Hip fracture-dislocation in football: a report of two cases and review of the literature

A rare soccer-related injury: Traumatic posterior hip fracture-dislocation - Case series and overview of the literature

BACKGROUND

Soccer is one of the most popular sports with millions of active professional and non-professional players worldwide. Traumatic hip dislocations are rare in soccer but can lead to major sequelae both physically and psychologically. The aim of this review was to obtain insight into the outcomes after surgerically repaired hip fracture-dislocation in soccer players as well as rehabilitation and prevention.

METHODS

Two cases of a posterior hip fracture-dislocation that occurred during an amateur soccer match are presented and mechanism of injury, complications and rehabilitation were analysed. Follow-up of both patients was at least one year after surgery. Questionnaires and physical examinations were obtained to quantify and qualify outcome.

RESULTS

In both cases the hip-dislocations were reduced within 3 h after injury. Semi-elective open reduction and internal fixation was performed within seven days. In one case, there was a concomitant Pipkin fracture and sciatic nerve neuropathy. There were no postoperative complications. Follow-up showed full of range of motion and normal hip functionality in both cases. However, both patients indicated a reduced quality of life and anxiety related to the accident.

CONCLUSION

Traumatic hip fracture-dislocations during soccer practice are extremely rare. Despite uncomplicated fracture healing after surgery and return of hip function, both patients still suffer from psychological problems resulting in a decreased quality of life. Further research is required to enhance psychological outcomes, as well as to facilitate return to pre-injury levels of participation and engagement in sports following traumatic hip fracture-dislocations related to soccer.

The great pretender: Multi-system tuberculosis and pathological fracture masquerading as a severe acute football groin injury - Case study with a 5-year follow-up

In this clinical case, a man presented with a groin injury on his dominant side, which he apparently sustained in football (soccer) practice on the previous day. The man was unable to walk unassisted and had to be transported in a wheelchair. The consulting practitioner grew suspicious upon finding minimal clinical evidence and nothing notable on the X-ray to suggest a severe acute injury. A subsequent detailed workup revealed extrapulmonary tuberculosis (EPTB) of the musculoskeletal (MSK) and genitourinary tract (GUT) systems, complicated by a pathological fracture of the acetabulum, as the cause of the groin injury. Management of the EPTB resolved the condition with no relapse nor long-term sequelae beyond five years, despite being immunocompromised. We present the clinical case and a five year follow-up. The case serves as a reminder of the possibility that other conditions may mimic sports injuries and further illustrates a rare presentation of such a condition.

Hip Dislocation and Subluxation in Athletes: A Systematic Review

BACKGROUND

Hip dislocation is a rare occurrence during sports but carries serious implications for athletes.

PURPOSE

To systematically review treatment strategies and outcomes for hip dislocation in athletes, with the ultimate goal of providing sports medicine physicians with the information necessary to appropriately treat and counsel patients sustaining this injury.

STUDY DESIGN

Systematic review; Level of evidence, 4.

METHODS

PubMed, MEDLINE, and Embase were searched for studies relating to hip instability and athletics from January 1, 1989 to October 1, 2019. Abstracts and articles were evaluated on the basis of predefined inclusion and exclusion criteria. Inclusion criteria were the following: (1) data from ≥1 patients, (2) native hip dislocation or subluxation occurring during sports, (3) patients aged at least 10 years, and (4) written in English. Exclusion criteria were (1) patients younger than 10 years; (2) nonnative or postoperative hip dislocation or subluxation; (3) a native hip injury without dislocation or subluxation; (4) patients with dislocation or subluxation secondary to neuromuscular, developmental, or syndromic causes; (5) dislocation or subluxation not occurring during sports; (6) patients with physeal fractures; or (7) review articles or meta-analyses. Data were recorded on patient demographics, injury mechanism, treatment strategies, and clinical and radiographic outcomes. Where possible, pooled analysis was performed. Studies were grouped based on reported outcomes. Meta-analysis was then performed on these pooled subsets.

