Rotationplasty Salvage Procedure as an Effective Alternative to Femoral Amputation in an Adult With a History of Osteosarcoma: A Case Report and Review

Rotationplasty or Borggreve-Van Ness surgery is lower limb salvage surgery, indicated mainly in the management of femoral bone sarcoma and congenital femur malformations in children. It can also be an interesting surgery option for managing chronic osteoarticular infections, or in cases of non union when curative therapy is no longer an option, as an alternative to femoral amputation. The principle of this surgery is to remove the affected knee and to apply a rotation of 180° to the distal part of the lower limb in order to give the ankle the function of a neo-knee. With the help of an adapted prosthesis, the aim is to allow patients to resume their social and professional activities by keeping most of their lower limb, thus avoiding the known complications of amputation (ghost limb pain, proprioceptive deficit, psychological disorders). Nevertheless, this surgery is complex and exceptional, with vascular, infectious, and psychological risks - the chimeric aspect of the lower limb may cause significant ill-being for the patient. This article reports the case of a 38-year-old patient consulting for management of a complex septic distal femoral non-union following osteosarcoma considered as being in remission. The patient underwent rotationplasty surgery on his left lower limb, with very good functional results and no surgical revision to date. In light of this particular case, we propose a didactic overview of the literature data concerning this surgery, especially in adulthood.

Cranial Cruciate Ligament Rupture in Dogs: Review on Biomechanics, Etiopathogenetic Factors and Rehabilitation

Cranial cruciate ligament (CrCL) rupture is one of the most common orthopaedic conditions in veterinary medicine. CrCL plays a fundamental role in the stability and biomechanics of the femoral-tibio-patellar joint, and its incorrect functionality severely impacts on the quality of life of patients. In dogs, the structural weakening of this joint due to the progressive degeneration of the ligament is the most accredited etiopathogenetic hypothesis in relation to the dog signalment (breed, sex and age) and the stifle joint conformation. In humans, this injury is often traumatic and generally occurs during sporting activities. CrCL rupture can be managed conservatively or surgically, and decisions regarding treatment are due to numerous factors: the patient’s age and health, the degree of stifle instability, and cost. Physiotherapy protocols play an important role in rehabilitation, with similar goals in humans and dogs: pain management, physiological articular range of motion recovery, periarticular and core muscle strengthening, and proprioceptive deficit correction. Physiotherapy, even if often neglected in veterinary medicine, is mandatory for the recovery of the correct functionality of the injured limb and for the return to normal daily and sporting activities.

The employment of cynomolgus monkey as proprioceptive deficit model of the anterior cruciate ligament

Introduction: Clinically, a consensus of the treatment strategies of ACL grade 2 injury is not reached. Therefore, the present study established a proprioceptive deficit model of the ACL via an arthroscope to aid with further studying ACL grade 2 injury and treatment strategies. Materials and Methods: 12 cynomolgus monkeys were randomly divided into the model group and the blank control group. In the model group, 1/4 of the ACL was cut under an arthroscope, whereas no intervention was performed in the blank control group. Physiological data including the maximum degree of knee flexion, the thigh circumstance and the calf circumference were measured, and the Pivot-shift, Anterior and Lachman tests were also performed. Moreover, electrophysiological data including somatosensory evoked potentials (SEPs) and motor nerve conduction velocity (MNCV) were measured. SEPs and MNCV were assessed for the latent period and amplitude. Results: Comparing the data before and after the surgery, in the blank control group, no significant difference was observed. In the model group, significant difference was observed in the Pivot-shift, Anterior drawer and Lachman test ( p < 0.05), indicating the instability of the ACL. Moreover, the latent period of SEPs and MNCV were significantly increased ( p < 0.009), whereas the amplitude of SEPs and MNCV was significantly decreased ( p < 0.009), indicating a degenerated proprioception of the knee joint. Conclusions: Following cutting 1/4 of the ACL, the knee joint became unstable and proprioception was declined. The results indicated that the proprioceptive deficit model of the ACL was successfully established, which could promote further studying ACL injury.

Evaluation of proprioception in denervated and healthy wrist joints

We recruited 25 patients after complete wrist denervation and 60 healthy adults to investigate conscious and unconscious proprioception of the wrist. Ipsi- and contralateral joint-position sense, force sense, and wrist reflexes were measured. The latter were triggered by a trapdoor, recording electromyographic signals from the extensor carpi radialis brevis, extensor carpi ulnaris, flexor carpi radialis, and flexor carpi ulnaris muscles. No significant differences were found for joint position sense, force sense, and wrist reflexes between both groups, except for reflex time of the flexor carpi ulnaris after denervation of the left wrist as compared with the left flexor carpi ulnaris in controls or in right operated wrists. At a mean follow-up of 32 months (range 8 to 133), we found no proprioceptive deficit of the conscious proprioceptive qualities of joint position sense, force sense, and the unconscious proprioceptive neuromuscular control of wrist reflex time for most muscles after complete wrist denervation. We conclude from this study that complete wrist denervation does not affect the proprioceptive senses of joint position, force sense, and reflex time of the wrist.

