Epidemiology of 1.6 million pediatric soccer-related injuries presenting to US emergency departments from 1990 to 2003

Guide to Muscular Injuries and Common Ligamentous Injuries Among Soccer Players

With over 250 million players worldwide, soccer is the most popular sport in the world. The overall number of players at professional, amateur, and recreational levels has increased along with an increase in player diversity, including age and sex. These increases in player numbers, as well as a variety of demographics, have resulted in an increase in soccer-related injuries. Injury in the professional setting can lead to time off the field and an effect on team results and earnings. Injury at the amateur and recreational levels can lead to time off work, away from other activities, and change in activities of daily living. We provide an extensive list of common injuries sustained by soccer players, their pathophysiology, diagnosis, treatment, and general guidelines on return to play.

Position comparison of sport-related concussions in female youth soccer players

OBJECTIVES

Youth soccer participation, particularly among females, continues to grow worldwide. With the high incidence of sport-related concussion (SRC) in soccer, it is important to investigate if SRC occurs disproportionally by positions. Our hypothesis was to see no positional differences in SRCs, SRC-related characteristics, and outcomes among in female youth soccer athletes.

METHODS

Data were prospectively collected from participants at a single sports medicine institution between August 2015-April 2021. Female participants aged 8-18 diagnosed with SRC sustained during an organized soccer practice, scrimmage, or game were separated into 4 groups based on position: Forward, Midfielder, Defender, and Goalkeeper. Demographics, medical history, injury-related details, and outcomes were reviewed. A chi-square test or Fisher's exact test was used for categorical variables. Continuous variables were compared with Mann-Whitney or Kruskal-Wallis test.

RESULTS

Two hundred fourteen participants were included: 52 Forwards, 65 Midfielders, 63 Defenders, and 34 Goalkeepers. There were no significant differences between the groups in age, race, ethnicity, or previous concussion history. Differences in mechanism existed with Goalkeepers most commonly reporting Head to Body Part. Goalkeepers, which make up 1/11 of the total positions on the field, had a significantly higher proportion of SRCs compared to Field Positions. (9.1% vs 15.9%)At 3-month post-enrollment, there were no significant differences in reported symptoms or return-to-play between the different positions.

CONCLUSION

In youth female soccer players, goalkeepers sustained a higher proportion of sport-related concussions compared to field players based upon the composition of a soccer team. The mechanism of injury also differed among the different soccer positions. However, no differences in concussion characteristics, outcomes, or RTP were seen across the different soccer positions.

Radiological characteristics and injury mechanism of Logsplitter injury: a descriptive and retrospective study

BACKGROUND

Logsplitter Injury is a type of high-energy ankle fracture dislocation. The mechanism of injury has not been described in detail. A detailed understanding of the radiological features and pathological changes can further guide treatment.

METHODS

Between April 2009 and December 2018, a retrospective analysis was conducted on 62 patients with Logsplitter injury. The study analysed the characteristics of fibular injury, tibial injury, syndesmosis injury, medial injury and lateral ligament injury on preoperative X-ray and CT scans. The incidence of the different injury types was summarised. The correlation between Logsplitter injuries and the mechanisms causing them were analysed using the Lauge-Hansen classification of ankle fractures.

RESULTS

The study provides data on the types of fractures observed. Of the total fractures, 98.4% were open fractures. The fibula injuries were classified as no fracture (1.6%), transverse or short oblique fractures (61.3%), butterfly fragments (25.8%), and comminuted fractures (11.3%). The tibial injuries included compression of lateral articular surfaces (38.7%) and posterior compressions (6.5%). Medial injuries, including medial malleolar fractures, accounted for 87.1%, and deltoid ligament rupture accounted for 12.9%. The study found that injuries to the syndesmosis consisted of simple ligament ruptures (11.3%), Tillaux fractures (8.1%), Volkmann fractures (43.5%), and Tillaux and Volkmann fractures (37.1%). In 12.9% of cases, there was a complete rupture of the lateral collateral ligament. Based on the Lauge-Hansen classification, 87.1% of injuries were pronation-abduction injuries, while 8.1% were pronation and external rotation injuries, and 1.6% were supination external rotation injuries. Furthermore, 3.2% of cases could not be classified.

CONCLUSION

The pathoanatomic characteristics of Logsplitter injury are diverse, with some cases accompanied by collateral ligament injury. It is important to note that these evaluations are objective and based on current results. The most common injury mechanism is vertical violence combined with abduction, although in some cases, it may be a vertical combined external-rotation injury.

LEVEL OF EVIDENCE

(4) case series.

TRIAL REGISTRATION

This study has been approved by the ethical research committee of the Honghui Hospital of Xi'an Jiaotong University, under the code: 202,003,002.

Trends in Soccer-Related Craniomaxillofacial Injuries, United States 2003-2022

BACKGROUND

Soccer is one of the most popular sports worldwide. However, it has risks of injury to craniomaxillofacial regions such as the head, neck, and mouth.

PURPOSE

The purpose of this study is to determine which demographic and injury characteristics among soccer players with craniomaxillofacial injuries are associated with increased hospitalizations.

STUDY DESIGN, SETTING, AND SAMPLE

This is a retrospective cohort study utilizing the National Electronic Injury Surveillance System. Subjects included in this study experienced an injury to a craniomaxillofacial area from soccer between January 1, 2003, and December 31, 2022.

PREDICTOR VARIABLE

The predictor variables included demographics (age, sex, race) and injury characteristics (craniomaxillofacial region, diagnosis).

MAIN OUTCOME VARIABLE

The primary outcome variable was injury severity defined as hospitalization outcome after injury (yes/no). The secondary outcome variable was the trends in the incidence of soccer craniomaxillofacial injuries over time (2003-2022).

COVARIATES

The covariates were the heterogenous set of predictor variables in this study.

ANALYSES

Descriptive statistics and univariate analyses were computed. Survey-weighted univariate and multivariate logistic regression were used to measure the association of demographic and injury variables with hospitalization outcome. Statistical significance was defined as P < .05.

RESULTS

The study sample included 26,642 subjects (national estimate, 799,393). The national incidence of craniomaxillofacial soccer injuries generally increased between 2003 and 2012 and decreased between 2016 and 2020. Subjects in the ≥30 age group had increased odds of hospitalization compared to those in the 10-19 age group (odds ratio [OR], 2.12; P < .001). Compared to females, males had significantly higher odds of hospitalization (OR, 1.53; P < .001). Head (OR, 8.42; P < .001) and neck (OR, 15.8; P < .001) injuries had increased odds of hospitalization compared to facial injuries. Relative to contusions/abrasions, subjects with fractures (OR, 94.7; P < .001), dental injuries (OR, 41.3; P < .001), and concussions (OR, 5.33; P = .017) were at significantly higher odds of hospitalization.

CONCLUSION AND RELEVANCE

Age, sex, craniomaxillofacial region, and diagnosis were significant predictors of hospitalization outcome after craniomaxillofacial soccer injury. Safer playing styles, use of mouthguards, and proper medical management may reduce future risks of craniomaxillofacial injury from soccer.

Soccer-related injuries utilization of U.S. emergency departments for concussions, intracranial injuries, and other-injuries in a national representative probability sample: Nationwide Emergency Department Sample, 2010 to 2013

Soccer participation in the United States (U.S.) has increased over time, and injuries as well as interest to prevent injuries has become more common. This study described Emergency Department (ED) visits related to concussions, intracranial injuries (ICI), and all-other injuries attributed to soccer play; described healthcare cost and length of hospital stay of soccer-related injuries; and determined independent predictors of concussions, ICI, and all-other soccer injuries leading to ED visits. The study examined soccer-related weighted discharge data from the Nationwide Emergency Department Sample, Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality. Weighted tabular analysis of univariate and bivariate analyses and weighted and adjusted logistic regression models were conducted. A total of 480,580 of U.S. ED visits related to soccer injuries were available for analysis between 2010 to 2013. Generally, 98% of soccer-related ED visits resulted in routine (treat-and-release) visits. However, the odds of transfer to a short-term hospital following ED evaluation and treatment was more than 37-fold higher for soccer-injured youth and adults diagnosed with ICI when compared to all-other soccer injuries; additionally, these patients showed 28-fold higher odds of being admitted for inpatient care at the ED-affiliated hospital. For concussion, soccer-injured patients with concussion showed nearly 1.5-fold higher odds of being transferred to a short-term hospital than did those with any other soccer injury. Soccer-related ED visits cost more than 700 million in U.S. dollars from 2010 to 2013. Notable differences were noted between concussions, ICI, and all-other soccer injuries presenting to U.S. ED. Albeit underestimated given that this study excludes other forms of health care and treatment for injuries, such as outpatient clinics, over the counter medications and treatment, and rehabilitation, healthcare cost associated with soccer-related injuries presenting to ED is high, and remarkably costly in those with an ICI diagnosis.

Acute Musculoskeletal Sports Injuries in School Age Children in Britain

OBJECTIVES

To determine the relative number of acute musculoskeletal injuries sustained by children due to different sports in a region of the UK, and assess the burden upon the NHS, through a cross sectional study.

METHODS

Collection of data for every child aged 6-18 seen at the Peterborough City Hospital fracture clinic, whose sports injury was from 1^st September 2018 - 31^st August 2019 (1 school year; n=689). Data was gathered throughout the year by three children's orthopaedic surgeons, who consulted the clinic records, notes and x-rays of all children who had attended clinic.