RESULTS

A total of 602 articles were initially identified, and after screening by 2 reviewers, 27 articles reporting on 145 patients were included in the final review. There were 2 studies that identified morphological differences between patients with posterior dislocation and controls, including decreased acetabular anteversion (P = .015 and .068, respectively), increased prevalence of a cam deformity (P < .0035), higher alpha angles (P≤ .0213), and decreased posterior acetabular coverage (P < .001). No differences were identified for the lateral center edge angle or Tonnis angle. Protected postreduction weightbearing was most commonly prescribed for 2 to 6 weeks, with 65% of reporting authors recommending touchdown, toe-touch, or crutch-assisted weightbearing. Recurrence was reported in 3% of cases. Overall, 4 studies reported on findings at hip arthroscopic surgery, including a 100% incidence of labral tears (n = 27; 4 studies), 92% incidence of chondral injuries, 20% incidence of capsular tears, and 84% incidence of ligamentum teres tears (n = 25; 2 studies). At final follow-up, 86% of patients reported no pain (n = 14; 12 studies), 87% reported a successful return to play (n = 39; 10 studies), and 11% had radiographic evidence of osteonecrosis (n = 38; 10 studies).

CONCLUSION

Various treatment strategies have been described in the literature, and multiple methods have yielded promising clinical and radiographic outcomes in patients with native hip dislocation sustained during sporting activity. Data support nonoperative treatment with protected weightbearing for hips with concentric reduction and without significant fractures and an operative intervention to obtain concentric reduction if unachievable by closed means alone. Imaging for osteonecrosis is recommended, with evidence suggesting 4- to 6-week magnetic resonance imaging and follow-up at 3 months for those with suspicious findings in the femoral head.

Epidemiology of Sports-Related Traumatic Hip Dislocations Reported in United States Emergency Departments, 2010-2019

Background:

Traumatic hip dislocations are rare injuries that most commonly occur in motor vehicle accidents. There is a paucity of literature that describes sports-related hip dislocations.

Purpose:

To estimate the incidence of sports-related hip dislocations and determine any sport- or sex-related epidemiological trends using the National Electronic Injury Surveillance System (NEISS) database.

Study Design:

Descriptive epidemiology study.

Methods:

Data regarding sports-related hip dislocations from 2010 to 2019 were retrieved from the NEISS, a database that catalogs injury information during emergency department visits from 100 hospitals across the United States to produce nationwide estimates of the injury burden. The estimated number of injuries was calculated using weights assigned by the NEISS database. The injuries were then stratified by sport and sex to determine any epidemiological patterns.

Results:

A total of 102 hip dislocation injuries were identified over the surveyed 10 years, indicating 2941 estimated injuries nationwide. Overall, 10 (9.8%) of 102 sports-related hip dislocations presented with concomitant acetabular fractures, representing an estimated 288 injuries nationally over 10 years. Male athletes sustained more sports-related hip dislocations than female athletes, with a relative incidence of 12.51 (P < .001). Adolescents aged 15 to 19 years recorded the highest number of hip dislocations. There were 17 sports identified as having caused at least 1 hip dislocation over the 10-year period. More hip dislocation injuries were sustained from contact sports (91.2%) than noncontact sports (8.8%) (P < .001). Football (estimated 164 injuries per year; 55.6%), snowboarding (28 per year; 9.5%), skiing (26 per year; 8.8%), and basketball (21 per year; 7.1%) had the highest rates of hip dislocation. Additionally, 43 (82.7%) football-related injuries were caused by tackling mechanisms, and 9 (17.3%) were caused by nontackling mechanisms (P < .001).

Conclusion:

The incidence of traumatic sports-related hip dislocations was extremely low in the United States during the study period. Male adolescents, aged 15 to 19 years, sustained the greatest number of injuries during football. Significantly more hip dislocations occurred in contact sports, most commonly football, snowboarding, skiing, and basketball, compared with noncontact sports. As adolescent athletes may have limited treatment options if osteonecrosis occurs, these data serve to increase the clinical awareness of these injuries.

Acetabular Labral Tear with a Missed Posterior Wall Fracture in an Adolescent Athlete: A Case Report

CASE

We present an adolescent contact-sport athlete presenting with hip pain after a traumatic in-play event. After delayed clinical improvement, a magnetic resonance arthrogram (MRA) revealed a posterior acetabular labral tear and the patient was referred for arthroscopic repair. However, subsequent critical interpretation of the MRA demonstrated a missed concomitant posterior acetabular wall fracture, which was later confirmed with computed tomography.

