Treatment for Common Combat Arts Injuries
The Common Treatments section was created to help combat athletes understand how to handle a devastating injury, what will occur when seeking medical treatment and a few ideas for home remedies for non-critical injuries. As always, you should discuss any and all injuries with your Healthcare Professional. Click on the body part of concern in the table of content above to learn how they are treated.
Initially, the first step is resting. The ligament injury is splinted or cast. This is not for a prolonged period though. While immobilization can decrease the pain and allow the swelling to resolve it causes functional problems like adhesions and decreased collagen synthesis. Rest and the RICE (Rest, Ice, Compression, Elevation) protocol is the first-line treatment for ligament injuries.
NSAID’s are prescribed for pain relief. However, their use is cautioned in athletes. They do allow pain relief but block enzymes that promote ligament healing. If they are to be used, they must be done for the shortest period. Often, corticosteroid injections are given indirectly at the site of the injury.
These do reduce inflammation. Their anti-inflammatory properties are great for providing significant immediate relief. They also inhibit collagen synthesis so it can affect healing.
Prolotherapy has also been tried. This is regenerative therapy where injections of platelet-rich plasma are given directly into the site of injury. This is done to stimulate healing. The growth factors in plasma can stimulate soft tissue repair.
In some cases, surgery is done to remove the torn ligament and replace it with another ligament from the athlete’s body or a deceased donor.
Ligament injuries take a long time to heal due to the lack of their blood supply. Healing takes place through collagen synthesis and fibrosis. Any fibrosis scarring can limit the function and stretch, it is therefore important to identify the injury early and then treat it accordingly.
Stress fractures are classified as high risk and low risk. The low-risk stress fractures that occur in the tibia, 2nd to 4th metatarsals, fibula, pubis, sacrum, and femur are managed differently. High-risk stress fractures where blood supply is challenging like the femoral neck, anterior tibia, tarsal navicular, talus, sesamoids bones, and 1st and 5th metatarsals do not do well with conservative treatment. These should be referred to surgery immediately. Manage must be managed with pain medications.
In general, low-risk stress fractures are treated conservatively with no weight-bearing for 2 to 6 weeks, and then a gradual return to activity. Calcium and vitamin D supplementation is beneficial. Braces and orthoses for spinal stress fractures are also helpful until the athlete is pain-free.
High and low-risk stress fractures require a rehabilitation plan. They both need a period of immobilization to allow healing of the fracture. The rehabilitation plan takes place in two phases. Phase one involves active rest. During this period of immobilization, the injury is allowed to heal without any further exacerbation.
Aerobic fitness using no-impact activities like cycling, swimming, deep water running, and zero-gravity running can be done instead. If the martial artists is been pain-free for two weeks, then phase two is started. During phase two, the rehabilitation focuses on strengthening.
The goal is to strengthen the muscles, improve proprioception, strengthen the core and pelvic girdle muscles if the injury involves the extremities, and return to the level of fitness before the injury. The result must be to return to full activity.
Gait analysis is also helpful for those who sustain a stress fracture in the feet. For those using running as part of their cardio activity increase the time and distance by only ten percent per week.
FULL FRACTURE / BROKEN BONES
ATLS Protocols must be followed to ensure that the athletes’ vitals are stable and not in hemorrhagic shock. IV fluids, pain medications, and resuscitation are carried out. Open fractures are an emergency and must be surgically treated without delay.
If the fracture is compromising a blood vessel, doctors may try to reduce the fracture immediately. The wound is irrigated with one liter or more of saline or a combination of saline and betadine. A sterile or betadine soaked dressing is placed over the wound.
The entire affected limb is immobilized with a well-padded splint. Keep the wound covered. Antibiotics are started. Tetanus status is checked. If a combat artist has not completed the tetanus series or not had a booster in the last five years, tetanus toxoid is given right away. An orthopedic surgeon is consulted to plan the surgery.
The extent of the injury, degree of contamination, time to treatment, and other comorbidities determine the time for healing. Open fractures require prolonged recovery times and fighters can sustain some degree of functional disability.
