Validation of the Ottawa ankle rules in children.
OBJECTIVE: To assess whether the Ottawa ankle rules can be used to accurately predict which children with ankle and midfoot injuries need radiography. METHODS: Prospective study with historical control group of all children aged 1-15 years presenting to Sheffield Children's Hospital accident and emergency department with blunt ankle and/or midfoot injuries during two five month periods before and after implementation of the Ottawa ankle rules. RESULTS: In the study group 432 out of 761 (56.76%) patients received radiography compared with 500 out of 782 (63.93%) in the control group. This was a statistically significant reduction in radiography rate of 7.2% (95% confidence interval 2.3% to 12.1%, p <0.01). The sensitivity of the Ottawa ankle rules was 98.3% and the specificity 46.9%. There was no increase in the number of missed fractures (one in each group). CONCLUSION: The Ottawa ankle rules can be applied in children to determine the need for radiography in ankle and midfoot injuries. Their implementation leads to a reduction in the radiography rate without leading to an increase in the number of missed fractures. (+info)
Measurements used to characterize the foot and the medial longitudinal arch: reliability and validity.
BACKGROUND AND PURPOSE: Abnormality in the structure of the medial longitudinal arch of the foot is commonly thought to be a predisposing factor to injury. The purpose of this investigation was to compare the reliability and validity of several measurements used to characterize various aspects of the foot, including the medial longitudinal arch. SUBJECTS: One hundred two feet (both feet of 51 subjects) were measured to establish a reference database. From this group, a subset of 20 feet (both feet of 10 subjects) was used to determine intertester and intratester reliability. Radiographs of a further subset of 10 feet (right feet of 10 subjects) were used to determine validity. METHODS: Five foot measurements were taken in 2 stance conditions: 10% of weight bearing and 90% of weight bearing. RESULTS: Intraclass correlation coefficients (ICCs) for intertester and intratester measurements were between.480 and.995. The most reliable method of characterizing arch type in 10% of weight bearing between testers was dividing navicular height by foot length in 10% of weight bearing. However, this measure yielded highly unreliable measurements in 90% of weight bearing. The most valid measurements were navicular height divided by truncated foot length, navicular height divided by foot length in 10% of weight bearing, and navicular height divided by foot length in 90% of weight bearing. Dorsum height at 50% of foot length divided by truncated foot length showed relatively high intertester reliability (ICC=.811 in 10% of weight bearing, ICC=.848 in 90% of weight bearing) and validity (ICC=.844 in 10% of weight bearing, ICC=.851 in 90% of weight bearing). CONCLUSION AND DISCUSSION: These data suggest that, of the measures tested, the most reliable and valid method of clinically assessing arch height across 10% and 90% of weight bearing was dividing the dorsum height at 50% of foot length by truncated foot length. (+info)
Frozen chips: an unusual cause of severe frostbite injury.
A case of severe frostbite injury to the right foot is presented. This was caused by the inappropriate application of a bag of frozen chips to the foot in an attempt to ease non-specific pain. No specific acute traumatic injury was identified. As the patient was a teacher of physical education, the pain had initially been assumed to originate from a minor musculoskeletal injury. Full recovery ensued after surgical excision of necrotic tissue and split skin grafting. The danger of inappropriate overenthusiastic use of ice packs or other frozen material to treat soft tissue injuries is emphasised. The need for education to prevent similar future injuries is discussed. (+info)
Fishing penetration injuries.
BACKGROUND: Fishing involves millions of people throughout the world and is considered a pleasant and harmless sport. However, many kinds of injury can occur. Penetrating injuries to the extremities by fishing equipment such as hooks and harpoons, and even by scales, or infection from penetration of scales etc are relatively common although hardly ever reported in the literature. METHODS: Illustrative cases of penetrating fishing injuries are presented and discussed, with suggestions for the recommended management of these types of injury. RESULTS: Most of these objects are designed to catch and hold resisting fish, so are usually sharp and narrow in the front and wider in the rear with or without spurs. Because of their very irregular shape, simple extraction by pulling is not recommended, because further damage may occur. CONCLUSIONS: The use of the appropriate imaging modalities, a full knowledge of the contours of the object, and careful preplanning of the method of treatment are very important. (+info)
A comparative study of foot dimension between adult male and female and evaluation of foot hazards due to using of footwear.
