Effects of deep deltoid ligament injury on postoperative ankle function in patients with pronation-external rotation ankle fractures / 中国基层医药

Objective:To investigate the effects of a deep deltoid ligament injury on postoperative ankle function and pain in patients with pronation-external rotation ankle fractures.Methods:Thirty patients with pronation-external rotation ankle fractures without deep deltoid ligament injury admitted to Weihai Municipal Hospital from March 2019 to March 2020 were included in the control group. Thirty patients with pronation-external rotation ankle fractures with deep deltoid ligament injury admitted to the same hospital from April 2020 to June 2021 were included in the observation group. Both groups received reduction and internal fixation of pronation-external rotation ankle fractures. American Orthopaedic Foot and Ankle Society score, pain, and quality of life were compared between the two groups.Results:At 1 and 3 months after surgery, American Orthopaedic Foot and Ankle Society scores in the observation group were (69.87 ± 2.89) points and (75.66 ± 4.27) points, which were significantly lower than (81.45 ± 4.78) points, and (93.62 ± 3.54) points in the control group ( t = 11.35, 17.37, both P < 0.01). At 1 and 3 months after surgery, Visual Analogue Scale (VAS) scores in the observation group were (7.16 ± 1.15) points and (5.84 ± 0.52) points, respectively, which were significantly higher than (6.42 ± 0.54) points and (4.28 ± 0.16) points in the control group ( t = 3.19, 15.70, both P < 0.05). At 3 months after surgery, the scores of physical health, mental health, social relationship, and surrounding environment in the observation group were (19.18 ± 1.96) points, (18.67 ± 1.82) points, (17.42 ± 2.54) points, (19.65 ± 2.43) points, respectively, which were significantly lower than (21.65 ± 3.58) points, (23.57 ± 3.56) points, (20.09 ± 3.95) points, (22.38 ± 3.67) points in the control group ( t = 3.31, 6.71, 3.11, 3.39, all P < 0.05). Conclusion:Deep deltoid ligament injury affects the recovery of pronation-external rotation ankle fracture and affects the quality of life. Therefore, it is necessary to repair deep deltoid ligament injury in time in patients with pronation-external rotation ankle fractures.

Can the percutaneous chevron and akin (peca) technique correct the pronation of the first metatarsal in hallux valgus? / A técnica percutânea de chevron e akin (peca) pode corrigir a pronação do primeiro metatarso em halux valgo?

ABSTRACT Objective Pronation of the first metatarsal in hallux valgus has recently been discussed among foot and ankle surgeons. This study aimed to evaluate the potential radiographic correction of moderate and severe hallux valgus using the percutaneous Chevron and Akin (PECA) technique. Methods We evaluated 45 feet in 38 patients (mean age 65.3 years old [36 - 83]; 4 men; 34 women; 7 bilateral) who underwent surgical correction using the PECA technique. The radiographic images evaluated were anteroposterior radiographs obtained pre- and postoperatively at least 6 months after surgery, including the metatarsophalangeal angle, the intermetatarsal angle, pronation of the first metatarsal, displacement of the distal fragment, medial sesamoid position and bone union. Results All parameters evaluated showed significant postoperative improvement, including correction of pronation of the first metatarsal (p < .05) and position of the sesamoid (p < .05). There was a union of osteotomies in all feet. No complications were observed, such as screw loosening or necrosis of the first metatarsal head. Conclusion The PECA technique can correct pronation of the first metatarsal in moderate and severe hallux valgus, and other deformity-associated parameters. Level of Evidence IV; Case Series.

RESUMO Objetivo A pronação do primeiro metatarso no hálux valgo tem sido um tema de discussão recente entre os cirurgiões de pé e tornozelo. O objetivo deste estudo foi avaliar o potencial de correção radiográfica do hálux valgo moderado e grave utilizando a técnica percutânea de Chevron e Akin (PECA). Métodos Avaliamos 45 pés em 38 pacientes (média de idade 65,3 anos [36 - 83]; 4 homens; 34 mulheres; 7 bilaterais) submetidos à correção cirúrgica pela técnica PECA. As imagens radiográficas avaliadas foram radiografias anteroposteriores obtidas no pré e pós-operatório com no mínimo 6 meses após a cirurgia, incluindo ângulo metatarsofalângico, ângulo intermetatarsal, pronação do primeiro metatarso, deslocamento do fragmento distal, posição do sesamoide medial e união óssea. Resultados Todos os parâmetros avaliados apresentaram melhora significativa no pós-operatório, incluindo correção da pronação do primeiro metatarso (p < 0,05) e posição do sesamoide (p < 0,05). Houve união de osteotomias em todos os pés. Não foram observadas complicações, como soltura do parafuso ou necrose da cabeça do primeiro metatarso. Conclusão A técnica PECA pode corrigir a pronação do primeiro metatarso no hálux valgo moderado e grave, bem como outros parâmetros associados à deformidade. Nível de Evidência IV; Série De Casos.

Saberes e práticas da enfermagem no manejo do paciente em posição prona: estudo descritivo / Nursing knowledge and practices regarding placing patients in the prone position: a descriptive study / Conocimientos y prácticas de enfermería en la gestión del paciente en posición prona: estudio descriptivo

OBJETIVO: descrever os saberes e as práticas dos profissionais de enfermagem que prestam assistência na Unidade de Terapia Intensiva (UTI) ao paciente em posição prona, acometido pela COVID-19. MÉTODO: estudo descritivo, qualitativo, realizado com uma amostra constituída por integrantes da equipe de enfermagem de uma UTI de um hospital público em Niterói, Rio de Janeiro. RESULTADOS: os saberes foram agrupados em três categorias temáticas: Assistência de enfermagem antes do procedimento de pronação; Procedimentos de enfermagem durante o período em posição prona; e Cuidados de enfermagem após o retorno para a posição supina. CONCLUSÃO: os saberes e as práticas dos profissionais de enfermagem, correlacionados aos cuidados ao paciente acometido pela COVID-19 em posição prona, apontam para abordagens focadas na prevenção das complicações, cuja finalidade pauta-se no bem-estar, recuperação, e na melhor qualidade de vida durante o período de internação.

OBJECTIVE: to describe the knowledge and practice of nursing workers providing intensive care to COVID-19 patients in prone position. METHOD: descriptive and qualitative study addressing the nursing staff of an intensive care unit (ICU) from a public hospital located in Niterói, Rio de Janeiro, Brazil. RESULTS: knowledge was grouped into three thematic categories: Nursing care provided before placing a patient in the prone position; Nursing procedures while patients are in the prone position; and Nursing care after patients return to the supine position. CONCLUSION: the knowledge and practices of nursing professionals concerning the care provided to COVID-19 patients while in the prone position indicate that workers focus on preventing complications and ensuring the patients' wellbeing, recovery, and improved quality of life during hospitalization.