The treatment of bone chips depends on the age of the fighter, how severe the symptoms are, and the stability of the lesions. In stable lesions, conservative management is preferred. This includes immobilization and protected weight-bearing.
Those fighters in whom conservative treatment fails are treated with drilling procedures. This could b retroarticular or transarticular drilling. When the lesions are unstable or displaced, surgical intervention is done arthroscopically. 58% of procedures for OCD lesions are done on the knee and are surgically treated by fixation, debridement, microfracture, and cartilage grafting.
Fixation of lesions in situ is done with metallic screws, bioabsorbable implants, or osteochondral plugs. Metallic fixation screws do need a second procedure after the initial fixation. This is done 6 to 12 weeks after the first one to remove the screw. Bioabsorbable implants do not require two procedures. Osteochondral autograft or allograft plugs are used to promote cartilage reformation and repair. This is an attempt to prevent early-onset osteoarthritis.
Stable osteochondral lesions heal better than unstable lesions. Stable lesions treated with conservative treatment alone heal spontaneously. Unstable lesions undergoing surgery have a success rate of 30% to 100%. The range is wide and largely depends on the technique. The vast majority of fighters with surgical treatment still develop early-onset osteoarthritis.
This is not an emergency as the condition develops over time. However, the American College of Foot and Ankle Surgeons still recommends conservative therapy as the first line of treatment.
Conservative treatment starts with a trial of wide shoes and orthotics. The symptoms are managed here and correction of the deformity is not attempted. Other steps in the treatment include modifying the shoes into low-heeled, wide shoes.
Orthoses are used to improve alignment and support. Analgesics like acetaminophen and NSAIDs are given to reduce the pain. Icing the inflamed deformity is advised to decrease inflammation. Bunion pads are prescribed to prevent irritation of the deformity. Stretching exercises are also recommended to keep the joint mobile and flexible.
If pain persists with conservative treatment then surgical management is advised. There are over 150 surgical procedures for the correction of HV deformity. The most common is an osteotomy. Here an incision is made in the first metatarsal bone. It is then fixed into a less adducted position. The cut varies in position and shape.
A Wilson osteotomy is done with a straight cut while a chevron osteotomy uses a wedge-shaped cut. The incision is made near the base of the metatarsal also called a proximal osteotomy. It could be done in the shaft also called scarf osteotomy, or in the neck called a distal osteotomy.
Arthroplasty is a procedure where the mobility of the first MTP joint is maintained. The pain is relieved by replacing the joint with an implant or removing the joint altogether. Both hemiarthroplasty and total joint arthroplasty techniques are used.
Hemiarthroplasty maintains toe length. It also requires less resection of the bone. An interpositional arthroplasty is also done in those with severe bunion where the joint is very rigid. It helps to maintain joint range of motion. The Keller resection is the most common procedure where 50% of the proximal phalanx is resected. Through this procedure, doctors attempt to increase dorsiflexion and decompress the joint.
Arthrodesis is a procedure where the metatarsocuneiform or MTP joint is fused into the correct position. It is only done if the joint has severely degenerated and if the doctor feels like the athlete will never regain functionality.
Soft tissue procedures like the McBride procedure are another option. In this procedure, the fibular sesamoid is excised. This allows the interphalangeal joint to achieve flexion, MTP joint hyperextension and there’s a deviation of the hallux medially.
Postoperative care depends on the procedure and differs from case to case. However, foot doctors typically apply a dressing at the time of surgery to provide corrective forces. The dressing serves to compress the surgical wound. This reduces postoperative edema.
Weight bearing is limited for the first 2 weeks. After the sutures are removed, the range of motion exercises are started and weight bearing activities are gradually increased. With any bone procedure, healing takes around 6 to 7 weeks. In smokers, the healing takes longer. Martial artists typically can return to play approximately 6 to 12 weeks after the surgery. Any improvement can take up to 1-year after surgery. Fighters can still develop and experience hematoma, numbness, infection of the bone, cellulitis, avascular necrosis, hallux varus, limited joint range of motion, and recurrence of bunions.
