Case Reports


Multiple Mandibular Fractures

I am writing a chapter on facial trauma in sports and am learning quite a lot as I go.

For many of you, I am preaching to the choir when I write that teaching is one of the best ways to learn.

My charge in this chapter is to cover many aspects of maxillofacial trauma, including entities I may have dealt with infrequently, or have referred promptly and never directly handled myself (maxillofacial trauma not infrequently requires surgical intervention).  That’s where the teaching–or writing in this case–as learning comes in.

I have seen my fair share of facial trauma during sideline coverage of sports.  Aside from simple contusions, I would estimate that the most common entity I have to deal with is facial lacerations, followed by nasal fractures and epistaxis.  But I have never conservatively managed an athlete with a frontal bone fracture.

One of the offerings in the journal that is relevant to this subject is our ‘Case Reports’ section.  I think the Original Research our journal offers is our strongest suit, but the published case reports cover such a wide variety of subjects, I find that I can learn a great deal from them.  This is most especially true if an author is reporting on a truly novel case or treatment.   I specifically leaned heavily on a specific case report in the writing of my chapter:  “Conservative Treatment in an Isolated Anterior Wall Frontal Bone Fracture in an Elite Soccer Player,” by C Eirale, R Lockhart, and C Hakim, in the 2010 CJSM.

I am citing this journal article in the writing of the chapter, as I found it to be full of useful information.  Frontal bone/sinus fractures can result in serious morbidity (ranging from chronic sinus dysfunction to meningitis); surgery is often indicated.  In this particular case, the authors and treating physicians felt they could treat conservatively, given that:

“(1) no posterior wall fracture on the imaging; (2) absence of cerebrospinal fluid (CSF) rhinorrhea; (3) integrity and patency of nasofrontal duct (no fracture on imaging and no signs of mucus or blood retention in the sinus); and (4) absence of laceration over the fracture (allowing a direct access for reduction and osteosynthesis).”


Rod of Asclepius

The soccer player made a remarkably quick recovery, playing a match (with facial protection) only three weeks after this serious injury.  How’s that for mending the wound!  Those sports clinicians would make Asclepius proud!

The journal’s Case Reports editor looks for discussions of novel pathologies or treatments.  Most of our submissions are solid but must be turned away because they do not follow our strict criteria for consideration of publication for these type of reports.  Our Case Report for the most recent, July 2014 CJSM is a good example of  what we look for when deciding to publish.  The case deals with the use of pulsed ultrasound (LIPUS) in the successful treatment of a delayed union of a hook of the hamate fracture.  We thought this was an uncommon enough pathology, with a novel treatment approach, to be considered worthy of publication.

And now,  I head back to writing the chapter.  A September 1 deadline is looming.  With football season nigh (first game is Friday evening August 29), soon enough I won’t be writing (or reading) about such injuries……I’ll be too busy handling them on the sideline!

There’s a lot coming up both in the world of sports (US Open tennis, the first kickoff of the American football season….) and the world of sports medicine (our 5th edition of CJSM for the year is about to publish). I have some great guests lined up for some upcoming podcasts.  It will be a great fall.  See you again soon on-line!


New Concussion Research from CJSM


claire and katie

With the dog days of summer come concussions. And with concussions come research!

I think of August as the ‘lull before the storm':  with the dog days of summer come two-a-days in American football.  Around the country, the school  fields fill with kids playing the most popular contact sport in the U.S.:  football, to an American; ‘gridiron football’ to the rest of the world.

And with these days we begin, in our clinics, to see a steady, inexorable rise in the number of concussions to be evaluated. By mid-September, we can’t seem to open enough clinic space to see everyone clamoring to get in.

Last year, at this time, I wrote a post on the freely available concussion offerings we have at CJSM, and I am re-posting that entry(see what follows this new entry, below) for folks to read and see what we have in store when you visit the main website.

Over the past year, we have published many additional research articles, some of which are in the print queue and only available on line.  I wanted to draw your attention to a couple of those offerings, as they have real, clinical impact on the way we may practice.

The authors Carrie Rahn, Barry Munkasy, Barry Joyner et al.  looked at the BESS test as performed on the sideline of actual events, and found that the test performance deteriorated when compared to more controlled environments.  They conclude that ” Clinicians need to consider the role of the local environment when performing the BESS test and should perform postinjury tests in the same environment as the baseline test.”

And a very interesting article with a group of authors including Bob Cantu and Chris Nowinski looked at the efficacy of concussion education programs and determined:  “Preseason concussion knowledge was not significantly associated with in-season reporting behavior. Intention to report concussion symptoms was significantly related to in-season reporting behavior.”   Important to the understanding of this article is their discussion on the psychosocial construct of ‘reporting intention.’  As ever, one finds in the realm of public health that education alone is unlikely to alter behavior.

Read these studies: “Sideline Performance of the Balance Error Scoring System During a Live Sporting Event” and  “Concussion Reporting Intention:  A Valuable Metric for Predicting Reporting Behavior and Evaluating Concussion Education,” by Emily Kroshus, Christine Baugh, Daniel Daneshvar, et al.

There’s a lot to learn!



Originally posted on Clinical Journal of Sport Medicine Blog:

We’ve been profiling sports-related concussions (SRCs) in the August posts here on the CJSM blog.

We’ve taken a peek at the use of computerized neurocognitive tests in the diagnosis and management of SRCs; conducted a poll on the entity known as “Second Impact Syndrome”; and interviewed Dr. Jason Mihalik of the University of North Carolina, who is one of the principal developers of a celebrated app helping laypeople identify when an athlete might be concussed.

