BACKGROUND Acute injuries to the tibiofibular syndesmosis,often associated with high ankle sprains or malleolar fractures,require precise diagnosis and treatment to prevent long-term complications.This case report exp...BACKGROUND Acute injuries to the tibiofibular syndesmosis,often associated with high ankle sprains or malleolar fractures,require precise diagnosis and treatment to prevent long-term complications.This case report explores the use of needle arthroscopy as a minimally invasive technique for the repair of tibiofibular syndesmosis injuries.CASE SUMMARY We report on a 40-year-old male patient who presented with a trimalleolar fracture and ankle subluxation following a high ankle sprain.Due to significant swelling and poor soft tissue quality,initial management involved external stabilization.Subsequently,needle arthroscopy was employed to assess and treat the tibiofibular syndesmosis injury.The procedure,performed under spinal anesthesia and fluoroscopic control,included nanoscopic evaluation of the ankle joint and reduction of the syndesmosis using a suture button.Follow-up assessments showed significant improvement in pain levels,range of motion,and functional scores.At 26 weeks post-procedure,the patient achieved full range of motion and pain-free status.Needle arthroscopy offers a promising alternative for the management of acute tibiofibular syndesmosis injuries,combining diagnostic and therapeutic capabilities with minimal invasiveness.CONCLUSION This technique may enhance clinical outcomes and reduce recovery times,warranting further investigation and integration into clinical practice.展开更多
Acute traumatic spinal cord injury is often a lifechanging and devastating event with considerable mortality and morbidity.Over half a million people suffer from traumatic spinal cord injury annually with the majority...Acute traumatic spinal cord injury is often a lifechanging and devastating event with considerable mortality and morbidity.Over half a million people suffer from traumatic spinal cord injury annually with the majority resulting from road traffic accidents or falls.The Individual,societal and economic costs are enormous.Initial recognition and treatment of acute traumatic spinal cord injury are crucial to limit secondary injury to the spinal cord and to provide patients with the best chance of some functional recovery.This article is an overview of the management of the acute traumatic spinal cord injury patient presenting to the emergency department.We review the initial assessment,criteria for imaging and clearing the spine,and evaluate the literature to determine the optimum timing of surgery and the role of non-surgical treatment in patients presenting with acute spinal cord injury.展开更多
BACKGROUND Evidence-based guidance on return to sport following toe phalanx fractures is limited.AIM To systemically review all studies recording return to sport following toe phalanx fractures(both acute fractures an...BACKGROUND Evidence-based guidance on return to sport following toe phalanx fractures is limited.AIM To systemically review all studies recording return to sport following toe phalanx fractures(both acute fractures and stress fractures),and to collate information on return rates to sport(RRS)and mean return times(RTS)to the sport.METHODS A systematic search of PubMed,MEDLINE,EMBASE,CINAHL,Cochrane Library,Physiotherapy Evidence Database,and Google Scholar was performed in December 2022 using the keywords‘Toe’,‘Phalanx’,‘Fracture’,‘injury’,‘athletes’,‘sports’,‘non-operative’,‘conservative’,‘operative’,‘return to sport’.All studies which recorded RRS and RTS following toe phalanx fractures were included.RESULTS Thirteen studies were included:one retrospective cohort study and twelve case series.Seven studies reported on acute fractures.Six studies reported on stress fractures.For the acute fractures(n=156),63 were treated with primary conservative management(PCM),6 with primary surgical management(PSM)(all displaced intra-articular(physeal)fractures of the great toe base of the proximal phalanx),1 with secondary surgical management(SSM)and 87 did not specify treatment modality.For the stress fractures(n=26),23 were treated with PCM,3 with PSM,and 6 with SSM.For acute fractures,RRS with PCM ranged from 0 to 100%,and RTS with PCM ranged from 1.2 to 24 wk.For acute fractures,RRS with PSM were all 100%,and RTS with PSM ranged from 12 to 24 wk.One case of an undisplaced intra-articular(physeal)fracture treated conservatively required conversion to SSM on refracture with a return to sport.For stress fractures,RRS with PCM ranged from 0%to 100%,and RTS with PCM ranged from 5 to 10 wk.For stress fractures,RRS with PSM were all 100%,and RTS with surgical management ranged from 10 to 16 wk.Six cases of conservatively-managed stress fractures required conversion to SSM.Two of these cases were associated with a prolonged delay to diagnosis(1 year,2 years)and four cases with an underlying展开更多
