RESUMEN
Every surgeon may have experienced a tragic event associated with death or debilitation secondary to deep vein thrombosis (DVT) or pulmonary embolism (PE) after foot and ankle trauma and surgery. Nevertheless, the prevention of such a tragic event needs to be carefully evaluated rationally with currently available epidemiologic data. With great postoperative protocols and access to care, most PE events can be prevented. There are modifiable risk factors, such as length/type of immobilization and operative trauma/time that can lower the incidence of DVT/PE. In addition, chemical prophylaxis may be warranted in certain people within the foot and ankle trauma population.
Asunto(s)
Traumatismos del Tobillo , Traumatismos de los Pies , Tromboembolia Venosa , Humanos , Traumatismos del Tobillo/complicaciones , Traumatismos del Tobillo/cirugía , Traumatismos de los Pies/complicaciones , Tromboembolia Venosa/etiología , Tromboembolia Venosa/prevención & control , Factores de Riesgo , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/prevención & control , Embolia Pulmonar/etiología , Embolia Pulmonar/prevención & control , Embolia Pulmonar/terapia , Anticoagulantes/uso terapéutico , IncidenciaRESUMEN
Turf toe injuries are common, particularly in athletes competing on artificial turf. This debilitating injury and its associated sequelae can affect the long-term performance of athletes and others. In this case is presented an atypical cause for development of grade III turf toe. This case presents an acute injury with significant damage to the plantar first metatarsophalangeal joint, with plantar plate rupture and tibial sesamoid retraction secondary to injury involving working calves on a ranch. The anatomy, mechanism, and associated treatments are reviewed. The anatomical and functional interplay with this injury is discussed.
Asunto(s)
Traumatismos en Atletas , Traumatismos de los Pies , Hallux , Articulación Metatarsofalángica , Placa Plantar , Humanos , Animales , Bovinos , Traumatismos en Atletas/diagnóstico , Placa Plantar/lesiones , Articulación Metatarsofalángica/diagnóstico por imagen , Articulación Metatarsofalángica/lesiones , Traumatismos de los Pies/complicacionesRESUMEN
A talar body fracture is typically associated with talar body dislocation, resulting in ankle and subtalar joint subluxation and/or dislocation. A talar body fracture with talar head dislocation is a very rare injury. In this report, we describe the case of a 23-year-old man who suffered a coronal shearing fracture of the talar body with talar head dislocation related to a navicular compression fracture. The patient sought orthopedic consultation 6 weeks after injury. The injury was managed with open reduction, talar head relocation, internal fixation of the talar body fracture with Kirschner wires and cancellous screws and talonavicular fusion with an iliac bone autograft. Follow-up 4 years after operative treatment showed that the patient had satisfactory treatment results, including good bone healing with minimal changes in the anterior talotibial compartment and excellent function of the hindfoot and ankle.
Asunto(s)
Traumatismos del Tobillo , Traumatismos de los Pies , Fracturas Óseas , Fracturas por Compresión , Luxaciones Articulares , Astrágalo , Humanos , Masculino , Adulto Joven , Traumatismos del Tobillo/cirugía , Traumatismos de los Pies/complicaciones , Fijación Interna de Fracturas/métodos , Fracturas Óseas/complicaciones , Fracturas Óseas/diagnóstico por imagen , Fracturas Óseas/cirugía , Fracturas por Compresión/complicaciones , Luxaciones Articulares/complicaciones , Luxaciones Articulares/diagnóstico por imagen , Radiografía , Astrágalo/diagnóstico por imagen , Astrágalo/cirugíaRESUMEN
Thermal injuries are one of the most common injuries in both civilian and combat scenarios. The importance of clinical determination of burn and frostbite injuries and treatment involves understanding the pathophysiology and mechanisms of these injuries while continually reviewing literature and studying new treatment modalities. This present review examines the (1) epidemiology, (2) etiology, (3) pathophysiology and classification, and (4) treatment of thermal injuries occurring to the foot. In addition to the paucity of new literature and studies on thermal injury, this is the first review, to the best of our knowledge, to examine the management of thermal injuries occurring to the foot.
