MRI of ankle sprain: the association between joint effusion and structural injury severity in a large cohort of athletes.

OBJECTIVE: To test the hypothesis if presence and amount of effusion in the tibiotalar and talocalcaneal joints are associated with an increased risk for severe structural injury in ankle sprains. METHODS: A total of 261 athletes sustaining acute ankle sprains were assessed on MRI for the presence and the amount of joint effusion in the tibiotalar and talocalcaneal joints, as well as for ligamentous and osteochondral injury. Specific patterns of injury severity were defined based on lateral collateral ligament, syndesmotic, and talar osteochondral involvement. The presence and the amount effusion (grades 1 and 2) were considered as risk factors for severe injury, while physiological amount of fluid (grade 0) was considered as the referent. Conditional logistic regression was used to assess the risk for associated severe injuries (syndesmotic ligament rupture and talar osteochondral lesions) based on the presence and amount of tibiotalar and talocalcaneal effusions. RESULTS: For ankles exhibiting large (grade 2) effusion in the tibiotalar joint (without concomitant grade 2 effusion in the talocalcaneal joint), the risk for partial or complete syndesmotic ligament rupture was increased more than eightfold (adjusted odds ratio 8.7 (95% confidence intervals 3.7-20.7); p < 0.001). The presence of any degree of effusion in any of the joints was associated with an increased risk for severe talar osteochondral involvement (several odds ratio values reported; p < 0.001), including large subchondral contusions and any acute osteochondral lesion. CONCLUSION: The presence of tibiotalar and talocalcaneal effusions is associated with an increased risk for severe concomitant structural injury in acute ankle sprains. KEY POINTS: • For ankles exhibiting severe (grade 2) effusion in the tibiotalar joint after sprain, the risk for partial or complete syndesmotic ligament rupture increases more than eightfold. • The presence of effusion in both tibiotalar and talocalcaneal joints is associated with an increased risk for severe ligament injury such as complete ATFL rupture as well as partial or complete syndesmotic ligament rupture. • The presence of effusion in the tibiotalar or talocalcaneal joints after sprain is associated with an increased risk for severe talar osteochondral involvement.

[A video-based analysis to classify shoulder injuries during the Handball World Championships 2015]. / Eine videobasierte Analyse zur Klassifizierung von Schulterverletzungen während der Handball-Weltmeisterschaft 2015.

Injuries play a major role in high-performance sports and occur in training and competition. Handball is a team sport with high physical demands, and the measurement of specific loads has the potential to identify risk factors for injuries. Few studies have identified this in handball during a World Cup. This study aims to record shoulder injuries that occurred during the 88 games of the 2015 Men's World Cup and to discuss position-specific differences. Players from 24 national teams were analysed using a camera system and special software (Prozone Handball V. 1.2, Prozone, Leeds, UK). In total, nine shoulder injuries were recorded. Three out of these nine injuries were non-contact injuries. The number of passes and throws is position-dependent, and the highest load was documented for the back players. The two back players who suffered a non-contact injury have an increased play time and an increased number of throws compared to their peers. To reduce the risk of injury, the load should be monitored (during training and tournament), and a targeted injury prevention should be performed to prepare the players for the requirements of the game/tournament.

Age, player position and 2 min suspensions were associated with match injuries during the 2017 Men's Handball World Championship (France).

AIM: To study the association between player characteristics, technical components of the game and the risk of match injuries during the 2017 Men's Handball World Championship. METHODS: Team physicians of the participating teams (n=24) were requested to provide injury report forms throughout the Men's Handball World Championship (France, January 2017). The individual time played, age, number of international matches played and all technical and penalty variables for each player were extracted from the official International Handball Federation (IHF) online database and used as risk factors in a general logistic linear model analysis. RESULTS: Of 387 players, 49 sustained one or more injuries (93 injuries in total). The total incidence of match injuries was 82.1 injuries per 1000 hours (95% CI 66.2 to 100.5), non-time-loss injury incidence was 40.6 injuries per 1000 hours (95% CI 29.3 to 54.9), while time-loss injury incidence was 30.9 injuries per 1000 hours (95% CI 21.5 to 42.9). Multivariate analysis showed that age (OR 1.1, 95% CI 1.02 to 1.18, p=0.011), player position (backs: OR 6.79, 95% CI 2.25 to 20.54, p=0.001; goalkeepers: OR 5.03, 95% CI 1.15 to 21.94, p=0.031) and 2 min suspensions (1-2 times: OR 2.77, 95% CI 1.27 to 6.04, p=0.011; 3 or more times: OR 2.66, 95% CI 1.18 to 6.38, p=0.029) were significant risk factors for getting injured during competition matches. CONCLUSION: Age, player position (backs, goalkeepers) and 2 min suspensions were associated with match injury. Stricter rule enforcement should be considered to prevent match injuries in elite handball.

