The Experience of the Cooperation in Science and Technology European Network for Innovative Diagnosis and Treatment of Chronic Neutropenias (COST EuNet-INNOCHRON) Action and the Sweden Experience in the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Era

Abstract Background-Aim: Infection from SARS-CoV-2 has emerged as new pathological entity within the global medical community. One of the earliest questions was in relation to the ability of the immunocompromised patients to clear the infection. In COST EuNet-INNOCHRON we were interested in the impact of SARS-CoV-2 infection in patients with different types of chronic neutropenia (CNP). The aim of the current study is to understand the impact of SARS-CoV-2 infection and to identify any possible characteristic patterns of the clinical course in patients with CNP. Patients and Methods: The COST EuNet-INNOCHRON Action in collaboration with the European Haematology Association - Scientific Working Group (EHA-SWG) on Granulocytes and Constitutional Marrow Failure Syndromes has conducted an online survey on SARS-CoV-2 infection in patients with CNP. The EuNet-INNOCHRON participants from different countries got access to an on-line platform fulfilling the General Data Protection Regulation (GDPR) and could register adult and paediatric CNP patients who had been infected by SARS-CoV-2 from March 2020 to June 2021. Data on demographic characteristics, type of CNP, patients' background and SARS-CoV-2 infection history (symptoms, laboratory features, radiological appearance, therapeutic approach and outcome) were collected. Results: Twenty-six patients with diagnosis of CNP, 7 males and 19 females were registered. Patient age distribution as follows: 16 patients >18 years old (y.o.)5 patients 5-18 y.o, 4 patients < 5 y.o whereas age was not available for one of the patients. Nine of the patients were diagnosed with idiopathic CNP, 7 patients with congenital neutropenia (6 of them with severe congenital neutropenia), 3 with secondary CNP, 2 with suspected autoimmune neutropenia of infancy (although antineutrophil Ab were negative), one with autoimmune neutropenia, one with drug induced neutropenia and 3 with other types of CNP. Twelve patients were on treatment with G-CSF and 6 patients had a history of previous viral or bacterial infections. Clonal Cytopenia(s) of Undetermined Significance (CCUS) was excluded in the eight patients who were investigated. Twenty-four out of 26 patients had positive PCR and one was found incidentally with positive antibodies for SARS-CoV-2. One more patient was symptomatic with history of close contact with SARS-CoV-2 infected family members. The commonest observed symptoms were fever >38 oC (19 patients), cough (10 patients), rhinorrhoea (10 patients), sore throat (6 patients), musculoskeletal pains (7 patients), taste/smell loss (5 patients), headache (5 patients), dyspnoea (4 patients), chest pain (one patient) and none of them had gastrointestinal symptoms. No other associated respiratory viral or bacterial infections were reported. Four patients who had one or more underlying conditions (immune deficiency, heart/respiratory/kidney disease) were admitted in hospital and needed anti SARS-CoV-2 treatment. Two of them had non-invasive ventilation and one of them needed admission in intensive care unit (ICU); both recovered. Another patient with Fallot's tetralogy needed mechanical ventilation in ICU and sadly passed away. No other deaths were observed. Deterioration of the pre-existing neutropenia was seen in two patients, two patients developed thrombocytopenia, one patient developed worsening lymphopenia and one anaemia. Twelve patients had chest X-ray and consolidation was found in two of them. All three patients who had chest CT scans were found with ground-glass changes. During the observation period (up to two months), no re-infection from SARS-CoV-2 was found. The Stockholm, Sweden experience is similar to the above data. One hundred fifty-four patients with CNP were followed up, for 10 months (March 1 to December 31, 2020) for SARS-CoV-2. Seventeen of these (i.e. 11 %) were infected. None needed hospitalization and there were no fatalities. Conclusion: Although the relative susceptibility of neutropenic patients to contract SARS-CoV-2 needs to be assessed with further studies, the clinical course and severity of SARS-CoV-2 infection doesn't seem to be worse in CNP patients (regardless the type of neutropenia and the need for GCSF treatment) compared to the general population. Also, like what has been observed in non-neutropenic patients, underlying comorbidities is a significant risk factor for severe disease and adverse outcome. Disclosures Dale: X4 Pharmaceuticals: Consultancy, Honoraria, Research Funding. Palmblad: Chiesi Ltd Sweden: Honoraria; Roche Sweden: Speakers Bureau; Chiesi Ltd Candada,: Honoraria.

