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Journal of Orthopaedic Trauma Oct 2018Although general trauma care systems and their effects on mortality reduction have been studied, little is known of the current state of musculoskeletal trauma delivery...
BACKGROUND AND RATIONALE
Although general trauma care systems and their effects on mortality reduction have been studied, little is known of the current state of musculoskeletal trauma delivery globally, particularly in low-income (LI) and low middle-income (LMI) countries. The goal of this study is to assess and describe the development and availability of musculoskeletal trauma care delivery worldwide.
MATERIALS & METHODS
A questionnaire was developed to evaluate different characteristics of general and musculoskeletal trauma care systems, including general aspects of systems, education, access to care and pre- and posthospital care. Surgical leaders involved with musculoskeletal trauma care were contacted to participate in the survey.
RESULTS
Of the 170 surveys sent, 95 were returned for use for the study. Nearly 30 percent of surgeons reported a formalized and coordinated trauma system in their countries. Estimates for the number of surgeons providing musculoskeletal trauma per one million inhabitants varied from 2.6 in LI countries to 58.8 in high-income countries. Worldwide, 15% of those caring for musculoskeletal trauma are fellowship trained. The survey results indicate a lack of implemented musculoskeletal trauma care guidelines across countries, with even high-income countries reporting less than 50% availability in most categories. Seventy-nine percent of the populations from LI countries were estimated to have no form of health care insurance. Formalized emergency medical services were reportedly available in only 33% and 50% of LI and LMI countries, respectively. Surgeons from LI and LMI countries responded that improvements in the availability of equipment (100%), number and locations of trauma-designated hospitals (90%), and physician training programs (88%) were necessary in their countries. The survey also revealed a general lack of resources for postoperative and rehabilitation care, irrespective of the country's income level.
CONCLUSION
This study addresses the current state of musculoskeletal trauma care delivery worldwide. These results indicate a greater need for trauma system development and support, from prehospital through posthospital care. Optimization of these systems can lead to better outcomes for patients after trauma. This study represents a critical first step toward better understanding the state of musculoskeletal trauma care in countries with different levels of resources, developing strategies to address deficiencies, and forming regional and international collaborations to develop musculoskeletal trauma care guidelines.
Topics: Delivery of Health Care; Global Health; Humans; Internationality; Musculoskeletal System; Needs Assessment; Orthopedics; Trauma Centers; Traumatology; Wounds and Injuries
PubMed: 30247404
DOI: 10.1097/BOT.0000000000001301 -
Journal of Science and Medicine in Sport Nov 2018Wearable physiological status monitoring is part of modern precision medicine that permits predictions about an individual's health and performance from their real-time...
Wearable physiological status monitoring is part of modern precision medicine that permits predictions about an individual's health and performance from their real-time physiological status (RT-PSM) instead of relying on population-based predictions informed by estimated human, mission, and environmental/ambient conditions. RT-PSM systems have useful military applications if they are soldier-acceptable and provide important actionable information. Most commercially available systems do not address relevant military needs, typically lack the validated algorithms that make real time computed information useful, and are not open architected to be integrated with the soldier technological ecology. Military RT-PSM development requires committed investments in iterative efforts involving physiologists, biomedical engineers, and the soldier users. Military operational applications include: (1) technological enhancement of performance by providing individual status information to optimize self-regulation, workload distribution, and enhanced team sensing/situational awareness; (2) detection of impending soldier failure from stress load (physical, psychological, and environmental); (3) earliest possible detection of threat agent exposure that includes the "human sensor"; (4) casualty detection, triage, and early clinical management; (5) optimization of individual health and fitness readiness habits; and (6) long term health risk-associated exposure monitoring and dosimetry. This paper is focused on the performance-related applications and considers near term predictions such as thermal-work limits, alertness and fitness for duty status, musculoskeletal fatigue limits, neuropsychological status, and mission-specific physiological status. Each new measurement capability has provided insights into soldier physiology and advances the cycle of invention, lab and field testing, new discovery and redesign.
