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Cleofort V, Attal R, Sayegh J, Yannoutsos A, Lazareth I, Emmerich J, Priollet P. Evaluation of the ankle brachial index and toe brachial index for peripheral arterial disease diagnosis in patients over 70 years with lower limb ulcers. J Med Vasc 2023; 48:11-17. [PMID: 37120264 DOI: 10.1016/j.jdmv.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Indexed: 05/01/2023]
Abstract
OBJECTIVE The aim of our study was to evaluate the diagnostic performance of the ankle brachial index using pulsed Doppler, and the toe brachial index using laser Doppler, in comparison with the arterial Doppler ultrasound of the lower limbs as a reference test, in a population of non-diabetic subjects over 70 years old with lower limb ulcers and without chronic renal failure. METHODS We included 50 patients, 100 lower limbs from the vascular medicine department of the Paris Saint-Joseph hospital from December 2019 to May 2021. RESULTS We found a sensitivity of 54.5% for the ankle brachial index and a specificity of 67.6%. Regarding the toe brachial index, the sensitivity was 80.3% and the specificity 44.1%. We could explain the low sensitivity of the ankle brachial index in our population by the mediacalcosis of elderly subjects, avoidable with the measurement of the toe blood pressure index, which had a better sensitivity. CONCLUSION In a population of subjects over 70 years of age with a lower limb ulcer, without diabetes and without chronic renal failure, it would seem judicious to use the ankle brachial index in association with the toe brachial index for the diagnosis of peripheral arterial disease, followed by an arterial Doppler ultrasound of the lower limbs in order to evaluate the lesion profile of patients with a result of less than 0.7 of toe brachial index.
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Affiliation(s)
- V Cleofort
- Service de médecine vasculaire, 185, rue Raymond-Losserand, 75674 Paris cedex 14, France.
| | - R Attal
- Service de médecine vasculaire, 185, rue Raymond-Losserand, 75674 Paris cedex 14, France
| | - J Sayegh
- Service de cardiologie pédiatrique, avenue de la Côte de Nacre, 14033 Caen cedex 9, France
| | - A Yannoutsos
- Service de médecine vasculaire, 185, rue Raymond-Losserand, 75674 Paris cedex 14, France
| | - I Lazareth
- Service de médecine vasculaire, 185, rue Raymond-Losserand, 75674 Paris cedex 14, France
| | - J Emmerich
- Service de médecine vasculaire, 185, rue Raymond-Losserand, 75674 Paris cedex 14, France
| | - P Priollet
- Service de médecine vasculaire, 185, rue Raymond-Losserand, 75674 Paris cedex 14, France
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Kaiser P, Loth F, Attal R, Kummann M, Schuster P, Riechelmann F, Schlumberger M. Static patella tilt and axial engagement in knee extension are mainly influenced by knee torsion, the tibial tubercle-trochlear groove distance (TTTG), and trochlear dysplasia but not by femoral or tibial torsion. Knee Surg Sports Traumatol Arthrosc 2020; 28:952-959. [PMID: 31267191 DOI: 10.1007/s00167-019-05588-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 06/19/2019] [Indexed: 01/27/2023]
Abstract
PURPOSE The aim of this study was to investigate the association of femoral (FT), tibial (TT), and knee torsion (KT) on the patella tilt (PT), the axial engagement index (AEI), and the tibial tuberosity-trochlear groove distance (TTTG). METHODS Femoral torsion, tibial torsion, knee torsion, patella tilt, the axial engagement index, the TTTG, and trochlear dysplasia were retrospectively evaluated on 59 patients suffering from recurrent patella instability or anterior knee pain with 118 torsional lower limb magnetic resonance imaging studies. RESULTS FT and TT did not show any significant associations with TTTG, PT, and AEI (n.s.). KT was significantly associated with a higher TTTG, higher PT, and lower AEI (all, p < 0.001). Higher grade trochlear dysplasia was associated with a higher PT and lower AEI (both, p < 0.001). The Dejour classification showed no significant association with FT, TT, KT, and TTTG (n.s.). All measurement parameters showed an excellent interrater agreement (ICC 0.89-0.97). CONCLUSIONS Static patella tilt and patellofemoral axial engagement in knee extension are mainly influenced by knee torsion, TTTG, and trochlear dysplasia but not by femoral or tibial torsion. These findings help to understand the underlying reasons for the patella position in knee extensions in CT and MRI investigations in patients suffering from patella instability and patellofemoral pain syndrome. LEVEL OF EVIDENCE III.
