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1.
Instr Course Lect ; 69: 433-448, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32017744

RESUMO

Lower extremity fractures, ranging from the proximal femur to the distal tibia, come in a variety of patterns and complexity. Treatment modalities typically consist of using plates and intramedullary nails; however, each has its advantages and disadvantages in each anatomic region. In this instructional course, salient points and nuances in setup and implant choice are reviewed. Furthermore, the essential tips and tricks to avoid pitfalls and achieve a desired clinical result are discussed.


Assuntos
Pinos Ortopédicos , Placas Ósseas , Fixação Intramedular de Fraturas , Fraturas Ósseas , Extremidade Inferior , Humanos , Tíbia
3.
Medicine (Baltimore) ; 99(4): e18789, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31977870

RESUMO

Clinical features of extremity fractures (EFs) in patients presenting with traumatic spinal fractures (TSFs) and spinal cord injury (SCI) have not been investigated. To investigate the clinical features and risk factors for EFs in patients presenting with TSFs and SCI.Data from 1392 patients presenting with TSFs and SCI in our hospitals between 2001 and 2010 were retrospectively reviewed, among which 165 patients (129 males and 36 females, 37.5 ±â€Š10.6 years old) presented with EFs. The clinical features of EFs have been investigated.The frequencies of upper limb fractures were significantly higher in the motor vehicle collisions (MVCs) group than in the high-fall group (P = .012) and the struck-by-object group (P = .002). The frequencies of lower limb fractures were significantly higher in the struck-by-object group (P = .019) and the high-fall group (P = .011) than the MVCs group. Univariate logistic regression analysis show that being in the 19 to 39 age group (P = .001), having a lumbar spinal fracture (P < .001) and experiencing a high fall (P < .001) were risk factors for EFs. Multivariate logistic regression analysis showed that we should focus on the factors that having a lumbar spinal fracture and experiencing a high fall.High fall and MVCs were the most common aetiologies for EFs. Having a lumbar spinal fracture and experiencing a high fall were significant risk factors for EFs. We should make early diagnoses and initiate timely treatment according to different patterns of extremity fractures in patients with TSFs and SCI.


Assuntos
Fraturas Ósseas/epidemiologia , Extremidade Inferior/lesões , Fraturas da Coluna Vertebral/epidemiologia , Extremidade Superior/lesões , Acidentes/estatística & dados numéricos , Adulto , Fatores Etários , Feminino , Fraturas Ósseas/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Fraturas da Coluna Vertebral/etiologia
4.
Plast Reconstr Surg ; 145(2): 412e-420e, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31985659

RESUMO

BACKGROUND: The muscle-sparing descending branch latissimus dorsi muscle (MSLD) flap is a versatile flap with numerous benefits. It is an often overlooked but useful option when considering free flap donors. In this article, the authors present the largest experience with the MSLD flap, with focus on its use in lower extremity reconstruction. METHODS: Patients undergoing lower extremity reconstruction with the MSLD flap at a single institution from 2012 to 2017 were identified. Patient and wound characteristics, surgical details, complications, and outcomes were examined. Outcomes were compared to a cohort who underwent lower extremity reconstruction with other free muscle flaps during the same period. RESULTS: Thirty-six consecutive patients who underwent MSLD flap surgery were identified. Mean follow-up was 18.8 months. Mean body mass index was 29.2 kg/m and 56 percent were smokers. The most common wound causes were motor vehicle collision (46 percent) and fall (22 percent). The most common anatomical location was the distal third of the tibia (33 percent). Mean operative time was 380 minutes. Complications included three total losses (8 percent) and one partial loss (3 percent). No donor-site seromas were reported. Four patients required subsequent amputation for orthopedic issues (nonunion/pain). Patients receiving MSLD and other flaps had similar rates of amputation, donor- and recipient-site complications, and ambulation status (p > 0.05). CONCLUSIONS: The MSLD flap is a useful and reliable option for free flap reconstruction of the lower extremity. Advantages include an easily contourable flap, low revision rate, low complication rate, and the ability to harvest in supine position. In addition, the MSLD flap preserves donor function useful for rehabilitation and minimizes seroma risk. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.