BACKGROUND Scaphoid fracture is the most commonly fractured carpal bone in the athletic patient, accounting for over 85% of all sport-related carpal bone fractures, and is particularly common in sports involving high ...BACKGROUND Scaphoid fracture is the most commonly fractured carpal bone in the athletic patient, accounting for over 85% of all sport-related carpal bone fractures, and is particularly common in sports involving high impact injuries to the wrist. The management of such injuries comprises both conservative and surgical techniques, as guided by fracture location and type. Athletes demonstrate a unique challenge with regards to the management of scaphoid fractures due to their requirement to return to sport, as soon as able.AIM To review systemically all studies recording return to sport following scaphoid fractures, to collate information on return rates to sport(RRS) and mean return times(RTS) to sport and to determine differences in sporting outcome for the various treatment methods.METHODS A systematic search of MEDLINE, EMBASE, CINAHAL, Cochrane, Google Scholar, Physiotherapy Evidence Database, SPORTDiscus, Web of Science and Scopus was performed in August 2018 using the keywords "scaphoid","fracture", "acute", "carpal", "athletes", "sports", "non-operative","conservative", "operative" and "return to sport". All studies that recorded RRS and RTS following scaphoid fractures were included. RTS was recorded as the length of time from commencement of either primary conservative management or primary surgical procedure to return to sport.RESULTS Eleven studies were included: Two randomised controlled trials, six retrospective cohort studies and three case series. Seven studies reported on conservative management(n = 77), and eight studies reported on surgical management(n =83). For conservative management, RRS was 90%(69/77), and the mean RTS was9.6 wk. Three studies allowed to return to sport in cast [RRS 89%(25/28); RTS 1.9 wk], and four studies required completion of cast treatment prior to returning to sport [RRS 90%(44/49); RTS 13.9 wk]. Four studies recorded fracture union data:Union rate 85%(47/55); mean time to union 14.0 wk. For surgical management,RRS was 98%(81/83), and RTS was 7.3 wk. Three studies repo展开更多
文摘BACKGROUND Acute injuries to the tibiofibular syndesmosis,often associated with high ankle sprains or malleolar fractures,require precise diagnosis and treatment to prevent long-term complications.This case report explores the use of needle arthroscopy as a minimally invasive technique for the repair of tibiofibular syndesmosis injuries.CASE SUMMARY We report on a 40-year-old male patient who presented with a trimalleolar fracture and ankle subluxation following a high ankle sprain.Due to significant swelling and poor soft tissue quality,initial management involved external stabilization.Subsequently,needle arthroscopy was employed to assess and treat the tibiofibular syndesmosis injury.The procedure,performed under spinal anesthesia and fluoroscopic control,included nanoscopic evaluation of the ankle joint and reduction of the syndesmosis using a suture button.Follow-up assessments showed significant improvement in pain levels,range of motion,and functional scores.At 26 weeks post-procedure,the patient achieved full range of motion and pain-free status.Needle arthroscopy offers a promising alternative for the management of acute tibiofibular syndesmosis injuries,combining diagnostic and therapeutic capabilities with minimal invasiveness.CONCLUSION This technique may enhance clinical outcomes and reduce recovery times,warranting further investigation and integration into clinical practice.
文摘Acute traumatic spinal cord injury is often a lifechanging and devastating event with considerable mortality and morbidity.Over half a million people suffer from traumatic spinal cord injury annually with the majority resulting from road traffic accidents or falls.The Individual,societal and economic costs are enormous.Initial recognition and treatment of acute traumatic spinal cord injury are crucial to limit secondary injury to the spinal cord and to provide patients with the best chance of some functional recovery.This article is an overview of the management of the acute traumatic spinal cord injury patient presenting to the emergency department.We review the initial assessment,criteria for imaging and clearing the spine,and evaluate the literature to determine the optimum timing of surgery and the role of non-surgical treatment in patients presenting with acute spinal cord injury.
