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1.
Article in Spanish | LILACS, BINACIS | ID: biblio-1358105

ABSTRACT

Las fracturas del calcáneo representan el 2-3,1% de las fracturas en general y las avulsiones del tendón de Aquiles son las menos frecuentes de este grupo. Fueron descritas por Bohler como "fracturas en pico de pato". Los casos publicados son muy escasos, Sang-Myung y cols. publicaron la revisión más grande con 764 casos de fracturas de calcáneo, 20 de ellos con avulsión de la tuberosidad del calcáneo. Los mecanismos de acción más frecuentes son tropiezo, caída o golpe directo. Se presenta a un paciente de 48 años que concurre al Servicio de Urgencias de un hospital de segundo nivel, tras caerse de un árbol y quedar suspendido sobre la pierna derecha. Ingresó para estudio con evidencia radiográfica de fractura por avulsión del calcáneo y fue sometido a una osteosíntesis, con una excelente evolución clínica. Consideramos importante comunicar este caso, dada la escasa frecuencia de este tipo de fracturas. Nivel de Evidencia: IV


Calcaneal fractures account for 2-3.1% of all fractures; among these the least common are avulsions of the Achilles tendon, described by Dr Bohler as "Beak fractures". Descriptions in the literature are very scarce, the largest report being that of Sang-Myung et al in 2012, where a summary of 764 cases of calcaneal fractures contained 20 avulsion fractures. The most common mechanisms of trauma are tripping, falling, or a direct knock. This report presents the clinical case of a 48 year-old patient, who attended the Emergency Service of a second-level hospital after falling from a tree which resulted in being suspended by the lower right limb. Radiographs revealed signs of a calcaneal avulsion fracture, which was surgically managed via osteosynthesis with excellent clinical outcomes in follow-up. Given the infrequency of this type of fracture, we considered it important to present this article. Level of Evidence; IV


Subject(s)
Middle Aged , Calcaneus , Foot Injuries , Fractures, Avulsion , Fracture Fixation, Internal
2.
Article in Spanish | LILACS, BINACIS | ID: biblio-1358100

ABSTRACT

Introducción: Las fracturas del cuello del astrágalo son infrecuentes, pero la tasa de complicaciones y reintervenciones es alta. El objetivo de este estudio fue analizar y describir las complicaciones a mediano y largo plazo en 20 pacientes con fractura del cuello del astrágalo. Nuestra hipótesis fue que, en las lesiones graves, la reducción abierta y fijación interna genera una tasa alta de complicaciones que requerirán de nuevas intervenciones quirúrgicas. Materiales y métodos: Se evaluó a 20 pacientes con fractura del cuello del astrágalo: 6 Hawkins II (29%), 11 Hawkins III (52%) y 3 Hawkins IV (19%). El seguimiento promedio fue de 11 años. Se analizaron el tipo de fractura (simple o conminuta), las lesiones asociadas, las complicaciones y la necesidad o no de un nuevo procedimiento quirúrgico. Resultados: Once pacientes (55%) tenían lesiones asociadas y 14 (70%), conminución en el trazo de fractura. Quince (75%) sufrieron complicaciones. Nueve (45%) requirieron una segunda intervención para tratar la complicación. Conclusiones: Los factores más relacionados con el desarrollo de complicaciones y la necesidad de una nueva intervención son: conminución en el trazo de fractura, lesiones asociadas en el miembro inferior homolateral, fracturas tipos III y IV de Hawkins, y fracturas expuestas. Creemos que, en las lesiones graves del cuello del astrágalo (tipos III y IV de Hawkins) con uno o más de estos factores, la artrodesis primaria podría disminuir el riesgo de complicaciones y de nuevas cirugías, y acortar el tiempo de recuperación de los pacientes. Nivel de Evidencia: IV


Introduction: Talar neck fractures are rare but present a high rate of complications and reoperations. The objective of this work was to analyze and describe the complications in the medium and long term in 20 patients with talar neck fracture. Our hypothesis was that, in severe injuries, ORIF presents a high rate of complications that will require new surgical interventions. Materials and methods: We evaluated 20 patients with talar neck fracture: 6 Hawkins II (29%), 11 Hawkins III (52%), and 3 Hawkins IV (19%). The mean follow-up was 11 years. We analyzed the fracture pattern (simple or comminuted), the presence of associated injuries, complications, and the need to perform a new surgical procedure. Results: 11 (55%) had associated injuries and 14 (70%) had comminution in the fracture line. We presented complications in 15 patients (75%). 9 (45%) pa-tients required a second intervention to treat the complication. Conclusions: The factors most related to the development of complications and the need for a new intervention are: comminution in the fracture line, associated injuries in the ipsilateral lower limb, Hawkins type III and IV fractures, and exposed fractures. We believe that in severe talar neck injuries (Hawkins type III and IV) with one or more of these factors, primary arthrodesis reduces the risk of complications and new surgeries and shortens recovery time. Level of Evidence: IV


