Injuries in mountain biking

Despite still growing attraction mountain biking as a matter of sports traumatology still lacks relevant data based on large cross-sectional surveys. To obtain an overview of risk factors, types, and main body sites of injuries occurring in mountain biking we assessed the results of a questionnaire answered by 3873 athletes. A total of 8133 single lesions were reported by 3474 athletes, 36% of whom regularly participated in competitions. The incidence of injuries in mountain biking is comparable to that in other outdoor sports, the majority of injuries being minor. Mountain biking athletes were found to have an overall injury risk rate of 0.6% per year and 1 injury per 1000 h of biking. The main risk factors included slippery road surface, cyclist's poor judgement of the situation, and excessive speed, representing personal factors that could be altered by preventive measures. Of all injuries 14% were due to collision with some part of the bike, especially the pedals and the handlebar. While 75% of the injuries were minor, such as skin wounds and simple contusions, 10% were so severe that hospitalization was required. A breakdown of the injuries according to body site and frequency of occurrence is presented.     

Internal fixation of closed tibial fractures for the management of sports injuries.

From 1985 to 1988, 90 closed tibial fractures were prospectively studied to assess the morbidity of such injuries to sports people and how this can be influenced by treatment regimens. All fractures were sustained during rugby or football matches. After random selection, 45 fractures were openly reduced and internally fixed (group A), and 45 fractures were manipulated under general anaesthesia and a long-leg plaster applied (group B). For patients in group A, below-knee plasters were used for 3 to 4 weeks, with immediate weight-bearing when tolerated. A total of 44 (98%) tibiae united clinically and radiologically within 14-18 weeks. Within 4 months of surgery 28 (62%) patients had returned to work and were able to play again by the following season. By 6 months 17 (38%) patients had resumed normal activities. In group B, only 24 (53%) tibiae united in a mean time of 16 weeks (range 12-40 weeks). Six (13%) patients required bone grafting for non-union, and one patient subsequently developed osteomyelitis. Only ten (22%) patients were back to work and playing sport again within 6 months of initial injury. It is concluded that internal fixation of closed tibial fractures as a primary procedure following low velocity sports injuries can be safely performed. It leads to a faster return to normal activities with fewer complications than does conservative treatment in plaster using contemporary methods.     

Half pipe snowboarding: an (un)forgettable experience or an increasing risk for head injury?

The case is presented of a professional half pipe snowboarder with a large post-traumatic subdural haematoma, which allowed close to normal functioning and socialisation. It is an example of a potentially life threatening sports injury in an increasingly commercialised and popular winter sport. It highlights that a knowledge of injury patterns and a high level of suspicion should be maintained in the treatment of snowboarding injuries.     

Pattern of craniofacial injuries in patients admitted to Tanta University Hospital – Egypt

The goal of this work was to determine the craniofacial injury patterns in hospitalized patients to facilitate the awareness, by identifying, describing and quantifying trauma for use in planning and evaluation of preventive programs. Two-hundred and fifty five patients with craniofacial injuries were registered at the department of neurosurgery in Tanta University Hospital. Data were collected including age, gender, medical history, cause of injury and type of injury, location and frequency of soft tissue injuries, skull fractures, facial bone fractures, brain injuries and concomitant injuries, patient symptoms, clinical signs and the radiological findings. The most common causes of craniofacial injuries were road traffic accidents, followed by activity of daily life and assaults. Gender distribution showed that, males were at higher risk than females with a ratio of 5.5/1. In total of skull fractures, 47.84% were fissure fracture and 24.31% were depressed fractures. In total of brain injuries, 7.06% for concussion, 4.71% for contusion, 10.98% for brain laceration, 14.12% for pneumocephalus and 36.47% for brain edema. Regression analysis revealed increased risk for skull fractures and brain injuries in traffic accidents were 84.78%, 94.20%, respectively, and 59.14%, 50.54% in activity of daily life, but the probability of soft tissue injuries increase in traffic accident and violence.     

