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Canadian Family Physician Medecin de... Sep 2023To provide an overview and approach to common nail bed injuries seen by primary care practitioners. (Review)
Review
OBJECTIVE
To provide an overview and approach to common nail bed injuries seen by primary care practitioners.
SOURCES OF INFORMATION
An Ovid MEDLINE literature search was performed using search terms and studies were graded based on level of evidence.
MAIN MESSAGE
Nail trauma is common in primary care practice and requires proper and prompt treatment to avoid lasting effects on finger function and cosmesis. When presented with a fingernail injury, primary care physicians should perform a thorough physical examination to determine extent of injury; take a history to rule out notable risk factors; perform a comprehensive neurovascular examination to assess pulp capillary refill, to do a 2-point discrimination, and to compare with an uninjured digit; and evaluate range of motion. Clinical evaluation may require local anesthesia and a tourniquet. Nail bed trauma can present in different ways and includes subungual hematomas, distal phalanx fractures, Seymour fractures, and-in more severe cases-fragmentation or avulsion of the nail bed. Treatment for subungual hematomas where the nail plate is intact does not require nail plate removal and nail bed exploration; however, exploration and repair are indicated for a nail plate injury, a proximal fracture involving the germinal matrix, and a distal phalanx fracture requiring stabilization.
CONCLUSION
Fingertips are essential to normal hand function. Nail trauma is common and can be managed by primary care physicians. Shared decision making concerning management is based on the mechanism and extent of the injury and aims to prevent secondary deformities.
Topics: Humans; Nails; Physicians, Primary Care; Fractures, Bone; Fingers; Nail Diseases
PubMed: 37704235
DOI: 10.46747/cfp.6909609 -
British Journal of Sports Medicine Mar 1980
Topics: Adolescent; Adult; Athletic Injuries; Child; Female; Femoral Fractures; Fibula; Fractures, Bone; Humans; Male; Metatarsus; Middle Aged; Radiography; Tibial Fractures
PubMed: 7378671
DOI: 10.1136/bjsm.14.1.40 -
British Medical Journal Feb 1974
Topics: Activities of Daily Living; Aged; Amputation, Surgical; Anesthesia; Artificial Limbs; Femoral Neck Fractures; Fracture Fixation, Internal; Fractures, Bone; Geriatrics; Hip; Humans; Locomotion; Orthopedics; Physical Therapy Modalities; Postoperative Care; Rest
PubMed: 4811849
DOI: 10.1136/bmj.1.5900.190 -
Journal of Physiotherapy 2011What is the effect of exercise on reducing impairment and increasing activity in the rehabilitation of people with upper limb fractures? (Review)
Review
QUESTION
What is the effect of exercise on reducing impairment and increasing activity in the rehabilitation of people with upper limb fractures?
DESIGN
Systematic review of controlled trials.
PARTICIPANTS
Adults following an upper limb fracture.
INTERVENTION
Any exercise therapy program, including trials where exercise was delivered to both groups providing there was an expectation of different amounts of exercise.
OUTCOME MEASURES
Body structure and function, and activity limitations.
RESULTS
13 relevant trials involving 781 participants with an upper limb fracture were identified. 12 of the 13 trials included exercise of different duration and administration in both intervention and comparison groups. In support of the role of exercise there is evidence that: exercise and advice compared to no intervention reduce pain and improve upper limb activity in the short term after distal radius fracture; starting exercise earlier after conservatively managed proximal humeral fractures can reduce pain and improve shoulder activity; and physiotherapy that included supervised exercise and home exercise increased wrist movement after distal radius fracture when compared to home exercise alone. There is contrary evidence from two trials one after distal radius fracture and one after proximal humeral fracture that a home exercise program was superior to a supervised plus home exercise program. Only a single meta-analysis was conducted due to clinical heterogeneity and a lack of common outcome measures among the included trials.
CONCLUSION
There is evidence to support the role of specific exercise regimens in reducing impairments and improving upper limb function following specific upper limb fractures.
Topics: Arm; Exercise Therapy; Fractures, Bone; Humans; Physical Therapy Modalities; Randomized Controlled Trials as Topic
PubMed: 21684488
DOI: 10.1016/S1836-9553(11)70017-0 -
Journal of the American Academy of... Feb 2020Orthopaedic surgeons are in a position to assist in identifying intimate partner violence (IPV) patients. It was the purpose of this study to analyze the demographics...
UNLABELLED
Orthopaedic surgeons are in a position to assist in identifying intimate partner violence (IPV) patients. It was the purpose of this study to analyze the demographics and fracture patterns of IPV patients in the United States.
