Interpreting elbow radiographs in children.

Accurate diagnosis of elbow fractures in children requires knowledge of anatomic development. The multiple ossification centers in the elbow can be mistaken for fractures, making radiographic diagnosis difficult. Anteroposterior and lateral radiographs are most commonly used, although oblique views may help in the detection of subtle injuries. Comparison views of the uninjured elbow are of questionable value. Anterior and posterior fat pad signs indicate joint effusion, which suggests significant trauma. Intersection of the anterior humeral and central radial lines can be used to assess joint alignment. Fractures displaced less than 2 mm are considered stable and may be treated conservatively.

Diagnosing left lower lobe pneumonia: usefulness of the 'spine sign' on lateral chest radiographs.

BACKGROUND: Left lower lobe pneumonia may be obscured by the heart on the postero-anterior (PA) chest radiograph. In such cases, the lateral projection may be helpful, especially if it exhibits the "spine sign", which is an interruption in the progressive increase in lucency of the vertebral bodies from superior to inferior. We investigated whether the spine sign would help family physicians diagnose left lower lobe pneumonia on chest radiographs. METHODS: We selected the chest radiographs of all patients with left lower lobe pneumonia who were seen between 1983 and 1995 at a family practice training program (N = 78) and an equal number of chest radiographs of patients without pneumonia. Six family physicians read these radiographs under two viewing conditions: PA only vs PA and lateral. We used receiver operating characteristic (ROC) curve methodology to compare the two viewing conditions. RESULTS: There was no significant difference in performance between the two viewing conditions. The lateral view was helpful in some patients but misleading in others. Among patients with pneumonia, the lateral view was helpful when the spine sign was present, but it was misleading when the spine sign was absent. CONCLUSIONS: In this study of family physicians, the lateral chest radiograph did not improve overall diagnostic accuracy in patients with left lower lobe pneumonia. Among pneumonia patients with the spine sign, however, the lateral view was often helpful.

Running and its effect on family life.

OBJECTIVES: To determine the frequency with which commitment to running conflicts with family life, to distinguish between runners who experience conflict and those who do not based on their levels of commitment to the roles of runner and family member, and to determine whether runners who reported conflict receive less support for running from their significant other. DESIGN: A questionnaire was mailed to 1426 members of a running club. Personal demographics, running quantity, conflict, commitment to running, family commitment, and spouse support were measured. The Family APGAR scale was used to measure global family functioning, assessing adaptation, partnership, growth, affection, and resolve. RESULTS: There were 724 respondents for a response rate of 50.8%. Five hundred fifty-eight runners (356 men, and 202 women) lived with a partner. The mean score for conflict was 1.9. Only 32 (5.5%) had a score above 3 (high conflict). When evaluated together and separately, the women and men in the high-conflict groups had equal commitment to running, lower family commitment, lower spouse support, and a lower Family APGAR score compared with the low-conflict group. CONCLUSIONS: In this study running is not a major contributor to family conflict. Those runners who are experiencing conflict seem to have a more global conflict with their families that is independent of running, manifested by decreasing spouse support for the runner's activities. If a runner is an active, committed member of his or her own family and sets this commitment as a priority, it does not appear that the time and energy of running is by itself a source of conflict.

Management of concussion in collision sports. Guidelines for the sidelines.

During high-risk sports events, it is important for team physicians to be alert to the possibility of concussion in athletes who may not realize they have been injured or may want to conceal their injury. If concussion is suspected and the player is conscious, history taking should include inquiries about loss of consciousness, loss of memory of events before and after the impact, headache, visual abnormalities, motor and sensory changes, and back, neck, and extremity pain. In an unconscious player, the airway, breathing, circulation, and cervical spine should be checked. The cervical spine must be stabilized before the player is moved if injury to it is suspected. Athletes with such an injury and those who have lost consciousness require hospital evaluation. If there is no cervical spine injury, a complete neurologic evaluation should be carried out on the sidelines and the player checked for signs of skull fracture. The Colorado Medical Society guidelines for grading concussions and deciding when athletes may return to competition are an excellent aid to clinical judgment.

Expectations and satisfaction of runners with injury treatments.

Seventy-eight runners competing in three Iowa races were surveyed concerning their most recent running injury for which they sought medical care from a family physician, an orthopedic surgeon, or a podiatrist. Their reasons for choosing a doctor, expectations of care, and satisfaction with treatment received were assessed. Most patients selected the orthopedic (50%) or podiatric (42%) physicians upon the recommendation of other runners; only 13% of the family physicians were selected from recommendations. Orthopedic and podiatric patients were more likely than family physician patients to expect x-rays. There was no difference in overall patient satisfaction with treatment received from the three groups of physicians. The runners felt that all physician groups treated their running injuries equally well.