Hallux Sesamoid Injury Characteristics in Young Athletes Presented to the Sports Medicine Clinic

OBJECTIVE

To investigate clinical diagnoses, sports participation, and return to sport timeline associated with hallux sesamoid injuries with sex comparisons.

DESIGN

Descriptive epidemiology study.

SETTING

Sports medicine clinics at a tertiary-level pediatric medical center.

PATIENTS

Six hundred eighty-three young athletes (546 women and 137 men).

INDEPENDENT VARIABLES

Sex (women vs men).

MAIN OUTCOME MEASURES

Clinical diagnoses, participating sports, and injury timeline.

RESULTS

The most common diagnosis was sesamoiditis (62.6%). The top 3 primary sports were dance (34.6%), running (13.7%), and soccer (11.7%). When stratified by sex, dance (40.1%), running (13.6%), and soccer (10.7%) were the top primary sports for women while running (19.4%), soccer (18.5%), and basketball (11.3%) were the leading diagnoses for male athletes. The mean time between injury occurrence and first clinic visit was 135.5 ± 229.3 days. The mean time between the first clinic visit and return to sport was 104.3 ± 128.2 days. Comparison by sex showed that women had a longer mean time than men (women: 111.5 ± 132.5 days, men: 67.2 ± 96.3 days, P = 0.001). The mean time from injury occurrence to return to sport was 235.2 ± 281.0 days. Women showed a longer mean timeline for return to sport compared with men (women: 245.2 ± 288.2 days, men: 179.3 ± 231.9 days, P = 0.014).

CONCLUSION

Sesamoiditis was the most common diagnosis, and dance, running, and soccer were top 3 sports. The most salient finding was that women taking almost twice as long to return the sport or activity compared with men, which likely stems from delay of reporting symptom onset to clinics.

Platelet rich plasma for hallux sesamoid injuries: a case series

OBJECTIVE

Hallux sesamoid injuries are well described and can be debilitating and chronically disabling. The role of orthobiologics such as platelet-rich plasma (PRP) in sesamoid injuries has not been reported. This study describes three cases of recalcitrant hallux sesamoid injuries in teenage athletes who returned to impact activities, pain free, following one treatment of PRP.

METHODS

This is a case-series study describing three teenage athletes presenting to a tertiary level pediatric sports medicine practice with chronic hallux sesamoid injuries.

RESULTS

The three patients (two female, one male) described in this case series were 13-, 16-, and 17-year-old athletes. Their primary sports were ballet, basketball, and Irish step dance, respectively. All three athletes received PRP: two received unilateral treatment (one tibial sesamoid, one fibular sesamoid) and one received treatment to bilateral tibial sesamoids. The average duration of symptoms prior to PRP was 52.5 weeks (14-128 weeks). The average time out of their primary sport was 48.7 weeks (20-78 weeks). Three of the 4 sesamoids treated with PRP were tibial sesamoids. Each site of injury was treated with one treatment of leukocyte-rich PRP. All three athletes were cleared to return to impact activities such as running and jumping at 6-9 weeks following PRP, specifically 9 weeks after the final PRP injection for the patient who underwent bilateral treatments.

CONCLUSION

In the three cases provided of sesamoid injuries treated with PRP, the time to return to impact activities was less than reported for athletes not treated with PRP. Acknowledging that other management factors likely contributed to return to impact activities, this case series sets the groundwork for future research investigating the role of PRP with needle fenestration in the treatment of sesamoid injuries.

Special Considerations for Growing Dancers

Care of young dancers requires a unique approach during a critical time of growth and development. Young dancers' well-being depends on factors including sleep, mental health, growth-associated musculoskeletal imbalances, and nutrition. Puberty is a particularly important time for young dancers. It coincides with an increased commitment to their art form and physical/psychosocial changes. It is imperative for practitioners to understand these various factors in order to optimize young dancers' health and allow them to safely train and perform.

Body Mass Index and Menstrual Patterns in Dancers

Questionnaires were distributed to investigate body mass index (BMI) and menstrual patterns in female dancers aged 12 to 17 years. The study cohort consisted of 105 dancers, mean age 14.8 ± 1.1 years, and mean BMI 19.5 ± 2.3 kg/m². In all, 92% were healthy weight for height. First menses age ranged from 10 to 15 years (mean 12.9 ± 1.1 years). A total of 44% reported irregular menses; of those, 14% described irregularity as "every other month," 37% as "every 3 months," and 49% as "skips a month occasionally." A total of 36% of the dancers stop getting their menses during times of increased activity/dance, and 30% have gone >3 months at any time without getting their menses. A significant negative correlation between BMI and age of first menses was found with lower BMI associated with increased age of first menses (linear regression, β = -0.49, P = .021). This study supports an association between BMI and age of menarche among young female dancers. Given bone health reliance on hormonal milieu in female dancers, future research is warranted.

"Nutcracker Fracture" in a Ballet Dancer Performing in The Nutcracker

A 26-year-old female professional dancer sustained an acute injury to her mid-foot during a performance of The Nutcracker. An intra-articular, comminuted, minimally displaced fracture of the cuboid was found. The patient was treated non-operatively with cast and boot immobilization, modified weightbearing, and progressive rehabilitation. She was able to return to professional dance at 6 months post-injury and continues to dance professionally over 1 year out from injury without issue. The unique demands of classical ballet, especially dancing en pointe, increase the risk for mid-foot fractures, and clinicians should have a high-index of suspicion in dancers suffering an acute injury to the foot and ankle with greater than expected pain or swelling. Multiple imaging modalities can be used to make the diagnosis, to include plain film radiographs, MRI, and CT scan. Fracture characteristics and patient-specific factors should be taken into account when deciding on a treatment plan.

The pacifier thermometer. Comparison of supralingual with rectal temperatures in infants and young children

OBJECTIVE

To determine the correlation between supralingual temperatures obtained with a new electronic pacifier thermometer (Steridyne) and rectal temperatures obtained with a digital electronic thermometer.

DESIGN

Prospective study.

SETTING

Pediatric emergency department and pediatric inpatient ward of a tertiary university hospital.

PARTICIPANTS

Convenience sample of 100 patients, aged 7 days to 24 months.

MAIN OUTCOME MEASURES

A supralingual and rectal temperature were obtained for each patient. For the first 30 patients, the time needed for the pacifier thermometer to signal a final, steady-state reading was recorded.

RESULTS

The mean +/- SD difference between rectal temperatures and supralingual temperatures adjusted upward by 0.5 degree F was -0.01 degree F +/- 0.42 degree F (statistically zero) (95% confidence interval, -0.09 degree F to 0.07 degree F). The correlation coefficient between supralingual and rectal temperatures was 0.95. Sensitivity and specificity of the pacifier thermometer for detecting fever (temperature > or = 100.4 degrees F [> or = 38.0 degrees C]) was 72.0% and 98.0%, respectively (positive predictive value, 97.3%; negative predictive value, 77.8%). Increasing supralingual temperatures by 0.5 degree F increased sensitivity to 92.0%, and decreased specificity to 76.0% (positive predictive value, 79.3%; negative predictive value, 90.5%). It took an average time of 3 minutes 23 seconds for the pacifier thermometer to display a steady-state temperature.

CONCLUSIONS

The pacifier thermometer evaluated here was found to be an accurate means of temperature measurement when recorded temperatures were adjusted upward by 0.5 degree F. The approximate 3 minutes required for a final temperature determination makes the pacifier thermometer most appropriate for use in low-volume ambulatory care settings and in the home. Further investigation of this device is recommended.