Treatment outcome of spontaneous chronic corneal epithelial defects in brachycephalic dogs comparing Boxers and non-Boxers: A retrospective multicenter study of 420 dogs.

OBJECTIVE: To compare characteristics and treatment outcomes of spontaneous chronic corneal epithelial defects (SCCEDs) in brachycephalic non-Boxers and Boxers. We hypothesized that brachycephalic non-Boxers develop SCCEDs at a younger age and develop complications more frequently than Boxers. ANIMALS STUDIED: Retrospective review of medical records of brachycephalic dogs treated for SCCEDs between January 2018 and December 2022 in multiple ophthalmology referral centers in the UK. PROCEDURE: Data recorded included breed, age, time of onset, treatment prior to referral, treatment at referral, time to heal, need for further procedures, and complications. RESULTS: A total of 464 SCCEDs in 420 dogs were included composed of 173 Boxers with 200 SCCEDs and 247 brachycephalic non-Boxer dogs with 264 SCCEDs. Boxers were significantly older (median 8.2, range 4.5-12.7 years) than brachycephalic non-Boxers (median 7.2, range 1.6-15.9 years) (p < .001). The first treatment (cotton-tipped applicator [CTA] debridement, diamond burr debridement, superficial keratectomy, grid keratotomy, punctate keratotomy, or combinations of these) selected was significantly different between groups (p < .001). Healing, excluding cases addressed by CTA debridement, following the first procedure was significantly more successful in Boxers (p = .049). Excluding cases addressed by CTA debridement, 9.6% of SCCEDs in Boxers (20/200) and 13.4% (32/239) of non-Boxers required more than one procedure. In the non-Boxer group, 9.5% (25/264) developed complications, contrasting with 4% (8/200) in the Boxer group. Non-Boxers were more likely to develop complications after the first treatment (p = .006). CONCLUSION: Non-Boxer brachycephalic dogs develop SCCEDs younger than Boxers. This study suggests SCCEDs in brachycephalic non-Boxers may be less likely to heal following one mechanical treatment and are more likely to develop complications.

Boxing Punch Detection with Single Static Camera.

Computer vision in sports analytics is gaining in popularity. Monitoring players' performance using cameras is more flexible and does not interfere with player equipment compared to systems using sensors. This provides a wide set of opportunities for computer vision systems that help coaches, reporters, and audiences. This paper provides an introduction to the problem of measuring boxers' performance, with a comprehensive survey of approaches in current science. The main goal of the paper is to provide a system to automatically detect punches in Olympic boxing using a single static camera. The authors use Euclidean distance to measure the distance between boxers and convolutional neural networks to classify footage frames. In order to improve classification performance, we provide and test three approaches to manipulating the images prior to fitting the classifier. The proposed solution achieves 95% balanced accuracy, 49% F1 score for frames with punches, and 97% for frames without punches. Finally, we present a working system for analyses of a boxing scene that marks boxers and labelled frames with detected clashes and punches.

POINT-OF-CARE ULTRASOUND FOR GUIDANCE OF CLOSED REDUCTION OF FIFTH METACARPAL NECK (BOXER'S) FRACTURE.

BACKGROUND: Ultrasound has been used previously in fracture identification, analgesia delivery, and fracture reduction for patients in the emergency department. It has not been previously described as a tool for the guidance of closed fracture reduction in fifth metacarpal neck fractures ("boxer's fractures"). CASE REPORT: A 28-year-old man presented with hand pain and swelling after punching a wall. Point-of-care ultrasound revealed a significantly angulated fifth metacarpal fracture, which was confirmed with a subsequent hand x-ray study. After an ultrasound-guided ulnar nerve block, closed reduction was performed. Ultrasound was used to assess reduction and ensure improvement in bony angulation during the closed reduction attempts. Post-reduction x-ray study confirmed improved angulation and adequate alignment. Why Should an Emergency Physician Be Aware of This? Point-of-care ultrasound has previously had efficacy in fracture diagnosis and anesthesia delivery for fifth metacarpal fractures. Ultrasound can also be used at the bedside to assist in the determination of adequate fracture reduction when performing closed reduction of a boxer's fracture.

