Sideline splinting, bracing, and casting of extremity injuries

Emergent and nonemergent splinting, bracing, and casting are effective ways to safely remove an injured athlete from the playing field, allow immediate return to play, and permit an athlete to return to play before an injury has completely healed. Sideline providers should be familiar with the materials and resources currently available, and be aware of the sport-specific guidelines regarding their use. Properly applied splints, casts, braces, and padding should function to prevent further injury, promote comfort, and not pose a risk of injury to other participants.

Are needle-free injections a useful alternative for growth hormone therapy in children? Safety and pharmacokinetics of growth hormone delivered by a new needle-free injection device compared to a fine gauge needle

The clinical safety, use and pharmacokinetics of a new needle-free device for delivery of growth hormone (GH) were compared with those of conventional needle injection devices. In an open-label, randomized, 4-period crossover study, 18 healthy adults received single subcutaneous injections of Genotropin administered by the Genotropin ZipTip needle-free device and by conventional injection. Bioequivalence was established between the devices. In a separate open-label, randomized, multicenter, 2-period crossover study, pediatric patients underwent 2-weeks Genotropin treatment administered by the Genotropin ZipTip and by a fine-gauge needle device (>95% used the Genotropin Pen). In total, 128/133 patients who were treated completed the study. Genotropin ZipTip was well tolerated and >50% of patients found no difference between the devices for all parameters assessed. After study completion, >20% patients preferred to continue using Genotropin ZipTip. Although statistical analyses demonstrated superiority of the Genotropin Pen versus Genotropin ZipTip for bleeding, pain, soreness, and bruising, Genotropin ZipTip was considered to provide a safe and bioequivalent alternative to needle injection.

The effects of topical vitamin K on bruising after laser treatment

BACKGROUND

Pulsed dye laser treatment and other cosmetic procedures result in significant bruising. Claims have been made regarding the efficacy of topical vitamin K in both preventing and speeding the clearing of bruising; however, well-controlled studies are lacking.

OBJECTIVE

The purpose of this study is to evaluate the effects of topical vitamin K versus placebo in the prevention and clearing of laser-induced purpura.

METHODS

A total of 22 patients were enrolled in this double-blind randomized placebo-controlled study. The patients were divided into pretreatment and posttreatment groups; the 11 patients in the former group applied vitamin K cream to half of their face and vehicle alone to the other half of their face twice daily for 2 weeks before laser treatment. The latter group followed the same procedure for 2 weeks after laser treatment. On day 0, all subjects underwent laser treatment for facial telangiectases using a 585-nm pulsed dye laser. Bruising was rated by the both the patient and physician by means of a visual analogue scale on days 0, 3, 7, 10, 14, and 17.

RESULTS

The side of the face treated with topical vitamin K before laser therapy showed no significant difference in bruising as compared to placebo. However, the side of the face treated with vitamin K cream after laser treatment had significantly lower scores of bruising severity when compared with the side treated with placebo.

CONCLUSION

Although pretreatment with vitamin K did not prevent bruising after laser treatment, use of vitamin K cream after laser treatment did reduce the severity of bruising, particularly in the initial days of application.

Influence of the design of facilities at auction markets and animal handling procedures on bruising in cattle

The movements of cattle at 12 livestock auction markets were observed to determine the possible causes of trauma leading to carcase bruising. Design faults included right-angled bends in races, dead ends, flooring with insufficient slope or grip, and steps. Sliding gates were often misused for goading cattle. Projecting fittings and square-edged corners were potentially injurious; conversely, rounded posts and curved races assisted the flow of cattle with minimal impacts. At all the markets, some cattle were hit directly and poked with wooden sticks, and the variations in their use could partially explain the differences between the markets in the prevalence of carcase bruising. Most harder hits were directed at less valuable parts of the body, such as the spine, hips and shoulders, and a survey of bruising at the abattoir showed that these were the areas with most bruising. In this survey of 48,926 carcases, the overall level of commercially significant bruising of 4.1 per cent was lower than the 6.5 per cent found in a previous survey. Carcases of cattle from markets had a greater incidence and severity of bruising (P<0.001) than those arriving directly from farms or dealers. Carcase bruising in young bulls was less (P<0.001) than in heifers and steers.

