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1.
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
2.
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
3.
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
4.
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
5.
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
6.
J Surg Orthop Adv ; 28(3): 201-208, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31675297

RESUMO

The objective of this study was to determine which plane of hip motion (rotational or sagittal) is more predictive of lower extremity (LE) injury in elite soccer players. A total of 69 athletes (43 professional and 26 collegiate) were examined (mean age, 22.6 years). Bilateral hip internal rotation (IR), external rotation, extension, and flexion measurements were taken along with the modified Thomas test during preseason physicals. There were 42 LE injuries (injury rate 3.74/1000 athlete exposures). Mean IR was 25.2. and 29.9° for injured versus noninjured extremities, respectively (p = .009). There was a significant association between decreased IR (categorized as IR < 28°) and incidence of ipsilateral LE injury (p = .042). Extremities with IR < 28° were 2.81 times more likely to sustain a LE injury (95% CI, 1.15.6.84; p = .023). With a utilitarian focus, the current study has identified a measurement of decreased hip IR with potential for substantial clinical value in collegiate and professional soccer players. (Journal of Surgical Orthopaedic Advances 28(3):201-208, 2019).


Assuntos
Extremidade Inferior , Futebol , Humanos , Extremidade Inferior/lesões , Estudos Prospectivos , Amplitude de Movimento Articular , Rotação , Futebol/lesões , Adulto Jovem
7.
Int J Sports Med ; 40(14): 903-908, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31614383

RESUMO

Football players frequently face the occurrence of non-contact injuries. Although there are likely multiple factors that contribute to increased risk of non-contact injury, it remains a challenge to correlate all these factors. However, it is not clear how much of individual training abilities may interfere in these events. As such, the primary aim of the present study was to determine whether the reduction of functional performance of the thigh in the isokinetic knee tests, anthropometric and morbid history can establish risk factors for lower-limb musculoskeletal injuries throughout the season. The incidence of injuries and odds ratios were calculated for suspected risk factors. Hamstring/Quadriceps conventional ratio outside of the safety range (55-64%) may be involved in the occurrence of non-contact muscle injuries and the risk for any musculoskeletal injuries in the lower extremities is 16 times higher when extensor peak of torque exceeds 10% and 12 times higher when flexor peak of torque difference was greater than 10%. This kind of evaluation can result in intervention programs that may decrease the risk of lower-limb musculoskeletal injuries. Based on these results we can establish a specific and individualized exercise program for each athlete and thus protect them during the season.


Assuntos
Extremidade Inferior/lesões , Medição de Risco/métodos , Futebol/lesões , Adolescente , Adulto , Antropometria , Teste de Esforço , Músculos Isquiotibiais/lesões , Músculos Isquiotibiais/fisiologia , Humanos , Joelho/fisiologia , Ligamentos/lesões , Estudos Longitudinais , Extremidade Inferior/fisiologia , Masculino , Condicionamento Físico Humano , Músculo Quadríceps/lesões , Músculo Quadríceps/fisiologia , Fatores de Risco , Futebol/fisiologia , Coxa da Perna/fisiologia , Lesões do Menisco Tibial/fisiopatologia , Adulto Jovem
8.
Medicine (Baltimore) ; 98(38): e17123, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31567950

RESUMO

To investigate the age, gender, time, and etiology differences of traumatic lower limb fractures (TLLFs) in a population of children (≤18 years old), we retrospectively reviewed 936 children who had TLLFs and who came to our university-affiliated hospitals from 2001 to 2010. This study enrolled 657 males (70.2%) and 279 females (29.8%) aged (11.6 ±â€Š4.9) years old. The most common etiologies and fracture sites were motor vehicle collisions (MVCs, 440, 47.0%) and tibias (376, 40.2%). A total of 126 (13.5%) patients suffered neurological deficits (NDs), 127 (13.6%) patients sustained associated injuries (ASOIs), and 78 (8.3%) patients sustained complications. During all periods the occurrence increased with increasing age group and a male preponderance was observed in all age groups. With increasing age, the proportion of injuries due to different etiologies increased and the proportion of femur fracture decreased from 65.2% to 34.5%. With increasing year of admission, the proportion of injuries due to MVCs decreased. The most common fracture sites were tibias in MVCs, femurs in low fall, high fall, and struck by object, feet in sprain. Male patients presented with significantly higher proportions of injuries due to struck by object and sprain, significantly lower proportions of pelvis fracture than the female patients. MVCs and tibias were the most common etiologies and fracture sites. Prevention and treatment should be taken according to the pattern of TLLFs which have specific annual, gender, and age characteristics.


