Ocular sports injuries: the current picture

Objectives—To determine the recent incidence of eye injury due to sport in Scotland, identify any trend, and establish which sports are responsible for most injury? The type of injury and final visual outcome is also evaluated. Methods—A prospective observational study of ocular injuries sustained during sport was performed over a one year period. Only patients requiring hospital admission were included. Data were collected on a standardised proforma and entered into a central database. Patients were followed up for at least three months. Results—Of 416 patients admitted because of ocular injury, 52 (12.5%) resulted from playing a sport. Although all racquet sports together accounted for 47.5% of these injuries, football was the single most common sport associated with ocular trauma, being responsible for 32.5% of cases. The most common clinical finding was macroscopic hyphaema occurring in 87.5% of patients. Overall the final visual acuity was 6/6 in 92.5% of patients. Conclusions—The incidence of eye injury due to sport at 12.5% is lower than previously reported, suggesting a change in the pattern of ocular trauma. Football is the single most common cause of ocular injury from sport in Scotland, but the wearing of protective headgear would be difficult to instigate. The incidence of hyphaema in sport related ocular trauma (87.5%) is almost double that of all ocular injury (47.8%), so the potential for serious visual loss as the result of a sports injury should not be underrated. Ophthalmologists have a role in protecting this young population at risk by actively encouraging the design and use of protective eyewear. Key Words: eye injury; ocular trauma; hyphaema; protective eyewear     

Eye injuries in sport: an increasing problem.

A prospective study of ocular injuries sustained during sport, was performed from January to June 1987. A total of 84 eye injuries were seen. Of these, 23 were severe enough to necessitate admission to hospital. These latter accounted for one quarter of all severe eye injuries during this period. Racquet sports caused 42% of the injuries, and 57% of the hospital admissions, including two penetrating injuries. The importance of sport in causing eye trauma is increasing. It is crucial to encourage safer play, including the wearing of adequate eye protection.     

Carbohydrates: The Complexities of a Simple Food

IN BRIEF: Sports eye injuries can be serious but are preventable. Any sport that involves a stick or racket, a ball or other projectile, or body contact presents a risk of serious eye injury. Physicians have an obligation to warn players of potential risk and to recommend appropriate eye protection. Sports eye protection should be designed specifically for the activity or sport. Eye protection that bears the seal of sanctioned organizations should be mandated for high-risk sports.     

Eye injuries in sports

In a retrospective study from 1988 to 1998, eye injuries were found in 553 patients. Seventy-six (13.7%) of these injuries were associated with sport. The mechanism of trauma was for the most part a ball (71.1%) or a club (13.2%). Most eye injuries occurred in soccer (35.5%), which is, by far, the most widespread sport in this region of Norway. A disproportionately high number of the injuries occurred in floorball (17.1%), bandy (13.2%), and squash (10.5%). The rules in these sports may, in theory, be strict enough to prevent eye injuries in most cases. However, these rules are often neglected in informal activities. Strategies for educating the general public about the potentially serious effect of eye injuries in sports exposed to such risk are of great importance.     

The risk of abdominal injury to women during sport

Although trauma to pregnant women is a potential risk during sport, as there is no published information about the magnitude of this risk, it is presumed to be low. Whilst there is an emerging literature about the risk of adverse outcomes following severe and catastrophic trauma to pregnant women, this literature almost exclusively focuses on road trauma victims or the result of assault. This paper describes the risk of abdominal injuries to women participants across a range of sports in Australia. An extensive search of the available literature could not identify any studies that had discussed this issue specifically in pregnant women. Studies, which have reported injuries in athletes, have generally found abdominal/chest injuries to account for fewer than 2% of all injuries, even in contact sports. Most of these published studies do not differentiate between the chest and abdomen and provide no specfic details on the exact nature or mechanisms of the injuries. Given the limitations of the published studies, an examination of data from two Australian general injury databases (one describing hospital admissions, the other hospital emergency department presentations), three Australian sports-injury treatment databases (sports medicine clinic attendances and medical coverage services) and one cohort study was undertaken to describe sports-related abdominal injuries. These analyses confirm that the risk of abdominal injury during sport is very low. In conclusion, currently there is not an adequate evidence-base for quantifying the risk of abdominal injuries during sport in women, let alone pregnant women or for justifying a ban of sport on this basis. Recommendations for future epidemiological sports injury studies and the potential for linkages with perinatal morbidity and mortality databases are given.     

