Successful Nonsurgical Management of a Posteriorly Displaced Medial Clavicular Physeal Fracture in an Adolescent Athlete: A Case Report.

ABSTRACT: Traumatic and sport-related sternoclavicular (SCJ) injuries in adolescent athletes are more commonly physeal fractures rather than true SCJ dislocations. Although rare, posterior displacement of the medial clavicular metaphysis after a physeal fracture necessitates prompt evaluation and treatment. Despite the inherent healing ability of physeal separations, delayed or failed diagnosis has the capacity to cause serious complications or fatality secondary to injury of retrosternal structures. Even with the potential severity, a lack of consensus exists in the literature regarding the most appropriate treatment modality. We report an adolescent football player with a medial clavicular physeal fracture with posterior metaphyseal displacement abutting the left brachiocephalic vein. After nonsurgical management and progression to play, the patient returned to play football. This case not only highlights the diagnostic principles of medial clavicular physeal fractures with posterior metaphyseal displacement but also discusses how these challenging injuries can be managed successfully with conservative treatment.

Ethical, Legal, and Administrative Considerations for Preparticipation Evaluation for Wilderness Sports and Adventures.

Preparticipation evaluations (PPEs) are common in team, organized, or traditional sports but not common in wilderness sports or adventures. Regarding ethical, legal, and administrative considerations, the same principles can be used as in traditional sports. Clinicians should be trained to perform such a PPE to avoid missing essential components and to maximize the quality of the PPE. In general, participants' privacy should be observed; office-based settings may be best for professional and billing purposes, and adequate documentation of a complete evaluation, including clearance issues, should be essential components. Additional environmental and personal health issues relative to the wilderness activity should be documented, and referral for further screening should be made as deemed necessary, if unable to be performed by the primary clinician. Travel medicine principles should be incorporated, and recommendations for travel or adventure insurance should be made.

General Medical Considerations for the Wilderness Adventurer: Medical Conditions That May Worsen With or Present Challenges to Coping With Wilderness Exposure.

Participation in wilderness and adventure sports is on the rise, and as such, practitioners will see more athletes seeking clearance to participate in these events. The purpose of this article is to describe specific medical conditions that may worsen or present challenges to the athlete in a wilderness environment.

Ethical, Legal, and Administrative Considerations for Preparticipation Evaluation for Wilderness Sports and Adventures.

Preparticipation evaluations (PPEs) are common in team, organized, or traditional sports but not common in wilderness sports or adventures. Regarding ethical, legal, and administrative considerations, the same principles can be used as in traditional sports. Clinicians should be trained to perform such a PPE to avoid missing essential components and to maximize the quality of the PPE. In general, participants' privacy should be observed; office-based settings may be best for professional and billing purposes, and adequate documentation of a complete evaluation, including clearance issues, should be essential components. Additional environmental and personal health issues relative to the wilderness activity should be documented, and referral for further screening should be made as deemed necessary, if unable to be performed by the primary clinician. Travel medicine principles should be incorporated, and recommendations for travel or adventure insurance should be made.

General Medical Considerations for the Wilderness Adventurer: Medical Conditions That May Worsen With or Present Challenges to Coping With Wilderness Exposure.

Participation in wilderness and adventure sports is on the rise, and as such, practitioners will see more athletes seeking clearance to participate in these events. The purpose of this article is to describe specific medical conditions that may worsen or present challenges to the athlete in a wilderness environment.

Spine injuries in dancers.

Care of a dancer calls for a unique balance between athlete and artist. The physician must familiarize himself or herself with dance terminology, common moves, correct technique, and dancer's mentality. The goal is to work intimately with the dancer to care for the injury and, if possible, continue to participate in portions of dance class to limit anxiety and increase compliance to treatment. The spine is the second most injured area of the body in dancers, and many issues stem from poor technique and muscle imbalance. This often leads to hyperlordosis, spondylolysis, spondylolisthesis, lumbar facet sprain, discogenic back pain, and muscle spasm and piriformis syndrome. This article reviews these causes of low back pain with a focus on dance-related presentation and treatment issues.

Use of protective equipment by adolescents in inline skating, skateboarding, and snowboarding.