RESULTS

Boys were 2.7 times more likely to sustain injury than girls. Children aged 6-9 had few injuries (mean 24 injuries each year group), 10-15 had a large number of injuries (mean 84), and 16-18 again had few injuries (mean 35). Football and rugby were responsible for the majority of injuries (61% between them), as well as the majority of physiotherapy appointments (72%). Sports with the highest likelihood that an injury will be sufficiently serious to require surgery were equestrian (42% of injuries required surgery), gymnastics (27%), ice skating (25%) and rugby (22%). Popular sports in which injuries were relatively rare include swimming, athletics, cricket, hockey, tennis and badminton.

CONCLUSION

The sports that caused the most injuries were football and rugby. Considering relative participation in different sports, it is clear that rugby has a disproportionate number of musculoskeletal injuries in total, of severe injuries requiring surgery, and requiring rehab from physiotherapy.

Purposeful Heading in Youth Soccer: A Review

Recent public concern over the short- and long-term effects of repetitive head impacts (RHI) associated with purposeful heading in soccer has led researchers to study a multitude of variables related to this important aspect of the game. Of particular interests are the effects of soccer heading in the youth population (≤ 13 years old) whose brains are undergoing rapid development. We conducted a review on youth soccer heading that includes purposeful heading frequency, head impact biomechanics, head injuries, clinical outcomes, and modifying factors. We have concluded that youth soccer players head the ball at a low frequency that typically increases with age and with a finding that boys head the ball more often than girls do. Interestingly, although girls head the ball less frequently than boys do, they tend to sustain higher head impact magnitudes. Head injuries are more likely to occur in girls versus boys and during games because of contact with another player. Clinical outcome measures of concussion are often utilized to study the effects of soccer heading, in both field and laboratory environments. Immediately following soccer heading, youth often report having a headache and demonstrate some deficits in balance measures. Modifying factors that may benefit soccer players participating in purposeful heading activities include stronger neck musculature, wearing headgear, and the use of mouthguards. Research involving youth soccer players needs to be expanded and funded appropriately to better understand the consequences of RHI in both the short and long term.

Trends in Soccer-Related Ocular Injuries within the United States from 2010 through 2019

Purpose: Soccer participation within the United States continues to increase, necessitating consideration of the various injuries that may occur. The present study analyzes trends in the incidence of ocular injuries secondary to soccer trauma, the associated mechanism, and related visual sequelae, and quantifies age- and sex-specific differences in the distributions of these variables.Methods: The Consumer Product Safety Commission's National Electronic Injury Surveillance System (NEISS) was queried for soccer-related ocular injuries from 2010 through 2019. Data exclusively focused on the globe were selected, and information regarding age, sex, specific diagnosis, mechanism of injury, and visual sequelae were acquired. Significance was calculated using the chi-squared test.Results: 628 NEISS entries were evaluated, extrapolating to a national average incidence of approximately 1580 soccer-related ocular injuries per year. There were a relatively static number of events during the ten-year time period of study. The most common diagnoses were contusions or abrasions (36.1%); among records with a reported mechanism of injury, the most common was contact with the soccer ball (80.9%). Visual sequelae were noted in a significant minority of patients (15.4%). Patients ≤18 and males comprised the majority of visits (68.2% and 70.2%, respectively). Significant sex- and age-specific differences were observed in the distributions of diagnoses.Conclusions: There are serious visual consequences associated with soccer-related ocular injury. Despite the existence of eye protection, there remain no regulations requiring its consistent use. Therefore, among all parties involved (e.g., players, families, and physicians), there remains a need to increase education regarding the potential ocular dangers associated with the sport.

Influence of Size and Maturity on Injury in Young Elite Soccer Players

The involvement of pre-adolescents in soccer is becoming more and more frequent, and this growing participation generates some concerns about the potential factors for sports injuries. The purpose of this study was to investigate sports injuries in younger (U9–U11) and older (U12–U13) children playing soccer at an elite level, analyzing potential anthropometric and maturity risk factors. A total of 88 elite soccer players aged 9–13 years were investigated. Weight, stature, and sitting height were measured at the start and at the end of the competitive season, computing the relative growth velocities. Additional body composition parameters were taken during a second survey. Maturity offset was calculated using predictive equations based on anthropometric traits such as years from age at peak height velocity (YPHV). Injuries suffered during the competitive season were recorded. Maturity and some anthropometric characteristics were significantly different according to the presence or absence of injuries among the players. Multiple logistic regression revealed that YPHV, body mass index (BMI), and calf muscle area were the factors most significantly correlated with injuries. Players with increased BMI, with decreased calf muscle area, and who were closer to their peak height velocity, were at a higher risk of injury. Findings showed that a monitoring program of anthropometric characteristics taking into account the maturational stage needs to be developed to prevent injuries.

Abdominal Organ Injuries in Youth Soccer: A Case Series and Review of Literature

ABSTRACT

We describe 13 children who presented to the Penn State Health Milton S. Hershey Medical Center (HMC) with pediatric soccer-related abdominal organ injuries. A review of the Pennsylvania Trauma System Foundation's Trauma Registry was performed between 2001 and 2015 for children with soccer injuries hospitalized at trauma centers across Pennsylvania. Out of 52 children at Hershey Medical Center, 13 suffered abdominal organ injuries. Injuries included the spleen [5], kidney [4], liver [2], and combined organ involvement [2]. All patients presented with abdominal and/or flank pain. All patients with kidney injuries presented with hematuria. All patients presented after a player-to-player (P2P) contact. Nearly all patients (12/13) were treated nonsurgically. Our findings showed that abdominal organ injuries constitute a substantial portion of pediatric soccer injuries requiring hospitalization, with spleen being the organ injured most frequently. Soccer-related abdominal organ injuries should be suspected in players who suffer abdominal and/or flank pain, and/or hematuria after a P2P contact.

Factors affecting emergency department visits, readmissions, and reoperations within 30 days of ankle fracture surgery- an institutional retrospective study

INTRODUCTION

With the U.S. healthcare system focused on value of care, providers and hospitals are increasingly measured by factors that increase patient care and decrease healthcare cost. Early postoperative adverse events not only increase healthcare cost, but also illuminate areas of potential improvement in patient care. This large single institution study aims to delineate factors that may influence emergency department visits, admissions, and reoperations within 30 days of ankle fracture surgery.

METHODS

This retrospective review of patients at a Level 1 trauma center evaluated 30-day outcomes after ankle fracture surgery over a 4-year period (2015-2018). A total of 596 patients were included in final analysis. The primary outcome measures assessed were emergency department (ED) visits within 30 days, unplanned readmissions within 30 days and unplanned return to the operating room (OR) within 30 days. Patient and injury characteristics were investigated as potential factors related to these 30-day outcomes. Multiple linear regression was used for outcomes.

RESULTS

Forty-three (7.2%) patients visited the ED within thirty days, 30 (5.0%) patients were readmitted within thirty days, and 10 (1.7%) patients requiring reoperation within thirty days. Sex, insurance status, several comorbidities, smoking status, and fracture type/location were not found to be significantly related to 30-day events. Age less than 45 was a significant risk factor for returning to the ED within 30 days (RR 2.1, p = 0.016). Open fractures were more likely to require unplanned reoperation than closed fractures (RR 5.7, p<0.01). Fifty-four percent of ED visits were for postoperative pain, while 37% of ED visits and 60% of readmissions within 30 days were for issues unrelated to the ankle fracture.

CONCLUSIONS

Age less than 45 years old was a risk factor for early ED visits, highlighting a potential "at-risk" population after ankle fracture surgery. Furthermore, many of the ED visits (37%) and readmissions (60%) were unrelated to the ankle fracture suggesting unnecessary healthcare utilization may be avoided with protocols that increase emphasis on reconditioning and optimization of comorbidities.

A Fraction of Recommended Practices: Implementation of the FIFA 11+ in NCAA Soccer Programs

Background and Objectives: National Collegiate Athletic Association (NCAA) soccer coaches implement numerous warm-up and flexibility strategies to prepare athletes for training and competition. The Fédération Internationale de Football Association (FIFA) developed the 11+ injury prevention program to reduce non-contact injuries. This study aimed to analyze the level of familiarity with and implementation of the evidence-based FIFA 11+ amongst NCAA Division I (DI) and Division III (DIII) men’s and women’s soccer coaches. Materials and Methods: NCAA soccer coaches in the United States received an Institutional Review Board—approved survey hyperlink. A total of 240 coaches completed the survey. The respondents represented 47.5% men’s and 52.5% women’s teams distributed within DI and DIII programs. Descriptive statistics are reported as frequency counts and mean ± standard deviation where applicable. Pearson’s chi-square tests were performed to assess potential differences with a significance level set at α < 0.05. Results: The results indicated that approximately 62% of the respondents reported being familiar with the FIFA 11+ program. Of those coaches familiar with the program, 15.0% reported full implementation, 57.5% reported partial implementation, and 27.5% reported no implementation. Chi-square analyses revealed significant differences in FIFA 11+ implementation based upon division level (χ² = 4.56, p = 0.033) and coaching certification levels (χ² = 13.11, p = 0.011). Conclusions: This study indicates that there is a gap between FIFA 11+ knowledge and actual implementation. To reduce the risk of non-contact injury, there is a need to educate coaches and athletic trainers on the purpose of the FIFA 11+ program and how to perform the exercises correctly.