Ocular Trauma in War Games

In brief: War games—a new and increasingly popular form of recreation that combines sports and military activity—are resulting in serious eye injuries. The 13 cases discussed in this paper represent 6% of all sports-related eye injuries reported in Quebec in 1984. None of the victims was wearing goggles or other facial protection when the injury occurred. Types of injuries include hyphema, vitreous hemorrhage, and cataract. Better ocular protection is essential for preventing injuries in those who participate in these games. In addition, more effort should be made to educate the players on the importance of using ocular protection.     

Sports-related eye injuries: floorball endangers the eyes of young players

The objectives of this study were to determine the distribution of different sports-related eye injuries and to identify injury types to enable recommendations to be made about the use of protective eyewear. The study population comprises all 565 eye trauma patients examined at the Ophthalmology Emergency Clinic of the Helsinki University Central Hospital over a 6-month period. Data were collected from patient histories and questionnaires. In addition, three severe floorball eye injury cases are presented. Of the 565 eye traumas, 94 (17%) were sports related. Of these, 42 (45%) were associated with floorball. Countrywide, in Finland, estimated over 300 (+95% CI 228-415) floorball eye injuries occur annually. The mean age of floorball patients was 22 years. The most common finding (55%) in sports injury patients was hyphema. Clinically severe eye injuries during this period accounted for one-fourth of all cases. During the study period, no eye injury was found in an organized junior ice hockey, where facial protection is mandatory. Floorball is estimated to belong to the highest risk group in sports, and thus, the use of protective eyewear is strongly recommended. We conclude that national floorball federations should make protective eyewear mandatory.     

Incidence and severity of reported acute sports injuries in 35 sports using insurance registry data

Acute injuries in sport are still a problem where limited knowledge of incidence and severity in different sports at national level exists. In Sweden, 80% of the sports federations have their mandatory injury insurance for all athletes in the same insurance company and injury data are systematically kept in a national database. The aim of the study was to identify high‐risk sports with respect to incidence of acute and severe injuries in 35 sports reported to the database. The number and incidences of injuries as well as injuries leading to permanent medical impairment (PMI) were calculated during 2008–2011. Each year approximately 12 000 injuries and 1 162 660 licensed athletes were eligible for analysis. Eighty‐five percent of the injuries were reported in football, ice hockey, floorball, and handball. The highest injury incidence as well as PMI was in motorcycle, handball, skating, and ice hockey. Females had higher risk of a PMI compared with males in automobile sport, handball, floorball, and football. High‐risk sports with numerous injuries and high incidence of PMI injuries were motorcycle, handball, ice hockey, football, floorball, and automobile sports. Thus, these sports ought to be the target of preventive actions at national level.     

A 1‐year prospective analysis of injuries in amateur and elite fistball

The purpose of this study was to examine the incidence and mechanisms of acute injuries in the sport of fistball. No scientific studies on injury characteristics have yet been conducted in this traditional sport game. The study was conducted prospectively over the course of 12 months. During a total of 40.308 h of sport‐specific exposure, 240 players reported 492 injuries, representing an overall injury rate of 12.2 injuries/1000 h of exposure. Most injuries were classified as bagatelle injuries (67.8%). The majority of the injuries were located in the knee (23.5%) followed by the elbow (11.9%) and the hip (11.5%). Ankle injuries resulted in the longest impairment from sports participation. The most common types of injury were abrasions (38.2%), contusions (21.1%), distortions (7.5%) and muscle strains (6.9%). Wrong or insufficient equipment (15.0%) was the most commonly mentioned causes of injury. The data indicate that the injury risk in fistball is rather high; however, the sport should not be considered a high‐risk sport because most of the injuries are slight and do not prevent the players from training or competition. Injury prevention strategies should include the development of fistball‐specific protective equipment with focus on the knee and elbow joint.     

