RESUMEN
The tibial plateau is an important load-bearing surface in the knee, and when fractured, there is subsequent loss of motion and stability. These fractures typically result from axial loading and twisting. Our case outlines a tibial plateau fracture in a 15-year-old soccer player. The physical examination was positive for a decreased range of motion, pain with valgus stress, and positive ballottement. Radiography of the knee revealed joint effusion but no definite fracture. MRI revealed a Schatzker Type III fracture and a partial medial collateral ligament (MCL) tear. Our patient was referred for open repair and internal fixation. The Schatzker classification system is divided by type and location of fracture. Types I through III are located laterally, Type IV is medial, Type V identifies bicondylar fractures, and Type VI identifies tibial diaphysis separation from the metaphysis. These fractures are managed both nonoperatively and operatively. Nonoperative management is recommended for minimally displaced fractures that will heal without notable deformity. Operative management is indicated for displaced and unstable fractures, which include all fracture Types IV through VI, and certain Type I through III fractures that have valgus alignment or large articular surface involvement. Recovery time is lengthy and largely dependent on the fracture type. The first six weeks usually involve non-weightbearing, the second six weeks include weightbearing as tolerated, with knee range of motion exercises and muscle strengthening. Although open repair and internal fixation usually provide good results, some athletes cannot return to their previous levels of activity.
RESUMEN
OBJECTIVE: To determine if there is any benefit to static stretching after performing a dynamic warm-up in the prevention of injury in high school soccer athletes. DESIGN: Prospective cluster randomized nonblinded study. SETTING: 12 high schools with varsity and junior varsity boys' soccer teams (24 soccer teams) across the state of Michigan. PARTICIPANTS: Four hundred ninety-nine student-athletes were enrolled, and 465 completed the study. One high school dropped out of the study in the first week, leaving a total of 22 teams. INTERVENTIONS: Dynamic stretching protocol vs dynamic + static (D+S) stretching protocol. MAIN OUTCOME MEASURES: Lower-extremity, core, or lower-back injuries per team. RESULTS: Twelve teams performed the dynamic stretching protocol and 10 teams performed the D+S stretching protocol. There were 17 injuries (1.42 ± 1.49 injuries/ team) among the teams that performed the dynamic stretching protocol and 20 injuries (2.0 ± 1.24 injuries/ team) among the teams that performed the D+S protocol. There was no statistically significant difference in injuries between the 2 groups (P = .33). CONCLUSIONS: There is no difference between dynamic stretching and D+S stretching in the prevention of lower-extremity, core, and back injuries in high school male soccer athletes. Static stretching does not provide any added benefit to dynamic stretching in the prevention of injury in this population before exercise.