1
|
Ganta A, Ferati SR, Gibbons K, Fisher ND, Konda S, Egol K. Risk factors for delayed return to work following tibial shaft fracture surgery. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024:10.1007/s00590-024-03991-x. [PMID: 38780792 DOI: 10.1007/s00590-024-03991-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Accepted: 05/08/2024] [Indexed: 05/25/2024]
Abstract
PURPOSE To determine when patients return to work following operative repair of tibial shaft fractures (TSF) and what risk factors are associated with a delayed return to work (RTW), defined as greater than 180 days after operative repair. METHODS Retrospective chart review was performed on a consecutive series of TSF patients who underwent operative repair. Time to RTW was based on documented work-clearance communications from the operating surgeon. Patients were divided into 3 groups based on when they returned to work: early (≤ 90 days), average (91-80 days), and late (≥ 180 days). Univariate analysis was performed, and significant variables were included in multinomial logistic regression. RESULTS There were 168 patients identified. Eighteen were excluded (retired, unemployed, or never returned to work) leaving 150 patients. The average time to RTW for the overall study population was 4.17 ± 2.06 months. There were 39 (26.0%) patients in the early RTW group, 85 (56.7%) in the average RTW group, and 26 (17.3%) in the late RTW group. Patient with high-energy injuries (p = 0.024), open fractures (p = 0.001), initial external-fixation (p = 0.036), labor-intensive job (p = 0.018) and post-operative non-weight bearing status (p = 0.023) all had significantly longer RTW. Multinomial logistic regression including these parameters found a closed fracture was associated with a 1.9 decreased risk of delayed RTW (p = 0.004, 95% CI 0.039-0.533). CONCLUSIONS Open fractures, initial external-fixation, restricted post-operative weight-bearing and labor-intensive jobs are associated with a delayed RTW following operative repair of TSFs. LEVEL OF EVIDENCE Therapeutic Level III.
Collapse
Affiliation(s)
- Abhishek Ganta
- NYU Langone Orthopedic Hospital, 301 E 17th St Suite 1402, New York, NY, 10003, USA.
- Jamaica Hospital Medical Center, 8900 Van Wyck Expressway, Richmond Hill, NY, 11418, USA.
| | - Sehar Resad Ferati
- NYU Langone Orthopedic Hospital, 301 E 17th St Suite 1402, New York, NY, 10003, USA
| | - Kester Gibbons
- NYU Langone Orthopedic Hospital, 301 E 17th St Suite 1402, New York, NY, 10003, USA
| | - Nina D Fisher
- NYU Langone Orthopedic Hospital, 301 E 17th St Suite 1402, New York, NY, 10003, USA
| | - Sanjit Konda
- NYU Langone Orthopedic Hospital, 301 E 17th St Suite 1402, New York, NY, 10003, USA
- Jamaica Hospital Medical Center, 8900 Van Wyck Expressway, Richmond Hill, NY, 11418, USA
| | - Kenneth Egol
- NYU Langone Orthopedic Hospital, 301 E 17th St Suite 1402, New York, NY, 10003, USA
| |
Collapse
|
2
|
Stannard JT, Stannard JP. Fractures and Dislocations on the Playing Field: Which Are Emergent and What to Do? Clin Sports Med 2023; 42:515-524. [PMID: 37208062 DOI: 10.1016/j.csm.2023.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
High-energy injuries, including fractures and dislocations, are occurring with increasing frequency in athletic competitions with the increasing size and speed of players. Common fractures and dislocations will be discussed in this article. We will evaluate emergent versus routine injuries and discuss appropriate treatment at the athletic venue. Fractures that can be seen with athletic activities include cervical spine; knee osteochondral fractures; tibia, ankle, and clavicle. Dislocations that will be considered include knee, patella, hip, shoulder, sternoclavicular joint, and proximal interphalangeal joint of the finger. These injuries vary significantly both in severity and in the emergent nature of the injury.
Collapse
Affiliation(s)
- James T Stannard
- Department of Orthopaedic Surgery, University of Missouri, 1100 Virginia Avenue, Columbia, MO 65212, USA
| | - James P Stannard
- Department of Orthopaedic Surgery, Missouri Orthopaedic Institute, University of Missouri, 1100 Virginia Avenue, Columbia, MO 65212, USA.
| |
Collapse
|
3
|
Robertson GAJ, Sinha A, Hodkinson T, Koç T. Return to sport following toe phalanx fractures: A systematic review. World J Orthop 2023; 14:471-484. [PMID: 37377988 PMCID: PMC10292062 DOI: 10.5312/wjo.v14.i6.471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 03/19/2023] [Accepted: 05/06/2023] [Indexed: 06/19/2023] Open
Abstract
BACKGROUND Evidence-based guidance on return to sport following toe phalanx fractures is limited.
AIM To systemically review all studies recording return to sport following toe phalanx fractures (both acute fractures and stress fractures), and to collate information on return rates to sport (RRS) and mean return times (RTS) to the sport.
