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Kyung MG, Yoon YS, Kim Y, Lee KM, Lee DY, Hwang IU. Prolonged Union in Conservative Treatment of Symphalangeal Toe Fractures: Case Series. Clin Orthop Surg 2024; 16:322-325. [PMID: 38562628 PMCID: PMC10973627 DOI: 10.4055/cios23174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 10/25/2023] [Indexed: 04/04/2024] Open
Abstract
Background Toe symphalangism is characterized by a fusion of the interphalangeal joint between the middle and distal phalanges. While typical lesser toe fractures heal well with conservative treatment, in our clinical experience, we encountered patients with symphalangeal toe fractures who experienced long-lasting pain and delayed radiographic union. Therefore, this study aimed to report radiographic outcomes following conservative treatment of symphalangeal fractures of the lesser toes. Methods We retrospectively reviewed 14 patients with symphalangeal lesser toe fractures who were treated conservatively. We investigated the mechanism of injury and measured the time from the initial injury date to the complete radiographic union. The fracture gap distance was measured on an initial lateral radiograph. Results Symphalangeal fractures involved the fourth toe in 4 patients (28.5%) and the fifth toe in 10 patients (71.4%). Regarding the mechanism of injury, 6 patients (42.9%) were injured by stubbing or bumping into the door, 5 patients (35.7%) were injured by tripping, 2 patients (14.3%) were injured by heavy objects falling directly on their toes, and 1 patient (2.3%) complained of pain after wearing pointed shoes for half a day. The mean time to complete union was 9.1 months, and the median period was 5.5 months (range, 0.8-29 months). The initial gap of the fracture was 0.60 mm (range, 0.30-1.04 mm). Conclusions The results of our case series may help counsel patients in the outpatient clinic that prolonged healing time may be required for the union of symphalangeal toe fractures.
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Affiliation(s)
- Min Gyu Kyung
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea
| | - Young Sik Yoon
- Department of Orthopedic Surgery, Kangwon National University Hospital, Chuncheon, Korea
| | - Yongwoo Kim
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea
| | - Kyoung Min Lee
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Dong Yeon Lee
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Il-Ung Hwang
- Global Operations and Business Development, Seoul National University Hospital, Seoul, Korea
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Dahan E, Waitzenegger T. [Severe and complex traumatic hand]. Rev Prat 2024; 74:154-157. [PMID: 38415416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
SEVERE AND COMPLEX TRAUMATIC HAND . Serious and complex traumatic injuries of the hand are multiple tissue injuries (skin, vascular, bone and nerves), requiring urgent surgical management. They are responsible for significant functional and aesthetic sequelae. Their incidence is clearly decreasing thanks to information, prevention and security measures. The absolute emergencies are injections under pressure, amputations-devascularizations, and serious mutilations. The objective of the management is to make a functional and aesthetic hand: restoration of the opposition of the thumb with a key-pinch, a sufficient length thumb, and restoration of the sensitivity of the reconstructed hand. This calls for numerous surgical and microsurgical techniques and must be undertaken by trained teams in specialized centers.
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Affiliation(s)
- Emmanuel Dahan
- Clinique Jouvenet, Paris, France. Hôpital Ambroise-Paré, AP-HP, Boulogne-Billancourt, France
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李 学, 张 玲, 孙 长, 张 辉, 李 文. [Effectiveness of finger reconstruction using nail flap anastomosing nerve branch of the first toe nail bed]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2023; 37:1496-1500. [PMID: 38130193 PMCID: PMC10739656 DOI: 10.7507/1002-1892.202310038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 11/14/2023] [Accepted: 11/14/2023] [Indexed: 12/23/2023]
Abstract
Objective To investigate the effectiveness of finger reconstruction using nail flap anastomosing the nerve branch of the first toe nail bed. Methods Between January 2016 and December 2022, 18 patients (18 fingers) with thumb or finger nail bed defects were admitted. There were 12 males and 6 females, with an average age of 32 years (range, 19-42 years). Four cases were finger tip tissue damage caused by machine compression, and 4 cases were distal tissue necrosis after finger replantation. There were 9 cases of thumb injury, 3 cases of index finger injury, 5 cases of middle finger injury, and 1 case of ring finger injury. There were 11 cases of distal nail damage and 7 cases of distal nail root (including nail root) damage. The time from injury to admission was 1-5 hours, with an average of 2 hours. After debridement and anti-infection treatment for 5-7 days, the wounds in size of 1 cm×1 cm to 4 cm×3 cm were reconstructed by using nail flaps anastomosing the nerve branches of the first toe nail bed. The size of the nail flaps ranged from 1.5 cm×1.5 cm to 4.5 cm×3.5 cm. The donor sites were repaired with the flaps in 16 cases and skin graft in 2 cases. Results All nail flaps, flaps, and skin grafts survived after operation and the wounds healed by first intention. All patients were followed up 6-12 months (mean, 10 months). The nails of 18 cases were all grown, in which 16 cases had smooth nails with satisfactory appearances, 1 case had uneven nails, and 1 case had obvious scar hyperplasia around the suture opening. At 6 months after operation, the two-point discrimination of the skin flap was 4-8 mm (mean, 6 mm). Meanwhile, the skin grafts and flaps at the donor sites regained protective sensation, good abrasion resistance, and had no negative effect upon walking and wearing shoes. Conclusion The application of a nail flap that anastomoses the nerve branch of the first toe nail bed for finger reconstruction has minimal damage and can achieve good nail bed repair results.
