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Armando F. Vidal, M.D. Surgical Director Sports Medicine Program for Young Athletes Childrens Hospital Colorado Team Physician, CU & DU Hip / Thigh Injuries Contusions Hip Pointers Lower Leg Tibia Fracture 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 Painful, Direct blow to Iliac Crest Football Hockey Soccer Protective Padding is key to prevention Acute Rest, Ice, Compression, minimization of hematoma Avoid Heat, Massage, NSAIDS and Physical Activity for first 48 hr XR are important Especially in Young Athletes Consider Injections on Game Day Return to play as symptoms allow Muscle Contusion Secondary to direct blunt trauma Risk of Myositis Ossificans (920%) Treatment Control Deep Bleeding RICE – Knee Flexion Avoid Early - PT, Heat, Massage, NSAIDS Return to Play Pain free ROM (0-120) Near Full return of strength @ 1-2 weeks Rare Injury Football Rugby Skiing / Snowboarding Posterior Much More Common than Anterior Hip Internally rotated, flexed and shortened Reduction 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 Sprinters RB Pain Posteriorly +/- “Pop” Exam Tenderness Defect Ecchymosis Cross Both Hip & Knee Joints Very Characteristic & Common Injury Sprinters RB Pain Posteriorly +/- “Pop” Exam Tenderness Defect Ecchymosis High Grade Injuries (5 Phase Tx) RICE Stretch/Isometrics/Estim Isotonics / +/- Isokinectic Running / Sport Specifics Return to Sports Interventions ? Corticoteroid Injection ? PRP Not Subtle Deformity obvious if present Planted foot, Pivoting “Knee Dislocated” 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 Relatively Rare EMERGENCY!!! Urgent Reduction & Transfer to ED Assessment Align Leg Splint / Stabilize 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 Non-Contact > Contact Female : 3-5x Risk No return in same event Sports Medicine Evaluation 6 month recovery from Reconstruction Obvious Deformity Inability to bear weight Immobilize / Stabilize Air Splint Do not attempt to remove shoe unless necessary Transport to ED Common in Collision Sports Football Hockey Low Grade Crutches / Boot ▪ 72 hr NWB ▪ Gradual return High Grade ORIF Distance of Symptoms up fibula ≅ Duration of Symptoms May lose many weeks of participation Rare in Athletics Basketball 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 Midfoot Injury “Pop or Snap” Pain & Ecchymosis Midfoot Plantar Ecchymosis 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 Stress Fractures Endurance Athlete Female Triad Many can be treated with shoewear modification / orthotics