Assuntos
Extremidade Inferior , Músculo Esquelético/transplante , Procedimentos Cirúrgicos Reconstrutivos/métodos , Retalhos Cirúrgicos/irrigação sanguínea , Ferimentos e Lesões/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Extremidade Inferior/lesões , Extremidade Inferior/cirurgia , Masculino , Pessoa de Meia-Idade , Músculo Esquelético/irrigação sanguínea , Transplante de Pele/métodos , Adulto Jovem
5.
J Comput Assist Tomogr ; 44(1): 20-25, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31939877

RESUMO

OBJECTIVES: The purpose of this study was to evaluate whether quantitative analysis of lower leg muscle enhancement measured from dynamic computed tomographic angiography (dyn-CTA) could be used for diagnosis of peripheral arterial occlusive disease. METHODS: Patients (N = 35) with known peripheral arterial occlusive disease underwent the dyn-CTA of calves first. Five minutes later, standard CTA of the peripheral runoff from the diaphragm to the toes was performed. A runoff score was assigned by radiologists as a reference standard for each of 4 lower leg artery segments. The lower leg muscle enhancement measured from the dyn-CTA was analyzed by using quantitative kinetic parameters, including initial enhancement (E1), peak enhancement (Epeak), and enhancement ratio (ER) calculated from average time attenuation curves. In addition, histogram of lower leg muscle enhancement was evaluated by using the first enhanced phase images. RESULTS: Lower extremities were diagnosed as a normal group (n = 22) with each vessel segment score equals to 1 or lower and runoff score, 7 or lower, and otherwise as an ischemia group (n = 48). Average ± SD E1 is 91.4% ± 8.5% and 82.3% ± 10.7%, Epeak is 122.7% ± 10.4% and 115.6% ± 11.1%, and ER is 0.75 ± 0.05 and 0.72 ± 0.09 for normal and ischemia group, respectively. Statistical analysis showed that average E1 and Epeak for the ischemia group were significantly lower (P < 0.05) than the normal group. The histogram analysis demonstrated that mean and median of muscle enhancement in the ischemia group were significantly smaller (P < 0.05), and coefficient of variation (CV) was significantly larger (P < 0.05) than the normal group. There were weak negative correlations (r = -0.42, P < 0.05) between runoff scores and E1 and Epeak, and weak positive correlation (r = 0.40, P < 0.05) between runoff scores and CV. The receiver operating characteristics analysis between the 2 groups had area under the curve of 0.77 and 0.76 for E1 and CV, respectively. CONCLUSIONS: Lower leg muscle enhancement measured from the dyn-CTA could be assessed quantitatively to assist diagnosis of ischemia in clinical practice.


Assuntos
Arteriopatias Oclusivas/diagnóstico por imagem , Angiografia por Tomografia Computadorizada/métodos , Extremidade Inferior/diagnóstico por imagem , Músculo Esquelético/diagnóstico por imagem , Doença Arterial Periférica/diagnóstico por imagem , Adulto , Idoso , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doses de Radiação
6.
Int J Sports Med ; 41(1): 3-11, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31791089

RESUMO

This study evaluated the morphological changes of the lower limb and associated hemodynamic responses to different lower-body compression pressures (COMPs) in physically active, healthy individuals at rest. Each of the 32 participants underwent three trials with three different degrees of lower-body compression applied: "Low" (2.2±1.4 mmHg), "Medium" (12.9±3.9 mmHg), and "High" (28.8±8.3 mmHg). In each COMP, a cross-sectional area of leg muscles (CSAmuscle), subcutaneous fat (CSAfat), superficial vessels (SupV), deep arteries (DA), and deep veins (DV) at the calf, knee, and thigh levels were measured using magnetic resonance imaging (MRI). Additionally, blood pressure (BP), heart rate (HR), cardiac output (CO), stroke volume (SV), and systemic vascular resistance (SVR) were measured using Doppler ultrasound (USCOM®). With High COMP, calf CSAmuscle and SupV were smaller (p<0.01), whereas DA and DV were larger (p<0.05). Calf CSAfat, however, was similar among all COMPs. There were no major changes in CSAmuscle and CSAfat at knee and thigh levels. CO (3.2±0.9 L/min) and SV (51.9±16.4 mL) were higher (p<0.05) only with High COMP, but other hemodynamic variables showed no significant changes across different COMPs. The High COMP at the lower limb induces leg morphological changes and increases associated hemodynamic responses of physically active healthy individuals at rest.


