423
Case reports
The use of crash helmets has been shown to lower the mortality in major accidents involving motorcyclists (Cairns, 1941). It has also been recommended that the anterior and lateral aspects of the tibia should be protected by the motorcyclist wearing knee length overboots (Finlay, 1972). It is clear that the wearing of ‘Levis’ jeans by motorcyclists, made increasingly popular by a recent television commercial, offers little protection to the endangered knees. Professional motorcyclists (Figure 3) wear knee pads and leather trousers to protect their knees. It is recommended that the commercially available leathers and knee pads are worn by all motorcyclists. Further research is needed to prove the effectiveness of these pads and to develop better alternatives.
References Bothwell P. W. (1960) Motor-cycle accidents. Lancet 279, 807. Bothwell P. W. (1962) The problem of motor-cycle accidents. Practitioner 188,474. Bauer K. H. (1957) Ciba Symposia 5, 280. Cairns D. (1941) Head injuries in motor-cyclists. Br. Med. 1, ii, 465. Finlay J. A. (1972) The motor-cycle tibia. Itijuyy 4, 75. Figure 3. Professional motorcyclist taking comer at speed with inner knee protected
by a pad and leathers.
damage being particularly The cases reported here soft tissue in front of the. motorcyclist takes a comer
Paper accepted 5 December
severe below the knee. highlight the vulnerability of the knee to frictional injury when a at speed.
Reqw&sfor reprints should be addressedto: Mr H. Casserly, I James Court, Woolton, Liverpool L24 8TJ, UK.
Marjolin’s prosthesis
ulcer complicating
B. Mahaisavariya’
and P. Mahaisavariya’
‘Department of Orthopaedics and Rehabilitation University, Khon Kaen, Thailand
Medicine
1990.
a poorly fabricated
and 2Dermatologic
Unit, Department
of Medicine,
Khon Kaen
Introduction
Case report
A self-fabricated below-knee prosthesis is not uncommonly used by the amputee in rural areas of Thailand. Besides the inappropriate material being used, the poor construction without padding often leads to the problem of pressure sores at the prominent bone part. There is no previous report of malignant change occurring at the stump as a complication of prolonged use of a poorly constructed prosthesis.
A 56-year-old male amputee was admitted at Srinagarind Hospital on 5 February 1990, because of a rapidly growing ulcerated mass at the end of his right below-knee stump. His right leg had been amputated 27 years before this admission because of gangrene of the distal part from snake-bite injury. He had fabricated his own below-knee prosthesis using local wood and pieces of iron sheet. This prosthesis had been used since 6 months after amputation. As the prosthesis was not a
0 1991 Butterworth-Heinemann 0020-1383/91/050423-02
Ltd
Injury: the British
Figure I. Prosthesis
constructed
by the patient.
proper fit, he used the two long straps for holding the prosthesis to the stump without any padding inside the prosthesis (Figure I). The problem of pressure sores had developed twice at the end of the stump, which completely healed after a short period not using the prosthesis. An ulcer developed at the scar tissue at the end of the stump 2 months before admission. The ulcer grew rapidly into a tumour-like mass, with easy bleeding on contact and abnormal foul smell. On physical examination there was a Y-cm diameter cauliflower mass with an ulcerated surface located at the end of the stump just distal to the tibia1 bony examination showed no stump (Figure 2). Radiographic bony involvement. There was no inguinal lymph node enlargement or lymphangitis. The wide excision of the tumour mass, including shortening of the tibia1 bone, was performed the day after admission. The tissue diagnosis was reported later as well-differentiated squamous cell carcinoma.
Journal
of Accident
Surgery
(1991) Vol. 22/No.
5
Figure 2. Cauliflower mass with ulcerated surface on the stump.
in bum scars in Japanese and Chinese populations (Novick et al., 1977). This is thought to be related to chronic exposure of the abdomen and thighs to heat, caused by the use of a heated iron pot placed under the garment for warmth. In this reported case there is no pre-existing abnormal condition of the stump before the malignant ulcer developed, other than the use of a poorly fitting, badly constructed prosthesis.
References Cruickshank A. H., McConnell E. M. and Miller D. C. (1963) Malignancy in scars, chronic ulcers and sinuses. 1. Clin. Puthol. 16, 573.
M., Gard D. A., Hardy S. B. et al. (1977) Bum scar carcinoma: A review and analysis of 46 cases. 1. Trauma 17,809.
Novick
Paper accepted 5 December
1990.
Discussion The malignant change occurring in areas of previous scar formation, Marjolin ulcer, has been well established (Cruickshank et al., 1963). It was reported to occur more frequently
Requests for reptints should be addressed to: B. Mahaisavariya MD, Department of Orthopaedics and Rehabilitation Medicine, Khon Kaen University, Khon Kaen 40002, Thailand.