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Affiliation(s)
- 学川 李
- 上海交通大学医学院附属瑞金医院烧伤科(上海 200025)Department of Burn, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, P. R. China
| | - 玲玲 张
- 上海交通大学医学院附属瑞金医院烧伤科(上海 200025)Department of Burn, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, P. R. China
| | - 长胜 孙
- 上海交通大学医学院附属瑞金医院烧伤科(上海 200025)Department of Burn, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, P. R. China
| | - 辉 张
- 上海交通大学医学院附属瑞金医院烧伤科(上海 200025)Department of Burn, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, P. R. China
| | - 文君 李
- 上海交通大学医学院附属瑞金医院烧伤科(上海 200025)Department of Burn, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, P. R. China
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Ling DI, Hannafin JA, Prather H, Skolnik H, Chiaia TA, de Mille P, Lewis CL, Casey E. The Women's Soccer Health Study: From Head to Toe. Sports Med 2023; 53:2001-2010. [PMID: 37195359 PMCID: PMC10191093 DOI: 10.1007/s40279-023-01860-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2023] [Indexed: 05/18/2023]
Abstract
OBJECTIVES Women are under-represented in the sports literature despite increasing rates of sports participation. Our objective was to investigate the risks and benefits of an elite women's soccer career in five health domains: general, musculoskeletal, reproductive endocrinology, post-concussion, and mental. METHODS An online survey was distributed to retired US college, semi-professional, professional, and national team soccer players using personal networks, email, and social media. Short validated questionnaires were used to evaluate the health domains, including the Patient-Reported Outcomes Measurement Information System (PROMIS), Single Assessment Numerical Evaluation (SANE), Post-Concussion Symptom Scale (PCSS), and Patient Health Questionnaire (PHQ). RESULTS A total of 560 eligible players responded to the survey over a 1-year period. The highest competitive levels were 73% college, 16% semi-professional, 8% professional, and 4% national team. The mean number of years since retirement was 12 (SD = 9), and 17.0% retired for involuntary reasons. The mean SANE scores (0-100 scale as percentage of normal) were knee = 75% (SD = 23), hip = 83% (SD = 23), and shoulder = 87% (SD = 21). The majority (63%) reported that their current activity level included participation in impact sports. A substantial proportion of players reported menstrual irregularities during their careers: 40% had fewer periods with increasing exercise and 22% had no periods for ≥ 3 months. The players (n = 44) who felt that post-concussion symptoms were due to soccer reported more time-loss concussions (F[2] = 6.80, p = 0.002) and symptom severity (F[2] = 30.26, p < 0.0001). Players who recently retired (0-5 years) reported the highest anxiety/depression scores and lowest satisfaction rates compared with those who retired 19+ years ago. CONCLUSION Health concerns include musculoskeletal injuries, post-concussion symptoms, and lower mental health in the early years following retirement. This comprehensive survey provides initial results that will lay the foundation for further analyses and prioritize research studies that can help all female athletes.
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Affiliation(s)
- Daphne I Ling
- Chang Gung Memorial Hospital, Taoyuan, Taiwan.
- Hospital for Special Surgery, New York, USA.
- Weill Cornell Medical College, New York, USA.
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Lee G, Kim B, Jeon N, Yoon JS, Hong KY, Han YS, Eo S. The role of reverse posterior interosseous artery (rPIA) flap in toe transfer. J Plast Reconstr Aesthet Surg 2020; 74:1355-1401. [PMID: 33309319 DOI: 10.1016/j.bjps.2020.11.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 10/19/2020] [Accepted: 11/22/2020] [Indexed: 11/18/2022]
Affiliation(s)
- GiJun Lee
- MS Jaegeon Hospital, DaeGu, South Korea
| | - BumSik Kim
- Department of Plastic and Reconstructive Surgery, DongGuk University Medical Center, DongGuk University School of Medicine, Dongguk-ro 27, IlSanDong-gu, GoYang-si, Seoul 10326, GyeongGi-do, South Korea
| | | | - Jung Soo Yoon
- Department of Plastic and Reconstructive Surgery, DongGuk University Medical Center, DongGuk University School of Medicine, Dongguk-ro 27, IlSanDong-gu, GoYang-si, Seoul 10326, GyeongGi-do, South Korea
| | - Ki Yong Hong
- Department of Plastic and Reconstructive Surgery, DongGuk University Medical Center, DongGuk University School of Medicine, Dongguk-ro 27, IlSanDong-gu, GoYang-si, Seoul 10326, GyeongGi-do, South Korea
| | - Yea Sik Han
- Department of Plastic and Reconstructive Surgery, DongGuk University Medical Center, DongGuk University School of Medicine, Dongguk-ro 27, IlSanDong-gu, GoYang-si, Seoul 10326, GyeongGi-do, South Korea
| | - SuRak Eo
- Department of Plastic and Reconstructive Surgery, DongGuk University Medical Center, DongGuk University School of Medicine, Dongguk-ro 27, IlSanDong-gu, GoYang-si, Seoul 10326, GyeongGi-do, South Korea.
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Gómez-Carlín LA, Yáñez-Solís GK, Patiño-Fernández JP, Ramírez-Gómez VJ, Valdez-Cueva V, Ortega-Orozco R. [Traumatic Turf-Toe: challenging diagnosis and controversial treatment]. Acta Ortop Mex 2020; 34:319-323. [PMID: 33634637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Turf-Toe includes a wide variety of traumatic injuries of the metatarsophalangeal joint of the first toe (MTF1). It is a potentially severe injury and there is no consensus for surgical management. The objective of this case report was to describe a patient with traumatic Turf-Toe injury grade III with a sesamoid fracture treated surgically. CLINICAL CASE 24-year-old male with motorcycle fall with hyperflexion of the MTF1 joint, presented pain, edema and functional limitation; the radiographs showed soft tissue edema, lateral displacement of lateral sesamoid with fracture. Traumatic Turf-Toe was established. The ultrasound of the MTF1 joint showed breakage of the plantar plate and collateral ligaments. Patient was surgically managed with sesamoid reduction and plantar plate repair; postoperative evolution was satisfactory. At 8 weeks the patient was assessed with the AOFAS forefoot scale, obtaining 82 points, SF-12 with 87% and VAS of two and returned to his daily activities. CONCLUSION We describe a patient with traumatic Turf Toe grade III injury, not related to sports practice; first report in the literature of the use of ultrasound in the evaluation of patients with lesion of the metatarso-phalangic joint of the first toe.
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Affiliation(s)
- L A Gómez-Carlín
- Clínica de Pie y Tobillo. Medyarthros Medicina Deportiva y Artroscopía.. México
- Centro Universitario de Ciencias de la Salud. Universidad de Guadalajara. Guadalajara, Jalisco, México
| | - G K Yáñez-Solís
- Antiguo Hospital Civil de Guadalajara «Fray Antonio Alcalde». Guadalajara, Jalisco, México
| | - J P Patiño-Fernández
- Antiguo Hospital Civil de Guadalajara «Fray Antonio Alcalde». Guadalajara, Jalisco, México
| | - V J Ramírez-Gómez
- Clínica de Pie y Tobillo. Medyarthros Medicina Deportiva y Artroscopía.. México
| | - V Valdez-Cueva
- Antiguo Hospital Civil de Guadalajara «Fray Antonio Alcalde». Guadalajara, Jalisco, México
| | - R Ortega-Orozco
- Medyarthros Medicina Deportiva y Artroscopía.. México
- Servicio de Artroscopía y Medicina Deportiva. Antiguo Hospital Civil de Guadalajara «Fray Antonio Alcalde». Guadalajara, Jalisco, México
- Centro Universitario de Ciencias de la Salud. Universidad de Guadalajara. Guadalajara, Jalisco, México
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Ratliff CR, Strider D, Rovnyak V. Quality of Life in Individuals With Peripheral Arterial Disease Who Underwent Toe Amputations: A Descriptive, Cross-sectional Study. Wound Manag Prev 2019; 65:34-40. [PMID: 30994473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
UNLABELLED Studies have shown above- or below-the-knee amputation has a profound impact on physical, mental, and emotional health; the impact of having a toe(s) amputated is unknown. PURPOSE This descriptive research study measured health-related quality of life (HRQoL) using the Vascular Quality-of-Life Questionnaire-6 (VascuQol-6) among persons with peripheral arterial disease (PAD) who had undergone toe amputations. METHODS A list of 127 patients discharged from the hospital in 2016 with a diagnosis of PAD and toe amputation was provided to the investigator. The independent variables of age (subsequently divided into groups of persons <65 and ≥65 years of age), gender, race, diabetes mellitus, and time of PAD diagnosis (within the year or 2 to 7 years before 2016) were abstracted from the patient charts. A letter was mailed to potential participants that explained the study and the VascuQol-6 tool, along with a prepaid envelope to return the completed tool. The VascuQol-6 tool is a valid and reliable instrument for assessing HRQoL that covered the different aspects of quality of life (QoL) affected by PAD. The tool contains six 4-point Likert scale questions about activity, symptoms, pain, emotional status, and social life, resulting in a total score between 6 and 24. Higher values indicate better perceived quality of life. Variables were analyzed using frequencies, percentages, means, and standard deviations, and a standard t test was used to compare interval scale items. Statistical significance was noted when P <.05. RESULTS Thirty-eight (38) completed surveys were returned (30% completion rate). The mean total score was 15.5 ± 3.93 (range 7-24), and the mean overall score of the 6 items was 2.66 ± 0.90 (range 1-4). In addition to a low overall QoL score, the data showed QoL was negatively affected in every area assessed, but some participants were strongly affected whereas others were not affected at all. No significant differences in QoL scores were noted concerning age groups, gender, race, the presence of diabetes mellitus, or time since PAD diagnosis. CONCLUSION In this study, patients with PAD and toe amputations had low QoL scores related to their disease. Additional research is needed to better understand HRQoL related to PAD to facilitate education of patients considering toe amputation.