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Affiliation(s)
- P Kaiser
- Department of Trauma Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - F Loth
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University Innsbruck, Innsbruck, Austria
| | - R Attal
- Department of Trauma Surgery, Landeskrankenhaus Feldkirch, Feldkirch, Austria.
| | - M Kummann
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - P Schuster
- Center of Arthroscopy and Sports Medicine, Orthopedic Hospital Markgroeningen, Markgroeningen, Germany.,Paracelsus Medical Private University, Salzburg, Austria
| | - F Riechelmann
- Department of Trauma Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - M Schlumberger
- Department of Trauma Surgery, Medical University Innsbruck, Innsbruck, Austria.,Center of Arthroscopy and Sports Medicine, Orthopedic Hospital Markgroeningen, Markgroeningen, Germany
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Liebensteiner MC, Henninger B, Kittl C, Attal R, Giesinger JM, Kranewitter C. The anterolateral ligament and the deep structures of the iliotibial tract: MRI visibility in the paediatric patient. Injury 2019; 50:602-606. [PMID: 30391071 DOI: 10.1016/j.injury.2018.10.040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 09/24/2018] [Accepted: 10/28/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To assess the visibility of both the anterolateral ligament (ALL) and the deep structures of the iliotibial tract (ITT) by means of MRI in paediatric patients. To determine reproducibility for such measurements. METHODS Knee MRI data from patients aged <18a without lesions of the capsule or ligaments, fractures, bone edemas, foreign material or motion artifacts were analyzed by two musculoskeletal radiologists separately and twice. The visibility of the different parts of the ALL was determined (femoral, meniscal, tibial parts). Similarly, the visibility of the different parts of the deep ITT was determined: deep attachments of the ITT to the distal femur (insertion near septum, supracondylar insertion and retrograde insertion) and capsulo-osseous layer of the ITT. RESULTS We studied 61 cases (36 female, 25 male). Age was 15 years (±2.3). Interobserver agreement was high. Cohen's Kappa was 0.864 (95%CI: 0.715-1.000) for the tibial part of the ALL and 1.0 for the femoral part of the ALL. For the deep attachments of the ITT to the distal femur Kappa was 0.828 (95%CI: 0.685-0.971). Regarding intraobserver agreement, Cohen's Kappa was 1.0 for the femoral part of the ALL and 0.955 (95%CI: 0.867-1.000) for the tibial part of the ALL. For the deep attachments of the ITT to the distal femur Cohen's Kappa was 0.896 (95%CI: 0.782-1.000). CONCLUSION On the basis of our findings it is concluded that the presence of the anterolateral structures of the knee can be determined by MRI in a pediatric population with substantial inter- and intraobserver agreement. This is true for both the ALL and the deep structures of the ITT. LEVEL OF EVIDENCE Diagnostic study - Level 3.
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Affiliation(s)
- M C Liebensteiner
- Dept. of Orthopaedic Surgery, Medical University of Innsbruck, Innsbruck, Austria.
