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PubMed2000

Nonunion of the femoral diaphysis. The influence of reaming and non-steroidal anti-inflammatory drugs.

We assessed factors which may affect union in 32 patients with nonunion of a fracture of the diaphysis of the femur and 67 comparable patients whose fracture had united. These included gender, age, smoking habit, the use of non-steroidal anti-inflammatory drugs (NSAIDs) the type of fracture (AO classification), soft-tissue injury (open or closed), the type of nail, the mode of locking, reaming nu non-reaming, infection, failure of the implant, distraction at the fracture site, and the time to full weight-bearing. Patients with severe head injuries were excluded. Both groups were comparable with regard to gender, Injury Severity Score and soft-tissue injury. There was no relationship between the rate of union and the type of implant, mode of locking, reaming, distraction or smoking. There were fewer cases of nonunion in more comminuted fractures (type C) and in patients who were able to bear weight early. There was a marked association between nonunion and the use of NSAIDs after injury (p = 0.000001) and delayed healing was noted in patients who took NSAIDs and whose fractures had united.

Adolescent↗

PubMed1999

Differential profile of facial injuries among mountainbikers compared with bicyclists.

BACKGROUND: Bicyclists and mountainbikers are prone to facial trauma. In the current study, we present a large series of cycling-related sports trauma to the face in an effort to identify the injury pattern among mountainbikers compared with bicyclists. METHODS: The medical records of a single pediatric and adult Level I trauma center were evaluated from January 1, 1991, through October 31, 1996. All admissions with injuries caused by cycling-related sports were reviewed, analyzed, and compared according to age and sex distributions, causes of accidents, injury types, frequency, and localization of fractures and associated injuries. The injury types were divided into three categories: fractures, dentoalveolar trauma, and soft-tissue injuries. RESULTS: Five hundred sixty-two injured bicyclists (10.3% of all trauma patients) were registered at the Department of Oral and Maxillofacial Surgery, University of Innsbruck, Austria, during the study period, accounting for 31% of all sports-related or 48.4% of all traffic collisions, respectively. The review of the patient records revealed especially more severe injury profiles in 60 mountainbikers, with 55% facial bone fractures, 22% dentoalveolar trauma, and 23% soft-tissue injuries, compared with 502 street cyclists showing 50.8% dentoalveolar trauma, 34.5% facial bone fractures, and 14% soft-tissue lesions. The dominant fracture site in bicyclists was the zygoma (30.8%), whereas mountainbikers sustained an impressive 15.2% Le Fort I, II, and III fractures. Condyle fractures were more common in bicyclists, with 18.8% opposing 10.8% in mountainbikers. CONCLUSION: Appropriate design of helmets with faceguards will reduce the incidence of facial injuries caused by cycling-related accidents and incentives are needed for making helmet use compulsory for all cyclists, particularly for mountainbikers.

Adolescent↗

PubMed2001

Distracting painful injuries associated with cervical spinal injuries in blunt trauma.

UNLABELLED: Distracting painful injuries (DPIs) may mask symptoms of spinal injury in blunt trauma victims and form an important element in a decision instrument used to identify individuals who require cervical spine radiography. OBJECTIVE: To identify the types and frequencies of injuries that actually act as DPIs among blunt trauma patients undergoing cervical spinal radiography. METHODS: This was a prospective observational study of consecutive blunt trauma victims presenting to an urban Level 1 regional trauma center between April 1, 1998, and September 30, 1998. Prior to cervical spinal radiography, treating physicians evaluated each patient to determine whether a DPI was present or absent and, if present, what type of injury was sustained. Injuries were categorized as fractures, soft-tissue injuries and lacerations, burns, visceral injuries, crush injuries, or other injuries. RESULTS: Data were collected for 778 patients, between 1 month and 98 years old, of whom 264 (34%) were considered to have DPIs. Physicians were unable to determine the DPI status in 47 (6%) additional cases. Fractures accounted for a majority of DPIs (154, or 58%), 42 (16%) were soft-tissue injuries or lacerations, and 86 (34%) were due to a variety of other entities, including visceral, crush, burn, or other miscellaneous injuries. Among the 37 (5%) patients with an acute cervical spinal injury, 20 (54%) had a DPI, including three (8%) who had DPI as the only indication for cervical radiography. CONCLUSIONS: A significant number of blunt trauma patients are believed by clinicians to have DPIs that can possibly mask the presence of cervical spinal injury. Fractures and trauma to soft tissues are the most common types of DPI.

