Achilles Tendon Ruptures in Young Female Basketball Players: A Case Series.

Achilles tendon ruptures are a common entity in middle-aged male athletes. There have been limited reports of these injuries in female athletes in general and no reports that we are aware of teenage female athletes with complete tears that required surgical intervention. We present a case series of three female basketball players treated at the same institution by the same surgeon under the age of 20 over a 9-month period with complete Achilles tendon ruptures that underwent surgery. Clinicians should be aware of this pathology when seeing female athletes with calf pain

Herniated disc disease: diagnostics

This issue of eMedRef provides information to clinicians on the pathophysiology, diagnosis, and therapeutics of herniated disc disease

Outcomes of intra-articular corticosteroid injections for adolescents with hip pain.

Intra-articular injection of corticosteroid and anesthetic (CSI) is a useful diagnostic tool for hip pain secondary to labral tears or femoroacetabular impingement (FAI). However, the effectiveness of CSI as a stand-alone treatment for hip pain in adolescents is unknown. The purpose of this study is to evaluate the use of CSI for the treatment of hip pain and determine factors that may affect outcomes after injection. Retrospective analysis of 18 patients and 19 hips that underwent fluoroscopic guided hip injection for the treatment of pain at a single institution from 2012 to 2015 was carried out in this study. Mean age at the time of injection was 15.1 years (range 13-17) with mean follow-up of 29.4 months. Fifty-two percent (10/19 hips) went on to surgery after the injection. Average time to surgical conversion was 12.8 months after CSI. Cam or pincer morphologies were present in 90% (9/10 hips) of the operative group. Patients with FAI were more likely to need surgery than patients without bony abnormalities (RR= 10, 95% CI 1.6-64.2, P = 0.0001). There was no difference in the presence of labral tears in the operative and non-operative groups (100% versus 89%, P = 0.47). For adolescents without bony abnormalities, 90% improved with CSI alone and did not require further treatment within 2.4 years. Fluoroscopic guided corticosteroid hip injection may have limited efficacy for the treatment of hip pain secondary to FAI in adolescents. However, for patients without osseous deformity, CSI may offer prolonged improvement of symptoms even in the presence of labral tears

Comparing Outcomes Between the Over-the-Top and All-Epiphyseal Techniques for Physeal-Sparing ACL Reconstruction: A Narrative Review.

A variety of techniques are used for physeal-sparing anterior cruciate ligament (ACL) reconstruction; however, there is no clear consensus on the ideal surgical technique, the frequency of complications, and how to best avoid growth disturbance. The purpose of this study was to compare outcomes and complications between over-the-top and all-epiphyseal ACL reconstruction techniques. The hypothesis was that both physeal-sparing reconstruction techniques are efficacious, with similar risk of growth disturbance and complications. The Embase and PubMed databases were queried for studies on ACL ruptures in the skeletally immature population from 1985 to 2018. Full-text English studies were included (N = 160). Studies reporting rerupture and/or complications after physeal-sparing ACL reconstruction, specifically growth disturbance, were included (n = 10). Studies were separated into 2 groups: an all-epiphyseal group with femoral and tibial fixation points within the epiphysis and a group that had over-the-top femoral and tibial physeal-sparing reconstruction. Complications not specific to the pediatric population were excluded. Demographics, evaluation of skeletal maturity, surgical technique, growth disturbance, rerupture, and patient-reported outcome scores were collected. Data were analyzed in aggregate. The 10 studies included 482 knees. The mean age was 12.0 years; 81% of patients were male; and mean follow-up was 47.7 months. A total of 178 patients underwent all-epiphyseal reconstruction, and 298 had the femoral graft placed over the top. The rerupture rate was 9.0% (16 of 178) in the all-epiphyseal group and 7.2% (14 of 195) in the over-the-top group, of which 82% required revision reconstruction. Six patients had overgrowth in the all-epiphyseal group (mean, 1.8 cm) and 1 patient in the over-the-top group (1.5 cm). Three angular deformities occurred, all of which were in the over-the-top group. Both physeal-sparing ACL reconstruction techniques are successful. Overgrowth was more common in the all-epiphyseal group and angular deformity in the over-the-top group. Rerupture rates were similar between the groups. The authors recommend standardization of skeletal age assessment and baseline lower extremity alignment films

