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At least 199 records · Page 11Linked to original sources
PubMed2000

[Comminuted fractures in multiple trauma patients: an analysis of 31 cases].

PURPOSE OF THE STUDY: We analyzed calcaneum burst fractures in multiple trauma patients and propose a management scheme. MATERIAL AND METHODS: In a retrospective study, we isolated 23 patients with 31 calcaneum burst fractures. All were stage V in the Duparc classification. We call them "pied de mine" fractures as they resembled those described in military reports. Half of them (16 cases; 54%) were open fractures. All patients suffered multiple injuries and 12 had a psychiatric history. These fractures were associated with spinal fracture in 17 cases (73%) and half had neurologic deficit, limb fracture in 16 (73%), and pelvic fracture in 12 (52%). The most frequent associated foot injuries were a talus fracture in 9 cases (29%) and Chopart displacement in 10 cases (32%). Clinical evaluation used the Maryland foot score, foot print and radiologic evaluation with lateral retrotibial view. RESULTS: Mean follow-up was 35 months. Mean Maryland foot score was 62.7 and 13 cases were pain free. Pain was due to conflict with the lateral malleolus, bony plantar thorns, medial malleolus and subtalar osteoarthritis. Orthopedic shoes were used 11 times. The other patients used sports shoes. Subtalar mobility was most frequently absent (23/29 cases, 2 amputations). Foot print showed 13/16 flat feet; 6 thorns were indirectly visible. Two patients had retraction toes and were initially treated by external fixation. Radiologic evaluation showed 23/29 complete subtalar arthrodeses, 23/29 migration of the great tuberosity, often(17/23 cases) associated with varus angulation. Eleven patients needed subsequent surgery: 5 for arthrodeses and 6 for resection of bony thorns. Rate of complication was high, especially for open fractures: 2 infections for 15 closed fractures, and 8 infections (50%) for 16 open fractures with 2 cases of chronic osteitis. Secondary amputation was required in 2/31 cases due to sepsis. TREATMENT PROPOSITIONS: For closed calcaneum burst fractures, it is better to wait one week before osteosynthesis. This delay is used to decrease edema with limb elevation and compressive bandaging. Skin tension due to trauma is increased by edema and osteosynthesis gives a high risk of wound disunion. We recommend reduction and Y-plate fixation even for burst fracture. Reduction must lower the tuberosity and correct the varus. After surgery, subtalar spontaneous arthrodesis is usually observed in a good position. Any bony plantar thorn must be resected. For open calcaneum burst fracture, the risk of sepsis is high. First treatment is debridement, stabilization and external fixation with antibiotic therapy. Stabilization should improve vascularization and facilitate internal fixation. The external fixation can be placed on the medial side to free the lateral approach to the calcaneum. Flap repair can be performed after one week when skin tension has subsided and areas of necrosis controlled.

Adult↗
PubMed2006

First ray injuries.

The first ray differs from the other rays in its position and its importance with weight bearing. Because it is a critical structure in the formation of the tripod of the foot, injuries to this ray can cause critical alterations in the biomechanics of the foot. This allows for pathologic weight-bearing points of contact and deformity that lead to a disabling gait. Physicians who are involved in the care of the foot and ankle should be familiar with the spectrum of injuries that concern the first ray. These injuries, their management, and sequelae are reviewed.

Athletic Injuries↗
PubMed1995

The foot in ballet dancers: the importance of second toe length.

Ballet dancers are prone to foot injuries. Our hypothesis was that the length of the second toe in relation to the big toe affected the distribution of stresses on the foot, correlating with calluses, injuries, and pain. Fifty-nine ballet dancers were examined for second toe length with respect to great toe, calluses, and metatarsophalangeal inflammation. Daily foot pain, limitation of work hours because of this, injuries, age, sex, and rank in the company were considered. The dancers' feet had an incidence of shorter, equal, or longer second toes which was comparable to a non-ballet-dancing cohort (N = 60). In female dancers (N = 34), total callus counts and pain scores were significantly lower in the group with shorter second toes versus those with equal or longer second toes. Counts were unrelated to age or rank. Longer second toes were related to hallux rigidus. Limitation of practice hours, ankle sprains, and foot/ankle fractures and sprains were comparable across the groups. The male dancers (N = 25) had significantly fewer calluses than did the women, but had equal pain scores and number of injuries. There were no significant differences among the males in total callus counts, pain scores, limitation of practice hours, or injuries between groups based on toe length, age, or rank. We conclude that there is no significantly more ideal pattern of toe lengths for male ballet dancers, but females with shorter second toes have fewer calluses and less daily foot pain. Those with a longer second toe had a higher incidence of hallux rigidus and correspondingly increased pain scores.

Adult↗
PubMed2002

Arthrodesis after workplace injuries.

Many foot and ankle injuries are incurred in the workplace. Despite steel-toed shoes, metatarsal bars, and ankle-high boots, fractures which require arthrodesis procedures can occur. The area of the foot and ankle involved, any pre-existing conditions, and the patient's occupational requirements must be taken into account. When an employer is flexible, the patient can often return to a sit down job during the postoperative recovery, if intermittent elevation of the extremity is permitted and hours are gradually increased. Alternatively, manual laborers who operate heavy machinery or work on ladders or elevated surfaces will require a prolonged recovery period before being able to return to the workplace. Algorithms with return to work dates may be helpful, but because so many factors exist, a functional capacity evaluation is often necessary to determine what, if any, permanent restrictions will be required.

