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A survey of snowboarding injuries was conducted over 10 seasons (1988 to 1998). A questionnaire evaluating 20 variables was used to collect data from 47 medical facilities near Colorado ski resorts. A total of 7430 snowboarding-related injuries were seen. A control group consisted of 3107 noninjured snowboarders. Most of those injured were 30 years of age or younger; 74% of injuries occurred in men and 26% in women; 39% of injured snowboarders were beginners and 61% were intermediate or experts. Men rode at more advanced levels than women. Injured snowboarders were more likely than noninjured snowboarders to be beginners. There were 3645 (49.06% of total) upper extremity injuries; 56.43% were fractures, 26.78% sprains, and 9.66% dislocations. The most common site of injury was the wrist (21.6% of all snowboarding injuries). Wrist fractures (except to the scaphoid) and sprains were more common in beginners, women, and younger age groups. Intermediate and expert men were more likely to sustain hand, elbow, and shoulder injuries, as well as more severe injuries. Falling was the predominant mechanism of upper extremity injuries. Snowboarders who wore protective wrist guards were half as likely to sustain wrist injuries as those who did not wear guards.

We undertook a prospective study to determine the type and distribution of foot and ankle snowboarding injuries. Reports of 3213 snowboarding injuries were collected from 12 Colorado ski resorts between 1988 and 1995. Of these, 491 (15.3%) were ankle injuries and 58 (1.8%) were foot injuries. Ankle injuries included 216 (44%) fractures and 255 (52%) sprains. Thirty-three (57%) of the foot injuries were fractures and 16 (28%) were sprains. The remaining injuries were soft tissue injuries, contusions, or abrasions. There was no significant correlation between boot type (soft, hybrid, or hard) and overall foot or ankle injury rate. There were significantly fewer ankle sprains in patients wearing hybrid boots and fewer fractures of the lateral process of the talus in patients wearing soft boots. An unexpectedly high number of fractures of the lateral process of the talus were noted. These 74 fractures represented 2.3% of all snowboarding injuries, 15% of all ankle injuries, and 34% of the ankle fractures. Many of these fractures are not visible on plain radiographs and require computed tomography imaging to be diagnosed. Diagnosis of this fracture pattern is paramount; the physician should be very suspicious of anterolateral ankle pain in the snowboarder, where subtle fractures that may require surgical intervention can be confused with anterior talofibular ligament sprains.

The purpose of this study was to compare the dynamic impact response of braced and unbraced cadaveric wrists using a commercially available wrist guard. Twelve arms were harvested from six cadavers. Each pair of forearms, one with and one without a brace, were impacted using a modified guillotine-type drop fixture placed over a force platform. Using a piece-wise linear regression analysis, we identified four phases of dynamic loading in the vertical force profile before fracture. These phases included an initial linear loading phase starting at impact, followed by a nonlinear phase, a second rapid linear loading phase, and a final nonlinear loading phase to failure. Three transition points were identified that defined the boundaries of the linear loading phases. Vertical force and impulse were significantly higher (P 0.01) at each transition point and at failure in all braced specimens compared with unbraced specimens. However, the most noticeable differences were found during the initial two loading phases. Time to each transition point and to failure was not significantly different (P 0.27) between the braced and unbraced wrists. The results of this study differ from those obtained under more quasistatic loading conditions. Dynamic impact testing suggests that wrist guards may have a prophylactic effect during low-energy dynamic impact situations.

A retrospective study of 26 submuscular ulnar nerve transpositions was performed with the specific use of grip and pinch analysis to evaluate this form of objective testing. Twenty-six patients were treated by submuscular transposition of the ulnar nerve between 1981 and 1985 and were followed an average of 21 months. Preoperative and postoperative analysis consisted of subjective questioning, clinical examination, quantitative two-point discrimination, quantitative pinch and grip analysis, and electromyographic (EMG) and nerve conduction velocity (NCV) evaluation. Many of the patients suffered from associated problems such as alcohol abuse, diabetes mellitus, and concurrent Guyon's canal compression, which adversely affected the outcome. Subjectively, 62% were improved, 31% were no better, and 7% were worse. Clinical examination demonstrated 46% improved, 35% no better, and 19% worse. Quantitative two-point discrimination was better in 59%, unchanged in 26%, and worse in 15%. Quantitative pinch and grip analysis revealed 28% improved, 56% with little improvement, or the same, and 16% worse, while EMG/NCV showed one-third of the patients in each category postoperatively. Quantitative pinch and grip analysis provided good preoperative and postoperative documentation, which is absent from previous studies in the literature concerning ulnar nerve transportation.

A retrospective review of 45 patients (62 feet) who had undergone a Grice subtalar arthrodesis and who had reached skeletal maturity was undertaken. Preoperative deformities were due to flaccid and spastic paralysis, as well as congenital abnormalities. There were failures in 32% and poor results in 61%. Unrecognized ankle valgus, overcorrection of the hindfoot into varus, uncorrected calcaneus deformity, and anterior graft orientation largely contributed to the poor results. Weight-bearing radiographs of the feet and ankles are necessary to distinguish ankle valgus from hindfoot valgus. A subtalar arthrodesis cannot be used to compensate for ankle valgus, nor can it be used to correct the calcaneus component of a deformity without appropriate muscle-balancing procedures or osteotomies.

Although an uncommon cause of arthritis, sporotrichosis may mimic other forms of joint disease and should be considered in the differential diagnosis of a patient with a chronic monoarticular arthritis or if granulomatous synovitis is recognized by histologic examination. Characteristic skin findings may be absent, repeated cultures may be necessary, severe osseous destructive changes can occur, and surgical extirpation of the diseased tissue combined with amphotericin B chemotherapy is recommended.

Sixty total hip arthroplasties (THA) were performed in 39 renal transplant recipients as the treatment for painful osteonecrosis of the femoral head. The average age was 32 years (range, 16-54 years). The average preoperative Harris hip score was 38, while the average postoperative score was 95 after an average follow-up period of 44 months. Ten hip dislocations occurred. The etiology appeared to be multifactorial. One femoral component loosened, and one patient died from a deep wound infection. Although renal transplant patients have a reduced life expectancy and chronic corticosteroid immunosuppression leads to osteoporosis of bone, THA is well tolerated and is recommended as the procedure of choice in patients with painful osteonecrosis.