Subject(s)
Adult , Postoperative Complications , Talus/surgery , Talus/injuries , Treatment Outcome , Foot Injuries , Fractures, Bone
3.
Article in Chinese | WPRIM | ID: wpr-888356

ABSTRACT

OBJECTIVE@#To compare the clinical efficacy of staged surgery on Sanders Ⅳ calcaneal fractures with soft tissue Ⅲ swelling.@*METHODS@#The clinical data of 76 patients with Sanders type Ⅳ closed calcaneal fracture with soft tissue three-degree swelling treated from June 2017 to May 2020 was retrospectively analyzed, including 54 males and 22 females, aged from 25 to 50 (38.16±10.24) years. The patients were divided into observation group and control group according to different treatment methods. Twenty-four patients in the observation group were treated by staged surgery stageⅠclosed prying traction reduction and Kirschner wire fixation, stageⅡopen reduction and internal fixation with titanium plate, including 17 males and 7 females, aged from 25 to 50 (36.12±9.56) years. There were 52 patients in the control group, including 37 males and 15 females, aged from 25 to 50 (38.32±10.67) years, these patients were treated with open reduction and internal fixation with titanium plate after the dermatoglyphic signs appeared. The swelling subsidence time, the length of hospitalization days, and the incidence of postoperative incision complications were compared between two groups. The Bhler angle, Gissane angle, and calcaneal varus angle were measured by X-ray before and 6 months after operation. American Orthopedic Foot and Ankle Society (AOFAS) about the ankle hindfoot score was used to evaluate the clinical efficacy.@*RESULTS@#All 76 patients were followed up for 8 to 12 (9.52±2.01) months. The swelling subsidence time and hospitalization days in observation group were (12.12± 3.24) d and (24.53±6.44) d, respectively, which in control group were (15.16±4.16) d and (29.46±9.61) d, with statistical difference between two groups (@*CONCLUSION@#Compared with open reduction and internal fixation with titanium plate after the appearance of dermatoglyphic signs, staged surgery for Sanders type Ⅳ calcaneal fractures with soft tissue three-swelling does not increase the risk of soft tissue complications, and can significantly shorten the patient's swelling subsidence time and hospitalization days, improve the quality of fracture reduction and short term function, and relieve pain.


Subject(s)
Ankle Injuries , Calcaneus/surgery , Female , Foot Injuries , Fractures, Bone/surgery , Humans , Male , Retrospective Studies
4.
Article in Chinese | WPRIM | ID: wpr-879465

ABSTRACT

OBJECTIVE@#To explore clinical effect of early incision and decompression combined with screw fixation in treating Lisfranc injury and foot osteofascial compartment syndrome.@*METHODS@#Clinical data of 5 patients with Lisfranc injury and foot osteofascial compartment syndrome were retrospective analysized from January 2017 to December 2018, including 4 males and 1 female, aged from 19 to 62 years old. All patients were suffered from closed injuries. The time from injury to treatment ranged from 1 to 14 h. According to Myerson classification, 1 patient was type A, 1 patient was type B, and 3 patients were type C. All patients were performed early incision decompression and screw fixation. Maryland foot functional scoring standard at 12 months after opertaion was used to evaluate clinical effect.@*RESULTS@#All patients were followed up for 10 to 48 months. All fractures were achieved bone union, and healing time ranged from 3 to 9 months. All metatarsal and tarsal joints were reached to anatomical reduction. No infection, osteomyelitis, loosening or breaking of internal fixation occurred. Postopertaive Maryland foot function score at 12 months was from 44 to 97, and 2 patients got excellent result, 2 good, and 1 poor.@*CONCLUSION@#Early incision and decompression with screw fixation for the treatment of Lisfranc injury and foot osteofascial compartment syndrome, which has advantages of simple opertaion, thoroughly decompression, screw fixation does not occupy space, stable decompression and fixation, and could receive satisfied clinical effect.


