A rare case of posterior interosseous nerve palsy associated with radial head fracture.

BACKGROUND: Radial head fractures are the most common fractures occurring about the elbow in adults, but there have been few reported cases of associated nerve injury. The little-known posterior interosseous nerve travels in close proximity to the radial head and is particularly susceptible to injury. OBJECTIVES: The objectives of this case report include raising awareness of the possibility of posterior interosseous nerve palsy after radial head fracture and reviewing the clinical assessment of the posterior interosseous nerve to exclude occult injury. CASE REPORT: Here we report a case of a 21-year-old man who developed a posterior interosseous nerve palsy after a fracture of the radial head sustained during a wrestling match. He also sustained frostbite to the extremity due to overaggressive icing of the injury. CONCLUSIONS: Physicians should screen patients with radial head fractures for associated nerve injury. A thorough neurovascular examination with attention to the motor innervation patterns in the hand and wrist will help identify posterior interosseous nerve involvement. Careful discharge instructions will help prevent iatrogenic frostbite from overaggressive icing of injuries.

Teaching Pediatric Otoscopy Skills to Pediatric and Emergency Medicine Residents: A Cross-Institutional Study.

OBJECTIVE: To evaluate a pediatric otoscopy curriculum with the use of outcome measures that included assessment of skills with real patients. METHODS: Thirty-three residents in an intervention group from 2 institutions received the curriculum. In the previous year, 21 residents in a nonintervention group did not receive the curriculum. Both groups were evaluated at the beginning and end of their internship years with the use of the same outcome assessments: 1) a written test, 2) an objective standardized clinical examination (OSCE), and 3) direct observation of skills in real patients with the use of a checklist with established validity. RESULTS: The intervention group had a significant increase in percentage reaching minimum passing levels between the beginning and end of the internship year for the written test (12% vs 97%; P < .001), OSCE (0% vs 78%; P < .001), and direct observation (0% vs 75%; P < .001); significant mean percentage gains for the written test (21%; P < .001), OSCE (28%; P < .001), and direct observation (52%; P = .008); and significantly higher (P < .001) mean percentage gains than the nonintervention group on the written test, OSCE, and direct observation. The nonintervention group did not have a significant increase (P = .99) in percentage reaching minimum passing levels, no significant mean percentage gains in the written test (2.7%; P = .30) and direct observation (6.7%; P = .61), and significant regression in OSCE (-5.2%; P = .03). CONCLUSIONS: A pediatric otoscopy curriculum with multimodal outcome assessments was successfully implemented across different specialties at multiple institutions and found to yield gains, including in skills with real patients.

Standardized Checklist for Otoscopy Performance Evaluation: A Validation Study of a Tool to Assess Pediatric Otoscopy Skills.

INTRODUCTION: Acute otitis media (AOM) is the most frequently diagnosed pediatric illness in the United States and the most common indication for antibiotic prescription. Skill in pediatric otoscopy is essential to correctly identify children with AOM. However, studies have found diagnostic inconsistency and significant overdiagnosis among practitioners. Given the potential public and individual health consequences, there has been a call for improved education regarding the diagnostic certainty of AOM. Yet educational efforts continue to be limited, particularly in regard to competency assessment. The lack of a validated tool to assess otoscopy skill attainment objectively diminishes the instructor's ability to provide useful feedback and direction to the learner. METHODS: We have undertaken an educational intervention with the goal of developing a validated Standardized Checklist for Otoscopy Performance Evaluation (SCOPE), building on key principles of the general pediatric ear exam. The SCOPE was developed with the input of process and content experts with attention to specific domains of validity. RESULTS: Our analysis provides important validity evidence for the SCOPE assessment tool. The instrument was piloted and successfully implemented with medical students and varying levels of residents in pediatrics and emergency medicine over a 5-year period in varied settings: urgent care, large and small pediatric clinics, and the emergency departments at two institutions. It has been used for both instruction and assessment purposes. DISCUSSION: Because the SCOPE can be used in teaching demonstration purposes, in formative and summative assessment settings, and across the continuum of learners, this instrument offers the potential for more educational efforts in the field of assessment in direct patient care. We anticipate that the SCOPE will foster an environment of efficient yet high-yield review and discussion of otoscopy and diagnostic competency.

