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Paediatric and adolescent foot disorders
Published in Maneesh Bhatia, Essentials of Foot and Ankle Surgery, 2021
Postoperatively, plaster is applied with the foot in a neutral position to stretch the peroneal tendons and the ankle in slight dorsiflexion to maintain hindfoot equinus correction. The plaster and the Kirschner wire are removed at 5–6 weeks postoperatively and a bar brace is provided to be worn full time for 2 months and then at bedtime time for 2 years. The boots are set to point in a straight position, rather than external rotation in the Ponseti clubfoot method. Ankle-foot orthoses (AFOs), with moulding under the medial arch, are fitted to provide more support when the child begins to stand or walk. This minimally invasive technique helps to avoid complications of extensive surgery and is more likely to result in a relatively more flexible and less painful foot. Recurrence is still a concern, mainly with in patients with underlying comorbidities, but happens at a much lower rate.
Burns
Published in Kenneth D Boffard, Manual of Definitive Surgical Trauma Care: Incorporating Definitive Anaesthetic Trauma Care, 2019
In any trauma resuscitation, the purpose is to combat shock, defined as tissue hypoxia inadequate to the needs of that tissue's survival. Burns are no different, but they present with some special challenges, particularly when the airway is compromised, or when circumferential full-thickness burns with a thick, unyielding eschar produce a tourniquet effect. This can occur around the chest, neck or limbs, producing a slow asphyxiation or critical limb ischaemia. Recognition of the need for escharotomy is vital and needs to be acted upon, usually within the emergency department. An escharotomy is indicated for relief of pressure in a limb or torso to allow vascular supply or ventilation. Circumferential deep limb burns with large overall burn area requiring large volume fluid resuscitation is the commonest scenario. The eschar does not expand to accommodate, and so fluid accumulates, and pressure rises. This process takes some time to reach a crescendo – some 6–8 hours. In an awake patient, the same symptoms and signs as a tight plaster cast are complained of: increasing, unbearable, deep aching pain, loss active muscle movement, extreme pain with forced stretching of muscle groups, cool digits, slowed capillary refill, and loss of digital Doppler signal. The feel of a limb that needs escharotomy can be likened to squeezing an apple- no give. It is common for limbs to be firm, but if there is ‘give’, escharotomy is not (yet) indicated. If pulses are lost and there is still ‘give’ to palpation, first check another limb and the blood pressure. Hypovolaemia may be the cause.
Extreme clubfoot deformities and their management
Published in R. L. Mittal, Clubfoot, 2018
Postoperative management: After wound closure, no force is required to keep the foot in the corrected position in less-resistant deformities with good circulation in the foot up to the toes, including the flap area. A well-padded, below-knee plaster cast is applied. Stitches are removed at three weeks along with the K-wire (sometimes later in more severe deformities) and a plaster cast reapplied. The period of immobilization varies from two to three months, depending upon age and severity of the deformity. A more severe deformity in an older child needs longer immobilization, with more cast changes. In more rigid and severe deformities in older children, force is required to keep the foot in the corrected position, with risk of circulatory embarrassment by postoperative edema. In such cases, a well-padded cast is given in the undercorrected position and reapplied in a more-corrected position every 2–3 weeks until full correction is achieved. After removing the plaster cast, the child usually walks about in ordinary shoes, except in some cases in which talipes shoes with a straight inner border and a shoe raise on the outer border are used to avoid recurrence of deformity. Regular follow up, with increasing intervals, is important for a couple of years.
Six month nonunion tibial diaphysis osteotomy treated with conventional pulsed therapeutic ultrasound: a case report
Published in Physiotherapy Theory and Practice, 2022
Carlos E. Pinfildi, Ricardo S. Guerra, Mariana C. Ventura
The patient in this case report agreed on the consent form to present this case and findings. The patient was a 46-year-old man, 1.65 m tall, and weighed 63 kg. He was homeless and lived in and out of a shelter. Figure 1 provides a timeline of the patient’s care. The treatment was performed at a public physiotherapy clinic of the Federal University. Past medical history included hypertension, alcohol, drug addiction, and smoking for a long time. Two years previous to the beginning of this report, he fractured the left calcaneus bone with nonunion healing. He did not receive physiotherapy treatment for that injury. He was involved in a bicycle accident 9 months later and was diagnosed with right closed oblique tibial and fibular fractures. The medical treatment option was conservative plaster immobilization for 3 months. After this time, there was no radiographic evidence of fracture healing, and the physician then decided to continue with immobilization until the start of a bone callus. Throughout this time, as a result of the challenges of his economic and living conditions,the patient did not adhere strictly to the medical recommendations of rest and no weight-bearing. The patient was not referred for physiotherapy. Five months later, reexamination revealed an infection within the fracture site as well as no signs of bone callus formation.
Long-term outcomes of corrective osteotomy for malunited fractures of the distal radius
Published in Journal of Plastic Surgery and Hand Surgery, 2020
Ingrid Andreasson, Gunilla Kjellby-Wendt, Monika Fagevik-Olsén, Ylva Aurell, Michael Ullman, Jón Karlsson
The osteotomy was carried out through a dorsal incision between the 2nd and the 4th extension compartment, after release of the EPL tendon. An oscillating saw was used and the volar cortex was fractured with a chisel. The osteotomy was widened with a distractor until the correct angle was achieved and temporarily fixed with two K-wires. Then a modified volar approach according to Henry was performed and the osteotomy fixed with a conventional volar titanium plate (DVR® Medica, Stryker Variax®) or a polyetheretherketon plate (PEEK-plate, DiphosR®, Lima Corporation, San Daniele del Friuli, Italy). The osteotomy gap was filled with autologous or synthetic graft (Hydroset®, Stryker Corp, Kalamazoo, MI) or left empty. The skin was closed using resorbable intra-cutaneous sutures (Monocryl 4-0). Then a plaster was applied for 2–4 weeks according to the surgeons’ discretion.
Stepwise approach in the management of penile strangulation and penile preservation: 15-year experience in a tertiary care hospital
Published in Arab Journal of Urology, 2019
Sandeep Puvvada, Priyatham Kasaraneni, Ramesh Desi Gowda, Prasad Mylarappa, Manasa T, Kanishk Dokania, Abhishek Kulkarni, Vivek Jayakumar
If Level 1 fails then we switch to Level 2 (Figure 11). Level 2 is usually needed for thick non-metallic objects or thin metallic objects. The patient should be under spinal or general anaesthesia to immobilise the patient (as the patients will be in a state of panic and will be more frightened by the instrument sounds during the removal of the foreign body) and prevent injury to the surrounding structures whilst removing the foreign body. The different instruments used include: bone cutter, K-wire cutter, Goldsmith saw, medical orthopaedic oscillating saw to cut plaster of Paris casts, and dental micromotor with wheel blade. We used a bone cutter for one case and a medical orthopaedic oscillating saw to cut plaster of Paris casts for another case. Sawant et al. [14] used a K-wire cutter, Abd El Salam et al. [15] used a bone cutter, and Paonam et al. [16] used a micromotor wheel-shaped bur to cut through metal rings. Whilst, May et al. [17] used an oscillating splint saw to cut through a plastic bottle.