Walley Kempland C, Farrar Nicholas, Shams Kameron, Anastasio Albert T, Gong Davin, Mell Kristopher, Holmes James R, Walton David M, Talusan Paul G
Department of Orthopaedic Surgery, University of Michigan, Michigan Medicine, Ann Arbor, MI, USA.
Department of Orthopaedic Surgery, Duke University, Durham, NC, USA.
Foot Ankle Orthop. 2023 Mar 13;8(1):24730114231160115. doi: 10.1177/24730114231160115. eCollection 2023 Jan.
Though ubiquitously used in orthopaedic trauma, lower extremity splints may have associated iatrogenic risk of morbidity. Although clinicians pad bony prominences to minimize skin pressure, the effect of joint position on skin pressure and, more specifically, changing joint position, is understudied. The purpose of this biomechanical study is to determine the effect of various short-leg splint application techniques on anterior ankle surface pressure in the development of iatrogenic skin pressure ulcers.
Various constructs of lower extremity, short-leg splints were applied to 3 healthy subjects (6 limbs total) with an underlying pressure transducer (Tekscan I-Scan system) on the skin surface centered on the tibialis anterior tendon at the level of the ankle. All subjects underwent anterior ankle surface pressure assessment when padding was applied in maximum plantar flexion and neutral position for conventional short-leg splints application in clinically relevant patient scenarios. Percentage change from initial contact pressure centered on the tibialis anterior with cast padding were calculated.
The percentage change in anterior ankle contact pressure when padding was applied in maximum plantar flexion (PF) and then definitively placed in neutral was increased at least 2-fold without the addition of plaster in lower extremity short-leg splints. Removing anterior ankle padding following final splint application in neutral reduced contact forces at the anterior ankle 46% and 59% in splints applied in maximum PF and neutral ankle position, respectively.
The present study is the first of its kind to underscore and quantify clinically relevant technical pearls that can be useful in reducing risk of iatrogenic risk of skin breakdown at the anterior ankle when placing short-leg splints, mainly, that it is imperative to apply padding in the intended final splint position and to remove anterior ankle padding following splint application when able.
Level IV, biomechanical study with clear hypothesis.
尽管下肢夹板在骨科创伤中广泛应用，但可能存在相关的医源性发病风险。虽然临床医生会对骨突部位进行衬垫以尽量减少皮肤压力，但关节位置对皮肤压力的影响，尤其是关节位置变化的影响，尚未得到充分研究。本生物力学研究的目的是确定各种短腿夹板应用技术对医源性皮肤压疮形成过程中前踝表面压力的影响。
将各种下肢短腿夹板应用于3名健康受试者（共6条肢体），在踝关节水平胫骨前肌腱中心的皮肤表面放置一个内置压力传感器（Tekscan I-Scan系统）。在临床相关患者场景中，当为传统短腿夹板应用在最大跖屈位和中立位进行衬垫时，所有受试者均接受前踝表面压力评估。计算以胫骨前为中心并带有石膏衬垫的初始接触压力的百分比变化。
在下肢短腿夹板中，在最大跖屈位（PF）应用衬垫然后最终置于中立位时，前踝接触压力的百分比变化至少增加了2倍，且未添加石膏。在最终夹板应用于中立位后去除前踝衬垫，分别使应用于最大PF位和中立踝位的夹板在前踝处的接触力降低了46%和59%。
本研究首次强调并量化了临床相关的技术要点，这些要点有助于降低放置短腿夹板时前踝处医源性皮肤破损的风险，主要是必须在预期的最终夹板位置应用衬垫，并在夹板应用后尽可能去除前踝衬垫。
IV级，具有明确假设的生物力学研究。