Femur, Tibia, and Fibula Fractures Secondary to Youth Soccer: A Descriptive Study and Review of the Literature

Objectives Soccer is the most popular sport in the world and is one of the top sports with increased participation. Despite the vast and increasing numbers of soccer players, limited data are available on pediatric lower extremity injuries. In particular, the purpose of the study is to describe the epidemiology of femur, tibia, and fibula fractures secondary to youth soccer. Methods A retrospective review concerning soccer-related femur, tibia, and fibula fractures was conducted in children under the age of 18 years from January 1, 2000 to December 31, 2015 with statewide data from the Pennsylvania Trauma Systems Foundation (PTSF), Mechanicsburg, PA. Results A total of 258 youth soccer players were admitted for femur, tibia, and fibula fractures from 2000 to 2015. These fractures constituted 33% of soccer-related injuries in youth admitted at trauma centers. Sixty-five percent of the fractures involved the tibia and 34% involved the femur. Body contact injury resulted in 54% of the fractures and non-body contact injury resulted in 46% of the fractures. Athletes the age of 13 and older sustained 67% of the fractures and were more likely to incur contact injuries (p-value=0.000041) than those less than 13. Males sustained 67% of the fractures, and gender was not associated with the mechanism of injury (p-value=0.43). Open fractures included 10% of tibia fractures and did not occur in femur fractures. The growth plate was involved in 24% of the femur fractures and 17% of the tibia fractures. Conclusion Youth soccer has the potential for serious femur, tibia, and fibula fractures. Intervention programs should aim at reducing non-body contact mechanism in children < 13 years of age and body contact mechanism in children ≥ 13 years of age. Further research should investigate injury prevention methods such as potentially reducing body contact mechanism by improving the effectiveness of shin guards.

Epidemiology of Surgical Treatment of Adolescent Sports Injuries in the United States: Analysis of the MarketScan Commercial Claims and Encounters Database

Purpose

To determine whether there is increasing surgical management of adolescent sports injuries and whether the average age of surgical patients is decreasing.

Methods

The Truven Health MarketScan Database was searched from 2008 to 2014 for patients 10 to 19 years of age using the International Classification of Disease, 9th Revision codes and Current Procedure Terminology, 4th Edition, codes for operative treatment for the following conditions: anterior cruciate ligament (ACL) injuries, knee collateral ligament (KCL) injuries, meniscal injuries, Osgood–Schlatter syndrome, and elbow ulnar collateral ligament injuries. Patients identified were characterized by sex, age, year of injury, and type of residence (urban vs rural) based on metropolitan statistical areas.

Results

A total of 516,892 patients sustained 1 of the identified injuries, and 133,541 (25.8%) patients underwent a related surgery. KCL and meniscal injuries demonstrated a consistent increase in the rate of surgical intervention (P < .0001). Average age of surgical intervention did not increase or decrease overall for any diagnosis. Female adolescents were more likely to undergo surgery for KCL injuries (adjusted odds ratio [aOR] 1.7, 95% confidence interval [CI] 1.58-1.79, P < .0001), Osgood–Schlatter syndrome (aOR 1.8, 95% CI 1.38-2.39, P < .0001), and ACL injuries (aOR 1.5, 95% CI 1.45-1.52, P < .0001), whereas male adolescents were more likely to undergo surgery for meniscal injuries (aOR 1.3, 95% CI 1.24-1.30, P < .0001) and ulnar collateral ligament injuries (aOR 1.1, 95% CI 1.06-1.23, P < .0005). Patients in rural areas were more likely to undergo surgical intervention for ACL and meniscal injuries (P < .0001) and KCL injuries (P = .02).

Conclusions

We found that surgical treatment of 5 common sports injuries remains stable, with only KCL injuries and meniscal injuries showing an increase in surgical incidence. Average age of surgical intervention did not change significantly over the 7-year time span for any diagnosis.

Level of Evidence

Level IV, Cross Sectional Study.

Pediatric Sports Injuries

With increasing pediatric participation in organized sport and the early specialization of children in single sports, the number of injuries seen in the pediatric and adolescent athletic population continues to increase. Children experience acute traumatic injuries during practice and competition as well as chronic overuse injuries secondary to the repetitive stress on their developing bodies. The unique nature of the pediatric patient often requires a different diagnostic, prognostic, and treatment approach to sports injuries compared with their adult counterparts.

Soccer Injuries in Children and Adolescents

Participation in youth soccer in the United States continues to increase steadily, with a greater percentage of preadolescent participants than perhaps any other youth sport. Despite the wide-ranging health benefits of participation in organized sports, injuries occur and represent a threat to the health and performance of young athletes. Youth soccer has a greater reported injury rate than many other contact sports, and recent studies suggest that injury rates are increasing. Large increases in the incidence of concussions in youth soccer have been reported, and anterior cruciate ligament injuries remain a significant problem in this sport, particularly among female athletes. Considerable new research has identified a number of modifiable risk factors for lower-extremity injuries and concussion, and several prevention programs have been identified to reduce the risk of injury. Rule enforcement and fair play also serve an important role in reducing the risk of injury among youth soccer participants. This report provides an updated review of the relevant literature as well as recommendations to promote the safe participation of children and adolescents in soccer.

Trends in Urgent Care Utilization Following Ankle Fracture Fixation

BACKGROUND:

The Centers for Medicare and Medicaid services (CMS) have implemented initiatives to improve postdischarge care and reduce unnecessary readmissions. Readmissions within 30 days are frequent and represent an economic burden on both patients and the healthcare system. The aim of this study was to evaluate the frequency and causes for urgent care visits within 30 days of discharge after ankle open reduction and internal fixation (ORIF) and determine factors correlated with such visits.

METHODS:

This was a retrospective analysis of prospectively collected data. All patients who underwent ankle ORIF at our institution between July 1, 2016, and June 30, 2017, were included. Patients were identified using Current Procedural Terminology (CPT) codes for ankle ORIF. Patients' demographics including age, sex, race, body mass index, occupation, insurance payer, and comorbidities were documented.

RESULTS:

Thirty-five patients (10.51%) had urgent care visits within 30 days of discharge. Patients presented at a mean of 11.8 days after the day of surgery. Sixteen patients (45.71%) had cast/splint-related issues, 7 (20%) presented with pain, and 7 (20%) with increased operative site drainage. Univariate analysis demonstrated a statistically significant association between postoperative urgent care visits and patients with diabetes ( P = .03) or underlying psychiatric disorders ( P = .03).

CONCLUSION:

In this population study of patients undergoing ankle fracture surgery, we found that the rate of urgent care visits within 30 days of discharge exceeded the rate of inpatient readmission. Additionally, patients with diabetes and psychiatric disorders were significantly more likely to present to an urgent care facility postoperatively, potentially accounting for increased expenditures of the healthcare system.

LEVEL OF EVIDENCE:

Level III, comparative series.

[Effectiveness comparison of open reduction and internal fixation for open and closed ankle Logsplitter fractures]

Objective

To investigate the effectiveness of open reduction and internal fixation on high-energy ankle Logsplitter injuries (a kind of transsyndesmotic ankle fracture dislocation), and compare the prognosis between open and closed Logsplitter fracture.

Methods

The clinical data of 36 Logsplitter fractures treated with open reduction and internal fixation between April 2011 and May 2016 were retrospectively analyzed. Among them, 15 cases were open fracture and dislocation (open group) and 21 cases were closed fracture and dislocation (closed group). There was no significant difference between the two groups in gender, age, combined injury, injury to hospital admission time, and other general data ( P>0.05), with comparability. The wound healing, ankle mobility recovery, complications, and fracture healing were observed after operation. The ankle function was evaluated by the American Orthopaedic Foot and Ankle Society (AOFAS) score.

Results

Both groups were followed up 12-29 months (mean, 19 months). There was no significant difference in the follow-up time between the open group and the closed group ( t=1.169, P=0.251). In the open group, there were 3 cases of postoperative infection, 3 cases of nonunion, and 5 cases of post-traumatic osteoarthritis; the above complications occurred in 1 case in the closed group; there was no significant difference in complications between the two groups ( P=0.41) except post-traumatic osteoarthritis ( P=0.02). At last follow-up, there was no significant difference in AOFAS score between the two groups ( t=1.981, P=0.056). According to AOFAS score criterion, the results were good in 10 cases and general in 5 cases in the open group, and good in 13 cases and general in 8 cases in the closed group, showing no significant difference ( P=0.45). There was no significant difference in the fracture healing time and ankle flexion, dorsal extension, varus, and valgus motion between the two groups ( P>0.05).

Conclusion

Open reduction and internal fixation for open or closed Logsplitter fractures can achieve satisfactory results, improve fracture healing rate, effectively reduce the incidence of complications, and improve ankle function.

Effects of the '11+ Kids' injury prevention programme on severe injuries in children's football: a secondary analysis of data from a multicentre cluster-randomised controlled trial

BACKGROUND

To assess the effects of the injury prevention programme '11+ Kids' on reducing severe injuries in 7 to 13 year old football (soccer) players.

METHODS

Football clubs (under-9, under-11 and under-13 age groups) from the Czech Republic, Germany, the Netherlands and Switzerland were cluster-randomised (clubs) into an intervention (INT) and a control group (CON). INT replaced their usual warm-up by '11+ Kids' two times a week. CON followed their regular training regime. Match and training exposure and injury characteristics were recorded and injury incidence rates (IRs) and 95% CIs calculated. For the present analysis, only severe injuries (absence from training/match ≥28 days) were considered. Hazard ratios (HR) were calculated using extended Cox models.