METHODS A systematic search of PubMed, MEDLINE, EMBASE, CINAHL, Cochrane Library, Physiotherapy Evidence Database, and Google Scholar was performed in December 2022 using the keywords ‘Toe’, ‘Phalanx’, ‘Fracture’, ‘injury’, ‘athletes’, ‘sports’, ‘non-operative’, ‘conservative’, ‘operative’, ‘return to sport’. All studies which recorded RRS and RTS following toe phalanx fractures were included.
RESULTS Thirteen studies were included: one retrospective cohort study and twelve case series. Seven studies reported on acute fractures. Six studies reported on stress fractures. For the acute fractures (n = 156), 63 were treated with primary conservative management (PCM), 6 with primary surgical management (PSM) (all displaced intra-articular (physeal) fractures of the great toe base of the proximal phalanx), 1 with secondary surgical management (SSM) and 87 did not specify treatment modality. For the stress fractures (n = 26), 23 were treated with PCM, 3 with PSM, and 6 with SSM. For acute fractures, RRS with PCM ranged from 0 to 100%, and RTS with PCM ranged from 1.2 to 24 wk. For acute fractures, RRS with PSM were all 100%, and RTS with PSM ranged from 12 to 24 wk. One case of an undisplaced intra-articular (physeal) fracture treated conservatively required conversion to SSM on refracture with a return to sport. For stress fractures, RRS with PCM ranged from 0% to 100%, and RTS with PCM ranged from 5 to 10 wk. For stress fractures, RRS with PSM were all 100%, and RTS with surgical management ranged from 10 to 16 wk. Six cases of conservatively-managed stress fractures required conversion to SSM. Two of these cases were associated with a prolonged delay to diagnosis (1 year, 2 years) and four cases with an underlying deformity [hallux valgus (n = 3), claw toe (n = 1)]. All six cases returned to the sport after SSM.
CONCLUSION The majority of sport-related toe phalanx fractures (acute and stress) are managed conservatively with overall satisfactory RRS and RTS. For acute fractures, surgical management is indicated for displaced, intra-articular (physeal) fractures, which offers satisfactory RRS and RTS. For stress fractures, surgical management is indicated for cases with delayed diagnosis and established non-union at presentation, or with significant underlying deformity: both can expect satisfactory RRS and RTS.
Collapse
Affiliation(s)
- Greg A J Robertson
- Department of Orthopaedic Surgery, Queen Alexandra Hospital, Portsmouth PO6 3LY, United Kingdom
| | - Amit Sinha
- Department of Trauma and Orthopaedic Surgery, Wales Deanery, Cardiff CF15 7QQ, United Kingdom
| | - Thomas Hodkinson
- Department of Orthopaedic Surgery, Hull University Teaching Hospitals NHS Trust, Hull HU3 2JZ, United Kingdom
| | - Togay Koç
- Department of Trauma and Orthopaedic Surgery, Southampton General Hospital, Southampton SO16 6YD, United Kingdom
| |
Collapse
|
4
|
Kohn L, Rauch A. [Fractures of tibial shaft and tibial head in winter sports]. ORTHOPADIE (HEIDELBERG, GERMANY) 2022; 51:882-890. [PMID: 36224282 DOI: 10.1007/s00132-022-04312-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/13/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Injuries in alpine skiing often affect the lower extremities, in particular the knee joint and lower leg. In addition to conventional radiological diagnostics, CT and, in the case of fractures of the knee joint area, MRI also play an important role. In the case of tibial head fractures, especially if there has been a dislocation mechanism, there is an increased risk of vascular and nerve injuries. Lower leg fractures are predestined for the development of a compartment syndrome. For these reasons, an exact survey of the vascular-nerve status and a monitoring of the soft tissues should be carried out. THERAPY In the further therapy, whether conservative or surgical, the soft tissue situation must also be included in the planning. In the case of tibial head fractures in particular, the choice of the right approach is essential for a good result in surgical therapy. Angle-stable plate osteosynthesis and screw osteosynthesis play the most important role as osteosynthesis methods in the knee joint area. In the case of fractures in the shaft area, medullary nail osteosynthesis or angle-stable plate systems are primarily used. In the case of severely compromised soft tissue or unstable situations, it may be necessary to apply an external fixator first. The initiated therapy should enable functional follow-up treatment as early as possible. PREVENTION Good physical fitness, driving-specific training, but also good core stabilization have a preventative effect against injuries. In addition, the correct material coordination between ski boot, binding and ski is important for accident prevention.