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Affiliation(s)
| | - David Strider
- University of Virginia Health System, Charlottesville, VA
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Sherman A, Kim S, Craft W, Lewis D. Micro-arteriovenous malformation causing spontaneous metacarpal pad hemorrhage in a dog. Can Vet J 2018; 59:659-662. [PMID: 29910482 PMCID: PMC5949943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
A 5-year-old neutered male Labrador retriever dog with a 3-year history of intermittent hemorrhage from the right metacarpal pad was evaluated. A small region of hyperattenuation of the metacarpal pad was evident on computed tomographic angiography. Excisional biopsy of the location of the purported hemorrhage revealed a micro-arteriovenous malformation on histologic examination.
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Affiliation(s)
- Alec Sherman
- Matthew J. Ryan Veterinary Hospital, University of Pennsylvania School of Veterinary Medicine, Philadelphia, Pennsyvania 19104, USA (Sherman); University of Florida - Small Animal Clinical Sciences, Gainesville, Florida 32608, USA (Kim, Craft, Lewis)
| | - Stanley Kim
- Matthew J. Ryan Veterinary Hospital, University of Pennsylvania School of Veterinary Medicine, Philadelphia, Pennsyvania 19104, USA (Sherman); University of Florida - Small Animal Clinical Sciences, Gainesville, Florida 32608, USA (Kim, Craft, Lewis)
| | - William Craft
- Matthew J. Ryan Veterinary Hospital, University of Pennsylvania School of Veterinary Medicine, Philadelphia, Pennsyvania 19104, USA (Sherman); University of Florida - Small Animal Clinical Sciences, Gainesville, Florida 32608, USA (Kim, Craft, Lewis)
| | - Daniel Lewis
- Matthew J. Ryan Veterinary Hospital, University of Pennsylvania School of Veterinary Medicine, Philadelphia, Pennsyvania 19104, USA (Sherman); University of Florida - Small Animal Clinical Sciences, Gainesville, Florida 32608, USA (Kim, Craft, Lewis)
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van Meurs A, Korpershoek M, van Herwaarden-Lindenboom M. Female Infant With Toe Swelling. Ann Emerg Med 2016; 67:785-796. [PMID: 27217130 DOI: 10.1016/j.annemergmed.2015.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Indexed: 11/19/2022]
Affiliation(s)
- Andrea van Meurs
- Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Marieke Korpershoek
- Department of Pediatrics, University Medical Center Utrecht, Utrecht, the Netherlands
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Abstract
Children begin ballet lessons as young as age 2 years. The graceful movements of classical ballet require a combination of artistry, flexibility, and strength to perform. During the training and development of a young ballerina, the transition to dancing en pointe ("on the toes") represents a significant milestone and traditionally begins around age 11 or 12 years, assuming the proper training background and dance aspirations. However, current dance medicine literature describes factors such as maturity, proper technique, strength, and postural control as the more significant factors in determining pointe readiness. An in-office evaluation of these factors can be performed by the clinician to assist dancers, their family, and their dance instructor(s) determine pointe readiness.
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Abstract
Hair tourniquet syndrome is a rare condition. It is an important emergency condition where urgent attention is needed. In this condition, body appendages are strangulated by hair that acts like a tourniquet. A strand or strands of hair act like a circumferential constriction band and subsequently strangulate the body appendages. Commonly affected sites include fingers, toes or even genitals. Failure to identify and release the acute constriction may result in amputation of affected body part. We report two cases of hair tourniquet syndrome of the thumb and toe that were successfully released without complications.
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Borenstein TR, Johnson JP, Cohen B, Kane P. High-Pressure Injection to the Great Toe with River Water. R I Med J (2013) 2015; 98:38-41. [PMID: 26517255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
CASE A 53-year-old male sustained a high-pressure water injection injury to his foot while working in a river. He was taken to the operating room for emergent irrigation and debridement of copious riverbed sediment. Cultures taken from the operating room were positive for multiple anaerobes, fungus and mold and he was treated with appropriate antibiotics. To date, his only residual deficit is a 1 cm area of numbness at the entrance wound. CONCLUSION High-pressure water injections to the foot are uncommon injuries. These are serious injuries that require emergent antibiotics, tetanus and surgical debridement.
