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Greece is the Word
Dr Monto presented the keynote speech, “Biologics in Orthopedics Today” at the 79th annual meeting of the venerable Hellenic Association of Orthopaedic Surgery and Traumatology in Athens, Greece.
LOOKING GOOD, DOC
Platelet Rich Plasma More Effective Than Hyaluronic Acid for Knee Arthritis
“A new study finds platelet-rich plasma (PRP) more effective than hyaluronic acid (HA) for knee arthritis.”
image: Exactech Inc
A new study finds PRP injections provide better long-term relief of knee pain and stiffness than HA (Synvisc, Euflexxa, etc) in patients with osteoarthritis. This is particularly relevant in light of recent increases in retail HA pricing, making PRP a practical option for the nonoperative management of knee arthritis. Click here to see the full article
Straight Talk on Crooked Feet
"As one of the great foot surgeons of the 20th century, Dr. Leonard Goldner, once said to a bunion patient: 'It would probably be better to operate on your shoe rather than on your foot,'" Monto said.
Dr. Monto reviews a new paper on the risks of bunion surgery.
Image credit: Pixabay
Turf Burns Suck
There is little doubt that most soccer players perceive that artificial turf is more threatening than natural grass.
original art courtesy of Storelli.com
5 THINGS TO KNOW ABOUT TURF BURNS
Rocco Monto, MD
Nantucket Cottage Hospital
We all know that injuries suck, but the undefeated King of Pain in soccer is the turf burn. We deep dive into understanding turf burns and the recommended methods of prevention, protection, and treatment.
1. Raspberry time
Field injuries are more common than you might think. Turf burns bleed, hurt, and can get dangerously infected (a.k.a. “turf burn infections”). Because most players play through these injuries, they often go unreported. But with the explosive global growth of soccer combined with generally poor field conditions and an increasing number of synthetic surfaces, skin burns and injuries are increasing in number and severity.
A Dutch study reported that 84% of professional soccer players sustained at least one major turf burn during the season, with goalkeepers at the highest risk. Several outbreaks of antibiotic-resistant staph infections in athletic teams have also been directly linked to turf burns.
2. The first cut is the deepest
Turf burns are not really thermal (burn) injuries. The combination of violent mechanical shearing of the skin and frictional abrasion can lead to large areas of superficial skin injury, which we all know are extremely painful and can take weeks to heal.
A new study examined severe turf burns and found that they were more similar to skin grafts and bikers’ road rash than to a heat or chemical burn. The same study found that less abrasive damage was seen during soccer slide tackles on wet natural grass than on dry grass or synthetic turf.
3. The grass is always greener
There is little doubt that most soccer players perceive that artificial turf is more threatening than natural grass. No shocker there. A group of international female soccer players felt so strongly that they filed suit against FIFA and the Canadian Soccer Association prior to the 2015 World World Cup to halt the use of synthetic turf during the tournament (the suit was later dropped). But current research on newer 3rd and 4th generation (Field Turf, etc) surfaces has not confirmed this belief. However, the conflicting data showing otherwise comparable injury rates between natural and synthetic turf fields still confirms that skin abrasion rates are higher on artificial grass surfaces.
Despite lingering health concerns, the high cost of maintaining high-grade natural grass fields has driven many communities around the country to convert to artificial surfaces. There are now over 14,000 synthetic sports fields in play in the US alone with a 10% increase per year.
4. You’ll never walk alone
We all know that soccer fields are not the most sterile places on earth. All types of bacteria and other nasty contaminants populate our pitches. The bigger problem with skin abrasions is that they provide sudden exposure of subcutaneous blood vessels to millions of these opportunistic bacteria. In one study, 42% of players harbored staph bacteria. Yikes!
Worse yet, antibiotic-resistant bacteria can live for weeks on both natural and synthetic fields as well and will happily colonize your crusty old gear. Because up to 10% of these abrasions will become infected if untreated, players need to become more proactive in treating turf burns. The old adage of “leave it alone and let the air get at it” not only delays healing but can also lead to increased scarring and re-injury.