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Herpesvirus type 7 infection may play an important role in individuals with a genetic profile of susceptibility to Graves' disease

Acta Endocrinologica ◽

10.1530/eje-09-0719 ◽

2010 ◽

Vol 162 (2) ◽

pp. 315-321 ◽

Cited By ~ 14

Author(s):

Janaina Luisa Leite ◽

Natassia Elena Bufalo ◽

Roberto Bernardo Santos ◽

João Hamilton Romaldini ◽

Laura Sterian Ward

Keyword(s):

Bacterial Infections ◽

Significant Risk ◽

Function Evaluation ◽

Graves Disease ◽

Genetic Profile ◽

Glutathione S Transferase ◽

Herpesvirus Type ◽

History Of ◽

Cytochrome P450 Family ◽

Design And Methods

ObjectiveAn inherited profile of genes related to the response to aggressive environmental factors such as viruses and chemicals may be related to an increased susceptibility to Graves' disease (GD).Design and methodsThis prospective case–control study was designed to examine the relationship between human herpesviruses (HHV) infection, determined by circulating DNA; tumour protein p53 (TP53) apoptotic ability; and detoxification system genes, and GD. We studied 280 confirmed GD patients paired to 284 controls with respect to environmental exposure. Exclusion criteria included medications that could interfere with thyroid function evaluation and a recent history of viral and bacterial infections.ResultsA stepwise regression analysis adjusted for age, gender, and ethnicity established the inheritance of glutathione S-transferase pi 1 (GSTP1) (odds ratio (OR)=3.423; 95% confidence interval (CI)=2.120–5.527; P<0.001) and cytochrome P450, family 1, subfamily A, polypeptide 1 (CYP1A1) variants (OR=1.649; 95% CI=1.012–2.686; P=0.0445) as significant risk factors for the disease. HHV-7 infection was much more common in GD patients (64.64%) than in controls (38.73%; χ2, P<0.0001), and it increased the risk for GD more than three times (OR=3.133; 95% CI=1.959–5.011; P<0.0001). The inheritance of less efficient Pro/Pro TP53 gene variants significantly increased the risk of GD development (OR=5.196; 95% CI=2.112–12.783; P<0.0001) and also favored HHV-7 infection (OR=2.835; 95% CI=1.100–7.310; P=0.0275). In addition, 72TP53 variants augmented the risk of GD relapse (OR=1.860; 95% CI=1.015–3.410; P=0.0446).ConclusionsWe suggest that an inherited genetic profile involving TP53 may favor HHV-7 infection and maintenance, which, in turn, may initiate and perpetuate GD autoimmune process.

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Mild traumatic brain injury affects the features of migraine

The Journal of Headache and Pain ◽

10.1186/s10194-021-01291-x ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Ryotaro Ishii ◽

Todd J. Schwedt ◽

Meesha Trivedi ◽

Gina Dumkrieger ◽

Melissa M. Cortez ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Physical Abuse ◽

