Mechanically assisted crevice corrosion in modular total hip replacements may lead to an adverse local tissue reaction (ALTR) with a variety of sequelae. Although an ALTR is most commonly recognized with metal-on-metal modular hip constructs, tribocorrosion at the head-neck junction of metal-on-polyethylene (MoP) total hip arthroplasties may also lead to an ALTR. We present a case of a 79-year-old woman with a history of MoP total hip arthroplasty who presented with unilateral leg swelling, joint pain, and stiffness and subsequently underwent revision for an ALTR secondary to mechanically assisted crevice corrosion. This unique case of lower extremity vascular compromise resulting from an ALTR is important because clinicians should consider corrosion-related ALTRs when treating patients with an MoP hip prosthesis presenting with new-onset lower extremity swelling.
Purpose
To assess statewide prevalence of medical access, concussion reporting, and concussion clearance rates of high school athletic departments in Massachusetts after the implementation of state-wide concussion legislation.
Methods
A random sample of 50 athletic directors (ADs) from Massachusetts high schools with an enrollment of >150 students was selected. A 10-minute electronic survey about access to athletic trainers and physicians, and concussion reporting and clearance practices was administered. Responses were anonymous.
Results
The response rate was 80% (n = 40). In total, 90% of respondents were male. Median age and experience of respondents was 52 years old and 10 years, respectively. The median school size was 637 students, represented from all Massachusetts geographic athletic districts. ADs disclosed that on average, 12% (95% confidence interval 7%-20%) of concussions go unreported at their schools. In total, 16% of respondents reported that at least 1 in 4 of concussed athletes at their school returned to play without appropriate medical clearance, and 5% of ADs reported that not all of their coaches had undergone any form of concussion training. Overall, 55% of high schools do not have access to a full-time athletic trainer and 50% do not have a team physician; 20% have affiliations with an orthopaedic surgeon and 8% with a neurologist.
Conclusions
Despite new regulations in Massachusetts, high school ADs report concussion reporting and clearance that are less than 100%. Less than one half of all Massachusetts high schools report access to a full-time athletic trainer or formal relationship with a school physician.
Clinical Relevance
Investigating compliance with Massachusetts school athletics safety regulations could help identify a need for reform of policies designed to help schools keep student athletes safer in situations where a concussion may have occurred.
Acute RSA with tuberosity repair may be a reasonable treatment modality in the setting of an acute brachial plexus palsy following a comminuted fracture-dislocation of the proximal aspect of the humerus in an elderly patient.
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