Want a better approach? Gently scrub the area clean with a disinfectant (chlorehexidine=GOOD, hydrogen peroxide=BAD) and then keep it clean, moist, and covered using Tegaderm or hydrogel. This can trim healing time from 3 weeks down to as little as 7-10 days. Oh, yeah, and no sharing towels in the locker room or using a communal whirlpool.
5. Less is more
Soccer players need to start borrowing tactics from our road rash-plagued bike racing cousins. We need to start covering ourselves with modern, breathable and next-generation contact padding, which, fortunately, has ignited growing interest in an effort to protect our largest organ. Field maintenance, although expensive, also needs to become a priority. Both natural and artificial turf fields should be irrigated to control radiant temperatures and decrease abrasive risk.
First published on Storelli.com
References:
1. Begier EM, Frenette K, Barrett NL: A high-morbidity outbreak of methicillin resistant staphylococcus aureus among players on a college football team, facilitated by cosmetic body shaving and turf burns.
2. http://www.calrecycle.ca.gov/publications/Documents/Tires%5C2010009.pdf
3. Centers for Disease Control and Prevention. Methicillin-resistant Staphylococcus aureus infections among competitive sports participants
4. DiFiori JP, Benjamin HJ, Brenner J, Gregory A, Jayanthi N, Landry GL, Luke A. Overuse injuries and burnout in youth sports: a position statement from the american medical society for sports medicine. Clin J Sports Med, 2014;24(1):3-20.
5. Synthetic playing surfaces and athlete health. J Am Acad Orthop Surg
6. Ekstrand J, Nigg BM: Surface-related injuries in soccer. Sports Med, 1989
7. Ekstrand J, Timpka T, Hagglund M: Risk of injury in elite football played on artificial versus natural grass: a prospective two-cohort study. Br J Sports Med
8.http://espn.go.com/espnw/news-commentary/article/11868149/sydney-leroux-explains-why-turf-terrible-soccer-players
9.http://www.mlssoccer.com/post/2013/03/29/la-galaxys-landon-donovan-argues-mental-health-should-be-treated-physical-health
10. Hill AP: Perfectionism and Burnout in Junior Soccer Players: A Test of the 2 x 2 Model of Dispositional Perfectionism. J Sport Exer Psych
11.http://www.ncaa.org/health-and-safety/sport-science-institute/understanding-student-athlete-burnout
12. Kazakova SV, Hageman JC, Matava M, et al: A clone of methicillin-resistant staphylococcus aureus among professional football players. N Engl J Med
13. Incidence, causes, and severity of high school football injuries on-field turf versus natural grass: A five-year prospective study. Am J Sports Med
14. Peppelman M, Van Den Elinde WA, Langewouters AM, Weghuis MNO, Van Erp PE: The potential of the skin as a readout system to test artificial turf systems: clinical and immunohistological effects of sliding on natural and artificial turf
15. Silva JM: An analysis of the training stress syndrome in competitive athletics. J App Sport Psych
16. Community-associated methicillin-resistant Staphylococcucsaureus survival on artificial substrates. Med Sci Sports Exer.
17. Yamaner F, Gumus M, Gulu E, Kartal A: Evaluation of injuries in professional Turkish football players. Eur J Gen Med.
18. Zanetti EM: Amateur football game on artificial turf: player’s perceptions. Appl Ergon.
A Pain in the Grass? Dr. Monto Talks Turf
photo John Stanto / Nantucket Inquirer and Mirror
“A good natural field still trumps an artificial-turf field. The problem is most fields are not great,” he said. “Most natural-turf stadiums are not well maintained. I think people sometimes have this image of this beautiful lush field, when in fact mostly it can be dirt. It is hard to keep grass fields up.”
Dr. Monto Reacts to NCH CEO Abrupt Departure
“Some things he did well, for example, he understood some of the public health aspects well, but I think he had a hard time recognizing the talent that we have available on the island and understanding that we’re an island of alphas here. We have strong personalities here and it takes someone with the ability to handle that to do well, understanding how to apportion the talent, leverage what we do well and know what we shouldn’t be doing and engage the community.”
