Pertti Myllynen

Acute injuries in soccer, ice hockey, volleyball, basketball, judo, and karate: analysis of national registry data.

Abstract Objective: To determine the acute injury profile in each of six sports and compare the injury rates between the sports. Design: Analysis of national sports injury insurance registry data. Setting: Finland during 1987-91. Subjects: 621691 person years of exposure among participants in soccer, ice hockey, volleyball, basketball, judo, or karate. Main outcome measures: Acute sports injuries requiring medical treatment and reported to the insurance company on structured forms by the patients and their doctors. Results: 54186 sports injuries were recorded. Injury rates were low in athletes aged under 15, while 20-24 year olds had the highest rates. Differences in injury rates between the sports were minor in this adult age group. Overall injury rates were higher in sports entailing more frequent and powerful body contact. Each sport had a specific injury profile. Fractures and dental injuries were most common in ice hockey and karate and least frequent in volleyball. Knee injuries were the most common cause of permanent disability. Conclusions: Based on the defined injury profiles in the different sports it is recommended that sports specific preventive measures should be employed to decrease the number of violent contacts between athletes, including improved game rules supported by careful refereeing. To prevent dental injuries the wearing of mouth guards should be encouraged, especially in ice hockey, karate, and basketball.

A controlled immunohistochemical study of inflammatory cells in disc herniation tissue

Study Design The presence and abundance of inflammatory cells was studied immunocytochemically in lumbar disc herniations (DH) and macroscopically normal discs for comparison. Objectives The objective of the study was to characterize inflammatory cells that appear in herniated disc tissue and to study the relative abundance of various types of inflammatory cells. Summary of Background Data Only few macrophages were observed in control discs, whereas abundant macrophages were present in half of the DH.Other types of inflammatory cells were less often abundant in the present material. In about a third of the DH interleukin-1 beta-expressing cells were also observed. Methods Twenty-four DH and control tissue from five discs were studied immunocytochemically, using specific monoclonal antibodies to various types of inflammatory cells and interleukin-1 beta. The results were compared with corresponding clinical data. Macrophages were studied with an antibody to CD68 antigen and Ber-MAC3 antibody separately. Results The obtained results suggest a variable inflammatory cell response in DH, which seems to be often dominated by macrophages at the time of operation. Thus previous suggestions of sometimes very active inflammation in DH tissue are supported. Conclusions Inflammation may be important in disc tissue pathophysiology, possibly also in discogenic pain mechanisms.

Outcome of clavicular fracture in 89 patients

SummaryDuring 1982, 118 patients with clavicular fracture were treated in the Department of Orthopaedics and Traumatology, Helsinki University Central Hospital. Eighty-nine patients appeared for the follow-up examination in 1984. Eighty-three fractures were treated with immobilization in a sling. Four fractures were treated with plate fixation primarily and two patients were operated on for delayed union. The immobilization averaged 21 days, range 10–42 days. The follow-up was 2 years in all cases. The result was good in 65 cases, satisfactory in 20, and poor in 4 cases. Patients with primary dislocation of more than 15 mm or with shortening observed at the follow-up examination had statistically significantly more pain than patients without these findings.ZusammenfassungAn der Orthopädisch-traumatologischen Klinik der Universität Helsinki wurden 1982 118 Patienten mit Klavikulafraktur behandelt. Neunundachtzig dieser Patienten konnten im Jahre 1984 nachuntersucht werden. Dreiundachtzig Frakturen waren durch Immobilisation im Armtragetuch behandelt worden. Vier Frakturen wurden primär verplattet, und zwei Fälle wurden wegen verzögerter Heilung sekundär operiert. Die Dauer der Immobilisation betrug durchschnittlich 21 Tage (10–42 Tage). Die Beobachtungszeit war in allen Fällen zwei Jahre. Das Ergebnis der Behandlung war gut in 65 Fällen, befriedigend in 20 Fällen und schlecht in 4 Fällen. Patienten mit primärer Dislokation von mehr als 15 mm oder bei der Nachuntersuchung festgestellter Verkürzung hatten signifikant mehr Schmerzen als Patienten ohne derartige Befunde.

COMPLICATIONS OF TRANSPEDICULAR LUMBOSACRAL FIXATION FOR NON-TRAUMATIC DISORDERS

We analysed the complications encountered in 102 consecutive patients who had posterolateral lumbosacral fusion performed with transpedicular screw and rod fixation for non-traumatic disorders after a minimum of two years. Of these, 40 had spondylolysis and spondylolisthesis, 42 a degenerative disorder, 14 instability after previous laminectomy and decompression, and six pain after nonunion of previous attempts at spinal fusion without internal fixation. There were 75 multilevel and 27 single-level fusions. There were 76 individual complications in 48 patients, and none in the other 54. The complications seen were screw misplacement, coupling failure of the device, wound infection, nonunion, permanent neural injury, and loosening, bending and breakage of screws. Screw breakage or loosening was more common in patients with multilevel fusions (p < 0.001). Screws of 5 mm diameter should not be used for sacral fixation. Forty-six patients had at least one further operation for one or several complications, including 20 fusion procedures for nonunion. The high incidence of complications is a disadvantage of this technically-demanding method.

