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Megan H. Murai, Matthew Pecci and Mark Laursen

Column-editor : Brian Bogdanowicz

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Mary Jones, Amanda K. Andrews and Janenne Ellis

Column-editor : Joseph J. Piccininni

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Deniece Oates and David O. Draper

Column-editor : David O. Draper

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Michael J. Carroll

Dislocation with an associated fracture of the ankle is a rare injury. A medial dislocation of the subtalar joint is uncommon, because the normal direction of the subtalar dislocation is lateral. This paper discusses a fracture medial dislocation of the ankle in a high school football player. Initial treatment of the injury included on-the-field management and referral to a hospital and an orthopedic surgeon. Rehabilitation of this injury was very slow and conservative in the initial stage after surgery. This included range of motion exercises for the ankle, full leg conditioning, and ice. After the fracture site was found stable the injury was treated much the same as a Grade II ankle sprain. The goal of rehabilitation was to return the range of motion, strength, and girth measurements of the affected side to those of the contralateral side as quickly as possible, so the athlete could resume athletics. When the affected side met these criteria, there was little to no pain with activity, and the orthopedic physician granted clearance, the athlete was allowed to return to competition.

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John A. Nyland, Dean P. Currier, J. Michael Ray and Mitchell J. Duby

This paper discusses function changes during an accelerated rehabilitation program at 6, 10, and 52 weeks postsurgery for a college athlete following anterior cruciate ligament reconstruction/meniscectomy of the left knee. The effects of combined pulsed electromagnetic field (PEMF) and neuromuscular electrical stimulation (NMES) on knee extensor torque, thigh girth, and pain level are presented. PEMF-NMES decreased stimulation pain by 76%. Knee extensor isometric torque increased by 23%, and thigh girth decreased less than 5% at 6 weeks. Knee extensor isokinetic torque was 13% and 3% deficient at 90°/s and 240°/s, and standing single-leg broad jump distance was 19% deficient at 10 weeks. Knee extensor isokinetic torque was 1% and 1.5% greater at 90°/s and 240°/s, and standing single-leg broad jump distance was 11% deficient at 52 weeks. Knee anterior laxity was 2 mm at 10 weeks and 3 mm at 52 weeks. PEMF-NMES appears to comfortably enhance knee extensor torque gains and diminish thigh girth loss. Despite early return to practice, functional deficit remained and anterior laxity was increased at 52 weeks.

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Lynn F. Brumm, David P. Carrier, Sally E. Nogle and Shirley M. Johnson

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Sandra Fowkes Godek and Arthur R. Bartolozzi

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Eric Emmanuel Coris, Stephen Walz, Jeff Konin and Michele Pescasio

Context:

Heat illness is the third leading cause of death in athletics and a leading cause of morbidity and mortality in exercising athletes. Once faced with a case of heat related illness, severe or mild, the health care professional is often faced with the question of when to reactivate the athlete for competitive sport. Resuming activity without modifying risk factors could lead to recurrence of heat related illness of similar or greater severity. Also, having had heat illness in and of itself may be a risk factor for future heat related illness. The decision to return the athlete and the process of risk reduction is complex and requires input from all of the components of the team. Involving the entire sports medicine team often allows for the safest, most successful return to play strategy. Care must be taken once the athlete does begin to return to activity to allow for re-acclimatization to exercise in the heat prior to resumption particularly following a long convalescent period after more severe heat related illness.

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Thomas G. Bowman and Riann Palmieri-Smith

Objective:

To present the case of an 18-year-old collegiate decathlete with a Salter-Harris type I epiphyseal plate fracture of the proximal humerus.

Background:

A collegiate decathlete was playing flag football and fell on an outstretched arm. He was taken to the emergency room and diagnosed with a type I epiphyseal plate fracture.

Differential Diagnosis:

AC sprain, dislocation or subluxation, rotator cuff tear, labral tear.

Treatment:

Active and passive range of motion exercises were completed after two days of immobilization. He then started strengthening exercises and returned to competitive activity in 10 weeks.

Uniqueness:

Proximal humeral epiphyseal plate fractures are uncommon injuries, especially in athletes over the age of 15.

Conclusions:

If an accurate diagnosis is made, an appropriate conservative rehabilitation program can be implemented to safely return an athlete to participation without permanent deformity following a type I Salter-Harris fracture.