TY - CONF
T1 - Poster 74 Van Nes Rotationplasty in Skeletally Mature Patient: A Case Report.
AU - Hamby, Donald L.
AU - Otchere, Justice
AU - Chau, Brian L.
AU - Teran, Shawn M.
AU - Humbert, Sarah E.
AU - Strum, Scott
N1 - Click on the book chapter title to read more.
PY - 2016/9/1
Y1 - 2016/9/1
N2 - Case/Program Description: A 55-year-old man with undifferentiated primitive malignancy, possibly of mesenchymal origin, who received Van Nes Rotationplasty. Setting: Acute Rehabilitation Facility. Results: The patient underwent rotationplasty of right leg after resection of a right femur tumor. Surgical indications were decreased pain, improved function, decreased risk of continued growth and/or metastasis, and decreased risk of mortality. Neuroplasty of the femoral and sciatic (including fibular and tibial branches) nerves was performed, and nerve branches entering the tumor were ligated with remaining nerve spared. Then shortening osteoplasty was performed on the right femur and tibia with fusion of femur to proximal right tibia. The leg was then rotated 180° and articulated with proximal femur. A cephalomedullary nail was used to fuse femur and tibia after confirmation of ankle joint to be in close relation to contralateral knee joint. He was non-weightbearing for the right leg and allowed to do active, but not passive, range of motion to protect from iatrogenic injury. On physical exam, patient was noted to have active dorsiflexion and plantarflexion of right foot. Sensation was intact to light touch and pinprick. He denied phantom limb pain or sensation. His course was complicated by wound healing difficulty but was ultimately discharge home successfully. Unfortunately, he passed away several months later from metastasis and before he could be fitted for prosthesis. Discussion: Van Nes rotationplasty is superior to above the knee amputations in terms of gait efficiency and decreased oxygen demand and is typically reserved for skeletally immature patients. Usually, adults receiving this operation have suffered severe surgical complications while skeletally immature individuals were considered better candidates due to less vascular disease. Conclusions: As technology and surgical interventions advance, new populations of patients will be suited for the acute rehabilitation setting, such as skeletally mature patients with rotationplasty.
AB - Case/Program Description: A 55-year-old man with undifferentiated primitive malignancy, possibly of mesenchymal origin, who received Van Nes Rotationplasty. Setting: Acute Rehabilitation Facility. Results: The patient underwent rotationplasty of right leg after resection of a right femur tumor. Surgical indications were decreased pain, improved function, decreased risk of continued growth and/or metastasis, and decreased risk of mortality. Neuroplasty of the femoral and sciatic (including fibular and tibial branches) nerves was performed, and nerve branches entering the tumor were ligated with remaining nerve spared. Then shortening osteoplasty was performed on the right femur and tibia with fusion of femur to proximal right tibia. The leg was then rotated 180° and articulated with proximal femur. A cephalomedullary nail was used to fuse femur and tibia after confirmation of ankle joint to be in close relation to contralateral knee joint. He was non-weightbearing for the right leg and allowed to do active, but not passive, range of motion to protect from iatrogenic injury. On physical exam, patient was noted to have active dorsiflexion and plantarflexion of right foot. Sensation was intact to light touch and pinprick. He denied phantom limb pain or sensation. His course was complicated by wound healing difficulty but was ultimately discharge home successfully. Unfortunately, he passed away several months later from metastasis and before he could be fitted for prosthesis. Discussion: Van Nes rotationplasty is superior to above the knee amputations in terms of gait efficiency and decreased oxygen demand and is typically reserved for skeletally immature patients. Usually, adults receiving this operation have suffered severe surgical complications while skeletally immature individuals were considered better candidates due to less vascular disease. Conclusions: As technology and surgical interventions advance, new populations of patients will be suited for the acute rehabilitation setting, such as skeletally mature patients with rotationplasty.
UR - https://onlinelibrary.wiley.com/doi/abs/10.1016/j.pmrj.2016.07.117
U2 - 10.1016/j.pmrj.2016.07.117
DO - 10.1016/j.pmrj.2016.07.117
M3 - Poster
ER -