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Affiliation(s)
- Todd R Borenstein
- Department of Orthopedics, Warren Alpert Medical School, Brown University, Providence, RI
| | - Joey P Johnson
- Department of Orthopedics Warren Alpert Medical School, Brown University, Providence, RI
| | - Brian Cohen
- Department of Orthopedics Warren Alpert Medical School, Brown University, Providence, RI
| | - Patrick Kane
- Department of Orthopedics, Clinical Instructor, Warren Alpert Medical School, Brown University, Providence, RI
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Abstract
BACKGROUND Surgery on fingers is a common procedure in emergency and day care surgery. Adrenaline combined with lidocaine can prolong digital nerve block and provide a bloodless operating field. Extended postoperative pain relief can reduce the need for analgesics and can facilitate hand rehabilitation. Conventionally, adrenaline is avoided at anatomical sites with end arteries such as digits, penis and pinna because of concerns about arterial spasm, ischaemia and gangrene distal to the site of drug infiltration. OBJECTIVES To assess the safety and efficacy of use of adrenaline (any dilution) combined with lidocaine (any dilution) for digital nerve blocks (fingers and toes). SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL, Issue 11, 2014), MEDLINE via Ovid SP (1966 to 18 November 2014) and EMBASE via Ovid SP (1980 to 18 November 2014). We also searched specific websites, such as www.indmed.nic.in; www.cochrane-sadcct.org; and www.Clinicaltrials.gov. SELECTION CRITERIA We included randomized controlled trials (RCTs) that compared the use of adrenaline with lidocaine and plain lidocaine in patients undergoing surgery on digits (fingers and toes). Our primary outcomes were duration of anaesthesia, adverse outcomes such as ischaemia distal to the injection site and cost analysis. Our secondary outcomes were duration of postoperative pain relief and reduced bleeding during surgery. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by The Cochrane Collaboration. Two review authors independently extracted details of trial methodology and outcome data from reports of all trials considered eligible for inclusion. We performed all analyses on an intention-to-treat basis. We used a fixed-effect model when no evidence of significant heterogeneity between studies was found and a random-effects model when heterogeneity was likely. MAIN RESULTS We included four RCTs with 167 participants. Risk of bias of the included studies was high, as none of them reported method of randomization, allocation concealment or blinding. Only one trial mentioned our primary outcome of duration of anaesthesia. The mean difference in duration of anaesthesia with use of adrenaline with lidocaine was 3.20 hours (95% confidence interval (CI) 2.48 to 3.92 hours; one RCT, 20 participants; low-quality evidence). No trial reported adverse events such as ischaemia distal to the injection site, and no trial reported cost analysis. One trial mentioned the secondary outcome of duration of postoperative pain relief, but available data were insufficient for analysis of the findings. Two trials reported the secondary outcome of reduced bleeding during surgery.Bleeding during surgery was observed in nine out of 52 participants as compared with 25 out of 51 participants in the adrenaline with lidocaine and plain lidocaine groups, respectively. The risk ratio for bleeding in the adrenaline with lidocaine group was 0.35 (95% CI 0.19 to 0.65; two RCTs, 103 participants; low-quality evidence). AUTHORS' CONCLUSIONS From the limited data available, evidence is insufficient to recommend use or avoidance of adrenaline in digital nerve blocks. The evidence provided in this review indicates that addition of adrenaline to lidocaine may prolong the duration of anaesthesia and reduce the risk of bleeding during surgery, although the quality of the evidence is low. We have identified the need for researchers to conduct large trials that focus on other important outcomes such as adverse events, cost analysis and duration of postoperative pain relief.
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Affiliation(s)
- Hemanshu Prabhakar
- Department of Neuroanaesthesiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India, 110029
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Abstract
This article includes the etiology and pathophysiological data of each entity, classifying them as dermatologic, systemic, infectious, neoplastic, traumatic, and other classifications. The entities inherent to the periungual folds are also included, such as acute paronychia, chronic paronychia, retronychia, hangnails, hematomas of the proximal fold caused by oximeter, onychocryptosis, hypertrophy of the lateral folds, and infections caused by Candida albicans, Pseudomonas, and Staphylococcus aureus. Additionally, pathologies caused by diabetes mellitus, sepsis, endocarditis, drug reactions, and finally less frequent diseases that also affect the nail folds are discussed.
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Affiliation(s)
- Patricia Chang
- Dermatology Service Social Security General Hospital - IGSS, 9ª. Street 7-55, Zone 9, Guatemala City 01009, Guatemala.
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Jellinek NJ, Daniel CR. Narrow-toed shoes and the toe-to-toe sign. Cutis 2014; 94:E1. [PMID: 25279481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Kemper TCPM, de Jong VM, Anema HA, van den Brink A, van Hulst RA. Frostbite of both first digits of the foot treated with delayed hyperbaric oxygen:a case report and review of literature. Undersea Hyperb Med 2014; 41:65-70. [PMID: 24649719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Frostbite is an uncommon event that can occur from exposure to temperatures below -4 degrees C and can lead to potential serious tissue damage and necrosis. This in turn can result in debilitating amputations in otherwise healthy people. The pathophysiological mechanisms of frostbite have marked similarities to those seen in thermal burns, ischemia/reperfusion injuries and crush injuries--i.e., non-healing wounds and inflammatory processes. These injuries are commonly treated with hyperbaric oxygen therapy. OBJECTIVES Evidence for treating frostbite with hyperbaric oxygen (HBO2) is scarce, and to date HBO2 is not a standard addition in the multidisciplinary care of freezing injuries. We aim to contribute to the available evidence with a case report and review the literature to reassess the multidisciplinary treatment of frostbite injuries. CASE REPORT AND REVIEW OF LITERATURE We present a case report of a woman with deep frostbite of the toes treated with hyperbaric oxygen therapy, after a delay of 21 days, with good results. No surgical intervention was needed. A literature search revealed 17 human case reports on frostbite and four animal studies in which hyperbaric oxygen was applied. All case reports showed positive effects, and in none of the cases was amputation necessary. In the animal studies, two showed significant positive results regarding tissue loss and reduction of inflammatory markers, whereas two did not. CONCLUSIONS Based on our case report as well as the literature and the mechanisms of hyperbaric oxygen, we make the recommendation that this therapy be considered as an addition to the multidisciplinary treatment of frostbite, even after significant delay of treatment.
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Moore EP, Strout TD, Saucier JR. Crying infant with painful toes. J Fam Pract 2012; 61:675-677. [PMID: 23256099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Our patient's sleepless parents sought care for their infant's mysteriously injured toes.
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Affiliation(s)
- Elisabeth P Moore
- Department of Emergency Medicine, Maine Medical Center, Portland, ME, USA
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Armed Forces Health Surveillance Center (AFHSC). Surveillance snapshot: Traumatic amputations among female service members, active and reserve components, U.S. Armed Forces, 2000-2011. MSMR 2012; 19:23. [PMID: 22876805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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19
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Abaeva IK. [Tourniquet syndrome in children]. Vestn Khir Im I I Grek 2012; 171:105-108. [PMID: 22774566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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20
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Lykissas MG, Koulouvaris P, Kostas-Agnantis I, Gkiatas I, Milionis HJ, Mavrodontidis AN. Snakebites of fingers or toes by viperidae family members: an orthopaedic approach. Acta Orthop Belg 2011; 77:246-251. [PMID: 21667738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The purpose of this study was to review current principles of therapy for affected patients and determine whether an emergent surgical approach or expectant management should be selected in cases of snakebites of fingers or toes by Viperidae family members. Over the past five years (January 2004 to December 2009), 12 patients bitten by Vipera ammodytes were admitted in our department. We retrospectively reviewed their demographic and epidemiological characteristics as well as their symptoms, laboratory findings, and complications. All snake bites occurred at the extremities (fingers and toes). The main complications were oedema, disseminated intravascular coagulation, and decrease in haematocrit. None of the patients developed compartment syndrome or required surgical debridement. The majority of the patients with snakebites of fingers or toes by Vipera ammodytes can be treated conservatively. Surgery is indicated only in case of compartment syndrome, where fasciotomies should be performed without delay after diagnosis.
