1/10. Understanding and meeting the needs of farmers with amputations.BACKGROUND: Despite the hazardous nature of the occupation, farmers who sustain serious permanently disabling injuries return to the physical labor of production agriculture. It is estimated that amputations account for 11% of all major farm-related injuries. PURPOSE: This report describes the process of reentry to farm work of farmers across the united states who experienced above-the-wrist traumatic amputations. SAMPLE: Interviews with 16 farmers revealed the unique features of the work and world view of these workers who labor in the fields. FINDINGS: The occupational recovery process included questioning, analyzing, and "getting along." Prostheses and formal rehabilitation programs were viewed as minimally helpful. Suggestions and resources that may be helpful for the orthopaedic nurse to assist this high-risk work group are included.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/10. Treatment of painful neuroma of amputated phalanx with distal toe transfer: a case report.A painful neuroma in the amputation stump of a finger can be psychologically and physically disabling. Numerous surgical procedures have been attempted to prevent and treat amputation neuromas of the finger, but the results are inconsistent. Microsurgical transfer of the distal second toe to the amputated stump of the finger can provide a pathway and target for the regenerating axons and avoid recurrence of neuromas. In this article, we present the experience of successful treatment of amputation neuromas of an index finger with microsurgical distal toe transfer.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
3/10. Limb deficiency and prosthetic management. 2. aging with limb loss.This self-directed learning module highlights the issues faced by people aging with limb loss. It is part of the study guide on limb deficiency and vascular rehabilitation in the Self-Directed Physiatric education Program for practitioners and trainees in physical medicine and rehabilitation. This article specifically focuses on the impact that limb loss has on health and physical function throughout the life span. Case examples are used to illustrate what effect limb loss in childhood or young adulthood has on the incidence and management of new impairments or disease processes commonly associated with aging. overall Article Objective: To discuss the impact of early-life limb loss on the incidence and management of physiologic and functional changes associated with aging.- - - - - - - - - - ranking = 2keywords = physical (Clic here for more details about this article) |
4/10. Limb deficiency and prosthetic management. 3. Complex limb deficiency.This self-directed learning module highlights rehabilitation and prosthetic issues associated with complex limb deficiencies. It is part of the chapter on acquired limb deficiencies in the Self-Directed Physiatric education Program for practitioners and trainees in physical medicine and rehabilitation. This article discusses rehabilitation and prosthetic management of patients with amputations for complex limb deficiencies secondary to trauma. Mechanisms of injury, prosthetic issues, prosthetic components, and potential problems in prosthetic fitting will be discussed. overall Article Objective: To evaluate common problems associated with complex limb deficiency.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
5/10. Traumatic hemipelvectomy: a case report.Traumatic hemipelvectomy is a devasting injury which few patients survive. A survivor of traumatic hemipelvectomy is described. Immediate and long-term management include prompt resuscitation, vascular control, urinary and fecal diversion, wound debridement, wound closure, and physical and psychologic rehabilitation.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
6/10. exercise testing in patients with musculoskeletal handicaps.To determine safe and effective exercise testing techniques for musculoskeletally handicapped individuals, 20 patients (mean age, 61 years) were studied. Types of handicaps included various degrees of paralysis of arms and legs, and leg amputations. Seventeen of the 20 patients had concurrent cardiovascular problems. All were currently hospitalized, engaged in various physical therapy exercises, and referred for exercise testing to increase rehabilitation therapy or for cardiovascular evaluation. Of 20 tests, arm ergometry was used in 15, leg or combination arm-leg ergometry in four, and treadmill in one. All patients completed testing with mean increases in heart rate (82 to 106 bpm arm, 88 to 125 other) and systolic blood pressure (114 to 127 mmHg arm, 118 to 146 other). Low-grade atrial and ventricular ectopy occurred in eight patients, decrease or plateauing of systolic blood pressure in three, increased diastolic blood pressure in two, and significant (greater than or equal to 1mm) ECG S-T segment displacement in one. With the use of appropriate equipment for each patient, exercise testing can be done safely and effectively in musculoskeletally handicapped individuals.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
7/10. Complications and salvage of an ectopically replanted thumb.The ectopic replantation of a thumb is described after a mutilating hand injury. The case was followed by a series of complications and surgical procedures to treat these complications. Through perseverance and multiple microsurgical procedures the patient attained a functional hand. The patient's psychological and physical course is described.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
8/10. Successful replantation in 10-digit complete amputations.We report a case of successful replantation of 10-digit complete amputations. The conditions of the wounds over the ends of the 10 amputated digits are bound to vary; some are too severe to be replanted, while others may be light and easy for replantation. We reported a case of 10-digit complete amputations, with severe avulsion injuries over four fingers. Appropriate measures were taken during surgery, and the replanted digits all survived. The replantation operation was done by a team of surgeons, although the surgeons were physically challenged by the long and difficult procedures. However, it was the great pleasure of the surgeons to work hard and whole-heartedly for the benefit of the patient. Postoperative physiotherapy and exercises were done. After 6 months, the functions of both hands had been largely recovered. Complete amputations of 10 digits as a rule result in multiple complicated wounds. The replantation procedure for these conditions is not an easy endeavor because there are numerous blood vessels that need to be anastomosed, the time of the operation will be dreadfully long, and also there is the danger of the occurrence of vascular crises during the postoperative period. It is difficult to achieve successful survival of all 10 amputated digits after replantation.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