Performance analysis of male handball goalkeepers at the World Handball championship 2015.

Goalkeepers have a very important role in handball. In coaching communities it is well recognized that goalkeepers' performances can predict team ranking in major tournaments. Despite this, few studies have been conducted on elite goalkeepers participating in World Championships. Therefore, the purpose of this study was to analyse goalkeepers' save performance during the 88 matches of the 2015 men's World Championships tournament. Goalkeepers from 24 national teams were analysed using a tracking camera system and bespoke software (Prozone Handball V.1.2, Prozone, Leeds, UK). The purpose of this study was to examine time-motion performance parameters and to evaluate the save rates for each goalkeeper. The mean total distance covered in a game by the goalkeepers was 1634±999 m. Goalkeepers spent most of the time walking or standing. The total amount of shots to the goal was 6893, with a mean save percentage of 30% (2088 saves). A significant relationship was identified between the goalkeepers' save statistics and the final team rankings. The save rate is important for teams to achieve a higher ranking, and therefore the selection and training of goalkeepers requires more than just assessing physical abilities. The throwing distribution and success/save rate during the Qatar 2015 Men Handball World Championships suggest strong and weak parts of the goal area, and coaches can use this information to adjust their training approaches for both goalkeepers and shooters.

Activity Profiles and Positional Differences of Handball Players During the World Championships in Qatar 2015.

CONTEXT: Handball is an Olympic sport played indoors by 6 court players and 1 goalkeeper with rolling substitutions. Limited data exist on elite players competing in a world championship, and virtually no information exists on the evolution of time-motion performance over the course of a long tournament. PURPOSE: To analyze time-motion characteristics of elite male handball players of the last world championships, played in Qatar in 2015. PARTICIPANTS: 384 handball players from 24 national teams. METHODS: The athletes were analyzed during 88 matches using a tracking camera system and bespoke software (Prozone Handball v. 1.2, Prozone, Leeds, UK). RESULTS: The average time on court (N = 2505) during the world championships for all players was 36:48 ± 20:27 min. Goalkeepers and left and right wings were on court most of the playing time (GK 43.00 ± 25:59 min; LW 42:02 ± 21:07 min; RW 43:44 ± 21:37 min). The total distance covered during each game (2607.5 ± 1438.4 m) consisted mostly of walking and jogging. The cumulative distance covered during the tournament was 16,313 ± 9423.3 m. Players performed 857.2 ± 445.7 activity changes with a recovery time of 124.3 ± 143 s. The average running pace was 78.2 ± 10.8 m/min. There was no significant difference between high-ranked and lower-ranked teams in terms of distance covered in different locomotion categories. CONCLUSIONS: Specific physical conditioning is necessary to maximize performance of handball players and minimize the occurrence of fatigue when performing in long tournaments.

Injury and illness surveillance during the 24th Men's Handball World Championship 2015 in Qatar.

BACKGROUND: The IOC encourages international federations to establish systematic athlete injury and illness surveillance programmes. OBJECTIVE: To describe pattern of injuries and illnesses during the 24th Men's Handball World Championship 2015 by implementing the IOC injury and illness surveillance protocol. METHODS: The medical staff of participating teams (n=24) were requested to report all new injuries and illnesses during matches and/or training on a daily basis throughout the event (15 January to 1 February, 2015). Exposure (number of player-hours) during all matches was calculated for all players (n=384) and for each of the 4 player positions (wing, back, line and goalkeeper). RESULTS: Medical staff of all teams submitted 96.7% (n=325) of the daily report forms. In total, 27.1% of the players were injured, and of the 132 injuries reported, 40% were time-loss injuries. The total incidence of injuries was 104.5 per 1000 player-hours. The highest risk of injury was found among line players, and more injuries occurred during the first half of the matches. The most frequent injury location was the ankle, followed by the thigh, knee and head/face. The majority of injuries were contusion, sprain or strain. In total, 10.9% of the players were affected by an illness during the event. Of the 42 cases recorded, 31 (73.8%) were reported as respiratory tract infection. CONCLUSIONS: The risk of injury in handball is high among Olympic sports. Preventive measures should focus on contusions, ankle sprains, and thigh muscle strains, as well as measures aimed to reduce upper respiratory tract infections.