Adult↗

PubMed2000

Treatment of comminuted intraarticular distal femur fractures with limited internal and external tensioned wire fixation.

OBJECTIVE: Evaluate the treatment of C3 distal femur fractures with limited internal fixation and tensioned wire circular external fixation. DESIGN: Prospective cohort study, from June 1992 to July 1996. SETTING: Urban Level I trauma center. PATIENTS: Sixteen fractures in sixteen patients: nine male, seven female. Fractures: C3.1 one, C3.2 one, C3.3 fourteen. Twelve fractures were open: one GI, seven GII, two GIIIA, one GIIIB, and one GIIIC. INTERVENTION: Fractures were treated with limited open fixation of the condylar joint surface and tensioned wire circular external fixation of the metaphysis and shaft for axial alignment. Three fractures had acute autologous bone grafts. MAIN OUTCOME MEASUREMENTS: The patient's extremity function was evaluated by the authors by using the Sanders et al. Distal Femur Functional Evaluation. RESULTS: Sixteen of sixteen fractures healed. Two patients had delayed bone grafting for delayed union. Average frame time was twenty-five weeks. Average range of motion was 0 to 92 degrees. Five patients had less than 90 degrees of flexion. Five patients required a quadricepsplasty. Average follow-up was thirty-five months. One patient developed a pintract infection. One patient developed septic arthritis, and another developed osteomyelitis. The average Sanders et al. Function knee score was twenty-eight, with a maximum possible score of forty. CONCLUSIONS: C3 fractures of the distal femur are associated with severe soft tissue injuries and bone loss. Loss of function appears to be directly related to these factors. Treatment with limited internal fixation and tensioned wire external fixation has equivalent results to other methods but has a higher incidence of infection and complications. Joint motion is retarded by binding of the soft tissues with fixation wires and pins. The technique is recommended only for salvage of severely comminuted and open fractures of the distal femur with extensive soft tissue injury. Distal femur fractures with moderate comminution and soft tissue injury should be treated with alternate methods.

Adolescent↗

PubMed2003

The pathomechanism of posttraumatic edema of the lower limbs: II--Changes in the lymphatic system.

BACKGROUND: The peripheral lymphatic system reacts to penetrating microorganisms and self-antigens released from tissues and cells damaged by trauma or intracellular pathogens. The response of regional lymph nodes to tissue trauma has not been thoroughly studied. We investigated the changes in lower limb lymphatics and nodes after fractures and soft tissue injuries. This type of injury is frequently complicated by limb edema. Posttraumatic edema of lower limbs is characterized by long-lasting swelling of the limb, erythema, and increased skin temperature at the site of injury. This suggests that a local inflammatory process is proceeding, even though the process of bone or soft tissue healing is considered to be completed. METHODS: Twenty-one patients with closed lower limb bone fractures and soft tissues injuries were studied by means of isotope lymphography. RESULTS: Dilated lymphatics of the entire limb were found in all patients, and 62% of them showed enlarged inguinal lymph nodes. Venous thrombosis was found in 24% of cases. There was no correlation between the degree of lymphatic dilatation, lymph node enlargement, and bone fracture or soft tissue injury or venous thrombosis. Surgical intervention was not an independent factor for lymph node enlargement. CONCLUSION: This study has shown that although the fracture or injured tissues are clinically healed, local inflammatory reaction at the site of injury persists and cytokine signals are sent to the regional lymph nodes.

Adolescent↗

PubMed1984

Combined skeletal and vascular injuries of the lower extremities.