Subject(s)
Adult , Bone Screws , Compartment Syndromes/surgery , Decompression , Female , Foot Injuries , Fracture Fixation, Internal , Fractures, Bone/surgery , Humans , Male , Middle Aged , Retrospective Studies , Tarsal Joints , Treatment Outcome , Young Adult
5.
Prensa méd. argent ; 106(10): 602-604, 20200000. fig
Article in English | LILACS, BINACIS | ID: biblio-1362562

ABSTRACT

Introduction: Decision making in determining management of post-trauma patient is very important, especially for traumatic in the small bones, fingers and toes. The global predictor to determine the management of retaining or amputating the limb is using the Mangled Extrimity Severity Score (MESS) scoring system, values above 7 are the indication for amputation. The decision maker have to pay attention for the end result of the actions which were performed in the initial management. Material and Methods: One case is reported from Orthopaedic emergency department Hospital in Makassar, South Sulawesi, Indonesia. A 39-year old male with motor vehicle accident trauma at left foot region since 6 hours before admitted to hospital, later was diagnosed with open comminutive fracture shaft proximal phalang of left 5th toe, the Mangled Extrimity Severity Score (MESS) was 8. Patient underwent emergency debridement and retained the toe by performed Open Reduction Internal Fixation (ORIF) K-Wire. Results: This patient has a good clinical outcome by following up 2 weeks and 8 months after surgery by retain the affected side with debridement and Open Reduction Internal Fixation (ORIF) K-Wire. Patient can ambulate normally with full weight bearing, and there is no difficulty to wearing shoe or sandal. Conclusions: Determination of action by retaining the traumatized limb needs to be considered for the good of the patient, but it is necessary to provide informed consent to the patient and family that there will be a possibility of tissue death with the worst possibility of limb amputation


Subject(s)
Humans , Male , Adult , Toe Joint/surgery , Bone Wires , Injury Severity Score , Fractures, Comminuted/surgery , Foot Injuries/therapy , Debridement , Fracture Fixation, Internal
6.
Rev. cuba. reumatol ; 22(3): e480,
Article in Spanish | LILACS, CUMED | ID: biblio-1144530

ABSTRACT

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)


Subject(s)
Humans , Raynaud Disease/complications , Raynaud Disease/therapy , Scleroderma, Systemic/complications , Foot Injuries/complications , Foot Injuries/prevention & control
7.
Rev. Asoc. Argent. Ortop. Traumatol ; 84(3): 252-259, jun. 2019.
Article in Spanish | LILACS, BINACIS | ID: biblio-1020340

ABSTRACT

Introducción: La enfermedad tromboembólica es una de las complicaciones serias en la cirugía ortopédica. La tromboprofilaxis para las cirugías de tobillo y pie no está estandarizada, porque la incidencia es baja, según la bibliografía. El objetivo de este estudio es aportar un algoritmo de prevención para la trombosis venosa profunda y una revisión de la bibliografía. Materiales y Métodos: Se llevó a cabo una revisión de las historias clínicas de los pacientes operados entre 2011 y 2017. La muestra estaba integrada por 696 hombres (28,98%) y 1706 mujeres (71,02%), con un promedio de edad de 51 años (rango 20-82). Se realizaron 2402 procedimientos, 575 (23,94%) fueron por patologías traumáticas y 1827 (76,06%), por patologías ortopédicas. Resultados: Nueve pacientes (0,37%) presentaron trombosis venosa profunda y solo dos, tromboembolismo pulmonar (0,08%). Los procedimientos en los que ocurrieron fueron: artroscopia, reparación aguda del tendón de Aquiles, hallux valgus y fractura del 5.° metatarsiano. Conclusiones: Se recomienda un enfoque multimodal para la profilaxis de la trombosis venosa profunda. Esto incluye abordar los factores de riesgo modificables, mediante la profilaxis mecánica, la movilización temprana y la profilaxis química. La heparina de bajo peso molecular es eficaz para reducir la tasa de trombosis venosa profunda y tromboembolismo pulmonar. Nivel de Evidencia: IV


Introduction: Deep vein thrombosis (DVT) is a major complication in orthopedic surgery. According to the literature, thromboprophylaxis in foot and ankle surgery is not a standardized practice due to the low incidence of DVT. Materials and Methods: We reviewed the medical records of surgical patients. Between 2011 and 2017, 1591 surgeries were performed, 6 of them due to symptomatic DVT. Results: The incidence of DVT in major orthopedic surgeries, such as knee and hip, is well documented, but there are only a few reports about its incidence in foot and ankle surgery. It is considered a relatively rare complication in many published studies; thus, preventive drug therapy is not routine practice. Conclusions: A multimodal approach to DVT prophylaxis for high-risk patients is recommended. All risk factors should be addressed, such as mechanical prophylaxis, early mobilization, and the use of chemoprophylaxis. Low molecular weight heparin is effective in reducing the rate of clinically significant DVT and is also likely to reduce the rate of pulmonary embolism. Level of Evidence: IV


Subject(s)
Adult , Middle Aged , Aged , Ankle Injuries/surgery , Ankle Injuries/complications , Foot Injuries/surgery , Foot Injuries/complications , Venous Thrombosis/prevention & control , Venous Thrombosis/therapy
8.
Article in Chinese | WPRIM | ID: wpr-776132