Assuntos
Hemodinâmica/fisiologia , Extremidade Inferior/fisiologia , Meias de Compressão , Artérias/diagnóstico por imagem , Artérias/fisiologia , Pressão Sanguínea/fisiologia , Estudos Cross-Over , Feminino , Frequência Cardíaca/fisiologia , Humanos , Extremidade Inferior/irrigação sanguínea , Extremidade Inferior/diagnóstico por imagem , Imagem por Ressonância Magnética , Masculino , Músculo Esquelético/irrigação sanguínea , Músculo Esquelético/diagnóstico por imagem , Músculo Esquelético/fisiologia , Volume Sistólico/fisiologia , Gordura Subcutânea/irrigação sanguínea , Gordura Subcutânea/diagnóstico por imagem , Gordura Subcutânea/fisiologia , Ultrassonografia Doppler , Resistência Vascular/fisiologia , Veias/diagnóstico por imagem , Veias/fisiologia , Adulto Jovem
7.
J Sports Sci ; 38(1): 100-105, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31638481

RESUMO

A common practice in resistance training is to perform sets of exercises at, or close to failure, which can alter movement dynamics. This study examined ankle, knee, hip, and lumbo-pelvis dynamics during the barbell back squat under a moderate-heavy load (80% of 1 repetition maximum (1RM)) when performed to failure. Eleven resistance trained males performed three sets to volitional failure. Sagittal plane movement dynamics at the ankle, knee, hip, and lumbo-pelvis were examined; specifically, joint moments, joint angles, joint angular velocity, and joint power. The second repetition of the first set and the final repetition of the third set were compared. Results showed that while the joint movements slowed (p < 0.05), the joint ranges of motion were not altered There were significant changes in most mean joint moments (p < 0.05), indicating altered joint loading. The knee moment decreased while the hip and lumbo-pelvis moments underwent compensatory increases. At the knee and hip, there were significant decreases (p < 0.05) in concentric power output (p < 0.05). Whilst performing multiple sets to failure altered some joint kinetics, the comparable findings in joint range ofmotion suggest that technique was not altered. Therefore, skilled individuals appear to maintain technique when performing to failure.


Assuntos
Extremidade Inferior/fisiologia , Região Lombossacral/fisiologia , Pelve/fisiologia , Treinamento de Resistência/métodos , Levantamento de Peso/fisiologia , Adulto , Tornozelo/fisiologia , Fenômenos Biomecânicos , Quadril/fisiologia , Humanos , Joelho/fisiologia , Masculino , Análise e Desempenho de Tarefas , Adulto Jovem
8.
Sports Health ; 12(1): 74-79, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31642726

RESUMO

BACKGROUND: Lower extremity overuse injuries are common among runners, especially first-time marathoners. Hip abductor and quadriceps strengthening is often recommended to reduce running-related injuries. HYPOTHESIS: A 12-week strength training program would decrease the rate of overuse injuries resulting in marathon noncompletion and improve race finishing time. STUDY DESIGN: Randomized trial. LEVEL OF EVIDENCE: Level 2. METHODS: Twelve weeks before the New York City Marathon, first-time marathon runners age 18 years and older were randomized into a strength training group or an observation group. The strength training group was instructed to perform a 10-minute program 3 times weekly using written and video instruction. This program targeted the quadriceps, hip abductor, and core muscle groups. Injuries were self-reported through biweekly surveys, with major injuries being those that resulted in marathon noncompletion and minor injuries being those that impaired training or race performance. RESULTS: A total of 720 runners were enrolled (mean age, 35.9 ± 9.4 years; 69.4% female), of whom 583 runners started the marathon and 579 completed it. The incidence of major injury was 8.9% and minor injury was 48.5%. Fifty two of 64 major injuries were overuse, of which 20 were bone stress injuries. The incidence of overuse injury resulting in marathon noncompletion was 7.1% in the strength training group and 7.3% in the observation group (risk ratio, 0.97; 95% CI, 0.57-1.63; P = 0.90). The mean finishing time was 5 hours 1 ± 60 minutes in the strength training group and 4 hours 58 ± 55 minutes in the observation group (P = 0.35). CONCLUSION: There is a high prevalence of injury among first-time marathon runners, but this self-directed strength training program did not decrease overuse injury incidence resulting in marathon noncompletion. CLINICAL RELEVANCE: Prevention strategies such as strength training need to be developed and evaluated through clinical trials to reduce the high prevalence of overuse injuries in runners, especially for high-risk populations such as first-time marathon runners.


