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Yendluri A, Hrabarchuk EI, Obana KK, Namiri NK, Plancher KD, Trofa DP, Parisien RL. Skiing Injuries in the US Pediatric Population: An Analysis of National Injury Trends and Mechanisms Between 2012 and 2022. Orthop J Sports Med 2024; 12:23259671241255704. [PMID: 38911123 PMCID: PMC11193339 DOI: 10.1177/23259671241255704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 12/06/2023] [Indexed: 06/25/2024] Open
Abstract
Background While prevention protocols have been implemented, skiing-related musculoskeletal injuries and concussions continue to present to emergency departments in the United States. Previous literature has suggested the pediatric population may constitute up to 40% of skiing-related injuries. Purpose To assess injury trends and the underlying mechanisms of skiing injuries in pediatric patients seen at emergency departments in the United States. Study Design Descriptive epidemiology study. Methods The National Electronic Injury Surveillance System (NEISS) was queried for pediatric (age ≤18 years) skiing injuries between January 1, 2012, and December 31, 2022. Injury mechanism, location, disposition, and diagnosis were recorded, and the statistical sample weight assigned by NEISS by hospital was used to calculate national estimates (NEs). Injury trends were evaluated with linear regression analysis. Results Overall, 2951 pediatric skiing injuries were included (NE = 123,386). The mean age of the patients was 12.4 ± 3.5 years, with 61.3% of the injuries occurring in male patients. Impact with the ground was the most common injury mechanism (NE = 87,407; 70.8%). Fractures were the most common diagnosis (NE = 38,527, 31.2%), followed by strains/sprains (NE = 22,562, 18.3%), contusions/abrasions (NE = 16,257, 13.2%), and concussions (NE = 12,449, 10.1%). The lower leg was the most common fracture site (NE = 9509, 24.7%), followed by the shoulder (NE = 7131, 18.5%) and lower arm (NE = 5876, 15.3%). Analysis of annual injuries revealed no significant trend between 2012 and 2022 (P = .17), with fluctuations apparent throughout the study period. Significant decreases were seen in strains/sprains (P < .01) and contusions/abrasions (P < .01), but not in concussions (P = .57) or fractures (P = .70). Conclusion Impacts with the snow/ground made up 70.8% of all injuries. Fractures were the most common injury diagnosis, followed by strains/sprains, with the lower leg being most frequently fractured. While strains/sprains and contusions/abrasions showed a significant decline, there were no significant trends in fractures and concussions between 2012 and 2022.
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Affiliation(s)
- Avanish Yendluri
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Scientific Collaborative for Orthopaedic Research and Education (SCORE) Group
| | - Eugene I. Hrabarchuk
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Scientific Collaborative for Orthopaedic Research and Education (SCORE) Group
| | - Kyle K. Obana
- Department of Orthopaedic Surgery, Columbia University Medical Center, New York, New York, USA
- Scientific Collaborative for Orthopaedic Research and Education (SCORE) Group
| | - Nikan K. Namiri
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Scientific Collaborative for Orthopaedic Research and Education (SCORE) Group
| | - Kevin D. Plancher
- Plancher Orthopaedics and Sports Medicine, New York, New York, USA
- Scientific Collaborative for Orthopaedic Research and Education (SCORE) Group
| | - David P. Trofa
- Department of Orthopaedic Surgery, Columbia University Medical Center, New York, New York, USA
- Scientific Collaborative for Orthopaedic Research and Education (SCORE) Group
| | - Robert L. Parisien
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Scientific Collaborative for Orthopaedic Research and Education (SCORE) Group
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Warren A, Dea M, Barron IG, Zapata I. Ski and snowboard injury patterns in the United States from 2010 to 2020 in pediatric patients. Injury 2023; 54:110899. [PMID: 37330404 DOI: 10.1016/j.injury.2023.110899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 05/19/2023] [Accepted: 06/12/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND Children and adolescents are at higher risk of injuries from winter sports like skiing and snowboarding which can cause severe lifelong debilitation and death. PURPOSE The objective of this study is to perform a nationwide analysis of pediatric skiing and snowboarding injuries to identify patterns regarding patient demographics, type of injuries, outcomes, and admission rates. STUDY DESIGN Descriptive Epidemiological Study. METHODS This was a retrospective cohort study of publicly available data. Cases were sourced from the National Electronic Injury Surveillance System (NEISS) from 2010 to 2020 and included 6421 incidents. RESULTS Even when the highest percentage of injuries was the head at 19.30%; the diagnosis of concussion was placed third while fractures were the most common diagnosis at 38.20%. The proportion of pediatric incidents by hospital type is changing with children's hospitals currently managing the majority of cases. CONCLUSIONS These findings can assist clinicians in the ED across different hospital types in understanding the patterns of injury to be better prepared for new cases.
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Affiliation(s)
- Andrew Warren
- Department of Biomedical Sciences, Rocky Vista University College of Osteopathic Medicine, Parker, CO 80134, United States of America
| | - Michael Dea
- Department of Biomedical Sciences, Rocky Vista University College of Osteopathic Medicine, Parker, CO 80134, United States of America
| | - Ileana G Barron
- Department of Epidemiology, University of Alabama Birmingham School of Public Health, Birmingham, AL 35233, United States of America
| | - Isain Zapata
- Department of Biomedical Sciences, Rocky Vista University College of Osteopathic Medicine, Parker, CO 80134, United States of America.
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Hermann A, Christl V, Hastreiter V, Carqueville P, Ellenberger L, Senner V. Muscular Fatigue and Quadriceps-to-Hamstring Ratio in Alpine Skiing in Women over 40 Years. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20085486. [PMID: 37107769 PMCID: PMC10138889 DOI: 10.3390/ijerph20085486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 03/29/2023] [Accepted: 04/03/2023] [Indexed: 05/11/2023]
Abstract
(1) Background: In alpine skiing, senior athletes and especially women have a high risk of knee injury. This may also be related to muscular fatigue (MF) of the knee-stabilizing thigh muscles. This study investigates both the evolution of muscle activity (MA) and of MF of the thighs throughout an entire skiing day. (2) Methods: n = 38 female recreational skiers over 40 years of age performed four specific skiing tasks (plough turns, V-steps uphill, turns with short, and middle radii) at specific times, while freely skiing the rest of the day. Surface EMG of the thigh muscle groups (quadriceps and hamstrings) was measured using special wearables (EMG pants). Apart from standard muscle activity parameters, the EMG data were also processed in the frequency domain to calculate the mean frequency and its shift over the day as a metric of muscle fatigue. (3) Results: The EMG pants showed reliable signal quality over the entire day, with BMI not impacting this. MF increased during skiing before and for both muscle groups significantly (p < 0.006) during lunch. MF, however, was not reflected in the quadriceps-hamstrings ratio. The plough manoeuvre seems to require significantly (p < 0.003) more muscle dynamics than the three other tasks. (4) Conclusion: MF may be quantified over an entire skiing day and thus fatigue information could be given to the skier. This is of major importance for skiers at the beginner level dominantly performing plough turns. Crucial for all skiers: There is no regenerative effect of a 45-min lunch break.
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Affiliation(s)
- Aljoscha Hermann
- Professorship of Sport Equipment and Materials, TUM School of Engineering and Design, Technical University of Munich, 85748 Garching, Germany; (V.C.); (V.H.); (V.S.)
- Correspondence:
| | - Vera Christl
- Professorship of Sport Equipment and Materials, TUM School of Engineering and Design, Technical University of Munich, 85748 Garching, Germany; (V.C.); (V.H.); (V.S.)
| | - Valentin Hastreiter
- Professorship of Sport Equipment and Materials, TUM School of Engineering and Design, Technical University of Munich, 85748 Garching, Germany; (V.C.); (V.H.); (V.S.)
- Institute of Sports Science, Faculty of Economics and Social Sciences, Eberhard Karls Universität Tübingen, 72074 Tübingen, Germany
| | - Patrick Carqueville
- Professorship of Sport Equipment and Materials, TUM School of Engineering and Design, Technical University of Munich, 85748 Garching, Germany; (V.C.); (V.H.); (V.S.)
| | - Lynn Ellenberger
- Swiss Council for Accident Prevention BFU, Hodlerstrasse 5A, 3001 Bern, Switzerland;
| | - Veit Senner
- Professorship of Sport Equipment and Materials, TUM School of Engineering and Design, Technical University of Munich, 85748 Garching, Germany; (V.C.); (V.H.); (V.S.)
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4
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Kohn L, Rauch A. [Fractures of tibial shaft and tibial head in winter sports]. ORTHOPADIE (HEIDELBERG, GERMANY) 2022; 51:882-890. [PMID: 36224282 DOI: 10.1007/s00132-022-04312-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/13/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Injuries in alpine skiing often affect the lower extremities, in particular the knee joint and lower leg. In addition to conventional radiological diagnostics, CT and, in the case of fractures of the knee joint area, MRI also play an important role. In the case of tibial head fractures, especially if there has been a dislocation mechanism, there is an increased risk of vascular and nerve injuries. Lower leg fractures are predestined for the development of a compartment syndrome. For these reasons, an exact survey of the vascular-nerve status and a monitoring of the soft tissues should be carried out. THERAPY In the further therapy, whether conservative or surgical, the soft tissue situation must also be included in the planning. In the case of tibial head fractures in particular, the choice of the right approach is essential for a good result in surgical therapy. Angle-stable plate osteosynthesis and screw osteosynthesis play the most important role as osteosynthesis methods in the knee joint area. In the case of fractures in the shaft area, medullary nail osteosynthesis or angle-stable plate systems are primarily used. In the case of severely compromised soft tissue or unstable situations, it may be necessary to apply an external fixator first. The initiated therapy should enable functional follow-up treatment as early as possible. PREVENTION Good physical fitness, driving-specific training, but also good core stabilization have a preventative effect against injuries. In addition, the correct material coordination between ski boot, binding and ski is important for accident prevention.