CONCLUSION

Despite the low incidence of acetabular fractures in adolescents, this case report highlights the importance of maintaining clinical suspicion in young athletes after a traumatic injury, recognizing the association with labral tears, and acknowledging the limitations of certain imaging modalities.

Hip and Groin Pain in Soccer Players

Purpose  The aim of this article is to illustrate the recent framework necessary to standardize studies on groin pain and review the existing literature on groin pain in football. Methods  The common pathological processes underlying groin pain such as muscle, tendon or ligament strain, bone injury or fracture, sport hernia, bursitis, osteitis pubis, and hip-related diseases have been reviewed and current management options have been considered. Results  Groin pain is considered a pain in pubic or lower abdominal or adductors region which can be monolateral or bilateral. It is common in high-intensity team sports and can negatively affect an athlete's professional carrier, causing serious disruption in the performance. Despite a high prevalence of groin pain in athletes, diagnosis and management of the underlying pathological processes remain a challenge for surgeons, radiologists, and physiotherapists alike. Conclusion  A multidisciplinary approach is essential for patients with groin pain allowing prompt diagnosis and initiation of treatment thus facilitating more rapid return to play and preventing potential long-term sequelae of chronic groin pathology.

Traumatic Posterior Hip Dislocation and Epiphysiolysis in a High School Football Player with Successful Outcome at 4 Years Follow-up: A Case Report

CASE

We describe a case of posterior hip dislocation in a 13-year-old boy after a contact football injury with attempted closed reduction resulting in complete separation of the epiphysis from the femoral neck metaphysis with associated femoral head fracture and posterior dislocation of the femoral head. Treatment was emergently performed with a greater trochanteric osteotomy, open reduction internal fixation using cannulated screws, and additional small diameter drill holes in the femoral head to promote blood flow. The patient did well postoperatively and at over 4 years follow-up had no evidence of avascular necrosis and returned to full athletics participation.

CONCLUSION

Particular attention should be taken when reducing hip dislocations in the adolescent population who may be predisposed to epiphysiolysis. Preservation of periosteal soft-tissue attachments and the use of small diameter drill holes to promote femoral head blood flow may have contributed to the excellent outcome.

Quantifying the likelihood and costs of hip replacement surgery after sports injury: A population-level analysis

OBJECTIVES

To quantify the likelihood of hip replacement (HR) surgery at a population level up to 15 years after sports injury.

DESIGN

Cohort study.

SETTINGS

Public and private hospitals in the state of Victoria, Australia.

PARTICIPANTS

The cohort was established by linking administrative datasets capturing all hospital admissions and emergency department (ED) presentations. All sports injury presentations from 2000 to 2005 and HR admissions from 2000 to 2015 were identified using ICD-10-AM codes.

MAIN OUTCOME MEASURES

Time to HR (number of days from sports injury admission to HR admission).

RESULTS

Over the study period there were 64,750 sports injuries (including 815 hip or thigh musculoskeletal injuries) that resulted in ED presentation or hospitalisation, and 368 HR procedures. Compared to all other sports injuries, having a hip or thigh injury tripled the hazard of subsequent HR in multivariate analysis (hazard ratio 3.07, 95%CI 2.00-4.72). Of the main hip or thigh injury types, femoral fractures (hazard ratio 3.08, 95%CI 1.77-5.36) and hip dislocations (hazard ratio 5.64, 95%CI 2.34-13.58) were significantly associated with HR.

CONCLUSION

Sports-related hip or thigh musculoskeletal injury is associated with a significantly higher likelihood of HR within 15 years. Effective injury prevention and appropriate post-injury management are needed to curtail this population burden.

Posterior hip dislocation in a non-professional football player: a case report and review of the literature

The majority of injuries during a football game are contusions, sprains and/or strains in the thigh, knee and ankle. Hip dislocations account for 2-5% of total hip dislocations, and they can be posterior or anterior. Major complications of traumatic hip dislocation include avascular necrosis of femoral head, secondary osteoarthritis, sciatic nerve injury and heterotopic ossification. On the occasion of a case of a 33-year-old football player, who suffered a posterior hip dislocation, associated with a posterior wall fracture of the acetabulum, while playing football, we review the literature and analyze the various mechanisms of injury, the possible complications and the management including surgery and rehabilitation.

