Running injuries--knees to toes.
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Traumatic arteriovenous (AV) fistulas produce several profound pathophysiologic and structural changes in the circulatory dynamics of the vessels associated with the fistula. Most of the changes are reversible with surgery. However, in longstanding AV fistulas, irreversible degenerative changes occur in the arterial wall and result in dilatation and thrombosis. This can make late closure technically difficult. This report presents a case of peroneal AV fistula of 18 years duration. The diagnosis, management, and complications of long-standing AV fistulas are discussed.
Children are the nearest thing in the human race to tadpoles in that they have tremendous powers of healing and regeneration. It should be remembered that they are subject to overstress injuries, more so than middle-aged adults. Precautions should be taken and the proper radiographs made when any swelling or tenderness occurs about a joint because of the tendency of children to develop injuries involving the growing centers of bone.
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The running population in the United States is estimated to be more than 60 million, and two out of every three of these runners will seek medical attention because of injuries. The cause of lower extremity injuries is the impulsive impact that occurs on foot strike. At 800 foot strikes per mile, a 150-pound runner will be subjected to forces of 120 tons per foot per mile. The use of the non-steroidal anti-inflammatory drugs (NSAIDs) in runners has become widespread. This is especially true in the case of marathon runners who use NSAIDs like piroxicam to relieve their overuse pains so they can continue to run with injuries, although this use is not advocated. NSAIDs do, however, play a role in treating many running injuries and can help the runner return to his chosen sport.
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A professional football franchise was studied consecutively from 1960 through 1985 for injuries incurred during regular-season games. A "significant" injury was defined as one requiring the player to miss at least two consecutive games (N = 331) and a "major" injury as one that caused the player to miss at least eight games or the equivalent time (N = 130). Significant injuries averaged 0.89 per game and major injuries 0.35 per game for the entire 26 years. Following a high injury rate prior to 1965, significant injury rates were episodic. Major injuries declined (rs = -.68; P less than .01). Since the team's first games on synthetic surfaces in 1968, there was no difference in the rates of significant injuries per game (0.57 vs 0.67) or major injuries per game (0.22 vs 0.33) between games played on grass or artificial turf, respectively. Since 1969 there has been a decline in major knee injuries (rs = -.51; P less than .05) and a decline in major injuries incurred during special-teams play (rs = -.55; P less than .05). The data indicate that this team suffered fewer injuries with the passing of time, primarily in injuries that caused a player to miss at least eight consecutive games. Observations of short duration do not lend themselves to current media perception that injury rates are higher and more serious today in professional football.
Five hundred and eighty high-school football players were studied over a period of two seasons to determine the effect of so-called prophylactic knee braces on the lower extremity. Two hundred and forty-seven athletes who wore single-hinged braces and eighty-three who wore double-hinged braces were paired for the same season of play with 250 athletes who were similar in height, weight, and playing position but who did not wear braces. The fifty-three injuries of the knee that occurred were significantly more frequent (p less than 0.001) in the group that wore single-hinged braces than in the matched, non-braced group. While there were more injuries of the knee in the participants who were double-hinged braces than in the matched controls, who did not wear braces, the increase in the number of injuries was not significant. There was also a dramatic increase (p less than 0.01) in the number of injuries of the ankle and foot in the athletes who wore braces. Our results question the efficacy of the braces that were studied and call attention to the potentially adverse effect of the braces on adjacent joints in the ipsilateral limb.
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