Mild Traumatic Brain Injury ◽

Clinical Course ◽

Categorical Variables ◽

Continuous Variables ◽

Lack Of Sleep ◽

History Of ◽

The Impact

Abstract Background Headache is one of the most common symptoms after concussion, and mild traumatic brain injury (mTBI) is a risk factor for chronic migraine (CM). However, there remains a paucity of data regarding the impact of mTBI on migraine-related symptoms and clinical course. Methods Of 2161 migraine patients who participated in the American Registry for Migraine Research between February 2016 and March 2020, 1098 completed questions assessing history of TBI (50.8%). Forty-four patients reported a history of moderate to severe TBI, 413 patients reported a history of mTBI. Patients’ demographics, headache symptoms and triggers, history of physical abuse, allodynia symptoms (ASC-12), migraine disability (MIDAS), depression (PHQ-2), and anxiety (GAD-7) were compared between migraine groups with (n = 413) and without (n = 641) a history of mTBI. Either the chi-square-test or Fisher’s exact test, as appropriate, was used for the analyses of categorical variables. The Mann-Whitney test was used for the analyses of continuous variables. Logistic regression models were used to compare variables of interest while adjusting for age, gender, and CM. Results A significantly higher proportion of patients with mTBI had CM (74.3% [307/413] vs. 65.8% [422/641], P = 0.004), had never been married or were divorced (36.6% [147/402] vs. 29.4% [187/636], P = 0.007), self-reported a history of physical abuse (24.3% [84/345] vs. 14.3% [70/491], P < 0.001), had mild to severe anxiety (50.5% [205/406] vs. 41.0% [258/630], P = 0.003), had headache-related vertigo (23.0% [95/413] vs. 15.9% [102/640], P = 0.009), and difficulty finding words (43.0% [174/405] vs. 32.9% [208/633], P < 0.001) in more than half their attacks, and headaches triggered by lack of sleep (39.4% [155/393] vs. 32.6% [198/607], P = 0.018) and reading (6.6% [26/393] vs. 3.0% [18/607], P = 0.016), compared to patients without mTBI. Patients with mTBI had significantly greater ASC-12 scores (median [interquartile range]; 5 [1–9] vs. 4 [1–7], P < 0.001), MIDAS scores (42 [18–85] vs. 34.5 [15–72], P = 0.034), and PHQ-2 scores (1 [0–2] vs. 1 [0–2], P = 0.012). Conclusion Patients with a history of mTBI are more likely to have a self-reported a history of physical abuse, vertigo, and allodynia during headache attacks, headaches triggered by lack of sleep and reading, greater headache burden and headache disability, and symptoms of anxiety and depression. This study suggests that a history of mTBI is associated with the phenotype, burden, clinical course, and associated comorbid diseases in patients with migraine, and highlights the importance of inquiring about a lifetime history of mTBI in patients being evaluated for migraine.

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Impact of Pretransplant Neutropenia on Post-Transplant Outcome in Patients with Myelodysplastic Syndrome (MDS).

Blood ◽

10.1182/blood.v108.11.599.599 ◽

2006 ◽

Vol 108 (11) ◽

pp. 599-599

Author(s):

Bart L. Scott ◽

J.Y. Park ◽

B. Storer ◽

K.A. Marr ◽

M. Boeckh ◽

...

Keyword(s):