Comparison of the radiological and functional results of a plaster splint and dynamic stabilization splint for Boxer's fractures: A prospective randomized controlled study.

PURPOSE: This study compared the clinical and radiological results of fifth metacarpal neck fractures treated with a short-arm plaster splint (SAPS) versus a dynamic metacarpal stabilization splint (DMSS). MATERIALS AND METHODS: The 119 patients were referred to our institute between 2018 and 2019 and treated with SAPS or DMSS after appropriate initial closed reduction. Follow-up examinations were conducted at days 10 and 20, and at 1, 2, and 3 months after treatment. Alignment of the fracture, range of motion (ROM), and complications were evaluated during each visit. Grip strength was evaluated using a dynamometer. Self-care, usual daily activities, pain/discomfort, and anxiety/depression were evaluated using the EuroQol 5-Dimension 5-Level (EQ-5D-5L) and a VAS. RESULTS: Of the 119 patients, 103 completed all follow up examinations. In total, 51 patients were treated with SAPS and 52 with DMSS. Skin lesions were detected in five patients in the DMSS group, but none in the SAPS group (p = 0.008). The grip strength of patients in the DMSS group was statistically better at the 1-, 2-month and 3-month follow-up visits (p < 0.001). ROM of the interphalangeal and metacarpophalangeal joints were statistically better in the DMSS group at the 1-month visit (p < 0.001) but similar at the 3-month visit (p = 0.27). Wrist ROM was statistically higher in the DMSS group at the 3-month visit (p < 0.05). Self-care, usual daily activities, pain/discomfort, and anxiety/depression were statistically better in the DMSS group at all follow-up visits (p < 0.05), as determined by the EQ-5D-5L. CONCLUSION: Dynamic stabilization of a stable boxer's fracture with DMSS is as effective as static stabilization with SAPS for maintaining the reduction and ensuring union. However, DMSS provides better early ROM, comfort, and muscle strength, as well as an earlier return to usual daily activities despite the occasional skin lesions happened.

Ossification of the posterior capitellum: description of a new pathology and its radiological appearance.

BACKGROUND: Boxer elbow and handball goalkeeper elbow are causes of impingement characterized by osteophytes formation at the olecranon and coronoid tip as well as their corresponding fossae. Herein, we present another distinct pathology in these patients: the formation of an exostosis at the posterolateral aspect of the elbow. METHODS: Between April 2016 and May 2020, 12 athletes with boxer elbow and handball goalkeeper elbow (mean age of 22 years) suffering from elbow pain were enrolled in the present study. Plain radiography, magnetic resonance imaging (MRI), and computer tomography (CT) scans were used to evaluate the bone conformation of the posterolateral aspect of the elbow. Assessment and staging of the ossification was performed by two independent fellowship-trained elbow surgeons. RESULTS: Bone marrow edema of the posterior aspect of the elbow at the origin of the anconeus muscle was initially detected in MRI scans. With the progression of the condition, imaging revealed an ossification posterior to the capitellum with bony bridges. In the advanced stage of the disease, the exostoses was unstable as the ossification had no adherence to the posterior capitellum during surgical excision. Plain radiographs are limited in their ability to detect the condition, whereas MRI and CT scans allow to identify a signal enhancement at the posterolateral aspect of the elbow. CONCLUSION: In patients without history of elbow trauma, bony irregularities of the posterior aspect of the capitellum may indicate ossification of the posterolateral aspect of the elbow, most likely caused by repetitive hyperextensions.

Trends in the Management of Fifth Metacarpal Neck Fractures.