Unfälle bei großen Mannschaftsballsportarten

Soccer injuries result primarily from the competitive tackling character of this sports discipline. The predominant injuries are contusion trauma, followed by ankle sprains, knee distortions and heading injuries. Particularly serious injuries are caused by sliding tackles. Because of the smaller distances and space in indoor soccer, more goalkeepers are injured due to parrying than in outdoor soccer. Soccer disability cases are primarily injuries to the knee joint caused by various mechanisms, such as twisting of the knee with and without an external influence, falling injuries, unfortunate collisions and sliding tackles. In principle traumatic deaths may occur in any team ball game sport if there is unfortunate body contact between players. Fatal skull and brain trauma injuries in soccer can be differentiated into unfortunate heading actions, the head being directly hit by the ball and direct head-to-head contact with another player as well as collisions against goalposts and other pieces of equipment. Contusion accidents also dominate in handball. Here the so-called rapid counterattack may result in serious injuries due to the high forces involved. Handball disability cases mainly concern the knee joint and severe invalidity is primarily caused by external influences (i.e. the opponent). In volleyball and basketball ankle sprains are the dominating injury types (in volleyball often when stepping on an opponent’s foot), followed by playing the ball, where primarily the fingers are affected. In the USA eye injuries were frequently registered in basketball, due to finger or elbow contact with the opposing players. Severe injuries in rugby affect the head and neck in approximately one-third of the cases, in rare cases with spinal cord involvement. In American football serious injuries resulted especially from a direct attack on the opponent (tackling). After optimization of the football helmet design in the early 1970s, a clear reduction of skull and brain injuries was observed, but unfortunately a massive increase in neck injuries was also registered, because the helmeted head was now used as a weapon in tackling. After changes to the rules in 1978 these injury mechanisms have now declined again.     

Risk factors for acute and overuse sport injuries in Swedish children 11 to 15 years old: What about resistance training with weights?

To determine the 1‐year self‐reported incidence of overuse and traumatic sport injuries and risk factors for injuries in children participating in a summer sports camp representing seven different sports. 4363 children, 11 to 15 years old participating in a summer camp in seven different sports answered a questionnaire. Injury in this cross‐sectional study was defined as a sport‐related trauma or overload leading to pain and dysfunction preventing the person from participation in training or competition for at least 1 week. A number of risk factors for injury were investigated such as sex, age, number of hours spent on training in general, and on resistance training with weights. Nearly half [49%, 95% confidence interval (CI) 48–51%] of the participants had been injured as a result of participation in a sport during the preceding year, significantly more boys than girls (53%, 95% CI 50–55% vs 46%, 95% CI 43–48%; P < 0.001). Three factors contributed to increased incidence of sport injuries: age, sex, and resistance training with weights. Time spent on resistance training with weights was significantly associated with sport injuries in a logistic regression analysis. In children age 11 to 15 years, the risk of having a sport‐related injury increased with age and occurred more often in boys than in girls. Weight training was the only modifiable risk factor that contributed to a significant increase in the incidence of sport injuries.     

Catastrophic injuries and fatalities in high school and college sports, fall 1982-spring 1988

Direct and indirect deaths and catastrophic injuries, defined as any injury incurred during participation in a high school/college sponsored sport in which there is permanent severe functional neurological disability (nonfatal) or transient but not permanent functional neurologic disability (serious), are presented for all sports during the period of fall 1982 to spring 1988. Football contributed the greatest numbers of catastrophic injuries but also had the largest number of participants. Ice hockey, gymnastics, and wrestling are the other sports where participants are at greatest risk of catastrophic injury or death. Mechanisms of injury in each sport and corrective actions are identified and discussed. While high school and college catastrophic injuries may never be totally eliminated, they can be dramatically reduced by reliable injury data collection and analysis.     

Civil unrest and ocular trauma.

