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Chen C, Lin JR, Zhang Y, Ye TB, Yang YF. A systematic analysis on global epidemiology and burden of foot fracture over three decades. Chin J Traumatol 2024:S1008-1275(24)00027-0. [PMID: 38508908 DOI: 10.1016/j.cjtee.2024.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 01/09/2024] [Accepted: 02/01/2024] [Indexed: 03/22/2024] Open
Abstract
PURPOSE To comprehensively analyze the geographic and temporal trends of foot fracture, understand its health burden by age, sex, and sociodemographic index (SDI), and explore its leading causes from 1990 to 2019. METHODS The datasets in the present study were generated from the Global Burden of Diseases Study 2019, which included foot fracture data from 1990 to 2019. We extracted estimates along with the 95% uncertainty interval (UI) for the incidence and years lived with disability (YLDs) of foot fracture by location, age, gender, and cause. The epidemiology and burden of foot fracture at the global, regional, and national level was exhibited. Next, we presented the age and sex patterns of foot fracture. The leading cause of foot fracture was another focus of this study from the viewpoint of age, sex, and location. Then, Pearson's correlations between age-standardized rate (ASR), SDI, and estimated annual percentage change were calculated. RESULTS The age-standardized incidence rate was 138.68 (95% UI: 104.88 - 182.53) per 100,000 persons for both sexes, 174.24 (95% UI: 134.35 - 222.49) per 100,000 persons for males, and 102.19 (95% UI: 73.28 - 138.00) per 100,000 persons for females in 2019. The age-standardized YLDs rate was 5.91 (95% UI: 3.58 - 9.25) per 100,000 persons for both genders, 7.35 (95% UI: 4.45 - 11.50) per 100,000 persons for males, and 4.51 (95% UI: 2.75 - 7.03) per 100,000 persons for females in 2019. The global incidence and YLDs of foot fracture increased in number and decreased in ASR from 1990 to 2019. The global geographical distribution of foot fracture is uneven. The incidence rate for males peaked at the age group of 20 - 24 years, while that for females increased with advancing age. The incidence rate of older people was rising, as younger age incidence rate declined from 1990 to 2019. Falls, exposure to mechanical forces, and road traffic injuries were the 3 leading causes of foot fracture. Correlations were observed between ASR, estimated annual percentage change, and SDI. CONCLUSIONS The burden of foot fracture remains high globally, and it poses an enormous public health challenge, with population ageing. It is necessary to allocate more resources to the high-risk populations. Targeted realistic intervention policies and strategies are warranted.
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Affiliation(s)
- Cheng Chen
- Department of Orthopedics, Tongji Hospital, School of Medicine, Tongji University, Shanghai, 200065, China
| | - Jin-Rong Lin
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Yi Zhang
- Department of Orthopedics, Tongji Hospital, School of Medicine, Tongji University, Shanghai, 200065, China
| | - Tian-Bao Ye
- Department of Cardiology, Shanghai Jiao Tong University Affiliated Sixth Peoples Hospital, Shanghai, 200233, China.
| | - Yun-Feng Yang
- Department of Orthopedics, Tongji Hospital, School of Medicine, Tongji University, Shanghai, 200065, China; Department of Orthopaedics, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200025, China.
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Pechlivanidou E, Constantas O, Kallaras E, Chatzikyriakos A, Margariti R, Sekouris N, Zogakis PN. Pediatric Ankle Fractures: Successful Remodeling and Restoration Through Comprehensive Diagnosis and Conservative Management in a Diverse Context. Cureus 2024; 16:e53547. [PMID: 38445114 PMCID: PMC10913128 DOI: 10.7759/cureus.53547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2024] [Indexed: 03/07/2024] Open
Abstract
Diagnosing toddler ankle fractures, especially those that affect several bones, can be difficult. The infrequency of such complex injuries, particularly in household environments, emphasizes the importance of increased awareness in diagnosing and managing these types of injuries. We present a compelling case study of a 20-month-old toddler of a low socioeconomic background who sustained fractures in the ankle, calcaneus, tibia, and fibula after being trapped under furniture. The diagnostic process involved trauma guidelines, radiographic assessments, and axial CT scans. Conservative management, including an eight-week plaster cast, was chosen based on the careful consideration of the child's age, the nature of the fracture, and the absence of immediate surgical indications. The follow-up period involved radiographic assessments, as well as repeated regular clinical examinations, revealing consistent alignment and the absence of complications. The successful outcome underscores the importance of a comprehensive diagnostic approach, thoughtful treatment planning, and meticulous follow-up. Individualized care, considering both clinical and socioeconomic factors, proved crucial for optimal outcomes in pediatric orthopedics. The case contributes valuable insights into the evolving landscape of early childhood orthopedics, emphasizing the need for a discerning approach to diagnosing and managing complex fractures in this population. Conservative treatment could significantly assist when absolute surgical indications are lacking both in cases of minimal resources where multiple operations are not plausible and when the patient's social history raises awareness.