Motorcycle racing injuries on track and road circuits in Ireland.

A retrospective study was carried out on all motorcycle injuries occurring at Mondelo Park racetrack for the 1983 and 1984 seasons. In this sport there were a total of 57 injuries for the two year period, 27 occurring in 1983 and 30 in 1984. Soft tissue injuries accounted for 66.7%, fractures 22.8% and head injuries 10.5% of the total. In the fracture group, 2 patients suffered spinal fractures which is noteworthy in that neither were wearing back protectors which as yet are not compulsory safety equipment in Eire. These figures were compared with data from the same two year period on the Ulster road circuit. The incidence of each type of injury was similar and equally low in both groups. Motorcycle racing injuries compared favourably with motor car racing injuries and had a lower incidence of serious head injury. In comparison with road traffic accidents involving motorcyclists the overall number of injuries, the number of serious head, abdominal and chest injuries and the overall fatality rate, are much lower. The two most relevant factors in our lower injury incidence were lack of alcohol and the absence of collision with cars. Experience, medical attention and speed had no direct influence on our injury incidence.     

Mountainbiking

For more than two decades the popularity of mountain biking as a national pastime as well as a competitive sport has been undiminished. However, its related risks are not monitored as closely as those, for example, of skiing. The injuries caused by mountain biking are specific and cannot be compared with those caused by other cycling sports. This is due not only to the characteristics of the terrain but also to the readiness to assume a higher risk compared to cycle racing. The particular value of radiology is in the acute trauma setting. Most often musculoskeletal lesions must be examined and digital radiography and MRI are the most useful techniques. Severe trauma of the cranium, face, spine, thorax and abdomen are primarily evaluated with CT, particularly in dedicated trauma centers. Therefore, radiology can play a role in the rapid diagnosis and optimal treatment of the trauma-related injuries of mountain biking. Thus, the unnecessarily high economical damage associated with mountain biking can be avoided.     

Hand injury patterns in softball players using a 16 inch ball

Softball is a popular recreational and competitive sport among both men and women. The injury rate in softball players is as high as that in baseball and basketball players. We conducted a retrospective analysis of 119 hand injuries in 108 patients treated at the University of Chicago hand clinic. All of the injuries were caused by the impact of a 16 inch circumference softball. Of the 119 injuries, 87 (73%) had bone involvement. Operative treatment was required in 26 (22%) injuries, 23 involving fractures and 3 involving soft tissue only. There was one (3.8%) operative complication. Of all injuries, 101 (86%) involved the finger joints, including 46 (39%) injuries to the distal interphalangeal (DIP) joint, 48 (40%) to the proximal interphalangeal (PIP) joint, and 7 (6%) to the metacarpophalangeal (MCP) joint. The most common DIP joint injury was a mallet injury. This fracture, the most common single type of injury in our series, accounted for 27% of all injuries. Of all mallet injuries, 86% were fractures. The most common PIP joint injury was a volar plate fracture, the second most common injury in our series. Variables such as the patient's sex, dominance or nondominance of hands, and early or late season play were not associated with a higher risk of injury. Certain parts of the hand, such as the more ulnar digits and the DIP and PIP joints, were at particularly high risk of injury.     

Impact of school sports injury

BACKGROUND: Most injuries in school occur during sport. OBJECTIVES: To explore the impact of sports injury in supervised school sport. METHOD: A prospective study of sports injury in children of secondary school age presenting to the accident and emergency department. Each patient was identified on registration, matched with medical records after discharge, and contacted later by telephone to complete a structured interview. Patients were only included if their injury was sustained during supervised school sport. RESULTS: During the study period, 194 patients aged 11-18 attended the accident and emergency department with an injury, 51% of which occurred during school sport. Injuries occurred most commonly in rugby (43%), followed by physical education and games together (17.5%). Most injuries were x rayed (72%). Just over 12% of pupils lost no time from sport, most (71%) were back to sport within three weeks, and 2.7% were injured for more than eight weeks. Almost a third of parents needed to take time off from work to deal with the injured child. CONCLUSION: School sports injuries are important. They account for just over half of all injuries in secondary school children. They cause significant disruption to school and sport and have important implications for the wider family.     

