RESUMO
The transmetatarsal amputation is considered a durable procedure with respect to limb salvage when managing the consequences of diabetic foot disease. The success of the procedure is, in part, determined by the preoperative appreciation of arterial and functional status. The objectives of the present investigation were to determine the length of the remaining first metatarsal required during transmetatarsal amputation to preserve the anastomotic connection of the deep plantar perforating artery and subsequent "vascular arch" of the foot and the insertion of the tibialis anterior tendon. The primary outcome measure of our investigation was a measurement of the distance between the first metatarsal-medial cuneiform articulation and the distal extent of the deep plantar perforating artery in 85 embalmed lower limbs. As a secondary outcome measure, the insertion of the tibialis anterior tendon was evaluated relative to the deep plantar perforating artery. The most distal extent of the deep plantar perforating artery was observed at a mean ± standard deviation of 15.62 ± 3.74 (range 6.0 to 28.28) mm from the first metatarsal-medial cuneiform articulation. Most (89.41%) of the arteries were found within 20 mm of the first metatarsal-medial cuneiform articulation. The insertion of the tibialis anterior tendon was found to be proximal to the deep plantar perforating artery in all specimens (100.0%). In conclusion, 2.0 cm of remnant first metatarsal might represent an anatomic definition of how "short" a transmetatarsal amputation can safely be performed in most patients when considering the vascular and biomechanical anatomy.
Assuntos
Amputação Cirúrgica , Salvamento de Membro , Ossos do Metatarso/cirurgia , Metatarso/irrigação sanguínea , Metatarso/cirurgia , Anastomose Cirúrgica , Cadáver , Pé Diabético/cirurgia , Humanos , Ossos do Metatarso/patologia , Metatarso/inervação , Tendões/irrigação sanguíneaRESUMO
A basic competency examination in musculoskeletal medicine has previously been administered to residents across a variety of medical specialties and has demonstrated that medical school preparation in musculoskeletal medicine might be inadequate. The objectives of the present study were to assess podiatric surgical resident performance on this examination and to assess podiatric surgical residency director opinions of the level of importance of the test subject areas. A total of 117 podiatric surgical residents from 15 residency programs completed the 25-question examination. The residents scored a mean ± standard deviation of 60.32% ± 12.60% (range 22.00% to 92.00%). On the 7 questions rated by podiatric residency directors as ≥8 on a 10-point scale of relative importance, this score improved to 84.92% ± 11.93% (range 39.29% to 100.0%). Senior level residents did not outperform junior level residents (60.76% versus 60.44%; p = .898), and those who had completed a general orthopedics rotation at some point in their education did not outperform those who had not (61.12% versus 58.64%; p = .370). The podiatric residency directors assigned a mean ± standard deviation importance score of 6.97 ± 2.07 out of 10 for the 25 questions and suggested a mean ± standard deviation passing score of 69.14% ± 9.03% for the examination. The results of the present investigation provide original data on podiatric surgical resident performance on a basic competency examination in musculoskeletal medicine. Although the residents scored well for some specific test areas, the overall performance was similar to that of previous iterations of the examination given to general surgery and internal medicine residents. The lower scores compared with those from the orthopedic and physical therapy specialties might indicate a need for improved general musculoskeletal medicine education within the podiatric curriculum.
Assuntos
Competência Clínica , Currículo , Educação Médica Continuada/métodos , Internato e Residência , Podiatria/educação , Humanos , Inquéritos e QuestionáriosRESUMO
The body mass index (BMI) is an objective patient finding that has been established to have a negative effect on the development and outcomes of podiatric pathologic entities and interventions. The objective of the present investigation was to assess the ability of podiatric physicians to estimate the patient BMI from clinical and radiographic observation. For the clinical estimation of the patient BMI, podiatric specialists across 3 levels of experience (i.e., students, residents, and practicing clinicians) performed 294 estimations on 72 patients in 3 clinical situations (standing, sitting in a treatment chair, and lying in a hospital bed). It was more common to inaccurately estimate the patient BMI (77.9%) than it was to correctly estimate it (22.1%), with underestimations being the most common error (48.3%). The estimations were particularly inaccurate when the patients were in the common clinical situation of sitting in a treatment chair or lying in a hospital bed and with patients actually classified as obese. For the radiographic estimation of patient BMI, 150 consecutive lateral ankle radiographs were analyzed, with the ratio of the overlying soft tissue diameter to the underlying bone diameter calculated and compared. Positive, but weak, relationships were observed with these ratios. From these data, we have concluded that podiatric practitioners should perform an actual calculation of the patient BMI during the patient examination and medical decision-making process to fully appreciate the potential risks inherent to the treatment of obese patients.