Frostbite in an Adolescent Football Player: A Case Report

Objective:

To present the case of vascular compromise of a finger from a confluent circumferential blister due to an inappropriately applied commercial cold pack in a high school athlete and to describe the mechanism of iatrogenic injury, acute surgical management, rehabilitation, and pathophysiology of frostbite and constriction injuries.

Background:

A 17-year-old male football player presented with a frostbite and constriction injury to the index finger secondary to prolonged use of a cooling pack after a mild traumatic injury to the digit. He developed a prolonged sensory deficit from thermal injury, as well as acute vascular compromise requiring urgent operative intervention.

Differential Diagnosis:

Frostbite and constriction injury to the index finger.

Treatment:

Emergency surgical decompression and occupational therapy.

Uniqueness:

Frostbite injuries can occur iatrogenically because of inappropriate use of cooling devices or gel packs. Fingers are commonly injured extremities that are particularly susceptible to frostbite and compression injuries. To our knowledge, no case of vascular compromise from the blister constriction of digits has been reported.

Conclusions:

Patients and their caregivers must be educated about how to properly use cooling devices. Clinicians need to fully evaluate patients with iatrogenic frostbite injuries, giving particular attention to neurovascular status, and must recognize the need for surgical release of constriction syndrome to prevent substantial morbidity.Key Words: constriction syndrome, freezing, cryotherapy, vascular compromise, hand injuries, ice packsFrostbite injuries are common in colder climates and during winter recreational activities. The most frequently involved areas are the distal and terminal structures, such as the fingers, toes, nose, and ears. With the wide acceptance of the rest, ice, compression, and elevation protocol, iatrogenic frostbite has become a risk that cannot be ignored. Thermal injuries have been described in the literature secondary to the use of ice packs and other cooling objects and devices.^1–3 We present the case of a teenaged athlete who developed vascular compromise of a finger from a confluent circumferential blister due to an inappropriately applied commercial cold pack on the football field. To our knowledge, no case of vascular compromise from the blister constriction of digits has been reported in the literature. The patient''s legal guardian provided written informed consent for this case report.     

Hip Pain in a High School Football Player: A Case Report

OBJECTIVE: To describe the evaluation, diagnosis, and conservative treatment of a 15-year-old male high school football player with an avulsion fracture of the ischial tuberosity. BACKGROUND: Avulsion fracture of the ischial tuberosity is a rare and often missed diagnosis. A literature review offered limited information concerning the evaluation and conservative treatment of such an injury. DIFFERENTIAL DIAGNOSIS: Avulsion fracture of the ischial tuberosity. TREATMENT: The athlete's treatment goal was to return to football and weight lifting without surgical intervention. Treatment initially focused on controlling pain and normalizing gait. The athlete then advanced to a progressive resistance exercise program and functional sporting drills as he improved in hip range of motion, strength, and neuromuscular control. He returned to unrestricted sporting activities 14 weeks after the injury. UNIQUENESS: Avulsion of the ischial tuberosity is a rare injury. Most published case reports have recommended surgical intervention for this injury, with little information describing conservative treatment. CONCLUSIONS: Sports medicine practitioners must obtain an accurate history, perform a thorough physical examination, and obtain appropriate radiographs in order to correctly diagnose an ischial tuberosity avulsion fracture. Furthermore, they should consider conservative treatment for minimally displaced ischial tuberosity avulsion fractures. Should the athlete not show significant functional gains within a month of conservative treatment, the health care provider should consider surgical treatment.     

Splenic Artery Avulsion in a High School Football Player: A Case Report

OBJECTIVE: To present the case of a high school football player who sustained avulsion of 2 branches of the splenic artery from his spleen as he was tackled and landed on the football. BACKGROUND: A high school football player was tackled and fell onto the football, left side first. He was examined by a certified athletic trainer and an internist. On evaluation, he had a positive Kehr sign, exquisite left upper abdominal quadrant tenderness, and complaint of nausea. He also exhibited signs of the onset of shock, including diaphoresis, a rapid pulse, and hypotension. He was immediately transported by ambulance to the local emergency facility. DIFFERENTIAL DIAGNOSIS: Splenic rupture, splenic laceration, splenic artery avulsion, or ruptured viscus. TREATMENT: Emergency surgery was performed, with removal of 2800 mL of blood and ligation of the 2 arterial branches avulsed from the spleen. The patient fully recovered within 6 weeks and was cleared to resume all sports activities. UNIQUENESS: Injury to the spleen in football is a known yet very uncommon injury. Even more unusual is the avulsion of splenic artery branches from the spleen. CONCLUSIONS: It is critical that athletic trainers and team physicians have an understanding of the mechanisms, signs, and symptoms of splenic injury. Because the spleen is a highly vascular organ, severe hemorrhage can be fatal in just minutes if not recognized and appropriately treated.     

