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Chen B, Williamson T, Murray A, Zhou H, Clement N. A Scoping Review of the Epidemiology, Management, and Outcomes of Golf-Related Fractures. Curr Sports Med Rep 2024; 23:174-182. [PMID: 38709943 DOI: 10.1249/jsr.0000000000001166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
ABSTRACT Golf is a popular sport; however, there is a paucity of data in relation to golf-associated fractures, and the rate and timing of returning to golf. The aim of this review is to describe golf-associated fractures, including epidemiology, management, and timing of returning to golf following treatment. A literature search was performed using MEDLINE/PubMed, Embase, and Web of Science. Data were extracted and summarized in a narrative synthesis. A total of 436 articles were identified with an initial search of which 58 met the inclusion criteria. Twelve anatomical sites of golf swing-related fractures were identified, of which 10 sites were specific for stress fractures. The most common sites of golf swing-related stress fractures were the ribs followed by the hook of hamate. There was a common theme of delay to diagnosis, being initially assigned to a soft tissue injury. Most golfers with swing-related stress fractures were able to return to golf with the exception of osteoporotic associated vertebral stress fractures. Timing of returning to golf was between 4 and 12 months for most of the golfers with stress fractures following conservative management. Operative intervention was an option of hook of hamate nonunion, following a stress fracture, and tibial shaft stress fractures. Golf equipment-related fractures were not rare and were associated with major trauma and in some cases associated with significant persistent morbidity. Golf-related stress fractures commonly involve the ribs and hook of hamate; knowledge of this may aid in early diagnosis and appropriate treatment when symptomatic golfers are encountered. Although golf is a noncontact sport, fractures associated with golf equipment can be life changing, and safety training guidelines should be established.
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Affiliation(s)
- Bin Chen
- Second Affiliated Hospital of Soochow University
| | | | - Andrew Murray
- European Tour Performance Institute, University of Edinburgh
| | - Haibin Zhou
- Second Affiliated Hospital of Soochow University
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Chung BH, Shaw KA, Burke JS, Jackson KL, Schmitz MR, Boomsma S, Hurvitz AP, Moreland CM, O'Brien FP, Antosh IJ, Huh J, Waterman BR, Wheatley BM, Potter BK. Consensus and Equipose in the Management of Military Trainee Femoral Neck Stress Fractures: A Survey of Military Surgeons. Mil Med 2024; 189:e82-e89. [PMID: 37261898 DOI: 10.1093/milmed/usac426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 10/25/2022] [Accepted: 12/23/2022] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND Femoral neck stress fractures (FNSFs) are a unique injury pattern not commonly treated in the civilian trauma population; however, it is particularly high with military trainees engaged in basic combat training. To date, no study has surveyed a population of military orthopedic surgeons on treatment preferences for military service members (SMs) with FNSF. QUESTIONS We aim to evaluate the extent of clinical equipoise that exists in the management of these injuries, hypothesizing that there would be consensus in the factors dictating surgical and non-surgical intervention for FNSF. PATIENTS AND METHODS A 27-question survey was created and sent to U.S. military orthopedic surgeon members of the Society of Military Orthopaedic Surgeons. The survey was designed in order to gather the experience among surgeons in treating FNSF and identifying variables that play a role in the treatment algorithm for these patients. In addition, seven detailed, clinical vignettes were presented to further inquire on surgeon treatment preferences. Binomial distribution analysis was used to evaluate for common trends within the surgeon's treatment preferences. RESULTS Seventy orthopedic surgeons completed the survey, the majority of whom were on active duty status in the U.S. Military (82.86%) and having under 5 years of experience (61.43%). Majority of surgeons elected for a multiple screw construct (92.86%), however the orientation of the multiple screws was dependent on whether the fracture was open or closed. Management for compression-sided FNSF involving ≥50% of the femoral neck width, tension-sided FNSF, and stress fractures demonstrating fracture line progression had consensus for operative management. Respondents agreed upon prophylactic fixation of the contralateral hip if the following factors were involved: Complete fracture (98.57%), compression-sided fracture line >75% (88.57%), compression-sided fracture line >50-75% with hip effusion (88.57%), contralateral tension-sided fracture (87.14%), and compression-sided fracture line >50-75% (84.29%). An FNSF < 50% on the contralateral femoral neck or a hip effusion was indeterminate in surgeons indicating need for prophylactic fixation. Majority of surgeons (77.1%) utilized restricted toe-touch weight-bearing for postoperative mobility restrictions. CONCLUSIONS Consensus exists for surgical and non-surgical management of FNSF by U.S. military orthopedic surgeons, despite the preponderance of surgeons reporting a low annual volume of FNSF cases treated. However, there are certain aspects in the operative and non-operative management of FNSF that are unanimously adhered to. Specifically, our results demonstrate that there is no clear indication on the management of FNSF when an associated hip effusion is involved. Additionally, the indications for surgically treating contralateral FNSF are unclear. LEVEL OF EVIDENCE IV.
