Steven G. Glasgow

Analysis of Failed Surgical Management of Fractures of the Base of the Fifth Metatarsal Distal to the Tuberosity: The Jones Fracture

Failure of surgical management of fractures of the base of the fifth metatarsal distal to the tuberosity is uncommon. Only one such failure has been reported in the literature to date. The purpose of this article is to present the clinical course of 11 patients with failure of surgically managed Jones fractures reviewed by the senior author (J.S.T.). Surgical management was complicated by delayed union in three patients, refracture in seven patients, and nonunion in one patient. The 11 procedures were divided between two established techniques: (1) intramedullary screw fixation (N = 6) and (2) inlaid corticocancellous bone graft (N = 5). In the six intramedullary fixation procedures, using other than a 4.5-mm ASIF malleolar screw for internal fixation correlated with failure. In the five inlaid bone graft procedures, undersized corticocancellous grafts and incomplete reaming of the medullary canal correlated with failure. Also, after both procedures, early return to vigorous physical activity is believed to have played a role in delayed union and refracture.

Spear tackler's spine An entity precluding participation in tackle football and collision activities that expose the cervical spine to axial energy inputs

We describe spear tacklers spine, a clinical entity that constitutes an absolute contraindication to participation in tackle football and other collision activities that ex pose the cervical spine to axial energy inputs. A subset of football players were identified who demonstrated: 1) developmental narrowing (stenosis) of the cervical canal; 2) persistent straightening or reversal of the normal cervical lordotic curve on erect lateral roentgen ograms obtained in the neutral position; 3) concomitant preexisting posttraumatic roentgenographic abnormal ities of the cervical spine; and 4) documentation of having employed spear tackling techniques. From data obtained by the National Football Head and Neck Injury Registry and the senior authors practice, 15 cases of spear tacklers spine were identified during 1987 to 1990. All 15 cases were evaluated because of complaints referable to the cervical spine or brachial plexus result ing from football injuries. Of these, 11 had complete neurologic recovery without permanent sequelae. Four cases resulted in permanent neurologic deficits: quad riplegia, 2; incomplete hemiplegia, 1; and residual long track signs, 1. Permanent neurologic injury occurred as the result of axial loading of a persistently straightened cervical spine from use of head-impact playing tech niques. We suggest that individuals who possess the aforementioned characteristics of spear tacklers spine be precluded from participation in collision activities that expose the cervical spine to axial energy inputs.

Anterior cruciate ligament injury and reconstruction among university students

The consequences of athletic injuries extend beyond the musculoskeletal system. Depression, anger, and tension have been observed in athletes with athletic injuries. It was hypothesized that among student athletes, the psychologic impact of injury may be seen as a drop in academic performance. Thirty-eight students who had an anterior cruciate ligament injury and subsequent reconstruction were evaluated retrospectively by academic transcript and questionnaire to measure their academic performance before their injury, in the semester of their injury, and in the semester after their surgery. The patients were compared with randomly selected undergraduate control subjects. To evaluate any effect of the timing of the surgery on academic performance, the patients were separated into two groups, according to the timing of their reconstruction: those who had surgery during the academic semester, and those who elected to wait for a school break. There was a significant drop in grade point average of 0.3 grade points during the semester of injury among all injured students. Compared with those who had surgery during a break, the students who had surgery during the semester received more frequently the grade of failure (6% versus 0%) or incomplete (33% versus 9%). These students also missed more school days (10.5 days versus 1.5 days) and examinations (2.2 examinations versus 0.1 examinations). Only 47% of students who had surgery during the semester were satisfied with their decision for surgical timing, compared with 96% satisfied with the timing during an academic break. Acute anterior cruciate ligament rupture, and surgical reconstruction during an academic semester, have a significant academic effect in university students.

Magnetic Resonance Imaging of Knee Disorders Clinical Value and Cost-Effectiveness in a Sports Medicine Practice

To prospectively evaluate the clinical value of magnetic resonance imaging of the knee in a referral sports medicine practice, we performed a three-part study. First, we asked 72 consecutive patients a series of clinically relevant questions regarding the ordering of their magnetic resonance imaging scans. Second, we asked the treating physicians at our center if the mag netic resonance imaging findings changed the diagno sis or treatment. Third, we compared the clinical eval uation with the findings on magnetic resonance imaging scans for 37 patients who had arthroscopic confirmation. From the physicians perspective, in only three cases would the results of the scan have changed the diagnosis. Information from the scans was judged to contribute to patient treatment in only 14 of 72 patients. Finally, comparison of clinical evaluation and magnetic resonance imaging findings with findings during arthroscopic procedures showed that clinical evaluation had a sensitivity and specificity of 100% for diagnosis of anterior cruciate ligament injuries, whereas magnetic resonance imaging was 95% sen sitive and 88% specific. For isolated meniscal lesions, the clinical assessment had a sensitivity and specificity of 91 % compared with 82% and 87%, respectively, for magnetic resonance imaging. For evaluation of articu lar surface damage, the predictive value of a positive test was 100% for clinical assessment and 33% for the

The effect of early versus late return to vigorous activities on the outcome of anterior cruciate ligament reconstruction

The effect of early (mean, 5 months) versus late (mean, 9 months) return to vigorous cutting activity on the long-term outcome of anterior cruciate ligament recon struction was evaluated retrospectively. Sixty-four re constructions, using a distally attached medial one-third patellar tendon, were reviewed on an average of 46 months postoperatively. After surgery, the timing of return to vigorous activity was based on biologic fixa tion of the graft, a negative Lachman test, absence of effusion, and the patients desire to return to previous activity. The 64 patients were retrospectively separated into two groups. The early group consisted of 31 patients who returned to activity 2 to 6 months after reconstruc tion, and the late group consisted of 33 patients who returned to activity 7 to 14 months after reconstruction. By clinical examination, KT-1000 arthrometer meas urements, subjective evaluation, and Cybex testing, there were no differences between the early and late return groups except for reestablishment of final range of motion. At an average followup of 46 months, this study indicates that an early return to vigorous physical cut ting activities after ACL reconstruction does not predis pose patients to reinjury or a less satisfactory long- term result.

Criteria for Return to Contact Activities Following Cervical Spine Injury

The literature dealing with the diagnosis and treatment of cervical spine injuries is considerable. Absent, however, are comprehensive criteria or guidelines for permitting or prohibiting return to contact activities. The purpose of this report is to describe congenital, developmental, as well as posttraumatic conditions of the cervical spine as presenting either (a) no contraindication, (b) relative contraindication, or (c) an absolute contraindication to continued participation. In addition to reviewing the relevant concepts of Bailes, Watkins, and White, a comprehensive set of guidelines is presented. In addition, “spear tacklers spine,” an absolute contraindication to participation, is described. Also, recommendations for managing individuals following cervical spine fusion are suggested.

Arthroscopic roofplasty: Correction of an extension deficit following conservative treatment of a type III tibial avulsion fracture

Extension loss following nonoperative treatment of a Type III tibial avulsion fracture does occur. Arthroscopic roofplasty (notchplasty) and scar excision are described to regain complete extension without compromising knee stability.

Tibial chondral fissures associated with the lateral meniscus

This article describes a relatively common lesion of the lateral tibial plateau that has not been reported in the literature. This lesion is a fissure of the articular cartilage parallel to the lateral meniscal rim. Sometimes asymptomatic, this articular fissure was noted in 10 of 61 consecutive patients (16%) undergoing knee arthroscopy in an outpatient surgery unit. This chondral fissure often demarcates an abrupt transition between firm and healthy articular cartilage, which is covered by the lateral meniscus, and exposed articular cartilage, which is soft and fibrillated. Progressive articular degeneration of knees with this lesion has not been documented; therefore, the clinical significance of these chondral fissure is not yet known.

Atraumatic spontaneous hemarthrosis associated with lyme arthritis : a case report

A 20-year-old male athlete had Lyme arthritis and an associated atraumatic spontaneous hemarthrosis of the knee. Lyme arthritis is a common and well-documented manifestation of Lyme disease, but an association with an atraumatic hemarthrosis to date has not been reported. Clinical diagnosis was confirmed by serologic testing. Treatment consisted of ceftriaxone, 1-g intravenous for 14 days.