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Skiers's thumb injuries associated with flared ski pole handles
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bone scan or (3) positive bacterial culture from bone aspiration. Clinical and laboratory data of the patients were reviewed and compared. Bacterial pathogens were recovered from 88 (84.6%) of the patients. Pseudomonas aeruginosa was isolated from 11 (10.6%) patients and Sfaphylococcus aureus from 63 (60.6%) patients. Patients with Pseudomonas osteomyelitis were older (mean age 13.4 years) than those with Staphylococcus osteomyelitis (mean 8.8 years) and were predominantly male. The most common site for Pseudomonas infection was the foot (10 of 11 patients), and it was associated with a preceding penetrating injury in all cases. Mean duration of symptoms prior to hospital admissions was 91.4 days (median 21 days) in patients with pseudomonal disease compared with 38.4 days (median 5 days) for those with staphylococcal infection. The peripheral WBC count, ESR, and incidence of fever were lower in the Psuedomonas group. Clinical management of Psuedomonas osteomyelitis should consist of adequate surgical exploration and debridement together with at least ten days of postoperative intravenous antibiotics. [Nguyen Vo, MD]
0 THE LONG-TERM FOLLOW-UP OF SOLDIERS WITH STRESS FRACTURES. Milgrom C, Giladi M, Chisin R, Dizian R. Am J Sports Med 1985; 13:398-400.
This study prospectively followed 66 soldiers who developed stress fractures during basic traming for a minimum period of one year after training. All patients were treated with a period of rest until they were asymptomatic and then returned to duty. Fifty five percent of the fractures occurred in the tibia, 34% in the femur, 9% in the feet, and 1% in the pelvis. After one year of follow-up, 47% of the patients had a full recovery, 13.6% had been persistently symptomatic for 4 or more months but were well at the end of the year, 19.6% had been asymptomatic for at least 3 months before developing a new stress fracture at the same or different site, 16.7% had periodic bone pain not consistent with a stress fracture, and 3% experienced a chronic stress fracture. Overall, 10.6% of the recruits who had sustained stress fractures during basic training developed recurrent stress fractures during subsequent training. Of the 60 control recruits (those not sustaining fractures
The Journal of Emergency Medicine
during basic training), only 1.7% were similarly affected. The authors conclude that a stress fracture can occur at any time and should be kept in mind throughout the full course of physical training. [John Neufeld, MD]
0
SKIERS’S THUMB INJURIES ASSOCIAT-
ED WITH FLARED SKI POLE HANDLES. Primiano GA. Am J Sports Med 1985; 13: 425-427. Typically, ski injuries of the ulnar collateral ligament of the thumb occur because of forced abduction of the thumb as the the hand becomes entangled in the ski pole strap. Strapless ski pole handles, intended to reduce frequency of this type of injury, have resulted in their own mechanism of trauma. The author describes three seasoned skiers who sustained significant thumb injuries while skiing. Each reported an inability to flex the interphalangeal joint around the flare of ski pole handle. Consequently, their thumbs protruded and acted as the point of initial contact during the fall, resulting in bony and ligamentous injuries. The author recommends that prior to the use of any ski pole, flexion of the interphalangeal joint of the thumb should be verified while the ski glove is being worn. [John Neufeld, MD]
0 THE EMERGENCY CARE NETWORK OF A SKI MARATHON. Gannon DM, Derse AR, Bronkema PJ, Primely DM. Am J Sports A4ed 1985; 13:316-320.