Collapse
Affiliation(s)
- L Kohn
- Klinik für Unfallchirurgie und Orthopädie, Krankenhaus Landshut-Achdorf, Achdorfer Weg 3, 84036, Landshut, Deutschland.
| | - A Rauch
- ECOM - Praxis für Orthopädie, Sportmedizin & Unfallchirurgie, München, Deutschland
- Sporttraumatologie und Kniechirurgie, ATOS-Klinik München, München, Deutschland
| |
Collapse
|
5
|
Robertson GA, Ang KK, Jamal B. Fractures in soccer: The current evidence, and how this can guide practice. J Orthop 2022; 33:25-30. [PMID: 35801201 PMCID: PMC9253526 DOI: 10.1016/j.jor.2022.06.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 05/27/2022] [Accepted: 06/16/2022] [Indexed: 11/09/2022] Open
Abstract
This article reviews the current evidence on traumatic fractures in soccer, and assesses how this can guide practice. The incidence of traumatic soccer-related fractures was found to be 0.64 to 0.71/1000 in the general population. Demographics vary between the general population and professional soccer players, with 68% of traumatic soccer fractures occurring in the upper extremity in the general population, and only 23% of traumatic soccer fractures occurring in the upper extremity in professional players. Within the general population, around 80% of traumatic soccer-related fractures are managed non-operatively, with 20% managed operatively. The optimal treatment method is determined by fracture location and configuration. There is an increasing role for primary operative treatment in unstable, non-displaced fracture types, to facilitate an accelerated return to soccer. Around 86% of soccer players return to sport post-fracture. Return times vary by fracture locations and playing level, with elite players having quicker return times than the general population. Regarding injury prevention, shin guards appear to confer substantial benefit against tibial diaphyseal fractures. However, further research is required to determine the optimal preventative measures against fractures in soccer.
Collapse
Affiliation(s)
- Greg A.J. Robertson
- RCPSG Limb Reconstruction Fellow, Department of Orthopaedic Surgery, Queen Elizabeth University Hospital, Glasgow, UK
| | - Kok K. Ang
- Core Surgical Trainee University Hospital Crosshouse, Kilmarnock, UK
| | - Bilal Jamal
- Consultant Orthopaedic Surgeon, Department of Orthopaedic Surgery, Queen Elizabeth University Hospital, Glasgow, UK
| |
Collapse
|
6
|
Kröger I, Müßig J, Brand A, Pätzold R, Wackerle H, Klöpfer-Krämer I, Augat P. Recovery of gait and function during the first six months after tibial shaft fractures. Gait Posture 2022; 91:66-72. [PMID: 34653876 DOI: 10.1016/j.gaitpost.2021.09.199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 09/14/2021] [Accepted: 09/27/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Tibial shaft fractures require surgical stabilization preferably by intramedullary nailing. Recovery is often unsatisfactory due to limited knee function and pain, resulting in reduced quality of life. The extent of these functional limitations with respect to gait deficits has not been sufficiently recognized. RESEARCH QUESTION Are there functional limitations during gait and squat performance during the first six months after surgically treated tibial shaft fractures? METHODS Twenty-three patients (BMI: 24 ± 3, Age:39 ± 15) with tibial shaft fractures and 23 healthy, matched controls (BMI: 24 ± 3, Age: 40 ± 14) were assessed using instrumented motion analysis two, three and six months after surgery. Kinematic and kinetic data of the lower extremities were collected during level walking and squat performance. Data were compared among follow-up time intervals and between groups. RESULTS Significant improvements were found for all spatiotemporal parameters and most kinetic parameters. Even six months after surgery functional deficits persisted when compared to healthy controls. There were only slight improvements in sagittal knee and ankle kinematics as well as knee moments and power within the follow-up period. A significant difference compared to the healthy controls can still be observed in these parameters. SIGNIFICANCE Although patients with tibia fractures demonstrated functional improvements over the early course of healing, some residual deficits in lower extremity movement biomechanics were identified at six months post surgery. In particular knee kinematics in squatting as well as knee kinematics and kinetics during walking only recovered incompletely. This result can help explain the often-reported functional limitations. CLINICAL TRIAL REGISTRATION NUMBER German register for clinical trials (DRKS00023790).
Collapse
Affiliation(s)
- Inga Kröger
- Institute for Biomechanics, Berufsgenossenschaftliche Unfallklinik Murnau, Germany; Institute for Biomechanics, Paracelsus Medical Private University, Salzburg, Austria.