The Effect of Insurance Status and Race on Access to Care for Pediatric and Adolescent Patients With Anterior Cruciate Ligament Injury

BACKGROUND: Anterior cruciate ligament injuries (ACL) of the knee are becoming increasingly common in the pediatric and adolescent population with the rise in organized sports participation. This injury can be devastating to a young athlete’s ability to engage in physical activity as the knee is rendered unstable; leaving it susceptible to further degenerative changes. As a result, a delay in both the diagnosis and treatment of ACL injuries can lead to secondary joint damage in this highly active population. The purpose of this study was to analyze whether the insurance status and race of pediatric and adolescent patients with ACL injuries impacts the time from injury to diagnosis and treatment, and consequently secondary joint damage. MATERIALS AND METHODS: This was a retrospective review of 170 consecutive patients at a tertiary care pediatric hospital treated by a single surgeon from 2011 to 2015 for ACL ruptures. The institution at which the patients were treated was a safety-net hospital that provides a significant level of care to low-income, uninsured, and vulnerable populations with no care preference given based on insurance status. Patients were stratified into public insurance and private insurance groups. Race was also considered. Ability to access care was compared between the groups in regards to time from injury to magnetic resonance imaging (MRI) exam (the gold standard for diagnosis of ACL injury) as well time from injury to surgical reconstruction. In addition, the presence of secondary injury (meniscal / chondral injury) that may have stemmed from treatment delay and continued activity with an unstable knee was compared between groups. RESULTS: One hundred and two patients had public insurance and 68 patients had private insurance. Patients with private insurance received an MRI nearly 50% faster after their injury (p \u3c 0.001, 19 days vs. 38 days). In addition, time from injury to ACL reconstruction was also faster (p \u3c 0.001, 61 days vs. 96 days) for privately insured patients. An increased rate of meniscal tears and chondral injuries was not significantly seen in the public insurance group. Race did not impact timing to treatment or secondary injuries. CONCLUSIONS: The results of this study demonstrated that time from injury to MRI diagnosis, and surgical treatment was significantly shorter in privately insured pediatric and adolescent patients even in a safety-net hospital setting. Clinicians must be cognizant of this disparity and develop means to ensure timely access to care

Proximal humerus fractures in the pediatric population: a systematic review

PurposeProximal humerus fractures and epiphyseal separations in skeletally immature children and adolescents are traditionally treated non-operatively. Recently, authors have described the operative fixation of these injuries, particularly in older children and adolescents with displaced fractures. We performed a systematic review of the literature to identify operative indications for proximal humerus fractures in children and to compare the results by age, displacement, and treatment modality.MethodsA systematic review of the literature from January 1960 to April 2010 was performed. All studies with patients under the age of 18 years who were treated for a proximal humerus fracture either operatively or non-operatively were included.ResultsThe available literature is largely composed of uncontrolled case series (Level IV). According to findings, the literature shows that asymptomatic union is the rule in proximal humerus fractures in children and adolescents. Poorer outcomes were noted in operatively treated patients, patients with more displaced fractures, and older patients.ConclusionsThe currently available literature supports a non-operative treatment approach, particularly in younger children with more growth remaining. Older patients (>13 years) with more widely displaced fractures may benefit from anatomic reduction with stabilization, though the data in the literature at this point is too weak to strongly recommend this approach. Further analysis with a more rigorous scientific method is necessary to evaluate the optimum treatment modality in this subgroup

Reducing Power Consumption in Sensor Network Using Sensor MAC Protocol

© ASEE 2009Wireless sensor networks are quickly gaining popularity due to the fact that they are potentially low cost solutions to a variety of real world challenges. Their low cost provides a means to deploy large sensor arrays in a variety of conditions capable of performing both military and civilian tasks. This technology consists of some of the electronic devices which work to run this system successfully and all those have some amount of power consumptions. It is a challenge of maximizing the processing capabilities and energy reserves of Wireless sensor nodes while also securing them against attackers. So, finally we have decided to work on finding out the optimum solution for controlling the power and saving energy. There are number of ways to reduce power consumption and MAC protocol is one of them. So we describe Sensor MAC protocol to reduce power consumption