9/10. Psychosocial consequences of upper limb injury.Upper limb surgeons have little in the way of training in the identification or management of the psychological aspects of limb injury. Surgeons in training tend to see their specialty in technical terms, only slowly appreciating that the psychological state of the patient profoundly affects outcome in many cases. The case report that follows charts the psychological progress of a patient following severe upper limb injury. Surgeons usually view rehabilitation in physical terms. This report emphasizes the psychological aspects of a major limb injury to a policeman (MP) who subsequently studied psychology at PhD level.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
10/10. Experiment of nurture: ablatio penis at 2 months, sex reassignment at 7 months, and a psychosexual follow-up in young adulthood.Guidelines of psychosexual management for infants born with physical intersex conditions are intended to assist physicians and parents in making decisions about sex of assignment and rearing including the following: 1) sex assignment should be to the gender that carries the best prognosis for good reproductive function, good sexual function, normal-looking external genitalia and physical appearance, and a stable gender identity; 2) the decision regarding sex assignment should be made as early as possible, preferably during the newborn period, with an upper age limit for reversal of an initial sex assignment no later than 18 to 24 months; and 3) there should be minimal uncertainty and ambiguity on the part of parents and professionals regarding the final decision about sex assignment and rearing. J. Money used these guidelines in a case of a biologically normal male infant (one of a pair of monozygotic twins) whose penis was accidentally ablated during a circumcision at the age of 7 months. The decision to reassign the infant boy to the female sex and to rear him as a girl was made at 17 months, with surgical castration and initial genital reconstruction occurring at 21 months. Money reported follow-up data on this child through the age of 9 years. Although the girl was described as having many "tomboyish" behavioral traits, a female gender identity had apparently differentiated. Thus, it was concluded that gender identity is sufficiently incompletely differentiated at birth as to permit successful assignment of a genetic male as a girl, in keeping with the experiences of rearing. Subsequent follow-up by other investigators reported that by early adolescence the patient had rejected the female identity and began to live as a male at the age of 14 years. In adulthood, the patient recalled that he had never felt comfortable as a girl, and his mother reported similar recollections. At age 25, the patient married a woman and adopted her children. The patient reported exclusive sexual attraction to females. The present case report is a long-term psychosexual follow-up on a second case of ablatio penis in a 46 XY male. During an electrocautery circumcision at the age of 2 months, the patient sustained a burn of the skin of the entire penile shaft, and the penis eventually sloughed off. At age 7 months, the remainder of the penis and the testes were removed. By age 7 months, if not earlier, the decision was made to reassign the patient as a female and to raise the infant as a girl. The patient was interviewed on two occasions: at 16 years and twice while in the hospital for additional surgery at 26 years of age. At ages 16 and 26, the patient was living socially as a woman and denied any uncertainty about being a female. During childhood, the patient recalled that she self-identified as a "tomboy" and enjoyed stereotypically masculine toys and games; however, the patient also recalled that her favorite playmates were usually girls and that her best friend was always a girl. When seen at age 16, the patient had been admitted to the hospital for vaginoplasty. At that time, she wished to proceed with the further repair of her genitalia to make them suitable for sexual intercourse with males. At age 26, the patient returned to the hospital for further vaginoplasty. Regarding the patient's sexual orientation, she was attracted predominantly to women in fantasy, but had had sexual experiences with both women and men. At the time of the second surgery, she was in a relationship with a man and wished to be able to have intercourse. The patient's self-described sexual identity was "bisexual." After surgery at age 26 years, the patient developed a rectovaginal fistula. Within a few months of the surgery, the patient and her male partner separated for reasons other than the patient's physical problems. The patient subsequently began living with a new partner, a woman, in a lesbian relationship. The psychosexual development of our patient was bot the other patient was married to a woman. Our patient had a "bisexual" sexual identity; the other patient had a "heterosexual" sexual identity. The patients were similar in that they had a childhood history of "tomboyism." Our patient was predominantly sexually attracted to women; the other patient was exclusively sexually attracted to women. Our patient had sexual experiences with both women and men; the other patient had sexual experiences only with women. The most plausible explanation of our patient's differentiation of a female gender identity is that sex of rearing as a female, beginning at around age 7 months, overrode any putative influences of a normal prenatal masculine sexual biology. Because cases of ablatio penis in infancy are so rare and long-term follow-up data are scant, it is obviously impossible to know whether our patient or the previous case would be more typical of the psychosexual outcome in a larger sample of such individuals. However, our case suggests that it is possible for a female gender identity to differentiate in a biologically "normal" genetic male. At present, however, the clinical literature is deeply divided on the best way to manage cases of traumatic loss of the penis during infancy. Further study is clearly required to decide on the optimal model of psychosocial and psychosexual management for affected individuals.- - - - - - - - - - ranking = 3keywords = physical (Clic here for more details about this article) |
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