Cuboid Edema Syndrome Following Fixation of Proximal Fifth Metatarsal Fractures in Professional Athletes

2019 ◽  
Vol 12 (4) ◽  
pp. 373-379 ◽  
Author(s):  
Lauren Roberts ◽  
Alessio Bernasconi ◽  
Cesar de Cesar Netto ◽  
Andrew Elliott ◽  
William Hamilton ◽  
...  
Keyword(s):  
Case Report ◽  
Elite Athletes ◽  
Magnetic Resonance Images ◽  
Complete Healing ◽  
Professional Athletes ◽  
Screw Head ◽  
Level Of Evidence ◽  
Metatarsal Fractures ◽  
Literature Highlight ◽  
Intramedullary Screw

Stress fractures of the proximal fifth metatarsal are common injuries in elite athletes. Fixation using an intramedullary screw represents the most popular surgery performed for treating these injuries, with excellent results in most cases. However, multiple reports in the literature highlight the possibility of painful hardware, usually related to the presence of the screw head, following intramedullary fixation In this case report, we outline 4 cases of professional athletes who developed lateral-based foot symptoms following complete healing of their surgically treated proximal fifth metatarsal fractures and were found to have significant cuboid edema on magnetic resonance images. We also outline recommendations regarding specific surgical technique considerations aiming to minimize this possible complication. Level of Evidence: Level V: Case report.

Fifth Metatarsal Jones Fractures in the Athlete

2017 ◽  
Vol 39 (2) ◽  
pp. 250-258 ◽  
Author(s):  
David A. Porter
Keyword(s):  
Screw Fixation ◽  
Nonoperative Treatment ◽  
Fracture Site ◽  
Medullary Canal ◽  
Return To Sports ◽  
Stress Reactions ◽  
Current Standard ◽  
Level Of Evidence ◽  
Metatarsal Fractures ◽  
Intramedullary Screw

Fifth metatarsal fractures, otherwise known as “Jones” fractures, occur commonly in athletes and nonathletes alike. While recent occurrence in the popular elite athlete has increased public knowledge and interest in the fracture, this injury is common at all levels of sport. This review will focus on all three types of Jones fractures. The current standard for treatment is operative intervention with intramedullary screw fixation. Athletes typically report an acute episode of lateral foot pain, described as an ache. Radiographic imaging with multiple views of the weightbearing injured foot are needed to confirm diagnosis. If these images are inconclusive, further magnetic resonance imaging (MRI) or computed tomography (CT) is used. Nonoperative treatment is not commonly used as the sole treatment, except when following reinjury of a stable screw fixation. While screw selection is still controversial, operative treatment with intramedullary screw fixation is the standard approach. Technical tips on screw displacement are provided for Torg (types I, II, III) fractures, cavovarus foot fractures, recurrent fractures, revision surgery, occult fractures/high-grade stress reactions, and Jones’ variants. Excellent clinical outcomes can be expected in 80% to 100% of patients when using the intramedullary screw fixation to “fit and fill” the medullary canal with threads across the fracture site. Most studies show the timing for return to sports with optimal healing to be seven to twelve weeks after fixation. Level of Evidence: Level V, expert opinion.

scholarly journals Atypical Stress-Avulsion Fracture of the Lisfranc Joint Complex

2014 ◽  
Vol 7 (2) ◽  
pp. 155-158 ◽  
Author(s):  
Barry J. O’Neill ◽  
Laura A. Sweeney ◽  
Paul J. Moroney ◽  
Kevin J. Mulhall
Keyword(s):  
Case Report ◽  
Antiphospholipid Syndrome ◽  
Avulsion Fracture ◽  
Stress Fractures ◽  
Therapeutic Level ◽  
Lisfranc Joint ◽  
Level Of Evidence ◽  
Ballet Dancers ◽  
Metatarsal Fractures ◽  
Unusual Injury

Antiphospholipid syndrome and systemic erythematosus have been associated with metatarsal stress fractures. Stress fractures of the Lisfranc joint complex are uncommon injuries but have been reported to occur most frequently in ballet dancers. We present a case of an avulsion fracture of the Lisfranc joint complex that occurred spontaneously. We have reviewed the association between systemic conditions and metatarsal fractures and proposed a series of hypothetical pathological events that may have contributed to this unusual injury. Level of Evidence: Therapeutic, Level IV: Case report

scholarly journals Intramedullary Screw Fixation of a Proximal Fifth Metatarsal Stress Fracture in an Elite Athlete: A Case Report