| | - B Henninger
- Dept. of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - C Kittl
- Dept. of Trauma, Hand and Reconstructive Surgery, Muenster University Hospital, Muenster, Germany
| | - R Attal
- Dept. of Trauma Surgery, Feldkirch Hospital, Feldkirch, Austria
| | - J M Giesinger
- Innsbruck Institute of Patient-centered Outcome Research (IIPCOR), Innsbruck, Austria
| | - C Kranewitter
- Dept. of Radiology, Medical University of Innsbruck, Innsbruck, Austria
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Stansal A, Tella E, Yannoutsos A, Keita I, Attal R, Gautier V, Sfeir D, Lazareth I, Priollet P. Supervised short-stretch compression therapy in mixed leg ulcers. J Med Vasc 2018; 43:225-230. [PMID: 29981730 DOI: 10.1016/j.jdmv.2018.05.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 05/09/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study was conducted to determine hemodynamic and clinical tolerance under short-stretch compression therapy in elderly patients suffering from mixed-etiology leg ulcers. DESIGN Transversal observational study conducted in 25 hospitalized patients with a moderate peripheral arterial occlusive disease defined as an ankle-brachial pressure index>0.5, an ankle pressure of>70mmHg and a toe cuff pressure (TP)>50mmHg. MATERIAL AND METHODS Short-stretch bandages were applied daily with pressures from 20 to 30mmHg. Ankle-brachial pressure, great toe laser Doppler flowmetry (LDF) and transcutaneous oxygen pressure (TcPO2) on dorsum of the foot were measured at baseline and after its removal at 24hours. Great toe LDF was also measured at 10minutes after bandage application. Compression pressure (CP) was measured with a sub-bandage device at baseline, at 10minutes and before bandage removal at 24hours. Clinical tolerance was evaluated taking into account the patient's pain and skin tolerance. RESULTS Mean age of patients was 80±15 years. Median duration of ulcers was 18 months. Hypertension was highly prevalent. One third of patients had diabetes. Toe pressure index and TcPO2 values did not significantly change under compression therapy (P=0.51 and P=0.09, respectively) whereas CP decreased significantly during 24hours. The loss of CP was significant 10minutes after bandage application (P<0.001). Nearly all ulcers were painful prior to placement of compression therapy and required level 1 analgesics. One patient required level 2 analgesic for pain relief. No increase in pain and no ischemic skin damage occurred under compression therapy. CONCLUSIONS In elderly patients with mixed leg ulcers and with an absolute TP>50mmHg, short-stretch compression of up to 30mmHg does not adversely affect arterial flow and appears clinically well tolerated. Such bandages with appropriate levels of compression may aid ulcer healing by treating the venous part of the disease.
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Affiliation(s)
- A Stansal
- Department of Vascular Medicine, Paris Saint-Joseph Hospital, 185, rue Raymond-Losserand, 75674 Paris cedex 14, France.
| | - E Tella
- Department of Vascular Medicine, Paris Saint-Joseph Hospital, 185, rue Raymond-Losserand, 75674 Paris cedex 14, France
| | - A Yannoutsos
- Department of Vascular Medicine, Paris Saint-Joseph Hospital, 185, rue Raymond-Losserand, 75674 Paris cedex 14, France
| | - I Keita
- Department of Vascular Medicine, Paris Saint-Joseph Hospital, 185, rue Raymond-Losserand, 75674 Paris cedex 14, France
| | - R Attal
- Department of Vascular Medicine, Paris Saint-Joseph Hospital, 185, rue Raymond-Losserand, 75674 Paris cedex 14, France
| | - V Gautier
- Department of Vascular Medicine, Paris Saint-Joseph Hospital, 185, rue Raymond-Losserand, 75674 Paris cedex 14, France
| | - D Sfeir
- Department of Vascular Medicine, Paris Saint-Joseph Hospital, 185, rue Raymond-Losserand, 75674 Paris cedex 14, France
| | - I Lazareth
- Department of Vascular Medicine, Paris Saint-Joseph Hospital, 185, rue Raymond-Losserand, 75674 Paris cedex 14, France
| | - P Priollet
- Department of Vascular Medicine, Paris Saint-Joseph Hospital, 185, rue Raymond-Losserand, 75674 Paris cedex 14, France
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Abstract
Case report of a patient with age-related macular degeneration whose digital ischemia can most plausibly be attributed to ranibizumab. PURPOSE To report ranibizumab as the probable cause of digital ischemia in a patient treated for age-related macular degeneration. METHODS Single-patient case report. RESULTS An 83-year-old woman with an unremarkable medical history suffered acute ischemia in her left hand with necrosis of the distal phalange of the fifth finger after six intravitreal injections of ranibizumab. Her etiological work-up was negative. Her condition improved after endovascular revascularization and remained good at six months' follow-up after three months of dual antithrombotic therapy (low molecular weight heparin then rivaroxaban, both with aspirin) followed by rivaroxaban alone and four courses of intravenous iloprost. CONCLUSION The increased incidence of peripheral arterial thromboembolic events in patients under ranibizumab treatment is slight but significant, with 0.8-5% of patients affected, most of which suffer strokes. These events seem to occur at a random time after ranibizumab treatment is initiated and no reliable marker has yet been identified. The most probable cause of digital ischemia in our patient was ranibizumab.
