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[Long-term results in the treatment of foot injuries in polytraumatized patients].

INTRODUCTION: The aim of this study was to evaluate the long-term outcome of multiple injured patients with foot injuries. While severity and frequency of multiple injuries could be decreased in the last years, it was not possible to decrease the severity of injuries of the foot and ankle region. These injuries are often not detected and their severity is underestimated in primarily diagnostics what might lead to complaints in the longterm course. METHODS: The multiple trauma database of the Department of Traumatology of the University of Vienna includes 386 patients from September 1992 to April 2001. 40 (10.4 %) of these patients suffered a fracture or dislocation of foot or ankle. 33 (82.5 %) multiple injured patients with injuries of foot or ankle could be reexamined between April and September 2002 and the longterm outcome of the foot and ankle region could be evaluated objectively and subjectively. RESULTS: 22 (66.7 %) patients were male, 11 (33.3 %) female. The mean age was 34.5 years. 27 (81.8 %) patients still suffered from complaints related to their injured foot and ankle region. After calculation of the AOFAS these complaints were predominantly located in the ankle-hindfoot region. 22 (66.7 %) patients had to limit their sports activity. DISCUSSION: In our study period an increasing number and severity of injuries of foot or ankle can be shown. Furthermore multiple injured patients with concomitant injuries of foot or ankle show a lower ISS what suggests that these patients might have a higher survival rate and consecutively enter rehabilitation process.

Abbreviated Injury Scale↗

Foot injuries caused by power lawn mowers.

Seventeen cases of foot injury caused by power lawn mowers are reviewed. Eleven patients were using an air-cushion type of mower. None was wearing adequate protective footwear. The types of injuries sustained and their long term problems are discussed. The need for user safety and education is stressed.

Accidents, Home↗

[Foot injuries caused by a chain saws].

Two cases of chain saw injuries of the foot are reported. The protective footwear did not provide sufficient protection. Suggestions are made for improving the footwear and for compulsory approval of the safety equipment.

Accidents, Occupational↗

The biomechanics of running. Implications for the prevention of foot injuries.

Understanding the biomechanics of running has brought implications for the prevention of foot injuries. These biomechanical considerations, both functional and non-functional, must be evaluated by the sports medicine practitioner. Although functional biomechanical findings are more accurate predictors of injury and diagnostic tools than static findings, a correlation between the two is essential. Other important variables, e.g. training methods, athletic shoes, psychology, general health, external environment (surfaces, weather) and overuse, must be correlated with the biomechanical findings. The methodology and results of research are inconsistent with the direct predictability of various overuse injuries, based on biomechanical abnormalities and/or contributing factors. Until more research is carried out, clinical experience and the results of structured research investigations will provide the basis of treatment.

Athletic Injuries↗

Management of foot injuries with free-muscle flaps.

Transfer of a free-muscle graft with application of a split-thickness skin graft is one of many techniques available for reconstruction of the massive foot injury. The durability of such a reconstruction has been questioned. We have treated nine patients suffering from foot injuries with extensive soft-tissue loss. Each patient underwent reconstruction using a free-muscle transfer covered by a split-thickness skin graft. A mean follow-up of 33 months (range 17 to 48 months) is reported for these nine patients. Each patient is ambulatory. One patient developed an ulcer on the plantar surface, which was treated successfully by flap revision and skin grafting. We feel this technique provides a durable reconstruction for significant soft-tissue loss of the foot.

Adult↗

Ankle and foot injuries in pediatric and adult athletes.

Foot and ankle injuries are among the most common in athletes.Differential diagnosis, imaging decisions, and treatment plan should be influenced by the age of the athlete. A thorough history and physical examination, with an understanding of the anatomy of the foot and ankle anatomy and the mechanism of injury, will give the best opportunity to make the correct diagnosis. For most athletes, the prognosis for returning to play after a foot or ankle injury is very good. The recipe for keeping our athletes healthy includes early intervention, undergoing proper rehabilitation, applying braces or orthotics when indicated, and preventing injuries when appropriate.

Adult↗

Medial peritalar dislocation-associated foot injuries and mechanism of injury.

1) Two cases of medial peritalar dislocation with accompanying foot injuries considerably altering prognosis are presented. 2) Although most cases of this uncommon injury respond well to treatment, a careful investigation for accompanying injuries should be performed. 3) The mechanism of injury is discussed.

Adult↗

Leg and foot injuries in racquet sports.

Injuries to the lower extremity are common in racquet sports. The acute injuries usually respond well to treatment. Chronic injuries may require more patience and sometimes a change of playing habits on the part of the player. Some chronic injuries will respond well to operative intervention but most will do well with conservative care.

Achilles Tendon↗

The Ottawa Ankle Rules in Asia: validating a clinical decision rule for requesting X-rays in twisting ankle and foot injuries.

This was a study to determine if the Ottawa Ankle Rules (OAR) for requesting x-ray studies in twisting ankle and foot injuries are applicable in our Asian population. Four hundred ninety-four consecutive eligible patients presenting to the emergency department with twisting injuries about the ankle were examined by emergency physicians for clinical criteria requiring ankle and foot x-ray studies according to the OAR. Four hundred eighty-eight of these patients underwent x-ray studies that were interpreted by a radiologist. The sensitivity and specificity of the OAR for predicting the presence of fracture were calculated to be 0.9 and 0.34, respectively. When the rules were modified to cast a wider screening net, sensitivity improved to 0.99. We conclude that the OAR are not applicable to our population because of inadequate sensitivity, but when modified become acceptable and can reduce the number of x-ray studies requested by 28%.

Adolescent↗

Anesthesia in the emergency setting: Part I. Hand and foot injuries.

Topical application and local infiltration of anesthetic agents are useful for localized areas, while a circular field block provides superficial anesthesia within the encircled area. Regional anesthesia is accomplished by injecting the anesthetic agent near a nerve or nerve group. Useful anesthetic techniques for repair of hand injuries include wrist blocks, intermetacarpal blocks and local infiltration anesthesia. Median nerve block, ulnar nerve block, radial nerve block or a combination of these blocks provides satisfactory anesthesia without inducing muscle paralysis in the anesthetized region. Intermetacarpal digital blocks are used to anesthetize any finger. Local infiltration is useful for closing minor lacerations. For foot injuries, the posterior ankle block is used to anesthetize the sole. The anterior ankle block is used for the dorsum of the foot.

Anesthesia, Local↗