2017 ◽  
Vol 03 (01) ◽  
pp. e6-e8
Author(s):  
Steffen Sauer
Keyword(s):  
Elite Athlete ◽  
Screw Fixation ◽  
Elite Athletes ◽  
Weight Bearing ◽  
Basketball Player ◽  
Competitive Sport ◽  
Varus Alignment ◽  
Pes Cavus ◽  
Metatarsal Fractures ◽  
Intramedullary Screw

AbstractIntramedullary screw fixation of proximal fifth metatarsal fractures is a simple surgical procedure, enabling early postoperative weight-bearing and subsequently rapid return to competitive sport, which is of great significance for elite athletes. The procedure is described in an elite basketball player in this article. Pes cavus and hindfoot varus alignment potentiate cyclic loading onto the fifth metatarsal and should be addressed as it may represent underestimated factors concerning fracture prognosis.

Treatment of Proximal Fifth Metatarsal Fractures and Refractures With Plantar Plating in Elite Athletes

2018 ◽  
Vol 39 (12) ◽  
pp. 1410-1415 ◽  
Author(s):  
Derek T. Bernstein ◽  
Ronald J. Mitchell ◽  
Patrick C. McCulloch ◽  
Joshua D. Harris ◽  
Kevin E. Varner
Keyword(s):  
Elite Athletes ◽  
Demographic Data ◽  
Case Series ◽  
Radiographic Evaluation ◽  
Autogenous Bone ◽  
Level Of Evidence ◽  
Patient Reported ◽  
Metatarsal Fracture ◽  
Metatarsal Fractures

Background: Fractures of the proximal fifth metatarsal are relatively common foot injuries in elite athletes. Acute fixation with intramedullary screws is the most common operative treatment. However, the rate of nonunion and refracture after this procedure remains a concern. The purpose of this study was to determine rates of clinical and radiographic fracture healing, return to sport, and patient-reported clinical outcomes of elite athletes with proximal fifth metatarsal fracture or refracture treated with plantar plating. Methods: An institutional review board–approved retrospective single-surgeon case series investigation assessed athletes (competing at college, Olympic, or professional levels) with proximal fifth metatarsal fracture or refracture, treated with open reduction internal fixation and calcaneal autogenous bone grafting using a plantar plate with a minimum 2-year follow-up. Demographic data, radiographic evaluation, and the time until return to unrestricted sporting competition were collected and analyzed. Means with standard deviations were calculated for continuous data, and frequencies of categorical data were calculated in percentages. Results: Four refractures and 4 primary fractures were treated in 8 male athletes with a mean age of 21.9 ± 1.9 years at a mean follow-up of 3.2 ± 0.4 years. Two patients experienced temporary neuropraxia of the sural nerve that resolved within 6 weeks. There were no incisional complications, delayed unions or nonunions, refractures, hardware loosening, or complaints of hardware prominence. Clinically asymptomatic radiographic union was observed in 100% of the athletes at 6.5 ± 1.1 weeks and full release given at 12.3 ± 1.9 weeks. All athletes returned to sport at the same level of competition. Conclusion: With minimum 2-year follow-up, plantar plating of proximal fifth metatarsal fractures was an effective and safe technique that was used in both primary and revision settings. Level of Evidence: Level IV, case series.

scholarly journals Ischemic priapism due to coagulopathy of severe COVID-19 infection

2021 ◽  
pp. 205141582110259
Author(s):  
Dominic C Grimberg ◽  
Rohit Tejwani ◽  
Armand Allkanjari ◽  
Michael T Forrester ◽  
Bryan D Kraft ◽  
...  
Keyword(s):  
Case Report ◽  
Respiratory Disease ◽  
Disease Process ◽  
Hypercoagulable State ◽  
Management Approach ◽  
Single Center ◽  
Level Of Evidence ◽  
Ischemic Priapism

Initially thought to be a primarily respiratory disease process, the hypercoagulable state associated with COVID-19 has been associated with myriad clinical sequelae. We report a case of stuttering ischemic priapism associated with COVID-19, and describe a management approach to achieve detumescence in patients undergoing ventilatory proning limiting penile access. Level of evidence: Not applicable for this single center case report.

