Page 34 - ISAKOS 2019 Newsletter Volume 1

CURRENT CONCEPTS
Stress Fractures in Footballers
Lateral (Tension-Side) Femoral Neck Stress Fracture
Because of the inherent risks of displacement and secondary osteonecrosis of the femoral head, current management protocols advocate for urgent surgical fixation of this fracture type in young active athletes. Surgical fixation is ideally performed with multiple cannulated 6.5 or 7.0-mm screws or with a Dynamic Hip Screw for more unstable shear patterns. There are limited data on return-to-sport rates and times for lateral femoral neck fractures because the majority of studies have been case reports or case series. In a recent systematic review that included all published reports on femoral neck stress fractures in runners, Neubauer et al. reported that 28 of 48 patients returned to running. Displaced fractures were associated with significantly lower return rates than nondisplaced fractures (6 of 18 compared with 22 of 30). The reported return-to-sport times ranged from 3 to 12 months.
Return to Play
The return-to-play decision depends on the location and pattern of the stress fracture. However, stress fractures can lead to prolonged absences from football. According to Ekstrand and Torstveit3, the mean absence from football was 3 months for patients with fifth metatarsal and tibial stress fractures and 4 to 5 months for those with pelvic stress fractures. We recommend that there be clear evidence of healing on both clinical examination and imaging studies (including supporting CT scans if necessary) before the athlete fully returns to play.
Prevention
The prevention of stress fractures in football is of paramount importance. Load controls through different training methods, injury-prevention programs, and the control of risk factors are crucial for the prevention of these injuries. Injury- prevention programs such as FIFA 11+ are very important, especially in low-skill-level youth teams.
References
1. Ekstrand J, Hägglund M, Waldén M. Injury incidence and injury patterns in professional football: The UEFA injury study. British Journal of Sports Medicine. 2011;45(7):553–8. 2. Dhillon MS, Ekstrand J, Mann G, Sharma S. Stress fractures in football. Journal of ISAKOS: Joint Disorders & Orthopaedic Sports Medicine. 2016;1(4):229–38. 3. Ekstrand J, Torstveit MK. Stress fractures in elite male football players. Scandinavian Journal of Medicine and Science in Sports. 2012;22(3):341–6.4. Mallee WH, Weel H, van Dijk CN, van Tulder MW, Kerkhoffs GM, Lin CW. Surgical versus conservative treatment for high- risk stress fractures of the lower leg (anterior tibial cortex, navicular and fifth metatarsal base): a systematic review. Br J Sports Med 2015; 49: 370-376 5. Zbeda RM, Sculco PK, Urch EY, Lazaro LE, Borens O, Williams RJ, Lorich DG, Wellman DS, Helfet DL. Tension Band Plating for Chronic Anterior Tibial Stress Fractures in High-Performance Athletes. Am J Sports Med 2015 Jul;43(7):1712-8.
Knee Arthroplasty
FELLOWSHIP
Sponsored by Nicolaas C. Budhiparama & Inge Widjaja Nicolaas Institute of Constructive Orthopaedic Research
& Education Foundation for Arthroplasty & Sports Medicine
Two Knee Arthroplasty Fellowships are available on a competitive basis
to young orthopaedic surgeons interested in the study and advancement of understanding
of the Knee Arthroplasty.
The dual purpose of the fellowship is to improve knee arthroplasty in developing nations and to promote better understanding and communication amongst knee surgeons around the world.
Fellowships are awarded in alternate years during the ISAKOS Biennial Congress. Two recipients will receive a travel stipend, waived registration to the ISAKOS Congress, and one year of ISAKOS Membership.
Application Deadline:
April 1, 2019
32 ISAKOS NEWSLETTER 2019: VOLUME I
isakos.com/Knee-Arthroplasty-Fellowship