ABSTRACT

As one of the most common fractures of the foot, the blood supply characteristics and unique anatomy of proximal fifth metatarsal fracture makes a high risk of delayed union or non-union of fractures occurring at the junction of the diaphyseal-metaphyseal. At present, the classification system of proximal fifth metatarsal fracture is complicated and not yet unified, and Lawrence and Botte classification is more recommended. The system divides proximal fifth metatarsal fracture into three types:avulsion fractures of tuberosity(Zone I), fractures at the metaphysis-diaphysis junction, which extend into the fourth-fifth intermetatarsal facet (Zone II) and the proximal diaphyseal fractures(Zone III). Based on the classification system, each type of fracture has a corresponding treatment plan and prognosis. There are a variety of surgical methods for proximal fifth metatarsal fracture. For the fracture of Zone II and Zone III, percutaneous intramedullary screw is the first choice. In addition, clinicians should also have a thorough understanding of common complications of fracture and associated disposal methods.


Subject(s)
Bone Screws , Foot , Foot Injuries , Fractures, Bone , Humans , Metatarsal Bones
9.
Rev. Asoc. Argent. Ortop. Traumatol ; 83(4): 298-302, dic. 2018. []
Article in Spanish | LILACS, BINACIS | ID: biblio-984997

ABSTRACT

Las roturas del extensor propio del hallux son poco frecuentes, más aún aquellas espontáneas o por traumas indirectos. Se pueden producir en cualquier parte del recorrido del tendón, pero las lesiones más frecuentes son las secciones tendinosas por heridas cortantes. No existe una técnica quirúrgica específica descrita para la reinserción distal del tendón. El objetivo de este artículo es presentar a un paciente de 35 años que, por un traumatismo indirecto, sufrió la rotura del extensor propio del hallux a nivel de la inserción distal. Se describen la técnica quirúrgica, la rehabilitación y los resultados según el puntaje de la AOFAS preoperatorio y posoperatorio. Nivel de Evidencia: IV


Extensor hallucis longus ruptures are infrequent, mainly those due to spontaneous or indirect traumas. Ruptures can occur anywhere along the tendon course, but the most frequent injuries are tendinous sections due to sharp wounds. There is no specific surgical technique described for distal reinsertion of the tendon. The objective of this paper is to present a 35-year-old patient who suffered an indirect trauma in forefoot, causing the rupture of extensor hallucis longus at the level of the distal insertion. Surgical technique, rehabilitation program, and results according to the pre- and post-surgery AOFAS score are described. Level of Evidence: IV


Subject(s)
Adult , Rupture , Hallux/surgery , Hallux/injuries , Foot Injuries/surgery
10.
Rev. bras. ortop ; 53(3): 319-322, May-June 2018. graf
Article in English | LILACS | ID: biblio-959149

ABSTRACT

ABSTRACT Objective This study presents the results of 25 consecutive patients and evaluates the success of reverse sural fasciocuteneous flap (RSFF) on coverage of the foot and ankle region. Methods A total of 25 patients with soft tissue defects in the lower leg, foot, or ankle were treated with RSFF, from January 2010 to January 2017. In the evaluation of patients, the form prepared by the clinic was used and the following data were collected: age, follow-up, gender, etiology, defect size, complications, and patient satisfaction rates. Results Mean follow up time was 18 months. In all patients, the defects were fully covered. Three patients developed partial necrosis due to venous congestion. There was no complete flap loss in any of the patients. Patient satisfaction was excellent in all cases. Conclusion RSFF is quick, versatile, and easy to apply; it also provides safe soft tissue coverage, requires no microvascular repair, and provides an alternative to microsurgical reconstruction.


RESUMO Objetivo Este estudo apresenta os resultados de 25 pacientes consecutivos e avalia o sucesso do retalho fasciocutâneo sural de fluxo reverso (RFSR) na cobertura da região do pé e tornozelo. Métodos Foram analisados 25 pacientes com defeitos de partes moles na parte inferior da perna, pé ou tornozelo com RFSR, de janeiro de 2010 a janeiro de 2017. Na avaliação dos pacientes, o formulário preparado pela clínica foi usado e os seguintes dados foram coletados: idade, seguimento, sexo, etiologia, tamanho do defeito, complicações e grau de satisfação do paciente. Resultados O tempo médio de seguimento foi de 18 meses. Em todos os pacientes os defeitos foram totalmente cobertos. Três pacientes desenvolveram necrose parcial devido à congestão venosa. Não houve perda total do retalho. O grau de satisfação dos pacientes foi excelente em todos os casos. Conclusão O retalho fasciocutâneo sural reverso é rápido, versátil e fácil de aplicar. Além disso, fornece uma cobertura de tecidos moles segura, não requer reparo microvascular e é uma opção à reconstrução microcirúrgica.