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Affiliation(s)
- Marios G Lykissas
- Department of Orthopaedic Surgery, School of Medicine, University of Ioannina, Ioannina, Greece.
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21
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Health tips. Care for an injured toe. Mayo Clin Health Lett 2010; 28:3. [PMID: 20925156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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23
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Lamont T, Watts F, Stanley J, Scarpello J, Panesar S. Reducing risks of tourniquets left on after finger and toe surgery: summary of a safety report from the National Patient Safety Agency. BMJ 2010; 340:c1981. [PMID: 20410165 DOI: 10.1136/bmj.c1981] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Tara Lamont
- National Reporting and Learning Service, National Patient Safety Agency, London W1T 5HD.
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Rehman H, Seguin A. Images in clinical medicine: Frostbite. N Engl J Med 2009; 361:2461. [PMID: 20018967 DOI: 10.1056/nejmicm0801077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Habib Rehman
- Regina Qu'Appelle Health Region, Regina, SK, Canada
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25
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Senanayake SMHMK. Driver's injury pattern; ex-articulation of right big toe nail. Ceylon Med J 2009; 50:171. [PMID: 16538916 DOI: 10.4038/cmj.v50i4.1413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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26
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Jiao YF, Wang HQ, Li YS. [Reverse second dorsal metatarsal artery island flap for repairing the soft tissue defect at toes]. Zhonghua Zheng Xing Wai Ke Za Zhi 2009; 25:427-429. [PMID: 20209932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To report the application of reverse second dorsal metatarsal artery island flap for From May 2005 to September 2008, 5 cases with soft tissue repairing the soft tissue defect at toes. METHODS defects at toes were treated with reverse second dorsal metatarsal artery island flaps. The flaps size ranged from 2 cm x 3 cm to 5 cm x 6 cm. RESULTS All the 5 flaps survived completely. The patients could walk 1-2 months after operation. The patients were followed up for 5-7 months with good appearance, texture and sensation of toes. CONCLUSION The reverse second dorsal metatarsal artery island flap has a reliable blood supply and good tissue texture. It is a practical method for repairing the soft tissue defect at toes.
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Affiliation(s)
- Yu-feng Jiao
- The Central Hospital of Feicheng Mine Company, Feicheng 271608 , China
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Rubio AM, Trigoso CS, Hernández NM. [Patient's comfort during cicatrization and wound protection process due to the use of Nobecutan plastic dressing administered by an aerosol]. Rev Enferm 2009; 32:16-20. [PMID: 20069954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
This report received the 2009 Nobecutan Nursing Prize. Born to Protect. This is a study which proposes to evaluate the comfort level patients perceive when they apply the Nobecutan transparent dressing administered by an aerosol. Dressing composition: plastic composed by a 4% acrylic co-polymer, 42.98% ethyl acetate, Tetramethylthiuram disulfide 0,02% and dimethyl 53%. Characteristics: *Micro-porous, prevents maceration of the skin. *Impervious to water and micro-organisms. *Easy to use as a aerosol which upon spraying an area, forms a thin film which permits transparency over a wound and therefore constant visual control; plus this film prevents allergic reactions.
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Yoshino N, Watanabe N, Fujita N, Fukuda Y, Yamashita T, Fujiwara H. Boutonniere deformity of the second toe after planter dislocation of proximal interphalangeal joint: a case report. Arch Orthop Trauma Surg 2009; 129:1527-9. [PMID: 19169694 DOI: 10.1007/s00402-009-0816-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2008] [Indexed: 11/26/2022]
Abstract
The boutonniere deformity is a well-known deformity in the fingers, however, its appearance on a lessor toe is extremely rare. In the present case, the deformity resulted from a rupture of the central slip of the extensor tendon and the shift of the lateral bands to the planter side after reduction of a traumatic planter dislocation of the PIP joint of the second toe. Surgical repair of the extensor mechanism brought good results.
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Affiliation(s)
- Nobuyuki Yoshino
- Department of Orthopaedic Surgery, Kyoto Kujo Hospital, Karahashi Rajomoncho 10, Kyoto, Japan.
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Claudet I, Pasian N, Debuisson C, Salanne S, Rekhroukh H. Tourniquet syndrome: interest of a systematic analysis of families' social conditions to detect neglect situations. Child Abuse Negl 2009; 33:569-572. [PMID: 19811829 DOI: 10.1016/j.chiabu.2009.03.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2008] [Revised: 11/20/2008] [Accepted: 03/02/2009] [Indexed: 05/28/2023]
Affiliation(s)
- Isabelle Claudet
- Pediatric Emergency Department, Children Hospital, 330, avenue de Grande Bretagne, TSA 70034, 31059 Toulouse Cedex 09, France
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Wolff GA, Posso C. One case of big-toe re-plantation: a 13-year follow-up and a literature review. J Plast Reconstr Aesthet Surg 2009; 63:838-40. [PMID: 19427827 DOI: 10.1016/j.bjps.2009.01.064] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2008] [Revised: 01/17/2009] [Accepted: 01/31/2009] [Indexed: 11/17/2022]
Abstract
In this case of a 3-year-old patient who had a left big-toe amputation through the proximal phalange, re-plantation was performed successfully. Big-toe amputations are not frequent entities, but it should always be re-planted to avoid unsatisfactory aesthetic and functional outcomes. There are just a few reports in literature and their follow-up is very brief compared with our report.
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Weigert M, Hüsing U, Püschel E. [The polyurethane shoe -- a new possibility in the treatment of the toe and metatarsal fractures (author's transl)]. Z Orthop Ihre Grenzgeb 2008; 118:137-9. [PMID: 7424100 DOI: 10.1055/s-2008-1051483] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The problem of supporting casts in the treatment of metatarsal and toe fractures is discussed. A therapeutic enrichment is given by a new polyurethane cast, the so-called PU-shoe, which can even be worn in a little wider than normal ready-made shoe. The proedure is demonstrated with some clinical examples.