Topics: Attention; Body Temperature; Energy Metabolism; Fatigue; Humans; Military Personnel; Monitoring, Physiologic; Stress, Physiological; Stress, Psychological; Wearable Electronic Devices; Workload; Wounds and Injuries
PubMed: 29960798
DOI: 10.1016/j.jsams.2018.06.004 -
Medicine May 2019Traumatic vascular injury is caused by explosions and projectiles (bullets and shrapnel); it may affect the arteries and veins of the limbs, and is common in wartime,...
BACKGROUND
Traumatic vascular injury is caused by explosions and projectiles (bullets and shrapnel); it may affect the arteries and veins of the limbs, and is common in wartime, triggering bleeding, and ischemia. The increasing use of high-energy weapons in modern warfare is associated with severe vascular injuries.
METHODS
To summarize the current evidence of diagnosis and treatment for traumatic vascular injury of limbs, for saving limbs and lives, and put forward some new insights, we comprehensively consulted literatures and analyzed progress in injury diagnosis and wound treatment, summarized the advanced treatments now available, especially in wartime, and explored the principal factors in play in an effort to optimize clinical outcomes.
RESULTS
Extremity vascular trauma poses several difficult dilemmas in diagnosis and treatment. The increasing use of high-energy weapons in modern warfare is associated with severe vascular injuries. Any delay in treatment may lead to loss of limbs or death. The development of diagnose and treat vascular injury of extremities are the clinical significance to the tip of military medicine, such as the use of fast, cheap, low invasive diagnostic methods, repairing severe vascular injury as soon as possible, using related technologies actively (fasciotomy, etc).
CONCLUSION
We point out the frontier of the diagnosis and treatment of traumatic vascular injury, also with a new model of wartime injury treatment in American (forward surgical teams and combat support hospitals), French military surgeons regarding management of war-related vascular wounds and Chinese military ("3 districts and 7 grades" model). Many issues remain to be resolved by further experience and investigation.
Topics: Amputation, Surgical; Ankle Brachial Index; Blast Injuries; Blood Vessel Prosthesis; Decompression, Surgical; Emergency Medicine; Extremities; Fasciotomy; Fractures, Bone; Humans; Military Medicine; Military Personnel; Retrospective Studies; Skin Transplantation; Time Factors; Trauma Severity Indices; United States; Vascular Surgical Procedures; Vascular System Injuries
PubMed: 31045795
DOI: 10.1097/MD.0000000000015406 -
Journal of Ultrasound in Medicine :... May 2022Injury to the A2 pulley is caused by high eccentric forces on the flexor-tendon-pulley system. Accurate diagnosis is necessary to identify the most appropriate treatment... (Review)
Review
Injury to the A2 pulley is caused by high eccentric forces on the flexor-tendon-pulley system. Accurate diagnosis is necessary to identify the most appropriate treatment options. This review summarizes the literature with respect to using ultrasound (US) to diagnose A2 pulley injuries, compares ultrasound to magnetic resonance imaging and computed tomography, and identifies current knowledge gaps. The results suggest that US should be used as the primary imaging modality given high accuracy, relatively low cost, ease of access, and dynamic imaging capabilities. Manual resistance is beneficial to accentuate bowstringing, but further research is needed to determine best positioning for evaluation.
Topics: Finger Injuries; Humans; Mountaineering; Rupture; Tendon Injuries; Ultrasonography
PubMed: 34342037
DOI: 10.1002/jum.15796 -
Journal of Athletic Training Nov 2016To identify and analyze articles in which the authors examined risk factors for soldiers during military static-line airborne operations. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To identify and analyze articles in which the authors examined risk factors for soldiers during military static-line airborne operations.
DATA SOURCES
We searched for articles in PubMed, the Defense Technical Information Center, reference lists, and other sources using the key words airborne, parachuting, parachutes, paratrooper, injuries, wounds, trauma, and musculoskeletal.
STUDY SELECTION
The search identified 17 684 potential studies. Studies were included if they were written in English, involved military static-line parachute operations, recorded injuries directly from events on the landing zone or from safety or medical records, and provided data for quantitative assessment of injury risk factors. A total of 23 studies met the review criteria, and 15 were included in the meta-analysis.
DATA EXTRACTION
The summary statistic obtained for each risk factor was the risk ratio, which was the ratio of the injury risk in 1 group to that of another (baseline) group. Where data were sufficient, meta-analyses were performed and heterogeneity and publication bias were assessed.