| | - Janina Müßig
- Institute for Biomechanics, Berufsgenossenschaftliche Unfallklinik Murnau, Germany; Institute for Biomechanics, Paracelsus Medical Private University, Salzburg, Austria
| | - Andreas Brand
- Institute for Biomechanics, Berufsgenossenschaftliche Unfallklinik Murnau, Germany; Institute for Biomechanics, Paracelsus Medical Private University, Salzburg, Austria
| | - Robert Pätzold
- Department of Trauma Surgery, Berufsgenossenschaftliche Unfallklinik Murnau, Germany
| | - Hannes Wackerle
- Institute for Biomechanics, Berufsgenossenschaftliche Unfallklinik Murnau, Germany; Institute for Biomechanics, Paracelsus Medical Private University, Salzburg, Austria
| | - Isabella Klöpfer-Krämer
- Institute for Biomechanics, Berufsgenossenschaftliche Unfallklinik Murnau, Germany; Institute for Biomechanics, Paracelsus Medical Private University, Salzburg, Austria
| | - Peter Augat
- Institute for Biomechanics, Berufsgenossenschaftliche Unfallklinik Murnau, Germany; Institute for Biomechanics, Paracelsus Medical Private University, Salzburg, Austria
| |
Collapse
|
7
|
Knapik DM, Mack CD, Lee R, Heersink W, Tanenbaum JE, Wetzel RJ, Voos JE. Epidemiology of Tibial Fractures in Professional American Football Athletes From 2013 to 2019. Orthop J Sports Med 2021; 9:23259671211040878. [PMID: 34790831 PMCID: PMC8591654 DOI: 10.1177/23259671211040878] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 06/08/2021] [Indexed: 11/15/2022] Open
Abstract
Background: Lower extremity injuries occur with high frequency in National Football League (NFL) athletes and cause high burden to players and teams. Tibial fractures are among the most severe lower extremity injuries sustained in athletes and are associated with prolonged time loss from sport. Purpose: To determine the number of tibial fractures in NFL athletes from the 2013 to 2019 NFL seasons and describe athlete demographics, fracture characteristics, and details of injury onset. Study Design: Case series; Level of evidence, 4. Methods: A retrospective review of the NFL injury database was performed to identify all NFL athletes sustaining tibial fractures over the 2013 to 2019 NFL seasons. Athlete characteristics, injury characteristics, days missed, and treatment (operative vs nonoperative) were examined. Descriptive statistics were used to calculate means, standard deviations, ranges, and percentages. Results: A total of 64 tibial fractures were identified in 60 athletes, resulting in a median loss of 74 days. Defensive secondary athletes had the highest number of injuries (n = 10; 16%), followed by running backs (n = 9; 14%), while 61% of these injuries occurred during NFL regular-season games, primarily between weeks 13 and 17. The most commonly reported activity during injury was athletes being tackled, with a direct impact to the tibia being the most common mechanism of injury. Lateral tibial plateau fractures were the most frequently reported, while distal tibial fractures resulted in the greatest number of days lost. The median time lost for injuries requiring surgery was 232 days compared with 56 days for injuries treated using conservative management. Conclusion: The highest proportion of tibial fractures were injuries to defensive secondary athletes and athletes being tackled while sustaining a direct impact to the leg, primarily to the lateral tibial plateau. Tibial fracture injuries were commonly sustained during NFL regular-season games, primarily during the final 4 weeks of the NFL regular season. Further investigations examining performance and career longevity in athletes sustaining tibial fractures are warranted to help improve the health and safety of NFL athletes.
Collapse
Affiliation(s)
- Derrick M Knapik
- Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.,University Hospitals Sports Medicine Institute, Cleveland, Ohio, USA.,Case Western Reserve University, School of Medicine, Cleveland, Ohio, USA
| | | | | | - William Heersink
- Case Western Reserve University, School of Medicine, Cleveland, Ohio, USA
| | - Joseph E Tanenbaum
- Case Western Reserve University, School of Medicine, Cleveland, Ohio, USA
| | - Robert J Wetzel
- Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.,University Hospitals Sports Medicine Institute, Cleveland, Ohio, USA.,Case Western Reserve University, School of Medicine, Cleveland, Ohio, USA
| | - James E Voos
- Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.,University Hospitals Sports Medicine Institute, Cleveland, Ohio, USA.,Case Western Reserve University, School of Medicine, Cleveland, Ohio, USA
| |
Collapse
|
8
|
Lavoie-Gagne O, Gong MF, Patel S, Cohn MR, Korrapati A, Forlenza EM, Barmonyallah M, Parvaresh KC, Wolfson TS, Forsythe B. Traumatic Leg Fractures in UEFA Football Athletes: A Matched-Cohort Analysis of Return to Play, Reinjury, Player Retention, and Performance Outcomes. Orthop J Sports Med 2021; 9:23259671211024218. [PMID: 34527753 PMCID: PMC8436324 DOI: 10.1177/23259671211024218] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 02/28/2021] [Indexed: 02/03/2023] Open
Abstract
Background: The average professional soccer team experiences 1 to 2 traumatic leg fractures per season, with unknown effects on player performance. Purpose: To (1) determine the rate and time to return to play (RTP) following leg fracture, (2) investigate the rate of reinjury following RTP, and (3) investigate long-term effects that lower extremity (LE) fracture may have on elite soccer player performance. Study Design: Cohort study; Level of evidence, 3. Methods: Using publicly available records, we identified athletes sustaining a traumatic leg fracture across the 5 major European soccer leagues (English Premier League, Bundesliga, La Liga, Ligue 1, and Serie A) between 2000 and 2016. Athletes with leg fracture (femur, tibia, and/or fibula) were matched 1:2 to controls by demographic characteristics and performance metrics 1 season before the index timepoint. Investigations included the RTP rate, reinjury rate, player characteristics associated with RTP within 2 seasons, long-term player retention, performance metrics during the 4 following seasons, and subgroup analysis by player position. Results: A total of 112 players with LE fracture and 224 controls were identified. Players with LE fractures were absent for a mean of 157 days (range, 24-601 days) and 21 games (range, 2-68 games). The rate of RTP within 1 season was 80%, with 4% experiencing subsequent refracture. Injured players remained active in the league at a higher rate than their uninjured counterparts. As compared with controls, injured athletes played 309 fewer total minutes (P < .05), scored 0.09 more assists per game (P < .01) 1 season after injury, and scored 0.12 more points per game 4 seasons after injury (P < .01). Defenders were most affected by an LE fracture, playing 5.24 fewer games (P < .05), 603 fewer total minutes (P < .01), and recording 0.19 more assists per 90 minutes of play as compared with controls 1 season after injury (P < .001). Attackers and midfielders demonstrated no significant difference in metrics after RTP when compared with controls. Conclusion: Most players sustaining an LE fracture returned to elite soccer at the same level after a significant loss of playing time, with a 4% rate of refracture. Player retention was higher for those sustaining an LE fracture versus uninjured controls. Overall, injured players did not experience a decline in performance after recovery from an LE fracture.