A prospective randomised trial of tourniquet in varicose vein surgery

A prospective randomised trial of 50 patients was carried out to assess the autoclavable Lofquist cuff (Boazal, Sweden) as a tourniquet in varicose vein surgery and determine the effect on bleeding, bruising, cosmesis and patient pain and activity. Patients undergoing unilateral long saphenous vein ligation, stripping and avulsions were randomised to tourniquet or no tourniquet. Lofquist cuffs were applied after inflation to 120 mmHg to the upper thigh for the duration of the surgery. Varicose vein grade, duration of surgery, blood loss, extent of bruising at 7 days, pain and activity scores over the first week, and wound complications and cosmetic result at 6 weeks were recorded. Patients' age, sex, and varicose vein grade were similar in the two groups. Peroperative blood loss (median, range) was significantly reduced in the tourniquet group (0 ml, 0-20 ml) compared to the no tourniquet group (125 ml, 20-300; P < 0.01). Operative time and thigh bruising (median, range) were also reduced in the tourniquet group (30 min, 11-47 min; 72 cm2, 30-429 cm2), respectively, compared to the no tourniquet group (37 min, 18-50 min; 179 cm2, 24-669 cm2) both (P < 0.01). There was no difference in pain and activity scores in the two groups and cosmetic results were also similar. The use of the Lofquist cuff tourniquet during varicose vein surgery reduces peroperative blood loss, operative time and postoperative bruising without any obvious drawbacks.

Post-tumescent liposuction care. Open drainage and bimodal compression

The goals of post-liposuction care must be to minimize edema, bruising, and patient discomfort. The postoperative pain and edema resulting from sutured incisions and prolonged post-liposuction compression is an irrational remnant from the days before the tumescent technique. This article discusses various issues involving post-liposuction care.

Injury rates in Shotokan karate

OBJECTIVE

To document the injury rate in three British Shotokan karate championships in consecutive years. In these tournaments strict rules governed contact, with only "light" or "touch" contact allowed. Protective padding for the head, hands, or feet was prohibited.

METHODS

Prospective recording of injuries resulting from 1770 bouts in three national competitions of 1996, 1997, and 1998. Details of ages and years of karate experience were also obtained.

RESULTS

160 injuries were sustained in 1770 bouts. The overall rate of injury was 0.09 per bout and 0.13 per competitor. 91 (57%) injuries were to the head. The average age of those injured was 22 years, with an average of nine years of experience in karate.

CONCLUSIONS

The absence of protective padding does not result in higher injury rates than in most other series of Shotokan karate injuries. Strict refereeing is essential, however, to maintain control and minimise contact.

The effect of pressure bandaging on complications and comfort in patients undergoing coronary angiography: a multicenter randomized trial

OBJECTIVES

To determine the effectiveness of pressure bandaging in reducing bleeding and bruising in patients undergoing coronary angiography and to investigate the contribution that pressure bandages make to patient discomfort after angiography.

DESIGN

A prospective multicenter, randomized study.

SETTING

Three university hospitals in Melbourne, Australia.

PATIENTS

One thousand seventy-five patients undergoing coronary angiography were randomized to receive a pressure bandage (N = 556) or no bandage (N = 519) after manual compression of the right femoral artery puncture site.

RESULTS

Patients without pressure bandages had a higher incidence of bleeding (P < 0.05) and bled earlier (mean 2.4 hours; SD 3.6 hours) after catheter removal (P < 0.001) than patients with bandages (mean 5.3 hours; SD 3.8 hours). The incidence of bleeding in patients without pressure bandages was 6.7%. The incidence and extent of bruising was the same for both groups. Patients with pressure bandages experienced a higher incidence of back (P < 0.05), groin (P < 0.001), and leg pain (P < 0.001), nausea (P < 0.05) and urinary difficulty (P < 0.01).

CONCLUSIONS

In view of the associated increase in patient discomfort and the delay in time of onset of bleeding, pressure bandages should not be used routinely in the management of patients after coronary angiography, especially in the context of early discharge from the hospital.