Story by Jason Graziadei/Nantucket Current Image credit: Yellow Productions/N Magazine
Just before noon on Tuesday, Nantucket Cottage Hospital staff found out via e-mail that their President and CEO Gary Shaw would be stepping down by the end of the month. For most, it was the first they had heard of his pending resignation.
Some hospital staff told the Current the news came as a total surprise. Others said they saw it coming.
“Not surprised,” one NCH nurse said. “He doesn’t really seem like the island type.”
“Nothing surprises me,” said another.
Many staff declined to comment about Tuesday’s abrupt announcement. But one who did have some thoughts to offer was Dr. Rocco Monto, the hospital’s orthopedic surgeon.
“I think he came here thinking he was taking the reins from Margot Hartmann with a community hospital in a bigger system and found himself in the middle of a pandemic,” Monto said. “Any judgement of his performance, being fair to him, has to be made in that context…Some of his frustrations may have come as the pandemic is winding down. Some people do a better job managing in a crisis than not in a crisis. Perhaps that’s the disconnect everyone is sensing. It also may be that he’s not the best match for the community.”
Monto acknowledged that running any community hospital – let alone one 30 miles out to sea – is a significant challenge for any healthcare executive. And finding the balance between leveraging Mass General Brigham (the hospital’s parent company) while also charting NCH on its own course is extremely difficult. But Monto said Shaw missed opportunities to capitalize on the talents of the hospital’s existing workforce and bring people together.
“Some things he did well, for example, he understood some of the public health aspects well, but I think he had a hard time recognizing the talent that we have available on the island and understanding that we’re an island of alphas here. We have strong personalities here and it takes someone with the ability to handle that to do well, understanding how to apportion the talent, leverage what we do well and know what we shouldn’t be doing and engage the community.”
Monto, who has been with NCH full-time since 2008, added that “It came down to vision, and I think that what he thought and where he thought we should go, there was a disconnect there. There was friction and he wasn’t able to energize the resources of the island. That’s what it comes down to. I’m not sure anyone could have done that in this environment. The only real criticism I had of him was that he didn’t do a good job of identifying our talent pool in the hospital and the community at large. There’s no reason for us to constantly be hiring outside people. We’re a miracle in the ocean. We shouldn’t exist. So how do you take this jewel and nurture it, but be demanding and wring everything out of everyone? We just couldn’t get on the same page. We can’t solve our problems by just going off island for things. We have to have a better commitment to our employees.”
Disclosure: the author of this report Jason Graziadei previously worked at Nantucket Cottage Hospital from 2013 to 2021, including during Shaw’s first year at NCH. N Magazine publisher Bruce Percelay is a major donor to Nantucket Cottage Hospital and the co-chair of the 2022 Boston Pops on Nantucket fundraiser for the hospital.
Praise for The Fountain
The verdict is in and The Fountain: A Doctor's Prescription to Make 60 the New 30 is a "gamechanger."
trailer produced by alexmontoproductions.com
“Smart, candid, and provocative, The Fountain is a must read for everyone who really cares about their wellness. Rocco confidently breaks down complex concepts into simple, elegant lessons for healthy living. It’s a dazzling book.”
“I really think Dr. Monto is on to something in the way he breaks down the intricacies of the confusing medical world we’re confronted with, toward the purpose of living longer and healthier lives.”
“For years we have considered Dr. Monto one of the nation’s leading medical, health and wellness experts. We were privileged to be able to publish several of his articles on Stack.com for our audience of athletes. We are thrilled the The Fountain now packages the full breadth of his expertise in an impactful and accessible form for the general public.”
“Dr. Monto can distill difficult and complex concepts with overwhelming clinical data into something quite simple to understand. His messages are clear, impactful, and captivating.”
Uber-Agent Alan Morell to Represent Dr. Monto
Dr. Monto has signed with Alan Morell of Creative Management Partners (Beverly Hills/Toronto/New York) to represent his literary, media, and speaking endeavours. Dr. Monto's upcoming book, The Fountain: How to Make 60 the New 30 will be considered by publishers in 2017. For more info contact: alanmorell@creativemanagementpartners.com