-
Journal of Foot and Ankle Research Jun 2024Diabetic foot ulcers (DFUs) are commonly contaminated with pathogenic organisms and precede most diabetes-related amputations. Antimicrobial dressings are used in the...
INTRODUCTION
Diabetic foot ulcers (DFUs) are commonly contaminated with pathogenic organisms and precede most diabetes-related amputations. Antimicrobial dressings are used in the treatment of DFUs; however, recent guidelines do not support their use. There are no data describing the experience of antimicrobial dressing use among podiatrists in Aotearoa New Zealand (AoNZ). This study aimed to (i) determine which antimicrobial dressings podiatrists in AoNZ use for the management of diabetic foot ulcers; and (ii) determine what factors influence AoNZ podiatrists' use of antimicrobial dressing when managing DFUs.
METHODS
An anonymous cross-sectional web-based survey was undertaken. Participants were AoNZ registered podiatrists who managed DFUs in their practice. The survey included questions relating to personal and professional demographic characteristics and DFU management and dressing practices. Descriptive statistics were computed to address the research aims.
RESULTS
Responses from 43 AoNZ podiatrists were included. Participants reported both cadexomer iodine and silver dressings were the most common antimicrobial dressings used, with honey dressings being the least frequently used. The most influential factors in choosing antimicrobial dressings when managing DFUs were the presence of current infection, ulcer exudate and ability to prevent future infection. The least influential factors in choosing antimicrobial dressings when managing DFUs were patient preferences, cost of dressings and comfort of dressing/pain on removal.
CONCLUSIONS
AoNZ podiatrists managing DFUs primarily use antimicrobial dressings containing cadexomer iodine or silver as active ingredients, while lower-cost options, such as honey and povidone iodine are less often used. Current recommendations highlight the lack of evidence to support positive outcomes from any particular antimicrobial dressing over another and advocate that exudate control, comfort and cost be prioritised in decision-making. As cost has been an increasing burden to our healthcare funding, clinicians and organisations may consider this before purchasing and stocking expensive dressings.
Topics: Humans; Diabetic Foot; New Zealand; Cross-Sectional Studies; Bandages; Podiatry; Male; Female; Practice Patterns, Physicians'; Middle Aged; Anti-Infective Agents; Surveys and Questionnaires; Adult; Honey
PubMed: 38884388
DOI: 10.1002/jfa2.12032 -
The Journal of Arthroplasty Jun 2024Little is known about the resumption of sporting activities following megaprosthetic reconstruction of the distal femur and proximal tibia after resection of a bone...
Patients Regularly Return to Medium- and Low-Impact Types of Sporting Activities Following Distal Femoral or Proximal Tibial Replacement After Resection of a Primary Bone Sarcoma.
BACKGROUND
Little is known about the resumption of sporting activities following megaprosthetic reconstruction of the distal femur and proximal tibia after resection of a bone sarcoma. Thus, the aims of our study were: (1) to assess the functional outcome; (2) to evaluate pre- and postoperatively performed sporting activities; and (3) to identify potential beneficial and limiting factors.
METHODS
Between 1993 and 2015, a total of 230 patients underwent distal femoral replacement (DFR), and 96 patients underwent proximal tibial replacement (PTR). Exclusion criteria were death, amputation, living overseas, and a congenital disability. Functional outcome and sporting activities were assessed using the Musculoskeletal Tumor Society Score (MSTS), Toronto Extremity Salvage Score (TESS), Forgotten Joint Score (FJS), Subjective Knee Value (SKV), the Tegner Activity Score (TS), and the modified Weighted Activity Score (WAS).
RESULTS
There were 93 patients who had a median follow-up of 182 months (interquartile range (IQR) 130 to 260) after DFR with the following median scores: MSTS 18 (IQR 12 to 23), TESS 75% (IQR 60 to 84), FJS 25 (IQR 8 to 40), SKV 53% (IQR 40 to 70), TS 3 (IQR 3 to 4), and WAS 4 (IQR 0 to 8). There were 42 patients who had a median follow-up of 193 months (IQR 137 to 244) after PTR had the following median scores: MSTS 17 (IQR 15 to 22), TESS 78% (IQR 68 to 88), FJS 32 (IQR 20 to 46), SKV 60% (IQR 40 to 70), TS 3 (IQR 3 to 4), and WAS 4 (IQR 1 to 10). Postoperatively, 61% of DFR and 76% of PTR patients participated in at least one sporting activity.