In order to determine the long-term results of surgical treatment in patients with significant combined skeletal and arterial injuries, the authors reviewed the records of those patients treated for this injury between 1970 and 1981, at their institutions. These cases were confined to fractures and/or dislocations of the femur, knee, and tibia which were associated with vascular injuries. Thirty-one patients with 32 injured extremities fit these criteria for our review. The distribution of the orthopedic injuries were as follows: femoral fractures, 16; tibial fractures, 20; and knee dislocations, four. Fifty percent of the injuries had neurologic deficit; significant soft tissue injury was present in 22 extremities; and all but 4 had attempted arterial revascularization. Vascular procedures included saphenous vein by-pass, saphenous vein interposition, end-to-end anastomosis and lateral arteriorrhaphy. Orthopedic repairs were generally accomplished by external means with only five cases treated by immediate internal fixation. Long-term results were categorized as excellent, fair, or poor. Amputations were classified as primary and secondary. Excellent results were found in only five of the reconstructed extremities. Thirty-five percent of the extremities were classified as having a fair result. Two extremities had a poor result. Four extremities were primarily amputated, and secondary amputation was performed on seven extremities. Associated nerve deficits and/or significant soft tissue injuries were found to be the major factors determining the eventual success or failure of reconstructive efforts.

Adolescent↗

PubMed1984

Experience with 112 shotgun wounds of the extremities.

Although shotgun and gunshot injuries are frequently grouped together, shotgun injuries are ballistically and clinically very different from gunshot wounds. Because of the differences between gunshot and shotgun injuries, the clinical records of 85 patients with 112 extremity shotgun wounds treated over a 6-year period were reviewed: 11% had Type I injuries; 30% and 59%, respectively, had Type II and Type III injuries. Overall, 59% had major soft-tissue injuries and 44% had bone or joint injuries, and nerve and vascular injuries were documented in 21% and 26%. The major cause of a prolonged hospital stay was the presence of a major soft-tissue injury, while the presence or absence of a neural injury was the most important determinate of whether the extremity would be functional. In contrast, neither skeletal nor vascular injuries resulted in long-term extremity disability. Thus, we recommend an aggressive operative approach towards early wound closure in these patients to decrease hospitalization time. Further, we believe that the operative determination of the presence or absence of anatomic damage of the nerves in patients with neural deficits is an important component in the long-term management of these patients.

Adolescent↗

PubMed2002

Factors influencing the decision to amputate or reconstruct after high-energy lower extremity trauma.

BACKGROUND: Factors thought to influence the decision for limb salvage include injury severity, physiologic reserve of the patient, and characteristics of the patient and their support system. METHODS: Eligible patients were between the ages of 16 and 69 with Gustilo type IIIB and IIIC tibial fractures, dysvascular limbs resulting from trauma, type IIIB ankle fractures, or severe open midfoot or hindfoot injuries. Data collected at enrollment relevant to the decision-making process included injury characteristics and its treatment, and the nature and severity of other injuries. Logistic regression and stepwise modeling were used to determine the effect of each covariate on the variable salvage/ amputation. RESULTS: Of 527 patients included in the analysis, 408 left the hospital with a salvaged limb. Of the 119 amputations performed, 55 were immediate and 64 were delayed. The multivariate analysis confirmed the bivariate analysis: all injury characteristics remained significant predictors of limb status with the exception of bone loss; and soft tissue injury and absence of plantar sensation were the most important factors in accounting for model validity. CONCLUSION: Soft tissue injury severity has the greatest impact on decision making regarding limb salvage versus amputation.

Adolescent↗

PubMed2002

[Clinical examination of menisci in the era of arthroscopy].