The first step is to rest the bone or joint. Apply an ice pack several times a day to reduce the swelling if any.
Elevate the injured limb above the level of your heart. This will also reduce swelling. Pain medication will help to manage pain. Wear a brace or other orthotic device to limit movement. Doctors may suggest changing the diet. A diet rich in calcium, vitamin D, and proteins to promote healing and metabolism of the bone. Certain pain medications might be restricted as they delay normal bone healing. Stop smoking as it can also delay bone healing.
Weight-bearing is restricted. Most bone bruises heal slowly. On average, they take over 2 to 4 months. A larger bone bruise takes much longer to heal as the clot resolves. Return to sports activities is restricted for weeks or months until there’s complete resolution. If symptoms persist, then an MRI is ordered.
The treatment of tendinitis / tendinosis is usually conservative. It’s not a medical emergency but to rule out a fracture imaging must be taken immediately.
Rest, cryotherapy, and eccentric exercises are usually started. This is done with the help of a physical or occupational therapist. Oral and topical NSAIDs are not recommended in the treatment of tendinopathy as they can cause more harm than good. Steroid injections were commonly prescribed because while they provide short term relief, they delay they disrupt the normal inflammatory process which facilitates healing.
Most fighters with overuse tendinopathies recover completely within 3 to 6 months. For those combat artists who are not responding to conservative treatment, other alternatives are sought. Most of these alternatives are focused on the associated neovascularization. These include high-volume guided injections, percutaneous needle tenotomy, sclerosis, and percutaneous needle scrapings.
Other treatments like Glyceryl Trinitrate patches, percutaneous ultrasonic tenotomy, and orthobiologics such as platelet-rich plasma, stem cells are also done. However, their long term benefits are still being studied clinically. If all else fails, then, in the end, surgery via percutaneous tendon release is recommended.
The main step in preventing the action that is causing tendinitis. Since relapse of symptoms is very common, martial artists cannot simply go back to doing the repetitive moves that are causing the tendon to be affected. Overall, most fighters do have a recurrence of symptoms and they will undergo a combination of treatments.
PINCHED OR IMPINGED NERVE
The first step in treatment is identifying the degree of nerve injury. In the case of first and second-degree nerve injuries, most fighters recover on their own. However, this takes several months.
Most of the combat artists respond very well with conservative management. This includes the removal of occlusive devices that are worn and rest. Limit the offending activity that is causing this nerve impingement. For example, in the wrist halt all activities where there is repetitive pronation, supination, wrist flexion, and ulnar deviation.
Nerve glide exercises are prescribed as part of occupational and physical therapy. Activities involving the affected joint are modified. If symptoms do not improve activity modification and rest, then splinting is recommended.
If the nerve impingement is in an accessible area, then a doctor may do an ultrasound-guided hydrodissection to free the compressed portion of the nerve.
Oral or topical NSAIDs are prescribed for pain management. Corticosteroid and an anesthetic combination are injected into the area of pain to provide temporary relief. The steroid decreases the inflammation.
Surgery is always the last option if the condition is now chronic and conservative treatment has not provided any relief even after six to twelve months.
In the case of third-degree nerve injuries or neurotmesis, surgery is advised.
For acute conditions, direct surgical repair of the partial and complete nerve laceration is done. Nerve grafting techniques are used in the case of lacerations with retractions. Residual defects or "injury gap" that measure more than 2.5 cm are advised to undergo nerve grafting techniques. Autograft comes from the sural or saphenous nerves.
If splinting is recommended pre or post-surgery, then the splint has to be worn for at least two to four weeks. Or the splint must be work until symptoms resolve. Additional protective padding is provided if the athlete is undergoing repetitive trauma.
The acute management of any nerve entrapment is surgical. After the surgery, the combat artists must see a neurologist, hand surgeon, physical, and occupational therapist. Once the surgical site heals, most fighters require an extensive rehabilitation program to recover motor and sensory function. Additionally, they may have to wear protective splints to protect the hand perpetually. Recovery often takes months. And many will have residual deficits. The rate of recovery depends entirely on how much release the nerve has had. In the case of complete release, the impingement resolves completely.