PURPOSE: To describe management trends of fifth metacarpal neck (5MCN) fractures within a large health care system. We aimed to define patient and surgeon factors associated with nonsurgical versus surgical treatment, as well as to identify factors associated with receiving care only in the emergency department (ED). METHODS: We identified all 5MCN fractures within our system for the years 2012-2020 and recorded baseline demographics for cases. Injury, treatment, and fracture characteristics were all recorded. For fractures treated nonsurgically, we determined the type of immobilization used (if any) and recorded whether patients were seen only in the ED or received subsequent outpatient follow-up. Demographic comparisons were made between groups, and adjusted logistic regression models were generated to predict the odds of having a surgical 5MCN fracture or being seen in the ED only. RESULTS: There were 611 5MCN fractures over an 8-year period, of which 10% were treated surgically. During the first half of the study period, 8% of isolated cases were treated surgically compared with 7% of cases in the second half. Soft dressings were increasingly used. There were no nonsurgically managed cases that underwent subsequent surgical procedures for symptomatic nonunion or malunion. Twenty-one percent of patients were seen only in the ED. Fracture angulation, associated injuries, insurance status, and treatment by a hand surgeon were all significantly associated with an increased likelihood of surgery. CONCLUSIONS: Of the 611 5MCN fractures identified, 90% were treated nonsurgically. Patient and surgeon factors were associated with increased odds of surgery. Of patients who sought care for 5MCN injuries, >20% received no follow-up care outside of the ED. These data can be used to assess future changes in management trends and suggest that nonunion and symptomatic malunions are uncommon occurrences. TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic IV.

A defect in the NOG gene increases susceptibility to spontaneous superficial chronic corneal epithelial defects (SCCED) in boxer dogs.

BACKGROUND: Superficial chronic corneal epithelial defects (SCCEDs) are spontaneous corneal defects in dogs that share many clinical and pathologic characteristics to recurrent corneal erosions (RCE) in humans. Boxer dogs are predisposed to SCCEDs, therefore a search for a genetic defect was performed to explain this susceptibility. DNA was extracted from blood collected from Boxer dogs with and without SCCEDs followed by whole genome sequencing (WGS). RNA sequencing of corneal tissue and immunostaining of corneal sections from affected SCCED Boxer dogs with a deletion in the NOG gene and affected non-Boxer dogs without the deletion were performed. RESULTS: A 30 base pair deletion at a splice site in Noggin (NOG) (Chr 9:31453999) was identified by WGS and was significantly associated (P < 0.0001) with Boxer SCCEDs compared to unaffected non-Boxer dogs. NOG, BMP4, MMP13, and NCAM1 all had significant fold reductions in expression and SHH was significantly increased in Boxers with the NOG deletion as identified by RNA-Seq. Corneal IHC from NOG deletion dogs with SCCEDs had lower NOG and significantly higher scores of BMP2. CONCLUSIONS: Many Boxer dogs with SCCED have a genetic defect in NOG. NOG is a constitutive protein in the cornea which is a potent inhibitor of BMP, which likely regulate limbal epithelial progenitor cells (LEPC). Dysregulation of LEPC may play a role in the pathogenesis of RCE.

Changes in cerebral hemodynamics in boxers with repeated traumatic brain injury.

There are currently insufficient study and analysis of changes in cerebral hemodynamics of boxers who have suffered repeated traumatic brain injury (TBI). To identify such changes, the most informative is the study of blood flow in the vessels of the neck and head using ultrasound duplex scanning (USDS) of the main vessels of the neck and transcranial duplex scanning (TCDS). AIM: The aim of study was to investigate the features of cerebral hemodynamics in boxers with repeated TBI. MATERIALS AND METHODS: A study of blood flow in the vessels of the neck and head was performed for 156 amateur boxers aged 16 to 42 years who had a history of repeated TBI. In the control group, 30 practically healthy people of a similar age were examined. Patients were analyzed by gender and the number of fights held. Obtained results were analyzed statistically. RESULTS: Boxers who have had a history of repeated TBI have hemodynamic disorders. They are characterized by an increase in the velocity of blood flow in extracranial vessels of the carotid basin and a decrease in the vessels of the vertebrobasilar basin with a change in the indicators of vascular resistance. For vessels of the intracranial section of the carotid basin, a decrease in blood flow velocity without changes in the indicators of vascular resistance was typical. Disorders of venous cerebral circulation was noted in most boxers, which was manifested by an increase in speed indicators in the internal jugular vein and veins of Rosenthal. CONCLUSIONS: The study of features of the cerebral hemodynamic in boxers with repeated TBI allows them to predict their competitive activity, correctly select the appropriate therapy and recommendations of the sports regime to prevent possible long-term consequences of injury.