Assuntos
Fraturas do Fêmur/epidemiologia , Fraturas da Tíbia/epidemiologia , Acidentes por Quedas/estatística & dados numéricos , Acidentes de Trânsito/estatística & dados numéricos , Adolescente , Fatores Etários , Criança , Serviços de Saúde da Criança , Pré-Escolar , China/epidemiologia , Feminino , Fraturas do Fêmur/etiologia , Humanos , Lactente , Extremidade Inferior/lesões , Masculino , Fatores Sexuais , Fraturas da Tíbia/etiologia
9.
Cir. pediátr ; 32(4): 212-216, oct. 2019. graf
Artigo em Espanhol | IBECS | ID: ibc-184112

RESUMO

Objetivos. Las mordeduras de perro son motivo de consulta habitual en urgencias pediátricas. Si bien en nuestro medio raramente son letales, algunas conllevan secuelas estéticas graves. El objetivo del trabajo es analizar la casuística de mordeduras de perro y su repercusión en nuestro entorno Material y métodos. Revisión retrospectiva de pacientes atendidos por mordedura de perro en un centro pediátrico terciario entre 2013-2018. Estudiamos variables demográficas, localización de mordedura, relación perro-paciente, antibioterapia, necesidad de ingreso, complicaciones y secuelas derivadas. Resultados. Se analizaron 256 casos (edad media 6,4 años), 133 niños (51,9%) y 123 niñas (48%). En 153 casos el perro agresor era del entorno del paciente (59,8%). La localización más frecuente de heridas fue cabeza y cuello (94,1%), seguida de extremidades (4,7%) y genitales (1,6%). En 227 casos (88,7%) se administró antibiótico. La complicación más frecuente fue la infección de herida en 5 pacientes (2%). Precisaron ingreso hospitalario 20 pacientes (7,8%) con estancia media de 1,6 días. Se describieron secuelas estéticas en 10 casos (3,9%), 7 precisaron cirugía correctora. Conclusiones. Las mordeduras de perro persisten como motivo frecuente de consulta, produciéndose mayoritariamente por perros del entorno del paciente. La infección de herida representa la complicación más común, y la secuela estética facial supone la indicación más fre-cuente de intervención quirúrgica. Consideramos que por la cantidad de mordeduras y sus secuelas, la inclusión de medidas preventivas ante estos accidentes en guías de prevención del hogar, podría ser de utilidad para concienciar a la población y disminuir la incidencia de estas lesiones


Aims. Dog bites are frequent reason for consultation in pediatrics emergency department. Despite in our environment dog bites are rarely lethal, some of these accidents can have serious aesthetics consequences. The main goal of this article is to analyze dog bites casuistry and their impact in our community. Material and methods. Retrospective review of patients treated for dog bite in a tertiary pediatric center between 2013-2018. We studied patient’s demographic variables, bite localization, dog-patient relation-ship, antibiotic therapy, need for admission, complications and secondary sequelae. Results. 256 cases were analyzed (average age 6.4 years), 133 boys (51.9%) and 123 girls (48%). In 153 cases, the aggressor dog was from the patient’s familiar environment (59.8%). The most frequent location of the wounds was head and neck (94.1%), followed by extremities (4.7%) and genitals (1.6%). In 227 cases (88.7%) antibiotics were administered. Wound infection was the most frequent complication, occurring in 5 patients (2%). 20 patients (7.8%) required hospital admission with a mean stay of 1.6 days. Aesthetic sequelae were described in 10 cases (3.9%), 7 of which required correcting surgery. Conclusions. Dog bites persist as a frequent reason for medical consultation, most of them are provoked by patient familiar dogs. Wound infection represents the major complication, and the facial aesthetic sequelae are the most frequent indication for surgical intervention. We consider due to the amount of dog bites and their sequelae, the inclusion of preventive measures against these accidents in home prevention guidelines could be useful to reduce the incidence of these injuries


