The traumatic or surgical amputation of the forearm or of the hand is a challenging interdisciplinary domain, requiring the collaboration of surgeons, engineers, prostheticians, clinical pharmacology experts in chronic pain management, exoprosthesis manufacturing companies, social workers and last but not least the patient himself/herself. There are a relative few methods of surgical preparation of the amputation stump for use use an external prosthesis. Most of these techniques do not provide a sufficient number of electrical sEMG signals for the efficient control of a modern myoelectric exoprosthesis. We present the surgical aspects and anesthesio-pharmacological implications of the practical study into the applicability of the concept of myoplastic transposition through a forearm fascia breach. We present the data and we discuss the results of sEMG signal acquisition, both before and after the procedure, and we conclude regarding the potential of the method as a means of improving the current standard surgical technique.

Myoelectric exoprostheses serve to aid in the everyday activities of patients with forearm or hand amputations. While electrical signals are known key factors controlling exoprosthesis, little is known about how we can improve their transmission strength from the forearm muscles as to obtain better sEMG. The purpose of this study is to evaluate the role of the forearm fascial layer in transmitting myoelectrical current. We examined the sEMG signals in three individual muscles, each from six healthy forearms (Group 1) and six amputation stumps (Group 2), along with their complete biometric characteristics. Following the tests, one patient underwent a circumferential osteoneuromuscular stump revision surgery (CONM) that also involved partial removal of fascia and subcutaneous fat in the amputation stump, with re-testing after complete healing. In group 1, we obtained a stronger sEMG signal than in Group 2. In the CONM case, after surgery, the patient’s data suggest that the removal of fascia, alongside the fibrotic and subcutaneous fat tissue, generates a stronger sEMG signal. Therefore, a reduction in the fascial layer, especially if accompanied by a reduction of the subcutaneous fat layer may prove significant for improving the strength of sEMG signals used in the control of modern exoprosthetics.

Forearm and hand pathologies, such as trauma, infections, tumors or extensive burns, represent a genuine challenge for the orthopedic surgeon, considering the fact that they have a major impact on the patient quality of life. Amputations at this level, though rare, are often a lifesaving procedure, which helps minimize the severe complications that may occur. We present a retrospective study made on a number of 3203 patients which were admitted to an Orthopedic clinic, from 2012 to 2014. We analyzed which is the most frequent cause for upper limb procedures, the distribution in both genders, the average hospitalization period of time and we determined which is the higher occurrence between lower and upper limb pathologies, aiming to determine the prevalence of forearm and hand amputations in the studied group.

Background. Primary bone tumors are rare and affect especially young persons, being at the same time very aggressive and mutilating, often also implicating the disarticulation of the affected hip. That is why it is necessary to find alternatives of treatment, so that these young people to be able to keep their normal functionality and mental comfort. Objectives. The objective of this paper was to be able to offer a surgical treatment alternative to the hip disarticulation in case of malignant tumors of the proximal femur in young patients. Methods. We present the case of a 25-year-old female patient, who was hospitalized in our clinic for pain and functional impairment of the right hip. The clinical and radiological exams established the diagnosis of fracture of pathological bone of the proximal femur and it raised the suspicion of a tumor with malignant characters. We performed arteriography of the right inferior member, which showed a very good vascularized tumor, possibly vascular, localized to the proximal femur, arterially powered by the branches of right profunda femoris artery. We surgically intervened and made an incisional biopsy with anatomopathological exam, which established the diagnosis of osteosarcoma. Then, we practiced the segmental resection of the tumor, preceded by the embolization of the right femoral artery and after that the reconstruction with bipolar cemented modular prosthesis of the right hip. The patient had a favorable evolution, she did neuromotor rehabilitation, and then she presented to the oncologist for the initiation of adjuvant chemotherapy, which she followed conformably to the recommendations.