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Affiliation(s)
- Evmorfia Pechlivanidou
- 1st Department of Orthopedics, P. & A. Kyriakou Children's Hospital, Athens, GRC
- Department of Hygiene, Epidemiology, and Medical Statistics, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
| | - Orestis Constantas
- 1st Department of Orthopedics, P. & A. Kyriakou Children's Hospital, Athens, GRC
| | - Evangelos Kallaras
- 1st Department of Orthopedics, P. & A. Kyriakou Children's Hospital, Athens, GRC
| | | | - Rodanthi Margariti
- 1st Department of Orthopedics, P. & A. Kyriakou Children's Hospital, Athens, GRC
| | - Nikolaos Sekouris
- 1st Department of Orthopedics, P. & A. Kyriakou Children's Hospital, Athens, GRC
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Yeramosu T, Young P, Cinats DJ, Toney CB, Satpathy J, Patel TT, Kates SL, Perdue PW. Safety of Prepping the External Fixator In Situ During Staged Internal Fixation of Pilon Fractures: A Retrospective Comparative Cohort Study. J Orthop Trauma 2023; 37:469-474. [PMID: 37053112 PMCID: PMC10524202 DOI: 10.1097/bot.0000000000002617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/07/2023] [Indexed: 04/14/2023]
Abstract
OBJECTIVE (1) To assess the rate of fracture-related infection (FRI) and unplanned reoperation of disinfecting and prepping in the external fixator (Ex-Fix) instrument during definitive open reduction and internal fixation (ORIF) of pilon fractures treated by a staged protocol and (2) to determine whether the amount of time from external fixation to ORIF influences the risk of FRI. DESIGN Retrospective cohort study. SETTING Level 1 academic trauma center. PATIENTS One hundred thirty-three patients who underwent operative treatment for pilon fracture between 2010 and 2020. INTERVENTION External fixation and ORIF with or without the Ex-Fix prepped in situ during definitive fixation. MAIN OUTCOME MEASUREMENTS FRI and unplanned reoperation rates. RESULTS 133 patients were enrolled, of which 47 (35.3%) had Ex-Fix elements prepped in situ. There was an overall infection rate of 23.3% and unplanned reoperation rate of 11.3%, and there was no significant difference in rates between the 2 cohorts. Patients with Ex-Fix elements prepped in situ who developed an FRI had a higher rate of MRSA and MSSA . Diabetes ( P = 0.0019), open fracture ( P = 0.0014), and longer (≥30 days) interval to ORIF ( P = 0.0001) were associated with postoperative FRI. CONCLUSIONS Prepping elements of the Ex-Fix in situ did not lead to an increase in rates of FRI or unplanned reoperation. Although diabetes and open fracture were associated with FRI risk, a stronger association was a longer interval of Ex-Fix utilization before definitive internal fixation, specifically 30 days or greater. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Teja Yeramosu
- Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Porter Young
- Department of Orthopaedic Surgery, Virginia Commonwealth University, Richmond, VA, USA
| | - David J. Cinats
- Department of Orthopaedic Surgery, Virginia Commonwealth University, Richmond, VA, USA
| | - Clarence B. Toney
- Department of Orthopaedic Surgery, Virginia Commonwealth University, Richmond, VA, USA
| | - Jibanananda Satpathy
- Department of Orthopaedic Surgery, Virginia Commonwealth University, Richmond, VA, USA
| | - Tejas T. Patel
- Department of Orthopaedic Surgery, Virginia Commonwealth University, Richmond, VA, USA
| | - Stephen L. Kates
- Department of Orthopaedic Surgery, Virginia Commonwealth University, Richmond, VA, USA
| | - Paul W. Perdue
- Department of Orthopaedic Surgery, Virginia Commonwealth University, Richmond, VA, USA
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Murawski CD, Mittwede PN, Wawrose RA, Belayneh R, Tarkin IS. Management of High-Energy Tibial Pilon Fractures. J Bone Joint Surg Am 2023; 105:1123-1137. [PMID: 37235679 DOI: 10.2106/jbjs.21.01377] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
➤ Pilon fractures in the younger patient population are frequently high-energy, intra-articular injuries and are associated with devastating, long-term impacts on patient-reported outcomes and health-related quality of life, as well as high rates of persistent disability.➤ Judicious management of associated soft-tissue injury, including open fractures, is essential to minimizing complications. Optimizing medical comorbidities and negative social behaviors (e.g., smoking) should be addressed perioperatively.➤ Delayed internal fixation with interval temporizing external fixation represents the preferred technique for managing most high-energy pilon fractures presenting with characteristically substantial soft-tissue trauma. In some cases, surgeons elect to utilize circular fixation for these scenarios.➤ Although there have been treatment advances, the results have been generally poor, with high rates of posttraumatic arthritis, despite expert care.➤ Primary arthrodesis may be indicated in cases with severe articular cartilage injury that, in the opinion of the treating surgeon, is likely unsalvageable at the time of the index management.➤ The addition of intrawound vancomycin powder at the time of definitive fixation represents a low-cost prophylactic measure that appears to be effective in reducing gram-positive deep surgical site infections.
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Affiliation(s)
- Christopher D Murawski
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Koetser ICJ, Espinosa Hernández EA, Kerkhoffs PDGMMJ, Goedegebuure S, Smithuis FF, Maas PDM. Don't Miss Me: Midfoot Sprains, A Point-of-Care Review. Semin Musculoskelet Radiol 2023; 27:245-255. [PMID: 37230125 DOI: 10.1055/s-0043-1767766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Athletes practicing high-contact sports are exposed to an increased risk of midfoot injuries, namely midtarsal sprains. The complexity of reaching an accurate diagnosis is clearly depicted in the reported incidence of midtarsal sprains, ranging from 5% to 33% of ankle inversion injuries. Because the focus of the treating physician and physical therapist is on lateral stabilizing structures, midtarsal sprains are missed at initial evaluation in up to 41% of patients, with delayed treatment as a result.Detecting acute midtarsal sprains requires a high degree of clinical awareness. Radiologists must become familiar with the characteristic imaging findings of normal and pathologic midfoot anatomy to avoid adverse outcomes such as pain and instability. In this article we describe Chopart joint anatomy, mechanisms of midtarsal sprains, clinical importance, and key imaging findings with a focus on magnetic resonance imaging. A team effort is essential to provide optimal care for the injured athlete.