DATA SYNTHESIS
Risk factors for static-line parachuting injuries included night jumps, jumps with extra equipment, higher wind speeds, higher air temperatures, jumps from fixed-wing aircraft rather than balloons or helicopters, jumps onto certain types of terrain, being a female paratrooper, greater body weight, not using the parachute ankle brace, smaller parachute canopies, simultaneous exits from both sides of an aircraft, higher heat index, winds from the rear of the aircraft on exit entanglements, less experience with a particular parachute system, being an enlisted soldier rather than an officer, and jumps involving a greater number of paratroopers.
CONCLUSIONS
We analyzed and summarized factors that increased the injury risk for soldiers during military static-line parachute operations. Understanding and considering these factors in risk evaluations may reduce the likelihood of injury during parachuting.
Topics: Aviation; Body Weight; Humans; Incidence; Military Personnel; Risk Assessment; Risk Factors; Safety; United States; Wounds and Injuries
PubMed: 28068166
DOI: 10.4085/1062-6050-51.9.10 -
Journal of Athletic Training Feb 2020Lower extremity musculoskeletal (LEMSK) injury may be more prevalent among those with a history of sport-related concussion (SRC).
CONTEXT
Lower extremity musculoskeletal (LEMSK) injury may be more prevalent among those with a history of sport-related concussion (SRC).
OBJECTIVE
To investigate the relationship between baseline postural control metrics and the LEMSK injury incidence in National Collegiate Athletic Association Division I student-athletes with a history of SRC.
SETTING
National Collegiate Athletic Association Division I athletes.
DESIGN
Cohort study.
PATIENTS OR OTHER PARTICIPANTS
Of 84 total athletes (62 males), 42 had been previously diagnosed with an SRC, and 42 were matched controls based on age, sex, height, weight, and sport.
MAIN OUTCOME MEASURE(S)
During the preseason baseline evaluation, all participants performed 3 trials of eyes-open and eyes-closed upright quiet stance on a force platform. Medical charts were assessed for all the LEMSK injuries that occurred from preseason baseline to 1 year later. Center-of-pressure data in the anteroposterior and mediolateral directions were filtered before we calculated root mean square and mean excursion velocity; the complexity index was calculated from the unfiltered data. Factorial analysis-of-variance models were used to examine differences between groups and across conditions for root mean square; mean excursion velocity, complexity index, and tests of association to examine between-groups LEMSK differences; and logistic regression models to predict LEMSK.
RESULTS
Concussion history and injury incidence were related in the SRC group ( = .043). The complexity index of the SRC group was lower with eyes closed (14.08 ± 0.63 versus 15.93 ± 0.52) and eyes open (10.25 ± 0.52 vs 11.80 ± 0.57) in the mediolateral direction than for the control participants ( < .05). Eyes-open root mean square in the mediolateral direction was greater for the SRC group (5.00 ± 0.28 mm) than the control group (4.10 ± 0.22 mm). Logistic regression models significantly predicted LEMSK only in control participants.
CONCLUSIONS
These findings may suggest that LEMSK after SRC cannot be predicted from postural-control metrics at baseline.
Topics: Adolescent; Athletic Injuries; Brain Concussion; Cohort Studies; Female; Humans; Incidence; Logistic Models; Lower Extremity; Male; Postural Balance; Young Adult
PubMed: 31935138
DOI: 10.4085/1062-6050-187-19 -
BMC Musculoskeletal Disorders Jan 2019Musculoskeletal injuries are a problem in military personnel as they detract from force readiness and may prevent deployment. Injuries occur during basic training at... (Comparative Study)
Comparative Study
BACKGROUND
Musculoskeletal injuries are a problem in military personnel as they detract from force readiness and may prevent deployment. Injuries occur during basic training at three times the rate observed in post-training military service and more commonly in part time (PT) when compared to full time (FT) army personnel. The purpose of this study was to examine differences in rates and patterns of reported injuries between full time (FT) and part time (PT) personnel undertaking army basic training.