Unrecognized acute exertional compartment syndrome of the leg and treatment.

Acute-on-chronic exertional compartment syndrome is rare and may be easily missed without a high degree of awareness and clinical suspicion. We report a case of unrecognized acute-on-chronic exertional compartment syndrome in a recreational soccer player. The late sequela of this condition, foot drop, was successfully treated with transfer of the peroneus longus tendon.

Nicolau syndrome in an athlete following intra-muscular diclofenac injection.

Nicolau Syndrome (also known as Embolia cutis medicamentosa and livedo-like dermatitis) is a rare but severe localized adverse drug reaction to a range of intra-muscular preparations. It manifests as acute pain, cutaneous, subcutaneous and intra-muscular inflammation and necrosis immediately following an injection, with potentially devastating sequelae. We describe the syndrome in a 21-year-old national level race walk athlete following an intramuscular diclofenac injection.

Midterm results with a bipolar radial head prosthesis: radiographic evidence of loosening at the bone-cement interface.

BACKGROUND: Metal prostheses are useful for restoring elbow and forearm stability when the radial head cannot be fixed after a fracture. Because the anatomy of the radial head is difficult to reproduce with a prosthesis, two different options have been proposed: a bipolar prosthesis with a fixed stem and a mobile head, and a monoblock prosthesis with a smooth stem that is intentionally fixed loosely in the neck of the radius. One concern with a fixed-stem implant with a mobile head has been the risk of osteolysis. The purpose of this study was to evaluate radiographic changes reflecting or suggesting progressive osteolysis in patients with a bipolar radial head prosthesis. METHODS: The functional and radiographic outcomes following treatment of fifty-one comminuted fractures of the radial head with a bipolar radial head prosthesis in fifty-one consecutive patients were evaluated at a mean of 8.4 years postoperatively. There were eleven isolated comminuted fractures involving the entire radial head. Thirty-four fractures were associated with a posterior elbow dislocation, and six patients had a posterior Monteggia lesion. RESULTS: According to the Mayo Elbow Performance Index, fourteen elbows were graded as excellent; twenty-five, as good; nine, as fair; and three, as poor. Radiographic changes reflecting or suggesting progressive osteolysis were present in thirty-seven patients. Complications occurred in ten patients, but only one underwent surgical treatment, for an ulnar neuropathy. CONCLUSIONS: Although satisfactory midterm functional results were achieved in thirty-nine of the fifty-one patients, the high prevalence of adverse radiographic changes suggesting periprosthetic osteolysis should alert clinicians to this possible drawback of the use of bipolar radial head prostheses, especially in young and/or active patients.

A comparative study between proximal radial morphology and the floating radial head prosthesis.

A morphometric study of the proximal radius was performed with computed tomography scanning in 51 healthy adults. These dimensions were then compared with those of a commercially available floating radial head prosthesis. Results were expressed as mean values, SD, and minimum and maximum values. The minimum and maximum diameters of the radial head were 21.9 +/- 1.9 mm and 22.9 +/- 1.9 mm, respectively. The minimum and maximum intramedullary diameters of the radial neck were 8.3 +/- 1.3 mm and 9.3 +/- 1.5 mm, respectively. The combined length of the radial head and neck was 22.47 +/- 2.84 mm. The implications for prosthetic design are as follows: the small floating cup (19 mm in diameter) is too small for the large majority of adults, the large floating cup (22 mm in diameter) is closer to the radial anatomy, the mean values are significantly different between male and female patients, and a single component would suffice for right and left elbows.

Concomitant plantar tarsometatarsal (Lisfranc) and metatarsophalangeal joint dislocations.

We report an unusual case of concomitant plantar tarsometatarsal (Lisfranc) and 1st and 2nd metatarsophalangeal (MTP) joint dislocations and fracture of the neck of the third metatarsal bone which has never been reported before. The plantar dislocation of the Lisfranc joint was treated by open reduction and fixation with K-wires; the dislocations of the MTP joints and neck fracture of the third metatarsal bone were treated by closed reduction and percutaneous fixation with K-wires and immobilized with a plaster cast. At the 5 year follow-up examination, our patient had no complaints, but the radiograph showed degenerative changes of the Lisfranc and the 1st MTP joint.