Objective-To describe the typical tibial diaphyseal fracture ("footballer's fracture") and to clarify the circumstances and mechanism of the injury. Methods-In an attempt to obtain a detailed analysis of the types of injury suffered, and thereby highlight areas for prevention, 100 consecutive adult football players with a tibial diaphyseal fracture were studied prospectively. Details of the circumstances and mechanism of injury were collected using a questionnaire (response rate 85%). Treatments depended on the Gustilo classification, displacement, and axial stability. Long term follow up was performed until clinical healing to define the overall prognosis. Results-61% of players suffered a fracture of both the tibia and the fibula. Ninety five percent of the tibial fractures were transverse or short oblique and were caused by impact during a tackle. Radiographic evidence of bridging callus was better than a classification ofthe bony injury for predicting weeks to clinical healing. The delayed union and non-union incidence following this injury is low. One patient suffered symptomatic shortening. One patient suffered symptomatic angulation and two patients with nonunion required bone grafting. Conclusions-Tibial fracture is an expensive injury. It prevents a young population from being employed and takes up valuable NHS resources. As 85% ofplayers were wearing shin guards, it is likely that improvements in shin guard design could reduce the rate of tibial fracture. (BrJ Sports Med 1996;30:171-175)

The findings of this study suggest that the grade and type of spondylolisthesis do influence global motion parameters. This information may be useful in the clinical assessment of this patient group.

We have measured the dynamic movement of the lumbar spine in 57 patients with degenerative lumbar disc disease. Each completed a questionnaire which recorded pain and subjective signs and symptoms. From plain lateral radiographs, the subjects were graded using the criteria of Kellgren and Lawrence and those of Lane et al, which are both based on the severity of degenerative changes. Measurements of the height of the disc space and the vertebral height were obtained and expressed as a ratio. We found no relationship between the characteristics of spinal movement and the overall grading of degenerative disc disease with either system. Both were influenced (p < 0.01) by age, walking distance, severity of symptoms, drug intake and frequency of pain. The present systems for grading degenerative disc disease from plain lateral radiographs have limited application.

Results and discussion Feedback forms were completed by over 75% of the 20 attendees. Participants included senior management (n=2) and trainees (n=17), as well as one rota coordinator. The workshop was attended by trainees from many specialties, of whom 14 completed the feedback form (Table 1). Three foundation trainees and three general practitioner trainees attended. The majority (57%) were specialty trainees. When asked whether the trust is supportive of LTFT training, 27% of participants felt that the trust scored the highest score on a Likert scale. Eighty per cent of those who completed the feedback form rated the workshop excellent to good. Conclusion Trainees found that the workshop met their needs. The concept of the workshop is being promoted nationally through a blog on the BMA website 4 and steps are being taken on a national level to improve information about flexible champions to all trainees by the national lead in LTFT training. A further workshop will be held in HEY in May 2019. Topics will include maternity, paternity and shared parental leave. ■

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