Experiencia con la aplicación del test de Shetty para el despistaje inicial de fracturas del pie y tobillo en el área de Urgencias / Experience using the «Shetty test» for initial foot and ankle fracture screening in the Emergency Department

Objetivo: La práctica indiscriminada de radiografías en los traumatismos de pie y tobillo no está justificada y numerosos estudios han corroborado la utilidad de los tests de despistaje clínicos como las reglas del tobillo de Ottawa. El objetivo de nuestro estudio es validar clínicamente el denominado test de Shetty. Material y método: Estudio transversal observacional mediante aplicación del test de Shetty a pacientes atendidos en el Servicio de Urgencias. Resultados: Seleccionamos a 100 pacientes con una edad media de 39,25 años (16-86). Tras efectuar el test de Shetty, la prueba fue positiva en 14 ocasiones. Realizando la radiografía posterior, se constató que en 10 casos había fractura y que 4 eran falsos positivos. Por otro lado, en los 86 pacientes restantes el test fue negativo y la radiografía confirmó la ausencia de fractura (sensibilidad del 100% y una especificidad del 95,56%, así como un valor predictivo positivo del 71,40% y un valor predictivo negativo del 100%). Conclusiones: El test de Shetty es una herramienta de despistaje clínico válida a la hora de tomar decisiones sobre la indicación de la radiografía simple en lesiones del pie y tobillo. Además, es una prueba sencilla, rápida y reproducible

Objective: The indiscriminate practice of radiographs for foot and ankle injuries is not justified and numerous studies have corroborated the usefulness of clinical screening tests such as the Ottawa Ankle Rules. The aim of our study is to clinically validate the so-called Shetty Test in our area. Material and method: A cross-sectional observational study by applying the Shetty test to patients seen in the Emergency Department. Results: We enrolled 100 patients with an average age of 39.25 (16-86). The Shetty test was positive on 14 occasions. Subsequent radiography revealed a fracture in 10 cases: 4 were false positives. The test was negative in the remaining 86 patients and radiography confirmed the absence of fracture (with sensitivity of 100% and specificity of 95.56%, positive predictive value of 71.40%, and negative predictive value of 100%). Conclusions: The Shetty test is a valid clinical screening tool to decide whether simple radiography is indicated for foot and ankle injuries. It is a simple, quick and reproducible test

Experience using the «Shetty test¼ for initial foot and ankle fracture screening in the Emergency Department. / Experiencia con la aplicación del test de Shetty para el despistaje inicial de fracturas del pie y tobillo en el área de Urgencias.

OBJECTIVE: The indiscriminate practice of radiographs for foot and ankle injuries is not justified and numerous studies have corroborated the usefulness of clinical screening tests such as the Ottawa Ankle Rules. The aim of our study is to clinically validate the so-called Shetty Test in our area. MATERIAL AND METHOD: A cross-sectional observational study by applying the Shetty test to patients seen in the Emergency Department. RESULTS: We enrolled 100 patients with an average age of 39.25 (16-86). The Shetty test was positive on 14 occasions. Subsequent radiography revealed a fracture in 10 cases: 4 were false positives. The test was negative in the remaining 86 patients and radiography confirmed the absence of fracture (with sensitivity of 100% and specificity of 95.56%, positive predictive value of 71.40%, and negative predictive value of 100%). CONCLUSIONS: The Shetty test is a valid clinical screening tool to decide whether simple radiography is indicated for foot and ankle injuries. It is a simple, quick and reproducible test.

Determinantes de la capacidad de esfuerzo en pacientes adultos diagnosticados de fibrosis quística / Determining exertion capacity of adult cystic fibrosis patients