METHODS
A retrospective cohort study was conducted to determine and compare rates and patterns of injuries which occurred during basic training in PT and FT personnel. Injury data from the period 01 July 2012 to 30 June 2014 was obtained in a non-identifiable format from the Workplace Health, Safety, Compensation and Reporting (WHSCAR) database of the Australian Department of Defence. Analysis included descriptive statistics and the calculation of injury rates and injury rate ratios.
RESULTS
A total of 1385 injuries were reported across FT and PT cohorts, with an injury rate ratio for FT:PT of 1.06 [0.80-1.40], when accounting for exposure. In FT personnel, 1192 (90%) were Minor Personal Injuries (MPIs) and 43 (3.2%) Serious Personal Injuries (SPIs). In PT personnel, 147 (94.8%) were MPIs and three (1.9%) SPIs. In both FT and PT personnel, injuries most commonly: occurred during Physical Training (41.7% FT, 515 MPIs, 10 SPIs, 32% PT. 48 MPIs, 1 SPI); affected the knee (FT 41.7% 159 MPIs, 7 SPIs, PT 36.0%, 22 MPIs, 0 SPIs); involved soft tissue damage (FT 60.9%, 744 MPIs, 8 SPIs, PT 69.3%, 103 MPIs, 1 SPI); and were due to muscular stress (FT 41.7%, 509 MPIs, 6 SPIs, PT 36%, 54 MPIs, 0 SPIs).
CONCLUSIONS
FT and PT recruits exhibited similar injury profiles, with mechanisms, sites and types of injuries in agreement with other research. Given these similarities, effective interventions that reduce injury risks in either population will likely benefit both.
Topics: Australia; Disability Evaluation; Health Status; Humans; Military Personnel; Musculoskeletal Diseases; Occupational Health; Occupational Injuries; Personnel Staffing and Scheduling; Retrospective Studies; Risk Factors; Workload
PubMed: 30611245
DOI: 10.1186/s12891-018-2390-2 -
Journal of Occupational Health 2009The prevalence of musculoskeletal symptoms and related factors were investigated by a structured questionnaire among male steel workers at a large steel company in Korea...
OBJECTIVES
The prevalence of musculoskeletal symptoms and related factors were investigated by a structured questionnaire among male steel workers at a large steel company in Korea including a number of aged employees and workers with prior acute injuries.
METHODS
Of an eligible 2,093 workers, 1,836 responded to the survey. Among 39 job groups, 8 major job groups (1,068 subjects) were selected to evaluate the potential risk factors of musculoskeletal symptoms.
RESULTS
The prevalence of musculoskeletal symptoms was 19.1% for the upper extremities, 7.6% for the back, and 7.7% for the lower extremities. Regardless of body part, the prevalence was 25.5%. In logistic regression analysis, among workers of 8 major job groups, those who experienced prior acute injuries were more likely to have musculoskeletal symptoms in the same region as that of the injury (for the upper extremities, odds ratio [OR] 2.19, 95% confidence interval [CI] 1.51-3.16; for the back, OR 7.35, 95% CI 4.01-13.48; for the lower extremities, OR 4.20, 95% CI 2.33-7.57), after adjusting for age, duration of employment, and job contents.
CONCLUSIONS
The effect of job contents differed according to the presence of prior acute injury. Among workers with prior injuries, the relationship between job contents and musculoskeletal symptoms was not statistically significant in general. Among workers with no prior injuries, job contents was a significant variable for the musculoskeletal symptoms of the upper extremities and back, after adjusting for age and duration of employment. These findings suggest that prior acute injuries are a potential risk factor for musculoskeletal disorders in the workforce. More detailed and specific strategies for managing musculoskeletal disorders including prevention of musculoskeletal injuries is needed.
Topics: Acute Disease; Adult; Aging; Humans; Industry; Korea; Male; Middle Aged; Musculoskeletal Diseases; Occupational Diseases; Steel; Trauma Severity Indices; Wounds and Injuries
PubMed: 19372627
DOI: 10.1539/joh.o8025 -
Clinical Orthopaedics and Related... Jul 2020Orthopaedic studies have reported the prevalence of injuries and outcomes after treatment in men and women patients, and although these differences have been recognized,... (Comparative Study)
Comparative Study
BACKGROUND
Orthopaedic studies have reported the prevalence of injuries and outcomes after treatment in men and women patients, and although these differences have been recognized, few studies have evaluated for gender-specific injury patterns, disease progression, and treatment outcomes. A thorough understanding of gender-related differences is important to better individualize treatment and improve outcomes.