Avulsion fractures of the pelvis in children: a report of 32 fractures and their outcome

Avulsion injuries of the apophyses of the pelvis are mainly athletic injuries and are usually seen in adolescents. In a series of 80 pelvic fractures in children seen and managed in The Royal Liverpool Children's Hospital, Alder Hey, in the last 10 years, 32 avulsion fractures in 25 patients were diagnosed and treated. Twenty-two of these patients were followed for an average of 44 months (range 4–120 months). Eight (33%) were girls, a higher proportion than in other published series. The average age of the children was 13.8 years. These fractures, though generally regarded as trivial injuries, have left disability persisting into adult life, with limitation of sporting ability in 10 of the 22 patients and persistent symptoms in 6, mostly in those with ischial avulsion injuries. Fourteen patients with acute injuries needed hospitalisation, with an average stay of 5 days. The other 11 were suffering from chronic traction injuries sustained in sport. This distinction between acute and chronic injuries has not been emphasized in the other reviews. The radiological appearances, diagnostic problems and morbidity are discussed in order to increase awareness of these injuries.     

Radiologic and clinical spectrum of occipital condyle fractures: retrospective review of 107 consecutive fractures in 95 patients

OBJECTIVE: We proposed to characterize the radiologic spectrum of occipital condyle fractures in a large series of patients and to correlate fracture pathology with neurosurgical treatment and patient outcome. MATERIALS AND METHODS: We conducted a retrospective review of the findings on conventional radiography, CT, and MR imaging in 95 patients with 107 occipital condyle fractures. We described fracture patterns according to two previously published classification systems. Clinical findings, neurosurgical management, and patient outcome were obtained from the medical records. RESULTS: Inferomedial avulsions (Anderson and Montesano type III) were the most common type of occipital condyle fracture, constituting 80 (75%) of 107 overall fractures. Unilateral occipital condyle fractures were found in 73 (77%) of 95 patients, and 58 patients were treated nonoperatively; occipitocervical fusion was required in nine patients for complex C1-C2 injuries, and six patients died. Bilateral occipital condyle fractures or occipitoatlantoaxial joint injuries were seen in 22 (23%) of 95 patients. Occipitocervical fusion or halo traction for the craniocervical junction was required in 12 patients, all of whom had CT evidence of bilateral occipitoatlantoaxial joint disruption and six of whom showed normal craniocervical relationships on conventional radiographs. Six patients with nondisplaced fractures were treated nonoperatively, and four patients died. Thirty (32%) of 95 patients showed continued disability, whereas 55 (57.5%) of 95 patients had good outcomes at 1 month. Associated cervical spine injuries were present in 29 (31%) of 95 patients. CONCLUSION: Given their associated traumatic brain and cervical spine injuries, occipital condyle fractures are markers of high-energy traumas. That conventional radiographs alone may miss up to half of the patients with acute craniocervical instability has not been well established. Avulsion fracture type and fracture displacement are associated with both injury mechanism and the need for surgical stabilization. In this series, most unilateral occipital condyle fractures were treated nonoperatively, whereas bilateral occipitoatlantoaxial joint injuries with findings of instability usually required surgical stabilization.     

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.     