OBJETIVO: describir los conocimientos y las prácticas de los profesionales de enfermería que prestan asistencia en la Unidad de Terapia Intensiva (UTI), al paciente en posición prona, afectado por el COVID-19. MÉTODO: estudio descriptivo y cualitativo, realizado con una muestra constituida por integrantes del equipo de enfermería de una UTI de un hospital público en Niterói, Rio de Janeiro. RESULTADOS: los conocimientos fueron agrupados en tres categorías temáticas: Asistencia de enfermería antes del procedimiento de pronación; Procedimientos de enfermería durante el período en posición prona; y Cuidados de enfermería después del retorno a posición supina. CONCLUSIÓN: los conocimientos y las prácticas de los profesionales de enfermería, correlacionados con los cuidados al paciente afectado por el COVID-19 en posición prona, apuntan para abordajes enfocados en la prevención de las complicaciones se guía por el bienestar, recuperación y la obtención de la mejor calidad de vida durante el período de internación.

A prevalência de eventos adversos na pronação de pacientes adultos e idosos entubados com COVID-19: revisão sistemática com meta-análise / The prevalence of adverse events in the pronation of adult and elderly patients intubated with COVID-19: systematic review with meta-analysis

Introdução: A síndrome da angústia respiratória (SARA), causada pelo novo coronavírus (SARS-CoV-2), surgiu em 2019 e rapidamente desencadeou uma pandemia, resultando em milhares de mortes em diversos países. No tratamento dos casos graves, em que a hipoxemia e a insuficiência respiratória estão presentes, é necessário utilizar ventilação mecânica invasiva, como estratégia de compensação. Além disso, o suporte ventilatório auxilia na melhora da oxigenação e trocas gasosas, aumentando os níveis alveolares e, por conseguinte, melhorando a oxigenação. Destaca-se que a prevenção da ocorrência de eventos adversos é um desafio constante quando se trata da COVID-19. Objetivo: Sintetizar as evidências científicas sobre a prevalência de eventos adversos na pronação de pacientes adultos e idosos entubados com COVID-19. Método: Revisão sistemática com meta-análise, realizada nas bases de dados Cochrane Library, Cinahl, Embase, Lilacs, Livivo, PubMed, Scopus e Web of Science, incluindo estudos observacionais de pacientes adultos e idosos com COVID-19 em ventilação mecânica tanto com o tubo orotraqueal quanto por traqueostomia, em posição prona. Dois revisores avaliaram independentemente os estudos e extraíram os dados. O terceiro revisor foi contatado em todas as fases, para resolução dos conflitos. Os estudos foram meta-analisados com auxílio do software JAMOVI 1.6.15. Utilizou-se um modelo de efeito randômico para identificar a prevalência global dos eventos adversos, o intervalo de confiança e os dados de heterogeneidade. O risco de viés foi avaliado com base na ferramenta Joanna Briggs Institute e a certeza da evidência mediante a aplicação da abordagem Grading of Recommendations Assessment, Development and Evaluation (GRADE). Resultados: Dos 7904 estudos identificados nas buscas, após leitura de título e resumos e resolução de conflitos, 169 foram incluídos para leitura na íntegra e, após, 10 incluídos na revisão. Os eventos adversos mais prevalentes em paciente ventilados mecanicamente pronados são: lesões por pressão, com prevalência global de 59%, presença de instabilidade hemodinâmica (23%), óbito (17%), perda ou tracionamento de dispositivo (9%). Conclusão: Eventos adversos causam lesões por vezes evitáveis, sendo que algumas delas geram sequelas permanentes, com impacto negativo na qualidade de vida do paciente acometido e de sua família. Investigar eventos adversos é o caminho para promover melhorias na qualidade e segurança dos pacientes e, a partir disso, padronizar protocolos e rotinas nacionais e internacionais para realizar a pronação e manutenção deste em prona com foco na prevenção desses eventos

Introduction: Respiratory distress syndrome (ARDS), emerged in 2019, caused by the new coronavirus (SARS-CoV-2), triggered a pandemic, resulting in hundreds of deaths in several countries. In severe cases of COVID-19, where hypoxemia and respiratory failure is present, it is necessary to use invasive mechanical ventilation, as a compensation strategy and ventilatory support helps to improve oxygenation and gas exchange and increase alveolar levels, and consequent improvement in oxygenation. Preventing the occurrence of adverse events is a constant challenge in the face of COVID-19. Objective: To synthesize the evidence on the prevalence of adverse events in pronation in adult and elderly patients intubated with COVID-19. Method: Systematic review with meta-analysis, performed in the following databases: Cochrane Library, Cinahl, Embase, Lilacs, Livivo, PubMed, Scopus and Web of Science, including observational studies of adult and elderly patients with COVID-19 on mechanical ventilation with both the orotracheal tube and tracheostomy, submitted to prone position. Two reviewers independently assessed the studies and extracted data, the third reviewer was contacted at all stages for conflict resolution. The studies were meta-analyzed using JAMOVI 1.6.15 software. Random effect model was used to identify the prevalence of adverse events, identifying the overall prevalence of events, confidence interval, and heterogeneity data. The risk of bias was assessed using the Joanna Briggs Institute tool and the certainty of evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Results: Of the 7904 studies identified in the searches, after reading the title and abstracts, conflict resolution, 169 studies were included for full reading, and 10 included in the review. The most prevalent adverse events in mechanically ventilated pronated patients are pressure injuries with an overall prevalence of 59%, presence of hemodynamic instability 23%, death 17%, device loss or traction 9%, edema, polyneuropathy, plexus injuries and eye injury. Conclusion: Adverse events cause injuries that are sometimes preventable, some of which generate permanent sequelae, generating a negative impact on the quality of life of this affected patient and his family. Carrying out the investigation of adverse events is the way to promote improvements in the quality and safety of patients and, from that, standardize international protocols and routines to perform pronation and maintenance of the patient in prone, focusing on the prevention of adverse events

Posição prona: efetividade da intervenção educativa no processo assistencial intensivo / Prone position: effectiveness of educational intervention in the intensive care process / Posición prona: efectividad de la intervención educativa en el proceso de cuidados intensivos

Objetivo: avaliar a efetividade da intervenção educativa no processo assistencial intensivo, no nível de conhecimento da equipe de enfermagem acerca do posicionamento prono em pacientes com síndrome do desconforto respiratório agudo. Método: trata-se de um estudo quantitativo do tipo quase experimental, com amostragem de 62 profissionais de setor intensivo. Coletaram-se dados relativos à variável conhecimento dos profissionais durante fase pré e pós-intervenção educativa, durante uma semana, através da aplicação de formulários de múltipla escolha. Para análise dos dados e avaliação da efetividade de intervenção educativa utilizou-se estatística descritiva e testes de Kolmogorov-Smirnova e Shapiro Wilk para prova de normalidade e o teste T de student para comparação das médias obtidas. Resultados: nas fases de pré e pós-intervenção educativa, observou-se que a média de acertos pré-intervenção foi de 6,12 (dp= 2,15), t(61)=11,31 e p=0,000, enquanto na fase pós-intervenção 9,43 (dp= 0,76), t(61)=11,31 e p=0,000. Conclusão: constatou-se efetividade da intervenção educativa no processo assistencial intensivo a cerca do conhecimento dos profissionais de enfermagem sobre o posicionamento prono, visto significativo aumento do escore de acertos obtidos na fase de pós-intervenção. Sendo assim, a educação continuada em setores intensivos, torna-se essencial para fins de aperfeiçoamento dos profissionais. (AU)