An Unusual Scalp Lesion in a 15-Year-Old Girl: A Case Report

OBJECTIVE: To present an unusual congenital malformation of the central nervous system. BACKGROUND: Neural tube defects (NTDs) are potentially serious congenital malformations. When undiagnosed in childhood, such lesions may later be mistaken for a variety of other soft tissue abnormalities. Athletic trainers should be aware of the clinical findings associated with NTDs and the potential for infection in the event of an injury, thus ensuring proper treatment for injured athletes and referral of any athletes with suspicious lesions. DIFFERENTIAL DIAGNOSIS: Atretic meningocele, hemangioma, lipoma, sebaceous nevus, dermoid cyst, scar tissue, aplasia cutis congenita, and hematoma. TREATMENT: The consulting pediatric neurosurgeon thought that repairing the atretic meningocele was only necessary if symptoms recurred and persisted. This young woman is at increased risk for having a child with an NTD and will benefit from high doses of folic acid early in a future pregnancy. UNIQUENESS: Typically, NTDs are diagnosed in infancy or early childhood. This case represents a young woman whose NTD was not properly diagnosed until adolescence. In addition, NTDs can be mistaken for a variety of other skin lesions. The location and appearance of an NTD are typically distinctive to the knowledgeable examiner. CONCLUSIONS: Although NTDs are unusual, athletic trainers should be aware of such pathologic conditions to avoid mistaking these lesions for traumatic sequelae and to identify those athletes who may need further evaluation to rule out a potentially serious condition.     

Recalcitrant Infrapatellar Tendinitis and Surgical Outcome in a Collegiate Basketball Player: A Case Report

OBJECTIVE: To present the history, surgery, rehabilitation management, and eventual functional and surgical outcomes of a collegiate basketball player with recalcitrant jumper's knee. BACKGROUND: A 21-year-old, male collegiate basketball player had a 2-year history of anterior knee pain. DIFFERENTIAL DIAGNOSIS: Injuries that often mimic symptoms of infrapatellar tendinitis include infrapatellar fat pad irritation, Hoffa fat pad disease, patellofemoral joint dysfunction, mucoid degeneration of the infrapatellar tendon, and, in preadolescents and adolescents, Sinding-Larsen-Johannsson disease. TREATMENT: After conservative treatment failed to improve his symptoms, the athlete underwent surgical excision of infrapatellar fibrous scar tissue and repair of the infrapatellar tendon. UNIQUENESS: This patient's case was unique in 3 distinct ways: (1) outcome surveys helped me to understand how this injury affected various aspects of this patient's life and how he viewed himself as he progressed through rehabilitation; (2) a modified functional test was used to help determine whether the athlete was ready to return to sport; and (3) the athlete progressed rapidly through rehabilitation and returned to competitive athletics in 3 months. CONCLUSIONS: This patient was able to return to sport without functional limitations. The surgical outcome was also considered excellent.     

An Abnormal Bone Lesion of the Scapula in a Collegiate Basketball Player: A Case Report

Objective:

To present the case of a bone lesion of the scapula in a collegiate basketball player.

Background:

A 19-year-old National Collegiate Athletic Association Division I male basketball player presented with pain in the posterior region of the right shoulder. During practice, he was performing a layup when his arm was forced into hyperflexion by a defender. Evaluation revealed a bone lesion involving the scapular spine and base of the acromion.

Differential Diagnosis:

Acromioclavicular joint sprain, subacromial bursitis, subscapular bursitis, humeral head contusion, acromial fracture.

Treatment:

The patient was treated for 2 months with therapeutic modalities and rehabilitation exercises. Because of persistent pain and the risk of a pathologic fracture, open surgical biopsy and bone grafting were then undertaken.

