (t=18.57, P=0.001). The height of hip center was 1.47±0.33 cm preoperatively and 3.85±1.13 cm postoperatively (t=12.15, P=0.001). The horizontal distance was 3.33±0.53 cm pre-operatively and 3.23±0.63 cm post-operatively (t=0.98, P=0.640). At the final follow-up, Trendelenburg sign improved from 25/10 (positive/negative, hips) preoperatively to 7/28 (χ2=18.65, P=0.001). There was 1 case of severe limp, moderate in 1, mild in 8 and other cases had no limp. The leg length discrepancy decreased from 1.84±1.92 cm preoperatively to 0.71±1.57 postoperatively (t=4.24, P=0.001). There were 6 cases of Paprosky IIIb with the use of ultra small cup and extremely high placement. The average Harris hip score improved from 26.65±13.46 points preoperatively to 79.83±10.55 (t=12.33, P=0.001). The average VAS score decreased from 8.50 ± 1.38 points preoperatively to 2.83 ± 2.64 postoperatively (t=4.61, P=0.006). One case had acetabular loosening at 4 years later postoperatively and re-revision surgery was performed. Other patients had no infection, dislocation, periprosthetic fracture or any other complications at the final follow-up. Conclusion Highly placement of biological acetabular component with a distal tapered modular stem can get enough contact with the host bone and achieve optimal clinical outcomes, regardless of the degree of high placement. Particularly, using ultra small cup in extremely high placement shows good effectiveness in simplified operation, and it can be used in many complicated or even impossible acetabular reconstruction. Key words: Arthroplasty, replacement, hip; Reoperation; Acetabulum; Osteolysis; Prosthesis-related infections