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Biomedical subjects

P Brukner

Publications and source records attributed to P Brukner.

At least 19 recordsLinked to original sources
PubMed2000

Calf and ankle swelling.

BACKGROUND: Swelling of the calf and ankle region is a common presenting symptom and historical features such as speed of onset, trauma and mechanism of injury are important in aiding diagnosis. OBJECTIVE: To discuss diagnosis and management of musculoskeletal causes of calf and ankle swelling. DISCUSSION: Calf muscle injuries and injuries around the ankle including Achilles tendon injuries, ankle ligament injuries and overuse injuries are discussed.

Achilles Tendon↗
PubMed1999

Risk factors for stress fractures.

Preventing stress fractures requires knowledge of the risk factors that predispose to this injury. The aetiology of stress fractures is multifactorial, but methodological limitations and expediency often lead to research study designs that evaluate individual risk factors. Intrinsic risk factors include mechanical factors such as bone density, skeletal alignment and body size and composition, physiological factors such as bone turnover rate, flexibility, and muscular strength and endurance, as well as hormonal and nutritional factors. Extrinsic risk factors include mechanical factors such as surface, footwear and external loading as well as physical training parameters. Psychological traits may also play a role in increasing stress fracture risk. Equally important to these types of analyses of individual risk factors is the integration of information to produce a composite picture of risk. The purpose of this paper is to critically appraise the existing literature by evaluating study design and quality, in order to provide a current synopsis of the known scientific information related to stress fracture risk factors. The literature is not fully complete with well conducted studies on this topic, but a great deal of information has accumulated over the past 20 years. Although stress fractures result from repeated loading, the exact contribution of training factors (volume, intensity, surface) has not been clearly established. From what we do know, menstrual disturbances, caloric restriction, lower bone density, muscle weakness and leg length differences are risk factors for stress fracture. Other time-honoured risk factors such as lower extremity alignment have not been shown to be causative even though anecdotal evidence indicates they are likely to play an important role in stress fracture pathogenesis.

Biomechanical Phenomena↗
PubMed1998

Stress fractures of the upper limb.

Stress fractures are commonly found in the lower limb, but also occur in the upper limb, and are particularly associated with upper limb-dominated sports such as tennis and swimming and those involving throwing activities. Stress fractures of the clavicle and scapula are rare but have been reported, whereas those of the humerus are more frequent and have been described mainly in adolescent baseball pitchers. Olecranon stress fractures occur in throwers and gymnasts. Stress fractures of the ulna and radius have also been reported in a number of different upper limb-dominated sports. In all cases, these fractures heal with conservative management. The physician should consider stress fracture as a possible diagnosis in cases of upper limb pain of bony origin where the pain is associated with overuse.

Arm Injuries↗
PubMed1997

Osteoarthritis of the knee in retired, elite Australian Rules footballers.

OBJECTIVE: To determine the functional and radiological status of knee joints of retired Australian Rules footballers compared with those of active community members. DESIGN: Retrospective cohort study. PARTICIPANTS: Fifty retired elite footballers aged 34-85 years (mean, 53.7 years; SD, 11.4) from four AFL clubs and 50 age-matched controls (35-79 years; mean, 55.7 years; SD, 12.4) who had played no contact sport since their teenage years. MAIN OUTCOME MEASURES: Severity of knee functional osteoarthritis as determined by a questionnaire, and assessment of osteoarthritis by posteroanterior weight-bearing radiographs taken of both knees of each participant in 45-degree flexion. RESULTS: After adjusting for age, height, weight and body mass index, footballers had a significantly greater prevalence (P < 0.0001) and severity (P < 0.05) of functional and radiological osteoarthritis than controls. Footballers with a history of intraarticular ligamentous and/or meniscal injury (Group 1) had a greater risk of functional osteoarthritis (P = 0.002) and radiological (P = 0.067) osteoarthritis than those with a history of collateral ligament injury or no injury (Group 2). Compared with controls, the odds of developing moderate to severe levels of functional and radiological osteoarthritis were 6.9 times (95% CI, 1.6-29.7; P = 0.01) and 105.0 times (95% CI, 11.8-931.8; P < 0.0001), respectively, those in Group 1 footballers and 3.6 times (95% CI, 0.8-16.2; P = 0.10) and 17.7 times (95% CI, 2.2-146.2; P = 0.0075), respectively, those in Group 2 footballers. CONCLUSIONS: Elite Australian Rules footballers have a significant risk of both functional and radiological osteoarthritis, and a history of intra-articular ligament or meniscal injury increases this risk.

Activities of Daily Living↗
PubMed1997

Injuries presenting to an Australian sports medicine centre: a 12-month study.