Bacterial Infections ◽

Fungal Infections ◽

International Prognostic Scoring System ◽

Bacillus Species ◽

Fungal Colonization ◽

Probability Of Survival ◽

Transfusion Requirements ◽

Increased Risk ◽

Neutropenic Patients ◽

The Impact

Abstract MDS comprises a spectrum of clonal hematopoietic disorders with very heterogeneous clinical courses. Several classification and scoring systems have been developed in an attempt to define subgroups of patients with similar prognoses. The International Prognostic Scoring System (IPSS) incorporates marrow myeloblast count, karyotype, and peripheral blood cytopenias. The recent addition of transfusion requirements to the IPSS (WPSS) has sharpened this prognostic tool. Isolated neutropenia is not reflected in these classifications, but bacterial and fungal colonization and infection are problems in patients with MDS. Hematopoietic cell transplantation is the only treatment strategy that has been shown to have curative potential, and many patients come to transplantation with neutropenia, particularly when the disease progresses. We wanted to determine the impact of neutropenia before transplantation on transplant success. We reviewed results in 291 patients with MDS (including MDS that had transformed to AML [tAML]), 1 to 66 (median 50) years of age, who from 1994 through 2003 were transplanted from related or unrelated donors following conditioning with myeloablative regimens. There were 178 patients (61%) who had neutropenia, defined as <1,500/microliter; in 16 of these (9%) neutropenia was an isolated finding. Among the 178 patients, 137 (47%) had neutrophil counts below 1,000, and 86 (30%) below 500. Patients with neutropenia following recent chemotherapy were excluded. The risk of clinically relevant bacterial infections after transplantation was significantly increased in patients with neutropenia (p=0.001). Neutropenic patients had an increased risk for infections with gram-positive (relative risk [RR] 1.77, p=0.02), but not gram negative bacteria (RR 1.33, p=0.53). Specific organisms for which the RR was significantly increased included coagulase negative Staphylococcus, Bacillus species and Corynebacterium spp., suggesting that at least part of this risk was associated with intravascular catheters. The RR for invasive fungal infections (Candida and Aspergillus spp.) was 2.56 (p=0.03) for patients with <1,500 neutrophils. The hazard rate (HR) for non-relapse mortality by day 100 (21%) was 1.8 (p=0.03), and by 5 years (42%) was 1.62 (p=0.01). The most frequent causes of death were infections. The HR for 5-year mortality was 1.55 (p=0.007) for neutropenic patients. The pattern for the small group of patients with isolated neutropenia was identical to that for all patients with neutropenia. Pre-transplant neutropenia had no significant impact on engraftment or graft-versus-host disease. The probability of survival did not differ significantly between patients with IPSS scores of 0 and 0.5 with isolated or multiple cytopenias. In summary, only few patients with MDS who undergo transplantation have isolated neutropenia. However, pre-transplant neutropenia in patients with MDS is associated with a significantly increased risk of posttransplant bacterial infections, fungal infections, and non-relapse mortality, and a decreased probability of survival after myeloablative transplantation. A correlation with pre-transplantation colonization remains to be determined. Intensified and possibly extended antibiotic coverage should be considered.

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Thyroid Cancer after Exposure to Radioiodine in Childhood and Adolescence: 131I-Related Risk and the Role of Selected Host and Environmental Factors

Cancers ◽

10.3390/cancers11101481 ◽

2019 ◽

Vol 11 (10) ◽

pp. 1481 ◽

Cited By ~ 1

Author(s):

Zupunski ◽

Ostroumova ◽

Drozdovitch ◽

Veyalkin ◽

Ivanov ◽

...

Keyword(s):

Risk Factors ◽

Thyroid Cancer ◽

Conditional Logistic Regression ◽

Significant Risk ◽

Dose Effect ◽

Childhood And Adolescence ◽

Related Risk ◽

History Of ◽

The Impact ◽

Stable Iodine

In this study, we expanded on a previously published population-based case-control study on subjects exposed to iodine-131 (131I) from Chernobyl fallout at age ≤18 years using improved individual 131I absorbed thyroid doses. We further studied the impact of iodine deficiency and other selected host risk factors on 131I-related thyroid cancer risk after childhood exposure. We included 298 thyroid cancer cases and 1934 matched controls from the most contaminated regions of Belarus and the Russian Federation. We performed statistical analysis using conditional logistic regression models. We found a statistically significant linear quadratic dose-effect association between thyroid cancer and 131I thyroid dose in the range up to 5 grays (Gy). Self-reported personal history of benign nodules, any thyroid disease except thyroid cancer, family history of thyroid cancer, increased body mass index, and deficient stable iodine status at the time of the accident were statistically significant risk factors (p < 0.05 for each factor) for thyroid cancer after adjustment for thyroid 131I dose effect. Subjects who received stable iodine supplementation in the years after the accident had a significantly lower 131I-related risk of thyroid cancer. Our findings are important for thyroid cancer prevention, and for further improvement of medical surveillance in the affected populations.