Most nerve compression injuries are treated conservatively. In a few cases, surgery is advised.
For chronic injuries, a baseline EMG should is done within 1 month, and initially treated with physical therapy (PT). If there has been an injury that causes nerve compression, then most martial artists recover with non-operative treatment. If there is a gradual reduction of muscle strength and there is the possibility of permanent paralysis developing. So the primary injury must be treated. In the case of axillary nerve compression, the shoulder must be reduced and immobilized from anywhere between days to 6 weeks. It is then rehabilitated through an extensive physiotherapy program to regain muscle strength and shoulder mobility.
Surgical intervention is recommended if EMG shows no improvement even after 3 months. Acute nerve lesions require expedited surgical management, especially in the case of rapidly developing symptoms like numbness and paralysis.
Neurorrhaphy, neurolysis, and nerve grafting are all different surgical options. If there is associated muscle atrophy due to chronic nerve injury, then a muscle transfer can also be done.
In fighters with neuropraxia, complete recovery takes about 6-12 months. The muscle weakness spontaneously resolves. For those with axonotmesis where the axons of peripheral nerves with their myelin sheath are damaged, the recovery rates are about 80% and take months. Serial electromyogram (EMG) studies to assess for regeneration as the fighters' injuries are monitored. If by 6-9 months, recovery hasn’t taken place, surgery is considered. For those with neurotmesis where the nerve and nerve sheath is damaged severely, there is no recovery without surgery.
Most injuries will completely recovery in 7 months. Studies show that 85% of nerve graft recipients and 79% of nerve transfer recipients reach muscle strength of grades 4/5 or greater after 18 to 24 months of surgery.
The rehab protocol for nerve injury is divided into two phases over two months. The initial phase focuses on the restoration of joint kinesis, stabilization of ligaments, and then strengthening of the associated muscle. The second phase focuses on a return to function with emphasis on motor, postural, and proprioceptive control of the joint.
The pain is usually treated with conservative management initially. This includes rest and preventing any activity that caused the neuralgia. Any position or movement that exacerbates the pain must be halted.
Analgesics like non-steroidal anti-inflammatory drugs (NSAIDs), opioids, antiepileptics, and antidepressants are often prescribed and have been beneficial in varying degrees. Rehabilitation can be done through, transcutaneous electric nerve stimulation and myofascial release.
These rehabilitative procedures and acupuncture can control symptoms of pain. Ultrasound-guided nerve blocks can interrupt the transmission of pain and provide temporary relief. The nerve can be a local anesthetic or neurolytic agent with or without steroids. In this procedure, the fighter lies supine, and a probe with a frequency ranging from 5 to 10MHZ transversely scans the area. The nerve is located and the doctor uses a needle to introduce the drug block to the selected nerve.
If there is persistent intractable pain and conservative treatment has failed, then surgery is recommended. The most common procedure is neurectomy. In this procedure, doctors identify and dissect the nerve before the area of trauma. Occasionally, they may dissect the entire length of the nerve. It can be done via open surgery or laparoscopically.
This will need an interprofessional approach between psychiatrists, neurologists, pain physicians, and surgeons. The athlete must be educated and aware of pain medications and their adverse effects.
CRAMPS & SPASMS
Muscle cramps and spasms are treated conservatively. This is not a medical emergency.
Stretch the involved muscle or begin deep massages. The best treatment is prevention. Warm-up and ensure correct heating before any physical activity. Hydration is key for all martial artists. There are no specific guidelines on treating cramps since various pathologies are considered to causes.
In the legs, muscle spasm is often called a Charley Horse. It is painful and spontaneously resolves. Stretching and massages are common remedies for minor muscle spasms.
Sit down and straighten out the affected limb. Stretch every joint slowly.
