Injuries associated with combat sports, active component, U.S. Armed Forces, 2010-2013.

The practice of combat sports creates a potential for training- and sports-related injuries among military members. During the 4-year surveillance period, there were 12,108 cases of injuries associated with combat sports among active component service members; the overall incidence rate was 21.0 per 10,000 person-years (p-yrs). The rates were higher among service members who were male, Hispanic, in the youngest age groups, in the Army, junior enlisted, and in combat-specific occupations. The rate among recruit/ trainees (779.4 per 10,000 p-yrs) was more than 165 times the rate among all other active component service members (non-recruits) (4.7 per 10,000 p-yrs). Sprains, strains, and contusions accounted for more than one-half of the primary (first-listed) diagnoses associated with combat sports cases. More serious conditions such as concussions/head injuries and skull/face fractures/intracranial injuries were reported among 3.9% and 2.1% of all cases and were more common among boxing-related cases. Hand/wrist fractures were also common among boxing cases. Wrestling had comparatively greater proportions of dislocations and open wounds. Although the combat sport training provides many physical and mental benefits to the individual, safety practices should be enforced to reduce the most frequent and serious injuries.

Osteoid osteoma of the carpal bones. Two case reports.

Osteoid osteoma rarely develops in the wrist. The symptoms resemble atypical tenosynovitis, with variations according to the location of the tumor. As a result, diagnostic wanderings are common. In addition, the pain may seem related to an injury, as illustrated by two cases reported herein. Conventional investigations often fail to contribute to the diagnosis. The most specific investigation is thin-slice computed tomography (CT), which can be coupled to magnetic resonance imaging. CT typically visualizes a round lucency surrounded by a rim of sclerosis; in addition, CT shows the exact location of the tumor, particularly relative to neighboring joints. Complete excision of the nidus must be achieved to ensure a permanent cure. Same-stage carpal bone fusion may be required in patients with extensive joint involvement.

Magnetic resonance imaging of the wrist: occult osseous lesions.

This article illustrates the magnetic resonance imaging (MRI) features of occult osseous lesions in three different patients. All three patients suffered from a history of wrist trauma, but had negative plain film radiographs. The three types of occult lesions (bone bruise, microfracture and chronic osseous damage) are described, and their MRI characteristics are demonstrated by proton density and T2 weighted images. MRI proved to be the diagnostic modality of choice for the detection of posttraumatic intrinsic marrow changes.

Scapholunate failure: a long term clinical follow-up.

Rotary subluxation of the carpal scaphoid is a rare condition that may lead to collapse of the wrist. The subluxation is the result of disruption of the scapholunate interosseous ligament, often secondary to scaphoid fracture or significant trauma. The characteristic clinical and radiographic findings are discussed. Controversy exists regarding treatment, but lack of treatment predisposes the wrist to degenerative changes. A case report is discussed which illustrates the salient features of this condition.

The use of electricity in bone healing.

The history of electrical bone healing and the vast amount of laboratory and clinical data that support its efficacy are reviewed. The paper presents guidelines for the proper use of electrical stimulation and a description of the various systems available. The use of electrical stimulation to treat scaphoid fractures is covered in detail. Contraindications to the use of electrical stimulation are also addressed.

Scaphoid malunion.

Forty-five patients with 46 scaphoid fractures were studied more than 6 months after union by clinical examination and trispiral tomography. Twenty had normal scaphoid alignment with lateral intrascaphoid angles less than 35 degrees; the rest had varying degrees of increased flexion angulation of the scaphoid, ranging from 36 degrees to 60 degrees. Increasing lateral scaphoid angulation, eventually resulting in a "humpback" deformity, was associated with progressively poor clinical and radiographic results. There were satisfactory clinical outcomes in 83% and posttraumatic arthritis in only 22% of those with normal scaphoid anatomy. Those with greater than 45 degrees of lateral intrascaphoid angulation present at the time of union had a satisfactory clinical outcome in 27% and posttraumatic arthritis in 54%. Union alone is an insufficient criterion for success in treating scaphoid fractures.

Treatment of scaphoid fractures with a removable cast.

Forty-four fractures of the scaphoid bone were treated with a short-term removable orthoplast cast and compared with 48 fractures treated with a conventional long-arm plaster cast. At the follow-up, there was no difference between the two treatment groups as regards nonunion or other sequelae. We conclude that the inconvenience of the treatment of scaphoid fracture and the need of physiotherapy can be reduced by using an orthoplast cast.

Traumatic volar dislocation of the second, third and fourth carpometacarpal joints: mechanism and manipulation.

Traumatic volar dislocation of the second, third and fourth carpometacarpal joints without associated fracture is extremely rare. A single case, treated successfully by manipulative reduction supplemented with splint immobilization and isometric and isotonic muscle exercise is reported, with restoration of complete anatomical alignment revealed by postmanipulative radiographs. The radiology of carpometacarpal joint dislocation is discussed. The conservative traction-dorsiflexion manipulative reduction for multiple volar carpometacarpal joint dislocations is described and recommended before using open reduction. Based on the case, it is postulated that the mechanism of a carpometacarpal joint dislocation is due to a sudden violent force acting almost perpendicularly to the metacarpal head or heads; the reactive forces create the opposite directed forces as a lever type of strain on the involved carpometacarpal joint and produce the dislocation.