Epidemiology of traumatic hip dislocation in patients treated in Ceará, Brazil

OBJECTIVE:

To describe the epidemiological profile of patients with traumatic hip dislocation treated in our Institute from November/2012 to July/2013.

METHODS:

A descriptive cross-sectional study based on interviews and involving 43 patients who suffered traumatic hip dislocation was conducted.

RESULTS:

The mean age of patients was 34.4 years old and 90.7% were male. Regarding the mechanism of injury, 95% involved traffic accidents. The posterior dislocation of the hip was the most common injury (93%). Associated lesions were observed in 74.4% of patients, hip fractures being the most frequent. The time span between accident and dislocation reduction was less than 6 hours in 37.2% of patients, between 6 and 12 hours in 32.5% and over 12 hours in 30.3%, ranging from 1 hour to 15 days. A fraction of 90.7% of patients was submitted to closed reduction.

CONCLUSION:

Traumatic hip dislocation affected mostly young adults, victims of traffic accidents. The posterior dislocation of the hip was the most frequent injury and closed reduction was performed in 90.7% of patients. The time span between accident and dislocation reduction was less than 12 hours in most patients.

Level of Evidence III, Study of Nonconsecutive Patients.

Risk factors for groin/hip injuries in field-based sports: a systematic review

BACKGROUND

Groin/hip injuries are common in the athletic population, particularly in sports requiring kicking, twisting, turning and rapid acceleration and deceleration. Chronic hip, buttock and groin pain account for 10% of all attendances to sports medicine centres. Understanding risk factors for field-based sports (FBS) players is important in developing preventive measures for injury.

OBJECTIVE

This systematic review aims to identify and examine the evidence for groin/hip injury risk factors in FBS.

METHODS

14 electronic databases were searched using keywords. Studies were included if they met the inclusion criteria and investigated one or more risk factors with relation to the incidence of groin/hip injuries in FBS. Studies were accumulated and independently analysed by two reviewers under a 12-point quality assessment scale (modified CASP (for cohort study design) assessment scale). Owing to the heterogeneity of studies and measures used, a meta-analysis could not be conducted. As a result risk factors were pooled for analysis and discussion.

RESULTS

Of the 5842 potentially relevant studies, 7 high-quality studies were included in this review. Results demonstrated that previous groin/hip injury was the most prominent risk factor, identified across four studies (OR range from 2.6 (95% CI 1.1 to 6.11) to 7.3, (p=0.001)), followed by older age (OR 0.9, p=0.05) and weak adductor muscles (OR 4.28, 95% CI 1.31 to 14.0, p=0.02) each identified in two studies. Eight other significant risk factors were identified once across the included studies.

CONCLUSIONS

11 significant risk factors for groin/hip injury for FBS players were identified. The most prominent risk factor identified was previous groin/hip injury. Future research should include a prospective study of a group of FBS players to confirm a relationship between the risk factors identified and development of groin/hip injuries.

Femoroacetabular impingement and low energy posterior hip dislocation: a case report

We report a case of a 28-year-old male who sustained an indirect injury of his left hip while playing soccer, which resulted in a posterior fracture-dislocation. Radiological examination showed signs of combined femoroacetabular impingement (FAI). We discuss the role of FAI as a risk factor for hip dislocation in low energy sport injuries.

The prevalence of radiographic hip abnormalities in elite soccer players

BACKGROUND

Hip injuries, both intra- and extra-articular, are becoming a more commonly recognized, diagnosed, and treated injury in athletes of all competitive levels. Our goal is to establish a previously undefined value in this athletic population--the prevalence of radiographic hip abnormalities in elite soccer athletes.

PURPOSE

To provide a foundation for the future body of literature regarding hip pathologic abnormalities and "at-risk" hips in athletes of all ages and levels of participation.

STUDY DESIGN

Descriptive epidemiology study.

METHODS

We retrospectively reviewed the anteroposterior pelvis and frog-leg lateral radiographs of 95 elite male and female soccer players to determine the prevalence of hip abnormalities. Athletes with a history of hip or groin injuries were included. Multiple radiographic parameters were used to assess the presence of cam and pincer-type femoroacetabular impingement. Measurements were conducted by a blinded, sports medicine fellowship-trained orthopaedic surgeon with experience in treating hip disorders.

