1/9. hydrofluoric acid burns of the lower extremity.Chemical burns to the lower extremity can be disabling and of serious consequence if not managed properly. The severity and rapid onset of the burns caused by hydrofluoric acid after initial contact make this a highly dangerous substance. The potential severity of injury and the following complications make it a chemical of which all physicians should have a basic understanding.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/9. Case study. Fractured ankle.To improve our practice performance for patients admitted to the emergency department with fractured ankles, our Clinical quality improvement Team (CQI) developed the Fractured Ankle Critical Path, for patients needing open reduction and internal fixation, but for whom surgery could or should be deferred as determined by the orthopaedic surgeon. Members of the team included an orthopaedic trauma surgeon, an emergency department physician, case managers, and representatives of the Home Care Department at rhode island Hospital. The critical path includes a Home Care referral procedure, an R.I. Hospital Fracture and Orthopaedic Information Sheet, and a Fractured Ankle Home Care Protocol. The goal of the Fractured Ankle Critical Path is to decrease length of stay while maintaining positive outcomes.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/9. sports-specific concerns in the young athlete: basketball.basketball is played by millions of athletes throughout the world and is the most popular team sport in American high schools. basketball is the leading cause of sports-related injury in the united states. Acute basketball injuries most often involve the extremities, especially the hands, wrists, ankles, and knees. This article reviews the history, epidemiology, and common injury patterns that occur in this sport. We include several case reports to emphasize diagnostic dilemmas frequently encountered by emergency physicians.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/9. Pushing the envelope. Case studies on how fast you can and cannot return the elite athlete to running.When treating an elite athlete, a physician always must keep in mind the status of the athlete in training, upcoming sports events, and the athlete's financial status. If the treatment requires the athlete to withdraw from regular training or sports events, a modified training program should be considered. This modified training must be balanced with returning the athlete back to full form and keeping him or her physically fit.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/9. The posteromedial process fracture of the talus: a case report.Injuries to the ankle tend to be some of the most common injuries seen in practice. Of these ankle injuries, fractures of the posteromedial process of the talus are often misdiagnosed as ankle sprains because of poor visualization on routine ankle radiographs. The examining physician must have a heightened awareness of this injury to accurately diagnose and treat this fracture. Proper treatment could help to lessen the possibility of post-traumatic arthritis to the ankle and subtalar joints. The authors present a case of a fracture of the posteromedial process of the talus, after a medial subtalar dislocation, treated with open reduction and internal fixation with bioabsorbable pins.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/9. Determining foot and ankle impairments by the AMA fifth edition guides.The fifth edition of the Guides has been criticized for its failure to provide a comprehensive, valid, reliable, unbiased, and evidenced-based system for rating impairments and the way in which workers' compensation systems use the ratings, resulting in inappropriate compensation [8]. The lower extremity chapter utilizes numerous functional and anatomic methods of assessment, as well as diagnosis-based estimates. Though this process of using multiple approaches to measure impairment increases the chances that an underlying physical impairment may be detected, it is time-consuming and may increase rating variability [9]. McCarthy et al studied the correlation between measures of impairment for patients with fractures of the lower extremity. They found that the anatomic approach of evaluation was better correlated than functional and diagnostic methods with measures of task performance based on direct observations as well as the patient's own assessment of activity limitation and disability. Also, muscle strength assessment as described in the Guides was a more sensitive measure of impairment than range of motion [9]. The most elusive part of the foot and ankle evaluation is the inability to capture the added impairment burden caused by pain. The assessment of pain is the most problematic part of any evaluation. Pain is considered and incorporated into the impairment ratings found in the foot and ankle section, as well as the other individual chapters. chronic pain is often not adequately accounted for, however, and the examiner must evaluate permanent impairment from chronic pain separately. The examiner has the ability to increase the percentage of organ system impairment from 1% to 3% if there is pain-related impairment that increases the burden of illness slightly. If there is significant pain-related impairment, a formal pain assessment is performed. Chapter 18 provides guidance in making these determinations. Impairments for Complex Regional Pain syndrome (CRPS), type 1 (reflex sympathetic dystrophy), and CRPS, type 2 (causalgia) should incorporate the use of a formal pain assessment in addition to the standard methods of assessment. The formal pain evaluation relies mostly on self-reports from the individual and is most heavily weighted for ADL deficits. The physician must make assessments of the individual's pain behavior and credibility for this evaluation. The formal pain assessment classifies the pain-related impairment into categories of mild, moderate, moderately severe, or severe and determines whether this impairment is ratable or not. These categories do not have impairment percentages associated with them. The individual's symptoms or presentation should match known conditions or syndromes in order to be ratable. If not ratable, the examiner should report that the individual has apparent impairment that is not ratable on the basis of current medical knowledge. In the end, pain evaluations are used administratively and, depending on the situation, may be given equal weight with the standard evaluation or may be totally disregarded.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/9. cellulitis in Grade III ankle sprain requiring treatment for antibiotic-resistant bacteria.This case report describes a novel occurrence of a Grade III ankle sprain complicated by cellulitis. The patient ultimately required aspiration of an extra-articular fluid collection and treatment with parenteral antibiotics due to worsening of the infection despite treatment with second-generation cephalosporins. This individual's infection was consistent with MRSA-cellulitis. cellulitis, in the context of a preceding ankle sprain, has not been reported in the literature; the resultant edema from the injury may have served as the nidus for infection. MRSA comprises a significant proportion of soft-tissue infections in the ambulatory setting, and physicians should incorporate this trend into therapeutic strategies for their infected patients.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/9. rehabilitation and return to activity after sports injuries.An athlete's successful return to sport following injury requires an effective rehabilitation program. It is important that the primary physician incorporate this program into the treatment plan.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
9/9. Limb threatening neuropathic complications from ankle fractures in patients with diabetes.Although less common than neuropathic (Charcot) deformities in feet, ankle deformities can occur and produce significant limb threatening complications after injury in patients with longstanding diabetes. A series of six such complications, including one that resulted in amputation and several near amputations, are presented. The authors' primary purpose is to alert or remind physicians and orthopaedic surgeons of the often unanticipated but significant complications of these rare and seemingly mild ankle injuries. A secondary purpose is to point out that complications may be avoided or mitigated with early stabilization and possibly with treatment of bone resorbing, inflammatory processes characteristic of neuroarthropathies.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |