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The frequency and nature of exertion pains of the leg in athletes were studied in 2,750 cases of overuse injuries treated at the Sports Clinic of the Deaconess Institute of Oulu, Finland, during the years 1972-1977. 465 cases of exertion pain (18%) were located in the shin. The medial tibial syndrome was the most common overuse injury among these athletes, comprising 9.5% of all exertion injuries and 60% of the leg exertion pains. Together with stress fracture of the tibia, the second most common exertion pain of the leg, it accounted for 75% of the total leg pains. There are certain difficulties in differentiating between the medial tibial syndrome and stress fracture of the tibia. They both occur at the same site with similar symptoms. Radiological examination and isotope scanning are needed. The medial tibial syndrome is an overuse injury at the medial tibial border caused by running exercises. The pain is elicited by exertional ischaemia. The pathogenesis is explained by increased pressure in the fascial compartment of the deep flexor muscles due to prolonged exercise. Similar chronic ischaemic pains from exercise are also found in other fascial compartments of the leg, especially in the anterior compartment. The only treatment needed for stress fractures is rest from training. Fascial compartment pains also usually subside. If chronic fascial syndromes prevent training, fasciotomy is recommended as a reliable method to restore the athlete to normal training without pains. [ABSTRACT FROM PUBLISHER]

Proximal stress fractures of the second metatarsal are rare. They have been reported mainly in classical ballet dancers. Non-operative treatment has usually led to good results and rapid return to full activities. We present a series of nine cases with stress fractures of the proximal second metatarsal. The patients were all actively involved in sports. None of them were dancers. In all of these patients non-operative treatment lasting for an average of 13 months had failed. All of the patients were operated on using the same method. In the operation drilling was performed around and through the fracture line. The patients were followed for an average of 38 months. All except one of the patients were able to return to their prior level of activity within 4-6 months. In conclusion if non-operative treatment fails surgery seems to give good results in most patients with a stress fracture of the proximal second metatarsal.

Total proximal avulsions of the quadriceps femoris muscle group are rare injuries. Between the years 2001 and 2004 five patients with a total proximal avulsion of the tendon of the rectus femoris muscle were treated surgically in Mehiläinen Hospital in Turku, Finland. The median age of the patients was 21 years (range, 19-27) and the patients were all men. There were four soccer players and one hurdler. In all cases an avulsion of the proximal tendon of the rectus femoris muscle was confirmed by MRI. All of the patients were operated on and the delay from the injury to surgery ranged from 18 to 102 days. The result of the surgical treatment was rated good in all cases. All of the patients were able to return to their pre-injury level of activity 5-10 months after surgery. The median follow-up time was 20 months (range, 9-38). Surgical treatment of a total proximal avulsion of the tendon of the rectus femoris muscle seems to result in return to the pre-injury activity level in most cases.

Background: Fractures of the proximal fifth metatarsal, other than those involving the tuberosity, have a tendency to delayed union or even nonunion., Hypothesis: Tension-band wire technique is a good alternative in treating fractures of the fifth metatarsal located in the proximal junction of the metaphysis and the diaphysis., Study Design: Case series; level of evidence, 4., Methods: Between 1996 and 2001, a total of 27 cases of proximal metaphysial/diaphysial fractures of the fifth metatarsal were treated with tension-band wiring. All of the patients had undergone prior unsuccessful nonoperative or operative treatment. The mean delay from the diagnosis of the fracture to the final operative procedure was 19.5 weeks (range, 6-48 weeks)., Results: The mean length of follow-up was 35 months (range, 12-70 months). All patients were able to return to their prior levels of activity. The mean time for union as shown on radiographs was 12.8 weeks, and the return to full activity took 8 to 20 weeks (mean, 14.7 weeks). There were no delayed unions, nonunions, or refractures during the follow-up., Conclusion: The tension-band wire technique seems to give good results in the treatment of proximal metaphysial/diaphysial fractures of the fifth metatarsal in cases of primary unsuccessful nonoperative treatment or primary unsuccessful intramedullary screw fixation.

Our aim was to identify factors predisposing athletes to multiple stress fractures, with the emphasis on biomechanical factors. Our hypothesis was that certain anatomic factors of the ankle are associated with risk of multiple stress fractures of the lower extremities in athletes. Thirty-one athletes (19 men and 12 women) with at least three separate stress fractures each, and a control group of 15 athletes without fractures completed a questionnaire focusing on putative risk factors for stress fractures, such as nutrition, training history, and hormonal history in women. Bone mineral density was measured by dual-energy x-ray absorptiometry in the lumbar spine and proximal femur. Biomechanical features such as foot structure, pronation and supination of the ankle, dorsiflexion of the ankle, forefoot varus and valgus, leg-length inequality, range of hip rotation, simple and choice reaction times, and balance in standing were measured. There was an average of 3.7 (range, 3 to 6) fractures in each athlete, totaling 114 fractures. The fracture site was the tibia or fibula in 70% of the fractures in men and the foot and ankle in 50% of the fractures in women. Most of the patients were runners (61%); the mean weekly running mileage was 117 km. Biomechanical factors associated with multiple stress fractures were high longitudinal arch of the foot, leg-length inequality, and excessive forefoot varus. Nearly half of the female patients (40%) reported menstrual irregularities. Runners with high weekly training mileage were found to be at risk of recurrent stress fractures of the lower extremities.