RESULTS

In total, 72% (54/75) of male and 50% (10/20) of female players demonstrated some evidence of radiographic hip abnormality. Cam lesions were present in 68% (51/75) of men (76.5% [39/51] bilateral involvement) and 50% (10/20) of women (90% [9/10] bilateral involvement). Pincer lesions were present in 26.7% (20/75) of men and 10% (2/20) of women. The average male alpha angle overall was 65.6°. Cam-positive hips averaged 70.7°. The average female alpha angle overall was 52.9°, with cam-positive hips averaging 60.8°.

CONCLUSION

The prevalence of radiographic hip abnormalities in elite soccer athletes is considerable, particularly in young male athletes. The establishment of the prevalence of these findings represents the first step in identifying the relationship between radiographic abnormalities and injuries of the hip and groin in athletes.

Avascular necrosis following fracture-dislocation of the hip and spontaneous relocation

Injuries occurring during soccer tend to occur with lower energy transfer than in some other contact sports. Tibial and femoral shaft fractures occasionally occur, but pelvic fractures are rare. We report a case of a missed posterior acetabular rim fracture, caused by a low energy trauma playing soccer, complicated by the development of avascular necrosis (AVN) of the femoral head and subsequent osteoarthritis.

Hip instability

Understanding of the etiology and pathology of hip instability has increased in recent years as new information has emerged regarding the disease processes of the hip. Hip instability, heretofore considered uncommon in clinical practice, is increasingly recognized as a pathologic entity. Instability may be classified as traumatic or atraumatic, and diagnosis is made based on patient history, physical examination, and imaging studies. Plain radiography, MRI, MRI arthrography, and hip instability tests (eg, posterior impingement, dial) can be used to confirm the presence of instability. Nonsurgical management options include physical therapy and protected weight bearing. Surgical intervention, whether arthroscopic or open, is required for large acetabular fractures and refractory instability. Knowledge of the etiology and evolving research of hip instability is essential to understand the spectrum of hip disease.

Arthroscopic anterior and posterior labral repair after traumatic hip dislocation: case report and review of the literature

With the improvements in flexible instrumentation, hip arthroscopy is being increasingly used to treat a variety of hip pathology, including labral tears. However, up to this point, there has not been a case report of an anterior and a posterior labral tear successfully repaired arthroscopically. We present a case report of a 27-year-old male firefighter who presented to our institution with an anterior and posterior labral tear, as well as a cam lesion and loose body, following a traumatic hip dislocation. The purpose of this case report is to illustrate that both anterior and posterior labral tears can be repaired using hip arthroscopy. Anterior and posterior labral tears can be caused by a traumatic hip dislocation, and both can be successfully repaired using arthroscopic techniques.

Anterior hip dislocation in a football player: a case report

Hip dislocations during sporting activities represent only 2%-5% of all hip dislocations. Most hip dislocations in sports can be categorised as "less complicated traumatic hip dislocations" by the Stewart-Milford classification due to the fact that minimal force is involved. The incidence of avascular necrosis of the femoral head greatly increases if the time to reduction is more than six hours. We report the case of a 38-year-old football player who suffered hip dislocation while kicking the ball with the medial aspect of the right foot in an external rotated manner of the right hip. Closed reduction was performed within 2 hours; postoperative follow-up was uneventful. Six months later the patient is out of any complaints; there is no sign of AVN of the femoral head.

Traumatic fracture-dislocation of the hip following rugby tackle: a case report

Posterior fracture-dislocation of hip is uncommonly encountered in rugby injuries. We report such a case in an adult while playing rugby. The treating orthopaedician can be caught unaware and injuries in such sports can be potentially misdiagnosed as hip sprains. Immediate reduction of the dislocation was performed in theatres. The fracture was fixed with two lag screws and a neutralization plate. This led to early rehabilitation and speedy recovery with return to sporting activities by 12 months.

Arthroscopic findings following traumatic hip dislocation in 14 professional athletes

PURPOSE

The purpose of this study was to investigate intra-articular hip joint pathologies in professional athletes who sustained dislocation and were treated with hip arthroscopy.

