Informe de caso: Resultado clínico de TOE conservado después de un evento traumático de pie / Case report: Clinical outcome of TOE preserved after Traumatic event of foot

Introduction: Decision making in determining management of post-trauma patient is very important, especially for traumatic in the small bones, fingers and toes. The global predictor to determine the management of retaining or amputating the limb is using the Mangled Extrimity Severity Score (MESS) scoring system, values above 7 are the indication for amputation. The decision maker have to pay attention for the end result of the actions which were performed in the initial management. Material and Methods: One case is reported from Orthopaedic emergency department Hospital in Makassar, South Sulawesi, Indonesia. A 39-year old male with motor vehicle accident trauma at left foot region since 6 hours before admitted to hospital, later was diagnosed with open comminutive fracture shaft proximal phalang of left 5th toe, the Mangled Extrimity Severity Score (MESS) was 8. Patient underwent emergency debridement and retained the toe by performed Open Reduction Internal Fixation (ORIF) K-Wire. Results: This patient has a good clinical outcome by following up 2 weeks and 8 months after surgery by retain the affected side with debridement and Open Reduction Internal Fixation (ORIF) K-Wire. Patient can ambulate normally with full weight bearing, and there is no difficulty to wearing shoe or sandal. Conclusions: Determination of action by retaining the traumatized limb needs to be considered for the good of the patient, but it is necessary to provide informed consent to the patient and family that there will be a possibility of tissue death with the worst possibility of limb amputation

Retalho plantar medial: uma série de casos / The medial plantar flap: a case series

Introdução: A cobertura do pé e especialmente da região do calcâneo são desafios técnicos para o cirurgião devido ao alto grau de especialização dos tecidos envolvidos e à relativa imobilidade dos tecidos próximos. Métodos: No presente estudo, apresentamos nossa experiência com uso do retalho baseado na artéria plantar medial para cobertura de defeitos teciduais no pé, especialmente na região de apoio plantar no calcâneo. Doze retalhos da artéria plantar medial feitos de 2001 a 2013 no Hospital Regional da Asa Norte, Brasília, DF, foram incluídos. Resultados: Dos 12 pacientes, 10 eram homens e dois eram mulheres. As indicações foram perda traumática do coxim do calcâneo em 10 pacientes e dorso do pé em dois casos. Todos os retalhos foram elevados como retalhos pediculados fasciocutâneos baseados na artéria plantar medial. Todos os retalhos cicatrizaram sem maiores complicações, exceto um caso com perda parcial. A área doadora foi coberta com enxerto de pele parcial e houve um caso de perda parcial do enxerto. Os retalhos apresentaram uma sensibilidade protetora levemente inferior ao lado normal. Conclusão: De acordo com os resultados, o retalho plantar medial é uma boa opção para cobertura do pé, especialmente do calcâneo. A versatilidade do retalho permite a cobertura de defeitos no calcâneo sobre o tendão de Aquiles e apoio plantar, assim como o dorso do pé. A cobertura da região de apoio plantar com pele de textura similar e sensibilidade protetora confere a esse retalho uma grande vantagem sobre outros retalhos para reconstrução dessa região.

Introduction: Reconstructive coverage of foot defects, especially those of the calcaneus region, is a unique technical challenge for the surgeon due to the high degree of specialization of the tissues involved and the relative immobility of the proximal tissues. Methods: In the present study, we present our experience with the use of the flap based on the medial plantar artery to cover tissue defects in the foot, especially in the region of the calcaneal fat pad. Twelve medial plantar artery flaps constructed from 2001 to 2013 at the As a Norte Regional Hospital, Brasília, DF, were included. Results: Of the 12 patients with the medial plantar artery flaps, 10 were men and 2 were women. The indications were traumatic tissue loss of the plantar fat pad in 10 patients and of the dorsum of the foot in two cases. All flaps were elevated as fasciocutaneous pedicle flaps based on the medial plantar artery. All the flaps healed without major complications, except one case that involved partial loss . The donor area was covered with a partial skin graft and there was one case of partial graft loss. The flap displayed a slightly lower protective sensitivity than the normal side. Conclusion: According to the results, the medial plantar flap is a good option for covering traumatic foot defects, especially those affecting the calcaneus. The versatility of the flap allows the coverage of defects of the calcaneus (e.g., the Achilles tendon and plantar fat pad regions), as well as those affecting the dorsum of the foot. The coverage of the plantar fat pad region with skin of similar texture and protective sensitivity confers to the medial plantar flap a large advantage over other flaps for reconstruction of this region.

Buddy Taping: Is It a Safe Method for Treatment of Finger and Toe Injuries?

