RESUMO
Proximal fifth metatarsal fractures are the most common foot fractures in children. Attempts to classify these injuries are misapplied and inadequately predict outcomes. This is the first study to identify factors associated with healing in pediatric fifth metatarsal fractures. In this retrospective cohort study (N = 305), proximal fifth metatarsal fractures were classified on radiographs by location on the bone, alignment (transverse or oblique), displacement (>2 mm), and completion through the bone. Based on the literature, they were secondarily sorted by category: apophyseal, intra-articular metaphyseal, extra-articular metaphyseal, and diaphyseal. Primary outcomes included times to healing, indicated by clinical symptoms, immobilization, and return to sports, as well as radiographic callus formation, bridging, and remodeling. Healing times were compared by ANOVA and linear regression. Location had a significant effect on times of immobilization and return to sports, but alignment, displacement, and completion were not associated with healing. When re-classified, the categories were also associated with immobilization and return to sports. Apophyseal fractures healed fastest and diaphyseal fractures required the most time to heal. There was no difference between extra- and intra-articular fractures. For every year of age, symptoms resolved about 2 days sooner. Neither gender nor body mass index (BMI) was positively or negatively associated with healing times. In conclusion, classifying fractures by apophyseal, metaphyseal, and diaphyseal is the most concise, accurate, and useful system. This is the largest series of nonoperatively treated proximal fifth metatarsal fractures in children and a robust standard to which surgical management can be compared.
Assuntos
Traumatismos do Pé , Fraturas Ósseas , Ossos do Metatarso , Humanos , Criança , Recém-Nascido , Ossos do Metatarso/cirurgia , Estudos Retrospectivos , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/terapia , Pé , Traumatismos do Pé/terapia , Traumatismos do Pé/cirurgiaRESUMO
Introduction: Decision making in determining management of post-trauma patient is very important, especially for traumatic in the small bones, fingers and toes. The global predictor to determine the management of retaining or amputating the limb is using the Mangled Extrimity Severity Score (MESS) scoring system, values above 7 are the indication for amputation. The decision maker have to pay attention for the end result of the actions which were performed in the initial management. Material and Methods: One case is reported from Orthopaedic emergency department Hospital in Makassar, South Sulawesi, Indonesia. A 39-year old male with motor vehicle accident trauma at left foot region since 6 hours before admitted to hospital, later was diagnosed with open comminutive fracture shaft proximal phalang of left 5th toe, the Mangled Extrimity Severity Score (MESS) was 8. Patient underwent emergency debridement and retained the toe by performed Open Reduction Internal Fixation (ORIF) K-Wire. Results: This patient has a good clinical outcome by following up 2 weeks and 8 months after surgery by retain the affected side with debridement and Open Reduction Internal Fixation (ORIF) K-Wire. Patient can ambulate normally with full weight bearing, and there is no difficulty to wearing shoe or sandal. Conclusions: Determination of action by retaining the traumatized limb needs to be considered for the good of the patient, but it is necessary to provide informed consent to the patient and family that there will be a possibility of tissue death with the worst possibility of limb amputation
Assuntos
Humanos , Masculino , Adulto , Articulação do Dedo do Pé/cirurgia , Fios Ortopédicos , Escala de Gravidade do Ferimento , Fraturas Cominutivas/cirurgia , Traumatismos do Pé/terapia , Desbridamento , Fixação Interna de FraturasRESUMO
BACKGROUND: The alignment of the foot-ankle complex may influence the kinematics and kinetics of the entire lower limb during walking. OBJECTIVES: This study investigated the effect of different magnitudes of varus alignment of the foot-ankle complex (small versus large) on the kinematics and kinetics of foot, ankle, knee, and hip in the frontal and transverse planes during walking. DESIGN: Cross-sectional study. METHOD: Foot-ankle complex alignment in the frontal plane was measured as the angle between the metatarsal heads and the inferior edge of the examination table, measured with the volunteer in prone maintaining the ankle at 0° in the sagittal plane. The participants (n = 28) were divided into two groups according to their alignment angles. The first group had values equal to or inferior to the 45 percentile, and the second group had values equal to or above the 55 percentile. The lower limb kinematics and kinetics were evaluated with the participant walking at self-select speed in an instrumented treadmill. RESULTS: The group of large varus alignment showed significantly higher (p < 0.03) forefoot inversion angle at initial contact, amplitude of rearfoot-shank eversion, and peak of inversion ankle moment. There were no differences (p > 0.05) between the groups for knee and hip amplitudes and moments in the frontal and transverse planes. The durations of rearfoot-shank eversion, knee abduction, knee medial rotation, hip adduction, and hip medial rotation were not different between groups (p > 0.05). CONCLUSION: Large varus alignment of the foot-ankle complex may increase the magnitude of foot pronation and ankle inversion moment during walking.
