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Bulletin of the NYU Hospital For Joint... 2009The timing of operative fracture care is often confounded by multisystem injuries, conflicting or absent literature, and lack of communication between orthopaedic... (Review)
Review
The timing of operative fracture care is often confounded by multisystem injuries, conflicting or absent literature, and lack of communication between orthopaedic surgeons and other physicians providing care to the patient. Much has been published regarding the proper sequence of events in providing care to patients with multisystem injuries. Only recently has the role of complex musculoskeletal injuries and the timing of fixation in multiply-injured patients been explored in detail. Timing of care for pelvic injuries is frequently determined by the presence of injury to other organ systems, the presence of open wounds, and hemodynamic status. There is likely an optimal time window for fixation. However, existing data is often difficult to compare, given varying definitions and protocols. Furthermore, reports are often conflicting, making the determination of an optimal time-window difficult. Similar concerns are present with lower extremity long bone fractures. Injury to other organ systems must be considered with timing of femur fixation, particularly in the presence of lung injury. Tibia fractures are frequently complicated by the presence of a tenuous soft tissue envelope and other injury factors that often alter the timing of fixation. These issues and, last, the timing of care for calcaneus and talus injuries are reviewed, as risk of avascular necrosis and quality of articular reduction are related to the timing of fixation.
Topics: Adult; Calcaneus; Debridement; Diaphyses; Female; Femoral Neck Fractures; Fracture Fixation; Fractures, Bone; Hemodynamics; Humans; Male; Patient Care Team; Pelvic Bones; Radiography; Surgical Flaps; Tibial Fractures; Time Factors; Treatment Outcome; Wounds, Gunshot; Young Adult
PubMed: 19302059
DOI: No ID Found -
Archives of Physical Medicine and... May 1999This self-directed learning module discusses classic concepts and highlights new advances in the diagnosis and management of shoulder and upper extremity injuries... (Review)
Review
This self-directed learning module discusses classic concepts and highlights new advances in the diagnosis and management of shoulder and upper extremity injuries commonly occurring from athletic competition. It is part of the chapter on musculoskeletal rehabilitation and sports medicine in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation.
Topics: Adult; Aged; Arm Injuries; Athletic Injuries; Baseball; Diagnosis, Differential; Female; Football; Golf; Humans; Male; Shoulder Injuries; Sports Medicine
PubMed: 10326903
DOI: 10.1016/s0003-9993(99)90103-x -
Clinical Orthopaedics and Related... Oct 2008Trauma is becoming a leading cause of death in most of the low-income and middle-income countries worldwide. The growing number of motor vehicles far surpasses the... (Review)
Review
Trauma is becoming a leading cause of death in most of the low-income and middle-income countries worldwide. The growing number of motor vehicles far surpasses the development and upkeep of the road and highway networks, traffic laws, and driver training and licensing. In Thailand, road traffic injuries have become the second leading cause of death and morbidity overall since 1990. The lack of improvement to existing roadways, implementation of traffic safety and ridership laws including seatbelt regulations, and poor emergency medical assistance support systems all contribute to these statistics. An insufficient number and inequitable distribution of healthcare professionals is also a national problem, especially at the district level. Prehospital care of trauma patients remains insufficient and improvements at the national level are suggested.
Topics: Accidents, Traffic; Delivery of Health Care; Developing Countries; Education, Medical; Emergency Medical Services; Health Care Costs; Health Care Rationing; Health Services Accessibility; Health Services Research; Healthcare Disparities; Humans; Musculoskeletal System; National Health Programs; Orthopedic Procedures; Outcome and Process Assessment, Health Care; Program Development; Thailand; Wounds and Injuries
PubMed: 18629597
DOI: 10.1007/s11999-008-0385-2 -
Sports Health 2023Risk for lower extremity musculoskeletal injury increases after sport-related concussion (SRC) and may result from unresolved motor control deficits. Muscle weakness is...
BACKGROUND
Risk for lower extremity musculoskeletal injury increases after sport-related concussion (SRC) and may result from unresolved motor control deficits. Muscle weakness is a deficit that could contribute to musculoskeletal injury risk.
HYPOTHESIS
Athletes with SRC will demonstrate quadriceps and hamstring muscle weakness at the time of return to sport and 30 days later compared with controls.
STUDY DESIGN
Prospective matched cohort.
LEVEL OF EVIDENCE
Level 3.