Assuntos
Humanos , Masculino , Feminino , Criança , Mordeduras e Picadas/complicações , Mordeduras e Picadas/tratamento farmacológico , Cães , Ferimentos e Lesões/complicações , Medicina de Emergência Pediátrica/estatística & dados numéricos , Medicina de Emergência Pediátrica/tendências , Estudos Retrospectivos , Extremidade Inferior/lesões , Extremidade Inferior/cirurgia , Mordeduras e Picadas/cirurgia
10.
Best Pract Res Clin Rheumatol ; 33(2): 236-263, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-31547981

RESUMO

Fractures of the extremities in the elderly constitute more than two-thirds of all fragility fractures befalling frail, osteoporotic and sarcopenic patients. Although treatment controversies abound, consensus exists. Upper extremity fractures hinder activities of daily living and are debilitating. Open fractures or displaced fractures will need surgical intervention. Wrist fractures treated operatively allow early use of the hand. Most pelvic fractures are treated conservatively. In the lower extremities, fractures of the long bones, tibia and femur need surgical intervention. Non-displaced fractures around the foot may be treated with immobilisation and avoidance of full weight-bearing. As a rule, fractures take four months for consolidation. Individually tailored solutions are needed for frail patients with comorbidities. Maintaining joint mobility and muscle strength preserves mobility and autonomy. Caring for extremities trauma is team work, involving family and health care providers. Prevention efforts are mandatory.


Assuntos
Artroplastia/métodos , Extremidade Inferior/lesões , Fraturas por Osteoporose/cirurgia , Extremidade Superior/lesões , Atividades Cotidianas , Idoso , Feminino , Fixação de Fratura/métodos , Fraturas do Quadril/fisiopatologia , Fraturas do Quadril/cirurgia , Humanos , Masculino , Fraturas da Coluna Vertebral/fisiopatologia , Fraturas da Coluna Vertebral/cirurgia
11.
Gait Posture ; 74: 236-241, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31563825

RESUMO

BACKGROUND: Persons with unilateral lower-limb loss are at increased risk for developing chronic low back pain. Aberrant trunk and pelvis motor behavior secondary to lower-limb loss potentially alters trunk postural control and increases demands on the trunk musculature for stability. However, it is unclear whether trunk postural control is associated with the presence or chronicity of low back pain within this population. RESEARCH QUESTION: Is there a potential role of impaired trunk postural control among persons with lower limb loss and chronic low back pain? METHODS: Two groups of males with unilateral lower-limb loss (n = 18 with chronic low back pain; n = 13 without pain) performed an unstable sitting task. Trunk postural control was characterized using traditional and non-linear measures derived from center-of-pressure time series, as well as trunk kinematics and the ratio of lumbar to thoracic erector spinae muscle activations. RESULTS: Traditional and non-linear center-of-pressure measures and trunk muscle activation ratios were similar between groups, while participants with chronic low back pain demonstrated greater trunk motion and reduced local dynamic stability. SIGNIFICANCE: Our results suggest that persons with both lower-limb loss and chronic low back pain exhibit impaired trunk postural control compared to those with limb loss but without pain. Aberrant trunk motor behavior may be a response to altered functional requirements of walking with a prosthesis. An inability to adequately control the trunk could lead to spinal instability and pain in the presence of repetitive exposure to aberrant motor behavior of these proximal structures during everyday activities.