In this post, I wanted to alert the readership to a special set of journal articles CJSM is releasing for free for a limited time, a set devoted to this issue of SRCs.

chris hughes 2

No, that’s not “Big Brother,”
that’s the CJSM Editor-in-Chief,
Christopher Hughes MBBS, MSc

Our Editor-in-Chief, Dr. Chris Hughes, describes the special collection of ten journal articles in this YouTube video.

I am very excited to pass this…

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Published On-Line First


What we once dubbed ‘Published Ahead of Print’ (PAP), we now call ‘Published On-Line First‘ (POLF???). Whatever the phrase or acronym, I can attest to the benefit as an editor, a reader, and an author.  The publication flexibility that publishing on line provides is extraordinary.  We get many excellent manuscripts submitted for consideration.  The few that make it through our rigorous peer review must then wait in the queue to get on the actual pages of the journal; and so, with publishing on line, we can make the authors’ scientific findings available immediately, even before we have copy on paper.  The articles are immediately found on PubMed and are citable with their unique digital object identifier (DOI) number.

As a reader, I enjoy this functionality.  I rarely get my medical information any more from paper.  I still receive CJSM and other journals (Sports Health, JAMA, MSSE, etc.) in the mail.  I might page through them as I eat breakfast; I will have them on my nightstand to skim prior to sleep.  But most of the time, I am reading my medical journals on the laptop or iPad.  Or I’m sharing a link to a study with someone on twitter.  All of this can only be done with an on-line publishing functionality.  It’s brilliant.

Finally, as an author:  it is always exciting to get your manuscript through peer review.  Always exciting to see the months to years of hard work culminate with an accepted manuscript.  Historically, one would then wait for some time before actually seeing the manuscript in print.  Now, once a CJSM author has completed their post-acceptance corrections, reviewed the galley proofs, and so on, their work can be disseminated immediately.  As an example, here is a recent bit of excitement I just had as an author in the pages of CJSM: ‘Reliability of a computerized neurocognitive test in baseline concussion testing of high school athletes.’ 

I am off on vacation, and so I thought I would share a post on PAP from 2013.  More soon!

Originally posted on Clinical Journal of Sport Medicine Blog:

Time to time, I like to share with readers of this blog some of the features of CJSM with which they may not be familiar.  Our journal’s website has a wealth of resources that I’d encourage you to check out regularly.

For instance, besides publishing the full journal every two months, we frequently disseminate breaking sports medicine research in a more fluid, continuous fashion via our “Published Ahead of Print” (PAP) feature.  PAP allows us to pursue a major goal we editors have:  to contribute to the world of clinical sports medicine in a contemporary fashion, taking advantage of the multi-media offerings of the digital world.   This goal is reflected in this blog itself; in the podcast feature we have just begun; in our engagement with you on social media; and in the journal’s iPad functionality.

“When you want it….where you want it…the way you want it.”  That’s…

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Dr. Hamish Kerr joins us on “5 Questions with CJSM”

The Commonwealth Games in Glasgow are having their closing ceremony today.  Among the many sports that have been declared a success in these games is Rugby 7’s, which saw South Africa beat the New Zealand All Blacks for rugby gold.

Soon, many of these same athletes will begin tramping around the globe:   the International Rugby Board (IRB) HSBC Sevens World Series begins in Australia in October. As the series circumnavigates the globe, it will make stops from Dubai to Las Vegas, and points in between, before it wraps up in May 2015 in England (which, by the way, will host the Rugby World Cup in 2015).

And by that time, we’ll be just about a year from Rugby 7’s making its debut as an Olympic Sport in Rio.

Yes, I would say, rugby is in ascendancy as a sport right now both globally and domestically.   Here in America, for instance, youth rugby is growing at an astounding rate.  We publish frequently on the sport in our journal, and I have a particular fondness for the sport having spent some of my adult life in southern Africa and in New Zealand, where it is, arguably, religion.

HK at Twickenham

Dr. Hamish Kerr at Twickenham Satidum, home of England Rugby

One of my colleagues whom I hold in great esteem, Dr. Hamish Kerr, is intimately involved with rugby.  I have been after him for a while to a guest post on our “5 Questions with CJSM” format.  It is appropriate that we have him guesting today, as the Glasgow games wrap up……

Dr. Kerr finished medical school in Glasgow in 1998 and moved to Albany, NY in 1999 for his combined Med/Peds residency. He spent another 18 months back in Scotland in 2004 prior to starting his sports fellowship in Boston in 2005, where he worked under Dr. Lyle Micheli, who, among his multiple other lifetime honors, was recently inducted into the USA Rugby Sports Medicine Hall of Fame.

Before I took off for a summer holiday, I asked Dr. Kerr to put pen to paper and answer the following questions.




1) CJSM: You wear a lot of hats:  practicing clinician, educator, team physician.  Can you give us a run down of your various commitments.

 HK: I am principally the sports medicine fellowship director for Albany Medical College. We have a fellow, residents and medical students rotating with us year round. I have 5 faculty who see a mix of musculoskeletal medicine and sports concussion patients. I practice in two sites, one with Capital Region Orthopedics and another academic office site where we see most of the sports concussions and have a multidisciplinary clinic. We have MSK ultrasound, ImPACT, and treadmill testing available.

My 2nd role is as head team physician at Siena College. We provide field side cover for men’s and women’s soccer and basketball , plus men’s lacrosse. Siena men’s basketball made the NCAA 3 tournaments in consecutive years 2008-2010 and will host the MAAC tournament in 2015.

USA Rugby I have been working with for 4-5 years. It is a voluntary position, but very enjoyable. I have covered the men’s national team for the 15-game and the 7’s-game as a team physician both on home soil and abroad, including the UK, Mexico (Pan Am Games 2011) and Moscow (IRB Sevens Rugby World Cup 2013). I also Chair the Medical & Risk Committee and serve as a member of the Rugby Committee helping administer the game in the USA from a medical perspective. Read more of this post

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