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Affiliation(s)
- L Kohn
- Klinik für Unfallchirurgie und Orthopädie, Krankenhaus Landshut-Achdorf, Achdorfer Weg 3, 84036, Landshut, Deutschland.
| | - A Rauch
- ECOM - Praxis für Orthopädie, Sportmedizin & Unfallchirurgie, München, Deutschland
- Sporttraumatologie und Kniechirurgie, ATOS-Klinik München, München, Deutschland
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Ryan S, Fenton SJ, Hansen K, Hewes HA. Sledding Accidents at a Level 1 Pediatric Trauma Center Between 2006 and 2016. Pediatr Emerg Care 2022; 38:e1291-e1293. [PMID: 35436765 DOI: 10.1097/pec.0000000000002728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Sledding is not a risk-free winter sport. According to the US Consumer Product Safety Commission, there were an estimated 13,954 sledding accidents requiring medical care in 2010. However, specific information concerning pediatric injuries related to sledding is not well defined. OBJECTIVES This study aimed to identify the most common types of injuries associated with sledding accidents and demographic factors related to risk of injury in pediatric patients, and to compare injuries associated with 2 different age groups and sexes. METHODS This is a retrospective descriptive study of pediatric patients (<18 years of age) presenting to a regional level I pediatric trauma center secondary to a sledding injury between 2006 and 2016. Demographic information including sex, age, mechanism of injury, and injury severity score was captured and analyzed using descriptive statistics. RESULTS There were 209 patients identified for 10 years. There were no mortalities. There were 85 patients with primary head injury, of which 82 (96.5%) were hospitalized and 33 (38.8%) required an intensive care unit (ICU) stay. Seventy-five patients primarily suffered from extremity injuries, of which 56 (74.6%) had lower extremity fractures requiring operative intervention. There was no difference in ICU or length of stay between younger children (0-11 years) and adolescents (12-18 years) or between male and female patients. CONCLUSIONS Childhood sledding can result in a variety of significant injuries requiring surgical intervention and hospitalization. Children pulled on sleds behind motorized vehicles are at higher risk for more severe injuries resulting in a higher rate of ICU admission.
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Affiliation(s)
- Sydney Ryan
- From the Division of Pediatric Emergency Medicine, Department of Pediatrics
| | - Stephen J Fenton
- Division of Pediatric Surgery, Department of Surgery, University of Utah
| | - Kris Hansen
- Primary Children's Hospital, Salt Lake City, UT
| | - Hilary A Hewes
- From the Division of Pediatric Emergency Medicine, Department of Pediatrics
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Mitra TP, Djerboua M, Mahmood S, Staudt S, Nettel‐Aguirre A, Russell K, Caird JK, Chisholm D, Lane C, Emery CA, Hagel BE. The evaluation of a risky behavior tool in novice pediatric skiers and snowboarders. TRANSLATIONAL SPORTS MEDICINE 2021. [DOI: 10.1002/tsm2.273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Tatum Priyambada Mitra
- Sport Injury Prevention Research Centre, Faculty of Kinesiology University of Calgary Calgary AB Canada
- MD program Sydney Medical School University of Sydney Sydney NSW Australia
- ICES Queen's Queen's University Kingston ON Canada
| | | | - Sheharzad Mahmood
- Faculty of Medicine & Dentistry University of Alberta Edmonton AB Canada
| | - Sebastiaan Staudt
- Faculty of Kinesiology and Rehabilitation Sciences KU Leuven Leuven Belgium
| | - Alberto Nettel‐Aguirre
- Centre for Health and Social Analytics, National Institute for Applied Statistics Research School of Mathematics and Applied Statistics, Faculty of Engineering and Information Sciences University of Wollongong Wollongong New South Wales Australia
| | - Kelly Russell
- Department of Pediatrics and Child Health University of Manitoba Winnipeg MB Canada
- Children’s Hospital Research Institute of Manitoba Winnipeg MB Canada
| | - Jeff K. Caird
- Department of Community Health Sciences, Cumming School of Medicine University of Calgary Calgary AB Canada
- O’Brien Institute of Public Health University of Calgary Calgary AB Canada
- Department of Psychology University of Calgary Calgary AB Canada
| | - Dirk Chisholm
- Faculty of Medicine & Dentistry University of Alberta Edmonton AB Canada
- WinSport Calgary AB Canada
| | | | - Carolyn A. Emery
- Sport Injury Prevention Research Centre, Faculty of Kinesiology University of Calgary Calgary AB Canada
- Department of Community Health Sciences, Cumming School of Medicine University of Calgary Calgary AB Canada
- O’Brien Institute of Public Health University of Calgary Calgary AB Canada
- Department of Pediatrics, Cumming School of Medicine University of Calgary Calgary AB Canada
- Alberta Children’s Hospital Research Institute University of Calgary Calgary AB Canada
| | - Brent E. Hagel
- Sport Injury Prevention Research Centre, Faculty of Kinesiology University of Calgary Calgary AB Canada
- ICES Queen's Queen's University Kingston ON Canada
- Centre for Health and Social Analytics, National Institute for Applied Statistics Research School of Mathematics and Applied Statistics, Faculty of Engineering and Information Sciences University of Wollongong Wollongong New South Wales Australia
- Department of Pediatrics and Child Health University of Manitoba Winnipeg MB Canada
- Children’s Hospital Research Institute of Manitoba Winnipeg MB Canada
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Russu OM, Pop TS, Ciorcila E, Gergely I, Zuh SG, Trâmbițaș C, Borodi PG, Incze-Bartha Z, Feier AM, Georgeanu VA. Arthroscopic Repair in Tibial Spine Avulsion Fractures Using Polyethylene Terephthalate Suture: Good to Excellent Results in Pediatric Patients. J Pers Med 2021; 11:jpm11050434. [PMID: 34069562 PMCID: PMC8160716 DOI: 10.3390/jpm11050434] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 05/15/2021] [Accepted: 05/17/2021] [Indexed: 11/20/2022] Open
Abstract
Background: The objective of the arthroscopic treatment in tibial spine avulsion fractures (TSAF) is to achieve firm reduction and strong internal fixation while still having the patient undergo a minimally invasive procedure. Material and methods: The study was performed on 12 young patients with avulsion fracture of the anterior tibial spine. All 12 patients had type 3 Modified Meyers and McKeever fractures. The injury mechanism was direct anterior to posterior trauma in full leg length hyperextension with sport trauma reported in all cases. The physical examination revealed decreased range of motion, extension deficit, and pain during walking. Radiology, MRI, and CT pathologic findings described complete fracture of the anterior tibial spine with no clear signs of callus formation at the time of examination. All patients underwent arthroscopic suture surgical treatment. The Tegner, the Lysholm, and the International Knee Documentation Committee (IKDC) scores were used to evaluate subjective outcomes at three and six months after the surgery. Radiographs were used to assess callus formation and healing status of the fracture. Results: The mean IKDC score was 33.4 ± 23.3 (p = 0.032) preoperatively and 84.2 ± 14.3 at final follow-up (p = 0.0032, CI = 95%). The mean Tegner score improved from 3.8 ± 1.1 pre-operatively to 6.7 ± 2.2 at six months follow-up (p = 0.0231, CI = 95%). The Lysholm score differed significantly at baseline compared to final follow-up (53.7 ± 17.3 vs. 87.7 ± 9.9; p = 0.0066, CI = 95%). In all cases (n = 12), the radiographs taken after six months revealed the healing of the fracture in the anatomic position without secondary displacement. No functional knee instability was detected at the end of the study. Conclusions: The study provides preliminary promising results regarding fracture healing, knee stability, and functional subjective scores. Patient selection was a major factor of success prediction for this technique.
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Affiliation(s)
- Octav Marius Russu
- Department of Orthopaedics and Traumatology, Clinical County Hospital, 540139 Tîrgu Mureș, Romania; (O.M.R.); (T.S.P.); (I.G.); (S.-G.Z.); (C.T.); (Z.I.-B.); (A.M.F.)
- Faculty of General Medicine, University of Medicine, Pharmacy, Sciences and Technology, 540139 Tîrgu Mureș, Romania;
| | - Tudor Sorin Pop
- Department of Orthopaedics and Traumatology, Clinical County Hospital, 540139 Tîrgu Mureș, Romania; (O.M.R.); (T.S.P.); (I.G.); (S.-G.Z.); (C.T.); (Z.I.-B.); (A.M.F.)
- Faculty of General Medicine, University of Medicine, Pharmacy, Sciences and Technology, 540139 Tîrgu Mureș, Romania;
| | - Emilian Ciorcila
- Department of Orthopaedics and Traumatology, Clinical County Hospital, 540139 Tîrgu Mureș, Romania; (O.M.R.); (T.S.P.); (I.G.); (S.-G.Z.); (C.T.); (Z.I.-B.); (A.M.F.)
- Faculty of General Medicine, University of Medicine, Pharmacy, Sciences and Technology, 540139 Tîrgu Mureș, Romania;
- Correspondence: ; Tel.: +40-265213720
| | - István Gergely
- Department of Orthopaedics and Traumatology, Clinical County Hospital, 540139 Tîrgu Mureș, Romania; (O.M.R.); (T.S.P.); (I.G.); (S.-G.Z.); (C.T.); (Z.I.-B.); (A.M.F.)