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Consideration of Migraines Among Risk Factors for Postoperative Nausea and Vomiting

Journal of Clinical Medicine ◽

10.3390/jcm9103154 ◽

2020 ◽

Vol 9 (10) ◽

pp. 3154

Author(s):

Jong-Ho Kim ◽

Man-sup Lim ◽

Sang-Hwa Lee ◽

Young-Suk Kwon ◽

Jae Jun Lee ◽

...

Keyword(s):

Risk Factors ◽

Clinical Data ◽

Postoperative Nausea ◽

Medical Center ◽

Significant Risk ◽

Postoperative Nausea And Vomiting ◽

Significant Risk Factor ◽

Nausea And Vomiting ◽

History Of ◽

The Impact

The impact of migraine on postoperative nausea and vomiting (PONV) is controversial, and few studies have focused on their relationship. Thus, we investigated the impact of migraine, among other risk factors, on PONV in a large retrospective study. We analyzed 10 years of clinical data from the Smart Clinical Data Warehouse of Hallym University Medical Center. PONV was defined as nausea or vomiting within the first 24 h after surgery. Patients diagnosed by a neurologist and with a history of triptan use before surgery were enrolled into the migraine group. We enrolled 208,029 patients aged > 18 years who underwent general anesthesia (GA), among whom 19,786 developed PONV within 24 h after GA and 1982 had migraine. Before propensity score matching, the unadjusted and fully adjusted odds ratios (ORs) for PONV in subjects with versus without migraine were 1.52 (95% confidence interval (CI), 1.34–1.72; p < 0.001) and 1.37 (95% CI, 1.21–1.56; p < 0.001), respectively. The OR for PONV in patients with migraine was also high (OR, 1.37; 95% CI, 1.13–1.66; p = 0.001) after matching. Our findings suggest that migraine is a significant risk factor for PONV.

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Aspiration-Induced Pulmonary Injury

Journal of Intensive Care Medicine ◽

10.1177/088506669701200602 ◽

1997 ◽

Vol 12 (6) ◽

pp. 279-297 ◽

Cited By ~ 4

Author(s):

Judith E. Nelson ◽

Marvin Lesser

Keyword(s):

Risk Factors ◽

Clinical Course ◽

Relevant Literature ◽

Pulmonary Injury ◽

Relative Risks ◽

Treatment And Prevention ◽

Gastric Contents ◽

History Of ◽

The Impact ◽

The Relationship

Pulmonary aspiration of gastric contents can cause a spectrum of sequelae that spans from relatively minor to rapidly lethal disease. To emphasize the extent of this spectrum and to encompass both noninfectious complications and infection, we use the term “aspiration-induced pulmonary injury” rather than “aspiration pneumonia.” In this article we review the relevant literature, focusing on more recent insights into the pathogenesis of lung injury, the natural history of aspiration, risk factors, the relationship between aspiration and infection, and recommendations for management. The relevance to human disease of studies using intra-airway acid instillation in animals is questioned. We discuss the difficulties in predicting the clinical course after aspiration. We identify risk factors for aspiration-induced pulmonary injury that are commonly encountered in the intensive care unit, and discuss in detail factors of special interest to the intensivist, including the impact of tracheal intubation; the effects of enteric intubation, particularly the comparison between pre- and postpyloric routes of enteric feeding administration; and the relative risks associated with particular feeding protocols. We conclude with recommendations regarding treatment and prevention strategies.