METHODS
Data from the National Electronic Injury Surveillance System All Injury Program from 2005 through 2013 were used. Injuries due to domestic violence were identified, and statistical analyses accounted for the weighted, stratified nature of the data.
RESULTS
There were 1.65 million emergency department visits over nine years for IPV. The median age was 29.8 years, 83.3% were women, and 55.3% occurred at home. The major diagnoses were contusion/abrasions (43.4%), lacerations (16.9%), strain/sprains (15.6%), internal organ injuries (14.4%), and fractures (9.7%). The most common fracture involved the face (48.3%), followed by the finger (9.9%), upper trunk (9.8%), and hand (6.4%). The highest proportion of lower extremity fractures occurred in men, and upper extremity fractures increased with increasing age. The odds of fracture in an IPV patient were greatest in those sustaining an upper extremity injury (odds ratio [OR] = 6.62), lower extremity injury (OR = 6.51), upper trunk injury (4.28), and head/neck injury (OR = 3.08) compared with a lower trunk injury (referent), and women (OR = 1.80) compared with men (referent). Older patients sustaining IPV had higher odds of a fracture (the few patients 10-14 and >65 years old were excluded from this analysis).
CONCLUSIONS
As this study encompasses the entire United States, these results are germane to all US orthopaedic surgeons. Knowing typical fracture patterns/locations is helpful in identifying IPV patients, although the victim may not fully divulge the history and details of the event. Identification is important for the physical and mental health of the victim, and abuse often continues if intervention does not occur. The odds of a fracture in an IPV patient are greatest when the injury involved the extremities and increased with increasing age of the patient.
Topics: Adolescent; Adult; Age Distribution; Emergency Service, Hospital; Female; Fractures, Bone; Health Care Surveys; Humans; Intimate Partner Violence; Lower Extremity; Male; Middle Aged; Sex Distribution; United States; Upper Extremity; Young Adult
PubMed: 32440627
DOI: 10.5435/JAAOSGlobal-D-20-00009 -
BMC Musculoskeletal Disorders Jul 2020To aid design of exercise trials for people with pelvic and lower limb fragility fractures a systematic review was conducted to identify what types of exercise...
BACKGROUND
To aid design of exercise trials for people with pelvic and lower limb fragility fractures a systematic review was conducted to identify what types of exercise interventions and mobility outcomes have been assessed, investigate intervention reporting quality, and evaluate risk of bias in published trials.
METHODS
Systematic searches of electronic databases (CENTRAL, MEDLINE, EMBASE, PEDro) 1996-2019 were conducted to identify randomised controlled trials of exercise for pelvic or lower limb fragility fractures. Two reviewers independently screened titles and abstracts. One reviewer extracted data, a second verified. Two reviewers independently assessed risk of bias. Intervention reporting quality was based on TIDieR, assessed by one reviewer and verified by a second. Narrative synthesis was undertaken. Registration: PROSPERO CRD42017060905.
RESULTS
Searches identified 37 trials including 3564 participants, median sample size 81 (IQR 48-124), participants aged 81 years (IQR 79-82) and 76% (2536/3356) female. All trials focussed on people with hip fracture except one on ankle fracture. Exercise types focussed on resistance exercise in 14 trials, weight bearing exercise in 5 trials, 13 varied dose of sessions with health professionals, and 2 trials each focussed on treadmill gait training, timing of weight bearing or aerobic exercise. 30/37 (81%) of trials reported adequate sequence generation, 25/37 (68%) sufficient allocation concealment. 10/37 (27%) trials lacked outcome assessor blinding. Of 65 exercise interventions, reporting was clear for 33 (51%) in terms of when started, 61 (94%) for where delivered, 49 (75%) for who delivered, 47 (72%) for group or individual, 29 (45%) for duration, 46 (71%) for session frequency, 8 (12%) for full prescription details to enable the exercises to be reproduced, 32 (49%) clearly reported tailoring or modification, and 23 (35%) reported exercise adherence. Subjectively assessed mobility was assessed in 22/37 (59%) studies and 29/37 (78%) used an objective measure.
CONCLUSIONS
All trials focussed on hip fracture, apart from one ankle fracture trial. Research into pelvic and other lower limb fragility fractures is indicated. A range of exercise types were investigated but to date deficiencies in intervention reporting hamper reproducibility. Adoption of TIDieR and CERT guidelines should improve intervention reporting as use increases. Trials would be improved by consistent blinded outcome assessor use and with consensus on which mobility outcomes should be assessed.