Asunto(s)
Quemaduras , Traumatismos de los Pies , Congelación de Extremidades , Humanos , Quemaduras/complicaciones , Quemaduras/terapia , Pie , Congelación de Extremidades/etiología , Congelación de Extremidades/terapia , Traumatismos de los Pies/complicacionesRESUMEN
The increase in artificial turf in the 1970s was thought to have contributed to increased incidence of turf toe injury in National Football League (NFL) players. To our knowledge, there are no publications that have analyzed the impact of this injury on performance. This is a retrospective case series. Online resources were used to identify NFL players who sustained a turf toe injury between the 2011 and 2014 seasons. The performance of each offensive skill player was analyzed separately by calculating their power rating (PR) over 6 seasons. Injured offensive skill players were then compared to a control group consisting of all RBs and WRs without a turf toe injury who competed in the 2012 season. Seventy-one turf toe injuries were identified. Twenty-nine occurred on grass, 29 on turf and the playing surface of 13 injuries could not be identified. The average PR prior to injury was 105.7/season (7.3/game), 87.3 (6.9/game) for the season of injury and 115.5 (8.1/ game) for postinjury seasons. The PR was not significantly different after a turf toe injury compared to before injury or to uninjured control player. There was no significant difference in NFL players' performances after turf toe injury based on power ratings.
Asunto(s)
Traumatismos en Atletas , Traumatismos de los Pies , Fútbol Americano , Fútbol , Humanos , Fútbol Americano/lesiones , Estudios Retrospectivos , Traumatismos en Atletas/epidemiología , Fútbol/lesiones , Traumatismos de los Pies/etiología , Traumatismos de los Pies/complicacionesRESUMEN
Acute compartment syndrome (ACS) in the foot is a challenging diagnosis and can lead to significant disabilities to patients. The present study aims to investigate the incidence, risk factors, demographics and association in the analysis of acute compartment syndrome (ACS) of the foot. We performed a retrospective review of the Trauma Quality Programs data from the American College of Surgeons including 70,525 patients who sustained a fracture of the foot from 2015 to 2018 (4 calendar years). Fasciotomies were performed in 0.7% of all foot fractures. Open fractures, crush injuries and multiple foot fractures were the strongest predictors of fasciotomies, with odds ratios of 2.38, 2.38 and 2.33 respectively. Being a male was associated with an increased likelihood of fasciotomies of 64% (p < .0001 O.R. = [1.42-1.90]), while a dislocation in the foot increased likelihood of fasciotomies by 48% (p = .0008 O.R. = [1.18-1.86]). Trauma centre level III had higher rate of fasciotomy than Tertiary Trauma centers. Multiple other factors were addressed while controlling for cofounders. This big data analysis provided information not previously reported on the risk factors, demographics, and clinical association of ACS in the foot.
Asunto(s)
Síndromes Compartimentales , Traumatismos de los Pies , Fracturas Abiertas , Humanos , Masculino , Pie , Síndromes Compartimentales/diagnóstico , Síndromes Compartimentales/epidemiología , Síndromes Compartimentales/etiología , Extremidad Inferior , Traumatismos de los Pies/complicaciones , Fasciotomía , Estudios Retrospectivos , Fracturas Abiertas/complicacionesRESUMEN
Subtalar joint arthrosis is common following intra-articular calcaneus fractures. The appropriate management of pain secondary to posttraumatic arthritis depends on the status of the remaining posterior facet articular cartilage, the magnitude of any residual joint displacement and distortions in the overall morphology of the calcaneus. In select circumstances, joint-preserving surgical techniques may be considered including lateral wall exostectomy, far lateral posterior facet joint debridement, and intra-articular osteotomies. When the subtalar joint is not salvageable, some form of arthrodesis procedure is pursued. Occasionally, an extra-articular osteotomy may be necessary in combination with arthrodesis to correct deformity.