Objective: To evaluate the effectiveness of educational intervention in the intensive care process, at the level of knowledge of the nursing team about the prone position in patients with acute respiratory distress syndrome. Methods: This is a quasi-experimental quantitative study, with a sample of 62 professionals from the intensive sector. Data was collected on the variable knowledge of professionals during the pre- and post-educational intervention phase, for a week, through the application of multiple choice forms. For data analysis and evaluation of the effectiveness of educational intervention, descriptive statistics and Kolmogorov-Smirnova and Shapiro Wilk tests were used to prove normality and the Student T test to compare the averages obtained. Results: When comparing the averages obtained in the pre and post educational intervention phases, it was observed that the average of correct answers before intervention was 6.12, while in the post intervention 9.43. Conclusion: The effectiveness of the educational intervention in the intensive care process was found to be about the knowledge of nursing professionals about the prone position, considering a significant increase in the score of correct answers obtained in the post intervention phase. Thus, continuing education in intensive sectors, becomes essential for the purposes of professional development. (AU)

Objetivo: Evaluar la efectividad de la intervención educativa en el proceso de cuidados intensivos, a nivel de conocimiento del equipo de enfermería sobre la posición prona en pacientes con síndrome de dificultad respiratoria aguda. Métodos: Se trata de un estudio cuantitativo cuasi-experimental, con una muestra de 62 profesionales del sector intensivo. Se recogieron datos sobre la variable conocimiento de los profesionales durante la fase de intervención pre y poseducativa, durante una semana, mediante la aplicación de formularios de opción múltiple. Para el análisis de datos y evaluación de la efectividad de la intervención educativa se utilizó estadística descriptiva y pruebas de Kolmogorov-Smirnova y Shapiro Wilk para comprobar la normalidad y la prueba T de Student para comparar los promedios obtenidos. Resultados: Al comparar los promedios obtenidos en las fases de intervención pre y poseducativa, se observó que el promedio de aciertos antes de la intervención fue de 6,12, mientras que en la intervención pos fue de 9,43. Conclusión: Se encontró que la efectividad de la intervención educativa en el proceso de cuidados intensivos se basa en el conocimiento de los profesionales de enfermería sobre la posición prona, considerando un aumento significativo en la puntuación de aciertos obtenidos en la fase posintervención. Así, la formación continua en sectores intensivos, se vuelve fundamental para los fines del desarrollo profesional. (AU)

Cardiopulmonary Resuscitation in Prone Position

Abstract Mechanical ventilation in prone position is an alternative strategy for patients with acute respiratory discomfort syndrome (ARDS) to improve oxygenation in situations when traditional ventilation modalities have failed. However, due to the significant increase in ARDS cases during the SARS-CoV-2 pandemic and the experimental therapeutic use of potentially arrhythmogenic drugs, cardiopulmonary resuscitation in this unusual position could be needed. Therefore, we will review the available scientific evidence of cardiopulmonary resuscitation in prone position.

Pronación: Tecnología de enfermería que produce bienestar en el cuidado de los pacientes COVID-19, en el Hospital General Dr. Manuel Gea González en la Ciudad de México / Pronation: A nursing technology that promotes wellbeing among COVID-19 patients at General Hospital Dr. Manuel Gea Gonzalez in México City

Introduction: pronation is a procedure used at the Intensive Care Unit with patients presenting Acute Respiratory Distress Syndrome (ARDS) with severe hypoxemia. Bibliographical references clearly support the application of this procedure due to the improvement it produces in oxygenation and the increased survival rate in patients. The main foundation behind this technology is that Ventral Decubitus (VD) promotes an improved redistribution of ventilation toward the dorsal regions of the lung, which are mainly collapsed during Dorsal Decubitus. Nursing staff have used this procedure because VD has proven to be a strategy with a useful and accessible impact over respiratory physiology. Objective: to analyze Pronation as a nursing technology and its promotion of COVID-19 patients' wellbeing at the General Hospital Dr. Manuel Gea González, in Mexico City. Material and methods: a nonexperimental, quantitative, cross-sectional, prolective, descriptive study to analyze pronation, as a nursing technology that promotes wellbeing in the care of COVID-19 patients at General Hospital Dr. Manuel Gea González, in Mexico City. Pronation as a nursing technology was the variable being measured. The universe was 530 nursing professionals working at the Hospital. The population and sample were 52 nursing specialists working with COVID-19 patients, representing 9.81% of the Universe. Results: as for training and experience with Pronation, 50% of the staff consider they have received sufficient training in regards to the SARS-CoV-2 virus, but they are still under training. Additionally, 84.62 % consider that Pronation promotes a remarkable recovery in the patients, with oxygen saturations between 80 to 100 %; 71.16 % believe that patients do show hemodynamic instability due to the position shift, but not in every case; and 80.77 % consider they make sure their patients do not develop pressure ulcers, given that 65.39 % practice patient hygiene and movement to prevent such ulcers. Discussion: from the interviewed staff, 50.01 % consider they have received sufficient training regarding COVID and the pronation of patients. This is consistent with Hernandez et al., who describe the need of a team trained specifically on the procedure, preferably comprised of Nurses specialized in Intensive Care. Likewise, 84.62% of staff members believe Pronation improves oxygen saturation in patients from 80% to 100%, this is contrasted with Barrantes and Vargas, who indicate that if Pronation does not result in 5% improvement in oxygen saturation, the patient must be returned to dorsal decubitus. Conclusion: ventilation in prone position is a pulmonary protective action used for over 30 years that produces an evident and continuous improvement in blood oxygenation and the respiratory physiology. Therefore, nursing specialists caring for COVID-19 patients recommend its use.