Assuntos
Transtornos Traumáticos Cumulativos/prevenção & controle , Extremidade Inferior/lesões , Força Muscular/fisiologia , Resistência Física/fisiologia , Treinamento de Resistência , Corrida/lesões , Adulto , Transtornos Traumáticos Cumulativos/epidemiologia , Transtornos Traumáticos Cumulativos/fisiopatologia , Humanos , Cidade de Nova Iorque/epidemiologia , Fatores de Risco , Corrida/fisiologia
9.
J Sports Sci ; 38(1): 6-12, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31603027

RESUMO

This study aimed to examine the characteristics of electromyography (EMG) and kinematics of the supporting leg affecting energy cost while running at incline, level, and decline slopes. Twelve male Japanese middle- and long-distance runners volunteered for this study. The subjects were asked to run at 13.5 km·h-1 on a treadmill under three slope conditions. Sagittal plane kinematics and the EMG of the lower limb muscles, respiratory gases were recorded. Energy cost differed significantly between slopes, being the lowest in decline slope and the greatest in incline slope. Integrated EMG (iEMG) of leg extensor muscles was greater in the incline slope than in the decline slope, and iEMG of the gastrocnemius and soleus muscles correlated positively with energy cost. The knee and ankle joint kinematics were associated with energy cost during running. In incline slope, the knee and ankle joints were more extended (plantarflexed) to lift the body. These movements may disturb the coordination between the ankle and knee joints. The gastrocnemius muscle would do greater mechanical work to plantarflex the ankle joint rather than transfer mechanical energy as well as greater mechanical work of mono-articular muscles. These muscular activities would increase energy cost.


Assuntos
Metabolismo Energético/fisiologia , Extremidade Inferior/fisiologia , Corrida/fisiologia , Articulação do Tornozelo/fisiologia , Fenômenos Biomecânicos , Eletromiografia , Teste de Esforço/métodos , Articulação do Quadril/fisiologia , Humanos , Articulação do Joelho/fisiologia , Masculino , Movimento/fisiologia , Músculo Esquelético/fisiologia , Troca Gasosa Pulmonar/fisiologia , Adulto Jovem
10.
World Neurosurg ; 133: 178-184, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31606502

RESUMO

BACKGROUND: Radiofrequency ablation (RFA) focally destroys abnormal or dysfunctional tissue using thermal energy generated from alternating current. The utilization of RFA has gained popularity as a minimally invasive procedure for the treatment of skeletal metastases with a particular focus on palliative pain treatments to the spine, pelvis, long bones, sternum, and glenoid. More recently, single-session procedures that combine RFA with vertebral augmentation techniques have allowed treatment to areas of pain associated with pathologic fractures secondary to metastatic disease. Although many studies have been done to investigate the safety and efficacy of RFA, there have been no reported cases to date in which the use of RFA for the treatment of spinal metastases has led to any major permanent neurological injury. CASE DESCRIPTION: This report describes a case of a 61-year-old woman who underwent RFA and kyphoplasty for spinal metastases and noted the immediate onset of lower extremity paralysis after the procedure. To the best of our knowledge, this is the first documented case of permanent lower extremity paralysis in the medical literature after radiofrequency thermal ablation of spine metastases. CONCLUSIONS: Postoperative magnetic resonance imaging and physical examination suggest RFA-induced thermal injury as the most likely mechanism of paralysis. In this report, a review of previous in vivo models used in studying the efficacy and safety of spine RFA is conducted. Additionally, the literature has been reviewed for any neurological events reported with the use of RFA in the treatment of patients with vertebral pathology.


Assuntos
Cifoplastia/efeitos adversos , Paraplegia/etiologia , Ablação por Radiofrequência/efeitos adversos , Neoplasias da Coluna Vertebral/cirurgia , Feminino , Humanos , Extremidade Inferior/diagnóstico por imagem , Extremidade Inferior/cirurgia , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Paraplegia/diagnóstico por imagem , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Neoplasias da Coluna Vertebral/secundário
11.
Vasa ; 49(1): 72-76, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31414968

RESUMO

Chronic total occlusion remains one of the most challenging lesions to treat despite continuing developments in medical devices and increasing operator experience. Guidewire perforation complications are being increasingly observed. Early recognition and timely institution of appropriate treatment are essential to prevent potentially devastating sequelae.


