Nursing in sports ankle injury based on the fitness exercise / A enfermagem nas lesões de tornozelo com base no exercício de aptidão física / La enfermería en las lesiones del tobillo basada en el ejercicio de aptitud física

ABSTRACT Introduction Ankle injury is an acute soft tissue pathology where the ankle ligaments are distended, lacerated, or ruptured due to violence during sport. This joint is also one of the most vulnerable in sports. After an injury, immediate and adequate care is significant in reducing pain and complication. Objective Statistically analyze the sports injuries of the ankle cases, determining the principal reasons for injury and outlining preventive measures. Methods A statistical investigation on the sports injuries of 275 Qiqihar higher education students was performed with questionnaires and teaching practice methods. The research was focused on the injured structures and the injury causes analysis. In parallel, corresponding proposals aimed at preventing these sports injuries were raised. Results Joint injuries and ankle sprains followed by hematomas represented the most significant proportion of ankle injuries. The reasons are lack of physical fitness, lack of awareness of self-protection, inadequate preparation in the sporting environment facilities, and performing tasks outside what the superior specified was specified. Conclusion Medical work needs to increase dissemination so that people realize the causes of sports injuries. At the same time, it helps people master the care measures before and after the injury. This reduces the incidence of sports injuries and reduces the occurrence of complications. Evidence level II; Therapeutic Studies - Investigating the results.

RESUMO Introdução A lesão no tornozelo é uma patologia aguda dos tecidos moles na qual os ligamentos do tornozelo são distendidos, lacerados, ou rompidos devido a violência durante o esporte. Essa articulação é também uma das mais vulneráveis nos esportes. Depois de uma lesão, o cuidado imediato e correto é significativo para aliviar a dor e reduzir complicações. Objetivo Analisar estatisticamente os casos de lesões esportivas do tornozelo, levantando as principais razões de lesão e traçar condutas preventivas. Métodos Uma investigação estatística sobre as lesões esportivas de 275 estudantes do ensino superior de Qiqihar foi executada com questionário e métodos de prática de ensino. A pesquisa foi concentrada na análise das estruturas lesionadas e a causa da lesão. Paralelamente foram levantadas propostas correspondentes visando a prevenção dessas lesões esportivas. Resultados As lesões articulares e entorses do tornozelo seguidas por hematomas representaram a maior proporção de lesões no tornozelo. Dentre os motivos, destacaram-se a falta de preparo físico, falta de consciência de autoproteção, preparação inadequada nas instalações do ambiente esportivo e execuções de tarefas fora do especificado pelo superior. Conclusão O trabalho médico precisa aumentar a divulgação para que as pessoas percebam as causas das lesões esportivas. Ao mesmo tempo, ajuda as pessoas a dominar as medidas de cuidado antes e depois da lesão. Isso reduz a incidência de lesões esportivas e reduz a ocorrência de complicações. Nível de evidência II; Estudos terapêuticos - Investigação de resultados.

RESUMEN Introducción La lesión de tobillo es una patología aguda de las partes blandas en la que los ligamentos del tobillo se distienden, desgarran o rompen debido a la violencia durante la práctica deportiva. Esta articulación es también una de las más vulnerables en el deporte. Después de una lesión, una atención rápida y correcta es importante para aliviar el dolor y reducir las complicaciones. Objetivo Analizar estadísticamente los casos de lesiones esporádicas del tobillo, levantando las principales causas de lesión y trazar conductas preventivas. Métodos Se realizó una investigación estadística sobre las lesiones deportivas de 275 estudiantes de educación superior en Qiqihar con métodos de cuestionario y práctica docente. La investigación se centró en el análisis de las estructuras lesionadas y la causa de la lesión. Paralelamente, se plantearon las correspondientes propuestas encaminadas a la prevención de estas lesiones deportivas. Resultados Las lesiones articulares y los esguinces de tobillo, seguidos de los hematomas, representaron la mayor proporción de lesiones de tobillo. Entre los motivos, destacaron la falta de preparación física, la falta de conciencia de autoprotección, la preparación inadecuada en las instalaciones del entorno deportivo y la ejecución de tareas fuera de lo especificado por el superior. Conclusión El trabajo médico debe aumentar la difusión para que la gente se dé cuenta de las causas de las lesiones deportivas. Al mismo tiempo, ayuda a las personas a dominar las medidas de cuidado antes y después de la lesión. Esto reduce la incidencia de las lesiones deportivas y disminuye la aparición de complicaciones. Nivel de evidencia II; Estudios terapéuticos - Investigación de resultados.

Effect of triage nurse-led application of the Ottawa Ankle Rules on number of radiographic tests and length of stay in selected emergency departments in Oman.

