Armando F. Vidal, M.D. Surgical Director Sports Medicine Program for Young Athletes Childrens Hospital Colorado Team Physician, CU & DU

 Hip / Thigh Injuries  Contusions  Hip Pointers  Hip Dislocation  Hamstring Strains  Knee  Patella Dislocation  Knee Dislocation  Ligamentous Injuries  Meniscal Injury  Lower Leg  Tibia Fracture  Foot / Ankle  Syndesmotic Injury / Masseneuve Fracture  Subtalar Dislocation  LisFranc Injury  Foot Fractures

 Painful, Direct blow to Iliac Crest  Football  Hockey  Soccer  Protective Padding is key to prevention  Acute  Rest, Ice, Compression, minimization of hematoma  Avoid Heat, Massage, NSAIDS and Physical Activity for first 48 hr

 XR are important  Especially in Young Athletes  Consider Injections on Game Day  Return to play as symptoms allow

 Muscle Contusion  Secondary to direct blunt trauma  Risk of Myositis Ossificans (9- 20%)  Treatment  Control Deep Bleeding  RICE – Knee Flexion  Avoid Early - PT, Heat, Massage, NSAIDS  Return to Play  Pain free ROM (0-120)  Near Full return of strength 1-2 weeks

 Rare Injury  Football  Rugby  Skiing / Snowboarding  Posterior Much More Common than Anterior  Hip Internally rotated, flexed and shortened  Reduction  Knee & Hip Flexed  Traction in-line with femur  Gentle Rotation  Counter-traction on pelvis  RARE TO DO ON FIELD!!!

 Cross Both Hip & Knee Joints  Very Characteristic & Common Injury  Sprinters  RB  Pain Posteriorly  +/- “Pop”  Exam  Tenderness  Defect  Ecchymosis

 Cross Both Hip & Knee Joints  Very Characteristic & Common Injury  Sprinters  RB  Pain Posteriorly  +/- “Pop”  Exam  Tenderness  Defect  Ecchymosis

 High Grade Injuries (5 Phase Tx)  RICE  Stretch/Isometrics/Estim  Isotonics / +/- Isokinectic  Running / Sport Specifics  Return to Sports  Interventions  ? Corticoteroid Injection  ? PRP

 Not Subtle  Deformity obvious if present  Planted foot, Pivoting  “Knee Dislocated”  Direct Contact  Many reduce spontaneously  Reduction  Gentle Knee Extension  No return to game if 1 st episode  Consider return in chronic dislocator if minimal symptoms & No effusion  Need Ortho Evaluation  Chondral fractures  Loose bodies

 Relatively Rare  EMERGENCY!!!  Urgent Reduction & Transfer to ED  Assessment  Align Leg  Splint / Stabilize

 Non-contact pivoting injury  Very Common  “Pop” + early effusion (70% have ACL)  Unable to return to play  Rapid Onset of Effusion  Lateral Knee pain is Common

ACL Injury Right Knee

ACL Injury Left Knee

LACHMANANTERIOR DRAWER

 Non-Contact > Contact  Female : 3-5x  Risk  No return in same event  Sports Medicine Evaluation  6 month recovery from Reconstruction

 Obvious Deformity  Inability to bear weight  Immobilize / Stabilize  Air Splint  Do not attempt to remove shoe unless necessary  Transport to ED

 Common in Collision Sports  Football  Hockey  Low Grade  Crutches / Boot ▪ 72 hr NWB ▪ Gradual return  High Grade  ORIF  Distance of Symptoms up fibula ≅ Duration of Symptoms  May lose many weeks of participation

 Rare in Athletics  Basketball  Inversion injury  Typical Appearance  Do not attempt to reduce on field  Splint / Protect  ED for XR and closed Reduction  RTP usually in several weeks or months after symptoms resolved  Unknown recurrence rate

 Midfoot Injury  “Pop or Snap”  Pain & Ecchymosis Midfoot  Plantar Ecchymosis  Arch Collapse  Ability to RTP is Variable for low grade injury  Sports Medicine Evaluation  XR - Boot or ORIF

 May take a long time to recover  Can be devastating injury  Often NWB for 8 – 10 wks  Low grade injury  Cast / Boot  Steel Shank / Carbon Fiber Insert

 5 th Metatarsal Fracture  Most common  Inversion Injury  Can be mistaken for lateral ankle sprain  Stress Fractures  Endurance Athlete  Female Triad  Many can be treated with shoewear modification / orthotics