Obesity and age as factors in leg amputations in fatal motorcycle crashes

The autopsy files at Forensic Science South Australia were searched over an 11-year period from January 2008 to December 2018 for all cases of motorcycle fatalities in which there had been lower-limb amputations. Six cases were identified, consisting of five male riders and one female pillion passenger. The age range was 48–67 years (average 59 years), which was significantly older than the control group (40.6 years; p < 0.01). All the decedents were overweight, with a body mass index (BMI) of 28.7–43.5 kg/m2 (average 34.9 kg/m2), which again was significantly greater than the control group (28.8 kg/m2; p < 0.05). Five of the incidents involved a collision between a motorcycle and a motor vehicle; the remaining case involved a collision with a tree. Five of the amputations were on the right side in the motorcycle-vehicle impacts, and they varied in severity from loss of a foot to a hind-quarter amputation. There was a single left lower-leg amputation which occurred during the collision with a tree, which was beside the road on the motorcyclist’s left. This study has shown that motorcyclists at greatest risk of lower-limb/pelvis amputations are older than the average rider with higher BMIs. This may be significant information given the increase in both BMI and age in many populations.

A Single Case Study of Diabetic Foot Ulcer treated with Vrana Dhoopana and Kshara Picchu

In present scenario due to the sedentary lifestyle, diabetes mellitus has become common disease. Diabetic foot ulcer is a complication of diabetes mellitus which is the leading cause of lower limb amputations. It occurs in 15% of all patient with diabetes mellitus and precedes 84% of patients with diabetic foot ulcer which needs lower leg amputation. The management of diabetic foot ulcer requires blood sugar control, debridement, advanced dressing and offloading modalities. In Ayurvedic literature, Acharya Sushruta has described sixty treatment modalities, He has given more importance to Vranashodhana and Ropana. Acharya Vagbhatta has explained that Vranas which are caused by Madhumeha can be treated with Aragwadhadigana Dravyas, hence in the present study for Vrana Shodhanartha Prakshalana with Aragwadhadi Qwatha and Vrana Dhoopana by Guggulu, Nimba Choorna, Haridra, Jatyadi Ghrita were selected and for Vrana Ropanartha Jatyadi Taila was selected.

Design of a Passive Ankle Prosthesis With Energy Return That Increases With Increasing Walking Velocity

An estimated 623,000 individuals are living with a major lower leg amputation in the United States [1]. Of these amputations, 78% were due to peripheral vascular disease (PVD) and 45% were due to PVD in individuals with type I or II diabetes [2]. With diabetes and PVD incidence levels on the rise [1] and those in a depressed socio-economic situation more susceptible to develop type II diabetes [3], the demand for affordable, high quality ankle prostheses has never been higher. Prostheses currently available on the market include both passive and active devices, neither of which fully satisfies user requirements. Passive prostheses, the more commonly prescribed style, are economically priced but lack the powered push-off observed in a natural ankle [4] due to the absence of an actuator. As a result, passive prostheses cause a multitude of quality of life detriments to the end user including asymmetrical gait (for unilateral amputees), slower self-selected walking speeds, higher metabolic cost per distance traveled and increased pain in the residual limb [5–6]. Conversely, active devices can nearly match the functionality and powered push-off of a natural ankle [7] but are cost prohibitive. Among active devices, one of the most successful models is the BiOM. Initially developed at MIT, the BiOM uses an actuator in series with a spring to achieve near natural ankle behavior. In 2013, two years after the product’s official launch, the device cost approximately $50,000 and had only sold about 1,000 units [7]. The limitations of currently available ankle prostheses motivates work on a new solution, the EaSY-Walk (Early Stance Y-deflection), a passive ankle device that mimics several key aspects of a natural ankle joint, especially nonlinear rotational stiffness and rotational work output (powered push-off) that increases with walking velocity while remaining relatively inexpensive.

Diagnosis and treatment of chondroblastoma: Our experience

The paper presented the results of diagnostics and treatment of patients with diagnosis of chondroblastoma, treated at the Institute of Orthopedic Surgery "Banjica", Belgrade. A total of 30 patients were analyzed, involving the period from 1975-2004. All important data were obtained using the complete medical documentation, physical examination, radiographic findings and available additional diagnostic procedures. The proximal part of tibia, the proximal part of humerus and the distal part of femur were the most common sites of tumor, accounting for 63% of cases. Higher incidence of chondroblastoma was found in male patients, especially in the second decade of life. Pathohistological tumor verification was done in all patients. The patients were then treated by different surgical procedures, both on account of primary lesion and recurrence. Curettage and osteoplasty using the auto- and homograft were carried out in 21 patients, wide resection in nine cases, and amputation was performed in three cases. One patient had radiotherapy due to recurrence of lesion, nevertheless malignant transformation of chondroblastoma occurred in time. Seven patients manifested local recurrence, and one of them even had relapse on two occasions and malignant transformation of chondroblastoma. Malignant lesions were found in three cases (10% of patients); one lesion was diagnosed as primary while other two malignancies were detected only after recurrence, and the treatment was completed by lower leg amputation.

Outcome of Infrainguinal Arterial Bypass Grafting in Limbs with Postthrombotic Syndrome

From among 336 infrainguinal bypass proce dures performed for treatment of atherosclerotic occlu sive disease, 27 patients with histories of deep venous thrombosis (DVT) were retrospectively analyzed with re gard to patency and limb salvage rates. In 25 patients, venous diagnosis was verified by antegrade phlebogra phy, which demonstrated postthrombotic changes in the deep venous system. Indications for infrainguinal bypass surgery were severe claudication (six patients), rest pain (nine patients), and nonhealing ulcer or gangrene (12 pa tients). Sixteen autologous saphenous vein grafts, six composite (PTFE-vein), and five prosthetic grafts were used. All 11 femorodistal bypass grafts occluded within 6 months compared to an 82% patency rate of femo ropopliteal bypasses. Among 16 femoropopliteal by passes, only one patient with poor runoff underwent lower leg amputation after bypass failure. On the other hand, all 11 patients with distal bypass underwent major amputation during the first 7 months. The dismal outcome of patients with previous DVT undergoing femorodistal bypass procedures in this small population might be due to the deleterious effect of venous outflow impairment on already limited distal runoff status due to severe athero sclerotic changes.