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Game of clones: A case of ELANE gene mutation-related neutrope

Journal of Medical Laboratory Science & Technology of South Africa ◽

10.36303/jmlstsa.2021.3.1.65 ◽

2021 ◽

pp. 24-26

Author(s):

N Mashigo ◽

M Esser

Keyword(s):

Bacterial Infections ◽

Fungal Infections ◽

Clinical History ◽

Full Blood Count ◽

Congenital Neutropenia ◽

Cyclic Neutropenia ◽

History Of ◽

Low Levels ◽

Almost All ◽

Stimulating Factor

Mutations in the ELANE gene, which encodes the neutrophil elastase (NE) protein in neutrophils, result in ELANE-related neutropenia. ELANE-related neutropenia encompasses both cyclic neutropenia (CN) and severe congenital neutropenia (SCN), with ELANE mutations seen in a majority of SCN and almost all of CN patients. Clinical history in affected individuals typically reveals recurrent episodes of fever, oral ulcerations and bacterial as well as fungal infections, correlating with periodic oscillations or chronically low levels in the absolute neutrophil count (ANC). ELANE-related neutropenia is characterised by severely low neutrophil counts where ANCs may drop as low as zero. A two-year-old child presented at our hospital with a longstanding history of recurrent bacterial infections and previous admissions at another centre during some of these infectious episodes. Her full blood count demonstrated a markedly low ANC, which was chronic on assessment of her previous results. Decreased granulopoiesis with maturation arrest was seen on her bone marrow and genetic testing for the ELANE gene demonstrated a pathogenic variant of the mutation. Treatment with granulocyte colony-stimulating factor (G-CSF) was initiated.

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Differential diagnosis and clinical course of autoimmune neutropenia in infancy: comparison with congenital neutropenia

Acta Paediatrica ◽

10.1111/j.1651-2227.2002.tb00125.x ◽

2007 ◽

Vol 91 (11) ◽

pp. 1179-1182 ◽

Cited By ~ 12

Author(s):

S Taniuchi ◽

M Masuda ◽

M Hasui ◽

S Tsuji ◽

H Takahashi ◽

...

Keyword(s):

Differential Diagnosis ◽

Clinical Course ◽

Autoimmune Neutropenia ◽

Congenital Neutropenia

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Presepsin (soluble CD14 subtype) Is Available in Febrile Neutropenic Patients with Hematological Malignancy As Diagnosis and Assesment Biomarker of Infections

Blood ◽

10.1182/blood.v126.23.4621.4621 ◽

2015 ◽

Vol 126 (23) ◽

pp. 4621-4621

Author(s):

Tatsuo Oyake ◽

Takayuki Masuda ◽

Norifumi Sugawara ◽

Maki Asahi ◽

Yuzo Suzuki ◽

...

Keyword(s):

