ABSTRACT
Contact stress distributions on the tibial plafond were mapped in a series of eight fresh-frozen cadaver specimens in which displaced lateral malleolar fractures were studied. These included gripping (a) by snugly lacing the foot in an athletic shoe, (b) by polymethylmethacrylate potting of the calcaneus alone, and (c) by potting of the calcaneus plus talus. Each of these three gripping conditions was tested both for rigid and for nearly frictionless transverse external constraint conditions. Across the series, the grip-dependent changes in contact stress distributions were found to be very minor compared with the wide interspecimen variability that was consistently present. Moreover, although contact stresses generally increased with progressive lateral fibular fragment offsets of up to 5 mm, such an effect was far more modest than that seen in previous cadaver work. The present laboratory cadaver findings suggest that the contact stress elevations occurring clinically for displaced lateral malleolar fractures are probably relatively mild and likely not directly responsible for late secondary degeneration.
Subject(s)
Ankle Injuries/physiopathology , Fractures, Closed/physiopathology , Restraint, Physical , Ankle Injuries/therapy , Cadaver , Fractures, Closed/therapy , Humans , Stress, MechanicalABSTRACT
The development of a chronic illness, whether it is physical or cognitive in nature, has far-reaching implications for elderly patients and their spouses. While the plight of the patient, or care recipient, has been well documented, it has only been in the past ten years that the problems incurred by elderly spousal caregivers has begun to receive attention. In this article, difficulties experienced by elderly spousal caregivers, particularly women, are identified and a model for conceptualizing the three stages of caregiving are presented. The ways in which health care professionals can assist caregivers and alleviate their burdens and methods for determining which stage of caregiving the caretaker may be in and the particular needs associated with each stage are also discussed.