Fat Embolism in Patients with Multiple Injuries

The diagnostic criteria of clinical fat embolism syndrome are most important. Petechial rush, positive chest X-ray films, low arterial oxygen content, and cerebral involvement are major features. Three different grades of fat embolism can be distinguished. The development of the first grade cannot b

Lumbar facet joint syndrome. A randomised clinical trial

A group of 109 patients with unilateral low back pain for over three months were randomised to receive one of three types of injection treatment: cortisone and local anaesthetic injected into two facet joints (28), the same mixture around two facet joints (39), or physiological saline into two facet joints (42). The effect of the treatment was evaluated in relation to work attendance, pain, disability and movements of the lumbar spine. Patients were examined one hour and two and six weeks after treatment and also completed a questionnaire after three months. A significant improvement was observed in work attendance, pain and disability scores, but this was independent of the treatment given and movements of the lumbar spine were not improved. Of the 70 patients with initial pain relief after injection, 36% reported persisting benefit at the three month follow-up, independent of the mode of treatment given. We conclude that facet joint injection is a non-specific method of treatment and the good results depend on a tendency to spontaneous regression and to the psychosocial aspects of back pain.

Deep venous thrombosis and pulmonary embolism in patients with acute spinal cord injury: a comparison with nonparalyzed patients immobilized due to spinal fractures

The occurrence of deep venous thrombosis (DVT) was studied in the series of 23 consecutive patients with acute spinal cord injury and 14 immobilized patients with spinal fractures without paralysis. The incidence of DVT in paralyzed patients was 100% as detected by the 125I-labeled fibrinogen test and confirmed by contrast venography, and 64% as detected by repeated clinical examinations and confirmed by contrast venography. The respective incidence of DVT in nonparalyzed patients with spinal fractures was 0%. The diagnosis of DVT was reached earlier with the radiofibrinogen test than with the clinical followup (5 days vs. 25 days). Two of the 23 paralyzed patients (9%) developed nonfatal clinical pulmonary embolism (PE). There were no differences in the values of routine coagulation tests. The result justifies prophylactic anticoagulant therapy in all cases of spinal cord injury during the acute post-traumatic phase.

Fractures of the Talus

A total of 35 patients treated in the years 1970 to 1977 for fractures of the talus were investigated for an analysis of the long-term clinical end results. Falling from height was the most common cause of injury (15 patients), the next most common being road traffic accidents (13 patients). The mean followup time was 8 years. At followup, 19 patients were free of any discomfort and none had pain at rest. The incidence of pain was correlated significantly (p less than 0.01) with the grade of dislocation both before and after reduction. In severely dislocated fractures open reduction and osteosynthesis with a compression screw are recommended.

Posterolateral lumbosacral fusion with transpedicular fixation:63 consecutive cases followed for 4 (2–6) years

We analyzed the clinical, vocational and radiologic outcomes of 63 consecutive posterolateral lumbosacral fusions performed with transpedicular fixation. The indication for surgery was long-standing intractable lumbar and/or radiating pain with spondylolysis-olisthesis in 31 cases, degenerative disc disease and/or facet joint arthrosis in 23 cases and pain after laminectomy/decompression in 9 cases. Radiographic union was finally achieved in 30 out of the 63 cases. Fixation device-related complications, such as screw misplacement, breakage, bending and loosening, occurred in 33 cases. 15 patients underwent refusion. 43 patients obtained good pain relief. There was no correlation between bony healing and a good clinical outcome. 28/49 preoperatively employed patients returned to work. There was no correlation between relief of pain and return to work. 20 patients retired on a full disability pension. The clinical results were best in the spondylolysis-olisthesis group. Only 2/15 patients with markedly reduced spondylolisthesis maintained the reduction. In 3 patients, progressive disc degeneration above the level of fusion was observed. We conclude that posterolateral lumbosacral fusion with transpedicular fixation provides a satisfactory clinical outcome in patients with spondylolysis-olisthesis, but the high incidence of complications related to the fixation device in the other indications studied is a serious drawback of the method.

Surgery for ununited clavicular fracture

Twenty-four ununited, primarily conservatively treated clavicular fractures were treated operatively. The follow-up period averaged 3.5 years. In all cases, the primary displacement was at least equal to the clavicular thickness. The subjective outcome was good in 17 cases, satisfactory in six, and poor in one. In two cases, resection was performed. Our experience of rigid plate fixation and cancellous bone grafting was good with union in 20/22 cases. However, the operations are not uncomplicated and there is a risk of diminished muscle power and range of movement in the shoulder if the clavicle is shortened.