Football commentary: phalangeal fractures--displaced/nondisplaced

Intramedullary Headless Screw Fixation for Phalanx Fractures: Technique and Review of Current Literature

Fractures of the phalanges can often be managed nonoperatively, but displaced phalangeal fracture patterns, including malrotation, are more amenable to operative treatment. There are several described methods for surgical management of phalanx fractures, but there remains no consensus on a clearly superior method of fixation. Percutaneous Kirschner wires, interfragmentary screws, plate and screw constructs, intramedullary nails, and cannulated intramedullary headless screws are all utilized in the treatment of these fractures. Intramedullary headless screws for phalanx fractures may provide suitable fixation allowing early motion and recovery. Here, we describe a technique for antegrade and retrograde intramedullary headless screw fixation for phalanx fractures.

Return to Sport After Metacarpal and Phalangeal Fractures: A Systematic Review and Evidence Appraisal

BACKGROUND

Fractures of the metacarpals and phalanges account for more than half of all upper extremity fractures sustained by competitive athletes.

PURPOSE

To determine which management strategy is best for expediting return to preinjury levels of competition in adult athletes with metacarpal and/or phalangeal fractures.

STUDY DESIGN

Systematic review; Level of evidence, 4.

METHODS

A methodology compliant with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) was used. A custom search strategy was designed and applied to MEDLINE and In-Process, Embase, EMCARE, and CINAHL.

RESULTS

Overall, 3135 records were identified, of which 8 met full inclusion criteria. All patients returned to preinjury levels of competition, at a mean of 30.6 days for phalangeal fractures and 21.9 days for metacarpal fractures. Meta-analysis demonstrated delayed return-to-sport time for operatively managed metacarpal fractures as compared with nonoperatively managed ones (28.5 vs 22.0 days). All studies were of fair or poor quality, and none were randomized.

CONCLUSION

Optimal management strategies for athletes with metacarpal and phalangeal fractures remain equivocal. Injury, treatment, and sport-specific factors may confound results and preclude accurate estimation of optimal treatment strategies at present.

Epidemiology of Hand and Wrist Injuries in NCAA Men's Football: 2009-2010 to 2013-2014

Background:

Participation in National Collegiate Athletic Association (NCAA) football is at an all-time high. This population of athletes experiences a substantial injury burden, with many injuries affecting the upper extremities.

Purpose/Hypothesis:

The purpose of this study was to describe the epidemiology of hand and wrist injuries in college football players from the academic years 2009–2010 to 2013–2014. We hypothesized that variables such as event type (practice vs game), mechanism of injury, and player position would have an effect on the injury incidence.

Study Design:

Descriptive epidemiological study.

Methods:

An epidemiological study utilizing the NCAA Injury Surveillance Program was performed to investigate rates and patterns of hand and wrist injuries in participating varsity football teams from 2009–2010 to 2013–2014.

Results:

A total of 725 hand and wrist injuries were captured in 899,225 athlete-exposures. The observed practice injury rate was 0.51 injuries per 1000 athlete-exposures, compared with a game injury rate of 3.60 (P < .01). Player-on-player contact was the most common injury mechanism reported, with blocking being the most common activity at the time of injury. Offensive linemen were most likely to experience an injury. Of all injuries sustained, 71.4% resulted in no time loss from competition, whereas 9.8% of injuries resulted in longer than 7 days of time loss. A fracture resulted in the greatest time loss from competition (mean ± SD, 8.3 ± 24.0 days; median, 0 days [range, 0-148 days] for injuries sustained in a practice setting) (mean ± SD, 7.7 ± 15.8 days; median, 0 days [range, 0-87 days] for injuries sustained in a game setting).

Conclusion:

Hand and wrist injuries were found to be significantly more common in games when compared with practices. This study provides valuable prognostic data regarding expected time loss on a per-injury pattern basis. Further investigation on specific injury subtypes and expected time loss as a result of these injures would provide trainers, players, and coaches with useful information on an expected postinjury recovery and rehabilitation timeline.

Expediting Professional Athletes' Return to Competition

Return-to-play (RTP) decisions often represent a challenge to physicians caring for athletes. The multifaceted and unique nature of each RTP decision makes standardization of the decision-making process impossible and demands of the physician thoughtful consideration of all competing interests and variables. Such difficult medical decisions are further complicated by unique ethical and legal considerations. Although no concrete RTP recommendations are available, the consensus of experienced team physicians and knowledge of the rules and regulations that apply to RTP are helpful guides to treating the various upper extremity injuries that occur in elite athletes.

Finger Injuries in Football and Rugby

Football and rugby athletes are at increased risk of finger injuries given the full-contact nature of these sports. Some players may return to play early with protective taping, splinting, and casting. Others require a longer rehabilitation period and prolonged time away from the field. The treating hand surgeon must weigh the benefits of early return to play for the current season and future playing career against the risks of reinjury and long-term morbidity, including post-traumatic arthritis and decreased range of motion and strength. Each player must be comprehensively assessed and managed with an individualized treatment plan.

[Finger injuries in ball sports]

Ball sports are the most frequent cause of sport injuries and 60% of all hand injuries involve the fingers. The most common injury is closed rupture of the extensor tendon of the distal interphalangeal joint (mallet finger). Rupture of the deep flexor tendon (jersey finger) occurs particularly in contact ball sports, such as rugby. Injuries of the proximal interphalangeal and metacarpophalangeal joints are of high functional relevance. These injuries frequently represent complex lesions which are demanding both in diagnostics and therapy. Errors in diagnosis or insufficient treatment can lead to misalignment and functional impairment of the hand. This article provides an overview of the current treatment strategies and includes recommendations for the treatment of professional athletes.