Collapse
Affiliation(s)
| | - Matthew F Gong
- Department of Orthopaedic Surgery, University of California-San Diego, San Diego, California, USA
| | - Sumit Patel
- Midwest Orthopaedics at Rush, Rush University, Chicago, Illinois, USA
| | - Matthew R Cohn
- Midwest Orthopaedics at Rush, Rush University, Chicago, Illinois, USA
| | | | - Enrico M Forlenza
- Midwest Orthopaedics at Rush, Rush University, Chicago, Illinois, USA
| | - Moses Barmonyallah
- Department of Orthopaedic Surgery, University of California-San Diego, San Diego, California, USA
| | - Kevin C Parvaresh
- Midwest Orthopaedics at Rush, Rush University, Chicago, Illinois, USA
| | | | - Brian Forsythe
- Midwest Orthopaedics at Rush, Rush University, Chicago, Illinois, USA
| |
Collapse
|
9
|
Robertson GAJ, Ang KK, Maffulli N, Keenan G, Wood AM. Return to sport following Lisfranc injuries: A systematic review and meta-analysis. Foot Ankle Surg 2019; 25:654-664. [PMID: 30321929 DOI: 10.1016/j.fas.2018.07.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 07/17/2018] [Accepted: 07/24/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND Information regarding return rates (RR) and mean return times (RT) to sport following Lisfranc injuries remains limited. METHODS A systematic search of nine major databases was performed to identify all studies which recorded RR or RT to sport following lisfranc injuries. RESULTS Seventeen studies were included (n=366). For undisplaced (Stage 1) injuries managed nonoperatively (n=35), RR was 100% and RT was 4.0 (0-15) wks. For stable minimally-displaced (Stage 2) injuries managed nonoperatively (n=16), RR was 100% and RT was 9.1 (4-14) wks. For the operatively-managed injuries, Percutaneous Reduction Internal Fixation (PRIF) (n=42), showed significantly better RR and RT compared to both: Open Reduction Internal Fixation (ORIF) (n=139) (RR - 98% vs 78%, p<0.019; RT - 11.6 wks vs 19.6 wks, p<0.001); and Primary Partial Arthrodesis (PPA) (n=85) (RR - 98% vs 85%, p<0.047; RT - 11.6 wks vs 22.0 wks, p<0.002). CONCLUSIONS Stage 1 and stable Stage 2 Lisfranc injuries show good results with nonoperative management. PRIF offers the best RR and RT from the operative methods, though this may not be possible with high-energy injuries. LEVEL OF EVIDENCE IV. Systematic Review of Level I to Level IV Studies.
Collapse
Affiliation(s)
- Gregory Aidan James Robertson
- Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SA, United Kingdom.
| | - Kok Kiong Ang
- Edinburgh Medical School, University of Edinburgh, 47 Little France Crescent, Edinburgh EH16 4TJ, United Kingdom
| | - Nicola Maffulli
- Queen Mary University of London, Mile End Road, London E1 4NS, United Kingdom
| | - Gary Keenan
- Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SA, United Kingdom
| | | |
Collapse
|
10
|
Robertson G, Ang KK, Maffulli N, Simpson CK, Rust PA. Return to sport following surgical management of triangular fibrocartilage tears: a systematic review. Br Med Bull 2019; 130:89-103. [PMID: 30943287 DOI: 10.1093/bmb/ldz013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/12/2019] [Indexed: 12/20/2022]
Abstract
INTRODUCTION This review aims to provide information on return rates and times to return to sport following surgical management of triangular fibrocartilage (TFC) tears. SOURCES OF DATA A systematic search of CINAHAL, Cochrane, EMBASE, Google Scholar, Medline, PEDro, Scopus, SPORTDiscus and Web of Science was performed using the keywords 'triangular', 'fibro-cartilage', 'complex', 'tear', 'distal radio-ulnar joint', 'athletes', 'sports', 'non-operative', 'conservative', 'operative' and 'return to sport'. AREAS OF AGREEMENT In all of the 10 studies included, conservative management for 6 weeks to 6 months was the first-line treatment. If symptoms persisted following this period, surgical management was advised. Arthroscopic debridement was recommended for central tears, and arthroscopic repair was recommended for peripheral tears. AREAS OF CONTROVERSY The optimal treatment modalities for TFC tears remain to be defined. GROWING POINTS Traumatic central tears can be treated with arthroscopic debridement alone. Arthroscopic repair with an all-inside repair can improve return rates to sport over an outside-in technique for ulna-sided tears. AREAS TIMELY FOR DEVELOPING RESEARCH Future prospective studies should aim to establish the optimal treatment modalities for TFC tears.
