Download - INDUSTRIAL INJURIES TO THE FOOT AND ANKLE
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INDUSTRIAL INJURIES TO THE FOOT AND ANKLE
Michael J. Shereff, M.D.
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INCIDENCEBureau of Labor StatisticsUS Department of Labor 12 million work – related
injuries occur each year = 20% of all injuries sustained in the United States.
7.2 million involve the musculoskeletal system.
.
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INCIDENCE Foot and Ankle injuries
= 9.9% of all injuries. Most common age = 25
to 30years Males:Females = 2-3:1 Most common in
technical,sales,and administrative support positions.
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ANKLE Service jobs = 25% Manufacturing =
17% Retail = 17% Construction = 13%
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FOOT Manufacturing =
25% Service & Retail =
18% Construction = 15%
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TOES Decreasing Order of
Frequency: Manufacturing Construction Retail Service
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Construction Industry 83% Foot and Ankle
injuries occur in men.
Mean age = 34years.
More frequent in summer.
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Construction Industry
Rate of return to work = 1.5 times higher for men than for women.
Rate of return to work = 20% less for each 10 year increase in age.
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ETIOLOGYFoot and Ankle Injuries
Sprains/Strains = 42%
Contusions = 9% Lacerations = 8% Fractures = 6% Other causes = 35%
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ANKLE Sprains & Strains =
70% Fractures = 15% Contusions = 5% Cuts, punctures,
burns & amputations = less common.
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FOOT Contusions = 30% Fractures = 20% Sprains & Strains =
15% Cuts & Punctures =
less common.
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TOES Fractures = 47% Bruises = 23 % Remaining causes =
less common.
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ETIOLOGY Ontario Construction
Industry Puncture wounds=6.3% Fractures=19.6% Sprains=34.3%
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Most Common Mechanism of Injury Contact with an
object Falls Exposure to a
harmful force – vehicles & machinery.
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Mechanism of InjuryWork – related injuries to the foot and
ankle due to repetitive trauma are VERY UNCOMMON.
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IMPACTMedian number of days missed from
work = 5.
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IMPACTNational Safety Council (U.S.) 600 million dollars paid in
compensation for work related injuries to the foot and ankle.
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NATIONAL ACADEMY OF SOCIAL INSURANCE Total costs to employers for Workers
Compensation have increased.Costs per covered employee has
declined.
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DECREASED COST PER EMPLOYEE Increased workplace safety.Medical care cost reforms.Return to work programs = good cost
containment.Reduction of length of disability.Tightening of eligibility for benefits.
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SITE OF INJURY (USBLS 1999)Ankle = 82,884 reported injuries =
51.63%Foot = 59,782 reported injuries =
37.24%Toes = 17,867 reported injuries =
11.13%TOTAL = 160,533 reported injuries
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SITE OF INJURYAmerican National Standards InstituteSole=30%Midfoot=23%Toes=22%
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SITE OF INJURY Canadian Injury
Survey Ankle=32% Metatarsal
Area=31% Toes=25% Heel=6% Sole=6%
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SITE OF INJURY Ontario Construction
Industry Ankle=50.1% Metatarsal
Area=32% Toes=7.3% Heel=5.4% Sole=3.9%
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PREDISPOSING FACTORS Increased in young
inexperienced workers
55% < 30 years 65% < 5 years
experience
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PREDISPOSING FACTORS Most common on
Mondays Decreases rest of week Increases before lunch Increases late in
afternoon Least common = Friday
AM
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OCCUPATIONAL INJURIES Phalangeal Area Metatarsal Region Sole Heel Ankle
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PHALANGEAL AREA Mechanism=direct
blow Phalangeal
Fractures Contusion-severe
crush
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FOREFOOT FRACTURES 50% = hallux and 1st
metatarsal Most common sites
= distal metatarsal and phalanx Great Toe
25% = 5th ray 25% = digits 2,3,&4.
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FOREFOOT FRACTURESTREATMENT External Fixation Internal Fixation
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METATARSAL REGIONMECHANISM Direct = foot trapped
or impacted beneath heavy object.
Indirect = plantar flexion & inversion injury
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METATARSAL REGIONTYPES OF INJURIES Contusion Traumatic synovitis
extensor tendons Fracture metatarsal
bones Lis Franc fracture-
dislocation Compartment
Syndrome
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METATARSAL REGIONTREATMENT Soft Tissue Injury:
Contusion Traumatic Synovitis Rx: Protected
mobilization = Boot/Post-op Shoe &
Crutches –NWB –PWB-FWB
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METATARSAL REGIONTREATMENT METATARSAL
FRACTURES Nondisplaced =
SLC-NWB Displaced = closed
or open reduction (+/-) internal fixation
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METATARSAL REGIONTREATMENT FRACTURE –
DISLOCATION Closed or open
reduction (+/-) internal fixation.
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COMPARTMENT SYNDROMES Treatment =
Fasciotomy
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SOLE Lacerations Puncture Wounds Treatment =
Tetanus, Antibiotics, Debridement,
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HEEL Traumatic heel pad
disruption – inserts. Plantar fascia tear –
Early =rest,NWB,ice Late = inserts
Fractures - nondisplaced = cast displaced = ORIF
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ANKLE #1 most common
site of industrial trauma
Mechanism Direct = blunt trauma Indirect = inversion injury
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ANKLE INJURIES Sprain ligaments Strain or rupture
tendons Fractures =less
common
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ANKLE SPRAIN Tear LCL Rx: Protected
Mobilization
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ANKLE FRACTURES Lateral Malleolus Medial Malleolus Bimalleolar Pilon Fractures Rx: Non – displaced
=SLC – NWB Rx: Displaced =
ORIF
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INJURIES BY OCCUPATION Aviators Astragalus Fracture of the neck
of the talus. Sudden impact of
foot against floorboard.
Rx: ORIF
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FIREFIGHTERS,ROOFERS,& PAINTERS Mechanism = Fall
from height Injury = Fracture
calcaneus Rx: ORIF
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WELDERS Mechanism = burns
from metal fragments
Rx: Debridement and local wound care.
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INDUSTRIAL CLEANING Mechanism =
scalding water burns Rx: Debridement
and local wound care.
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PIPELINE WORK Mechanism =
Frostbite Rx: Local wound
care
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ELECTRICAL WORK Mechanism = high
voltage burns Rx: Debridement
plastic surgical reconstruction.
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INDUSTRIAL SHOEWEAR Z41 Committee of
ANSI (American National Safety Institute)
Mandates Safety Shoe standards.
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INDUSTRIAL SHOEWEAR Must protect from
exposure to specific hazards on the job.
Constuction = safety toe shoes & puncture resistant soles.
Electrical = nonconductive soles.
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THANK YOU !