Assuntos
Angioplastia , Síndromes Compartimentais , Extremidade Inferior/cirurgia , Cateterismo , Desenho de Equipamento , Humanos , Extremidade Inferior/irrigação sanguínea , Resultado do Tratamento
12.
J Sports Sci ; 38(1): 29-37, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31631783

RESUMO

This study investigated the role of reactive and eccentric strength in stiffness regulation during maximum velocity sprinting (Vmax) in team sport athletes compared with highly trained sprinters. Thirteen team sport athletes and eleven highly trained sprinters were recruited. Vmax was measured using radar, and stiffness regulation was inferred from modelled vertical and leg spring stiffness. Reactive strength (RSI) was determined from a 0.50 m drop jump, and an eccentric back squat was used to assess maximum isoinertial eccentric force. Trained sprinters attained a higher Vmax than team sport athletes, partly due to a briefer contact time and higher vertical stiffness. Trained sprinters exhibited a moderately higher RSI via the attainment of a briefer and more forceful ground contact phase, while RSI also demonstrated large to very large associations with vertical stiffness and Vmax, respectively. Isoinertial eccentric force was largely correlated with Vmax, but only moderately correlated with vertical stiffness. Reactive and eccentric strength contribute to the ability to regulate leg spring stiffness at Vmax, and subsequently, the attainment of faster sprinting speeds in highly trained sprinters versus team sport athletes. However, stiffness regulation appears to be a task-specific neuromuscular skill, reinforcing the importance of specificity in the development of sprint performance.


Assuntos
Desempenho Atlético/fisiologia , Extremidade Inferior/fisiologia , Força Muscular/fisiologia , Músculo Esquelético/fisiologia , Condicionamento Físico Humano , Corrida/fisiologia , Aceleração , Adulto , Fenômenos Biomecânicos , Estudos Transversais , Feminino , Humanos , Masculino , Adulto Jovem
13.
Vasc Endovascular Surg ; 54(2): 97-101, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31746279

RESUMO

Preprocedural cross-sectional imaging (PCSI) for peripheral artery disease (PAD) may vary due to patient complexity, anatomical disease burden, and physician preference. The objective of this study was to determine the utility of PCSI prior to percutaneous vascular interventions (PVIs) for PAD. Patients receiving first time lower extremity angiograms from 2013 to 2015 at a single institution were evaluated for PCSI performed within 180 days, defined as computed tomography angiography (CTA) or magnetic resonance angiography (MRA) evaluating abdominal to pedal vasculature. The primary outcome was technical success defined as improving the target outflow vessels to <30% stenosis. Of the 346 patients who underwent lower extremity angiograms, 158 (45.7%) patients had PCSI, including 150 patients had CTA and 8 patients had MRA. Of these, 48% were ordered by the referring provider (84% at an outside institution). Preprocedural cross-sectional imaging was performed at a median of 26 days (interquartile range: 9-53) prior to the procedure. The analysis of the institution's 5 vascular surgeons identified PCSI rates ranging from 31% to 70%. On multivariate analysis, chronic kidney disease (odds ratio [OR] = 0.35; 95% confidence interval [CI]: 0.17-0.73) was associated with less PSCI usage, and inpatient/emergency department evaluation (OR = 3.20; 95% CI: 1.58-6.50) and aortoiliac disease (OR = 2.78; 95% CI: 1.46-5.29) were associated with higher usage. After excluding 31 diagnostic procedures, technical success was not statistically significant with PSCI (91.3%) compared to without PCSI (85.6%), P = .11. When analyzing 89 femoral-popliteal occlusions, technical success was higher with PCSI (88%) compared to procedures without (69%) P = .026. Our analysis demonstrates that routine ordering of PCSI may not be warranted when considering technical success of PVI; however, PCSI may be helpful in treatment planning. Further studies are needed to confirm these findings in another practice setting, with more prescriptive use of PCSI to improve procedural success, and thereby improve the value of PCSI.