PURPOSE OF THE STUDY: A profound clinical history and examination in case of a soft-tissue injury of the knee joint has a principal significance for the diagnosis and the following treatment. Our aim was to compare the development of surgery of the soft-tissue injury of the knee in our region within a 25-year interval. The most frequently affected structures in the knee joint are the menisci. We have focussed on the evaluation of the extent to which selected clinical history and symptoms are actually associated with the affection of menisci. MATERIAL: First we compared groups of patients operated on for the soft-tissue injury of the knee joint within a 25-year interval. The scope of the care in the out-patient department was in this period almost the same. Then we examined a group of patients with a suspect tear of menisci and focussed on the clinical history and findings which are most often related to the injuries of menisci. METHODS: In a retrospective study aimed at the acquisition of sufficient statistical data and concentrated on the development of the surgery of the soft-tissue knee we compared a group of 91 patients operated on by arthrotomy in the period of 1973-1975 with a group of 780 patients operated on in the years 1996-98 by arthroscopy. In the subsequent prospective study we examined 104 patients sent to arthroscopic examination for a suspect tear of the medial or lateral meniscus. Based on the performed arthroscopy we divided the patients into three group--with the injured medial meniscus, with the injured lateral meniscus and without affection of meniscus. We investigated the diagnostic value of clinical history and clinical symptoms. RESULTS: In the retrospective study comparing the groups of patients in the 25-year interval the number of knee joints operated on increased 9times, the average age decreased by 8 years and the duration of hospitalisation was reduced by 9 days, the period of after-treatment in the out-patient department was reduced by 59 days. In the prospective study focussed on the lesion of meniscus the success rate of clinical history and examinations was 62% in lesions of the medial meniscus, 47% in lesions of the lateral meniscus. Significant in the clinical history of both menisci was a joint effusion and click phenomenon in the knee joint. Of clinical symptoms relating to lesion of the medial meniscus there often (above 60%) occurred pain of the medial joint line, painful bend and positive Steinmann II test, in case of the lateral meniscus painful bend and inability of full bend (nebo flexion--co má autor na mysli termínem "dotazení?) and walking in bend. Their disadvantage is a low specificity. On the contrary lower sensitivity but higher specificity is recorded by the clinical history of the locked knee and the presence of click phenomena during clinical examination. Simultaneous affection of the cartilage of the medial condyle of the femur in the lesion of the medial meniscus was in 64% of cases and of the lateral condyle of the femur in the lesion of the lateral meniscus in 47% of cases. DISCUSSION: Opinion on the clinical history and examination of the injured knee joint has not changed substantially during 25 years as shown by the comparison of the literature, but arthroscopy thanks to its visualisation of the joint cavity and a lower invasiveness contributed to the improvement of the diagnostics of the lesions of the knee joint, a less invasive surgery resulting in a reduced period of treatment. As compared to other authors we achieved in the evaluation of clinical history and examination practically the same success rate of diagnosis in the lesion of the medial meniscus but a lower success rate in the lesion of the lateral meniscus. As concerns clinical history we did not find any significant differences in comparison with other authors, in case of clinical examination we did not achieve such good results in case of McMurray test and as the most significant manoeuvre we consider the Steinmann II test for the medial meniscus. Frequent simultaneous injury of the cartilage and menisci corresponds to the findings of other authors. CONCLUSION: Indication for surgery for the affection of menisci therefore has to be based on a careful analysis of clinical history and examination of the patient, it is not possible to rely on any of the menisci symptoms and their significance is only supportive. As the most significant symptoms we assess the clinical history of the verified knee swelling, click phenomena and locked knee in the knee joint, in the clinical examination pain and click phenomena of the joint lines.

Adolescent↗

PubMed1994

A comprehensive analysis of craniofacial trauma.

A review of the literature identified a need for a prospective study of the complete range of craniofacial trauma. The aims of this study were to determine the incidence, etiology, and mechanisms of craniofacial and associated injuries, enabling a greater understanding of their range and magnitude. Nine hundred fifty consecutive patients seen at an urban university hospital with any degree of craniofacial trauma were prospectively investigated. Craniofacial trauma was found to be very common at all ages. The causes were directly related to age, sex, and alcohol consumption, and determine the type and severity of injury. The commonest cause of soft-tissue injury was falls, whereas that of fractures was interpersonal violence. Falls accounted for most of the injuries in children and the elderly, whereas interpersonal violence was mainly responsible for those occurring in patients aged 15 to 50 years. Interpersonal violence mostly involved young male adults: fights occurring mainly between strangers who had consumed excessive amounts of alcohol. Women were usually assaulted by assailants known to them, their partners. Pedestrians showed a propensity to sustain cranial fractures, whereas motor vehicle occupants tended to sustain midfacial fractures and bicyclists mandibular fractures. Pedestrians incurred the severest injuries of all road users, and a significant proportion of road user collisions involved bicyclists. Sports were responsible for a significant proportion of craniofacial injuries in youths and young adults. Craniofacial soft-tissue injuries overall occurred most frequently on the forehead, nose, lips, and chin, and a method for their classification is proposed. The commonest craniofacial fracture was that of the nasal bones (45%), followed by cranial bones (24%), mandible (13%), zygoma (13%), orbital blow-out (3%), and maxilla (2%). The incidence of craniofacial trauma can be greatly reduced by improvements in interior home design, school education in alcohol abuse and handling potentially hostile situations (especially for men), improvement in automotive safety devices and compliance by motor vehicle occupants, and utilization of full-face helmets by bicyclists and motorcyclists.