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Affiliation(s)
- Inge C J Koetser
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers (AUMC), Amsterdam, the Netherlands
- Academic Center for Evidence-based Sports Medicine (ACES), Amsterdam, the Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), Amsterdam Movement Sciences (AMS), Amsterdam Institute Sport Sciences (AISS), Amsterdam, the Netherlands
| | - Enrique A Espinosa Hernández
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers (AUMC), Amsterdam, the Netherlands
- Academic Center for Evidence-based Sports Medicine (ACES), Amsterdam, the Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), Amsterdam Movement Sciences (AMS), Amsterdam Institute Sport Sciences (AISS), Amsterdam, the Netherlands
| | - Prof Dr Gino M M J Kerkhoffs
- Department of Orthopaedic Surgery and Sports Medicine, Amsterdam University Medical Centers (AUMC), Academic Center for Evidence-based Sports Medicine (ACES), Amsterdam, the Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), The Netherlands Amsterdam Movement Sciences (AMS), Amsterdam Institute Sport Sciences (AISS), Amsterdam, the Netherlands
| | - Simon Goedegebuure
- Department of Orthopaedic Surgery and Sports Medicine, Amsterdam University Medical Centers (AUMC), Academic Center for Evidence-based Sports Medicine (ACES), Amsterdam, the Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), The Netherlands Amsterdam Movement Sciences (AMS), Amsterdam Institute Sport Sciences (AISS), Amsterdam, the Netherlands
| | - Frank F Smithuis
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers (AUMC), Amsterdam, the Netherlands
- Academic Center for Evidence-based Sports Medicine (ACES), Amsterdam, the Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), Amsterdam Movement Sciences (AMS), Amsterdam Institute Sport Sciences (AISS), Amsterdam, the Netherlands
| | - Prof Dr Mario Maas
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers (AUMC), Amsterdam, the Netherlands
- Academic Center for Evidence-based Sports Medicine (ACES), Amsterdam, the Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), Amsterdam Movement Sciences (AMS), Amsterdam Institute Sport Sciences (AISS), Amsterdam, the Netherlands
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Yeramosu T, Satpathy J, Perdue PW, Toney CB, Torbert JT, Cinats DJ, Patel TT, Kates SL. Risk Factors for Infection and Subsequent Adverse Clinical Results in the Setting of Operatively Treated Pilon Fractures. J Orthop Trauma 2022; 36:406-412. [PMID: 34999622 PMCID: PMC9253198 DOI: 10.1097/bot.0000000000002339] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/28/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine patient-specific and injury-specific factors that may predict infection and other adverse clinical results in the setting of tibial pilon fractures. DESIGN Retrospective chart review. SETTING Level 1 academic trauma center. PATIENTS Two hundred forty-eight patients who underwent operative treatment for tibial pilon fractures between 2010 and 2020. INTERVENTION External fixation and/or open reduction and internal fixation. MAIN OUTCOME MEASUREMENTS Fracture-related infection rates and specific bacteriology, risk factors associated with development of a fracture-related infection, and predictors of adverse clinical results. RESULTS Two hundred forty-eight patients were enrolled. There was an infection rate of 21%. The 3 most common pathogens cultured were methicillin-resistant Staphylococcus aureus (20.3%), Enterobacter cloacae (16.7%), and methicillin-resistant Staphylococcus aureus (15.5%). There was no significant difference in age, sex, race, body mass index, or smoking status between those who developed an infection and those who did not. Patients with diabetes mellitus ( P = 0.0001), open fractures ( P = 0.0043), and comminuted fractures (OTA/AO 43C2 and 43C3) ( P = 0.0065) were more likely to develop a fracture-related infection. The presence of a polymicrobial infection was positively associated with adverse clinical results ( P = 0.006). History of diabetes was also positively associated with adverse results ( P = 0.019). CONCLUSIONS History of diabetes and severe fractures, such as those that were open or comminuted fractures, were positively associated with developing a fracture-related infection after the operative fixation of tibial pilon fractures. History of diabetes and presence of a polymicrobial infection were independently associated with adverse clinical results. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Teja Yeramosu
- Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Jibanananda Satpathy
- Department of Orthopaedic Surgery, Medical College of Virginia, Virginia Commonwealth University, Richmond, VA, USA
| | - Paul W. Perdue
- Department of Orthopaedic Surgery, Medical College of Virginia, Virginia Commonwealth University, Richmond, VA, USA
| | - Clarence B. Toney
- Department of Orthopaedic Surgery, Medical College of Virginia, Virginia Commonwealth University, Richmond, VA, USA
| | - Jesse T. Torbert
- Department of Orthopaedic Surgery, Medical College of Virginia, Virginia Commonwealth University, Richmond, VA, USA
| | - David J. Cinats
- Department of Orthopaedic Surgery, Medical College of Virginia, Virginia Commonwealth University, Richmond, VA, USA
| | - Tejas T. Patel
- Department of Orthopaedic Surgery, Medical College of Virginia, Virginia Commonwealth University, Richmond, VA, USA
| | - Stephen L. Kates
- Department of Orthopaedic Surgery, Medical College of Virginia, Virginia Commonwealth University, Richmond, VA, USA
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Chirvi S, Pahapill N, Yoganandan N, Curry W, Stemper B, Kleinberger M, Pintar FA. Calcaneus fracture pattern and severity: Role of local trabecular bone density. J Mech Behav Biomed Mater 2022; 134:105332. [DOI: 10.1016/j.jmbbm.2022.105332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 05/25/2022] [Accepted: 06/19/2022] [Indexed: 10/17/2022]
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8
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Kasnakova P, Mihaylova A, Djurdjev B, Tornyova B. Randomized controlled trial of multidisciplinary rehabilitation therapy using mobile applications in cases of ankle fractures. Eur J Transl Myol 2022; 32. [PMID: 35638576 PMCID: PMC9295163 DOI: 10.4081/ejtm.2022.10471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 05/07/2022] [Indexed: 11/23/2022] Open
Abstract
A multidisciplinary approach to rehabilitation in patients with ankle fractures is needed to return to their daily activities. Mobile health applications can improve or optimize the rehabilitation process. The purpose of this study is to monitor the efficiency of a modified and validated rehabilitation scheme for the functional rehabilitation of the lower limbs. The subjects of the study are patients in the post-immobilization and post-operative period. The algorithm of procedures administered to the patients were performed by physiotherapists and monitored via mobile apps. The results show a reduction of the swelling and the pain, overcoming the muscular imbalance, enhanced stabilization, correct way of walking, and an improved quality of life of the patients with ankle fractures. Despite a certain trend towards residual deficit, the implementation of kinesitherapeutic means creates the necessary background on the basis of which specialized methods can be applied - joint-mobilizing techniques and passive stretching, for the purpose of the full recovery of the functions of the lower extremity. The application of mobile apps optimizes the recovery process and increases access to rehabilitation.
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Affiliation(s)
| | | | - Boris Djurdjev
- Department of Physical and Rehabilitation Medicine, Faculty of Medicine, Medical University of Plovdiv.
| | - Biyanka Tornyova
- Department of Health Care Management, Faculty of Public Health, Medical University of Plovdiv.
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Hoebee S, Ron E, Alattar Z, Kang P, vanSonnenberg E. Assessing the Cushion Effect: A Systematic Review and Meta-Analysis of the Role of Obesity in Motor Vehicle Injuries and Fatalities. J Intensive Care Med 2021; 37:293-303. [PMID: 33663252 DOI: 10.1177/0885066621989978] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE A systematic review and meta-analysis were done to evaluate the effect of obesity in injury and mortality due to motor vehicle accidents. MATERIALS & METHODS The systematic review consisted of 20 studies meeting the inclusion criteria. The meta-analysis was conducted on these studies to analyze obesity as a risk factor for specific injuries, as well as overall injury and mortality compared to non-obese patients. RESULTS The data revealed that obesity was associated with increased lower extremity injuries (odds ratio [OR] = 1.44, 95% confidence interval [CI] = 1.19-1.69, P ≤ 0.05), neck injuries (OR = 3.38, 95% CI = 1.58-5.19, P ≤ 0.05), and overall mortality (OR = 1.51, 95% CI = 1.40-1.61, P ≤ 0.05). When stratified for obesity class with class I as BMI >30.1-34.9, class II BMI 35-39.9, and class III BMI >40, only class II (OR = 1.20, 95% CI = 1.15-1.24, P ≤ 0.05) and class III (OR = 1.49, 95% CI = 1.30-1.68, P ≤ 0.05) were associated with increased mortality risk. No significant differences were seen with head, upper extremity, thoracic, abdominal, or pelvic injuries. CONCLUSION Obesity is a risk factor in motor vehicle accidents for fatality and injury, specifically lower extremity and neck injuries.
