|
1
|
Helm JM, Myers NL, Conway JE. Non-Medial Ulnar Collateral Ligament Elbow Pathology in the Thrower: Valgus Extension Overload, Osteochondritis Dissecans, Olecranon Stress Fracture, and Ulnar Nerve. Clin Sports Med 2025; 44:195-214. [PMID: 40021252 DOI: 10.1016/j.csm.2024.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2025]
Abstract
Injury rates in baseball players reach as high as 5.8 per 1000 at the professional level. Recent data have singled out the elbow as the leading cause of injured list necessitating injuries and the costliest injury location in professional baseball. While the medial ulnar collateral ligament (MUCL) has gained the largest notoriety in this population, elbow injury in the thrower occurs as a spectrum of pathologies. These pathologies may encompass other injuries often resulting from or occurring in conjunction with MUCL insufficiency. These conditions include valgus extension overload syndrome, osteochondritis dissecans, olecranon stress fractures, and ulnar nerve pathology.
Collapse
Affiliation(s)
- J Matthew Helm
- Department of Orthopaedic Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, 6400 Fannin Street, Suite 1700, Houston, TX 77030, USA
| | - Natalie L Myers
- Memorial Hermann's Rockets Sports Medicine Institute, 6400 Fannin Street, Suite 1620, Houston, TX 77030, USA
| | - John E Conway
- Department of Orthopaedic Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, 6400 Fannin Street, Suite 1700, Houston, TX 77030, USA.
| |
Collapse
|
|
2
|
Kim HK, Mirjalili SA. Differences in running biomechanics and tibiotalar cartilage T2 relaxation time between runners with and without asymptomatic tibial sesamoid bone marrow edema - clinical case series. Sports Biomech 2024; 23:3466-3477. [PMID: 38803210 DOI: 10.1080/14763141.2024.2356859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 05/02/2024] [Indexed: 05/29/2024]
Abstract
The impact of asymptomatic bone marrow edema (BME) in sesamoids on running biomechanics remains largely unknown, but exploring this relationship could aid early detection of forefoot-related injuries with cost-effective modalities. This study aimed to compare the running biomechanics of runners with asymptomatic BME in the tibial sesamoids with that of healthy controls. Four runners with asymptomatic BME in tibial sesamoids and four healthy runners participated. Lower extremity joint kinetics and kinematics were assessed along with plantar pressure while running at a self-selected speed. The T2 relaxation time of the tibiotalar cartilage was measured using MRI-derived T2 maps. Compared to the non-injured group, the injured group exhibited significantly lower plantar pressure under the hallux (p = 0.001), increased peak ankle rotation angles (p = 0.025), reduced ankle power generation (p = 0.049), and increased knee extension torque (p = 0.015). No significant differences in T2 values of the tibiotalar cartilage were observed. It appears that runners with asymptomatic BME adapted their running strategies by modifying their ankle biomechanics and reducing plantar pressure, even in the absence of pain. While the precise implications of these biomechanical alterations warrant further investigation, this study provides valuable insights into the relationship between asymptomatic BME and running biomechanics.
Collapse
Affiliation(s)
- Hyun Kyung Kim
- School of Kinesiology, Louisiana State University, Baton Rouge, LA, USA
| | - Seyed Ali Mirjalili
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| |
Collapse
|
|
3
|
Fearing M, Behzadpour V, House RD, Tarakemeh A, Morey T, Randall J, Vopat B, Darche JP. Rib Stress Fractures and a Novel Muscle-Sparing Rib Fixation Plating in an Elite Tennis Player: A Systematic Review of the Literature and Case Report. Sports Health 2024; 16:573-580. [PMID: 37688535 PMCID: PMC11195866 DOI: 10.1177/19417381231195271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/11/2023] Open
Abstract
A nationally ranked Division One female collegiate tennis player presented with pain in the chest and right posterior rib region after feeling a popping sensation during a routine overhead movement. The patient was eventually diagnosed with 2 lower rib stress fractures. After unsuccessful conservative management, the player underwent an open reduction and internal fixation and autologous bone grafting of the sixth and seventh ribs with a muscle-sparing approach and was able to return to full competition. We present this case along with a systematic review of the literature regarding rib stress fractures, which included 6 separate online data sources (PubMed, EMBASE, Cochrane, CINAHL, SportDiscus, and Medline). The successful surgical intervention demonstrates a significant option for elite athletes who wish to return to competition but have been unable to with standard of care conservative management of rib stress fractures.
Collapse
Affiliation(s)
- Marcus Fearing
- Department of Family Medicine and Sports Medicine, University of Kansas Health System, Kansas City, Kansas
| | - Vafa Behzadpour
- University of Kansas School of Medicine - Wichita Campus, Wichita, Kansas
| | - Richard D. House
- Department of Orthopaedic Surgery and Sports Medicine, University of Kansas Health System, Kansas City, Kansas
| | - Armin Tarakemeh
- Department of Orthopaedic Surgery and Sports Medicine, University of Kansas Health System, Kansas City, Kansas)
| | - Tucker Morey
- Department of Orthopaedic Surgery and Sports Medicine, University of Kansas Health System, Kansas City, Kansas
| | - Jeffrey Randall
- Department of Orthopaedic Surgery and Sports Medicine, University of Kansas Health System, Kansas City, Kansas
| | - Bryan Vopat
- Department of Orthopaedic Surgery and Sports Medicine, University of Kansas Health System, Kansas City, Kansas
| | - Jean-Philippe Darche
- Department of Family Medicine and Sports Medicine, University of Kansas Health System, Kansas City, Kansas
| |
Collapse
|
|
4
|
Witkowska-Piłaszewicz O, Malin K, Dąbrowska I, Grzędzicka J, Ostaszewski P, Carter C. Immunology of Physical Exercise: Is Equus caballus an Appropriate Animal Model for Human Athletes? Int J Mol Sci 2024; 25:5210. [PMID: 38791248 PMCID: PMC11121269 DOI: 10.3390/ijms25105210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 04/30/2024] [Accepted: 05/06/2024] [Indexed: 05/26/2024] Open
Abstract
Domestic horses routinely participate in vigorous and various athletic activities. This enables the horse to serve as a model for studying athletic physiology and immunology in other species, including humans. For instance, as a model of physical efforts, such as endurance rides (long-distance running/aerobic exercise) and races (anaerobic exercise), the horse can be useful in evaluating post-exercise response. Currently, there has been significant interest in finding biomarkers, which characterize the advancement of training and adaptation to physical exercise in the horse. The parallels in cellular responses to physical exercises, such as changes in receptor expression and blood cell activity, improve our understanding of the mechanisms involved in the body's response to intense physical activity. This study focuses on the changes in levels of the pro- and anti-inflammatory cytokines and cellular response in the context of post-exercise immune response. Both the direction of changes in cytokine levels and cellular responses of the body, such as proliferation and expression of surface markers on lymphocytes, monocytes and neutrophils, show cross-functional similarities. This review reveals that horses are robust research models for studying the immune response to physical exercise in human athletes.
Collapse
Affiliation(s)
- Olga Witkowska-Piłaszewicz
- Department of Large Animals Diseases and Clinic, Institute of Veterinary Medicine, Warsaw University of Life Sciences, Nowoursynowska 166, 02-787 Warsaw, Poland
| | - Katarzyna Malin
- Department of Population Health and Reproduction, School of Veterinary Medicine, University of California, Davis, CA 95616, USA
| | - Izabela Dąbrowska
- Department of Large Animals Diseases and Clinic, Institute of Veterinary Medicine, Warsaw University of Life Sciences, Nowoursynowska 166, 02-787 Warsaw, Poland
| | - Jowita Grzędzicka
- Department of Large Animals Diseases and Clinic, Institute of Veterinary Medicine, Warsaw University of Life Sciences, Nowoursynowska 166, 02-787 Warsaw, Poland
| | - Piotr Ostaszewski
- Department of Physiological Sciences, Faculty of Veterinary Medicine, Warsaw University of Life Sciences, Nowoursynowska 159, 02-776 Warsaw, Poland
| | - Craig Carter
- Veterinary Diagnostic Laboratory, University of Kentucky, Lexington, KY 40506, USA;
| |
Collapse
|
|
5
|
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.
Collapse
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
| | | |
Collapse
|
|
6
|
Riga A, Profico A, Mori T, Frittitta R, Nava A, Mancini L, Dreossi D, Radovčić D, Rice H, Bondioli L, Marchi D. The Middle Pleistocene human metatarsal from Sedia del Diavolo (Rome, Italy). Sci Rep 2024; 14:6024. [PMID: 38472259 DOI: 10.1038/s41598-024-55045-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 02/20/2024] [Indexed: 03/14/2024] Open
Abstract
The peopling of Europe during the Middle Pleistocene is a debated topic among paleoanthropologists. Some authors suggest the coexistence of multiple human lineages in this period, while others propose a single evolving lineage from Homo heidelbergensis to Homo neanderthalensis. The recent reassessment of the stratigraphy at the Sedia del Diavolo (SdD) site (Latium, Italy), now dated to the beginning of marine isotope stage (MIS) 8, calls for a revision of the human fossils from the site. In this paper, we present the morphometric, biomechanical and palaeopathological study of the second right metatarsal SdD2, to both re-evaluate its taxonomical affinities and possibly determine the levels of physical activity experienced by the individual during lifetime. Results demonstrate the persistence of archaic features in SdD2 suggesting new insights into the technology and hunting strategies adopted by Homo between MIS 9 and MIS 8.
Collapse
Affiliation(s)
- Alessandro Riga
- Department of Biology, University of Florence, Florence, Italy
| | | | - Tommaso Mori
- Department of Biology, University of Florence, Florence, Italy
| | | | - Alessia Nava
- Department of Odontostomatological and Maxillofacial Sciences, Sapienza University of Rome, Rome, Italy
| | - Lucia Mancini
- ZAG-Slovenian National Building and Civil Engineering Institute, Ljubliana, Slovenia
| | - Diego Dreossi
- Elettra-Sincrotrone Trieste S.C.P.A., Basovizza, Trieste, Italy
| | - Davorka Radovčić
- Department of Geology and Paleontology, Croatian Natural History Museum, Zagreb, Croatia
| | - Hannah Rice
- Department of Physical Performance, Norwegian School of Sport Sciences, Oslo, Norway
| | - Luca Bondioli
- Department of Cultural Heritage, University of Bologna, Bologna, Italy
- Service of Bioarchaeology, Museum of Civilizations, Rome, Italy
| | - Damiano Marchi
- Department of Biology, University of Pisa, Pisa, Italy
- Centre for the Exploration of Deep Human Journey, University of Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
|
7
|
Schroeter S, Heiss R, Hammer CM, Best R, Brucker P, Hinterwimmer S, Grim C, Engelhardt M, Hotfiel T. Pathogenesis and Diagnosis of Proximal Hamstring Tendinopathies. SPORTVERLETZUNG SPORTSCHADEN : ORGAN DER GESELLSCHAFT FUR ORTHOPADISCH-TRAUMATOLOGISCHE SPORTMEDIZIN 2024; 38:31-39. [PMID: 37348536 DOI: 10.1055/a-2010-8121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Abstract
The proximal hamstring complex is a highly vulnerable area that is especially prone to injury. Proximal hamstring tendinopathies (PHTs) remain challenging in diagnosis, treatment, rehabilitation, and prevention due to a large variety of different injuries, slow healing response, persistent symptoms, and functional impairments. PHTs are often misdiagnosed or underdiagnosed, leading to delayed treatment and therapy failure. In addition, many athletes are at a high risk of PHT recurrence, a leading cause of prolonged rehabilitation and impaired individual performance. Until now, there have been no clear criteria for the diagnosis and classification of PHT. Tendinopathies can be graded based on their symptoms and onset. Additionally, radiological characteristics exist that describe the severity of tendinopathies. The diagnosis usually includes a battery of pain provocation tests, functional tests, and imaging to ensure a proper classification. Understanding the specific tasks in the pathogenesis and diagnostic process of PHT requires knowledge of functional anatomy, injury pattern and pathophysiological mechanisms as well as examination and imaging techniques. This work provides a structured overview of the pathogenesis and diagnostic work-up of PHT, emphasizing structured examination and imaging to enable a reliable diagnosis and rapid treatment decisions.
