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1.
Bone Joint J ; 102-B(11): 1469-1474, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33135454

RESUMO

AIMS: To describe a new objective classification for open fractures of the lower limb and to correlate the classification with patient-centred outcomes. METHODS: The proposed classification was investigated within a cohort of adults with open fractures of the lower limb who were recruited as part of two large clinical trials within the UK Major Trauma Network. The classification was correlated with patient-reported Disability Rating Index (DRI) and EuroQol five-dimension questionnaire (EQ-5D) health-related quality of life in the year after injury, and with deep infection at 30 days, according to the Centers for Disease Control and Prevention definition of a deep surgical site infection. RESULTS: A total of 748 participants were included in the analysis. Of these, 288 (38.5%) had a simple open fracture and 460 (61.5%) had a complex fracture as defined by the new classification system. At 12 months, the mean DRI in the simple fracture group was 32.5 (SD 26.8) versus 43.9 (SD 26.1) in the complex fracture group (odds ratio (OR) 8.19; 95% confidence interval (CI) 3.69 to 12.69). At 12 months the mean health-related quality of life (EQ-5D utility) in the simple fracture group was 0.59 (SD 0.29) versus 0.56 (SD 0.32) in the complex fracture group (OR -0.03; 95% CI -0.09 to 0.02). The differences in the rate of deep infection at 30 days was not statistically significant. CONCLUSION: The Orthopaedic Trauma Society open fracture classification is based upon objective descriptors of the injury and correlates with patient-centred outcomes in a large cohort of open fractures of the lower limb. Cite this article: Bone Joint J 2020;102-B(11):1469-1474.


Assuntos
Fraturas Expostas/classificação , Extremidade Inferior/lesões , Adulto , Avaliação da Deficiência , Feminino , Fraturas Expostas/etiologia , Fraturas Expostas/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Ortopedia , Avaliação de Resultados da Assistência ao Paciente , Qualidade de Vida , Sociedades Médicas , Infecção da Ferida Cirúrgica
2.
Niger J Clin Pract ; 23(9): 1221-1228, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32913160

RESUMO

Background: : Vascular injuries are commonly seen in both emergency services and forensic medicine practise. They are often life-threatening, with high morbidity and mortality rates. Aims: This study aimed to retrospectively evaluate extremity vascular injuries and the associated treatment approaches. Methods: After obtaining approval from the ethics committee of the university, those patients admitted to the emergency department of Adiyaman between 1 February 2013 and 31 August 2018 were included in this study. The patients' data were obtained through the electronic records system, and the cases were evaluated according to the age, gender and cause of injury, including blunt force trauma injuries (accidents, traffic accidents, crush injuries and occupational accidents) and penetrating injuries (stabbing, gunshot wounds, suicide attempts and assaults). Additionally, the injuries were evaluated based on the extremity, according to the anatomical location and whether the injury was life-threatening. Results: This study included 76 patients with extremity vascular injuries; 65 were males (85.52%), 11 were females (14.48%) and their average age was 33.24 ± 15.85 years. Forty-five (59.2%) of the patients had upper extremity vascular injuries, and 31 (40.3%) had lower extremity vascular injuries. In addition to arterial injuries, 26 (34.21%) of the patients had venous injuries and 22 (28.94%) had nerve injuries. Nine of these patients had neurological deficits due to their nerve injuries. All of the patients were revascularized within 3-5 hours, and none of the patients required amputations. Conclusion: The primary goals in extremity vessel injury cases are to prevent mortality, especially after major vascular injuries, and save the extremity from amputation. With a fast, effective and multi-disciplinary approach, an accurate diagnosis and effective surgical intervention can prevent morbidity and mortality as well as reduce the rate of undesirable complications.


Assuntos
Extremidade Inferior/irrigação sanguínea , Extremidade Inferior/lesões , Procedimentos Cirúrgicos Vasculares/métodos , Lesões do Sistema Vascular/diagnóstico por imagem , Lesões do Sistema Vascular/cirurgia , Ferimentos Penetrantes/diagnóstico por imagem , Acidentes de Trânsito , Adolescente , Adulto , Artérias/diagnóstico por imagem , Artérias/lesões , Angiografia por Tomografia Computadorizada , Extremidades , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Ferimentos por Arma de Fogo/complicações , Ferimentos por Arma de Fogo/epidemiologia , Ferimentos por Arma de Fogo/cirurgia , Ferimentos não Penetrantes/complicações , Ferimentos não Penetrantes/epidemiologia , Ferimentos Penetrantes/epidemiologia , Ferimentos Penetrantes/cirurgia , Adulto Jovem
3.
Khirurgiia (Mosk) ; (7): 97-101, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32736472

RESUMO

Mine-explosive trauma is one of the most serious types of combat lesion and injuries in peacetime. We report a patient with mine-explosive trauma of the lower limbs followed by injury of the vascular bundle. Well-coordinated work of a multidisciplinary team of specialists at all stages of treatment is presented. The management was effective to save patient's life, avoid amputation and restore lower limb function.