- Faculty of General Medicine, University of Medicine, Pharmacy, Sciences and Technology, 540139 Tîrgu Mureș, Romania;
| | - Sándor-György Zuh
- Department of Orthopaedics and Traumatology, Clinical County Hospital, 540139 Tîrgu Mureș, Romania; (O.M.R.); (T.S.P.); (I.G.); (S.-G.Z.); (C.T.); (Z.I.-B.); (A.M.F.)
- Faculty of General Medicine, University of Medicine, Pharmacy, Sciences and Technology, 540139 Tîrgu Mureș, Romania;
| | - Cristian Trâmbițaș
- Department of Orthopaedics and Traumatology, Clinical County Hospital, 540139 Tîrgu Mureș, Romania; (O.M.R.); (T.S.P.); (I.G.); (S.-G.Z.); (C.T.); (Z.I.-B.); (A.M.F.)
- Department of Anatomy and Embryology, University of Medicine, Pharmacy, Sciences and Technology, 540139 Tîrgu Mureș, Romania
| | - Paul Gabriel Borodi
- Faculty of General Medicine, University of Medicine, Pharmacy, Sciences and Technology, 540139 Tîrgu Mureș, Romania;
| | - Zsuzsanna Incze-Bartha
- Department of Orthopaedics and Traumatology, Clinical County Hospital, 540139 Tîrgu Mureș, Romania; (O.M.R.); (T.S.P.); (I.G.); (S.-G.Z.); (C.T.); (Z.I.-B.); (A.M.F.)
- Department of Anatomy and Embryology, University of Medicine, Pharmacy, Sciences and Technology, 540139 Tîrgu Mureș, Romania
| | - Andrei Marian Feier
- Department of Orthopaedics and Traumatology, Clinical County Hospital, 540139 Tîrgu Mureș, Romania; (O.M.R.); (T.S.P.); (I.G.); (S.-G.Z.); (C.T.); (Z.I.-B.); (A.M.F.)
- Faculty of General Medicine, University of Medicine, Pharmacy, Sciences and Technology, 540139 Tîrgu Mureș, Romania;
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Lagerstrand K, Baranto A, Hebelka H. Different disc characteristics between young elite skiers with diverse training histories revealed with a novel quantitative magnetic resonance imaging method. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 30:2082-2089. [PMID: 34013394 DOI: 10.1007/s00586-021-06869-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 03/05/2021] [Accepted: 05/02/2021] [Indexed: 12/17/2022]
Abstract
PURPOSE To evaluate if there are differences in thoraco-lumbar disc characteristics between elite skiers and non-athletic controls as well as between different types of elite skiers, with diverse training histories, using a novel quantitative MRI method. METHODS The thoraco-lumbar spine of 58 elite skiers (age = 18.2 ± 1.1 years, 30 males) and 26 normally active controls (age = 16.4 ± 0.6 years, 9 males) was examined using T2w-MRI. Disc characteristics were compared quantitatively between groups using histogram and regional image analyses to determine delta peak and T2-values in five sub-regions. RESULTS A statistical difference in the delta peak value was found between skiers and controls (p <0.001), reflecting higher degree of disc degeneration. The histogram analysis also revealed that the type of training determines where and to what extent the changes occur. Alpine skiers displayed lumbar changes, while mogul skiers displayed changes also in the thoracic spine. Alpine skiers with diverse training dose differed in delta peak value (p = 0.005), where skiers with highest training dose displayed less changes. Regional T2-value differences were found in skiers with divergent training histories (p <0.05), reflecting differences in disc degeneration patterns, foremost within the dorsal annulus. CONCLUSION Differences in quantitative disc characteristics were found not only between elite skiers and non-athletic controls but also between subgroups of elite skiers with diverse training histories. The differences in the disc measures, reflecting tissue degradation, are likely related to type and intensity of the physical training. Future studies are encouraged to explore the relation between disc functionality, training history and pain to establish adequate prevention and rehabilitation programs.
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Affiliation(s)
- K Lagerstrand
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
- Department of Medical Physics and Techniques, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - A Baranto
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Orthopedics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - H Hebelka
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden
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9
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Goldman RD, Kong C, Henkelman E. Organic facial foreign body in a ski accident: Case report and review of the literature. J Paediatr Child Health 2021; 57:723-726. [PMID: 32583949 DOI: 10.1111/jpc.14966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 05/11/2020] [Accepted: 05/14/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Ran D Goldman
- The Pediatric Research in Emergency Therapeutics (PRETx) Program, Division of Pediatric Emergency Medicine, Department of Pediatrics, BC Children's Hospital, The University of British Columbia, Vancouver, British Columbia, Canada.,BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Cynthia Kong
- The Pediatric Research in Emergency Therapeutics (PRETx) Program, Division of Pediatric Emergency Medicine, Department of Pediatrics, BC Children's Hospital, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Erika Henkelman
- BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada.,Division of Plastic Surgery, BC Children's Hospital, Department of Surgery, The University of British Columbia, Vancouver, British Columbia, Canada
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10
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Gentile JM, O'Brien MC, Conrad B, Horodyski M, Bruner ML, Farmer KW. A Biomechanical Comparison Shows No Difference Between Two Knee Braces used for Medial Collateral Ligament Injuries. Arthrosc Sports Med Rehabil 2021; 3:e901-e907. [PMID: 34195660 PMCID: PMC8220611 DOI: 10.1016/j.asmr.2021.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 03/05/2021] [Indexed: 11/16/2022] Open
Abstract
Purpose The purpose of this study was to assess the ability of 2 commonly used knee braces to control knee valgus motion and subsequent strain on the medial collateral ligament (MCL) in a laboratory-controlled environment. Methods Twenty healthy individuals (6 male, 14 female; mean age, 23 ± 3 years) with no history of knee injury or brace use performed a jump landing task while wearing either no brace or 1 of 2 braces: the Playmaker and Total Range of Motion . Three-dimensional joint kinematics and kinetics were measured in our biomechanics laboratory. Results Significantly less knee dynamic valgus angulation was noted when using either brace (−0.51° ± 3.9° and −1.3° ± 3.2°) compared no brace (4.8° ± 3.0°). Dynamic valgus angulation did not differ significantly between the 2 braces tested, which were both not statistically different from baseline alignment. There were significant differences seen in peak knee flexion angle between each brace (77.9° ± 8.8°and 83.1° ± 8.4°), as well as between both braces and no brace (90.6° ± 11.1°). There was no significant difference in knee frontal plane moment or peak vertical ground reaction force loading among all 3 testing conditions. Conclusions Compared to no brace, both braces allowed significantly less dynamic valgus angulation of the knee under physiological vertical loads but were not significantly different from one another. Clinical Relevance Knee braces are commonly used to protect the MCL when placed under physiological loads. It is important to know which braces effectively reduce valgus stress to provide the best outcomes.
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Affiliation(s)
- Joseph M Gentile
- University of Florida College of Medicine, Department of Orthopedics and Rehabilitation, UF Orthopaedics and Sports Medicine Institute, Gainesville, Florida, U.S.A
| | - Michael C O'Brien
- University of Florida College of Medicine, Department of Orthopedics and Rehabilitation, UF Orthopaedics and Sports Medicine Institute, Gainesville, Florida, U.S.A
| | - Bryan Conrad
- University of Florida College of Medicine, Department of Orthopedics and Rehabilitation, UF Orthopaedics and Sports Medicine Institute, Gainesville, Florida, U.S.A
| | - MaryBeth Horodyski
- University of Florida College of Medicine, Department of Orthopedics and Rehabilitation, UF Orthopaedics and Sports Medicine Institute, Gainesville, Florida, U.S.A
| | - Michelle L Bruner
- University of Florida College of Medicine, Department of Orthopedics and Rehabilitation, UF Orthopaedics and Sports Medicine Institute, Gainesville, Florida, U.S.A
| | - Kevin W Farmer
- University of Florida College of Medicine, Department of Orthopedics and Rehabilitation, UF Orthopaedics and Sports Medicine Institute, Gainesville, Florida, U.S.A
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Gauß G, Beller R, Boos J, Däggelmann J, Stalf H, Wiskemann J, Götte M. Adverse Events During Supervised Exercise Interventions in Pediatric Oncology-A Nationwide Survey. Front Pediatr 2021; 9:682496. [PMID: 34490156 PMCID: PMC8417361 DOI: 10.3389/fped.2021.682496] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 05/18/2021] [Indexed: 12/25/2022] Open
Abstract
Objectives: Exercise interventions during and after treatment for pediatric cancer are associated with beneficial physical, psychological, and social effects. However, valid data about adverse events (AEs) of such interventions have rarely been evaluated. This retrospective study evaluates AEs that occurred during supervised oncological exercise programs for pediatric cancer patients and survivors. Methods: This Germany-wide study used a self-administered online survey focusing on general program characteristics and AEs retrospectively for 2019. The questionnaire included (a) basic data on the offered exercise program, (b) AEs with consequences (Grade 2-5) that occurred in 2019 during an exercise intervention, (c) number of Grade 1 AEs, (d) safety procedures as part of the exercise programs, and (e) possibility to give feedback and describe experience with AEs in free text. Results: Out of 26 eligible exercise programs, response rate of program leaders was 92.3% (n = 24). Representatives working for Universities (n = 6), rehabilitation clinics (n = 3), acute cancer clinics (n = 12), and activity camps (n = 3) participated. In total, 35,110 exercise interventions with varying duration were recorded for 2019. Six AEs with consequences (Grade 2-3) occurred during exercise interventions after cancer treatment resulting in an incidence of 17 per 100,000 exercise interventions (0.017%). No life-threatening consequences or death were reported and no serious AE occurred during acute cancer treatment. Grade 1 AE occurred with a frequency of 983, corresponding to an incidence of 2,800 per 100,000 interventions (2.8%). Most frequent Grade 1 AE were muscle soreness, circulatory problems, and abdominal pain. The most frequent preventive safety procedures at the institutions were regular breaks, consultations with the medical treatment team, and material selection with low injury potential. Conclusions: Supervised exercise interventions for pediatric cancer patients and survivors seem to be safe and AEs with consequences comparatively rare when compared to general childhood population data. Occurrence of grade 1 AEs was common, however, causality was probably not evident between AEs and the exercise intervention. Future research should standardize assessment of AEs in clinical practice and research, and prospectively register and evaluate AEs that occur in the context of exercise interventions in pediatric cancer patients and survivors.