Assuntos
Angiografia por Tomografia Computadorizada , Procedimentos Endovasculares , Extremidade Inferior/irrigação sanguínea , Angiografia por Ressonância Magnética , Doença Arterial Periférica/diagnóstico por imagem , Doença Arterial Periférica/terapia , Padrões de Prática Médica/tendências , Idoso , Tomada de Decisão Clínica , Angiografia por Tomografia Computadorizada/tendências , Bases de Dados Factuais , Procedimentos Endovasculares/tendências , Feminino , Humanos , Angiografia por Ressonância Magnética/tendências , Masculino , Variações Dependentes do Observador , Seleção de Pacientes , Doença Arterial Periférica/fisiopatologia , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Estudos Retrospectivos , Resultado do Tratamento
14.
Br J Sports Med ; 54(3): 139-153, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31142471

RESUMO

OBJECTIVE: To systematically review the biomechanical deficits after ACL reconstruction (ACLR) during single leg hop for distance (SLHD) testing and report these differences compared with the contralateral leg and with healthy controls. DESIGN: Systematic review with meta-analysis. DATA SOURCES: A systematic search in Pubmed (Ovid), EMBASE, CINAHL, Scopus, Web of Science, PEDro, SPORTDiscus, Cochrane Library, grey literature and trial registries, was conducted from inception to 1 April 2018. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Studies reporting kinematic, kinetic and/or electromyographic data of the ACLR limb during SLHD with no language limits. RESULTS: The literature review yielded 1551 articles and 19 studies met the inclusion criteria. Meta-analysis revealed strong evidence of lower peak knee flexion angle and knee flexion moments during landing compared with the uninjured leg and with controls. Also, moderate evidence (with large effect size) of lower knee power absorption during landing compared with the uninjured leg. No difference was found in peak vertical ground reaction force during landing. Subgroup analyses revealed that some kinematic variables do not restore with time and may even worsen. CONCLUSION: During SLHD several kinematic and kinetic deficits were detected between limbs after ACLR, despite adequate SLHD performance. Measuring only hop distance, even using the healthy leg as a reference, is insufficient to fully assess knee function after ACLR. PROSPERO trial registration number CRD42018087779.


Assuntos
Reconstrução do Ligamento Cruzado Anterior , Teste de Esforço , Joelho/fisiopatologia , Desempenho Físico Funcional , Lesões do Ligamento Cruzado Anterior/fisiopatologia , Lesões do Ligamento Cruzado Anterior/cirurgia , Fenômenos Biomecânicos , Humanos , Extremidade Inferior
15.
Sports Health ; 12(1): 66-73, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31469616

RESUMO

BACKGROUND: The relationship of training load to injury using wearable technology has not been investigated in professional American football players. The primary objective of this study was to determine the correlation between player workload and soft tissue injury over the course of a football season utilizing wearable global positioning system (GPS) technology. HYPOTHESIS: Increased training load is associated with a higher incidence of soft tissue injuries. STUDY DESIGN: Case-control study. LEVEL OF EVIDENCE: Level 3. METHODS: Player workloads were assessed during preseason and regular-season practice sessions using GPS tracking and triaxial accelerometry from 2014 to 2016. Soft tissue injuries were recorded during each season. Player workload during the week of injury (acute) and average weekly workload during the 4 weeks (chronic) prior to injury were determined for each injury and in uninjured position-matched controls during the same week. A matched-pairs t test was used to determine differences in player workload. Subgroup analysis was also conducted to determine whether observed effects were confounded by training period and type of injury. RESULTS: In total, 136 lower extremity injuries were recorded. Of the recorded injuries, 101 injuries with complete GPS and clinical data were included in the analysis. Injuries were associated with greater increases in workload during the week of injury over the prior month when compared with uninjured controls. Injured players saw a 111% (95% CI, 66%-156%) increase in workload whereas uninjured players saw a 73% (95% CI, 34%-112%) increase in workload during the week of injury (P = 0.032). Individuals who had an acute to chronic workload ratio higher than 1.6 were 1.5 times more likely to sustain an injury relative to time- and position-matched controls (64.6% vs 43.1%; P = 0.004). CONCLUSION: Soft tissue injuries in professional football players were associated with sudden increases in training load over the course of a month. This effect seems to be especially pronounced during the preseason when player workloads are generally higher. These results suggest that a gradual increase of training intensity is a potential method to reduce the risk of soft tissue injury. CLINICAL RELEVANCE: Preseason versus regular-season specific training programs monitored with wearable technology may assist team athletic training and medical staff in developing programs to optimize player performance.