QUESTIONS/PURPOSES
In this study, we sought (1) to determine the proportion of studies published in six orthopaedic journals that provided sex- or gender-specific analyses in 2016 and whether a difference was found in outcomes between men and women and (2) to evaluate whether this proportion varied across several orthopaedic subspecialty journals or between general orthopaedic journals and subspecialty journals.
METHODS
Six leading orthopaedic surgery journals were selected for review, including two general orthopaedic journals (Journal of Bone and Joint Surgery and Clinical Orthopaedics and Related Research®) and four subspecialty journals (American Journal of Sports Medicine, Journal of Arthroplasty, Journal of Shoulder and Elbow Surgery, and Spine). Journal issues published in the even-numbered months of 2016 were reviewed for clinical randomized controlled, cohort, and case-control studies in which women were a part of the study population. A total of 712 studies evaluating 24,607,597 patients met the criteria and were included in our review of publications from 2016. The selected studies were stratified based on whether gender was a variable in a multifactorial statistical model. Outcomes of interest included the proportion of patients who were women and the presence or absence of a gender-specific analysis. These endpoints were compared between journals.
RESULTS
Overall, 55% (13,565,773 of 24,607,597) of patients analyzed in these studies were women. Only 34% (241 of 712) of the studies published in 2016 included gender as variable in a multifactorial statistical model. Of these, 39% (93 of 241) demonstrated a difference in the outcomes between patients who were men and women. The Journal of Arthroplasty had the greatest percentage of patients who were women (60%, 9,251,068 of 15,557,187) and the American Journal of Sports Medicine had the lowest (44%, 1,027,857 of 2,357,139; p < 0.001). Orthopaedic subspecialty journals tended to include a greater percentage of women (54%) than did general orthopaedic journals (50%; p = 0.04).
CONCLUSION
Currently, it is unclear what percentage of published orthopaedic studies should include a gender-specific analysis. In the current study, more than one-third of publications that performed a gender-specific analysis demonstrated a difference in outcomes between men and women, thereby emphasizing the need to determine when such an analysis is warranted.
CLINICAL RELEVANCE
Future studies should aim to determine when a gender-specific analysis is necessary to improve the management of orthopaedic injuries in men and women. It is important for investigators at the individual-study level to look for every opportunity to ensure that both men's and women's health needs are met by performing appropriate by-sex and by-gender analyses, but not to perform them when they are unnecessary or inappropriate.
Topics: Bibliometrics; Biomedical Research; Female; Health Status Disparities; Healthcare Disparities; Humans; Male; Musculoskeletal Diseases; Orthopedic Procedures; Orthopedics; Periodicals as Topic; Sex Distribution; Sex Factors; Treatment Outcome; Wounds and Injuries
PubMed: 32281769
DOI: 10.1097/CORR.0000000000001172 -
Clinical Orthopaedics and Related... Oct 2008Deficiencies in the delivery of musculoskeletal trauma care in low- and middle-income countries can be attributed to a variety of causes, all of which can be linked to... (Review)
Review
Deficiencies in the delivery of musculoskeletal trauma care in low- and middle-income countries can be attributed to a variety of causes, all of which can be linked to failure of the health system to deliver the necessary services to prevent death and disability. As such, a "systems" approach will be required to improve the delivery of services. The goal of this review is to familiarize the orthopaedic surgeon with selected topics in public health, including health systems, burden of disease, disability adjusted life year (DALY), cost-effective analysis, and related concepts (eg, met versus unmet need, access, utilization, effective coverage).
Topics: Cost of Illness; Cost-Benefit Analysis; Delivery of Health Care; Developing Countries; Disability Evaluation; Global Health; Health Care Costs; Health Services Accessibility; Health Services Research; Health Systems Plans; Humans; Musculoskeletal System; National Health Programs; Orthopedic Procedures; Program Development; Public Health; Wounds and Injuries
PubMed: 18712457
DOI: 10.1007/s11999-008-0413-2