-
Pediatric Clinics of North America Feb 2020A limp is a common presentation to pediatricians, emergency centers, and orthopedists. A directed history and physical examination, and the development of a differential... (Review)
Review
A limp is a common presentation to pediatricians, emergency centers, and orthopedists. A directed history and physical examination, and the development of a differential diagnosis based on limp type, patient's age, and the anatomic site that is most likely affected, provides a selective approach to diagnostic testing. Laboratory tests are indicated when infection, inflammatory arthritis, or a malignancy is considered. Imaging usually begins with plain radiography. Ultrasonography is valuable in assessing irritable hips. Advanced imaging is done in select cases. Prompt referral to an orthopedist is essential, especially if septic joint, vascular or compartment issues, or open fractures are suspected.
Topics: Adolescent; Child; Child, Preschool; Decision Trees; Gait; Gait Analysis; Humans; Infant; Musculoskeletal Diseases; Musculoskeletal System; Wounds and Injuries
PubMed: 31779828
DOI: 10.1016/j.pcl.2019.09.009 -
Pediatric Clinics of North America Feb 2020The management of pediatric orthopedic trauma continues to evolve rapidly. Whereas the strong healing potential of pediatric patients often allows for the nonoperative... (Review)
Review
The management of pediatric orthopedic trauma continues to evolve rapidly. Whereas the strong healing potential of pediatric patients often allows for the nonoperative treatment of most conditions, many injuries require urgent operative treatment to ensure that patients may return to all activities without disability. Some injuries may require additional follow-up and interventions, as complications such as growth arrests or deformity may occur. This article summarizes the most common fractures and orthopedic injuries of the pediatric patient. The keys to diagnosis, acute management, nonoperative and operative treatments, and complications are discussed. The detection and management of nonaccidental trauma are also examined.
Topics: Child; Child Abuse; Fractures, Bone; Humans; Musculoskeletal System; Wounds and Injuries
PubMed: 31779827
DOI: 10.1016/j.pcl.2019.09.010 -
BMC Musculoskeletal Disorders Nov 2019Prognosis of musculoskeletal disorders following injury is essential in determining appropriate treatment and care. A generic validated prognostic tool to stratify risk...
Positive recovery for low-risk injuries screened by the short form - Örebro musculoskeletal pain screening questionnaire following road traffic injury: evidence from an inception cohort study in New South Wales, Australia.
BACKGROUND
Prognosis of musculoskeletal disorders following injury is essential in determining appropriate treatment and care. A generic validated prognostic tool to stratify risk of poor recovery for people with musculoskeletal injuries after road traffic crash is not available. This study aimed to examine differences in recovery, return to work and health related quality of life between low and high-risk of poor recovery people with musculoskeletal injuries stratified by the Short form - Örebro Musculoskeletal Pain Screening Questionnaire (SF-OMPSQ).
METHODS
In an inception cohort study, participants with non-fracture musculoskeletal injury with the main site being the neck, lower back or lower limb were stratified into low (score ≤ 50) and high (score > 50) risk of poor recovery using the SF-OMPSQ score at baseline. We assessed the proportion of fully recovered participants (Global Perceived Effect scale ≥4), the proportion returning to work and changes in short form 12-item (SF-12) scores between baseline and 6-month follow-up in low and high-risk groups. Modified Poisson regression was used to estimate the adjusted risk ratio (RR) of being recovered and return to work in the low and high-risk groups. Paired t-test was used to compare changes in SF-12 physical and mental component summary scales, and chi-square test was used to assess the significance of the risk ratio of fully recovered between low and high-risk groups.
RESULTS
The study included 498 participants (166 with neck, 78 with lower back and 254 with lower limb injuries). The proportion of being recovered was significantly higher in the low than the high-risk groups (Adjusted risk ratio: 2.96 [95% CI: 1.81 to 4.82]). Significantly more people in the low-risk group returned to work (91.0%) than the high-risk group (54.6%). People at low-risk had higher SF-12 scores at baseline and 6-month follow-up than those at high-risk. There were no differences between injury types for recovery and return to work at 6 months.
CONCLUSION
The SF-OMPSQ could be recommended as a generic prognostic tool to identify individuals with musculoskeletal injuries early after road traffic injury, who would have a higher or lower likelihood of recovering or returning fully to pre-injury work.
TRIAL REGISTRATION
Australia New Zealand Clinical trial registry identification number - ACTRN12613000889752. Registered 09 August 2013.
