Download Lower Extremity Injuries - University of Colorado Denver

Armando F. Vidal, M.D.
Surgical Director
Sports Medicine Program for Young
Athletes
Childrens Hospital Colorado
Team Physician, CU & DU
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Hip / Thigh Injuries
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 Contusions
 Hip Pointers
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Lower Leg
 Tibia Fracture
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Foot / Ankle
 Hip Dislocation
 Syndesmotic Injury /
 Hamstring Strains
Masseneuve Fracture
 Subtalar Dislocation
 LisFranc Injury
 Foot Fractures
Knee
 Patella Dislocation
 Knee Dislocation
 Ligamentous Injuries
 Meniscal Injury
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Painful, Direct blow to
Iliac Crest
 Football
 Hockey
 Soccer
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Protective Padding is
key to prevention
Acute
 Rest, Ice, Compression,
minimization of
hematoma
 Avoid Heat, Massage,
NSAIDS and Physical
Activity for first 48 hr
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XR are important
 Especially in Young
Athletes
Consider Injections on
Game Day
 Return to play as
symptoms allow
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Muscle Contusion
 Secondary to direct blunt
trauma
 Risk of Myositis Ossificans (920%)
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Treatment
 Control Deep Bleeding
 RICE – Knee Flexion
 Avoid Early - PT, Heat,
Massage, NSAIDS
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Return to Play
 Pain free ROM (0-120)
 Near Full return of strength
 @ 1-2 weeks
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Rare Injury
 Football
 Rugby
 Skiing / Snowboarding
Posterior Much More
Common than Anterior
 Hip Internally rotated, flexed
and shortened
 Reduction
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Knee & Hip Flexed
Traction in-line with femur
Gentle Rotation
Counter-traction on pelvis
RARE TO DO ON FIELD!!!
Cross Both Hip & Knee
Joints
 Very Characteristic &
Common Injury
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 Sprinters
 RB
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Pain Posteriorly
 +/- “Pop”
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Exam
 Tenderness
 Defect
 Ecchymosis
Cross Both Hip & Knee
Joints
 Very Characteristic &
Common Injury
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 Sprinters
 RB

Pain Posteriorly
 +/- “Pop”
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Exam
 Tenderness
 Defect
 Ecchymosis
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High Grade Injuries (5
Phase Tx)
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RICE
Stretch/Isometrics/Estim
Isotonics / +/- Isokinectic
Running / Sport Specifics
Return to Sports
Interventions
 ? Corticoteroid Injection
 ? PRP
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Not Subtle
 Deformity obvious if present
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Planted foot, Pivoting
 “Knee Dislocated”
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Direct Contact
Many reduce spontaneously
Reduction
 Gentle Knee Extension

No return to game if 1st episode
 Consider return in chronic
dislocator if minimal symptoms &
No effusion

Need Ortho Evaluation
 Chondral fractures
 Loose bodies
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Relatively Rare
EMERGENCY!!!
Urgent Reduction &
Transfer to ED
 Assessment
 Align Leg
 Splint / Stabilize
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Non-contact pivoting
injury
Very Common
“Pop” + early effusion
(70% have ACL)
Unable to return to
play
Rapid Onset of Effusion
Lateral Knee pain is
Common
ACL Injury
Right Knee
ACL Injury
Left Knee
LACHMAN
ANTERIOR DRAWER
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Non-Contact >
Contact
Female : 3-5x  Risk
No return in same
event
Sports Medicine
Evaluation
6 month recovery
from Reconstruction
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Obvious Deformity
Inability to bear weight
Immobilize / Stabilize
 Air Splint
Do not attempt to
remove shoe unless
necessary
 Transport to ED
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Common in Collision
Sports
 Football
 Hockey
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Low Grade
 Crutches / Boot
▪ 72 hr NWB
▪ Gradual return
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High Grade
 ORIF
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Distance of Symptoms up
fibula ≅ Duration of
Symptoms
May lose many weeks of
participation
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Rare in Athletics
 Basketball
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Inversion injury
Typical Appearance
Do not attempt to
reduce on field
Splint / Protect
ED for XR and closed
Reduction
RTP usually in several
weeks or months after
symptoms resolved
Unknown recurrence
rate
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Midfoot Injury
“Pop or Snap”
Pain & Ecchymosis
Midfoot
 Plantar Ecchymosis
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Arch Collapse
Ability to RTP is Variable
for low grade injury
Sports Medicine
Evaluation
 XR - Boot or ORIF
May take a long time
to recover
 Can be devastating
injury
 Often NWB for 8 – 10
wks
 Low grade injury

 Cast / Boot
 Steel Shank / Carbon
Fiber Insert

5th Metatarsal Fracture
 Most common
 Inversion Injury
 Can be mistaken for
lateral ankle sprain
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Stress Fractures
 Endurance Athlete
 Female Triad
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Many can be treated
with shoewear
modification /
orthotics