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INDUSTRIAL INJURIES TO THE FOOT AND ANKLE Michael J. Shereff, M.D.

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Presentation on theme: "INDUSTRIAL INJURIES TO THE FOOT AND ANKLE Michael J. Shereff, M.D."— Presentation transcript:

1 INDUSTRIAL INJURIES TO THE FOOT AND ANKLE Michael J. Shereff, M.D.

2 INCIDENCE Bureau of Labor Statistics US 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. .

3 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.

4 ANKLE  Service jobs = 25%  Manufacturing = 17%  Retail = 17%  Construction = 13%

5 FOOT  Manufacturing = 25%  Service & Retail = 18%  Construction = 15%

6 TOES  Decreasing Order of Frequency:  Manufacturing  Construction  Retail  Service

7 Construction Industry  83% Foot and Ankle injuries occur in men.  Mean age = 34years.  More frequent in summer.

8 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.

9 ETIOLOGY Foot and Ankle Injuries  Sprains/Strains = 42%  Contusions = 9%  Lacerations = 8%  Fractures = 6%  Other causes = 35%

10 ANKLE  Sprains & Strains = 70%  Fractures = 15%  Contusions = 5%  Cuts, punctures, burns & amputations = less common.

11 FOOT  Contusions = 30%  Fractures = 20%  Sprains & Strains = 15%  Cuts & Punctures = less common.

12 TOES  Fractures = 47%  Bruises = 23 %  Remaining causes = less common.

13 ETIOLOGY  Ontario Construction Industry  Puncture wounds=6.3%  Fractures=19.6%  Sprains=34.3%

14 Most Common Mechanism of Injury  Contact with an object  Falls  Exposure to a harmful force – vehicles & machinery.

15 Mechanism of Injury  Work – related injuries to the foot and ankle due to repetitive trauma are VERY UNCOMMON.

16 IMPACT  Median number of days missed from work = 5.

17 IMPACT  National Safety Council (U.S.)  600 million dollars paid in compensation for work related injuries to the foot and ankle.

18 NATIONAL ACADEMY OF SOCIAL INSURANCE  Total costs to employers for Workers Compensation have increased.  Costs per covered employee has declined.

19 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.

20 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

21 SITE OF INJURY  American National Standards Institute  Sole=30%  Midfoot=23%  Toes=22%

22 SITE OF INJURY  Canadian Injury Survey  Ankle=32%  Metatarsal Area=31%  Toes=25%  Heel=6%  Sole=6%

23 SITE OF INJURY  Ontario Construction Industry  Ankle=50.1%  Metatarsal Area=32%  Toes=7.3%  Heel=5.4%  Sole=3.9%

24 PREDISPOSING FACTORS  Increased in young inexperienced workers  55% < 30 years  65% < 5 years experience

25 PREDISPOSING FACTORS  Most common on Mondays  Decreases rest of week  Increases before lunch  Increases late in afternoon  Least common = Friday AM

26 OCCUPATIONAL INJURIES  Phalangeal Area  Metatarsal Region  Sole  Heel  Ankle

27 PHALANGEAL AREA  Mechanism=direct blow  Phalangeal Fractures  Contusion-severe crush

28 FOREFOOT FRACTURES  50% = hallux and 1 st metatarsal  Most common sites = distal metatarsal and phalanx Great Toe  25% = 5 th ray  25% = digits 2,3,&4.

29 FOREFOOT FRACTURES TREATMENT  External Fixation  Internal Fixation

30 METATARSAL REGION MECHANISM  Direct = foot trapped or impacted beneath heavy object.  Indirect = plantar flexion & inversion injury

31 METATARSAL REGION TYPES OF INJURIES  Contusion  Traumatic synovitis extensor tendons  Fracture metatarsal bones  Lis Franc fracture- dislocation  Compartment Syndrome

32 METATARSAL REGION TREATMENT  Soft Tissue Injury:  Contusion  Traumatic Synovitis  Rx: Protected mobilization = Boot/Post-op Shoe &  Crutches –NWB – PWB-FWB

33 METATARSAL REGION TREATMENT  METATARSAL FRACTURES  Nondisplaced = SLC-NWB  Displaced = closed or open reduction (+/-) internal fixation

34 METATARSAL REGION TREATMENT  FRACTURE – DISLOCATION  Closed or open reduction (+/-) internal fixation.

35 COMPARTMENT SYNDROMES  Treatment = Fasciotomy

36 SOLE  Lacerations  Puncture Wounds  Treatment = Tetanus, Antibiotics, Debridement,

37 HEEL  Traumatic heel pad disruption – inserts.  Plantar fascia tear – Early =rest,NWB,ice Late = inserts  Fractures - nondisplaced = cast displaced = ORIF

38 ANKLE  #1 most common site of industrial trauma  Mechanism Direct = blunt trauma Indirect = inversion injury

39 ANKLE INJURIES  Sprain ligaments  Strain or rupture tendons  Fractures =less common

40 ANKLE SPRAIN  Tear LCL  Rx: Protected Mobilization

41 ANKLE FRACTURES  Lateral Malleolus  Medial Malleolus  Bimalleolar  Pilon Fractures  Rx: Non – displaced =SLC – NWB  Rx: Displaced = ORIF

42 INJURIES BY OCCUPATION  Aviators Astragalus  Fracture of the neck of the talus.  Sudden impact of foot against floorboard.  Rx: ORIF

43 FIREFIGHTERS,ROOFERS,& PAINTERS  Mechanism = Fall from height  Injury = Fracture calcaneus  Rx: ORIF

44 WELDERS  Mechanism = burns from metal fragments  Rx: Debridement and local wound care.

45 INDUSTRIAL CLEANING  Mechanism = scalding water burns  Rx: Debridement and local wound care.

46 PIPELINE WORK  Mechanism = Frostbite  Rx: Local wound care

47 ELECTRICAL WORK  Mechanism = high voltage burns  Rx: Debridement plastic surgical reconstruction.

48 INDUSTRIAL SHOEWEAR  Z41 Committee of ANSI (American National Safety Institute)  Mandates Safety Shoe standards.

49 INDUSTRIAL SHOEWEAR  Must protect from exposure to specific hazards on the job.  Constuction = safety toe shoes & puncture resistant soles.  Electrical = nonconductive soles.

50 THANK YOU !


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