Topics: Accidents, Traffic; Adult; Female; Health Status; Humans; Low Back Pain; Male; Middle Aged; Musculoskeletal Pain; Neck Pain; New South Wales; Pain Measurement; Predictive Value of Tests; Prognosis; Quality of Life; Recovery of Function; Return to Work; Risk Assessment; Risk Factors; Surveys and Questionnaires; Wounds and Injuries; Young Adult
PubMed: 31722704
DOI: 10.1186/s12891-019-2881-9 -
The Orthopedic Clinics of North America Oct 2013
Topics: Humans; Musculoskeletal System; Peripheral Nerve Injuries; Wounds and Injuries
PubMed: 24095083
DOI: 10.1016/j.ocl.2013.07.007 -
European Journal of Orthopaedic Surgery... Aug 2017
Topics: Bone Neoplasms; Career Choice; Humans; Interprofessional Relations; Musculoskeletal System; Orthopedics; Wounds and Injuries
PubMed: 28638949
DOI: 10.1007/s00590-017-2000-2 -
Aviation, Space, and Environmental... Aug 1996Astronauts in NASA's space program are expected to remain fit to complete their on-orbit tasks and to function effectively in the event of contingency operations. Due to...
Astronauts in NASA's space program are expected to remain fit to complete their on-orbit tasks and to function effectively in the event of contingency operations. Due to the generally self-directed exercise program and reliance on competitive sports and running for conditioning, plus limited emphasis on training techniques and rehabilitation, there have been a surprising number of orthopedic injuries and surgeries in this small adult population. This article examines the orthopedic injury history of U.S. astronauts during the period from 1987-95. The type of injury, activity involved, and subsequent surgical interventions are cataloged. There were a total of 26 fractures, 36 serious ligament, cartilage, or soft tissue injuries, and 28 orthopedic surgical procedures in this adult group with a mean astronaut corps size of only 94. Women accounted for 16% of the study population but accounted for only 1 of 28 surgical procedures. Knee injuries required surgical intervention 19 times. Running, skiing, and basketball were most frequently associated with injuries. The descriptive data regarding frequency of adverse events and activity associated with injuries is presented. These injury patterns are analyzed and suggestions made for future improvement, including decreased reliance on running and competitive athletics for conditioning, improved personal fitness training preflight, and coordinated rehabilitation postflight. Also recommended is the use of a lap pool for preflight total body fitness training, since swimming provides conditioning to those muscle groups used during spaceflight, and for variably weighted gravity rehabilitation postflight.
Topics: Adult; Aerospace Medicine; Female; Fractures, Bone; Humans; Male; Musculoskeletal System; Orthopedics; Retrospective Studies; United States; United States National Aeronautics and Space Administration; Wounds and Injuries
PubMed: 8853833
DOI: No ID Found -
Sports Medicine and Arthroscopy Review Sep 2019Special Operations Combat Personnel (SOCP) face significant challenges and occupational demands that put them at significant risk for musculoskeletal injury.... (Review)
Review
Special Operations Combat Personnel (SOCP) face significant challenges and occupational demands that put them at significant risk for musculoskeletal injury. Musculoskeletal injury leads to lost-duty days, medical disqualification, and compromises operational readiness and mission success. Optimizing human performance and developing injury prevention strategies can position SOCP for success, but human performance optimization is a complex process that demands the integration of multiple disciplines to address a broad range of capabilities necessary for this success. The Warrior Model for Human Performance Optimization outlines a step-by-step approach to human performance optimization embedded within a scientific, evidenced-based approach to injury prevention and performance optimization that includes a step to ensure specificity of training and interventions. This evidence-based approach can insure that SOCP capabilities match the demands of occupation enabling them to successfully execute their occupation tasks without risk of injury. While the focus of this review is on military personnel, the same principles have application to nonmilitary high-performance athletes.
Topics: Humans; Military Personnel; Musculoskeletal System; Physical Functional Performance; Population Surveillance; Wounds and Injuries
PubMed: 31361719
DOI: 10.1097/JSA.0000000000000248 -
Preventive Veterinary Medicine Mar 2020There is limited literature concerning the types of injuries that military working dogs (MWDs) face while in a deployed theater of operations and associated risk...