Introducción: la pronación es una maniobra utilizada en las unidades de cuidados intensivos, en pacientes que presentan síndrome de distrés respiratorio agudo (SDRA), cuando la hipoxemia es severa. Apoyada por una sólida evidencia científica, tiene impacto en la forma en que se ventila a los pacientes como parámetro de seguridad, esto aumenta la supervivencia. Objetivo: analizar la pronación, como tecnología de enfermería, que produce bienestar en el cuidado de los pacientes COVID-19, en el Hospital General Dr. Manuel Gea González, en la Ciudad de México. Material y métodos: estudio de carácter cuantitativo, no experimental, transversal, prospectivo, descriptivo. Variable medida: la pronación, como tecnología de enfermería. El universo 530 profesionales de enfermería que trabajan en el hospital, muestra: 52 especialistas de enfermería que trabajan con pacientes COVID-19. Resultados: en relación a la capacitación y experiencia en pronación, el 50% del personal manifiestan que sí recibieron suficiente capacitación sobre el virus SARS-CoV-2, aunque siguen capacitándose en ésta área; el 84.62 % consideran que en la pronación, los pacientes mejoran bastante, saturando entre el 80 y 100 % de oxígeno y el 80.77 % siempre cuidan que los pacientes no tengan úlceras por presión.Discusión: el 50.01 % del personal entrevistado manifiesta que sí recibió suficiente capacitación sobre la COVID-19 para pronar a los pacientes, lo que es semejante a la investigación de Hernández GD., et al.¹ Conclusión: la ventilación en posición prono es una medida de protección pulmonar utilizada hace más de 30 años que produce una mejoría evidente y sostenida de la oxigenación de la sangre y en la fisiología respiratoria, por lo que los especialistas de enfermería que atiende pacientes COVID-19 recomiendan su aplicación, pues está asociada al aumento de probabilidad de supervivencia.

Renal replacement therapy by the popliteal vein in a critical patient with COVID-19 in the prone position / Terapia renal substitutiva pela veia poplítea em paciente crítico com COVID-19 na posição de pronação

Abstract This patient was a 73-year-old man who initially came to our service with acute respiratory failure secondary to COVID-19. Soon after hospitalization, he was submitted to orotracheal intubation and placed in the prone position to improve hypoxia, due to severe acute respiratory syndrome (SARS). On the third day of hospitalization, he developed acute oliguric kidney injury and volume overload. The nephrology service was activated to obtain deep venous access for renal replacement therapy (RRT). The patient could not be placed in the supine position due to significant hypoxemia. A 50-cm Permcath (MAHURKARTM, Covidien, Massachusetts, USA) was inserted through the left popliteal vein. This case report describes a possible challenging scenario that the interventional nephrologist may encounter when dealing with patients with COVID-19 with respiratory impairment in the prone position.

Resumo O paciente era um homem de 73 anos de idade que inicialmente veio ao nosso serviço com insuficiência respiratória aguda secundária à COVID-19. Logo após a internação, ele foi submetido à intubação orotraqueal e pronado para melhorar a hipóxia devido à síndrome respiratória aguda grave (SARS - do inglês "severe acute respiratory syndrome"). No terceiro dia de internação, o mesmo desenvolveu lesão renal aguda oligúrica e sobrecarga de volume. O serviço de nefrologia foi acionado para realizar acesso venoso profundo para terapia renal substitutiva (TRS). O paciente não pôde ser colocado na posição de decúbito dorsal devido a uma hipoxemia significativa. Um Permcath de 50 cm (MAHURKARTM, Covidien, Massachusetts, EUA) foi inserido através da veia poplítea esquerda. Este relato de caso descreve um possível cenário desafiador com o qual o nefrologista intervencionista pode se deparar ao lidar com pacientes com COVID-19 com problemas respiratórios e colocados em pronação.

Corrección del componente rotacional prequirúrgico y postquirúrgico del primer metatarsiano secundario a osteotomía de Chevron modificado / Correction of the pre- and post-surgical rotational component of the first metatarsal secondary to modified Chevron osteotomy

Resumen: Introducción: Hallux valgus (HV) es una patología compleja del antepié, recientemente se ha mostrado interés en el componente rotacional (CR) distal del primer metatarsiano por su relación con recidivas postquirúrgicas de la deformidad. La selección de la técnica quirúrgica es controversial con escasa literatura acerca de la corrección de rotación con osteotomías comunes. Nuestro objetivo es evaluar características radiológicas prequirúrgicas y postquirúrgicas respecto a CR del primer metatarsiano en la cirugía de corrección de HV moderado a severo usando osteotomía de Chevron largo. Material y métodos: Estudio observacional, prospectivo y comparativo en el que se evaluó el CR del primer metatarsiano en nueve pies pertenecientes a seis pacientes con una edad media de 45 años. El CR fue evaluado con base en la metáfisis proximal del primer metatarsiano en fluoroscopías axiales sin carga y AP de pie. Las mediciones se realizaron por un residente de ortopedia y traumatología y un subespecialista en cirugía de pie y Tobillo. Resultados: Se documentaron diferencias significativas (p = 0.05) en el ángulo de pronación prequirúrgico y postquirúrgico al utilizar osteotomía de Chevron largo. El resultado funcional de los pacientes evaluados fue excelente a 11 meses de seguimiento. Conclusiones: Radiológicamente, la corrección rotacional es variable y previamente no se ha reportado en la literatura con esta osteotomía. Se establecen bases morfológicas para la realización de estudios posteriores en la evaluación de rotación de cabeza del primer metatarsiano con diferentes osteotomías.

Abstract: Introduction. Hallux valgus (HV) is a complex forefoot pathology, in which interest has recently been shown in the distal rotational component (CR) of the first metatarsal due to its relationship with postsurgical relapses of the deformity. The selection of surgical technique is controversial with little current literature on the correction of rotation with common osteotomies. The aim of this study is to evaluate preoperative and postoperative radiological characteristics regarding CR of the first metatarsal using long Chevron osteotomy for moderate to severe HV. Material and methods: An observational, prospective and comparative study was carried out in which the CR of the first metatarsal was evaluated in nine feet belonging to six patients with a mean age of 45 years. The RC was evaluated based on the proximal metaphysis of the first metatarsal in axial fluoroscopies of unloaded metatarsals and standing AP. Measurements were performed by an Orthopedic and Traumatology resident and a Foot and Ankle Surgery subspecialist. Results: Significant differences (p = 0.05) were documented in the preoperative and postoperative pronation angle when using long Chevron osteotomy. The functional result of the evaluated patients was excellent at 11 months of follow-up. Conclusions: Radiologically, the rotational correction is variable and has not previously been reported in the literature with this osteotomy. We establishes the morphological bases for the performance of subsequent studies in the evaluation of head rotation of the 1st metatarsal with different osteotomies.