METHODS

Between August 23, 2000, and September 15, 2006, 14 professional athletes (12 male and 2 female) sustained a nonfracture traumatic hip dislocation during active competition and were treated by a single surgeon. A retrospective chart review of this cohort was done to report the intra-articular hip pathologies identified at the time of arthroscopy.

RESULTS

The average time from dislocation to relocation was 3.56 hours. The mean time from dislocation to surgery was 125 days (range, 0 to 556 days). The average age at the time of arthroscopy was 30.5 years (range, 16 to 46 years). All patients had labral tears. All patients had chondral defects. Two had isolated femoral head chondral defects, 6 had isolated acetabular chondral defects, and 6 had chondral defects on both surfaces. Eleven patients had loose osteochondral fragments. Eleven patients had partial or complete tears of the ligamentum teres. Nine patients had evidence of femoroacetabular impingement; 4 had isolated cam lesions, 1 had an isolated pincer lesion on the acetabular rim, and 4 patients had mixed type pathology. Two patients had capsulolabral adhesions. Two patients had a capsular tear. Additionally, 3 patients underwent intraoperative evaluation of the lateral epiphyseal vessels with Doppler imaging to confirm good blood flow to the femoral head with consistent pulse.

CONCLUSIONS

The results of this study show that traumatic dislocation is accompanied by a variety of intra-articular hip joint pathologies, the most common being labral, chondral, intra-articular loose fragments, and disruption of the ligamentum teres.

Can posterior hip fracture-dislocation occur in indoor football (futsal)? A report of two cases

Hip fracture-dislocation is extremely rare in sports and is most frequently seen after road traffic accidents. This injury is associated with considerable long-term disability and rapidly progressive joint degeneration. This case report illustrates two cases of hip fracture dislocation that occurred while playing recreational indoor football (futsal). Futsal is a fast-emerging recreational sport in Malaysia and we are now beginning to see high-impact injuries rarely encountered in recreational sports. Therefore, futsal cannot be taken lightly and it is important to take adequate precautions to prevent serious injuries when participating in such sports.

Hip injuries and labral tears in the national football league

BACKGROUND

Injuries to the hip account for approximately 10% of all injuries in football, but definitive diagnosis is often challenging. Although these injuries are often uncomplicated contusions or strains, intra-articular lesions are increasingly found to be sources of hip pain.

PURPOSE

The objective was to define the incidence and etiologic factors of intra- and extra-articular hip injuries in the National Football League (NFL).

STUDY DESIGN

Descriptive epidemiology study.

METHODS

The NFL Injury Surveillance System was used to define all hip-related injuries from 1997 to 2006. Injuries were included if the athlete missed more than 2 days. All hip and groin injuries were included for evaluation. The authors also report on NFL players with intra-articular injuries seen at their institution outside of the NFL Injury Surveillance System.

RESULTS

There were a total of 23 806 injuries from 1997 to 2006, of which 738 were hip injuries (3.1%) with an average of 12.3 days lost per injury. Muscle strains were the most common injury. Intra-articular injuries resulted in the most time lost. Contact injuries most likely resulted in a contusion, and noncontact injuries most often resulted in a muscle strain. In the authors' institutional experience, many of the athletes with labral tears have persistent adductor strains that do not improve despite adequate therapy.

CONCLUSION

Hip injuries represent a small but substantial percentage of injuries that occur in the NFL. A majority of these injuries are minor, with a return to play within 2 weeks. Intra-articular injuries are more serious and result in a significant loss of playing time. The "sports hip triad" (labral tear, adductor strain, and rectus strain) is described as a common injury pattern in the elite athlete.

Traumatic dislocation of the hip in a high school football player

BACKGROUND

Although traumatic dislocation of the hip often occurs as a result of automobile accidents, dislocations have been reported to occur during sports activities.

OBJECTIVE

Using the experience in treating a 17-year-old high school football player with a posterior dislocation, complicated by involvement of the sciatic nerve, this case report provides background information on hip dislocations and provides a description of the immediate treatment by the physician, followed by 6 weeks of immobilization, and a detailed account of the 5-month intervention.