METHODS
A total of 31 athletes with SRC (CONCUSSION) were matched by sex, age, and activity level to controls (CONTROL). Testing was conducted at initial assessment and 30 days later; initial assessment in CONCUSSION occurred when cleared for return to play. Isokinetic testing assessed quadriceps and hamstring strength of the dominant and nondominant legs at 60 and 180 deg/s. Peak torque values were normalized to body mass (N-m/kg). Data were analyzed with repeated measures general linear models (group × time), and effect sizes were calculated.
RESULTS
Analysis at 60 deg/s included 26 matched pairs (15 male per group) and at 180 deg/s included 30 matched pairs (17 males per group). Time from concussion to initial assessment was 21.3 (7.8) mean (standard deviation) days. No significant interactions or main effects were detected ( > 0.05). Across muscle groups, legs, and testing speeds, effect sizes at initial assessment were small ( = 0.117 to 0.353), equating to a strength deficit in CONCUSSION of 0.04 to 0.18 N-m/kg, and effect sizes were further reduced at 30-day follow-up = -0.191 to 0.252).
CONCLUSION
In athletes with SRC, quadriceps and hamstring strength were decreased only minimally at return to play compared with controls and the difference lessened over 30 days.
CLINICAL RELEVANCE
Strength deficits may not be a major contributor to increased lower extremity musculoskeletal injury risk after SRC. Strength training could be implemented before return to play after SRC to mitigate any strength deficits.
Topics: Humans; Male; Athletic Injuries; Prospective Studies; Hamstring Muscles; Brain Concussion; Sports; Quadriceps Muscle; Leg Injuries; Muscle Strength
PubMed: 36517989
DOI: 10.1177/19417381221136140 -
European Journal of Sport Science 2014Acute muscle belly injuries to the semitendinosus, semimembranosus and biceps femoris (the 'hamstring' muscles) remain a common problem in the sporting population.... (Review)
Review
Acute muscle belly injuries to the semitendinosus, semimembranosus and biceps femoris (the 'hamstring' muscles) remain a common problem in the sporting population. Physiotherapy-led rehabilitation remains the mainstay of treatment, and the physician's input is often minimal. Anecdotally, many different topical, oral and injectable therapies are used around the world in an effort to accelerate the healing of these injuries and to prevent their recurrence. This article reviews the evidence available to support some of the most commonly used medical therapies and the pathophysiological basis for their use. It also presents the evidence behind some of the more promising future treatments for muscle injury, including stem cell therapy, growth factor delivery and potential novel uses of current medication not traditionally used in the musculoskeletal setting.
Topics: Athletic Injuries; Humans; Leg Injuries; Muscle, Skeletal
PubMed: 24422710
DOI: 10.1080/17461391.2013.878756 -
American Family Physician Jan 1998When not diagnosed early and managed appropriately, common musculoskeletal injuries may result in long-term disabling conditions. Anterior cruciate ligament tears are... (Review)
Review
When not diagnosed early and managed appropriately, common musculoskeletal injuries may result in long-term disabling conditions. Anterior cruciate ligament tears are some of the most common knee ligament injuries. Slipped capital femoral epiphysis may present with little or no hip pain, and subtle or absent physical and radiographic findings. Femoral neck stress fractures, if left untreated, may result in avascular necrosis, refractures and pseudoarthrosis. A delay in diagnosis of scaphoid fractures may cause early wrist arthrosis if nonunion results. Ulnar collateral ligament tears are a frequently overlooked injury in skiers. The diagnosis of Achilles tendon rupture is missed as often as 25 percent of the time. Posterior tibial tendon tears may result in fixed bony planus if diagnosis is delayed, necessitating hindfoot fusion rather than simple soft tissue repair. Family physicians should be familiar with the initial assessment of these conditions and, when appropriate, refer patients promptly to an orthopedic surgeon.