Assuntos
Traumatismos por Explosões/cirurgia , Traumatismos da Perna/cirurgia , Salvamento de Membro/métodos , Extremidade Inferior/cirurgia , Lesões do Sistema Vascular/cirurgia , Humanos , Extremidade Inferior/irrigação sanguínea , Extremidade Inferior/lesões , Equipe de Assistência ao Paciente , Recuperação de Função Fisiológica , Resultado do Tratamento
4.
J Rehabil Med ; 52(8): jrm00092, 2020 Aug 31.
Artigo em Inglês | MEDLINE | ID: mdl-32778903

RESUMO

BACKGROUND: Ambulant biofeedback devices can be used to provide real-time feedback for trauma patients on weight-bearing regimes. The devices also enable prescribing clinicians to monitor and train patients' level of weight-bearing. However, there is limited evidence regarding the feasibility of use of such devices in controlling weight-bearing, and their full potential remains to be elucidated. OBJECTIVE: To investigate the feasibility of using ambulant biofeedback training devices to improve compliance with weight-bearing regimes in trauma patients with lower extremity fractures. METHODS: A literature review of the feasibility and clinical validity of ambulant biofeedback devices. RESULTS: Three clinically validated biofeedback devices were found feasible for use in monitoring the compliance of patients who have lower extremity fractures with different weight-bearing regimes. CONCLUSION: Further information about the feasibility and clinical validity of biofeedback training devices is nee-ded in order to optimize weight-bearing instructions for patients.


Assuntos
Biorretroalimentação Psicológica/métodos , Fraturas Ósseas/terapia , Extremidade Inferior/lesões , Suporte de Carga/fisiologia , Ferimentos e Lesões/terapia , Estudos de Viabilidade , Feminino , Humanos , Masculino , Cooperação do Paciente , Reprodutibilidade dos Testes
5.
Ann Surg ; 272(4): 564-572, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32657917

RESUMO

OBJECTIVES: Estimating the likely success of limb revascularization in patients with lower-extremity arterial trauma is central to decisions between attempting limb salvage and amputation. However, the projected outcome is often unclear at the time these decisions need to be made, making them difficult and threatening sound judgement. The objective of this study was to develop and validate a prediction model that can quantify an individual patient's risk of failed revascularization. METHODS: A BN prognostic model was developed using domain knowledge and data from the US joint trauma system. Performance (discrimination, calibration, and accuracy) was tested using ten-fold cross validation and externally validated on data from the UK Joint Theatre Trauma Registry. BN performance was compared to the mangled extremity severity score. RESULTS: Rates of amputation performed because of nonviable limb tissue were 12.2% and 19.6% in the US joint trauma system (n = 508) and UK Joint Theatre Trauma Registry (n = 51) populations respectively. A 10-predictor BN accurately predicted failed revascularization: area under the receiver operating characteristic curve (AUROC) 0.95, calibration slope 1.96, Brier score (BS) 0.05, and Brier skill score 0.50. The model maintained excellent performance in an external validation population: AUROC 0.97, calibration slope 1.72, Brier score 0.08, Brier skill score 0.58, and had significantly better performance than mangled extremity severity score at predicting the need for amputation [AUROC 0.95 (0.92-0.98) vs 0.74 (0.67-0.80); P < 0.0001]. CONCLUSIONS: A BN (https://www.traumamodels.com) can accurately predict the outcome of limb revascularization at the time of initial wound evaluation. This information may complement clinical judgement, support rational and shared treatment decisions, and establish sensible treatment expectations.


Assuntos
Algoritmos , Artérias/lesões , Artérias/cirurgia , Sistemas de Apoio a Decisões Clínicas , Extremidade Inferior/irrigação sanguínea , Extremidade Inferior/cirurgia , Adolescente , Adulto , Amputação , Humanos , Extremidade Inferior/lesões , Aprendizado de Máquina , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do Tratamento , Procedimentos Cirúrgicos Vasculares , Adulto Jovem
6.
J Orthop Traumatol ; 21(1): 10, 2020 Jul 18.
Artigo em Inglês | MEDLINE | ID: mdl-32683562