Fractures of the scaphoid bone. How to handle this common wrist injury.

A combination of forces makes the scaphoid bone susceptible to fracture. The common mechanism of trauma is a force applied to the palmar aspect of the wrist while it is in extreme dorsiflexion. Because early fracture diagnosis by x-ray study is difficult, all patients with a suspicious wrist injury and tenderness in the scaphoid region should be treated as if they have a fracture until radiographs at two and four weeks are normal. Treatment usually consists of immobilization using a long or short plaster arm cast. Various treatment methods, including electrical stimulation, are used when nonunion occurs. It is important to remember that patients are mainly concerned with results, not means, as long as such means are fast, safe, and minimally disabling.

Electrical stimulation applied to bone and nerve injuries in the upper extremity.

In conclusion, electrical stimulation of bone has advanced from the laboratory to clinical reality. Despite the lack of good double-blind clinical studies, it is impossible to ignore the excellent results reported from numerous multicenter trials. Doubts and controversies will and should continue. Electrical stimulation has a definite place in the treatment of scaphoid nonunion as well as other failures of osteogenic biology in the upper extremity. The future may realize the enormous potential of electrical stimulation in areas of nerve repair, wound healings, or osteoporosis. The hand surgeon may soon be operating in the age of biophysics where he or she can charge by the kilowatt hour. Yet one should not become a mere technician, but understand the basic science of what one is doing and, above all, maintain a balanced and critical approach.

Treatment of nonunited scaphoid fractures by pulsed electromagnetic field and cast.

Thirty-five of 44 nonunited scaphoid fractures that were at least 6 months old healed in a mean time of 4.3 months during pulsed electromagnetic field (PEMF) treatment using external coils and a thumb spica cast. The mean time from the onset of the fracture to treatment was 40 months. No concurrent operation was performed. Follow-up time averaged 8.4 months. Eight of nine fractures with avascular necrosis healed. Five of eight fractures in the proximal third healed. Twelve (75%) of 16 patients treated in short-arm thumb spica casts and PEMF healed versus 22 (92%) of 24 patients treated initially in long-arm thumb spica casts and PEMF. We have found PEMF to be a reliable alternative method of treating nonunited scaphoid fractures. Because of the low risk, simplicity of use, and reliability, we recommend its consideration in the treatment of undisplaced, nonunited fractures without carpal instability less than 5 years after the injury. Treatment should initially begin with a long-arm cast.

[Pseudarthrosis of the scaphoid]. / Die Pseudarthrose des Scaphoids.

For the treatment of scaphoid non-unions, innumerable curative and palliative operations have been recommended. Of the curative operations, the various methods of bone grafting give the best results, whereas screw fixation is not satisfactory. Bone pegs with a cortical graft are no longer used because of technical difficulties. Corticocancellous grafts (Matti-Russe) yield bony union in almost 90% of cases. The combination of corticocancellous grafts with plate stabilization gives the highest rate of bony union (99%). A cure should therefore always be attempted in all non-union cases, with the exception of cases already involving severe, generalized osteoarthritis or extensive necrosis of the scaphoid. Of the different palliative methods, the early results of prosthetic partial or total replacement of the scaphoid are satisfactory. Late results are less satisfactory, with a high rate of complications and carpal collapse. With severe osteoarthrosis, proximal carpectomy, especially the transscaphoideo-lunate resection, gives good results. Intercarpal arthrodeses have been disappointing. Radiocarpal arthrodesis results in a pain-free, strong wrist; however, there is complete loss of motion, whereas denervation gives satisfactory results in 57% and preserved mobility of the wrist.

Scaphoid (navicular) fracture of the wrist.

This common fracture most frequently affects young males. In most cases, the fracture is found on initial examination. Occasionally, it is missed on the initial radiographic evaluation but becomes apparent on follow-up films. Although most scaphoid fractures respond to conservative therapy, some fail to heal. Nonunion of the scaphoid may respond to various nonoperative and operative techniques. In such cases, consultation with a hand surgeon is useful.

Treatment of nonunion of the scaphoid by direct current.

Seventy-one per cent (12 of 17) of scaphoid nonunions previously treated by other methods united when the semi-invasive technique of electrical stimulation was used. Patient acceptance of this electrode technique is high, and morbidity is lower than in patients treated by iliac bone grafting. The treatment of nonunion of the scaphoid by the semi-invasive electrical stimulation technique is a reasonable alternative to bone grafting and provides a salvage procedure when bone grafting or other therapeutic modalities have failed.

Treatment of pseudarthroses with electrodynamic potentials of low frequency range.

In 319 patients suffering from septic and noninfected pseudarthroses, bone consolidation has been achieved in 93.6% by a cancellous bone graft plus a semi-invasive method of electrostimulation of nonunion using low frequency A.C. potentials, i.e., the electrodynamic procedure. By inductively coupled electromagnetic fields, the potentials are produced in inductable implants. There are no contraindications for the procedure and no side effects.