Epidemiological, Clinical and Paraclinical Profile of Osteoarthritis of the Lower Limbs in Obese Patients at the Cocody University Teaching Hospital

Objective: To describe the epidemiological, clinical and paraclinical characteristics of osteoarthritis of the lower limbs in obese patients at the Cocody University Teaching Hospital. Methodology: This was an analytical cross-sectional study carried out in the rheumatology department of the Cocody UTH in Abidjan (Ivory Coast) from March 1 to April 30 2023. Patients who came for rheumatology consultation presenting with mechanical arthralgia of the lower limbs, who were obese, had radiographic images were included. All patients without radiographic images were excluded. Obesity was defined as a body mass index (BMI) greater than or equal to 30 kg/m. The Chi2 test was used to compare proportions and determine the existence of associations between osteoarthristis and obesity, obesity severity and radiographic stage of osteoarthritis as well as the functional impact. A p-value below a predefined threshold (p = 0,05) indicates a significant relationship between the variables. Result: Out of 185 patients received for osteoarthritis of the lower limbs during the study period, 136 were obese (74%). There were 115 women (84.6%) with an average age of 56.03 with a standard deviation of 12.72 years (extremes: 22 and 84 years). The main socio-professional category was the informal sector (30%). The majority of patients had a low socio-economic level (80.2%) and lived in urban areas (92.6%). The most common past medical history was hypertension (33.08%) followed by peptic ulcer disease (16.91%). Patients had a body mass index class 1 (81.6%), class 2 (15.40%) and class 3 (2.90%). The average duration of symptom progression until diagnosis was 11 months. Genu varum was the main static disorder (56.10%) and the knee joint was the dominant topography (90.4%) with a bilateral localization (80%). The average Lequesne index was greater than 8 (59.5%). The Kellgren and Lawrence radiographic stages were stage 1 (9.20%), stage 2 (46.90%), stage 3 (29.20%) and stage 4 (6.90%). The Obesity severity was significantly associated with osteoarthritis of the knee (p = 0.042). There was no statistically significant association between obesity severity and radiographic stage of osteoarthritis (p = 0.163) or functional impact (p = 0.180). Conclusion: Osteoarthritis of the lower limbs affected obese women and was dominated by stage 2 osteoarthritis of the knee (Kellgren and Lawrence). There is an association between the severity of obesity and osteoarthritis of the knee.

Honey Dressing of Cutaneous Wounds on Limbs in the Traumatology Orthopaedics Department of Bouaké University Hospital

The study evaluated the effectiveness of honey dressings in healing recent skin wounds with soft tissue loss on limbs. Conducted over a year with 60 patients, results showed a significant reduction in wound size and early healing, with complete recovery on average within 29 days. The study supports honey as a viable wound treatment.

Knowledge of Patients and Their Accompanying Persons about Obliterative Arteriopathy of the Lower Limbs at Conakry University Hospital in 2022

Introduction: Obliterative arterial disease of the lower limbs is a marker of advanced atherosclerosis. It is one of the world’s most common cardiovascular diseases, present in one in five people over the age of 60, and carries an increased risk of morbidity and mortality. The aim of this study was to assess the knowledge of patients and their carers about obliterative arteriopathy of the lower limbs at Conakry University Hospital. Material and Methods: We conducted a descriptive cross-sectional study lasting 3 months, from March 12 to June 12, 2022 in the hospitals of the University Hospital of Conakry (Donka and Ignace Deen). Following free and informed consent, they were interviewed on the basis of a pre-established questionnaire. Socio-demographic data (age, gender, level of education) were collected, and knowledge of obliterative arterial disease of the lower limbs. Results: The study involved 159 people, comprising 106 patients (66.66%) and 53 accompanying persons (33.34%) in the hospitals of the University Hospital of Conakry (Donka and Ignace Deen). The 60 to 79 age group was the most represented (44.7%), with an average age of 55.4 ± 15.9 years and extremes of 20 to 84 years. Half (47.8%) had not attended school, and almost all (96.4%) of those who had attended school had a low level of education (primary and secondary). Almost all of them (91.2%) had never heard of AOMI. Only 5% identified at least one risk factor, diabetes, hypertension and smoking. Amputation was the most frequently identified complication. About 98% did not know that AOMI is associated with myocardial infarction and stroke, and 93.7% did not know of any complications. Almost all the participants (99.4%) had poor knowledge of the following complications. Conclusion: Obliterative arterial disease of the lower limbs could be prevented or delayed by screening and controlling risk factors. Our results show a huge deficit in knowledge of this pathology, including risk factors, preventive measures, clinical signs and complications among patients and their relatives. A study conducted outside the hospital environment would provide a better understanding of the extent to which the general population is unaware of this disease.