Subject(s)
Humans , Male , Female , Treatment Outcome , Patient Satisfaction , Ankle Injuries , Foot Injuries , Reconstructive Surgical Procedures
11.
Rev. cuba. ortop. traumatol ; 32(1): 1-8, ene.-jun. 2018. ilus
Article in Spanish | LILACS, CUMED | ID: biblio-985583

ABSTRACT

Las lesiones del pie son difíciles de tratar por la complejidad anatómica de la región y por su infraestimación diagnóstica y terapéutica. Por lo general, se producen por traumas de alta energía. Se presenta un paciente del sexo masculino, blanco, de 56 años de edad, que llegó al cuerpo de guardia de emergencia con múltiples traumas producto de un accidente automovilístico. Se diagnosticó una luxofractura tarsometatarsiana asociada a luxación mediotarsiana y luxación subastragalina. Con criterio de tratamiento quirúrgico de urgencia fue llevado al salón de operaciones y se le realizó la reducción cerrada de la articulación mediotarsiana y subastragalina, y la estabilización con clavo de Steimann. La evolución fue satisfactoria tras el tratamiento quirúrgico(AU)


Foot injuries are difficult to treat due to the anatomical complexity of the region and the diagnostic and therapeutic underestimation. Generally, high-energy trauma produced this kind of injuries. We present a 56 year-old, white, male patient, who arrived at the emergency room with multiple traumas resulting from a car accident. The diagnosis was a tarsometatarsal luxo-fracture associated with midtarsal dislocation and subtalar dislocation. He underwent an emergency surgical treatment to closed reduce of the midtarsal and subtalar joint, and stabilization was achieve with Steinmann Pins. The evolution was satisfactory after the surgical treatment(AU)


Les lésions du pied sont difficiles à traiter due à la complexité anatomique de cette région et à leur faible estimation diagnostique et thérapeutique. En général, ces lésions résultent des traumatismes à haute énergie. Le cas d'un patient âgé de 56 ans, blanc, arrivé au service d'urgence avec plusieurs traumatismes causés dans un accident de route, est présenté. Une fracture-luxation tarsométatarsienne, associée à une luxation médiotarsienne et une luxation sous-astragalienne, a été diagnostiquée. Répondant à un critère d'urgence chirurgicale, il a subi une réduction fermée de l'articulation médiotarsienne et sous-astragalienne et une stabilisation par clou de Steinmann. Son évolution a été satisfaisante après ce geste chirurgical(AU)


Subject(s)
Humans , Male , Middle Aged , Ankle Injuries/surgery , Fracture Dislocation/diagnosis , Foot Injuries/surgery
12.
Chinese Journal of Traumatology ; (6): 197-205, 2018.
Article in English | WPRIM | ID: wpr-691011

ABSTRACT

<p><b>PURPOSE</b>To express the versatility of a variety of non-microsurgical skin flaps used for coverage of difficult wounds in the lower third of the leg and the foot over 4 years period. Five kinds of flaps were used. Each flap was presented with detailed information regarding indication, blood supply, skin territory and technique.</p><p><b>METHODS</b>Altogether 26 patients underwent lower leg reconstruction were included in this study. The reconstructive procedures applied five flaps, respectively distally based posterior tibial artery perforator flap (n = 8), distally based peroneal artery perforator flap (n = 4), distally based sural flap (n = 6), medial planter artery flap (n = 2) and cross leg flaps (n = 6).</p><p><b>RESULTS</b>In all cases, there were no signs of osteomyelitis of underlying bones or discharge from the undersurface of the flaps. Fat necrosis occurred at the distal end of posterior tibial artery perforator flap in one female patient. The two cases of medial planter artery flap showed excellent healing with closure of donor site primarily. One cross leg flap had distal necrosis.</p><p><b>CONCLUSION</b>Would at lower third of leg can be efficiently covered by posterior tibial, peroneal artery and sural flaps. Heel can be best covered by nearby tissues such as medial planter flap. In presence of vascular compromise of the affected limb or exposure of dorsum of foot, cross leg flap can be used.</p>


Subject(s)
Adolescent , Adult , Child , Child, Preschool , Female , Foot Injuries , General Surgery , Free Tissue Flaps , Humans , Leg Injuries , General Surgery , Male , Middle Aged , Postoperative Care , Reconstructive Surgical Procedures , Methods , Surgical Flaps , Young Adult
13.
Article in Korean | WPRIM | ID: wpr-717135

ABSTRACT

Chopart joint fracture and dislocation are rare injuries compared with other joint injuries with various clinical manifestations. Moreover, there is a lack of knowledge of the radiological findings of the joints, and thus, the extent of joint ligament damage may be underestimated, leading to improper treatment. This paper reports three cases of Chopart joint injury and seeks to reconsider the importance of Chopart joint evaluation and treatment.