There is limited literature concerning the types of injuries that military working dogs (MWDs) face while in a deployed theater of operations and associated risk factors. To summarize injuries and identify injury risk factors in MWDs during their first deployments to Iraq, demographic and medical data were collected for 794 MWDs from the U.S. Army, Air Force, Navy, and Marine Corps that deployed to Iraq between March 20, 2003 and December 31, 2007. Sixty-two percent (n = 490) had a medical encounter during deployment. Injuries were categorized as traumatic or musculoskeletal. MWD demographics, characteristics, and injury types were summarized. Injury risk factors were assessed using multivariable logistic regression. A majority of the population were German Shepherds (56 %), intact males (49 %), and dogs certified in both patrol and explosives detection (73 %). During their first deployment to Iraq, 20 % (n = 156) experienced an injury. Risk factors included breed, age, and occupational certification. Belgian Malinois and Labrador Retriever dogs had greater odds of injury compared to German Shepherds (p = 0.04 and p = 0.02) and the oldest MWDs had about a 50 % higher risk of injury compared to the youngest (p = 0.01), especially for musculoskeletal injuries. MWDs with Specialized Search certification were at increased injury risk (p = 0.02). Training, equipment, and supplies for veterinary service personnel, MWD handlers, and MWDs should be tailored with consideration of the injury risks of the MWD population. Further study is needed to investigate chronic injuries in military working dogs to better understand causation and prevention.
Topics: Animals; Dogs; Iraq; Military Personnel; Risk Factors; United States; Wounds and Injuries
PubMed: 32066025
DOI: 10.1016/j.prevetmed.2020.104911 -
Journal of Science and Medicine in Sport Nov 2018Injuries cause more morbidity among soldiers in the U.S. Army than any other health condition. Over two-thirds of U.S. soldiers' injuries occur gradually from cumulative...
Injuries cause more morbidity among soldiers in the U.S. Army than any other health condition. Over two-thirds of U.S. soldiers' injuries occur gradually from cumulative micro-traumatic damage to the musculoskeletal system as a result of physical training activities. Paradoxically, the very physical training activities required to improve soldier performance also result in injury. Determining the amounts and types of physical training that maximize performance while minimizing injuries requires scientific evidence. This evidence must be incorporated into a framework that ensures scientific gaps are addressed and prevention efforts are evaluated. The five-step public health approach has proven to be an effective construct for Army public health to organize and build an injury prevention program. Steps include: 1) surveillance to define the magnitude of the problem, 2) research and field investigations to identify causes and risk factors, 3) intervention trials and systematic reviews to determine what works to address leading risk factors, 4) program and policy implementation to execute prevention, and 5) program evaluation to assess effectiveness. Dissemination is also needed to ensure availability of scientific lessons learned. Although the steps may not be conducted in order, the capability to perform each step is necessary to sustain a successful program and make progress toward injury control and prevention. As with many U.S. public health successes (e.g., seatbelts, smoking cessation), the full process can take decades. As described in this paper, the U.S. Army uses the public health approach to assure that, as the science evolves, it is translated into effective prevention.
Topics: Humans; Military Personnel; Musculoskeletal System; Occupational Injuries; Physical Conditioning, Human; United States; Wounds and Injuries
PubMed: 29602720
DOI: 10.1016/j.jsams.2018.02.011 -
Military Medicine Dec 2014Musculoskeletal injuries (MSIs) result in the most medical encounters, lost duty days, and permanent disability. Women are at greater risk of injury than men and...
Musculoskeletal injuries (MSIs) result in the most medical encounters, lost duty days, and permanent disability. Women are at greater risk of injury than men and physical training is the leading cause of injury. The purpose of this study was to investigate the demographic, body composition, fitness, and physical training risk factors for injuries in female Soldiers serving in garrison Army units over the past 12 months. Self-report survey was collected from 625 women. The ankle was the most frequently injured body region, 13%. Running was the activity most often associated with injury, 34%. In univariate analysis lower rank, older age, history of deployment, no unit runs, weekly frequency of personal resistance training, and history of injury were all associated with injury. In multivariate analysis rank, history of injury, weekly frequency of unit runs, and weekly frequency of personal resistance training were the best combination of predictors of injury. Running once or twice a week with the unit protected against MSIs, whereas participating in personal resistance training sessions once or twice a week increased the risk of MSIs. With more emphasis on running and resistance training, the U.S. Army could reduce injuries and save billions of dollars in training and health care costs.
Topics: Adult; Age Factors; Body Composition; Female; Humans; Military Personnel; Musculoskeletal System; Physical Conditioning, Human; Physical Fitness; Resistance Training; Risk Factors; Running; United States; Wounds and Injuries; Young Adult
PubMed: 25469963
DOI: 10.7205/MILMED-D-14-00164