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Biomedical subjects

A Hulkko

Publications and source records attributed to A Hulkko.

36 records · Page 2Linked to original sources
PubMed1991

Diagnosis and treatment of delayed and non-union stress fractures in athletes.

Stress fractures in athletes usually heal well with merely rest and conservative treatment. It has been estimated that in Finland 400-500 athletic stress fractures occur annually per year. In sports clinic series stress fractures comprise 3.3 to 4.6 per cent of all overuse injuries. Delayed and non-union have been reported to occur in athletes quite often, up to 10 per cent of athletic stress fractures in Finland. The reason is on the one hand delayed diagnosis due to late consultation of expert physicians, and on the other hand too short a rest from hard physical activity. Delayed and non-union are most often seen in the hallux sesamoids, mid-tibial staft, base of fifth metatarsal, tarsal navicular and olecranon. The pars articularis of the fourth and fifth lumbar vertebra is a site of stress fracture and spondylolysis. In this report the diagnosis, symptoms and findings as well as the operative treatment of these overuse injuries is discussed.

Athletic Injuries↗
PubMed1987

Stress fractures in athletes.

During the 14-year period of 1971-1985, 368 stress fractures in 324 athletes were treated. The series contained 268 fractures in males and 100 fractures in females; 32 fractures occurred in children (less than 16 years), 117 in adolescents (16-19 years), and 219 in adults. Forty-six fractures were incurred by athletes at an international level, 274 by athletes at a national or district level and 48 by recreational athletes. Of the total cases, 72% occurred to runners and a further 12% to athletes in other sports after running exercises. The distribution of the stress fractures by site was: tibia 182, metatarsal bones 73, fibula 44, big toe sesamoid bones 15, femoral shaft 14, femoral neck 9, tarsal navicular 9, pelvis 7, olecranon 5 and other bones 10. Of the total fractures, 342 were treated conservatively and 26 fractures required surgical treatment. The operative indication was dislocation in 5 cases and delayed union/nonunion in 21 cases. The sites most often affected by delayed union were: anterior midtibia, sesamoid bones of the big toe, base of the fifth metatarsal, olecranon, and tarsal navicular. The athletes at an international level experienced the greatest risk of multiple separate fractures, protracted healing, or fractures requiring surgery.

Adolescent↗
PubMed1986

Stress fractures of the olecranon in javelin throwers.

Between the years 1977 and 1984, four javelin throwers with a stress fracture of the olecranon were seen and treated. In one patient, acute painful dislocation of the fracture occurred during a competitive throw. Two patients had stress fracture of the tip. The fracture treated conservatively healed in 18 months. The patient treated by excision of the tip was able to throw after 2 months. Two patients had slightly oblique, more distally located stress fractures, which were treated with a tension band and 2 Kirschner wires. The fractures healed in 4 months. One of the patients had a refracture 11 months after the primary operation. It was successfully treated with a compression screw and two bone pegs. Because of the high risk of delayed union and nonunion, stress fractures of the olecranon should be treated operatively in javelin throwers.

Adult↗
PubMed1985

Stress fractures of the sesamoid bones of the first metatarsophalangeal joint in athletes.

Over a period of 11 years 15 cases of stress fractures of the sesamoid bones of the first metatarsophalangeal (MTP) joint were treated in athletes. The mean age of the patients was 22.3 years, and there were 9 males and 6 females in the series. All patients were athletes, who began to suffer from the symptoms during training without any trauma. Eight fractures were located in the medial, six in the lateral sesamoid bone, and in one case both sesamoids were affected. The diagnosis was performed on the basis of the history, symptoms, clinical examination, and radiological, or isotope scanning findings. Ten of the patients were treated conservatively by prescribing an avoidance of excessive physical activity and better training shoes. In five cases surgical excision of the fragmented painful sesamoid bone was performed. There were no complications in the series and the athletes could start gradually training 6-8 weeks after the operation. The histology showed fibrotic non-union at the fracture site and supported the diagnosis of stress fracture. Three of the conservatively treated athletes had mild symptoms in intensive training, others had a good end result.

Adolescent↗
PubMed1985

Stress fracture of the navicular bone. Nine cases in athletes.

Nine cases of stress fractures of the tarsal navicular bone were treated in athletes. The diagnosis was made with radiographs and bone scan within 6 months. Only two patients were treated surgically. The only poor result was seen in a patient in whom the fracture was only explored.

Adolescent↗
PubMed1985

Stress fracture of the fifth metatarsal in athletes.