Accidents, Occupational↗
PubMed1993

Management of lawn mower injuries to the foot and ankle.

Seventy consecutive patients treated for lawn mower injuries to the foot and ankle were reviewed to determine optimal treatment, functional results, and complications. Injuries were classified into 1 or more functional-anatomical zones (I, digits; II, dorsum; III, plantar nonweight-bearing surface; IV, heel; and V, ankle) for a total of 96 injuries. Thirty-one patients were available for follow-up. Mean age was 36.7 years and 84% were males. Most injuries (67%) involved patients > 16 years old using a push mower; however, 18% involved children < 5 years old, usually caused by riding mowers (70%). Primary closure after adequate irrigation and debridement was the preferred method of treatment except in patients with Zone IV injuries. Antibiotic prophylaxis was used in almost all injuries (93%). A 100% ambulation rate was achieved with 10% of patients requiring a prosthesis. Zone IV (heel) injuries had a 50% complication rate from chronic soft tissue breakdown. The wound infection rate per injury was 12.5% and did not vary significantly between closed (11.4%) and open (17.6%) treatment. Lawn mower injuries to the foot and ankle can be closed primarily after adequate irrigation and debridement without compromise of infection rate or function. Antibiotic prophylaxis is recommended. One-sixth of these injuries involve children < 5 years of age and can be prevented.

Accidents, Home↗
PubMed1994

Marine injuries. Prevention and treatment.

Penetrating wounds, stings, and inoculation of venom are common marine injuries to unwary walkers during the summer season. In many circumstances, foreign bodies such as wood splinters or small shards of glass can be removed readily with fine-pointed forceps. Other times, objects may not be noticed until radiographic examination of the injured area. With deeply penetrated foreign bodies, attempts at removal must often be weighed against the likelihood of continued symptoms and damage should the object be left in the foot. This review presents methods of prevention and treatment for common sources of marine foot injuries.

Accidents↗
PubMedDate not supplied

Bone cyst of a fishy origin: from an old catfish spine puncture wound to the foot.

A rare first metatarsal unicameral-type bone cyst with a deceptive radiographic appearance and size and an unusual pathological etiology was identified in a female patient. This eccentric cyst was observed only postoperatively by radiograph. Review of the patient's history documented a foot injury from a catfish spine as the etiology of this chronically inflamed cyst.

Animals↗
PubMedDate not supplied

Sprinting on a running track: a rare cause of a Lisfranc dislocation.

We present a case report of a young man who sustained a serious foot injury while sprinting in a straight line. We discuss the management of these injuries and emphasise the importance of a high index of suspicion amongst orthopaedic, casualty and radiology trainees.

Adolescent↗
PubMed1996

Moving car-tire injuries of the foot: reconstruction with microvascular free flaps.

Moving car-tire injury of the foot is a condition that appears to be a new clinical entity in Istanbul, in which the non-weight-bearing surface of the foot is prone to be injured. Between 1992 and 1995, eight moving car-tire injuries of the foot were managed. Patient age averaged 10.25 years (range: 7 to 21 years). All patients presented with soft-tissue loss combined with extensor tendon and bone lesions. In 6 patients, immediate flap coverage after initial debridement and, in 2 patients, delayed coverage after multiple debridements, were performed. All the flaps survived. Although in all patients, the weight-bearing region was always intact, some had gait-pattern abnormalities due to the bone and soft-tissue injuries. Early removal of all devitalized tissues and closure of the wounds with transfer of healthy tissue have a higher rate of success, lower incidence of infection, require fewer operative procedures, and shorter hospitalizations.

Accidents, Traffic↗
PubMedDate not supplied

Irreducible dislocation of the great toe following a sports injury. A case report.

The increasing number of competitive and recreational athletes has resulted in more sports-related foot injuries. An understanding of the sesamoid anatomy of the foot will facilitate management of these injuries. We recommend use of the dorsal approach in the surgical treatment of irreducible interphalangeal dislocations.

Adult↗
PubMed1990

Prediction rules for selective radiographic assessment of extremity injuries in children and adolescents.

To assess the potential for selective use of roentgenography in evaluating extremity injuries, prediction rules were developed based on prospective observations for 617 injured children and adolescents examined in our Emergency Department (phase 1) and tested on 601 examined 1 year later (phase 2). Logit analysis produced best-fitting statistical models for phase 1 data with significant (P less than 0.05) direct effects of gross signs, point tenderness, activity not routine, swelling moderate or severe, time from injury less than 6 hours, and pain with motion for upper extremity injuries; and, for lower extremity injuries, not knee injury, activity not routine, point tenderness, and foot injury. Prediction rules developed in phase 1 performed equally well when tested on phase 2 injuries. Data from both phases were combined, therefore, in analysis that produced risk estimates. For all injury types (ie, for injuries with all possible combinations of presence or absence of these findings), risk for fracture was derived. For upper extremity injuries, with a threshold risk for fracture of 20% used to select specific injury types for roentgenography, prediction rule outcomes were 18.1% of roentgenograms avoided and 5.3% of fractures missed. For lower extremity injuries, using a threshold risk of 10% to select injury types for roentgenography, outcomes were 25.8% of roentgenograms avoided and 5.3% of fractures missed. Alternative prediction rules allowed still greater roentgenogram avoidance, although missed fractures also increased. Risk of adverse functional outcome from missed fractures appeared small. Annual national cost savings from the elimination of 18.1% of upper and 25.8% of lower extremity roentgenographic evaluations was estimated at $103 million.