CASE DESCRIPTION

The patient was injured while making a tackle during a high school football game when another player fell on him from behind. The case report describes his plan of care after immediate hip reduction surgery and 6 weeks on crutches. Generally, the program utilized a progression of non-weight-bearing resistance training and stretching in the initial stages of intervention and progressed to weight-bearing activities (on land and in the pool) as the patient was able to tolerate more stress. In addition, the treatment of the sciatic nerve using electrical stimulation during treadmill walking is described.

OUTCOMES

The patient was seen in an outpatient physical therapy clinic an average of 2 times per week for 5 months. At the end of 5 months, results of the Lower Extremity Functional Scale (LEFS) indicated that recreational and sporting activities were within normal limits, and the patient was able to return to playing on his high school football team the next year.

Assessment of the bone quality of black male athletes using calcaneal ultrasound: a cross-sectional study

BACKGROUND

Lifestyle, genetics and environmental factors are established determinants of bone density. We aimed to describe the bone characteristics of competitive top-ranked Nigerian male athletes using calcaneal ultrasound and to assess whether intensive training promotes higher bone density in an environment with reportedly low calcium intake; to compare the bone characteristics of footballers with runners and other sportsmen; and to assess the correlation of stiffness index (SI) with activity level, since energy expenditure correlates with length of training and by extension, magnitude of skeletal loading.

METHODS

We recruited 102 male athletes: these included football (n = 68), running (n = 15), handball (n = 7), taekwando (n = 6), cycling (n = 2), judo (1), badminton (1) and high jump (1). Anthropometric data were first recorded on a structured form and energy expenditure was indirectly estimated with a validated questionnaire. Bone density was assessed using the Lunar Achilles+ calcaneal ultrasonometer.

RESULTS

The mean age of athletes was 25 +/- 6 years. The means of BMI and energy expenditure were 21.9 +/- 2.0 kg/m2 and 35.0 +/- 13.7 kcal/kg/day, respectively. Footballers were younger (p < 0.001) and heavier (p < 0.001) than runners. Football was a significant determinant of BUA independent of age, BMI and energy expenditure (p = 0.001). Football was also a significant determinant of SOS independent of age, height, weight and BMI (p < 0.001). The mean SI was 127 +/- 16 and the median T-score was 0.82 (-1.88, 3.35). The mean SI of footballers (130 +/- 15), runners (130 +/- 12) and other sportsmen (115 +/- 18) differed significantly (p = 0.001). Multivariate analyses revealed that football (p < 0.001) and running (p < 0.001) were significant determinants of SI independent of age and BMI. Footballers when compared with other sportsmen had a higher mean SI independent of age and BMI (p < 0.001). Age was not correlated with SI. The median T-score of footballers, 0.94 (-1.0, 3.35) was higher than that of other sportsmen.

CONCLUSION

Repetitive skeletal loading at the heel has the potential to improve bone density in black male athletes. The magnitude of increase may be higher in medium impact sports such as soccer and running compared with low or non-impact sports such as judo or taekwando, and is independent of age and BMI. However, future longitudinal data will be required to support our observations.

Fratura-luxação traumática do quadril no futebol: relato de caso

De ocorrência rara no futebol, esporte coletivo mais praticado no mundo, as fraturas de acetábulo que se associam às luxações da articulação do quadril são lesões com grande potencial de gerar seqüelas graves e limitantes. O rápido atendimento, a precisão do diagnóstico e procedimentos de salvamento da articulação pela redução e correta fixação são essenciais para perspectiva de retomar a atividade física regular praticada anteriormente ou outra que se adapte à nova situação.

Diagnosis and Management of Traumatic and Atraumatic Hip Instability in the Athletic Patient

Although relatively uncommon compared with the shoulder, hip instability can be a source of significant disability and is a commonly unrecognized injury. Hip instability can be traumatic or atraumatic in origin. Our understanding and treatment plan for hip instability due to traumatic events is well established. However, our understanding and treatment modalities for hip instability due to atraumatic events or repetitive motion in high level athletes are not as well defined. In this article, we will review the spectrum of traumatic and atraumatic hip instability and discuss the relevant anatomy, history, and physical examination findings, imaging studies, and treatment options with a focus on hip arthroscopy, and review of the literature.