Acute Compartment Syndrome in the Athlete.

In sports, acute compartment syndrome (ACS) develops following lower limb fracture, with subsequent high intracompartmental pressures and pain out of proportion to the physical examination. A prompt diagnosis is the key to a successful outcome in patients with ACS. The goal of treatment of ACS, namely decompressive fasciotomy, is to reduce intracompartmental pressure and facilitate reperfusion of ischemic tissue before onset of necrosis. A delay in diagnosis and treatment may result in devastating complications, including permanent sensory and motor deficits, contractures, infection, systemic organ failure, limb amputation, and death.

Building Blocks of Wellness: Where Do We Start When Our Tasks Have No End?

Surgeon wellness, and the means by which it may be realized, has recently come to the forefront as awareness of burnout among orthopaedic surgeons has increased. Individual surgeons face unique challenges toward finding their own path to thrive. It is important to incorporate varying perspectives regarding potential solutions to surgeons' stresses in both work and extracurricular life. Specifically, the goal is to initiate a discussion regarding wellness by providing insight into the challenges facing surgical residents, supplemented with the perspectives of women and minorities within the field. Peer coaching plays an essential role in optimizing mental health.

Do Intra-articular Corticosteroid Injections Prior to Total Knee Arthroplasty Increase Postoperative Complication Rates: A Retrospective Review.

There is conflicting literature suggesting that intra-articular corticosteroid injections before total knee arthroplasty (TKA) may lead to an increase in the rate of postoperative complications, specifically periprosthetic joint infection (PJI). Thus, this retrospective review of all TKAs performed at a large, urban hospital will add valuable evidence to help guide future patient care. After exclusion criteria, we retrospectively reviewed 417 patients who received a TKA from a group of fellowship-trained orthopaedic surgeons between 2009 and 2016 at a single academic medical center. Minimum follow-up time was 1 year. Patients were separated into two groups: those who received a preoperative intra-articular corticosteroid injection and those who did not receive an injection. Subgroups were created based on the timing of their most recent preoperative injection: 0 to 3 months, 3 to 6 months, 6 to 12 months, 12+ months, and an unknown time period. Postoperative outcomes for PJI, revision TKA, and manipulation under anesthesia (MUA) were analyzed via a Chi-square test. No statistically significant postoperative differences were observed between groups: PJI (p = 0.904), revision TKA (p = 0.206), and MUA (p = 0.163). The temporal subgroups also failed to demonstrate a statistically significant result: PJI (p = 0.348), revision TKA (p = 0.701), and MUA (p = 0.512). This study revealed no absolute or temporal association between preoperative, intra-articular corticosteroid injections, and complications after TKA. Because these injections are a commonly used treatment modality prior to TKA, further studies should be conducted on a nationwide basis to draw more concrete conclusions.

Is average club head speed a risk factor for lower back injuries in professional golfers? A retrospective case control study.

BACKGROUND: Our hypothesis was that higher average club head speed is correlated with lower back injuries in professional golfers. METHODS: This was a retrospective case control study of male professional golfers who suffered lower back injuries while playing golf. The injured group was composed of 14 Professional Golfers' Association (PGA) golfers who withdrew from a PGA tour event due to a back injury during the years 2017-2019. The case-control matching procedure was used to randomly match cases and controls with a 2:1 allocation ratio, respectively, based on age. Variables were chosen based on currently proposed risk factors. Data was statistically analyzed using SPSS 25. RESULTS: There were 14 PGA golfers who suffered lower back injuries during the years 2017-2019 who were included in this study. There was no significant difference in age, height, weight or BMI between the injured and control group. The injured group had a higher mean club head speed than the control group (P < 0.01). CONCLUSION: This study found that average club head speed was significantly higher in PGA golfers who suffered back injuries while golfing during a two-year period (2017-2019) when compared with age-matched controls.

Does the MLB's collision at home plate rule change prevent concussion injuries in catchers?

Background: In 2013, appropriate conduct of both the catcher and baserunner at the home plate was outlined with the addition of rule 7.13. This new rule was mandated in order to protect athletes from 'egregious' collisions at the home plate. The aims of this study were to quantify the impact of the Collision at Home Plate rule on concussion rates among MLB catchers, and time spent on the DL with concussion symptoms, before and after rule 7.13 was officially enacted (2012-2013, 2015-2016). Hypothesis: We hypothesized that the rate of concussions suffered by MLB catchers would be significantly lower after the enactment of rule 7.13 and that there would be no significant difference in time spent on the DL between the two cohorts. Study design: Retrospective Cohort Level of evidence: Level 3 Methods: The data was compiled using publicly available information extracted from MLB transactions. All MLB catchers placed on the DL for a concussion injury from 2012 to 2013 and 2015 to 2016 were included in this study. Relative risk (with 95% CI) was calculated by using the number of injuries per 1,0000 athletic exposures for the 2 seasons under the rule change (2015-2016) versus the previous 2 seasons (2012-2013). Results: Among catchers the relative risk of concussion per 1000 athletic exposures was 0.31 (95% CI, 0.11-0.85) when comparing the 2 seasons after the introduction of rule 7.13 (2015, 2016) versus the 2 seasons before (2012, 2013). There was no significant statistical difference in average time catchers spent on the DL for concussion injuries when comparing the 2012 and 2013 seasons versus 2015 and 2016. Conclusions: The MLB's rule limiting home plate collisions significantly reduced the number of concussions suffered by MLB catchers. Clinical relevance: This study provides important insight regarding patterns and injury rates in professional baseball catchers and can serve as a benchmark for discussion about injury prevention in players of this position. To our knowledge, no other study has focused on rule 7.13 and its effect on concussion rates in MLB catchers.

Arthroscopic Lysis of Adhesions With Manipulation Under Anesthesia Versus Manipulation Alone in the Treatment of Arthrofibrosis After TKA: A Matched Cohort Study.

Arthrofibrosis following total knee arthroplasty (TKA) is a debilitating complication. Treatment options include physical therapy, manipulation under anesthesia (MUA), and arthroscopic lysis of adhesions (ALOA) with or without MUA. The authors studied 70 patients with arthrofibrosis after TKA treated with MUA or ALOA plus MUA. In this matched cohort study, 35 patients were treated with MUA and 35 patients were treated with ALOA plus MUA. Total knee arthroplasty followed by MUA was performed by 2 surgeons and TKA followed by MUA plus ALOA was performed by 1 surgeon at 1 institution. Electronic records were used to collect information and match cohorts based on age, sex, body mass index, diabetes mellitus, perioperative range of motion (ROM), and timing of the procedure for arthrofibrosis. The combination of MUA and ALOA yielded changes in ROM: a 72.7% increase 4 to 12 weeks after index TKA (P=.032), a 50.0% increase 12+ weeks after TKA (P=.032), and a 99.8% increase in patients with a pre-manipulation ROM of 0° to 60° (P=.001). Manipulation under anesthesia yielded a 49.2% increase 4 to 12 weeks after TKA (P=.161), a 27.0% increase 12+ weeks after TKA (P=.161), and a 68.8% increase in patients with pre-manipulation ROM of 0° to 60° (P=.084). Patients treated with ALOA plus MUA had greater increases in ROM (P=.026) and final knee flexion (P=.028) compared with those treated with MUA alone. Arthrofibrosis following TKA is a complication that often requires additional procedures. Traditionally, ALOA is added 3+ months from index TKA, when abundant scar formation has occurred. This study found a benefit to ALOA plus MUA compared with MUA alone, with the largest benefit in patients whose pre-manipulation ROM was 0° to 60°. [Orthopedics. 2019; 42(3):163-167.].