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Affiliation(s)
- R Attal
- Service de médecine vasculaire, groupe hospitalier Paris-Saint-Joseph, 75014 Paris, France.
| | - I Lazareth
- Service de médecine vasculaire, groupe hospitalier Paris-Saint-Joseph, 75014 Paris, France
| | - G Angelopoulos
- Service de radiologie interventionnelle, hôpital privé de Parly-II, 78150 Le-Chesnay, France
| | - P Priollet
- Service de médecine vasculaire, groupe hospitalier Paris-Saint-Joseph, 75014 Paris, France
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Euler SA, Kastenberger T, Attal R, Rieger M, Blauth M, Petri M. Do we still need autopsy in times of modern multislice computed tomography?-Missed diagnoses in the emergency room. Arch Orthop Trauma Surg 2017; 137:43-47. [PMID: 27826651 PMCID: PMC5216103 DOI: 10.1007/s00402-016-2588-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Indexed: 10/30/2022]
Abstract
INTRODUCTION In spite of increasing quality of emergency room (ER) assessment in trauma patients and improved accuracy of modern multislice computed tomography (MSCT), the number of potentially missed diagnoses is still controversial. The aim of this study was to compare the initial findings of ER assessment and MSCT to the findings during autopsy in trauma patients not surviving the first 48 h after admission. We hypothesized that autopsy was more accurate than MSCT in diagnosing potentially fatal diagnoses. PATIENTS AND METHODS Between January 2004 and September 2007, all trauma patients undergoing ER treatment in our institution who deceased within 48 h after admission were analyzed regarding diagnoses from initial ER assessment, including MSCT, and diagnoses from autopsy. Data were prospectively collected and retrospectively analyzed. Autopsy reports were compared to diagnoses of ER assessment and MSCT. Missed diagnoses (MD) and missed potentially fatal diagnoses (MPFD) were analyzed. RESULTS Seventy-three patients with a mean age of 53.2 years were included into the study. Sixty-three percent were male. Autopsy revealed at least one missed diagnosis in 25% of the patients, with the thoracic area accounting for 67% of these. At least one MPFD was found in 4.1% of the patients, all of them being located in the thorax. Total numbers of MD and MPFD were significantly lower for the newer CT generation (64 MSCT, N = 11), compared to older one (4 MSCT, N = 26). CONCLUSIONS As determined by autopsy, modern multislice computed tomography is an accurate method to diagnose injuries. However, 25% of all diagnoses, and 4.1% of potentially fatal diagnoses are still missed in trauma patients, who deceased within the first 48 h after admission. Therefore, autopsy seems to be necessary to determine potentially missed diagnoses for both academic and medicolegal reasons as well as for quality control.