Non-functional thyroid cystadenoma in three boxer dogs.

BACKGROUND: Thyroid neoplasia is a common endocrine neoplasm in dogs. The boxer is one of the reported breeds predisposed to malignant thyroid neoplasia. However, the association between thyroid neoplasia, malignancy and breed should be considered with caution. CASES PRESENTATION: This article describes the presentation, clinical pathological findings, computed tomographic (CT) imaging findings and histopathological features of benign cystic thyroid tumour (cystadenoma) diagnosed in three boxers. These three dogs were presented for investigation of unilateral (n = 2) or bilateral (n = 1) cervical masses with no associated clinical signs of thyroid dysfunction. In each case, post-contrast CT scan identified a large, lateralised, non-invasive, well-defined homogeneous cystic structure with a hyperattenuating contrast-enhancing capsule of suspected thyroid origin displacing the surrounding cervical tissues. Ultrasound-guided fine needle aspiration of the cysts yielded fluid with a high thyroxine concentration in each case. Histopathology was consistent with thyroid cystadenoma in all cases. One dog was concurrently diagnosed with oral melanoma and euthanased. Two dogs underwent surgical excision with one lost to follow-up after 36 months and the other euthanased after 16 months following diagnosis of mast cell tumour. CONCLUSIONS: To the authors' knowledge, this is the first detailed report of non-functional benign thyroid cystadenoma in dogs and provides relevant information about case management for this type of tumour. The presence of a large cystic structure associated with benign non-functional thyroid neoplasia may be a condition to which boxer dogs are predisposed.

Epidemiology, clinical and cytological features of lymphoma in Boxer dogs.

The aim of this study was to evaluate the epidemiology, clinical and laboratory characteristics of canine lymphomas as well as some aspects of treatment outcomes. The study was conducted on Boxer dogs with lymphoma diagnosed by cytology and immunocytochemistry (CD3 and CD79 alpha). During the study period, lymphoma was diagnosed in 63 Boxers; 86.8% were T-cell (based on the Kiel classification: small clear cell lymphoma, pleomorphic small cell lymphoma, pleomorphic mixed T-cell lymphoma, pleomorphic large T-cell lymphoma, lymphoblastic lymphoma/acute lymphoblastic leukaemia) and 13.2% were B-cell lymphomas (according to the Kiel classification: B-cell chronic lymphocytic leukaemia, centroblastic/centroblastic polymorphic lymphoma). Overall survival (OS) was significantly longer in dogs with low-grade than with high-grade lymphoma (median OS of 6.8 and 4.7 months, respectively; P = 0.024). OS was not influenced by WHO clinical stage, WHO clinical substage, presence of splenomegaly, early administration of glucocorticoids or the time from the first presentation to the beginning of chemotherapy. There are no significant differences in clinical and laboratory parameters between low-grade and high-grade lymphomas. Boxer dogs are predisposed to T-cell lymphoma, with a predominance of high-grade tumour, especially pleomorphic, mixed small and large T-cell subtype. It is possible that Boxer dogs may respond less favourably to chemotherapy than patients of other breeds.

Magnetic resonance imaging in boxers with repeated traumatic brain injury.

Currently, neuroimaging changes in boxers who have suffered repeated traumatic brain injury (TBI) have not been sufficiently studied and analyzed. To detect such changes, magnetic resonance imaging (MRI) is the most informative. AIM: The aim of study was to investigate the features of MRI changes in boxers with repeated TBI. MATERIALS AND METHODS: An MRI scan of the brain was carried out on 174 amateur boxers aged 16 to 42 years who had a history of repeated TBI. In the control group, 30 practically healthy people of similar age were examined. Patients were analyzed by gender, age, weight category, number of fights conducted. RESULTS: A significant increase in the width of the lateral ventricles (LV) on both sides, 3rd ventricle and cavum septum pellucidum (CSP) was noted in boxers, among whom men dominated. There was an increase in the width of the LV on both sides, 3rd ventricle and CSP with increasing age, weight category, number of fights. A normal MRI scan of the brain was more common in the younger age group female boxers. There has been an increase in the frequency of expansion of the CSP with increasing age, the number of fights held. There was an increase in the frequency of foci of the modified MRI signal (subcortical, periventricular) with increasing age. Frequency of arachnoid cysts increased with an increase in weight category, and the frequency of diffuse expansion of subarachnoid spaces increased with an increase in the number of fights conducted. CONCLUSIONS: In boxers who had a history of repeated TBI, there are changes according to MRI of the brain from both the cerebrospinal fluid pathways and the brain matter. Studying the features of MRI scans of the boxers will make it possible to predict their competitive activity, timely diagnose brain disorders, carry out the necessary treatment and take preventive measures in order to prevent possible long-term effects of trauma.

