Acute injuries in Badminton from 10 to 66 years of age: an epidemiological study of 140 cases among all types of practice

PURPOSE

The main objective of this retrospective study was to establish an epidemiological overview of patients admitted to an Emergency department specialized in musculo-skeletal trauma for acute lesions related to Badminton practice in the period from January 1st 2010 to January 1st 2015.

METHODS

There were 135 patients with 140 admissions and 146 total number of injuries. There were 67 females (48%) and 73 males (52%). The mean age was 28 ± 13.8 years, ranging 10-66 years. 91 patients (65%) could be contacted by telephone to fill a questionnaire aimed at completing the information provided by the medical records.

RESULTS

129 lesions (88.3%) were located to the lower limbs, 16 (11%) to the upper limbs, and one (0.7%) at the head. For the whole series, there were 89 sprains (60.9%), 32 tendino-muscular lesions (21.9%), 13 fractures (8.9%), 5 dislocations (3.4%), 3 painful contusions (2.1%), 3 meniscal injuries (2.1%) and one wound (0.7%). In the lower limbs, lateral ankle sprain was the most frequent diagnosis (43.4%), followed successively by rupture of the Achilles tendon (13.9%), tennis leg (8.5%), and mid-foot sprain (6.9%). Of the 146 lesions, 117 (80.1%) received non-operative treatment, 28 (19.1%) received surgical treatment in the operation room, and one simple wound (0.7%) was sutured in the emergency room.

CONCLUSIONS

Lateral ankle sprains followed by tendino-muscular lesions of the calf are by far the most frequent lesions of badminton. Modification of the shoes of badminton players should be considered to decrease the high incidence of ankle injuries.

Patellar Clunk Syndrome Following Posterior Stabilized Total Knee Replacement: Report of Two Cases

Patellar clunk syndrome (PCS) occasionally occurs after posterior stabilized total knee replacement (PS-TKR), and is characterized by a painful palpable audible clunk of the patella when the knee moves from flexion to extension. It has been classically attributed to the formation of fibrous nodule at the junction of the proximal pole of the patella and the undersurface of the distal quadriceps tendon. However, various intra-articular peripatellar proliferative fibrous formations have also been reported with a wide spectrum of symptoms, ranging from crepitation to frank patellar clunk. Treatment of the syndrome remains essentially surgical, and usually consists of resection of the fibrous nodules. This paper reports two cases of PCS and aims at bringing attention to this entity in terms of pathogenesis, clinical diagnosis, and treatment, through a review of the literature.

Missed Bilateral Anterior Shoulder Dislocation With Bilateral Coracoid Fracture and Unilateral Long Head of Biceps Rupture

Missed or chronic bilateral anterior shoulder dislocation is a rare presentation, usually secondary to epileptic attack. We present herein an exceptional case of this injury pattern, associated with bilateral displaced fracture of the coracoid process, and unilateral rupture of the long head of biceps. Treatment consisted of open reduction through osteotomy of the lesser tuberosity, with additional stabilization of the glenohumeral joint, using the Latarjet procedure by transposition of the coracoid fragment with its attached conjoint tendon to the antero-inferior glenoid rim. Rupture of the long head of the biceps required tenodesis. Temporary glenohumeral pin transfixation was performed for residual instability at the end of the procedure. Patients with postictal shoulder pain, discomfort, or disability should be investigated with adequate radiographs, in addition to CT scan or MRI when needed. Early diagnosis allows for safe closed reduction, and helps avoid late and more complex surgical treatment required for missed or chronic dislocations.

Quanta of geometry: noncommutative aspects

In the construction of spectral manifolds in noncommutative geometry, a higher degree Heisenberg commutation relation involving the Dirac operator and the Feynman slash of real scalar fields naturally appears and implies, by equality with the index formula, the quantization of the volume. We first show that this condition implies that the manifold decomposes into disconnected spheres, which will represent quanta of geometry. We then refine the condition by involving the real structure and two types of geometric quanta, and show that connected spin manifolds with large quantized volume are then obtained as solutions. The two algebras M_{2}(H) and M_{4}(C) are obtained, which are the exact constituents of the standard model. Using the two maps from M_{4} to S^{4} the four-manifold is built out of a very large number of the two kinds of spheres of Planckian volume. We give several physical applications of this scheme such as quantization of the cosmological constant, mimetic dark matter, and area quantization of black holes.