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Zhang Z, Liu J, Meng G, Wu Y. [Preventing effect of TGF-beta1 antibody compounded with fibrin glue on postoperative adhesions of flexor tendon]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2008; 22:349-353. [PMID: 18396720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVE To explore the preventing effects of TGF-beta1 antibody (TGF-beta1Ab) compounded with fibrin glue (FG) on postoperative adhesions of flexor tendon. METHODS Seventy-two Leghorn chickens were randomly divided into 4 groups (groups A, B, C and D), 18 chickens for each group, and the long flexor tendons of the 3rd and 4th toes in zone II of all chickens were transversed and sutured with the 4-strand cruciate repair technique to make defect models. In group A, 0.2 mL TGF-beta1 Ab was applied at repair site. In group B, 0.2 mL FG was applied at repair site. In group C, 0.2 mL TGF-beta1Ab and FG was applied at repair site. In group D, 0.2 mL normal sodium was applied at repair site. At 1, 3 and 8 weeks after operation, the tendons of 6 chickens in each group were harvested for morphological and histological evaluation. Six specimens of each group were obtained for biomechanical test at 3 and 8 weeks. RESULTS The gross-observation showed that the differences in grading of tendon adhesion were not significant among 4 groups at 1 week after operation (P > 0.05), but the differences were significant between groups A, B, D and group C at 3 and 8 weeks after operation (P < 0.05). Histological observation showed that collagen fibers arranged irregularly in groups A, B and D, but arranged regularly in group C at 3 and 8 weeks' after operation. At 3 weeks after operation the gliding excursion ratio of the tendon in groups A, B, C and D were 0.45 +/- 0.05, 0.40 +/- 0.10, 0.79 +/- 0.09 and 0.25 +/- 0.07 respectively; the simulated active flexion ratio were 0.61 +/- 0.02, 0.67 +/- 0.03, 0.91 +/- 0.03 and 0.53 +/- 0.04 respectively; the work of flexion were (18.00 +/- 0.77), (17.80 +/- 1.13), (27.60 +/- 1.73) and (15.60 +/- 1.27) degrees/N respectively. There were significant differences between group C and other three groups (P < 0.05). The tendon anastomosis breaking strength were (14.2 +/- 1.9), (15.2 +/- 2.2), (16.0 +/- 2.2) and (14.7 +/- 2.7) N, showing no significant differences among 4 groups (P > 0.05). At 8 weeks after operation, the gliding excursion ratio of the tendon in groups A, B, C and D were 0.45 +/- 0.07, 0.43 +/- 0.08, 0.80 +/- 0.09 and 0.29 +/- 0.05 respectively; the simulated active flexion ratio were 0.61 +/- 0.02, 0.63 +/- 0.03, 0.92 +/- 0.03 and 0.53 +/- 0.03 respectively, the work of flexion were (18.30 +/- 0.84), (18.60 +/- 0.80), (27.90 +/- 1.24) and (15.30 +/- 0.75) degrees/N respectively. There were significant differences between group C and other three groups (P < 0.05). The tendon anastomosis breaking strength were(51.9 +/- 3.0), (51.4 +/- 1.4), (53.3 +/- 1.3) and (52.3 +/- 2.2) N, showing no significant differences among 4 groups (P > 0.05). CONCLUSION TGF-beta1Ab compounded with FG could significantly prohibit the formation of fibrous adhesions without interfering with the healing process.
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Affiliation(s)
- Zhimin Zhang
- Department of Orthopaedics, Xijing Hospital of Fourth Military Medical University, Xi'an Shaanxi, 710032, P. R. China
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King B. Toe bandaging to prevent and manage oedema. Nurs Times 2007; 103:44-47. [PMID: 17993118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Toe oedema is more commonly associated with lymphoedema but is frequently seen in patients with venous hypertension. In the long-term it leads to toe deformity and it is essential that the problem is managed. Brenda King outlines how to apply toe bandages and the long-term management once the problem is resolved.
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Affiliation(s)
- Anna L Waterbrook
- Department of Emergency Medicine, Maine Medical Center, 321 Brackett Street, Portland, ME 04102, USA.
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Guo M, Zhang J, Tian D. [An effect of 5-fluorouracil on tendon adhesion formation after flexor tendon repair in chickens]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2007; 21:842-6. [PMID: 17882881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
OBJECTIVE To assess an effect of 5-fluorouracil (5-FU) applied topically on the tendon adhesion and the healing process after the flexor tendon repair in Leghorn chickens. METHODS Thirty-two white Leghorn chickens, aged 4 months and weighing 1.5-1.7 kg, were randomly divided into 2 groups: Group A and Group B, with 16 chickens in each group. The flexor digitorum profundus tendons of the 2nd, 3rd and 4th toes were transected and repaired. The repair site in Group A was given 5-FU in a concentration of 25 mg/ml with a soaked sponge that was cut into pieces 7 mm X 20 mm x 1 mm in size, and the synovial sheath of the repair site was wrapped with the 5-FU-soaked sponge for 1 min for 4 times. The repair site in Group B was served as a control, with no 5-FU but with the sterile normal saline. At 3 and 6 weeks postoperatively, the repaired tendons and the tendon adhesion formation were examined macroscopically and histologically, and the repaired tendons were tested biomechanically. The tissue blocks from the tendon repair site were examined under the transmission electron microscope. RESULTS At 3 and 6 weeks postoperatively, the macroscopic and histological observation showed that the peritendinous adhesions in Group A were looser when compared with those in Group B. The length of the tendon gliding and the extent of yieldance to exercise were found to be 4.85+/-1.31 mm, 0.67+/-0.42 mm and 5.74+/-1.61 mm, 1.55+/-0.35 mm respectively at 3 and 6 weeks after operation in Group A,but 2. 99+/-0.51 mm,0.24+/-0.14 mm and 3.65+/-0.54 mm, 1.22+/-0.16 mm in Group B. Group A was significantly greater in the above-mentioned parameters than Group B (P<0.05). At 3 weeks after operation, the ultimate breaking strength was 20.28 +/- 4.92 N in Group A and 21.29 +/- 4.88 N in Group B, with no statistically significant difference found between the two groups (P>0.05). At 6 weeks, the ultimate breaking strength was 47.12+/-6.76 N in Group A but 39. 31 +/- 7.20 N in Group B, with a significant difference between the two groups (P < 0.05). CONCLUSION 5-fuorouracil, when applied topically, can reduce the tendon adhesion, with no inhibition of the intrinsic healing mechanism. It is an ideal treatment strategy to prevent peritendinous adhesion.
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Affiliation(s)
- Mingke Guo
- Department of Orthopedics, 260th Hospital of PLA, Shijiazhuang Hebei, China.