Between 1975 and 1984 11 athletes with stress fractures of the fifth metatarsal were treated. There were 6 diaphyseal fractures, all of them in runners, and 5 transverse fractures of the base (Jones' fractures). The diaphyseal fractures healed with rest in 3-4 weeks. One patient with Jones' fracture was treated conservatively with a non-weight-bearing toe-to-knee plaster with good results. Four patients with delayed unions were treated operatively, three with a tension band and two Kirschnerwires, one with drilling and a single, thick Kirschner-wire. The fractures treated operatively progressed to bony union in about 3 months. The tendency of the Jones' fracture to delayed union and non-union in active athletes makes special requirements to the initial therapy of stress fractures. Best results have been obtained with a toe-to-knee cast with non-weight-bearing for 6-7 weeks. In delayed unions we recommend a tension band fixation with two Kirschner-wires. Non-unions should be treated with curettage and bone-grafting.

Adult↗
PubMed1984

Stress fracture of the mid-tibial shaft.

In a series of 151 tibial stress fractures in athletes and joggers, seven were located at the mid-third of the diaphysis. The diagnosis was made radiographically several months after the onset of symptoms; a transverse fissure line or gap was noted in the middle of the hypertrophied anterior tibial cortex. Histologic examination of a biopsy of the fracture line showed features resembling pseudoarthrosis. All the patients returned to physical activities.

Adult↗
PubMed1981

Stress fractures in young athletes.

In a series of 16 cases of stress fractures in 15-year-old and younger athletes 8 fractures occurred in boys and 8 in girls. There were no differences between the sexes in the athletes' training habits. Ten of the fractures were located at the tibia, seven at its upper third and three at the lower part of the bone. Three fractures were found in the fibula, in the metatarsal bones two stress fractures and in the femur one stress fracture. Most stress fractures were caused by endurance type sports. The daily training distances were not particularly high at the time of the onset of the symptoms. In most cases the diagnosis was based on a radiological evaluation. A sufficiently long pause from all athletic activity was enough treatment. Stress fractures in children are very uncommon.

Adolescent↗
PubMed1981

Exertion injuries in female athletes.

Because sports injuries in men form most of the available statistics, the reportage of injuries in female athletes is sparse. We describe exertion injuries and disorders in 281 women athletes, all of which hampered athletic training or performances. Sixty per cent of the injuries occurred to girls ages between 12-19 years, and about forty-eight per cent were track and field athletes. The most common sites of injury were the ankle, foot, heel and leg. Osteochondritic disorders were the most typical injuries in the series, and the chronic medical tibial syndrome was the injury that needed surgical treatment most frequently. Overuse injuries seem to differ very little from each other in the events included in this survey.

Adolescent↗
PubMed1981

Comparison of dextranomer and streptokinase-streptodornase in the treatment of venous leg ulcers and other infected wounds.

The clinical efficacy of dextranomer (Debrisan) and streptokinase-streptodornase (Varidase) was compared in a controlled randomized in-patient study. There were two patient groups: Group A consisting of 28 patients with a total of 31 venous leg ulcers and Group B consisting of 56 patients with other infected wounds (posttraumatic and postoperative wounds, amputation stumps, burn wounds, arteriosclerotic ulcers, decubital ulcers, ulcers due to bone disease, rheumatic ulcers, ulcers due to erysipelas and wounds of mixed aetiology). Both agents have a good cleansing effect as well as a good effect on infection and wet necrosis. Dextranomer stimulates the formation of granulation tissue faster than streptokinase-streptodornase.

Bacterial Infections↗
PubMed1981

Tinidazole in the prophylaxis of post-appendicectomy infections.

A total of 223 consecutive suspected appendicitis patients were treated preoperatively with parenteral tinidazole or physiological saline (control group). An infusion of 500 mg tinidazole was given to 110 patients over 30 minutes beginning about 30 minutes before the start of the operation, the control group comprised 111 patients. Postoperative infections were diagnosed in three patients in the group receiving tinidazole (3%) and in 17 patients in the control group (15%). The difference was statistically significant. There were no side-effects due to the drugs. Tinidazole appears to be well suited to the prophylaxis of post-appendicectomy infections.

Adult↗
PubMed1980

Regulation of the glycosylations of collagen hydroxylysine in chick embryo tendon and cartilage cells.