Topical oro-dispersible budesonide tablets for stricture prevention after near circumferential ESD for esophageal squamous cell cancer – a case report

2021 ◽  
Author(s):  
Daniel Mathies ◽  
Tsuneo Oyama ◽  
Ingo Steinbrück ◽  
Franz Ludwig Dumoulin
Keyword(s):  
Case Report ◽  
High Risk ◽  
Endoscopic Resection ◽  
Squamous Cell ◽  
Squamous Cell Cancer ◽  
Cell Cancer ◽  
Complete Healing ◽  
Esophageal Squamous Cell Cancer ◽  
Stricture Formation ◽  
Local Injections

Abstract Background Endoscopic resection is the treatment of choice for early esophageal cancers. However, resections comprising more than 70–80 % of the circumference are associated with a high risk of stricture formation. Currently, repetitive local injections and/or systemic steroids are given for prevention. Case report We present here the case of a 78-year-old male patient who had a near circumferential endoscopic submucosal dissection for a pT1a mm, L0, V0, R0, G2 esophageal squamous cell cancer. At the end of endoscopic resection, 80 mg of triamcinolone was injected locally. The patient was then treated with oro-dispersible budesonide tablets (2 × 1 mg/day) and nystatin (4 × 100 000 I.E.) for 8 weeks. This treatment resulted in complete healing without any stricture formation and did not result in any complications. Discussion Treatment with orodispersible budesonide tablets could help prevent strictures after large endoscopic resections in the esophagus.

scholarly journals Comminuted Patella Fracture in Elderly Patients: A Systematic Review and Case Report

2017 ◽  
Vol 8 (3) ◽  
pp. 135-144 ◽  
Author(s):  
Brent Matthews ◽  
Kaushik Hazratwala ◽  
Sergio Barroso-Rosa
Keyword(s):  
Case Report ◽  
Elderly Patients ◽  
Treatment Options ◽  
The Elderly ◽  
Fracture Pattern ◽  
Patella Fracture ◽  
Level Of Evidence ◽  
Fixation Failure ◽  
Number Of Patients ◽  
Mesh Augmentation

Objectives: To review comminuted patella fracture in the elderly patients and examine the surgical options to avoid complications such as fixation failure and poor functional outcome. To provide an example of mesh augmentation in comminuted patella fracture in the elderly patients. Data Sources: A literature review was conducted by the authors independently using Ovid, Medline, Cochrane, PubMed, and Clinical Key in English. We aimed to review data on patients older than 65 with comminuted patella fracture. Search conducted between July and December 2015. Study Selection: Search terms included patella fracture, elderly, and fixation failure. Abstracts were included if they were a case report, cohort series, or randomized control trial. Further inclusion criteria were that they were available in full text and included patient age(s), operative details, follow-up, and outcome discussion. Data Extraction: Each study was assessed according to its level of evidence, number of patients, age of patients, fracture patterns described, complications of treatment, and results summarized. Data Synthesis: Paucity of data and heterogeneity of studies limited statistical analysis. Data are presented as a review table with the key points summarized. Conclusion: In patella fracture, age >65 years and comminuted fracture pattern are predictors of increased fixation failure and postoperative stiffness, warranting special consideration. There is a trend toward improved functional outcomes when augmented fixation using mesh or plates is used in this group. Further level 1 studies are required to compare and validate new treatment options and compared them to standard surgical technique of tension band wire construct.

scholarly journals MRI Study on the Distance between the Distal Radius and the Flexor and Extensor Tendons: Is There Any Room for Error/Hardware?

2019 ◽  
Vol 08 (06) ◽  
pp. 470-476
Author(s):  
Minke Bergsma ◽  
Jemara Board ◽  
Job N. Doornberg ◽  
Inger Sierevelt ◽  
Mark Rickman ◽  
...  
Keyword(s):  
Distal Radius ◽  
Magnetic Resonance Images ◽  
Dorsal Side ◽  
Flexor Digitorum Profundus ◽  
Dorsal Cortex ◽  
Level Of Evidence ◽  
Extensor Pollicis Longus ◽  
Extensor Tendons ◽  
Flexor Digitorum ◽  
Extensor Carpi Radialis

