Intra- and interobserver agreement on the Oestern and Tscherne classification of soft tissue injury in periarticular lower-limb closed fractures / Concordancia intra e interobservador de la clasificación de Oestern y Tscherne para lesiones de tejidos blandos en fracturas cerradas periarticulares del miembro inferior

Background: The soft tissues injury in periarticular fractures of the lower extremities determines the proper time to perform bone fixation. Objective: The aim of this study was to determine the intra and interobserver agreement in the Tscherne classification. Methods: This is a descriptive, prospective study for patients admitted to the Pablo Tobón Uribe Hospital (PTUH) with tibial plateau or tibial pilon fractures. We performed a standardize evaluation using video photography at the time of admission and 24, 48, and 72 h after admission. Fifteen five reviewers who had various levels of training produced a total of 1,200 observations. The intra- and interobserver agreement was assessed using a weighted kappa for multiple raters and more than two categories. Results: Twenty patients were admitted with tibial plateau and tibial pilon fractures. The intraobserver agreement for all 15 raters was kappa 0.81 (95% CI 0.79-0.83), and the interobserver agreement for all 15 raters was kappa 0.65 (95% CI 0.55-0.73). The interobserver agreement at 24 h was kappa 0.67 (95% CI 0.46-0.86). Conclusions: Classifying the severity of soft tissue injury is critical in planning the surgical management of fractures of the lower extremities. Based on our results, we can reasonably argue that the Tscherne classification produced an adequate level of agreement and could be used to standardize and to guide the treatment, and to conduct research studies.

Antecedentes: La lesión de los tejidos blandos en fracturas periarticulares del miembro inferior determina el momento adecuado para realizar la fijación ósea. Objetivo: El propósito de este estudio fue determinar la concordancia intra e interobservador para la clasificación de Tscherne. Métodos: Estudio descriptivo, prospectivo en pacientes ingresados al Hospital Pablo Tobón Uribe con fracturas de platillos tibiales o pilón tibial. Se realizó una evaluación estandarizada utilizando videos y fotografías al momento del ingreso y 24, 48 y 72 h después. Quince evaluadores que tenían diferentes niveles de entrenamiento produjeron 1200 observaciones. La concordancia intre e interobservador fue evaluada utilizando kappa ponderado para múltiples evaluadores y más de dos categorías. Resultados: Veinte pacientes fueron admitidos con fracturas de los platillos o del pilón tibial. La concordancia intraobservador para los 15 evaluadores fue kappa 0.81 (95% IC 0.79-0.83), y la concordancia interobservador para los 15 evaluadores fue kappa 0.65 (95% IC 0.55-0.73). La concordancia interobservador a las 24 h del ingreso fue kappa 0.67 (95% IC 0.46-0.86). Conclusión: Clasificar la gravedad de la lesión de los tejidos blandos es un paso fundamental en la planeación del manejo quirúrgico de las fracturas periarticulares del miembro inferior, con base en nuestros resultados podemos afirmar razonablemente que la clasificación de Oestern y Tscherne tiene un nivel de concordancia adecuado y podría utilizarse de forma sistemática para estandarizar la evaluación entre los ortopedistas para orientar el tratamiento y también con fines investigativos.

Revisão do diagnóstico de enfermagem integridade tissular prejudicada: uma análise de conceito / Nursing diagnosis review of impaired tissue integrity: a concept analysis

Os diagnósticos de enfermagem, enquanto categoria nominal, expressam o raciocínio diagnóstico realizado pelo enfermeiro a partir do exame clínico e permitem a comunicação dos fenômenos pertinentes à assistência. Entretanto, observa-se que determinados diagnósticos de enfermagem da taxonomia da NANDA-I não representam completamente os fenômenos observados na prática assistencial doenfermeiro. Nesse contexto, verifica-se que a definição do diagnóstico integridade tissular prejudicada não contempla danos às estruturas teciduais localizadas abaixo do tecido subcutâneo limitando sua utilização para diagnosticar lesões físicas com comprometimento de músculos, tendões, ossos, ligamentos, articulações e/ou cápsulas. Além disso, as listas de características definidoras e de fatoresrelacionados do diagnóstico em questão não apresentam, respectivamente, outras lesões teciduais e outros fatores associados à ocorrência de lesões que são evidenciados na prática. No intuito de contribuir para aumentar a abrangência do diagnóstico em estudo, bem como para o aprimoramento da taxonomia da NANDA-I, realizou-se este estudo com o objetivo de revisar o diagnóstico de enfermagemintegridade tissular prejudicada apresentado pela taxonomia da NANDA – I (2009-2011). Trata-se de uma análise de conceito utilizando o modelo de Walker e Avant. Para determinar o uso do conceito integridade tissular prejudicada, bem como os atributos definidores e os antecedentes desse diagnóstico realizou-se uma revisão integrativa da literatura orientada pelas seguintes questões: quais característicasdefinidoras do diagnóstico de enfermagem integridade tissular prejudicada são descritas na literatura? quais fatores relacionados do diagnóstico de enfermagem integridade tissular prejudicada são descritos na literatura? Os estudos foram selecionados nas bases de dados PUBMED, LILACS, BDEnf, CINAHL, Banco de Teses da CAPES, TESESENF, Banco de Dados Bibliográficos da USP (DEDALUS)...