The detailed description of the emergency care system at a large cross-country ski marathon is presented. From more than 8,000 skiers, 353 injuries were evaluated, 50 of which required a hospital visit. The most common injuries were facial abrasions from falling. Also encountered, in declining order of frequency, were muscle cramps, hypothermia, minor cuts, musculoskeletal injuries, and concussions. All cases of hypothermia occurred in the last half of the 58 km race. Novice skiers were often overdressed, leading to marked sweating. Upon resting, their wet clothing served to conduct heat away from their bodies, producing hypothermia. Advanced skiers wore two layers of clothing only, the inner layer being polypropylene, which wicks away perspiration. The authors recommend that each participant indicate any med-
bone scan or (3) positive bacterial culture from bone aspiration. Clinical and laboratory data of the patients were reviewed and compared. Bacterial pathogens were recovered from 88 (84.6%) of the patients. Pseudomonas aeruginosa was isolated from 11 (10.6%) patients and Sfaphylococcus aureus from 63 (60.6%) patients. Patients with Pseudomonas osteomyelitis were older (mean age 13.4 years) than those with Staphylococcus osteomyelitis (mean 8.8 years) and were predominantly male. The most common site for Pseudomonas infection was the foot (10 of 11 patients), and it was associated with a preceding penetrating injury in all cases. Mean duration of symptoms prior to hospital admissions was 91.4 days (median 21 days) in patients with pseudomonal disease compared with 38.4 days (median 5 days) for those with staphylococcal infection. The peripheral WBC count, ESR, and incidence of fever were lower in the Psuedomonas group. Clinical management of Psuedomonas osteomyelitis should consist of adequate surgical exploration and debridement together with at least ten days of postoperative intravenous antibiotics. [Nguyen Vo, MD]
0 THE LONG-TERM FOLLOW-UP OF SOLDIERS WITH STRESS FRACTURES. Milgrom C, Giladi M, Chisin R, Dizian R. Am J Sports Med 1985; 13:398-400.
This study prospectively followed 66 soldiers who developed stress fractures during basic traming for a minimum period of one year after training. All patients were treated with a period of rest until they were asymptomatic and then returned to duty. Fifty five percent of the fractures occurred in the tibia, 34% in the femur, 9% in the feet, and 1% in the pelvis. After one year of follow-up, 47% of the patients had a full recovery, 13.6% had been persistently symptomatic for 4 or more months but were well at the end of the year, 19.6% had been asymptomatic for at least 3 months before developing a new stress fracture at the same or different site, 16.7% had periodic bone pain not consistent with a stress fracture, and 3% experienced a chronic stress fracture. Overall, 10.6% of the recruits who had sustained stress fractures during basic training developed recurrent stress fractures during subsequent training. Of the 60 control recruits (those not sustaining fractures
The Journal of Emergency Medicine
during basic training), only 1.7% were similarly affected. The authors conclude that a stress fracture can occur at any time and should be kept in mind throughout the full course of physical training. [John Neufeld, MD]
0
SKIERS’S THUMB INJURIES ASSOCIAT-
ED WITH FLARED SKI POLE HANDLES. Primiano GA. Am J Sports Med 1985; 13: 425-427. Typically, ski injuries of the ulnar collateral ligament of the thumb occur because of forced abduction of the thumb as the the hand becomes entangled in the ski pole strap. Strapless ski pole handles, intended to reduce frequency of this type of injury, have resulted in their own mechanism of trauma. The author describes three seasoned skiers who sustained significant thumb injuries while skiing. Each reported an inability to flex the interphalangeal joint around the flare of ski pole handle. Consequently, their thumbs protruded and acted as the point of initial contact during the fall, resulting in bony and ligamentous injuries. The author recommends that prior to the use of any ski pole, flexion of the interphalangeal joint of the thumb should be verified while the ski glove is being worn. [John Neufeld, MD]
0 THE EMERGENCY CARE NETWORK OF A SKI MARATHON. Gannon DM, Derse AR, Bronkema PJ, Primely DM. Am J Sports A4ed 1985; 13:316-320.
The detailed description of the emergency care system at a large cross-country ski marathon is presented. From more than 8,000 skiers, 353 injuries were evaluated, 50 of which required a hospital visit. The most common injuries were facial abrasions from falling. Also encountered, in declining order of frequency, were muscle cramps, hypothermia, minor cuts, musculoskeletal injuries, and concussions. All cases of hypothermia occurred in the last half of the 58 km race. Novice skiers were often overdressed, leading to marked sweating. Upon resting, their wet clothing served to conduct heat away from their bodies, producing hypothermia. Advanced skiers wore two layers of clothing only, the inner layer being polypropylene, which wicks away perspiration. The authors recommend that each participant indicate any med-