Decreased femoral head–neck offset: a possible risk factor for ACL injury

Purpose

Reduction in anterior cruciate ligament (ACL) injuries in young, active individuals continues to be a major goal in sports medicine. The purpose of this study was to determine the head–neck offset, as measured by AP pelvis alpha angles, in patients presenting to a single surgeon with isolated ACL and non-ACL knee injuries.

Methods

In a group of 48 patients with complete, primary ACL rupture and 42 controls with non-ACL injury (i.e., meniscus tear, cartilage defect), a single surgeon, blinded to the diagnosis, took radiographic measures of the AP alpha angle of both hips and the weight-bearing line at both knees. All knee pathology was confirmed with knee arthroscopy. Inclusion criteria included no previous hip or knee surgery, and long-leg standing alignment radiographic series completed at index visit.

Results

There was no difference in gender distribution, height, BMI or age between groups. ACL-injured patients had a significantly higher alpha angle (mean = 84, SD = 14) on the injured side than the controls (mean = 59, SD = 7, p < 0.0001). Ninety-four percent of the ACL-injured group had alpha angles over 60°, while only 35% of the non-ACL-injured group had alpha angles over 60° (p = 0.001). Those patients with alpha angle over 60° were 27 times more likely (95% CI 6.4–131) to be in the ACL injury group than those patients with alpha angle 60° or less (p = 0.001).

Conclusion

Our findings establish an important preliminary correlation between ACL injury and diminished femoral head–neck offset, as characterized by abnormal, elevated alpha angles.

Level of evidence

Prognostic study, Level III.     

Is motivation for marathon a protective factor or a risk factor of injury?

This research investigated whether and how self‐determined motivation predicts perceived susceptibility to injury during competition (marathon). Two correlational studies including 378 (Study 1) and 339 (Study 2) marathon runners were conducted. Participants filled out a questionnaire the day before the race measuring self‐determined motivation, perceived susceptibilities to marathon‐related injury and to keep running through pain, and control variables. Study 1 showed that self‐determined motivation was negatively related to perceived susceptibility to marathon‐related injury. Study 2 replicated this finding and showed that this relationship was partially mediated by perceived susceptibility to keep running through pain during the race. Moreover, results indicated that the predictive role of self‐determination was mostly driven by controlled forms of motivation, and more particularly external regulation. These results suggest that self‐determined motivation for sport is a protective factor of injury.     

The inflammatory response: friend or enemy for muscle injury?

Limiting certain aspects of inflammation may be a useful new treatment for sport related muscle injury.     

High-speed running and sprinting as an injury risk factor in soccer: Can well-developed physical qualities reduce the risk?

Objectives

This study investigated the association between high-speed running (HSR) and sprint running (SR) and injuries within elite soccer players. The impact of intermittent aerobic fitness as measured by the end speed of the 30–15 intermittent fitness test (30–15 V_IFT) and high chronic workloads (average 21-day) as potential mediators of injury risk were also investigated.

Thyroid dose from common head and neck CT examinations in children: is there an excess risk for thyroid cancer induction?

This study was conducted to estimate thyroid dose and the associated risk for thyroid cancer induction from common head and neck computed tomography (CT) examinations during childhood. The Monte Carlo N-particle transport code was employed to simulate the routine CT scanning of the brain, paranasal sinuses, inner ear and neck performed on sequential and/or spiral modes. The mean thyroid dose was calculated using mathematical phantoms representing a newborn infant and children of 1year, 5 years, 10 years and 15 years old. To verify Monte Carlo results, dose measurements were carried out on physical anthropomorphic phantoms using thermoluminescent dosemeters (TLDs). The scattered dose to thyroid from head CT examinations varied from 0.6 mGy to 8.7 mGy depending upon the scanned region, the pediatric patient’s age and the acquisition mode used. Primary irradiation of the thyroid gland during CT of the neck resulted in an absorbed dose range of 15.2–52.0 mGy. The mean difference between Monte Carlo calculations and TLD measurements was 11.8%. Thyroid exposure to scattered radiation from head CT scanning is associated with a low but not negligible risk of cancer induction of 4–65 per million patients. Neck CT can result in an increased risk for development of thyroid malignancies up to 390 per million patients.     

Vomiting—is this a good indication for CT head scans in patients with minor head injury?

The National Institute for Health and Clinical Excellence head injury guidelines advise CT imaging within 1 h if there is more than one episode of vomiting post-head injury in adults and three or more episodes in children. Since the guideline publication, studies have found that, following head injury, vomiting alone is associated with an abnormal CT head scan in 13-45% of cases. CT head scan requests referred from the emergency department between 1 May 2009 and 30 April 2010 were retrospectively reviewed. Patients with vomiting as the sole indication for an "immediate" CT head scan performed within 1 h were included in the study. Reports produced by experienced neuroradiologists were reviewed and the detection of significant head injury was noted. There were 1264 CT head scans performed during our study period. 151 (124 adults, 27 children) were indicated owing to vomiting following head injury. 5 of the 124 adult scans and 1 of the 27 paediatric scans showed an abnormal finding, giving positive predictive values (PPV) of 4% and 3.7%, respectively. None of these patients required either acute or delayed neurosurgical intervention. In our experience, vomiting alone has a PPV of 4% for significant head injury in adults. However, none of these injuries were serious enough to warrant acute or delayed intervention. Given these findings, vomiting following head injury is a reasonable indication for a CT head scan; however, as none of the patients required acute intervention, we suggest that these scans do not usually need to be performed within 1 h of request.     