Assuntos
Acelerometria/instrumentação , Comportamento Competitivo/fisiologia , Monitores de Aptidão Física , Futebol Americano/lesões , Condicionamento Físico Humano/efeitos adversos , Condicionamento Físico Humano/métodos , Lesões dos Tecidos Moles/etiologia , Adulto , Estudos de Casos e Controles , Humanos , Estudos Longitudinais , Extremidade Inferior/lesões , Masculino , Estudos Retrospectivos , Fatores de Risco , Lesões dos Tecidos Moles/prevenção & controle , Adulto Jovem
16.
Sports Health ; 12(1): 12-22, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31390306

RESUMO

BACKGROUND: Understanding how existing youth injury prevention programs affect specific modifiable injury risk factors will inform future program development for youth athletes. OBJECTIVE: To comprehensively evaluate the effects of injury prevention programs on the modifiable intrinsic risk factors associated with lower extremity performance in youth athletes. DATA SOURCES: This systematic review followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A systematic search of the literature was performed using multiple databases (PubMed, EBSCOhost [including CINAHL, Medline, and SPORTDiscus], and PEDro). Secondary references were appraised for relevant articles. Article types included randomized or cluster randomized controlled trials and randomized cohort designs with youth athletes engaged in organized sports, along with outcomes that included at least 1 physical performance outcome measure. STUDY SELECTION: Eight studies met inclusion and exclusion criteria and were reviewed by 2 independent reviewers, with a third consulted in the case of disagreement, which was not needed. STUDY DESIGN: Systematic review. LEVEL OF EVIDENCE: Level 3. DATA EXTRACTION: Included studies underwent review of methodological quality using the Physiotherapy Evidence Database scale. RESULTS: Studies included mixed-sex samples of youth athletes who predominantly participated in soccer at different skill levels. The FIFA 11+ series was the most commonly used injury prevention program. Among studies, the mean percentage of improvement identified was 11.3% for force generation, 5.7% for coordination, 5.2% for posture, and 5.2% for balance. The lowest mean percentage improvement was in speed (2.2%). Endurance was not significantly affected by any of the programs. CONCLUSION: This systematic review shows that injury prevention programs improve several modifiable intrinsic risk factors of lower extremity performance among youth athletes, particularly force generation. However, several intrinsic risk factors were either not significantly affected or specifically addressed by existing programs.


Assuntos
Traumatismos em Atletas/prevenção & controle , Extremidade Inferior/lesões , Esportes Juvenis/lesões , Humanos , Avaliação de Programas e Projetos de Saúde , Fatores de Risco
17.
Sports Biomech ; 19(1): 76-89, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29902127

RESUMO

A potential challenge associated with sports is that athletes must often perform the cognitive processing associated with decision-making (i.e., movement selection) when fatigued. The purpose of this systematic review was to summarise studies that have analysed the extent to which fatigue influences the effects of decision-making on lower extremity mechanics during execution of common sports manoeuvres. We specifically focused on mechanics associated with ACL injury risk. Reviewers searched the PubMed, SPORTDiscus, CINAHL and Web of Science databases. The search identified 183 unique articles. Five of these articles met our eligibility criteria. Two of the studies incorporated fatigue protocols where athletes progressed to exhaustion and found that the effects of decision-making on mechanics were more pronounced with fatigue. The nature of the results appears to indicate that fatigue may compromise an athlete's cognitive processing in a manner that diminishes their ability to control movement when rapid decision-making is required. However, three subsequent studies utilised fatigue protocols designed to mimic sports participation and found that fatigue did not influence the effects of decision-making on mechanics. In general, these findings appear to indicate that fatigue may only affect the cognitive processing associated with decision-making when athletes approach a state of exhaustion.