Glypican4 modulates lateral line collective cell migration non cell-autonomously.

Collective cell migration is an essential process during embryonic development and diseases such as cancer, and still much remains to be learned about how cell intrinsic and environmental cues are coordinated to guide cells to their targets. The migration-dependent development of the zebrafish sensory lateral line proves to be an excellent model to study how proteoglycans control collective cell migration in a vertebrate. Proteoglycans are extracellular matrix glycoproteins essential for the control of several signaling pathways including Wnt/ß-catenin, Fgf, BMP and Hh. In the lateral line primordium the modified sugar chains on proteoglycans are important regulators of cell polarity, ligand distribution and Fgf signaling. At least five proteoglycans show distinct expression patterns in the primordium; however, their individual functions have not been studied. Here, we describe the function of glypican4 during zebrafish lateral line development. glypican4 is expressed in neuromasts, interneuromast cells and muscle cells underlying the lateral line. knypekfr6/glypican4 mutants show severe primordium migration defects and the primordium often U-turns and migrates back toward the head. Our analysis shows that Glypican4 regulates the feedback loop between Wnt/ß-catenin/Fgf signaling in the primordium redundantly with other Heparan Sulfate Proteoglycans. In addition, the primordium migration defect is caused non-cell autonomously by the loss of cxcl12a-expressing muscle precursors along the myoseptum via downregulation of Hh. Our results show that glypican4 has distinct functions in primordium cells and cells in the environment and that both of these functions are essential for collective cell migration.

Boxer's elbow: internal impingement of the coronoid and olecranon process. A report of seven cases.

BACKGROUND: Boxer's elbow has been described in the literature as an extension and hyperextension injury. However, in our experience, there is a coexisting impingement lesion in the anterior compartment of the elbow that has not previously been described. We report a series of professional boxers with elbow disease treated arthroscopically. The aim of the paper was to accurately describe the pathoanatomy of the condition, the key points in its diagnosis, and the outcomes of surgical treatment. METHODS: Seven professional boxers were treated for symptomatic elbow disease. Clinical evaluation included range of motion and Disabilities of the Arm, Shoulder, and Hand score. The arthroscopic findings and procedures were documented. RESULTS: Symptoms were mainly those of anterior and posterior impingement; 6 elbows had an anterior impingement lesion and 6 had a posterior impingement lesion. Postoperatively, the mean Disabilities of the Arm, Shoulder, and Hand score was 2.7 (range, 0-13.3) at a median of 15 (range, 6-36) months postoperatively. All boxers returned to their previous level of competition and 5 won their next bout. All of the boxers used an orthodox stance, and in all but 1 case the left elbow was the pathologic elbow. CONCLUSION: Boxers are prone to development of anterior and posterior elbow impingement. The side of the pathologic process is related to the boxer's stance, with the lead arm being more vulnerable. Arthroscopic débridement is an effective treatment, enabling return to a high competitive level. Surgeons, sports medicine physicians, and physiotherapists should be aware of the condition.

Fifth metacarpal neck fractures treated with soft wrap/buddy taping compared to reduction and casting: results of a prospective, multicenter, randomized trial.