A multifunctional CT technology: Reality or illusion for patient risk assessment?

Journal of Nuclear Cardiology - A high-speed, multi-slice coronary computed tomography (CT) imaging has emerged as a promising or clinically available multifunctional technique for the assessment...     

Can virtual reality simulation prepare patients for an MRI experience?

IntroductionA Magnetic Resonance Imaging (MRI) examination is often described by patients as frightening and uncomfortable. To prepare patients for an MRI examination, this study explored the use of virtual reality (VR) simulation compared to a mock MRI scan (full-scale MRI machine replica, without internal magnets).MethodsTwenty participants underwent a VR and a mock MRI scan. Ratings of anxiety and how comfortable and relaxed the participants felt were recorded at five touchpoints during and after each simulation. Post-simulation questionnaires were used to gather responses on the experience and preferences.ResultsNo significant differences were found in participants’ ratings of how anxious they felt during or between the two simulations (χ2 (9) = 27.269, p = .126), or how relaxed they felt (χ2 (9) = 14.664, p = .101). There were also no significant differences in the reported levels of comfort between the two types of simulation (χ2 (9) = 20.864, p = .013, post hoc tests for all VR versus mock scan rankings p > .05). There were no significant differences in how real the participants thought each simulation felt, or how anxious, relaxed, and comfortable they felt following each type of simulation (p > .05). Although 65% of participants thought the mock simulation felt more real than the VR, 86% found VR simulation to be a helpful way to prepare for a real MRI exam.ConclusionVR could be a feasible and accessible alternative to mock scanning. It has the potential to improve patient experiences of potentially stressful MRI examinations.Implications for practiceVR offers clinicians a new cost-effective tool to prepare patients for an MRI examination. VR technology could be used at home, as a training tool, to familiarise clinicians and clinical trainees with the MRI procedure and better understand patients’ experiences.     

Craniofacial gunshot injuries: an unrecognised risk factor for blunt cervical vascular injuries?

Objectives

To review our institutional experience with cervical arterial injuries remote from the penetrating tract seen in the setting of craniofacial gunshot injuries.

Methods

Institutional Review Board approval was obtained. Our institutional trauma registry was queried over a 5-year period for patients with cervical arterial injuries due to penetrating craniofacial gunshot wounds who underwent CT angiography. Imaging results and clinical notes were reviewed.

Results

A total of 427 patients sustained gunshot wounds to the head, face and/or neck, of whom 222 underwent CT angiography yielding 56 patients with 78 vascular injuries. There were five internal carotid artery injuries remote from the wound tract. The incidence of these “indirect” cervical arterial injuries in our patient population was 1.2%, or 2.8% of patients who underwent CT angiography.

Conclusions

The incidence of “indirect” cervical arterial injuries with craniofacial gunshot wounds is comparable to or slightly higher than those seen in pure blunt trauma. Screening patients with craniofacial gunshot injuries with CT angiography may yield unexpected cervical vascular injuries remote from the penetrating tract. The significance and optimal therapy of these injuries are unknown. Additional experience will be needed to determine the significance of “indirect” cervical arterial injuries in the setting of craniofacial gunshot wounds.

Key Points

? There are several known risk factors for blunt cervical arterial injuries. ? Cervical arterial injuries may occur remote from the wound following craniofacial gunshot wounds. ? Craniofacial gunshot wounds pose a risk for blunt cervical vascular injuries.     

Distracting injury defined: does an isolated hip fracture constitute a distracting injury for clearance of the cervical spine?

Objectives

As the population within the USA ages, the number of hip fractures seen yearly in the emergency department is expected to rise. According to the NEXUS criteria, many of these patients receive computerized tomographic scan (CT) evaluation of the cervical spine because a hip fracture may constitute a distracting injury. The objective of this study is to determine if an isolated hip fracture constitutes a distracting injury which requires imaging of the cervical spine.

Methods

Data were prospectively collected on 158 trauma patients with isolated hip fractures between April 1, 2015 and March 9, 2016. Patient demographics were analyzed and compared to the National Emergency X-Radiography Utilization Study (NEXUS).

Results

Patients with isolated hip fractures were predominantly elderly, on average 78.6 +/? 15.9 years old, and 94.3% of these injuries occurred after a fall from standing. Only one patient also had a cervical spine fracture which was not clinically significant. When compared to the established rate of cervical spine injury of 2.4%, the absolute risk reduction (ARR) was 0.35% (95% CI, ? 1.06 to 1.75%) and the number needed to treat (NNT) was 290.

