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September 9, 2018 Leave a comment
A tibial spine avulsion fracture — an injury requiring surgery, and significant pain management.
The new academic year has begun in North America, and with it a new set of sporting seasons and a surge in sports’ injuries in our clinics. Youth and school soccer and football provide many of the injured patients I manage. For instance, a few days ago, on a Friday, I saw a 12-year-old boy who described a twisting injury to his knee, with immediate disability and an effusion. I saw him in my clinic the day after his injury and discovered he had sustained a tibial spine avulsion fracture.
These injuries typically occur in skeletally immature patients aged 8 to 14 who sustain twisting or valgus moments to a hyperextended knee. Though relatively uncommon, a tibial spine avulsion fracture is seen rather often in a specialty center like mine that focuses on the care of the pediatric and adolescent athlete.
In the USA (perhaps everywhere?), these will almost always require surgical fixation. Since I am a primary care sports medicine physician, this means I was on the phone immediately with my orthopedic surgical colleague, and the child was booked for the OR on Monday.
What remained for me to deal with were the important issues of splinting and pain management over the weekend.
Pain management in the injured athlete — a broad topic which challenges a clinician on an almost daily basis. I would add that I have found the issue has become increasingly challenging with the opioid epidemic that has ravaged the USA, most especially in states like Ohio, where I practice.
Over the nearly 25 years I have been a physician, I have seen the conversation about analgesia change from one putting an emphasis on ‘pain as a vital sign’ to one asking the question: in the physician’s efforts to alleviate pain, has patient safety been compromised?
(L to R) Three greats from South Africa: Martin Schwellnus, Wayne Derman, Pierre Viviers
It is an ever-timely contribution, then, that our September 2018 issue is a thematic issue devoted to the topic of pain management in the athlete. I am delighted to add that our Guest Editor this month is Professor Wayne Derman who is Director and Chair of the Institute of Sport and Exercise Medicine at the Division of Orthopaedic Surgery, Stellenbosch University, Cape Town, South Africa.
I count Wayne as a friend, and I am happy to let you know I plan to conduct a podcast with him in the next month so you can hear directly from our guest editor how he brought this issue together.
In the meantime I urge you to go to this issue and check out the many interesting articles, ranging from the excellent editorial about ‘deromanticising’ the image of athletic pain authored by Prof. Derman to the open access study on Cannabis and the Health and Performance of the Elite Athlete.
