Nonunion of olecranon stress fractures in adolescent baseball pitchers: a case series of 5 athletes.

BACKGROUND: Adolescent athletes participating in overhead throwing sports suffer a variety of overuse elbow injuries, many of which have been well described in the literature. Nonunion stress fractures of the olecranon across the epiphyseal plate, however, have received little attention. PURPOSE: To describe this unusual clinical entity in the differential diagnosis of the adolescent athlete with elbow pain and to demonstrate that operative treatment is an effective means of quickly and safely returning the patient to sporting activities. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Five adolescent baseball pitchers (mean age, 15 years) who suffered chronic elbow pain and who were diagnosed with olecranon epiphyseal stress fracture nonunions were treated with open reduction and internal fixation using a 7.0 cancellous screw and washer with or without 18-gauge tension banding. RESULTS: Return to preoperative range of motion was achieved at a mean of 8.6 weeks (range, 3.4-16.6 weeks). Patients were clinically asymptomatic at a mean of 11 weeks (range, 7.7-13.6 weeks) after surgery. Radiographic evidence of stress fracture union was achieved at a mean of 15.4 weeks (range, 6.1-33 weeks), including 1 patient with a delayed union according to radiographs, which healed at 33 weeks. Patients were started on a light strengthening program at 5 to 7 weeks and a throwing progression program at 15.6 weeks (range, 6.4-28.1 weeks). All 5 patients were able to return to their previous level of activities, with a mean return time of 29.4 weeks (range, 18.9-40.4 weeks). CONCLUSION: Surgical management of olecranon apophysis stress fractures provided excellent results with minimal complications in this series of 5 consecutive cases.

Potential risk of rerupture in primary achilles tendon repair in athletes younger than 30 years of age.

BACKGROUND: Complete Achilles tendon ruptures are found more often in athletes who participate in sports involving explosive acceleration or maximal effort. In most studies, the consensus for athletes is surgery. This form of treatment has been shown to exhibit the best functional performance with a lower rerupture rate. HYPOTHESIS: Achilles tendon ruptures in a young population (<30 years) have a higher rerupture rate than similar injuries in an older age group (31-50 years), in which the injury is more common. STUDY DESIGN: Cohort study; Level of evidence, 4. METHODS: Retrospective study was carried out by chart review. Magnetic resonance images were obtained comparing appearance of repair in young and old patients at 8 to 12 weeks after operation. RESULTS: There were a total of 4 reruptures in the 89 Achilles tendon repairs. This was an overall rerupture rate of 4.5%, which was consistent with the literature. When the reruptures were critically analyzed, it was noted that the 4 reruptures of the repaired tendon occurred in a young population. Of the 89, there was a subgroup of athletes (n=24) who were 30 years of age or younger at the time of injury. The incidence of rerupture for these individuals was 16.6%. In the remaining athletes (n=65) older than 30 years, the incidence of rerupture was zero. There were no significant differences (P < or =.05) in all parameters measured (average days in a boot, average days to active range of motion, average time to full weight-bearing, average days to bike or use a stair climbing machine, average return to sports) between age groups except in the time from injury to surgery (7.1 days, for athletes < or =30 years vs 2.65 days for athletes >31 years). CONCLUSIONS: The results of Achilles tendon repair with an early weightbearing and an early range of motion rehabilitation program are good. However, caution may need to be taken in the younger athlete (< or =30 years) during rehabilitation. CLINICAL RELEVANCE: Although the authors recommend aggressive rehabilitation for Achilles tendon repairs, caution should be observed in the younger athlete.