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Affiliation(s)
- S. A. Euler
- Department of Trauma Surgery, Medical University Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria
| | - T. Kastenberger
- Department of Trauma Surgery, Medical University Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria
| | - R. Attal
- Department of Trauma Surgery, Medical University Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria
| | - M. Rieger
- Department of Diagnostic & Interventional Radiology, Hall Regional Hospital, Milserstr. 10, 6060 Hall in Tirol, Austria
| | - M. Blauth
- Department of Trauma Surgery, Medical University Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria
| | - M. Petri
- Trauma Department, Hannover Medical School (MHH), Carl-Neuberg-Str. 1, 30625 Hannover, Germany
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Besbes S, Attal R, Mirshahi S, Chidiac J, Mahé I, Pocard M, Soria J, Mirshahi M. PO-47 - Microparticles derived from ovarian cancer cell line contained genomic and biologically active proteins, including tissue factor involved in coagulation. Thromb Res 2016; 140 Suppl 1:S194. [DOI: 10.1016/s0049-3848(16)30180-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Lill M, Attal R, Rudisch A, Wick MC, Blauth M, Lutz M. Does MIPO of fractures of the distal femur result in more rotational malalignment than ORIF? A retrospective study. Eur J Trauma Emerg Surg 2015; 42:733-740. [PMID: 26555728 DOI: 10.1007/s00068-015-0595-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 10/24/2015] [Indexed: 11/25/2022]
Abstract
PURPOSE Intraoperative control of rotational malalignment poses a big challenge for surgeons when using modern MIPO (minimally invasive plate osteosynthesis) techniques. We hypothesized that distal femoral fractures treated with MIPO technique are more often fixed in malrotation than those treated with open reduction internal fixation (ORIF). METHODS In this retrospective study, we identified 20 patients who met the inclusion criteria and agreed to take part in the study. In ten patients MIPO was applied, in the other ten ORIF was used. Mean age was 44.8 (19-71 years). Functional status was assessed using clinical scores (Harris Hip Score, WOMAC Hip, KS Score, WOMAC Knee, Kujala Score). Rotational alignment was assessed with magnetic resonance imaging and compared to the opposite leg. RESULTS We discovered a significant difference in the mean rotational difference between the MIPO group (14.3°) and the ORIF group (5.2°). Functionally, patients in the ORIF group outperformed patients in the MIPO group in all clinical scoring systems although no one proved to be statistically significant. MIPO technique was associated with significantly more rotational malalignment compared to ORIF in distal femur fracture fixation. However, implant failure and nonunion was more common in the ORIF group, with a revision rate of 3 versus 1 in the ORIF group. Clinical scoring did not significantly different between both groups. CONCLUSION Taking into account the undisputable advantages of minimally invasive surgery, improved teaching of methods to avoid malrotation as well as regular postoperative investigations to detect any malrotation should be advocated.
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Affiliation(s)
- M Lill
- Department for Trauma Surgery and Sports Medicine, Innsbruck Medical University, Anichstrasse 35, 6020, Innsbruck, Austria.
- Trauma Hospital Salzburg, Dr. Franz-Rehrl-Platz 5, 5020, Salzburg, Austria.
| | - R Attal
- Department for Trauma Surgery and Sports Medicine, Innsbruck Medical University, Anichstrasse 35, 6020, Innsbruck, Austria
| | - A Rudisch
- Department of Radiology, Innsbruck Medical University, Anichstrasse 35, 6020, Innsbruck, Austria
| | - M C Wick
- Department of Radiology, Karolinska University Hospital, 17176, Stockholm, Sweden
| | - M Blauth
- Department for Trauma Surgery and Sports Medicine, Innsbruck Medical University, Anichstrasse 35, 6020, Innsbruck, Austria
| | - M Lutz
- Department for Trauma Surgery and Sports Medicine, Innsbruck Medical University, Anichstrasse 35, 6020, Innsbruck, Austria
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Attal R, Mahé E, Bilan P, Sin C, Amy de la Breteque M, Dias C, Sigal ML. [Compression care for venous leg ulcers: Assessment of medical practices in 100 patients]. ACTA ACUST UNITED AC 2015; 40:158-64. [PMID: 25907132 DOI: 10.1016/j.jmv.2015.03.