Using footwear often becomes troublesome and creates many problems. Most of these problems are associated with the wearing of ill-fitting footwear, as it leads to biomechanical imbalance and ultimately give rise to different foot problems. In the present investigation different foot problems, viz., discomfort, pain and other hazards related to the use of footwear have been evaluated and attempts have been made to study different foot dimensions of men and women that are related to the design of footwear. For the present study different foot dimensions of both right and left feet of the subjects were measured on 300 Bengalee (Indian) subjects having the age range of 20-35 years. The subjects reported that they had got discomfort, pain, blister and corn due to using different footwear. It was noted that the occurrence of these problems in right foot was greater than that in left foot. There was no significant correlation between foot troubles and type of footwear. Results also showed that there was no significant difference in most of the foot dimensions between left foot and right foot. However, significant difference (P < 0.001) in all foot dimensions was observed between male and female subjects. Correlation coefficient among different foot dimensions has also been evaluated and it was noted that foot length was highly correlated with stature and foot volume, particularly in left foot. Footwear should be made according to the foot dimensions of the user population. The database collected from the Bengalee (Indian) population may be a helpful guide for manufacturing different footwear. (+info)
Validation of Ottawa ankle rules protocol in Greek athletes: study in the emergency departments of a district general hospital and a sports injuries clinic.
OBJECTIVE: To validate the Ottawa ankle rules protocol for predicting ankle and midfoot fractures in Greek athletes. METHOD: A prospective survey in the emergency departments of a district general hospital and a sports injury clinic in Greece over nine months. A clinical evaluation was made of 122 patients with acute ankle and/or midfoot injury, and then radiographs were taken. RESULTS: Nine ankle and eight midfoot fractures were detected. The sensitivity of the Ottawa ankle rules protocol in predicting fractures in both the malleolar and midfoot zones was 100%. The negative predictive value for each of these areas was also 1.0. Specificity was estimated to be 0.3 for ankle fractures and 0.4 for midfoot fractures. Positive predictive values were 0.16 and 0.28 respectively. A possible reduction of up to 28.7% was found in the need for radiography. CONCLUSIONS: Use of the Ottawa ankle rules protocol in evaluating injured Greek athletes resulted in 100% sensitivity when performed by orthopaedic residents or sports medicine doctors, and had the potential to reduce the use of radiography. (+info)
Minimal fixation in the treatment of open hand and foot bone fractures caused by explosive devices: case series.
AIM: To evaluate minimal fixation method with Kirschner's wires in the treatment of open fractures of the hand and foot short bones, caused by explosive devices. METHOD: There were 270 wounded persons with open fractures of hand and foot short bones, who were surgically treated at the Department of Surgery at the Osijek University Hospital. The stabilization of an unstable open fracture was performed with intramedullary positioned Kirschner's wires. In a few cases, satisfactory stabilization was achieved with Kirschner's wires positioned percutaneously alongside the wound and perpendicularly through the fracture. In the rest of the wounded, plaster immobilization was sufficient after surgical treatment and fracture reposition. RESULTS: Among 270 persons with 412 open hand and foot bone fractures, 49% had fracture only in the feet, 27% only in the hands, and 24% in both hands and feet. Unstable short bone fractures were found in 56 patients (21%). Such fractures were stabilized with Kirschner's wires (n=71). In 58 patients (21%) partial hand and foot amputations had to be performed. Reconstructive operations to improve pseudarthrosis after minimal osteosynthesis were performed on 5 short bones (7%). Osteitis was found on four short bones (6%) after minimal osteosynthesis. CONCLUSION: Minimal osteosynthesis with Kirschner's wires is a reliable and adequate method of the treatment of open unstable short bone fractures caused by explosive devices. (+info)
Towards evidence based emergency medicine: best BETs from the Manchester Royal Infirmary. Antibiotics after puncture wounds to the foot.
A short cut review was carried out to establish whether antibiotics reduce infective complications after puncture wounds to the foot. A total of 29 papers were found using the reported search, of which none answered the question posed. Further research is needed in this area. (+info)