RESULTS

The overall IR of severe injuries per 1000 football hours was 0.33 (95% CI 0.25 to 0.43) in CON and 0.15 (95% CI 0.10 to 0.23) in INT. There was a reduction of severe overall (HR 0.42, 95% CI 0.24 to 0.72), match (0.41, 0.17 to 0.95) and training injuries (0.42, 0.21 to 0.86) in INT. The injury types that were prevented the most were: other bone injuries 66%, fractures 49% and sprains and ligament injuries 37%. Severe injuries located at the knee (82%), hip/groin (81%), the foot/toe (80%) and the ankle (65%) were reduced tremendously.

CONCLUSIONS

'11+ Kids' has a large preventive effect on severe injuries by investing only 15 to 20 min per training session. The present results should motivate coaches to implement effective injury prevention programmes such as the '11+ Kids' in children's football.

TRIAL REGISTRATION NUMBER

NCT02222025.

Trends and Epidemiologic Factors Contributing to Soccer-Related Fractures That Presented to Emergency Departments in the United States

Background:

Understanding the risks and trends of soccer-related injuries may prove beneficial in creating preventative strategies against season-ending injuries.

Hypothesis:

Soccer-related fractures will have decreased over the past 7 years.

Study Design:

Descriptive epidemiology study.

Level of Evidence:

Level 3.

Methods:

The National Electronic Injury Surveillance System (NEISS) database was queried to identify soccer-related injuries from 2010 through 2016. The sum of the weighted values provided in the NEISS database was used to determine injury frequency and allowed us to estimate the incidence and annual trends of soccer-related fractures. The estimated annual number of hospital admissions resulting from each fracture location was calculated. Statistical analyses were performed, and a linear regression was used to analyze the annual injury trends, reported as the correlation coefficient.

Results:

Over the 6-year period, there were an estimated 1,590,365 soccer-related injuries. The estimated annual frequency of soccer-related injuries slightly increased from 225,910 in 2010 to 226,150 in 2016 (P = 0.477). The most common injuries were sprains/strains (32.4%), followed by fractures (20.4%). Fractures at the wrist were the most common (18%), while upper leg fractures were the most common soccer-related fractures to be admitted to the hospital (51.6%). The annual trends of the most common soccer-related fractures demonstrated increases in shoulder (r = 0.740; R² = 0.547; P = 0.057) and wrist (r = 0.308; R² = 0.095; P = 0.502) fractures. There were no significant changes in the trends of soccer-related fractures of the lower arm (r = 0.009; R² = 7.3 × 10⁻⁵; P = 0.986), finger (r = 0.679; R² = 0.460; P = 0.094), lower leg (r = 0.153; R² = 0.024; P = 0.743), ankle (r = 0.650; R² = 0.422; P = 0.114), toe (r = 0.417; R² = 0.174; P = 0.353), or foot (r = 0.485; R² = 0.235; P = 0.270).

Conclusion:

Despite the reported growing number of soccer players in the United States, the overall number of soccer-related injuries has remained relatively stable. Overall, 60% of reported fractures occurred in the upper extremity, with the wrist being the most common site, while lower extremity fractures were the most likely to lead to hospital admission.

Clinical Relevance:

This study offers an overview of the most common types of fractures that affect soccer players and may prove beneficial in creating preventative strategies against season-ending injuries.

Epidemiology of Upper Extremity Soccer Injuries Among High School- and College-Aged Players in the United States: An Analysis of the 1999-2016 NEISS Database

BACKGROUND:

Although lower extremity injuries are more common than upper extremity injuries in high school- and college-aged soccer players, upper extremity injuries may be equally severe. The epidemiology of upper extremity injuries is poorly characterized in this population.

HYPOTHESIS:

Upper extremity injuries are an important contributor to soccer-related morbidity among high school- and college-aged players.

STUDY DESIGN:

Descriptive epidemiology study.

LEVEL OF EVIDENCE:

Level 3.

METHODS:

The National Electronic Injury Surveillance System (NEISS) is a nationally representative sample of 100 hospital emergency departments (EDs). Each record contains demographic and injury information. Records from 1999 to 2016 were analyzed, including patients between the ages of 14 and 23 years with a soccer-related injury sustained at school or during an athletic event.

RESULTS:

A total of 1,299,008 high school- or college-aged patients presented to the ED for a soccer-related injury from 1999 to 2016, of which 20.4% were in the upper extremity. Patients were predominantly male (58.0%) and high school-aged (81.4%). Males constituted a greater proportion of upper extremity injuries when compared with other injury locations (63.5% male for upper extremity). Upper extremity injuries were more likely to be fractures (43.7% vs 13.9%) and dislocations (7.1% vs 3.4%) and less likely to be strains/sprains (27.8% vs 56.6%). Males suffered more shoulder dislocations (81.8% males among patients with shoulder dislocation vs 57.8% among those with other injuries), finger dislocations (72.0% vs 58.0%), upper arm fractures (74.9% vs 57.6%), and forearm fractures (68.3% vs 57.3%).

CONCLUSION:

Upper extremity injuries are frequent in high school- and college-aged soccer players presenting to the ED. Efforts to reduce soccer-related injuries should include strategies targeting the upper extremity, perhaps reducing the incidence of high-energy falls.

CLINICAL RELEVANCE:

Efforts to reduce soccer-related injuries should include strategies targeting upper extremity injuries, particularly among males and college-aged players.

Risk factors associated with self-reported injury history in female youth soccer players

BACKGROUND

studies that investigate risk factors for musculoskeletal injuries in female youth athletes are limited, especially related to training attributes and position status.

OBJECTIVE

to determine risk factors including training attributes and position status for a self-reported musculoskeletal injury history in female youth soccer players.

METHODS

we conducted a cross-sectional study of young female soccer players (mean age: 13.6 ± 2.3 years). we asked about their history of musculoskeletal injuries using an electronic questionnaire. the proportion of young female soccer players with and without a history of soccer-related musculoskeletal injuries were compared based on physical characteristics, training attributes, position status (single vs. multiple), lower extremity strength, and joint laxity. a binary logistic regression analysis was used to generate, and adjusted odds ratios adjusted for potential co-variates (aor). a 95% confidence interval (95%ci) that did not cross one or p < 0.05 were considered statistically significant.

RESULTS

a total of 160 young female soccer players (mean age: 13.6 ± 2.3 years) participated in the study. an independent association was found between prior musculoskeletal injuries and older ages (aor: 1.60, 95%ci: 1.17, 2.20, p = 0.004), higher weight (aor: 1.10, 95%ci: 1.01, 1.20, p = 0.026), and greater bmi (aor: 1.43, 95%ci: 1.07, 1.90, p = 0.014).

CONCLUSIONS

musculoskeletal injuries were associated with age, weight, and bmi in female youth players. the current study indicates that maintaining proper body composition may be beneficial to reduce musculoskeletal injuries among female youth soccer players.

FIT & STRONG! PLUS: DESCRIPTIVE DEMOGRAPHIC AND RISK CHARACTERISTICS IN A COMPARATIVE EFFECTIVENESS TRIAL FOR OLDER AFRICAN-AMERICAN ADULTS WITH OSTEOARTHRITIS

Objectives

The prevalence of osteoarthritis (OA) has increased in the US. We report on a comparative effectiveness trial that compares Fit & Strong!, an existing evidence-based physical activity (PA) program, to Fit & Strong! Plus, which combines the Fit & Strong! intervention with a weight management intervention.

Methods

Participants included 413 overweight/obese (BMI 25-50 kg/m²) adults with lower extremity (LE) OA. The majority of the sample was African-American and female. Both interventions met 3 times weekly for 8 weeks. Primary measures included diet and weight.

Results

The baseline mean BMI for all participants was 34.8 kg/m^², percentage of calories from fat was high, and self-reported PA was low.

Discussion

This sample of overweight/obese African-American adults had lifestyle patterns at baseline that were less than healthful, and there were differences between self-report and performance-based measures as a function of age.

Characteristics of patients with ankle sprain presenting to an emergency department in the south of England (UK): A seven-month review

INTRODUCTION

There is lack of evidence about ankle sprain patients presenting to emergency department (ED) in the UK. The study aim was to determine prevalence, demographic and clinical characteristics of patients attending to one ED. Knowing those characteristics may help setting prevention strategies and inform effective clinical practice.

METHODS

A retrospective review of records from patients' database system was conducted between May and November 2015 (inclusive).

RESULTS

909 new patients with ankle sprain were recorded during the study period. Patients had a median age of 27 years (IQR 20). Men aged between 14 and 37 years had higher percentage of injuries compared to women of a similar age. Overall prevalence of injury was equally distributed between men and women. Most patients were sent to radiography department for ankle/foot X-ray (89%). Over half of patients (58%) were sent home with no follow-up treatment. A subsample (n = 106) from the original sample (n = 909) showed a variety of causes of injury such as tripping (29%), non-specific injury (26.4%), sports (26%), walking (12.2%) and other accidental causes (6%). Football was the most prevalent sport (13%).

CONCLUSIONS

Prevention strategies, appropriate assessment tools and tailored rehabilitation programs are warranted to reduce number of patients and potential chronic symptoms.

Anatomy and injuries of the pediatric wrist: beyond the basics

Ligamentous injuries of the pediatric wrist, once thought to be relatively uncommon, are increasingly recognized in the context of acute high-energy mechanism trauma and chronic axial loading, including those encountered in both recreational and high-performance competitive sports. Recent advances in MR-based techniques for imaging the pediatric wrist allow for sensitive identification of these often radiographically occult injuries. Detailed knowledge of the intrinsic and supportive extrinsic ligamentous complexes, as well as normal developmental anatomy and congenital variation, are essential to accurately diagnose injuries to these structures. Early identification of ligamentous injury of the pediatric wrist is essential within the conservative treatment culture of modern pediatric orthopedics because treatment of these lesions often necessitates surgery, and outcomes often depend on early and sometimes aggressive intervention. In this article, we review MR arthrogram technique and pediatric wrist anatomy, and correlate appearances on MR and selected ligamentous pathologies of the pediatric wrist.