Accidental Falls↗

PubMed2006

Multiplanar cervical spine injury due to head-turned rear impact.

STUDY DESIGN: Head-turned whole cervical spine model was stabilized with muscle force replication and subjected to simulated rear impacts of increasing severity. Multiplanar flexibility testing evaluated any resulting injury. OBJECTIVES: To identify and quantify cervical spine soft tissue injury and injury threshold acceleration for head-turned rear impact, and to compare these data with previously published head-forward rear and frontal impact results. SUMMARY OF BACKGROUND DATA: Epidemiologically and clinically, head-turned rear impact is associated with increased injury severity and symptom duration, as compared to forward facing. To our knowledge, no biomechanical data exist to explain this finding. METHODS: Six human cervical spine specimens (C0-T1) with head-turned and muscle force replication were rear impacted at 3.5, 5, 6.5, and 8 g, and flexibility tests were performed before and after each impact. Soft tissue injury was defined as a significant increase (P < 0.05) in intervertebral flexibility above baseline. Injury threshold was the lowest T1 horizontal peak acceleration that caused the injury. RESULTS: The injury threshold acceleration was 5 g with injury occurring in extension or axial rotation at C3-C4 through C7-T1, excluding C6-C7. Following 8 g, 3-plane injury occurred in extension and axial rotation at C5-C6, while 2-plane injury occurred at C7-T1. CONCLUSIONS: Head-turned rear impact caused significantly greater injury at C0-C1 and C5-C6, as compared to head-forward rear and frontal impacts, and resulted in multiplanar injuries at C5-C6 and C7-T1.

Accidents, Traffic↗

PubMed2001

Diagnosis of occult scaphoid fractures and other wrist injuries. Are repeated clinical examinations and plain radiographs still state of the art?

To examine the efficacy of repeated clinical examinations and follow-up radiographs, 121 patients were prospectively and consecutively randomised and clinically followed until a final diagnosis was achieved. All of these patients additionally underwent magnetic resonance imaging (MRI) scans within an average of 3 days after trauma to control the results of this study. MRI detected 112 injuries in 82 patients (67%). Twenty-eight (25%) of these injuries were scaphoid fractures. There were 15 fractures of other carpal bones, 14 avulsion fractures of extrinsic ligaments (AFL), 26 other bone injuries (fractures of distal radius, fractures of radial styloid, ulnar head fracture metacarpal fracture, bone bruises), and 29 soft tissue injuries (triangular fibro-cartilaginous complex injuries, complete or partial ruptures of the scapholunate ligament, ruptures of the radial collateral ligament, hemarthrosis). By means of repeated clinical examinations and plain scaphoid views, experienced observers were able to detect all the occult scaphoid fractures within 38 days, as well as most of the other fractures about the wrist except one fracture of the triquetrum. Soft tissue injuries, however, were diagnosed only in two cases of complete scapholunate ligament tears. It was further obvious that 70% of all scaphoid fractures and 60% of the AFLs were detected in a review of the initial X-rays by experienced surgeons. Only 30% of all scaphoid fractures detected were really occult and all of these were diagnosed correctly. This prospective study demonstrates that clinical and radiological standard procedures are reliable in the diagnosis of occult fractures of the carpus and wrist when performed by experienced observers. MRI scans are indicated for early diagnosis of occult fractures and soft tissue injuries about the wrist.

Adult↗

PubMed2005

Timing of fixation of major fractures in blunt polytrauma: role of conventional indicators in clinical decision making.

Grading of the clinical status in patients with multiple trauma is important regarding the treatment plan. In recent years, 4 different clinical conditions have been described: stable, borderline, unstable, in extremis. Clinical parameters have been widely used in patients with penetrating injuries, and 3 categories were found to be important: shock, hypothermia, coagulopathy. However, in blunt trauma patients, the role of conventional parameters for decision making regarding the timing of fracture treatment is poorly described. After blunt trauma, additional factors seem to play a role, because the injuries affect multiple body regions. These additional factors are summarized under the term, "soft-tissue injuries," which may include the soft tissues of the extremities, lung, abdomen, and pelvis. The study describes four pathophysiologic cascades that are relevant to the clinical conditions listed above. Threshold values for separation of the patient conditions are documented, leading to a staged surgical strategy.