Collapse
Affiliation(s)
- Sarah Schroeter
- Center for Muskuloskeletal Surgery Osnabrück (OZMC), Klinikum Osnabrück, Osnabrück, Germany
| | - Rafael Heiss
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
- Committee Muscle and Tendon, German-Austrian-Swiss Society for Orthopaedic Traumatologic Sports Medicine (GOTS), Germany
| | - Christian Manfred Hammer
- Institute of Functional and Clinical Anatomy, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
- Anatomy Unit, Section of Medicine, University of Fribourg, Fribourg, Switzerland
| | - Raymond Best
- Committee Muscle and Tendon, German-Austrian-Swiss Society for Orthopaedic Traumatologic Sports Medicine (GOTS), Germany
- Department of Sports Medicine, University of Tuebingen, Tuebingen, Germany
- Department of Orthopaedic and Sports Trauma Surgery, Sportklinik Stuttgart GmbH, Stuttgart, Germany
| | | | | | - Casper Grim
- Center for Muskuloskeletal Surgery Osnabrück (OZMC), Klinikum Osnabrück, Osnabrück, Germany
- Department of Human Sciences Institute for Health Research and Education, University of Osnabrück, Osnabrück, Germany
| | - Martin Engelhardt
- Center for Muskuloskeletal Surgery Osnabrück (OZMC), Klinikum Osnabrück, Osnabrück, Germany
| | - Thilo Hotfiel
- Center for Muskuloskeletal Surgery Osnabrück (OZMC), Klinikum Osnabrück, Osnabrück, Germany
- Committee Muscle and Tendon, German-Austrian-Swiss Society for Orthopaedic Traumatologic Sports Medicine (GOTS), Germany
- Department of Orthopedic and Trauma Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| |
Collapse
|
|
8
|
Fukuda Y, Kato K, Otoshi K, Hakozaki M, Kaneuchi Y, Matsumoto Y. Rib stress fracture in a female athlete caused by bouncing the barbell in bench press exercise: A case report. SAGE Open Med Case Rep 2024; 12:2050313X241232863. [PMID: 38362226 PMCID: PMC10868490 DOI: 10.1177/2050313x241232863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 01/24/2024] [Indexed: 02/17/2024] Open
Abstract
Rib stress fractures can occur in sports involving repetitive trunk muscle contractions. Few documented cases show rib fractures from repetitive upper-limb training. This report presents a case of a rib stress fracture from micro blunt trauma during bench press exercises. The patient was a 24-year-old elite female sprinter with a history of left navicular stress fracture and secondary amenorrhea treatment a year prior. She modified her bench press technique to involve bouncing the barbell on her rib cage. Within weeks, she experienced anterior chest pain, exacerbated by sneezing. Computed tomography revealed a fifth rib fracture with callus formation. After refraining from bench presses for 4 weeks, her chest pain subsided, allowing her to resume upper-limb training. When athletes performing bench press exercises experience chest pain, rib fractures should be considered, even without acute trauma. Additionally, research on the safety of the bouncing bench pressing technique is required.
Collapse
Affiliation(s)
- Yuya Fukuda
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima City, Japan
- Department of Orthopaedic Surgery, Shirakawa Kosei General Hospital, Shirakawa City, Japan
| | - Kinshi Kato
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima City, Japan
- Department of Sports Medicine, Fukushima Medical University School of Medicine, Koriyama City, Japan
| | - Kenichi Otoshi
- Department of Sports Medicine, Fukushima Medical University School of Medicine, Koriyama City, Japan
| | - Michiyuki Hakozaki
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima City, Japan
| | - Yoichi Kaneuchi
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima City, Japan
| | - Yoshihiro Matsumoto
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima City, Japan
| |
Collapse
|
|
9
|
Michelin RM, Manuputy I, Schulz BM, Schultzel M, Lee BK, Itamura JM. Retrograde headless compression screw fixation of olecranon stress fractures in throwing athletes: a novel technique. JSES Int 2024; 8:222-226. [PMID: 38312287 PMCID: PMC10837725 DOI: 10.1016/j.jseint.2023.08.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2024] Open
Abstract
Background An olecranon stress fracture (OSF) is a rare injury most commonly seen in high-level overhead throwing athletes with no clear consensus on surgical treatment. The most common surgical treatment described in the literature is cannulated screw fixation but there have been high rates of reported hardware irritation and need for subsequent hardware removal. Hypothesis/Purpose This study describes a novel surgical technique in the treatment of OSFs in high-level throwing athletes using retrograde headless compression screws. We hypothesized that patients would have excellent outcomes and decreased rates of hardware irritation postoperatively. Methods A retrospective review of competitive-level throwing athletes who sustained OSFs that were treated operatively using a novel technique using retrograde cannulated headless compression screws to avoid disruption of the triceps tendon. Postoperative outcome measures obtained included the Disabilities of the Arm, Shoulder and Hand score, Mayo Elbow Performance Score, Simple Elbow Test score, Single Assessment Numerical Evaluation score, Visual Analog Scale, arch of motion, and time to return to sport as well as level returned to. Radiographs were obtained routinely at 2-week, 6-week, 12-week, 6-month, 1-year, and 2-year follow-up. Results Five of 5 patients who met inclusion criteria were available for final follow-up. Mean age at time of surgery was 20 years (range 17-24). Mean follow-up was 17 months (range 4-33). All patients were baseball players, 4 of which were pitchers and 1 position player. All patients were able to return to sport at the same level or higher at a mean of 5.8 months (range 3-8). Postoperatively, mean arch of motion was 138°, Visual Analog Scale score was 0, Single Assessment Numerical Evaluation score was 90, Disabilities of the Arm, Shoulder and Hand score was 2.0, Mayo Elbow Performance Score was 100, and Simple Elbow Test score was 12. There was no incidence of hardware removal. Conclusion This study presents a novel surgical technique in the treatment of OSFs in high-level throwing athletes. The results presented demonstrate that this technique is safe and effective for getting athletes back to play quickly without any complications of hardware irritation which has previously shown to be a significant problem in prior literature.
Collapse
Affiliation(s)
- Richard M Michelin
- Cedars Sinai-Kerlan Jobe Institute, Los Angeles, CA, USA
- White Memorial Medical Center, Los Angeles, CA, USA
| | - Isaac Manuputy
- Cedars Sinai-Kerlan Jobe Institute, Los Angeles, CA, USA
- White Memorial Medical Center, Los Angeles, CA, USA
| | - Brian M Schulz
- Cedars Sinai-Kerlan Jobe Institute, Los Angeles, CA, USA
| | - Mark Schultzel
- Cedars Sinai-Kerlan Jobe Institute, Los Angeles, CA, USA
- United Medical Doctors, San Diego, CA, USA
| | - Brian K Lee
- Cedars Sinai-Kerlan Jobe Institute, Los Angeles, CA, USA
- White Memorial Medical Center, Los Angeles, CA, USA
| | - John M Itamura
- Cedars Sinai-Kerlan Jobe Institute, Los Angeles, CA, USA
- White Memorial Medical Center, Los Angeles, CA, USA
| |
Collapse
|
|
10
|
Maghami E, Najafi A. Microstructural fatigue fracture behavior of glycated cortical bone. Med Biol Eng Comput 2023; 61:3021-3034. [PMID: 37582979 DOI: 10.1007/s11517-023-02901-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 07/29/2023] [Indexed: 08/17/2023]
Abstract
The current study aims to simulate fatigue microdamage accumulation in glycated cortical bone with increased advanced glycation end-products (AGEs) using a phase field fatigue framework. We link the material degradation in the fracture toughness of cortical bone to the high levels of AGEs in this tissue. We simulate fatigue fracture in 2D models of cortical bone microstructure extracted from human tibias. The results present that the mismatch between the critical energy release rate of microstructural features (e.g., osteons and interstitial tissue) can alter crack initiation and propagation patterns. Moreover, the high AGEs content through the increased mismatch ratio can cause the activation or deactivation of bone toughening mechanisms under cyclic loading. The fatigue fracture simulations also show that the lifetime of diabetic cortical bone samples can be dependent on the geometry of microstructural features and the mismatch ratio between the features. Additionally, the results indicate that the trapped cracks in cement lines in the diabetic cortical microstructure can prevent further crack growth under cyclic loading. The present findings show that alterations in the materials heterogeneity of microstructural features can change the fatigue fracture response, lifetime, and fragility of cortical bone with high AGEs contents. Cortical bone models are created from microscopy images taken from the cortical cross-section of human tibias. Increased glycation contents in the cortical bone sample can change the crack growth trajectories.
Collapse
|
|
11
|
Loose O, Eberhardt O, Fernandez FF. [Stress injuries of bone in children and adolescents]. UNFALLCHIRURGIE (HEIDELBERG, GERMANY) 2023; 126:839-847. [PMID: 37410116 DOI: 10.1007/s00113-023-01351-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/06/2023] [Indexed: 07/07/2023]
Abstract
Stress injuries of bone in childhood and adolescence are the result of an imbalance between physical stress on the growing musculoskeletal system and its intrinsic resilience. Children who are very active in sports are particularly affected. The classical stress injuries mainly occur in the area of the lower leg, the metatarsus and the lower lumbar spine due to the disproportionate load on healthy bone; however, overuse syndromes can also occur in the area of the growth plates and possibly lead to growth plate disorders. The anamnesis usually shows stress-related pain that has existed for a long time without trauma. As part of the differential diagnosis, a stress injury must first be included in the considerations due to it being a rare entity. An X‑ray examination can show the first signs of a stress reaction. In the event of a conspicuous periosteal reaction, a malignant event must also be considered. As a rule, the MRI examination is then groundbreaking and in some rare cases biopsies have to be considered. The treatment of stress injuries is usually conservative. Recurrences should be counteracted by exercise control.