Principles and Precautions of Nursing for Post-amputation Residual Limbs in an Earthquake

Nursing plays an important part in the rehabilitation of residual limbs and the utilization of artificial limbs after the attack of the earthquake,which also prevent and reduce the damage severity,supplement and improve functional state,increase quality of life and strengthen the social life participating capacity of the amputees. According to the Guiding Principles for Adaptation and Utilization of Common Assistive Devices for Injury of the Wounded in Earthquake [1]compiled jointly by CDPF and Ministry of Health,to further promote the development of scientific work for rehabilitation of the wounded in the earthquake,improve the whole level and efficacy of medical remedy and rehabilitation,and maximally reduce the severity of disability,this study mainly interpreted the precautions to the post-amputation nursing for residual limbs of the wounded,hoping to provide reference for medical staff who will receive patients for amputation to implement rehabilitation therapy.

Kinetostatics Analysis of a Novel 6-DOF Parallel Manipulator with Three Planar Limbs and Equipped with Three Fingers

It is significant to develop a robot hand with high rigidity by a 6-DOF parallel manipulator（PM）.However,the existing6-DOF PMs include spherical joint which has less capability of pulling force bearing,less rotation range and lower precision under alternately heavy loads.A novel 6-DOF PM with three planar limbs and equipped with three fingers is proposed and its kinematics and statics are analyzed systematically.A 3-dimension simulation mechanism of the proposed manipulator is constructed and its structure characteristics is analyzed.The kinematics formulae for solving the displacement,velocity,acceleration of the platform,the active legs and the fingers are established.The statics formulae are derived for solving the active forces of PM and the finger mechanisms.An analytic example is given for solving the kinematics and statics of proposed manipulator and the analytic solved results are verified by the simulation mechanism.It is proved from the error analysis of analytic solutions and simulation solutions that the derived analytic formulae are correct and provide the theoretical and technical foundations for its manufacturing,control and application.

Adaptive Robust Control for a Lower Limbs Rehabilitation Robot Running Under Passive Training Mode

This paper focuses on the problem of the adaptive robust control of a lower limbs rehabilitation robot(LLRR) that is a nonlinear system running under passive training mode. In reality, uncertainties including modeling error, initial condition deviation, friction force and other unknown external disturbances always exist in a LLRR system. So, it is necessary to consider the uncertainties in the unilateral man-machine dynamical model of the LLRR we described. In the dynamical model, uncertainties are(possibly fast) time-varying and bounded. However, the bounds are unknown. Based on the dynamical model, we design an adaptive robust control with an adaptive law that is leakagetype based and on the framework of Udwadia-Kalaba theory to compensate for the uncertainties and to realize tracking control of the LLRR. Furthermore, the effectiveness of designed control is shown with numerical simulations.

Application of the Somatosensory Interaction Technology Combined with Virtual Reality Technology on Upper Limbs Function in Cerebrovascular Disease Patients

Objective: To explore the effects of the somatosensory interaction technology combined with virtual reality technology on upper limbs function and activities of daily living (ADL) in cerebrovascular disease patients. Methods: Form January, 2019 to December, 2019, 80 cerebrovascular disease patients were recruited, and had been divided into control group (n = 40) and observation group (n = 40), randomly. The control groups received conventional rehabilitation treatment, for 40 minutes per day, while observation group received conventional rehabilitation treatment, for 20 minutes per day, and virtual reality technology treatment, 20 minutes per day, 5 days a week for 4 weeks. Wolf Motor Function Test (WMFT), Fugl-Meyer Assessment-Upper Extremities (FMA-UE) and modified Barthel index (MBI) were used to assess the motor function of the upper limbs and ADL before and after treatment. Results: Before treatment, the scores of WMFT, FMA-UE and MBI were no significant difference between two groups (P > 0.05). The scores improved in both groups after treatment (P < 0.01), and were higher in the observation group than in the control group (P < 0.05). Conclusion: The somatosensory interaction technology combined with virtual reality technology could facilitate to improve the upper limbs function and ADL in cerebrovascular disease patients.