RESUMO

BACKGROUND: Open fractures are among the most severe injuries observed in orthopedic patients. Treating open fractures is difficult because such patients with infections may require multiple operations and amputations. Furthermore, only a few studies have focused on antibiotic prophylaxis in open fractures and evaluated how to cover lost soft tissue to increase the success rate of reconstruction. We evaluated the risk factors for deep infection in lower limb Gustilo-Anderson (G-A) type III fractures. MATERIALS AND METHODS: This retrospective study investigated patients who underwent surgical procedures for lower limb G-A type III fractures between January 2007 and January 2017 at our institution. We enrolled 110 patients with 114 lower limb G-A type III fractures (77 G-A type IIIA fractures and 37 G-A type IIIB fractures) who were followed up for at least 2 years. We compared patients presenting infections with those without infections by assessing the following factors: severe contamination, diabetes, smoking, Injury Severity Scale, segmental fracture, location of fracture, G-A classification, damage control surgery, methods of surgery, timing of fixation, combination of antibiotics used, duration of antibiotic prophylaxis, timing of wound closure, and soft-tissue reconstruction failure. RESULTS: Eighteen fractures presented deep infections. Compared with patients without infections, patients developing infections differed significantly in terms of severe contamination (P < 0.01), G-A classification (P < 0.01), duration of antibiotic prophylaxis (P < 0.01), timing of wound closure (P < 0.01), and incidence of soft-tissue reconstruction failure (P < 0.01). Skin grafting was associated with significantly higher failure rates than muscle and free flap reconstructions (P = 0.04). Treatment with antibiotics was significantly longer in patients with drug-resistant bacterial infections than in those without infections (P < 0.01). CONCLUSION: Early flaps rather than skin grafting should be used to cover G-A type IIIB fractures, because skin grafting resulted in the highest failure rate among soft-tissue reconstructions in open fractures. Longer duration of antibiotic use had a significant impact not only on deep infection rates but also on the presence of drug-resistant bacteria. These findings suggest that prolonged use of antibiotics should be avoided in cases of open fractures. LEVEL OF EVIDENCE: Level IV retrospective observational study.


Assuntos
Antibacterianos/administração & dosagem , Fraturas Expostas/cirurgia , Infecção da Ferida Cirúrgica/prevenção & controle , Fraturas da Tíbia/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Antibioticoprofilaxia , Desbridamento , Feminino , Fixação Interna de Fraturas/métodos , Fraturas Expostas/complicações , Fraturas Expostas/tratamento farmacológico , Humanos , Extremidade Inferior/lesões , Extremidade Inferior/microbiologia , Extremidade Inferior/cirurgia , Masculino , Pessoa de Meia-Idade , Osteomielite/etiologia , Osteomielite/prevenção & controle , Osteomielite/terapia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Estudos Retrospectivos , Fatores de Risco , Infecções dos Tecidos Moles/diagnóstico , Infecções dos Tecidos Moles/etiologia , Infecções dos Tecidos Moles/microbiologia , Infecções dos Tecidos Moles/terapia , Lesões dos Tecidos Moles/complicações , Lesões dos Tecidos Moles/terapia , Retalhos Cirúrgicos , Infecção da Ferida Cirúrgica/diagnóstico , Infecção da Ferida Cirúrgica/etiologia , Infecção da Ferida Cirúrgica/terapia , Fraturas da Tíbia/tratamento farmacológico , Fraturas da Tíbia/microbiologia , Resultado do Tratamento , Adulto Jovem
7.
Int J Sports Med ; 41(11): 729-735, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32492733

RESUMO

Side differences in the limb symmetry index during hop tests have been rarely investigated in uninjured athletes. Unknown differences can result in false interpretation of hop tests and affect return to sport decision. Hypothesis was that un-injured athletes in Judo and Taekwondo have side differences in hop test and that asymmetries can be predicted based on the athletes fighting display. Differences, risk relationships were analyzed using the chi-squared test and the odds ratio. A two-tailed p value of<0.05 was considered statistically significant. 115 athletes from the national teams were included (mean age 18.4 years; range 13-27 years). 93, 97.4 and 98.3% did not have symmetric hop distance for three hop tests. Up to a quarter did not reach a limb symmetry index of>90. Moreover, 57.4% (n=66) reached longer jumping distance with the standing leg. Ignoring such pre-existent side differences in evaluation of hop tests and not knowing which limb was dominant prior the injury, can lead to premature or delayed return to sports in the rehabilitation process. Therefore, it might be helpful to refer to individual jump lengths for each limb in case of injury by using hop tests in pre-season screening in professional athletes in Judo and Taekwondo.


Assuntos
Lateralidade Funcional , Extremidade Inferior/fisiologia , Artes Marciais/fisiologia , Adolescente , Adulto , Teste de Esforço/métodos , Feminino , Humanos , Extremidade Inferior/lesões , Masculino , Artes Marciais/lesões , Volta ao Esporte , Adulto Jovem
8.
Gerokomos (Madr., Ed. impr.) ; 31(2): 119-124, jun. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-193894