Asunto(s)
Traumatismos del Tobillo , Calcáneo , Traumatismos de los Pies , Fracturas Óseas , Fracturas Mal Unidas , Osteoartritis , Articulación Talocalcánea , Humanos , Articulación Talocalcánea/cirugía , Calcáneo/cirugía , Fracturas Mal Unidas/complicaciones , Fracturas Mal Unidas/cirugía , Fracturas Óseas/complicaciones , Fracturas Óseas/cirugía , Traumatismos de los Pies/complicaciones , Artrodesis/métodos , Traumatismos del Tobillo/complicacionesRESUMEN
OBJECTIVE: Venous thromboembolism (VTE) is an uncommon, but potentially morbid, complication following foot and ankle fractures. Current standard is to not administer thromboprophylaxis to patients with such injuries. Nonetheless, patient and fracture factors might affect this risk/benefit consideration. The goal of this study was to determine what patients are most at risk. METHODS: The M53Ortho Pearldiver database was used to identify patients with fractures isolated to the foot and ankle that were treated non-operatively or operatively. Patients with pilon, other appendicular fractures remote from the foot and ankle, and other traumatic injuries were excluded. The 90-day occurrence of VTE was identified based on codes for deep vein thrombosis or pulmonary embolism. Characteristics of those patients who did and did not have VTEs were compared using chi-square analyses. Multivariate logistical regression was then performed to determined factors independently associated with VTE. Finally, timing of VTE relative to fracture was analyzed. RESULTS: A total of 298,886 patients with isolated foot or ankle fractures were identified, of which 1,661 (0.56%) had VTE in the 90 days following fracture. In terms of timing, 27.3% occurred in the first week, and 49.8% occurred in the first three weeks. Independent risk factors for VTE included (in decreasing order):prior VTE (odd ratio [OR] = 25.44), factor V Leiden (OR = 24.34), active cancer (OR = 1.84), specific fracture relative to metatarsal fracture (multiple fractures [OR: 1.51], ankle fracture [OR = 1.51], and calcaneus fracture [OR = 1.24]), surgical treatment (OR = 1.41), male sex (OR = 1.19), greater Elixhauser index (OR = 1.05), and increasing age (OR:1.05 per decade) (p<0.05 for each). CONCLUSIONS: The present study found that, although only 0.56% of isolated foot and ankle fractures had a VTE within ninety days. Defined risk factors, such as Factor V Leiden, prior VTE, surgical treatment, active cancer, specific fracture patterns, and surgical treatment significantly affected the odds of their occurrence.
Asunto(s)
Fracturas de Tobillo , Traumatismos del Tobillo , Traumatismos de los Pies , Embolia Pulmonar , Tromboembolia Venosa , Humanos , Masculino , Tromboembolia Venosa/epidemiología , Tromboembolia Venosa/etiología , Tromboembolia Venosa/prevención & control , Fracturas de Tobillo/complicaciones , Fracturas de Tobillo/cirugía , Fracturas de Tobillo/tratamiento farmacológico , Anticoagulantes/uso terapéutico , Embolia Pulmonar/epidemiología , Factores de Riesgo , Traumatismos del Tobillo/complicaciones , Traumatismos de los Pies/complicaciones , Estudios RetrospectivosRESUMEN
Fracture of the os peroneum is rare, and displacement of the fracture can be indicative of a tear in the peroneal longus tendon. A fifth metatarsal base fracture is a common injury caused by sudden inversion and plantar flexion of the hindfoot. We observed a rare case of a fifth metatarsal base zone I fracture combined with a displaced os peroneum fracture in a 34-year-old woman. The patient was treated with resection of the os peroneum and repair of the peroneal longus tendon, as well as open reduction and internal fixation of the fifth metatarsal base. After exposing the fragment of the fifth metatarsal base, the distal part of the fractured os peroneum was found to be located just under the fracture site. There were no complications or discomfort of the foot or ankle at 2 years postoperatively. Resection of the os peroneum and direct repair of the peroneal longus tendon were easily performed after the fifth metatarsal base fragment was exposed. This was an innovative method for performing peroneal longus tendon repair in the deep portion of the midfoot.