Trans-fracture transposition of the radial nerve during the open approach of humeral shaft fractures

The radial nerve constitutes a major problem in humeral shaft fractures; it may be injured immediately or during closed reduction or open reduction and internal fixation with plate and screws. After fixation, the nerve always runs directly over the plate without any interposed structure. If a revision surgery is indicated, the nerve is at high risk as it is usually difficult to dissect from surrounding fibrotic scar tissue or callus formation. To avoid these complications, some authors reported transposition of the radial nerve through the fracture line. We present herein the surgical technique of the trans-fracture transposition of the radial nerve during open reduction and internal fixation of humeral shaft fractures, along with our preliminary results in 6 cases and a review of the literature.

Increased expression of Nox1 in neointimal smooth muscle cells promotes activation of matrix metalloproteinase-9

OBJECTIVE

Vascular injury causes neointimal hypertrophy, which is characterized by redox-mediated matrix degradation and smooth muscle cell (SMC) migration and proliferation. We hypothesized that, as compared to the adjacent medial SMCs, neointimal SMCs produce increased superoxide via NADPH oxidase, which induces redox-sensitive intracellular signaling to activate matrix metalloproteinase-9 (MMP-9).

METHODS AND RESULTS

Two weeks after balloon injury, rat aorta developed a prominent neointima, containing increased expression of NADPH oxidase and reactive oxygen species (ROS) as compared to the medial layer. Next, SMCs were isolated from either the neointima or the media and studied in culture. Neointimal-derived SMCs exhibited increased Nox1 expression and ROS levels as compared to medial SMCs. Neointimal SMCs had higher cell growth rates than medial SMCs. ROS-dependent ERK1/2 phosphorylation was greater in neointimal SMCs. MMP-9 activity, as detected by gel zymography, was greater in neointimal SMCs under resting and stimulated conditions and was prevented by expression of an antisense to Nox1 or treatment with an ERK1/2 inhibitor.

CONCLUSIONS

Following vascular injury, the increased expression of Nox1 in SMCs within the neointima initiates redox-dependent phosphorylation of ERK1/2 and subsequent MMP-9 activation.

Glutathione peroxidase-deficient smooth muscle cells cause paracrine activation of normal smooth muscle cells via cyclophilin A

BACKGROUND/AIMS

Reduced activity of the antioxidant glutathione peroxidase-1 (GPx1) correlates with increased risk of cardiovascular events in patients with coronary artery disease. However, it remains unclear whether this imbalance in antioxidant capacity directly contributes to activation of vascular cells. In response to oxidative stress, smooth muscle cells (SMCs) secrete the pro-inflammatory immunomodulator cyclophilin A (CyPA). We hypothesized that reduction in vascular cell GPx1 activity causes secretion of CyPA and paracrine-mediated activation of NF-κB and proliferation of SMCs.

METHODS/RESULTS

Using a murine model of GPx1 deficiency (GPx1(+/-)), we found elevated levels of hydrogen peroxide levels and increased secretion of CyPA in both arterial segments and cultured SMCs as compared to wild type (WT). Conditioned media from GPx1(+/-) SMCs caused increased NF-κB activation of quiescent WT SMCs, and this was inhibited by the antioxidant N-acetyl-l-cysteine or by cyclosporine A (CsA). In co-culture experiments, SMCs derived from GPx1(+/-) aorta caused increased proliferation of WT SMCs, which was also inhibited by CsA.

CONCLUSIONS

Reduction in vascular cell GPx1 activity and the associated increase in oxidative stress cause CyPA-mediated paracrine activation of SMCs. These findings identify a novel mechanism by which an imbalance in antioxidant capacity may contribute to vascular disease.

