Accessory ossicles and sesamoid bones: recognition and treatment.

Accessory ossicles and sesamoid bones are normal variants of bone development. In foot and ankle X-rays these bones can appear similar to, or can obscure, fractures, which makes the X-rays difficult to interpret. This article illustrates and describes some of the more common ossicles and sesamoid bones, and provides a brief description of the management of the patients with foot or ankle pain whose X-rays are inconclusive.

[Negative pressure therapy in traumatology]. / La thérapie par pression négative en traumatologie.

The treatment of complex wounds in traumatology is a source of concern for nurses. Negative pressure therapy constitutes a solution for difficult-to-treat situations in the framework of open fractures and loss of limb tissue.

Principles of preventative foot care.

The lower extremities of the body, particularly the heel and ankle, are at risk of ulceration, skin tears and other forms of trauma. This is especially so in today's health-care environment, where society is faced with the challenges of an ageing population, alongside an increased incidence of diabetes, vascular insufficiency, obesity and dermatological conditions, all of which pose both clinical and economic challenges to health-care providers. Once established, damage to the foot can have a detrimental impact on the patient's overall wellbeing, often over extended periods of time, with some patients spending many years within the health-care system. Advanced wound care products tend to have a strong focus upon management of tissue damage, infection, maceration and the promotion of an optimum environment to facilitate the healing process. This clinician-patient collaboration product review challenges traditional ideals and explores the impact of using an adherent soft silicone foam dressing in maintaining skin integrity and preventing tissue damage in those high-risk patient groups.

[Nursing process for patients treated with negative pressure therapy afther severe foottrauma]. / Proces sestrinske skrbi kod pacijenata lijecenih negativnim tlakom nakon teske ozljede stopala.

Foot injuries inflicted by firearms and high pressure washing machines cause distortion of psychophysical and biomechanical characteristics with decrease of ability to satisfy the basic human needs and existing mode of living. Treatment with negative pressure accelerates wound healing process and recovery. Nursing role is significant in all these problems, which arise as patient reaction to the severe trauma. With the extensive surgical procedures required and nursing intervention, the actual and potential patient problems are minimized or eliminated, as evidenced from the good functional and esthetic results, and resuming independence and usual daily activities.

Nurse practitioners treating ankle and foot injuries using the Ottawa Ankle Rules: a comparative study in the emergency department.

BACKGROUND: Nurse practitioners (NPs) in the Emergency Department (ED) have been trained to assess a range of clinical problems and minor complaints such as acute ankle injury. This study compared assessment of suspected ankle and foot injuries using the Ottawa Ankle Rules (OAR) by NPs and ED medical doctors (ED-Drs). METHODS: A prospective, comparative, observational study was undertaken in an Australian acute adult and paediatric urban district ED. NPs and ED-Drs recorded information for patients with acute ankle and/or mid-foot injuries on demographic characteristics, OAR features, use of X-ray and patient management. Outcome measures included X-ray rates and identification of fracture. RESULTS: 174 patients were included in this study: 51 received NP and 123 received ED-Dr care. Assessed as requiring X-ray assessment (NP: 78.4%, ED-Dr: 88.6%; p=0.081), and detection of significant fracture (NP: 17.6%, ED-Dr: 22.8%; p=0.453) were similar. ED-based medical registrars were more likely to miss a fracture compared with NP (NP: 0%, ED-based Registrar: 28.6%, p=0.013). There were no significant differences in rates of OAR features for patients seen by NPs or ED-Drs. CONCLUSION: This study suggests that NPs are less likely to miss significant fractures of the ankle and/or foot compared with ED-based medical registrars. Future research should focus on actual use of the OAR and accuracy of X-ray assessment by NPs.

A mistaken case of peroneal dislocation.

This article is centred around the similarities and highlights some differences between a sports injury compared with any other injury profile. The authors use a musculoskeletal assessment, diagnosis and management of an injury based on a particular case study. The intention is to highlight how problems may be masqueraded in the history and perception of the injured athlete and how this perception may have complicated the injury and the rehabilitation process. This issue generates a renewed awareness for all primary care nurses and health practitioners who may be involved in treatment pathways for associated injuries related to sports medicine problems. The article gives an insight into peroneal dislocation/subluxation, but primarily focuses on peroneal tendonitis/tendonosis. The management of the injury briefly touches on the associated benefits (and risks) of barefoot running and its role in the prevention of sporting injuries. This article illustrates how the frustration of a chronic injury can lead to the athlete making ill-informed decisions and highlights the need for a thorough assessment and an evidence-based management plan that is negotiated with the athlete.

Cost-effectiveness of the SEN-concept: Specialized Emergency Nurses (SEN) treating ankle/foot injuries.

BACKGROUND: Emergency Departments (EDs) are confronted with progressive overcrowding. As a consequence, the workload for ED physicians increases and waiting times go up with the risk of unnecessary complications and patient dissatisfaction. To cope with these problems, Specialized Emergency Nurses (SENs), regular ED-nurses receiving a short, injury-specific course, were trained to assess and treat minor injuries according to a specific protocol. METHODS: An economic evaluation was conducted alongside a randomized controlled trial comparing House Officers (HOs) and SENs in their assessment of ankle and foot injuries. Cost prices were established for all parts of healthcare utilization involved. Total costs of health care utilization were computed per patient in both groups. Cost-effectiveness was investigated by comparing the difference in total cost between groups with the difference in sensitivity and specificity between groups in diagnosing fractures and severe sprains. Finally, cost-effectiveness ratios were calculated and presented on a cost-effectiveness plane. RESULTS: No significant differences were seen between treatment groups for any of the health care resources assessed. However, the waiting times for both first assessment by a treatment officer and time spent waiting between hearing the diagnosis and final treatment were significantly longer in the HO group. There was no statistically significant difference in costs between groups. The total costs were euro 186 (SD euro 623) for patients in the SEN group and euro 153 (SD euro 529) for patients in the HO group. The difference in total costs was euro 33 (95% CI: - euro 84 to euro 155). The incremental cost-effectiveness ratio was euro 27 for a reduction of one missed diagnosis and euro 18 for a reduction of one false negative. CONCLUSION: Considering the benefits of the SEN-concept in terms of decreased workload for the ED physicians, increased patient satisfaction and decreased waiting times, SENs appear to be a useful solution to the problem of ED crowding.