Neuroaxonal Dystrophy in a mule: first case reported

ABSTRACT A 12-month-old mule (sterile hybrid equine species) presented unspecific neurological changes (symmetric ataxia, dysmetria, conscious proprioceptive deficit and weakness). Due to poor prognosis and to the fact that a sibling from the previous generation exhibited similar clinical signs that were not definitively diagnosed, the animal was euthanized. Diagnosis of neuroaxonal dystrophy was confirmed by anatomohistopathological analysis. This is the first clinical case of neuronal dystrophy in a mule reported in the world. The clinical and histopathological characteristics of this disease were very similar to those reported for several equine breeds. Therefore, the disease should also be considered in the diagnosis of neurological conditions in mules and donkeys.

Unilateral neglect is associated with poor proprioception after stroke – a systematic review

BackgroundProprioceptive impairment is a potential contributing factor to the clinical presentation of Unilateral Neglect (UN), a common and debilitating condition that can occur after stroke. To date there has not been a comprehensive review of studies examining the various aspects of proprioception in UN after stroke.AimTo determine if the presence of UN is associated with more severe proprioceptive deficit in stroke affected populations.MethodsThe MEDLINE, Embase, Scopus, CINAHL and Web of Science databases were searched from inception to January 2019 using an a priori search strategy. Two independent reviewers screened abstracts and full texts. Two reviewers then independently extracted data from each full text. A third reviewer resolved disagreements at each step. Risk of bias was assessed using the AXIS Quality Assessment tool. For full protocol see PROSPERO, registration number CRD42018086070. One-hundred and sixty-seven abstracts were identified, of which fifty-four were eligible for full text screening. A total of 18 papers were included in the review.ConclusionsMore severe proprioceptive deficit is associated with the presence of UN after stroke. However, the available evidence is limited by the large heterogeneity of assessment of both UN and proprioception, and level of study quality. UN and proprioception are seldom completely assessed in research, and it is likely this is true in everyday clinical practice.

Poisoning by Senecio brasiliensis in Horses in Northern Rio Grande do Sul

Background: In various regions of Brazil, horses and cattle are considered the most susceptible animals to plant poisoning. The plants of the genus Senecio are the most important in Rio Grande do Sul because they have the active principle known as the pyrrolizidine alkaloid. Its diagnosis is made through epidemiology, clinical signs and histopathological analysis, either of the tissues obtained by biopsy or necropsy. The objective of this study was to report and characterize the epidemiological, clinical and anatomopathological findings of three cases of natural poisoning by Senecio brasiliensis in horses assisted at the Hospital Veterinário (HV) of the Universidade de Passo Fundo (UPF).Cases: Three traction horses, two males and one female, were admitted at the HV-UPF for clinical care. The animals were presenting anorexia, weight loss, dysmetria, proprioceptive deficit and signs suggestive of colic. The epidemiological study revealed that the sites where these animals were located were infested by Senecio brasiliensis. The support therapy used for equine colic in all three cases was unsuccessful. One of the animals died and the other two were euthanized, all three of them being reffered for necropsy. The post-mortem findings were mainly found in the liver, which showed accentuation of the lobular pattern and the appearance of nutmeg. During necropsy, fragments of organs from thoracic and abdominal cavities and central nervous system were collected and fixed in 10% buffered formalin. Subsequently, the samples were processed chemically, submitted to cuts of five micrometers of thickness and stained with hematoxylin and eosin for microscopic analysis. Microscopically, the liver of all three horses presented megalocytosis, fibrosis and bile ducts hyperplasia. In the central nervous system, spongiosis and the presence of Alzheimer type II astrocytes were observed. Thus, through the association of information, the diagnosis of poisoning by Senecio brasiliensis was achieved.Discussion: The diagnosis of natural poisoning by Senecio brasiliensis was obtained through the epidemiological survey that showed S. brasiliensis in pastures where all three horses were allocated. Cases of intoxication by S. brasieliensis in cattle are more frequent than in equines, although both species are considered the most susceptible. In horses, the main clinical manifestations observed include neurological disorders, apathy, anorexia, dysphagia, weight loss, subcutaneous edema and icterus. The clinical signs presented by the equines suggested initial signs of colic syndrome, although anorexia, weight loss, dysmetria and proprioceptive deficit are commonly observed in pyrrolizidine alkaloid poisoning in the liver, both in cattle and horses. The pyrrolizidine alkaloids present in the genus Senecio that become toxic when biotransformed in the liver into a pyrrholic form highly reactive that inhibits cell mitosis and leads to the onset of megalocytosis, cell death and liver fibrosis. The necropsy findings and histopathology were characteristic of poisoning in equines, since the predominant macroscopic lesions in the liver were hepatomegaly and accentuation of lobular pattern, whereas microscopically, there was a predominance of hepatic fibrosis, megalocytosis, spongiosis and the incidence of Alzheimer's type II astrocytes in the brain. These lesions are observed both in natural and in experimental cases of poisoning in horses. Thus, through the ante-mortem and complete post-mortem evaluation of the three equines, it was possible to establish the occurrence of natural poisoning by Senecio brasiliensis in Northern Rio Grande do Sul, as well as to characterize the epidemiological, clinical and anatomopathological findings of poisoning in this species.