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Affiliation(s)
- Gabriele Gauß
- Department of Pediatric Hematology and Oncology, Pediatrics III, West German Cancer Center, University Hospital Essen, Essen, Germany
| | - Ronja Beller
- Department of Pediatric Hematology and Oncology, Pediatrics III, West German Cancer Center, University Hospital Essen, Essen, Germany
| | - Joachim Boos
- Department of Pediatric Hematology and Oncology, University Children's Hospital Muenster, Münster, Germany
| | - Julia Däggelmann
- Department of Molecular and Cellular Sports Medicine, Institute of Cardiology and Sports Medicine, German Sport University Cologne, Cologne, Germany
| | - Hannah Stalf
- Division of Pediatric Hematology and Oncology, Hospital for Children and Adolescents, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Joachim Wiskemann
- Working Group Exercise Oncology Division of Medical Oncology, University Clinic Heidelberg and National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Miriam Götte
- Department of Pediatric Hematology and Oncology, Pediatrics III, West German Cancer Center, University Hospital Essen, Essen, Germany
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12
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Maisonneuve E, Roumeliotis N, Basso A, Venchiarutti D, Vallot C, Ricard C, Bouzat P, Mortamet G. Epidemiology of severe paediatric trauma following winter sport accidents. Acta Paediatr 2020; 109:2125-2130. [PMID: 31990998 DOI: 10.1111/apa.15196] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Revised: 01/07/2020] [Accepted: 01/23/2020] [Indexed: 12/13/2022]
Abstract
AIM This study describes the epidemiology of severe injuries related to winter sports (skiing, snowboarding and sledding) in children and assesses potential preventive actions. METHODS A single-centre retrospective study performed at Pediatric or Adult Intensive Care Unit in the French Alps. All patients less than 15 years old, admitted to the Intensive Care Unit following a skiing, snowboarding or sledding accident from 2011 to 2018, were included. RESULTS We included 186 patients (mean age 10.6 years and 68% were male); of which 136 (73%), 21 (11%) and 29 (16%) had skiing, snowboarding and sledding accidents, respectively. The average ISS (injury severity score) was 16. The major lesions were head (n = 94 patients, 51%) and intra-abdominal (n = 56 patients, 30%) injuries. Compared to skiing/snowboarding, sledding accidents affected younger children (7 vs 11 years, P < .001); most of whom did not wear a helmet (89% vs 8%, P < .001). Severity scores were statistically different amongst winter sports (ISS = 16 (IQR 9-24) for skiing, 9 (IQR 4-16) for snowboarding and 16 (IQR 13-20) for sledding accident, P = .02). CONCLUSION Winter sports can cause severe trauma in children. Sledding accidents affect younger children that may benefit from wearing protective equipment.
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Affiliation(s)
| | | | - Amélie Basso
- Pediatric Intensive Care Unit CHU Grenoble‐Alpes La Tronche France
| | - Damien Venchiarutti
- Réseau Nord‐Alpin des Urgences CH Annecy Annecy France
- Emergency Department CH Albertville Albertville France
| | - Cécile Vallot
- Réseau Nord‐Alpin des Urgences CH Annecy Annecy France
| | - Cécile Ricard
- Réseau Nord‐Alpin des Urgences CH Annecy Annecy France
| | - Pierre Bouzat
- Department of anesthesiology and intensive care medicine Grenoble Alps Trauma center Grenoble University Hospital Grenoble France
| | - Guillaume Mortamet
- Pediatric Intensive Care Unit CHU Grenoble‐Alpes La Tronche France
- Réseau Nord‐Alpin des Urgences CH Annecy Annecy France
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Koncan D, Gilchrist M, Vassilyadi M, Hoshizaki TB. Simulated brain strains resulting from falls differ between concussive events of young children and adults. Comput Methods Biomech Biomed Engin 2020; 23:500-509. [PMID: 32207335 DOI: 10.1080/10255842.2020.1741555] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Compared to adults, it has been documented that children are at elevated risk for concussion, repeated concussions, and experience longer recovery times. What is unknown, is whether the developing brain may be injured at differing strain levels. This study examined peak and cumulative brain strain from 20 cases of concussion in both young children and adults using physical reconstructions and finite element modelling of the brain response to impacts. The child group showed lower impact kinematics as well as strain metrics. Results suggest children may suffer concussive injuries with lower brain strains compared to adults.
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Affiliation(s)
- David Koncan
- Human Kinetics, University of Ottawa, Ottawa, Ontario, Canada
| | - Michael Gilchrist
- School of Mechanical & Materials Engineering, University College Dublin, Dublin, Ireland
| | - Michael Vassilyadi
- Faculty of Medicine, Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, Ontario, Canada
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BAILLY NICOLAS, LLARI MAXIME, DONNADIEU THIERRY, MASSON CATHERINE, ARNOUX PIERREJEAN. Numerical Reconstruction of Traumatic Brain Injury in Skiing and Snowboarding. Med Sci Sports Exerc 2018; 50:2322-2329. [DOI: 10.1249/mss.0000000000001701] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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15
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Provance AJ, Daoud AK, Tagawa A, Rhodes J. Pediatric and adolescent injury in skiing. Res Sports Med 2018; 26:150-165. [DOI: 10.1080/15438627.2018.1438282] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Aaron J. Provance
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Ariel K. Daoud
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Alex Tagawa
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Jason Rhodes
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, USA
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Abstract
Skiing and snowboarding have increased in popularity since the 1960s. Both sports are responsible for a substantial number of musculoskeletal injuries treated annually by orthopaedic surgeons. Specific injury patterns and mechanisms associated with skiing and snowboarding have been identified. No anatomic location is exempt from injury, including the head, spine, pelvis, and upper and lower extremities. In these sports, characteristic injury mechanisms often are related to the position of the limbs during injury, the athlete's expertise level, and equipment design. Controversy exists about the effectiveness of knee bracing and wrist guards in reducing the incidence of these injuries. Understanding these injury patterns, proper training, and the use of injury prevention measures, such as protective equipment, may reduce the overall incidence of these potentially debilitating injuries.