Topics: Aged; Exercise; Exercise Therapy; Fractures, Bone; Humans; Lower Extremity; Pelvis; Randomized Controlled Trials as Topic
PubMed: 32622352
DOI: 10.1186/s12891-020-03361-8 -
BMC Musculoskeletal Disorders Jul 2023In this study, to provide a theoretical basis for understanding the clinical characteristics of epiphyseal fractures in children and improving their management, we...
BACKGROUND
In this study, to provide a theoretical basis for understanding the clinical characteristics of epiphyseal fractures in children and improving their management, we explored and analyzed the proportions of different types of epiphyseal fractures in children and evaluated the causes of injury and epidemiological characteristics.
METHODS
We retrospectively analyzed children younger than 18 years with fresh epiphyseal fractures who were admitted to our hospital from July 2015 to February 2020. Demographic information, injury mechanisms, fracture characteristics, fracture classification and surgical information were collected.
RESULTS
A total of 1124 pediatric patients (1147 epiphyseal fractures), including 789 boys and 335 girls, were included in this study. Epiphyseal fractures were classified as Salter-Harris type II (1002 cases), type IV (105 cases), type III (25 cases), Salter-Harris type I (14 cases), and Salter-Harris type V (1 case). The number of fracture sites peaked in the adolescent group (440 cases). The most three common sites of epiphyseal fractures were the distal radius (460 cases) in which Salter-Harris type II fractures were the most common (454 cases) and Salter-Harris type I (3 cases), Salter-Harris type IV (2 cases), Salter-Harris type III was the least common (1 case). Followed by phalanges of fingers (233 cases) in which Salter-Harris type II fractures were the most common (224 cases) and Salter-Harris type IV (4 cases), Salter-Harris type I (3 cases), Salter-Harris type III fractures were the least common (2 cases). Distal humerus (146 cases) in which Salter-Harris type II fractures were the most common (95 cases), followed by Salter-Harris type IV (49 cases), Salter-Harris type I fractures were the least common (2 cases). The most three important causes of fractures were falls (720 patients), car accident injuries (68 patients), and basketball falls (43 patients). Among the 1124 children with epiphyseal fractures, 1058 were treated mainly by surgery and the ratio of open and closed reduction was 1:5.3. Eighty-eight patients showed an interval > 72 h between the injury and the hospital visit. Among these 88 patients, the most common fracture type was distal radial epiphyseal fracture (32 cases), and all fractures were of Salter-Harris type II.
CONCLUSIONS
The epidemiological characteristics of epiphyseal fractures in children indicate the need to strengthen health and safety education and protective measures to prevent the occurrence of these fractures in children. In addition, emergency surgeons and orthopedic surgeons in general hospitals should strengthen their basic knowledge of diagnosing and treating epiphyseal injuries in children to reduce missed diagnoses, misdiagnoses or malpractice.
Topics: Adolescent; Male; Female; Humans; Child; Retrospective Studies; Fractures, Bone; Fractures, Closed; Wrist Fractures; Fingers
PubMed: 37479999
DOI: 10.1186/s12891-023-06728-9 -
Medicine Nov 2023This study aimed to assess the preventive role of rehabilitation nursing in the formation of deep vein thrombosis (DVT) in the lower limbs after fracture and its effect... (Randomized Controlled Trial)
Randomized Controlled Trial
This study aimed to assess the preventive role of rehabilitation nursing in the formation of deep vein thrombosis (DVT) in the lower limbs after fracture and its effect on the patient's quality of life. Ninety patients with lower limb fractures were randomly divided into a study group (n = 45) and a control group (n = 45). Patients in the control group received routine care postoperatively, whereas patients in the study group received rehabilitation nursing intervention on the same postoperative day. A follow-up examination was conducted after 3 months. The occurrence rate of lower limb DVT (LDVT) complications, hemorheology, quality of life (SF-36) scores, coagulation profile, and nursing satisfaction were compared between the groups. After the intervention, the study group presented with lower extremity DVT and higher hemorheology indices than those of the control group (P < .05). The SF-36 scores of both groups increased, but the increase in SF-36 scores in the study group was more significant (P < .001). The satisfaction level of the patients in the study group with nursing services was higher than that of the control group (P = .004). Coagulation indicators can be effectively adjusted and the occurrence of postoperative complications can be reduced in patients undergoing spine fracture surgery such as DVT via standardized rehabilitation care, thereby improving patients' quality of life and nursing conditions.