Máscara de mergulho adaptada para ventilação não-invasiva e posição prona em paciente com COVID-19 grave: relato de caso / Diving mask adapted for non-invasive ventilation and prone position in a patient with severe covid-19: case report / Máscara de buceo adaptada para ventilación no invasiva y posición de prono en un paciente con covid-19 grave: reporte de caso

Justificativa e objetivos: Na busca de estratégias para o tratamento da insuficiência respiratória aguda causada pela COVID-19, surge a ventilação não invasiva (VNI) e o uso da posição prona em respiração espontânea. Objetiva-se apresentar o caso de uma paciente com COVID-19 grave admitida em unidade de terapia intensiva (UTI) e submetida à máscara de mergulho adaptada, que se configura em uma interface inovadora para VNI, bem como a posição prona. Métodos: Relato de caso de paciente hospitalizado diagnosticado com COVID-19 submetido à VNI precoce por meio da máscara de mergulho adaptada e uso da posição prona em respiração espontânea por 8 horas noturnas e 6 horas diurnas. Resultados: Paciente do sexo feminino, 56 anos, hipertensão arterial sistêmica e obesidade, apresentando tosse seca, odinofagia, fadiga e dispneia intensa na admissão. A tomografia de tórax demonstrou opacidades em vidro fosco bilaterais. A VNI foi instituída 1-2,75 vezes/dia, por 40-60 minutos, com pressão positiva ao final da expiração de 8 (7,25-8,00) cmH2O e pressão de suporte de 5,5 (4,00-6,00) cmH2O. Fuga aérea de 6 a 30%, com boa tolerância. A posição prona em respiração espontânea resultou em aumento da saturação periférica de oxigênio e redução do desconforto respiratório 30 minutos após. Conclusão: A associação do uso da VNI com máscara de mergulho adaptada e posição prona em respiração espontânea demonstrou ser eficaz em evitar a intubação orotraqueal de paciente com COVID-19 grave, ressaltando a importância da intervenção proposta.(AU)

Justification and objectives: In the search of strategies to treat acute respiratory failure caused by COVID-19, non-invasive ventilation (NIV) and the use of prone position in spontaneous breathing appear. The objective is to present the case of a patient with severe COVID-19 admitted to an intensive care unit (ICU) who used an adapted diving mask, which is configured as an innovative interface for NIV, and the prone position. Methods: Case report of a hospitalized patient diagnosed with COVID-19 who underwent early NIV by means of an adapted diving mask and the prone position during spontaneous breathing for 8 hours at night and 6 hours in the day. Results: Female patient, 56 years old, systemic arterial hypertension and obesity, with dry cough, odynophagia, fatigue and severe dyspnea on admission. Chest tomography with bilateral ground-glass opacities. Non-invasive ventilation was instituted 1-2.75 times/day, for 40-60 minutes, with positive pressure at the end of expiration of 8 (7.25-8.00) cmH2O and support pressure of 5.5 (4.00 -6.00) cmH2O. Air leaks of 6 to 30%, with good tolerance. The prone position during spontaneous breathing resulted in increased peripheral oxygen saturation and reduced respiratory discomfort 30 minutes later. Conclusion: The association of the use of NIV with an adapted diving mask and prone position during spontaneous breathing proved to be effective in preventing the orotracheal intubation of a patient with severe COVID-19, emphasizing the importance of the proposed intervention.(AU)

Justificación y objetivos: En la búsqueda de estrategias para el tratamiento de la insuficiencia respiratoria aguda causada por COVID-19, aparecen la ventilación no invasiva (VNI) y el uso de la posición de prono con la respiración espontánea. El objetivo es presentar el caso de un paciente con COVID-19 grave ingresado en una unidad de cuidados intensivos (UCI) que utilizó una máscara de buceo adaptada, que se configura como una interfaz innovadora para VNI, así como la posición de prono. Métodos: Reporte de caso de una paciente hospitalizada con diagnóstico de COVID-19 que fue sometida a VNI precoz mediante máscara de buceo adaptada y la posición de prono con respiración espontánea durante 8 horas en la noche y 6 horas en el día. Resultados: Paciente de sexo femenino, 56 años, hipertensión arterial sistémica y obesidad, con tos seca, odinofagia, fatiga y disnea severa al ingreso. Tomografía de tórax con opacidades bilaterales en vidrio esmerilado. La VNI se instituyó de 1 a 2,75 veces/día, durante 40-60 minutos, con presión positiva al final de la espiración de 8 (7,25-8,00) cmH2O y presión de soporte de 5,5 (4, 00 -6,00) cmH2O. Fugas de aire del 6 al 30%, con buena tolerancia. La posición de prono con respiración espontánea resultó en un aumento de la saturación de oxígeno periférico y una reducción de las molestias respiratorias 30 minutos después. Conclusión: La asociación del uso de VNI con máscara de buceo adaptada y la posición de prono con respiración espontánea demostró ser efectiva para prevenir la intubación orotraqueal de una paciente con COVID-19 severo, enfatizando la importancia de la intervención propuesta.(AU)

Clinical analysis of full-repair strategy under small incision for closed Lauge-Hansen pronation-external rotation type Ⅳ ankle fracture / 中国修复重建外科杂志

Objective: To investigate the safety, feasibility, and efficacy of full repair strategy under small incision in the treatment of closed Lauge-Hansen pronation-external rotation type Ⅳ ankle fracture. Methods: The clinical data of 57 patients with closed Lauge-Hansen pronation-external rotation type Ⅳ ankle fracture treated by full repair strategy (fracture, ligament, and cartilage repair) under small incision between January 2012 and January 2017 were retrospectively analyzed. There were 31 males and 26 females, with an average age of 41.1 years (range, 21-65 years). The causes of injury included traffic accident injury in 33 cases and falling injury in 24 cases. All of them were closed fractures, including 20 cases of medial malleolus fracture, 37 cases of complete medial malleolus but deep and shallow rupture of deltoid ligament. The average time from injury to admission was 9.6 hours (range, 3-34 hours). The quality of reduction of distal tibial articular surface (based on Ketz-Sanders standard), the reduction of tibiofibular syndesmosis (the anterior and posterior distances of distal tibiofibular syndesmosis and the lateral ankle twist angle measured by CT scan at 10 mm above the ankle joint line), and the fracture healing were evaluated. The medial clear space (MCS), tibiofibular clear space (TFCS), and distal fibular tip to lateral process of talus (DFTL) were measured on the X-ray films of ankle points. Before and after operation, the pain and functional improvement of ankle joint were evaluated by visual analogue scale (VAS) score and American Orthopedic Foot and Ankle Association (AOFAS) score, and the activities of ankle dorsiflexion and plantar flexion were measured. Results: Three cases with osteochondral lesions of the talus were found during operation and all were treated with microfracture techniques. Tournament paralysis occurred in 2 cases after anesthesia. The surgical incisions healed by first intention in all patients. All the 57 patients were followed up 24-84 months, with an average of 38.6 months. All patients achieved bone healing without bone nonunion and malunion at 12 months after operation. The reduction quality of distal tibial articular surface was excellent in 56 cases and good in 1 case at 3 months after operation, the excellent and good rate was 100%. There was no significant difference in the MCS, TFCS, DFTL, anterior distance of distal tibiofibular syndesmosis, posterior distance of distal tibiofibular syndesmosis, and lateral ankle twist angle between the affected and healthy sides at 12 months after operation ( P>0.05). At last follow-up, the VAS score, AOFAS score, ankle dorsiflexion and plantar flexion activities of the affected side were significantly improved when compared with preoperative ones ( P0.05). Conclusion: Full-repair strategy under small incisions for the treatment of Lauge-Hansen pronation-external rotation type Ⅳ ankle fracture is effective and safe. It can not only reduce wound complications, but also improve the quality of joint reduction of the ankle joint and distal tibiofibular syndesmosis. Full repair of ligaments and cartilage can improve the internal fixation strength and joint stability of the ankle joint.

