Estudio prospectivo de maduración, desarrollo e incidencia lesional en balonmano formativo de élite. ¿Puede el estado madurativo ser un factor determinante de la incidencia lesional en balonmano? / Prospective study of maturity, development, and injury incidence in a professional Handball Academy. Could ‘maturational status’ be a risk factor for injury incidence in different handball team categories?

El objetivo de este estudio es describir la relación entre incidencia lesional (IL) y estado madurativo de jugadores varones de balonmano formativo (BmF) de alto nivel competicional. Se analizan durante 2 temporadas la incidencia de lesión deportiva de forma prospectiva en 133 jugadores, los criterios de maduración biológica y la carga física de exposición. Se siguieron los criterios para estudios de epidemiología lesional según el consenso UEFA. Las variables utilizadas para analizar el estado madurativo son los estadios de Tanner, la pubertad, el pico de velocidad de crecimiento, el volumen testicular y la edad ósea. Se registraron 190 lesiones para un total de 34.222 h de exposición. La IL total media de todas las categorías fue de 5,6 lesiones/1.000 h de exposición. En competición, el valor fue de 21,8 lesiones/1.000 h, y en entrenamiento, de 3,1 lesiones/1.000 h. No se encontraron diferencias estadísticamente significativas entre IL, la edad cronológica y los diferentes estados madurativos por ANOVA. El análisis estadístico multivariante registra cierta tendencia entre las asociaciones de IL en competición para categoría (p = 0,07), y en la IL en entrenamientos para Tanner (p = 0,091) y pubertad (p = 0,021). En conclusión, si bien no se detectaron diferencias significativas en la IL por edades en jugadores de BmF, sí se aprecia una tendencia real en determinados estadios madurativos mediante el análisis multivariante. Esto deberá tenerse en cuenta para planificación entrenamientos y estrategias de prevención de la lesión deportiva en el contexto del BmF

The objective of this study is to determine the relationship between injury incidence (IL) and maturity stage in male elite handball players. A prospective study was conducted during two seasons, evaluating the sports injuries, maturity status and exposure time in hours in 133 young handball players, using the UEFA methodology model for epidemiological studies. The maturity stage with different parameters is presented, as well as Tanner’s stage, puberty stages, peak high velocity, testicular volume, and the bone age. Finally, 190 injuries from a total of 34,222 hours of exposure were registered. The mean total Injury Incidence (IL) by categories was 5.6 injuries/1000 hours of exposure. Injury incidence during competition: 21.8 injuries/1000 hours and in training: 3.1 injuries/1000 h, with no statistically significant differences between IL, chronological age, and different maturity stages using ANOVA. The multivariate statistical analysis showed a tendency of associations between IL in competition category (P = .07), and the IL in training for Tanner (P = .091) and puberty (P = .021). In conclusion: There was a significant difference in total IL by age categories in handball players, and there was a statistically significance tendency as regards some maturity stages using multivariate analysis. This last result should be taken into account when planning training seasons and strategies for injury prevention in the context of the handball training

Epidemiología lesional del balonmano de elite: estudio retrospectivo en equipos profesional y formativo de un mismo club / Epidemiology of injuries in elite handball: Retrospective study in professional and academy handball team

Objetivo: Evaluar la incidencia y el patrón lesional en el balonmano de elite. Método: Estudio retrospectivo y transversal de 496 jugadores, de 29 equipos (divididos por categorías según edad y nivel), durante 5 temporadas (2007-2012), de un club del sur de Europa. El equipo médico evaluó las lesiones y el tiempo de exposición por equipos. Se siguieron los criterios epidemiológicos según consenso UEFA y codificación OSICS-10. Resultados: Se registraron 557 lesiones con 117.723 h de exposición totales. La incidencia lesional media de los equipos fue: 4,9 lesiones/1.000 h de exposición. Para el equipo Senior A (Profesional) fue de 4,3 (DE 1,8); Senior B, 3,4 (DE 1,6); Juvenil, 5,6 (DE 1,4); Cadete A, 5,5 (DE 2,5); Cadete B, 5,7 (DE 3,2), e Infantil, 4,9 (DE 1,9). No hubo diferencias estadísticamente significativas entre ellos, aunque los seniors tuvieron la mayor cantidad de horas de exposición (p < 0,001).Las localizaciones más frecuentes fueron tobillo (18,1%), rodilla (15,3%), muslo (12,9%) y región lumbar (10,6%). Las estructuras afectadas con más frecuencia fueron la lesión ligamentosa (27,3%) y la lesión «muscular por mecanismo indirecto» (20,5%). Esta última más en el Senior A, y la lesión ligamentosa en las categorías inferiores, aunque no se registraron diferencias significativas entre categorías. Conclusión: El patrón y la incidencia lesional en el balonmano de elite es uniforme entre los equipos de diferentes categorías, con pequeñas diferencias que deberán tenerse en cuenta para optimizar los programas de prevención en cada categoría del balonmano formativo de elite

