Acute disposition of neck injuries

Neck injuries can be some of the most serious and anxietyproducing injuries that occur during sporting events. It is important for the team physician to be prepared for the care of these injuries and be able to identify some of the more serious injuries. Proper care of these injuries can be life saving and prevent further injury and permanent disability. This article reviews the principles of management and latest evidence for acute neck injuries.     

Spinal injury in sport

Spinal injuries are very common among professional or amateur athletes. Spinal sport lesions can be classified in overuse and acute injuries. Overuse injuries can be found after years of repetitive spinal load during sport activity; however specific overuse injuries can also be found in adolescents. Acute traumas are common in contact sports. Most of the acute injuries are minor and self-healing, but severe and catastrophic events are possible. The aim of this article is to review the wide spectrum of spinal injuries related to sport activity, with special regard to imaging finding.     

On-field issues of the C-spine-injured helmeted athlete

Football is a violent collision sport and can lead to various serious injuries. Cervical spine injuries are numerous, ranging from bony fractures and dislocations to spinal cord disruption. These injuries can be a devastating and debilitating. Although most injuries that occur are self-limiting there is a significant proportion that can cause permanent disability. Due to the equipment used in football, unique on-field care is implemented in evaluating athletes with possible cervical spine injury. Early preseason preparation and proper on-field intervention can help improve outcomes for these athletes.     

Maxillofacial injuries in sport

Maxillofacial injuries occur in contact and noncontact sports. Despite advancements in protective equipment and rule changes, there is still an unacceptably high rate of maxillofacial injuries. These injuries are clinically challenging. The significant morbidity, deformity, and disability associated with these injuries can be avoided by their prompt diagnosis and appropriate management. It is important for the sports medicine professional to be competent in the correct diagnosis and management of maxillofacial injuries. This article reviews some of the major maxillofacial injuries, along with their emergent examinations and treatments.     

Closed tendon injuries of the hand in athletics

Closed tendon injuries in the hand are common in the athlete. Neglect of such injuries may result in irreparable damage to the hand. Even seemingly minor injuries must be carefully evaluated and treated by a physician. Early diagnosis, accurate and precise treatment, and proper rehabilitation are extremely important to regain optimal function after these injuries. Most of the injuries can be controlled by conservative means. However, when surgical repair is indicated, it is important for the surgeon to be trained and familiar with the anatomy and techniques of surgery of the hand.     

Baseball and softball injuries

Baseball and softball injuries can be a result of both acute and overuse injuries. Soft tissue injuries include contusions, abrasions, and lacerations. Return to play is allowed when risk of further injury is minimized. Common shoulder injuries include those to the rotator cuff, biceps tendon, and glenoid labrum. Elbow injuries are common in baseball and softball and include medial epicondylitis, ulnar collateral ligament injury, and osteochondritis dissecans. Typically conservative treatment with relative rest, medication, and a rehabilitation program will allow return to play. Surgical intervention may be needed for certain injuries or conservative treatment failure.     

Virtopsy—noninvasive detection of occult bone lesions in postmortem MRI: additional information for traffic accident reconstruction

In traffic accidents with pedestrians, cyclists or motorcyclists, patterned impact injuries as well as marks on clothes can be matched to the injury-causing vehicle structure in order to reconstruct the accident and identify the vehicle which has hit the person. Therefore, the differentiation of the primary impact injuries from other injuries is of great importance. Impact injuries can be identified on the external injuries of the skin, the injured subcutaneous and fat tissue, as well as the fractured bones. Another sign of impact is a bone bruise. The bone bruise, or occult bone lesion, means a bleeding in the subcortical bone marrow, which is presumed to be the result of micro-fractures of the medullar trabeculae. The aim of this study was to prove that bleeding in the subcortical bone marrow of the deceased can be detected using the postmortem noninvasive magnetic resonance imaging. This is demonstrated in five accident cases, four involving pedestrians and one a cyclist, where bone bruises were detected in different bones as a sign of impact occurring in the same location as the external and soft tissue impact injuries.     

Evaluation and treatment of chronic medial collateral ligament injuries of the knee

Injuries to the medial collateral ligament (MCL) can occur as isolated injuries or in conjunction with injuries to other structures about the knee. Most grade I and II MCL injuries without meniscal avulsion, alone or in combination with anterior or posterior cruciate ligament injuries, can be treated nonoperatively. Grade III or complete tears also can be treated nonoperatively, but only after careful exclusion of any associated injuries that may require surgical treatment. Treatment recommendations also have been based on the location of the MCL tear and the associated injuries. Surgical treatment may include reconstruction of the anterior and posterior cruciate ligaments with primary repair of the MCL. Chronic medial knee injuries often are associated with concomitant ligament injuries, which also must be treated. Treatment options include nonoperative (bracing, activity modification, and rehabilitation) and operative reconstruction.     