A School-Based Neuromuscular Training Program and Sport-Related Injury Incidence: A Prospective Randomized Controlled Clinical Trial

CONTEXT

  An estimated 40 million school-aged children (age range = 5-18 years) participate annually in sports in the United States, generating approximately 4 million sport-related injuries and requiring 2.6 million emergency department visits at a cost of nearly $2 billion.

OBJECTIVE

  To determine the effects of a school-based neuromuscular training (NMT) program on sport-related injury incidence across 3 sports at the high school and middle school levels, focusing particularly on knee and ankle injuries.

DESIGN

  Randomized controlled clinical trial.

SETTING

  A total of 5 middle schools and 4 high schools in a single-county public school district.

PATIENTS OR OTHER PARTICIPANTS

  A total of 474 girls (222 middle school, 252 high school; age = 14.0 ± 1.7 years, height = 161.0 ± 8.1 cm, mass = 55.4 ± 12.2 kg) were cluster randomized to an NMT (CORE; n = 259 athletes) or sham (SHAM; n = 215 athletes) intervention group by team within each sport (basketball, soccer, and volleyball).

INTERVENTION(S)

  The CORE intervention consisted of exercises focused on the trunk and lower extremity, whereas the SHAM protocol consisted of resisted running using elastic bands. Each intervention was implemented at the start of the season and continued until the last competition. An athletic trainer evaluated athletes weekly for sport-related injuries. The coach recorded each athlete-exposure (AE), which was defined as 1 athlete participating in 1 coach-directed session (game or practice).

MAIN OUTCOME MEASURE(S)

  Injury rates were calculated overall, by sport, and by competition level. We also calculated rates of specific knee and ankle injuries. A mixed-model approach was used to account for multiple injuries per athlete.

RESULTS

  Overall, the CORE group reported 107 injuries (rate = 5.34 injuries/1000 AEs), and the SHAM group reported 134 injuries (rate = 8.54 injuries/1000 AEs; F_1,578 = 18.65, P < .001). Basketball (rate = 4.99 injuries/1000 AEs) and volleyball (rate = 5.74 injuries/1000 AEs) athletes in the CORE group demonstrated lower injury incidences than basketball (rate = 7.72 injuries/1000 AEs) and volleyball (rate = 11.63 injuries/1000 AEs; F_1,275 = 9.46, P = .002 and F_1,149 = 11.36, P = .001, respectively) athletes in the SHAM group. The CORE intervention appeared to have a greater protective effect on knee injuries at the middle school level (knee-injury incidence rate = 4.16 injuries/1000 AEs) than the SHAM intervention (knee-injury incidence rate = 7.04 injuries/1000 AEs; F_1,261 = 5.36, P = .02). We did not observe differences between groups for ankle injuries ( F_1,578 = 1.02, P = .31).

CONCLUSIONS

  Participation in an NMT intervention program resulted in a reduced injury incidence relative to participation in a SHAM intervention. This protective benefit of NMT was demonstrated at both the high school and middle school levels.

ACL and meniscal injuries increase the risk of primary total knee replacement for osteoarthritis: a matched case-control study using the Clinical Practice Research Datalink (CPRD)

OBJECTIVES

The aim of this study was to investigate whether ACL injury (ACLi) or meniscal injury increases the risk of end-stage osteoarthritis (OA) resulting in total knee replacement (TKR).

METHODS

A matched case-control study of all TKRs performed in the UK between January 1990 and July 2011 and recorded in the Clinical Practice Research Datalink (CPRD) was undertaken. The CPRD contains longitudinal data on approximately 3.6 million patients. Two controls were selected for each case of TKR, matched on age, sex and general practitioner location as a proxy for socioeconomic status. Individuals with inflammatory arthritis were excluded. The odds of having TKR for individuals with a CPRD-recorded ACLi were compared with those without ACLi using conditional logistic regression, after adjustment for body mass index, previous knee fracture and meniscal injury. The adjusted odds of TKR in individuals with a recorded meniscal injury compared with those without were calculated.

RESULTS

After exclusion of individuals with inflammatory arthritis, there were 49 723 in the case group and 104 353 controls. 153 (0.31%) cases had a history of ACLi compared with 41 (0.04%) controls. The adjusted OR of TKR after ACLi was 6.96 (95% CI 4.73 to 10.31). 4217 (8.48%) individuals in the TKR group had a recorded meniscal injury compared with 669 (0.64%) controls. The adjusted OR of TKR after meniscal injury was 15.24 (95% CI 13.88 to 16.69).

CONCLUSION

This study demonstrates that ACLi is associated with a sevenfold increased odds of TKR resulting from OA. Meniscal injury is associated with a 15-fold increase odds of TKR for OA.

Injury Recurrence Among High School Athletes in the United States: A Decade of Patterns and Trends, 2005-2006 Through 2015-2016

Background

As participation in high school athletics increases, so does the number of adolescents experiencing sports-related injury. Understanding injury patterns is an important component to developing and evaluating prevention and rehabilitation programs.

Purpose

To analyze recurrent injury rates and patterns among high school athletes, to compare recurrent injuries with new injuries, and to evaluate injury trends over time.

Study Design

Descriptive epidemiology study.

Methods

High school sports injury data on 24 sports were collected from 2005-2006 through 2015-2016 via the High School RIO (Reporting Information Online) surveillance system. Injury rates were calculated as number of injuries per 10,000 athletic exposures (AEs). Injury rate ratios and injury proportion ratios (IPRs) were calculated to compare differences among subgroups.

Results

Overall, 78,005 injuries were sustained during 40,195,806 AEs, for an injury rate of 19.41 per 10,000 AEs. Of these, 69,821 (89.5%) were new injuries, and 8184 (10.5%) were recurrent. The ankle was the most commonly injured body part among recurrent injuries, while the head/face was the most common body part that sustained new injuries. Ligament sprains were more often recurrent, while concussions were more commonly diagnosed as new, although concussions represented 16.7% of recurrent injuries. Trends for recurrent injuries over time were relatively stable. The proportion of athletes who had >3 weeks of time loss or medical disqualification (15.8% vs 13.3%; IPR, 1.19; 95% CI, 1.13-1.26) or who voluntarily withdrew from sport (2.5% vs 1.1%; IPR, 2.33; 95% CI, 2.00-2.73) was significantly greater for recurrent injuries than new injuries. Furthermore, a greater proportion of recurrent injuries resulted in surgery (8.1% vs 6.0%; IPR, 1.34; 95% CI, 1.24-1.46).

Conclusion

Although only 10.5% of all injuries were recurrent, they more frequently resulted in missing >3 weeks of playing time and were more often managed surgically when compared with new injuries. The rate of recurrent injuries has not increased over the past decade.

Cross-Sectional Study to Assess the Functional Outcome of Neglected Bimalleolar Fracture

INTRODUCTION

Ankle fracture is the most common intra-articular fracture of a weight-bearing joint and accounts for 9% of all fractures. Ankle fractures are classified into 3 subgroups: unimalleolar, bimalleolar, and trimalleolar fractures. Accurate reduction and stable internal fixation is necessary in bimalleolar fractures; otherwise, it may lead to posttraumatic painful restriction of movements or osteoarthritis. The purpose of this study is to assess the functional outcome and results of treatment of neglected bimalleolar fracture.

MATERIALS AND METHODS

Seventeen neglected bimalleolar fracture patients were treated with open reduction and internal fixation. Patients were followed-up at 1, 2, and 5 years and functional ability was assessed by using the modified Weber Rating Scale.

RESULTS

The mean age of patients was 41.4 ± 13.28 years. After 2 year of surgery, 13 out of 17 patients showed excellent results and 4 patients had fair results.

CONCLUSION

Good to excellent functional results were observed after long-term follow-up in neglected bimalleolar fracture treated with open reduction and internal fixation, and we advise surgical intervention in all such patients.

LEVELS OF EVIDENCE

Therapeutic, Level III: Retrospective Cohort study.

Epidemiologic comparisons of soccer-related injuries presenting to emergency departments and reported within high school and collegiate settings

BACKGROUND

Few studies compare sports injury patterns in different settings. This study described the epidemiology of soccer injuries presenting to emergency departments (EDs) and compared injuries presenting to EDs to injuries presenting to collegiate and high school athletic trainers (ATs).

METHODS

Soccer-related injuries (product code 1267) in the National Electronic Injury Surveillance System (NEISS) that were sustained by individuals at least two years of age in 2004-2013 were included. High School Reporting Information Online (HS RIO) data for high school soccer injuries during the 2005/06-2013/14 academic years were compared to NEISS data for those aged 14-17 years in 2005-2013. National Collegiate Athletic Association Injury Surveillance Program (NCAA-ISP) data for collegiate soccer injuries during the 2009/10-2013/14 academic years were compared to NEISS data for those aged 18-22 years in 2009-2013. All datasets included weights to calculate national estimates. Injury proportion ratios (IPRs) with 95% confidence intervals (CIs) compared nationally estimated injury distributions between the HS RIO/NCAA-ISP and NEISS data subsets.

