A study of serum sodium level among Hong Kong runners.

OBJECTIVE: Hyponatremia and the associated life-threatening complications have emerged as an important issue among marathon runners. This study was conducted to estimate the serum sodium level among local marathon runners and to identify the associated risk factors of dysnatremia. DESIGN: Prospective observational cohort study. SETTING: Hong Kong Marathon 2008. PARTICIPANTS: Subjects were approached at their convenience to participate in the study. Only full-marathon runners were recruited. They were to have had an unremarkable medical and drug history. INTERVENTIONS: Demographic data, training information, previous marathon experience, anticipated drinking strategy, details of fluid consumption throughout the race, weight change, finishing time, and physical complaint. MAIN OUTCOME MEASURES: Post-race serum sodium level. RESULTS: Of the 6488 entries to the race, 370 runners (5.7%) were recruited. Among them, 272 (73.5%) completed the race and attended for blood sampling and data collection. One runner (0.4%) had hyponatremia (133 mmol/L) and 35 runners (12.9%) had hypernatremia (>145 mmol/L), whereas 236 runners (86.7%) had normal serum sodium (135-145 mmol/L) after the race. No symptomatic dysnatremia was found. A mean weight reduction of 0.70 kg was found after the race. An average of 1.9 L of fluid was consumed during the race and 2.5 L if the fluid consumed immediately before and after the race was also included. Hypernatremia was seen in runners who were better trained before the race, those who performed better, and those who drank less water after the race. CONCLUSIONS: This is the largest prospective observational cohort study of dysnatremia conducted on athletes completing a standard marathon in Asia. No case of symptomatic dysnatremia was found.

F-18 FDG PET/CT in an adult case of group B streptococcal sacroiliitis.

An adult patient presented with acute severe pelvic and low-back pain. Evaluations with CT and MRI were negative/inconclusive. F-18 FDG PET/CT localized the site of pathology in right sacroiliac-joint by demonstrating hypermetabolic activities conformal with the joint's outline, signifying infectious/inflammatory sacroiliitis. Blood culture was positive for Group B streptococcus (GBS). Antibiotic treatment was started within 24 hours from onset of symptoms, and there was almost immediate partial pain relief. GBS sacroiliitis is a rare form of septic sacroiliitis requiring prompt diagnosis and urgent treatment. This is the first report of F-18 FDG PET/CT for diagnosing GBS sacroiliitis in adults with no predisposing factors.

Bone-periosteum-bone graft reconstruction for chronic ulnar instability of the metacarpophalangeal joint of the thumb--minimum 5-year follow-up evaluation.

PURPOSE: The present study evaluated prospectively the functional and radiological results of a consecutive series of 7 patients who had bone-periosteum-bone (BPB) grafts harvested from the iliac crest for treatment of chronic ulnar instability of the metacarpophalangeal (MCP) joint of the thumb after a minimum of 60 months. METHODS: Seven thumbs from 7 patients were entered into a prospective study for surgical treatment of chronic finger joint instability. Treatment consisted of reconstruction of the ulnar collateral ligament of the MCP joint of the thumb by a BPB graft harvested from the iliac crest. Stability, range of motion, pinch grip, and radiographs were evaluated at least 60 months after surgery. RESULTS: All 7 patients had full active range of motion of the treated thumb at the final follow-up evaluation (average, 75 months after surgery). All patients had equal stability and normal pinch grip when comparing with the untreated thumb. The mean time off work was 3 months for 6 patients who were injured at work. At final follow-up evaluation, radiographs showed all grafts incorporated without implant complications, no osteoarthritis changes were noted, and stress radiographs showed that all patients had normal stability in the treated thumb when compared with the untreated thumb. CONCLUSIONS: Chronic ulnar instability of the MCP joint of the thumb reconstructed with BPB graft harvested from the iliac crest is an effective and safe method to allow restoration and maintenance of a stable, pain-free thumb. The results of the current study support the long-term durability of this method. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Endoscope damaged during endoscopic carpal tunnel release--the solution method.

An unusual problem occurred during the endoscopic carpal tunnel release procedure of a patient with carpal tunnel syndrome. The endoscope was damaged because of inadequate knowledge in handling the instruments. The procedure was completed smoothly with a knee arthroscope.

Distal radioulnar joint dorsal instability treated with dorsal capsular reconstruction.

Six patients with post-traumatic distal radioulnar joint dorsal instability were treated with dorsal capsular reconstruction. This new technique of reconstruction requires less extensive dissection than the previously described methods in the literature and requires no tendon graft. A total of six patients treated from 1999 to 2001 were included in this study. Two were males and four were females. The average age of patients was 30 years and all the instabilities were secondary to trauma. One of them had associated minimally displaced distal radius fracture. All patients had arthrogram and arthroscopy done before the reconstruction and had no significant triangular fibrocartilage complex injury. The surgery consisted of duplication capsulorrhaphy of the dorsal capsular structures of the distal radioulnar joint. All patients had satisfactory results after the operations in terms of pain relief, range of motion and stability.

Comparison of methods of skeletal fixation for severely injured digits.

Our objective is to compare the results of three different methods of osteosynthesis used in severely injured digits, namely the K-wire group, the K-wire & Wire-loop group and the Plate & Screws group. The results of 38 patients with 50 severely injured fingers managed between 1994 and 2000 were reviewed. Majority of them had serious injury caused by electric-saw and Zone III was the most common level of injury using Biemer's classification. Using the scoring system of Nakamura and Tamai, excellent and good results were obtained in 59.5% of the patients. The rate of bony complications was different among the three methods of osteosynthesis though the final functional outcomes were comparable. The rate of bony complications in this series was 20.4%, which included non-union (7), migration of K-wires (2) and infection (1). All occurred in K-wire and K-wire & Wire-loop groups. Plate & Screws, therefore, is the preferred method of bony fixation if further operation for non-union is to be avoided. This is more so for the proximal injuries.