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There is an increasing amount of literature suggesting that 3-dimensional (3D) weight-bearing computed tomography (WBCT) imaging overcomes the inherent limits of traditional bidimensional imaging in foot and ankle surgery. This seems to have a significant impact on the study and on the clinical management of adult acquired flatfooot deformity (AAFD) that by definition is a 3D complex deformity. In this study, we reviewed the recent literature about the use of WBCT in AAFD, starting from a critical analysis about the biases related to conventional radiography and to non-standing CT. Then, we focused on the effects of load on the 3D architecture of the foot and ankle in AAFD. Finally, we discussed the benefits and future perspectives for the use of WBCT in the management of this condition and as a surgical planning tool as well.

Background: We investigated the association between hindfoot residual malalignment assessed on weightbearing computed tomography (WBCT) images and the development of periprosthetic cysts (PPCs) after total ankle replacement (TAR). We hypothesized that PPCs would be found predominantly medially in the varus configuration and laterally in the valgus configuration. Methods: Cases of primary TAR with available WBCT imaging of the ankle were included in this retrospective study. The location of the PPC was marked and the following volumes were calculated: total (TCV), medial (MCV), central (CCV), and lateral (LCV) cyst volumes. Hindfoot alignment was measured as Foot and Ankle Offset (FAO), with 95% confidence intervals (95% CIs) calculated to define varus (95% CI) groups. Cyst volumes were compared between these 2 groups. The American Orthopaedic Foot & Ankle Society (AOFAS) score at the time of the WBCT was also retrieved. Receiver operating characteristic (ROC) curves were used to determine FAO thresholds for predicting an increased risk of PPC. Results: Forty-eight TARs (mean follow-up, 44.6 months) were included, 81% of which had at least 1 PPC. The mean FAO was 0.12% (95% CI, –1.12 to 1.36). Patients with greater residual malalignment ( P < .001) and those with longer follow-up ( P < .001) presented with increased TCV. In varus cases, the MCV was greater than the LCV ( P = .042), with a threshold FAO value of −2.75% or less predicting an increased MCV. In valgus cases, the LCV was greater than the MCV ( P = .049), with a FAO threshold value of 4.5% or more predicting an increased LCV. Conclusion: In this series, the PPC volume after primary TAR significantly correlated with postoperative hindfoot malalignment and longer follow-up. Level of Evidence: Level III, retrospective comparative series.

Sepsis is a syndromic entity with high prevalence and mortality. The management of sepsis is standardized and exhibits time-dependent efficiency. However, the management of patients with sepsis is complex. The heterogeneity of the forms of presentation can make it difficult to detect and manage such cases, in the same way as differences in training, professional competences or the availability of health resources. The Advisory Commission for Patient Care with Sepsis (CAAPAS), comprising 7 scientific societies, the Emergency Medical System (SEM) and the Catalan Health Service (CatSalut), have developed the Interhospital Sepsis Code (CSI) in Catalonia (Spain). The general objective of the CSI is to increase awareness, promote early detection and facilitate initial care and interhospital coordination to attend septic patients in a homogeneous manner throughout Catalonia.

Resumen Fundamento. El objetivo de este estudio es conocer el grado de implantación, las características y la formación de la ecografía a pie de cama, realizada por médicos de urgencias (MU), en los servicios de urgencias hospitalarios (SUH) públicos de Cataluña. Método. Estudio descriptivo basado en una encuesta realizada a los responsables de los SUH públicos de Cataluña y estructurada en tres bloques: dificultad de implementación de la técnica y motivos percibidos en dicha dificultad, aparataje disponible en urgencias y su uso, y formación de los MU. Resultados. Contestaron la encuesta el 96,3% de los SUH públicos. En el 63,5% los MU realizan ecografía a pie de cama. El 86,5% manifestaron un elevado grado de dificultad para implementar la ecografía y el 78,8% disponen de ecógrafo propio. El uso más frecuente es la exploración abdominal (87,9%), torácica (72,7%) o vascular periférica (69,7%). Es escasa la presencia de protocolos y registros de la actividad. La formación no es uniforme entre médicos de plantilla y de guardia. No se encontraron diferencias significativas en función del tipo de hospital, del grado de actividad o de la presencia de radiólogo las 24 horas del día, excepto para el protocolo FAST, más empleado en hospitales comarcales que en el resto (89,5% vs. 42,9%; p=0,007). Conclusiones. La ecografía a pie de cama hecha por MU se usa en más de la mitad de los SUH públicos catalanes. Es necesario que el uso de la ecografía en el SUH se extienda, sea más reglado, registrado de manera adecuada y que participen de él todos los médicos que trabajan en urgencias.