Collapse
Affiliation(s)
- Greg Robertson
- Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, Scotland, United Kingdom
| | - Kok Kiong Ang
- Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, Scotland, United Kingdom
| | - Nicola Maffulli
- Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, Scotland, United Kingdom
| | - Claire K Simpson
- Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, Scotland, United Kingdom
| | - Philippa A Rust
- Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, Scotland, United Kingdom
| |
Collapse
|
11
|
Goffin JS, Liao Q, Robertson GAJ. Return to sport following scaphoid fractures: A systematic review and meta-analysis. World J Orthop 2019; 10:101-114. [PMID: 30788227 PMCID: PMC6379737 DOI: 10.5312/wjo.v10.i2.101] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 11/03/2018] [Accepted: 01/10/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Scaphoid fracture is the most commonly fractured carpal bone in the athletic patient, accounting for over 85% of all sport-related carpal bone fractures, and is particularly common in sports involving high impact injuries to the wrist. The management of such injuries comprises both conservative and surgical techniques, as guided by fracture location and type. Athletes demonstrate a unique challenge with regards to the management of scaphoid fractures due to their requirement to return to sport, as soon as able.
AIM To review systemically all studies recording return to sport following scaphoid fractures, to collate information on return rates to sport (RRS) and mean return times (RTS) to sport and to determine differences in sporting outcome for the various treatment methods.
METHODS A systematic search of MEDLINE, EMBASE, CINAHAL, Cochrane, Google Scholar, Physiotherapy Evidence Database, SPORTDiscus, Web of Science and Scopus was performed in August 2018 using the keywords “scaphoid”, “fracture”, “acute”, “carpal”, “athletes”, “sports”, “non-operative”, “conservative”, “operative” and “return to sport”. All studies that recorded RRS and RTS following scaphoid fractures were included. RTS was recorded as the length of time from commencement of either primary conservative management or primary surgical procedure to return to sport.
RESULTS Eleven studies were included: Two randomised controlled trials, six retrospective cohort studies and three case series. Seven studies reported on conservative management (n = 77), and eight studies reported on surgical management (n = 83). For conservative management, RRS was 90% (69/77), and the mean RTS was 9.6 wk. Three studies allowed to return to sport in cast [RRS 89% (25/28); RTS 1.9 wk], and four studies required completion of cast treatment prior to returning to sport [RRS 90% (44/49); RTS 13.9 wk]. Four studies recorded fracture union data: Union rate 85% (47/55); mean time to union 14.0 wk. For surgical management, RRS was 98% (81/83), and RTS was 7.3 wk. Three studies reported on Percutaneous Screw Fixation [RRS 97% (32/33); RTS 6.5 wk], and five studies reported on Open Reduction Internal Fixation [RRS 98% (49/50); RTS 7.9 wk]. Six studies recorded fracture union data: Union rate 97% (69/71); mean time to union 9.8 wk. On meta-analysis, RRS (RR = 1.09; 95% confidence interval (CI): 1.00-1.18; P < 0.045), RTS (MD 2.3 wk; 95%CI: 0.79-3.87; P < 0.002), union rates (RR = 1.14; 95%CI: 1.01-1.28; P < 0.030) and mean times to union (MD 4.2 wk; 95%CI: 3.94-4.36; P < 0.001) were all significantly better for the surgical cohort compared to the conservative cohort.
CONCLUSION Surgical management of scaphoid fractures can provide significantly improved RRS and RTS to sport compared to conservative management. Both treatments, however, remain acceptable options, and athletes should be fully informed of the benefits and risks of both prior to deciding treatment plans. Immediate return to sport in a cast should be avoided due to the significant risk of non-union.
Collapse
Affiliation(s)
- Joaquim S Goffin
- Department of Orthopaedic and Trauma Surgery, Ninewells Hospital, Dundee DD2 1SY, United Kingdom
| | - Quintin Liao
- Department of Orthopaedic and Trauma Surgery, Forth Valley Royal Hospital, Larbert FK5 4WR, United Kingdom
| | - Gregory AJ Robertson
- Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, Scotland EH16 4SA, United Kingdom
| |
Collapse
|
12
|
Helmig K, Treme G, Richter D. Management of injuries in snowboarders: rehabilitation and return to activity. Open Access J Sports Med 2018; 9:221-231. [PMID: 30349409 PMCID: PMC6188004 DOI: 10.2147/oajsm.s146716] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Snowboarding has seen a continuous increase in popularity, leading to an increase in the number of snowboarding injuries seen in orthopedic practice. Upper-extremity injuries are more common than lower-extremity, spine, and pelvis injuries. In this review, we focus on the most common snowboarding injuries of the extremities, spine, and pelvis and provide an overview of their respective rehabilitation and return-to-sport protocols. Despite many of the injuries seen in snowboarding also occurring in other sports, objective data about rehabilitation and return to sport are lacking for many injuries. This provides an opportunity for research in the area with regard to many sports and many different injuries.
