Fractures about the orbit in professional American football players

Adult Maxillofacial Trauma Patterns in American Football

INTRODUCTION

The authors aimed to identify and categorize adult maxillofacial trauma patterns in the setting of American football.

METHODS

The National Electronic Injury Surveillance System was accessed to identify adult patients presenting with football-related head and facial injuries from 2009 to 2018. Data surrounding each event were collected including age, injury type, injury location, and disposition of the patient. Chi-squared testing was performed to compare categorical variables, with a Bonferroni correction applied.

RESULTS

During the study period, 1784 total patients (national estimate = 65,052) were identified. The average age for this cohort was 27.26 (SD ± 8.49), with young adults (86.1%) and males (87.9%) sustaining the majority of injuries. Lacerations were the most common injury type (43.1%). Maxillofacial fractures comprised 15.8% of the sample, with nasal bone (52.8%) being the most common subtype. Female patients were significantly more likely to present with head injuries than men (46.8% versus 29.0%, P < 0.001). Young and middle-aged adults combined were more likely to be discharged from the emergency department, whereas the elderly were significantly less likely (P = 0.002). Patients with fractures were significantly more likely to be admitted to the hospital compared to all other types of injuries (P < 0.001).

CONCLUSIONS

An understanding of maxillofacial injuries while participating in American football is important in developing safety initiatives. To address these, it is crucial that providers understand the patterns of craniofacial injuries as they relate to American football trauma.

Types of ocular injury and their antecedent factors: A systematic review and meta-analysis

BACKGROUND

Ocular injuries are an important workplace hazard that can lead to vision loss, decreased functioning, and socioeconomic costs. The aim of this systematic review is to identify types of occupational ocular injuries and examine factors associated with these injuries.

METHODS

Four health sciences databases (Ovid Medline, Embase, PsycINFO, and CINAHL) were reviewed to identify evidence pertaining to occupational ocular injuries. This systematic review was registered with PROSPERO (registration number: CRD42018089876) and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The PICO (Population/Intervention/Comparison/Outcome) tool was used to support, structure, and improve our search strategy.

RESULTS

Overall, 12 studies with quantitative Critical Appraisal Skills Programme grading scores were assessed in a systematic review and meta-analysis of ocular injuries in the workplace. The systematic review identified four main factors associated with occupational ocular injury: (a) use of eye protection at the time of the ocular injury, (b) being male, (c) exposure to biological or chemical occupational hazards, and (d) risk-taking behavior.

CONCLUSIONS

Differences in risk between countries of origin, occupational sectors, and dates of publication, suggest likely differences or changes in safety procedures. We recommend that employers ensure that safety equipment is tailored to the protection of their specific occupational hazards, and that employees are adhering to safety protocols.

Epidemiology of National Football League training camp injuries from 1998 to 2007

BACKGROUND

Football is one of the leading causes of athletic-related injuries. Injury rates and patterns of the training camp period of the National Football League are unknown.

HYPOTHESIS

Injury rates will vary with time, and injury patterns will differ between training camp practices and preseason games.

STUDY DESIGN

Descriptive epidemiology study.

METHODS

From 1998 to 2007, injury data were collected from 1 National Football League team during its training camp period. Injuries were recorded as a strain, sprain, concussion, contusion, fracture/dislocation, or other injury. The injury was further categorized by location on the body. Injury rates were determined based on the exposure of an athlete to a game or practice event. An athlete exposure was defined as 1 athlete participating in 1 practice or game. The injury rate was calculated as the ratio of injuries per 1000 athlete exposures.

RESULTS

There were 72.8 (range, 58-109) injuries per year during training camp. Injuries were more common during weeks 1 and 2 than during weeks 3 to 5. The rate of injury was significantly higher during games (64.7/1000 athlete exposures) than practices (12.7/1000 athlete exposures, P < .01). The rate of season-ending injuries was also much higher in games (5.4/1000 athlete exposures) than practices (0.4/1000 athlete exposures). The most common injury during the training camp period was a knee sprain, followed by hamstring strains and contusions.

CONCLUSION

Muscle strains are the most common injury type in practices. Contact type injuries are most common during pre-season games, and the number of significant injuries that occur during preseason games is high.

Orbital fractures in sport: a review

Orbital fractures represent a small proportion of sports-related injuries in the US and abroad. However, the significant functional and cosmetic sequelae of such fractures warrant a comprehensive evaluation of any athlete sustaining facial trauma. Initial evaluation is directed at excluding neurological impairment or the presence of vision-threatening injury. Subsequent examination should ascertain the presence of signs and symptoms consistent with orbital fracture. These include gross bony deformity, limitation of gaze, diplopia and malposition of the globe. The presence of any of the aforementioned symptoms should prompt further investigation using computed tomography to corroborate or refute clinical suspicion. Orbital fracture mandates referral to an ophthalmologist or oculoplastic surgeon; initial management is dictated by the severity of functional symptoms, and may necessitate early surgical intervention. Those patients who are managed conservatively should return for frequent follow-up, as progressive diplopia, enophthalmos, or gaze limitation are indications for late operative repair. The majority of patients who sustain orbital fractures are able to return to sport, however, persistent diplopia is not uncommon, and may persist despite optimal treatment.

The effects of airbags on orbital fracture patterns in frontal automobile crashes

PURPOSE

To investigate orbital fractures that occurred in frontal automobile crashes and to determine the effects of frontal airbags on injury incidence and severity.

METHODS

The National Automotive Sampling System database files from 1993 to 2000 were examined. Frontal crashes were selected that included drivers and front-seat passengers only and excluded ejected occupants and rollover crashes. Orbital fractures could be closed, open, displaced, or any combination of these and were identified by using the Abbreviated Injury Scale codes.

RESULTS

The analysis included 12,429,580 front-seat occupants from 25,464 cases. Of all occupants who were exposed to an airbag deployment, 0.09% sustained an orbital fracture. In contrast, occupants who were not exposed to an airbag deployment were more than twice as likely to sustain an orbital fracture (0.22%). In addition to reduction in incidence, airbags were also shown to decrease the severity of orbital fractures that occupants sustained. Occupants exposed to airbag deployment mostly sustained closed, less severe fractures (61.9%), whereas occupants not exposed to airbag deployment sustained the majority as more severe, open, displaced, or comminuted fractures (61.3%).

CONCLUSIONS

This article presents the most comprehensive study of orbital fractures in automobile crashes to date. It is shown that both the incidence and the overall severity of orbital fractures decreases considerably with exposure to airbag deployment. This is accomplished because the airbag minimizes occupant contact with the windshield and steering wheel, which are the two leading sources of orbital fractures for occupants not exposed to airbag deployment.