OBJECTIVES: Determine the frequency of personal protective equipment (PPE) use in adolescent inline skaters, skateboarders, and snowboarders; explore factors influencing PPE use; identify factors that would influence use; and examine the association of high-risk behaviors and PPE use. DESIGN: Cross-sectional survey. SETTING: Central/southeast Wisconsin. PARTICIPANTS: Participants 13-18 years-old. INTERVENTIONS: None. Independent variables = age, gender, sport. MAIN OUTCOME MEASUREMENTS: None. Dependent variables = PPE use, factors influencing use, and frequency of other high-risk behaviors. RESULTS: The mean age of 333 participiants was 14.9 years. Adolescents wore considerably less PPE than recommended. Inline skaters wore the most; snowboarders the least. The most common reasons adolescents wore PPE were parents, peers, and rule/requirement. Younger adolescents cited parents more often than older adolescents as a factor for PPE use. Discomfort and lack of perceived need were the most common reasons for nonuse. Sustaining/witnessing an accident was the most common reason that would convince adolescents to wear PPE. Almost half of adolescents reported nothing would convince them to wear PPE. Younger adolescents wore more PPE than older adolescents. An association was seen between PPE use in all sports and bicycle helmets. An inverse relationship was found for tobacco and helmet use among skaters, as well as alcohol and helmet use in skateboarders. CONCLUSIONS: Adolescents underuse PPE. PPE reinforcement by parents/peers, encouraging bike helmets, manufacturing more comfortable gear, educating adolescents, and instituting PPE requirements in public areas may increase compliance. This could lead to decreased injuries. Physicians should discuss PPE with their patients/families. There may be an association between PPE use in extreme sports and decreased high-risk health behaviors.

A survey of inner city youth and their parents about participation in sports.

BACKGROUND: Several studies have explored motivating factors for sports participation for youth, but limited data is available regarding factors motivating inner-city children to participate in sports. METHODS: A consecutive sample of parents (n=100 parents) and children (n=138 children) attending a health fair in an inner-city community were surveyed regarding motivating factors for enrolling in a team sport (or enrolling their child in a team sport). Parents and children indicated the importance of 10 factors (1=not very important to 4=very important) on separate but similar written surveys. RESULTS: "Developing healthy habits" and "Becoming physically fit and healthy" received the highest mean rankings from both parents and children. "Helping my child gain or lose weight" received one of the lowest rankings from parents. CONCLUSIONS: To encourage sports participation by inner-city children, health care professionals and others should emphasize identified motivational factors for children and their parents.

Sport-specific injuries and medical problems of figure skaters.

Figure skating is becoming increasingly popular as both a recreational and competitive sport. As the number of figure skating participants increases, so will the number of active patients who present to their primary care physician with sport-related injuries and medical problems. Figure skating is a unique sport that continues to evolve and progress with participants partaking in more difficult moves and more rigorous training programs. Common problems in figure skating include acute musculo-skeletal injuries and chronic overuse injuries, which primarily occur in the foot, ankle, knee, leg, hip, and lower back. Figure skaters are also more likely to endure specific medical problems such as exercise-induced bronchospasm and eating disorders. Primary care physicians are able to contribute to their figure skating patient's health by recognition and appropriate treatment of acute injuries and prevention of chronic injuries and other medical problems.

Infectious disease and the extreme sport athlete.

Extreme sport competition often takes place in locations that may harbor atypical diseases. This article discusses infections that may be more likely to occur in the extreme sport athlete, such as selected parasitic infections, marine infections, freshwater-borne diseases, tick-borne disease, and zoonoses. Epidemiology, presentation, treatment, complications, and return-to-sport issues are discussed for each of these diseases.

Clinical examination of the foot and ankle.

The foot and ankle are critical components in our ability to ambulate. Injuries to either can significantly interfere with a patient's ability to carry out normal activities. In severe cases, they can be devastating to a patient's independence. Careful examination of the foot and ankle using established mechanical tests, along with understanding of the anatomy of the complex,is needed to confirm the history and to assist in the diagnosis and treatment of foot and ankle injuries. The following points are key to clinical examination of the foot and ankle: . The examination of the foot and ankle needs to be done with the patient in both weight-bearing and non-weight bearing positions. . The examination of the foot and ankle should include an evaluation of the patient's gait. . Reproduction of a patient's symptoms is the key to making a correct diagnosis. . Although anatomic variants may predispose some individuals to injury,in general, if asymptomatic, no treatment should be done.

Extreme sports: injuries and medical coverage.

Extreme sports (including in-line skating, snowboarding, mountain bicycling, extreme skiing, rock climbing, indoor tackle football, kickboxing, skateboarding, and ultra-endurance racing) are growing in popularity. Often these sports are designed to expose athletes to greater thrills and risks than are found in traditional sporting activities. Despite this increased risk of injury, athletes competing in these sports often have little or no formal medical coverage. This article reviews what is known about this emerging area of sports medicine to assist physicians in preparing for medical coverage of these athletes and their competitions.