Objective: To evaluate the injury incidence and pattern of injuries in elite handball by different ages. Method: A retrospective, cross sectional study, was conducted over 5 seasons (2007-2012), analyzing a total of 496 players, 29 teams (from different categories separated by age and performance level) of the same club in southern Europe. The same medical team has assessed the injuries and exposure time by teams. Epidemiological criteria according to UEFA and consensus OSICS-10 diagnostic coding were followed. Results: A total of 57 injuries were recorded during 117,723 hours of total exposure. There was a mean team injury incidence of 4.9 injuries/1000 hours of total exposure. For the Senior A (Professional Senior) it was was 4.3 (SD 1.8), Senior B (Amateur 18-28 years) 3.4 (SD 1.6), Youth (U-18 year) 5.6 (SD 1.4), Cadete A (U-16 year) 5.5 (SD 2.5), Cadete B (U-15 year) 5.7 (SD 3.2) and Infantil (U-14 year) 4.9 (SD 1.9). There were no statistically significant differences between categories, although seniors teams had more hours of exposure compared to other teams (P < 0.001). The most frequently affected sites were ankle (18.1%), knee (15.3%), thigh (12.9%) and lumbar region (10.6%). The most common type of injury to all teams was the sprain (27.3%) and non-traumatic muscle injury (20.5%). Muscle injuries were more common at Senior A (Professional) level, but in lower level teams it was the sprain, although there is no significant differences between them. Conclusion: The pattern and incidence of injury in elite handball is uniform between teams from different categories at the same club; with a few differences between each other that you should take this into account to optimize a preventions programs in each category of elite handball training

Wrist synovial chondromatosis: case report and literature review.

Primary synovial chondromatosis is a proliferation of cartilaginous bodies within the synovial membrane, tendon sheath or bursa. It is a rare orthopaedic entity especially when it occurs in the distal radioulnar joint. We report a 27-year-old man with recurrent synovial chondromatosis, nine years after his first operation. Although rare, synovial chondromatosis must be considered in the differential diagnosis in a patient with pain and swelling of the distal radioulnar joint. From our literature review, we report a 17% (5/30) recurrence rate for synovial chondromatosis involving the wrist joint which has not been documented in the medical literature previously.

Tendon transfer fixation in the foot and ankle: a biomechanical study.

BACKGROUND: Tendon transfers are often used in foot and ankle surgery. Different fixation devices and techniques have been described. The most recently developed ones are bone anchors and interference screws. MATERIALS AND METHODS: A biomechanical study was designed to compare tendon transfer fixation, using Corkscrew bone anchors 5 x 15.5 mm and Bio-interference screws (8 x 23 mm). Fifteen fresh cadaver specimens underwent both fixation techniques for split anterior tibial tendon transfer at the cuboid bone. All the specimens underwent standardized X-rays in order to evaluate mineral bone density using a standardized measurement system. All were tested until maximal load to failure. RESULTS: The ultimate load to failure of the tendon secured to the cuboid using anchors was 103 N (SD, 52), compared with 150 N (SD, 68) for tendons secured to the bone with interference screws (p = 0.003). No difference was found between the techniques that could be related to bone density. CONCLUSION: Interference screws provided greater strength than bone anchors. CLINICAL RELEVANCE: This study demonstrated increased strength in securing bone to tendon in vitro for SPLATT tendon transfer with interference screws as compared to suture anchors.

Dislocation of rotating-hinge knee prostheses with antidislocation mechanism.

At our institution, we have used Endo-Model prostheses (Waldermar Link GmbH & Co, Hamburg, Germany) for difficult knee reconstructions. These rotating-hinge prostheses have an antidislocation feature that prevents dislocation due to distraction disengagement. In a series of 192 consecutive prostheses, we have identified 2 cases of femorotibial dislocations. An increased flexion laxity allows excessive distraction and hence implant dislocation after antidislocation feature loosening. To our knowledge, there are no other reports in the literature regarding dislocation of a rotating-hinge knee prosthesis with antidislocation design.