Pediatric and adolescent injury in mountain biking

ABSTRACT

Mountain-biking has become a popular competitive and recreational activity but also involves risk of injury. This article provides an overview of what is known about the scope of the injury problem affecting children and adolescent mountain bikers, the risk factors involved and injury prevention strategies. The proportion of injured child and adolescent mountain bikers ranges from 10.6% to 64.0%, but few studies provide separate analysis of youth injuries. Upper extremity injuries appear most common except among adolescents where the risk of head injury and traumatic brain injuries are greater. Concern is raised regarding the reported frequency of spine fractures and spinal cord injuries. Multi-faceted, longitudinal injury research focusing on youth mountain bikers is required to provide a reliable basis for testing risk factors and evaluating preventive measures. Reducing mountain biking-related injuries will require multiple strategies that integrate approaches from education, engineering, and evidence-based safety measures and their enforcement.     

骨折合并颅脑伤的处理（附153例分析）

本文分析10年中收治的骨折合并颅脑伤153例，大多伤情严重，急症时50.9%有不同程度的休克,采取多科室综合治疗。对严重多发伤骨折的处理，应酌情早期施行内固定手术。     

Missed injuries in military patients with major trauma: original study

OBJECTIVE: The incidence and subsequent outcomes of missed injuries and the primary factors contributing to each missed injury were analyzed. METHODS: Records of 709 trauma patients were reviewed between December 2003 and December 2004. Demographic data were compared and analyzed for two patient groups: those with multiple injuries diagnosed in 24 hours and those with multiple injuries diagnosed in >24 hours. RESULTS: Fifty-two missed injuries were determined in 34 (4.8%) patients. There were significant differences between the patients with and without delayed diagnoses, including the mean injury severity scores (23 vs. 16.9), morbidity, and mortality (p < 0.05 for all). Among 69 contributing factors identified, 28 (40.6%) were unavoidable and 41 (59.4%) were potentially avoidable. CONCLUSIONS: Missed injuries could usually be encountered in the most seriously injured patients, particularly in those with altered levels of consciousness. Missed injuries were mostly avoidable and most were the result of inadequate clinical examination.     

War injuries of the talus

Twenty-eight patients with war fractures of the talus were reviewed to determine the incidence of infection and late functional results. The average age of our patients was 37.5 years. Twenty-one injuries were explosive fractures that resulted from shell fragments or mines; seven fractures resulted from gunshot missiles. Seven patients had isolated talus injuries, whereas 21 patients had associated fractures of other bones of the foot or lower leg. All patients were initially treated with debridement, tetanus immunization, intravenous antibiotics, and stabilization, either with cast immobilization or an external fixator. Five days after injury, wound cultures were positive in 25 of 28 feet. Infection was eventually eradicated in all patients, allowing for soft tissue coverage. One patient eventually required a below-knee amputation. The patients were reviewed for functional outcome at 36 to 60 months after injury. Most patients reported a certain degree of residual complaints. The overall result can be considered excellent in only one patient.     

Wakeboarding injuries

BACKGROUND: Wakeboarding is a popular water sport that has the potential to produce serious injuries. To date, there has been only one article describing an injury caused by wakeboarding. HYPOTHESIS: Wakeboarding injuries are common. STUDY DESIGN: Analysis of data obtained from physician and patient questionnaires. METHODS: Analysis of questionnaire data obtained from 156 orthopaedic surgeons and 86 wakeboarders. RESULTS: Of 156 orthopaedic surgeons completing a wakeboarding injuries questionnaire, 49% reported no wakeboarding injuries, 36% (57) reported treating at least 1 wakeboarding injury, and 15% had never heard of wakeboarding. Fifty-seven orthopaedic surgeons reported 122 injuries, of which 47% were either anterior cruciate ligament (ACL) tears (31%) or shoulder dislocations (15%). In addition, 21% of all the injuries were some type of fracture. Of 86 wakeboarders completing the injuries survey, 77% reported sustaining an injury. There were 82 reported injuries in this group, of which 34% were either ACL tears (17%) or ankle sprains (17%). CONCLUSIONS: This survey of wakeboarding injuries demonstrates that serious injuries can occur from participation in this sport. The most common injuries reported were ACL tears, shoulder dislocations, and ankle sprains. In addition, 21% of all the injuries were some type of fracture.     