AIM: Ankle injuries are commonly seen in the emergency department (ED) and contribute to overcrowding. In Oman, injuries are a leading cause of years of life lost, disability-adjusted life years, and pose a burden to the healthcare system. This study aimed to evaluate the effectiveness of ED triage nurse-led application of the Ottawa Ankle Rules (OARs) toward improving the healthcare outcomes of ankle injury patients. METHODS: A quasi-experimental design was used to collect data (demographic characteristics, waiting time, length of stay, and number of radiographic tests) from 96 patients. The intervention group (n = 46) received ED triage nurse-led assessment and initiation of radiographic tests based on the OARs. The control group (n = 50) received usual care. RESULTS: The participants' mean age was 26.4 ± 7.90 years. The main causes of ankle injuries were football (36%), falls (31%) and twisting while walking (24%). There was a significant difference in number of ankle X-rays (t = 6.19; p < .001); length of stay (U = 549; p < .001); and waiting time (U = 167; p < .001) between the control and intervention group. The intervention reduced the mean waiting time and length of stay by 25.09 and 41.01 min, respectively. CONCLUSION: Application of the OARs by the ED triage nurse can decrease the number of unnecessary radiographic tests, waiting time and length of stay in the ED. Nurses' utilization of evidence-based clinical decision-making tools can improve ED care outcomes of common acute conditions such as ankle injuries.

School Nurses on the Front Lines of Medicine: Emergencies Associated With Sport and Physical Activities: Part 1.

Illness and injury associated with sport and physical activities may occur in the school setting. Although most sport-related illness and injury in students are considered minor emergencies, life- and limb-threatening illnesses or injuries may occur, such as sudden cardiac arrest, heat stroke, status asthmaticus, catastrophic brain or cervical spine injuries, hypoglycemia, blunt chest/abdominal injuries, or extremity fractures requiring surgery. It is important for the school nurse to recognize potential life- and limb-threatening emergencies associated with sport and physical activity, to initiate stabilization of the student with life- and limb-threatening symptoms, and to triage these students to an appropriate level of care (back to the classroom, home with their guardian with follow up at their primary healthcare provider's office, or directly to the closest emergency department via emergency medical services). This article describes the initial assessment and management of three common emergencies associated with sport and physical activities.

The cost-effectiveness of semi-rigid ankle brace to facilitate return to work following first-time acute ankle sprains.

AIMS AND OBJECTIVES: To examine the cost-effectiveness of semi-rigid ankle brace to facilitate return to work following first-time acute ankle sprains. DESIGN: Economic evaluation based on cost-utility analysis. BACKGROUND: Ankle sprains are a source of morbidity and absenteeism from work, accounting for 15-20% of all sports injuries. Semi-rigid ankle brace and taping are functional treatment interventions used by Musculoskeletal Physiotherapists and Nurses to facilitate return to work following acute ankle sprains. METHODS: A decision model analysis, based on cost-utility analysis from the perspective of National Health Service was used. The primary outcomes measure was incremental cost-effectiveness ratio, based on quality-adjusted life years. Costs and quality of life data were derived from published literature, while model clinical probabilities were sourced from Musculoskeletal Physiotherapists. RESULTS: The cost and quality adjusted life years gained using semi-rigid ankle brace was £184 and 0.72 respectively. However, the cost and quality adjusted life years gained following taping was £155 and 0.61 respectively. The incremental cost-effectiveness ratio for the semi-rigid brace was £263 per quality adjusted life year. Probabilistic sensitivity analysis showed that ankle brace provided the highest net-benefit, hence the preferred option. CONCLUSION: Taping is a cheaper intervention compared with ankle brace to facilitate return to work following first-time ankle sprains. However, the incremental cost-effectiveness ratio observed for ankle brace was less than the National Institute for Health and Care Excellence threshold and the intervention had a higher net-benefit, suggesting that it is a cost-effective intervention. Decision-makers may be willing to pay £263 for an additional gain in quality adjusted life year. RELEVANCE TO CLINICAL PRACTICE: The findings of this economic evaluation provide justification for the use of semi-rigid ankle brace by Musculoskeletal Physiotherapists and Nurses to facilitate return to work in individuals with first-time ankle sprains.

Does nurse-led initiation of Ottawa ankle rules reduce ED length of stay?