RESUMO

Las úlceras de la extremidad inferior siguen siendo en la actualidad un problema global. Las opciones analgésicas para el control del dolor se basan generalmente en medidas farmacológicas con acción local y/o sistémica. El sevoflurano es un anestésico general inhalatorio, asociado a sus efectos sobre el sistema nervioso central, y tradicionalmente no se emplea por otras vías que no sea inhalado. Sin embargo, hoy en día se le conoce una acción analgésica a nivel central y también periférico. Actualmente, su uso clínico ha llevado a algunos autores a considerar la posibilidad de nuevos efectos del sevoflurano a través de la vía tópica. OBJETIVO: Sintetizar las evidencias científicas disponibles sobre el uso del sevoflurano aplicado de forma tópica en úlceras de la extremidad inferior. METODOLOGÍA: Revisión sistematizada de la literatura científica, siguiendo la guía PRISMA. La búsqueda de estudios se realizó en las principales bases de datos bibliográficas, sin límite de fechas ni de idiomas. También se realizó una búsqueda incluyendo resúmenes de congresos. RESULTADOS: Se obtuvieron un total de 120 referencias. Finalmente, ocho de ellas correspondían a los estudios incluidos para la síntesis cualitativa. En la mayoría de los estudios se encontró una disminución del dolor de 8 a 2 puntos en las escalas empleadas. CONCLUSIONES: Los escasos estudios parecen sugerir un importante efecto analgésico aplicado de forma tópica, un probable efecto antibacteriano y un posible efecto promotor de la cicatrización. Sin embargo, son necesarios más estudios comparativos con un tamaño de muestra mayor, con mejor calidad en sus diseños


Leg ulcers are a global problem daily. The analgesic options for pain control are generally based on pharmacological measures with local and / or systemic action. Sevoflurane is a general inhalation anesthetic, associated with its effects on the central nervous system, its use not being traditional by other routes that are not inhaled. However, today it is known an analgesic action at the central level and at the peripheral level. Actually, the clinical use of this product has led some authors to consider the possibility of new effects of Sevoflurane topically. OBJECTIVE: To synthesize the available scientific evidences about the use of Sevoflurane topically on leg ulcers. METHODOLOGY: Systematized review of the scientific literature, following the PRISMA guide. The main bibliographic databases were searched without date or language limits. Also references lists and congress abstracts were searched. RESULTS: 120 references were identified. Finally, 8 of them were selected for qualitative synthesis. In most studies, was found a decrease in pain of 8 to 2 points in the scales used. CONCLUSIONS: The few studies suggest an analgesic effect applied topically, a probable antibacterial effect and a possible healing promoting effect. However, comparative studies of large sample are needed, with a better quality designs


Assuntos
Humanos , Sevoflurano/uso terapêutico , Extremidade Inferior/lesões , Úlcera do Pé/tratamento farmacológico , Administração Tópica , Prática Clínica Baseada em Evidências/métodos , Enfermagem Baseada em Evidências/métodos , Cicatrização/efeitos dos fármacos
9.
Am J Sports Med ; 48(9): 2287-2294, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32485114

RESUMO

BACKGROUND: Lower extremity injuries are the most common injuries in professional sports and carry a high burden to players and teams in the National Football League (NFL). Injury prevention strategies can be refined by a foundational understanding of the occurrence and effect of these injuries on NFL players. PURPOSE: To determine the incidence of specific lower extremity injuries sustained by NFL players across 4 NFL seasons. STUDY DESIGN: Descriptive epidemiology study. METHODS: This retrospective, observational study included all time-loss lower extremity injuries that occurred during football-related activities during the 2015 through 2018 seasons. Injury data were collected prospectively through a leaguewide electronic health record (EHR) system and linked with NFL game statistics and player participation to calculate injury incidence per season and per 10,000 player-plays for lower extremity injuries overall and for specific injuries. Days lost due to injury were estimated through 2018 for injuries occurring in the 2015 to 2017 seasons. RESULTS: An average of 2006 time-loss lower extremity injuries were reported each season over this 4-year study, representing a 1-season risk of 41% for an NFL player. Incidence was stable from 2015 to 2018, with an estimated total missed time burden each NFL season of approximately 56,700 player-days lost. Most (58.7%) of these injuries occurred during games, with an overall higher rate of injuries observed in preseason compared with regular season (11.5 vs 9.4 injuries per 10,000 player-plays in games). The knee was the most commonly injured lower extremity region (29.3% of lower body injuries), followed by the ankle (22.4%), thigh (17.2%), and foot (9.1%). Hamstring strains were the most common lower extremity injury, followed by lateral ankle sprains, adductor strains, high ankle sprains, and medial collateral ligament tears. CONCLUSION: Lower extremity injuries affect a high number of NFL players, and the incidence did not decrease over the 4 seasons studied. Prevention and rehabilitation protocols for these injuries should continue to be prioritized.