Introducción: La fibrosis quística (FQ) es una enfermedad hereditaria que se relaciona con un deterioro de la función pulmonar, malnutrición e intolerancia progresiva al ejercicio. La finalidad de nuestro estudio fue examinar la capacidad de esfuerzo de pacientes adultos diagnosticados de FQ y su relación con la función pulmonar, el estado nutricional y la actividad física. Método: Incluimos a 50 pacientes adultos diagnosticados de FQ, edad 24,4 (5,9) años con FEV1 60,4 (28)%. Las medidas incluyeron el índice de masa corporal (IMC), masa magra de extremidades (MMe), función pulmonar, evaluación de la capacidad de ejercicio (VO2max) y test de los 6 minutos (6MM). La actividad física fue medida mediante un acelerómetro portátil. Se calculó un modelo de regresión lineal múltiple para VO2max.Resultados: Los pacientes tenían un reducido IMC (20,6 (2,7) kg/m2) y MMe (17,2 (2,6) g/cm2). La distancia media andada en el 6MM fue 633,3 (74,5) m y el VO2max alcanzado fue 70,9 (17,7)%. La media de los pasos medios medidos fue 8.173,8 (3.776,2). La VO2max se relacionaba de forma significativa con la edad (–0,3 (–0,561 / –0,061), FEV1 (0,117; 0,059-0,175), media de pasos diarios (0,001 [0-0,001]), 6MM (0,022[0-0,045]) e IMC (–0,658[–1,2 / –0,067]). Conclusiones: En nuestro grupo de pacientes con FQ, había limitación en la realización de ejercicio, estando ésta influenciada por la función respiratoria, la actividad física y el estado nutriciona (AU)

Introduction: Cystic fibrosis (CF) is a hereditary disease linked to the deterioration of lung function, malnutrition and progressive exercise intolerance. The objective of this study was to examine the exertion capacity of CF patients and the relationship with lung function, nutritional status and physical activity. Method: Included in the study were fifty (50) patients who had been diagnosed with CF, age 24.4 (±5.9 years with FEV160.4 (28%). Measurements included body mass index (BMI), limb lean mass (LLM), lung function, assessment of exercise capacity (VO2 max) and 6-minute walk test. Physical activity was measured using a portable accelerometer. A multiple lineal regression model was calculated for VO2 max. Results: Patients had a reduced BMI (20.6 (±2.7) kg/m2) and LLM (17.2 (±2.6) g/cm2). The mean distance walked for the 6-minute walk was 633.3 (±74.5) m and the VO2 max reached was 70.9% (±17.7) The mean of the average steps measured was 8,173.8 (3,776.2). The VO2 max related significantly with the age (–0.3 (–0.561 / –0.061), FEV1 (0.117; 0.059-0.175), average of daily steps (0.001 [0-0.001]), 6-minute walk (0.022[0-0.045]) and BMI (–0.658[–1.2 / –0.067]). Conclusions: In our group of patients with CF, there were limits when exercising, with exercise being influenced by respiratory function, physical activity and nutritional status (AU)

Isolated subtalar arthrodesis through minimal incision surgery.

BACKGROUND: In recent years there has been an increase in the use of minimally invasive techniques, such as arthroscopy, percutaneous, and minimally invasive incisions, for foot and ankle surgery. The purpose of this study was to analyze the fusion rate and clinical results of isolated subtalar arthrodesis (ISA) using the novel and original technique of minimal incision surgery (MIS). METHODS: There were a total of 77 feet in 76 patients who underwent ISA and were followed for 50 months on average (range, 15-108). The first 30 cases were evaluated retrospectively, and 47 cases were evaluated prospectively. MIS without tourniquet was used in all cases and fusion was assessed radiographically and clinically. Clinical outcome measures used were the Angus and Cowell Scoring System, AOFAS Ankle-Hindfoot, the SF-36, and a patient satisfaction questionnaire 12 months after the intervention. RESULTS: Radiographic and clinical consolidation was achieved in 92% of cases. Main outcomes were "good" in 57 patients as determined by the Angus and Cowell criteria, with 13 "fair" and 7 "poor" results. In the prospective group, AOFAS scores improved by 47.6 points (95% CI: 50.7-42.5) 12 months after surgical intervention. SF-36 outcomes improved by 14.5 points (95% CI: 11.58-17.31) in the mental summary component and 4.2 points (95% CI: 2.2-6.1) in the physical summary component. We recorded no cases of early complications such as wound infections, neurovascular damage, or delayed wound healing. CONCLUSIONS: To our knowledge, the present series represents the largest study on subtalar arthrodesis using minimally invasive surgery. The data obtained showed a similar rate of bony union and clinical outcomes compared with the literature, but without early wound complications. ISA using the MIS technique was a good option for patients at greater risk of wound healing complications. LEVEL OF EVIDENCE: Level IV, case series.