OBJECTIVE: To document the conditions seen by medical practitioners at a multidisciplinary sports medicine clinic during a 12-month period on the basis of site of injury, pathology, and sport played. DESIGN: A coding system for anatomical region, pathology, and sport played was designed. PATIENTS: The total number of patient diagnoses coded and entered for analysis was 2,429. RESULTS: The most common sports involved were Australian football 322 (13.3%), distance running 299 (12.3%), netball/basketball 210 (8.6%), racquet sports 140 (5.8%), and track running 135 (5.6%). The most commonly injured region was the knee with 668 presentations (27.5%), followed by the upper limb (8.8%). The most frequently diagnosed pathology was overuse/inflammation with 1,115 (45.9%). Other pathologies diagnosed were partial ligament sprains 316 (13.0%), muscle strain 99 (4.1%), compartment syndrome 85 (3.5%), and third-degree ligament tear (3.5%). The most common diagnoses seen were patellofemoral syndrome, lumbar spine disorders, rotator cuff tendinitis, lateral ligament ankle sprain, medial meniscus tear, medial collateral ligament knee sprain, lateral meniscus tear, achilles tendinosis, anterior cruciate ligament tear and sacroiliac joint inflammation. CONCLUSION: A study of this nature provides valuable information both to the epidemiologist and clinician.

Athletic Injuries↗
PubMed1997

Stress fractures in female athletes. Diagnosis, management and rehabilitation.

Stress fractures are a common overuse injury among athletes. The incidence of stress fractures among females is higher in the military, but this difference is not as evident in the athletic population. The history of the patient with stress fracture is typically one of insidious onset of activity-related pain. If the patient continues to exercise, the pain may well become more severe or occur at an earlier stage of exercise. As well as obtaining a history of the patient's pain and its relation to exercise, it is important to determine the presence of predisposing factors. On physical examination, the most obvious feature is localised bony tenderness. Occasionally, redness, swelling or periosteal thickening may be present at the site of the stress fracture. The diagnosis of stress fracture is primarily a clinical one; however, if the diagnosis is uncertain, various imaging techniques can be used to confirm the diagnosis. In the majority of stress fractures, there is no obvious abnormality on plain radiograph. Although the triple phase bone radiograph is extremely sensitive, the fracture itself is not visualised and it may be difficult to precisely locate the site, especially in the foot. The radionuclide scan will detect evolving stress fractures at the stage of accelerated remodelling, so the findings must be closely correlated with the clinical picture. The characteristic bone scan appearance of a stress fracture is of a sharply marginated area of increased uptake, usually involving one cortex of the bone. Computerised tomography scanning is a helpful addition if the fracture needs to be visualised, or to distinguish between a stress reaction and stress fracture. Magnetic resonance imaging (MRI) is being used increasingly as the investigation of choice for stress fractures. The typical findings on MRI are of periosteal and marrow oedema, as well as fracture line. The basis of treatment of a stress fracture involves rest from the aggravating activity. Most stress fractures will heal in a straightforward manner, and return to sport occurs within 6 to 8 weeks. The rate of resumption of activity should be influenced by symptoms and physical findings. When free of pain, the aggravating activity can be resumed and slowly increased. It is important that the athlete with a stress fracture maintain fitness during this period of rehabilitation. The most commonly used methods are cycling, swimming, upper body weights and water running. There are a number of specific stress fractures that require additional treatment because of a tendency to develop delayed union or nonunion. These include stress fractures of the neck of the femur, anterior cortex of the tibia, navicular and second and fifth metatarsals. An essential component of the management of stress fractures, as with any overuse injury, involves identification of the factors that have contributed to the injury and, where possible, correction or modification of some of these factors to reduce the risk of the injury recurring. Stress fractures are more common in female athletes with menstrual disturbances. This may be due to the effect on bone density. The role of hormonal replacement in the management of these athletes is unclear at this stage.

Adolescent↗
PubMed1996

Stress fracture of the body of the talus in athletes demonstrated with computer tomography.

PURPOSE: This article describes a series of four previously unreported stress fractures of the body of the talus. CASE SUMMARY: The four patients presented with ankle pain of gradual onset for periods of three weeks to 12 months. Radioisotope scans in all four patients showed identical pictures of markedly increased uptake in the region of the body of the talus. Computed tomographic scan images were also similar showing a distinct fracture line through the posterolateral aspect of the body of the talus extending into the subtalar joint. All four patients were treated differently ranging from rest to surgery, but no treatment appears totally successful. DISCUSSION: A single case of stress fracture of the neck of talus has previously been reported in a runner, but no previous cases of stress fracture of the body of the talus have been reported. The mechanism may be that in the presence of excessive subtalar pronation and plantar-flexion, the lateral process of the calcaneus impinges on the concave posterolateral corner of the talus. No treatment appeared totally successful but the authors would recommend a six week period of non-weight-bearing rest. RELEVANCE: The diagnosis of stress fracture of the body of the talus should be considered in the athlete who presents with gradual onset of ankle pain.

Adult↗