PROTECTION AND SAFETY FOOTWEAR - work injuries in the FT
Many people who suffer injuries to their ankles or feet due to the development of their work. There are many workers who either falls from heights, their feet trapped under heavy objects or driving vehicles, suffer significant injuries.
prevention of these injuries and treat them, is a very important issue. Prevention through education by companies how to avoid injury, and the use of security measures, both whole body and the use of harnesses, to avoid falls and the use of protective footwear or avoid causing serious injury , are measures to be taken into account.
With regard to treatment, orthopedic surgeons specializing in reconstruction of foot and ankle injuries should always try to restore the functionality of the feet, so that if it can be returned to him the ability to walk without pain and of course try to return to work as soon as possible. This requires keeping abreast of reconstruction techniques avoiding, as in many centers, leave the feet very stiff and unsuitable for walking.
injury rates can identify three types of injury as the mechanism of production, such as precipitation occurred, which are caused by entrapment and those resulting from motor vehicle accidents as cars and motorcycles.
In the first group, the most common are fractures of the tibial pilon, the ankle and heel, being less frequent in the rest of foot bones. Pilon fractures are injuries that call for high energy, such as falls from several meters high. The consequence is that explodes the most distal tibia and fibula, seriously affecting the ankle joint. In a few cases this may not be affected joint, but typically falls from low heights. In addition, there may be factors that aggravate the injury and the fracture is open, that is, broken bones also break the skin, leading to the infected, in many cases worse prognosis.
ankle fractures tend to occur more torque than falls from heights. In most cases you set foot through the shoe on the floor, turning above the body, creating a twisting force that can break the ligaments initially, but if it continues to produce this force carries a broken tibia and fibula with the talus dislocation fractures as in "C Weber. " With respect to the calcaneus, is perhaps the most complex bone that is in the foot, since its design allows continuous loads of small magnitude, but not resilient as they occur in falls from heights, leading to the structure crush, lost relationships through joint with neighboring bones.
In the second group we find those who are injured as a result of your feet or ankles trapped by heavy objects such as containers, stones or machinery. The results are often very severe injuries usually affect the fingers, bones of the forefoot and midfoot, may lose some injured skin, tendons and nerves.
The third group would find the injury from the use of vehicles such as cars and motorbikes. It's amazing how everyday companies engaged in building cars, spend millions of euros in airbags designed to protect the head and body but, surprisingly, below the knee have not developed anything with it that an accident traffic as a frontal collision the engine block acts as a battering ram crashing into the ankle or foot and resulting in serious injury also produced a high-energy mechanism. On the other hand, the use of motorcycles, for example, courier or police, is also a high possibility of injuries occur from the use of these vehicles where the body is our bumper. In this section there are serious injuries ranging from ankle injuries and in particular of the talus and calcaneus, injuries and midfoot this partial amputations. Jobs that are more injuries can occur within an arc that would include people who work in construction and must be on high ground such as formwork, electricians, plasterers etc. Others as they work on loading docks unloading or handling pallets are subsidiaries of entrapment injuries in the latter group fall jobs as delivery drivers, couriers or policemen.
Treatment The treatment of these injuries is important to be done by doctors and health professionals with expertise in foot and ankle reconstruction. In many cases the injuries are such that they should not be treated by an orthopedic surgeon general. International Institute of Orthopaedic Surgery Foot Madrid reach many patients previously treated in other centers, with complications in many cases a direct result of surgical error, either in addressing the reduction and / or the fixation of fractures.
is important to assess the overall situation of the injured, especially those who have suffered falls or traffic accidents because other than knowing the general condition is necessary to rule out the presence of fractures in other parts of the body and that, given the state of injured, not initially going to give us that information (eg in case of rain, apart from lower limb injuries is common to have vertebral fractures), once established a complete diagnosis en el que se habrán hecho pruebas como radiografías de ambos pies o tobillos y, en muchos casos, escáner para evaluar la magnitud de la lesión.
Desde mi punto de vista, hay muy pocas lesiones del pie o tobillo que deban ser operadas de urgencia, incluso en las fracturas que son abiertas es mejor limpiar las heridas, cerrar la piel, dejando antibióticos locales y estabilizando las fracturas mediante el uso de un fijador externo. Pasados unos días en que los procesos inflamatorios hayan pasado y la posible infección controlada, se puede iniciar el proceso de reconstrucción. Aquí debe el médico tener preparada una completa estrategia para dar los pasos adecuados poder estabilizar las fracturas; la falta of this is causing in many cases the treatment failure.