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Affiliation(s)
- Shelby Hoebee
- University of Arizona College of Medicine-Phoenix, AZ, USA
| | - Eyal Ron
- University of Arizona College of Medicine-Phoenix, AZ, USA
| | - Zana Alattar
- University of Arizona College of Medicine-Phoenix, AZ, USA
| | - Paul Kang
- University of Arizona College of Medicine-Phoenix, AZ, USA
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GODOY-SANTOS ALEXANDRELEME, GIORDANO VINCENZO, CESAR NETTO CESARDE, SPOSETO RAFAELBARBAN, BITAR ROGÉRIOCARNEIRO, WAJNSZTEJN ANDRÉ, SAKAKI MARCOSHIDEYO, FERNANDES TÚLIODINIZ. HALLUX PROXIMAL PHALANX FRACTURE IN ADULTS: AN OVERLOOKED DIAGNOSIS. ACTA ORTOPEDICA BRASILEIRA 2020; 28:318-322. [PMID: 33328790 PMCID: PMC7723381 DOI: 10.1590/1413-785220202806236612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objectives: To describe the surgical treatment of fractures that involves the hallux interphalangeal joint, current indications and management options. Methods: we performed a literature review of relevant clinical studies in multiple databases, including PubMed, MedLine and Scopus, from January 1989 to October 2020. Results: There is consensus for surgical treatment of intra-articular fractures with a deviation greater than 2 mm, metadiaphyseal fractures with malrotation and/or malangulation, open fractures and unstable fractures. Conclusion: The use of more rigid implants allow alignment maintenance during healing process and lower risk of reduction loss. Valgus deformity and interphalangeal joint osteoarthritis are possible complications that must be avoided. Level of Evidence III, Systematic review of Level III studies.
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Walter WR, Hirschmann A, Alaia EF, Tafur M, Rosenberg ZS. Normal Anatomy and Traumatic Injury of the Midtarsal (Chopart) Joint Complex: An Imaging Primer. Radiographics 2018; 39:136-152. [PMID: 30500305 DOI: 10.1148/rg.2019180102] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The midtarsal (Chopart) joint complex consists of the talonavicular and calcaneocuboid joints and their stabilizing ligaments. Detailed assessment of this complex at MRI can be challenging owing to frequent anatomic variation and the small size of the structures involved. Nevertheless, a wide spectrum of pathologic conditions affect the joint complex, and its imaging evaluation deserves more thorough consideration. This review focuses on MRI evaluation of normal ligamentous anatomy and common variations about the Chopart joint, presenting practical imaging tips and potential diagnostic pitfalls. Imaging findings across a spectrum of traumatic Chopart joint injuries are also reviewed, from midtarsal sprains to Chopart fracture-dislocations. Midtarsal sprains-commonly associated with ankle inversion injuries-are emphasized, along with their often predictable radiographic and MRI injury patterns. Online DICOM image stacks are available for this article. ©RSNA, 2018.
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Affiliation(s)
- William R Walter
- From the Department of Radiology, Musculoskeletal Division, NYU Langone Orthopedic Hospital, 301 E 17th St, 6th Floor, New York, NY 10003 (W.R.W., E.F.A., Z.S.R.); Clinic of Radiology and Nuclear Medicine, University of Basel Hospital, Basel, Switzerland (A.H.); and Joint Department of Medical Imaging, University of Toronto, Toronto, ON, Canada (M.T.)
| | - Anna Hirschmann
- From the Department of Radiology, Musculoskeletal Division, NYU Langone Orthopedic Hospital, 301 E 17th St, 6th Floor, New York, NY 10003 (W.R.W., E.F.A., Z.S.R.); Clinic of Radiology and Nuclear Medicine, University of Basel Hospital, Basel, Switzerland (A.H.); and Joint Department of Medical Imaging, University of Toronto, Toronto, ON, Canada (M.T.)
| | - Erin F Alaia
- From the Department of Radiology, Musculoskeletal Division, NYU Langone Orthopedic Hospital, 301 E 17th St, 6th Floor, New York, NY 10003 (W.R.W., E.F.A., Z.S.R.); Clinic of Radiology and Nuclear Medicine, University of Basel Hospital, Basel, Switzerland (A.H.); and Joint Department of Medical Imaging, University of Toronto, Toronto, ON, Canada (M.T.)
| | - Monica Tafur
- From the Department of Radiology, Musculoskeletal Division, NYU Langone Orthopedic Hospital, 301 E 17th St, 6th Floor, New York, NY 10003 (W.R.W., E.F.A., Z.S.R.); Clinic of Radiology and Nuclear Medicine, University of Basel Hospital, Basel, Switzerland (A.H.); and Joint Department of Medical Imaging, University of Toronto, Toronto, ON, Canada (M.T.)
| | - Zehava S Rosenberg
- From the Department of Radiology, Musculoskeletal Division, NYU Langone Orthopedic Hospital, 301 E 17th St, 6th Floor, New York, NY 10003 (W.R.W., E.F.A., Z.S.R.); Clinic of Radiology and Nuclear Medicine, University of Basel Hospital, Basel, Switzerland (A.H.); and Joint Department of Medical Imaging, University of Toronto, Toronto, ON, Canada (M.T.)
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12
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Imaging of Chopart (Midtarsal) Joint Complex: Normal Anatomy and Posttraumatic Findings. AJR Am J Roentgenol 2018; 211:416-425. [PMID: 29927330 DOI: 10.2214/ajr.17.19310] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE The objective of this article is to review the normal anatomy and posttraumatic findings of the Chopart joint complex. Key imaging features of the normal ligaments and patterns of ligamentous and osseous injuries are discussed. CONCLUSION Traumatic midtarsal injuries, particularly midtarsal sprain, are often overlooked clinically and on imaging but are relatively common and typically are associated with inversion ankle injuries. Radiologists should be familiar with Chopart joint anatomy and the imaging features of midtarsal injuries because early diagnosis may help optimize clinical management.
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13
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Almeida RR, Mansouri M, Tso DK, Johnson AH, Lev MH, Singh AK, Flores EJ. The added value of cross-sectional imaging in the detection of additional radiographically occult fractures in the setting of a Chopart fracture. Emerg Radiol 2018; 25:513-520. [PMID: 29876712 DOI: 10.1007/s10140-018-1615-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 05/30/2018] [Indexed: 10/14/2022]
Abstract
PURPOSE Radiography has a low sensitivity for the detection of fractures related to the talonavicular and calcaneocuboid articulations, also known as Chopart fractures. The purpose of this study is to determine the sensitivity of radiographs for detecting additional foot and ankle fractures related to Chopart fracture using CT or MRI as the reference standard. METHOD We performed an IRB-approved, retrospective review of radiology reports between 2010 and 2014. Inclusion criteria were (1) diagnosis of a Chopart fracture and (2) at least one radiograph and subsequent cross-sectional imaging (CT or MR). CT or MRI was considered the diagnostic reference standard. Results were stratified by the energy of trauma and by type of radiograph performed (weight-bearing (WB) versus non-WB). RESULTS One hundred eight patients met the inclusion criteria. The calcaneocuboid articulation was the most commonly involved type of Chopart fracture, seen in 75% of cases (81/108). Chopart fractures were detected on the initial radiographs in 67.6% of cases (73/108). Additional fractures of the ankle and midfoot were diagnosed in 34.2% of cases (37/108), with 56.7% (21/37) of these cases having at least one additional fracture seen on CT or MRI that was not seen on the initial radiographs, with fractures of the midfoot most often missed. In 56.7% (17/30) patients whose radiographs detected Chopart fractures, at least one additional fracture was missed; 30% of them demonstrated intra-articular extension and 56.7% were considered displaced. High-energy trauma was related to higher incidence of additional fractures. There was no significant difference in the sensitivity of radiographs to detect additional fractures between high versus low-energy trauma (p = 0.3) and WB versus non-WB radiographs (p = 0.5). Most patients were treated nonoperatively (56.5%, 61/108), with surgical intervention more frequent in patients with a high energy of trauma (51.7% versus 33.3%, p = 0.05). CONCLUSION In the setting of a Chopart fracture, CT or MRI can add significant value in the detection of additional ankle or midfoot fractures, irrespective of the energy of trauma. Since additional fractures can have important management implications, CT or MRI should be considered as part of the standard workup for all midfoot fractures.
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Affiliation(s)
- Renata R Almeida
- Emergency Radiology, Radiology Department, Massachusetts General Hospital - Harvard Medical School, 55 Fruit St, Boston, MA, 02114, USA.
| | - Mohammad Mansouri
- Emergency Radiology, Radiology Department, Massachusetts General Hospital - Harvard Medical School, 55 Fruit St, Boston, MA, 02114, USA
| | - David K Tso
- Emergency Radiology, Radiology Department, Massachusetts General Hospital - Harvard Medical School, 55 Fruit St, Boston, MA, 02114, USA
| | - Anne H Johnson
- Foot & Ankle Center, Orthopaedics, Massachusetts General Hospital - Harvard Medical School, Boston, MA, USA
| | - Michael H Lev
- Emergency Radiology, Radiology Department, Massachusetts General Hospital - Harvard Medical School, 55 Fruit St, Boston, MA, 02114, USA
| | - Ajay K Singh
- Emergency Radiology, Radiology Department, Massachusetts General Hospital - Harvard Medical School, 55 Fruit St, Boston, MA, 02114, USA
| | - Efren J Flores
- Emergency Radiology, Radiology Department, Massachusetts General Hospital - Harvard Medical School, 55 Fruit St, Boston, MA, 02114, USA
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Acute Fracture of the Anterior Process of Calcaneus: Does It Herald a More Advanced Injury to Chopart Joint? AJR Am J Roentgenol 2018; 210:1123-1130. [DOI: 10.2214/ajr.17.18678] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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15
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JOURNAL CLUB: MRI Evaluation of Midtarsal (Chopart) Sprain in the Setting of Acute Ankle Injury. AJR Am J Roentgenol 2018; 210:386-395. [DOI: 10.2214/ajr.17.18503] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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16
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Acute plantar midtarsal dislocation with intercuneiform dislocation: Case study, diagnosis and management. J Orthop 2016; 14:26-29. [PMID: 27821997 DOI: 10.1016/j.jor.2016.10.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Accepted: 10/16/2016] [Indexed: 11/21/2022] Open
Abstract
The midtarsal joint, also known as the Chopart or the transverse tarsal joint, is composed of the talonavicular and calcaneocuboid articulations.1 Midtarsal joint dislocations are rare injuries given the strong periarticular ligamentous support.2, 3 Medial, lateral, dorsal, and rarely plantar dislocations have been reported from multiple high-energy mechanisms.4, 5 We describe the case of a 24-year-old male who sustained talonavicular and calcaneocuboid plantar dislocations associated with a middle and lateral intercuneiform dislocation, open proximal 5th metatarsal fracture, 2nd-4th metatarsal base fractures, and lateral cuneiform fracture. The mechanism of injury, diagnosis, management, operative intervention, and follow up are discussed.
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Isolated dorsal dislocations of the talonavicular and calcaneocuboid articulations (Chopart joints) from a low-energy mechanism. Am J Emerg Med 2016; 34:1733.e1-4. [DOI: 10.1016/j.ajem.2015.12.054] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 12/18/2015] [Indexed: 11/21/2022] Open
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Sharma GK, Dhillon MS, Dhatt SS. The influence of foot and ankle injury patterns and treatment delays on outcomes in a tertiary hospital; a one-year prospective observation. Foot (Edinb) 2016; 26:48-52. [PMID: 26895255 DOI: 10.1016/j.foot.2015.12.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Revised: 10/08/2015] [Accepted: 12/06/2015] [Indexed: 02/04/2023]
Abstract
BACKGROUND Ankle and foot fractures are amongst the most common injuries, and patterns may vary from primary care set up to tertiary hospitals. Severe foot injuries are projected to have significantly worse outcomes and surgical delays are thought to alter prognosis. METHODS All patients with foot and ankle trauma were prospectively evaluated at a Tertiary trauma centre over one year. The incidence, fracture patterns, risk factors, and outcomes were evaluated, and cases were divided into simple foot injuries (FASS ≤ 3) and severe foot injuries (FASS>3). Injury mechanisms, associated injuries, and delays in treatment were evaluated, and outcomes were analyzed using Visual-Analogue Scale Foot and Ankle (VASFA), Maryland Foot Score (MFS) and Foot and ankle disability index (FADI). RESULTS 294 Foot and Ankle injuries (51 females, 243 males) were encountered in 2919 trauma cases (incidence of 10%). 80 patients (27.2%) had simple foot injuries and 214 (72.8%) had severe foot injuries. 29 patients (9.9%) were below 18 years; most (65.3%) patients were between 18 and 45 years age. Road traffic accident was most commonest mode of injury, with ankle fractures (30.6%) the most common. Metatarsal fractures (27.9%) and calcaneal fractures (21.4%) were 2nd and 3rd most common injuries in the foot. Surgical delay averaged 1 day in both severe and simple injuries. Injury led to 32 (10.9%) below knee amputations. Outcome evaluation in 127 (91 severe, 36 simple injuries) patients showed mean Maryland foot score of 89.30 in simple injury group and 84.87 in severe injury group. Mean VASFA score was 82.87 (simple) and 81.87 in severe injury, and mean FADI score was 93.13 (simple) and 91.05 (severe injury). More detailed analysis revealed that more good scores (64.4%) were documented in severe injuries group, and more excellent scores (52.8%) in simple injuries group. CONCLUSION Foot injuries constitute 10% of all orthopaedic trauma at tertiary hospitals; Majority of them are severe foot injuries, with 68.7% being open injuries. Surgical delay was similar in simple and severe foot and ankle injuries. Outcomes of severe injuries were similar to simple foot and ankle injuries, reflecting on the quality of care that could be administered to them when they present to tertiary hospitals.