Case reports
The use of crash helmets has been shown to lower the mortality in major accidents involving motorcyclists (Cairns, 1941). It has also been recommended that the anterior and lateral aspects of the tibia should be protected by the motorcyclist wearing knee length overboots (Finlay, 1972). It is clear that the wearing of ‘Levis’ jeans by motorcyclists, made increasingly popular by a recent television commercial, offers little protection to the endangered knees. Professional motorcyclists (Figure 3) wear knee pads and leather trousers to protect their knees. It is recommended that the commercially available leathers and knee pads are worn by all motorcyclists. Further research is needed to prove the effectiveness of these pads and to develop better alternatives.
References Bothwell P. W. (1960) Motor-cycle accidents. Lancet 279, 807. Bothwell P. W. (1962) The problem of motor-cycle accidents. Practitioner 188,474. Bauer K. H. (1957) Ciba Symposia 5, 280. Cairns D. (1941) Head injuries in motor-cyclists. Br. Med. 1, ii, 465. Finlay J. A. (1972) The motor-cycle tibia. Itijuyy 4, 75. Figure 3. Professional motorcyclist taking comer at speed with inner knee protected
by a pad and leathers.
damage being particularly The cases reported here soft tissue in front of the. motorcyclist takes a comer
Paper accepted 5 December
severe below the knee. highlight the vulnerability of the knee to frictional injury when a at speed.
Reqw&sfor reprints should be addressedto: Mr H. Casserly, I James Court, Woolton, Liverpool L24 8TJ, UK.
Marjolin’s prosthesis
ulcer complicating
B. Mahaisavariya’
and P. Mahaisavariya’
‘Department of Orthopaedics and Rehabilitation University, Khon Kaen, Thailand
Medicine
1990.
a poorly fabricated
and 2Dermatologic
Unit, Department
of Medicine,
Khon Kaen
Introduction
Case report
A self-fabricated below-knee prosthesis is not uncommonly used by the amputee in rural areas of Thailand. Besides the inappropriate material being used, the poor construction without padding often leads to the problem of pressure sores at the prominent bone part. There is no previous report of malignant change occurring at the stump as a complication of prolonged use of a poorly constructed prosthesis.
A 56-year-old male amputee was admitted at Srinagarind Hospital on 5 February 1990, because of a rapidly growing ulcerated mass at the end of his right below-knee stump. His right leg had been amputated 27 years before this admission because of gangrene of the distal part from snake-bite injury. He had fabricated his own below-knee prosthesis using local wood and pieces of iron sheet. This prosthesis had been used since 6 months after amputation. As the prosthesis was not a
0 1991 Butterworth-Heinemann 0020-1383/91/050423-02
Ltd
Injury: the British
Figure I. Prosthesis
constructed
by the patient.
proper fit, he used the two long straps for holding the prosthesis to the stump without any padding inside the prosthesis (Figure I). The problem of pressure sores had developed twice at the end of the stump, which completely healed after a short period not using the prosthesis. An ulcer developed at the scar tissue at the end of the stump 2 months before admission. The ulcer grew rapidly into a tumour-like mass, with easy bleeding on contact and abnormal foul smell. On physical examination there was a Y-cm diameter cauliflower mass with an ulcerated surface located at the end of the stump just distal to the tibia1 bony examination showed no stump (Figure 2). Radiographic bony involvement. There was no inguinal lymph node enlargement or lymphangitis. The wide excision of the tumour mass, including shortening of the tibia1 bone, was performed the day after admission. The tissue diagnosis was reported later as well-differentiated squamous cell carcinoma.
Journal
of Accident
Surgery
(1991) Vol. 22/No.
5
Figure 2. Cauliflower mass with ulcerated surface on the stump.
in bum scars in Japanese and Chinese populations (Novick et al., 1977). This is thought to be related to chronic exposure of the abdomen and thighs to heat, caused by the use of a heated iron pot placed under the garment for warmth. In this reported case there is no pre-existing abnormal condition of the stump before the malignant ulcer developed, other than the use of a poorly fitting, badly constructed prosthesis.
References Cruickshank A. H., McConnell E. M. and Miller D. C. (1963) Malignancy in scars, chronic ulcers and sinuses. 1. Clin. Puthol. 16, 573.
M., Gard D. A., Hardy S. B. et al. (1977) Bum scar carcinoma: A review and analysis of 46 cases. 1. Trauma 17,809.
Novick
Paper accepted 5 December
1990.
Discussion The malignant change occurring in areas of previous scar formation, Marjolin ulcer, has been well established (Cruickshank et al., 1963). It was reported to occur more frequently
Requests for reptints should be addressed to: B. Mahaisavariya MD, Department of Orthopaedics and Rehabilitation Medicine, Khon Kaen University, Khon Kaen 40002, Thailand.
