RESUMEN
Popliteal artery trauma is uncommon but is associated with a high risk of limb loss depending on the scenario involving blunt or penetrating trauma as well as the severity and extent of injury that has occurred. In our setting there is a significant amount of gang and civilian warfare resulting in Vascular Trauma. There were 32 patients over a decade who sustained traumatic injury to the popliteal artery consisting of 30 males (94%) and 2 females with an age range 16-59 years with a mean of 32. There were 20 cases of penetrating trauma (63%) and 12 cases of blunt trauma (37%). Of the penetrating trauma, 18 were due to gunshot wounds (GSWs) (90%) and 2 stabs. The majority (7/12; 58%) of blunt trauma was due to falls, and 42% (5/12) secondary to motor vehicular accidents (MVAs). In terms of extent of injury, 21 of 32 patients (65%) sustained an isolated popliteal artery injury, whilst 6 (19%) had injury to both the popliteal artery and vein and another 5 (16%) had combined popliteal artery, vein and nerve injuries. There were 14 cases with associated orthopaedic injuries: 7 posterior knee dislocations, 1 fracture/dislocation of the knee, 2 femoral fractures, 2 tibial plateau fractures and 2 tibia/fibula fracture. Methods of repair included 14 reversed vein grafts, 16 polytetrafluoroethylene (PTFE) grafts and 2 primary. The overall amputation rate was 28% (9 patients). Of the penetrating trauma patients 25% required amputations composed of 5 GSWs, 33% of the blunt trauma patients required amputations. It was noted that factors associated with (but not statistically significant) poor outcomes included combined artery/vein injury, artery/vein/nerve injury, concomitant fracture/dislocation and delayed transfer to a Vascular Surgery Unit. The type of graft or repair did not affect outcome. The incidence of popliteal artery trauma was calculated at 2.46 per 100,000 population per year.
Asunto(s)
Amputación Quirúrgica/estadística & datos numéricos , Traumatismos de la Pierna/fisiopatología , Recuperación del Miembro/métodos , Arteria Poplítea/lesiones , Lesiones del Sistema Vascular/cirugía , Heridas no Penetrantes/fisiopatología , Heridas Penetrantes/fisiopatología , Adolescente , Adulto , Femenino , Hospitales de Enseñanza , Humanos , Traumatismos de la Pierna/complicaciones , Traumatismos de la Pierna/cirugía , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , Resultado del Tratamiento , Trinidad y Tobago/epidemiología , Procedimientos Quirúrgicos Vasculares/métodos , Lesiones del Sistema Vascular/etiología , Lesiones del Sistema Vascular/fisiopatología , Heridas no Penetrantes/complicaciones , Heridas no Penetrantes/cirugía , Heridas Penetrantes/complicaciones , Heridas Penetrantes/cirugía , Adulto JovenRESUMEN
Marjolin's ulcer is a rare and aggressive cutaneous malignancy arising from previously traumatized skin, most commonly at the site of previous burns. We present a unique case of Marjolin's ulceration secondary to an orthopedic injury and a nonburn history of trauma. The patient had been involved in a motorcycle accident >20 years earlier. For 17 months, the patient had refused to acknowledge the severity of his disease state. He had refused the standard of care and opted for local wound care only until a minor fall caused a pathologic fracture, leading to an above the knee amputation. Road traffic incidents remain an uncommon cause of subsequent Marjolin's transformation in developed countries. As such, we present the case of a patient with a unique combination of a continued lack of compliance after diagnosis and the unusual cause of his initial trauma.
Asunto(s)
Amputación Quirúrgica/métodos , Carcinoma de Células Escamosas/patología , Traumatismos de la Pierna/fisiopatología , Úlcera de la Pierna/patología , Neoplasias Cutáneas/patología , Accidentes de Tránsito , Biopsia con Aguja , Carcinoma de Células Escamosas/fisiopatología , Carcinoma de Células Escamosas/cirugía , Enfermedad Crónica , Progresión de la Enfermedad , Fémur/cirugía , Estudios de Seguimiento , Humanos , Inmunohistoquímica , Puntaje de Gravedad del Traumatismo , Traumatismos de la Pierna/complicaciones , Traumatismos de la Pierna/diagnóstico por imagen , Úlcera de la Pierna/fisiopatología , Úlcera de la Pierna/terapia , Masculino , Persona de Mediana Edad , Radiografía/métodos , Enfermedades Raras , Medición de Riesgo , Índice de Severidad de la Enfermedad , Neoplasias Cutáneas/fisiopatología , Neoplasias Cutáneas/cirugía , Resultado del Tratamiento , Negativa del Paciente al TratamientoRESUMEN
Vertical ground reaction force (vGRF) has been commonly used in human gait analysis making possible the study of mechanical overloads in the locomotor system. This study aimed at applying the principal component (PC) analysis and two Artificial Neural Networks (ANN), multi-layer feed forward (FF) and self organized maps (SOM), for classifying and clustering gait patterns from normal subjects (CG) and patients with lower limb fractures (FG). The vGRF from a group of 51 subjects, including 38 in CG and 13 in FG were used for PC analysis and classification. It was also tested the classification of vGRF from five subjects in a treatment group (TG) that were submitted to a physiotherapeutic treatment. Better results were obtained using four PC as inputs of the ANN, with 96% accuracy, 100% specificity and 85% sensitivity using SOM, against 92% accuracy, 100% specificity and 69% sensitivity for FF classification. After treatment, three of five subjects were classified as presenting normal vGRF.
Asunto(s)
Diagnóstico por Computador/métodos , Fracturas Óseas/diagnóstico , Fracturas Óseas/fisiopatología , Marcha , Traumatismos de la Pierna/fisiopatología , Redes Neurales de la Computación , Reconocimiento de Normas Patrones Automatizadas/métodos , Algoritmos , Análisis de Componente Principal , Reproducibilidad de los Resultados , Sensibilidad y EspecificidadRESUMEN
Discrete parameters from ground reaction force (GRF) are been considered in gait analysis studies. However, principal component analysis (PCA) may provide additional insight into gait analysis for considering the complete pattern of GRF. This study aimed at testing the application of PCA to discriminate the vertical GRF pattern between control group (CG) and patients with lower limb fractures (FG), as well as proposing a score to quantify the abnormality of gait. Thirty-eight healthy subjects participated of CG and 13 subjects in FG, five subjects from FG were also evaluated after physiotherapeutic treatment (FGA). The GRF was measured by an instrumented treadmill. Principal component coefficients (PCCs) were obtained by singular value decomposition using GRF of complete stride. Two, four and six PCCs were used to obtain the standard distance (D). The classification between groups was mainly given by the first PC, which indicated higher loading factors during push off of affected side and heel strike of unaffected side. The classification performance achieved 92.2% accuracy with two PCCs, 94.1% with four PCCs and 96.1% with six PCCs. Four subjects reached normal boundary after treatment, with all FGA subjects presenting decreased D. This study demonstrates that PCA is an adequate method for discriminating normal and abnormal gait and D allows an objective evaluation of the progress and effectiveness of rehabilitation treatment.