Assuntos
Amputados , Dor Lombar/fisiopatologia , Extremidade Inferior/lesões , Equilíbrio Postural/fisiologia , Postura Sentada , Tronco/fisiologia , Adulto , Análise de Variância , Fenômenos Biomecânicos , Doença Crônica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Músculo Esquelético/fisiologia
12.
Chirurg ; 90(10): 806-815, 2019 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-31501936

RESUMO

The treatment of complex injuries of the lower extremities in geriatric and/or multimorbid patients requires optimized preoperative and perioperative management as well as differentiated and interdisciplinary surgical approaches. Timely and definitive treatment should be strived for to avoid longer periods of immobilization. Temporary external stabilization of complex fractures, when necessary, should be followed by permanent loading stable internal osteosynthesis as soon as possible. Accompanying soft tissue defects are reconstructed after wound débridement using the full armamentarium of plastic and reconstructive surgical procedures, including microvascular free flap. In the context of perfusion compromised soft tissue situations, negative pressure wound therapy can provide sterile temporary defect coverage and aid in preconditioning poorly vascularized tissue before definitive reconstruction. A clarification of the vascular status in geriatric patients is paramount and relevant perfusion disorders should be treated either by intervention or open surgery before complex reconstructive interventions. Close interdisciplinary coordination of the various surgical procedures is imperative in order to guarantee an optimized stable reconstructive outcome with acceptable patient risk. Taking these principles into account, the reconstruction of complex trauma to the extremities can be carried out even in geriatric or multimorbid patients in specialized interdisciplinary surgical centers with excellent functional results.


Assuntos
Traumatismos da Perna/cirurgia , Extremidade Inferior/lesões , Extremidade Inferior/cirurgia , Procedimentos Cirúrgicos Reconstrutivos , Cirurgia Plástica , Idoso , Desbridamento , Humanos , Complicações Pós-Operatórias , Estudos Retrospectivos
13.
J Athl Train ; 54(8): 858-868, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31386579

RESUMO

CONTEXT: Determining meaningful aspects of health is crucial for outcome assessment; however, limited literature exists on the aspects of health that are deemed meaningful by the athletic patient population. OBJECTIVE: To identify experiences and meaningful outcomes after lower extremity (LE) musculoskeletal injury among collegiate athletes. DESIGN: Qualitative study. SETTING: University laboratory. PATIENTS OR OTHER PARTICIPANTS: A purposive sample of 20 athletes (10 men, 10 women; age = 20.1 ± 1.83 years) from a National Collegiate Athletic Association Division I institution in the Midwest who had sustained an LE injury. DATA COLLECTION AND ANALYSIS: Semistructured face-to-face interviews and inductive data analysis were conducted. Trustworthiness of the data was established using member checks and peer debriefing. RESULTS: Four themes emerged from the data, revealing that physical changes, psychological changes, personal and lifestyle changes, and support were the most meaningful outcomes among athletes with an LE injury. The 4 themes were associated with 21 subthemes, indicating the complexity with which LE injury affects individuals. CONCLUSIONS: Our findings demonstrate the importance of caring for the whole person. Athletic trainers must broaden their focus to provide the best patient care and consider the person's activities and life demands outside of athletic participation. The themes identified in this study provide a basis for selecting appropriate health markers and outcome measures.


Assuntos
Atletas/psicologia , Extremidade Inferior/lesões , Sistema Musculoesquelético/lesões , Qualidade de Vida , Ferimentos e Lesões , Feminino , Humanos , Masculino , Assistência Centrada no Paciente/organização & administração , Pesquisa Qualitativa , Recuperação de Função Fisiológica , Apoio Social , Estudantes/psicologia , Universidades , Ferimentos e Lesões/etiologia , Ferimentos e Lesões/psicologia , Ferimentos e Lesões/reabilitação , Adulto Jovem
14.
J Athl Train ; 54(8): 869-880, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31386581