Specialized emergency nurses treating ankle and foot injuries: a randomized controlled trial.

OBJECTIVE: To cope with emergency departments (EDs) being progressively overcrowded, the concept of specialized emergency nurses (SENs) was conceived. In this study, the ability of SENs to treat ankle/foot injuries was assessed. METHODS: Regular emergency nurses were trained in a 2-day session that addressed all aspects of ankle/foot injuries. A randomized controlled trial was set up in which the diagnostic accuracy of SENs was compared with that of house officers (HOs). Secondary outcome parameter was patient satisfaction measured by a standardized questionnaire. RESULTS: In total, 512 consecutive patients were included. The sensitivity of SENs was 0.94 (95% confidence interval [CI], 0.78-0.99) compared with 0.78 (95% CI, 0.57-0.91) of HOs. Specificity was 0.94 (95% CI, 0.90-0.97) for SENs compared with 0.95 (95% CI, 0.91-0.98) for HOs. The delivered care by SENs was found to be significantly better and the median waiting time at the ED was significantly reduced (21 minutes for SENs vs 32 minutes for HOs). CONCLUSIONS: Specialized emergency nurses are capable of assessing and treating ankle/foot injuries accurately with excellent patient satisfaction and with a reduction of waiting times. Other injury-specific courses are now developed for this approach.

Cura de ampollas por fricción. A propósito del camino de Santiago / The treatment of blisters caused by friction while hiking the road to Santiago

Se recoge una experiencia práctica de tratamiento de ampollas por fricción en los pies de peregrinos del Camino de Santiago. En el diseño del plan de tratamiento se consideraron las peculiaridades de una marcha que se prolonga durante días: criterios de comodidad, seguridad y prevención de complicaciones. Los sujetos de estudio son peregrinos, compañeros de viaje de los autores. Como principales características diferenciales del método propuesto se destacan el desbridamiento precoz de la piel de la ampolla, la utilización de una cura húmeda con nitrofurazona y la fijación con un vendaje. Siguiendo este método se atendieron 16 lesiones, realizándose un total de 112 curas, registrando una evolución favorable en seis días y sin diferencias significativas en la mejoría de la lesión

this article deals with a practical experience treating blisters caused by friction on feet of pilgrims who hiked the Road to Santiago. To design this treatment plan, the authors considered the peculiarities a hike which lasts to over many days has: comfort criteria, security and prevention of complications. The study subjects were pilgrims, traveling companions of teh authors. these stand out as main differentiating characteristics of this proposed treatment, the precocious debridement of the skin of the blister, the use of a wer cure which has nitrofurazone in it and the application of a banage. following this procedure, the authors of this study tended to 16 lesions, carrying out a total of 112 cures which showed a favourable evolution within six days and no significant differences in the improvement of the lesion

The fracture liaison service: success of a program for the evaluation and management of patients with osteoporotic fracture.

INTRODUCTION: Fracture care often represents the first opportunity for clinical management of osteoporosis; however, many patients do not receive any evaluation after a fracture. In Glasgow, Scotland, fewer than 10% of fracture patients underwent bone mineral density (BMD) testing. In an effort to better meet the needs of fracture patients by providing routine assessment and, where necessary, treatment for osteoporosis after their fracture, a novel service (The Fracture Liaison Service) was designed and implemented in two separate National Health Service trusts in Glasgow. METHODS: An agreed-upon standard of care for men and women 50+ years of age with fractures was established in collaboration with orthopedic surgeons and primary care physicians. The Fracture Liaison Service assumes responsibility for fracture case-finding and for assessing and performing diagnostic evaluations (including axial DXA), and making specific treatment recommendations for the secondary prevention of osteoporotic fractures. RESULTS: During the first 18 months of operation, more than 4,600 patients with fractures of the hip, wrist, humerus, ankle, foot, hand, and other sites were seen by the Fracture Liaison Service's osteoporosis specialist nurses. Nearly three quarters of these patients were considered for BMD testing; treatment was recommended for approximately 20% of the patients without need for BMD testing. Overall, 82.3% of patients who had BMD testing were found to be osteopenic or osteoporotic at the hip or spine. CONCLUSIONS: The Fracture Liaison Service has successfully identified and evaluated most patients with fractures. Only those patients who declined were not evaluated. The ultimate success of the program will be measured by the subsequent fracture experience of these patients, but clear improvements in diagnosing and treating low bone mineral density in patients with fracture have already been demonstrated.

Neurovascular assessment.

The outcome of an injured extremity is affected primarily by initial assessment and immediate treatment of the extremity. Delaying the recognition of neurovascular compromise can cause the amputation of an extremity, or even the death of the patient. However, having the foundation of knowledge regarding total neurovascular function can equip the nurse with accurate assessment skills and the knowledge of the need for immediate action. This essential orthopaedic knowledge is used daily by the orthopaedic nurse to provide the best patient care possible with the best possible outcome.