Topics: Humans; Quality of Life; Rehabilitation Nursing; Lower Extremity; Fractures, Bone; Venous Thrombosis
PubMed: 38013261
DOI: 10.1097/MD.0000000000036180 -
European Radiology Aug 2021To recognize most common patterns of upper extremity (UE) injuries in victims of Intimate Partner Violence (IPV).
OBJECTIVES
To recognize most common patterns of upper extremity (UE) injuries in victims of Intimate Partner Violence (IPV).
METHODS
Radiological review of 308 patients who reported physical IPV at our institution from January 2013 to June 2018, identified 55 patients with 88 unique UE injuries. Demographic data and injury patterns and associations were collected from the electronic medical records.
RESULTS
The cohort included 49 females and 6 males (age 19-63, mean 38). At the time of injury, IPV was reported in 15/88 (17%) and IPV screening was documented for 22/88 (25%) injuries. There were 46 fractures, 8 dislocations or subluxations, and 34 isolated soft tissue injuries, most commonly involving the hand (56/88). Fractures most commonly involved the fingers (21/46, 46%) and the 5th digit (8/27, 30%). Medial UE fractures (5th digit, 4th digit) constituted 44% of hand and finger fractures (12/27) and 26% of all fractures (12/46). Comminuted and displaced fractures were rare (8/46, 17%). Head and face injuries were the most common concomitant injuries (9/22, 41%) and subsequent injuries (21/61, 35%). Of 12 patients with recurrent UE injuries, 6 had recurrent injuries of the same hand. Five of 6 non-acute fractures (83%) were of the hand.
CONCLUSIONS
Hand and finger injuries are the most common UE injuries in patients with IPV, with finger being the most common site and medial hand the most common region of fracture. Repeated injuries involving the same site and a combination of medial hand and head or face injuries could indicate IPV.
KEY POINTS
• Upper extremity injuries in victims of intimate partner violence are most commonly seen in the hand and fingers. • Fingers are the most common site of fracture and the medial hand is the most common region of fracture in the upper extremity in victims of intimate partner violence. • In intimate partner violence victims with upper extremity injuries, concomitant injuries and subsequent injuries are most commonly seen in the head and neck region.
Topics: Adult; Female; Fractures, Bone; Humans; Intimate Partner Violence; Male; Mass Screening; Middle Aged; Upper Extremity; Young Adult
PubMed: 33459857
DOI: 10.1007/s00330-020-07672-1 -
The Bone & Joint Journal Dec 2021The aim of this study is to develop a core set of outcome domains that should be considered and reported in all future trials of childhood limb fractures.
AIMS
The aim of this study is to develop a core set of outcome domains that should be considered and reported in all future trials of childhood limb fractures.
METHODS
A four-phase study was conducted to agree a set of core outcome domains. Identification of candidate outcome domains were identified through systematic review of trials, and outcome domains relevant to families were identified through semi-structured interviews with 20 families (parent-child pairing or group). Outcome domains were prioritized using an international three-round Delphi survey with 205 panellists and then condensed into a core outcome set through a consensus workshop with 30 stakeholders.
RESULTS
The systematic review and interviews identified 85 outcome domains as relevant to professionals or families. The Delphi survey prioritized 30 upper and 29 lower limb outcome domains at first round, an additional 17 upper and 18 lower limb outcomes at second round, and four additional outcomes for upper and lower limb at the third round as important domains. At the consensus workshop, the core outcome domains were agreed as: 1) pain and discomfort; 2) return to physical and recreational activities; 3) emotional and psychosocial wellbeing; 4) complications from the injury and treatment; 5) rturn to baseline activities daily living; 6) participation in learning; 7) appearance and deformity; and 8) time to union. In addition, 9a) recovery of mobility and 9b) recovery of manual dexterity was recommended as a core outcome for lower and upper limb fractures, respectively.
CONCLUSION
This set of core outcome domains is recommended as a minimum set of outcomes to be reported in all trials. It is not an exhaustive set and further work is required to identify what outcome tools should be used to measure each of these outcomes. Adoption of this outcome set will improve the consistency of research for these children that can be combined for more meaningful meta-analyses and policy development. Cite this article: 2021;103-B(12):1821-1830.
Topics: Adolescent; Child; Child, Preschool; Delphi Technique; Extremities; Fracture Fixation; Fractures, Bone; Humans; Outcome Assessment, Health Care
PubMed: 34412506
DOI: 10.1302/0301-620X.103B.BJJ-2020-2321.R2