RESUMO

CONTEXT: The International Classification of Functioning, Disability and Health (ICF) provides a framework and common language for describing and understanding health that incorporates function and disability, as well as contextual factors. However, whether the meaningful patient outcomes reported by collegiate athletes who have sustained a lower extremity (LE) injury correspond to the ICF model is uncertain. OBJECTIVES: To determine if the patient outcomes reported by collegiate athletes after LE injury corresponded with the ICF classification and to identify the most relevant ICF categories and domains. DESIGN: Themes and subthemes from the qualitative analysis were linked to the ICF using established linking rules. The frequencies of the linked ICF categories were identified. SETTING: University laboratory. PATIENTS OR OTHER PARTICIPANTS: Twenty collegiate athletes (10 men, 10 women; age = 20.1 ± 1.83 years) from a National Collegiate Athletic Association Division I institution in the Midwest who had sustained an LE injury. DATA COLLECTION AND ANALYSIS: Semistructured face-to-face interviews and ICF linking process. RESULTS: The data from the qualitative interviews were successfully linked to 63 ICF second-level domains (eg, moving around, d455) across all 4 ICF categories: body functions (b), body structures (s), activities and participation (d), and environmental factors (e). The 63 second-level domains corresponded with 20 first-level domains (eg, mobility, d4). CONCLUSIONS: The ICF provided a common language for describing health and disability, as all outcomes reported by our collegiate athletes after LE injury were linked with the ICF classification. Athletic trainers should use the results of this study for assessing and monitoring collegiate athletes' health and function after an LE injury.


Assuntos
Classificação Internacional de Funcionalidade, Incapacidade e Saúde , Extremidade Inferior/lesões , Ferimentos e Lesões , Atividades Cotidianas , Avaliação da Deficiência , Feminino , Humanos , Entrevistas como Assunto , Masculino , /normas , Recuperação de Função Fisiológica , Ferimentos e Lesões/psicologia , Ferimentos e Lesões/reabilitação , Adulto Jovem
15.
Int J Sports Med ; 40(11): 704-710, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31404936

RESUMO

Competitive cricket demands a high level of performance from fast bowlers. Ground reaction forces during the landing phase pose a risk for lower limb and lumbar spine injury. Good dynamic knee strength allows the knee to flex to absorb these forces and extend prior to ball release for maximum efficiency. Plyometric training has been shown to improve dynamic strength. There is a lack of literature on this subject for cricket. This study evaluated the effect of a combined plyometric and strength training program on isokinetic knee strength of fast bowlers. Forty-two professional fast bowlers were randomly assigned to a training group (n=21) and a control group (n=21). Both groups underwent isokinetic knee strength and vertical and standing broad-jump testing. Quadriceps and hamstring concentric and eccentric peak torques, bilateral strength asymmetries (BSAs), and dynamic control ratios (DCRs) were evaluated by isokinetic testing. The study group underwent 12 weeks of plyometric training, whereas the control group continued with their own training methods. The study group showed a significant improvement (p<0.05) in jump performance and eccentric strength. There was a reduction in the proportion of bowlers with poor BSA and DCR. Improving dynamic knee strength through plyometric training reduces injury risk and improves performance in cricket fast bowlers.


Assuntos
Articulação do Joelho/fisiologia , Força Muscular/fisiologia , Exercício Pliométrico/métodos , Treinamento de Resistência/métodos , Esportes/fisiologia , Adolescente , Adulto , Traumatismos em Atletas/prevenção & controle , Desempenho Atlético/fisiologia , Fenômenos Biomecânicos , Teste de Esforço , Humanos , Extremidade Inferior/lesões , Vértebras Lombares/lesões , Masculino , Fatores de Risco , Adulto Jovem
16.
Indian J Med Microbiol ; 37(1): 19-23, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31424005

RESUMO

Background: Culture-negative infections in open long bone fractures are frequently encountered in clinical practice. We aimed to identify the rate and outcome of culture-negative infections in open long bone fractures of lower limb. Methodology: A prospective cohort study was conducted from November 2015 to May 2017 on Gustilo and Anderson Grade III open long bone fractures of the lower limb. Demographic data, injury details, time from injury to receiving antibiotics and index surgical procedure were noted. Length of hospital stay, number of additional surgeries and occurrence of complications were also noted. Patients with infected open fractures were grouped as culture positive or culture negative depending on the isolation of infecting microorganisms in deep intraoperative specimen. The clinical outcome of these two groups was statistically analysed. Results: A total of 231 patients with 275 open fractures involving the femur, tibia or fibula were studied. There was clinical signs of infection in 84 patients (36.4%) with 99 fractures (36%). Forty-three patients (51.2%) had positive cultures and remaining 41 patients had negative cultures (48.8%). The rate of culture-negative infection in open type III long bone fractures in our study was 17.7%. There was no statistical difference in the clinical outcome between culture-negative and culture-positive infections. Conclusion: Failure to identify an infective microorganism in the presence of clinical signs of infection is routinely seen in open fractures and needs to be treated aggressively.


