MR imaging of the foot and ankle has an effect on clinical decision making. Regardless of the clinician's confidence in diagnosis, MR imaging consistently plays a central role in further defining the diagnosis and treatment.

Background: Brazilian jiu-jitsu (BJJ) is a martial art that focuses on ground combat, emphasizing skill over strength and submission over striking. The purpose of this study is to evaluate the nature of injuries affecting practitioners of BJJ in the settings of competition, training, and conditioning.Methods: An online survey was created to collect demographic and injury-specific information. This survey was distributed to the 234 schools in the United States registered with the International Brazilian Jiu-Jitsu Federation (IBJJF). The survey was also distributed to local BJJ schools and at local tournaments in the Greater New York City area. Data from a total of N=56 participants were recorded for this survey.Results: The majority of participants were male (n=44, 78.6%) and amateur competitors (n=29, 51.8%) with an average duration of BJJ training of 6.9 ± 5.9 years. The majority of participants (82.1%) train at least six hours per week and compete in an average of 4.6 ± 2.5 competitions per year. The most common injuries were to the finger/hand (78.6%) and knee (61.5%). The most commonly reported fracture was of the hand/fingers (n=6). Of the 156 total injuries reported, 133 (85.3%) occurred during practice or training rather than in competition and 76 (48.7%) required medical attention. Few injuries required surgical intervention.Conclusions: This study provides novel information regarding injury characteristics of BJJ practitioners with respect to the level of training and use of protective equipment that can guide expectations and management for this unique group of athletes. Amateur BJJ practitioners are the most commonly injured, and largely experience injuries of the upper extremities during training or conditioning rather than during competition.

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Category: Other; Ankle Introduction/Purpose: On March 1, 2020, the first case of novel coronavirus (COVID-19) in New York City (NYC) was confirmed. By March 16, the NYC mayor and New York State Governor issued executive orders to postpone elective surgeries. At our tertiary care academic medical care center in the Bronx, the densely populated community of 1.4 million saw many COVID-19 positive cases. In response, the hospital quickly accommodated these patients, while maintaining outpatient orthopedic care. Consequently, only emergent orthopedic cases were granted permission to rapidly proceed to surgery. Most foot and ankle cases were deemed amenable to non-surgical or delayed surgical care. The purpose of this study is to characterize a series of patients with foot and ankle pathology whose orthopedic care was altered due to the pandemic. Methods: This is a retrospective chart review from February 2020-May 2020 encompassing the time that elective surgery was on hold and one month prior, to capture those patients were scheduled for surgery prior to the pandemic. Included were patients with foot and ankle pathology that required urgent orthopedic care, who were seen in the foot and ankle clinic, fracture clinic, and subsequently in the general orthopedic clinic that was instituted on an emergent bases. Excluded were patients who required intervention to address elective foot and ankle issues such as osteoarthritis, or ankle instability, and those were referred to an outside institution for further treatment. Throughout the pandemic, contact was made with patients either directly in clinic, via a telehealth portal or telephone. Descriptive statistics are taken. Results: Of the 17 patients included in this series, 11 (65%) patients were managed non operatively. Of these, 4 chose nonoperative management due to shared decision making between the patient and surgeon. 2 patients could not have surgery due to complications related to COVID-19. As the zenith of the pandemic passed 2 patients remained fearful of infection and therefore chose non operative management. 3 patients that had been in contact with the orthopedic department refused further imaging. 6 patients were managed operatively. 2 patients had surgery during the peak of the pandemic, both of whom tested positive for COVID and who failed conservative management. 4 patients had delayed surgery. Of these four cases, 3 were malunion corrections that would have benefitted from more prompt surgery. Conclusion: There was an overall decrease in foot & ankle cases. Non- emergent foot and ankle surgery was delayed to divert resources to patients who were stricken with the COVID-19 virus. While every attempt was made to provide the appropriate care for all, a personalized approach to foot and ankle health was developed to address health concerns, preferences, and logistics. As the course of this global pandemic is still uncertain, it is imperative to have a strategy in place to deal with urgent cases, should a second wave of cases once again affect our ability to provide routine care.