Search Results
Background:
We sought to investigate the different configurations of Kirschner wires used in distal femur Salter-Harris (SH) type 2 epiphyseal fracture for stabilization after reduction under axial, rotational, and bending forces and to define the biomechanical effects on the epiphyseal plate and the fracture line and decide which was more advantageous.
Methods:
The SH type 2 fracture was modeled using design software for four different configurations: cross, cross-parallel, parallel medial, and parallel lateral with two Kirschner wires, and computer-aided numerical analyses of the different configurations after reduction were performed using the finite element method. For each configuration, the mesh process, loading condition (axial, bending, and rotational), boundary conditions, and material models were applied in finite element software, and growth cartilage and von Mises stress values occurring around the Kirschner wire groove were calculated.
Results:
In growth cartilage, the stresses were highest in the parallel lateral configuration and lowest in the cross configuration. In Kirschner wires, the stresses were highest in the cross configuration and lowest in the cross-parallel and parallel lateral configurations. In the groove between the growth cartilage and the Kirschner wire interface, the stresses were highest in the parallel lateral configuration and lowest in the cross configuration.
Conclusions:
The results showed that the cross configuration is advantageous in fixation. In addition, in the SH type 2 epiphyseal fracture, we believe that the fixation shape should not be applied in the lateral configuration.
We present a case of a pediatric patient with a history of spina bifida who presented to the emergency department of a large Army medical treatment facility with a partially amputated right fifth digit she sustained while sleeping with the family canine. There are several reports in the popular press that suggest that an animal, particularly a dog, can detect human infection, and it is hypothesized that the toe chewing was triggered by a wound infection. This case provides an opportunity to provide further education in caring for foot wounds in patients with spina bifida.
Virtually no attention has been given in public education efforts to the potentially devastating effects of smoking on the lower extremities. An analysis of the epidemiologic studies that have been done by the Office of the Surgeon General and other clinical investigators has been presented, leading to the conclusion that cigarette smoking is the single most powerful risk factor for peripheral vascular disease. In the care of patients with peripheral vascular disease, the podiatric physician has an opportunity to be a participant in efforts to solve one of the nation's major public health problems.
The health care academic delivery system is dramatically changing in today's economy. In order to survive, the delivery system must decrease its costs and increase productivity. Integration of academic affiliates and community health care facilities has produced a more efficient health care system and improved medical education. The formation and methodology of the mutual benefits and responsibilities between a health care system and a college of podiatric medicine are examined in detail. Developing unique sharing partnerships can mutually improve medical student experiences, reduce financial burdens, combine joint research projects, and ultimately improve patient care.
The authors conducted a mail survey that examined foot problems, rates of utilization of foot-health services, and the perception of foot problems as medical conditions in a sample of people aged 65 years and older who lived independently. Although 71% of the 128 respondents reported suffering from foot problems, only 39% had consulted medical personnel about their feet, and only 26% identified their foot pathologies as medical conditions. More female than male respondents experienced foot problems and had visited medical personnel about their feet. Increased education of older individuals about their foot-care requirements, as well as increased access to podiatric medical services, is recommended.
Multimedia technology was once rarely found outside the realm of commercial production studios or in elaborate computer games. However, with the addition of only a few simple accessories, recent advances have made this technology readily available to the podiatric medical practitioner on a desktop office computer. The role that the application of multimedia technology using a computerized digital camera can play in a podiatric medical practice--including in such areas as record keeping, outcome measurement, patient education, interdisciplinary communications, and practice-management tools--is discussed.
A review and typical case history of a patient with skin burns caused by prolonged exposure to wet cement was presented. This case is similar to other reported cases in the length of exposure, prolonged healing time, and typical scar formation. Burns from prolonged exposure to wet cement can result in potentially devastating long-term sequelae. The dermatologic hazards of wet cement are well recognized; however, many patients have suffered cement burns from working in wet cement. Product education and proper protection appear to be the best preventive measures.
The number of patients with HIV (human immunodeficiency virus) and AIDS (acquired immune deficiency syndrome) has increased to the point that every podiatric physician in this country will be treating patients who are HIV positive, knowingly or not. Podiatric physicians continue to be part of the medical team that must bear responsibility for the rapid changes in HIV education. Attention must be focused on educating physicians about all aspects of this disease, especially the primary and secondary diseases of AIDS and new treatments and their side effects. Sterile technique and universal precautions have now taken on new importance.
The author takes the position that a mandatory fifth postgraduate year to serve as a uniform period of clinical education for podiatric medical graduates is unnecessary. A need exists to define primary podiatric medicine as the entry level podiatric medical field of practice. The colleges of podiatric medicine are urged to deemphasize podiatric surgery while placing greater emphasis on primary podiatric care. The author believes that the colleges are responsible for preparing primary podiatric medical practitioners. Residency programs should focus on specialty training in podiatric surgery and podiatric orthopedics.
This study evaluated the magnitude and location of activity of diabetic patients at high risk for foot amputation. Twenty subjects aged 64.6 ± 1.8 years with diabetes, neuropathy, deformity, or a history of lower-extremity ulceration or partial foot amputation were dispensed a continuous activity monitor and a log book to record time periods spent in and out of their homes for 1 week. The results indicate that patients took more steps per hour outside their home, but took more steps per day inside their homes. Although 85% of the patients wore their physician-approved shoes most or all of the time while they were outside their homes, only 15% continued to wear them at home. Focusing on protection of the foot during in-home ambulation may be an important factor on which to focus future multidisciplinary efforts to reduce the incidence of ulceration and amputation. The ability to continuously monitor the magnitude, duration, and time of activity ultimately may assist clinicians in dosing activity just as they dose drugs. (J Am Podiatr Med Assoc 91(9): 451-455, 2001)