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17
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Witwit WA, Kovac P, Sward A, Agnvall C, Todd C, Thoreson O, Hebelka H, Baranto A. Disc degeneration on MRI is more prevalent in young elite skiers compared to controls. Knee Surg Sports Traumatol Arthrosc 2018; 26:325-332. [PMID: 28409199 PMCID: PMC5754419 DOI: 10.1007/s00167-017-4545-3] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 04/07/2017] [Indexed: 12/13/2022]
Abstract
PURPOSE Evidence-based facts regarding spine abnormalities and back pain are needed in order to develop rehabilitation programs and prevent spine injuries in young skiers. The aim therefore is to identify MRI changes in the thoraco-lumbar spine and the lifetime prevalence of back pain, as well as the association between them, in young skiers compared to non-athletes. METHODS Seventy-five young elite alpine and mogul skiers, age range 16-20 years, were compared with 27 non-athletic controls. All subjects underwent spinal MRI and answered back pain questionnaires. RESULTS Fifty-six percent of skiers had at least one disc Pfirrmann grade ≥3 compared to 30% of controls (p = 0.027). Schmorl's nodes (46%) and disc height reduction (37%) were significantly more prevalent in skiers compared to controls (0%) (p < 0.001). When all parameters were combined together, skiers had significantly higher rate of radiological changes than controls, 82% compared to 54% (p = 0.007). The mean number of discs with Pfirrmann grade ≥3 was 1.1 per individual in skiers (median 1, range 0-6) versus 0.6 in controls (median 0, range 0-3). There was no significant difference in lifetime prevalence of back pain between skiers (50%) and controls (44%) (n.s.). MRI abnormalities in skiers did not correlate with lifetime prevalence of back pain. Skiers had a better health perception than controls (p = 0.026). CONCLUSION Alpine skiers have more degenerative disc changes compared to non-athletes, but these changes do not correlate with the lifetime prevalence of back pain. Lifetime prevalence of back pain is not significantly different between the groups; however, skiers report more severe pain on VAS score. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Wisam A. Witwit
- Department of Radiology, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, 41345 Gothenburg, Sweden
| | - Peter Kovac
- Department of Radiology, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, 41345 Gothenburg, Sweden
| | - Anna Sward
- Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Cecilia Agnvall
- Sportsmedicine Åre and Åre Ski High School, Ostersund, Sweden
| | - Carl Todd
- Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Olof Thoreson
- Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Hanna Hebelka
- Department of Radiology, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, 41345 Gothenburg, Sweden
| | - Adad Baranto
- Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
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18
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Wang D, De Vito G, Ditroilo M, Delahunt E. Effect of sex and fatigue on muscle stiffness and musculoarticular stiffness of the knee joint in a young active population. J Sports Sci 2016; 35:1582-1591. [PMID: 27590889 DOI: 10.1080/02640414.2016.1225973] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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19
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Svider PF, Bobian M, Hojjat H, Sheyn A, Zuliani G, Eloy JA, Folbe AJ. A chilling reminder: Pediatric facial trauma from recreational winter activities. Int J Pediatr Otorhinolaryngol 2016; 87:78-82. [PMID: 27368447 DOI: 10.1016/j.ijporl.2016.05.025] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 05/11/2016] [Accepted: 05/12/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND Winter activities offer children and adolescents an outdoor recreational opportunity during the coldest months. Our objectives were to estimate the national incidence of facial injury associated with recreational winter activities. Furthermore, we analyze demographic trends and clinical characteristics of patients presenting to emergency departments (EDs). METHODS The National Electronic Injury Surveillance System (NEISS), a population-based resource, was evaluated for ED visits from 2010 to 2014 for children injured from "active" winter -undertakings (snowboarding, skiing, ice skating) and sledding/tubing. Entry narratives were evaluated for demographics, diagnoses, and other clinical factors. RESULTS 841 entries amounting to an estimated 27,618 patients were evaluated. The most common injuries were lacerations (69.4%), contusions/abrasions (19.5%), and fractures (5.5%), with the most common fracture sites being the nose (60.9%), orbit (15.2%), and mandible (10.9%). Median age was 9 years (IQR 5-12), and 65.8% were male. A greater proportion of adolescents sustained fractures than younger children (8.1% vs. 4.0%). The majority of fractures were to the nose. CONCLUSION With nearly 30,000 ED visits over five years, participation in winter sports can be perilous. Adolescents harbor a greater risk of sustaining serious injuries than younger children, and patients injured sledding/tubing had a greater fracture risk compared to those participating in more "active" winter activities. As upper/mid-face fractures occurred in only 1.4%, these findings reinforce a very limited role for CT. These findings suggest a need for greater use of facial protection and closer supervision of older children participating in these activities.
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Affiliation(s)
- Peter F Svider
- Department of Otolaryngology - Head and Neck Surgery, Wayne State University School of Medicine, Detroit, MI, USA.
| | - Michael Bobian
- Department of Otolaryngology - Head and Neck Surgery, Wayne State University School of Medicine, Detroit, MI, USA
| | - Houmehr Hojjat
- Department of Otolaryngology - Head and Neck Surgery, Wayne State University School of Medicine, Detroit, MI, USA
| | - Anthony Sheyn
- Department of Otolaryngology - Head and Neck Surgery, The University of Tennessee Health Science Center School of Medicine, Memphis, TN, USA
| | - Giancarlo Zuliani
- Department of Otolaryngology - Head and Neck Surgery, Wayne State University School of Medicine, Detroit, MI, USA; Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology - Head and Neck Surgery, Wayne State University School of Medicine, Detroit, MI, USA
| | - Jean Anderson Eloy
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA; Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA; Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Newark, NJ, USA
| | - Adam J Folbe
- Department of Otolaryngology - Head and Neck Surgery, Wayne State University School of Medicine, Detroit, MI, USA; Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI, USA
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Bailly N, Llari M, Donnadieu T, Masson C, Arnoux PJ. Head impact in a snowboarding accident. Scand J Med Sci Sports 2016; 27:964-974. [DOI: 10.1111/sms.12699] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2016] [Indexed: 11/29/2022]
Affiliation(s)
- N. Bailly
- Laboratoire de Biomécanique Appliquée; UMRT24 IFSTTAR - Université de la Méditerranée; Marseille Cedex 20 France
- Salomon S.A.S.; Annecy Cedex 9 France
| | - M. Llari
- Laboratoire de Biomécanique Appliquée; UMRT24 IFSTTAR - Université de la Méditerranée; Marseille Cedex 20 France
| | | | - C. Masson
- Laboratoire de Biomécanique Appliquée; UMRT24 IFSTTAR - Université de la Méditerranée; Marseille Cedex 20 France
| | - P. J. Arnoux
- Laboratoire de Biomécanique Appliquée; UMRT24 IFSTTAR - Université de la Méditerranée; Marseille Cedex 20 France
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Trans-physeal anterior cruciate ligament reconstruction in adolescents. Knee Surg Sports Traumatol Arthrosc 2016; 24:707-11. [PMID: 25649728 DOI: 10.1007/s00167-015-3516-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Accepted: 01/15/2015] [Indexed: 10/24/2022]
Abstract
PURPOSE The aim of the study was to evaluate, in a group of adolescents, the onset of varus-valgus deviations in the sagittal plane after performing a trans-tibial trans-epiphyseal technique of ACL reconstruction with a follow-up of at least 2 years. METHODS Seventy-one patients aged 12-15 years old (Tanner scale 3 and 4) have undergone ACL reconstruction with STG using arthroscopy. All patients were evaluated clinically using the visual analogue scale (VAS), the Lysholm score and the Tegner activity score at the time of surgery. All patients were reevaluated after a follow-up period of at least 2 years (T1) using the VAS, the Lysholm score, the Tegner activity score and radiographic studies in order to compare the operated limb with the healthy control limb. RESULTS Valgus difference exceeding 2° in the knee axis between the operated limb and the healthy control limb was observed only in three patients (4.2%: 95% CI 0.88-11.86%). The average difference was <1° (0.3°, 95% CI 0.0-0.55). CONCLUSION The trans-tibial trans-epiphyseal technique of ACL reconstruction, according to the results obtained, seems to be a valid alternative procedure, when performed by a skilled orthopaedic surgeon, offering an excellent safety profile and at the same time very good clinical results. LEVEL OF EVIDENCE IV.
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22
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Prevention and rehabilitation of paediatric anterior cruciate ligament injuries. Knee Surg Sports Traumatol Arthrosc 2016; 24:730-6. [PMID: 26572630 DOI: 10.1007/s00167-015-3856-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Accepted: 10/27/2015] [Indexed: 01/14/2023]
Abstract
PURPOSE To review the current knowledge on anterior cruciate ligament (ACL) injury prevention and ACL rehabilitation in individuals who have not yet reached musculoskeletal maturity. METHODS This is a narrative review based on a targeted and systematic literature search for paediatric ACL injury risk factors, injury prevention and rehabilitation. RESULTS The search strategies resulted in 119 hits on risk factor studies, 57 hits on prevention and 37 hits on rehabilitation. Modifiable risk factors for ACL injury are largely unknown in the paediatric population. ACL injury prevention using neuromuscular training is highly successful in the adolescent population, and existing injury prevention programmes are cost-effective. The efficacy of ACL injury prevention programmes in children is, however, investigated to a markedly lesser degree. Paediatric ACL injury rehabilitation is poorly described, although supervised active rehabilitation progressed through phases with functional milestones is generally encouraged. CONCLUSION Although limited, current evidence supports implementation of injury prevention programmes in female football players from the age of 12. Supervised active rehabilitation where progression is guided by functional milestones is also advocated. Future identification of modifiable risk factors is needed to design prevention programmes for younger children. There is a need for international multicentre studies on treatment algorithms and rehabilitation to increase knowledge on the short- and long-term outcomes following existing algorithms. STUDY DESIGN Narrative review, level III.
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Concussion Among Youth Skiers and Snowboarders: A Review of the National Trauma Data Bank From 2009 to 2010. Pediatr Emerg Care 2016; 32:9-13. [PMID: 25834958 DOI: 10.1097/pec.0000000000000364] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE There are limited data regarding concussion among youth skiers and snowboarders. The objective of this study was to examine the frequency of concussion among helmeted and unhelmeted youth skiers and snowboarders presenting to trauma centers. METHODS Subjects 18 years or younger with a ski- or snowboard-related injury were studied using data from the National Trauma Data Bank from 2009 to 2010. We further selected those with head/neck injuries and stratified based on helmet status. Concussive injuries were identified from International Classification of Diseases, 9th Revision codes. Severity analysis was based on the Glasgow Coma Scale and Injury Severity Score. RESULTS A total of 1001 subjects met inclusion criteria with 678 subjects having documented helmet status. Subjects 12 years or younger were more likely to use helmets compared to 13-18 year-olds (odds ratio, 2.21; 95% confidence interval [95% CI], 1.52-3.21). Skiers were more likely to use helmets compared to snowboarders (odds ratios, 1.60; 95% CI, 1.16-2.19). Snowboarders had a greater likelihood of concussion (estimated-β, 2.1; 95% CI, 1.48-2.85) after adjusting for helmet status and age. There was no significant difference in the frequency of concussion among helmeted compared to unhelmeted subjects. Imputing missing values for helmets status had no effect on outcome for concussion. We found no difference in injury severity among helmeted compared to unhelmeted subjects. CONCLUSIONS Among youth skiers and snowboarders who present to trauma centers with a head injury, the likelihood of that injury involving a concussion was not associated with helmet use.