Decision Making↗

PubMed2003

Orthopedic injuries related to snowmobile use.

OBJECTIVES: To document the locations of injury, frequency of associated injuries, and need for operative intervention in patients presenting to a tertiary medical center after sustaining an orthopedic injury related to snowmobile use. DESIGN: Retrospective review. SETTING: Tertiary care center with level I trauma designation in southern Minnesota. PATIENTS/PARTICIPANTS: Seventy-eight patients who sustained orthopedic injuries from snowmobile accidents between January 1985 and December 1996 were treated at our institution. Information regarding patient demographics and injury characteristics was collected. These data were stratified into patient populations presenting directly to the emergency department (n = 47) and those referred from outside hospitals (n = 31). RESULTS: A total of 209 injuries (118 fractures, 31 orthopedic soft-tissue injuries, and 60 nonorthopaedic injuries) were diagnosed within the study population. Tibia (n = 20), radius (n = 14), ulna (n = 12), and spine (n = 14) fractures accounted for half of the fractures reported. There were 13 open fractures. Twenty-four fractures were treated operatively. Ligament injuries to the knees (n = 7) and compartment syndrome of the lower extremity (n = 5) represented the most common orthopedic soft-tissue injuries. The acromioclavicular joint was the most frequently dislocated joint (n = 4). Associated injuries commonly involved the head (n = 17), abdomen (n = 13), and chest (n = 9). As compared to patients presenting directly to the emergency department, referred patients on average had a statistically greater number of total injuries, total operations, and operations for fractures. CONCLUSION: Snowmobile accidents represent a frequent cause of orthopedic injuries in northern regions. An understanding of these injuries may help emergency departments prepare for patients injured on these machines. Recognition of the most common orthopedic injuries may help in the design of safer snowmobiles.

Adolescent↗

PubMedDate not supplied

[Micromorphology of injuries to soft tissues of the scalp in the acute period of craniocerebral trauma with various levels of consciousness].

Presents a comparative analysis of vascular and tissue reactions at the site of injuries to soft integument of the hairy part of the head in the acute period of craniocerebral injury in various forms of consciousness disturbances. Analyzes the time course of vascular changes in various topographic zones of soft integument of the head during 13 days, divided into 7 intervals, of the acute period of craniocerebral injury.

Acute Disease↗

PubMed2003

Cricket injuries: a longitudinal study of the nature of injuries to South African cricketers.

OBJECTIVE: To determine the incidence and nature of injuries sustained by elite cricketers during a three season period in order to identify possible injury patterns. METHODS: Thirty six physiotherapists and 13 doctors working with 11 provincial and the South African national teams completed a questionnaire for each cricketer who presented with an injury during each season to determine anatomical site of injury, month of injury during the season, diagnosis, mechanism of injury, whether it was a recurrence of a previous injury, whether the injury had recurred again during the season, and biographical data. RESULTS: A total of 436 cricketers sustained 812 injuries. Bowling (41.3%), fielding and wicketkeeping (28.6%), and batting (17.1%) accounted for most of the injuries. The lower limbs (49.8%), upper limbs (23.3%), and back and trunk (22.8%) were most commonly injured. The injuries occurred primarily during first class matches (27.0%), limited overs matches (26.9%), and practices (26.8%) during the early part of the season. Acute injuries made up 64.8% of the injuries. The younger players (up to 24 years) sustained 57% of the first time injuries, and the players over 24 years of age sustained 58.7% of the injuries that recurred from a previous season. The injuries were mainly soft tissue injuries predominantly to muscle (41.0%), joint (22.2%), tendon (13.2%), and ligament (6.2%). The primary mechanism of injury was the delivery and follow through of the fast bowler (25.6%), overuse (18.3%), and fielding (21.4%). CONCLUSION: The results indicate a pattern of cause of injury, with the young fast bowler most likely to sustain an acute injury to the soft tissues of the lower limb while participating in matches and practices during the early part of the season.

Adolescent↗

PubMed1993

Spinal injury in sport: epidemiologic considerations.