A prospective study of injury patterns in collegiate pole vaulters.

BACKGROUND: Although pole vaulting has been a sanctioned collegiate event since the 1920s, little is known about the injury patterns observed in the sport. PURPOSE: To describe injury incidence, patterns, and risks in collegiate pole vaulters. STUDY DESIGN: Descriptive epidemiology study. METHODS: This was a prospective cohort study of collegiate athletes participating in pole vault over a single track-and-field season. Baseline athlete information was collected on study enrollment. Injuries were recorded in a standardized form to document diagnosis and event circumstances. A log of practice and competition exposures was maintained for each athlete. Injury incidence was reported as the proportion of injured vaulters and number of new injuries per 1000 athlete-exposures. Regression analysis on baseline variables was performed to determine risks for injury. RESULTS: A total of 135 vaulters from 15 universities took part in the study. There were 70 injury events reported during 8823 exposures. Forty-one percent of vaulters sustained injury, and there were 7.9 injuries per 1000 athlete-exposures. The low back was the most common injury location (16.7%), followed by the hamstrings and lower leg (13.9% each). Overall, 60% of injuries were to the lower extremities, 21% to the upper extremities, and 18% to the back. No head or neck injuries were reported. Injuries were most commonly muscular strains (39.2%) or overuse type (25.5%). Thirty percent, including 83% of low back injuries, occurred during the plant/takeoff phase of the vault. One-third of lumbar injuries were spondylolysis, with 75% of these being season ending. The odds of injury were 2.7 (95% CI, 1.1-7.1) times greater in vaulters with multiple prior injuries. CONCLUSION: This is the first prospective study of injury patterns in collegiate pole vaulters. The results indicate that injuries are very common in experienced vaulters. Medical personnel and coaches should be aware of the propensity for overuse-type injuries and institute activity modification to reduce time lost. In addition, coaches and athletes should focus on proper technique, particularly during the plant/takeoff to help minimize back injury. Medical providers should maintain a high level of suspicion for symptomatic spondylolysis in any vaulter complaining of frequent or persistent low back pain. Detailed medical histories are important to identify prior injuries, and coaches should focus on changing technical flaws or behaviors that may contribute to reinjury.

A prospective study of injury patterns in high school pole vaulters.

BACKGROUND: The pole vault is a track and field event that has witnessed a large increase in participants during the past 5 years. Currently there are no prospective studies that have evaluated injury patterns in pole vaulters. OBJECTIVES: To determine the injury rate and to describe injury patterns in high school pole vaulters. STUDY DESIGN: Descriptive epidemiological study. METHODS: This was a prospective cohort study of 140 Wisconsin high school athletes who participated in pole vaulting during the 2005 and 2006 track and field seasons. Baseline athlete information was obtained at the beginning of each season. When an injury occurred, an injury report form was completed to document diagnosis and circumstances of the incident. Injury rates were expressed as injuries per 100 athletes per season as well as injuries per 1000 athletic exposures. Risk factors were analyzed by calculating relative risks for baseline athlete variables. RESULTS: The injury rates were 26.4 injuries per 100 athletes per season (95% confidence interval, 18.6-36.4) and 7.1 injuries per 1000 athletic exposures (95% confidence interval, 5.0-9.8). Trauma to the lower extremities accounted for 71.5% of injuries. The most common injury types were ligament sprains (31.6%). Landing incorrectly was the most frequent mechanism of injury (26.3%). A history of pole-vault injury was associated with increased risk of injury (relative risk, 2.4; 95% confidence interval, 1.4-4.1). CONCLUSION: Injuries are common in young vaulters. Injury mechanisms indicate that many could be avoided by using proper technique, particularly during the landing phase. Coaches should focus on vaulters with prior injuries to identify risky behavior and to help correct poor technique.