Uniqueness:

Most simple bone cysts affect the proximal humerus and femur, whereas our patient''s lesion was in the acromial complex.

Conclusions:

Athletic trainers should be alert to the unusual possibility of bone cysts, which are usually identified incidentally when radiographs are obtained for other reasons. Most simple bone cysts are asymptomatic, but a pathologic fracture can occur with trauma.Key Words: bone cysts, chondromyxoid fibromas, upper extremity, shoulderSimple bone cysts make up 3% of all bone lesions¹ and occur twice as often in males as in females.^2,3 Several simple bone cysts of the scapula have been described. However, the reported sites included the glenoid and neck, coracoid process, and body of the scapula.^4–7 We present the case of a collegiate athlete with a bone lesion of the scapular spine and acromial base.     

Acute Pancreatitis Induced by Methimazole Treatment in a 51-Year-Old Korean Man: A Case Report

Methimazole (MMI)-induced acute pancreatitis is very rare but severe adverse reaction. A 51-yr-old male developed a high fever, chills, and abdominal pain, two weeks after commencement on MMI for the treatment of Graves'' disease. There was no evidence of agranulocytosis, and fever subsided soon after stopping MMI treatment. However, 5 hr after taking an additional dose of MMI, abdominal pain and fever developed again. His symptoms, biochemical, and imaging studies were compatible with acute pancreatitis. After withdrawal of MMI, he showed clinical improvement. This is the first case of MMI-induced acute pancreatitis in Korea. Clinicians should be aware of the rare but possible MMI-induced pancreatitis in patients complaining of fever and abdominal pain.

Graphical Abstract

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Traumatic Hemarthrosis of the Knee Secondary to Hemophilia A in a Collegiate Soccer Player: A Case Report

OBJECTIVE: To present the case of a collegiate soccer player who suffered from a traumatic knee hemarthrosis secondary to hemophilia A. This case presents an opportunity to discuss the participation status of athletes with hemophilia. BACKGROUND: Hemophilia is a hereditary blood disease characterized by impaired coagulability of the blood. Hemophilia A is the most common of the severe, inherited bleeding disorders. This type, also called classic hemophilia, is due to a deficiency of clotting factor VIII. The athlete with hemophilia A reported pain and loss of function of his knee during a soccer game despite the absence of injury. DIFFERENTIAL DIAGNOSIS: Anterior cruciate ligament tear, intra-articular fracture, meniscus tear, capsular tear, hemarthrosis. TREATMENT: After the injury, the athlete was admitted to the hospital, where his knee joint was aspirated and he was infused with factor VIII. Later, he participated in traditional knee rehabilitation and was returned to play at the discretion of the orthopaedist and the hematologist. UNIQUENESS: In past participation guidelines, individuals with bleeding disorders were disqualified from athletic participation; however, with advances in medical care, these individuals may be permitted to participate in accordance with the law. CONCLUSIONS: Individuals with hemophilia participate in athletics; therefore, team physicians and athletic trainers must be prepared to care for these individuals.     

Chondroectodermal Dysplasia in an African Child: A Case Report

Chondroectodermal dysplasia is a rare autosomal recessive disorder characterized by short extremities, short stature, polydactyly, and nail hypoplasia. Dental abnormalities, congenital heart defects, and thoracic abnormalities impending respiration are seen in many patients. Virtually all previous reports of the classic disorder have been in Caucasians. In the following case report, chondroectodermal dysplasia is described in a black Cameroonian infant.     

A Case Report for Severe COVID-19 in a 9-Year-Old Child Treated with Remdesivir and Dexamethasone

Coronavirus disease 2019 (COVID-19) is generally milder in children than in adults, and a substantial proportion of children with the disease have asymptomatic infections. Remdesivir is recommended for severe COVID-19. To date, there are little data on the outcomes of remdesivir treatment in children. We report a case of severe COVID-19 in a previously healthy but obese (body mass index, 27.6; 99.8^th percentile of the age) 9-year-old boy treated with remdesivir and dexamethasone. The patient had pneumonia at the time of diagnosis and required supplemental oxygen due to hypoxia one day after diagnosis. The patient developed respiratory distress as his pneumonia progressed rapidly. Therefore, remdesivir with dexamethasone therapy was initiated on hospital day 2. Supplemental oxygen was gradually weaned on hospital day 6 and stopped on hospital day 9. Significant improvement in pneumonic consolidations on chest X-ray was noted on hospital day 8. The patient was discharged on hospital day 21. We did not observe any adverse effects of remdesivir therapy and successfully treated a 9-year-old child with severe COVID-19.     

