An overview of common soccer injuries. Management and prevention.

The most common injuries in soccer involve the ankle and knee joints, and the muscles and ligaments of the thigh and calf. Rehabilitation to restore strength and endurance after healing is extremely important to prevent a recurrence of the injury, which is much more severe and disabling than the initial injury. Sprains and strains of the hamstring and quadriceps, and injuries to the external and internal structures of the knee joints are frequent and relatively more disabling. Recent progress in the technical aspect of investigative medicine, such as magnetic resonance (MRI) imaging/quantitative only computer tomography (CT) scanning, ultrasonic imaging of soft tissues and isokinetic measurement of muscle characteristics, lead to better diagnosis and management of soccer injuries. Appropriate nutritional and physiological preparation, maintaining fluid and electrolytes during the game and restoration of the reserves following completion of exhaustive activities will help to minimise injuries.

Low-back pain. Factors of value in predicting outcome.

Two separate samples of 50 workers' compensation patients were assessed within 3 to 6 months of their first back injury and were reassessed at a mean of 13.7 months postinjury, at which time work status was also determined. A number of predictors on the first assessment then were correlated with return to work. These predictors included orthopaedic evaluations of severity and prognosis, the number of nonorganic physical signs, Minnesota Multiphasic Personality Inventory (MMPI) scales 1 and 3, age, education, proficiency in English, and the accuracy of patients' understanding of the bases for their medical condition as determined by the Schema Assessment Instrument (SAI). The SAI was the only variable to predict return to work significantly in both samples. These data point to the importance of patients' understanding of their medical condition for their prognosis.

New clinical test for fracture of the scaphoid.

The authors noted that in patients with scaphoid fractures pronation of the affected wrist followed by ulnar deviation produces pain in the anatomic snuff box that is not present in those without a scaphoid fracture. They therefore evaluated this test prospectively in 73 patients. The test gave a 52% positive predictive value and a 100% negative predictive value. They recommend that the test may be used with confidence in the emergency department to exclude a scaphoid fracture in patients with clinical features suggesting scaphoid injury but a normal x-ray film. Use of this test would reduce the number of patients whose wrists are needlessly immobilized in a scaphoid cast.

Do nonorganic signs help to predict the return to activity of patients with low-back pain?

The value of the nonorganic signs in predicting return to activity following an initial episode of low-back pain was determined. One hundred and twenty patients were assessed within 6 months of the onset of their first episode of disabling low-back pain and again at a mean of 15.3 months following injury. No correlation was found between the presence of nonorganic signs at initial assessment and either return to activity or resolution of the patient's symptoms.

Acute management for the injured hand.

If not optimally treated, a hand injury can lead to disability which often has considerable economic and social implications. The role of the primary care physician is to diagnose the injury correctly and initiate management which will keep this disability to a minimum. This is best achieved by making a composite diagnosis to include all the injured components of the hand. The emphasis must be on early mobilization of the injured area and the maintenance of mobility in all joints of the upper limb. Early referral to physiotherapy and occupational therapy departments is highly desirable. The major pitfall in managing hand injuries is over zealous treatment of the fracture at the expense of the soft tissue injury, resulting in iatrogenic stiffness.

The use of modified A.O. reduction forceps in percutaneous fracture fixation.

A simple modification of standard A.O. reduction forceps is described. This instrument has greatly facilitated the management of fractures in the hand that require percutaneous wire fixation.

Complete carpal disruption of the hand.

A case of radiocarpal and inter-carpal dislocations associated with a fracture-dislocation of the ulnar four carpo-metacarpal joints is presented, with a description of treatment and long term follow-up. A review of the literature shows this to be a unique combination of injuries.

The quality and educational value of medical records--a survey of student opinion.

In July 1975 clinical students at the Royal Free Hospital School of Medicine were asked to complete a questionnaire, including questions on medical records. Full and accurate recording of clinical information was considered an important characteristic of the good physician, but less important for success as a medical student. Students felt they should be given more instruction on the writing of medical records and that teachers should pay more attention to students' notes. Review of students' notes is a valuable method of teaching clinical medicine; teachers can ensure that patients are the focus of learning and can encourage students to simulate real clinical practice.

Metacarpal shortening.

A case of Psoriatic Arthritis with disabling flexion deformities at the metacarpo-phalangeal joints of the fingers is described. Skeletal shortening decreased the deformity and improved the function.

8. Self-compressing implants in the management of fractures.

Internal fixation of fractures has become increasingly important since the introduction of self-compressing implants. Rigidity of fixation thus ensured permits primary bone healing. Two types of self-compressing implants are available--screws and plates. The former produces compression between fracture fragments, the latter, along the long axis of the bone. Two common types of plates are the dynamic compression plate and the Osteo self-compressing plate. Use of self-compressing implants requires familiarity with the technique, a definite plan of operation, and strict asepsis and lack of infection in the patient. Indications for the technique include failure or unsuitability of closed reduction of fractures, care of associated serious soft-tissue injuries, and displaced intra-articular fractures. Use of self-compressing plates hastens rehabilitation, lessens joint stiffness and reduces the duration of hospitalization. The incidence of nonunion with self-compression techniques is lower than with traditional methods of fracture management.

Distension arthrography of the shoulder joint.

Pain and stiffness resulting from degenerative disease of the rotator cuff of the glenohumeral joint is not always self-limiting. In a few patients, the symptoms persist despite medication and physiotherapy. Distension arthrography, a method of hydrostatic manipulation, has been used in six such patients; five recovered full range of abduction and rotation and the sixth was improved. It is concluded that distension arthrography should be part of the treatment of intractable pain stiffness of the shoulder joint.