Collapse
Affiliation(s)
- Oliver Loose
- Olgahospital, Klinikum Stuttgart, Kriegsbergstr. 62, 70174, Stuttgart, Deutschland.
| | - Oliver Eberhardt
- Olgahospital, Klinikum Stuttgart, Kriegsbergstr. 62, 70174, Stuttgart, Deutschland
| | | |
Collapse
|
|
12
|
Elkins MR. Physiotherapy management of rib fractures. J Physiother 2023; 69:211-219. [PMID: 37714770 DOI: 10.1016/j.jphys.2023.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 08/30/2023] [Indexed: 09/17/2023] Open
Affiliation(s)
- Mark R Elkins
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
| |
Collapse
|
|
13
|
Greeves JP, Beck B, Nindl BC, O'Leary TJ. Current risks factors and emerging biomarkers for bone stress injuries in military personnel. J Sci Med Sport 2023:S1440-2440(23)00075-0. [PMID: 37188615 DOI: 10.1016/j.jsams.2023.04.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 04/01/2023] [Accepted: 04/17/2023] [Indexed: 05/17/2023]
Abstract
INTRODUCTION Bone stress injuries (BSIs) have plagued the military for over 150 years; they afflict around 5 to 10% of military recruits, more so in women, and continue to place a medical and financial burden on defence. While the tibia generally adapts to the rigours of basic military training, the putative mechanisms for bone maladaptation are still unclear. METHODS This paper provides a review of the published literature on current risk factors and emerging biomarkers for BSIs in military personnel; the potential for biochemical markers of bone metabolism to monitor the response to military training; and, the association of novel biochemical 'exerkines' with bone health. RESULTS The primary risk factor for BSI in military (and athletic) populations is too much training, too soon. Appropriate physical preparation before training will likely be most protective, but routine biomarkers will not yet identify those at risk. Nutritional interventions will support a bone anabolic response to training, but exposure to stress, sleep loss, and medication is likely harmful to bone. Monitoring physiology using wearables-ovulation, sleep and stress-offer potential to inform prevention strategies. CONCLUSIONS The risk factors for BSIs are well described, but their aetiology is very complex particularly in the multi-stressor military environment. Our understanding of the skeletal responses to military training is improving as technology advances, and potential biomarkers are constantly emerging, but sophisticated and integrated approaches to prevention of BSI are warranted.
Collapse
Affiliation(s)
- Julie P Greeves
- Army Health and Performance Research, Army HQ, Andover, United Kingdom; Norwich Medical School, University of East Anglia, United Kingdom; Division of Surgery and Interventional Science, UCL, United Kingdom.
| | - Belinda Beck
- School of Health Sciences and Social Work, Griffith University, Australia; The Bone Clinic, Australia.
| | - Bradley C Nindl
- School of Health and Rehabilitation Sciences, University of Pittsburgh, United States.
| | - Thomas J O'Leary
- Army Health and Performance Research, Army HQ, Andover, United Kingdom; Division of Surgery and Interventional Science, UCL, United Kingdom.
| |
Collapse
|
|
14
|
Navas A, Kassarjian A. Bone Marrow Lesions in Athletic Stress Injuries: An Overview. Semin Musculoskelet Radiol 2023; 27:54-72. [PMID: 36868245 DOI: 10.1055/s-0043-1761613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
Abstract
This article discusses the presumed pathophysiology of osseous sport-related stress changes, the optimal imaging strategy for detecting the lesions, and the progression of the lesions as seen on magnetic resonance imaging. It also describes some of the most common stress-related injuries in athletes by anatomical location and introduces some new concepts in the field.
Collapse
Affiliation(s)
- Ana Navas
- Department of Radiology, Division of Musculoskeletal Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Ara Kassarjian
- Department of Radiology, Division of Musculoskeletal Radiology, Olympia Medical Center, Elite Sports Imaging, Madrid, Spain
| |
Collapse
|
|
15
|
Muacevic A, Adler JR, Kortbawi R, Ayoubi R, Kortbawi C. Atraumatic Isolated Stress Fracture of the Distal Tibial Metaphysis in a Pre-menopausal Patient: A Case Report. Cureus 2023; 15:e34068. [PMID: 36843744 PMCID: PMC9943965 DOI: 10.7759/cureus.34068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2023] [Indexed: 01/25/2023] Open
Abstract
Stress fractures are partial or complete bone fractures usually occurring in the weight-bearing bones resulting from repeated cycles of submaximal stress and bone remodeling. When the tibia is involved, it usually affects the proximal or middle third part of the bone. This pathology is most often seen in athletes or related to traumatic activities. This case describes a healthy, pre-menopausal, non-athlete woman presenting with a distal tibial atraumatic stress fracture. Diagnosis is usually confirmed by a CT scan or MRI since radiographs could often show no abnormalities. Treatment of such fractures is conservative in the majority of cases and when present, predisposing or causative factors should also be investigated and assessed.
Collapse
|
|
16
|
Demir Benli M. Bilateral Cuboid Stress Fracture in A Young Female: A Rare Case Report. Curr Sports Med Rep 2022; 21:427-430. [PMID: 36508597 DOI: 10.1249/jsr.0000000000001014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Merve Demir Benli
- Department of Sports Medicine, Health Sciences University, Bozyaka Education and Research Hospital, Izmir, Turkey
| |
Collapse
|
|
17
|
Schowalter S, Le B, Creps J, McInnis KC. Rib Fractures in Professional Baseball Pitchers: Mechanics, Epidemiology, and Management. Open Access J Sports Med 2022; 13:89-105. [PMID: 36248020 PMCID: PMC9563740 DOI: 10.2147/oajsm.s288882] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 09/14/2022] [Indexed: 11/21/2022] Open
Abstract
Pitching is a complex kinetic chain activity requiring the transfer of energy from the lower body, through the core and trunk, and finally through the arm to generate explosive acceleration of the baseball. As a result, large forces are generated in the trunk musculature and rib attachments from the late cocking phase of pitching through deceleration. The repetitive cumulative load and high pitch velocities put professional pitchers at risk of rib stress fracture. Given the potential for a prolonged recovery course and high rate of recurrence, early recognition of rib bone stress injury is critical to optimize care. Identifying torso strength imbalances, suboptimal pitching biomechanics (such as late or inadequate pelvic rotation), as well as metabolic deficiencies that may adversely affect bone health are essential to expedite safe return to play and prevent future injury. In this review, we discuss risk factors, mechanism of injury, typical clinical presentation, diagnostic imaging findings, and propose treatment and prevention strategies for rib stress fractures in overhand pitchers.
Collapse
Affiliation(s)
- Sean Schowalter
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Charlestown, MA, USA,Correspondence: Sean Schowalter, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, 300 1st Avenue, Charlestown, MA, 02129, USA, Tel +1 617 952 5000, Email
| | - Bryan Le
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Charlestown, MA, USA
| | - James Creps
- Sports Medicine Service, Boston Red Sox, Boston, MA, USA
| | - Kelly C McInnis
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Charlestown, MA, USA,Division of Sports Medicine, Massachusetts General Hospital, Boston, MA, USA
| |
Collapse
|
|
18
|
Rizzi AM, Baker HP, Lee CS, Athiviraham A. Lower Extremity Stress Fractures in the National Basketball Association, 2013-2014 Through 2018-2019. Orthop J Sports Med 2022; 10:23259671221126485. [PMID: 36225389 PMCID: PMC9549108 DOI: 10.1177/23259671221126485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 07/27/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Players in the National Basketball Association (NBA) are at risk for lower extremity stress fractures, partly because of the sport's high-intensity demand on the lower body. PURPOSE To provide insight on the identification and management of potential risk factors associated with lower extremity stress fractures in NBA athletes. STUDY DESIGN Case series; Level of evidence, 4. METHODS A retrospective study was conducted using the NBA electronic medical record database for all players who were on an NBA roster for ≥1 game from the 2013-2014 through 2018-2019 seasons. Player characteristics, games missed, and treatment methodology were independently analyzed. Results were presented as incidence per 1000 player-games. RESULTS There were 22 stress fractures identified in 20 NBA players over the course of 6 years, with an average of 3.67 stress fractures per year and an incidence of 0.12 stress fractures per 1000 player-games. Most stress fractures occurred in the foot (17/22), and 45% (10/22) of stress fractures were treated surgically, with the most common site of operation being the navicular. On average, approximately 37 games and 243 days were missed per stress fracture injury. There was no significant difference in time to return to play between high-risk stress fractures treated operatively versus nonoperatively (269.2 vs 243.8 days; P = .82). CONCLUSION The overall incidence of stress fractures in NBA players was 0.12 per 1000 player-games, and a high percentage of players returned to NBA activity after the injury. There was a relatively even distribution between high-risk stress fractures treated operatively and nonoperatively. When comparing high-risk stress fractures treated operatively to ones treated nonoperatively, no significant difference in average time to return to play in the NBA was found.
Collapse
Affiliation(s)
- Andrew M. Rizzi
- Department of Orthopaedic Surgery, University of Chicago Medicine,
Chicago, Illinois, USA.,Andrew M. Rizzi, MD, Department of Orthopaedic Surgery,
University of Chicago Medicine, 5841 S. Maryland Avenue, Chicago, IL 60637, USA
()
| | - Hayden P. Baker
- Department of Orthopaedic Surgery, University of Chicago Medicine,
Chicago, Illinois, USA
| | - Cody S. Lee
- Department of Orthopaedic Surgery, University of Chicago Medicine,
Chicago, Illinois, USA
| | - Aravind Athiviraham
- Department of Orthopaedic Surgery, University of Chicago Medicine,
Chicago, Illinois, USA
| |
Collapse
|
|
19
|
Hudyma N, Lisjak A, Tatone BS, Garner HW, Wight J, Mandavalli AS, Olutola IA, Pujalte GGA. Comparison of Cortical Bone Fracture Patterns Under Compression Loading Using Finite Element–Discrete Element Numerical Modeling Approach and Destructive Testing. Cureus 2022; 14:e29596. [PMID: 36321046 PMCID: PMC9599044 DOI: 10.7759/cureus.29596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2022] [Indexed: 11/17/2022] Open
Abstract
Finite element analysis may not be the only method by which bone fracture initiation and propagation may be analyzed. This study compares fracture patterns generated from compression testing of bone to fracture patterns generated using a combination of both the finite element method (FEM) and discrete element method (DEM) as defined by the finite discrete element method (FDEM). Before testing, a three-dimensional bone model was developed using CT. Force and displacement data were collected during testing. The tested specimen was reimaged using CT. The solid model was discretized and material properties adjusted such that finite element-discrete element macro behavior matched the force-displacement data. A qualitative comparison of the fracture patterns demonstrates that FDEM can successfully be used to simulate and predict fracturing in bone, with this study representing the first time this has been done and reported.
Collapse
|
|
20
|
McCaskie CJ, Sim M, Newton RU, Heasman J, Rogalski B, Hart NH. Characterising lower-body musculoskeletal morphology and whole-body composition of elite female and male Australian Football players. BMC Sports Sci Med Rehabil 2022; 14:168. [PMID: 36068592 PMCID: PMC9450395 DOI: 10.1186/s13102-022-00561-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 09/01/2022] [Indexed: 12/26/2022]
Abstract
BACKGROUND Physical demands and injury rates differ between elite female and male Australian Football (AF) players. To improve understanding of contributing physical factors to these differences, the purpose of this study was to investigate lower-body morphology and whole-body composition of elite footballers competing in the Australian Football League (AFL) and Australian Football League Women's (AFLW). METHODS Lower-body morphology and whole-body composition of 23 AFL players and 23 AFLW players were assessed using peripheral Quantitative Computed Tomography and Dual-energy X-ray Absorptiometry at the beginning of pre-season. Differences between cohorts, with sub-analyses of kicking vs. support limbs, and experienced vs. inexperienced player status were assessed using two-sample independent t-tests. Magnitude of differences were assessed using Cohen's d effect sizes. RESULTS AFL players had greater absolute (p < 0.001; ES = 3.28) and relative (p < 0.001; ES = 2.29) whole body lean soft-tissue mass, with less absolute (p = 0.004; ES = 0.91) and relative (p < 0.001; ES = 2.29) fat mass than AFLW players. For AFLW players, no significant differences existed between kicking and support limbs with few differences observed between experienced and inexperienced players. CONCLUSIONS Greater emphasis on physical development in AFLW players may be required to enable increases in muscle mass and skeletal robustness, to ensure they can tolerate the loads of elite competition.