Assuntos
Antibacterianos/uso terapêutico , Fraturas Ósseas/microbiologia , Fraturas Expostas/microbiologia , Extremidade Inferior/microbiologia , Infecção dos Ferimentos/tratamento farmacológico , Infecção dos Ferimentos/epidemiologia , Adolescente , Adulto , Idoso , Técnicas de Tipagem Bacteriana , Ciprofloxacino/uso terapêutico , Cloxacilina/uso terapêutico , Desbridamento , Feminino , Fêmur/lesões , Fêmur/microbiologia , Fíbula/lesões , Fíbula/microbiologia , Fraturas Ósseas/patologia , Fraturas Ósseas/cirurgia , Fraturas Expostas/patologia , Fraturas Expostas/cirurgia , Gentamicinas/uso terapêutico , Humanos , Extremidade Inferior/lesões , Extremidade Inferior/patologia , Masculino , Pessoa de Meia-Idade , Penicilinas/uso terapêutico , Estudos Prospectivos , Tíbia/lesões , Tíbia/microbiologia , Resultado do Tratamento , Infecção dos Ferimentos/microbiologia , Adulto Jovem
17.
Clin Interv Aging ; 14: 1361-1369, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31440041

RESUMO

Background: Transfer fractures in the lower limbs of bedridden and chair-bound nursing home patients can result from trauma induced by the usual lifting, moving, turning, or transferring maneuvers. Treatment entails immobilization for pain control and position change; however, splints/hard casts increase the risk of pressure sores. Therefore, we evaluated the use of a sponge cast. Materials and methods: Between March 2011 and October 2017, 17 patients with a lower limb transfer fracture due to transferring maneuvers in a nursing home were recruited. We evaluated the improvement in pseudo-motion and divided the patients as having bony union, fibrous union, or remaining pseudo-motion. We also investigated the occurrence of pressure sores due to immobilization up until the final follow-up. Results: Femur fractures occurred in 15 patients and lower leg fractures in two. Six of the 15 femur fractures were periprosthetic (four hip arthroplasty and two knee arthroplasty). Pseudo-motion was improved in 15 of 17 cases, within an average of 17.3 weeks for the improvement (14-23 weeks; bony union: 11 cases and fibrous union: four cases). Pseudo-motion remained in two cases: one periprosthetic fracture around the knee arthroplasty and the other, a femur neck fracture. No pressure sores occurred. Conclusions: A sponge cast appears to be one of the effective treatment options available for bedridden or chair-bound patients with a lower limb fracture due to its low risk of complications and satisfactory clinical results.


Assuntos
Fraturas Ósseas/terapia , Instituição de Longa Permanência para Idosos , Extremidade Inferior/lesões , Movimentação e Reposicionamento de Pacientes/efeitos adversos , Casas de Saúde , Contenções , Adulto , Idoso , Idoso de 80 Anos ou mais , Tratamento Conservador , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Resultado do Tratamento
18.
Plast Reconstr Surg ; 144(3): 759-767, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31461042

RESUMO

BACKGROUND: Marko Godina, in his landmark paper in 1986, established the principle of early flap coverage for reconstruction of traumatic lower extremity injuries. The aim of this study was to determine how timing influences outcomes in lower extremity traumatic free flap reconstruction based on Godina's original findings. METHODS: A retrospective review identified 358 soft-tissue free flaps from 1979 to 2016 for below knee trauma performed within 1 year of injury. Patients were stratified based on timing of coverage: 3 days or less (early), 4 to 90 days (delayed), and more than 90 days (late). The delayed group was further divided into two groups: 4 to 9 days and 10 to 90 days. Flap outcomes were examined based on timing of reconstruction. RESULTS: Flaps performed within 3 days after injury compared with between 4 to 90 days had decreased risk of major complications (OR, 0.40, p = 0.04). A receiver operating curve demonstrated day 10 to be the optimal day for predicting flap success. Flaps performed less than or equal to 3 days versus 4 to 9 days had no differences in any flap outcomes. In contrast, flaps performed within 4 to 9 days of injury compared to within 10 to 90 days were associated with significantly lower total flap failure rates (relative risk, 0.29, p = 0.025) and major complications (relative risk, 0.37, p = 0.002). CONCLUSIONS: Early free flap reconstruction performed within 3 days of injury had superior outcomes compared with the delayed (4 to 90 day) group, consistent with Godina's original findings. However, as an update to his paradigm, this ideal early period of reconstruction can be safely extended to within 10 days of injury without an adverse effect on outcomes. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.


