Injuries associated with arm wrestling: A narrative review.

OBJECTIVE: Arm wrestling is common sport amongst amateur enthusiasts. Multiple injuries are described as a result of the sport. The authors present a narrative review of the common injuries associated with the sport. DESIGN: Systematic review with a critical appraisal of the literature and a narrative review of the injuries associated with arm wrestling. DATA SOURCES: Seven electronic databases were systematically searched using medical subject headings (MeSH) terms as follows. Arm wrestling, Indian Wrestling, Fractures, Injury, Ligament Injury with Boolean search terms "AND". An extensive review of orthopaedic textbooks was also performed. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Inclusion criteria were publications which included patients who suffered bony or soft tissue injuries as a result of arm wrestling published in English language. RESULTS: A total of 152 patients was seen across all studies. Spiral fractures of the distal third of the humerus are by far the most common injury reported in the setting of arm wrestling. The humerus fails due torsional and bending stresses. 23% were complicated by medial butterfly fragment and the incidence of radial nerve palsy was 23%. Fracture patterns differ in the skeletally immature arm wrestler, who show an increased incidence of medial humeral epicondyle fractures. We also report on the atypical fracture and soft tissue injury patterns that present.

Acute compartment syndrome of the foot due to a twisting injury while playing sports.

Acute compartment syndrome (ACS) of the foot is one of the most severe injuries of the foot and typically results from a fracture, crush or vascular injury. ACS, isolated to a single foot compartment, is a rare complication following a simple twisting injury of the ankle. In this article, the authors present the case report of a 25-year-old man who developed ACS, isolated to the lateral compartment of the foot, secondary to rupture of the lateral ligament complex and subsequent haematoma formation. An emergency fasciotomy was performed and the patient had complete resolution of his symptoms. ACS is usually associated with significant trauma, however, there are reported cases in the literature associated with a minor injury. In this case report, the authors describe how ACS developed following a simple ankle sprain playing sports in the absence of a high-energy insult or fracture.

History, treatment and analysis of a rare form of Exeter stem fracture.

The Exeter stem by Stryker has become one of the most successful and widely used stems in modern cemented hip arthroplasty. We present a case of a rare stem fracture which was treated by 'cement-in-cement' revision arthroplasty technique. The patient, an 87-year-old man, presented with left hip pain and an inability to weight bear following a cracking sensation when he was standing to dress himself. The patient denied history of fall or trauma. On examination he was noted to have a shortened externally rotated left lower limb without neurovascular compromise. On pelvic radiograph he was noted to have an incomplete stem fracture of his left-sided total hip replacement. He was treated with a cement-in-cement revision. Postoperatively the stem was sent for analysis in the London Implant Retrieval Centre. This is an example of a rare form of stem fatigue failure treated with a well-described technique in revision arthroplasty.

Fluctuating hypercalcaemia caused by cavitary Mycobacterium bovis pulmonary infection.

Hypercalcaemia occurs in many granulomatous diseases. Among them, sarcoidosis and tuberculosis are the most common causes. Other causes include berylliosis, coccidioidomycosis, histoplasmosis, Crohn's disease, silicone-induced granulomas, cat-scratch disease, Wegener's granulomatosis and Pneumocystis carinii pneumonia. Hypercalcaemia in granulomatous disease occurs as a consequence of dysregulated production of 1,25-(OH)2 D3 (calcitriol) by activated macrophages in granulomas. Hypercalcaemia in patients with Mycobacterium tuberculosis infection has been reported in 0%-28% of cases. Uncultured bronchoalveolar lavage cells from patients with M. tuberculosis produce greater amounts of calcitriol compared with controls. Although Nayar et al described hypercalcaemia in a case of sepsis associated with intravesical Bacille Calmette Guerin therapy, there are no published reports describing hypercalcaemia in patients with pulmonary M. bovis infection. We describe a patient with M. bovis cavitary pulmonary infection with sustained hypercalcaemia that fluctuated and recurred repeatedly over the course of therapy, ultimately culminating in normalisation of serum calcium when therapy had led to cure. Treatment consisted of antituberculous therapy, oral corticosteroids and intravenous bisphosphonates with a favourable outcome.