Collapse
Affiliation(s)
- Callum J McCaskie
- School of Medical and Health Sciences, Edith Cowan University, 270 Joondalup Drive, Joondalup, Perth, WA, 6027, Australia.
- West Coast Eagles Football Club, Perth, WA, Australia.
| | - Marc Sim
- School of Medical and Health Sciences, Edith Cowan University, 270 Joondalup Drive, Joondalup, Perth, WA, 6027, Australia
- Faculty of Health and Medical Sciences, The University of Western Australia, Perth, WA, Australia
| | - Robert U Newton
- School of Medical and Health Sciences, Edith Cowan University, 270 Joondalup Drive, Joondalup, Perth, WA, 6027, Australia
- Exercise Medicine Research Institute, Edith Cowan University, Perth, WA, Australia
- School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, QLD, Australia
| | | | | | - Nicolas H Hart
- School of Medical and Health Sciences, Edith Cowan University, 270 Joondalup Drive, Joondalup, Perth, WA, 6027, Australia
- Exercise Medicine Research Institute, Edith Cowan University, Perth, WA, Australia
- Caring Futures Institute, College of Nursing and Health Science, Flinders University Adelaide, Adelaide, SA, Australia
- Institute for Health Research, University of Notre Dame Australia, Perth, WA, Australia
- Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, QLD, Australia
| |
Collapse
|
|
21
|
Rosenthal MD, Rauh MJ, Cowan JE. Prospective Assessment of Clinical Tests Used to Evaluate Tibial Stress Fracture. Orthop J Sports Med 2022; 10:23259671221122356. [PMID: 36147792 PMCID: PMC9486277 DOI: 10.1177/23259671221122356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 06/09/2022] [Indexed: 12/04/2022] Open
Abstract
Background: Tibial stress fracture (SFx) is the most common SFx of the lower extremity.
Presently, diagnostic accuracy of clinical examination techniques for tibial
SFx remains suboptimal. Purpose: To assess the diagnostic effectiveness of 5 clinical tests for tibial SFx
individually versus a test item cluster. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: A total of 50 patients with tibial pain (17 with bilateral symptoms) were
assessed with 5 clinical examination tests (tibial fulcrum test, focal
tenderness to palpation, heel percussion test, therapeutic ultrasound test,
and 128-Hz tuning fork test) before they underwent diagnostic imaging
(radionuclide bone scan). The application of the clinical tests was
counterbalanced to minimize the likelihood of carryover effects. Patients
provided a pain rating immediately before and after the application of each
clinical test. Results: The prevalence of tibial SFx among the study participants was 52.2%. High
levels of specificity were produced by the therapeutic ultrasound test
(93.8%), tuning fork test (90.6%), and percussion test (90.6%). The fulcrum
test had moderate to high specificity (84.4%). All tests demonstrated low
levels of sensitivity, with the highest levels found for focal tenderness to
palpation (48.6%) and fulcrum (45.7%). The fulcrum test provided the highest
positive likelihood ratio (2.93), followed by the therapeutic ultrasound
test (2.30). The fulcrum test had the lowest negative likelihood ratio
(0.64), with the focal tenderness to palpation and tuning fork tests having
negative likelihood ratios >1.0. Combinations of these clinical tests did
not improve the prediction of tibial SFx above that observed among the
individual tests. Conclusion: The clinical tests evaluated were generally highly specific, but all had low
sensitivity. The fulcrum test provided the highest level of diagnostic
accuracy; however, it was inadequate for definitive clinical management.
Combining tests did not improve the diagnostic accuracy of tibial SFx.
Collapse
Affiliation(s)
| | | | - James E Cowan
- US Army-Baylor University, Fort Sam Houston, San Antonio, Texas, USA
| |
Collapse
|
|
22
|
Yan C, Bice RJ, Frame JW, Warden SJ, Kersh ME. Multidirectional basketball activities load different regions of the tibia: A subject-specific muscle-driven finite element study. Bone 2022; 159:116392. [PMID: 35314384 PMCID: PMC10201946 DOI: 10.1016/j.bone.2022.116392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 03/11/2022] [Accepted: 03/14/2022] [Indexed: 11/20/2022]
Abstract
The tibia is a common site for bone stress injuries, which are believed to develop from microdamage accumulation to repetitive sub-yield strains. There is a need to understand how the tibia is loaded in vivo to understand how bone stress injuries develop and design exercises to build a more robust bone. Here, we use subject-specific, muscle-driven, finite element simulations of 11 basketball players to calculate strain and strain rate distributions at the midshaft and distal tibia during six activities: walking, sprinting, lateral cut, jumping after landing, changing direction from forward-to-backward sprinting, and changing direction while side shuffling. Maximum compressive strains were at least double maximum tensile strains during the stance phase of all activities. Sprinting and lateral cut had the highest compressive (-2,862 ± 662 με and -2,697 ± 495 με, respectively) and tensile (973 ± 208 με and 942 ± 223 με, respectively) strains. These activities also had the highest strains rates (peak compressive strain rate = 64,602 ± 19,068 με/s and 37,961 ± 14,210 με/s, respectively). Compressive strains principally occurred in the posterior tibia for all activities; however, tensile strain location varied. Activities involving a change in direction increased tensile loads in the anterior tibia. These observations may guide preventative and management strategies for tibial bone stress injuries. In terms of prevention, the strain distributions suggest individuals should perform activities involving changes in direction during growth to adapt different parts of the tibia and develop a more fatigue resistant bone. In terms of management, the greater strain and strain rates during sprinting than jumping suggests jumping activities may be commenced earlier than full pace running. The greater anterior tensile strains during changes in direction suggest introduction of these types of activities should be delayed during recovery from an anterior tibial bone stress injury, which have a high-risk of healing complications.
Collapse
Affiliation(s)
- Chenxi Yan
- Department of Mechanical Science and Engineering, University of Illinois Urbana-Champaign, United States of America
| | - Ryan J Bice
- Department of Physical Therapy, Indiana University School of Health and Human Sciences, United States of America
| | - Jeff W Frame
- Department of Physical Therapy, Indiana University School of Health and Human Sciences, United States of America
| | - Stuart J Warden
- Department of Physical Therapy, Indiana University School of Health and Human Sciences, United States of America; Indiana Center for Musculoskeletal Health, Indiana University School of Medicine, United States of America; La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Bundoora, Victoria, Australia.
| | - Mariana E Kersh
- Department of Mechanical Science and Engineering, University of Illinois Urbana-Champaign, United States of America; Beckman Institute for Advanced Science and Technology, University of Illinois Urbana-Champaign, United States of America; Carle Illinois College of Medicine, University of Illinois Urbana-Champaign, United States of America.
| |
Collapse
|
|
23
|
Zaremski JL, Pazik M, Moser MW, Horodyski M. Olecranon Stress Fracture Management Challenges in a High School Baseball Pitcher: A Case Report and Review of the Literature. Curr Sports Med Rep 2022; 21:171-173. [PMID: 35703742 DOI: 10.1249/jsr.0000000000000962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
| | - Marrisa Pazik
- Department of Orthopedics and Rehabilitation, University of Florida, Gainesville, FL
| | - Michael W Moser
- Department of Orthopedics and Rehabilitation, University of Florida, Gainesville, FL
| | - MaryBeth Horodyski
- Department of Orthopedics and Rehabilitation, University of Florida, Gainesville, FL
| |
Collapse
|
|
24
|
Nezu S, Shimamura Y, Yamawaki T, Saito T, Ozaki T. Surgical treatment of humeral medial column stress fracture in a baseball pitcher: a case report. JSES REVIEWS, REPORTS, AND TECHNIQUES 2022; 2:254-259. [PMID: 37587971 PMCID: PMC10426622 DOI: 10.1016/j.xrrt.2021.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Affiliation(s)
- Satoshi Nezu
- Department of Orthopaedic Surgery, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Yasunori Shimamura
- Department of Orthopaedic Surgery, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Tadashi Yamawaki
- Department of Orthopaedic Surgery, Kousei Hospital, Okayama, Japan
| | - Taichi Saito
- Department of Orthopaedic Surgery, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Toshifumi Ozaki
- Department of Orthopaedic Surgery, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| |
Collapse
|
|
25
|
Survey on Video-Based Biomechanics and Biometry Tools for Fracture and Injury Assessment in Sports. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12083981] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
This work presents a survey literature review on biomechanics, specifically aimed at the study of existent biomechanical tools through video analysis, in order to identify opportunities for researchers in the field, and discuss future proposals and perspectives. Scientific literature (journal papers and conference proceedings) in the field of video-based biomechanics published after 2010 were selected and discussed. The most common application of the study of biomechanics using this technique is sports, where the most reported applications are american football, soccer, basketball, baseball, jumping, among others. These techniques have also been studied in a less proportion, in ergonomy, and injury prevention. From the revised literature, it is clear that biomechanics studies mainly focus on the analysis of angles, speed or acceleration, however, not many studies explore the dynamical forces in the joints. The development of video-based biomechanic tools for force analysis could provide methods for assessment and prediction of biomechanical force associated risks such as injuries and fractures. Therefore, it is convenient to start exploring this field. A few case studies are reported, where force estimation is performed via manual tracking in different scenarios. This demonstration is carried out using conventional manual tracking, however, the inclusion of similar methods in an automated manner could help in the development of intelligent healthcare, force prediction tools for athletes and/or elderly population. Future trends and challenges in this field are also discussed, where data availability and artificial intelligence models will be key to proposing new and more reliable methods for biomechanical analysis.
Collapse
|
|
26
|
Kumar A, Ghosh R. A review on experimental and numerical investigations of cortical bone fracture. Proc Inst Mech Eng H 2022; 236:297-319. [DOI: 10.1177/09544119211070347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This paper comprehensively reviews the various experimental and numerical techniques, which were considered to determine the fracture characteristics of the cortical bone. This study also provides some recommendations along with the critical review, which would be beneficial for future research of fracture analysis of cortical bone. Cortical bone fractures due to sports activities, climbing, running, and engagement in transport or industrial accidents. Individuals having different diseases are also at high risk of cortical bone fracture. It has been observed that osteon orientation influences cortical bone fracture toughness and fracture mechanisms. Apart from this, recent studies indicate that fracture parameters of cortical bone also depend on many factors such as age, sex, temperature, osteoporosis, orientation, location, loading condition, strain rate, and storage facility, etc. The cortical bone regains its fracture toughness due to various toughening mechanisms. Owing to these factors, several experimental, clinical, and numerical investigations have been carried out to determine the fracture parameters of the cortical bone. Cortical bone is the dense outer surface of the bone and contributes to 80%–82% of the skeleton mass. Cortical bone experiences load far exceeding body weight due to muscle contraction and the dynamics of motion. It is very important to know the fracture pattern, direction of fracture, location of the fracture, and toughening mechanism of cortical bone. A basic understanding of the different factors that affect the fracture parameters and fracture mechanisms of the cortical bone is necessary to prevent the failure and fracture of cortical bone. This review has summarized the advancement considered in the various experimental techniques and numerical methods to get complete information about the fracture mechanisms of cortical bone.
