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Kyung MG, Yoon YS, Kim Y, Lee KM, Lee DY, Hwang IU. Prolonged Union in Conservative Treatment of Symphalangeal Toe Fractures: Case Series. Clin Orthop Surg 2024; 16:322-325. [PMID: 38562628 PMCID: PMC10973627 DOI: 10.4055/cios23174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 10/25/2023] [Indexed: 04/04/2024] Open
Abstract
Background Toe symphalangism is characterized by a fusion of the interphalangeal joint between the middle and distal phalanges. While typical lesser toe fractures heal well with conservative treatment, in our clinical experience, we encountered patients with symphalangeal toe fractures who experienced long-lasting pain and delayed radiographic union. Therefore, this study aimed to report radiographic outcomes following conservative treatment of symphalangeal fractures of the lesser toes. Methods We retrospectively reviewed 14 patients with symphalangeal lesser toe fractures who were treated conservatively. We investigated the mechanism of injury and measured the time from the initial injury date to the complete radiographic union. The fracture gap distance was measured on an initial lateral radiograph. Results Symphalangeal fractures involved the fourth toe in 4 patients (28.5%) and the fifth toe in 10 patients (71.4%). Regarding the mechanism of injury, 6 patients (42.9%) were injured by stubbing or bumping into the door, 5 patients (35.7%) were injured by tripping, 2 patients (14.3%) were injured by heavy objects falling directly on their toes, and 1 patient (2.3%) complained of pain after wearing pointed shoes for half a day. The mean time to complete union was 9.1 months, and the median period was 5.5 months (range, 0.8-29 months). The initial gap of the fracture was 0.60 mm (range, 0.30-1.04 mm). Conclusions The results of our case series may help counsel patients in the outpatient clinic that prolonged healing time may be required for the union of symphalangeal toe fractures.
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Affiliation(s)
- Min Gyu Kyung
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea
| | - Young Sik Yoon
- Department of Orthopedic Surgery, Kangwon National University Hospital, Chuncheon, Korea
| | - Yongwoo Kim
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea
| | - Kyoung Min Lee
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Dong Yeon Lee
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Il-Ung Hwang
- Global Operations and Business Development, Seoul National University Hospital, Seoul, Korea
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Truter P, Edgar D, Mountain D, Saggers A, Bulsara C. 'I just need to find out if I had broken something or not.' A qualitative descriptive study into patient decisions to present to an Emergency Department with a simple fracture. Int Emerg Nurs 2024; 73:101420. [PMID: 38408404 DOI: 10.1016/j.ienj.2024.101420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 01/13/2024] [Accepted: 02/01/2024] [Indexed: 02/28/2024]
Abstract
Background To investigate what factors contribute to a working age adult with a simple fracture seeking care in an Australian metropolitan Emergency Department (ED) Methods In this Qualitative Descriptive study, we interviewed ED patients with simple fractures including 5th metacarpal, 5th metatarsal, toe, radial head and clavicle fractures. Results We interviewed 30 patients aged 18-65. Two thirds of participants were aware they might have a minor injury. Many were well informed health consumers and convenience was the most important decision-making factor. Participants focussed on organising imaging, diagnosis and immobilisation. This sequence of care was often perceived as more complex and inefficient in primary care. ED was trusted and preferred to urgent primary care with an unknown doctor. Some patients defaulted to attending ED without considering alternatives due to poor health system knowledge or from escalating anxiety. Conclusions ED is safe, free and equipped to manage simple and complex injuries. Patients would attend primary care if comprehensive fracture management was easily accessible from a trusted clinician. To effectively divert simple fracture presentations from ED, primary care requires collocated imaging, imaging interpretation, orthopaedic expertise, and fracture management resources. Services need to operate 7 days a week and must have accessible 'urgent' appointments.
