Refracture of proximal fifth metatarsal (Jones) fracture after intramedullary screw fixation in athletes

This study details six instances of refracture of clinically and radiographically healed fractures of the base of the fifth metatarsal after intramedullary screw fixation. Four professional football players, one college basketball player, and one recreational athlete underwent intramedullary screw fixation of fifth metatarsal fractures. The athletes were released to full activities an average of 8.5 weeks (range, 5.5 to 12) after fixation, when healing was clinically and radiographically documented. Three football players developed refracture within 1 day of return to full activity. The other three athletes refractured at 2.5, 4, and 4.5 months after return to activity. Two football players underwent repeat fixation with larger screws and returned to play in the same season. The college basketball player underwent bone grafting and returned to play in subsequent seasons. The other three athletes underwent nonoperative management and healed uneventfully over 6 to 8 weeks. On the basis of this series, we recommend that 1) screw fixation using a large-diameter screw should be given careful consideration for patients with large body mass for whom early return to activity is important; 2) functional bracing, shoe modification, or an orthosis should be considered for return to play; 3) if refracture occurs, exchange to a larger screw may allow return to play in the same season; and 4) alternative imaging should be considered to help document complete healing.     

Energy and macronutrient intakes of professional football (soccer) players.

OBJECTIVE: To examine the dietary habits of professional soccer players at two Scottish Premier League clubs during the competitive season. METHODS: A study of the dietary intake of 51 professional soccer players with two different clubs was carried out by the seven day weighed intake method. RESULTS: Physical characteristics of the two groups of players were similar, with only small differences in age and body mass but no difference in height and body fat. Mean (SD) daily energy intake for club A was 11.0 (2.6) MJ, and for club B 12.8 (2.2) MJ. The higher energy intake at club B was largely accounted for by a higher (P < 0.005) fat intake (118 v 93 g d-1): there was no difference in the absolute amounts of protein, carbohydrate, or alcohol consumed. When expressed as a fraction of total energy intake, mean protein intake was higher (P < 0.05) and fat intake lower (P < 0.01) at club A. CONCLUSIONS: The mean energy intake of these players was not high compared with athletes in endurance sports. Fractional contribution of the macronutrients to total energy intake was broadly similar to that of the general population.     

Depression and pain in retired professional football players

PURPOSE: To assess the prevalence of depressive symptoms and difficulty with pain in retired professional football players, difficulties with the transition from active athletic competition to retirement, perceptions of barriers to receiving assistance for those difficulties, and recommended programs to provide such assistance. METHODS: Survey sent to 3377 retired members of the National Football League Players Association (NFLPA), with usable responses received from 1617 members (functional response rate, 48.6%). RESULTS: Respondents were categorized as experiencing no to mild depression (N=1366; 84.5%) or moderate to severe depression (N=237; 14.7%). Respondents were also categorized according to whether they reported difficulty with pain as not or somewhat common (N=837; 51.8%) versus quite or very common (N=769; 47.6%). Respondents most frequently reported trouble sleeping, financial difficulties, marital or relationship problems, and problems with fitness, exercise, and aging, all of which were strongly correlated with the presence of moderate to severe depression and with quite or very common difficulty with pain. The same difficulties were even more commonly experienced by respondents who reported both moderate to severe depression and quite or very common difficulty with pain, compared with those who reported low scores in both domains. CONCLUSION: Retired professional football players experience levels of depressive symptoms similar to those of the general population, but the impact of these symptoms is compounded by high levels of difficulty with pain. The combination of depression and pain is strongly predictive of significant difficulties with sleep, social relationships, financial difficulties, and problems with exercise and fitness. A hypothesis explaining this association is that significant musculoskeletal disability and chronic pain interferes with physical activity and fitness during retirement and increases the risk of depression.     

Treatment and return to sport following a Jones fracture of the fifth metatarsal: a systematic review

Purpose

The aim of this study is to better inform the sports surgeon of current evidence for the treatment of Jones fractures of the base of the 5th metatarsal. The study aimed to establish what the outcomes were for different treatments modalities. By doing this, the clinician will be better prepared to institute a logical, evidence-based approach to the treatment of their patients with this injury.