Collapse
Affiliation(s)
- Ajay Kumar
- School of Engineering, Indian Institute of Technology Mandi (IIT Mandi), Kamand, Mandi 175005, Himachal Pradesh, India
| | - Rajesh Ghosh
- School of Engineering, Indian Institute of Technology Mandi (IIT Mandi), Kamand, Mandi 175005, Himachal Pradesh, India
| |
Collapse
|
|
27
|
Stress Fractures of the Foot and Ankle. OPER TECHN SPORT MED 2021. [DOI: 10.1016/j.otsm.2021.150852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
|
28
|
[Stress fractures of the lower limbs]. DER ORTHOPADE 2021; 50:763-774. [PMID: 34415371 DOI: 10.1007/s00132-021-04139-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/15/2021] [Indexed: 10/20/2022]
Abstract
Stress reactions and fractures represent an important differential diagnostic entity, especially in patients active in sports. The lower extremities have predilection sites for stress fractures, which require special treatment in the context of the underlying risk factors. Clinically, patients usually complain of stress-dependent pain in the affected region and sport activities are mostly limited or even impossible. The detection of acute stress fractures is usually missed by conventional X‑ray within the first 4-6 weeks. The gold standard diagnostic tool is magnetic resonance imaging (MRI). Depending on the location, a distinction must be made between low-risk and high-risk stress fractures. Low-risk fractures show a high healing rate after conservative treatment including load and stress reduction as well as avoiding risk factors. High-risk fractures can take a complicated course under conservative treatment measures and in some cases, surgical intervention is required.
Collapse
|
|
29
|
Ellison MA, Fulford J, Javadi A, Rice HM. Do non-rearfoot runners experience greater second metatarsal stresses than rearfoot runners? J Biomech 2021; 126:110647. [PMID: 34343863 DOI: 10.1016/j.jbiomech.2021.110647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 07/01/2021] [Accepted: 07/18/2021] [Indexed: 11/26/2022]
Abstract
Stress fracture of the second metatarsal is a common and problematic injury for runners. The choice of foot strike pattern is known to affect external kinetics and kinematics but its effect on internal loading of the metatarsals is not well understood. Models of various complexities can be used to investigate the effects of running characteristics on metatarsal stresses. This study aimed to compare second metatarsal stress between habitual rearfoot and non-rearfoot strikers during barefoot running, using a novel participant-specific finite element model, including accurate metatarsal and soft tissue geometry. Synchronised force and kinematic data were collected during barefoot overground running from 20 participants (12 rearfoot strikers). Stresses were calculated using a previously evaluated and published 3D finite element model. Non-rearfoot strikers demonstrated greater external loading and joint contact forces than rearfoot runners, but there were no differences in stresses between groups. Additionally, the study allowed for a qualitative assessment of bone geometries and stresses. No correlation was found between bone volume and stresses, however, there was found to be a large variation in metatarsal shapes, possibly accounting for the lack of difference in stresses. This emphasises the importance of bone geometry when estimating bone stress and supports the suggestion that external forces should not be assumed to be representative of internal loading.
Collapse
Affiliation(s)
- M A Ellison
- Sport and Health Sciences, University of Exeter, Exeter, UK.
| | - J Fulford
- NIHR Exeter Clinical Research Facility, University of Exeter Medical School, Exeter, UK
| | - A Javadi
- College of Engineering, Mathematics and Physical Sciences, University of Exeter, Exeter, UK
| | - H M Rice
- Sport and Health Sciences, University of Exeter, Exeter, UK
| |
Collapse
|
|
30
|
Allado E, Ankri M, Khiami F, Tamgho T, Hamroun A, Proenca Lopes C, Poussel M, Chenuel B. Case Report: Stress Fracture in an International Triple Jumper: Importance of an Integrated Care Approach Which Also Incorporates Biomechanics. Front Sports Act Living 2021; 3:683691. [PMID: 34124662 PMCID: PMC8193055 DOI: 10.3389/fspor.2021.683691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 05/06/2021] [Indexed: 11/16/2022] Open
Abstract
Athletes fear stress fracture (SF) injuries as they can put a premature end to their athletic careers. Understanding any mechanical constraints can suggest preventive management approach. Specifically, for the triple jump, the mechanical stresses that occur during the event appear to be the main factors for risk of injury. This clinical case describes three successive episodes of anterior tibial fracture in an international triple jumper between 2011 and 2013. The first fracture received surgical treatment involving intramedullary nailing. The second fracture occurred in the same location and was considered a recurrence requiring medical treatment, whilst the third was a complete fracture of the surgical material and required surgical revision. These recurrent fractures can be explained by the fatigue of materials (bone and nail) induced by triple jump practice and emphasize the importance of integrating biomechanics into an assessment of the case. The use of biomechanical modelization to identify these weaknesses could be an approach for clinical management of such patients. Observation of the intrinsic mechanical stresses during high-level triple jump may lead to identification of modifiable risk factors for bone fragility.
Collapse
Affiliation(s)
- Edem Allado
- CHRU-Nancy, University Center of Sports Medicine and Adapted Physical Activity, Nancy, France.,Université de Lorraine, DevAH, Nancy, France
| | - Marine Ankri
- Department of Orthopedic Surgery and Trauma, Hospital Group (GH) Saint-Louis, Lariboisière, Fernand-Widal, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
| | - Frédéric Khiami
- Department of Orthopedic Surgery and Trauma, Hospital Group (GH) Pitié-Salpêtrière, Charles Foix, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
| | - Teddy Tamgho
- Institut National du Sport, de l'Expertise et de la Performance (INSEP), Paris, France
| | - Aghiles Hamroun
- Centre for Research in Epidemiology and Population Health, Paris-Saclay University, UMRS 1018, Villejuif, France
| | - Catarina Proenca Lopes
- Medicine Department, American Memorial Hospital, Reims, France.,University Hospital of Reims, Reims, France
| | - Mathias Poussel
- CHRU-Nancy, University Center of Sports Medicine and Adapted Physical Activity, Nancy, France.,Université de Lorraine, DevAH, Nancy, France
| | - Bruno Chenuel
- CHRU-Nancy, University Center of Sports Medicine and Adapted Physical Activity, Nancy, France.,Université de Lorraine, DevAH, Nancy, France
| |
Collapse
|
|
31
|
Schiefer M, Nanci F, Abílio LE, Ching San Junior YA, Motta Filho G. Fratura por estresse diafisária do úmero em atleta de tênis adolescente: Relato de caso. Rev Bras Ortop 2021; 57:175-179. [PMID: 35198126 PMCID: PMC8856851 DOI: 10.1055/s-0040-1721837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 09/17/2020] [Indexed: 10/28/2022] Open
Abstract
ResumoUm tenista adolescente tinha dor crônica no braço dominante durante os treinos de tênis. A ressonância magnética (RM) sugeriu lesão por estresse na diáfise do úmero. Depois de 4 semanas, ele se tornou assintomático e voltou a jogar. No entanto, houve recidiva da dor após 3 dias. A nova RM revelou fratura diafisária não desviada do úmero e edema significativo da medula óssea. O paciente ficou em repouso por 4 semanas. Depois disso, exercícios de fortalecimento foram introduzidos e o retorno aos treinamentos foi permitido após 12 semanas. Mesmo que assintomáticos, sugerimos que esses pacientes não voltem a jogar antes das 12 semanas, dependendo dos exames físicos e dos achados por imagem.
Collapse
Affiliation(s)
- Márcio Schiefer
- Departamento de Ortopedia, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
- Centro de Cirurgia do Ombro e Cotovelo, Instituto Nacional de Traumatologia e Ortopedia, Rio de Janeiro, RJ, Brasil
| | - Francisco Nanci
- Hospital Central da Polícia Militar, Rio de Janeiro, RJ, Brasil
| | - Luiz Eduardo Abílio
- Estagiário de Ombro e Cotovelo, Instituto Nacional de Traumatologia e Ortopedia, Rio de Janeiro, RJ, Brasil
| | | | - Geraldo Motta Filho
- Centro de Cirurgia do Ombro e Cotovelo, Instituto Nacional de Traumatologia e Ortopedia, Rio de Janeiro, RJ, Brasil
| |
Collapse
|
|
32
|
Iizawa N, Sonoki K, Obara Y, Kataoka T, Majima T. An Isolated Iliac Wing Stress Fracture in a Male Marathon Runner: A Case Report. JBJS Case Connect 2021; 11:01709767-202106000-00035. [PMID: 33979810 DOI: 10.2106/jbjs.cc.20.00541] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE A 49-year-old man, who had started jogging 3 months before his first participation in a marathon race, presented with acute pain and difficulty walking that began during the marathon race. Tumors and bone metabolism factors were ruled out by blood examination and various imaging findings. Isolated iliac wing fatigue fracture was diagnosed and treated with conservative therapy. CONCLUSION This is the first English-literature report we know of an isolated iliac wing stress fracture in a male marathon runner without underlying disease. Our study highlights the importance of considering this rare fracture when diagnosing patients presenting with iliac pain.
Collapse
Affiliation(s)
- Norishige Iizawa
- Department of Orthopaedic Surgery, Nippon Medical School, Tokyo, Japan
| | | | | | | | | |
Collapse
|
|
33
|
Risk Factors, Diagnosis and Management of Bone Stress Injuries in Adolescent Athletes: A Narrative Review. Sports (Basel) 2021; 9:sports9040052. [PMID: 33923520 PMCID: PMC8073721 DOI: 10.3390/sports9040052] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 04/03/2021] [Accepted: 04/13/2021] [Indexed: 12/14/2022] Open
Abstract
Physical activity is known to be beneficial for bone; however, some athletes who train intensely are at risk of bone stress injury (BSI). Incidence in adolescent athlete populations is between 3.9 and 19% with recurrence rates as high as 21%. Participation in physical training can be highly skeletally demanding, particularly during periods of rapid growth in adolescence, and when competition and training demands are heaviest. Sports involving running and jumping are associated with a higher incidence of BSI and some athletes appear to be more susceptible than others. Maintaining a very lean physique in aesthetic sports (gymnastics, figure skating and ballet) or a prolonged negative energy balance in extreme endurance events (long distance running and triathlon) may compound the risk of BSI with repetitive mechanical loading of bone, due to the additional negative effects of hormonal disturbances. The following review presents a summary of the epidemiology of BSI in the adolescent athlete, risk factors for BSI (physical and behavioural characteristics, energy balance and hormone disruption, growth velocity, sport-specific risk, training load, etc.), prevention and management strategies.