INTRODUCTION: Ankle injuries can account for up to 3.8% of UK Emergency Department (ED) presentations per annum and this figure is comparative to the 4.4% in North America. Growing ED attendance impacts on crowding, waiting times, patient satisfaction and service provision. One way to streamline service would be widespread use of the Ottawa Ankle Rules (OAR), which reduces the need to wait for radiography. AIM: To examine the best available evidence on the impact of OAR on ED length of stay (LoS) following standard systematic review methodology. METHODS: A systematic search was undertaken in the CINAHL, EMBASE, MEDLINE, SCOPUS, and BNI databases. Studies that examined OAR use in the ED adult population were considered. Four studies met the inclusion criteria and were included in the narrative synthesis. RESULTS: All four studies point towards a reduction in LoS following OAR introduction. The quality of the body of evidence is considered to be low due to moderate risk of bias and indirectness between the studies. DISCUSSION: A strong body of evidence supports OAR use in reducing radiography but further research is needed to explore impact on LoS. This would inform clinical practice and potentially combat current pressures faced within EDs worldwide.

Accessory ossicles and sesamoid bones: recognition and treatment.

Accessory ossicles and sesamoid bones are normal variants of bone development. In foot and ankle X-rays these bones can appear similar to, or can obscure, fractures, which makes the X-rays difficult to interpret. This article illustrates and describes some of the more common ossicles and sesamoid bones, and provides a brief description of the management of the patients with foot or ankle pain whose X-rays are inconclusive.

Nurse practitioners treating ankle and foot injuries using the Ottawa Ankle Rules: a comparative study in the emergency department.

BACKGROUND: Nurse practitioners (NPs) in the Emergency Department (ED) have been trained to assess a range of clinical problems and minor complaints such as acute ankle injury. This study compared assessment of suspected ankle and foot injuries using the Ottawa Ankle Rules (OAR) by NPs and ED medical doctors (ED-Drs). METHODS: A prospective, comparative, observational study was undertaken in an Australian acute adult and paediatric urban district ED. NPs and ED-Drs recorded information for patients with acute ankle and/or mid-foot injuries on demographic characteristics, OAR features, use of X-ray and patient management. Outcome measures included X-ray rates and identification of fracture. RESULTS: 174 patients were included in this study: 51 received NP and 123 received ED-Dr care. Assessed as requiring X-ray assessment (NP: 78.4%, ED-Dr: 88.6%; p=0.081), and detection of significant fracture (NP: 17.6%, ED-Dr: 22.8%; p=0.453) were similar. ED-based medical registrars were more likely to miss a fracture compared with NP (NP: 0%, ED-based Registrar: 28.6%, p=0.013). There were no significant differences in rates of OAR features for patients seen by NPs or ED-Drs. CONCLUSION: This study suggests that NPs are less likely to miss significant fractures of the ankle and/or foot compared with ED-based medical registrars. Future research should focus on actual use of the OAR and accuracy of X-ray assessment by NPs.

Treatment options for ankle ligament sprain.

There is a wealth of literature on the management of ankle sprains, but the quality of evidence is variable and conclusions diverge. Practice in emergency departments (EDs) also varies and in some cases does not reflect the evidence base. This article reviews some of the most recent research on the subject and suggests air-stirrup ankle braces can be used in EDs for management of moderate and severe ankle sprains.

Venous thromboembolism: reducing the risk.

This article demonstrates how services provided in minor injury units (MIUs) and emergency departments (EDs) can be improved by the implementation of routine thromboprophylaxis by subcutaneous injections of low molecular weight heparin for patients whose lower limbs are immobilised by plaster casts. The author offers evidence of the need for such a change in practice from a literature review and a case study, and describes how it can be achieved in five steps. She also outlines a protocol for routine thromboprophylaxis in MIUs and EDs.

Actuación enfermera en pacientes con esguince de tobillo grado I y II en Atención Primaria de Salud / Nursing intervention in patients with a grade I-II ankle sprain in Primary Health Care

El esguince es una de las patologías más frecuentes del sistema músculoesquelético; su incidencia diaria es aproximadamente de 1 por cada 10.000 habitantes. Desde la Atención Primaria de Salud (APS) pueden ser tratados los esguinces grado I y II (según los protocolos de actuación) siendo los de grado III los que deberán ser remitidos al servicio hospitalario. La actuación requiere un trabajo en equipo en el que el profesional de Enfermería es una pieza clave para establecer el plan de cuidados cuyo objetivo será la resolución o mejora del problema. El objetivo de este artículo es definir los pasos a seguir desde que el paciente acude al centro de salud hasta que se recupera de su lesión, mostrandolas diferentes técnicas de actuación, es decir, un seguimiento global,cercano y accesible, los tres puntos estrella de los servicios de APS (AU)

A sprain is one of the most frequent pathologies of the musculoskeletalsystem; with a daily incidence of approximately 1 per each 10,000 people. Grade I and II sprain (according to practice guidelines) can betreated at Primary Care settings. Grade III sprains should be referred to hospital settings.The intervention is team work where the nursing professional is a key elementto establish the care plan to resolve or improve the condition.The aim of this paper is to define the steps to be taken from the moment the patient presents to the health care centre until he or she recovers from his or her injury, implementing the different intervention techniques, which are based on the three key landmarks of primary care centres: overall follow-up, closeness to the patient and accessible care (AU)

Ankle sprains and fractures in adults.

