Rotationplasty—a unique surgical procedure with a functional outcome

The article "Rotationplasty--A unique surgical course with a functional outcome" is the basis for this AORN Journal independent research The behavioral objectives and examination for this program were prepared by dint of Rebecca Holm, RN, MSN, CNOR, clinical editor, with consultation from Susan Bakewell, RN M BC education program professional, Center for Perioperative Education.

Participants receive feedback upon incorrect answers. Each applicant who luckily completes this study will receive a certificate of completion. The deadline for submitting this close attention is Aug 31, 2009.

thorough the examination answer sheet and learner evaluation ground on pages 217-218 and mail with appropriate compensation to

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or fax the information with a credit card number to (303) 750-3212

You also may access this dwelling Study via AORN Online at http://www.aorn.org/journal/homestudy/default.htm.

BEHAVIORAL OBJECTIVES

After reading and studying the article upon rotationplasty, nurses will be able to

1 identify the indications for appropriate selection of patients for the rotationplasty procedure

2 discuss nursing care specific to patients undergoing rotationplasty,

3 describe the rotationplasty procedure

4 discuss complications of the rotationplasty process and

5. explain the advantages of the rotationplasty procedure

In a completed world, birth defects and childhood cancer would not exist. In reality, however, these conditions do be found and inventive solutions must be devised to treat them. single such solution is rotationplasty, a unique surgical conduct used to treat a congenital default or tumor of the leg

Traditionally, treatment of inexorable congenital femoral deficiencies required a knee fusion with a Syme amputation, which includes disarticulation of the ankle (ie, amputation above the ankle joint) and a flap made with the skin of the heel. many times tumors of the femur still are treated with high-level, above-the-knee amputation (AKA) requiring adjuncts to assist with ambulation. family with these types of amputations have an unnatural gait and disburse increased energy because they lack an active, biological knee joint.

The importance of an active knee joint in the biomechanics of lower limb function has been demonstrated in multiple studies. (1-3) A below-the-knee amputation (BKA) is more functional and force efficient, and consequently, results in a more natural appearing gait with the aid of a BKA prosthesis.

With rotationplasty, the surgical spring is a leg shortened and rotated 180 steps so the reversed ankle functions as a knee joint. The ankle plantar flexion simulates knee extension and ankle dorsiflexion simulates knee flexion, providing function similar to a BKA. The consequence is visually unusual but actual functional for children who place a higher value upon physical capabilities than appearance (Figure 1)

[FIGURE 1 OMITTED]

HISTORY OF ROTATIONPLASTY

Borggreve first described rotationplasty in Germany in 1927 for a 12-year-old patient whose knee was ruined by tuberculosis. (4) He described a management in which the femur was shortened and the leg rotated 180 stages so the foot faced posterior and the ankle functioned as a knee joint when fitted into a prosthesis.

Van Ne modified and popularized the management in 1950, reporting the rises of rotationplasty in three patients with congenital femoral deficiencies. (5) In 1982 Kotz and Saltzer described the use of a modified version of a rotationplasty operation to treat malignant tumors of the distal thigh-bone (6) Torode and Gillespie provided further modifications for congenital femoral deformities in 1983 through combining a knee arthrodesis with partial rotation (ie, fusion of the knee joint through removing the articular surfaces and securing bony union) and a tibial rotational osteotomy from one side the mid shaft as originally described by means of Van Nes to address the turn for distal derotation. (6) Krajbich modified Torode's and Gillespie's approach to achieve full rotation through knee arthrodesis. (7) Although the manner of proceeding in tumor surgery was first unfolded for abnormalities of the distal thigh-bone modifications of the Van Ne operation now allow use of rotationplasty for lesions of the proximal thigh-bone and the proximal tibia. (8)

When the hip joint is involved, the operation can be modified in several ways to create a functioning hip joint. If the femoral head and neck are involved, the proximal thigh-bone is resected, and the distal thigh-bone with its intact knee joint is rotated and secur to the acetabulum for a like reason the knee can provide hip flexion and extension and the ankle can function as the novel knee joint (Figure 2). In 2000 Winkelmann described at the same time another modification of rotationplasty, a hip rotationplasty mark B-IIIa. The hip rotationplasty is indicated when a tumor involves the entire thigh-bone or when skip lesions (ie, when the tumor has semened to a second site in the bone) are not away (9) This modification involves resecting the entire thigh-bone rotating the tibia-foot segment 180 steps then placing the lateral tibial plateau into the acetabulum. above time, the tibial plateau remodel to become anatomically similar to a femoral head. (10)