Effect of pronated foot posture on proprioception and postural stability based on foot posture index / 中国组织工程研究

BACKGROUND: Studies outside China have shown that there is a certain relationship between foot posture and posture stability. OBJECTIVE: Based on foot posture index scale system, to compare the effect of pronated foot posture on postural stability and proprioception. METHODS: Thirty healthy youths aged from 20 to 30 years old were enrolled, and divided into two groups according to the right foot posture index: pronated group (foot posture index > 5) and neutral group (0 ≤ foot posture index 0.05). (2) When tested with single-leg (right side) static stance, sway area and length of pressure center were larger in pronated group than that in neutral group (P 0.05). (3) When tested with two-leg static stance, sway length of pressure center was larger in pronated group than that in neutral group (P 0.05). (4) Results confirmed that foot posture exerts a significant effect on postural stability. Pronated foot can reduce postural stability, which will increase sports injury and the risk of fall in the elder.

Hyperelastic tape modifies the kinematics of the pronated foot in young women: self-controlled clinical trial / A bandagem hiperelástica modifica a cinemática do pé pronado em mulheres jovens: ensaio clínico autocontrolado

Abstract Introduction: Excessive pronation has been linked to increased risk of developing lower limb injuries. In this respect, assessing the effectiveness of therapeutic resources, such as hyperelastic taping, becomes relevant. Objective: evaluate the influence of adhesive hyperelastic taping on excessive pronation of the ankle-foot complex in young women. Method: Self-controlled clinical trial of ten women with excessive pronation (Foot Posture Index ≥ 6). Three-dimensional gait was assessed according to the Vicon Oxford Foot Model before and after taping. Hyperelastic tape was applied on the side with greater pronation (experimental side) and the opposite side was used as control (control side). The segments evaluated were the hindfoot, midfoot and forefoot. The Shapiro-Wilk normality, paired t and Wilcoxon tests were applied and Significance was set at p <0.05. Results: No change (p> 0.05) was observed in the hindfoot on the experimental or control side; the midfoot showed a decrease in arch height (p <0.05) only on the experimental side; forefoot eversion (p <0.05) declined only on the experimental side. Conclusion: The use of hyperelastic tape reduced forefoot eversion; however, this decrease is not clinically desirable, since excessive pronation in a closed chain increased in the sample of young women studied.

Resumo Introdução: A pronação excessiva tem sido relacionada ao aumento do risco de desenvolver lesões nos membros inferiores. Nesse sentido, verificar a efetividade de recursos terapêuticos, como a bandagem hiperelástica, tornou-se relevante. Objetivo: Avaliar a influência da bandagem hiperelástica na pronação excessiva do pé em mulheres jovens. Método: Ensaio clínico autocontrolado, no qual participaram dez mulheres com pronação excessiva (Foot Posture Index ≥ 6). Realizou-se então a avaliação tridimensional da marcha de acordo com o modelo Oxford Foot Model da Vicon em dois momentos: antes e após a bandagem. Foi aplicada bandagem hiperelástica no lado com maior pronação (lado experimental) e o lado oposto foi utilizado como controle (lado controle). Quanto aos segmentos avaliados, estes foram o retropé, antepé e mediopé. Para análise dos dados aplicou-se o teste de normalidade Shapiro Wilk, testes t pareado e Wilcoxon. E o nível de significância foi considerado como p<0,05. Resultados: No retropé não foi verificada mudança (p>0,05) no lado experimental ou controle; no mediopé foi observado redução da altura do arco (p<0,05) somente no lado experimental, porém sem diferença entre grupos (p>0,05); e no antepé foi observado redução da eversão (p<0,05) somente no lado experimental. Conclusão: A aplicação utilizada de bandagem hiperelástica reduziu a eversão do antepé, porém essa redução não é desejável clinicamente, uma vez que em cadeia fechada a pronação excessiva aumenta na amostra de mulheres jovens estudadas.

Anatomical study of the transfer of flexor digitorum superficialis nerve branch of median nerve to restore wrist extension and forearm pronation / Estudo anatômico da transferência do ramo do nervo mediano destinado ao músculo flexor superficial dos dedos para restaurar a extensão do punho e a pronação do antebraço

Abstract Objective To analyze the anatomical variations of the innervation of the flexor digitorum superficialis muscle and to determine if the branch of the median nerve that supply this muscle is connected to the branches to the extensor carpi radialis brevis and the pronator teres muscles, without tension, and how close to the target-muscles the transfer can be performed. Methods Fifty limbs of 25 cadavers were dissected to collect data on the anatomical variations of the branches to the flexor digitorum superficialis muscle. Results This muscle received innervation from the median nerve in the 50 limbs. In 22 it received one branch, and in 28 more than one. The proximal branch was identified in 22 limbs, and in 12 limbs it shared branches with other muscles. The distal branch was present in all, and originated from the median nerve as an isolated branch, or a common trunk with the anterior interosseous nerve in 3 limbs, and from a common trunk with the flexor carpi radialis muscle and anterior interosseous nerve in another. It originated distally to the anterior interosseous nerve at 38, in 5 on the same level, and in 3 proximal to the anterior interosseous nerve. In four limbs, innervation came from the anterior interosseous nerve, as well as from the median nerve. Accessory branches of the median nerve for the distal portion of the flexor digitorum superficialis muscle were present in eight limbs. Conclusion In 28 limbs with two or more branches, one of them could be connected to the branches to the extensor carpi radialis brevis and pronator teres muscles without tension, even during the pronation and supination movements of the forearm and flexion-extension of the elbow.

RESUMO Objetivo Analisar as variações anatômicas da inervação do músculo flexor superficial dos dedos e determinar se o ramo do nervo mediano destinado a esse músculo pode ou não ser conectado aos ramos para os músculos extensor radial curto do carpo e pronador redondo sem tensão, e quão próximo dos músculos-alvo a transferência pode ser realizada. Métodos Foram dissecados 50 membros de 25 cadáveres para coletar dados sobre as variações anatômicas dos ramos para o músculo flexor superficial dos dedos. Resultados O referido músculo recebeu inervação do nervo mediano nos 50 membros. Em 22 recebeu um ramo, em 28 mais que um. O ramo proximal foi identificado em 22 membros e em 12 compartilhava ramos com outros músculos. O ramo distal estava presente em todos e desprendeu-se do nervo mediano como um ramo isolado ou de um tronco comum com o nervo interósseo anterior em 3 membros, e de um tronco comum com músculo flexor radial do carpo e nervo interósseo anterior em outro. Originou-se distalmente ao nervo interósseo anterior em 38, em 5 no mesmo nível e em 3 proximal ao nervo interósseo anterior. Em quatro recebeu inervação do nervo interósseo anterior, além daquela recebida pelo mediano. Ramos acessórios do nervo mediano para a porção distal do músculo flexor superficial dos dedos estavam presentes em oito membros. Conclusão Nos 28 membros em que existam 2 ou mais ramos, 1 desses poderia ser conectado aos ramos para o músculo extensor radial curto do carpo e pronador redondo sem tensão, mesmo durante os movimentos de pronossupinação do antebraço e flexão-extensão do cotovelo.