BACKGROUND: Buddy taping is a well known and useful method for treating sprains, dislocations, and other injuries of the fingers or toes. However, the authors have often seen complications associated with buddy taping such as necrosis of the skin, infections, loss of fixation, and limited joint motion. To our knowledge, there are no studies regarding the complications of buddy taping. The purpose of this study was to report the current consensus on treating finger and toe injuries and complications of buddy taping by using a specifically designed questionnaire. METHODS: A questionnaire was designed for this study, which was regarding whether the subjects were prescribed buddy taping to treat finger and toe injuries, reasons for not using it, in what step of injury treatment it was use, indications, complications, kinds of tape for fixation, and special methods for preventing skin injury. Fifty-five surgeons agreed to participate in the study and the survey was performed in a direct interview manner at the annual meetings of the Korean Pediatric Orthopedic Association and Korean Society for Surgery of the Hand, in 2012. RESULTS: Forty-eight surgeons (87%) used buddy taping to treat finger and toe injuries, especially proximal interphalangeal (PIP) injuries of the hand, finger fractures, toe fractures, metacarpophalangeal injuries of the hand, and PIP injuries of the foot. Sixty-five percent of the surgeons experienced low compliance. Forty-five percent of the surgeons observed skin injuries on the adhesive area of the tape, and skin injuries between the injured finger and healthy finger were observed by 45% of the surgeons. CONCLUSIONS: This study sheds light on the current consensus and complications of buddy taping among physicians. Low compliance and skin injury should be considered when the clinician treats finger and toe injuries by using buddy taping.

Dermatomicosis en ancianos institucionalizados y estudios de sensibilidad in vitro a los antifúngicos sistémicos / Dermatomycosis in institutionalized elderly patients and in vitro sensitivity study to systemic antifungus

Se determinó la prevalencia de dermatomicosis en ancianos institucionalizados de Ciudad Bilívar, Estado Bolívar, Venezuela, y se evaluó la sensibilidad in vitro de los aislamientos clínicos a los antifúngicos itraconazol, fluconazol y terbinafina mediante el método de microdilución en medio líquido, recomendado por el Comité Internacional de Laboratorios Clínicos (M38-P), con algunas modificicaciones. Los hongos fueron identificados mediante métodos tradicionales. Las levaduras se identificaron mediante pruebas bioquímicas, sistema Api 20 C AUX (Biomérieux SA®, France) y crecimiento en medio de Staib. Se estudiaron 74 ancianos, todos recluidos en el Asilo "San Vicente de Paúl" y el Geriátrico "Carlos Fragachán" quienes dieron consentimiento por escrito para participar en el estudio. La edad de los pacientes estuvo comprendida entre 63 y 98 años (80 ± 8,4 años), la mayoría eran hombres (73%). Todos los pacientes tenían lesiones sugestivas de onicomicosis en los pies. El único dermatofito aislado fue Trichophyton rubrum (n=2) el cual resultó sensible al Itraconazol, terbinafina y sensibilidad variable a flucozazol. Asimismo se logró aislar Aspergillus niger (n=5; 6,7%) demostrándose sensible a terbinafina y fluconazol con sensibilidad variable a itraconazol. Candida albicans (n=3; 4,1%) fue sensible a fluconazol, resistentes a itraconazol y variable a la terbinafina. Aspergillus flavus fue aislado en dos casos (2,7%). Además de Geomyces sp, Fusarium oxysporum y Pseudeurotium ovale. Se concluye que existe una prevalencia baja de dermatomicosis en los ancianos institucionalizados de Ciudad Bolívar y que las lesiones clinicamente observadas son debidas a los cambios degenerativos propios de la edad.

A study determine prevalence of dermatomycosis in 74 institutionalized elderly patients was conductted in Ciudad Bolivar, state of Bolivar, Venezuela. Clinical isolates were assayed for in vitro sensitivity to itraconazole, fluconazole, and terbinafine using a slightly modified version of the microdilution method in liquid medium recommended by the International Committee of Clinical Laboratory (M38-P). Traditional methods were used to identify the fungi. The yeasts were identified by Api 20C AUX biochemical testing (bioMérieux SA®, France) and growth on Staib media. The elders, mostly men (73%), from the "San Vicente de Paúl" Nursing Home and the "Carlos Fragachan" Geriatric Hospital, were aged between 63 and 98 (80 ± 8.4 years). All the patients, whose written consent was secured, had lesions suggestive of onychomycosis. Trichophyton rubrum was the only isolated dermatophyte (n=2), which resulted sensitive to itraconazole and terbinafine, with variable sensitivity to fluconazole. Aspergillus niger (n=5;6.7%) was sensitive to terbinafine and fluconazole with variable itraconazole sensitivity. Candida albicans (n=3; 4.1%) was fluconazole sensitive, resistant to itraconazole, and variable to terbinafine. Aspergillus flavus was isolated in two cases 2.7%). Geomyces sp., Fusarium oxysporum, and Pseudeurotium ovale were also isolated. It is concluded that there is a low prevalence of dermatomycosis among institutionalized elders in Ciudad Bolivar, and that the lesions clinically observed were due to degenerative changes naturally occurring with aging.