Assuntos
Atletas/psicologia , Tomada de Decisões , Fadiga/psicologia , Lesões do Ligamento Cruzado Anterior/fisiopatologia , Antecipação Psicológica , Traumatismos em Atletas/fisiopatologia , Humanos , Extremidade Inferior/fisiologia , Movimento/fisiologia , Fadiga Muscular/fisiologia , Fatores de Risco
18.
Vasc Endovascular Surg ; 54(1): 69-74, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31500525

RESUMO

Acute limb ischemia (ALI) is an abrupt decrease of blood flow to a limb, resulting in a potential threat to that body part. In ALI, which is commonly caused by embolism or traumatic occlusion, symptoms appear quickly due to a lack of collateral blood flow and extension of the thrombus to arterial outflow. In cases with ALI presentation, urgent evaluation and management are necessary. Here, we report 3 cases with ALI due to thromboembolism. Conventional open thromboembolectomy was performed with a femoral artery cutdown and antegrade passage of the embolectomy catheter. Further, distal access was created in the dorsalis pedis artery and/or posterior tibial artery at the ankle level. After the retrograde passage of the guidewire and antegrade insertion of the embolectomy catheter, the embolus was completely removed.


Assuntos
Embolectomia , Isquemia/cirurgia , Extremidade Inferior/irrigação sanguínea , Trombectomia , Tromboembolia/cirurgia , Doença Aguda , Idoso , Idoso de 80 Anos ou mais , Humanos , Isquemia/diagnóstico por imagem , Isquemia/fisiopatologia , Masculino , Tromboembolia/diagnóstico por imagem , Tromboembolia/fisiopatologia , Resultado do Tratamento
19.
Vasc Endovascular Surg ; 54(1): 85-88, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31547785

RESUMO

The common femoral artery (CFA) is the most widely used inflow in all types of surgical revascularization in patients with peripheral artery disease. However, the CFA cannot always be used because of calcification, obstruction, or previous dissection. Here, we report a rare case of selecting the deep circumflex iliac artery (DCIA) as a source of inflow to perform a surgical revascularization in a patient with chronic limb-threatening ischemia. A 62-year-old man was admitted to our hospital due to necrotized third and fifth toes with pain at rest. Computed tomography showed severe stenosis of the CFA, superficial femoral artery, and deep femoral artery, and an entirely stented external iliac artery. The DCIA was identified as the only patent artery. Considering the condition of the other arteries, we selected the DCIA as a source of inflow. Deep circumflex iliac-popliteal bypass was performed with a saphenous vein. The bypass graft was patent 9 months after surgery and limb salvage had been achieved.


Assuntos
Artéria Ilíaca/cirurgia , Isquemia/cirurgia , Extremidade Inferior/irrigação sanguínea , Doença Arterial Periférica/cirurgia , Enxerto Vascular/métodos , Doença Crônica , Humanos , Artéria Ilíaca/diagnóstico por imagem , Artéria Ilíaca/fisiopatologia , Isquemia/diagnóstico por imagem , Isquemia/fisiopatologia , Masculino , Pessoa de Meia-Idade , Doença Arterial Periférica/diagnóstico por imagem , Doença Arterial Periférica/fisiopatologia , Resultado do Tratamento , Grau de Desobstrução Vascular
20.
Internist (Berl) ; 61(1): 36-43, 2020 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-31848646

RESUMO

Swelling of soft parts of the lower extremities, whether uni- or bilateral, is a common reason for consulting a general practitioner (GP). Complex interactions mean that GPs are faced with a wide range of differential diagnoses during clarification of such findings. Of enormous importance is the prevention of a dangerous course, e.g., by initiating weight-adapted calculated antibiotic treatment, antithrombotic therapy, or even initial inpatient treatment and acute diagnostic workup in case of impending compartment syndrome or extensive venous thrombosis of the leg with or without suspicion of pulmonary embolism. Sometimes an acute venous thrombosis of the leg unmasks malignant disease. A swollen leg/swollen legs are frequently a leading symptom of decompensating heart or renal failure. Another possible cause are drug side effects, which may be exacerbated in a warm environment. An endocrine cause must also be considered in some cases. The GP is the appropriate physician for patients to contact and to initiate and coordinate diagnostics and treatment. In addition to coordination of specialist examinations, it is not infrequent that nurses and physiotherapists have to be involved in treatment, to ensure successful outpatient care.


Assuntos
Edema/diagnóstico , Medicina Geral , Perna (Membro)/fisiopatologia , Embolia Pulmonar/complicações , Insuficiência Venosa/complicações , Trombose Venosa , Diagnóstico Diferencial , Edema/etiologia , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Extremidade Inferior
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