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This week in BMJ Case Reports: Rugby injuries, dental infection, harms of poppers

BMJ

Unusual sporting injuries in young rugby players

Acetabular fractures affect the socket of the hip bone, and are generally sustained after violent trauma, such as road traffic accidents.

But a group of doctors in Ireland, writing in the journal BMJ Case Reports, describe these injuries in three young rugby players and say "we have not previously encountered these injuries in a juvenile sporting population"

The injuries were sustained while playing rugby union, two during seasonal match play and one during a training drill. Previously, the doctors reported two acetabular fractures in two other young rugby players, aged 16 and 24 years.

All four injuries occurred during the tackle phase of play, and occurred as a result of pressure exerted through a flexed hip with the knee on the ground. This position can be encountered during a two man tackle, as one tackler hits low and the other hits high.

Three of these fractures occurred along with with hip dislocations.

All three boys, as reported in this latest case, recovered following surgery and rehabilitation, without any major implications. However, these injuries can have a potentially devastating impact on growth, sporting participation and lifestyle of young players.

"In order to prevent the potentially devastating consequences of these injuries it may be necessary to implement rule changes or size restrictions in the juvenile game," say the doctors.

Players may be of the same age, but can be different in size and stage of development. This is associated with an increased injury risk, they explain, adding to the problems linked with excessive force in an immature skeleton.

"An evaluation of the rules at the breakdown and an emphasis on proper tackling could aid injury prevention," they explain.

Article: Acetabular fractures in skeletally immature rugby players
Journal: BMJ Case Reports
Public link after embargo lifts: http://casereports.bmj.com/content/2016/bcr-2015-211637.full?sid=6b349302-4b01-4b2b-9c8f-0e154c0c54ed

Man has distorted vision after inhaling poppers

A 52-year-old man developed distorted vision after inhaling poppers for the first time.

Writing in an article published in BMJ Case Reports, the doctors who treated the man explain that upon hospital admission he had been experiencing 10 days of blurring in his central vision and metamorphopsia, a type of vision problem where the shape of objects seen are distorted. His peripheral vision was normal.

These problems were experienced immediately after a night of clubbing, during which he inhaled poppers.

An examination revealed disruption of the inner and outer segment layers of the fovea, a small area in the retina of the eye where visual acuity is highest.

Doctors advised the man to stop taking the drugs, and after three months there was marginal improvement in his vision.

Despite the high use of poppers, there have been only around 30 published cases of poppers causing vision loss and damage, but "the actual incidence is likely to be much higher," they say. Disease progression can be prevented by stopping the use of these drugs, but recovery is variable.

Poppers are legal highs regularly used for their euphoric effects, especially by men in the gay community. These are not controlled under the Misuse of Drugs Act and are available from a range of sources.

However, the 'Psychoactive Substances Bill' is currently under review at the House of Commons proposes to tighten control of substances, including poppers, in the UK.

Article: Poppers retinopathy
Journal: BMJ Case Reports
Public link after embargo lifts: http://casereports.bmj.com/content/2016/bcr-2016-214442.full?sid=a9c05d32-fe63-473c-a714-b4f650da0dee

Routine dental trip leaves patient with a rare infection

A man who visited his dentist for a routine dental cleaning developed a rare and potentially life-threatening infection.

In a BMJ Case Report, doctors say the man had a liver abscess (a pocket of pus that formed in his liver) that was caused by the rare bacterium Fusobacterium necrophorum. If left untreated, the infection can be life threatening.

The 57-year-old man was admitted to hospital in Pennsylvania with a fever and pain on his upper right body. An MRI of the abdomen confirmed a hepatic abscess, and cultures confirmed it to be caused by F. necrophorum.

They say the only possible cause of the infection is the oral cavity as the patient had routine dental examination and cleaning two weeks before. The patient had good oral health, and did not have any invasive dental work.

This case is interesting, say the doctors, because it suggests that even routine dental cleaning may lead to the presence of bacteria in the blood, which can travel to different areas of the body.

They speculate that the dental cleaning may have involved some trauma to the lining of the mouth that could have served as an entryway to the blood stream.

Doctors treated the man by draining the pus and prescribing a course of antibiotic treatment.

Article: Hepatic abscess caused by Fusobacterium necrophorum after a trip to the dentist
Journal: BMJ Case Reports
Public link after embargo lifts: http://casereports.bmj.com/content/2016/bcr-2015-210235.full.pdf

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About the journal:

BMJ Case Reports is one of the more than 50 specialist journals published by BMJ. For more information, visit: http://casereports.bmj.com/

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