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Diabetes Mellitus, Obesity, Lipoprotein Disorders and other Metabolic Diseases
Published in John S. Axford, Chris A. O'Callaghan, Medicine for Finals and Beyond, 2023
Peripheral neuropathy can cause small-muscle wasting with weakness of the interosseous muscles in the foot. Over time, unopposed action of the long flexors in the foot causes clawing of the toes and a high foot arch. These changes redistribute pressure over the foot and cause high pressure over the metatarsal heads. Callus (hard skin) builds up over the metatarsal heads, but paradoxically this increases shear pressure in the underlying soft tissues, leading to haemorrhage and an inflammatory exudate. Rupture of this region through the overlying skin produces the ulcer (Figure 11.8).
Paediatric Orthopaedic Surgery
Published in Timothy W R Briggs, Jonathan Miles, William Aston, Heledd Havard, Daud TS Chou, Operative Orthopaedics, 2020
Jonathan Wright, Russell Hawkins, Aresh Hashemi-Nejad, Peter Calder
Following longitudinal capsulotomy, the epiphysis must be correctly identified as the anteriorly displaced neck may be mistaken for it. Two osteotomies are required: First, an osteotomy is performed perpendicular to the neck at the level of the physis taking more anteriorly to create a wedge. The aim is to leave a convex surface for later reduction and shorten the neck by 3–4 mm. Over-shortening will lead to instability. Care must also be taken to avoid driving instruments into the posterior capsule, compromising the blood supply.Second, an osteotomy is made in the long axis of the neck to remove the bony beak on the side of the slip, again taking care not to breach the posterior capsule. Any remaining callus is carefully removed with a spoon from the posterior capsule.
Leg ulcers: diagnostic approach and management
Published in Robert A. Norman, Geriatric Dermatology, 2020
A. I. Rojas, Y. M. Bello, T.J. Phillips
Surgical debridement is crucial in the management of neuropathic ulcers. The use of scalpel or scissors is recommended to remove the surrounding callus and devitalized material. Shaving thin layers of hyperkeratotic tissue around the ulcers is recommended to avoid bacterial invasion to deep tissues and unnecessary bleeding35. Local analgesia is usually not required but should be used as needed18. The clinician should be familiar with the anatomy of the wound area and decide when the patient needs to be debrided by a plastic surgeon.
Bone fracture healing within a continuum bone remodelling framework
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2022
Ina Schmidt, Jacob Albert, Marina Ritthaler, Areti Papastavrou, Paul Steinmann
The novel healing model is examined using different fracture patterns motivated from literature at the proximal femur head. For the sake of clear and visible illustration, only a two-dimensional model is used in the following. Nevertheless, extending the model to 3 D can easily be adapted. The finite element model is motivated by Carter and Beauprè (2001) and uses bi-linear element expansions with a 2 × 2 Gauss quadrature rule. The mesh consists of 13317 elements and 13602 nodes, see Figure 1 left, which is proven to ensure sufficient accuracy from a convergence study. Ordinary daily loading of healthy bone is motivated by Carter and Beauprè (2001) and includes three typical load cases representing the midstance phase of gait, extreme abduction and adduction. The bone geometry is maintained during the simulation and is therefore not changed by possible callus formation. This assumption is reasonable, as the formation of callus tissue in the area around joints is usually prevented by appropriate treatments in order not to hinder its smooth functioning. For the sake of simplicity, no fixation systems on the bone are considered. In view of this condition, fractures at the distal radius head would represent some better examples, as no surgical intervention is necessary in some cases. However, so far there have been hardly any studies on typical loading on the radius.
Biomechanical evaluation of a novel mandibular distraction osteogenesis protocol: an in-vitro validation and the practical use of the method
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2021
A. T. Şensoy, I. Kaymaz, Ü. Ertaş
The theoretical studies as well as the in-vitro validation experiments conducted in this study have both shown that OMS is a promising method in terms of operation success. Moreover, the intraoperative efficiency of the proposed method has clinically confirmed by a maxillofacial surgeon. Owing to the patient-specific optimum surgery guide designed using OMS method, operation time and uncertainities regarding the variation of operational parameters were decreased. In addition, OMS method has been experimentally validated to be a better approach than the conventional one in terms of preoperative planning and postoperative complications. It has been concluded from the results of both theoretical and in-vitro studies that the stability of callus tissues has notably increased.
Management of acute lesser toe pain
Published in Postgraduate Medicine, 2021
Jessyca Ray, Nicholas A. Andrews, Aseel Dib, Whitt M. Harrelson, Ankit Khurana, Maninder Shah Singh, Ashish Shah
Metatarsalgia is defined as pain on the plantar aspect of the forefoot most commonly under the 2nd and 3rd metatarsal heads and, more rarely, involves the 4th metatarsal head [7,19,20]. Metatarsalgia can be the result of anatomical abnormalities or trauma to the foot and ankle [8]. To correctly identify the cause of metatarsalgia, careful attention should be given to locate the exact point of maximal tenderness and pain on physical exam [7,21]. Any plantar keratoses should be noted as they are the result of abnormal loading on the metatarsal heads [8]. Typically, patients present with pain under the metatarsal heads that is increased upon walking or wearing tight shoes. The formation of calluses under the respective metatarsal heads may be seen as well.