CONCLUSION
Functional outcome is overall good with a regular resumption of sporting activities. Patients' age at surgery and higher preoperative sporting levels were associated with better functional outcomes and higher postoperative sporting activity.
PubMed: 38880406
DOI: 10.1016/j.arth.2024.06.014 -
BMC Musculoskeletal Disorders Jun 2024Traumatic proximal tibiofibular fracture and dislocation (PTFD) have been rarely studied and are easily missed in clinical practice. PTFD is considered a marker of...
BACKGROUND
Traumatic proximal tibiofibular fracture and dislocation (PTFD) have been rarely studied and are easily missed in clinical practice. PTFD is considered a marker of severely traumatized knees. The purpose of this study was to retrospectively analyze the incidence and impact of PTFD in traumatized knees with vascular injury.
METHODS
Patients with knee trauma and vascular injury were included from January 2022 to October 2023. X-rays and CT scans of included patients were retrospectively analyzed to determine the presence of PTFD. Patients were further divided into PTFD group and non-PTFD group for further comparative analysis.
RESULTS
A total of 27 patients (28 limbs) were included. Incidence of PTFD was 39.3% (11/28) in traumatic knee with vascular injury, including 8 anterolateral dislocations and 3 posteromedial dislocations. PTFD group had significantly more limbs with open injuries compared with non-PTFD group (10/11 VS 7/17, p<0.05). Amputation rate of PTFD group was as high as 40% (4/10), compared to 23.5% (4/17) in non-PTFD group. However, the difference between two groups was not statistically significant (p>0.05).
CONCLUSIONS
PTFD was easily overlooked or missed. In traumatized knees with vascular injury, incidence of PTFD was high. The presence of PTFD might indicate severe knee trauma and the possibility of open injury. Although there was no significant difference compared with non-PTFD group, PTFD group had a relatively high amputation rate of 40%.
Topics: Humans; Male; Female; Retrospective Studies; Adult; Middle Aged; Tibial Fractures; Knee Dislocation; Fibula; Incidence; Young Adult; Tomography, X-Ray Computed; Vascular System Injuries; Amputation, Surgical; Aged; Knee Injuries; Adolescent
PubMed: 38879480
DOI: 10.1186/s12891-024-07577-w -
Nursing Open Jun 2024To understand the experiences of individuals who undergo LEA due to DFU after disability.
AIM
To understand the experiences of individuals who undergo LEA due to DFU after disability.
DESIGN
A descriptive research design in qualitative research.
METHODS
Semi-structured interviews were used in this qualitative descriptive study. Eleven middle-aged patients (45-59 years) who underwent LEA due to DFU were purposively selected and interviewed. Qualitative data were thematically analysed.
RESULTS
Three themes and 10 subthemes were identified. The themes were (1) role function confusion, (2) self-concept stress and (3) unreasonable objective support. Subthemes included (1) weakened career role, (2) family role reversal, (3) social role restriction, (4) over-focusing on appearance, (5) immersion in patient experience, (6) living with faith, (7) polarization of independent consciousness, (8) low perceived benefits of peer support, (9) existence of treatment disruption and (10) poor participation in medical decision-making.
Topics: Humans; Qualitative Research; Middle Aged; Male; Female; China; Amputation, Surgical; Diabetic Foot; Disabled Persons; Lower Extremity; Social Support; Interviews as Topic; Self Concept
PubMed: 38875354
DOI: 10.1002/nop2.2213 -
Canadian Prosthetics & Orthotics Journal 2023The world of prosthetics has been undergoing significant changes, with the evolution of materials, design techniques, and manufacturing methodologies converging to...
The world of prosthetics has been undergoing significant changes, with the evolution of materials, design techniques, and manufacturing methodologies converging to redefine the landscape. Central to this narrative is the imperative for a holistic approach, harmonizing the trinity of materials, design, and methodologies to yield optimal outcomes. This balance is especially pivotal for the overlooked yet significant segment of those with partial hand and finger differences. Historically, this demographic has been underserved, with rehabilitation and prosthetic innovations often falling short. The sheer prevalence of partial hand differences underscores the urgency of tailored solutions. Traditional fabrication methods like wet lamination have posed challenges, particularly in aligning and efficiency. The advent of additive manufacturing has been transformative. The case of designing and printing a partial finger socket for Point Designs, LLC's Point Partial finger highlights this paradigm shift. Where conventional techniques demanded hours, digital design and 3D printing have condensed the process to mere minutes, without compromising on quality. This is not merely a win in terms of time efficiency; the implications for the end users are profound, ensuring a more customized and efficient solution. The journey underscores the potential of blending technology and traditional prosthetic knowledge, pointing towards a future where prosthetics align more seamlessly with users' needs.