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Abstract
Alpine skiing is one of the most popular leisure time winter sporting activities. Skiing imposes high requirements concerning physical fitness, particularly regarding balance abilities. The main objective of this study was to evaluate the changes in balance performance of recreational skiers after a seven-day ski camp. A total of 78 students - 24 women and 54 men - participated in the study. The ski course was held in accordance with the official program of the Polish Ski Federation. The study sample was comprised of 43 beginners and 35 intermediate skiers. All students were tested with the MFT S3-Check, the day before and the day after the ski camp. The test system consisted of an unstable uniaxial platform, with an integrated sensor and corresponding software. Changes in balance performance (sensory and stability index) were evaluated using paired t-tests. Additionally, changes in sensory and stability categories, which were based on the norm data, were analyzed. Female and male participants showed significantly better sensory and stability indices after skiing. Considerable changes from weak or very weak to average or good balance categories could be seen after skiing for both sexes. Regarding skiing experience, both beginners and intermediate skiers improved their sensory and stability indices significantly after skiing. Hence, recreational alpine skiing resulted in better balance performance regardless of sex or skiing experience. Skiing as an outdoor activity offers the opportunity to improve balance performance with a positive impact on everyday life activities.
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Joeris A, Lutz N, Wicki B, Slongo T, Audigé L. An epidemiological evaluation of pediatric long bone fractures - a retrospective cohort study of 2716 patients from two Swiss tertiary pediatric hospitals. BMC Pediatr 2014; 14:314. [PMID: 25528249 PMCID: PMC4302599 DOI: 10.1186/s12887-014-0314-3] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Accepted: 12/11/2014] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Children and adolescents are at high risk of sustaining fractures during growth. Therefore, epidemiological assessment is crucial for fracture prevention. The AO Comprehensive Injury Automatic Classifier (AO COIAC) was used to evaluate epidemiological data of pediatric long bone fractures in a large cohort. METHODS Data from children and adolescents with long bone fractures sustained between 2009 and 2011, treated at either of two tertiary pediatric surgery hospitals in Switzerland, were retrospectively collected. Fractures were classified according to the AO Pediatric Comprehensive Classification of Long Bone Fractures (PCCF). RESULTS For a total of 2716 patients (60% boys), 2807 accidents with 2840 long bone fractures (59% radius/ulna; 21% humerus; 15% tibia/fibula; 5% femur) were documented. Children's mean age (SD) was 8.2 (4.0) years (6% infants; 26% preschool children; 40% school children; 28% adolescents). Adolescent boys sustained more fractures than girls (p < 0.001). The leading cause of fractures was falls (27%), followed by accidents occurring during leisure activities (25%), at home (14%), on playgrounds (11%), and traffic (11%) and school accidents (8%). There was boy predominance for all accident types except for playground and at home accidents. The distribution of accident types differed according to age classes (p < 0.001). Twenty-six percent of patients were classed as overweight or obese - higher than data published by the WHO for the corresponding ages - with a higher proportion of overweight and obese boys than in the Swiss population (p < 0.0001). CONCLUSION Overall, differences in the fracture distribution were sex and age related. Overweight and obese patients seemed to be at increased risk of sustaining fractures. Our data give valuable input into future development of prevention strategies. The AO PCCF proved to be useful in epidemiological reporting and analysis of pediatric long bone fractures.
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Sagalyn EB, McDevitt MC, Ernst R. Utah ski patrol: assessing training types and resources. Wilderness Environ Med 2014; 25:450-6. [PMID: 25281589 DOI: 10.1016/j.wem.2014.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Revised: 06/03/2014] [Accepted: 06/05/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Skiers and snowboarders incur a variety of injuries and medical emergencies each year at ski resorts. The ski patrol is primarily responsible for initial triage, assessment and stabilization of these problems. OBJECTIVE The purpose of this study was to subjectively evaluate the type of training, resources, and equipment available to local ski patrols within Utah. METHODS Ski patrol directors at ski resorts in Utah were asked to complete a voluntary computerized survey. RESULTS Of the 14 ski areas in Utah, ski patrol directors representing 8 resorts responded. The majority of patrols in Utah use Outdoor Emergency Care (OEC) as their primary education and certification source. Most programs also include site-specific training in addition to basic certification. All responding resorts had basic first responder equipment, including splinting devices, basic airway management, and hemorrhage control. Six of 8 responding resorts had affiliated clinics, and all had access to aeromedical transport. All of the responding ski patrol directors believed the current training level was adequate. CONCLUSIONS Utah area ski patrollers frequently see trauma-related injuries and have the resources to assess and provide initial immobilization techniques. Many resorts have affiliated clinics with advanced providers, and all have access to aeromedical support to rapidly transfer patients to trauma centers. Medical directors may be of use for training as well as developing extended scope of practice protocols for advanced airway use or medication administration. Patrols may benefit from additional resort-specific training that addresses other frequently seen injuries or illnesses.
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Affiliation(s)
- Emily B Sagalyn
- Division of Emergency Medicine, University of Utah, Salt Lake City, UT.
| | - Marion C McDevitt
- Division of Emergency Medicine, University of Utah, Salt Lake City, UT
| | - Ryan Ernst
- Division of Emergency Medicine, University of Utah, Salt Lake City, UT
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Kohl S, Stutz C, Decker S, Ziebarth K, Slongo T, Ahmad SS, Kohlhof H, Eggli S, Zumstein M, Evangelopoulos DS. Mid-term results of transphyseal anterior cruciate ligament reconstruction in children and adolescents. Knee 2014; 21:80-5. [PMID: 23972566 DOI: 10.1016/j.knee.2013.07.004] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2012] [Revised: 07/06/2013] [Accepted: 07/10/2013] [Indexed: 02/02/2023]
Abstract
BACKGROUND Optimal therapy for anterior cruciate ligament (ACL) rupture in the paediatric population still provokes controversy. Although conservative and operative treatments are both applied, operative therapy is slightly favored. Among available surgical techniques are physeal-sparing reconstruction and transphyseal graft fixation. The aim of this study was to present our mid-term results after transphyseal ACL reconstruction. METHODS Fifteen young patients (mean age=12.8±2.6, range=6.2-15.8 years, Tanner stage=2-4) with open physis and traumatic anterior cruciate rupture who had undergone transphyseal ACL reconstruction with unilateral quadriceps tendon graft were prospectively analyzed. All children were submitted to radiological evaluation to determine the presence of clearly open growth plates in both the distal femur and proximal tibia. Postoperatively, all patients were treated according to a standardized rehabilitation protocol and evaluated by radiographic analysis and the Lysholm-Gillquist and IKDC 2000 scores. Their health-related quality of life was measured using the SF-12 PCS (physical component summary) and MCS (mental component summary) questionnaires. RESULTS Mean postoperative follow-up was 4.1 years. Mean Lysholm-Gillquist score was 94.0. Thirteen of the 15 knees were considered nearly normal on the IKDC 2000 score. The mean SF-12 questionnaire score was 54.0±4.8 for SF-12 PCS and 59.1±3.7 for SF-12 MCS. No reruptures were observed. Radiological analysis detected one knee with valgus deformity. All patients had a normal gait pattern without restrictions. CONCLUSION Transphyseal reconstruction of the anterior cruciate ligament shows satisfactory mid-term results in the immature patient.
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Affiliation(s)
- Sandro Kohl
- Department of Orthopaedic Surgery, Inselspital, University of Bern, Bern, Switzerland
| | - Chantal Stutz
- Department of Orthopaedic Surgery, Inselspital, University of Bern, Bern, Switzerland
| | - Sebastian Decker
- Department of Orthopaedic Surgery, Inselspital, University of Bern, Bern, Switzerland
| | - Kai Ziebarth
- Division of Paediatric Trauma and Orthopaedics, Department of Paediatric Surgery, University Children's Hospital, Bern, Switzerland
| | - Theddy Slongo
- Division of Paediatric Trauma and Orthopaedics, Department of Paediatric Surgery, University Children's Hospital, Bern, Switzerland
| | - Sufian S Ahmad
- Department of Orthopaedic Surgery, Inselspital, University of Bern, Bern, Switzerland
| | - Hendrik Kohlhof
- Department of Orthopaedic Surgery, Inselspital, University of Bern, Bern, Switzerland
| | - Stefan Eggli
- Sonnenhof Orthopaedic Clinics, Bern, Switzerland
| | - Matthias Zumstein
- Department of Orthopaedic Surgery, Inselspital, University of Bern, Bern, Switzerland
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Ruedl G, Brunner F, Woldrich T, Faulhaber M, Kopp M, Nachbauer W, Burtscher M. Factors Associated With the Ability to Estimate Actual Speeds in Recreational Alpine Skiers. Wilderness Environ Med 2013; 24:118-23. [DOI: 10.1016/j.wem.2012.11.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Revised: 11/13/2012] [Accepted: 11/30/2012] [Indexed: 10/27/2022]
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Abstract
Skiing and snowboarding are popular recreational and competitive sport activities for children and youth. Injuries associated with both activities are frequent and can be serious. There is new evidence documenting the benefit of wearing helmets while skiing and snowboarding, as well as data refuting suggestions that helmet use may increase the risk of neck injury. There is also evidence to support using wrist guards while snowboarding. There is poor uptake of effective preventive measures such as protective equipment use and related policy. Physicians should have the information required to counsel children, youth and families regarding safer snow sport participation, including helmet use, wearing wrist guards for snowboarding, training and supervision, the importance of proper equipment fitting and binding adjustment, sun safety and avoiding substance use while on the slopes.
