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Bergeron MC, Ferland J, Malay DS, Lewis SE, Burkmar JA, Giovinco NA. Use of Metatarsophalangeal Joint Dorsal Subluxation in the Diagnosis of Plantar Plate Rupture. J Foot Ankle Surg 2019; 58:27-33. [PMID: 30448184 DOI: 10.1053/j.jfas.2018.06.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Indexed: 02/03/2023]
Abstract
A dorsal drawer exam, also known as a modified Lachman's test, is a common clinical test for plantar plate insufficiency. This disorder presents as a dislocated metatarsophalangeal joint. The aim of this cadaveric case study was to quantify the degree of the plantar plate pathology necessary to correlate with a positive Lachman's test. The second metatarsophalangeal joint was tested on 18 cadaveric lower extremities. Limbs with previous digital surgery or with an obvious digital deformity were excluded from this study. A plantar linear incision over the plantar aspect of the second metatarsophalangeal joint was performed, and the flexor tendons were retracted to expose the plantar plate. After evaluating the plantar plate's integrity and measuring its width, a Lachman's test was then performed under fluoroscopy. The plantar plate was subsequently severed in a serial manner in 2-mm increments. A modified Lachman's test was performed with the different levels of rupture to assess the degree of dislocation. We found that a tear as small as 2 mm, detected in 12 (66.7%) of 18 specimens, produced gross instability in the second metatarsophalangeal joint. We also showed that a simulated plantar plate tear ≥4 mm but <6 mm resulted in joint subluxation (positive modified Lachman's test) with a sensitivity of 90.3%. This study reinforces the finding that a modified Lachman's test is a clinical exam that demonstrates high sensitivity in diagnosing plantar plate insufficiency.
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Affiliation(s)
- Marie-Christine Bergeron
- Faculty, Department of Surgery, New York College of Podiatric Medicine, New York, NY; Faculty, The Podiatry Institute, Decatur, GA.
| | - Julie Ferland
- Faculty, The Podiatry Institute, Decatur, GA; Staff Surgeon, Kosciusko Community Hospital, Warsaw, IN
| | - D Scot Malay
- Faculty, The Podiatry Institute, Decatur, GA; Staff Surgeon and Director of Podiatric Research, Penn Presbyterian Medical Center, Philadelphia, PA
| | - Sara E Lewis
- Faculty, The Podiatry Institute, Decatur, GA; Staff Surgeon and Director of Podiatric Research, Penn Presbyterian Medical Center, Philadelphia, PA; Fellow, The Southeast Permanente Medical Group, Atlanta, GA
| | | | - Nicholas A Giovinco
- Faculty, The Podiatry Institute, Decatur, GA; Resident, Dekalb Medical Center Podiatry Residency, Decatur, GA; Staff Surgeon, Piedmont Clinics Physician, Newnan, GA
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Eriksen II, Melberg HO, Bringedal B. Norwegian physicians' knowledge of the prices of pharmaceuticals: a survey. PLoS One 2013; 8:e75218. [PMID: 24040402 PMCID: PMC3770612 DOI: 10.1371/journal.pone.0075218] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2012] [Accepted: 08/13/2013] [Indexed: 11/18/2022] Open
Abstract
The objectives of this study are to measure physicians’ knowledge of the prices of pharmaceuticals, and investigate whether there are differences in knowledge of prices between groups of physicians. This article reports on a survey study of physicians’ knowledge of the prices of pharmaceuticals conducted on a representative sample of Norwegian physicians in the autumn of 2010. The importance of physicians’ knowledge of costs derives from their influence on total spending and allocation of limited health-care resources. Physicians are important drivers in the effort to contain costs in health care, but only if they have the knowledge needed to choose the most cost-effective treatment options. A survey was sent to 1 543 Norwegian physicians, asking them for price estimates and their opinions on the importance of considering the cost of treatment to society as a decision factor when treating their patients. This article deals with a subsection in which the physicians were asked to estimate the price of five pharmaceuticals: simvastatin, alendronate (Fosamax), infliximab (Remicade), natalizumab (Tysabri) and escitalopram (Cipralex). The response rate was 65%. For all the five pharmaceuticals, more than 50% and as many as 83% gave responses that differed more than 50% from the actual drug price. The price of more expensive pharmaceuticals was underestimated, while the opposite was the case for less expensive medicines. The data show that physicians in general have poor knowledge of the prices of the pharmaceuticals they offer their patients. However, the physicians who frequently deal with a drug have better knowledge of its price than those who do not handle a medication as often. The data also suggest that those physicians who agree that cost of care to society is an important decision factor have better knowledge of drug prices.
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Affiliation(s)
- Ida Iren Eriksen
- University of Oslo, Department of Health Management and Health Economics, Oslo, Norway
- * E-mail:
| | - Hans Olav Melberg
- University of Oslo, Department of Health Management and Health Economics, Oslo, Norway
| | - Berit Bringedal
- LEFO, the Institute for Studies of the Medical Profession, Oslo, Norway
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Sagsveen M, Rørtveit G. Skal legene prioritere etter kostnader eller nytte? TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2010; 130:588. [DOI: 10.4045/tidsskr.10.0173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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