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Lescun TB, McClure SR, Ward MP, Downs C, Wilson DA, Adams SB, Hawkins JF, Reinertson EL. Evaluation of transfixation casting for treatment of third metacarpal, third metatarsal, and phalangeal fractures in horses: 37 cases (1994-2004). J Am Vet Med Assoc 2007; 230:1340-9. [PMID: 17472561 DOI: 10.2460/javma.230.9.1340] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate clinical findings, complications, and outcome of horses and foals with third metacarpal, third metatarsal, or phalangeal fractures that were treated with transfixation casting. DESIGN Retrospective case series. Animals-29 adult horses and 8 foals with fractures of the third metacarpal or metatarsal bone or the proximal or middle phalanx. PROCEDURES Medical records were reviewed, and follow-up information was obtained. Data were analyzed by use of logistic regression models for survival, fracture healing, return to intended use, pin loosening, pin hole lysis, and complications associated with pins. RESULTS In 27 of 35 (77%) horses, the fracture healed and the horse survived, including 10 of 15 third metacarpal or metatarsal bone fractures, 11 of 12 proximal phalanx fractures, and 6 of 8 middle phalanx fractures. Four adult horses sustained a fracture through a pin hole. One horse sustained a pathologic unicortical fracture secondary to a pin hole infec-tion. Increasing body weight, fracture involving 2 joints, nondiaphyseal fracture location, and increasing duration until radiographic union were associated with horses not returning to their intended use. After adjusting for body weight, pin loosening was associated with di-aphyseal pin location, pin hole lysis was associated with number of days with a transfixation cast, and pin complications were associated with hand insertion of pins. CONCLUSIONS AND CLINICAL RELEVANCE Results indicated that transfixation casting can be successful in managing fractures distal to the carpus or tarsus in horses. This technique is most suitable for comminuted fractures of the proximal phalanx but can be used for third metacarpal, third metatarsal, or middle phalanx fractures, with or without internal fixation.
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Affiliation(s)
- Timothy B Lescun
- Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Purdue University, West Lafayette, IN 47907-1248, USA
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Abstract
Hair-thread tourniquet syndrome is a rare condition where appendages are strangulated by an encircling strand of hair, a thread, or a fiber. The condition usually occurs in very young patients in the first few months of life. We present a unique case of a 3-month-old baby girl with hair-thread tourniquet syndrome in whom a hair cheese-wired through the skin and soft tissue of the toe and caused bony erosion of the underlying phalanx. An extensive literature review and meta-analysis of the topic are also presented.
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Affiliation(s)
- Arman Z Mat Saad
- Department of Plastic, Reconstructive and Hand Surgery, University College Hospital, Galway, Ireland.
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Daniel CR, Iorizzo M, Tosti A, Piraccini BM. Ingrown toenails. Cutis 2006; 78:407-8. [PMID: 17243428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Ingrown toenails are common, especially in young patients. Several predisposing factors contribute to the formation of an irregular sharp edge (spicule) of the lateral nail plate that penetrates and injures the soft tissue of the lateral nail fold. Depending on the severity of the disease, treatment varies from simple disembedding of the spicule to phenolization of the lateral nail matrix. This article provides a step-by-step guide to the management of patients with ingrown toenails.
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Affiliation(s)
- C Ralph Daniel
- Department of Dermatology, University of Mississippi Medical Center, Jackson, USA
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Hemady N. Growing plantar lesion following trauma. Am Fam Physician 2006; 74:1173-4. [PMID: 17039755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Affiliation(s)
- Nikhil Hemady
- North Oakland Medical Center, Pontiac, Michigan, USA
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Affiliation(s)
- Hilary R Umans
- Albert Einstein College of Medicine, Division of Musculoskeletal Radiology, Jacobi Medical Center, Bronx, New York 10461, USA.
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Abstract
The biphalangeal little toe is an anatomical anomaly that has been previously well described in the early anatomical literature. But, as is the case with many anomalies, there is a lack of awareness of it amongst current clinicians. We report the case of a fracture through the distal phalanx of the little toe, with a delay in the diagnosis due to confusion over the X-ray findings. X-rays revealed a biphalangeal toe with a fracture through the distal phalanx, which mimicked the usual triphalangeal toe. This is the first reported case of clinical confusion over this anatomical variation. A review of 102 human skeletal feet at the Department of Anatomy, University of Melbourne, was performed to evaluate the frequency of the biphalangeal little toe variant, revealing an incidence of 26%.
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Affiliation(s)
- Warren Matthew Rozen
- Department of Anatomy, The University of Melbourne, Parkville, Victoria, Australia.
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Joyce J, Baxter GM, Sarrafian TL, Stashak TS, Trotter G, Frisbie D. Use of transfixation pin casts to treat adult horses with comminuted phalangeal fractures: 20 cases (1993–2003). J Am Vet Med Assoc 2006; 229:725-30. [PMID: 16948586 DOI: 10.2460/javma.229.5.725] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine the clinical applications, short and long-term survival, and complications of using transfixation pin casts for treatment of comminuted phalangeal fractures in adult horses. DESIGN Retrospective case series. ANIMALS 20 horses. PROCEDURES Medical records were reviewed to obtain information regarding signalment, fracture location, treatment methods, complications, and short-term survival (discharge from hospital). Long-term follow-up information was obtained via contact with owners or trainers. RESULTS 12 fractures were in a hind limb, and 8 were in a forelimb. Fourteen fractures occurred in a middle phalanx, and 6 occurred in a proximal phalanx. Eleven fractures were treated with internal fixation combined with transfixation pin casts, and 9 fractures were treated with transfixation pin casts alone. Transfixation pin casts were maintained for a mean of 52 days (median, 49 days; range, 1 to 131 days). Fourteen (70%) horses were discharged from the hospital, whereas 6 (30%) were euthanized during the treatment period. Reasons for euthanasia included secondary fracture of the third metacarpal or metatarsal bone, avascularity of the distal aspect of the limb associated with an open fracture, and displacement of the fracture after transfixation pin cast removal. A significantly greater number of horses was discharged from the hospital when the transfixation pin cast was maintained for > 40 days, compared with those in which the transfixation pin cast was maintained for < 40 days. CONCLUSIONS AND CLINICAL RELEVANCE Results suggested that horses should be maintained in a transfixation pin cast for a minimum of 40 days, as this was associated with an increase in short-term survival without an increased risk of catastrophic failure.
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Affiliation(s)
- Jolynn Joyce
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, 80523-1620, USA
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Dupuy O, Garrabé E, Bordier L, Boyer B, Goasguen O, Mayaudon H, Bauduceau B. [Pasteurella dagmatis spondylodiscitis in a diabetic patient]. Rev Med Interne 2006; 27:803-4. [PMID: 16978746 DOI: 10.1016/j.revmed.2006.05.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2006] [Accepted: 05/31/2006] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Healthy pets contact are able to induce unusual and severe diseases. CLINICAL CASE This case reports the medical history of a dorsal spondylodiscitis in a diabetic patient admitted for a chronic wound of his toes. He had a long-standing history of regular consumption of alcohol and tobacco. Blood bottles and biopsy of intervertebral disc infected discovered Pasteurella dagmatis, commonly colonizing the oropharynx of healthy dogs and cats. In this case, licking of his injured toe by his dog was the likely source of entry of the organism. DISCUSSION We found no identical cases in the medical literature. Diabetes mellitus and other immunocompromised disorders justify to change behaviours toward domestic animals.