Maintain adequate electrolytes. Often a strict workout can dehydrate the body and deplete it of electrolytes through sweating. Heat and humidity can also accelerate this loss. Take supplements or fruits before or during your workout.
Hydrate well. Increase fluid intake based on ambient temperate, size, weight, muscle content, workout schedule, training schedule, and general health. Avoid alcohol which inhibits vasopressin and causes the body to release fluids, thereby increasing dehydration.
Most muscle strains are treated with conservative treatment. The first step is to rest from sports and other physical activities.
Ice, compression, analgesia, and physical therapy must follow. Analgesic options are acetaminophen and non-steroidal anti-inflammatory medications. A rehabilitation program that includes stretching, the range of motion exercises, and strengthening of the affected limb is started. Exercises to strengthen the core followed by a gradual return to sport. Acute injuries can take about 4 to 8 weeks to heal while chronic strains may take months.
Other treatment modalities are available for those in who cramps don’t completely resolve. This includes corticosteroid injection into the muscle and needle tenotomy. They are only done under ultrasound guidance. There are no clear guidelines on which injuries should be surgically managed. However, if the recovery is poor and there are full-thickness tears or avulsion injuries. Surgery is also recommended in those with persistent weakness of the affected limb.
The prognosis for muscle strains is generally good. Most martial artists return to play with minimal pain and normal function. Rest and rehabilitation are all that is required. If they return too soon or not adequately rehabilitated, their pain may lead to chronic injury.
Studies show that 42% of athletes with muscle-tendon groin injuries couldn’t return to physical activity before 20 weeks after being injured. An active training program focused on the strength and conditioning of pelvic muscles is effective in treating the pain and preventing long term injury.
Most bursitis cases resolve spontaneously. Conservative treatment involves rest, ice, compression, and elevation for the treatment of symptoms.
Martial artists must avoid exacerbating movements. They can protect certain superficial bursa with padding who experience prolonged pressure on the elbows or knees. A foam donut is used by fighters with ischial bursitis. Stretching and core strengthening exercises improve and alleviate symptoms.
For bursitis occurring near the Achilles tendon, proper-fitting footwear that reduces pressure on the area should be encouraged. For analgesia, NSAIDs and/or acetaminophen are first-line agents. For the deeper bursa, corticosteroid injections, sometimes with a local anesthetic, can provide symptomatic relief.
Local injections of corticosteroid are not done for superficial bursa, as it can cause sepsis, local injury to the tendons, atrophy of the skin, or draining sinus tracts.
It can also improve pain while delaying the diagnosis of tendon tears, for which surgical repair is only possible within a set period. Physical therapy and range of motion exercises strengthen the muscles that support the area surrounding the bursa.
Systemic antibiotics are only given in fighters with septic bursitis. Mostly this is oral and admission is only done if the fighter is unstable. In cases where symptoms do not improve, the bursa is excised surgically, by endoscopy or arthroscopy.
Martial artists who do not avoid the triggers or continue with the same repetitive activity develop recurrences. Physical therapy helps and those who do not respond to conservative measures require steroid injections for pain relief. Range of motion exercises increase muscle strength of support muscles around the bursa
Surgery is only recommended for those who fail conservative treatment.
This is a chronic condition that develops due to repetitive damage to the synovial joint and the capsule. The cornerstone of therapy is controlling the inflammation.
Prolotherapy is a proactive therapy for ruptured ligaments. A drug that stimulates the production of new collagen fibers into the fibro-osseous junction. It artificially stimulates the production of new collagen fibers.
Inflammation is also treated with intra-articular steroids. The effect is largely dose-dependent. Intramuscular depot corticosteroids have better short-term effects on knee pain. The novel slow-release, microsphere formulation of triamcinolone provides analgesia for up to 13 weeks.
Potential therapies like methotrexate (MTX) has an anti-inflammatory effect. Biologic therapies that modify other inflammatory components like anti-TNF agents, growth factors, and IL-1 antagonists, are currently being studied in clinical trials.
Dislocations must be handled delicately and require immediate attention. It can be difficult to tell a broken bone from a dislocated bone. Both types of injury require immediate medical aid.