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Affiliation(s)
| | - M S Dhillon
- Department of Orthopaedics, PGIMER, Sector 12, Chandigarh 160012, India.
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Molina CS, Stinner DJ, Fras AR, Evans JM. Risk factors of deep infection in operatively treated pilon fractures (AO/OTA: 43). J Orthop 2015; 12:S7-S13. [PMID: 26719630 PMCID: PMC4674535 DOI: 10.1016/j.jor.2015.01.026] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2014] [Accepted: 01/27/2015] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND/AIMS The purpose of this study is to evaluate risk factors of deep infection following pilon fractures. METHODS This investigation was performed after gathering a six-year retrospective database from a single academic trauma center. RESULTS These include an overall incidence of deep infection of 16.1% (57/355). Deep infection was diagnosed at an average of 88 days (±64 days) from initial injury with a range of 10-281 days. Development of deep infection occurred in 23.2% (33/142) of open fractures, vs 11.3% (24/213) of closed fractures. CONCLUSION Open fractures, hypertension and male gender were associated with an increased risk of developing deep infection. In addition, even optimal surgical management may not significantly modify rates of deep surgical site infection.
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Affiliation(s)
- Cesar S. Molina
- Vanderbilt Department of Orthopaedic Surgery and Rehabilitation, Orthopaedic Trauma Institute, Nashville, TN 37232, United States
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20
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Shibuya N, Liu GT, Davis ML, Grossman JP, Jupiter DC. Risk Factors for Open Malleolar Fractures: An Analysis of the National Trauma Data Bank (2007 to 2011). J Foot Ankle Surg 2015; 55:94-8. [PMID: 26403573 DOI: 10.1053/j.jfas.2015.07.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Indexed: 02/03/2023]
Abstract
A limited number of studies have described the epidemiology of open fractures, and the epidemiology of open ankle fractures is not an exception. Therefore, the risk factors associated with open ankle fractures have not been extensively evaluated. The frequencies and proportions of open ankle fractures among all the recorded malleolar fractures in the US National Trauma Data Bank data set from January 2007 to December 2011 were analyzed. Clinically relevant variables captured in the data set were also used to evaluate the risk factors associated with open ankle fractures, adjusting for other covariates. The entire cohort was further subdivided into "lower" and "higher" energy trauma groups and the same analysis performed for each group separately. We found that a body mass index of >40 kg/m(2) and farm location were risk factors for open ankle fractures and impaired sensorium was protective against open ankle fractures. In the "lower energy" group, male gender, alcohol use, peripheral vascular disease, other injuries, and injury occurring at a farm location were risk factors for open fractures. In the "higher energy" group, female gender, work-related injury, and injury at a farm or industry location demonstrated statistically significantly associations with open fractures.
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Affiliation(s)
- Naohiro Shibuya
- Associate Professor, Department of Surgery, Texas A&M Health Science Center, College of Medicine, and Chief, Section of Podiatry, Surgical Services, Central Texas Veterans Affairs Health Care System, Temple, TX.
| | - George T Liu
- Assistant Professor, Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Matthew L Davis
- Associate Professor, Department of Surgery, Texas A&M Health Science Center, College of Medicine, and Director of Trauma, Baylor Scott and White Healthcare System, Central, Temple, TX
| | | | - Daniel C Jupiter
- Assistant Professor, Department of Preventive Medicine and Community Health, The University of Texas Medical Branch, Galveston, Texas
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21
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Molina CS, Stinner DJ, Fras AR, Evans JM. Course of treatment and rate of successful salvage following the diagnosis of deep infection in patients treated for pilon fractures (AO/OTA: 43). J Orthop 2015; 12:S18-24. [PMID: 26719624 DOI: 10.1016/j.jor.2015.01.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2014] [Accepted: 01/27/2015] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND/AIMS The purpose of this study is to report the rate of successful salvage and describe typical treatment course for patients with infected pilon fractures. METHODS This investigation was performed after gathering a Six-year retrospective database from a single academic trauma center including patients with pilon fractures diagnosed with post-operative deep infection. RESULTS These include a rate of successful salvage in patients diagnosed with deep infection of 88.5% (46/52). Patients who were successfully salvaged required an average of 3.5 (±2.3) procedures following diagnosis of infection, 2.5 (±1.5) debridements and 1.1 (±1.2) reconstructive procedures. CONCLUSIONS Considerable morbidity follows the diagnosis of deep infection, with 14% of patients ultimately treated with amputation. Successful salvage can be reliably anticipated in over 80% of patients, but typically requires more than 3 additional procedures.