The regulation of the glycosylations of hydroxylysine was studied in isolated chick-embryo cells by labelling with a [14C]lysine pulse. The course of the procollagen lysyl modifications was compared in tendon and cartilage cells, and the effect on the gycosylations of the degree of lysyl hydroxylation and the concentration of Mn2+ and Fe2+ were also studied, in tendon cells. Procollagen triple helix formation was inhibited in most experiments in order to eliminate the effect of this process on the continuation of the reactions. Both in the tendon and cartilage cells the intracellular lysyl modifications proceeded in a biphasic fashion. After an initial sharp linear increase, the reactions did not cease but were protracted at a slower but constant rate. Lysyl hydroxylation was followed by rapid galactosylation in both cell types and this was followed almost immediately by rapid glucosylation, suggesting a close association of the corresponding enzymes. The data further suggest that other factors must also exist, in addition to the differences in the timing of triple helix formation and the actual hydroxylysine content, which are responsible for the different amounts of galactose in the collagens synthesized by these cell types. The amount of glucosylgalactosylhydroxylysine nevertheless seemed to be determined by the available acceptor sites, i.e., the amount of galactosylhydroxylysine. In further experiments with tendon cells the oxygen participating in lysyl hydroxylation was displaced by nitrogen at various points in time. When the degree of lysyl hydroxylation was reduced to less than one-third of the original, the total amounts of glycosylated residues decreased correspondingly, but their proportion relative to total hydroxylysine remained unchanged. Extra Mn2+ increased the proportion of galactosylated hydroxylysine, suggesting that the activity of hydrosylysyl galactosyltransferase is not saturating in respect of the catalyzed reaction. Experiments on the addition of Fe2+ or its chelation by alpha, alpha'-dipyridyl gave indications that the presence of this co-factor is not required for either glycosylation reaction in isolated tendon cells.

Animals↗
PubMedDate not supplied

Risk factors for recurrent stress fractures in athletes.

Our aim was to identify factors predisposing athletes to multiple stress fractures, with the emphasis on biomechanical factors. Our hypothesis was that certain anatomic factors of the ankle are associated with risk of multiple stress fractures of the lower extremities in athletes. Thirty-one athletes (19 men and 12 women) with at least three separate stress fractures each, and a control group of 15 athletes without fractures completed a questionnaire focusing on putative risk factors for stress fractures, such as nutrition, training history, and hormonal history in women. Bone mineral density was measured by dual-energy x-ray absorptiometry in the lumbar spine and proximal femur. Biomechanical features such as foot structure, pronation and supination of the ankle, dorsiflexion of the ankle, forefoot varus and valgus, leg-length inequality, range of hip rotation, simple and choice reaction times, and balance in standing were measured. There was an average of 3.7 (range, 3 to 6) fractures in each athlete, totaling 114 fractures. The fracture site was the tibia or fibula in 70% of the fractures in men and the foot and ankle in 50% of the fractures in women. Most of the patients were runners (61%); the mean weekly running mileage was 117 km. Biomechanical factors associated with multiple stress fractures were high longitudinal arch of the foot, leg-length inequality, and excessive forefoot varus. Nearly half of the female patients (40%) reported menstrual irregularities. Runners with high weekly training mileage were found to be at risk of recurrent stress fractures of the lower extremities.

Adolescent↗
PubMedDate not supplied

Delayed unions and nonunions of stress fractures in athletes.

From 1971 to 1985, 369 athletes presented to us with stress fractures. Of these patients, 10% (37) were treated for development of delayed unions or nonunions. Twenty-seven of the patients were male and 10 were female. Their mean age was 23.1 years (range, 17 to 39). About half of the athletes were involved in endurance sports. The diagnostic criteria for a delayed union or nonunion were clinical and radiological evidence. There was a diagnostic delay of about 3.5 months in the series. Plain radiographs, tomography, and isotope scans were used in the diagnosis. Special radiographic views were also used. In 15 cases (10 hallux sesamoid bone fractures, 1 midtibial shaft fracture, 1 metatarsal V base fracture, 1 tarsal navicular fracture, 1 olecranon fracture, and 1 proximal tibial shaft fracture) nonoperative treatment was used. Operative treatment was used 22 times (5 sesamoid fractures, 5 midtibial fractures, 5 metatarsal V base fractures, 3 tarsal navicular fractures, 3 olecranon fractures, and 1 proximal tibial shaft fracture). Results were good or excellent in 32 cases (86.5%), moderate in 4 cases, and poor in 1 case.

Adolescent↗
PubMedDate not supplied

Stress avulsion fracture of the tarsal navicular. An uncommon sports-related overuse injury.

We report nine cases of stress-related avulsion fracture of the tarsal navicular in athletes. This uncommon over-use injury is thought to occur following repetitive cyclic compressive loading secondary to an impingement of the tarsal navicular. The small dorsal triangular fragment is best seen in weightbearing lateral view radiographs and isotope scan and/or tomography help confirm the diagnosis. We feel that operative treatment is the method of choice in highly symptomatic cases and among top athletes because of the shorter recovery time.

Adolescent↗