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On the Field Management of Lower Extremity Injuries

Armando F. Vidal, M.D. Surgical Director Sports Medicine Program for Young Athletes Childrens Hospital Colorado Team Physician, CU & DU. On the Field Management of Lower Extremity Injuries. Overview. Hip / Thigh Injuries Contusions Hip Pointers Hip Dislocation Hamstring Strains

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On the Field Management of Lower Extremity Injuries

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  1. Armando F. Vidal, M.D. Surgical Director Sports Medicine Program for Young Athletes Childrens Hospital Colorado Team Physician, CU & DU On the Field Management of Lower Extremity Injuries

  2. Overview • 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

  3. Hip Pointer • 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

  4. Hip Pointer • XR are important • Especially in Young Athletes • Consider Injections on Game Day • Return to play as symptoms allow

  5. Thigh Contusions • Muscle Contusion • Secondary to direct blunt trauma • Risk of MyositisOssificans (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

  6. Hip Dislocation • 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!!!

  7. Hamstring Injuries • Cross Both Hip & Knee Joints • Very Characteristic & Common Injury • Sprinters • RB • Pain Posteriorly • +/- “Pop” • Exam • Tenderness • Defect • Ecchymosis

  8. Hamstring Injuries • Cross Both Hip & Knee Joints • Very Characteristic & Common Injury • Sprinters • RB • Pain Posteriorly • +/- “Pop” • Exam • Tenderness • Defect • Ecchymosis

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

  10. Patella Dislocation • 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 1st episode • Consider return in chronic dislocator if minimal symptoms & No effusion • Need Ortho Evaluation • Chondral fractures • Loose bodies

  11. Knee Dislocation • Relatively Rare • EMERGENCY!!! • Urgent Reduction & Transfer to ED • Assessment • Align Leg • Splint / Stabilize

  12. Ligamentous Knee InjuryACL • 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

  13. Ligamentous Knee Injuries: ACL ACL Injury Right Knee

  14. Ligamentous Knee Injuries: ACL ACL Injury Left Knee

  15. ACL: Physical Exam LACHMAN Anterior Drawer

  16. ACL: Physical ExamPivot Shift

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

  18. Tibial / Ankle Fractures • Obvious Deformity • Inability to bear weight • Immobilize / Stabilize • Air Splint • Do not attempt to remove shoe unless necessary • Transport to ED

  19. Syndesmotic Injury • 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

  20. Subtalar Dislocation • 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

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

  22. LisFranc Injury • 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

  23. Foot Fractures • 5th 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

  24. Thank You

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