Collapse
|
|
34
|
Ulnar shaft stress fractures in fast-pitch softball pitchers: a case series and proposed mechanism of injury. Skeletal Radiol 2021; 50:835-840. [PMID: 32978679 DOI: 10.1007/s00256-020-03624-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 09/17/2020] [Accepted: 09/20/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Stress fractures of the upper extremities in athletes are important injuries for radiologists to appreciate despite being far less common than stress fractures of the lower extremities. Among upper extremity stress fractures, those involving the olecranon have been well described in overhead pitching athletes. Isolated stress fractures of the ulnar shaft however are less commonly reported in the literature and considered to be rare. We have observed a correlation between young patients with ulnar shaft stress fractures and the activity of fast-pitch softball pitching. CASE REPORTS In this series, we present the imaging findings in four cases of ulnar shaft stress fractures in softball pitchers who presented with insidious onset forearm pain. Furthermore, a review of the literature focusing on softball pitching mechanics is provided to offer a potential underlying mechanism for the occurrence and location of these injuries. CONCLUSION An awareness of the imaging appearance of ulnar shaft stress fractures along with an understanding of its proposed mechanism will facilitate accurate and timely imaging diagnosis of this injury by the radiologist.
Collapse
|
|
35
|
Nozawa T, Bell-Peter A, Doria AS, Marcuz JA, Stimec J, Whitney K, Feldman BM. Tibia stress injury and the imaging appearance of stress fracture in juvenile dermatomyositis: six patients' experiences. Pediatr Rheumatol Online J 2021; 19:17. [PMID: 33596941 PMCID: PMC7890837 DOI: 10.1186/s12969-021-00501-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 02/04/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Tibial stress injuries are frequent injuries of the lower extremity and the most common causes of exercise-induced leg pain among athletes and military recruits. They sometimes occur in patients with pathological conditions of bone metabolism such as osteoporosis or rheumatoid arthritis, but there are previously no cases reported in juvenile dermatomyositis (JDM). Here we report 6 JDM patients who presented with shin pain, and the imaging appearance of tibial stress fractures or stress reactions. CASE PRESENTATION All 6 patients with JDM presented with shin pain or tenderness in the anterior tibia without any evidence of excessive exercise or traumatic episode. They were diagnosed with tibial stress injuries based on a combination of radiographs, three-phase bone scans, and magnetic resonance imaging (MRI), and 5 out of 6 patients had been treated with prednisone and/or methotrexate at onset of tibial stress injuries. In one patient, we could not find any abnormalities in his radiograph, but the subsequent MRI showed tibial stress reaction. In all 6 patients, the tibial stress injuries improved with only rest and/or analgesics. CONCLUSION We experienced 6 children with JDM who presented with shin pain, and who were diagnosed with tibial stress fractures or stress reactions. Their underlying disease and weakness, treatment with glucocorticoid and methotrexate, or inactivity may have resulted in these tibial injuries, and made these patients more predisposed than other children. In addition to preventing JDM patients from getting osteoporosis, we need to consider stress reactions when children with JDM complain of sudden shin pain.
Collapse
Affiliation(s)
- Tomo Nozawa
- Division of Rheumatology, Department of Pediatrics, The Hospital for Sick Children, 555 University Ave, M5G 1X8, Toronto, ON, Canada. .,Department of Pediatrics, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Japan.
| | - Audrey Bell-Peter
- grid.42327.300000 0004 0473 9646Division of Rheumatology, Department of Pediatrics, The Hospital for Sick Children, 555 University Ave, M5G 1X8 Toronto, ON Canada
| | - Andrea S. Doria
- grid.17063.330000 0001 2157 2938Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, 555 University Ave, M5G 1X8 Toronto, ON Canada
| | - Jo-Anne Marcuz
- grid.42327.300000 0004 0473 9646Division of Rheumatology, Department of Pediatrics, The Hospital for Sick Children, 555 University Ave, M5G 1X8 Toronto, ON Canada
| | - Jennifer Stimec
- grid.17063.330000 0001 2157 2938Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, 555 University Ave, M5G 1X8 Toronto, ON Canada
| | - Kristi Whitney
- grid.42327.300000 0004 0473 9646Division of Rheumatology, Department of Pediatrics, The Hospital for Sick Children, 555 University Ave, M5G 1X8 Toronto, ON Canada
| | - Brian M. Feldman
- grid.42327.300000 0004 0473 9646Division of Rheumatology, Department of Pediatrics, The Hospital for Sick Children, 555 University Ave, M5G 1X8 Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, 155 College Street, M5T 3M6 Toronto, Toronto, ON Canada
| |
Collapse
|
|
36
|
Chow TH, Chen YS, Tsai WC, Lin MH. Plantar Pressure Profiles and Possible Foot Syndromes of Taiwanese College Elite Basketball Players. J Am Podiatr Med Assoc 2021; 111:441319. [PMID: 32701122 DOI: 10.7547/18-043] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Plantar pressure assessments are useful for understanding the functions of the foot and lower limb and for predicting injury incidence rates. Musculoskeletal fatigue is likely to affect plantar pressure profiles. This study aimed to characterize college elite basketball players' plantar pressure profiles and pain profiles during static standing and walking. METHODS Fifty-one male elite basketball players and 85 male recreational basketball players participated in this study. An optical plantar pressure measurement system was used to collect the arch index (AI), regional plantar pressure distributions (PPDs), and footprint characteristics during static and dynamic activities. Elite basketball players' pain profiles were examined for evaluating their common musculoskeletal pain areas. RESULTS The AI values were in the reference range in recreational basketball players and considerably lower in elite basketball players. Elite basketball players' static PPDs of both feet were mainly exerted on the lateral longitudinal arch and the lateral heel and were relatively lower on the medial longitudinal arch and medial and lateral metatarsal bones. The PPDs mainly transferred to the lateral metatarsal bone and lateral longitudinal arch and decreased at the medial heel during the midstance phase of walking. The footprint characteristics of elite basketball players illustrated the features of calcaneal varus (supinated foot) of high arches and dropped cuboid foot. The lateral ankle joints and anterior cruciate ligaments were the common musculoskeletal pain areas. CONCLUSIONS Elite basketball players' AI values indicated high arches, and their PPDs tended to parallel the features of the high-arched supinated and dropped cuboid foot. Their pain profiles resonated with the common basketball injuries and reflected the features of Jones fracture and cuboid syndrome. The potential links among high-arched supinated foot, Jones fracture, and cuboid syndrome are worth further study.
Collapse
|
|
37
|
Sultan O, Nuhmani S, Muaidi QI. Comparison of plantar loading patterns on natural grass and artificial turf during various athletic activities. J Sports Med Phys Fitness 2021; 61:680-686. [PMID: 33472347 DOI: 10.23736/s0022-4707.21.11342-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND This study aimed to investigate the differences in plantar pressure during various athletic activities on natural grass and artificial turf. METHODS Twenty-one athletes were fitted with properly sized soccer shoes and corresponding F-Scan system insoles and performed walking, running, vertical jumping and cutting activities to the right and left sides on both natural and artificial turf. RESULTS There were no statistically significant differences between natural grass and artificial turf in peak pressure, maximum force and force-time integral during all the athletic activities (P˃0.05). On both turfs, the highest peak pressure and maximum force values occurred during running and cutting to the right, and the highest force-time integral value occurred during cutting to the right. There were no statistically significant differences between the two turfs in peak pressure in the various anatomical regions during any of the athletic activities (P˃0.05). The peak pressure was the highest on the first metatarsal and the hallux during all five activities. A clinically meaningful difference between the surfaces in peak pressure on the second to fifth metatarsals was found during walking, indicating more loading on artificial turf than on natural grass. There was more loading on artificial turf than on natural grass during cutting left and at hallux and third toe on natural grass during cutting right. However, these differences were not statistically significant (P˃0.05). CONCLUSIONS The results of this study suggest that it is important to limit or prevent athletes from undertaking certain activities that increase the risk of re-injury during rehabilitation.
Collapse
Affiliation(s)
- Omar Sultan
- Department of Physical Therapy, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Shibili Nuhmani
- Department of Physical Therapy, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia -
| | - Qassim I Muaidi
- Department of Physical Therapy, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| |
Collapse
|
|
38
|
Griffin KL, Knight KB, Bass MA, Valliant MW. Predisposing Risk Factors for Stress Fractures in Collegiate Cross-Country Runners. J Strength Cond Res 2021; 35:227-232. [PMID: 29239997 DOI: 10.1519/jsc.0000000000002408] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
ABSTRACT Giffin, KL, Knight, KB, Bass, MA, and Valliant, MW. Predisposing risk factors and stress fractures in collegiate cross-country runners. J Strength Cond Res 35(1): 227-232, 2021-The purpose of this study was to explore factors associated with increased stress fractures in collegiate cross-country runners. Subjects in this study were 42 male and female cross-country runners at a Division I university. Each athlete completed a questionnaire regarding smoking status, vitamin/mineral intake, previous stress fracture history, birth control usage, menstrual status, and demographic information. Nutritional assessment using a 3-day food record and measurements of whole body, lumbar spine, and hip bone mineral densities (BMDs) were also conducted on each athlete. Results indicated that 40% of the female and 35% of the male runners reported a history of stress fracture, and that all of them did not meet the recommended daily energy intake or adequate intakes for calcium or vitamin D required for their amount of training. Two-tailed t-test found statistically higher incidences of lumbar spine BMD in male and female runners whose daily calcium and vitamin D intakes were below minimum requirements as well as for women whose caloric intake was below the required level. When data on the lumbar spine was evaluated, 31% of subjects (31.8% of the male and 30% of the female runners) were identified as having osteopenia and 4.8% with osteoporosis. Results warrant a need for future longitudinal studies.
Collapse
Affiliation(s)
- Kaci L Griffin
- Department of Nutrition and Hospitality Management, University of Mississippi, University, Mississippi; and
| | - Kathy B Knight
- Department of Nutrition and Hospitality Management, University of Mississippi, University, Mississippi; and
| | - Martha A Bass
- Department of Health, Exercise Science, and Recreation Management, University of Mississippi, University, Mississippi
| | - Melinda W Valliant
- Department of Nutrition and Hospitality Management, University of Mississippi, University, Mississippi; and
| |
Collapse
|
|
39
|
Popp KL, Ackerman KE, Rudolph SE, Johannesdottir F, Hughes JM, Tenforde AS, Bredella MA, Xu C, Unnikrishnan G, Reifman J, Bouxsein ML. Changes in Volumetric Bone Mineral Density Over 12 Months After a Tibial Bone Stress Injury Diagnosis: Implications for Return to Sports and Military Duty. Am J Sports Med 2021; 49:226-235. [PMID: 33259223 DOI: 10.1177/0363546520971782] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Bone stress injuries (BSIs) occur in up to 20% of runners and military personnel. Typically, after a period of unloading and gradual return to weightbearing activities, athletes return to unrestricted sports participation or military duty approximately 4 to 14 weeks after a BSI diagnosis, depending on the injury location and severity. However, the time course of the recovery of the bone's mechanical competence is not well-characterized, and reinjury rates are high. PURPOSE To assess the bone microarchitecture and volumetric bone mineral density (vBMD) over 12 months after a tibial BSI diagnosis. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS We enrolled 30 female athletes from the local community (aged 18-35 years) with a tibial BSI (grade ≥2 of 4 on magnetic resonance imaging) for this prospective observational study. Participants completed a baseline visit within 3 weeks of the diagnosis. At baseline and 6, 12, 24, and 52 weeks after the BSI diagnosis, we collected high-resolution peripheral quantitative computed tomography scans of the ultradistal tibia (4% of tibial length) of the injured and uninjured legs as well as pain and physical activity assessment findings. RESULTS From baseline to 12 weeks after the diagnosis, total, trabecular, and cortical vBMD declined by 0.58% to 0.94% (P < .05 for all) in the injured leg. Total and trabecular vBMD also declined by 0.61% and 0.67%, respectively, in the uninjured leg (P < .05 for both). At 24 weeks, mean values for all bone parameters were nearly equivalent to baseline values, and by 52 weeks, several mean values had surpassed baseline values. Of the 30 participants, 10 incurred a subsequent BSI during the course of the study, and 1 of these 10 incurred 2 subsequent BSIs. Participants who suffered an additional BSI were younger and had a later age of menarche, a greater incidence of previous fractures, and lower serum parathyroid hormone levels (P < .05 for all). CONCLUSION Bone density declined in both the injured and the uninjured legs and, on average, did not return to baseline for 3 to 6 months after a tibial BSI diagnosis. The observed time to the recovery of baseline vBMD, coupled with the high rate of recurrent BSIs, suggests that improved return-to-sports and military duty guidelines may be in order.