Ice and immobilize the joint right away, if possible, and keep it that way while waiting. An untreated dislocation could heal improperly, possibly heal with bones out of place or misaligned, causing damage to tendons, ligaments, muscles, nerves, or blood vessels. For dislocations that do not spontaneously reduce, the reduction must be done under sedation and analgesia. The type of reduction depends on the joint being reduced.
Given proper treatment, most dislocations will heal after several weeks. Outcomes following reduction are very good and a martial artist can return to play in four weeks.
ABRASIONS & CONTUSIONS
Abrasions are simple and minor abrasions do not generally require medical care.
Polyurethane and hydrocolloid plasters are effective in would healing for abrasions. Since the epidermis is lost, the outermost layer of the skin is susceptible to Clostridium tetani and Staphylococcus aureus, particularly in sports injuries.
Tetanus toxoid status has to be confirmed. Abrasions are cleansed and dressed, to prevent reinjury. Debridement is done if dirt and contaminants are embedded in the wound. Antibiotic ointments are applied; after confirming any history of allergies to antibiotics. A dressing depends on the area and depth of the abrasion.
Facial abrasions are more serious and they have a higher risk of cicatrization or contractions due to fibrous tissue. Abrasions on the face must be cleaned, debrided, and dressed daily.
Abrasions are minor injuries that heal in two weeks, usually without any resultant scarring. Extensive and deep abrasions, and those that get infected, scar. Scarring is prevented by daily wound care and dressing. Debridement is done to avoid extensive cicatrization.
PUNCTURES AND LACERATIONS
Lacerations are serious depending on the location and characteristics of the wound
Doctors will close the laceration with local anesthetic drawn up with a small gauge needle and the appropriate closure device like suture, staple, glue for the wound.
The repair material depends on the location, depth, length, and width of the laceration.
Scalp lacerations are safely closed with staples. They do have a higher risk of scarring and are used in thicker skin. Tissue adhesives are used when the laceration can be approximated with minimal tension. Steri-strips are another option for primary closure of lacerations.
This is more so if it does not overlie a joint.
Local anesthesia is used to clean and repair lacerations. The wound is then irrigated to remove any dirt or foreign objects with a saline solution.
Simple interrupted sutures are used for most wounds. Horizontal/ Vertical mattress sutures have an increased risk of scar formation. Deep sutures reduce tension on the superficial sutures and help reduce scarring in the future. They are also more likely to get infected.
After the laceration is closed, antibiotic ointment or petroleum infused gauze is placed over the sutures with overlying gauze affixed by tape. The wound must remain clean and removal depends on the location of repair, its complexity, and the type of suture.
Sutures that are not removed at the appointed time, can get infected and scar more easily.
Generally, sutures on the face are removed in 3 to 5 days. Sutures in the scalp and arms take about 7 to 10 days. Sutures in the trunk, legs, hands, and feet take 10 to 14 days. Palms or soles take about 14 to 21 days.
Initial treatment for Cartilage Tears includes rest, physical therapy, and corticosteroid injections. Six months of conservative treatment is reasonable in most cartilage injuries. Bracing can be done. However, there’s limited evidence that proves long term benefits.
Usually, one week of rest with splinting is done. The injury is re-examined after one week. If there is a tear of long arm immobilization for 3 weeks followed by short-arm immobilization for 3 weeks. A gradual return to play is advised. In the case of chronic tears, surgery is considered if conservative treatment. Common surgical techniques include arthroscopic repair, debridement, and shortening. The type of surgery depends on various classifications for each cartilage. A debridement is a surgical option where bleeding is induced to stimulate healing.
Prognosis is very favorable and with arthroscopic procedures even better. Physiotherapy following surgery can limit any joint stiffness and most athletes return to competitive sports with full function.
The Advanced Trauma Life Support is carried out to triage, do the primary survey, resuscitation, and resuscitate when required. The diagnosis of various blunt impact injuries is done by gross and microscopic examination of wounds. Recent blunt impact versus older blunt impact injuries is treated differently.