Anterior interosseous nerve: anatomical study and clinical implications / Nervo interósseo anterior: estudo anatômico e implicações clínicas

ABSTRACT Objective: The goal of this study was to describe anatomical variations and clinical implications of anterior interosseous nerve. In complete anterior interosseous nerve palsy, the patient is unable to flex the distal phalanx of the thumb and index finger; in incomplete anterior interosseous nerve palsy, there is less axonal damage, and either the thumb or the index finger are affected. Methods: This study was based on the dissection of 50 limbs of 25 cadavers, 22 were male and three, female. Age ranged from 28 to 77 years, 14 were white and 11 were non-white; 18 were prepared by intra-arterial injection of a solution of 10% glycerol and formaldehyde, and seven were freshly dissected cadavers. Results: The anterior interosseous nerve arose from the median nerve, an average of 5.2 cm distal to the intercondylar line. In 29 limbs, it originated from the nerve fascicles of the posterior region of the median nerve and in 21 limbs, of the posterolateral fascicles. In 41 limbs, the anterior interosseous nerve positioned between the humeral and ulnar head of the pronator teres muscle. In two limbs, anterior interosseous nerve duplication was observed. In all members, it was observed that the anterior interosseous nerve arose from the median nerve proximal to the arch of the flexor digitorum superficialis muscle. In 24 limbs, the branches of the anterior interosseous nerve occurred proximal to the arch and in 26, distal to it. Conclusion: The fibrous arches formed by the humeral and ulnar heads of the pronator teres muscle, the fibrous arch of the flexor digitorum superficialis muscle, and the Gantzer muscle (when hypertrophied and positioned anterior to the anterior interosseous nerve), can compress the nerve against deep structures, altering its normal course, by narrowing its space, causing alterations longus and flexor digitorum profundus muscles.

RESUMO Objetivo: Analisar as relações anatômicas e as variações do nervo interósseo anterior e suas implicações clínicas. A paralisia completa do nervo interósseo anterior resulta na incapacidade de fletir as falanges distal do polegar e indicador; na incompleta, ocorre menor dano axonal e apenas o polegar ou o indicador são afetados. Método: Este estudo baseou-se na dissecção de 50 membros de 25 cadáveres, 22 eram do sexo masculino e três do feminino. A idade variou entre 28 e 77 anos, 14 da etnia branca e 11 não branca; 18 foram preparados por injeção intra-arterial de uma solução de glicerina e formol a 10% e sete foram dissecados a fresco. Resultados: O nervo interósseo anterior originou-se do nervo mediano em média de 5,2 cm distal à linha intercondilar. Em 29 membros, originou-se dos fascículos nervosos da região posterior do nervo mediano e em 21 membros, dos fascículos posterolaterais. Em 41 membros, o nervo interósseo anterior posicionava-se entre as cabeças umeral e ulnar do músculo pronador redondo. Em dois membros, observou-se a duplicação do nervo interósseo anterior. Em todos os membros, registramos que o nervo interósseo anterior se desprendia do nervo mediano proximalmente à arcada do músculo flexor superficial dos dedos. Em 24 antebraços a ramificação do nervo interósseo anterior ocorreu proximalmente à arcada do músculo flexor superficial dos dedos em 26, distalmente. Conclusão: As bandas fibrosas formadas pelas cabeças umeral e ulnar do músculo pronador redondo, a arcada fibrosa do músculo flexor superficial dos dedos e o músculo de Gantzer, quando hipertrofiado e posicionado anteriormente ao nervo interósseo anterior, podem comprimir o nervo contra estruturas profundas, alterar seu curso normal, por estreitar o espaço de sua passagem, causar alterações no músculo flexor longo do polegar e no flexor profundo dos dedos da mão.

Functional Outcome of Pronation-External Rotation-Weber C Ankle Fractures with Supracollicular Medial Malleolar Fracture Treated with or without Syndesmotic Screws: A Retrospective Comparative Cohort Study / 中华医学杂志(英文版)

<p><b>Background</b>In treatment of ankle fracture, intraoperative stress tests are used to assess the syndesmotic injury and instability. However, the optimized timing of the strees test should be applied whether in pre- or post-bony fixation during operation is seldom be reported in previous studies. The different strategies on stress test timing would exhibit opposite results within a type of pronation-external rotation (PER) fractures with supracollicular medial malleolar (SMM) fractures. This study was designed to assess the 3-year functional outcomes of the special PER fractures with or without a syndesmotic transfixation based on the results of two different intraoperative stress test strategies.</p><p><b>Methods</b>This retrospective cohort study included 61 PER injury-Weber C ankle fractures combined with SMM fractures who were treated in Beijing Jishuitan Hospital between 2013 and 2014 and followed up for 3 years. Stress test was performed twice intraoperatively. A positive intraoperative stress test before bony fixation and a negative intraoperative stress test after bony fixation were found in these included patients. Twenty-nine patients (Group 1) were treated without a supplemental syndesmotic screw fixation, according to the negative intraoperative stress test after bony fixation, while 32 patients (Group 2) were treated with an additional syndesmotic screw fixation based on the positive intraoperative stress test before bony fixation. The American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale and Visual Analog Scale (VAS) for pain scores were the main measurements of outcome. The statistical index of demographic data, fracture morphologic data, time interval of follow-up, AOFAS and VAS were recorded and assessed by SPSS 21.0 software through Fisher exact tests and one-way analysis of variance. The associations between the main outcomes and influential factors were evaluated by linear regression models.</p><p><b>Results</b>We observed no difference in the distribution of age, sex, presence of associated posterior malleolus (PM), fracture dislocation, and fixation of associated PM between two treatment groups. With the numbers available, no statistically significant association could be detected with regard to the AOFAS (Group 1 vs. Group 2, 96.72 ± 6.20 vs. 94.63 ± 8.26, F = 1.24, P = 0.27) and VAS (Group 1 vs. Group 2, 1.47 ± 2.14 vs. 0.72 ± 1.49, F = 2.44, P = 0.12) in association with two strategies.</p><p><b>Conclusions</b>The present study indicates no difference to the use of the syndesmotic screw in terms of the functional outcome between syndesmosis transfixation and no-fixation patients among PER-Weber C ankle fracture patients with SMM fracture after 3-year follow-up. More attention should be paid to pre- and post-bony-fixation intraoperative stress tests and the morphology of medial malleoli fractures in ankle fractures.</p>

Where Is the Ulnar Styloid Process? Identification of the Absolute Location of the Ulnar Styloid Process Based on CT and Verification of Neutral Forearm Rotation on Lateral Radiographs of the Wrist