We determined the incidence of a total Achilles tendon rupture in the city of Oulu and changes over the 16-year period 1979-1994. During this time, 110 ruptures occurred. The incidence increased from 2 ruptures/10(5) inhabitants in 1979-1986 to 12 in 1987-1994, with a mean of 7. The peak annual incidence, 18, was recorded in 1994. The incidence was highest in the age group 30-39 years. Male dominance was 5.5:1, and 81% of the ruptures were related to sports, with 88% occurring in ball games. The mean age was significantly lower for the sports injuries.

The association between ABO blood groups and Achilles tendon (AT) ruptures was studied in 215 consecutive AT rupture patients treated at Oulu University Hospital during the 16-year period from 1979 to 1994 as compared with control material consisting of earlier blood group determinations performed on an unselected sample of 5,536 young Finnish male adults. There was no blood group O dominance or other statistical differences in ABO blood groups between the patients with AT rupture and the control population (chi 2 3.79, P = 0.28), the A/O ratio being 1.82 in the rupture group and 1.42 in the controls. We found no blood group O dominance in competitive athletes, recreational athletes or non-athletes, in patients with sports-related AT ruptures or non-sports-related ruptures and in younger (< 45 years) or older (> or = 45--years) patients. In conclusion, our results do not confirm early findings of blood group O dominance in patients with AT rupture.

Objective: To determine the acute injury profile in each of six sports and compare the injury rates between the sports., Design: Analysis of national sports injury insurance registry data., Setting: Finland during 1987-91., Subjects: 621,691 person years of exposure among participants in soccer, ice hockey, volleyball, basketball, judo, or karate., Main Outcome Measures: Acute sports injuries requiring medical treatment and reported to the insurance company on structured forms by the patients and their doctors., Results: 54,186 sports injuries were recorded. Injury rates were low in athletes aged under 15, while 20-24 year olds had the highest rates. Differences in injury rates between the sports were minor in this adult age group. Overall injury rates were higher in sports entailing more frequent and powerful body contact. Each sport had a specific injury profile. Fractures and dental injuries were most common in ice hockey and karate and least frequent in volleyball. Knee injuries were the most common cause of permanent disability., Conclusions: Based on the defined injury profiles in the different sports it is recommended that sports specific preventive measures should be employed to decrease the number of violent contacts between athletes, including improved game rules supported by careful refereeing. To prevent dental injuries the wearing of mouth guards should be encouraged, especially in ice hockey, karate, and basketball.

During three years, 274 exertion injuries in middle-aged keep-fit athletes were collected. A keep-fit athlete was a person, who regularly took part in noncompetitive sports activities. Exertion injury was a nontraumatic pain syndrome in the musculo-skeletal system. In the material, there were 35 women and 239 men. Most of them were 30--39 years old. Most exertion injuries took place in July, August, and September. About 80% of the patients were joggers. 80% of them had been training regularly for more than one year. At the moment of occurence of the symptoms, 68% of the patients trained 3--5 times a week. Joggers ran approx. 40 km/week. About 30% of the injuries took place in the knee, 24% in the ankle, heel and foot, 17% in the leg, and 9% in the achilles tendon. Almost one fifth of the pain syndromes were chronic in nature. The majority responded well to rest and to conservative treatment. Fifteen cases were treated surgically. Most of the exertion injuries were typical exertion syndromes seen also in competitive athletes. Others were degenerative changes, organic anomalies etc., which revealed their first symptoms during regular keep-fit activities.

Over a period of three years 829 cases of greater than or equal to 16-year-old athlete exertion injuries and syndromes were collected. There were 75 women and 754 men in the series. About 90% of the athletes had been training regularly for more than two years, and 75% of them trained 6 times a week or more. Approximately 52% of the injuries occurred in track and field athletics, about 17% in ball events, 13.6% in skiing, 7.4% in orienteering, and 4.7% in power events. Other sports were associated with fewer exertion injuries. 28.7% of the conditions occurred in the knee, 17% in the ankle, foot and heel, 14.8% in the leg, 8.2% in the back and trunk, 8.1% in the thigh, 7.4% in the achilles tendon. The rest were in the shoulder, neck and upper extremities. In 92% of the patients conservative treatment and rest were used. Only 8% of the cases were treated surgically.