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Acute Fracture Injuries in Sport

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Fractures in Sport

Abstract

Acute fractures in sport are a significant problem for the athlete, given that fractures can result in one of the longest return times to sport of all injuries.

Optimal clinical management of these injuries relies on a robust understanding of the basic science principles that are associated with fractures.

Fracture healing is key to expedient recovery of these injuries. Given the young healthy demographic of athletic patients, an appreciation of the optimal fracture healing capacity of such individuals, can facilitate the earliest return to sport possible.

Given the sport-specific, and often recurring, actions that account for such fractures, it is key to review their injury mechanisms, to better predict the occurrence of these injuries. A robust understanding of the biomechanical properties underpinning the mechanism of fracture, allows the clinician to make a comprehensive assessment regarding causative factors, modifiable risk factors, and injury stability.

Further to this, it must be appreciated that the management of such injuries should be developed to facilitate the earliest return to sport, with the lowest morbidity possible. As such, several adaptations to ‘traditional’ fracture management can be advocated in the athletic patient. A sound understanding of the biomechanical principles of fracture management allows the clinicians to appropriately select the optimal management techniques.

Injury prevention forms a key component in reducing the incidence and morbidity of acute sport-related fractures. Key basic principles that allow a comprehensive understanding and subsequent application of this topic include: the practice of injury surveillance, the development of injury prevention equipment and techniques, and the clinical integration of such practices to assess their safety and effectiveness.

This chapter provides an overview of the basic science principles of acute fractures in sport, reviewing fracture healing models, common injury patterns, general treatment principles, associated biomechanics principles and preventative measures.

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Author information

Authors and Affiliations

  1. Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, Edinburgh, UK

    Greg A. J. Robertson

  2. Oxford Trauma Unit, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK

    Alexander M. Wood

  3. Kings College Hospital, London NHS Trust & Kings Diabetic Foot Unit, London, UK

    Raju S. Ahluwalia

  4. Edinburgh Orthopaedic Trauma Unit, Edinburgh, UK

    Gary F. Keenan

Authors
  1. Greg A. J. Robertson
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  2. Alexander M. Wood
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  3. Raju S. Ahluwalia
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  4. Gary F. Keenan
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Editor information

Editors and Affiliations

  1. Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, Edinburgh, UK

    Greg A. J. Robertson

  2. Centre for Sports and Exercise Medicine, Queen Mary University of London, London, UK

    Nicola Maffulli

Review

Review

1.1 Questions

  1. 1.

    Which treatment method demonstrates primary fracture healing?

    1. (a)

      Intra-Medullary Nailing

    2. (b)

      K-Wire Fixation

    3. (c)

      Bridge Plate Fixation

    4. (d)

      Cast Immobilisation

    5. (e)

      Lag Screw and Neutralisation Plate Fixation

  2. 2.

    Which fracture pattern results from a tension force?

    1. (a)

      Transverse

    2. (b)

      Oblique

    3. (c)

      Spiral

    4. (d)

      Simple Wedge

    5. (e)

      Comminuted

  3. 3.

    What is the recommended treatment method for an undisplaced tibial diaphyseal fracture in a professional soccer player?

    1. (a)

      Cast Immobilisation

    2. (b)

      Sarmiento Brace Immobilisation

    3. (c)

      External Frame Fixation

    4. (d)

      Intra-Medullary Nail Fixation

    5. (e)

      Bed Rest with Skeletal Traction

  4. 4.

    Which practice results in the greatest risk reduction of catastrophic cervical spine injuries in Rugby Union?

    1. (a)

      The Implementation of Non-Impact Scrum Laws

    2. (b)

      Routine Scrum Cap Usage

    3. (c)

      Regular Lower Limb Proprioception Training

    4. (d)

      Routine Shoulder Pad Usage

    5. (e)

      Playing on Grass Surface Pitches

1.2 Answers

  1. 1.

    (e)—All the other treatment methods demonstrate secondary fracture healing (i.e. endochondral ossification with periosteal bridging callus).

  2. 2.

    (a)—Tension forces result in transverse fracture patterns (e.g. at the patella, olecranon and medial malleolus). Pure bending forces can also result in transverse fracture patterns (e.g. at the tibia diaphysis). None of the other listed fracture patterns result from tension forces.

  3. 3.

    (d)—An undisplaced tibial diaphyseal fracture is an unstable fracture pattern. In a professional soccer player, this should undergo ‘internal’ surgical stabilisation i.e. Intra-Medullary Nail Fixation. The other options either provide conservative management or ‘external’ surgical stabilisation – these would result in a delayed rehabilitation and a prolonged return to sport.

  4. 4.

    (a)—The implementation of non-impact scrum laws, in rugby union, has been found to result in a 44% reduction in catastrophic cervical spine injuries. None of the other injury prevention measures have been proven to reduce catastrophic cervical spine injuries.

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Robertson, G.A.J., Wood, A.M., Ahluwalia, R.S., Keenan, G.F. (2021). Acute Fracture Injuries in Sport. In: Robertson, G.A.J., Maffulli, N. (eds) Fractures in Sport. Springer, Cham. https://doi.org/10.1007/978-3-030-72036-0_3

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