Asunto(s)
Traumatismos del Tobillo , Traumatismos de los Pies , Fracturas Óseas , Traumatismos de la Rodilla , Huesos Metatarsianos , Huesos Sesamoideos , Traumatismos de los Tendones , Adulto , Traumatismos del Tobillo/complicaciones , Femenino , Traumatismos de los Pies/complicaciones , Traumatismos de los Pies/diagnóstico por imagen , Traumatismos de los Pies/cirugía , Fracturas Óseas/cirugía , Humanos , Traumatismos de la Rodilla/complicaciones , Huesos Metatarsianos/cirugía , Huesos Sesamoideos/lesiones , Traumatismos de los Tendones/diagnóstico por imagen , Traumatismos de los Tendones/etiología , Traumatismos de los Tendones/cirugíaRESUMEN
Foot compartment syndrome is an uncommon condition that should be recognized by all orthopedic surgeons. The clinical presentation is often less clear than other limb compartment syndromes and requires high clinical suspicion with a low threshold for direct measurement of compartment pressure. Controversy exists regarding the number of anatomic compartments and the most effective treatment. Both acute surgical intervention and delayed management can result in significant morbidity and long-term sequelae.
Asunto(s)
Síndromes Compartimentales/etiología , Síndromes Compartimentales/cirugía , Traumatismos de los Pies/complicaciones , Traumatismos de los Pies/cirugía , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/cirugía , Humanos , Procedimientos Ortopédicos/métodosRESUMEN
RATIONALE: Degloving foot injuries are challenging to treat and associated with life-long sequelae for patients. An appropriate debridement of ischemic soft tissues with maximal preservation of glabrous skin is key during the reconstruction of these injuries. Indocyanine green (ICG) fluorescence angiography is an established technique for the intraoperative evaluation of tissue perfusion. PATIENT CONCERNS: Two patients sustained complex foot injuries in traffic accidents, including multiple fracture dislocations and extensive degloving of the plantar skin. DIAGNOSIS: Clinical inspection revealed significant degloving of the glabrous skin in both patients. INTERVENTIONS: After fracture fixation, ICG fluorescence angiography-assisted debridement with immediate latissimus dorsi free flap reconstruction was performed. OUTCOMES: In both cases, this technique allowed a precise debridement with maximal preservation of the glabrous skin. The healing of the remaining glabrous skin was uneventful and the 6-month follow-up was characterized by stable soft tissues and satisfying ambulation. LESSONS: ICG fluorescence angiography is a safe, user-friendly, and quick procedure with minimal risks, expanding the armamentarium of the reconstructive surgeon. It is highly useful for the debridement of extensive plantar degloving injuries and may also help to minimize the number of procedures and the risk of infection.
Asunto(s)
Desbridamiento/métodos , Angiografía con Fluoresceína/métodos , Traumatismos de los Pies/cirugía , Pie/diagnóstico por imagen , Adulto , Cuidados Posteriores , Niño , Lesiones por Desenguantamiento/cirugía , Femenino , Pie/irrigación sanguínea , Pie/patología , Traumatismos de los Pies/complicaciones , Fracturas Múltiples/cirugía , Humanos , Verde de Indocianina/administración & dosificación , Masculino , Procedimientos de Cirugía Plástica/métodos , Trasplante de Piel/métodos , Traumatismos de los Tejidos Blandos/cirugía , Colgajos Quirúrgicos/cirugía , Resultado del TratamientoRESUMEN
Organisms penetrate the central nervous system (CNS) via three routes. The commonest is the hematogenous route, and other routes include contiguous or penetrating injury or rarely via retrograde axoplasmic route. Although the axoplasmic highway is often used by viruses, only a few bacteria are known to penetrate the CNS via this route. We present a 57-year-old man who developed a penetrating injury while working in a field. Over the next 4 months, he developed pain at the site of the poorly healing wound, which ascended up the right leg and presented as a conus-cauda syndrome. Magnetic resonance imaging (MRI) showed an enhancing intradural intramedullary enhancing lesion in the conus on the right side with cord edema from D11 to L1 level. Extensive evaluation was negative, and he continued to progress to holocord myelitis and developed bilateral corticospinal tract lesions ("tractopathy") in the brain stem and internal capsule. He died after developing a right-sided cerebritis with mass effect. Tissue biopsy from the brain at the time of decompressive craniectomy grew Burkholderia pseudomallei and confirmed a diagnosis of neuromelioidosis (NM). We reviewed the literature for NM, its variable presentations, and the concept of an "infectious tractopathy" and imaging findings which could generate suspicion of this entity.