Collapse
Affiliation(s)
- Kathryn Helmig
- Department of Orthopaedic Surgery, University of New Mexico, Albuquerque, NM, USA,
| | - Gehron Treme
- Department of Orthopaedic Surgery, University of New Mexico, Albuquerque, NM, USA,
| | - Dustin Richter
- Department of Orthopaedic Surgery, University of New Mexico, Albuquerque, NM, USA,
| |
Collapse
|
13
|
Trajectory of Short- and Long-Term Recovery of Tibial Shaft Fractures After Intramedullary Nail Fixation. J Orthop Trauma 2017; 31:559-563. [PMID: 28538288 DOI: 10.1097/bot.0000000000000886] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine the trajectory of recovery after tibial shaft fracture treated with intramedullary nail over the first 5 years and to evaluate the magnitude of the changes in functional outcome at various time intervals. DESIGN Prospective cohort study. SETTING A Level 1 trauma center. PATIENTS/PARTICIPANTS One hundred thirty-two patients with tibial shaft fracture (OTA 42-A, B, C) were enrolled into the Center's prospective orthopaedic trauma database between January 2005 and February 2010. Functional outcome data were collected at baseline, 6 months, 1 year, and 5 years. INTERVENTION Enrolled patients were treated acutely with intramedullary nailing of their tibia. MAIN OUTCOME MEASUREMENTS Evaluation was performed using the Short Form-36 and Short Musculoskeletal Function Assessment (SMFA). RESULTS Mean SF-36 physical component scores improved between 6 and 12 months (P = 0.0008) and between 1 and 5 years (P = 0.0029). Similarly, mean SMFA dysfunction index scores improved between 6 and 12 months (P = 0.0254) and between 1 and 5 years (P = 0.0106). In both scores, the rate or slope of this improvement is flatter between 1 and 5 years than it is between 6 and 12 months. Furthermore, SF-36 and SMFA scores did not reach baseline at 5 years (SF-36 P < 0.0001, SMFA P = 0.0026). A significant proportion of patients were still achieving a minimal clinically important difference in function between 1 and 5 years (SF-36 = 54%, SMFA = 44%). CONCLUSIONS The trajectory of functional recovery after tibial shaft fracture is characterized by an initial decline in function, followed by improvement between 6 and 12 months. There is still further improvement beyond 1 year, but this is of flatter trajectory. The 5-year results indicate that function does not improve to baseline by 5 years after injury. LEVEL OF EVIDENCE Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Collapse
|
14
|
Management of Sport-Related Fractures: Operative Versus Non-Operative Management. Trauma Mon 2017. [DOI: 10.5812/traumamon.21485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
15
|
Robertson GAJ, Wong SJ, Wood AM. Return to sport following tibial plateau fractures: A systematic review. World J Orthop 2017; 8:574-587. [PMID: 28808629 PMCID: PMC5534407 DOI: 10.5312/wjo.v8.i7.574] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Revised: 04/03/2017] [Accepted: 04/24/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To systemically review all studies reporting return to sport following tibial plateau fracture, in order to provide information on return rates and times to sport, and to assess variations in sporting outcome for different treatment methods.
METHODS A systematic search of CINAHAL, Cochrane, EMBASE, Google Scholar, MEDLINE, PEDro, Scopus, SPORTDiscus and Web of Science was performed in January 2017 using the keywords “tibial”, “plateau”, “fractures”, “knee”, “athletes”, “sports”, “non-operative”, “conservative”, “operative”, “return to sport”. All studies which recorded return rates and times to sport following tibial plateau fractures were included.
RESULTS Twenty-seven studies were included: 1 was a randomised controlled trial, 7 were prospective cohort studies, 16 were retrospective cohort studies, 3 were case series. One study reported on the outcome of conservative management (n = 3); 27 reported on the outcome of surgical management (n = 917). Nine studies reported on Open Reduction Internal Fixation (ORIF) (n = 193), 11 on Arthroscopic-Assisted Reduction Internal Fixation (ARIF) (n = 253) and 7 on Frame-Assisted Fixation (FRAME) (n = 262). All studies recorded “return to sport” rates. Only one study recorded a “return to sport” time. The return rate to sport for the total cohort was 70%. For the conservatively-managed fractures, the return rate was 100%. For the surgically-managed fractures, the return rate was 70%. For fractures managed with ORIF, the return rate was 60%. For fractures managed with ARIF, the return rate was 83%. For fractures managed with FRAME was 52%. The return rate for ARIF was found to be significantly greater than that for ORIF (OR 3.22, 95%CI: 2.09-4.97, P < 0.001) and for FRAME (OR 4.33, 95%CI: 2.89-6.50, P < 0.001). No difference was found between the return rates for ORIF and FRAME (OR 1.35, 95%CI: 0.92-1.96, P = 0.122). The recorded return time was 6.9 mo (median), from a study reporting on ORIF.
CONCLUSION Return rates to sport for tibial plateau fractures remain limited compared to other fractures. ARIF provides the best return rates. There is limited data regarding return times to sport. Further research is required to determine return times to sport, and to improve return rates to sport, through treatment and rehabilitation optimisation.