The incidence and causes of ocular trauma among Israeli troops serving in the West Bank and Gaza between 1987 and 1989 was investigated. Of the 985 soldiers who were reported injured, 11.3% (111) were reported to have suffered from injuries to the eye. Although most of the soldiers were supplied with some kind of protective gear, only 27% reported that they received eye protection; none used this protection at the time of injury. Fifty-seven percent of the injuries were caused by stones and 38% by flying glass; 14.6% of soldiers suffered bilateral eye injuries. Only 12.1% of those injured wore corrective lenses. Although only 5% were originally reported to have suffered moderate to severe injuries, 38% complained of residual vision impairment. Better eye protection and enforcement of orders to use such gear would reduce the number and severity of ocular injuries.     

后交叉韧带损伤的临床流行病学研究

目的:探讨后交叉韧带损伤的临床流行病学特点。方法:回顾我所1999年3月至2006年12月187例后交叉韧带损伤患者的临床资料,对性别和年龄分布、致伤运动项目分布、创伤因素、创伤机制、创伤类型、伤后就诊时间、不稳症状出现时间、后交叉韧带损伤程度等进行研究分析。结果:男性发病率(77.54%)高于女性(22.46%),35岁以内的年轻患者(60.96%)居多。创伤因素中以意外伤(66.84%)居多,其中交通事故伤最多。运动伤总体发生率为33.16%,其中足球项目占40.32%。创伤类型以单一后交叉韧带损伤为主(69.52%),联合韧带伤占30.48%。创伤机制中运动伤以屈曲外翻伤多见(42.62%),意外伤则以胫前伤为主(65.08%)。伤后就诊时间平均359.28天,伤后出现不稳时间平均271.62天。损伤部位主要为实质部撕裂(72.12%),后交叉韧带损伤存在前外束和后内束中一束断裂或两束不同部位同时断裂。结论:后交叉韧带损伤以意外伤居多,其中以交通伤为主。后交叉韧带损伤合并其它韧带损伤发生率也较高。运动损伤发生于多种运动项目中,以足球项目最多见,专业运动员发生率较低。后交叉韧带损伤患者多需接受后交叉韧带重建手术治疗。     

Martial arts injuries. The results of a five year national survey

A 5 year national survey of martial arts was done using the National Electronic Injury Surveillance System (NEISS). Seventy-four percent of the injuries involved the extremities and 95% were mild to moderate in nature. Even though most of the injury types were contusions/abrasions (36%). lacerations (14%), and sprains/strains (28%), 15% were dislocations and fractures. Five percent of all injuries were severe, and there were 18 hospitalizations. There were no deaths. Weapon-related injuries were rare and never serious. Overall, the risk of serious injury in the sport was found to be low, especially when compared to other contact sports.     

Injuries in team sport tournaments during the 2004 Olympic Games

BACKGROUND: Several authors have analyzed the incidence of injuries in a given sport, but only a few have examined the exposure-related incidence of injuries in different types of sports using the same methodology. PURPOSE: Analysis of the incidence, circumstances, and characteristics of injuries in different team sports during the 2004 Olympic Games. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: During the 2004 Olympic Games, injuries in 14 team sport tournaments (men's and women's soccer, men's and women's handball, men's and women's basketball, men's and women's field hockey, baseball, softball, men's and women's water polo, and men's and women's volleyball) were analyzed. After each match, the physician of the participating teams or the official medical representative of the sport completed a standardized injury report form. The mean response rate was 93%. RESULTS: A total of 377 injuries were reported from 456 matches, an incidence of 0.8 injuries per match (95% confidence interval, 0.75-0.91) or 54 injuries per 1000 player matches (95% confidence interval, 49-60). Half of all injuries affected the lower extremity; 24% involved the head or neck. The most prevalent diagnoses were head contusion and ankle sprain. On average, 78% of injuries were caused by contact with another player. However, a significantly higher percentage of noncontact (57%) versus contact injuries (37%) was expected to prevent the player from participating in his or her sport. Significantly more injuries in male players (46%) versus female players (35%) were expected to result in absence from match or training. The incidence, diagnosis, and causes of injuries differed substantially between the team sports. CONCLUSION: The risk of injury in different team sports can be compared using standardized methodology. Even if the incidence and characteristics of injuries are not identical in all sports, prevention of injury and promotion of fair play are relevant topics for almost all team sports.     