INTRODUCTION: The majority of fifth metacarpal neck fractures (boxers fracture) are treated conservatively without surgery. The purpose of this prospective, randomized, multicenter trial was to determine if the outcomes of soft wrap and buddy taping (SW) was noninferior to reduction and cast (RC) in boxer's fracture with palmar angulation ≤70° and no rotational deformity. MATERIALS AND METHODS: Sixty-eight patients with similar characteristics were prospectively enrolled and randomized at four institutions. Our primary outcome was measured by the shortened Disabilities of the Arm, Shoulder and Hand (quickDASH) questionnaire at 4 months. Noninferiority was claimed if there was no more than +10 points difference in the quickDASH. Other secondary radiographic and clinical outcomes were measured. RESULTS: At 4 months, mean difference in the quickDASH between the two groups was -10.4 (95 % confidence interval, -27.0; +6.2) which was under the pre-specified margin. There was no significant difference between both groups' secondary outcomes of pain, satisfaction with the esthetic appearance, mobility of the metacarpophalangeal-joint at flexion and extension, or power grip. Increased fracture angulation, as measured on follow-up radiographs, was not significantly different between both groups. The degree of palmar fracture angulation was not related to work leave or profession. Duration of time off from work was 11 days shorter in SW compared to RC (P = 0.03). CONCLUSION: This study supports the use of soft wrap and buddy taping for treatment of boxer's fracture with palmar angulation ≤70° and no rotational deformity. Although there was no statistical difference in satisfaction with the esthetic appearance, the patient must be willing to accept the loss of the "knuckle" with this treatment method.

Closed Sagittal Band Injury of the Metacarpophalangeal Joint.

Although it is an uncommon injury, traumatic rupture of the sagittal band often results in subluxation or dislocation of the extensor digitorum communis tendon. The radial sagittal band prevents ulnar subluxation of the extensor tendon at the metacarpophalangeal joint. Injury may result from a direct blow to the hand or from relatively low-energy mechanisms. Symptoms range from metacarpophalangeal joint pain and edema to dislocation of the extensor tendon. Associated injuries include collateral ligament sprains, capsular injury, and osteochondral fractures. Many acute injuries can be managed nonsurgically with extension splints. Optimal management of subacute or chronic injuries remains undefined. Surgical management consists of repair or reconstruction of the radial sagittal band. Numerous adjunctive surgical techniques have been described to prevent subluxation of the extensor tendon.

The Effect of Closed Reduction of Small Finger Metacarpal Neck Fractures on the Ultimate Angular Deformity.

PURPOSE: To assess whether or not attempted closed reduction of fifth metacarpal neck fractures results in decreased fracture angulation at final follow-up. METHODS: Retrospective chart review of all patients aged 18 and older managed for isolated fifth metacarpal neck fractures between 2004 and 2014. RESULTS: Sixty-six patients managed for an isolated boxer fracture met inclusion criteria. Twenty-three patients underwent attempted reduction and 43 patients did not. Patients undergoing attempted reduction had a statistically significant improvement in fracture angulation following reduction compared with patients not undergoing attempted reduction. At final follow-up, there was no difference in fracture angle between the 2 groups. CONCLUSIONS: Closed reduction and splint immobilization of fifth metacarpal neck fractures was not an effective means of maintaining a significant improvement in fracture alignment upon healing. Other means, such as closed reduction with pin fixation or open reduction internal fixation, should be considered when maintenance of reduction is desired. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic III.

Effect of corneal contact lens wear on healing time and comfort post LGK for treatment of SCCEDs in boxers.