Asunto(s)
Traumatismos de los Pies/complicaciones , Pie/microbiología , Encefalitis Infecciosa/diagnóstico por imagen , Encefalitis Infecciosa/microbiología , Melioidosis/complicaciones , Mielitis/complicaciones , Antibacterianos/uso terapéutico , Encéfalo/diagnóstico por imagen , Encéfalo/microbiología , Burkholderia pseudomallei/patogenicidad , Resultado Fatal , Pie/patología , Traumatismos de los Pies/microbiología , Humanos , Encefalitis Infecciosa/tratamiento farmacológico , Encefalitis Infecciosa/etiología , Imagen por Resonancia Magnética , Masculino , Melioidosis/diagnóstico por imagen , Melioidosis/tratamiento farmacológico , Persona de Mediana Edad , Médula Espinal/patologíaRESUMEN
AIM: To evaluate the impact of surgical debridement on the microbiology of resection margins of an infected diabetic foot ulcer and to compare the use of marginal sampling as a guide for antimicrobial therapy. METHODS: Forty consecutive participants were studied. Tissue samples from infected diabetic foot ulcers were obtained at first contact by podiatrists. After surgical debridement to macroscopically healthy tissue, multiple samples were obtained from the margins of the residuum and also from excised non-viable tissue. Debridement was done by a single surgeon. Bacterial species were classified according to pathogenic potential a priori into Red Group-Definite pathogen causing infection, Yellow Group-Likely to be causing infection if present in more than one specimen and Green Group -Commensals, not causing infection. RESULTS: There was a relative reduction of 49% (p = 0.002) in bacteria in the most pathogenic (red) group, and 59% (p = 0.002) in the yellow group in podiatry samples compared with resection specimen. Positive cultures from margins of the residuum were observed in 75% of cases. There was a relative reduction of 67% (p = 0.0001) in bacteria in the red and 48% (p = 0.06) in the yellow group in marginal samples from the residuum compared with podiatry samples. CONCLUSIONS: After surgical debridement to healthy tissue, positive cultures from marginal tissue samples provided vital information on the presence of pathogenic bacteria. This allowed antibiotics to be individualised post-surgical debridement.
Asunto(s)
Pie Diabético/microbiología , Pie Diabético/cirugía , Infecciones/microbiología , Márgenes de Escisión , Anciano , Antibacterianos/uso terapéutico , Programas de Optimización del Uso de los Antimicrobianos , Técnicas de Tipificación Bacteriana , Desbridamiento , Pie Diabético/patología , Femenino , Traumatismos de los Pies/complicaciones , Traumatismos de los Pies/microbiología , Traumatismos de los Pies/patología , Traumatismos de los Pies/cirugía , Humanos , Infecciones/patología , Infecciones/cirugía , Masculino , Persona de Mediana Edad , Reino Unido , Cicatrización de Heridas/efectos de los fármacosRESUMEN
BACKGROUNDS: Deep vein thrombosis (DVT) occurring during the preoperative waiting period may affect the prognosis of traumatic patients, but there still lack of relevant data. This study aimed to address the preoperative DVT in isolated calcaneal fractures. METHODS: Patients who presented with isolated calcaneal fracture and received preoperative Duplex ultrasound scanning of bilateral lower extremities for detection of DVT between October and December 2018 were eligible for inclusion. Relevant data were prospectively collected, including demographics, comorbidities, lifestyles, injury, and laboratory biomarkers at admission. Univariate analyses were used to compare the difference of each variable between patients with and without DVT. Multivariate logistics regression analysis was used to identify the independent risk factors for DVT. RESULTS: Totally, 770 patients met the criteria and were included, and 24 (3.1%) had preoperative DVT diagnosed at mean of 5.3 days after injury, all of which were asymptomatic. Among patients with DVTs, 36 thrombi were found and 29 (80.6%) were in distal veins. Eight patients had DVTs in multiple veins, but no patients had bilateral DVTs. The multivariate analyses showed older age (≥58 vs <58 years, OR = 3.84), delay from injury to DUS (in each day, OR = 1.23) and elevated plasma D-dimer level (≥1.79 vs <1.79 mg/L, OR = 2.53) were independent risk factors associated with DVT. CONCLUSIONS: Due to low prevalence of DVT in isolated fracture, routine throboprophylaxis is not recommended. However, emphasis should be given in older patients with delay to admission and elevated plasma D-dimer level for targeted detection of DVT and rapid therapeutic intervention.