Missed injuries in explosion-related deaths

In this study we aim to compare clinical diagnoses and post-mortem diagnoses of explosion-related deaths and identify the unrevealed diagnoses missed by physicians. Forensic autopsy reports of three years between January 2012 and December 2014 were collected retrospectively and 277 explosion-related deaths are included in the study. Out of 277 cases, 245 (88.4%) of them are male and 32 (11.6%) of them are female. The mean age is 27.8 years. The mean injury severity score is 37.8 ± 14.54.90 and 32.5% of the cases died in the first 24 h after getting injured. The most frequent injury is head injury (39.0%) and the second most frequent is injuries to multiple body regions (27.8%). Of eight cases of lower extremity injuries, six were found to have injuries of large vessels in post-mortem examinations. Our conclusion is that injury severity scores in cases of explosion-related injuries are higher than those in cases of general trauma. The frequency of missed diagnoses is higher in cases of vessel injuries and multiple injuries. It can be thought that small but lethal lesions can be overlooked when a major trauma is dealt with. In addition, injuries of the internal organs due to blast effects without any macroscopic examination findings can be misleading for physicians.     

Prevention of springboard and platform diving injuries

Although diving is one of the safer sports, because of the inherent complexity of many maneuvers, injuries can occur. Most of the injuries that a diver sustains are minor, but major and even fatal injuries have occurred. Training under a well qualified and experienced coach is important. Support from parents in terms of encouragement and finance is needed to ensure that the diver receives the best and safest training available. With appropriate facilities and preparation, many of the serious injuries can be prevented.     

Recognition and Prevention of Rugby Injuries

In brief: Rugby is a popular, strenuous contact sport that demands almost continuous action by the players. Players, coaches, and physicians must be aware of the potential for and types of injuries that occur during matches and of ways to avoid, or at least reduce, this number and severity. Minor and moderate injuries are more frequent than severe injuries, but all must be regarded seriously. Concussions, although relatively rare, can have serious consequences, and cervical spine injuries can be catastrophic. Player fitness and conditioning and a pregame warm-up are all essential for preventing injuries. Equally important are coaching, adherence to the rules of the game, and avoidance of dangerous play. If these measures are practiced consistently, rugby will be safer.     

Pediatric sports elbow injuries

Elbow injuries in the pediatric and adolescent population represent a spectrum of pathology that can be categorized as medial tension injuries, lateral compression injuries, and posterior shear injuries. Early and accurate diagnosis can improve outcomes for both nonoperative and operative treatments. Prevention strategies are important to help reduce the increasing incidence of elbow injuries in youth athletes.     

Softball injuries. Aetiology and prevention.

Over 40 million individuals nationally participate in organised softball leagues, playing an estimated 23 million games per year in the United States. It has also been estimated that softball causes more injuries leading to emergency room visits in the United States than any other sport. Between 1983 and 1989, over 2.6 million injuries were documented through selected emergency rooms throughout the United States. In addition, the potential costs of these injuries can be staggering, therefore, prevention is of utmost importance. Prior to implementation of any preventative measures, the aetiology and distribution of injuries must be ascertained. Softball-related injuries can be grouped into 3 categories: (a) sliding-related injuries--the most common injury scenario; (b) collision-related injuries; and (c) falls sustained by the player. Various preventative approaches have been utilised to reduce the incidence of these recreational sports injuries and the associated health care costs. In regard to sliding-related injuries, breakaway bases have been utilised and have been found to reduce sliding-related injuries by approximately 98%. In reference to collision injuries, deformable walls and padded back stops and field maintenance have been found to prevent the majority of injuries secondary to collisions and falls. In addition, better coaching techniques as well as stretching and conditioning programmes have all been found to benefit players in the prevention of their injuries. As physicians, trainers and individuals involved with sporting activities, it is imperative that we turn and focus our attention on prevention. The cornerstone to diminished injuries and subsequent prevention of an injury is a safer environment for the recreational softball player to participate in.     

创伤骨科急诊入院病人漏诊与误诊的分析

探讨创伤骨科急诊人院病人漏误诊原因及防止措施。方法根据１９９７年１１０４例创伤骨科急诊入院病人的病历记录,对５７例６４处损伤初诊被漏诊或误诊进行统计分析,寻找与漏诊发生的相关因素。结果１１０４例创伤骨科急诊入院病人中,５７例６４处损伤初诊被漏诊或误诊,漏误诊率为５．１％。     

Successful treatment of multiple organ system failure in a wartime environment: a case report from Operation Desert Storm.

Military weapons produce massive traumatic injuries. Multiple organ system failure can be expected to occur frequently as a result of such injuries. This case report from the recent conflict with Iraq is representative of wartime injuries and complications and the positive impact of modern intensive care capability on such injuries. Availability of critical care in future conflicts is essential.     

