Sideline Management of Fractures

Abstract

Athletes have the potential to sustain a myriad of injuries, ranging from muscle strains and overuse to fractures and dislocations. The team physician and sideline medical professionals must be keenly aware of the risk potential, and have an emergency plan in place to address any potential injuries. Bone injury can range from unstable, open fractures to overuse and stress fractures. Coaches and players may challenge recommendations regarding not only treatment, but also return-to-play issues. The fundamental guideline must always be what is safe for the athlete. Decisions must be individualized for each athlete, anatomic site, and injury. If the athlete is not at significant risk to himself, the fracture is healed or can be protected, and the athlete can function at his previous level with a protective device, he may be able to return to sport.

Extremity trauma: field management of sports injuries

“…Radiographs should also be obtained for all athletes who have sustained joint dislocations or ligamentous injuries with gross laxity to look for associated bony avulsions or osteochondral fractures. The need for additional imaging (CT scans, MR imaging, etc) should be at the discretion of physicians with expertise in management of those specific musculoskeletal injuries [11].…”

“…Sideline treatment of closed fractures is focused on preventing the injury from becoming an open fracture and minimizing the risk to neurovascular structures from the splintered bone ends [11]. The team physician may attempt to reduce markedly displaced fractures prior to obtaining initial radiographs.…”

“…Reduction should only be attempted once as there may be a soft tissue block to reduction, and additional attempts may cause further damage. A postreduction neurovascular examination is mandatory and any change in neurovascular status requires urgent transfer [11,12]. After reduction, the physician should immobilize the fractured bone as well as the adjacent joints [11,18].…”

“…A postreduction neurovascular examination is mandatory and any change in neurovascular status requires urgent transfer [11,12]. After reduction, the physician should immobilize the fractured bone as well as the adjacent joints [11,18]. Immobilization, ice, and elevation can reduce the pain and swelling associated with fractures and allows early treatment of fractures requiring surgery (Fig.…”

Medical Management of Youth Baseball and Softball Tournaments

“…For severe injuries, where emergency care is immediately available, the simplest thing is to make the player as comfortable as possible and call for the onsite paramedics. Minor injuries where the patient seems comfortable and there is no clear displacement or neurovascular compromise can be splinted and referred to an urgent care or close outpatient follow-up (8,9,15,20).…”