Deep Venous Thrombosis: Commonly Affected Veins in the Lower Limbs

Aim and Objectives: This study aimed to record the commonly affected veins in the lower limbs, to compare the affected sides and gender and to correlate the Doppler findings and stages of deep venous thrombosis (DVT). Materials and Methods: A descriptive retrospective study of 46 already diagnosed cases of lower limb DVT. Results: Out of 46 cases of DVT, 71.74% were females. The majority of patients (93.47%) were affected in unilateral lower limb with significant predominance (65.22%) to affect the left lower limb (p Conclusion: Lower limb deep venous thrombosis affects left lower limb more than right and females more than males. Superficial femoral vein (SFV) and common femoral vein (CFV) are the most common affected veins. Lower limb DVT predominantly present in acute stage with venous distension and absent blood flow.

Botulinum toxin type A plus rehabilitative training for improving the motor function of the upper limbs and activities of daily life in patients with stroke and brain injury

BACKGROUND:Botulinum toxin type A(BTX-A)is mostly to be used to treat various diseases of motor disorders,whereas its effect on muscle spasm after stroke and brain injury needs further observation.OBJECTIVE:To observe the effect of BTX-A plus rehabilitative training on treating muscle spasm after stroke and brain injury.DESIGN:A randomized controlled observation.SETTINGS:Department of Rehabilitation,Department of Neurology and Department of Neurosurgery,the Second Hospital of Hebei Medical University.PARTICIPANTS:Sixty inpatients with brain injury and stroke were selected from the Department of Rehabilitation,Department of Neurology and Department of Neurosurgery,the Second Hospital of Hebei Medical University from January 2001 to August 2006.They were all confirmed by CT and MRI,and had obvious increase of spastic muscle strength in upper limbs,their Ashworth grades were grade 2 or above.The patients were randomly divided into treatment group(n=30)and control group(n=30).METHODS:①Patients in the treatment group undertook comprehensive rehabilitative trainings,and they were administrated with domestic BTX-A,which was provided by Lanzhou Institute of Biological Products,Ministry of Health(S10970037),and the muscles of flexion spasm were selected for upper limbs,20-25 IU for each site.②Patients in the treatment group were assessed before injection and at 1 and 2 weeks,1 and 3 months after injection respectively,and those in the control group were assessed at corresponding time points.The recovery of muscle spasm was assessed by modified Ashworth scale(MAS,grade 0-Ⅳ;Grade 0 for without increase of muscle strength;GradeⅣfor rigidity at passive flexion and extension);The recovery of motor function of the upper limbs was evaluated with Fugl-Meyer Assessment(FMA,total score was 226 points,including 100 for exercise,14 for balance,24 for sense,44 for joint motion,44 for pain and 66 for upper limb);The ADL were evaluated with Barthel index,the total score was 100 points,60 for mild dysfunction,60-41 for moderate dysfunction,<40 for severe dysfunction).MAIN OUTCOME MEASURES:Changes of MAS grade,FMA scores and Barthel index before and after BTX-A injection.RESULTS:All the 60 patients with brain injury and stroke were involved in the analysis of results.①FMA scores of upper limbs:The FMA score in the treatment group at 2 weeks after treatment was higher than that before treatment[(14.98±10.14),(13.10±9.28)points,P<0.05],whereas there was no significant difference at corresponding time point in the control group.The FMA scores at 1 and 3 months in the treatment group[(23.36±10.69),(35.36±11.36)points]were higher than those in the control group[(20.55±10.22),(30.33±10.96)points,P<0.01].②MAS grades of upper limbs:There were obviously fewer cases of gradeⅢin MAS at 2 weeks after treatment than before treatment in the treatment group(0,9 cases,P<0.05),whereas there was no obvious difference in the control group.There were obviously fewer cases of gradeⅢin MAS at 2 weeks and 1 month after treatment in the treatment group(0,0 case)than the control group(5,2 cases,P<0.01).③Barthel index of upper limbs:The Barthel index at 2 weeks after treatment was higher than that before treatment in the treatment group[(30.36±22.25),(28.22±26.21)points,P<0.05],whereas there was no significant difference in the control group.The Barthel indexes at 1 and 3 months after treatment in the treatment group were obviously higher than those in the control group[(20.55±10.22),(30.33±10.96)points,P<0.01].CONCLUSION:BTX-A has obvious efficacy on decreasing muscle tension after stroke and brain injury,and relieving muscle spasm;Meanwhile,the combination with rehabilitative training can effectively ameliorate the motor function of upper limbs and ADL of the patients.