Methods

A thorough literature search was performed from 1980 to present day. Studies were included based on set criteria and analysed for their validity, and their results were scrutinised. Jones fractures were segregated into acute fractures, delayed unions and non-unions.

Results

Twenty-six studies were included, of which 22 were level 4 evidence, with only 1 randomised controlled trial. Functional outcome data were limited to return to sports in most studies with few studies using established scoring systems. Return to sports following intra-medullary screw fixation for acute fractures ranged from 4 to 18 weeks. Acute fractures treated non-operatively had a union rate of 76 % (pooled), whereas in fractures treated with a screw it was 96 % (pooled). Delayed unions treated non-operatively had a union rate of 44 and 97 % treated operatively. Non-unions treated with screw fixation healed in 97 % of cases.

Conclusions

Although supported by mostly level 4 evidence, intra-medullary screw fixation is more likely to lead to successful union of all types of Jones fractures compared to non-operative treatments. Early return to play in athletes prior to full radiological union is not advised in case of re-fracture.

Level of evidence

IV.     

Role of MRI in prevention of metatarsal stress fractures in collegiate basketball players

OBJECTIVE: Metatarsal stress fractures are common and represent debilitating and potentially season-ending injuries for basketball players. Bone marrow edema is readily visualized on MRI and can be a sign of stress changes. Twenty-six asymptomatic male National Collegiate Athletic Association basketball players were imaged before the 2003-2004 season and 14 players were reimaged after the conclusion of the season with a screening study of long- and short-axis fat-suppressed T2-weighted images (TR/effective TE, 3,500/56) to identify bone marrow edema in the metatarsals. CONCLUSION: Six (12%) of 52 feet showed a signal indicating bone marrow edema in the metatarsals. MRI depicts bone marrow edema in the feet before a fracture becomes evident. Identification of this edema may reveal stress changes, allowing early treatment and prevention of debilitating stress fractures.     

Hip and shoulder internal rotation range of motion deficits in professional tennis players

One hundred tennis players were recruited from the professional men's tennis tour to investigate the correlation between hip internal rotation deficits and low back pain (LBP), as well as shoulder internal rotation deficits and shoulder pain. A statistically significant correlation was observed between dominant shoulder internal rotation deficits and shoulder pain. Also observed was a statistically significant correlation between lead hip internal rotation deficits and lumbar extension deficits with LBP. We conclude that due to repetitive demands on the dominant shoulder and repetitive pivoting at the lead hip, the cycle of microtrauma and scar formation leads to capsular contracture and subsequent reduction in internal range of motion. It is likely that the limitation in lumbar extension in the symptomatic group is not only due to decreased flexibility from an increased load on the spine, but also due to a protective mechanism to prevent further exacerbation of the LBP. Physical conditioning that includes shoulder as well as hip internal rotation stretching programs should therefore be essential aspects in the treatment of tennis players with shoulder pain and LBP respectively.     

Body cell mass measured by bioelectrical impedance spectroscopy in professional football (soccer) players

AIM: The aim of this study was to measure body cell mass (BCM) in two football (soccer) teams and assess if there are differences in body composition among players of different field positions. METHODS: Two professional Italian (male) football teams, representing two different divisions (A and C), have been recruited. There were 14 players (4 forwards, 4 defenders, 6 midfielders) in A and 18 players (4 forwards, 4 defenders, 8 midfielders, 2 goalkeepers) in C. Fat free mass (FFM), fat mass (FM), percent body fat (%BF), and BCM have been assessed using bioelectrical impedance spectroscopy (BIS). RESULTS: There were no significant differences in age, body weight, height or body mass index between teams. Team A's BCM was approximately 4 kg greater than C (P=0.001). FFM was significantly greater in midfielders and defenders in A vs C (P=0.02). FFM was significantly lower in forwards compared to defenders within A (P=0.02). Within A, FM and %BF were significantly lower for defenders compared to forwards and midfielders (P=0.01), and BCM was significantly greater in forwards vs defenders (P=0.01), with no significant differences among other field positions. BCM was significantly greater in forwards vs midfielders and defenders within C (P=0.02), with no significant differences between midfielders and defenders. CONCLUSIONS: BCM, measured using BIS, represents an innovative, simple approach to assess body composition. The present study demonstrates that it is very important to analyze body composition in football players, not only with the aim to evaluate the variation of weight in a quantitative and qualitative way, but also with the purpose of selecting players for specific roles. Although these results must be considered not yet conclusive, they could be an important information for coaches, especially during the selection of young football players.     