文摘BACKGROUND Evidence-based guidance on return to sport following toe phalanx fractures is limited.AIM To systemically review all studies recording return to sport following toe phalanx fractures(both acute fractures and stress fractures),and to collate information on return rates to sport(RRS)and mean return times(RTS)to the sport.METHODS A systematic search of PubMed,MEDLINE,EMBASE,CINAHL,Cochrane Library,Physiotherapy Evidence Database,and Google Scholar was performed in December 2022 using the keywords‘Toe’,‘Phalanx’,‘Fracture’,‘injury’,‘athletes’,‘sports’,‘non-operative’,‘conservative’,‘operative’,‘return to sport’.All studies which recorded RRS and RTS following toe phalanx fractures were included.RESULTS Thirteen studies were included:one retrospective cohort study and twelve case series.Seven studies reported on acute fractures.Six studies reported on stress fractures.For the acute fractures(n=156),63 were treated with primary conservative management(PCM),6 with primary surgical management(PSM)(all displaced intra-articular(physeal)fractures of the great toe base of the proximal phalanx),1 with secondary surgical management(SSM)and 87 did not specify treatment modality.For the stress fractures(n=26),23 were treated with PCM,3 with PSM,and 6 with SSM.For acute fractures,RRS with PCM ranged from 0 to 100%,and RTS with PCM ranged from 1.2 to 24 wk.For acute fractures,RRS with PSM were all 100%,and RTS with PSM ranged from 12 to 24 wk.One case of an undisplaced intra-articular(physeal)fracture treated conservatively required conversion to SSM on refracture with a return to sport.For stress fractures,RRS with PCM ranged from 0%to 100%,and RTS with PCM ranged from 5 to 10 wk.For stress fractures,RRS with PSM were all 100%,and RTS with surgical management ranged from 10 to 16 wk.Six cases of conservatively-managed stress fractures required conversion to SSM.Two of these cases were associated with a prolonged delay to diagnosis(1 year,2 years)and four cases with an underlying
文摘BACKGROUND Scaphoid fracture is the most commonly fractured carpal bone in the athletic patient, accounting for over 85% of all sport-related carpal bone fractures, and is particularly common in sports involving high impact injuries to the wrist. The management of such injuries comprises both conservative and surgical techniques, as guided by fracture location and type. Athletes demonstrate a unique challenge with regards to the management of scaphoid fractures due to their requirement to return to sport, as soon as able.AIM To review systemically all studies recording return to sport following scaphoid fractures, to collate information on return rates to sport(RRS) and mean return times(RTS) to sport and to determine differences in sporting outcome for the various treatment methods.METHODS A systematic search of MEDLINE, EMBASE, CINAHAL, Cochrane, Google Scholar, Physiotherapy Evidence Database, SPORTDiscus, Web of Science and Scopus was performed in August 2018 using the keywords "scaphoid","fracture", "acute", "carpal", "athletes", "sports", "non-operative","conservative", "operative" and "return to sport". All studies that recorded RRS and RTS following scaphoid fractures were included. RTS was recorded as the length of time from commencement of either primary conservative management or primary surgical procedure to return to sport.RESULTS Eleven studies were included: Two randomised controlled trials, six retrospective cohort studies and three case series. Seven studies reported on conservative management(n = 77), and eight studies reported on surgical management(n =83). For conservative management, RRS was 90%(69/77), and the mean RTS was9.6 wk. Three studies allowed to return to sport in cast [RRS 89%(25/28); RTS 1.9 wk], and four studies required completion of cast treatment prior to returning to sport [RRS 90%(44/49); RTS 13.9 wk]. Four studies recorded fracture union data:Union rate 85%(47/55); mean time to union 14.0 wk. For surgical management,RRS was 98%(81/83), and RTS was 7.3 wk. Three studies repo