Collapse
Affiliation(s)
- Kristin L Popp
- Endocrine Unit, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA.,Military Performance Division, United States Army Research Institute of Environmental Medicine, Natick, Massachusetts, USA
| | - Kathryn E Ackerman
- Endocrine Unit, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA.,Boston Children's Hospital, Boston, Massachusetts, USA
| | - Sara E Rudolph
- Endocrine Unit, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Fjola Johannesdottir
- Harvard Medical School, Boston, Massachusetts, USA.,Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Julie M Hughes
- Military Performance Division, United States Army Research Institute of Environmental Medicine, Natick, Massachusetts, USA
| | - Adam S Tenforde
- Harvard Medical School, Boston, Massachusetts, USA.,Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA
| | - Miriam A Bredella
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Chun Xu
- Biotechnology High Performance Computing Software Applications Institute, Department of Defense, Frederick, Maryland, USA
| | - Ginu Unnikrishnan
- Biotechnology High Performance Computing Software Applications Institute, Department of Defense, Frederick, Maryland, USA
| | - Jaques Reifman
- Biotechnology High Performance Computing Software Applications Institute, Department of Defense, Frederick, Maryland, USA
| | - Mary L Bouxsein
- Endocrine Unit, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA.,Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| |
Collapse
|
|
40
|
Yoshimoto K, Noguchi M, Maruki H, Ishibashi M, Okazaki K. Nonunion of a medial malleolar stress fracture in an adolescent athlete secondary to lateral ankle instability: A case report. Int J Surg Case Rep 2020; 78:235-240. [PMID: 33360975 PMCID: PMC7772367 DOI: 10.1016/j.ijscr.2020.12.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 12/15/2020] [Indexed: 11/25/2022] Open
Abstract
A 13-year-old male football player presented with chronic medial left ankle pain. Radiographic examination showed nonunion of the medial malleolar stress fracture and chronic lateral ankle instability. Internal fixation with the arthroscopic modified Broström procedure was performed. The Self-Administered Foot Evaluation Questionnaire improved in all parameters. The method is useful for medial malleolar stress fractures due to chronic lateral ankle instability. Introduction Medial malleolar stress fractures are relatively uncommon. This report describes the successful treatment of nonunion of a medial malleolar stress fracture due to chronic lateral ankle instability. Presentation of case A 13-year-old middle school student who belonged to a football club presented to our clinic with chronic medial left ankle pain lasting over a year. He had sprained his left ankle several times 6 years earlier. A plain anteroposterior ankle radiograph showed a vertical fracture line in the medial malleolus involving the epiphyseal plate, and computed tomography demonstrated the vertical fracture seen on the plain radiographs and bone sclerosis at the fracture site. We performed internal fixation for nonunion of the medial malleolar stress fracture with arthroscopic modified Broström for lateral ankle instability. Two years after surgery, the Self-Administered Foot Evaluation Questionnaire improved in all parameters, and both the anterior drawer and varus stress tests were negative. Discussion Early diagnosis of medial malleolar stress fracture is important for a rapid return to sports. Magnetic resonance imaging is helpful for early diagnosis. Because lateral ankle instability can cause medial malleolar stress fracture, arthroscopic modified Broström procedure is meaningful for medial malleolar stress fracture with lateral ankle instability. Conclusion Internal fixation and the arthroscopic modified Broström procedure could achieve good clinical outcomes for medial malleolar stress fractures with lateral ankle instability.
Collapse
Affiliation(s)
- Kensei Yoshimoto
- Department of Orthopedic Surgery, Tokyo Women's Medical University, 8-1 Kawadacho, Shinjuku-ku, Tokyo 162-0054, Japan; Orthopaedic Foot and Ankle Center, Shiseikai Daini Hospital, 5-19-1 Kamisoshigaya, Setagaya-ku, Tokyo, 157-8550, Japan
| | - Masahiko Noguchi
- Department of Orthopedic Surgery, Tokyo Women's Medical University, 8-1 Kawadacho, Shinjuku-ku, Tokyo 162-0054, Japan; Orthopaedic Foot and Ankle Center, Shiseikai Daini Hospital, 5-19-1 Kamisoshigaya, Setagaya-ku, Tokyo, 157-8550, Japan; Orthopedic Foot and Ankle Center, Daisan, Kitashinagawa Hospital, 3-3-7 Kitashinagawa, Shinagawa-ku, Tokyo 140-0001, Japan.
| | - Hideyuki Maruki
- Orthopaedic Foot and Ankle Center, Shiseikai Daini Hospital, 5-19-1 Kamisoshigaya, Setagaya-ku, Tokyo, 157-8550, Japan
| | - Mina Ishibashi
- Orthopaedic Foot and Ankle Center, Shiseikai Daini Hospital, 5-19-1 Kamisoshigaya, Setagaya-ku, Tokyo, 157-8550, Japan
| | - Ken Okazaki
- Department of Orthopedic Surgery, Tokyo Women's Medical University, 8-1 Kawadacho, Shinjuku-ku, Tokyo 162-0054, Japan
| |
Collapse
|
|
41
|
Nonunion of a Stress Fracture at the Base of the Second Metatarsal in a Soccer Player Treated by Osteosynthesis with the Bridging Plate Fixation Technique. Case Rep Orthop 2020; 2020:6649443. [PMID: 33489396 PMCID: PMC7803179 DOI: 10.1155/2020/6649443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 12/03/2020] [Accepted: 12/08/2020] [Indexed: 01/13/2023] Open
Abstract
Background A stress fracture of the second metatarsal base in soccer players is extremely rare. In this case study, we report a nonunion of a stress fracture at the base of the second metatarsal in a female soccer player who had persistent pain despite continued conservative treatment, who then was treated with the bridging plate fixation technique. Case Report. A 19-year-old female college soccer player complained of pain on the dorsum of her right midfoot during a game without history of trauma and was conservatively treated for 6 months. Radiographic examination showed an oblique fracture with small bone fragment at the proximal base of the second metatarsal and computed tomography demonstrated sclerotic change around the fracture site. We diagnosed her with nonunion of a stress fracture at the base of the second metatarsal and performed operative treatments using autogenous cancellous iliac bone grafting and plate fixation bridging a second metatarsal and medial cuneiform with a locking plate. At 4 months after the initial surgery, she was able to return to playing soccer at preinjury level without complications or pain. Conclusion We report a rare case of nonunion of a stress fracture at the base of the second metatarsal in a female soccer player without underlying diseases. Surgical treatment was applied, because the conservative treatment was ineffective for 6 months and led to nonunion. The plate fixation technique bridging the second metatarsal and medial cuneiform was a useful option to attain the bone fusion for small fracture fragment for a treatment of nonunion of a stress fracture at the base of the second metatarsal.
Collapse
|
|
42
|
Sarpong NO, Levitsky M, Held M, Coury J, Greisberg J, Vosseller JT. Isolated fibular stress fractures: Radiographic parameters. Foot Ankle Surg 2020; 26:935-938. [PMID: 31937428 DOI: 10.1016/j.fas.2019.12.004] [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: 07/01/2019] [Revised: 12/06/2019] [Accepted: 12/30/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Fibular stress fractures are uncommon injuries with an incompletely understood pathogenesis and predisposing characteristics. This study investigated the demographic and radiographic risk factors for fibular stress fractures. METHODS A retrospective chart review from 2010 to 2018 revealed thirteen patients with isolated fibular stress fractures. Demographics, history of fracture, fracture location, bone quality, and heel alignment were collected. RESULTS The cohort consisted of six men and seven women with a mean age of 41.8 years. The average BMI was 28.5kg/m2. Three patients used tobacco. 69.2% of fractures were in the distal third, 23.1% proximal third, and 7.7% middle third. No patients had evidence of osteopenia. Distal fibula stress fractures were more common in women (66.7%) and associated with hindfoot valgus. CONCLUSION Distal third fibula stress fractures were most common and associated with hindfoot valgus. This could be due to a greater amount of axial force through fibula in this alignment. LEVEL OF EVIDENCE Level IV, Retrospective Case Series.
Collapse
Affiliation(s)
- Nana O Sarpong
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY, USA.
| | - Matthew Levitsky
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Michael Held
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Josephine Coury
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Justin Greisberg
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - J Turner Vosseller
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY, USA
| |
Collapse
|
|
43
|
Troy KL, Davis IS, Tenforde AS. A Narrative Review of Metatarsal Bone Stress Injury in Athletic Populations: Etiology, Biomechanics, and Management. PM R 2020; 13:1281-1290. [PMID: 33155355 DOI: 10.1002/pmrj.12518] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 10/21/2020] [Accepted: 10/27/2020] [Indexed: 01/13/2023]
Abstract
Metatarsal bone stress injuries (BSIs) are common in athletic populations. BSIs are overuse injuries that result from an accumulation of microdamage that exceeds bone remodeling. Risk for metatarsal BSI is multifactorial and includes factors related to anatomy, biology, and biomechanics. In this article, anatomic factors including foot type, metatarsal length, bone density, bone geometry, and intrinsic muscle strength, which each influence how the foot responds to load, are discussed. Biologic factors such as low energy availability and impaired bone metabolism influence the quality of the bone. Finally, the influence of biomechanical loads to bone such as peak forces, load rates, and loading cycles are reviewed. General management of metatarsal BSI is discussed, including acute care, rehabilitation, treatment of refractory metatarsal BSI, and evaluation of healing/return to sport. Finally, we identify future research priorities and emerging treatments for metatarsal BSI.