PubMed: 38873135
DOI: 10.33137/cpoj.v6i2.42139 -
Canadian Prosthetics & Orthotics Journal 2023Victoria Hand Project (VHP) is a Canadian charity with a mission to provide 3D printed prosthetic arms to people in-need across the world, by partnering with prosthetic...
Victoria Hand Project (VHP) is a Canadian charity with a mission to provide 3D printed prosthetic arms to people in-need across the world, by partnering with prosthetic care providers. This article explores the journey of VHP, sharing insights, lessons learned, ongoing directions, and the impact of 3D printing on prosthetic care for people with upper-limb amputation. Benefits such as affordability and customization are explored, as well as the challenges encountered, including quality control and the steep learning curve associated with working in the digital 3D space. Through this article, the potential of 3D printing to continue to transform the field of assistive technology and prosthetic and orthotic applications is underscored, especially when used for collaborative, humanitarian initiatives.
PubMed: 38873134
DOI: 10.33137/cpoj.v6i2.42142 -
Canadian Prosthetics & Orthotics Journal 2023Cosmetic covers provide better aesthetic appearance and may facilitate increased acceptance of the prosthesis. Traditionally, cosmetic covers aimed to achieve an... (Review)
Review
Cosmetic covers provide better aesthetic appearance and may facilitate increased acceptance of the prosthesis. Traditionally, cosmetic covers aimed to achieve an aesthetic and realistic appearance; through time, a fresh perspective has developed on cosmetic covers where traditional/realistic covers evolved into a custom-made product, which truly promotes the patient's personality. The objectives of the study were to gather information from five well-known companies in the cosmetic cover industry (UNYQ, Limb-Art, Alleles, WillowWood and Aqua-Leg), analyse and compare their design elements using the Pugh matrix, and suggest a novel design using the best performing criteria of each design. The overall results of the Pugh matrix revealed the opportunity of a new design with improved design elements mainly in terms of "cover fit/aesthetics", "ease of attachment" and "practicality". The novel design had a vast difference in total score from the second-best design, revealing the improvement possibilities such cover design may have in the future. Although the study successfully presented a theoretical novel design, it was based on data found through literature and web resources, making the overall results of the study more objective rather than subjective. Future research is encouraged to be conducted based on a more subjective approach towards cosmetic covers.
PubMed: 38873131
DOI: 10.33137/cpoj.v6i2.42176 -
Canadian Prosthetics & Orthotics Journal 2023Major limb loss can have profound physical and psychosocial implications for individuals, impacting their quality of life and well-being. Despite the effectiveness of... (Review)
Review
BACKGROUND
Major limb loss can have profound physical and psychosocial implications for individuals, impacting their quality of life and well-being. Despite the effectiveness of peer support in improving outcomes for various chronic conditions, its impact on individuals with major limb loss remains understudied.
OBJECTIVES
This review aims to explore the existing literature on peer support for individuals with major limb loss. Specifically, exploring how the literature defines peer support; examining its implementation, identifying outcomes measured in peer support interventions, assessing the benefits for individuals with major limb loss, and identifying barriers associated with peer support provision.
STUDY DESIGN
This review followed Arksey and O'Malley's methodological framework, analysing relevant literature to identify evidence, definitions, and key factors related to peer support for individuals with major limb loss.
METHODOLOGY
A comprehensive search in January 2023 utilized databases: MEDLINE, PsychInfo, Embase, and CINAHL. After a two-phase screening process, articles meeting specific criteria were included. Thematic and descriptive numerical analyses were applied to the extracted data.
FINDINGS
Twenty-two articles were reviewed. Peer support was described as an opportunity to provide education, advice, and encouragement between individuals with lived experiences. Across the two intervention-based studies investigating peer support programs, outcome measures included physical, psychological, social, and quality of life. Qualitative studies described perceived benefits as improved psychosocial well-being and the opportunity to exchange knowledge. Perceived barriers included a lack of formal training and male-dominated groups, which deterred individuals with amputation from participating.
