Critical review of the available evidence indicates that a relationship exists between sufficient vitamin D status and stress fractures, although genetic and environmental factors are involved as well. Patients at high risk for stress fracture should be educated on protective training techniques and the potential benefits of supplementation with combined calcium and vitamin D, particularly if increased exercise is planned during winter or spring months, when vitamin D stores are at their lowest. The amount of vitamin D intake required is highly variable depending on many factors including sun exposure, and therefore many recommendations have been made for daily vitamin D intake requirements. While the Institute of Medicine guidelines suggest that 600 to 800 IU of vitamin D are required for adequate bone health in most adults, we recommend that most patients receive 800 to 1,000 IU and perhaps as high as 2,000 IU of vitamin D3 as outlined by the previously mentioned review article since vitamin D is a safe treatment with a high therapeutic index. Also, at least 1,000 mg of calcium per day is required for optimal bone health and 1,200 mg may be needed in certain populations. Orthopaedists should consider prescribing vitamin D and calcium prophylactically in high-risk patients. In patients in whom deficiency is a concern, serum 25(OH)D level is the appropriate screening test, with therapeutic goals for bone health being at least 50 nmol/L (20 ng/mL) and may be as high as 90 to 100 nmol/L (36 to 40 ng/mL).

Medial-sided knee injuries can result in pain, instability, and loss of function. Many clinical studies have been written on the treatment of medial-sided knee injuries; however, the vast majority are isolated case series of surgical or nonoperative treatment regimens, and only a few randomized prospective clinical trials can be found in the literature that compare different treatment modalities. Comparison of these treatments is challenging due to the variety of medial-sided structures that can be involved, the multiple different approaches to treatment, and the variability of how objective and subjective clinical outcomes are reported. In this paper we report on the injuries by extent and type of anatomic structures damaged including partial medial-sided injuries, completed isolated medial-sided knee injuries, and combined injuries. In general, most authors concur that isolated partial or complete medial collateral ligament (MCL) injuries can be treated nonoperatively with a brace and early motion with good clinical outcomes. Prospective, randomized trials support nonoperative treatment of the MCL in combined anterior cruciate ligament-MCL injuries. Knee dislocations and posterior medial corner injuries appear to have better results with surgical management including reconstruction. Multiple reconstructive techniques have been described for chronic injuries but it is difficult to compare their results.

No abstract

Internationally, several policies have been designed to prevent pathological or "problematic" gaming issues in youth, commonly referred to simply as 'game addiction'. Particularly following the release of the World Health Organization's (WHO) "gaming disorder" diagnoses, policy makers may be inclined to enact further policies on this matter. With new data reflecting lack of success for South Korea's shutdown policy, the efficacy of current policy efforts remain in doubt. Given continued controversies regarding whether pathological gaming (PG) or gaming disorder (GD) is best conceptualized as a unique disorder rather than symptomatic of other, underlying disorders, little data has emerged to encourage policy interventions. By contrast, policy interventions at this juncture may risk doing considerable harm and wag the dog in the sense of reifying a pathological gaming disorder that remains problematic and under contentious debate in the field. We advise caution, ethnographic and qualitative research approaches, open science, etiological comprehension, and more time to fully understand whether pathological gaming is the best target for policy interventions and informing clinicians. regarding the efficacy of public policies targeting gaming overuse and provides suggestions for future policies. A Brief Overview of Gaming Overuse Research. Scholarship on gaming overuse began as early as 1983 when perhaps the first article on the topic referred to "junk-time junkies" (Soper & Miller, 1983). In the intervening 36 years a subject search on PsychINFO for ["pathological gaming" OR "video game addiction"] returned 101 articles. So this is definitely a topic of great interest. Several excellent reviews of this topic have been written from varying perspectives (e.g. Hellman et al., 2013; Pontes, 2018). A full summary of this nearly 4-decades old research field is beyond the scope of this paper. Thus our review here is summative. Much of the research has focused on the parameters of pathological gaming. These include issues such as it's conceptual utility, means of diagnosis, biological or neurological markers (if any), distinguishing pathological from engaged gaming (e.g. Charlton & Danforth, 2007), cooccurrence with other mental disorders, as well as cultural reactions to new technology including technophobia and moral panic (Bowman, 2016). Despite several decades of research, opinions among scholars on these issues remain significantly divided. This is not to say that one view is correct and the other wrong, merely to note that a wide ranging literature has not always provided either consensus or clarity on these fundamental issues. Perhaps the one issue most scholars might agree upon is that some individuals play games instead of engaging in other life responsibilities. Yet, whether the games themselves are responsible for this, or whether gaming is a fun activity some people do to distract themselves from other mental health issues remains less clear. Nonetheless, several efforts have moved forward with implementing polici...