Collapse
|
16
|
Robertson GAJ, Goffin JS, Wood AM. Return to sport following stress fractures of the great toe sesamoids: a systematic review. Br Med Bull 2017; 122:135-149. [PMID: 28444129 DOI: 10.1093/bmb/ldx010] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Accepted: 04/04/2017] [Indexed: 01/13/2023]
Abstract
INTRODUCTION This review aims to provide information on return rates and times to sport following stress fractures of the great toe sesamoids (SFGTSs). SOURCES OF DATA A systematic search of CINAHAL, Cochrane, EMBASE, Google Scholar, Medline, PEDro, Scopus, SPORTDiscus and Web of Science was performed using the keywords 'stress', 'fractures', 'great', 'toe', 'sesamoid', 'athletes', 'sports', 'non-operative', 'conservative', 'operative' and 'return to sport'. AREAS OF AGREEMENT Fourteen studies were included: three studies reported on the outcome of conservatively-managed SFGTSs; thirteen studies reported on the outcome of surgically-managed SFGTSs. The management principles were to attempt conservative management for 2-6 months using activity modification, analgesia, orthotics and physiotherapy; if symptoms persisted following this, surgical management was to be recommended, either with internal fixation or sesamoidectomy. AREAS OF CONTROVERSY The optimal treatment modalities for SFGTSs remain to be defined. GROWING POINTS Internal fixation shows the best return to full-level sport rates with low rates of complications. AREAS TIMELY FOR DEVELOPING RESEARCH Future prospective studies should aim to establish the optimal treatment modalities for SFGTSs.
Collapse
Affiliation(s)
- G A J Robertson
- Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, 5/6 Gladstone Terrace, Edinburgh EH9 1LX, UK
| | - J S Goffin
- Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, 5/6 Gladstone Terrace, Edinburgh EH9 1LX, UK
| | - A M Wood
- Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, 5/6 Gladstone Terrace, Edinburgh EH9 1LX, UK
| |
Collapse
|
17
|
Robertson GAJ, Wood AM. Return to sport following clavicle fractures: a systematic review. Br Med Bull 2016; 119:111-28. [PMID: 27554280 DOI: 10.1093/bmb/ldw029] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/21/2016] [Indexed: 12/19/2022]
Abstract
INTRODUCTION This review aims to provide information on the return rates and return times to sport following clavicle fractures. SOURCES OF DATA A systematic search of Medline, EMBASE, CINAHAL, Cochrane, Web of Science, PEDro, SPORTDiscus, Scopus and Google Scholar was performed using the keywords 'clavicle', 'clavicular', 'fractures', 'athletes', 'sports', 'non-operative', 'conservative', 'operative', 'return to sport'. AREAS OF AGREEMENT Twenty-three studies were included: 10 reported on mid-shaft fractures, 14 on lateral fractures. The management principles for athletic patients were to attempt non-operative management for undisplaced fractures to undertake operative intervention for displaced lateral fractures and to recommend operative intervention for displaced mid-shaft fractures. AREAS OF CONTROVERSY The optimal surgical modality for mid-shaft and lateral clavicle fractures. GROWING POINTS Operative management of displaced mid-shaft fractures offers improved return rates and times to sport compared to non-operative management. Suture fixation and non-acromio-clavicular joint (ACJ)-spanning plate fixation of displaced lateral fractures show promising results. AREAS TIMELY FOR DEVELOPING RESEARCH Future prospective studies should aim to establish the optimal treatment modalities for clavicle fractures.
Collapse
Affiliation(s)
- G A J Robertson
- Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, UK.
| | - A M Wood
- Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, UK
| |
Collapse
|
18
|
|
19
|
Robertson GAJ, Wood AM. Fractures in sport: Optimising their management and outcome. World J Orthop 2015; 6:850-63. [PMID: 26716081 PMCID: PMC4686432 DOI: 10.5312/wjo.v6.i11.850] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 09/04/2015] [Accepted: 10/01/2015] [Indexed: 02/06/2023] Open
Abstract
Fractures in sport are a specialised cohort of fracture injuries, occurring in a high functioning population, in which the goals are rapid restoration of function and return to play with the minimal symptom profile possible. While the general principles of fracture management, namely accurate fracture reduction, appropriate immobilisation and timely rehabilitation, guide the treatment of these injuries, management of fractures in athletic populations can differ significantly from those in the general population, due to the need to facilitate a rapid return to high demand activities. However, despite fractures comprising up to 10% of all of sporting injuries, dedicated research into the management and outcome of sport-related fractures is limited. In order to assess the optimal methods of treating such injuries, and so allow optimisation of their outcome, the evidence for the management of each specific sport-related fracture type requires assessment and analysis. We present and review the current evidence directing management of fractures in athletes with an aim to promote valid innovative methods and optimise the outcome of such injuries. From this, key recommendations are provided for the management of the common fracture types seen in the athlete. Six case reports are also presented to illustrate the management planning and application of sport-focussed fracture management in the clinical setting.
Collapse
|