Organizational and media stress among professional football players: testing an achievement goal theory model

The purpose of this study was to investigate media and coach-athlete stress experienced by professional football players and their relationship to motivational variables by testing an achievement goal theory (AGT) stress model. In order to do so, we developed scales specifically designed to assess media and coach-athlete stress. Eighty-two elite football players (M(age) =25.17 years, SD=5.19) completed a series of questionnaires. Correlations and bootstrapping were used as primary statistical analyses, supplemented by LISREL, to test the hypotheses. Results revealed that a mastery climate was directly and negatively associated with coach-athlete stress, while a performance climate was directly and positively associated with coach-athlete stress. In addition, an indirect positive path between the performance climate and media stress was revealed through ego orientation. These findings support some of the key postulates of AGT; a mastery climate reduces the perception of stress among athletes, and the converse is true for a performance climate. Coaches of elite footballers are advised to try to reduce the emphasis on performance criteria because of its stress-reducing effects.     

Recurrent concussion and risk of depression in retired professional football players

PURPOSE: The purpose of our study was to investigate the association between prior head injury and the likelihood of being diagnosed with clinical depression among retired professional football players with prior head injury exposure. METHODS: A general health questionnaire, including information about prior injuries, the SF-36 (Short Form 36), and other markers for depression, was completed by 2552 retired professional football players with an average age of 53.8 (+/-13.4) yr and an average professional football-playing career of 6.6 (+/-3.6) yr. A second questionnaire focusing on mild cognitive impairment (MCI)-related issues was completed by a subset of 758 retired professional football players (50 yr and older). RESULTS: Two hundred sixty-nine (11.1%) of all respondents reported having prior or current diagnosis of clinical depression. There was an association between recurrent concussion and diagnosis of lifetime depression (chi2=71.21, df=2, P<0.005), suggesting that the prevalence increases with increasing concussion history. Compared with retired players with no history of concussion, retired players reporting three or more previous concussions (24.4%) were three times more likely to be diagnosed with depression; those with a history of one or two previous concussions (36.3%) were 1.5 times more likely to be diagnosed with depression. The analyses controlled for age, number of years since retirement, number of years played, physical component score on the SF-36, and diagnosed comorbidities such as osteoarthritis, coronary heart disease, stroke, cancer, and diabetes. CONCLUSION: Our findings suggest a possible link between recurrent sport-related concussion and increased risk of clinical depression. The findings emphasize the importance of understanding potential neurological consequences of recurrent concussion.     

Incidence of cervical spinal stenosis in professional and rookie football players

Sagittal canal/vertebral body ratios were measured on cervical spine lateral radiographs of 124 professional football players and 100 rookie football players. A total of 894 levels were measured in 224 players. Thirty-two percent (40) of the 124 professional football players, and 34% of the 100 rookies had a ratio of less than 0.80 at one or more levels from C3 to C6. The 0.80 ratio has been considered indicative of cervical spinal stenosis. This is the first time that the incidence of spinal stenosis, as determined by Torg's ratio, has been demonstrated in a population of professional and rookie football players. Because one-third of this population has cervical spinal stenosis as determined by the Torg ratio, other factors should be considered in the evaluation of a player with a transient quadriplegic episode when making continued play decisions.     

Does kinesiology taping of the ankles affect proprioceptive control in professional football (soccer) players?