RESULTS

During the study period, 63,258 soccer-related injuries were captured by NEISS, which translates to an estimated 2,039,250 injuries seen at US EDs nationwide. Commonly injured body parts included the head/face (19.1%), ankle (17.6%), hand/wrist (15.3%), and knee (12.2%). Common diagnoses included sprains/strains (34.0%), fractures (22.2%), and contusions (17.7%). Compared to their respective age ranges in NEISS, sprains/strains comprised a larger proportion of injuries in HS RIO (48.3% vs. 33.7%; IPR = 1.38; 95% CI: 1.33, 1.42) and NCAA-ISP (51.3% vs. 37.0%; IPR = 1.39; 95% CI: 1.31, 1.46). In contrast, fractures comprised a smaller proportion of injuries in HS RIO than in NEISS (7.5% vs. 18.6%; IPR = 0.43; 95% CI: 0.39, 0.47) and NCAA-ISP (2.8% vs. 15.7%; IPR = 0.18; 95% CI: 0.14, 0.22).

CONCLUSIONS

ATs more commonly reported injuries that are easily diagnosed and treated (e.g., sprains/strains); EDs more commonly reported injuries with longer recovery times and rehabilitation (e.g., fractures). Although ED surveillance data can identify the most severe sports-related injuries, high school and college sports surveillance may better describe the breadth of sports-related injuries. Our findings may provide further support for school-based sports medicine professionals, but further research is needed to comprehensively examine the potential economic and health-related benefits.

Pediatric Cheerleading Injuries Treated in Emergency Departments in the United States

This study investigates the epidemiology of cheerleading injuries to children in the United States. Data were analyzed from the National Electronic Injury Surveillance System for children 5 through 18 years of age treated in US emergency departments for cheerleading injuries from 1990 through 2012. An estimated 497 095 children ages 5 to 18 years were treated in US emergency departments for a cheerleading injury during the 23-year study period, averaging 21 613 injured children per year. From 1990 to 2012, the annual cheerleading injury rate increased significantly by 189.1%; and from 2001 to 2012, the annual rate of cheerleading-related concussion/closed head injury increased significantly by 290.9%. Falls were the most common mechanism of injury (29.4%) and were more likely to lead to hospitalization (relative risk = 2.47; 95% confidence interval = 1.67-3.68) compared with other injury mechanisms. The rising number and rate of pediatric cheerleading injuries underscore the need for increased efforts to prevent these injuries.

Distal Fibula Fractures in National Football League Athletes

Background:

Despite the frequency of distal fibula fractures in elite athletes and the significant potential impact on the athletes’ season and future careers, little data exist characterizing the epidemiology of these injuries or, more importantly, return to competition.

Purpose:

To (1) evaluate the incidence of acute distal fibula fractures in National Football League (NFL) athletes, including isolated distal fibula and combined ankle fracture patterns; (2) analyze distal fibula fracture rates in NFL athletes by position, type of play, and contact type; (3) determine the rates of distal fibula fracture surgery in NFL athletes; and (4) report the days missed due to distal fibula fractures in NFL athletes.

Study Design:

Descriptive epidemiology study.

Methods:

A retrospective review of distal fibula fractures reported to the NFL from 2000 to 2014 was performed using the NFL Injury Surveillance System. All distal fibula fractures were included, along with isolated and combined fracture patterns. Stress fractures and proximal fibula fractures were excluded. Epidemiological data and rates of surgery were determined. Return to sport was calculated and stratified by injury pattern and management.

Results:

Overall, 237 distal fibula fractures in NFL athletes from 2000 to 2014 were included; 197 (83%) were isolated distal fibula fractures. A mean of 16 distal fibula fractures occurred each year (median, 16 per year). Fractures occurred most frequently on running (38%) and passing (24%) plays, but the frequency was next highest on kickoffs (16%), despite the relative infrequency of kickoffs during the average game compared with other play types. Surgery was reported for more than half of all distal fibula fractures (n = 128, 54%). Overall, patients who underwent surgery missed significantly more days (mean, 123.8 days) than players who did not undergo surgery (mean, 75.3 days) (P < .001). Players with isolated distal fibula fractures had significantly fewer days missed (mean, 93.6 days) compared with those with combined patterns (mean, 132.3 days) (P = .0004).

Conclusion:

Fibula fractures affect a number of NFL athletes and result in significant time missed from competition. Further research is required to determine the optimal management of fibula fractures in NFL athletes. In this study, time to return to play depended on both the fracture pattern and whether surgery was required and ranged from 72 to 145 days.

Traumatic Facial Injuries Among Elderly Nursing Home Residents: Never Event or Frequent Occurrence?

Importance

As the nursing home population continues to increase, an understanding of preventable injuries becomes exceedingly important. Although other fall-related injuries have been characterized, little attention has been dedicated to facial trauma.

Objectives

To estimate the incidence of facial trauma among nursing home residents and detail mechanisms of injury, injury characteristics, and patient demographic data.

Design, Setting, and Participants

The National Electronic Injury Surveillance System was used to calculate a weighted national incidence of facial trauma among individuals older than 60 years from a nationally representative collection of emergency departments from January 1, 2011, through December 31, 2015. Entries were screened for nursing home residents, and diagnosis, anatomical site, demographic data, and mechanism of injury were analyzed.

Results

There were 109 795 nursing home residents (median age, 84.1 years; interquartile range, 79-89 years; 71 466 women [65.1%]) who required emergency department care for facial trauma. Women sustained a greater proportion of injuries with increasing age. The most common injuries were lacerations (48 679 [44.3%]), other soft-tissue injuries (45 911 [41.8%]; avulsions, contusions, and hematomas), and fractures (13 814 [12.6%]). Nasal (9331 [67.5%]) and orbital (1144 [8.3%]) fractures were the most common sites. The most common injury causes were direct contact with structural housing elements or fixed items (62 604 [57.0%]) and transfer to and from bed (24 870 [22.6%]).

Conclusions and Relevance

Despite falls being considered a Centers for Medicare & Medicaid Services preventable never event in hospitals, our analysis in the nursing home setting found more than 100 000 facial injuries during 5 years, suggesting these underappreciated injuries contribute substantially to health care expenditures. Although structural elements facilitated the greatest number of falls, transfer to and from bed remains a significant mechanism, suggesting an area for intervention.

Gait abnormalities in patients with chronic ankle instability can improve following a non-invasive biomechanical therapy: a retrospective analysis

[Purpose] The purpose of this study was to evaluate the changes in gait patterns and clinical outcomes of patients with chronic ankle instability (CAI) following treatment with a home-based non-invasive biomechanical device. [Subjects and Methods] Thirty-three patients with CAI were compared with 43 healthy controls. Patients underwent a spatiotemporal gait assessment before and three months following treatment. Clinical evaluation was recorded with SF-36 Health Survey and the Foot and Ankle Outcome Score (FAOS). [Results] Significant baseline differences were found between groups. Patients with CAI showed a statistically significant improvement in velocity, cadence, symptomatic limb step length and single limb support over time. Significant improvements in SF-36 PCS and FAOS outcome scores were found in patients with CAI. [Conclusion] Patients with CAI have baseline spatiotemporal gait abnormalities as compared with healthy controls. However, clinical and gait metrics improvement can be expected after 12 weeks of perturbation training using a non-invasive biomechanical device.

The Pediatric International Knee Documentation Committee (Pedi-IKDC) Subjective Knee Evaluation Form: Normative Data

BACKGROUND

Children are participating in sports at an increasingly younger age, which has contributed to an increased incidence of knee injuries among this population. Because of increased interest in the application of patient-reported outcome measures in orthopaedic surgery to evaluate treatment results, numerous knee outcome scores, including the International Knee Documentation Committee Subjective Form (IKDC), have been used to evaluate the knee. Although the IKDC has been validated only in adults, it is also being used for children because of a lack of appropriate outcome scores in the pediatric population. To address this concern, a pediatric version of the IKDC (Pedi-IKDC) was developed and evaluated for reliability, validity, and responsiveness. However, normative data for the Pedi-IKDC have not been established.

PURPOSE

We aimed to aid the interpretation of Pedi-IKDC scores by characterizing normative data in children and adolescents and to validate the Pedi-IKDC by examining differences in scores among children who had a history of knee surgery or limited activity compared with those who did not.

STUDY DESIGN

Cross-sectional study; Level of evidence, 3.

METHODS

We conducted a cross-sectional survey of 2000 children and adolescents aged 10 to 18 years living in the United States, who were recruited by ORC International to obtain equal numbers of participants by sex and by integer age group. Participants were asked to complete the Pedi-IKDC for 1 study-designated "index" knee (right or left) and to provide demographic data and information on their knee surgery history and recent (4-week) activity limitations. Raw Pedi-IKDC total scores were rescaled to a 0 to 100 scale. We used nonparametric Wilcoxon or Kruskal-Wallis tests to compare subgroup scores, and we used the van Elteren test to adjust for age. Unadjusted and adjusted P values were similar, and only unadjusted values are reported.

RESULTS

The number of respondents (N = 2000) was uniform with respect to age and sex, with 11% in each age represented (10-18 years). Fifty percent of respondents were female. Forty-nine states plus Washington, DC, were represented. In addition, 68% and 86% of respondents identified themselves as white and non-Hispanic, respectively. Seven percent of respondents (n = 136) respondents reported having prior surgery in 1 or both knees; 4% of these surgeries (n = 79) were in the index knee. The Pedi-IKDC score distribution was skewed left (mean ± SD score, 86.7 ± 16.8; median, 94.6) and 34% of scores reached the ceiling value of 100. Participants who reported prior surgery or limited activity in the index knee had median Pedi-IKDC scores that were approximately 25 points lower than participants without these histories ( P < .0001 for both comparisons). In contrast, although it was statistically significant, the variation by age ( P = .02), race ( P = .02), ethnicity ( P = .01), and level of sports/exercise participation ( P = .04) was much smaller (all ranges of median scores <4.5). There were no significant differences in scores in terms of respondent sex or geographic region.