CONCLUSION
The evidence from the findings of the review sheds light on the current understanding of peer support for individuals with amputation. Due to the limited number of studies available, future research is necessary to develop and evaluate the effectiveness of peer support interventions tailored to this population.
PubMed: 38873011
DOI: 10.33137/cpoj.v6i1.42170 -
Canadian Prosthetics & Orthotics Journal 2023The choice of prosthetic socket interface material significantly affects user comfort and satisfaction. The Affordable Ethylene-Vinyl Acetate Roll-On (AERO) liner was...
BACKGROUND
The choice of prosthetic socket interface material significantly affects user comfort and satisfaction. The Affordable Ethylene-Vinyl Acetate Roll-On (AERO) liner was created with the aim of improving functionality and streamlining the wearing process for users.
OBJECTIVE
The purpose of this study was to comprehensively assess user satisfaction, comfort, and durability of the AERO liner and compare it with the common soft Pe-Lite liner.
METHODOLOGY
Fourteen individuals with transtibial amputation participated in this three-month randomized crossover trial study. The Prosthesis Evaluation Questionnaire (PEQ), Expanded Socket Comfort Score (ESCS), and liner thickness measurements were used to comprehensively compare the AERO and Pe-Lite liner.
FINDINGS
The AERO liner demonstrated notable improvements in prosthetic comfort and functionality over Pe-Lite liner. After three months use, there was a significant reduction in reported frustration with the AERO liner (p=0.023, r=0.604) in the PEQ subscale. Specific aspects, such as walking with the prosthesis (p=0.030, r=0.601) and odor perception (p=0.024, d=0.579), favored the use of the AERO liner. The expanded socket comfort score (ESCS) revealed significant superiority for the AERO liner "at best" (p=0.04) and "on average" (p=0.02) after one and three months, respectively. Liner thickness analysis showed significant reductions at the mid-patellar tendon location for the AERO liner at one (0.57±0.48) and three months (0.90±0.69, p=0.01) and in the posterior region after three months (0.63±0.64, p=0.05).
CONCLUSION
Our study highlights the potential advantages of the AERO liner in enhancing comfort and satisfaction. Yet, durability and thinning of the liner when compared to Pe-Lite may be a concern which may eventually affect socket fit. These findings contribute to ongoing efforts to optimize prosthetic interventions and improve the quality of life of individuals with lower limb prosthesis in resource-limited environments.
PubMed: 38873010
DOI: 10.33137/cpoj.v6i1.41865 -
Canadian Prosthetics & Orthotics Journal 2023There is a dearth of literature evaluating the accuracy of Air Displacement Plethysmography (ADP) compared to Dual-energy X-ray Absorptiometry (DXA) for assessing body...
BACKGROUND
There is a dearth of literature evaluating the accuracy of Air Displacement Plethysmography (ADP) compared to Dual-energy X-ray Absorptiometry (DXA) for assessing body composition in individuals with lower limb amputations. Validity of ADP in persons with lower limb amputations must be established.
OBJECTIVE
The objective of this study was to compare body composition in persons with lower limb amputations using the BOD POD and DXA.
METHODOLOGY
Body composition was performed on eleven lower limb prosthesis users (age 53.2±14.3 years, weight 81.9±22.3kg) using ADP and DXA with and without prosthesis.
FINDINGS
Repeated measures ANOVA indicated no significant difference in body composition among and between trials, F(3,8)= 3.36, p= 0.075. There were no significant differences in Body Fat (BF) percentage with and without prostheses on the BOD POD (28.5±15.7% and 33.7±12.1%, respectively) nor the DXA (32.9±10.6% and 32.0±9.9%, respectively). Association between the BOD POD and DXA were greatest when prostheses were not worn compared to when they were worn. Bland-Altman plots indicate agreement between BOD POD and DXA was greatest while wearing the prosthesis.
CONCLUSION
This study is a first to compare total body fat percent between the BOD POD and DXA in lower limb prosthesis users. BOD POD report valid indices of BF%. Future work will utilize the BOD POD in intervention studies for monitoring body composition changes across the continuum of rehabilitation.
PubMed: 38873009
DOI: 10.33137/cpoj.v6i1.41605