Factors Affecting the Treatment of Stress Fractures in Athletes: An Analysis of the Literature

1999 ◽  
Vol 8 (2) ◽  
pp. 135-147
Author(s):  
Susan K. Verscheure ◽  
Marc R. Hoefelein
Keyword(s):  
Surgical Approach ◽  
Weight Bearing ◽  
Stress Fractures ◽  
Anatomical Location ◽  
Stress Reactions ◽  
Factors Affecting ◽  
Aggressive Surgical Approach ◽  
Repetitive Loading ◽  
Cross Tabulation ◽  
The Individual

Stress fractures are a common overuse injury among athletes. Repetitive loading during weight bearing causes a broad range of stress reactions, from increased bone remodeling to painful fractures. The literature indicates that such injuries are usually treated conservatively with rest or immobilization, but a more aggressive, surgical approach to treatment of stress fractures has also been reported. This study was designed to identify the factors that influence the decision to treat an athlete surgically or conservatively. An analysis of 28 articles was performed. A cross-tabulation design was used to compare 4 categories with the treatment chosen. The categories included severity, anatomical location, and type of stress fracture, as well as the athletic motivation of the individual. All 4 factors were found to influence the treatment of choice, although it was remarkable that only athletes who demonstrated high athletic motivation were treated surgically.

scholarly journals Epidemiology of imaging-detected bone stress injuries in athletes participating in the Rio de Janeiro 2016 Summer Olympics

2017 ◽  
Vol 52 (7) ◽  
pp. 470-474 ◽  
Author(s):  
Daichi Hayashi ◽  
Mohamed Jarraya ◽  
Lars Engebretsen ◽  
Michel D Crema ◽  
Frank W Roemer ◽  
...  
Keyword(s):  
Rio De Janeiro ◽  
Sports Injuries ◽  
Lower Extremities ◽  
Stress Fractures ◽  
Track And Field ◽  
Anatomical Location ◽  
Stress Reactions ◽  
Bone Stress ◽  
Stress Injuries ◽  
Olympic Village

BackgroundBone stress injuries are common in high-level athletics.AimTo describe the demographics, frequency and anatomical location of stress injuries (ie, stress reaction and stress fractures) in athletes at the Rio de Janeiro 2016 Summer Olympic Games.MethodsWe recorded all sports injuries at the Rio de Janeiro 2016 Summer Olympics reported by the National Olympic Committee (NOC) medical teams and in the polyclinic and medical venues. Imaging was performed through the official IOC clinic within the Olympic Village, using digital X-ray cameras and 3T and 1.5T magnetic resonance (MR) scanners. Images were read centrally and retrospectively by musculoskeletal radiologists with expertise in sports injuries.Results11 274 athletes (5089 women (45%), 6185 men (55%)) from 207 NOCs participated in the study. 1101 injuries were reported. Imaging revealed 9 stress fractures (36%) and 16 stress reactions (64%) in 18 female and 7 male athletes (median age 25 years, age range 18–32). Stress injuries were mostly in the lower extremities (84%), particularly tibia (44%) and metatarsals (12%), with two in the lumbar spine (8%). Stress injuries were most common in track and field athletes (44%) followed by volleyball players (16%), gymnastics (artistic) (12%) and other type of sports.ConclusionsTwenty-five bone stress injuries were reported, more commonly in women, mostly in the lower extremities and most commonly in track and field athletes. Our study demonstrates the importance of early imaging with MRI to detect stress reactions before they can progress to stress fractures.

Revising the Indications of Transtemporal Surgical Approaches in the Modern Endoscopic Era of Skull Base Surgery: A Dying Art

2020 ◽  
Author(s):  
Ravi Sankar Manogaran ◽  
Raj Kumar ◽  
Arulalan Mathialagan ◽  
Anant Mehrotra ◽  
Amit Keshri ◽  
...  
Keyword(s):  
Skull Base ◽  
Surgical Approach ◽  
Nerve Palsy ◽  
Tertiary Care ◽  
Surgical Approaches ◽  
Microsurgical Anatomy ◽  
Complete Excision ◽  
Lateral Skull Base ◽  
The Individual ◽  
Selection Of