Patients' perception of traditional bone setting in Calabar

Background: Patients with orthopaedic injuries patronize traditional bonesetters in our communities. This study was undertaken to find out and document the reasons and factors responsible for this patronage; who made the choice; the role of healthworkers; patients' perception of the practice and if their experience will encourage or discourage them from patronizing traditional bone setting in future. We also compared the cost between orthodox and traditional bone setting for close humeral and femoral fractures.Methods: A prospective study of patients in three traditional bone setting centres in Calabar. A pre-tested questionnaire requesting information on age; sex; educational level; type of injury; reasons for choice of traditional bone setting was administered. Other details included who decided on traditional treatment; perception of outcome; and the option of choice in the event of a future injury. Results: There were 98 patients with 106 injuries. The male: female ratio was 66:32 (2.1:1) and age range was 9 months to 60 years. There were 76 fractures in 68 patients; 28 dislocations and 2 brachial plexus injuries. Traditional bone setting was chosen in 50 patients (51.0) because traditional bonesetters were believed to be more skillful than orthodox orthopaedic practitioners; 32 patients (32.7) thought it was cheaper; 12 patients (12.2) believed orthodox orthopaedic practitioners have no empathy towards their patients and 4 patients (4.1) had no health facility in their locality. In 68 patients (69.4) the locus of decision was external; in 22 patients (22.4) internal and 8 patients (8.2) were encouraged by a healthworker. Complications including pain; mal/nonunion; joint stiffness and contractures occurred in 60 patients (61.2). Treatment outcome was adjudged satisfactory by 48 patients (49.0); fair by 40 patients (40.8) and unsatisfactory by 10 patients (10.2). Traditional bone setting for the management of humeral and femoral fractures was more expensive than orthodox management. Conclusion: Traditional bone setting is popular for varied reasons. The freedom to advertise may have helped to woo a public already biased towards traditional bone setting by cultural attachment. A paradigm shift is necessary to reverse the trend

Evolução das fraturas intra-articulares desviadas do calcâneo com tratamento cirúrgico / Evolution of calcaneus deviated intra-joint fractures surgically treated

Fraturas do calcâneo correspondem a 2 por cento do total de fraturas do corpo humano. Apresentam acentuada importância social e grande impacto econômico, pois ocorrem em indivíduos economicamente ativos. Para reconhecer a evolução das fraturas intra-articulares desviadas do calcâneo, um estudo retrospectivo é apresentado. A amostra constituiu-se de 71 doentes com fratura de calcâneo intra-articular desviada, 63 homens (88,73 por cento) e 8 mulheres (11,27 por cento). A idade esteve entre 14 e 74 anos. Conforme a escala de ESSEX-LOPRESTI, 55 delas eram do tipo depressão articular (77,46 por cento) e 16 do tipo em língua (22,54 por cento). A incisão mais usada foi a lateral em L (91,55 por cento). Sessenta e uma das fraturas foram fixadas com placa "duplo H" (85,92 por cento), 9 necessitaram apenas de parafusos (12,68 por cento) e uma delas foi fixada com fios de Kirschner. Sete fraturas necessitaram de enxerto ósseo (9,86 por cento). O tempo médio de seguimento foi de 11,59 ± 6,72 meses. Complicações precoces estiveram presentes em 33,82 por cento dos doentes sendo mais comum a infecção e a necrose de pele. Complicações tardias foram identificadas em 63,38 por cento dos doentes, principalmente edema residual e artrose. A incidência de complicações tardias não esteve relacionada ao tipo de fratura. As fraturas do tipo depressão articular contribuíram para a maior limitação das atividades (p=0,0315). O ângulo de Bõhler, medido no pós-operatório, apresentou relação direta com o resultado final e ângulos menores do que 20 graus determinam maior incidência de maus resultados (p=0,0111). Observando a escala AOFAS, 59,26 por cento de todos os doentes, evoluíram com bons e excelentes resultados.

Luxaçäo medial da articulaçäo subtalar: relato de caso / Medial dislocation of subtalar joint: case report

Os autores relatam um caso de luxaçao subtalar do pé. Esta lesao é causada por uma vigorosa força de torçao, relatada primeiramente conforme a literatura, em 1811, tendo poucos casos descritos até agora. Neste trabalho foram detalhados todos os processos de investigaçoes diagnósticas e a tática terapêutica empregada.

Fracturas del antepie / Forefoot fractures

Se hace una revisión de las fracturas cerradas del antepié analizando las fracturas del cuboides, de las cuñas, metatarsianos y ortejos. Son fracturas de ocurrencia común en la vida civil y militar cuya recuperación funcional dependen estrechamente de un buen enfoque diagnóstico y terapéutico. Se destacan el adecuado estudio clínico y radiológico y se detallan las medidas teraéuticas que generalmente se pueden tomar en forma y con elementos simples