Subject(s)
Joint Dislocations , Foot Injuries , Joints , Ligaments , Tarsal Joints
14.
Rev. bras. ortop ; 52(6): 699-704, Nov.-Dec. 2017. graf
Article in English | LILACS | ID: biblio-899203

ABSTRACT

ABSTRACT OBJECTIVE: To study use of the medial plantar flap for reconstruction of the heel and foot. METHOD: The authors share their clinical experience with the use of the medial plantar artery flap for coverage of tissue defects around the foot and heel after trauma. Twelve cases of medial plantar artery flap performed from January 2001 to December 2013 were included. RESULTS: Of the 12 patients, ten were male and two were female. The indications were traumatic loss of the heel pad in ten cases and the dorsal foot in two cases. All the flaps healed uneventfully without major complications, except one case with partial flap loss. The donor site was covered with a split-thickness skin graft. The flaps had slightly inferior protective sensation compared with the normal side. CONCLUSION: From these results, the authors suggest that the medial plantar artery flap is a good addition to the existing armamentarium for coverage of the foot and heel. It is versatile flap that can cover defects on the heel, over the Achilles tendon and plantar surface, as well as the dorsal foot. It provides tissue to the plantar skin with a similar texture and intact protective sensation.


RESUMO OBJETIVO: Estudar casos de retalho plantar medial na reconstrução do calcanhar e do pé. MÉTODO: Os autores apresentam sua experiência com o uso do retalho baseado na artéria plantar medial para cobertura de defeitos teciduais no pé, especialmente do calcanhar. Doze retalhos da artéria plantar medial, feitos entre janeiro de 2001 e dezembro de 2013, foram incluídos. RESULTADOS: Dos 12 pacientes, dez eram homens e duas mulheres. As indicações foram perda traumática do coxim do calcanhar em dez pacientes e dorso do pé em dois casos. Todos os retalhos cicatrizaram sem maiores complicações, exceto um caso com perda parcial. A área doadora foi coberta com enxerto de pele parcial. Os retalhos apresentaram uma sensibilidade protetora levemente inferior ao lado normal. CONCLUSÃO: De acordo com os resultados, o retalho plantar medial é uma boa opção para cobertura do pé, especialmente da região do calcanhar. A versatilidade do retalho permite a cobertura de defeitos no calcanhar, sobre o tendão de Aquiles e apoio plantar, assim como o dorso do pé. Esse retalho confere para região plantar uma pele de textura similar e sensibilidade protetora intacta.


Subject(s)
Humans , Male , Female , Child, Preschool , Child , Adolescent , Adult , Middle Aged , Foot Injuries , Heel , Wounds and Injuries
17.
Rev. bras. cir. plást ; 32(4): 603-607, out.-dez. 2017. ilus
Article in English, Portuguese | LILACS | ID: biblio-878791

ABSTRACT

Introdução: As reconstruções complexas da região do pé são planejadas com base nas subunidades anatômicas acometidas e pelo fator etiológico da lesão. Para coberturas de defeitos de dorso de pé, temos várias opções, desde as mais simples como enxertia local e retalhos locais ao acaso e retalhos pediculados locorregionais e as complexas com retalhos livres. Este trabalho tem por objetivo relatar um caso, cuja tática cirúrgica inédita na literatura utilizou um retalho plantar medial de fluxo retrógrado na reconstrução dorso-distais do pé. Sua originalidade consiste na passagem do retalho da planta para o dorso através do primeiro espaço intermetatársico. Métodos: Paciente 20 anos, sexo feminino, vítima de acidente de moto com trauma no pé, com perda de substância de dorso ao nível de 1 ao 5 metatarso, com exposição de osso e tendão. Foi utilizado um retalho plantar medial de fluxo retrógrado, com transposição para o dorso do pé. Resultados: A reconstrução da região distal do antepé e dedos são desafios. Os enxertos não são ideais para defeitos profundos e com exposição de estruturas nobres. Retalhos locais não são acessíveis para defeitos de dedos. E os retalhos livres são bem indicados para defeitos grandes. Os retalhos de fluxo reverso da artéria plantar medial está indicado e consagrado para a região do antepé e alguns autores modificaram para região de dorso do primeiro metatarso. Conclusão: Este retalho se mostra útil também para lesões de dorso de pé por meio dessa nova tática cirúrgica inédita na literatura, com a originalidade da passagem do pedículo da planta para o dorso através do primeiro espaço intermetatársico.