Abstract Objectives The aim of the study is to emphasize and explore the possible transtemporal approaches for spectrum of complicated lateral skull base pathologies. Design Retrospective analysis of complicated lateral skull base pathologies was managed in our institute between January 2017 and December 2019. Setting The study was conducted in a tertiary care referral center. Main Outcome Measures The study focused on the selection of approach based on site and extent of the pathology, the surgical nuances for each approach, and the associated complications. Results A total of 10 different pathologies of the lateral skull base were managed by different transtemporal approaches. The most common complication encountered was facial nerve palsy (43%, n = 6). Other complications included cerebrospinal fluid (CSF) collection (15%, n = 2), cosmetic deformity (24%, n = 4), petrous internal carotid artery injury (7%, n = 1), and hypoglossal nerve palsy (7%, n = 1). The cosmetic deformity included flap necrosis (n = 2) and postoperative bony defects leading to contour defects of the scalp (n = 2). Conclusion Surgical approach should be tailored based on the individual basis, to obtain adequate exposure and complete excision. Selection of appropriate surgical approach should also be based on the training and preference of the operating surgeon. Whenever necessary, combined surgical approaches facilitating full tumor exposure are recommended so that complete tumor excision is feasible. This requires a multidisciplinary team comprising neurosurgeons, neuro-otologist, neuroanesthetist, and plastic surgeons. The surgeon must know precise microsurgical anatomy to preserve the adjacent nerves and vessels, which is necessary for better surgical outcomes.

scholarly journals Interactive effects between travel behaviour and COVID-19: a questionnaire study

2021 ◽  
Author(s):  
Jinbao Zhang ◽  
Jaeyoung Lee
Keyword(s):  
Early Stage ◽  
Travel Behaviour ◽  
Interactive Effects ◽  
Factors Affecting ◽  
Individual Level ◽  
Passenger Volume ◽  
Spatial Autoregressive ◽  
Railway Passenger ◽  
The Individual ◽  
And Control

Abstract This study has two main objectives: (i) to analyse the effect of travel characteristics on the spreading of disease, and (ii) to determine the effect of COVID-19 on travel behaviour at the individual level. First, the study analyses the effect of passenger volume and the proportions of different modes of travel on the spread of COVID-19 in the early stage. The developed spatial autoregressive model shows that total passenger volume and proportions of air and railway passenger volumes are positively associated with the cumulative confirmed cases. Second, a questionnaire is analysed to determine changes in travel behaviour after COVID-19. The results indicate that the number of total trips considerably decreased. Public transport usage decreased by 20.5%, while private car usage increased by 6.4%. Then the factors affecting the changes in travel behaviour are analysed by logit models. The findings reveal significant factors, including gender, occupation and travel restriction. It is expected that the findings from this study would be helpful for management and control of traffic during a pandemic.

scholarly journals Factors affecting the organizational performance of manufacturing firms

2017 ◽  
Vol 9 ◽  
pp. 184797901771262 ◽  
Author(s):  
Ahmad Adnan Al-Tit
Keyword(s):  
Organizational Performance ◽  
Measurement Instrument ◽  
Manufacturing Firms ◽  
Factors Affecting ◽  
Mediating Role ◽  
Values And Beliefs ◽  
The Individual ◽  
The Impact ◽  
The Relationship

Numerous studies have been conducted to explore the individual effects of organizational culture (OC) and supply chain management (SCM) practices on organizational performance (OP) in different settings. The aim of this study is to investigate the impact of OC and SCM on OP. The sample of the study consisted of 93 manufacturing firms in Jordan. Data were collected from employees and managers from different divisions using a reliable and valid measurement instrument. The findings confirm that both OC and SCM practices significantly predict OP. The current study is significant in reliably testing the relationship between SCM practices and OP; however, it is necessary to consider cultural assumptions, values and beliefs as the impact of OC on OP is greater than the impact of SCM practices. Based on the results, future studies should consider the moderating and mediating role of OC on the relationship between SCM practices and OP.