A Case Report of Postinfectious Bronchiolitis Obliterans After Coronavirus Disease 2019 in a 10-Year-Old Child

Coronavirus disease 2019 (COVID-19) is usually less severe in children and adolescents than in adults. However, it can cause severe respiratory illness in a small proportion of children with risk factors. Here, we report a rare case of a 10-year-old boy with postinfectious bronchiolitis obliterans that developed after pneumonia caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). This patient was previously healthy apart from a high body mass index (BMI, 30.13; 99.6th percentile for the age bracket), history of preterm birth (35 weeks), and low birth weight (1,850 g). He had persistent exertional dyspnea after recovering from SARS-CoV-2-related pneumonia. Spirometry revealed obstructive lung disease with the following results: predicted forced vital capacity (FVC%_pred), 71%; forced expiratory volume in 1 second (FEV₁%_pred), 63%; FEV₁/FVC, 0.81; and forced expiratory flow_25-75%_pred, 55%. Chest computed tomography showed multifocal areas of parenchymal hyperlucency and mosaic attenuation in both lungs. This case suggests that careful observation of children with obesity and low birth weight is necessary after recovery from SARS-CoV-2-related pneumonia.     

Hypothyroid Myxedema and Hyponatremia in an Eight-Year-Old Child: A Case Report

An eight-year-old black male with severe growth and mental retardation presented with massive myxedema, hyponatremia, and hypothermia. History of hypothyroidism was confirmed by laboratory investigation. The hypothyroidism appeared to be secondary to organic pituitary insufficiency due to diffuse brain damage. Appropriate therapeutic response was achieved initially only with intravenous thyroxine therapy. This case is reported to illustrate the unusual association of secondary hypothyroidism with severe myxedema and hyponatremia in the pediatric age group. The physiopathology of hyponatremia in hypothyroid myxedema is discussed also.     

Acute Subdural Hematoma in a High School Football Player After 2 Unreported Episodes of Head Trauma: A Case Report

OBJECTIVE: To discuss the association between 2 unreported episodes of head trauma and an acute subdural hematoma in a high school football player; to address the role of the sport health care team in secondary schools when caring for an athlete with head trauma; and to recognize the importance of educating athletes and coaches about this condition. BACKGROUND: A previously healthy athlete experienced 2 unreported episodes of head trauma during a single game. The athlete was conscious and oriented to person, time, and place, but he vomited and complained of severe headache, nausea, and vertigo. During transfer, the athlete appeared to have a seizure. DIFFERENTIAL DIAGNOSIS: Subdural hematoma, epidural hematoma, intracerebral hemorrhage, second-impact syndrome, cervical spine injury, or epilepsy. TREATMENT: Computed tomography scan indicated fluid over the left frontal temporal fossa. Conservative treatment was begun, and the fluid resolved without incident. UNIQUENESS: A single episode of blunt trauma has been thought to cause an acute subdural hematoma. However, multiple concussions can also result in this condition. CONCLUSION: Single or multiple episodes of head trauma can lead to an acute subdural hematoma. This case study reflects the importance of proper education in the recognition and care of head trauma and return-to-play guidelines for athletes and coaches. A sport health care team in all secondary schools can provide the immediate and appropriate intervention for such injuries.     

Malignant Thyroid Teratoma: Report of an Aggressive Tumor in a 64-Year-Old Man

Malignant teratoma of the thyroid is a rare and aggressive tumor, frequent in children than in adults. Histologically, thyroid teratomas usually show a predominance of a neuroectodermal component. Mature cartilage and bone may be present. We present the case of primary malignant teratoma of the thyroid in a 64-year-old man. Histologically, the tumor displayed a predominant neuroectodermal component. The diagnosis was confirmed by immunohistochemistry. The patient underwent a radical thyroidectomy with central neck dissection as primary treatment and radioiodine treatment afterwards. The patient had local and distant recurrence. A second surgery was performed with poor results and the patient died 3 months afterwards.