Repetitive training for ameliorating upper limbs spasm of hemiplegic patients

BACKGROUND: The main aim of rehabilitation is to ameliorate motor function and use the damaged limbs in the activities of daily living. Several factors are needed in the self-recovery of the patients, and the most important one is to reduce spasm. Some mechanical repetitive movements can affect and change the excitability of motor neurons. OBJECTIVE: To observe the effect of repetitive training on ameliorating spasm of upper limbs of hemiplegic patients. DESIGN: A self-controlled observation before and after training. SETTING: Department of Rehabilitation, Xuanwu Hospital of Capital Medical University. PARTICIPANTS: Seven hemiplegic patients induced by brain injury were selected from the Department of Rehabilitation, Xuanwu Hospital, Capital Medical University from March to June in 2005. Inclusive criteria: ① Agreed and able to participate in the 30-minute training of hand function; ② Without disturbance of understanding. The patients with aphasia or apraxia, manifestation of shoulder pain, and severe neurological or mental defects. For the 7 patients, the Rivermead motor assessment (RMA) scores ranged 0-10 points, the Rivermead mobility index (RMI) ranged 1-3, and modified Ashworth scale (MAS) was grade 2-4. Their horizontal extension of shoulder joint was 0°-30°, anteflextion was 0°-50°, internal rotation was 50°-90°, external rotation was 0°-10°; and the elbow joint could extend for 15°-135°. METHODS: The viva 2 serial MOTOmed exerciser (Reck Company, Germany) was used. There were three phases of A-B-A. ① The phase A lasted for 1 week. The patient sat on a chair facting to the MOTOmed screen, and did the circumduction of upper limbs forwardly, 30 minutes a day and 5 days a week. ② The phase B lasted for 3 weeks. The training consisted of forward circumduction of upper limbs for 15 minutes, followed by backward ones for 15 minutes and 5-minute rest. ③ The training in the phase A was performed again for 2 weeks. The extensions of upper limbs were recorded at phase A, the extension and flexion of elbow joints were recorded at phase B, and the extensions were recorded at the second A phase. All the patients were evaluated by the same therapeutist. ① RMA was used to evaluate the motor function completely, including the motor control of both upper and lower limbs, but only the data of upper limbs were recommended to be used. The flexibility and concordance of upper limbs were described by detecting the ability of hand to move objects with 15 items, 2 grades for each item: 0 for could not complete and 1 for could complete. ② RMI was used to measure the flexion and extension of elbow joint and shoulder joint, the scores ranged from 0 (no movement and no obvious muscle contraction) to 5 (close to normal movement). ③ MAS was used to evaluate the muscle tension in clinic. Grade 1 for without abnormal increase of muscle tension, and grade 5 for muscle rigidity, and it was unable for passive movement. ④ Ranges of motion of elbow joint and should joint were measured using protractor. MAIN OUTCOME MEASURES: ① The strength of each limb to persist for 40 s recorded by two hand pedals; ② Changes of muscle tensions detected by the two hand pedals; ③ Changes of muscle contraction at the flexion and extension of ipsilateral limb recorded by EMG; ④ Minimal moment of iplateral end foot; ⑤ RMA; ⑥ RMI; ⑦ MAS; ⑧ Ranges of motion of elbow joints and shoulder joints. RESULTS: The functions were evaluated at 6 weeks after training. ① The strength of each limb to persist for 40 s was recorded, and the strength of the ipsilateral limb changed obviously from 20%-40% to 50%-70%. ② The muscle tensions detected by the two hand pedals changed from 2.2-4.0 N·m to 0.2-1.0 N·m. ③ EMG displayed that along with the enhancement of fast movements, the strength curve increased (the EMG for the extension of elbow joints were obvious). ④ The minimal moment of iplateral end foot was 5.0 N·m. ⑤ The RMA scores ranged 15-30 points. ⑥ The RMI ranged 4-5. ⑦ MAS were grades 0-2. ⑧ For shoulder joints, the ranges of motion were 90°-180° for external extension, 90° for anteflexion, 90° for internal rotation and 50°-75° for external rotation; For elbow joints, the extension of active movements was close to 0°. CONCLUSION: After repetitive movements, the strength of upper limb increased, the range of motion enlarged, and spasm reduced.