Blunt force trauma is better managed in a trauma center. Martial artists with a Glasgow coma scale score more than 13, respiratory rates between 10/min.-29/min need ventilatory support.
For those with two or more long bone fractures, pulseless extremities, pelvic fractures, paralysis, or depressed skull fractures need to go to a trauma center.
Many traumatic injuries heal with supportive care alone. Few require surgery or interventional radiology for hemorrhage control.
The outcomes of blunt force trauma injuries depend on age, type of injury, time to treatment, and the number of organs involved. The length of hospital stay and return to sport depends on the type of blunt force trauma and the need for surgery.
The first step in the management of dentoalveolar injuries is to apply a cold pack to the injured area. This will reduce any pain and swelling.
Treatment must be prompt if the tooth has to survive and restored to its original function. If the trauma involves a tooth’s enamel, it can be treated through bonding. It can be restored with composite resin.
Tooth fractures that extend into the dentin can be managed by covering the dentinal tubules that have been exposed with glass ionomer cement. A more permanent restoration is achieved with composite resins that resemble the tooth color.
Tooth fractures that involve the pulp of mature teeth are managed via root canal therapy. In crown root fractures that do not involve the pulp, the crown root fragment is removed. The apical tooth fragment is restored.
Root fractures are managed by splinting with a flexible splint for four weeks. After this, a root canal treatment coronal fragment of the tooth is done.
In the case of concussion injuries, the pulp tissue is monitored for one year. Subluxation injuries are splinted with flexible splinting for two weeks.
Extrusive luxation injuries are managed with repositioning the tooth in the socket. It is then splinted for two weeks.
No intervention is necessary for intrusive luxation injuries of less than 3 mm. If it is more than 7mm, then surgical repositioning is done followed by root canal treatment.
The consequence of fractured tooth depends upon the type of injury, delay in treatment if any, and quality of treatment rendered. Tooth fracture of the pulp and periodontal tissues heal well. This takes 1 to 2 weeks. Minor fractures restricted to the enamel heal better, while deeper fractures can get infected and turn into an abscess. Therefore, constant follow up is essential. Pain management is with NSAIDs.
Depending on the type of injury and how stable the athlete is manual compression or a compressive dressing should be done to control bleeding. A tourniquet must be applied en route to a hospital until the definitive repair is done. Those with hard signs require immediate surgery.
Surgery is necessary if there is a pulsatile hematoma, early pseudoaneurysm, occlusion, or AV fistula of a major vessel. In the case of extravasation only of smaller vessels, therapy is different. Occlusions of vessels are observed and therapeutic embolization is done for AV fistulas. A repeat arteriogram or duplex ultrasound is repeated 3-5 days later to rule out a pseudoaneurysm or a pulsatile hematoma.
Intimal defects heal without vascular surgery. The patients are placed on heparin or aspirin prophylaxis.
The peripheral artery spasms can be treated by rewarming the area. There are numerous intra-arterial treatments for severe limb-threatening vessel spasms like papaverine bolus of 60 mg followed by an infusion, nitroglycerin of 50 to 100mg, or an infusion of 1L of normal saline plus 1000 U of heparin.
If the injured vessel is not completely transected with little tissue loss, an interrupted or continuous repair of the vessel is done with 6-0 or 7-0 polypropylene. For complete transections, the artery is debrided. For transactions in arteries that are distal to the major arteries less than 1 cm in diameter, a spatulated end-to-end anastomoses with 6-0 or 7-0 polypropylene is done.
If there is a loss of the segment of the vessel, an autologous graft from the greater saphenous vein or ringed Teflon is used. In the upper extremity, the basilic or cephalic veins are acceptable alternatives. Any repair needs to be dressed; exposure risks infection.
The size and type of injury determine how soon an athlete can return to sport. Large arterial injuries that require surgery will require repeat arteriograms to ensure palpable pulses and return of blood flow. Once achieved, the repair is dress in gauze-soaked antibiotics.