Correlation Coefficient ◽

Bacterial Infections ◽

Hematological Malignancy ◽

Conflicts Of Interest ◽

Protein Complexes ◽

Soluble Cd14 ◽

Monocytic Cells ◽

Reactive Protein ◽

Neutropenic Patients ◽

The Impact

Abstract BACKGROUND: Febrile neutropenia (FN) is often observed in hematological malignancy (HEM). Although most are considered to be due to bacterial infections, it is often difficult to specify the focuses and pathogens of infections in FN patients. Presepsin (Pre-SEP) is a subtype of soluble CD14, which is a receptor for lipopolysaccharide (LPS)/LPS-binding protein complexes and is expressed on the myeloid and monocytic cells' surface. Recently, Pre-SEP has been shown to be a useful biomarker for assessing the severity of sepsis. However, little is known about the biological characteristics of Pre-SEP in FN patients. Therefore, we compared the Per-CEP to the established infection markers including procalcitonin (PCT) and C-reactive protein (CRP) continually in FN patients. METHODS: We measured Pre-SEP concentration in the plasma, PCT and CRP on Day 0, 2, 4, 7 and 14 after the onset of FN and compared them to those of non-febrile neutropenic patients. Furthermore we evaluated the impact of Pre-SEP, PCT and CRP on the diagnosis and assessment of active infection status in FN, using the cut-off value by setting to 314 pg/ml, 0.50 ng/ml and 0.30 mg/ml. Correlation analysis was performed using Peason's correlation coefficient test. RESULTS: Sixty-two hospitalized FN patients with HEM (AML 14, ALL 9, MDS 14, NHL 13, MM 8, ATL 2, others 2 cases) were treated according to IDSA guideline. Figure 1 showed the each data in Pre-SEP, PCT and CRP value on day 0, 2, 4, 7 and 14. The frequency of less than the cut-off value at day 0 of FN onset were 33.8 %, 77.4 % and 37.1 % in Pre-SEP, PCT and CRP respectively, indicating that Pre-SEP showed the highest sensitivity. On day 0, a significant correlation was not observed between Pre-SEP and PCT (P=0.457, correlation coefficient: 0.096) but it was observed between Pre-SEP and CRP (P<0.01, correlation coefficient: 0.599). However, on day 2 and 4, significant correlations were observed between Pre-SEP and PCT (P<0.01, correlation coefficient: 0.650, p<0.01, correlation coefficient: 0.702 respectively) as well as between Pre-SEP and CRP (P<0.01, correlation coefficient: 0.542, p<0.01, correlation coefficient: 0.722 respectively). These data strongly suggested that Pre-SEP and CRP were available early in FN for a diagnosis and assessment of infection. On day 7, the negative frequencies were 43.5 %, 88.7 % and 45.1 % in Pre-SEP, PCT and CRP. These data strongly suggested that more sensitive assessment of infection would be possible using Pre-SEP. CONCLUSION: (1) Pre-SEP is available even in neutropenia. (2) Pre-SEP is a useful biomarker for infection on the onset of FN as well as CRP. (3) Pre-SEP can help more sensitive assessment of infection. Figure 1. Figure 1. Disclosures No relevant conflicts of interest to declare.

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Prevalence of Jones Fracture Repair and Impact on Short-Term NFL Participation

Foot & Ankle International ◽

10.1177/1071100717733990 ◽

2017 ◽

Vol 39 (1) ◽

pp. 6-10 ◽

Cited By ~ 5

Author(s):

Leigh-Anne Tu ◽

Derrick M. Knapik ◽

Joseph Sheehan ◽

Michael J. Salata ◽

James E. Voos

Keyword(s):

Significant Risk ◽

Case Series ◽

Fracture Repair ◽

American Football ◽

Return To Play ◽

Short Term ◽

Jones Fracture ◽

Early Return ◽

History Of ◽

The Impact

Background: Elite American football athletes are at high risk for Jones fractures. Fixation is recommended to minimize nonunion and allow early return to play. The purpose of this investigation was to evaluate the prevalence of Jones fracture repair in athletes invited to the National Football League (NFL) Combine and the impact of fracture repair on short-term NFL participation compared to athletes with no history of repair. Methods: A total of 1311 athletes participating in the Combine from 2012 to 2015 were evaluated. Athletes with history of Jones fracture repair were identified. Athlete demographic information was collected while physical examination findings were recorded. Radiographs were evaluated to determine fixation type and the presence of nonunion. Future participation in the NFL was evaluated based on draft status, games played, and games started in the athlete’s first season following the Combine. Results: Fixation was performed for 41 Jones fractures in 40 athletes (3.1%). The highest prevalence was in defensive linemen (n = 10 athletes), with the greatest rate in tight ends (5.1%, n = 4 of 79 athletes). Intramedullary screw fixation was used for all fractures. Incomplete bony union was present in 3 (8%) fractures. Athletes with a history of repair were not at significant risk for going undrafted ( P = .61), playing ( P = .23), or starting ( P = .76) fewer NFL games compared to athletes with no history of repair during athletes’ first NFL season. Conclusion: Athletes with a history of Jones fracture repair were not at significant risk of going undrafted or for diminished participation during their first season in the NFL. Level of Evidence: Level IV, case series.

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