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Affiliation(s)
- Piers Truter
- School of Health Sciences and Physiotherapy, The University of Notre Dame Australia, Fremantle, WA 6160, Australia; Fiona Stanley Hospital, Emergency Department, Perth, Murdoch, WA 6150, Australia.
| | - Dale Edgar
- Safety and Quality Unit, Armadale Kalamunda Group Health Service, East Metropolitan Health Service, Mt Nasura, WA, Australia; Institute of Health Research, The University of Notre Dame Australia, Fremantle, WA 6160, Australia
| | - David Mountain
- Emergency Department, Sir Charles Gairdner Hospital, Nedlands, WA, Australia; Curtin University Medical School, Bentley, WA, Australia
| | - Annabel Saggers
- School of Health Sciences and Physiotherapy, The University of Notre Dame Australia, Fremantle, WA 6160, Australia
| | - Caroline Bulsara
- Institute of Health Research, The University of Notre Dame Australia, Fremantle, WA 6160, Australia; School of Nursing and Midwifery, The University of Notre Dame, Fremantle, Australia
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Diminished coordination skills may predispose injury to lesser toe fractures—a pilot study. Neurol Sci 2022; 43:4531-4536. [DOI: 10.1007/s10072-022-05989-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 02/25/2022] [Indexed: 11/25/2022]
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GODOY-SANTOS ALEXANDRELEME, GIORDANO VINCENZO, CESAR NETTO CESARDE, SPOSETO RAFAELBARBAN, BITAR ROGÉRIOCARNEIRO, WAJNSZTEJN ANDRÉ, SAKAKI MARCOSHIDEYO, FERNANDES TÚLIODINIZ. HALLUX PROXIMAL PHALANX FRACTURE IN ADULTS: AN OVERLOOKED DIAGNOSIS. ACTA ORTOPEDICA BRASILEIRA 2020; 28:318-322. [PMID: 33328790 PMCID: PMC7723381 DOI: 10.1590/1413-785220202806236612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objectives: To describe the surgical treatment of fractures that involves the hallux interphalangeal joint, current indications and management options. Methods: we performed a literature review of relevant clinical studies in multiple databases, including PubMed, MedLine and Scopus, from January 1989 to October 2020. Results: There is consensus for surgical treatment of intra-articular fractures with a deviation greater than 2 mm, metadiaphyseal fractures with malrotation and/or malangulation, open fractures and unstable fractures. Conclusion: The use of more rigid implants allow alignment maintenance during healing process and lower risk of reduction loss. Valgus deformity and interphalangeal joint osteoarthritis are possible complications that must be avoided. Level of Evidence III, Systematic review of Level III studies.
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Abstract
Metatarsal and toe fractures are the most frequent injuries of the foot skeleton. Nondislocated fractures can be conservatively treated with good success. Long-term relief and immobilization including the ankle joint are unnecessary. Metatarsal fractures close to the base are nearly always associated with Lisfranc luxation and treatment must also take the instability of the tarsometatarsal joints into consideratíon. Basal fractures of the 5th metatarsal bone require a differentiated consideration. The correct classification is necessary in order to initiate an adequate treatment. In general, intra-articular layer formation, inclination >10° and shortening between 3 mm and 5 mm, taking the position of the head of the metatarsal bone into consideration, are recommended as indications for surgery. Operative treatment of toe fractures is only rarely necessary.
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Affiliation(s)
- M Beck
- Klinik für Orthopädie und Unfallchirurgie, St. Bernward Krankenhaus, Treibestr. 9, 31134, Hildesheim, Deutschland.