Underbelly injury based identification of the driver in a three-rider motorcycle accident

This paper presents a three-rider motorcycle accident which took place in a suburb of Chongqing China. In the accident, the motorcycle impacted the terminal of a bridge footpath and led to two riders died and one rider injured. After the accident, one rider received injuries around the groin area including the underbelly area and the perineum area. Another rider suffered from injuries only on the perineum areas. In medico-legal judgments, injuries around the groin area also called groin injuries in victims of motorcycle accidents are usually regarded as “fuel tank injuries” which are commonly found in drivers. But, the injuries around the groin area are sometimes confused with the perineum injuries. Therefore, the perineum injuries are often wrongly reckoned as the “fuel tank injuries” and used to identify the drivers too. Actually, passengers can sometimes suffer from perineum injuries in many head-on impacting motorcycle accidents. It is of vital matters to understand the differences between groin injuries and perineum injuries so that the real driver who should be responsible for the accident can be recognized. In this paper, the three-rider motorcycle accident was presented and the injury information of the three riders was studied in order to distinguish the real driver from the riders. We consider that the groin injury has some differences with the perineum injury and the latter should not always be related to the driver especially in high-speed head-on impacting motorcycle accidents. In addition, the injury on underbelly areas is important to identify the driver.     

Physical examination and imaging of the medial collateral ligament and posteromedial corner of the knee

The medial side is one of the most commonly injured areas of the knee. The anatomy, diagnosis, and treatment of medial collateral ligament and posteromedial corner (PMC) injuries can be challenging. Understanding the mechanism of injury and performing a thorough physical examination and radiographic evaluation is essential. Frequently, there are concomitant meniscal and other ligament injuries associated with medial-side injuries. Correct identification of all injured structures is important, as missed diagnoses can lead to significant disability. Unrecognized PMC injuries have been implicated in anteromedial rotary instability and failed anterior cruciate ligament reconstructions. Valgus stress testing is the cornerstone for the identification of medial-side knee injuries. Coronal sequences from magnetic resonance imaging are the most useful tool to view the medial collateral ligament and posteromedial structures. Stress x-rays and ultrasound may also be helpful. Thorough physical examination and imaging of injuries to the PMC should dictate the appropriate treatment for optimal results.     

Blunt abdominal trauma in adults: role of CT in the diagnosis and management of visceral injuries Part 1: Liver and spleen

Computed tomography is now widely used in the initial diagnostic workup of adult trauma victims with suspected intra-abdominal injuries. We review the role of CT in the detection and management of blunt visceral injuries in two parts. In the first part we discuss general aspects of performing CT in the setting of abdominal trauma and the diagnostic findings of intra-abdominal hemorrhage and blunt hepatic and splenic injuries. Hepatic and splenic injuries can be detected by means of CT with a high accuracy. The vast majority of hepatic injuries can be successfully managed conservatively, even when CT demonstrates parenchymal damage of more than three segments and major hemoperitoneum. Delayed complications, e. g., formation of biloma or a false aneurysm, can be readily detected on repeat CT studies, although they are quite uncommon. The outcome of conservative treatment of splenic injuries remains unpredictable because delayed splenic rupture may occur even when initial CT shows only minor parenchymal lesions and little or no intraperitoneal hemorrhage. Received 22 July 1997; Revision received 16 October 1997; Accepted 23 October 1997     

The role of biomechanics in the epidemiology of injuries

In this paper a review of the epidemiology of both traumatic and overuse injuries is presented with special emphasis on the role of biomechanics. Biomechanical analysis of injuries and the specific sports has increased in sophistication to such a degree we have a much better understanding of both aetiology and management. Particularly in the area of overuse injuries this biomechanical data can also be utilised in prevention. This paper discusses acute traumatic injuries with emphasis on knee injuries. A detailed examination of knee injuries during skiing is explored. In addition, cervical injuries in gridiron football and rugby are outlined. Overuse injuries occurring during running are next discussed. Aetiological factors including training errors, muscular dysfunction and inflexibility, footwear, running gait and lower extremity malalignment are considered. Overuse injuries in swimming, dance, gymnastics and throwing sports are briefly discussed. Biochemical analysis is felt to be important in developing strategies that lead to rule changes, alteration of training techniques and improvement in equipment and footwear.     

Medial and posteromedial instability of the knee: evaluation, treatment, and results

Medial-sided knee ligament injuries are complex and require a thorough understanding of the anatomy and the scope of injury to successfully treat. Patients with isolated medical collateral ligament (MCL) tears can normally be treated with bracing followed by physical therapy with outstanding results. Patients with isolated Grade III injuries to the MCL are controversial. A reason for the disparity in results reported may be due to the fact that many (if not most) Grade III MCL tears have associated injuries to the anterior cruciate ligament and/or posteromedial corner injury. Patients with combination injuries should be treated surgically with repair or reconstruction in most cases. Either allograft or autograft reconstructions of both the MCL and posteromedial corner can be successful. Successful elimination of anteromedial rotary instability is the key to successfully treating posteromedial corner injuries.