Asunto(s)
Traumatismos del Tobillo/complicaciones , Enfermedades Asintomáticas/epidemiología , Calcáneo/lesiones , Traumatismos de los Pies/complicaciones , Fracturas Óseas/complicaciones , Periodo Preoperatorio , Trombosis de la Vena/epidemiología , Trombosis de la Vena/etiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Biomarcadores/sangre , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Estudios Retrospectivos , Factores de Riesgo , Adulto JovenRESUMEN
BACKGROUND: Both diabetes mellitus (DM) and burn injuries lead to physical and psychological impairments. Foot burns are still a challenging health condition because of its important sensory role. No previous studies have assessed the physical therapy intervention on diabetic patients with foot burns. Therefore, this study aimed to assess the potential efficacy of sensorimotor exercise on pain, proprioception, mobility, balance, and quality of life in diabetic patients with foot burns. METHODS: Between July 2019 and February 2020, thirty-three diabetic patients with foot burns, aged 32 to 46yrs, were enrolled in this randomized control study, and randomized consecutively into two groups, study group (n=16) and control group (n=17). The study group underwent a sensorimotor exercise program thrice a week for 12 consecutive weeks, however the control group did not undergo the exercise intervention. Both groups were instructed to conduct home exercises. Visual analogue scale (VAS), proprioceptive responses, time-up and go (TUG) values, and short form-36 (SF-36) have been assessed prior and subsequent to the study intervention. RESULTS: No significant differences were observed between groups regarding baseline data (pË0.05). Subsequent to 12wk intervention, the study group showed significant improvements in outcome measures (proprioceptive responses, pË0.05, VAS, pË0.001, TUG, p=0.003, and SF-36, pË0.001) and the control group exhibited significant changes in VAS and SF-36 (p=0.004, p=0.043 respectively) however, no significant changes were found in proprioceptive responses and TUG values (pË0.05). Between groups, the post-intervention comparison demonstrated statistical differences with tending toward the study group (proprioceptive responses, pË0.05, VAS, pË0.001, TUG, p=0.013, and SF-36, p=0.046). CONCLUSIONS: Sensorimotor exercise training may improve, pain, proprioceptive responses, mobility, balance, and quality of life in diabetic patients with foot burns. Physiotherapists and rehabilitation providers should include the sensorimotor exercise in their protocols in the treatment of diabetic patients with foot burns.
Asunto(s)
Quemaduras/complicaciones , Terapia por Ejercicio/normas , Traumatismos de los Pies/complicaciones , Corteza Sensoriomotora/lesiones , Adulto , Quemaduras/fisiopatología , Diabetes Mellitus/metabolismo , Diabetes Mellitus/fisiopatología , Ambulación Precoz/métodos , Terapia por Ejercicio/métodos , Terapia por Ejercicio/estadística & datos numéricos , Femenino , Pie/fisiopatología , Traumatismos de los Pies/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Manejo del Dolor/normas , Manejo del Dolor/estadística & datos numéricos , Dimensión del Dolor , Propiocepción/fisiología , Calidad de Vida/psicología , Corteza Sensoriomotora/fisiopatología , Método Simple Ciego , Resultado del TratamientoRESUMEN
BACKGROUND: Ankle and hindfoot malalignment is a common finding in patients suffering from post-traumatic ankle osteoarthritis. However, no studies have addressed the effect of concomitant foot deformities on intrinsic foot kinematics and kinetics. Therefore, the objective of this study was to investigate the effect of ankle and hindfoot malalignment on the kinematics and kinetics of multiple joints in the foot and ankle complex in patients suffering from post-traumatic ankle osteoarthritis. METHODS: Twenty-nine subjects with post-traumatic ankle osteoarthritis participated in this study. Standardized weight-bearing radiographs were obtained preoperatively to categorize patients as having cavus, planus or neutral ankle and hindfoot alignment, based on 4 X-ray measurements. All patients underwent standard gait assessment. A 4-segment foot model was used to estimate intrinsic foot joint kinematics and kinetics during gait. Statistical parametric mapping was used to compare foot kinematics and kinetics between groups. FINDINGS: There were 3 key findings regarding overall foot function in the 3 groups of post-traumatic ankle osteoarthritis: (i) altered frontal and transverse plane inter-segmental angles and moments of the Shank-Calcaneus and Calcaneus-Midfoot joints in the cavus compared to the planus group; (ii) in cavus OA group, Midfoot-Metatarsus joint abduction sought to compensate the varus inclination of the ankle joint; (iii) there were no significant differences in inter-segmental angles and moments between the planus and neutral OA groups. INTERPRETATION: Future studies should integrate assessment of concomitant foot and ankle deformities in post-traumatic ankle osteoarthritis, to provide additional insight into associated mechanical deficits and compensation mechanisms during gait.