In general, all fractures should be addressed through longitudinal incisions. If they are multiple, parallel them respecting an amplitude sufficient separation that does not compromise blood flow. At the level of the distal tibia and ankle stabilization has shown how the two plates placed on both sides, for example, in the warm, gives more satisfactory results than simple assembly.
The talus and calcaneus should be perfectly reduced and stabilized by the use of needles and then move to the placement of osteosynthesis plates and screws. These procedures although they may be long and perhaps somewhat tedious for the surgeon, have shown better results than those treated with plaster, as those fully restored the anatomy of the fractured joints. I do not think that performing a primary arthrodesis of the subtalar joint by minimally invasive techniques, as you indicate now is the best solution, since they are sacrificing a joint input essential for the proper functioning of the foot, which will lack a permanent sequelae for the patient.
Regarding fractures involving the bones of the middle and forefoot, treatments follow a similar tactic as set forth above: completely reconstruct the anatomy of the foot, even in high-energy fractures where there are severe compression fractures of the bones by using distractors that restore length and alignment of the columns of the foot, and later rebuilt, whenever possible, joint essential. In many cases it is necessary to use bone graft taken from the patient to encourage consolidation.
A case worth mentioning is the treatment of open fractures which have caused serious injury to both bone and nerves, tendons, and especially when the skin loses sole . I I have witnessed many times how you have had patients with repeated reconstructive procedures, including through skin grafts from other body parts that have failed repeatedly. And although it has saved the foot, their lives are most affected, losing their jobs, sometimes at his family and, worse, self-esteem. It is in these cases so severely grave where the surgeon should discuss with the patient so that he knows it's much better having an amputation, which will in many cases the return to a normal life in a period of three months, not sometimes be up to three years, with repeated hospital admissions, many operations, long-term medication to end fail and, in many cases, losing a foot or leg infection. In our setting, many patients reject this possibility, assuming it is due to a cultural problem more than anything else. Dr. Ernest Burgess, the father of medical prostheses, said that "amputation can not be considered as treatment failure, but rather a reconstructive surgery, aimed at preparing the leg or foot as the transition between our body and the prosthesis. " Actually, in advanced societies, many people reject the possibility of being a long time with surgeries and treatments that result in many cases very stiff feet and not very functional, knowing that now have developed carbon fiber prosthetics that allow walking and running without difficulty, as do a majority of the athletes participating in the Paralympics.
Prevention Prevention in most cases begins with the training of workers to take appropriate preventive measures to avoid many of these injuries, the knowledge by technical prevention of occupational injuries, the availability of adequate and permanent protection elements appropriate review of the machinery for the failure of these not cause lesions on the feet, in the case of precipitation from heights, the use of harnesses that are connected to anchors, or to steel cables stretched along some stretches where, coupled with rings, can move , the preventive measures in the works to prevent falls by the stairwells or elevator shafts, the use of footwear with steel plate protected, reinforcing the soles and toes to avoid in most cases that are injured foot heavy weights seriously by falling over or at least that injuries are not serious (this type of protective footwear should be used as messengers and police are using motorcycles to avoid the risk of major amputations).
In summary, the joint and coordinated work of all those involved in prevention, starting with the first by workers, will significantly reduce these injuries with companies continuously invest in items, footwear and protection.
Finally, physicians who are dedicated to repairing these serious injuries we have a responsibility to keep up in the process of treatment and reconstruction of fractures, assessed by self-criticism also from the functional standpoint, the results of treatments, choosing those who have been successful and discarding those who repeatedly have failed. Appropriate strategies for the implementation of such treatments usually produce good results and vice versa. On the other hand, we must further increase the "super specialization" of orthopedic surgeons in the reconstruction of the foot and ankle injuries, leaving the treatment for these specialists, which will raise the success rate, when you feet functional and, of course, making falls exponentially the number of poor results and consequences.
Dr. Fernando Noriega. Director of the International Institute of Orthopaedic Surgery of the Foot.
The photographs belong to the individual file Dr. Fernando Noriega.
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APESSLA
Strengthening the Quality of Life of its Associates.
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