Assuntos
Traumatismos do Tornozelo/terapia , Fenômenos Biomecânicos/fisiologia , Traumatismos do Pé/terapia , Modalidades de Fisioterapia , Rotação , Caminhada/fisiologia , Adolescente , Adulto , Estudos Transversais , Feminino , Humanos , Cinética , Masculino , Adulto JovemRESUMO
Acute compartment syndrome of the foot and ankle is a relatively rare clinical finding. Lower extremity compartment syndrome is customarily due to vascular or orthopedic traumatic limb-threatening pathologic issues. Clinical correlation and measurement of intracompartmental pressure are paramount to efficient diagnosis and treatment. Delayed treatment can lead to local and systemically adverse consequences. Frostbite, a comparatively more common pathologic entity of the distal extremities, occurs when tissues are exposed to freezing temperatures. Previously found in military populations, frostbite has become increasingly prevalent in the general population, leading to more clinical presentations to foot and ankle specialists. We present a review of the published data of acute foot compartment syndrome and pedal frostbite, with pathogenesis, treatment, and subsequent sequelae. A case report illustrating 1 example of bilateral foot, atraumatic compartment syndrome, is highlighted in the present report. The patient presented with changes consistent with distal bilateral forefoot frostbite, along with gangrenous changes to the distal tuft of each hallux. At admission and evaluation, the patient had increasing rhabdomyolysis with no other clear etiology. Compartment pressures were measured in the emergency room and were >100 mm Hg in the medial compartment and 50 mm Hg dorsally. The patient was taken to the operating room urgently for bilateral pedal compartment release. Both pathologic entities have detrimental outcomes if not treated in a timely and appropriate manner, with amputation rates increasing with increasing delay.
Assuntos
Síndromes Compartimentais/etiologia , Síndromes Compartimentais/cirurgia , Fasciotomia/métodos , Congelamento das Extremidades/complicações , Gangrena/complicações , Doença Aguda , Adulto , Terapia Combinada/métodos , Síndromes Compartimentais/fisiopatologia , Seguimentos , Traumatismos do Pé/complicações , Traumatismos do Pé/diagnóstico , Traumatismos do Pé/terapia , Congelamento das Extremidades/diagnóstico , Congelamento das Extremidades/terapia , Gangrena/diagnóstico , Gangrena/terapia , Humanos , Escala de Gravidade do Ferimento , Masculino , Reaquecimento/métodos , Medição de Risco , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do TratamentoRESUMO
Introdução: A cobertura do pé e especialmente da região do calcâneo são desafios técnicos para o cirurgião devido ao alto grau de especialização dos tecidos envolvidos e à relativa imobilidade dos tecidos próximos. Métodos: No presente estudo, apresentamos nossa experiência com uso do retalho baseado na artéria plantar medial para cobertura de defeitos teciduais no pé, especialmente na região de apoio plantar no calcâneo. Doze retalhos da artéria plantar medial feitos de 2001 a 2013 no Hospital Regional da Asa Norte, Brasília, DF, foram incluídos. Resultados: Dos 12 pacientes, 10 eram homens e dois eram mulheres. As indicações foram perda traumática do coxim do calcâneo em 10 pacientes e dorso do pé em dois casos. Todos os retalhos foram elevados como retalhos pediculados fasciocutâneos baseados na artéria plantar medial. Todos os retalhos cicatrizaram sem maiores complicações, exceto um caso com perda parcial. A área doadora foi coberta com enxerto de pele parcial e houve um caso de perda parcial do enxerto. Os retalhos apresentaram uma sensibilidade protetora levemente inferior ao lado normal. Conclusão: De acordo com os resultados, o retalho plantar medial é uma boa opção para cobertura do pé, especialmente do calcâneo. A versatilidade do retalho permite a cobertura de defeitos no calcâneo sobre o tendão de Aquiles e apoio plantar, assim como o dorso do pé. A cobertura da região de apoio plantar com pele de textura similar e sensibilidade protetora confere a esse retalho uma grande vantagem sobre outros retalhos para reconstrução dessa região.
Introduction: Reconstructive coverage of foot defects, especially those of the calcaneus region, is a unique technical challenge for the surgeon due to the high degree of specialization of the tissues involved and the relative immobility of the proximal tissues. Methods: In the present study, we present our experience with the use of the flap based on the medial plantar artery to cover tissue defects in the foot, especially in the region of the calcaneal fat pad. Twelve medial plantar artery flaps constructed from 2001 to 2013 at the As a Norte Regional Hospital, Brasília, DF, were included. Results: Of the 12 patients with the medial plantar artery flaps, 10 were men and 2 were women. The indications were traumatic tissue loss of the plantar fat pad in 10 patients and of the dorsum of the foot in two cases. All flaps were elevated as fasciocutaneous pedicle flaps based on the medial plantar artery. All the flaps healed without major complications, except one case that involved partial loss . The donor area was covered with a partial skin graft and there was one case of partial graft loss. The flap displayed a slightly lower protective sensitivity than the normal side. Conclusion: According to the results, the medial plantar flap is a good option for covering traumatic foot defects, especially those affecting the calcaneus. The versatility of the flap allows the coverage of defects of the calcaneus (e.g., the Achilles tendon and plantar fat pad regions), as well as those affecting the dorsum of the foot. The coverage of the plantar fat pad region with skin of similar texture and protective sensitivity confers to the medial plantar flap a large advantage over other flaps for reconstruction of this region.
Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Pessoa de Meia-Idade , Adulto Jovem , Retalhos Cirúrgicos , Transplante , Ferimentos e Lesões , Calcâneo , Estudos Retrospectivos , Traumatismos do Pé , Procedimentos de Cirurgia Plástica , Retalhos de Tecido Biológico , Transplante/métodos , Ferimentos e Lesões/cirurgia , Ferimentos e Lesões/terapia , Calcâneo/cirurgia , Calcâneo/lesões , Traumatismos do Pé/cirurgia , Traumatismos do Pé/terapia , Procedimentos de Cirurgia Plástica/métodos , Retalhos de Tecido Biológico/cirurgiaAssuntos
Traumatismos do Tornozelo , Traumatismos em Atletas , Traumatismos do Pé , Fraturas de Estresse , Traumatismos do Tornozelo/diagnóstico , Traumatismos do Tornozelo/etiologia , Traumatismos do Tornozelo/terapia , Traumatismos em Atletas/diagnóstico , Traumatismos em Atletas/etiologia , Traumatismos em Atletas/terapia , Diagnóstico Diferencial , Feminino , Traumatismos do Pé/diagnóstico , Traumatismos do Pé/etiologia , Traumatismos do Pé/prevenção & controle , Traumatismos do Pé/terapia , Fraturas de Estresse/diagnóstico , Fraturas de Estresse/etiologia , Fraturas de Estresse/prevenção & controle , Fraturas de Estresse/terapia , Humanos , Masculino , Estudos Observacionais como Assunto , Recuperação de Função Fisiológica , Fatores de Risco , Fatores SexuaisRESUMO
INTRODUCTION: The incidence of diabetes mellitus (DM) in the United States is expected to increase from 8 per 1000 in 2008 to 15 per 1000 by 2050 [20]. As a result, DM patients will constitute a large proportion of Burn Center admissions, with burns typically due to contact burn or scalding. Peripheral vascular disease (PVD) and peripheral neuropathy (PN) are far more common in DM patients, particularly in those with poorly controlled disease, and are often associated with worse outcomes than non-diabetic (nDM) burn patients. This study sought to analyze whether the outcome of isolated leg and foot burns among DM and nDM individuals differed significantly. MATERIALS AND METHODS: Retrospective data on 207 consecutive patients (>18 years old) admitted to a Burn Center with isolated leg or foot burns between 1999 and 2009 was collected and analyzed for this study. Age, gender, ethnicity, total body surface area (TBSA), degree of burn, etiology, hospital and burn intensive care unit (ICU), length of stay (LOS), and status at discharge were reviewed. Patients were grouped as diabetic (DM) or non-diabetic (nDM). Differences were analyzed using either the Student's t-test or Chi-square. RESULTS: 43 DM and 164 nDM patients with isolated lower extremity or foot burns were treated during the study period (1999-2009). The mean age of DM and nDM patients was 54.6 and 43.7 years, respectively (p<0.001). The most common burn etiology was scalding, flame, or contact burn. Percentage of total body surface area (TBSA) burn in DM patients averaged±standard deviation 1.8±1.3% compared to 1.8±1.6% in nDM (p<0.9). Among DM patients, 86% (N=37) of patients suffered third degree burns and 14% (N=6) of patients had second degree burns compared to 76% (N=125) of patients and 24% (N=39) of patients among nDM patients, respectively (p<0.16). The DM group had significantly higher burn ICU admission rates, 16.3% of patients versus 8.5% of patients (p<0.001), total length of hospital stay (mean±standard deviation), 14.1±10 versus 9.8±9.3 days (p<0.01) and renal failure, 4.7% of patients versus 0.6% of patients (p<0.05) compared to the nDM group. 