PURPOSE: To determine whether dogs with spontaneous chronic corneal epithelial defects (SCCEDs) would heal faster and with an improved comfort score following linear grid keratotomy (LGK) combined with corneal contact lens (Acrivet(™) ) wear when compared to dogs having the LGK procedure alone. STUDY DESIGN: Prospective study. METHODS: Twenty-seven boxer dogs (27 eyes) diagnosed with a SCCEDs were enrolled in the study. A LGK was performed on all dogs under dexmedetomidine and butorphanol sedation. Fourteen eyes were randomly assigned to receive a corneal contact lens. The dogs were evaluated typically at 7, 10, and 14 days or until the ulceration was healed. Client surveys were completed by the owners to subjectively assess comfort level and contact lens retention. Statistical analyses were performed utilizing generalized linear models and survival analysis with the Wilcoxon-Gehan test to evaluate group differences. RESULTS: All ulcers healed after the LGK procedure. Dogs with bandage contact lenses had a statistically significant (P = 0.035) decrease in median healing time (7 days (95% CI [7,9]) compared to those without contact lenses (10 days (95% CI [7,12])). There was no difference in subjective comfort score between treatment groups. Early contact loss occurred in 28.6% (95% CI [8.4%, 58.1%]) of dogs. All of the Acrivet(™) ruler corneal measurements agreed to within 1 mm (95% CI [87.2%, 100%]) of the Jameson caliper measurements of horizontal corneal diameter. CONCLUSIONS: The use of corneal bandage contact lenses significantly decreased median healing time although there was no effect on subjective comfort score. The Acrivet(™) ruler measurements were accurate in determining corneal diameter and therefore contact lens size.

Boxer's fracture: management and outcomes.

Boxer's fractures are common hand injuries, but their management varies greatly. Two years ago, a boxer's fracture care pathway was developed for use in the Royal London Hospital emergency department to standardise management. This article describes a clinical service evaluation carried out to test the validity of the pathway. The evaluation examined the functional outcomes of patients with boxer's fractures with 50° or less palmar angulation who were discharged with no follow up. Findings show that most returned to work immediately and had good functional outcomes, which suggests that the pathway is safe for uncomplicated fractures with 50° or less palmar angulation.

Interobserver variability in the treatment of little finger metacarpal neck fractures.

PURPOSE: To address the null hypothesis that surgeons shown radiographs of little finger metacarpal neck fractures with measured fracture angulation would recommend surgery as often as surgeons shown unmarked radiographs. METHODS: Members of the Science of Variation Group, an international collaboration of fully trained orthopedic and trauma surgeons, were asked to review 20 little finger metacarpal neck fracture cases, which included a vignette and 3 high-quality radiographs. Members were then randomized to review radiographs with or without measured fracture angulation on the lateral view and select operative or nonoperative management. RESULTS: Surgeons shown radiographs with measured angulation were more likely to recommend surgery, and there was less variability among these surgeons, particularly for fractures with less angular deformity. CONCLUSIONS: Measured fracture angulation has a small but significant influence on treatment recommendations for little finger metacarpal neck fractures. TYPE OF STUDY/LEVEL OF EVIDENCE: Diagnostic III.

Clinical evaluation of ophthalmic findings in active, amateur, adult, competitive male boxers in India.

Background: In the popular fighting sport of boxing, opponents strike each other above the belt line in the face, chest, and belly. The physical parts most exposed are therefore the nose and eyes. In amateur boxing, fights go only three rounds - three minutes for men and one minute for women - with a one-minute break in between. They wear gloves, but the head protection used in the men's game has been removed by AIBA due to the high likelihood of concussion when using head protection. Because chronic ocular changes may take longer than the expected short-term effects, this study included at least 3 years of competitive sports participation. Study design and setting: Institutional-based cross-sectional study. Materials and methods: To evaluate ophthalmic outcomes, 200 eyes of 100 active amateur, adult, and competitive male boxers were studied. Results: Of the 100 boxers, 51 had ophthalmic changes in at least one eye, and 49 had normal eyes. The average age of boxers was 24.98 years. The average duration of boxing training was 7.04 years. Healed eyelid scars, subconjunctival hemorrhages, conjunctival papillae, traumatic mydriasis, posterior synechiae, angulation abnormalities, traumatic cataracts, lens subluxation, increased intraocular pressure, and peripapillary atrophy were observed on the ocular side. None of these could be attributed to boxing. Conclusion: Boxing-related eye injuries are common in India and the most common vision-threatening eye abnormalities include traumatic cataracts, lens subluxation, and angle abnormalities. Surprisingly, no macular lesions were found on physical examination and OCT. Additional studies with a larger number of boxers will be needed to evaluate and prevent clinical symptoms. All boxers should have a complete eye exam regularly. Abbreviations: AIBA = Association Internationale de Boxe Amateur, OCT = Optical Coherence Tomography.