Sports injuries as seen at an accident and emergency department

Differences in patient and injury characteristics between sports- and non-sports related distal radius fractures

INTRODUCTION

The incidence of distal radius fractures (DRFs) is increasing as the number of people in recreational or sporting activities rises, due to a combination of increased leisure time and greater public awareness of the health-related benefits of sports. Despite the increases in sports-related distal radius fractures (SR-DRFs), there are limited studies regarding the characteristics of treatment and recovery.

HYPOTHESIS

There are characteristics specific to SR-DRF treated with conservative or operative management.

MATERIAL AND METHODS

Retrospective review was carried out between January 2010 and December 2017. Overall, 1706 patients were included in the study analysis. Among them, 317 patients were injured during sports activity (18.6%) and 1389 were injured during non-sports activity (81.4%). Demographic data were compared between the two groups. The type of sports was investigated in SR-DRF. Also, we compared surgically treated DRF patients to describe differences in patient characteristics, fracture characteristics, and postoperative complications.

RESULTS

The mean age of patients with SR-DRFs was significantly younger (28 vs. 52 years). The proportion of men was also significantly higher in SR-DRF group compared to NSR-DRF group (62.8 vs. 33.8%). We identified 27 kinds of sports associated with DRFs and the 5 sports topping the list associated were soccer (22.7%), cycling (17.7%), snowboarding (11.0%), ice-skating (9.1%), and mountain hiking (9.1%). There was no difference in terms of the treatment method. However, SR-DRF group had higher proportion of AO/OTA type A fracture (32.6 vs. 13.7%), and NSR-DRF group had higher proportion of type C fracture (79.5 vs. 64.2%). Postoperative complications showed no significant differences, except higher implant removal rate in SR-DRF.

DISCUSSION

Patients with SR-DRF were significantly younger and had higher proportion of men. Proportion of AO/OTA type A was higher in SR-DRF group and proportion of AO/OTA type C was higher in NSR-DRF group. Proportion of surgical treatment was similar in two groups. Given the growing population participating in sports activity worldwide, SR-DRFs are predicted to increase and further study is required.

LEVEL OF EVIDENCE

III; retrospective, epidemiological study.

The epidemiology and etiology of pediatric ocular trauma

Eighteen million people worldwide have uniocular blindness from traumatic injury. Injuries occur disproportionally commonly in childhood. Every year a quarter of a million children present with serious ocular trauma. For the vast majority the injury is preventable. We review the international literature that identifies high-risk circumstances.

Epidemiology of non-submersion injuries in aquatic sporting and recreational activities

Although the issues of drowning and near-drowning in aquatic sporting and recreational activities receive considerable attention in the epidemiological literature, there is not a recognised literature on non-submersion injuries occurring in these activities. This review draws together the epidemiological literature on non-submersion injuries and describes the incidence, nature and causes of these injuries, common risk factors, and strategies for prevention. Activities covered by the review include swimming, diving, boating, surf sports, fishing, water polo and water sliding. For most activities there is a dearth of good quality descriptive studies, with most involving cases-series designs and few providing estimates of incidence. Inconsistencies in inclusion criteria and the reporting of incidence rates makes comparisons within and between activities difficult. Incidence rates were identified for most activities and in general the incidence of injury was low, especially for more serious injury. However, some activities were associated with severely disabling injury, such as spinal cord injury (diving) and amputation (from propeller strikes in water skiing and swimming). Only three studies reporting the significance of postulated risk factors were identified. Lack of knowledge about the water being entered and alcohol consumption are significant risk factors in recreational diving; increased blood alcohol concentrations were reported to increase the risk of death in boating; and obesity and tandem riding were reported to increase the risk of injury on public water slides. Few evaluations of preventive measures were identified. Two studies reported reductions in the incidence of water slide injuries following the introduction of design changes and supervision, but neither had a non-intervention comparison group. Improvements in swimming and diving skills were reported in three studies, but these were not designed to measure changes in the risk of injury.This review demonstrates that there is a need for well-designed epidemiological research on non-submersion injury in aquatic sporting and recreational activities. The first priority should be for studies designed to describe accurately the incidence, nature, severity and circumstances of these injuries, followed by research on the significance of postulated risk factors. Once this research has been undertaken, interventions targeted at reducing the incidence of injury in aquatic sporting and recreational activities can be designed and evaluated.

Epidemiology of medically treated sport and active recreation injuries in the Latrobe Valley, Victoria, Australia

OBJECTIVE

To quantify and describe medically treated sport and active recreation injuries in a defined region of the Latrobe Valley from 7 November 1994 to 6 November 1995.

METHOD

A geographic target area was defined, restricted to the six postcodes that fell wholly within the catchment area of the Latrobe Regional Hospital. Data describing medically treated sport and active recreation injuries to Latrobe Valley residents aged over 4 years (about 70,000) were selected by postcode from three sources: the Victorian Admitted Episodes Dataset (hospital admissions), the Victorian Injury Surveillance System (presentations to hospital emergency departments), and the Extended Latrobe Valley Injury Surveillance (ELVIS) project (presentations to general practitioners).