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Affiliation(s)
| | - K Aaron Shaw
- Dwight D. Eisenhower Army Medical Center, Fort Gordon, GA 30905, USA
| | - Joseph S Burke
- University of Kentucky College of Medicine, Lexington, KY 40506, USA
| | - Keith L Jackson
- Dwight D. Eisenhower Army Medical Center, Fort Gordon, GA 30905, USA
- Uniformed Services University of Health Sciences, Bethesda, MD 20814, USA
| | - Matthew R Schmitz
- University of Kentucky College of Medicine, Lexington, KY 40506, USA
- Uniformed Services University of Health Sciences, Bethesda, MD 20814, USA
| | - Shawn Boomsma
- University of Kentucky College of Medicine, Lexington, KY 40506, USA
- Jackson Memorial Hospital, Miami, FL 33136, USA
- Department of Orthopaedic Surgery, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | | | | | | | - Ivan J Antosh
- Uniformed Services University of Health Sciences, Bethesda, MD 20814, USA
- San Antonio Military Medical Center, San Antonio, TX 78219, USA
| | - Jeannie Huh
- Uniformed Services University of Health Sciences, Bethesda, MD 20814, USA
- San Antonio Military Medical Center, San Antonio, TX 78219, USA
| | - Brian R Waterman
- Wake Forest University School of Medicine, Winston-Salem, NC 27109, USA
- U.S. Ski & Snowboard, Park City, UT 84060, USA
| | | | - Benjamin K Potter
- Uniformed Services University of Health Sciences, Bethesda, MD 20814, USA
- Department of Surgery, Walter Reed National Military Medical Center, Bethesda, MD 20814, USA
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Yang K, Sambandam S, Yan MJ, Huo M. Femoral neck stress fracture return to activity and the effect of metabolic dysfunction on recovery: A systematic review. J Orthop 2023; 43:79-92. [PMID: 37545869 PMCID: PMC10400407 DOI: 10.1016/j.jor.2023.07.023] [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: 06/08/2023] [Revised: 07/19/2023] [Accepted: 07/20/2023] [Indexed: 08/08/2023] Open
Abstract
Background Femoral neck stress fractures are rare fractures traditionally found in athletes and military personnel. There is limited literature on return to activity. Objectives To report return to activity rates and times, and long-term outcomes for femoral neck stress fractures reported in the literature. To examine the effects of bone metabolic dysfunction and surgical management on return to activity following FNSF. Research design & methods A systematic literature review of case reports and case series on adults with femoral neck stress fracture that were diagnosed by gross fracture line on X-ray or gold-standard diagnosis with MRI was conducted. Initial search was limited to articles published from January 1997 to Jan 2023 listed in Medline, Embase, and Scopus. Additional articles were manually added via search of retained paper sources. Patient demographics, fracture type, return to activity time, and surgical vs non-surgical treatment modality were collected. In addition, long-term outcomes and metabolic effects, if reported, were abstracted. Results A total of 40 case reports or case series were retained. 123 stress fractures of the femoral neck from 103 patients were compiled. Of the 103 patients, data on return to activity at least one year following treatment was available for 53 patients. 71% (37/53) of those with long-term follow-up information returned to full pre-injury activity. 24% (13/53) at long-term follow-up had functional recovery but did not return to pre-injury activity due to residual pain. 4% (3/53) had disabling pain. Metabolic workup information was available for 36 patients. Conclusion Long-term follow-up and return to activity information following FNSF treatment are not commonly reported. Based on the available data, outcomes appear benign with most returning to full activity. There is a clear need for standardization of follow-up periods and hip function measure after FNSF treatment. Additionally, a sizable proportion of FNSF occurred in a new population of low-activity individuals with abnormal bone metabolism, which warrants further exploration.