Review of previous epidemiologic studies, involving both contact and noncontact sports at all levels of competition ranging from the high school level to the professional level, reveals that the overwhelming majority of sports injuries related to the spine are soft-tissue injuries and self-limiting. The spectrum of injury is related to the mechanism, the force involved, and the point of application of the force. The immediate consequence of a soft-tissue injury is decreased immobilization with result in deconditioning. Most athletes have a strong desire to compete both at the amateur and professional levels. The inability to compete can have both psychologic and emotional consequences. The professional athlete is potentially burdened with financial consequences as well. The mainstay of prevention and treatment is maintaining good strength and flexibility through conditioning. Injuries can occur at the level of the disc, resulting in disc herniation, disc degeneration, and ultimately developmental stenosis. The biochemistry and biomechanics of the disc are age related, and thus, the adolescent and older athlete may have different concerns with regards to the diagnosis, treatment, and prognosis after injury to the spine. Remember, not only injuries cause back pain in the athlete. Athletes, too, can have tumors, infection, rheumatologic disorders, and other nontraumatic etiologies of back pain. Rarely athletic injuries to the spine do result in significant neurologic compromise. These injuries have been brought to national attention with the tragic recent injuries of well-known professional football and hockey athletes.(ABSTRACT TRUNCATED AT 250 WORDS)

Athletic Injuries↗

PubMed2002

Physiotherapist-led programmes and interventions for rehabilitation of anterior cruciate ligament, medial collateral ligament and meniscal injuries of the knee in adults.

BACKGROUND: Soft-tissue injuries of the knee, mainly involving the anterior cruciate ligament (ACL), the medial collateral ligament (MCL) and menisci, are common and their rehabilitation after non-surgical or surgical treatment often involves intensive and prolonged physiotherapy. OBJECTIVES: To examine the evidence for effectiveness of various physiotherapist-led (or 'directed') rehabilitation programmes, and of various interventions used within these programmes, for rehabilitation of acute or chronic ACL, MCL or meniscal injuries of the knee in adults. SEARCH STRATEGY: We searched the Cochrane Musculoskeletal Injuries Group's specialised register (to June 2001), MEDLINE (from 1966 to August 1999), EMBASE (from 1980 to February 1997), CINAHL (1982 to April 1999), CURRENT CONTENTS (up to March 1999) and reference lists of relevant articles, and consulted colleagues. Date of the most recent search: June 2001. SELECTION CRITERIA: Randomised or quasi-randomised clinical trials evaluating physiotherapist-led rehabilitation programmes, or components of rehabilitation programmes, for the treatment or post-surgical rehabilitation of ACL, MCL or knee meniscal injuries. Excluded were trials investigating electrical stimulation, or various interventions such as cryotherapy, immobilisation braces and continuous passive motion when used in initial or early treatment. Laboratory based trials reporting intermediate outcomes were also excluded. DATA COLLECTION AND ANALYSIS: All trials, judged as fitting the selection criteria by two reviewers, were independently assessed by two reviewers for methodological quality by use of an 11 item checklist. Data were independently extracted by two reviewers. Any disagreement was resolved by discussion. Although quantitative data from most trials are presented, using relative risks or mean differences together with 95 per cent confidence intervals, trial heterogeneity and lack of outcome data prevented meaningful pooling of results from comparable trials. MAIN RESULTS: Thirty-one trials, involving 1545 mainly young and male patients, met the inclusion criteria of the review. Methodological quality was highly variable: allocation concealment and / or assessor blinding were rare, and assessment of outcome was often incomplete and short-term. ACL injury and /or deficiency was the main focus of 18 trials, MCL injury of two trials, meniscal injury of nine trials and a mixture of soft-tissue injuries in the other two trials. The trial comparisons fell into five main categories: rehabilitation programme versus control (6 trials); one rehabilitation programme versus another (6 trials); different timing of rehabilitation (4 trials); one component of a programme versus another (6 trials); supplementary interventions to a programme versus none (9 trials). No trial provided sufficient evidence to establish the relative effectiveness of the intervention(s) under investigation. REVIEWER'S CONCLUSIONS: The available evidence for physiotherapist-led rehabilitation of ACL, MCL and meniscal injuries is wide ranging in terms of scope but insufficient to establish the relative effectiveness of the various approaches and methods in current use. There is a need for further research involving good quality, large scale randomised trials with sufficiently long follow-up to fully assess knee function and recovery.

Anterior Cruciate Ligament Injuries↗