CLINICAL AND EXPERIMENTAL STUDIES ON THE TREATMENT OF NUMBNESS AND PAIN IN THE LIMBS WITH RAMULUS CINNAMOMI

Most numbness and pain in the limbs iscaused by invasion of pathogenic wind,cold anddampness into the deficient body,blocking themeridians of the limbs with stagnation of Qi orblood,and diffusion of impeded body fluids.Ramulus Cinnamomi has the property of warm-

CLINICAL OBSERVATION ON 617 CASES OF PEDIATRCIC SYNDROME OF ATROPHIC PARALYSIS OF THE LIMBS TREATED WITH ACUPUNCTURE

The syndrome of atrophic paralysis of thelimbs refers to a group of diseases characterizedby atrophy and weakness of the limbs.Patientswith this syndrome are unable to move theirlimbs voluntarily,which may be accompaniedby numbness and muscular atrophy.This diseaseis more commonly seen in the lower limbs.

The design of exoskeleton lower limbs rehabilitation robot

To achieve human lower limbs rehabilitation training, the exoskeleton lower limbs rehabilitation robot is designed. Through respective motor driving, the retarding mechanism and telescopic adjusting mechanism, the function of human walking is accomplished. After the design of the mechanical structure, the finite element analysis is carried out on the important parts and the control system is achieved by Single Chip Microcomputer.

ACUPUNCTURE IN RELIEF OF PAIN AND HEALING OF GANGRENE OF LIMBS

Pain and gangrene in limbs due to Buerger’s disease, Raynaud’s phenomenon andatherosclerosis are a great problern to manage in modern medicine. Vasodilators, sympathectomy andprogressive amputations cannot solve the problem. Electr0acupuncture shows very good results so that drugs and surgery may be spared. Total 32 cases (Buerger’s 27, Raynaud’s 4, atherosc1erosis 1 )were treated with acupuncture needling and electrostimulation. Acupoints used were Weizhong (BL4O ), Taixi (KI 3), Zusanli (ST 36), Jiexi (ST 41 ), Bafeng (Extra), Neiguan (PC 6), Hegu (LI4 ), Baxie (Extra) . The frequency of electrostimulation at acupoints was 100- 500 cycles per minute.Daily treatment was carried out the first 1O days, then the times of treatment reduced. The therapywas maintained once in two beths. Of 27 cases of Buerger’s disease, 19 cases (82. 6 % ) were healed. Pain was relieved but uker not healed in 1 case (4. 3% ). Failure was 3 (13% ). 3/4 (75 % ) ofRaynaud’s cases, pain and gungrene were fully control1ed; the

Endovascular interventions may save limbs in elderly subjects with severe lower extremity arterial disease

Endovascular intervention,such as percu-taneous transluminal angioplasty(PTA),improves claudication and saves limbs of patients with severe lower extremity arterial dis-ease(LEAD).[1]A previous study showed that the mortality among octogenarians was as high as 29%regardless of the type of intervention and that re-vascularization was associated with high peripro-cedural mortality.[2]A previous study had already shown that reconstructive surgery for elderly indi-viduals over 80 years old resulted in a significantly higher mortality rate than that for patients between 70 and 80 years old,whereas endovascular inter-vention and primarily conservative treatment had comparable prognoses.[3]Consistently,another study showed that the risks of both overall and am-putation-free survival were significantly lower with endovascular treatment than with bypass surgery in patients with critical limb ischemia.[4]A systematic review and meta-analysis of 27 studies(15 cohort and 12 randomized controlled trials)with 1642 pa-tients suggests that conservative treatment may be considered for nonreconstructable patients with critical limb ischemia;[5]however,because a high risk of bias and serious inconsistencies were found in the included studies,the meta-analysis provided low-quality evidence.In contrast,a small cohort study with 49 patients suggests that amputation im-proved quality of life and health status in fragile elderly individuals.