Nursing diagnosis, as a nominal category, express a diagnostic reasoning of a clinical examination performed by a nurse and allows a communication of pertinent phenomena to assistance. Nevertheless, it can be noticed that some NANDA-I Taxonomy nursing diagnosis do not represent completely the observed phenomena in the nurse’s care practice. In this context, it was observed that impaired tissue integrity do not consider damage to the tissue structure located under thesubcutaneous tissue limiting its use to diagnose physical lesions compromising muscles, tendon , bones, ligaments, joints and/or capsule. Besides that, the list of defining characteristics and factors related to the diagnosis mentioned do not show, respectively, other tissue lesions and other factors associated to the occurrence oflesions which are enhanced in practice. In order to contribute to increase this study diagnosis scope, as well as to enhance NANDA-I taxonomy, the aim of this study was to review the structural components of nursing diagnosis of impaired tissue integrity shown by NANDA – I taxonomy (2009-2011). This paper is about a concept analysis using Walker and Avant´s model. In order to determine the concept of impaired tissue integrity, as well as the defining attributes and this diagnosticpreceding it was performed an integrative literature review guided by the following questions: which defining characteristics of nursing diagnosis impaired tissue integrity are described in the literature? Which factors related to nursing diagnosis impaired tissue integrity are described in the literature? The studies were selected from the following databases PUBMED, LILACS, BDEnf, CINAHL, CAPES Digital Bank of Theses Summaries, TESESENF, USP bibliographic database (DEDALUS) andthrough Google Advanced Scholar search, considering the following criteria of inclusion: articles published in Portuguese, English and Spanish and dissertations or theses which described defining characteris...

Lesiones traumáticas de las partes blandas: concepto, clasificación, tratamiento / Traumatic lesions of soft tissues: concept, classification, treatment

Se consideran lesiones traumáticas de las partes blandas, aquellas que asientan en: la piel, el tejido celular subcutáneo, las aponeurosis y los músculos. Se clasifican en cerradas y abiertas dentro de estas en superficiales y profundas y de acuerdo a las mismas se sigue un esquema de tratamiento de las mismas(AU)

They are considered traumatic lesions of the soft parts, those that agree in: the skin, the subcutaneous cellular fabric, the aponeurosis and the muscles. They are classified in closed and open inside these in superficial and deep and according to the same ones an outline of treatment of the same ones is continued(AU)

Patterns of etiologies and soft tissue defects in upper limb and use of different reconstruction modalities

A total of 48 cases of soft tissue defects of upper limb were managed during one calendar year. This included 34 males and 14 females. Post burn complication was the most common etiology. Ten cases had machine injury while other 6 cases had household trauma. Another group of six cases had injuries during fireworks at various ceremonies. Whereas 17 cases were dealt by simple measures like healing by secondary intension, primary closure and skin grafting, 31 cases needed soft tissue coverage with various flaps. Only ten cases were dealt with the help of local flaps while rest of the 21 cases needed various regional and distant flaps

Clasificación ultrasonografica de los desgarros musculares / Ultrasonographic classification of the muscle tears

Los desgarros musculares son lesiones frecuentes en la práctica deportiva y conllevan especial importancia cuando se trata de deportistas profesionales. El ultrasonido ha demostrado ser una herramienta de diagnóstico muy eficaz en el diagnóstico y caracterización de estas lesiones, en base a patrones más o menos característicos que hemos observado en nuestra experiencia. La clasificación anglosajona en grado 1,2 y 3, no tiene mayor utilidad práctica, al menos en nuestro país. Se propone, una clasificación basada en el tipo y ubicación de estas lesiones (aspecto cualitativo), sumado a la medición (aspecto cuantitativo), que ha demostrado utilidad para el manejo terapéutico.