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Westin M, Alricsson M, Werner S. Injury profile of competitive alpine skiers: a five-year cohort study. Knee Surg Sports Traumatol Arthrosc 2012; 20:1175-81. [PMID: 22349602 DOI: 10.1007/s00167-012-1921-x] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2011] [Accepted: 02/03/2012] [Indexed: 01/26/2023]
Abstract
PURPOSE The aim of this study was to make a survey of injuries in young elite alpine skiers. METHODS During 5 years, all students at the Swedish Ski High schools were prospectively followed regarding injuries, time of exposure, injury location, type of injury, injury severity and gender. Four hundred and thirty-one skiers, 215 males and 216 females completed the entire study. RESULTS Of 431 skiers, 193 (91 males, 102 females) sustained 312 injuries during the 5-year study period. The injury incidence for males was 1.62 injuries/1,000 ski hours or 2.97 injuries/100 months at a Ski High school, and the corresponding values for females were 1.77 and 3.25, respectively. Forty-one percent of the injuries involved the knee, 69% were ligament injuries, and 49% were classified as severe injuries. Of 190 injured skiers, 120 injured their left leg (P = 0.0097). This was their first time injury. The risk of sustaining a re-injury or a new injury increased the sooner the first time injury occurred (P = 0.001). CONCLUSION There was a high risk for alpine ski students to sustain an injury during their education at the Swedish Ski High schools. Most injuries, especially ligament injuries, occurred in the knee joint in both males and females. Both genders were more likely to sustain injuries to the left than to the right leg. Nearly 50% of the injuries were classified as severe. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Maria Westin
- Department of Molecular Medicine and Surgery, Stockholm Sports Trauma Research Center, Karolinska Institutet, Box 5605, 114 86 Stockholm, Sweden.
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Abstract
Anterior cruciate ligament (ACL) injuries in skeletally immature individuals remain a challenge for the child, the parents, orthopaedic surgeons, and physical therapists. The main challenges are the potential risk of recurrent instability, secondary injuries following nonoperative treatment, and the risks involved with surgical treatment due to the vulnerability of the epiphyseal growth plates. We first present the physiological background for considerations that must be made when advising on treatment alternatives for skeletally immature individuals after ACL injury. The implications of continuous musculoskeletal development for treatment decisions are emphasized. No randomized controlled trials have been performed to investigate outcomes of different treatment algorithms. There is no consensus in the literature on clinical treatment decision criteria for whether a skeletally immature child should undergo transphyseal ACL reconstruction, physeal sparing ACL reconstruction, or nonoperative treatment. Additionally, well-described rehabilitation programs designed for either nonoperative treatment or postoperative rehabilitation have not been published. Based on the currently available evidence, we propose a treatment algorithm for the management of ACL injuries in skeletally immature individuals. Finally, we suggest directions for future prospective studies, which should include development of valid and reliable outcome measures and specific rehabilitation programs.
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Gammons M, Boynton M, Russell J, Wilkens K. On-Mountain Coverage of Competitive Skiing and Snowboarding Events. Curr Sports Med Rep 2011; 10:140-6. [DOI: 10.1249/jsr.0b013e31821a9fd5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Helmet use in winter sport activities--attitude and opinion of neurosurgeons and non-traumatic-brain-injury-educated persons. Acta Neurochir (Wien) 2011; 153:101-6; discussion 106. [PMID: 20532575 DOI: 10.1007/s00701-010-0704-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2010] [Accepted: 05/26/2010] [Indexed: 10/19/2022]
Abstract
PURPOSE During the last winter season, some fatal sport injuries with severe traumatic brain injury (TBI) prompted major discussions about protective helmet use. Although ski helmets reportedly lead to a 60% decrease of risk to incur TBI, little is known about the distribution of helmet users and which factors are crucial for the decision to wear a helmet. Especially, it is unknown whether knowledge or experience concerning TBI in winter sports influences the use of helmets, as well as the attitude and opinion of people. METHODS Since treatment of TBI is a major field in neurosurgery, 55 neurosurgical departments (NS) in Germany, Switzerland and Austria were addressed and asked to answer anonymous questionnaires. A "non-trauma-educated" control cohort (NTP) was interviewed in ski resorts in Austria as well as sports equipment stores in Germany. RESULTS Questionnaires were returned by 465 NS and 546 NTP. Half of NS and NTP wore helmets in winter sports. Although some interviewees showed cognitive dissonant behaviour, experience in TBI after ski or snowboard accidents significantly affected the decision to wear helmets. After the fatal ski accidents, and increased media coverage 15.4% NS and 13.2% NTP bought their helmet. Furthermore, incidence of helmet use in children was correlated with the actual use and disposition of their parents to make the use of helmet compulsory. CONCLUSIONS This study indicates that brain-trauma education affects ones attitude and opinion concerning protective helmet use in winter sports. However, without neglecting educational measures, emotional arguments should be added in the promotion of helmets to make them a popular integral part of winter sport outfits.
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Frosch KH, Stengel D, Brodhun T, Stietencron I, Holsten D, Jung C, Reister D, Voigt C, Niemeyer P, Maier M, Hertel P, Jagodzinski M, Lill H. Outcomes and risks of operative treatment of rupture of the anterior cruciate ligament in children and adolescents. Arthroscopy 2010; 26:1539-50. [PMID: 21035009 DOI: 10.1016/j.arthro.2010.04.077] [Citation(s) in RCA: 144] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2009] [Revised: 04/18/2010] [Accepted: 04/22/2010] [Indexed: 02/02/2023]
Abstract
PURPOSE The aim of this meta-analysis was to evaluate the clinical outcomes and risks of anterior cruciate ligament (ACL) surgery in children and adolescents. METHODS We electronically searched Medline, the Cochrane Controlled Trial Database, Embase, and Medpilot for studies on surgical treatment for ACL ruptures in skeletally immature patients. We extracted baseline demographics, follow-up intervals, surgical details (i.e., ligament suture or reconstruction, physeal-sparing or transphyseal techniques, type of transplant, and methods of fixation). Endpoints comprised rates of growth disturbances and reruptures, as well as knee function (measured by the International Knee Documentation Committee's documentation system and the Lysholm score). Unweighted overall effect sizes (risks, risk ratios [RRs], and means of functional scores) were estimated by use of crude nominators and denominators, and random-effects meta-regression analysis was used for weighted data synthesis. RESULTS A total of 55 articles reporting on 935 patients (median age, 13 years; range, 1.5 to 16 years) were suitable for the study. After a median follow-up of 40 months (range, 14 to 89 months), the weighted rate of leg-length differences or axis deviations was 1.8% (95% confidence interval [CI], 0% to 3.9%] and that of reruptures was 4.8% (95% CI, 2.9% to 6.7%). Excellent or good function (International Knee Documentation Committee grade A or B) was achieved in 84.2% (95% CI, 75.8% to 92.6%) of all knees, and Lysholm scores averaged 96.3 (95% CI, 95.5 to 97.2). Transphyseal reconstruction was associated with a significantly lower risk of leg-length differences or axis deviations compared with physeal-sparing techniques (1.9% v 5.8%; RR, 0.34; 95% CI, 0.14 to 0.81) but had a higher risk of rerupture (4.2% v 1.4%; RR, 2.91; 95% CI, 0.70 to 12.12). Sutures did not result in any growth disturbances, with a weighted rerupture rate of 4.6% (95% CI, 2.6 to 6.7). Fixation far from the joint line fared better than close fixation with regard to this endpoint (1.4% v 3.2%; RR, 0.42; 95% CI, 0.09 to 1.93). Bone-patellar tendon-bone grafts, which are also less likely to fail, were associated with higher risks of leg-length differences or axis deviations than were hamstrings (3.6% v 2.0%; RR, 1.82; 95% CI, 0.66 to 5.03). Meta-regression did not show a significant impact of the publication year on event rates. CONCLUSIONS This meta-analysis showed low rates of leg-length differences or axis deviations and graft failures after ACL reconstruction in skeletally immature patients. Hamstring transplants may lower the risk of leg-length differences or axis deviations, and physeal-sparing techniques may increase the risk. Randomized controlled trials are needed to clarify important issues in managing ACL ruptures in children and adolescents. LEVEL OF EVIDENCE Level IV, meta-analysis of case series.
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Affiliation(s)
- Karl-Heinz Frosch
- Department of Trauma Surgery, Plastic and Reconstructive Surgery, Georg-August-University, Göttingen, Germany.
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Affiliation(s)
- Michael C Meyers
- Department of Health and Human Development, Montana State University, Bozeman, Montana 59717-2940, USA.
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Affiliation(s)
- Michael C Meyers
- Department of Health and Human Development, Montana State University, Bozeman, Montana 59717-2940, USA.
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Abstract
OBJECTIVE To determine whether a ski helmet reduces skiers' hearing particularly sounds that can warn skiers of potentially dangerous situations. DESIGN Randomized repeated measures (first part), environmental field measurements (second part). SETTING Audiology Centre of Rijeka Medical School, ski slopes at Platak resort. PARTICIPANTS Thirty healthy subjects not used to wearing a helmet each served as their own control. INTERVENTION Ski cap, ski helmet, and no intervention in randomized order. MAIN OUTCOME MEASUREMENTS Laboratory open-field audiometric testing: bareheaded, ski cap, and ski helmet (0.125-8 kHz protocol), and environmental A-weighted sound measurements on the slope for potentially dangerous situations like snowboarder breaking or skier passing by. In both parts of the study, the sound pressure levels (dB) and sound spectrum frequencies were analyzed. RESULTS First part-No differences were found between bare head and wearing only a ski cap. Significant sound attenuation characteristics of the helmet were determined for frequencies 2, 4, and 8 kHz (P < 0.001). Second part-High sound pressure levels were found for all the danger sounds measured on the slope, especially at frequencies that were most affected by helmet sound attenuation (2-8 kHz) in previously conducted laboratory tests. CONCLUSIONS Helmets could influence the level of the hearing threshold in frequencies between 2 and 8 KHz. The spectrum of danger sounds on the slope has high pressure levels at frequencies that were most affected by helmet sound attenuation characteristics (2-8 kHz), so the helmet wearers might misinterpret the sounds of potentially dangerous situations because the sound might be distorted.