ObjectiveTo determine whether the bilateral application of kinesiology tape (KT) to professional footballers' ankles can improve their lower limb proprioception.DesignA single blind randomised crossover study. Participants were randomly assigned to complete a proprioception test in either a taped or not taped condition first. Following a wash out period, participants were then re-tested in the alternate condition.SettingA UK Championship League Football Club, mid-season.ParticipantsTwenty male professional football players over the age of 18, currently match fit with no injuries.Outcome measureProprioception was assessed by participants undertaking the moving target program on the balance module attached to a Kin-Com 125AP isokinetic dynamometer. A paired sample two tailed t-test was used to assess whether there was a significant difference between the participants test scores in the not taped and taped conditions.ResultsThe bilateral application of KT to professional footballers' ankles did not bring about a significant change in participants' scores when tested with a fine movement and balance control test. Percentage accuracy score mean difference 4.2 (p = 0.285).ConclusionThe results of this study do not support the use of KT when applied to the ankles of healthy footballers as a method of improving proprioception.     

Stress fracture risk factors in female football players and their clinical implications

A stress fracture represents the inability of the skeleton to withstand repetitive bouts of mechanical loading, which results in structural fatigue, and resultant signs and symptoms of localised pain and tenderness. Reports of stress fractures in female football players are not prevalent; however, they are probably under-reported and their importance lies in the morbidity that they cause in terms of time lost from participation. By considering risk factors for stress fractures in female football players it may be possible to reduce the impact of these troublesome injuries. Risk factors for stress fractures in female football players include intrinsic risk factors such as gender, endocrine, nutritional, physical fitness and neuromusculoskeletal factors, as well as extrinsic risk factors such as training programme, equipment and environmental factors. This paper discusses these risk factors and their implications in terms of developing prevention and management strategies for stress fractures in female football players.     

Osteitis pubis in professional football players: MRI findings and correlation with clinical outcome

Background and purposeOsteitis pubis (OP), a common pathology in elite athletes, is an aseptic inflammatory process of the pubic symphysis bone, and may involve surrounding soft tissues, tendons and muscles. OP is typically characterized by (often recurring) groin pain and is an important cause of time-off from sports activity in athletes. Aim of this retrospective study was to analyze magnetic resonance imaging (MRI) findings in professional football players with clinical diagnosis of OP and to correlate MRI findings with clinical outcome.Material and methodsAll professional football players (23 males, 1 female; mean age: 21 ± 3.7 years; range: 16–30 years) with groin pain and clinical diagnosis of OP, who underwent pelvic MRI in our institution were retrospectively analyzed. The MR images were analyzed regarding the presence of bone marrow edema and its extension, whether fluid in the symphysis pubis or periarticular soft tissue edema with a rim-like periosteal distribution or edema in the muscles located around the symphyseal joint were present, whether degenerative changes of the symphysis pubis and of signs of symphyseal instability were encountered. A quantitative measurement of the signal intensity in bone marrow edema on 3 T STIR sequences was performed, normalizing these values to the mean signal intensity values in the ipsilateral iliopsoas muscle. All patients were classified according to a 3-point grading scale.For each patient, both the symptoms 18 months after the initial MRI examination, the duration of time off from playing football and the kind of treatment applied were evaluated.ResultsAmong all professional athletes, in 20/24 (83.3%) MRI showed signs of OP with bone marrow edema at the pubic bone. 12 of these patients showed complete clinical recovery without any symptoms after 18 months, while in 8 patients partial recovery with persistence of groin pain during higher sports activity was observed. Patients with edema in periarticular soft tissues or in the muscles around the symphyseal joint on MRI at the beginning of symptoms presented significantly more often with a partial recovery after returning to high sports activity (p = 0.042 and p = 0.036, respectively). A partial recovery was also significantly associated with higher normalized mean signal intensity values in bone marrow edema on STIR sequences at the beginning of symptoms (mean = 4.77 ± 1.63 in the group with partial recovery vs. mean = 2.86 ± 0.45 in the group with complete recovery; p = 0.0019). No significant association was noticed between MRI findings and time of abstinence from high sports activity, as well as between the 3-point grading scale and the time off from high sport activity and recovery at 18 months.ConclusionsEdema in periarticular soft tissues, edema with extension to the muscles located around the symphyseal joint, as well as higher normalized signal intensity values in bone marrow edema on STIR sequences in the pubic bones at the beginning of groin pain are the most reliable MRI findings of a poor clinical long-term outcome of OP in professional football players and should be regarded as negative prognostic factors.