RESULTS

At least 2300 cases of medically treated sport and active recreation injury were recorded. This corresponds to a hospital admission rate of 16/10,000 population, emergency department presentation rate of 169/10,000 population, and a general practitioner presentation rate of 187/10,000 population. There were more male patients than female, and younger age groups were also overrepresented, but these data may reflect the greater participation of these groups in sport and active recreation. Australian football was associated with the highest number of injuries (accounting for 24.0% and 22.0% of presentations to emergency departments and general practitioners respectively) followed by cycling (15.7% and 12.6%) and basketball (17.5% and 13.5%).

CONCLUSIONS

This study shows that routine health sector data collections in defined populations can provide useful information on the size, distribution, and characteristics of the problem of sport and active recreation injuries at the community level. However, all current health sector systems for injury data collection and surveillance require attention to improve case capture and identification and data quality.

An audit of sports injuries in children attending an Accident & Emergency department

OBJECTIVE

To assess the incidence of attendance, type of injury, sport involved and management of sports injuries in children attending an Accident & Emergency (A&E) department.

METHOD

Children, aged between 5-16 years, presenting with an injury related to sport, were studied over a period of three months.

RESULTS

1858 children attended the A&E department during the three month period. 238 (12.8%) were classified as sports injuries. Boys (71%) were injured more frequently than girls (29%). Injury rates in boys peaked at 14 years whereas in girls a peak occurred earlier at 12 years. Football was the most common sport implicated in injuries (39%). Rollerblading (14%), Rugby (8%), Basketball (7%) and Physical Education at school (7%) were the next most frequently involved sports. Soft tissue injuries dominated (61%). The upper limb was the most common anatomical area injured (46%). Other injuries involved the lower limb (36%), head and neck (15%) and the trunk (3%). Injuries to the wrist were the most frequent presentation accounting for 30 fractures and 30 soft tissue injuries (25%). The majority of children were discharged from the A&E department after treatment (71%). 26% were reviewed at out-patient clinics and 3% required hospital admission. No children were referred for physiotherapy.

CONCLUSION

Children participate in sport and can be injured. The majority of sports injuries presenting to an A&E department appear to be of a minor nature and could be managed with simple first aid techniques by parents, teachers and coaches at the scene or by attending primary care in the first instance. Supervision of children, participation in organised sport and the use of protection devices may help to prevent serious injury.

Measurement of severity of sports injuries: an epidemiological study

OBJECTIVE

To evaluate the severity of sports injuries in relation to the severity of injuries due to other causes and in relation to type of sport, using generally applied measures of injury severity.

SUBJECTS

A total of 12403 patients, 4-50 years old, who were treated in the trauma department of the Groningen University Hospital for a sports injury, from January 1990 until January 1997.

METHOD

All patients treated because of an injury entered the study. A distinction was made between injuries caused by playing sports, home and leisure accidents, traffic accidents and violence. The severity of the injuries was assessed by using the criteria of rate of admission, Injury Severity Scale (ISS). Finally the sports injuries were analysed with regard to type of sport.

RESULTS

In total, 57760 injuries were registered. After injuries due to home and leisure accidents (44%; 25228) sports injuries (21%; 12 403) were the most frequent cause of injury. Of the patients with a sports injury, 7.9% (980) were admitted, which is more than with home and leisure accidents (6.7%; 1690) but less than with traffic accidents (21.5%; 2202) and violence (9.3%; 364). In a majority of cases, admission was related to a limited number of types of sport. The mean ISS of sports injuries was low, as with injuries following home and leisure accidents and violence. The percentage of sports injuries with an ISS higher than or equal to 16 and the percentage mortality were both low in comparison to injuries due to violence or traffic accidents.

CONCLUSIONS

Sports injuries rank second highest in terms of cause of injury, after home and leisure accidents; and rank third in terms of severity, after traffic accidents and violence. Even though the ISS is low, sports injuries may have serious consequences.

Ocular sports injuries: the current picture

OBJECTIVES

To determine the recent incidence of eye injury due to sport in Scotland, identify any trend, and establish which sports are responsible for most injury? The type of injury and final visual outcome is also evaluated.

METHODS

A prospective observational study of ocular injuries sustained during sport was performed over a one year period. Only patients requiring hospital admission were included. Data were collected on a standardised proforma and entered into a central database. Patients were followed up for at least three months.

RESULTS

Of 416 patients admitted because of ocular injury, 52 (12.5%) resulted from playing a sport. Although all racquet sports together accounted for 47.5% of these injuries, football was the single most common sport associated with ocular trauma, being responsible for 32.5% of cases. The most common clinical finding was macroscopic hyphaema occurring in 87.5% of patients. Overall the final visual acuity was 6/6 in 92.5% of patients.

CONCLUSIONS

The incidence of eye injury due to sport at 12.5% is lower than previously reported, suggesting a change in the pattern of ocular trauma. Football is the single most common cause of ocular injury from sport in Scotland, but the wearing of protective headgear would be difficult to instigate. The incidence of hyphaema in sport related ocular trauma (87.5%) is almost double that of all ocular injury (47.8%), so the potential for serious visual loss as the result of a sports injury should not be underrated. Ophthalmologists have a role in protecting this young population at risk by actively encouraging the design and use of protective eyewear.