Assuntos
Traumatismos em Atletas/epidemiologia , Futebol Americano/lesões , Extremidade Inferior/lesões , Humanos , Incidência , Ligamentos/lesões , Músculo Esquelético/lesões , Estudos Retrospectivos , Ruptura/epidemiologia , Entorses e Distensões/epidemiologia
10.
J Sports Sci ; 38(19): 2177-2185, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32520644

RESUMO

The aim of this study was to compare the effects of 20 min neuromuscular training with a programme of 10 min in youth football players. 342 (15.4 ± 1.7 years) male football players from 18 teams were included, and cluster-randomized by team into two intervention groups. Both groups performed an injury prevention programme twice a week over five months using the same exercises but a different duration. The first intervention group (INT10, n = 175) performed the programme for 10 min, the second intervention group (INT20, n = 167) for 20 min. Primary outcomes were lower extremity (LE) injuries. Secondary outcomes were injury type, severity, mechanism and compliance to the intervention. 13 teams with 185 players were included for final analysis. No significant group difference was found between INT10 (6.37 per 1000 h) and INT20 (7.20 per 1000 h) for the incidence rate ratio of the lower extremities (IRR = 1.03, 95% confidence interval 0.59, 1.79), nor for the distribution of injury location, type, severity or mechanism. The results show that performing preventive exercises for 10 min is no less effective than 20 min in youth football players. Shorter training sessions can, therefore, be effectively used for injury prevention. TRIAL REGISTRATION: DRKS00015282.


Assuntos
Extremidade Inferior/lesões , Condicionamento Físico Humano/métodos , Futebol/lesões , Adolescente , Antropometria , Traumatismos em Atletas/epidemiologia , Traumatismos em Atletas/prevenção & controle , Alemanha/epidemiologia , Humanos , Incidência , Masculino , Fatores de Tempo , Adulto Jovem
11.
Am Fam Physician ; 101(11): 669-679, 2020 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-32463641

RESUMO

Family physicians use anesthesia to provide diagnostic and procedural analgesia for conditions such as neuropathies, fracture reduction, foreign body removals, and complex wound management. Local infiltration of anesthetics is commonly used in this setting because of the ease of use, safety, and effectiveness of the procedure. Nerve blocks are a specific regional anesthesia technique that blocks nerve function distal to the injection site. An understanding of the sensory distribution of the peripheral nervous system is essential in determining the safest and most effective nerve block for the procedure. There are various nerve block techniques, including landmark-guided and ultrasound-guided. Ultrasound guidance increases the effectiveness of the nerve block while decreasing complications when compared with other techniques. Depending on the required area of anesthesia for the procedure, various points throughout the lower extremity can be used to block the lateral femoral cutaneous, common peroneal, saphenous, tibial, deep peroneal, superficial peroneal, and sural nerves.


Assuntos
Extremidade Inferior/lesões , Bloqueio Nervoso/métodos , Anestesia Local/métodos , Humanos , Extremidade Inferior/anatomia & histologia , Extremidade Inferior/fisiopatologia , Manejo da Dor/métodos , Ultrassonografia/métodos
12.
Clin J Sport Med ; 30(3): 216-223, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32341288

RESUMO

OBJECTIVE: The purpose of this study was to evaluate injury characteristics by position groups. DESIGN: Prospective, observational study. SETTING: A single, major Division I collegiate football program. PARTICIPANTS: All players on a collegiate football program each fall regular season. INDEPENDENT VARIABLES: Exposure to Division I collegiate football and position groups. MAIN OUTCOME MEASURES: Injury rates (IRs) per 1000 athlete exposures (AEs) and injury rate ratios (IRRs) were calculated and analyzed for all monitored injury variables, which included time in the season, body part, type of injury, game and practice injuries, mechanism of injury, and type of exposure. RESULTS: During the 2012 to 2016 fall regular seasons, there were 200 reported injuries sustained from 48 615 AE. The overall 5-year IR was 4.11 per 1000 AEs (3.57-4.72 95% confidence intervals). Skill players sustained the highest IR in the preseason (IR, 7.56) compared with line (IR, 4.26) and other (IR, 4.10) position groups. In addition, skill players demonstrated a significantly higher IRR compared with the line (IRR, 1.75, P < 0.05) and other (IRR, 1.85, P < 0.05) position groups. CONCLUSIONS: Skill players sustained most of their injuries in the preseason, whereas the linemen and other position groups suffered most of their injuries in the first half of the regular season. Skill players demonstrated a significantly higher IR in preseason, noncontact mechanism injuries, and injuries to the upper leg and thigh compared with line and other position groups. Efforts to reduce soft-tissue muscle strains in skill players targeting the preseason may provide one of the best opportunities to significantly decrease current football IRs, whereas efforts to reduce contact exposures may have the greatest effect on concussions and contact mechanism injuries for the other position group. There were no significant differences in IRs between position groups and type of exposure.