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Affiliation(s)
- Kristine Yang
- University of Texas Southwestern Medical Center, Dept. of Orthopaedic Surgery, United States
| | - Senthil Sambandam
- University of Texas Southwestern Medical Center, Dept. of Orthopaedic Surgery, United States
- Veteran's Affairs North Texas Health Care System, Dept. of Orthopaedic Surgery, United States
| | - Matthew J. Yan
- David Geffen School of Medicine, University of California Los Angeles, United States
| | - Michael Huo
- University of Texas Southwestern Medical Center, Dept. of Orthopaedic Surgery, United States
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Biolzi F, Dinnen R, Jacobs B, Doty T, Barkley C, Jackson KL, Shaw KA. The Subcapital Femoral Neck Stress Fracture: A Novel Subtype of Compression-sided Stress Fracture-A Report of Three Cases. Mil Med 2023; 188:e2819-e2822. [PMID: 36226755 DOI: 10.1093/milmed/usac304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 09/14/2022] [Accepted: 09/21/2022] [Indexed: 11/12/2022] Open
Abstract
Femoral neck stress fractures (FNSFs) are increasingly common, particularly in military training. The usual mode of classifying these injuries is based on the involvement of the compression or tension side of the femoral neck; however, this may oversimplify and fail to address factors such as the orientation of the fracture line. We present a novel subtype of a compression-sided FNSF affecting the subcapital femoral neck and report the treatment outcomes in a military trainee population. A retrospective analysis of patients with a subcapital, compression-sided FNSF was identified from a single U.S. Army basic trainee installation. Radiographic evaluation as well as treatment outcomes associated with the ability to complete military training were reported. A total of three patients with a subcapital compression-sided FNSF were identified in a military trainee population, accounting for 10% of all FNSFs that developed over a 3-month period. Of these individuals, one was treated operatively while the other two were treated non-operatively. Overall, one patient was able to return to and successfully complete military training.
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Affiliation(s)
- Francesco Biolzi
- Department of Orthopaedic Surgery, Dwight D. Eisenhower Army Medical Center, Fort Gordon, GA 30905, USA
| | - Ryan Dinnen
- College of Medicine, Uniformed Services University of Health Sciences, Bethesda, MD 20814, USA
| | - Bonamico Jacobs
- Department of Orthopaedic Surgery, Dwight D. Eisenhower Army Medical Center, Fort Gordon, GA 30905, USA
| | - Tyler Doty
- West Virginia School of Osteopathic Medicine, Lewisburg, WV 24901, USA
| | - Colleen Barkley
- Department of Physical Therapy, Moncrief Army Community Hospital, Columbia, SC 29207, USA
| | - Keith Lynn Jackson
- Department of Orthopaedic Surgery, Dwight D. Eisenhower Army Medical Center, Fort Gordon, GA 30905, USA
- Department of Surgery, Uniformed Services University of Health Sciences, Bethesda, MD, USA
| | - K Aaron Shaw
- Department of Orthopaedic Surgery, Dwight D. Eisenhower Army Medical Center, Fort Gordon, GA 30905, USA
- Department of Surgery, Uniformed Services University of Health Sciences, Bethesda, MD, USA
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Schultz BJ, Mansour A, Eastman JA, Routt MC. Symptomatic Ischial Stress Fractures in Elite Athletes Treated With Percutaneous Screws: A Report of 2 Cases. JBJS Case Connect 2022; 12:01709767-202212000-00050. [PMID: 36820848 DOI: 10.2106/jbjs.cc.22.00481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 11/01/2022] [Indexed: 02/24/2023]
Abstract
CASES Two high-level athletes with symptomatic gluteal pain with explosive movements that had failed nonoperative management were eventually diagnosed with ischial stress fractures. These were treated with percutaneous posterior column screws. Both patients healed their fractures and made full return to sport. CONCLUSION Ischial stress fractures should be considered in the differential for athletes with persistent gluteal pain. Percutaneous fixation is a minimally invasive and effective method of treating symptomatic ischial stress fractures that have failed nonoperative treatment.
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Affiliation(s)
- Blake J Schultz
- Department of Orthopaedic Surgery, University of Texas McGovern Medical School, Houston, Texas
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