Asunto(s)
Tobillo/patología , Traumatismos de los Pies/complicaciones , Pie/patología , Pie/fisiopatología , Osteoartritis/patología , Osteoartritis/fisiopatología , Adulto , Tobillo/fisiopatología , Fenómenos Biomecánicos , Femenino , Humanos , Cinética , Masculino , Persona de Mediana Edad , Osteoartritis/diagnóstico por imagen , Radiografía , Soporte de PesoRESUMEN
PURPOSE: The aim of the soft tissue reconstruction of plantar forefoot should yield weight-bearing function and aesthetic contour, which poses a significant challenge for reconstructive surgeons to provide an appropriate flap according to the "like for like" reconstructive principle. Local flaps and pedicled flaps have been described for the reconstruction of small- to medium-sized defects of plantar forefoot and achieved optimal results. However, reconstruction of extensive defects of plantar forefoot is rarely investigated. In this study, we present our experience using the free anterolateral thigh (ALT) flap in the reconstruction of extensive defects of plantar forefoot. METHODS: Between November 2011 and April 2017, 9 patients were treated for extensive soft tissue defects in the plantar forefoot areas with ALT flaps. The mean age at the time of surgery was 39.3 years (range, 25-64 years). RESULTS: The follow-up period ranged from 12 to 77 months, with a mean of 31 months. All flaps survived well, and the patients were satisfied with the aesthetic and functional results. The size of the flaps ranged from 63 to 455âcm, with a mean of 197.7âcm. Seven patients with no bony involvement began to gradually weight-bear at 3 weeks postoperatively. During the follow-up time, postoperative ulceration at the reconstructed weight-bearing areas was not encountered. CONCLUSION: The ALT flap is a reliable option for treatment of extensive defects of plantar forefoot, resulting in an optimal functional and aesthetic outcome. Even when a total plantar loss exits, excellent results can be achieved.
Asunto(s)
Antepié Humano/cirugía , Colgajos Tisulares Libres/trasplante , Muslo/cirugía , Adulto , Estética , Femenino , Estudios de Seguimiento , Traumatismos de los Pies/complicaciones , Traumatismos de los Pies/cirugía , Antepié Humano/anomalías , Humanos , Masculino , Persona de Mediana Edad , Procedimientos de Cirugía Plástica/métodos , Resultado del Tratamiento , Soporte de Peso/fisiologíaRESUMEN
BACKGROUND: During the coronavirus disease (COVID-19) pandemic, people volunteered for sewing hand-made face masks. However, sewing-machine operating might be associated with high ergonomic risk and a negative impact on musculoskeletal health. OBJECTIVE AND METHODS: This paper describes an ultrasonographic diagnosis of a foot ganglion - after sewing 300 face masks within two months using a foot-operated sewing machine. RESULTS: The patient significantly improved after an ultrasound-guided aspiration and corticosteroid injection. CONCLUSION: In short, we highlight the importance of ultrasound examination in the management of work (overuse)-related disorders in occupational medicine practice.