Assuntos
Traumatismos em Atletas/epidemiologia , Futebol Americano/lesões , Concussão Encefálica/epidemiologia , Traumatismos Craniocerebrais/epidemiologia , Futebol Americano/fisiologia , Humanos , Extremidade Inferior/lesões , Masculino , Destreza Motora/fisiologia , Estudos Prospectivos , Fatores de Risco , Entorses e Distensões/epidemiologia , Tronco/lesões , Estados Unidos/epidemiologia , Extremidade Superior/lesões
13.
Infection ; 48(3): 333-344, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32270441

RESUMO

INTRODUCTION: The current treatment concepts of fracture-related infection (FRI) [Consensus Conference (Anti-Infection Task Force (AITF)) on the definition of acute or chronic osteomyelitis (cOM)] are associated with unsolved challenges and problems, underlining the need for ongoing medical research. METHOD: Literature review of treatments for FRI and description of own cases. RESULTS: We could include eight papers with 394 patients reporting treatments and outcome in FRI. The infection was resolved in 92.9% (mean) of all treatments. The mean follow-up was 25 months with a persistent non-union in 7% of the patients. We diagnosed 35 (19f/16m; 56.4 ± 18.6 years) patients with bone infections anatomically allocated to the proximal and distal femur (12×), the pelvis (2×), distal tibia (3×), tibial diaphysis (11×), the ankle joint (4×) and calcaneus (3×). These 35 patients were treated (1) with surgical debridement; (2) with antibiotic-eluting ceramic bone substitutes; (3) bone stabilization (including nail fixation, arthrodesis nails, plates, or external ring fixation), (4) optionally negative pressure wound therapy (NPWT) and (5) optionally soft tissue closure with local or free flaps. The mean follow-up time was 14.9 ± 10.6 months (min/max: 2/40 month). The overall recurrence rate is low (8.5%, 3/35). Prolonged wound secretion was observed in six cases (17.1%, 6/35). The overall number of surgeries was a median of 2.5. CONCLUSION: The results in the literature and in our case series are explicitly promising regarding the treatment of posttraumatic fracture-related infection.


Assuntos
Antibacterianos/uso terapêutico , Substitutos Ósseos/uso terapêutico , Fraturas Ósseas/complicações , Infecções/terapia , Fraturas Ósseas/tratamento farmacológico , Fraturas Ósseas/cirurgia , Humanos , Infecções/tratamento farmacológico , Infecções/etiologia , Extremidade Inferior/lesões , Extremidade Inferior/cirurgia
15.
Int J Sports Med ; 41(8): 495-504, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32242332

RESUMO

The musculoskeletal system has an integral role throughout life, including structural support to the body, protection, and allowing a range of fine to complex movements for daily living to elite sporting events. At various times, injuries to the musculoskeletal system occur resulting in varying levels of impact to the person both acutely and chronically. Specifically, there is a spectrum of complexity in orthopedic injuries, with some such as common muscle strains, that while burdensome will have no impact on life-long functional ability, and others that can result in long lasting disability. Focusing on extremity injuries, this review highlights: i)the current impact of orthopedic injuries in sport and daily life; ii) the foundation of bone and skeletal muscle repair and regeneration; and iii) the disruptions in regenerative healing due to traumatic orthopedic injuries. This review seeks to maximize the broad and collective research impact on sport and traumatic orthopedic injuries in search of promoting ongoing innovation for treatment and rehabilitation approaches aimed to improve musculoskeletal health throughout life.


Assuntos
Extremidade Inferior/lesões , Extremidade Inferior/fisiopatologia , Músculo Esquelético/lesões , Músculo Esquelético/fisiopatologia , Regeneração/fisiologia , Extremidade Superior/lesões , Extremidade Superior/fisiopatologia , Atividades Cotidianas , Traumatismos em Atletas/fisiopatologia , Traumatismos em Atletas/reabilitação , Regeneração Óssea , Fraturas Ósseas/fisiopatologia , Fraturas Ósseas/reabilitação , Humanos , Inflamação/fisiopatologia , Modalidades de Fisioterapia , Cicatrização/fisiologia
16.
Br J Sports Med ; 54(18): 1089-1098, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32253193

RESUMO

OBJECTIVE: To evaluate the effects of injury prevention programmes on injury incidence in any women's football code; explore relationships between training components and injury risk; and report injury incidence for women's football. DESIGN: Systematic review and meta-analysis. DATA SOURCES: Nine databases searched in August 2019. ELIGIBILITY CRITERIA: Randomised controlled trials evaluating any injury prevention programme (eg, exercise, education, braces) were included. Study inclusion criteria were: ≥20 female football players in each study arm (any age, football code or participation level) and injury incidence reporting. RESULTS: Twelve studies, all in soccer, met inclusion criteria, with nine involving adolescent teams (aged <18 years). All studies (except one) had a high risk of bias. Eleven studies examined exercise-based programmes, with most (9/11) including multiple (≥2) training components (eg, strength, plyometric, balance exercises). Multicomponent exercise programmes reduced overall (any reported) injuries (incidence rate ratio (IRR) 0.73, 95% CI 0.59 to 0.91) and ACL injuries (IRR 0.55, 95% CI 0.32 to 0.92). For exercise-based strategies (single-component and multicomponent), hamstring injuries were also reduced (IRR 0.40, 95% CI 0.17 to 0.95). While exercise-based strategies resulted in less knee, ankle and hip/groin injuries, and the use of multiple training components was associated with greater reductions in overall and knee injuries, further studies would be required to increase the precision of these results. The incidence of overall injuries in women's football was 3.4 per 1000 exposure hours; with ankle injuries most common. CONCLUSION: In women's football, there is low-level evidence that multicomponent, exercise-based programmes reduce overall and ACL injuries by 27% and 45%, respectively. PROSPERO REGISTRATION NUMBER: CRD42018093527.