CONCLUSION

Normative Pedi-IKDC scores were determined in this study. The strong association between Pedi-IKDC scores and prior knee surgery as well as recent activity limitations in the index knee can be used to evaluate clinical outcomes and supports the construct validity of the Pedi-IKDC. There was a large ceiling effect, with 34% of scores at the maximum value of 100. The lack of a sex-based effect and the minor variation with age both simplify the interpretation and use of the Pedi-IKDC. Therefore, Pedi-IKDC score distributions can provide assumptions for use in sample size or power calculations for research.

Head injuries in children's football-results from two prospective cohort studies in four European countries

Head injuries are considered harmful in children. We analyzed head and neck injuries in organized football in 7- to 12-year-old children. Data for this analysis were obtained from a prospective cohort study over two consecutive football seasons in two European countries, and a randomized intervention trial over one season in four European countries. Football exposure and injuries were documented through an online database. Detailed information regarding injury characteristics and medical follow-up was retrieved from coaches, children and parents by phone. Thirty-nine head injuries and one neck injury (5% of all 791 injuries) were documented during 9933 player-seasons (total football exposure 688 045 hours). The incidence was 0.25 [95%CI 0.15, 0.35] head/neck injuries per 1000 match hours (N=23 match injuries) and 0.03 [95%CI 0.02, 0.03] per 1000 training hours. Eleven concussions (27.5%), nine head contusions (22.5%), eight lacerations or abrasions (20%), two nose fractures (2.5%), and two dental injuries (2.5%) occurred. The remaining eight injuries were nose bleeding or other minor injuries. Thirty injuries (75%) resulted from contact with another player, and ten injuries were due to collision with an object, falling or a hit by the ball. Whereas 70% of all head injuries (N=28) were due to frontal impacts, 73% of concussions (N=8) resulted from an impact to the occiput. The incidence and severity of head injuries in children's football are low. Coaches and parents, however, should be sensitized regarding the potential of concussions, particularly after an impact to the occiput.

Use of Robotic Manipulators to Study Diarthrodial Joint Function

Diarthrodial joint function is mediated by a complex interaction between bones, ligaments, capsules, articular cartilage, and muscles. To gain a better understanding of injury mechanisms and to improve surgical procedures, an improved understanding of the structure and function of diarthrodial joints needs to be obtained. Thus, robotic testing systems have been developed to measure the resulting kinematics of diarthrodial joints as well as the in situ forces in ligaments and their replacement grafts in response to external loading conditions. These six degrees-of-freedom (DOF) testing systems can be controlled in either position or force modes to simulate physiological loading conditions or clinical exams. Recent advances allow kinematic, in situ force, and strain data to be measured continuously throughout the range of joint motion using velocity-impedance control, and in vivo kinematic data to be reproduced on cadaveric specimens to determine in situ forces during physiologic motions. The principle of superposition can also be used to determine the in situ forces carried by capsular tissue in the longitudinal direction after separation from the rest of the capsule as well as the interaction forces with the surrounding tissue. Finally, robotic testing systems can be used to simulate soft tissue injury mechanisms, and computational models can be validated using the kinematic and force data to help predict in vivo stresses and strains present in these tissues. The goal of these analyses is to help improve surgical repair procedures and postoperative rehabilitation protocols. In the future, more information is needed regarding the complex in vivo loads applied to diarthrodial joints during clinical exams and activities of daily living to serve as input to the robotic testing systems. Improving the capability to accurately reproduce in vivo kinematics with robotic testing systems should also be examined.

Treatment and outcome prognosis of patients with high-energy transsyndesmotic ankle fracture dislocation-the "Logsplitter" injury

Background

This study aimed to retrospectively review the clinical efficacy of open reduction and internal fixation (ORIF) for treatment of high-energy transsyndesmotic ankle fracture dislocation—the “Logsplitter” injury.

Methods

Between December 2006 and December 2014, 41 patients (29 males and 12 females; mean age, 41.46 ± 13.42 years) with Logsplitter injury were treated by ORIF procedure. Patients were grouped as typical injury (mainly vertical axial stress) and untypical injury (mainly rotational stress) according to the injury mechanism and the degree of the talus wedged into the distal tibiofibular joint.

Results

After the follow-up of 32.48 ± 24.18 weeks, average American Orthopedic Foot and Ankle Society (AOFAS) score at final follow-up was 78.54 ± 10.66 and the excellent and good rate of 82.9%. Three patients in typical group developed nonunion, and other three cases had infection vs. none in untypical group (both P = 0.053). Burwell-Charnely scoring system revealed anatomic reduction of fracture was achieved in 22 cases, fair reduction in 16 cases, and poor in only 3 cases. Patients in untypical group had better fracture reduction (P = 0.015) and lower incidence rate of posttraumatic ankle arthritis (P = 0.042) than typical cases as well as the range of motion (P < 0.01).

Conclusions

The ORIF may be an optimal approach to treat Logsplitter injuries. Patients with untypical injury had better fracture reduction, range of motion, and low incidence rate of posttraumatic ankle arthritis than those typical ones, and the postoperative outcome was affected by the injury and treatment characteristics.

Projecting Lifetime Risk of Symptomatic Knee Osteoarthritis and Total Knee Replacement in Individuals Sustaining a Complete Anterior Cruciate Ligament Tear in Early Adulthood

OBJECTIVE

To estimate the lifetime risk of knee osteoarthritis (OA) and total knee replacement (TKR) in persons sustaining anterior cruciate ligament (ACL) tear by age 25 years.

METHODS

We used the Osteoarthritis Policy Model to project the cumulative incidence of symptomatic knee OA requiring TKR in varying situations: no prevalent or incident injury; isolated ACL tear, surgically treated; isolated ACL tear, nonoperatively treated; or a prevalent history or surgically treated ACL and meniscal tear (MT). We estimated MT prevalence and incidence and increased risk of knee OA associated with ACL injury and MT from published literature. We conducted a range of sensitivity analyses to examine the impact of uncertainty in input parameters.

RESULTS

Estimated lifetime risk of symptomatic knee OA was 34% for the cohort with ACL injury and MT, compared to 14% for the no-injury cohort. ACL injury without MT was associated with a lifetime risk of knee OA between 16% and 17%, depending on ACL treatment modality. Estimated lifetime risk of TKR ranged from 6% in the no-injury cohort to 22% for the ACL injury and MT cohort. Subjects in the ACL injury and MT cohort developed OA approximately 1.5 years earlier (55.7 versus 57.1) and underwent TKR approximately 2 years earlier (66 versus 68) than the cohort without knee injuries.

CONCLUSION

Sustaining ACL injury early in adulthood leads to greater lifetime risk and earlier onset of knee OA and TKR; concomitant MTs compound this risk. These data provide insight into the impact of sustainable injury prevention interventions in young adults.

Number of Persons With Symptomatic Knee Osteoarthritis in the US: Impact of Race and Ethnicity, Age, Sex, and Obesity

OBJECTIVE

The prevalence of symptomatic knee osteoarthritis (OA) has been increasing over the past several decades in the US, concurrent with an aging population and the growing obesity epidemic. We quantify the impact of these factors on the number of persons with symptomatic knee OA in the early decades of the 21st century.

METHODS

We calculated the prevalence of clinically diagnosed symptomatic knee OA from the National Health Interview Survey 2007-2008 and derived the proportion with advanced disease (defined as Kellgren/Lawrence grade 3 or 4) using the Osteoarthritis Policy Model, a validated simulation model of knee OA. Incorporating contemporary obesity rates and population estimates, we calculated the number of persons living with symptomatic knee OA.

RESULTS

We estimate that approximately 14 million persons had symptomatic knee OA, with advanced OA comprising more than half of those cases. This includes more than 3 million persons of racial/ethnic minorities (African American, Hispanic, and other). Adults younger than 45 years of age represented nearly 2 million cases of symptomatic knee OA and individuals between 45 and 65 years of age comprised 6 million more cases.

CONCLUSION

More than half of all persons with symptomatic knee OA are younger than 65 years of age. As many of these younger persons will live for 3 decades or more, there is substantially more time for greater disability to occur, and policymakers should anticipate health care utilization for knee OA to increase in the upcoming decades. These data emphasize the need for the deployment of innovative prevention and treatment strategies for knee OA, especially among younger persons.

Effect of early supervised physiotherapy on recovery from acute ankle sprain: randomised controlled trial

OBJECTIVE

 To assess the efficacy of a programme of supervised physiotherapy on the recovery of simple grade 1 and 2 ankle sprains.

DESIGN

 A randomised controlled trial of 503 participants followed for six months.

SETTING

 Participants were recruited from two tertiary acute care settings in Kingston, ON, Canada.

PARTICIPANTS

 The broad inclusion criteria were patients aged ≥16 presenting for acute medical assessment and treatment of a simple grade 1 or 2 ankle sprain. Exclusions were patients with multiple injuries, other conditions limiting mobility, and ankle injuries that required immobilisation and those unable to accommodate the time intensive study protocol.

INTERVENTION

 Participants received either usual care, consisting of written instructions regarding protection, rest, cryotherapy, compression, elevation, and graduated weight bearing activities, or usual care enhanced with a supervised programme of physiotherapy.