Abstract Purpose This study aims to quantify the distances between the cortex of the distal radius and flexor and extensor tendons. Methods We analyzed 50 magnetic resonance images (MRI) of intact wrist without pathology. The distances between the volar cortex and the flexor pollicis longs (FPL), index flexor digitorum profunduns (FDPi), flexor digitorum profundus (FDP), and flexor digitorum superficialis (FDS) were measured at the level of the watershed line and 3- and 6-mm proximal to this level. The distances between the dorsal cortex and the extensor carpi radialis longus (ECRL), extensor carpi radialis brevis (ECRB), extensor pollicis longus (EPL), extensor indicis proprius (EIP), and the extensor digitorum communis (EDC) were measured at the level of Lister's tubercle and 5-mm distal to this level. Analysis was descriptive. Results At the watershed line, the FPL, FDPi, FDP, and FDS were located at an average of 3.1, 2.4, 3.6, and 5.1 mm, respectively, volar to the volar cortex. The distances of the FDP and FDS increased at 3-mm proximal to the watershed line and increased for all four tendons at 6-mm proximal to the watershed line. Dorsally, at Listers' tubercle the ECRL, ECRB, EPL, EIP, and EDC were identified at an average of 0.7, 0.5, 0.5, 2.6, and 3.2 mm, respectively, dorsal to the dorsal cortex of the distal radius. At 5-mm more distal, these tendons were located on average 1.2, 1.0, 0.7, 1.9, and 1.8 mm, respectively, dorsal to the dorsal cortex. Conclusion On the volar side, on average there is enough room for a volar plate when staying proximal to the watershed line. On the dorsal side, there is virtually no room for protruding screws as physical anatomical space is limited to a maximum of 0.7 mm from cortex to the closest tendon (the FDP), with screw increments being 2 mm. Level of Evidence This is a Level II Study.

scholarly journals Management of surgical wound dehiscence by oxygen-ozone therapy in a FIV-positive cat – a case report

2020 ◽  
Vol 89 (2) ◽  
pp. 189-194
Author(s):  
Călin Cosmin Repciuc ◽  
Corina Gina Toma ◽  
Ciprian Andrei Ober ◽  
Liviu Ioan Oana
Keyword(s):  
Case Report ◽  
Wound Dehiscence ◽  
Complete Healing ◽  
Limb Amputation ◽  
X Rays ◽  
Surgical Wound ◽  
Ozone Therapy ◽  
Contraction Phase ◽  
Surgical Wound Dehiscence ◽  
Low Efficiency

Patients infected with the feline immunodeficiency virus (FIV) are frequently victims of postoperative wound dehiscence due to low efficiency of the immune system that predisposes to delayed scaring and epithelization processes. This case report aimed to describe the successful use of medical ozone in the treatment of a dehisced wound in a feline patient that presented this type of FIV-associated complication. Here we present a case of a 12-year-old, mixed-breed, male, FIV-positive cat with purulent arthritis affecting the shoulder, elbow, and the carpal joints with subsequent periostitis and arthrogryposis affecting the right forelimb. After a thorough investigation (clinical examination, X-rays) it was decided that limb amputation would be the proper choice. The surgical wound did not tend to heal, followed by rejection of the suture material, skin necrosis, and wound dehiscence. After 13 days following the surgery with allopathic treatment and no improvement, oxygen-ozone-therapy was started. Clinically, oxygen-ozone therapy showed significant results after the first session: borders of the wound got into the contraction phase, got attached to the underlying tissues, and exudates were significantly diminished. The therapy continued every 2 days showing improved blood perfusion of the affected area and a visible advancement of the contraction phase daily with complete healing in 1.5 months.

scholarly journals STUDY ON CARDIOVASCULAR MONITORING AND DIAGNOSIS OF ATHLETES

2021 ◽  
Vol 27 (8) ◽  
pp. 822-825
Author(s):  
Zhangbo Xiao ◽  
Chang Sun ◽  
Jie Bai ◽  
Xingjiang Li
Keyword(s):  
Information Fusion ◽  
High Intensity ◽  
Heart Function ◽  
Elite Athletes ◽  
Monitoring And Evaluation ◽  
Control Group ◽  
Cardiovascular Monitoring ◽  
Source Information ◽  
Level Of Evidence ◽  
Sinus Arrhythmia

ABSTRACT Introduction: The study and collection of athletes’ heart function index parameters and the correct and reasonable evaluation of body functions can effectively adjust training plans and avoid athletes’ bodily exhaustion. Objective: To study the diagnosis of myocardial injury by cardiovascular monitoring in athletes from two aspects: extraction of characteristic parameters of heart function and research of signal processing. Methods: The heart function intelligent evaluation algorithm was studied by using multi-source information fusion, and embedded technology; miniature sensors were used as well. Results: The incidence of severe ventricular arrhythmia was lower in both groups. The incidence of sinus arrhythmia and intermittent second degree I atrioventricular block in the high-intensity group was significantly higher than that in the control group. The number of atrial and ventricular premature beats was lower in the control group, but increased significantly in the high-intensity group. Conclusions: This study applied the theory of multi-source information fusion to carry out representative research on the intelligent monitoring and evaluation of the heart function of elite athletes, centering on the application requirements of the heart function monitoring of elite athletes. Level of evidence II; Therapeutic studies - investigation of treatment results.

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