CT detection of serious internal and skeletal injuries in patients with pelvic fractures

RATIONALE AND OBJECTIVES: The purpose of this study was to determine the percentage of patients with known pelvic fractures who have additional findings of intraabdominal injury, as diagnosed at abdominal computed tomography (CT), and to determine if patients with specific types or patterns of fractures are more likely to have additional injuries. MATERIALS AND METHODS: The authors reviewed the medical records of 200 consecutive patients (125 women, 75 men; age range, 4-86 years) who had been admitted to a level 1 trauma center with osseous pelvic injury secondary to blunt trauma and who had undergone abdominal CT examinations. Abdominal CT findings in these patients were classified as negative, positive, or minimal and correlated with mechanism of pelvic fracture. RESULTS: Sixty-five (32%) of the 200 patients had negative CT findings, 43 (22%) had findings attributable to the trauma but required no follow-up, and 92 (46%) had positive findings that required nonsurgical management or exploratory laparotomy. Additional pelvic fractures were identified in 63 (32%) patients. The highest prevalence of additional injuries was in patients with Malgaigne fractures (four of 15, 27%) or bilateral pubic rami fractures (six of 18, 33%). CONCLUSION: CT examinations revealed that 135 (68%) of 200 patients with pelvic fractures secondary to blunt trauma had concomitant internal or skeletal injuries and that 92 (46%) patients had injuries severe enough to require nonsurgical management or exploratory laparotomy. Patients with bilateral pubic rami fractures or Malgaigne fractures were particularly prone to additional injuries; therefore, abdominal CT examinations are recommended in these patients.     

Injuries in intercollegiate rodeo athletes

Collegiate rodeo athletes (N = 156) in the National Intercollegiate Rodeo Association (NIRA) Southern Region, were examined for injuries during a 7 month (10 rodeo) season from 1987 to 1988. Sixty-two athletes sustained a total of 138 acute injuries resulting from 3292 exposures. One hundred twenty-seven injuries (92% of total injuries) occurred in the roughstock and steer wrestling events, and 11 injuries (8%) occurred in the roping and female events. When calculating opportunity for injury, rodeo athletes face an 89% potential for injury per season. Ninety-one of the injuries incurred were upper body injuries; 47 were lower body injuries. A 6:1 exposure to injury ratio among roughstock events exemplifies the magnitude of injury potential in this sport, affecting 25% of roughstock competitors. Contusions, strains, and concussions comprised 42%, 16%, and 11% of the total injuries, respectively, whereas fractures and dislocations comprised only 5% of the total. Twenty-three percent of the injuries occurred during the completion of an athlete's ride, with 21% of injuries attributed to equipment mishaps. Frequency of injury by performance, relation of seasonal participation and exposure to injury, orthotic care, use of conditioning programs, medication history, and need for enhanced sports medicine education in this sport are discussed.     

The radiology of in-line skating injuries

Injuries from in-line skating (rollerblading) accidents are being seen with increasing frequency in emergency centers as this new sport gains popularity. To determine the types of injuries occurring with in-line skating accidents and the role of radiology in their diagnosis, a retrospective review was carried out. Between January 1, 1990, and October 15, 1994, 56 patients were identified who had been examined in the Emergency Radiology Division of the Massachusetts General Hospital for an in-line skating injury. The radiologic examinations and patient records were reviewed, and follow-up information was obtained. Thirty-five patients had injuries detected radiologically, including 18 with upper extremity fractures or dislocations, 7 with soft tissue injuries alone, including 1 case of ultrasound-diagnosed testicular trauma, 5 with lower extremity fractures, 2 with pelvic fractures, 2 with sacral/coccygeal fractures, 2 with head trauma, 1 with thoracic spine fracture, and 1 with clavicular fracture. The likelihood of injury was associated with the skill level of the skater and use or lack of protective gear.