Sport and active recreation injuries in Australia: evidence from emergency department presentations

OBJECTIVE

Despite the rise in specialist clinical services for the management of sports and active recreation injury, many patients attend hospital emergency departments for treatment. The purpose of this study was to describe sports injury cases presented to selected hospital emergency departments around Australia for the period 1989-1993.

METHODS

Routinely collected emergency department injury presentation data from the Australian National Injury Surveillance Unit were examined. Data on 98,040 sports and active recreation emergency department presentations were analysed. Sports and active recreation activities were ranked according to frequency of presentation. Relative proportions of injury type and body region injured were determined. Data are presented separately for children (<15 years of age) and adults (>15 years of age).

RESULTS

Among the 10 activities that most commonly led to a sports or active recreation injury presentation for all ages were cycling, Australian football, basketball, soccer, cricket, netball, and rugby. For children, injuries were also commonly associated with roller skating/blading, skateboarding, and trampolining. Hockey, martial arts, and dancing injuries were frequent in adults. Most sporting injuries occurred during organised competition or practice whereas the active recreation injuries occurred in a variety of settings. Fractures, strains, and sprains, particularly to the lower and upper extremities, were common types of injury.

CONCLUSION

The rich, but nevertheless limited, information available about sports and active recreation injuries from data collected in emergency departments indicates that these activities are a common context for injury at the community level in Australia.

Sports members' participation in assessment of incidence rate of injuries in five sports from records of hospital-based clinical treatment

This study is about the incidence rate of sports injuries in five different types of sports, gymnastics, soccer, volleyball, hockey, and basketball, for which 5,154 patients were admitted to the Emergency Unit of the Groningen University Hospital during the period 1990 through 1994. Incidence rate had been computed by membership participation. Basketball had the highest incidence rate (231 injured persons per 10,000 participants), followed by hockey (158 injured persons per 10,000 participants). The highest mean Injury Severity Score, 2.39, was found for gymnastics which had the lowest incidence rate (7 injured persons per 10,000 participants). Gymnastics had the highest percentage (12%) clinically treated patients, whereas basketball had the smallest percentage (2%) of clinically treated patients. The most frequent type of injury was distorsion, except for hockey, in which contusion had the highest percentage of occurrence. For all five types of sports, the majority (about 90%) of the injuries were observed at either the lower or at the upper extremities.

Sports, exercise, and other causes of injuries: results of a population survey

Mortality rates and injuries requiring medical treatment associated with sports and exercise are generally low. However, higher injury rates are reported for athletes and members of sports clubs. This study focuses on the sport- and exercise-related injury rate for various age and sex groups in the general population and how sport and exercise injury rates compare with those for other activities. The data presented are based on telephone interviews. Of the participants (N = 6,596), 335 (5.1%) reported having sustained an injury in the previous month; 46% of injuries among males and 14% of those among females were sport or exercise related. The data show a downward trend in sport- and exercise-related injury rates with increasing age. It is concluded that, as a proportion of all injuries sustained, the sport- and exercise-related injury rate is high, particularly among males. Possible future research on sport- and exercise-related injuries is discussed.

Sport injury patterns in urban and rural accident and emergency units

Sport injuries are a common yet an unwanted aspect of participation in sports. Previous studies have indicated disparities between urban and rural injury patterns. This study examines sport injuries specifically. Although similar in many features, there were major variations in the patterns of rural and urban sports injuries. Rural injuries appeared to revolve around football codes while the urban pattern reflected involvement in a wider variety of sport. The results confirm that injury data can be used to determine specific priorities within different communities. Consequently local data are seen as imperative to initiate appropriate preventive action in rural areas.

Sports fractures of the distal radius--epidemiology and outcome

Of 2774 consecutive, prospectively documented fractures of the distal radius, 225 (8 per cent) occurred as sports injuries, mainly in young men. Soccer produced the greatest number of wrist fractures with 112 cases (50 per cent). Skiing, dancing and rugby caused 12 per cent, 9 per cent and 7 per cent of all sporting wrist fractures respectively. Skiing, horseriding and dancing consistently resulted in more complex fractures. In soccer, synthetic pitches increased the likelihood of a fracture following a fall by a factor of five. Twelve per cent of fractures required further treatment because of instability leading to redisplacement. The complication rate was 14 per cent with the majority being cases of malunion (12 per cent). Of the 131 patients who returned a questionnaire, 72.5 per cent had returned to their original sport. This was influenced mainly by the patient's age and pre-injury standard of competition.

Sport related injuries attending the accident and emergency department

Of new patients attending our hospital, 7.1% had injured themselves playing sport. The majority had been playing football and had sustained a soft tissue injury. Many of the patients presented late, i.e. after 24 h or longer. These patients would be best dealt with in a sports clinic, staffed by personnel with an interest in this field.