Conclusion

In the case of an elderly patient with an isolated hip fracture and no cervical midline tenderness, cervical spine imaging may be reserved for those who have other NEXUS criteria for further workup.

     

Is body mass index a risk factor for sport injury in adolescents?

ObjectivesTo investigate the relationship between sport injury and body mass index in adolescents (12–19 years).DesignSecondary analysis of data collected in junior and senior high school surveys in Alberta, Canada.MethodsParticipants (n = 4339) included students from 59 schools. All sport injury was defined as injury reported in the past one year. Medically treated injury, as any more serious sport related injury reported in the last year that required medical attention. Overweight, obese, and healthy was defined using international cut points, as the exposure.ResultsMultivariate logistic regression analysis controlling for clustering by school, and adjusting for potential risk factors was used. There was a 34% increased risk for all sport injury in obese adolescents compared to healthy adolescents [odds ratio (OR) = 1.34 (95% CI: 1.02–1.80)]. There was increased risk for all sport injury and medically treated injury with hours of participation, where the highest group had a 4-fold increase in risk (OR = 4.17, 95%CI: 2.77–6.30 and OR = 3.80, 95%CI: 2.54–5.69, respectively). There was also increased risk for both all sport injury and medically treated injury in Caucasians compared to non-Caucasians [OR = 1.45 (95%CI: 1.15–1.82), OR = 1.94 (95%CI: 1.59–2.37), respectively], as well as for club/team play compared to less elite play [OR = 1.87 (95%CI: 1.43–2.44) and OR = 2.12 (95%CI: 1.57–2.87), respectively].ConclusionsThe risk of sustaining a sport injury in obese adolescents was greater compared to those of healthy weight. There is also a greater risk with increasing hours of play, in Caucasian adolescents, and those that play at a higher sporting level.     

Is bowling workload a risk factor for injury to Australian junior cricket fast bowlers?

Objectives: To examine whether bowling workload is a risk factor for overuse injury to Australian junior cricket fast bowlers and to evaluate the appropriateness of current bowling workload guidelines. Methods: Forty four male fast bowlers (mean (standard deviation) age 14.7 (1.4) years) were monitored prospectively over the 2002–2003 season. Bowlers completed a daily diary to record bowling workloads and self reported injuries, which were validated by a physiotherapist. Bowling workload prior to the first injury (for those bowlers who were injured) was compared to workload across the whole season for uninjured bowlers. Results: Eleven (25%) bowlers reported an overuse-type injury, with seven of these sustaining a back injury. Injured bowlers had been bowling significantly more frequently than uninjured bowlers (median number of days since the previous bowling day: 3.2 v 3.9 days, Mann-Whitney U = 105.0, p = 0.038). Compared with bowlers with an average of ⩾3.5 rest days between bowling, bowlers with an average of <3.5 rest days were at a significantly increased risk of injury (risk ratio (RR) = 3.1, 95% confidence interval (CI) 1.1 to 8.9). There were also trends towards an increased risk of injury for those who bowled an average of ⩾2.5 days per week (RR = 2.5, 95% CI 0.9 to 7.4) or ⩾50 deliveries per day (RR = 2.0, 95% CI 0.7 to 5.4). Conclusions: This study has identified high bowling workload as a risk factor for overuse injury to junior fast bowlers. Continued research is required to provide scientific evidence for bowling workload guidelines that are age-specific for junior fast bowlers.     

Traumatic lumbar hernias: do patient or hernia characteristics predict bowel or mesenteric injury?

Traumatic lumbar hernias are rare but important injuries to diagnose in blunt abdominal trauma, both because of delayed complications of the hernia itself and because of well-documented association with bowel and mesenteric injuries. No study to our knowledge has determined whether specific features of the hernia—size of the wall defect, inferior or superior location, or the side of the hernia—bear any predictive value on the presence of underlying bowel and mesenteric injury. A retrospective query of the radiology information system yielded 21 patients with lumbar hernias which were diagnosed on CT. These were reviewed by three radiologists to confirm the presence of an acute lumbar hernia and to determine the size and location of the hernia. The patients’ medical records were reviewed to determine the presence of operatively confirmed bowel and/or mesenteric injuries, which occurred in 52 % of patients. A significant (p?<?0.001) difference was found in the frequency of bowel and/or mesenteric injury with hernia defects greater than 4.0 cm (100 %) and those less than 4.0 cm (17 %). Larger hernias also resulted in more procedures (p?=?0.042) and a trend towards longer ICU stay, but no difference in injury severity score (ISS) or overall hospital stay. No significant difference was seen in the frequency of bowel and/or mesenteric injuries based on side or location of the hernia, though distal colonic injuries were more commonly seen with left-sided hernias (50 %) compared to right-sided hernias (18 %). Although based on a small patient population, these results suggest that larger traumatic lumbar hernias warrant particularly close evaluation for an underlying bowel and/or mesenteric injury.