MAIN OUTCOME MEASURES

 The primary outcome of efficacy was the proportion of participants reporting excellent recovery assessed with the foot and ankle outcome score (FAOS). Excellent recovery was defined as a score ≥450/500 at three months. A difference of at least 15% increase in the absolute proportion of participants with excellent recovery was deemed clinically important. Secondary analyses included the assessment of excellent recovery at one and six months; change from baseline using continuous scores at one, three, and six months; and clinical and biomechanical measures of ankle function, assessed at one, three, and six months.

RESULTS

 The absolute proportion of patients achieving excellent recovery at three months was not significantly different between the physiotherapy (98/229, 43%) and usual care (79/214, 37%) arms (absolute difference 6%, 95% confidence interval -3% to 15%). The observed trend towards benefit with physiotherapy did not increase in the per protocol analysis and was in the opposite direction by six months. These trends remained similar and were never statistically or clinically important when the FAOS was analysed as a continuous change score.

CONCLUSIONS

 In a general population of patients seeking hospital based acute care for simple ankle sprains, there is no evidence to support a clinically important improvement in outcome with the addition of supervised physiotherapy to usual care, as provided in this protocol.Trial registration ISRCTN 74033088 (www.isrctn.com/ISRCTN74033088).

Physical Exam Risk Factors for Lower Extremity Injury in High School Athletes: A Systematic Review

OBJECTIVE

A stated goal of the preparticipation physical evaluation (PPE) is to reduce musculoskeletal injury, yet the musculoskeletal portion of the PPE is reportedly of questionable use in assessing lower extremity injury risk in high school-aged athletes. The objectives of this study are: (1) identify clinical assessment tools demonstrated to effectively determine lower extremity injury risk in a prospective setting, and (2) critically assess the methodological quality of prospective lower extremity risk assessment studies that use these tools.

DATA SOURCES

A systematic search was performed in PubMed, CINAHL, UptoDate, Google Scholar, Cochrane Reviews, and SportDiscus. Inclusion criteria were prospective injury risk assessment studies involving athletes primarily ages 13 to 19 that used screening methods that did not require highly specialized equipment. Methodological quality was evaluated with a modified physiotherapy evidence database (PEDro) scale.

MAIN RESULTS

Nine studies were included. The mean modified PEDro score was 6.0/10 (SD, 1.5). Multidirectional balance (odds ratio [OR], 3.0; CI, 1.5-6.1; P < 0.05) and physical maturation status (P < 0.05) were predictive of overall injury risk, knee hyperextension was predictive of anterior cruciate ligament injury (OR, 5.0; CI, 1.2-18.4; P < 0.05), hip external:internal rotator strength ratio of patellofemoral pain syndrome (P = 0.02), and foot posture index of ankle sprain (r = -0.339, P = 0.008).

CONCLUSIONS

Minimal prospective evidence supports or refutes the use of the functional musculoskeletal exam portion of the current PPE to assess lower extremity injury risk in high school athletes. Limited evidence does support inclusion of multidirectional balance assessment and physical maturation status in a musculoskeletal exam as both are generalizable risk factors for lower extremity injury.

Soccer-Related Injuries Treated in Emergency Departments: 1990-2014

OBJECTIVE

To investigate the epidemiology of youth soccer-related injuries treated in emergency departments in the United States.

METHODS

A retrospective analysis was conducted of soccer-related injuries among children 7 through 17 years of age from 1990 through 2014 with data from the National Electronic Injury Surveillance System. Injury rates were calculated from soccer participation data.

RESULTS

An estimated 2 995 765 (95% confidence interval [CI], 2 309 112-3 682 418) children 7 through 17 years old were treated in US emergency departments for soccer-related injuries during the 25-year study period, averaging 119 831 (95% CI, 92 364-147 297) annually. The annual injury rate per 10 000 soccer participants increased significantly, by 111.4%, from 1990 to 2014. Patients 12 to 17 years old accounted for 72.7% of injuries, 55.5% of patients were male, and most injuries occurred in a place of sport or recreation (68.5%) or school (25.7%). Struck by (38.5%) and fell (28.7%) were the leading mechanisms of injury. Injuries most commonly were diagnosed as sprain or strain (34.6%), fracture (23.2%), and soft tissue injury (21.9%), and occurred to the upper extremity (20.7%), ankle (17.8%), and head or neck (17.7%). Concussions or other closed head injuries accounted for 7.3% of the injuries, but the annual rate of concussions/closed head injuries per 10 000 participants increased significantly, by 1595.6%, from 1990 to 2014.

CONCLUSIONS

This study is the first to comprehensively investigate soccer-related injuries and calculate injury rates based on soccer participation data among children at the national level. The increasing number and rate of pediatric soccer-related injuries, especially soccer-related concussions/closed head injuries, underscore the need for increased efforts to prevent these injuries.

Soccer-Related Facial Trauma: A Nationwide Perspective

PURPOSE

Soccer participation continues to increase among all ages in the US. Our objective was to analyze trends in soccer-related facial injury epidemiology, demographics, and mechanisms of injury.

MATERIALS AND METHODS

The National Electronic Injury Surveillance System was evaluated for soccer-related facial injuries from 2010 through 2014. Results for product code "soccer" were filtered for injures to the face. Number of injuries was extrapolated, and data were analyzed for age, sex, specific injury diagnoses, locations, and mechanisms.

RESULTS

In all, 2054 soccer-related facial trauma entries were analyzed. During this time, the number of injures remained relatively stable. Lacerations were the most common diagnosis (44.2%), followed by contusions and fractures. The most common sites of fracture were the nose (75.1%). Of fractures with a reported mechanism of injury, the most common was head-to-head collisions (39.0%). Patients <19 years accounted for 66.9% of injuries, and athletes over 18 years old had a higher risk of fractures.

CONCLUSIONS

The incidence of soccer-related facial trauma has remained stable, but the severity of such injuries remain a danger. Facial protection in soccer is virtually absent, and our findings reinforce the need to educate athletes, families, and physicians on injury awareness and prevention.

Ankle Injury Prevention Programs for Soccer Athletes Are Protective: A Level-I Meta-Analysis

BACKGROUND

Soccer has one of the highest rates of ankle injury in sports for both males and females. Several injury prevention programs have been developed to address this concern. The purposes of this study were to conduct a meta-analysis of ankle injury prevention programs for soccer players, assess the heterogeneity among the studies, and evaluate the reported effectiveness of the prevention programs.

METHODS

A systematic search of the literature was conducted in PubMed (MEDLINE), Embase, CINAHL (Cumulative Index to Nursing and Allied Health), and the Cochrane Central Register of Controlled Trials (CENTRAL) database. Studies were limited to clinical investigations of injury prevention programs specific to the ankle in soccer players. Title, abstract, and full-text review were utilized to identify articles that met the inclusion criteria. The Cochrane Q test and I(2) index were independently used to assess heterogeneity among the studies. Sensitivity analyses were performed to assess heterogeneity. The pooled risk difference was calculated by random-effects models with use of the DerSimonian-Laird method. Publication bias was assessed with a funnel plot and Egger weighted regression technique.

RESULTS

Ten studies met the inclusion criteria as randomized controlled trials. A total of 4,121 female and male soccer athletes were analyzed for ankle injuries. Significant heterogeneity was found among studies of ankle injury prevention (p = 0.002), with an I(2) index of 65.2%. For studies of ankle injury prevention programs, the risk ratio was 0.60 (95% confidence interval, 0.40 to 0.92) and a significant reduction in the risk of ankle injury was found in the prevention group (p = 0.002). No evidence of publication bias was found among the included studies.

CONCLUSIONS

This meta-analysis of studies regarding ankle injury prevention programs identified a significant reduction in the risk of ankle injury. Future high-quality research designs with a low risk of bias are necessary to further evaluate the effectiveness of specific exercises and the optimal timing and age at intervention for the prevention of ankle injuries in the athletic soccer player.

LEVEL OF EVIDENCE

Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Epidemiology and Severity of Sports and Recreation Injuries Presenting to a Tertiary Adult Emergency Department

OBJECTIVE

This study aims to evaluate all sports and recreation injuries that present to an emergency department, identify the activity and injury patterns associated with hospital admission, and determine injuries that could be better treated in alternative care settings.

METHODS

This is a retrospective review of all sports injuries that presented to the emergency department of a high volume, urban, tertiary referral center from 1/1/2010 to 12/31/2011. These were identified by a sports term search algorithm applied to all emergency department records. The main outcome measured was hospital admission status after sports injury. Univariate and multivariate regression analysis was performed to identify risk factors for hospital admission in the sports injury population.

RESULTS

1,101 of the 191,259 encounters (0.6%) had 1,210 sports injuries. 84 were admitted (7.6%). Basketball injuries were most prevalent (31.6%). All-terrain vehicle (ATV) related injuries was most often admitted (46.4%). Logistic regression identified ATV riding (95% CI 6.15-23.37, p < 0.001) and age over 50 years-old (4.09-17.40, p < 0.001) as independent risk factors for admission while basketball (0.101-0.985, p = 0.047) and black race (0.17-0.77, p = 0.008) were independently protective. Isolated sprains/strains and soft tissue injuries (4/649, 0.6%) rarely required admission.

CONCLUSIONS

The 7.6% admission rate is higher than previously reported, likely because the study institution is a tertiary referral center. ATV riding is associated with higher severity injuries that are more likely to require hospital admission. Most sports injuries that present to an emergency department, specifically isolated soft tissue injuries of the extremities, may be more efficiently treated in a non-emergent setting.