Evaluation of Tarsal Navicular Stress Fracture Fixation Using Intraoperative O-arm Computed Tomography

2014 ◽  
Vol 7 (6) ◽  
pp. 515-521 ◽  
Author(s):  
Andrew R. Hsu ◽  
Simon Lee
Keyword(s):  
Computed Tomography ◽  
Stress Fracture ◽  
Guide Wire ◽  
Weight Bearing ◽  
Fracture Site ◽  
Stress Fractures ◽  
Functional Impairments ◽  
Intraoperative Ct ◽  
Intraoperative Computed Tomography ◽  
Anatomic Reduction

Stress fractures of the tarsal navicular are high-risk injuries that can result in displacement, avascular necrosis, malunion, and nonunion. Delayed diagnosis and improper treatment can lead to long-term functional impairments and poor clinical outcomes. Increased shear stress and decreased vascularity in the central third of the navicular can complicate bony healing with often unpredictable return times to activity using conservative management in a non-weight-bearing cast. There recently has been increasing debate regarding the effectiveness of treatment options with a trend toward surgical management to anatomically reduce and stabilize navicular stress fractures in athletes. However, anatomic reduction and fixation of the navicular can be difficult despite direct visualization and intraoperative fluoroscopy. We report a case of a chronic navicular stress fracture in a high-level teenage athlete treated with open reduction internal fixation (ORIF) and calcaneus autograft using intraoperative computed tomography (CT) (O-arm®, Medtronic, Minneapolis, MN) for real-time evaluation of fracture reduction and fixation. Intraoperative CT was fast, reliable, and allowed for confirmation of guide wire orientation, alignment, and length across the fracture site. Anatomic fixation of navicular stress fractures can be challenging, and it is important for surgeons to be aware of the potential advantages of using intraoperative CT when treating these injuries. Levels of Evidence: Therapeutic, Level IV: Case Report

scholarly journals Oligometastatic Growing Teratoma Syndrome: A Case for an Aggressive Surgical Approach

2015 ◽  
Vol 9 (3) ◽  
pp. 163-165 ◽  
Author(s):  
William S. Gange ◽  
Robert H. Blackwell ◽  
John Biemer ◽  
Güliz A. Barkan ◽  
Maria M. Picken ◽  
...  
Keyword(s):  
Surgical Approach ◽  
Clinical Stage ◽  
Mature Teratoma ◽  
Disease Free Survival ◽  
Testicular Germ Cell Tumor ◽  
Testicular Germ Cell ◽  
Growing Teratoma Syndrome ◽  
Aggressive Surgical Approach ◽  
Metastatic Sites

Growing teratoma syndrome is an infrequent presentation of testicular cancer. We present a case of growing teratoma syndrome in a patient who initially presented with clinical stage I nonseminomatous testicular germ cell tumor, who subsequently developed large volume oligometastases to the retroperitoneum, thorax, and thigh. Despite two regimens of chemotherapy, his disease progressed. Complete surgical extirpation of all gross tumors confirmed mature teratoma. An aggressive surgical approach, including postchemotherapy resection of all known metastatic sites, can provide long-term disease-free survival.

A descriptive study of stress fractures in competitive event horses in the UK

2004 ◽  
Vol 1 (4) ◽  
pp. 233-238
Author(s):  
Emma Hayton ◽  
Jennifer C Sneddon
Keyword(s):  
Stress Fracture ◽  
Descriptive Study ◽  
Stress Fractures ◽  
Anatomical Location ◽  
True Prevalence ◽  
Fracture Prevalence ◽  
The Uk ◽  
The Impact ◽  
Larger Sample ◽  
Age Category