Assuntos
Microcirurgia/métodos , Tratamento de Ferimentos com Pressão Negativa/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Lesões dos Tecidos Moles/terapia , Tempo para o Tratamento , Adolescente , Adulto , Feminino , Retalhos de Tecido Biológico/transplante , História do Século XX , Humanos , Extremidade Inferior/lesões , Masculino , Microcirurgia/história , Microcirurgia/normas , Pessoa de Meia-Idade , Tratamento de Ferimentos com Pressão Negativa/história , Tratamento de Ferimentos com Pressão Negativa/normas , Guias de Prática Clínica como Assunto , Procedimentos Cirúrgicos Reconstrutivos/história , Procedimentos Cirúrgicos Reconstrutivos/normas , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
19.
Chirurg ; 90(10): 795-805, 2019 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-31463658

RESUMO

Complex injuries of the lower extremities in geriatric patients with multiple pre-existing comorbidities represent an increasing challenge to an interdisciplinary team of surgeons. Functional reconstruction of the extremity through osteosynthesis, revascularization and defect coverage aims to preserve mobility and achieve an early return to activities of daily life at home, while avoiding major amputation and the associated risks regarding morbidity and mortality. An interdisciplinary assessment of geriatric patients regarding dystrophy of soft tissue and skín, cardiovascular and metabolic comorbidities as well as specific geriatric diagnostics are crucial steps in ensuring favorable outcomes. Perioperatively, all improvable risk factors should be actively optimized and a specialized interdisciplinary approach to treatment planning (extremity board) is absolutely necessary for success of treatment. It outlines the special features of the geriatric assessment, diagnostics, perioperative management and treatment targets.


Assuntos
Avaliação Geriátrica , Extremidade Inferior/lesões , Extremidade Inferior/cirurgia , Procedimentos Cirúrgicos Vasculares , Idoso , Envelhecimento , Amputação , Fixação Interna de Fraturas , Humanos
20.
IEEE Int Conf Rehabil Robot ; 2019: 536-541, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31374685

RESUMO

Lower limb exoskeletons (LLEs) are susceptible to falls, and users are at risk of head and/or hip injuries. To address concerns regarding the safety of LLE users, optimization techniques were used to study safe-fall control strategies. Simulation results of these studies showed promising performance that leads to head impact avoidance and mitigation of hip impact velocity. The motivation for the current research was to extend the application of previously developed optimization techniques to study more realistic human-LLE fall conditions. We examined a range of feasible fall durations for the human-LLE model and found the optimal fall duration for which the user's safety is maximized. Next, we used a range of coefficients of friction to examine fall strategies on different ground surface conditions. We found that the effectiveness of a safe-fall strategy is higher when falling on less slippery surfaces compared to more slippery ones. The simulation results were implemented in a half-scale physical model of a three-link inverted pendulum, which represented a human-LLE model. Results of our experiments verified that the optimal safe-fall strategy could be implemented in a mechanical test setup. The hip linear velocity at impact was found to have similar values in both the experimental (2.04 m/s) and simulation results (2.09 m/s). Further studies should be conducted with appropriate software and hardware platforms to successfully implement safe-fall strategies in an actual LLE.


Assuntos
Acidentes por Quedas/prevenção & controle , Traumatismos Craniocerebrais/prevenção & controle , Lesões do Quadril/prevenção & controle , Extremidade Inferior/fisiopatologia , Fenômenos Biomecânicos , Humanos , Extremidade Inferior/lesões
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