Dr Aubrey Smith, Orthopedic Surgery
Shoulder Surgery, Arthroscopic and Reconstructive Surgery
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Dr Aubrey Smith, Orthopedic Surgery
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Sports News
Head injury prevention, especially in soccer The American Board of Neurology has some new recommendations about head injury. One of the leading causes of fatal head injuries due to sports for children is soccer. When a child gets a head injury, the special regulatory mechanism that controls the pressure of the fluid in the brain may be injured. When the child gets another head injury before full recovery, such as with a header, the brain immediately swells uncontrolled and may herniate and cause sudden death. This is disastrous and preventable.. We need to all be aware of the new recommendations of the American Board of Neurology. Concussions come in 3 grades: 1. No loss of consciousness, mild confusion less than 15 minutes. 2. No loss of consciousness, confusion more than 15 minutes (see the doctor). 3. Any loss of consciousness (see the doctor, always) When to return to sports: 1. For one Grade 1, if symptoms resolve in less than 15 minutes, may return immediately. 2. For more than one Grade 1 or a Grade 2, remove from all sports one week. 3. For more than one Grade 2, see a doctor and remove from all sports 2 weeks. 4. For a grade 3, see a doctor and stay out of sports 2 weeks minimum. For more than one grade 3, out for at least a month. What does this mean to you? How should you use this? First of all, if you are worried about your child, see your doctor. The way I use this is as follows. A header is to be avoided for one to two weeks after a head injury no matter how mild. Say for instance, two soccer boys collide and hit heads and neither boy has a loss of consciousness and neither has any confusion whatsoever after 15 minutes. I would recommend to avoid another header for two weeks to prevent the child from going to the next category of return. In the recommendations above, more than one Grade 1 is removed from sports for one week. So, a header too soon after a significant head injury may put your child at serious risk. Let's all get educated and be safe. What to look for in a concussion: Symptoms of an early concussion are: headache, dizzy, confused, nausea. Symptoms of a late concussion are: headache, light headed, poor attention, memory disfunction, fatigue, irritable, intolerant of bright lights, blurred vision, anxiety, sleep disturbance. When to go to the doctor: If there are symptoms of a concussion early or late, check with your doctor. Whenever it is Grade 2 or multiple Grade 1's, see the doctor and remove from sports until cleared. When in doubt, make the decision on the side of overly conservative.
Torn Knee Cartilage
A recent article by Dr. Rose in New York reviews the treatment plans for torn knee cartilage, otherwise known as a torn meniscus. The article simply gives a good overview of what we know about torn menisci. In the knee, there are two big shock absorbers called menisci. One is on the inside (medial) and one is on the outside (lateral). What a meniscus does is to increase the congruency between the shape of the end of the thigh bone or femur. In other words, the meniscus makes the joint surface match much better and the stresses are then dispersed better through a "hoop" mechanism. The important thing about the meniscus is that it helps distribute the forces across the knee really well. It is well known that without the meniscus, degenerative changes occur much more rapidly. Many years ago, Dr. Fairbanks described the x-ray changes associated with patients that had a menisectomy. Much has been written about knee surgery since the old classic Dr. Fairbanks article. What has happened over the years is that most everything can be done through the arthroscope as an outpatient. Because the outer one third of the meniscus has a blood supply, many surgeons make every attempt at trying to repair the meniscus. Not all tears can be repaired, and the size and shape of the tear make all the difference in the odds of the tear healing. It should be remembered that no matter who does the surgery, the results are going to be varied. One of the most important points to remember is that a good diagnosis, a good treatment plan early, and a good surgery can often lead to an extremely improved result over no treatment or delayed treatment. You can read the entire review if you desire by going to www.orthopedicse.com and looking up Dr Louis C. Rose's article in the Orthopedic Special Edition, Volume 7, Number 2 of 2. If you want to learn more about sports injuries, please click on my website at the Academy of Orthopaedic Surgeons found below and then click on the area "patient info/office forms. Scroll down to "meniscus tears". Be patient if you are not high speed on the internet. The list is extensive.
http://OrthoDoc.aaos.org/DrAubreySmith
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Last modified08/23/09: |