AbstractThe impact of stress fractures on competitive event horses in the UK is completely unknown. Ninety-one replies to 450 questionnaires sent to competitive event riders across the UK indicated that 11 horses, representing 12% of the responders, had a confirmed stress fracture. As data on the total number of horses owned or ridden by the riders were not available, the true prevalence of stress fractures in this sample of horses could not be directly assessed. Within the bounds of this study, competitive level of the rider had a significant effect on stress fracture prevalence (X2(0.05, df. 2) = 24.74, P<0.05), as did years of eventing experience (X2(0.05, df. 1) = 27.80, P<0.01). Training regime was also influential (X2(0.05,df. 1) = 26.30, PX20.01). There was a predominance of fractures in geldings (X2(0.05, df. 1) = 24.45, P<0.03); however, geldings constituted 82% of reported cases. Thoroughbred cross horses had a significantly lower incidence of stress fractures than Thoroughbreds (X2(0.05, df. 1) = 20.82, P<0.01) but constituted only 18% of the sample. Horses in the oldest age category (9–12 years) had 6% of all stress fractures (X2(0.05, df. 2) = 24.54, P<0.1). All fractures occurred on the foreleg at the knee or below, with no significant effect of anatomical location. Seventy-three per cent of horses were not competing when diagnosed (X2(0.05, df. 1) = 22.27, P<0.1). These data indicate that useful preliminary data were yielded by the questionnaire and that further research with a larger sample size is justified.

scholarly journals Bile Acids Function Synergistically To Repress Invasion Gene Expression in Salmonella by Destabilizing the Invasion Regulator HilD

2016 ◽  
Vol 84 (8) ◽  
pp. 2198-2208 ◽  
Author(s):  
Colleen R. Eade ◽  
Chien-Che Hung ◽  
Brian Bullard ◽  
Geoffrey Gonzalez-Escobedo ◽  
John S. Gunn ◽  
...  
Keyword(s):  
Bile Acids ◽  
Type Iii Secretion ◽  
Acute Infection ◽  
Short Chain Fatty Acids ◽  
Common Mechanism ◽  
Environmental Cues ◽  
Anatomical Location ◽  
Content Type ◽  
Bacterial Signaling ◽  
The Individual

Salmonellaspp. are carried by and can acutely infect agricultural animals and humans. After ingestion, salmonellae traverse the upper digestive tract and initiate tissue invasion of the distal ileum, a virulence process carried out by the type III secretion system encoded withinSalmonellapathogenicity island 1 (SPI-1). Salmonellae coordinate SPI-1 expression with anatomical location via environmental cues, one of which is bile, a complex digestive fluid that causes potent repression of SPI-1 genes. The individual components of bile responsible for SPI-1 repression have not been previously characterized, nor have the bacterial signaling processes that modulate their effects been determined. Here, we characterize the mechanism by which bile represses SPI-1 expression. Individual bile acids exhibit repressive activity on SPI-1-regulated genes that requires neither passive diffusion nor OmpF-mediated entry. By using genetic methods, the effects of bile and bile acids were shown to require the invasion gene transcriptional activatorhilDand to function independently of known upstream signaling pathways. Protein analysis techniques showed that SPI-1 repression by bile acids is mediated by posttranslational destabilization of HilD. Finally, we found that bile acids function synergistically to achieve the overall repressive activity of bile. These studies demonstrate a common mechanism by which diverse environmental cues (e.g., certain short-chain fatty acids and bile acids) inhibit SPI-1 expression. These data provide information relevant toSalmonellapathogenesis during acute infection in the intestine and during chronic infection of the gallbladder and inform the basis for development of therapeutics to inhibit invasion as a means of repressingSalmonellapathogenicity.

scholarly journals A Study of Vascular Injuries in Pediatric Supracondylar Humeral Fractures

2001 ◽  
Vol 9 (2) ◽  
pp. 37-40 ◽  
Author(s):  
Ritabh Kumar ◽  
Vivek Trikha ◽  
Rajesh Malhotra
Keyword(s):  
Vascular Injury ◽  
Surgical Approach ◽  
Open Reduction Internal Fixation ◽  
Vascular Injuries ◽  
Supracondylar Fractures ◽  
Satisfactory Outcome ◽  
Vascular Compromise ◽  
Supracondylar Humeral Fractures ◽  
Aggressive Surgical Approach ◽  
Grade Iii

194 children with supracondylar fractures of the humerus were reviewed. Of the 49 children with Gartland grade III displacement, signs of vascular compromise were clinically suspected in 5 cases. Immediate open reduction, internal fixation and exploration were performed. Four children had a satisfactory outcome. One child required amputation. A careful clinical evaluation for vascular injury and an aggressive surgical approach is suggested, when indicated.

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