Assuntos
Traumatismos em Atletas/prevenção & controle , Futebol/lesões , Traumatismos em Atletas/epidemiologia , Feminino , Humanos , Incidência , Extremidade Inferior/lesões , Condicionamento Físico Humano , Fatores de Risco , Fatores Sexuais
17.
Am J Phys Med Rehabil ; 99(9): 789-794, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32195737

RESUMO

OBJECTIVE: Prevalence and characteristics of fractures and factors related to loss of ambulation after lower limb fractures were investigated. DESIGN: Chart review included height, weight, dual-energy x-ray absorptiometry, corticosteroid use, vitamin D, fracture history, muscle strength, range of motion, and timed performance tests (10 meter walk/run, Gowers, and four steps). Patients were grouped by fracture location and ambulation loss after fracture. RESULTS: Two hundred eighty-seven patients with Duchenne muscular dystrophy were identified, 53 of these had experienced fracture. Eighty-one percent were older than 9 yrs at first fracture and 36.4% became nonambulatory after fracture. Dorsiflexion range of motion (fracture side, P = 0.021), quadriceps strength (right side, P = 0.025), and shoulder abduction strength (right, left, and fracture side; P = 0.028, P = 0.027, and P = 0.016) were significantly different within the groups. Patients who became nonambulatory after fracture initially had less dorsiflexion (right, left, fracture side; 2.25 vs. -7.29, P = 0.004; 2.67 vs. -12, P = 0.001; and 2.41 vs. -7.42, P = 0.002) and slower 10-meter walk/run times (7.43 secs vs. 14.7 secs, P = 0.005). CONCLUSIONS: Fracture represents a significant risk in patients with Duchenne muscular dystrophy; both slower walking speed and ankle contracture confer an increased risk of ambulation loss after fracture. TO CLAIM CME CREDITS: Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME OBJECTIVES: Upon completion of this article, the reader should be able to: (1) Identify the main factors that are associated with ambulation loss after fracture in patients with Duchenne muscular dystrophy; (2) Identify the risk of fracture in the Duchenne muscular dystrophy population; and (3) Articulate the characteristics associated with fracture in patients with Duchenne muscular dystrophy. LEVEL: Advanced. ACCREDITATION: The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.


Assuntos
Fraturas Ósseas/fisiopatologia , Extremidade Inferior/lesões , Limitação da Mobilidade , Distrofia Muscular de Duchenne/fisiopatologia , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Fraturas Ósseas/etiologia , Humanos , Extremidade Inferior/fisiopatologia , Masculino , Distrofia Muscular de Duchenne/complicações , Amplitude de Movimento Articular , Estudos Retrospectivos , Fatores de Risco , Caminhada/fisiologia , Adulto Jovem
18.
Orthop Nurs ; 39(2): 99-106, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32218004

RESUMO

BACKGROUND: With the urgency related to improving quality and creating efficiency in healthcare, partnership is emerging as a critical concept related to transitions of care. PURPOSE: This quality improvement project included facilitation of hospital partnership with skilled nursing facilities to improve outcomes associated with the lower extremity total joint arthroplasty population. METHODS: The clinical nurse specialist (CNS) utilized a standardized framework to implement partnership strategies with multidisciplinary teams. Outcomes were monitored for the 2 quarters of partnership activities. RESULTS: All recommendations for developing a partnership model were facilitated within the project timeline. Patient experience and quality measures remained at, or improved, from baseline and met all strategic targets. Efficiency through episode payment demonstrated improvement at each interval during the study period. Analysis revealed a significant (p < .05) reduction in the mean hospital length of stay. CONCLUSION: The CNS practice outcomes suggest that the use of structured partnership strategies between agencies improves efficiency of care and accelerates rapid spread of innovation.


Assuntos
Artroplastia de Substituição/normas , Extremidade Inferior/cirurgia , Avaliação de Resultados em Cuidados de Saúde/estatística & dados numéricos , Melhoria de Qualidade , Artroplastia de Substituição/efeitos adversos , Artroplastia de Substituição/estatística & dados numéricos , Comportamento Cooperativo , Humanos , Tempo de Internação/estatística & dados numéricos , Extremidade Inferior/lesões , Extremidade Inferior/fisiopatologia , Osteoartrite/complicações , Osteoartrite/cirurgia , Indicadores de Qualidade em Assistência à Saúde
19.
JAMA ; 323(6): 519-526, 2020 02 11.
Artigo em Inglês | MEDLINE | ID: mdl-32044942