| | - A Wichelhaus
- Abteilung für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsmedizin Rostock, Schillingallee 35, 18057, Rostock, Deutschland
| | - R Rotter
- Abteilung für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsmedizin Rostock, Schillingallee 35, 18057, Rostock, Deutschland
| | - P Gierer
- Abteilung für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsmedizin Rostock, Schillingallee 35, 18057, Rostock, Deutschland
| | - T Mittlmeier
- Abteilung für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsmedizin Rostock, Schillingallee 35, 18057, Rostock, Deutschland
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Nishikawa DRC, Duarte FA, de Cesar Netto C, Monteiro AC, Albino RB, Fonseca FCP. Internal Fixation of Displaced Intra-articular Fractures of the Hallux Through a Dorsomedial Approach: A Technical Tip. Foot Ankle Spec 2018; 11:77-81. [PMID: 29076759 DOI: 10.1177/1938640017735889] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
UNLABELLED Phalangeal fractures of the toes represent common injuries of the forefoot. In the hallux, most fractures occur at the distal phalanx and frequently result from a direct crushing type of injury. Intra-articular fractures of the hallux are usually treated nonoperatively, except when the fragments are displaced and the joint is incongruent. Displaced fractures treated nonoperatively can result in degenerative arthritis of the interphalangeal joint, causing pain and range of motion limitation, hindering gait and weightbearing. The aim of this study was to present an option of operative approach in the treatment of displaced interphalangeal joint fractures of the hallux, along the medial border of the extensor hallucis longus tendon. It is our understanding that this approach minimizes injury to the soft tissue envelope, allowing a rigid fixation and early weightbearing and range of motion. LEVELS OF EVIDENCE Level V: Expert opinion.
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Affiliation(s)
- Danilo Ryuko Cândido Nishikawa
- Foot and Ankle Clinic, Department of Orthopedic Surgery, Hospital do Servidor Público Municipal de São Paulo, São Paulo, SP, Brazil (DRCN, FAD, ACM, FCPF).,Orthopaedic Surgery, General Surgery Department, University of Alabama at Birmingham, Birmingham, Alabama (CdCN).,Foot and Ankle Clinic, Department of Orthopedic Surgery, Universidade Estadual Paulista-Campus de Botucatu (UNESP), São Paulo, SP, Brazil (RBA)
| | - Fernando Aires Duarte
- Foot and Ankle Clinic, Department of Orthopedic Surgery, Hospital do Servidor Público Municipal de São Paulo, São Paulo, SP, Brazil (DRCN, FAD, ACM, FCPF).,Orthopaedic Surgery, General Surgery Department, University of Alabama at Birmingham, Birmingham, Alabama (CdCN).,Foot and Ankle Clinic, Department of Orthopedic Surgery, Universidade Estadual Paulista-Campus de Botucatu (UNESP), São Paulo, SP, Brazil (RBA)
| | - Cesar de Cesar Netto
- Foot and Ankle Clinic, Department of Orthopedic Surgery, Hospital do Servidor Público Municipal de São Paulo, São Paulo, SP, Brazil (DRCN, FAD, ACM, FCPF).,Orthopaedic Surgery, General Surgery Department, University of Alabama at Birmingham, Birmingham, Alabama (CdCN).,Foot and Ankle Clinic, Department of Orthopedic Surgery, Universidade Estadual Paulista-Campus de Botucatu (UNESP), São Paulo, SP, Brazil (RBA)
| | - Augusto César Monteiro
- Foot and Ankle Clinic, Department of Orthopedic Surgery, Hospital do Servidor Público Municipal de São Paulo, São Paulo, SP, Brazil (DRCN, FAD, ACM, FCPF).,Orthopaedic Surgery, General Surgery Department, University of Alabama at Birmingham, Birmingham, Alabama (CdCN).,Foot and Ankle Clinic, Department of Orthopedic Surgery, Universidade Estadual Paulista-Campus de Botucatu (UNESP), São Paulo, SP, Brazil (RBA)
| | - Rômulo Ballarin Albino
- Foot and Ankle Clinic, Department of Orthopedic Surgery, Hospital do Servidor Público Municipal de São Paulo, São Paulo, SP, Brazil (DRCN, FAD, ACM, FCPF).,Orthopaedic Surgery, General Surgery Department, University of Alabama at Birmingham, Birmingham, Alabama (CdCN).,Foot and Ankle Clinic, Department of Orthopedic Surgery, Universidade Estadual Paulista-Campus de Botucatu (UNESP), São Paulo, SP, Brazil (RBA)
| | - Fabio Corrêa Paiva Fonseca