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Affiliation(s)
- Cesar S Molina
- Vanderbilt Department of Orthopedics and Rehabilitation, Orthopedic Trauma Institute, Nashville, TN 37232, USA
| | - Daniel J Stinner
- Vanderbilt Department of Orthopedics and Rehabilitation, Orthopedic Trauma Institute, Nashville, TN 37232, USA
| | - Andrew R Fras
- Vanderbilt Department of Orthopedics and Rehabilitation, Orthopedic Trauma Institute, Nashville, TN 37232, USA
| | - Jason M Evans
- Vanderbilt Department of Orthopedics and Rehabilitation, Orthopedic Trauma Institute, Nashville, TN 37232, USA
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Shibuya N, Davis ML, Jupiter DC. Epidemiology of foot and ankle fractures in the United States: an analysis of the National Trauma Data Bank (2007 to 2011). J Foot Ankle Surg 2014; 53:606-8. [PMID: 24785202 DOI: 10.1053/j.jfas.2014.03.011] [Citation(s) in RCA: 119] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Indexed: 02/03/2023]
Abstract
Understanding the epidemiology of foot and ankle trauma could be useful in health services research and for policy makers. It can also define practice patterns. Using the National Trauma Data Bank data set from 2007 to 2011, we analyzed the frequency and proportion of each fracture in the foot and ankle in major trauma hospitals in the United States. A total of 280,933 foot and/or ankle fractures or dislocations were identified. Although oversampling of more severe trauma in younger patients might have occurred owing to the nature of the data set, we found that the most common fractures in the foot and ankle were ankle fractures. Midfoot fractures were the least common among all the foot and ankle fractures when categorized by anatomic location. Approximately 20% of all foot and ankle fractures were open.
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Affiliation(s)
- Naohiro Shibuya
- Associate Professor, Department of Surgery, Texas A&M University Health Science Center, College of Medicine, College Station, TX; Chief, Section of Podiatry, Central Texas Veterans Affairs Health Care System, Temple, TX; and Staff, Scott and White Health Care System, Temple, TX.
| | - Matthew L Davis
- Assistant Professor, Department of Surgery, Texas A&M University Health Science Center, College of Medicine, College Station, TX; and Trauma Medical Director, Scott and White Hospital Health Care System, Temple, TX
| | - Daniel C Jupiter
- Assistant Professor, Department of Preventive Medicine and Community Health, The University of Texas Medical Branch, Galveston, TX
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23
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Tadros AMA, Eid HO, Abu-Zidan FM. Epidemiology of foot injury in a high-income developing country. Injury 2010; 41:137-40. [PMID: 19570532 DOI: 10.1016/j.injury.2009.05.031] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2009] [Revised: 05/20/2009] [Accepted: 05/26/2009] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To study the epidemiology of foot injuries and factors predicting their severity in a high-income developing country so as to define prevention priorities. PATIENTS AND METHODS All patients admitted to Al-Ain Hospital with foot injury between March 2003 and March 2006 were identified from a prospectively collected Trauma Registry. Injuries were scored using foot and ankle severity scale (FASS). Bilateral, multiple or segmental injuries, open fractures or those with FASS score higher than 3 were included in severe foot injury group and compared with simple foot injury group regarding patients' demography, co-morbidities, trauma mechanism and energy, incident location, number of associated injuries, Injury Severity Score (ISS) and hospital stay using a univariate analysis. A logistic regression model was then used to study factors predicting severity of foot injury. RESULTS 171 patients (156 males) were studied. The average (range) age was 34 (2-75). 95 had right foot injury, 66 had left, and 10 had both. Fall from height was the most common mechanism. 105 (61%) had work-related injuries. 130 (76%) had isolated foot injury. 151 (88%) had 212 foot fractures. 20 (12%) had soft tissue injuries. 70 (41%) had severe injuries while 101 (59%) had simple ones. The multiple logistic model was highly significant (p=0.002). Number of associated injuries (p=0.025) and location of trauma (p=0.044) were significant while the amount of energy (p=0.054) showed a strong trend to predict severity. CONCLUSIONS Fall from height is the most common mechanism of foot injury in United Arab Emirates. The number of associated injuries, high-energy trauma, and being work related are predictors of foot injury severity. Prevention priorities include counteractions against falling from height and falling heavy objects as occupational hazards.
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Affiliation(s)
- Ayman M A Tadros
- Orthopedic Trauma Fellow, Orthopaedic Department, University of British Columbia, Vancouver General Hospital, British Columbia, Canada.
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24
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Abstract
STUDY DESIGN Experimental laboratory study supplemented by a case series. OBJECTIVES (1) To assess the effect of a 4-week intervention with a full-length insert on functional outcomes in patients with midfoot arthritis; (2) to examine the effect of the custom molded three-quarter-length (3Q) and full-length (FL) carbon graphite insert on plantar loading in patients with midfoot arthritis. BACKGROUND Given the coexistence of pain and lower-arched foot alignment in patients with midfoot arthritis, arch-restoring orthotic devices such as the 3Q insert are frequently recommended. However, patients continue to report foot pain despite using the 3Q insert. The FL insert has been proposed as an alternative, but objective data examining its efficacy are lacking. METHODS Twenty female patients with midfoot arthritis participated in the study. Functional outcomes were assessed using the Foot Function Index-Revised (FFI-R). Plantar loading during walking was measured in the following conditions: shoe only, shoe with 3Q insert, and shoe with FL insert. Repeated-measures analyses of variance with post hoc analyses were used for statistical analysis. RESULTS FL insert use for 4 weeks resulted in a 12% improvement in total FFI-R score (mean +/- SD before, 35.6 +/- 10.9; after, 31.1 +/- 9.8 [P = .03]). FL insert use resulted in a 20% reduction in medial midfoot average pressure loading (mean +/- SD, 64.8 +/- 20.4 and 51.0 +/- 15.4 kPa, with 3Q and FL insert respectively [P = .015]) and an 8.5% reduction in medial midfoot contact time (mean +/- SD, 84.9% +/- 6.4% and 76.4% +/- 7.1% of stance, with 3Q and FL insert respectively [P<.01]), compared to the 3Q insert. No differences in plantar loading were discerned between the shoe-only and FL conditions. CONCLUSION Symptomatic improvement in patients with midfoot arthritis treated with a FL insert was accompanied by reduced magnitude and duration of loading under the medial midfoot. These preliminary outcomes suggest that the FL insert may be a viable alternative in the conservative management of patients with midfoot arthritis. LEVEL OF EVIDENCE Therapy, level 4. J Orthop Sports Phys Ther 2009;39(7):522-531. doi:10.2519/jospt.2009.2900.
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25
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Abstract
Fractures and dislocations of the midfoot and Chopart complex are among the most difficult foot injuries to manage. The treating surgeon is faced with a wide array of treatment challenges. Plain radiographs often grossly underestimate the extent of injury. The anatomy in this region of the foot is quite intricate with numerous articulations. Fractures can occur in isolation or as part of a more complex injury pattern. Misdiagnosis and under treatment can lead to severe alterations of both normal anatomy and function. This article discusses the rationales and techniques for treating these difficult injuries.
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Affiliation(s)
- Michael P Swords
- Section of Orthopedics, Sparrow Health System, Mid Michigan Orthopedic Institute, Michigan State University College of Osteopathic Medicine, 830 W. Lake Lansing Suite 190, East Lansing, MI 48823, USA.