Musculoskeletal injuries in the young tennis player

Tennis is becoming increasingly popular, especially with young athletes. Despite recent advances in epidemiologic research of tennis injuries, there still is a need for more injury research in all of the racquet sports. The data that does exist show that the young athlete is susceptible to injury in these different sports. Injury patterns in the skeletally immature racquet sports athlete are becoming apparent. Although most of the sports result in similar injury patterns, such as a predominance of lower extremity injury, there are differences. It appears that the physical demands of the sport are becoming more clearly documented, and the adaptive response to these demands is becoming understood. The adaptive response reveals a common origin for many of the injuries in the different sports. This is related most often to repetitive microtrauma with resultant loss in flexibility and strength. The sports medicine practitioner must understand these differences, know the demands, do serial musculoskeletal evaluations for maladaptations, and adhere to a periodized prehabilitation program of preventative exercises to maximize performance and minimize injury risk.     

Cerebral concussion in sport. Management and prevention.

This article explains the various stresses (tensile, compressive, and shearing) that can affect the brain, and how they may produce the different types of brain injury. The biomechanical forces and dynamics that produce coup versus contra coup injury are covered, as are the common intracranial athletic head injuries, i.e. concussion and the various intracranial haematomas (epidural, subdural, subarachnoid and intracerebral). Though less common in occurrence, because their outcome is so catastrophic, space is also devoted to the recognition, the treatment and (especially in the latter case) the prevention of the malignant brain oedema syndrome of the adolescent and the second impact syndrome of the adult. A major emphasis of this paper is the recognition of the 3 grades of cerebral concussion and the delineation of clear guidelines as to when it is safe to return to collision sports after sustaining such injuries, for the first, second or third time during a given season. Clear guidelines are also presented as to when to discontinue collision sport competition for the remainder of the season after multiple concussions. Because of the concern for the second impact syndrome, the requirement to never allow an athlete with postconcussion syndrome symptoms to return to competition is emphasised. Also covered is the prevention of head injuries, which sports are at greatest risk, and the need for additional research on the cumulative effects of concussion.     

Computed tomography of ocular trauma

A wide variety of ocular (eyeball and related soft tissues) injuries resulting from concussive (blunt) and penetrating trauma can be diagnosed by computed tomography (CT). CT can show intraorbital and intraocular emphysema and themorrhage, lens dislocation and subluxation, globe rupture associated with corneal and scleral lacerations, retinal and choroidal detachment, optic nerve injury, and extraocular muscle injury. CT also can localize foreign bodies, and identify injuries caused by them and determine their nature. Not only may CT provide useful information when ocular trauma is clinically suspected, but trauma head and face CT scans may identify unsuspected ocular injuries in the multiple trauma patient. It is imperative that orbital contents be scrutinized carefully on both soft tissue and bone windows of all trauma head and face CT scans in order that clinically significantly ocular injuries not be overlooked.     

Injuries treated at a sports injury clinic compared with a neighbouring accident and emergency department.

Previous reports relating to sports injuries treated at hospital Accident and Emergency departments (A&E) or Sports Injury Clinics (SIC) indicate differences between the groups. This study compared directly the sports injuries treated during overlapping time periods at an A&E department (n = 2490) and a SIC (n = 340) set within the same geographical area. The two populations were found to differ significantly in age, sport, injury and injury site. Hospital patients tended to be younger, with an acute injury to the upper body or head which occurred during participation in sports where contact is likely. SIC patients tended to be older, with chronic or overuse injuries to the back or lower limb. It was found that there are significant differences between the sports injuries treated at the sports injury clinic and the hospital casualty department. It is concluded that demand is clearly shown for both types of treatment site when both are available in the same geographical area.