- Foot and Ankle Clinic, Department of Orthopedic Surgery, Hospital do Servidor Público Municipal de São Paulo, São Paulo, SP, Brazil (DRCN, FAD, ACM, FCPF).,Orthopaedic Surgery, General Surgery Department, University of Alabama at Birmingham, Birmingham, Alabama (CdCN).,Foot and Ankle Clinic, Department of Orthopedic Surgery, Universidade Estadual Paulista-Campus de Botucatu (UNESP), São Paulo, SP, Brazil (RBA)
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Abstract
PURPOSE OF REVIEW Injuries to the great toe are common in athletes. While most are managed nonoperatively and allow return to sports activity, some great toe injuries are highly problematic and can impact function. The purpose of this review is to highlight several specific injuries and disease processes involving the hallux and to detail current recommendations and management options in order to help raise suspicion for injuries that can result in long-term dysfunction. RECENT FINDINGS Toe injuries have been found to represent nearly 10% of injuries presenting to fracture clinics. While most injuries can be treated nonsurgically, there are a number of specific injuries that require a high index of suspicion, careful management, and in some cases, surgical intervention. Injuries detailed in this review include turf toe, traumatic bunion, and hallux and sesamoid fractures. Additional pathologies that are covered include sesamoiditis and sesamoid avascular necrosis as well as hallux rigidus. Appropriate workup and current treatment recommendations are discussed. Injuries to the hallux can result in long-term pain and disability if not properly diagnosed and treated. A high index of suspicion is required.
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Affiliation(s)
- Philip J York
- Department of Orthopedic Surgery, University of Colorado School of Medicine, 12631 E. 17th Ave, Room 4508, Aurora, CO, 80045, USA
| | - Frank B Wydra
- Department of Orthopedic Surgery, University of Colorado School of Medicine, 12631 E. 17th Ave, Room 4508, Aurora, CO, 80045, USA
| | - Kenneth J Hunt
- Department of Orthopedic Surgery, University of Colorado School of Medicine, 12631 E. 17th Ave, Room 4508, Aurora, CO, 80045, USA.
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Legg P, Ramoutar D, Shivji F, Choudry B, Milner S. The construction and implementation of a clinical decision-making algorithm reduces the cost of adult fracture clinic visits by up to £104,800 per year: a quality improvement study. Ann R Coll Surg Engl 2016; 99:280-285. [PMID: 27659369 DOI: 10.1308/rcsann.2016.0276] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION Inappropriate referrals to the new patient fracture clinic unnecessarily consume hospital resources and many hospitals lack clear guidelines as to what should be referred. Many of these injuries can be definitively managed by the emergency department. Our aim was to construct and disseminate a clinical decision-making algorithm to reduce the frequency of inappropriate referrals to fracture clinics at our institution, to improve the management of patients with minor injuries and save the hospital and the patient the cost of unnecessary visits. MATERIALS AND METHODS Data were prospectively collected for all new fracture clinic referrals over two separate 1-week cycles with cohorts of 94 and 74 patients, respectively. After the first cycle, the referral algorithm was disseminated both electronically (intranet) and orally (presentations to emergency department staff). The results of this intervention were examined in the second cycle, which took place 6 months after the first cycle. RESULTS The introduction of this algorithm significantly reduced inappropriate referrals by almost 20% (P = 0.0445). DISCUSSION This simple intervention highlighted a potential annual cost saving of up to £104,000. We advocate the use of this concise algorithm in improving the efficiency of the referral system to fracture clinics.
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Affiliation(s)
- P Legg
- Derby Teaching Hospitals NHS Foundation Trust , UK
| | - D Ramoutar
- Derby Teaching Hospitals NHS Foundation Trust , UK
| | - F Shivji
- Derby Teaching Hospitals NHS Foundation Trust , UK
| | - B Choudry
- Derby Teaching Hospitals NHS Foundation Trust , UK
| | - S Milner
- Derby Teaching Hospitals NHS Foundation Trust , UK
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