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27
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Abstract
High energy pilon fractures present a unique challenge to the patient and orthopaedic surgeon. Care for the soft tissue envelope is as important as management of this articular fracture. This article reviews the fundamental principles for treatment of the patient with severe pilon fracture. Staged operative care is emphasised to prevent wound and infectious complications which have historically plagued pilon fracture surgery. New innovations directed at improving results are discussed including biological planting and wound care using the vacuum assisted closure device. Lastly, validated outcomes are presented which highlight the severity of these injuries despite optimal care.
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28
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Marin LE, Wukich DK, Zgonis T. The surgical management of high- and low-energy tibial plafond fractures: A combination of internal and external fixation devices. Clin Podiatr Med Surg 2006; 23:423-44, vii. [PMID: 16903160 DOI: 10.1016/j.cpm.2006.01.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Fractures of the distal tibial articular surface are complex injuries that can destroy the ankle joint. This article discusses the mechanism of injury, classifications and historical means of treating these fractures, the authors' approach to treating low- and high-energy pilon fractures, prognosis, and complications.
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Affiliation(s)
- Luis E Marin
- Palmetto General Hospital, 2001 W 68th Street, Hialeah, FL 33016, USA
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29
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Smith BR, Begeman PC, Leland R, Meehan R, Levine RS, Yang KH, King AI. A mechanism of injury to the forefoot in car crashes. TRAFFIC INJURY PREVENTION 2005; 6:156-69. [PMID: 16019401 DOI: 10.1080/15389580590931635] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
OBJECTIVE The purpose of this study was to determine a mechanism of injury of the forefoot due to impact loads and accelerations as noted in some frontal offset car crashes. METHODS The impact tests conducted simulated knee-leg-foot entrapment, floor pan intrusions, whole-body deceleration, muscle tension, and foot/pedal interaction. Specimens were impacted at speeds of up to 16 m/s. To verify this injury mechanism research was conducted in an effort to produce Lisfranc type injuries and metatarsal fractures. A total of 54 lower legs of post-mortem human subjects were tested. Two possible mechanisms of injury were investigated. For the first mechanism the driver was assumed to be braking hard with the foot on the brake pedal and at 0 deg plantar flexion (Plantar Nominal Configuration) and the brake pedal was in contact with the foot behind the ball of the foot. The second mechanism was studied by having the ball of the foot either on the brake pedal or on the floorboard with the foot plantar-flexed 35 to 50 deg (Plantar Flexed Configuration). RESULTS The Plantar Nominal injury mechanism yielded few injuries of the type the study set out to produce. Out of 13 specimens tested at speeds of 16 m/s, three had injuries of the metatarsal (MT) and tarsometatarsal joints. The Plantar Flexed Configuration injury mechanism yielded 65% injuries at high (12.5-16 m/s) and moderate (6-12 m/s) speeds. CONCLUSION It is concluded that Lisfranc type foot injuries are the result of impacting the forefoot in the Plantar Flexed Configuration. The injuries were consistent with those reported by physicians treating accident victims and were verified by an orthopedic surgeon during post impact x-ray and autopsy. They included Lisfranc fractures, ligamentous disruptions, and metatarsal fractures.
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Affiliation(s)
- B R Smith
- Bioengineering Center, Wayne State University, Detroit, Michigan 48202, USA.
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Hardin EC, Su A, van den Bogert AJ. Foot and ankle forces during an automobile collision: the influence of muscles. J Biomech 2004; 37:637-44. [PMID: 15046992 DOI: 10.1016/j.jbiomech.2003.09.030] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2003] [Indexed: 11/29/2022]
Abstract
Muscles have a potentially important effect on lower extremity injuries during an automobile collision. Computational modeling can be a powerful tool to predict these effects and develop protective interventions. Our purpose was to determine how muscles influence peak foot and ankle forces during an automobile collision. A 2-D bilateral musculoskeletal model was constructed with seven segments. Six muscle groups were included in the right lower extremity, each represented by a Hill muscle model. Vehicle deceleration data were applied as input and the resulting movements were simulated. Three models were evaluated: no muscles (NM), minimal muscle activation at a brake pedal force of 400 N (MN), and maximal muscle activation to simulate panic braking (MX). Muscle activation always resulted in large increases in peak joint force. Peak ankle joint force was greatest for MX (10120 N), yet this model also had the lowest peak rearfoot force (629 N). Peak force on the Achilles tendon was 4.5 times greater, during MX (6446 N) compared to MN (1430 N). We conclude that (1). external and internal forces are dependent on muscles, (2). muscle activation level could exacerbate axial loading injuries, (3). external and internal forces can be inversely related once muscle properties are included.
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Affiliation(s)
- E C Hardin
- Department of Biomedical Engineering, The Cleveland Clinic Foundation ND-2, 9500 Euclid Avenue, Cleveland, OH 44195, USA
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Wickman AM, Pinzur MS, Kadanoff R, Juknelis D. Health-related quality of life for patients with rheumatoid arthritis foot involvement. Foot Ankle Int 2004; 25:19-26. [PMID: 14768960 DOI: 10.1177/107110070402500105] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
HYPOTHESIS Rheumatoid arthritis is a common disabling form of arthritis that frequently affects the hands and feet. With time, the majority of affected individuals will become disabled. METHODS Sixty-nine consecutively selected mild to moderately affected individuals with rheumatoid arthritis provided demographic data and agreed to complete the Short Musculoskeletal Function Assessment (SFMA) instrument. Focus group subjects selectively used minimally adaptive nonprescription footwear. Control subjects had similar disease expression, but did not alter their choice of footwear due to their disease. RESULTS Adult patients with rheumatoid arthritis demonstrate a significant negative impact on their quality of life with mild or moderate disease expression, as evidenced by poor scores in all six domains of the SFMA. Subjects who used even mildly adaptive nonprescription footwear demonstrated a statistically significant negative impact in mobility (p < .044) and functional index (p < .052) domains as compared with the control population having similar overall disease expression. Focus subjects also demonstrated a trend to less favorable scores in the arm and hand domain. Mean scores of the daily activity, emotional status, and bother index domains fared worse than population norms, but there was no statistical difference between subjects using, or not using, adaptive footwear. CONCLUSIONS Individuals affected with mild to moderate rheumatoid arthritis are disabled as compared with the general population. There is a severe negative impact on mobility and functional capacity when the disease process begins to affect their feet.
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Affiliation(s)
- Amy M Wickman
- Department of Orthopaedic Surgery & Rehabilitation, Loyola University Medical Center, 2160 South First Avenue, Maywood, IL 60153, USA
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