Evaluation of the KTP 532 laser in aesthetic facial surgery

This study investigated the ability of the KTP 532 laser to reduce postoperative swelling and bruising in aesthetic facial surgery. Thirty consecutive patients receiving a laser-assist procedure (following skin incision with a scalpel, dissection and hemostasis were accomplished primarily with the laser) were compared to 16 patients who had similar technical operations but relied on scissor/scalpel dissection and electrocautery for hemostasis. Evaluations were performed by comparison of serial photographs after surgery and by patient self-assessment. The clinical observations demonstrated a noticeable reduction in postoperative swelling, bruising, and discomfort in the patients whose procedure was performed with the aid of the laser.

Effect of glutamic acid on broilers given submarginal crude protein with adequate essential amino acids using feeds high and low in potassium

Broiler males were examined for their response to feeds containing CP 1 to 2% below levels advocated by NRC (1994) and when supplemented with L-glutamic acid. Crude protein and glutamic acid treatments were imposed in starting, growing, and finishing feeds over 7 wk with K at high and low levels likely to occur in practice (0.80 vs 0.65 to 0.55%). All feeds were formulated to be isocaloric (3.20 kcal ME/g) and satisfy NRC (1994) essential amino acid (EAA) minimum requirements. Improved live weight gain occurred during the first 6 wk with supplementation of glutamic acid to the low CP feed but not when intact protein per se was used to increase CP. A similar advantage in growth was obtained from glutamic acid in response to its addition at equivalence of 1 to 2% CP as well as when dietary adjustments maintained low CP. Response to altered K could not be interpreted because of concurrent differences in glutamic acid and AMEn intakes. High glutamic acid levels did not decrease abdominal fat unless CP increased concurrently, whereas carcass back bruising and drumstick deformations were relieved by supplemental glutamic acid independent of CP. Increased weight gain from glutamic acid was only evident with drumsticks and debris that included the back when carcasses were cone-deboned. Supplemental glutamic acid is believed to improve the rate of connective tissue formation during rapid growth.

Handling of sheep at markets and the incidence of bruising

Most sheep sent for slaughter in the United Kingdom are sold through livestock markets. This study counted the potentially bruising events at two markets handling 12,119 sheep in 549 groups and recorded the bruises on carcases of sheep from these markets. There were 1324 and 744 potentially bruising events per 1000 sheep at markets A and B, respectively. The unloading of 1501 sheep in 40 groups and the pre-slaughter handling of 1085 sheep in 60 groups were observed at the commercial slaughterhouse where the bruises were recorded. The number of potentially bruising events at the slaughterhouse was 694 per 1000 sheep. The bruising on the carcases of 58 groups of sheep from market A and 29 groups from market B, and of 30 groups of sheep sent to slaughter direct from farms was assessed. The sheep from market A had 581 bruises per 1000 sheep, those from market B had 377 per 1000 sheep, and the sheep sent direct from farms had 399 bruises per 1000 sheep. There were some differences in the distribution of the bruises on the carcases from the three sources, but no significant differences between the total numbers of bruises.

Perioperative and postoperative tranexamic acid reduces the local wound complication rate after surgery for breast cancer

A randomized double-blind trial has shown that, in 160 women with breast cancer undergoing lumpectomy or mastectomy with axillary clearance, perioperative and postoperative administration of tranexamic acid 1 g three times daily resulted in a significant reduction in the mean postoperative drainage volume compared with patients given placebo (283 versus 432 ml, P < 0.001). The frequency of postoperative seroma formation was also decreased by tranexamic acid administration (27 versus 37 per cent, P = 0.2). Haematoma formation was infrequent in both groups and was not altered by administration of tranexamic acid. No infectious complications occurred. Age over 60 years was a significant risk factor for overall wound complications but tumour size and regional lymph node metastases were not. Tranexamic acid may be used to reduce the frequency of postoperative wound complications following surgery for breast cancer.