93% of DM patients were discharged to home without further medical attention while 4.7% of patients underwent further treatment. In comparison, 85.4% of the nDM patients were discharged home with no further treatment while 8.5% of patients received home care (p<0.01). CONCLUSION: DM patients who suffer isolated burns to the feet or lower extremities have poorer clinical outcomes and more complicated and protracted hospital courses when compared to nDM patients with similar burns. Although diabetics in the current study did not experience larger or more severe burns than nDM patients, they were nearly twice as likely to be admitted to the ICU, spent an average of four days longer in the hospital, and had a higher likelihood of developing renal failure compared to nDM patients.
Assuntos
Queimaduras/terapia , Diabetes Mellitus , Traumatismos da Perna/terapia , Adulto , Idoso , Unidades de Queimados/estatística & dados numéricos , Queimaduras/complicações , Feminino , Traumatismos do Pé/terapia , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Estudos Retrospectivos , Adulto JovemRESUMO
The pressure distribution on the plantar surface may reveal information not only about the feet structure, also it may bring out information about the entire body posture not only on health but also pathologic conditions. The application in ergonomics and occupational health gives access to the postural correction that on a long term may provoke professional injuries giving presition and security. This study is on 132 workers of Universidad de las Américas.
Assuntos
Ergonomia/métodos , Traumatismos do Pé/terapia , Pé , Saúde Ocupacional , Suporte de Carga/fisiologia , Adolescente , Adulto , Antropometria , Equador , Ergonomia/instrumentação , Feminino , Pé/anatomia & histologia , Pé/fisiologia , Traumatismos do Pé/prevenção & controle , Humanos , Masculino , Pessoa de Meia-Idade , Equilíbrio Postural/fisiologia , Adulto JovemRESUMO
BACKGROUND: Surgeons usually witness only the limb-threatening stages of infected, closed pedal puncture wounds in diabetics. Given that this catastrophic outcome often represents failure of conservative management of pre-infected wounds, some suggest consideration of invasive intervention (coring or laying-open) for pre-infected wounds in hope of preventing contamination from evolving into infection, there being no evidence based guidelines. However, an invasive pre-emptive approach is only justifiable if the probability of progression to catastrophic infection is very high. Literature search revealed no prior studies on the natural history of closed pedal puncture wounds in diabetics. METHODS: A survey was conducted via an interviewer-administered questionnaire on 198 adult diabetics resident in the parish of St. James, Jamaica. The sample was selected using a purposive technique designed to mirror the social gradient and residential distribution of the target population and is twice the number needed to detect a prevalence of puncture wounds of 14% with a range of 7-21% in a random sample of the estimated adult diabetic population. RESULTS: The prevalence of a history of at least one closed pedal puncture wound since diagnosis of diabetes was 25.8% (CI; 19.6-31.9%). The only modifiable variable associated at the 5% level of significance with risk of pedal puncture wound, after adjustment by multivariable logistic regression, was site of interview/paying status, a variable substantially reflective of income more so than quality-of-care.Of 77 reported episodes of closed pedal puncture wound among 51 participants, 45.4% healed without medical intervention, 27.3% healed after non-surgical treatment by a doctor and 27.3% required surgical intervention ranging from debridement to below-knee amputation. Anesthetic foot (failure to feel the puncture) and sole of the forefoot as site of puncture were the variables significantly associated with risk of requiring surgical intervention. CONCLUSIONS: That 72.7% of wounds healed either spontaneously or after non-surgical treatment means that routine, non-selective surgical intervention for pre-infected closed pedal puncture wounds in diabetics is not justifiable. However the subset of patients with an anesthetic foot and a wound on the sole of the forefoot should be marked for intensive surveillance and early surgical intervention if infection occurs.