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Joseph MF, Denegar CR, Horn E, Macdougall B, Rahl M, Sheehan J, Trojian T, Anderson JM, Clark JE, Kraemer WJ. A 5° medial wedge reduces frontal but not saggital plane motion during jump landing in highly trained women athletes. Open Access J Sports Med 2010; 1:23-7. [PMID: 24198539 PMCID: PMC3781851 DOI: 10.2147/oajsm.s7793] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Lower extremity mechanics during landing have been linked to traumatic and nontraumatic knee injuries, particularly in women’s athletics. The effects of efforts to mitigate these risks have not been fully elucidated. We previously reported that a 5° medial wedge reduced ankle eversion and knee valgus. In the present report we further investigated the effect of a 5° medial wedge inserted in the shoes of female athletes on frontal plane hip motion, as well as ankle, knee, hip, and trunk saggital plane motion during a jump landing task. Kinematic data were obtained from 10 intercollegiate female athletes during jump landings from a 31 cm platform with and without a 5° medial wedge. Hip adduction was reduced 1.98° (95% CI 0.97–2.99°) by the medial wedge but saggital plane motions were unaffected. A 5° medial wedge reduces frontal plane motion and takes the knee away from a position associated with anterior cruciate ligament injury and patellofemoral pain syndrome. Although frontal plane motion was not captured it is unlikely to have increased in a bilateral landing task. Thus, it is likely that greater muscle forces were generated in these highly trained athletes to dissipate ground reaction forces when a medial wedge was in place. Additional investigation in younger and lesser trained athletes is warranted to assess the impact of orthotic devices on knee joint mechanics.
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Affiliation(s)
- Michael F Joseph
- Department of Kinesiology, University of Connecticut, Storrs, CT, USA
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Abstract
OBJECTIVE To increase the evidence base by characterizing various features of pediatric sports-related abdominal injuries. DESIGN A review of the trauma database at The Children's Hospital at Westmead was undertaken for all abdominal injuries presenting to the emergency department between 2001 and 2006. SETTING The Children's Hospital at Westmead is a tertiary-level pediatric trauma center servicing Sydney's west. It sees approximately 50,000 patients a year. PARTICIPANTS Only those injuries occurring during an organized sport were included for analysis. Thirty-three of the original 513 patients were eligible for inclusion. MAIN OUTCOME MEASURES The data collected included basic demographics, mechanism of injury, sport injury, time to presentation, length of stay, diagnoses, treatment, and complications. Injury severity scores were assigned retrospectively. RESULTS Males sustained more injuries than females. Collisions and falls were the most common modes of injury. Rugby was the most common sport for injury. Most patients presented within 12 hours, and most presented with musculoskeletal injuries. Injury severity was usually mild; treatment, conservative; length of stay, short; and complications, uncommon. When characteristics were compared by sex, males had mostly collision injuries in high-impact/contact sports, with females having more falls in other sports. When characteristics were compared by age, the only statistically significant difference was in the organ injured: older children had more single solid organ injuries, and younger children had more multiple and hollow viscus injuries. CONCLUSIONS Sports-related abdominal injuries in children are mostly minor and not as common as other injury mechanisms. Despite this, they can be serious, with early diagnosis often delayed because of their subtle nature. Sports-related abdominal injuries in children require a high index of suspicion in the part of the clinician if they are to be recognized early and managed effectively.
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Abstract
There are many commonly discussed myths about ski safety that are propagated by industry, physicians, and skiers. Through a review of the literature concerning 12 such topics, this article demonstrates that the following are untrue: (1) Broken legs have been traded for blown-out knees. (2) If you know your DIN (a slang term for release indicator value), you can adjust your own bindings. (3) Toe and heel piece settings must be the same to function properly. (4) Formal ski instruction will make you safer. (5) Very short skis do not need release bindings. (6) Spending a lot of money on children's equipment is not worth the cost. (7) Children need plenty of room in ski boots for their growing feet. (8) If you think you are going to fall, just relax. (9) Exercise can prevent skiing injuries. (10) Lower release settings can reduce the risk of anterior cruciate ligament injury. (11) Buying new ski equipment is safer than renting. (12) Skiing is among the most dangerous of activities. It is important for the skiing public, physicians, and all those interested in improving skiing safety to verify the measures they advocate. The statements analyzed here are simply untrue and have the potential to cause harm if taken as fact by those exposed to these unsupported opinions.
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Seifert J, Kröll J, Müller E. The Relationship of Heart Rate and Lactate to Cumulative Muscle Fatigue During Recreational Alpine Skiing. J Strength Cond Res 2009; 23:698-704. [DOI: 10.1519/jsc.0b013e3181a2b55e] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Dipla K, Tsirini T, Zafeiridis A, Manou V, Dalamitros A, Kellis E, Kellis S. Fatigue resistance during high-intensity intermittent exercise from childhood to adulthood in males and females. Eur J Appl Physiol 2009; 106:645-53. [PMID: 19404672 DOI: 10.1007/s00421-009-1058-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2009] [Indexed: 02/01/2023]
Abstract
This study examined the maturation pattern of fatigue resistance (FR) from childhood to adulthood in females and males during high-intensity intermittent exercise and compared FR between females and males in childhood and adolescence. Thirty males (boys 11.3 +/- 0.5 years, teen-males 14.7 +/- 0.3 years, men 24.0 +/- 2.1 years) and 30 females (girls 10.9 +/- 0.6 years, teen-females 14.4 +/- 0.7 years, women 25.2 +/- 1.4) participated in this study. They performed high-intensity intermittent exercise (4 x 18 maximal knee flexions and extensions with 1-min rest) on an isokinetic dynamometer at 120 degrees s(-1). Peak torque of flexors (PTFL) and extensors (PTEX), and total work (TW) were measured. FR was calculated as % of PTEX, PTFL, and TW in 4th versus 1st set. FR was greater (P < 0.05) in boys versus teen-males and men, and in teen-males versus men. In females, FR was greater (P < 0.05) in girls versus teen-females and women, but not different between teen-females and women. FR was not different in boys versus girls and in teen-males versus teen-females. FR for PTFL, PTEX, and TW correlated negatively (P < 0.001) with the respective peak values (r = -0.68 to -0.84), and FR for TW with peak lactate (r = -0.58 to -0.69). In addition, age correlated (P < 0.01) with FR for males (r = -0.75) and females (r = -0.55). In conclusion, FR during high-intensity intermittent exercise undergoes a gradual decline from childhood to adulthood in males, while in females the adult profile establishes at mid-puberty (14-15 years). The maturation profile of FR in males and females during development appears to reflect the maturation profiles of peak torque, short-term muscle power, and lactate concentration after exercise.
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Affiliation(s)
- Konstantina Dipla
- Department of Physical Education & Sport Sciences at Serres, Aristotle University of Thessaloniki, Ag. Ioannis, 62110 Serres, Greece
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Leiper JB, Junge A, Maughan RJ, Zerguini Y, Dvorak J. Alteration of subjective feelings in football players undertaking their usual training and match schedule during the Ramadan fast. J Sports Sci 2008; 26 Suppl 3:S55-69. [DOI: 10.1080/02640410802538176] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Traumatologie du ski et du snowboard chez l’enfant et l’adolescent : épidémiologie, physiopathologie, prévention et principales lésions. Arch Pediatr 2008; 15:1717-23. [DOI: 10.1016/j.arcped.2008.08.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2008] [Revised: 08/27/2008] [Accepted: 08/28/2008] [Indexed: 11/20/2022]
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Wilfond B, Ross LF. From genetics to genomics: ethics, policy, and parental decision-making. J Pediatr Psychol 2008; 34:639-47. [PMID: 18647793 DOI: 10.1093/jpepsy/jsn075] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE Ethical evaluation of genetic testing in children is traditionally based on balancing clinical benefits and risks. However, this focus can be inconsistent with the general practice of respecting parental decision-making about their children's health care. We argue that respect for parental decision-making should play a larger role in shaping pediatric genetic testing practices, and play a similar role regarding decisions to use emerging genomic technologies. METHODS Genomic testing involves the examination of thousands of DNA markers spanning genes throughout the genome and their interrelationships, yielding virtually limitless interpretations. We presume that parents and providers should proceed cautiously in applying genomic testing in children, as we explore how genomic testing will stress the fault lines of the traditional ethical analysis. RESULTS Empirical data about the psychosocial risks and benefits of genetic testing of children do not reveal serious harms, yet virtually no such data exist yet about genomic testing. Unless empirical social and behavioral data indicate that genomic testing is highly likely to cause serious harms to the children, parental decisions to obtain comprehensive genomic testing in their children should be respected. Once comprehensive genomic testing of children becomes routine, resultant information may be more easily integrated by families than anticipated. CONCLUSIONS Research on the social and behavioral impact of comprehensive genomic testing on children and their families is needed to further inform parents, clinicians, and policy makers.
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Affiliation(s)
- Benjamin Wilfond
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital, Seattle, WA 98101, USA.
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