Introduction: Complex reconstructions of the foot region are planned based on the anatomical subunits affected by the etiological factors of lesions. We have several options for covering defects of the back of the feet, from the simpler ones, such as local graft and local flap at random and locoregional pedicled flaps, to the more complex ones, such as free flaps. Here, we report a case in which an unpublished technique using a retrograde flow medial plantar flap in the reconstruction of dorso-distal structures of the foot was used. Its originality consisted in the passage of the flap of the plant to the back through the first intermetatarsal space. Methods: The patient was a 20-year-old woman who had a motorcycle accident, wherein she sustained foot trauma with loss of back substance at the first to fifth metatarsal level, with bone and tendon exposure, and retrograde flow medial plantar flap was used, with transposition to the back of the foot. Results: The reconstruction of the distal region of the forefoot and fingers is a challenge. Grafts are not ideal for deep defects and exposure of noble structures. Local flaps are inaccessible for finger defects. Furthermore, the free flaps are well indicated for large defects. The flaps of the medial plantar artery are indicated and consecrated to the forefoot region, and some authors have modified to the dorsum region of the first metatarsal. Conclusion: This flap is useful for reconstruction of feet with dorsal lesions through this new technique that is unpublished in the literature, with the originality of the passage of the pedicle from the plant to the back through the first intermetatarsal space.


Subject(s)
Humans , Female , Adult , History, 21st Century , Surgical Flaps , Foot Injuries , Reconstructive Surgical Procedures , Perforator Flap , Surgical Flaps/surgery , Foot Injuries/surgery , Reconstructive Surgical Procedures/instrumentation , Reconstructive Surgical Procedures/methods , Perforator Flap/surgery
18.
Rev. cuba. ortop. traumatol ; 31(2): 1-10, jul.-dic. 2017. ilus
Article in Spanish | LILACS, CUMED | ID: biblio-960648

ABSTRACT

La articulación de Chopart o transversa del tarso está constituida por la articulación calcaneocuboidea y la astragaloescafoidea. Las lesiones que ocurren en estas articulaciones se conocen como luxo-fractura de Chopart y son extremadamente raras. Entre las causas más frecuentes se encuentran los accidentes en motocicletas y las caídas de altura. El tratamiento es la reducción anatómica y fijación estable. La necrosis avascular del astrágalo, así como la artritis postraumática son las complicaciones más temidas. Con este trabajo se pretende describir la conducta y evolución perioperatoria de dos pacientes con luxo-fractura de Chopart, atendidos en el Servicio de Urgencias del Hospital Militar Central Dr Luis Díaz Soto. Fueron diagnosticados tempranamente y se les realizó reducción abierta más fijación interna con una recuperación en los primeros tres meses. La baja prevalencia de la luxo-fractura de Chopart requiere un diagnóstico adecuado y correcto para lograr un buen resultado clínico(AU)


The Chopart joint or transverse tarsus is constituted by the calcaneocuboid and the astragaloescafoidea joints. The injuries that occur in these joints are known as Chopart luxo-fracture and are extremely rare. Motorcycle accidents and falls from heights are among the most frequent causes of Chopart luxo-fractures. The treatment is the anatomical reduction and stable fixation. The avascular necrosis of the talus, as well as post-traumatic arthritis are the most feared complications. This paper aims to describe the behavior and perioperative evolution of two patients with Chopart luxo-fracture, treated in the Emergency Service at Dr Luis Díaz Soto Central Military Hospital. They were early diagnosed and underwent open reduction and internal fixation. They recovered in the first three months. The low prevalence of Chopart luxo-fracture requires adequate and correct diagnosis to achieve good clinical results(AU)


L'articulation de Chopart, ou médio-tarsienne, est constituée de deux articulations distinctes: l'articulation calcanéo-cuboïdienne et l'articulation astragalo-scaphoïdienne. Les lésions produites dans ces articulations sont connues comme des fractures-luxations de l'articulation de Chopart, et sont assez rares. Parmi les causes les plus fréquentes, on peut trouver les accidents du trafic (surtout, de moto) et les chutes de haut. Le traitement consiste généralement à une réduction anatomique et une fixation stable. La nécrose avasculaire de l'astragale et l'arthrite post-traumatique sont les complications les plus souvent à craindre. Le but de ce travail est de décrire le comportement et l'évolution péri-opératoire de deux patients atteints d'une fracture-luxation de l'articulation de Chopart, et traités au service d'urgence de l'hôpital militaire Dr Luis Díaz Soto. Ils sont rapidement diagnostiqués, et traités par réduction ouverte et fixation interne. Leur récupération est réussie en trois mois. La faible prévalence de la fracture-luxation de l'articulation de Chopart exige un diagnostic précis pour atteindre de bons résultats cliniques(AU)