The orthopaedic nurse will undoubtedly care for patients with ankle injuries. Ankle sprains and fractures are common injuries seen in orthopaedic practices in the United States. To provide comprehensive nursing care of these injuries, nurses should understand ankle biomechanics as well as anatomy. Knowledge of fracture classification schemes, pathology of injury, and treatment modalities is also important. Fracture classification schemes vary as do treatment modalities. Ankle sprains and fractures can be treated operatively or nonoperatively, and orthopaedic nurses play an important role in the care of patients with such ankle injuries.

Assessment of ankle injuries.

School nurses are faced with the challenge of identifying and treating ankle injuries in the school setting. There is little information guiding the assessment and treatment of these children when an injury occurs. It is essential for school nurses to understand ankle anatomy, pathophysiology of the acute ankle injury, general and orthopedic assessment guidelines, and various treatment options to assure proper management of students with injuries to the ankle. The benefits of adhering to these guidelines are that students will receive better, cost-effective treatment and the nurse will make appropriate referral recommendations to parents and other school personnel.

Atención enfermera al paciente con esguince de tobillo / Nursing care for the patient with a sprained ankle

Debido a su frecuencia en la vida diaria, son múltiples los esguinces de tobillos que tendremos que tratar a lo largo de nuestra carrera profesional. La figura de la enfermera y su rol, desarrollan un papel fundamental a lahora de la valoración, tratamiento y evolución del esguince de tobillo. Por todo, este trabajo tiene como propósito describir las principales característicasdel esguince de tobillo (aspectos anatómicos, mecanismos de producción, tipos de lesión, cuadro clínico), su exploración, diagnóstico y tratamiento; y finalmente proponer cuál es el papel enfermero en este problemade salud, tanto desde el punto de vista de los problemas de colaboración como de los diagnósticos enfermeros que pueden darse más frecuentemente en las personas que sufren un esguince de tobillo

Due to their frequency in daily life, it will be many sprained ankles that we will have to treat in our professional career. The nurse’s figure androle are of utmost importance in the assessment, treatment and progression of a sprained ankle.The aim of this article is therefore to describe the main characteristics of a sprained ankle (anatomical aspects, production mechanisms, types of lesions, clinical picture), its examination, diagnosis and treatment, and finally to suggest what the nursing role is in this health problem, from the point of view of collaboration problems and the nursing diagnosesthat may more frequently occur in people who have sustained a sprained ankle

Cost-effectiveness of the SEN-concept: Specialized Emergency Nurses (SEN) treating ankle/foot injuries.

BACKGROUND: Emergency Departments (EDs) are confronted with progressive overcrowding. As a consequence, the workload for ED physicians increases and waiting times go up with the risk of unnecessary complications and patient dissatisfaction. To cope with these problems, Specialized Emergency Nurses (SENs), regular ED-nurses receiving a short, injury-specific course, were trained to assess and treat minor injuries according to a specific protocol. METHODS: An economic evaluation was conducted alongside a randomized controlled trial comparing House Officers (HOs) and SENs in their assessment of ankle and foot injuries. Cost prices were established for all parts of healthcare utilization involved. Total costs of health care utilization were computed per patient in both groups. Cost-effectiveness was investigated by comparing the difference in total cost between groups with the difference in sensitivity and specificity between groups in diagnosing fractures and severe sprains. Finally, cost-effectiveness ratios were calculated and presented on a cost-effectiveness plane. RESULTS: No significant differences were seen between treatment groups for any of the health care resources assessed. However, the waiting times for both first assessment by a treatment officer and time spent waiting between hearing the diagnosis and final treatment were significantly longer in the HO group. There was no statistically significant difference in costs between groups. The total costs were euro 186 (SD euro 623) for patients in the SEN group and euro 153 (SD euro 529) for patients in the HO group. The difference in total costs was euro 33 (95% CI: - euro 84 to euro 155). The incremental cost-effectiveness ratio was euro 27 for a reduction of one missed diagnosis and euro 18 for a reduction of one false negative. CONCLUSION: Considering the benefits of the SEN-concept in terms of decreased workload for the ED physicians, increased patient satisfaction and decreased waiting times, SENs appear to be a useful solution to the problem of ED crowding.