BACKGROUND: The location of the ulnar styloid process can be confusing because the radius and the hand rotate around the ulna. The purpose of this study was to identify the absolute location of the ulnar styloid process, which is independent of forearm pronation or supination, to use it as a reference for neutral forearm rotation on lateral radiographs of the wrist. METHODS: Computed tomography (CT) images of 23 forearms taken with elbow flexion of 70° to 90° were analyzed. The axial CT images were reconstructed to be perpendicular to the distal ulnar shaft. The absolute location of the ulnar styloid process in this study was defined as the position of the ulnar styloid process on the axial plane of the ulnar head relative to the long axis of the humeral shaft with the elbow set in the position for standard lateral radiographs of the wrist. To identify in which direction the ulnar styloid is located on the axial plane of the ulnar head, the angle between “the line of humeral long axis projected on the axial plane of the ulna” and “the line passing the center of the ulnar head and the center of the ulnar styloid” was measured (ulnar styloid direction angle). To identify how volarly or dorsally the ulnar styloid should appear on the true lateral view of the wrist, the ratio of “the volar-dorsal diameter of the ulnar head” and “the distance between the volar-most aspect of the ulnar head and the center of the ulnar styloid” was calculated (ulnar styloid location ratio). RESULTS: The mean ulnar styloid direction angle was 12° dorsally. The mean ulnar styloid location ratio was 1:0.55. CONCLUSIONS: The ulnar styloid is located at nearly the ulnar-most (the opposite side of the humerus with the elbow flexed) and slightly dorsal aspects of the ulnar head on the axial plane. It should appear almost midway (55% dorsally) from the ulnar head on the standard lateral view of the wrist in neutral forearm rotation. These location references could help clinicians determine whether the forearm is in neutral or rotated position on an axial CT/magnetic resonance imaging scan or a lateral radiograph of the wrist.

Finite Element Analysis on Manual Reduction with Inverse Shift for Pronation-Extorsion Trimalleolar Fracture / 医用生物力学

Objective To investigate the feasibility of manual reduction with inverse shift for pronation-extorsion trimalleolar fracture by applying the finite element method combined with clinical experience. Methods Based on CT images and anatomical features of bone, ligaments and other tissues as well as material parameters, a normal ankle model with completed muscles and bones for a Chinese young male was established. According to the related characteristics of the pronation-extorsion trimalleolar fractures, fracture was simulated in the proper position to make osteotomy model. The finite element model of pronation-extorsion trimalleolar fractures was thus established and then applied with mechanical loading to simulate manual reduction with inverse shift. Results The established finite element model of pronation-extorsion trimalleolar fractures was effectively restored by the displacement loading. Conclusions The finite element analysis on pronation-extorsion trimalleolar fractures by inverse shift maneuver could further prove the feasibility, effectiveness and scientificity of manual reduction with inverse shift based on clinical experience.

Checklist da prona segura: construção e implementação de uma ferramenta para realização da manobra de prona / Safe prone checklist: construction and implementation of a tool for performing the prone maneuver

RESUMO Objetivo: Construir e implementar um instrumento (checklist) para melhoria do cuidado na manobra prona. Métodos: Estudo aplicativo, qualitativo e descritivo. O instrumento foi desenvolvido a partir de ampla revisão da literatura, para construção de um protocolo de atendimento assistencial, utilizando as principais bases eletrônicas (MEDLINE, LILACS e Cochrane). Resultados: Descrevemos a construção de uma ferramenta de segurança do paciente com suas inúmeras modificações e adaptações, a partir das observações da equipe multidisciplinar com seu uso na prática diária. Conclusão: A aplicação do checklist na manobra de prona acrescentou confiabilidade e segurança ao procedimento. O entendimento da importância da ferramenta na segurança do paciente, por parte da equipe, e sua capacitação são necessários para seu sucesso.

ABSTRACT Objective: To construct and implement an instrument (checklist) to improve safety when performing the prone maneuver. Methods: This was an applied, qualitative and descriptive study. The instrument was developed based on a broad review of the literature pertaining to the construction of a care protocol using the main electronic databases (MEDLINE, LILACS and Cochrane). Results: We describe the construction of a patient safety tool with numerous modifications and adaptations based on the observations of the multidisciplinary team regarding its use in daily practice. Conclusion: The use of the checklist when performing the prone maneuver increased the safety and reliability of the procedure. The team's understanding of the tool's importance to patient safety and training in its use are necessary for its success.

Change of Pronation Angle of the Subtalar Joint has Influence on Plantar Pressure Distribution / Alteração do Ângulo de Pronação da Articulação Subtalar tem Influência na Distribuição de Pressão Plantar: Um Estudo Preliminar

Abstract Several studies have investigated the relationship between heel pronation with plantar pressure during gait. With a degree of variability and influence of the footwear, usually excessive pronation is associated with higher mechanical loads. However, larger loads are commonly associated with pronation. his study aims to compare the plantar pressure distribution among individuals with different pronation angles of the subtalar joint angle during gait with controlled speed. he maximum angle of the subtalar joint was determined by capturing images in the frontal plane and the pressure plant peaks were acquired by EMED pressure platform. he pronated group showed pressure plant peaks significantly higher in the lateral heel area (18%; p=0.031), medial heel (17%, p=0.034), lateral midfoot (30%; p=0.032) and medial midfoot (41%; p=0.018) when compared to the control group. Excessive pronation of the subtalar joint caused changes in plantar pressure distribution, and an increase in pressure plant peaks, especially in the heel and midfoot regions. This demonstrates the need for a specific care of this population, mainly because the increased pressure plant peaks is related to pain in the feet and onset of injuries.

Resumo Diversos estudos investigaram a relação da pronação da articulação subtalar com a pressão plantar na marcha. Com certo grau de variabilidade e influência do calçado, geralmente uma pronação excessiva está associada a cargas mecânicas mais elevadas. Contudo, popularmente se associa qualquer índice de pronação com aumento das cargas. Neste estudo buscamos comparar a distribuição de pressão plantar entre indivíduos com diferentes comportamentos do ângulo de pronação da articulação subtalar durante a marcha com velocidade controlada. O ângulo máximo de pronação da articulação subtalar foi determinado por meio da aquisição de imagens no plano frontal e os picos de pressão plantar foram adquiridos através da plataforma de pressão EMED. O grupo pronado apresentou picos de pressão plantar significativamente mais elevados na região do calcanhar lateral (18%; p=0,031), do calcanhar medial (17%, p=0,034), do mediopé lateral (30%; p=0,032) e do mediopé medial (41%; p=0,018) quando comparado ao grupo controle. A excessiva pronação da articulação subtalar provocou alterações na distribuição de pressão plantar, com aumento nos picos de pressão plantar, principalmente nas regiões do calcanhar e do mediopé. Isto demonstra a necessidade de um cuidado especifico em relação e este público, principalmente pelo aumento dos picos de pressão plantar estar relacionado com dores nos pés e com o surgimento de lesões.