Subject(s)
Humans , Male , Adult , Clinical Evolution , Foot Injuries/surgery , Fracture Dislocation/surgery , Calcaneus/injuries , Metatarsus/injuries , Talus/injuries
19.
Rev. Asoc. Argent. Ortop. Traumatol ; 82(2): 136-140, jun. 2017.
Article in Spanish | LILACS, BINACIS | ID: biblio-896262

ABSTRACT

Introducción: Los traumatismos de alta energía en miembros inferiores se asocian, con frecuencia, a defectos de partes blandas y su reconstrucción puede presentarse como una tarea desafiante. En el extremo distal de la pierna y el pie, los colgajos de perforantes representan la mejor opción de cobertura. El motivo de este trabajo es comunicar el resultado del tratamiento de lesiones de partes blandas de pierna distal, tobillo y talón utilizando exclusivamente el colgajo de perforantes fasciocutáneo sural. Materiales y Métodos: Entre marzo de 2008 y febrero de 2016, en nuestro Hospital, se realizaron 37 colgajos fasciocutáneos surales en 35 pacientes. El criterio de inclusión fue todo paciente con defecto tegumentario en el tercio distal de tibia y talón con exposición ósea, tendinosa o defecto de la almohadilla plantar. La edad promedio fue de 49.6 años y el seguimiento promedio, de 18 meses. Resultados: Se logró la cobertura completa de defecto de tejidos blandos en 29 casos. Se detectaron tres colgajos con necrosis parcial y cinco con necrosis completa; cuatro de estos pacientes tenían antecedentes de enfermedad vascular. El tamaño del defecto fue de 9,6 x 6,7 cm (15 x 9). Conclusiones: Aunque esta serie no es extensa, los resultados coinciden con los publicados. Creemos que este colgajo es una alternativa viable para lesiones distales de pierna y pie, con una baja tasa de complicaciones y de morbilidad en el miembro afectado, y con resultados satisfactorios. Nivel de Evidencia: IV


Introduction: High energy injuries in lower limbs are frequently associated with soft tissue defect and soft tissue reconstruction can be a challenge. Perforator flaps are the best option to cover soft tissue defects in the lower leg, ankle and foot. The objective of this paper is to report the results after the use of a distally-based reverse fasciocutaneous sural flap in the reconstruction of soft tissue loss around the distal leg, ankle and foot. Methods: A total of 37 fasciocutaneous pedicled reverse sural flaps were performed in 35 patients between March 2008 and February 2016, in our Hospital. The inclusion criterium was a soft tissue defect of the lower third of the leg, ankle and heel in which bone, tendons and sole are exposed. Average age: 49.6 years and average follow-up: 18 months. Results: Complete soft tissue defect coverage was achieved in 29 cases. Three flaps with partial necrosis and five with complete necrosis were observed; four of these patients had history of vascular disease. Defect size averaged 9.6 x 6.7 cm (15 x 9). Conclusions: Although this series is not extensive, results are consistent with those reported in the literature. We consider that this flap is a valid alternative for lesions involving the distal leg, ankle and foot, with a low rate of complications and morbidity, and satisfactory results. Level of Evidence: IV


Subject(s)
Adult , Surgical Flaps , Ankle Injuries/surgery , Soft Tissue Injuries/surgery , Foot Injuries/surgery , Treatment Outcome
20.
Rev. méd. Minas Gerais ; 27: [1-3], jan.-dez. 2017.
Article in Portuguese | LILACS | ID: biblio-1000399

ABSTRACT

Este relato descreve a evolução de lesão podólica associada ao diabetes mellitus em que a amputação foi a medida tertapêutica necessária. Alerta para a gravidade da evolução do pé diabético, complicação potencialmente prevenível mas muito prevalente no Brasil, com repercussões pessoais e sociais graves, com acometimento de parcela importante de jovens. A importância de sua abordagem requer organização da equipe multiprofissional de saúde e intervenção ativa do médico da Unidade Básica de Saúde não só para o tratamento adequado como para sua prevenção e profilaxia, propiciando ao diabético melhor qualidade de vida. (AU)


This report describes the evolution of podic lesion associated with diabetes mellitus in which amputation was the necessary therapeutical measure. Alert for the severity of diabetic foot evolution, a potentially preventable but very prevalent complication in Brazil, with serious personal and social repercussions, involving a significant portion of young people. The importance of its approach requires the organization of the multiprofessional health team and the active intervention of the physician of the Basic Health Unit not only for the appropriate treatment but also for its prevention and prophylaxis, providing diabetics with a better quality of life. (AU)


Subject(s)
Humans , Female , Middle Aged , Diabetic Foot , Diabetic Foot/complications , Diabetes Mellitus , Risk , Mortality , Foot Ulcer , Foot Injuries , Foot
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