RESUMO

Importance: Following surgery to treat major trauma-related fractures, deep wound infection rates are high. It is not known if negative pressure wound therapy can reduce infection rates in this setting. Objective: To assess outcomes in patients who have incisions resulting from surgery for lower limb fractures related to major trauma and were treated with either incisional negative pressure wound therapy or standard wound dressing. Design, Setting, and Participants: A randomized clinical trial conducted at 24 trauma hospitals representing the UK Major Trauma Network that included 1548 patients aged 16 years or older who underwent surgery for a lower limb fracture caused by major trauma from July 7, 2016, through April 17, 2018, with follow-up to December 11, 2018. Interventions: Incisional negative pressure wound therapy (n = 785), which involved a specialized dressing used to create negative pressure over the wound, vs standard wound dressing not involving negative pressure (n = 763). Main Outcomes and Measures: The primary outcome measure was deep surgical site infection at 30 days diagnosed according to the criteria from the US Centers for Disease Control and Prevention. A preplanned secondary analysis of the primary outcome was performed at 90 days. The secondary outcomes were patient-reported disability (Disability Rating Index), health-related quality of life (EuroQol 5-level EQ-5D), surgical scar assessment (Patient and Observer Scar Assessment Scale), and chronic pain (Douleur Neuropathique Questionnaire) at 3 and 6 months, as well as other local wound healing complications at 30 days. Results: Among 1548 participants who were randomized (mean [SD] age, 49.8 [20.3] years; 561 [36%] were aged ≤40 years; 583 [38%] women; and 881 [57%] had multiple injuries), 1519 (98%) had data available for the primary outcome. At 30 days, deep surgical site infection occurred in 5.84% (45 of 770 patients) of the incisional negative pressure wound therapy group and in 6.68% (50 of 749 patients) of the standard wound dressing group (odds ratio, 0.87 [95% CI, 0.57 to 1.33]; absolute risk difference, -0.77% [95% CI, -3.19% to 1.66%]; P = .52). There was no significant difference in the deep surgical site infection rate at 90 days (11.4% [72 of 629 patients] in the incisional negative pressure wound therapy group vs 13.2% [78 of 590 patients] in the standard wound dressing group; odds ratio, 0.84 [95% CI, 0.59 to 1.19]; absolute risk difference, -1.76% [95% CI, -5.41% to 1.90%]; P = .32). For the 5 prespecified secondary outcomes reported, there were no significant differences at any time point. Conclusions and Relevance: Among patients who underwent surgery for major trauma-related lower limb fractures, use of incisional negative pressure wound therapy, compared with standard wound dressing, resulted in no significant difference in the rate of deep surgical site infection. The findings do not support the use of incisional negative pressure wound therapy in this setting, although the event rate at 30 days was lower than expected. Trial Registration: isrctn.org Identifier: ISRCTN12702354.


Assuntos
Bandagens , Fixação Interna de Fraturas , Fraturas Expostas/cirurgia , Extremidade Inferior/lesões , Tratamento de Ferimentos com Pressão Negativa , Infecção da Ferida Cirúrgica/prevenção & controle , Adolescente , Adulto , Feminino , Fixação Interna de Fraturas/efeitos adversos , Humanos , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Infecção da Ferida Cirúrgica/epidemiologia
20.
J Strength Cond Res ; 34(5): 1249-1253, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32084107

RESUMO

Case, MJ, Knudson, DV, and Downey, DL. Barbell squat relative strength as an identifier for lower extremity injury in collegiate athletes. J Strength Cond Res 34(5): 1249-1253, 2020-The aim of the study was to determine the efficacy of using the relative strength level of Division I athletes in One repetition maximum (1RM) barbell back squat as an identifier of seasonal lower extremity (LE) injury. One repetition maximum back squat (kg) and reported LE injuries were retrospectively collected for Division I male football (n = 46), female volleyball and softball athletes (n = 25). Maximum preseason relative (body mass normalized) back squat strength values were compared with 2 analyses of variance (p < 0.05) between injured and uninjured male (football) and female athletes (softball & volleyball). Relative back squat strength was significantly lower in injured athletes than uninjured athletes in both men (F = 6.03, p = 0.02) and women (F = 4.68, p = 0.04) with a moderate to large effect size (g = 0.86-0.85). These data indicate the potential of 1RM back squat relative strength serving as one tool in multi-factor preseason screening for LE injury risk in these sports. Male athletes with relative squat strength below 2.2 and female athletes below 1.6 in these sports could be more susceptible to LE injury over a season. Strength professionals should consider using body mass normalized 1RM back squats as a screening tool for seasonal LE injury risk in college athletes.


Assuntos
Extremidade Inferior/lesões , Extremidade Inferior/fisiologia , Força Muscular/fisiologia , Treinamento de Resistência/métodos , Esportes/fisiologia , Adulto , Atletas , Feminino , Humanos , Masculino , Postura , Estudos Retrospectivos
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