Stress Fracture of the Trapezoid in a Professional Tennis Player

Background: Repetitive microtrauma can lead to trapezoid and second metacarpal stress fractures in racket sport players. Nontraumatic trapezoid stress fractures are rare and difficult to diagnose. To our knowledge, only 3 cases had been reported as of May 2023. We report the fourth case of a nontraumatic sports-related trapezoid stress fracture and only the second case in a tennis player. Case Report: A 29-year-old professional and right hand-dominant male tennis player presented with right hand and wrist pain for 3 weeks. He complained of dorsal wrist tenderness proximal to the base of the second metacarpal that was exacerbated by extension of the index finger. Initial radiographs were normal, but magnetic resonance imaging of the wrist showed a stress fracture of the trapezoid bone and base of the second metacarpal. The patient was treated conservatively with a wrist brace, cessation of sports activities, and modification of his training routine. The patient was asymptomatic at 1-year follow-up. Conclusion: This case highlights the relationship between trapezoid and second metacarpal stress fractures in athletes. A high index of suspicion for trapezoid stress fractures should be maintained and included in every differential diagnosis for athletes, especially racket sport players presenting with wrist pain. To avoid future injuries, clinicians should not only treat the fracture but also address the risk factors predisposing to this injury.

The Wild Carrot (Daucus carota): A Phytochemical and Pharmacological Review

Daucus carota L., a member of the Apiaceae family, comprises 13 subspecies, with one being cultivated (D. carota L. ssp. sativus (Hoffm.) Arcang.) and the remaining being wild. Traditionally, the wild carrot has been recognized for its antilithic, diuretic, carminative, antiseptic, and anti-inflammatory properties and has been employed in the treatment of urinary calculus, cystitis, gout, prostatitis, and cancer. While extensive literature is available on the phytochemical, pharmacological, and therapeutic evaluations of the cultivated carrot, limited information has been published on the wild carrot. A thorough search was conducted on the phytochemical composition, folk-medicine uses, and pharmacological properties of wild carrot subspecies (Daucus carota L. ssp. carota). Various electronic databases were consulted, and the literature spanning from 1927 to early 2023 was reviewed. Thirteen wild Daucus carota subspecies were analyzed, revealing over 310 compounds, including terpenoids, phenylpropenoids, flavonoids, and phenolic acids, with 40 constituting more than 3% of the composition. This review also highlights the antioxidant, anticancer, antipyretic, analgesic, antibacterial, antifungal, hypolipidemic, and hepato- and gastroprotective properties of wild carrot subspecies. Existing in vitro and in vivo studies support their traditional uses in treating infections, inflammation, and cancer. However, further research on other subspecies is required to confirm additional applications. Well-designed preclinical and clinical trials are still necessary to establish the safety and efficacy of wild Daucus carota for human use.

Pilot study: Post-operative rehabilitation pathway changes and implementation of functional closed kinetic chain exercise in total hip and total knee replacement patient

OBJECTIVE

The aim of this study was to assess the feasibility of introducing a functional closed kinetic chain exercise program to an acute care setting to reduce length of hospital stay and assess tolerance to exercise immediately following total hip or total knee arthroplasty.

METHODS

A protocol change implementing a functional closed kinetic chain based exercise program, post total hip (n = 535) and total knee (n = 695) arthroplasty, was performed at Windsor Regional Hospital Ouellette Campus in Windsor, Ontario Canada. A chart review was performed to compare the length of stay, post-surgery, of the new protocol to the length of stay of the previous range of motion and open kinetic chain based protocols of the previous two years.

RESULTS

A significant (P-value <0.05) number of total hip and total knee arthroplasty patients reduced the length of hospital stay to less than 4 days using the closed kinetic chain program.

CONCLUSION

Evidence suggests that closed kinetic chain exercises are tolerated in the acute care setting and may be useful in reducing hospital length of stay post total hip and total knee arthroplasty.

Splints and scar management for acute and reconstructive burn care

Because patients assume a position of comfort during acute burn management, affected joints or regions must be splinted in positions of function to avoid contractures. Particularly with the increasing trend towards ambulatory burn care, close monitoring by the burn team and patient education is required to achieve the best functional result. Despite adequate initial care, contractures sometimes occur, requiring a shift in splinting tactics to correct the deformity. If secondary reconstruction is required, the affected region is once again maintained in the position of function. Although the physiologic mechanism is incompletely defined, pressure therapy to prevent and treat hypertrophic burn scars is an integral component of burn care. Multiple materials and methods are available with treatment, starting soon after burn wound closure, and modified as needed until scar maturation has occurred.