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 03/06/2015] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The etiologic treatment of venous ulcers is based on compression therapy in compliance with the new guidelines promulgated by the French National Authority for Health (HAS) in 2010. Prescriptions often originate from a request by the nurse delivering care in the patient's home. A recent French study demonstrated the positive impact of compression therapy on venous ulcer healing. The objective of this study was to evaluate medical practices in order to target corrective actions. MATERIALS AND METHODS We conducted a single-center prospective observational study, using a standardized questionnaire from January to May 2014. Patients with venous ulcers who had an indication for compression therapy were included consecutively. The questionnaire collected demographic and clinical data and also recorded the results of complementary tests and the characteristics of the compression therapy. RESULTS One hundred patients were included (61 women and 39 men). The average age was 76 years. Patients were recruited during consultations (n = 69), with a majority of patients living at home (n = 80) and receiving home care delivered by a nurse (n = 81). Thirteen patients were seen for the first time and 87 patients were receiving long-term care. The ulcers evolved for 5.7 years on average. Patients presented peri-lesional edema (n = 58), ankle ankylosis (n = 49), autonomous mobilization (n = 40) and walking problems (n = 60). Physical therapy was prescribed for 39 patients and was effectively carried out for 24. The two main causes were venous varices (n = 66) and post-phlebitis disease (n = 18). Compression therapy was prescribed for 97 patients and the products delivered by the pharmacy were consistent with the prescription for 74 patients. Compliance with compression therapy was faulty for 28 patients because of poor tolerance, misunderstanding, manipulation problems, or inappropriate footwear. At assessment, 66 patients were wearing the bands, but not always correctly (starting at the base of the toes [n = 61], heel included [n = 43], proper stretching [n = 43] up to below the knee [n = 57]). Proper footwear was noted in 70 patients. CONCLUSION Data are scarce on compliance with compression banding. This study shows that further efforts are needed to ensure proper patient education and professional training for physicians and allied profession concerning the installation of compression therapy. Total compliance was observed in only 35% of patients. In addition, the products delivered by the pharmacy were not consistent with the prescription in 26% of cases. Many discrepancies were observed between what was prescribed and what the patients achieved. Patient adherence is a crucial issue for compression therapy.
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Affiliation(s)
- R Attal
- Service de dermatologie-médecine vasculaire, hôpital Victor-Dupouy, 69, rue du Lieutenant-Colonel Prudhon, 95100 Argenteuil, France.
| | - E Mahé
- Service de dermatologie-médecine vasculaire, hôpital Victor-Dupouy, 69, rue du Lieutenant-Colonel Prudhon, 95100 Argenteuil, France
| | - P Bilan
- Service de dermatologie-médecine vasculaire, hôpital Victor-Dupouy, 69, rue du Lieutenant-Colonel Prudhon, 95100 Argenteuil, France
| | - C Sin
- Service de dermatologie-médecine vasculaire, hôpital Victor-Dupouy, 69, rue du Lieutenant-Colonel Prudhon, 95100 Argenteuil, France
| | - M Amy de la Breteque
- Service de dermatologie-médecine vasculaire, hôpital Victor-Dupouy, 69, rue du Lieutenant-Colonel Prudhon, 95100 Argenteuil, France
| | - C Dias
- Service de dermatologie-médecine vasculaire, hôpital Victor-Dupouy, 69, rue du Lieutenant-Colonel Prudhon, 95100 Argenteuil, France
| | - M L Sigal
- Service de dermatologie-médecine vasculaire, hôpital Victor-Dupouy, 69, rue du Lieutenant-Colonel Prudhon, 95100 Argenteuil, France
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Attal R, Maestri V, Doshi HK, Onder U, Smekal V, Blauth M, Schmoelz W. The influence of distal locking on the need for fibular plating in intramedullary nailing of distal metaphyseal tibiofibular fractures. Bone Joint J 2014; 96-B:385-9. [DOI: 10.1302/0301-620x.96b3.32185] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Using human cadaver specimens, we investigated the role of supplementary fibular plating in the treatment of distal tibial fractures using an intramedullary nail. Fibular plating is thought to improve stability in these situations, but has been reported to have increased soft-tissue complications and to impair union of the fracture. We proposed that multidirectional locking screws provide adequate stability, making additional fibular plating unnecessary. A distal tibiofibular osteotomy model performed on matched fresh-frozen lower limb specimens was stabilised with reamed nails using conventional biplanar distal locking (CDL) or multidirectional distal locking (MDL) options with and without fibular plating. Rotational stiffness was assessed under a constant axial force of 150 N and a superimposed torque of ± 5 Nm. Total movement, and neutral zone and fracture gap movement were analysed. In the CDL group, fibular plating improved stiffness at the tibial fracture site, albeit to a small degree (p = 0.013). In the MDL group additional fibular plating did not increase the stiffness. The MDL nail without fibular plating was significantly more stable than the CDL nail with an additional fibular plate (p = 0.008). These findings suggest that additional fibular plating does not improve stability if a multidirectional distal locking intramedullary nail is used, and is therefore unnecessary if not needed to aid reduction. Cite this article: Bone Joint J 2014;96-B:385–9.