A review of brain retraction and recommendations for minimizing intraoperative brain injury

Brain retraction is required for adequate exposure during many intracranial procedures. The incidence of contusion or infarction from overzealous brain retraction is probably 10% in cranial base procedures and 5% in intracranial aneurysm procedures. The literature on brain retraction injury is reviewed, with particular attention to the use of intermittent retraction. Intraoperative monitoring techniques--brain electrical activity, cerebral blood flow, and brain retraction pressure--are evaluated. Various intraoperative interventions--anesthetic agents, positioning, cerebrospinal fluid drainage, operative approaches involving bone resection or osteotomy, hyperventilation, induced hypotension, induced hypertension, mannitol, and nimodipine--are assessed with regard to their effects on brain retraction. Because brain retraction injury, like other forms of focal cerebral ischemia, is multifactorial in its origins, a multifaceted approach probably will be most advantageous in minimizing retraction injury. Recommendations for operative management of cases involving significant brain retraction are made. These recommendations optimize the following goals: anesthesia and metabolic depression, improvement in cerebral blood flow and calcium channel blockade, intraoperative monitoring, and operative exposure and retraction efficacy. Through a combination of judicious retraction, appropriate anesthetic and pharmacological management, and aggressive intraoperative monitoring, brain retraction should become a much less common source of morbidity in the future.

Wound compression pads are of no value after local anaesthetic breast biopsy

In a randomised study of 120 patients undergoing breast biopsy, wound compression pads did not reduce the frequency of postoperative bruising or haematoma formation, and 12% of the 62 patients having pads had complaints regarding their use. Wound compression pads are of no value after local anaesthetic breast biopsy.

[Occupational injuries caused by breakages of hoses]

During the period 1.1.1984-31.12.1986, 77 accidents caused by breakages of hoses or connections in connection with snap-couplings were notified to the Danish Directorate of National Labour Inspection. These consisted of 33 (42.9%) accidents in connection with employment pressurized air hoses, 25 (32.5%) accidents in connection with employment of steam hoses or hoses with warm water and 19 (24.7%) accidents while employing hoses with chemicals. Accidents with pressurized air resulted in bruising on the neck, head, eyes and upper limbs. Accidents with steam hoses caused scalds scattered over the entire body. Accidents with hoses containing chemicals were mainly responsible for corrosive injuries to the eyes. Prophylactic measures which would probably have prevented approximately 85% of the abovementioned injuries are suggested.

Clinical evaluation of three techniques for administering low-dose heparin

The purpose of this study was to investigate the effect of three techniques for administering subcutaneous low-dose heparin on the formation of bruises at the injection site in adult postoperative cardiothoracic surgery patients. Forty-three subjects comprised the sample. All received subcutaneous injections of heparin, 5,000 units every 12 hours postsurgery. Three subcutaneous injection techniques, identified to study the variables of needle manipulation and tracking of the medication, were administered randomly to each subject. Forty-eight hours after the third injection, the sites were observed and bruises, if present, were measured. Data were analyzed by means of the Friedman test, and a 0.569 level of significance was obtained. It was concluded that, for this sample, none of the three techniques appeared clearly superior in yielding smaller or fewer bruises.

Bruising in cattle fasted prior to transport for slaughter

Three trials, each with 100 bullocks previously grazing improved pasture, compared bruising in cattle fasted for 0, 24 and 48 hours prior to transport for slaughter. Overall the weight of bruised trim from unfasted bullocks (0.48 kg) was significantly less (P less than 0.01) than from bullocks fasted for 24 h (0.99 kg) or 48 h (1.03 kg). length of fast overall had no significant effect. This pattern was not consistent within trials.

Effect of tipped horns on cattle bruising

Six trials in Queensland compared the bruising of 960 cattle with untipped, tipped and no horns. In three of the trials the treatment groups were kept separate during transit to the abattoir. In the other trials all cattle were handled as the one group. Tipped and untipped cattle had similar bruising, whether sent for slaughter as separate groups or together. Thus tipping was ineffective in preventing bruising. Hornless cattle had significantly (P less than 0.05) less bruising than horned cattle when consigned as separate groups. However, this advantage was lost when hornless cattle were mixed with tipped or untipped animals.