Collapse
Affiliation(s)
- Karen L Troy
- Department of Biomedical Engineering, Worcester Polytechnic Institute, Worcester, MA, USA
| | - Irene S Davis
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Charlestown, MA, USA.,Spaulding National Running Center, Spaulding Hospital, Cambridge, MA, USA
| | - Adam S Tenforde
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Charlestown, MA, USA.,Spaulding National Running Center, Spaulding Hospital, Cambridge, MA, USA
| |
Collapse
|
|
44
|
Rice HM, Kenny M, Ellison MA, Fulford J, Meardon SA, Derrick TR, Hamill J. Tibial stress during running following a repeated calf-raise protocol. Scand J Med Sci Sports 2020; 30:2382-2389. [PMID: 32757284 DOI: 10.1111/sms.13794] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 07/13/2020] [Accepted: 07/30/2020] [Indexed: 12/11/2022]
Abstract
Tibial stress fractures are a problematic injury among runners. Increased loading of the tibia has been observed following prolonged weight-bearing activity and is suggested to be the result of reduced activity of the plantar flexor muscles. The musculature that spans the tibia contributes to bending of the bone and influences the magnitude of stress on the tibia during running. Participant-specific models of the tibia can be used as a non-invasive estimate of tibial stress. This study aimed to quantify tibial stress during running using participant-specific bone geometry and to compare tibial stress before and after a protocol of repeated muscular contractions of the plantar flexor muscle group. Fourteen participants who run recreationally were included in the final analysis of the study. Synchronized force and kinematic data were collected during overground running before and after an exhaustive, weighted calf-raise protocol. Bending moments and stress at the distal third of the tibia were estimated using beam theory combined with inverse dynamics and musculoskeletal modeling. Bone geometry was obtained from magnetic resonance images. There was no difference in stress at the anterior, posterior, medial, or lateral peripheries of the tibia after the calf-raise protocol compared with before. These findings suggest that an exhaustive, repeated calf-raise protocol did not alter tibial stress during running.
Collapse
Affiliation(s)
- Hannah M Rice
- Sport and Health Sciences, University of Exeter, Exeter, UK
| | - Megan Kenny
- Sport and Health Sciences, University of Exeter, Exeter, UK
| | | | - Jon Fulford
- NIHR Exeter Clinical Research Facility, University of Exeter Medical School, Exeter, UK
| | - Stacey A Meardon
- Department of Physical Therapy, East Carolina University, Greenville, NC, USA
| | | | - Joseph Hamill
- Department of Kinesiology, University of Massachusetts, Amherst, MA, USA
| |
Collapse
|
|
45
|
Rice H, Weir G, Trudeau MB, Meardon S, Derrick T, Hamill J. Estimating Tibial Stress throughout the Duration of a Treadmill Run. Med Sci Sports Exerc 2020; 51:2257-2264. [PMID: 31634292 DOI: 10.1249/mss.0000000000002039] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Stress fractures of the tibia are a problematic injury among runners of all levels. Quantifying tibial stress using a modeling approach provides an alternative to invasive assessments that may be used to detect changes in tibial stress during running. This study aimed to assess the repeatability of a tibial stress model and to use this model to quantify changes in tibial stress that occur throughout the course of a 40-min prolonged treadmill run. METHODS Synchronized force and kinematic data were collected during prolonged treadmill running from 14 recreational male rearfoot runners on two separate occasions. During each session, participants ran at their preferred speed for two consecutive 20-min runs, separated by a 2-min pause. The tibia was modeled as a hollow ellipse and bending moments and stresses at the distal third of the tibia were estimated using beam theory combined with inverse dynamics and musculoskeletal modeling. RESULTS Intraclass correlation coefficients indicated good-to-excellent repeatability for peak stress values between sessions. Peak anterior and posterior stresses increased after 20 min of prolonged treadmill running and were 15% and 12% greater, respectively, after 40 min of running compared with the start of the run. CONCLUSION The hollow elliptical tibial model presented is a repeatable tool that can be utilized to assess within-participant changes in peak tibial stress during running. The increased stresses observed during a prolonged treadmill run may have implications for the development of tibial stress fracture.
Collapse
Affiliation(s)
- Hannah Rice
- Sport and Health Sciences, University of Exeter, Exeter, UNITED KINGDOM.,Biomechanics Laboratory, University of Massachusetts, Amherst, MA
| | - Gillian Weir
- Biomechanics Laboratory, University of Massachusetts, Amherst, MA
| | | | - Stacey Meardon
- Department of Physical Therapy, East Carolina University, NC
| | | | - Joseph Hamill
- Biomechanics Laboratory, University of Massachusetts, Amherst, MA
| |
Collapse
|
|
46
|
Abstract
Olecranon stress fractures are a rare upper extremity fracture that primarily affects throwing athletes. The incidence of olecranon stress fractures are increasing owing to the number of patients playing and the volume of engagement in competitive sports, especially in the pediatric population. However, olecranon stress fractures can present a challenge from a management and a rehabilitation perspective owing to their vague presentation, thereby affecting how these patients are diagnosed and managed. Therefore, it is imperative to further evaluate the disease process, diagnosis, and treatment of this condition to best manage our patients.
Collapse
Affiliation(s)
- Dylan N Greif
- University of Miami Sports Medicine Institute, 5555 Ponce De Leon Boulevard, Coral Gables, FL 33146, USA.
| | - Christopher P Emerson
- University of Miami Sports Medicine Institute, 5555 Ponce De Leon Boulevard, Coral Gables, FL 33146, USA
| | - Paul Allegra
- University of Miami Sports Medicine Institute, 5555 Ponce De Leon Boulevard, Coral Gables, FL 33146, USA
| | - Brandon J Shallop
- University of Miami Sports Medicine Institute, 5555 Ponce De Leon Boulevard, Coral Gables, FL 33146, USA
| | - Lee D Kaplan
- University of Miami Sports Medicine Institute, 5555 Ponce De Leon Boulevard, Coral Gables, FL 33146, USA
| |
Collapse
|
|
47
|
Incorporating subject-specific geometry to compare metatarsal stress during running with different foot strike patterns. J Biomech 2020; 105:109792. [DOI: 10.1016/j.jbiomech.2020.109792] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 04/02/2020] [Accepted: 04/04/2020] [Indexed: 12/19/2022]
|
|
48
|
Earl-Boehm JE, Poel DN, Zalewski K, Ebersole KT. The effects of military style ruck marching on lower extremity loading and muscular, physiological and perceived exertion in ROTC cadets. ERGONOMICS 2020; 63:629-638. [PMID: 32191155 DOI: 10.1080/00140139.2020.1745900] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 03/02/2020] [Indexed: 06/10/2023]
Abstract
Military ruck marching with load carriage increases ground reaction forces, which are related to bone stress injuries (BSI). This study's purpose was to examine whether a ruck march increases impact loading and to describe muscular, physiological and perceived exertion in Army Reserve Officer Training Corps (ROTC) cadets. Secondary purposes examined relationships among loading changes after the ruck march and baseline characteristics. Fifteen Army ROTC cadets performed a 4-mile march. Lower extremity loading and muscular, physiological and perceived exertion were measured pre- and post-march. Results indicated significant increases in peak impact force and loading rate and decreases in ankle dorsiflexion and plantarflexion strength. Factors that might have been related to changes seen in lower extremity loading did not yield any compelling relationships to explain those changes. In conclusion, the ruck march led to increased peak impact force and loading rate, which have been shown to be related to the risk of BSI. Practitioner summary: This study examined ROTC cadets ankle strength and lower extremity loading before and after a ruck march. We found that lower extremity loading increased after the march, and ankle dorsiflexion (DF) strength decreased, despite the cadets not feeling fatigued. These changes are consistent with risk factors for bone stress injuries. Abbreviations: BSI: bone stress injury; ROTC: Reserve Officer Training Corps; PIF: peak impact force; LR: loading rate; RPE: rate of perceived exertion; APFT: Army physical fitness test; DF: dorsiflexors; PF: plantar-flexors; INV: invertors; EV: evertors; HHD: handheld dynamometer; %HRmax: percentage of maximum heart rate.
Collapse
Affiliation(s)
- Jennifer E Earl-Boehm
- Department of Kinesiology - Integrated Healthcare and Performance, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Daniel N Poel
- Sanford Sports Science Institute - Sanford Health, Sioux Falls, SD, USA
| | - Kathryn Zalewski
- School of Health Care Professions, University of Wisconsin-Stevens Point, Stevens Point, WI, USA
| | - Kyle T Ebersole
- Department of Kinesiology - Integrated Healthcare and Performance, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| |
Collapse
|
|
49
|
Tibial bone stress injury: diagnostic performance and inter-reader agreement of an abbreviated 5-min magnetic resonance protocol. Skeletal Radiol 2020; 49:425-434. [PMID: 31420694 DOI: 10.1007/s00256-019-03297-8] [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: 05/27/2019] [Revised: 07/08/2019] [Accepted: 08/05/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To compare the diagnostic performance and inter-reader agreement of an abbreviated (5 min) MR protocol compared to a complete (25 min) protocol, for evaluation of suspected tibial bone stress injury. MATERIALS AND METHODS This IRB-approved retrospective study consisted of 95 consecutive MR examinations in 88 patients with suspected tibial bone stress injury. Three musculoskeletal radiologists independently classified all examinations utilizing both an abbreviated protocol consisting only of axial T2-weighted images with fat suppression, and after a washout period again classified the complete examinations. Accuracy was calculated as proportion of cases classified exactly, within 1 grade, within 2 grades, and also utilizing a simplified "clinically relevant" classification combining grades 2, 3, and 4A into a single group. Significance testing was performed with the chi-test, and a post-hoc power analysis was performed. Inter-reader agreement was calculated with Kendall's coefficient of concordance, with significance testing performed utilizing the z-test after bootstrapping to obtain the standard error. RESULTS AND CONCLUSIONS There was no significant difference in accuracy of grading tibial bone stress injuries between complete and abbreviated examinations. For complete exams, pooled exact accuracy was 47.8%; accuracy within 1 grade was 82.8%; and accuracy within 2 grades was 96.1%. For the abbreviated protocol, corresponding accuracies were 50.2, 82.0, and 93.9%. With the "clinically relevant" simplified classification, accuracy was 58.6% for complete exams and 64.2% for abbreviated exams. There was no significant difference in inter-reader agreement, with substantial agreement demonstrated for both complete (Kendall coefficient of concordance 0.805) and abbreviated examinations (coefficient of 0.767).
Collapse
|
|
50
|
Metacarpal Stress Fracture Is Not an Uncommon Condition in Adolescent Racket Athletes. Case Rep Orthop 2020; 2020:5840925. [PMID: 32089931 PMCID: PMC7031721 DOI: 10.1155/2020/5840925] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 01/20/2020] [Indexed: 11/17/2022] Open
Abstract
Background Stress fractures of the metacarpal bones are considered uncommon. We report on 11 adolescent athletes with these stress fractures, successfully treated with cessation of sports activities. Representative case presentation. In case 1, a 15-year-old male tennis player presented with right hand pain of 4-week duration without an acute trauma history. Tenderness existed on palpation along the dorsal and proximal second metacarpal bone. Plain radiographs demonstrated a periosteal reaction on the proximal shaft of the second metacarpal. Racket swinging was suspended. He returned to competitive tennis 2 months after the initial visit and continues to participate without symptoms. In case 2, a 16-year-old male boxer presented with right hand pain of 2-week duration that arose while punching. Acute trauma history was absent. Tenderness existed on palpation over the third metacarpal of the right hand. Plain radiographs demonstrated no periosteal reaction or fracture line. MRI showed a high signal on the third metatarsal bone on fat suppression and a low signal on T2-weighted images. Nonoperative treatment was initiated without external fixation, and punching was suspended. He returned to boxing 1 month after the initial visit without symptoms. Conclusions The current case series of metacarpal stress fractures demonstrate that this condition is not as rare as previously reported. Metacarpal stress fractures are generally ignored since the clinical and radiological findings are mostly unclear. If an athlete experiences hand pain without acute onset during sports activities, especially in racket sports, the presence of a metacarpal stress fracture should be assessed by MRI.
Collapse
|