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Affiliation(s)
- R. Attal
- Medical University Innsbruck , Department
of Trauma Surgery and Sports Medicine, Anichstrasse
35, Innsbruck, Austria
| | - V. Maestri
- Medical University Innsbruck , Department
of Trauma Surgery and Sports Medicine, Anichstrasse
35, Innsbruck, Austria
| | - H. K. Doshi
- Tan Tock Seng Hospital, Department
of Orthopaedics and Trauma Surgery, National Health
Group, Singapore
| | - U. Onder
- Medical University Innsbruck , Department
of Trauma Surgery and Sports Medicine, Anichstrasse
35, Innsbruck, Austria
| | - V. Smekal
- AUVA-Traumacenter, Waidmannsdorfer
Straße 35, Klagenfurt, Austria
| | - M. Blauth
- Medical University Innsbruck , Department
of Trauma Surgery and Sports Medicine, Anichstrasse
35, Innsbruck, Austria
| | - W. Schmoelz
- Medical University Innsbruck , Department
of Trauma Surgery and Sports Medicine, Anichstrasse
35, Innsbruck, Austria
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Haug LC, Glodny B, Deml C, Lutz M, Attal R. A new radiological method to detect dorsally penetrating screws when using volar locking plates in distal radial fractures. The dorsal horizon view. Bone Joint J 2013; 95-B:1101-5. [PMID: 23908427 DOI: 10.1302/0301-620x.95b8.31301] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Penetration of the dorsal screw when treating distal radius fractures with volar locking plates is an avoidable complication that causes lesions of the extensor tendon in between 2% and 6% of patients. We examined axial fluoroscopic views of the distal end of the radius to observe small amounts of dorsal screw penetration, and determined the ideal angle of inclination of the x-ray beam to the forearm when making this radiological view. Six volar locking plates were inserted at the wrists of cadavers. The actual screw length was measured under direct vision through a dorsal approach to the distal radius. Axial radiographs were performed for different angles of inclination of the forearm at the elbow. Comparing axial radiological measurements and real screw length, a statistically significant correlation could be demonstrated at an angle of inclination between 5° and 20°. The ideal angle of inclination required to minimise the risk of implanting over-long screws in a dorsal horizon radiological view is 15°.
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Affiliation(s)
- L C Haug
- Medical University Innsbruck, Department of Trauma Surgery and Sports Medicine, Anichstrasse 35, Innsbruck, Austria
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12
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Höntzsch D, Blauth M, Attal R. Winkelstabile Verriegelung von Marknägeln mit dem Angular Stable Locking System® (ASLS). Oper Orthop Traumatol 2012; 23:387-96. [DOI: 10.1007/s00064-011-0048-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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13
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Smekal V, Attal R, Dallapozza C, Krappinger D. Elastisch stabile intramedulläre Nagelung nach Korrekturosteotomie von symptomatisch fehlverheilten Klavikulafrakturen. Oper Orthop Traumatol 2011; 23:375-84. [DOI: 10.1007/s00064-011-0137-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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14
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Reinhold M, Bach C, Audigé L, Bale R, Attal R, Blauth M, Magerl F. Comparison of two novel fluoroscopy-based stereotactic methods for cervical pedicle screw placement and review of the literature. Eur Spine J 2008; 17:564-75. [PMID: 18210169 DOI: 10.1007/s00586-008-0584-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2007] [Revised: 10/16/2007] [Accepted: 12/21/2007] [Indexed: 10/22/2022]
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15
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Attal R, Chaïeb S, Bensimon D. Breaking of replica symmetry in a mean-field model of disordered membranes. Phys Rev E Stat Phys Plasmas Fluids Relat Interdiscip Topics 1993; 48:2232-2239. [PMID: 9960842 DOI: 10.1103/physreve.48.2232] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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