Asunto(s)
COVID-19 , Enfermedades del Pie/diagnóstico por imagen , Ganglión/diagnóstico por imagen , Enfermedades Profesionales/diagnóstico por imagen , Industria Textil , Voluntarios , Anestésicos Locales/administración & dosificación , Antiinflamatorios/administración & dosificación , COVID-19/epidemiología , COVID-19/prevención & control , Trastornos de Traumas Acumulados/complicaciones , Drenaje/métodos , Femenino , Enfermedades del Pie/etiología , Traumatismos de los Pies/complicaciones , Ganglión/etiología , Humanos , Máscaras , Acetato de Metilprednisolona/administración & dosificación , Persona de Mediana Edad , Enfermedades Profesionales/etiología , Pandemias , SARS-CoV-2 , Trimecaína/administración & dosificación , Ultrasonografía IntervencionalRESUMEN
Las úlceras pueden aparecer sobre protuberancias óseas, como las falanges proximales o los codos, pero es más probable que sean secundarias a la piel tensa y al trauma y no respondan a la terapia vasodilatadora. Todas las úlceras son muy dolorosas. El propósito de este trabajo es presentar aspectos relacionados con la atención de las úlceras digitales en la esclerodermia, según la experiencia de diferentes autores. En reumatología, se recomienda, en todo paciente con dolor reumático crónico, calcular la intensidad del dolor, tanto para la elección primera del tratamiento analgésico como para la medición de la respuesta. Y, para ello, se han propuesto varios métodos de cuantificación. El manejo de las úlceras digitales en la esclerodermia incluye la intervención no farmacológica, farmacológica y quirúrgica. El uso de nitratos, infusiones de acetilcisteína, el gel de vitamina E, entre otros métodos mejoran el tiempo de curación en pacientes con esclerodermia. La falta de terapias aprobadas por la Administración de Alimentos y Medicamentos de los Estados Unidos para las ulceraciones digitales garantiza un enfoque y una atención renovados para encontrar opciones de tratamiento significativas. Los médicos deberán emplear un enfoque terapéutico multifacético para optimizar el tratamiento de úlceras digitales existente y evitar la formación de nuevas lesiones para proporcionar a los pacientes la mejor calidad de vida(AU)
Ulcers can occur on bony bumps, such as the proximal phalanges or elbows, but are more likely to be secondary to tight skin and trauma and not responsive to vasodilator therapy. All ulcers are characteristically very painful. To present aspects related to the management of digital ulcers in scleroderma based on the experience of different authors. The management of digital ulcers in scleroderma includes non-pharmacological, pharmacological and surgical intervention. The use of nitrates, infusions of acetylcysteine, Vitamin E Gel, among other methods, improve the healing time in patients with scleroderma. The lack of US Food and Drug Administration approved therapies for digital ulcerations ensures a renewed focus and attention on finding meaningful treatment options. Clinicians should employ a multi-faceted therapeutic approach to optimize existing digital ulcers treatment and avoid new lesion formation to provide patients with the best quality of life(AU)
Asunto(s)
Humanos , Enfermedad de Raynaud/complicaciones , Enfermedad de Raynaud/terapia , Esclerodermia Sistémica/complicaciones , Traumatismos de los Pies/complicaciones , Traumatismos de los Pies/prevención & control , EcuadorRESUMEN
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a newly identified strain of coronavirus in the human body and was reported in Wuhan at the end of 2019. So far, the epidemic is continuing and very serious, with the number of infections and deaths increasing. Despite active investigations around the world to better understand the dynamics of transmission and the scope of clinical disease, COVID-19 continues to spread rapidly from person to person. The common signs and symptoms of SARS-CoV-2 infection include fever, fatigue, dry cough, and dyspnea; in severe cases, patients may have acute respiratory distress syndrome, septic shock, metabolic acidosis difficult to treat and coagulation disorder. However, some patients who test positive for SARS-CoV-2 in their respiratory tract may not have such clinical signs and symptoms. This report presents a case study analysis of a patient admitted in the Fourth Taiyuan People's Hospital, who had suffered traumatic injuries from a car accident and survived COVID-19, with pleural effusion as the initial symptom. We report a case of 2019-NCOV with pleural effusion as the first symptom. Describe in detail the differential diagnosis, diagnosis, clinical management, and cure of this case. In order to combat the novel CoronaviruscoVID-19 in the process to provide lessons and help.