Adolescent↗
PubMed2005

Rodent bites on the feet of diabetes patients in Tanzania.

AIM: To characterize the epidemiology of rodent bite foot injuries in patients presenting to a diabetes clinic in Tanzania. METHODS: During July 1998-September 2003, all adult diabetes patients presenting with rodent bite injuries were identified. Follow-up included antimicrobial therapy and surgery, where appropriate. RESULTS: All 34 patients with rodent bites had Type 2 diabetes and peripheral neuropathy. Median age was 55.5 years; 62% were male. All bites occurred during sleep. The median time between acquiring the bite and presentation to MNH was 7 (range: 1-17) days. Patients who delayed seeking medical attention were significantly more likely to develop gangrene. Seventeen patients underwent minor or major amputation. Complete healing occurred in 30 (88%) patients; four patients died. CONCLUSION: Diabetes patients with peripheral neuropathy are at increased risk of bite injuries in areas with large rodent populations. Preventive efforts should include covering the feet at bedtime, and daily feet examination by patient or relatives.

Adult↗
PubMed1994

A new method of training for the lower extremity using unloading.

Rehabilitation of the patient with lower extremity dysfunction is frequently limited to open kinetic chain exercise due to pain and weakness in weight-bearing positions. Although hydrotherapy has been used in the past as a method of reducing body weight forces, task-specific training is not possible due to the resistance offered by water and the inability to regulate load. This clinical commentary describes a new form of lower extremity rehabilitation through the use of Unloading, a controlled reduction in body weight during task-specific activities. Two case reports of professional basketball players with foot injuries are presented in order to describe this method of therapy, which, in the authors' opinion, has the potential for broad applications in physical rehabilitation and deserves further research.

Basketball↗
PubMed2000

Primary surgical treatment of war injuries of the foot.

Presented are the results of primary surgical treatment of war injuries of the foot in 250 patients wounded in the territory of former Yugoslavia in the period June 1991-October 1995. Total number of feet treated was 275. Aetiologically, the most frequent injuries were those inflicted by the effect of mine blasts (65.2%) and by bullets from firearms (30.8%). Injuries to a single foot were present in 140 (56.0%), combined injuries in 107 (42.8%) and associated with burn injuries in three (1.2%) patients. Soft tissue injuries were present in 25 (9.1%) and injuries to bone structures and joints in 250 (90.9%) feet. Injuries resulting from solid blasts were found in nine (3.2%) feet. Postoperative bone fragment stabilization was required in 115 (41.8%) feet. Stabilization was by plaster of Paris in 87 (75.6%) and by external fixation in 23 (20. 0%) feet. Amputations were performed in 73 (26.5%) feet. Covering of soft tissue and bone defects was required in 84 (33.6%) patients.

Adolescent↗
PubMed2004

4.5-gram monofilament sensation beneath both first metatarsal heads indicates protective foot sensation in diabetic patients.

BACKGROUND: Loss of protective plantar foot sensation is the major cause of diabetic foot ulcerations and ultimate limb loss. Identification of patients without protective sensation can reduce the risk of unrecognized foot injury. The current recommended screening protocol requires 10-g monofilament testing of ten foot sites with use of a forced-choice paradigm. The objective of the present study was to determine whether testing of fewer than ten sites could provide accuracy comparable with that obtained by testing all ten sites. METHODS: A cross-sectional comparative study of plantar sensory levels in diabetic subjects with and without plantar ulceration was conducted in a tertiary-care teaching hospital setting. We examined forty-seven diabetic subjects with a history of foot ulceration and forty-five diabetic subjects with no history of foot ulceration. Plantar sensory threshold values at five sites on the sole of each foot were measured with a quasi-continuous range of applied forces, and receiver operating characteristic analysis techniques were applied. RESULTS: Screening on the basis of only the maximum force threshold for the left and right first metatarsal head sites provided comparable or better performance at high levels of sensitivity than did either the mean or the maximum force threshold across all ten sites. A sensory threshold of 4.5 g for both the left and right first metatarsal head sites predicted the risk of ulceration with a sensitivity of 100% and a specificity of 67%. CONCLUSIONS: Testing of diabetic patients for protective sensation may be simplified to testing under both first metatarsal heads with a 4.5-g monofilament. If a patient cannot sense the application of a 4.5-g monofilament under either first metatarsal head, he or she probably has lost protective sensation and should be considered to be at risk for undetected injury.

Adolescent↗