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Affiliation(s)
- O Dupuy
- Service d'endocrinologie, HIA Bégin, 69, avenue de Paris, 94160 Saint-Mandé, France.
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Abstract
BACKGROUND Soft-tissue defects of the great toe that include exposed tendon and bone present a reconstructive challenge for plastic surgeons. This study investigates the feasibility and reliability of reverse first dorsal metatarsal artery flap (FDMA) for reconstruction of the dorsal great toe soft-tissue defects. METHODS Six male patients with dorsal great toe defects (mean 2.2 x 4.7 cm) underwent reconstruction using the reverse FDMA flap. Preoperative angiography was performed to confirm the existence and patency of the distal communicating artery between the FDMA and plantar metatarsal artery. The flap was raised by dividing the dorsalis pedis artery and proximal communicating arteries and rotated 180 degrees to cover the defect. RESULTS All flaps survived completely. Mean follow-up time was 3.3 months. Painless full range of motion was recovered and the contour of the flap was satisfactory. All patients returned to their normal walking and running activities and none necessitated special footwear. No donor-site morbidity was encountered. CONCLUSION Reverse FDMA flap presents a viable alternative for reconstruction of soft-tissue defects of dorsal great toe when local flap coverage is required. Because of anatomic variations, preoperative angiography is necessary for successful reconstruction, especially in patients with comorbidities affecting patency of their vasculature.
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Affiliation(s)
- Ming-Huei Cheng
- Department of Plastic Surgery, Chang Gung Memorial Hospital, Chang Gung, Chang Gung University, Taipei, Taiwan.
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Abstract
It is rare for traumatic amputation of the big toe to occur as a single injury. This trauma is especially significant in children for influencing foot development and for possible psychological impact. Two cases of successful replantation of completely amputated big toes in two girls, 2 years 7 months and 5 years 2 months old, are presented. Follow-up was 10 years. In the younger child, the replanted big toe was 49.2 percent shorter compared to the contralateral side, because growth was limited by the affected growth zone in the proximal phalanx. In the older child, the growth zone of the bone was intact, with consequent bone growth unimpaired, and an initial shortage of 10.4 percent was reduced to 2 percent compared to the contralateral side.
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Affiliation(s)
- Cedomir S Vucetic
- School of Medicine, University of Belgrade, Institute of Orthopaedic Surgery and Traumatology, Serbia and Montenegro
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Abstract
Report on therapeutic procedures in patients with second and third degree congelations (frostbite) on the feet. Two mechanisms of tissue damage caused by exposure to cold temperature will be discussed pathophysiologically: direct freezing injuries and cell death through intra and extracellular ice crystal formation as well as transient and finally irreversible tissue damage due to decreased perfusion. The condition of decreased perfusion results from persistent vaso-constriction induced by cold temperature, increased blood viscosity, sludge phenomenon and occlusion by platelet thrombi in the microvasculature. Frostbite beyond the erythematous stage should be treated primarily with a parenteral therapy in order to improve the hemorrheologic parameters, in particular within the micro-vascular compartment. Colloidal plasma volume expander such as 10% dextran solution is used to increase the intravascular volume. This solution (with its coating effect) and pentoxifyllin lowers the aggregation of erythrocytes and platelets. The latter will also be favourably influenced by the use of iloprost or acetylsalicylic acid. Iloprost as a stable metabolite of prostacyclin is a powerful vasodilator which attenuates the peripheral vascular resistance and activates fribrinolysis. Pentoxifyllin is considered to lower pathologically increased levels of fibrinogen. Both drugs may protect against damage of the vascular endothelium. Based on their pharmacological effects the above-mentioned drugs may improve tissue perfusion and therefore tissue damage caused by frostbite can be limited. However, an important factor is to strictly avoid bacterial infections in the cold-damaged tissue.
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Affiliation(s)
- Stefan Hödl
- Universitätsklinik für Dermatologie und Venerologie, Medizinische Universität Graz, Graz, Osterreich.
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Shearer D, Falkenstein K. Inconsolable crying in a baby. Adv Nurse Pract 2005; 13:16. [PMID: 16294996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
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Abstract
Digital amputations may be indicated for trauma, tumor, transplantation, infection, peripheral vascular disease, congenital deformities, and chronic pain. This article reviews indications, general principles of amputation, surgical procedures, complications, postoperative course and rehabilitation, and clinical cases.
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Affiliation(s)
- Ritchard C Rosen
- Podiatric Surgery, Holy Name Hospital, 718 Teaneck Road, Teaneck, NJ 07666, USA.
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Roukis TS, Zgonis T. Modifications of the great toe fibular flap for diabetic forefoot and toe reconstruction. Ostomy Wound Manage 2005; 51:30-2, 34, 36 passim. [PMID: 16014991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Diabetic forefoot and toe wounds are difficult to heal in a timely fashion. Despite proper continued offloading and protective shoe-gear techniques, these wounds are frequently complicated by recurrent breakdown and adjacent toe deformities. When properly performed, pedicle flaps from the fibular border of the great toe represent viable and cost-effective means of providing early and durable soft tissue coverage and osseous reconstruction of diabetic forefoot and lesser toe wounds. Two modifications of the traditional great toe fibular flap are described: the great toe fibular adipofascio-cutaneous flap and the great toe fibular osteo-cutaneous flap, useful for providing forefoot and toe reconstruction, respectively. Understanding the surgical aspects of the treatment provides insights into overall care for these challenging wounds. Long-term outcomes studies involving these toe reconstruction techniques are needed to fully evaluate their success in preventing recurrent toe deformity and forefoot ulceration.
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Affiliation(s)
- Thomas S Roukis
- Weil Foot and Ankle Institute, 1455 E. Golf Road, Suite 110, Des Plaines, IL 60016, USA.
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Kawamura K, Yajima H, Kobata Y, Shigematsu K, Maegawa N, Takakura Y. Coverage of Big Toe Defects After Wrap-Around Flap Transfer with a Free Soleus Perforator Flap. J Reconstr Microsurg 2005; 21:225-9. [PMID: 15971138 DOI: 10.1055/s-2005-871747] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
In thumb reconstruction, a wrap-around flap transfer from the big toe gives excellent results aesthetically and functionally; however, there may be some problems at the donor site, such as delayed wound healing and skin ulceration. In 10 patients, a free soleus perforator flap was used for immediate coverage of defects of the big toe with wrap-around flap procedures. Eight flaps survived completely, and the time required for wound healing was less than 1 month. Two flaps developed partial necrosis and required additional skin grafts. The average follow-up period was 46 months. There were no patients requiring defatting of the flaps. There were no patient complaints, such as postoperative skin erosion or ulceration. All patients were satisfied with the outcome. A free soleus perforator flap is an available method for covering defects of the big toe after wrap-around flap transfer.
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Affiliation(s)
- Kenji Kawamura
- Department of Orthopaedic Surgery, Nara Medical University, Kashihara, Japan
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