Effects of Hip Arthroplasties on Bone Adaptation in Lower Limbs: A Computational Study

Gait disorders contribute to the risk of falls and successive injuries, especially to elderly populations. The risk of falls becomes higher for hip osteoarthritis (OA) and hip arthroplasties patients due to poor balancing and gait impairment. Bone adaptation and bone loss are fundamental issues in considering the changes of bone behavior and gait pattern. In this study, computational analysis of the lower limbs was conducted to estimate the bone adaptation after hip arthroplasties procedure. 3D inhomogeneous model of lower limb was developed from computed topography (CT- based) data of 79 years old patient with hip osteoarthritis problem in left limb. Two types of arthroplaties were constructed in the left limb, namely total hip arthroplasty and resurfacing hip arthroplasty using commercial biomedical software, Mechanical Finder v6.1. Prosthesis stem and acetabular cup of THA were modelled as titanium alloy material (E = 114 GPa, v = 0.34), femoral ball and bearing insert as alumina properties (E = 370 GPa, v = 0.22). Meanwhile, RHA implant was assigned as Co-Cr-Mo material (E = 230 GPa, v = 0.30). Contact between both implants and bone were considered to be perfectly bonded at the interface. A load case of quiet standing position was conducted in this analysis with 60 kg of the patients’ body weight. The load was applied at the cross sectional lumbar vertebra and fixed at the distal of femoral shafts. Results show different patterns of stress distribution in right and left (operated) limbs for hip OA, THA and RHA models. An indication of stress alteration on both limbs after arthroplasties suggested that the bone adaptation occurred. The higher percentage of change in the left limb projected that the adaptation was more critical in operated limb.

Training and Recommendations on the Lower Limbs Explosive Force of Juvenile Amateur Men Sprinters

Based on the characteristics of physiological development of China's juvenile men sprinters,combined with the training mechanism of explosive force,and taking the track- and- field team of Jianshan High School in Chongqing as experimental object,this article selects the combination of one leg training methods and the combination of two legs training methods to carry out group control experiment. The result shows: each index score of the two groups of athletes is improved after training,but the characteristics of employing forces and the way of muscle work in one leg jumping exercises such as the one leg jump and step are much closer to sprint techniques. And using this kind of methods can effectively develop the special quality of juvenile sprinter.

ONE-STAGE ARTERIOVENOUS REVERSAL FOR REVASCULARIZATION OF SEVERELY ISCHEMIC LIMBS

Staged arteriovenous reversal has been successfully established forrevascularization of severely ischemic limbs since 1984. The authors tried to constrict thecentral venous limb immediately after the arteriovenous fistula formation to make the pres-sure distal to the anastomosis raising to its maximum to shorten the time required for thedistal valves to become incompetent. Thus, the revascularization of the severely ischemiclimbs may be established much sooner than the staged arteriovenous reversal, and more di-seased limbs will be saved. Forty-two patients with a total of 60 upper and lower limbshave been operated on with good results.

Fracture of Limbs Bones in a Town in Post Conflict (Case of Bukavu Town)

Background: Rapid urbanization and increasing fleet in low-income countries are the basis of the higher rate of trauma and fractures. In a post conflict environment, the abnormal movement of firearms and poverty from them may change the configuration’s epidemiological, anatomical and clinical fractures of the limbs bones as well as their care. Goal: To make an inventory on the fractures of the limb bones in Bukavu town, a town in post armed conflict. Method: This work is transversal, retrospective and descriptive on 500 fractures of the limbs bones recorded on a period of 3 months from 1st June to 31st August 2013. Twenty investigators went around different places of Bukavu town to interview and complete a research protocol ad hoc. In total, we recorded 500 subjects with 570 fractures of the limb bones. Results: The average age is 29.4 years old and 37% are male fractured. The main circumstances of occurrence of the fracture of the limbs bones are the falls (31.7%), firearms (22.2%) followed closely by road traffic accidents (21.9%). Students (38.6%) and the unemployed (29.4%) are most victims’ fractures of limb bones. The forearm bones (31.7%) and leg bones (27.2%) are most concerned, 52.2% fractured turned to modern medicine against 41.8% for traditional medicine. Conclusion: The fractures of the limbs bones in Bukavu mainly concern young male subjects. They occur with the waning of a fall and preferentially affect the bones of the forearm. Good governance would reduce the incidence of fractures of the limbs bones and their assessment.