Incidence of meniscal injury and chondral pathology in anterior tibial spine fractures of children.

BACKGROUND: Pediatric avulsion fractures of the anterior tibial spine are injuries similar to anterior cruciate ligament injuries in adults. Sparse data exists on the association between anterior tibial spine fractures (ATSFs) and injury to the meniscus or cartilage of the knee joint in children. This research presents a retrospective review of clinical records, imaging, and operative reports to characterize the incidence of concomitant injury in cases of ATSFs in children. The purpose of this study was to better delineate the incidence of associated injuries in fractures of the anterior tibial spine in the pediatric population. METHODS: We identified 58 patients who sustained an ATSF and met inclusion criteria for this study between 1996 and 2011. The subjects were separated by the Myers and McKeever classification into type I, II, and III fractures, and each of these were subclassified by associated injury pattern. RESULTS: 59% of children with an ATSF had an associated soft tissue or other bony injury diagnosed by magnetic resonance imaging or arthroscopy. The most prevalent associated injuries were meniscal entrapment, meniscal tears, and chondral injury. We found no meniscal or chondral injury associated with type I fractures. Twenty-nine percent of type II injuries demonstrated meniscal entrapment, 33% showing meniscal tears. Seven percent demonstrated chondral injury. Forty-eight percent of type III fractures had entrapment, whereas 12% showed meniscal tears. Eight percent had a chondral injury. CONCLUSIONS: A majority (59%) of displaced ATSF had either concomitant meniscal, ligamentous, or chondral injury. This finding suggests that magnetic resonance imaging evaluation is an important aspect of the evaluation of these injuries, particularly in type II and type III patterns. To date, this study reports the largest number of patients to evaluate the specific question of concomitant injuries in ATSFs in the pediatric population. LEVEL OF EVIDENCE: Level IV.

Proteinuria in a high-altitude 161-km (100-mile) ultramarathon.

PURPOSE: Urine dipstick analysis (UDA) is a useful tool in clinical practices. Abnormalities in UDA parameters have been observed as a result of extreme exercise. The exact incidence of UDA abnormalities, particularly proteinuria, as the result of running ultramarathons is unknown. The purpose of this study was to estimate the incidence of proteinuria and to identify the characteristics of those with proteinuria. METHODS: We conducted a prospective observational study using urine samples from volunteer athletes before and immediately after the Leadville Trail 100 Run in August 2014. There were 33 runners with both pre-race and post-race samples and a total of 70 provided post-race samples. Demographic information was collected as a part of a larger study. RESULTS: At least one abnormality was demonstrated in 89% of post-race urine samples. Twenty-one (30%) runners had post-race proteinuria (≥1+). Serum creatine kinase concentration (CK) was the only variable that was significantly correlated with the incidence of proteinuria in a multiple logistic regression model. CONCLUSION: A majority of runners developed abnormalities in their UDA. Proteinuria was common and found to be associated with serum CK concentration.