Irreducible volar dislocation of the proximal interphalangeal finger joint

Volar dislocation of the proximal interphalangeal finger joint is rare. The trauma that causes this injury consists in a rotation mechanism in almost all cases. It may be initially missed and diagnosed at a late sequel stage. Closed reduction should always be attempted first but this procedure may result in failure, necessitating a surgical intervention. In irreducible cases, the surgical investigation shows a longitudinal split which separates one of the lateral bands (ulnar or radial) from the central slip of the terminal extensor tendon. In addition, the lateral band is displaced to the volar aspect of the head of the first phalanx, and partially entrapped into the proximal interphalangeal joint, the head of the first phalanx being trapped between the central slip and the displaced lateral band. Surgical relocation of the displaced lateral band gives an immediate reduction of the dislocated joint. We present a case of irreducible dislocation of the proximal interphalangeal joint of the right index finger in a 42-year-old female patient who required a surgical treatment. We present the diagnostic, anatomic and therapeutic aspects of this rare injury, together with a review of the literature.

Conceptual explanation for the algebra in the noncommutative approach to the standard model

The purpose of this Letter is to remove the arbitrariness of the ad hoc choice of the algebra and its representation in the noncommutative approach to the standard model, which was begging for a conceptual explanation. We assume as before that space-time is the product of a four-dimensional manifold by a finite noncommmutative space F. The spectral action is the pure gravitational action for the product space. To remove the above arbitrariness, we classify the irreducible geometries F consistent with imposing reality and chiral conditions on spinors, to avoid the fermion doubling problem, which amounts to have total dimension 10 (in the K-theoretic sense). It gives, almost uniquely, the standard model with all its details, predicting the number of fermions per generation to be 16, their representations and the Higgs breaking mechanism, with very little input.

Quantum gravity boundary terms from the spectral action of noncommutative space

We study the boundary terms of the spectral action of the noncommutative space, defined by the spectral triple dictated by the physical spectrum of the standard model, unifying gravity with all other fundamental interactions. We prove that the spectral action predicts uniquely the gravitational boundary term required for consistency of quantum gravity with the correct sign and coefficient. This is a remarkable result given the lack of freedom in the spectral action to tune this term.

Gp91phox contributes to NADPH oxidase activity in aortic fibroblasts but not smooth muscle cells

Reactive oxygen species (ROS) derived from vascular NADPH oxidase are important in normal and pathological regulation of vessel growth and function. Cell-specific differences in expression and function of the catalytic subunit of NADPH oxidase may contribute to differences in vascular cell response to NADPH oxidase activation. We examined the functional expression of gp91phox on NADPH oxidase activity in vascular smooth muscle cells (SMC) and fibroblasts (FB). As measured by dihydroethidium fluorescence in situ, superoxide (O2-*) levels were greater in adventitial cells compared with medial SMC in wild-type aorta. In contrast, there was no difference in O2-* levels between adventitial cells and medial SMC in aorta from gp91phox-deficient (gp91phox KO) mice. Adventitial-derived FB and medial SMC were isolated from the aorta of wild-type and gp91phox KO mice and grown in culture. Consistent with the observations in situ, basal and stimulated ROS levels were reduced in FB isolated from aorta of gp91phox KO compared with FB from wild-type aorta, whereas ROS levels were similar in SMC derived from gp91phox KO and wild-type aorta. There were no differences in expression of superoxide dismutase between gp91phox KO and wild-type FB to account for these observations. Because gp91phox is associated with membranes, we examined NADPH-stimulated O2-. production in membrane-enriched fractions of cell lysate. As measured by chemiluminescence, NADPH oxidase activity was markedly greater in wild-type FB compared with gp91phox KO FB but did not differ among the SMCs. Confirming functional expression of gp91phox in FB, antisense to gp91phox decreased ROS levels in wild-type FB. Finally, deficiency of gp91phox did not alter expression of the gp91phox homolog NOX4 in isolated FB. We conclude that the neutrophil subunit gp91phox contributes to NADPH oxidase function in vascular FB, but not SMC.