Assuntos
Complicações do Diabetes/terapia , Traumatismos do Pé/terapia , Cicatrização , Ferimentos Penetrantes/terapia , Adulto , Estudos Transversais , Complicações do Diabetes/fisiopatologia , Progressão da Doença , Feminino , Traumatismos do Pé/fisiopatologia , Pesquisas sobre Atenção à Saúde , Humanos , Masculino , Ferimentos Penetrantes/fisiopatologiaRESUMO
Se determinó la prevalencia de dermatomicosis en ancianos institucionalizados de Ciudad Bilívar, Estado Bolívar, Venezuela, y se evaluó la sensibilidad in vitro de los aislamientos clínicos a los antifúngicos itraconazol, fluconazol y terbinafina mediante el método de microdilución en medio líquido, recomendado por el Comité Internacional de Laboratorios Clínicos (M38-P), con algunas modificicaciones. Los hongos fueron identificados mediante métodos tradicionales. Las levaduras se identificaron mediante pruebas bioquímicas, sistema Api 20 C AUX (Biomérieux SA®, France) y crecimiento en medio de Staib. Se estudiaron 74 ancianos, todos recluidos en el Asilo "San Vicente de Paúl" y el Geriátrico "Carlos Fragachán" quienes dieron consentimiento por escrito para participar en el estudio. La edad de los pacientes estuvo comprendida entre 63 y 98 años (80 ± 8,4 años), la mayoría eran hombres (73%). Todos los pacientes tenían lesiones sugestivas de onicomicosis en los pies. El único dermatofito aislado fue Trichophyton rubrum (n=2) el cual resultó sensible al Itraconazol, terbinafina y sensibilidad variable a flucozazol. Asimismo se logró aislar Aspergillus niger (n=5; 6,7%) demostrándose sensible a terbinafina y fluconazol con sensibilidad variable a itraconazol. Candida albicans (n=3; 4,1%) fue sensible a fluconazol, resistentes a itraconazol y variable a la terbinafina. Aspergillus flavus fue aislado en dos casos (2,7%). Además de Geomyces sp, Fusarium oxysporum y Pseudeurotium ovale. Se concluye que existe una prevalencia baja de dermatomicosis en los ancianos institucionalizados de Ciudad Bolívar y que las lesiones clinicamente observadas son debidas a los cambios degenerativos propios de la edad.
A study determine prevalence of dermatomycosis in 74 institutionalized elderly patients was conductted in Ciudad Bolivar, state of Bolivar, Venezuela. Clinical isolates were assayed for in vitro sensitivity to itraconazole, fluconazole, and terbinafine using a slightly modified version of the microdilution method in liquid medium recommended by the International Committee of Clinical Laboratory (M38-P). Traditional methods were used to identify the fungi. The yeasts were identified by Api 20C AUX biochemical testing (bioMérieux SA®, France) and growth on Staib media. The elders, mostly men (73%), from the "San Vicente de Paúl" Nursing Home and the "Carlos Fragachan" Geriatric Hospital, were aged between 63 and 98 (80 ± 8.4 years). All the patients, whose written consent was secured, had lesions suggestive of onychomycosis. Trichophyton rubrum was the only isolated dermatophyte (n=2), which resulted sensitive to itraconazole and terbinafine, with variable sensitivity to fluconazole. Aspergillus niger (n=5;6.7%) was sensitive to terbinafine and fluconazole with variable itraconazole sensitivity. Candida albicans (n=3; 4.1%) was fluconazole sensitive, resistant to itraconazole, and variable to terbinafine. Aspergillus flavus was isolated in two cases 2.7%). Geomyces sp., Fusarium oxysporum, and Pseudeurotium ovale were also isolated. It is concluded that there is a low prevalence of dermatomycosis among institutionalized elders in Ciudad Bolivar, and that the lesions clinically observed were due to degenerative changes naturally occurring with aging.