Topics: Achilles Tendon; Anterior Cruciate Ligament Injuries; Carpal Bones; Collateral Ligaments; Diagnosis, Differential; Epiphyses, Slipped; Femoral Neck Fractures; Femur Head; Fractures, Bone; Humans; Joint Diseases; Joints; Musculoskeletal System; Rupture; Tendon Injuries; Tibia; Ulna
PubMed: 9456991
DOI: No ID Found -
Journal of Biomechanics 2007This paper presents a survey of side impact trauma-related biomedical investigations with specific reference to certain aspects of epidemiology relating to the growing... (Review)
Review
This paper presents a survey of side impact trauma-related biomedical investigations with specific reference to certain aspects of epidemiology relating to the growing elderly population, improvements in technology such as side airbags geared toward occupant safety, and development of injury criteria. The first part is devoted to the involvement of the elderly by identifying variables contributing to injury including impact severity, human factors, and national and international field data. This is followed by a survey of various experimental models used in the development of injury criteria and tolerance limits. The effects of fragility of the elderly coupled with physiological changes (e.g., visual, musculoskeletal) that may lead to an abnormal seating position (termed out-of-position) especially for the driving population are discussed. Fundamental biomechanical parameters such as thoracic, abdominal and pelvic forces; upper and lower spinal and sacrum accelerations; and upper, middle and lower chest deflections under various initial impacting conditions are evaluated. Secondary variables such as the thoracic trauma index and pelvic acceleration (currently adopted in the United States Federal Motor Vehicle Safety Standards), peak chest deflection, and viscous criteria are also included in the survey. The importance of performing research studies with specific focus on out-of-position scenarios of the elderly and using the most commonly available torso side airbag as the initial contacting condition in lateral impacts for occupant injury assessment is emphasized.
Topics: Accidents, Traffic; Age Factors; Aged; Aged, 80 and over; Air Bags; Animals; Humans; Male; Wounds and Injuries
PubMed: 16527285
DOI: 10.1016/j.jbiomech.2006.01.002 -
American Family Physician Nov 2019According to the U.S. Census Bureau, 18.2 million veterans were living in the United States in 2017, of whom 1.6 million were female. Less than one-half of all veterans...
According to the U.S. Census Bureau, 18.2 million veterans were living in the United States in 2017, of whom 1.6 million were female. Less than one-half of all veterans receive care at a Veterans Health Administration or military treatment facility, leaving most to receive services from primary care physicians. Injuries and illnesses common among this patient population include musculoskeletal injuries and chronic pain, mental health issues such as posttraumatic stress disorder (PTSD) and moral injury, traumatic brain injury, chemical and noise exposures, and infectious disease concerns. Family physicians should ask about military service and be well informed about the range of veterans' health concerns, particularly PTSD, depression, and suicidality. Physicians should screen veterans for depression using the Patient Health Questionnaire-9 and for PTSD using the PTSD Checklist for DSM-5. Veterans with traumatic brain injury should be screened specifically for comorbid PTSD and chronic pain because the diagnosis informs treatment. Exposures to loud noise, chemicals, and infectious diseases are prevalent and can cause disability. Family physicians can use available resources and clinical practice guidelines such as those from the U.S. Department of Veterans Affairs and Department of Defense to inform care and to assist veterans.
Topics: Adult; Chronic Pain; Communicable Diseases; Comorbidity; Curriculum; Education, Medical, Continuing; Female; Humans; Male; Mental Disorders; Middle Aged; Military Medicine; Practice Guidelines as Topic; United States; Veterans; Wounds and Injuries
PubMed: 31674738
DOI: No ID Found -
Acta Orthopaedica Apr 2023Trauma causes over 4 million annual deaths globally and accounts for over 10% of the global burden of disease. Trauma patients often sustain multiple injuries in...
BACKGROUND AND PURPOSE
Trauma causes over 4 million annual deaths globally and accounts for over 10% of the global burden of disease. Trauma patients often sustain multiple injuries in multiple organ systems. We aimed to investigate the proportion and distribution of musculoskeletal injuries in adult trauma patients.
PATIENTS AND METHODS
This is a register-based study using data from the national Swedish trauma register (SweTrau) collected in 2015-2019. By categorizing Abbreviated Injury Scale (AIS) codes into different injury types, we provide a detailed description of the types of musculoskeletal injuries that occurred in trauma patients.
RESULTS
51,335 cases were identified in the register. After exclusion of 7,696 cases that did not have any trauma diagnosis (AIS codes) registered from the trauma and 6,373 patients aged < 18, a total of 37,266 patients were included in the study. 15,246 (41%) had sustained musculoskeletal injury. Of the patients with musculoskeletal injuries, 7,733 (51%) had more than 1 such injury. Spine injuries were the most common injury location (n = 7,083 patients, 19%) followed by lower extremity injuries (n = 5,943 patients, 16%) and upper extremity injuries (n = 6,273 patients, 17%). Fractures were the dominating injury type with 30,755 (87%) of injuries being a fracture.
CONCLUSION
41% of the trauma patients had at least 1 musculoskeletal injury. A spine injury was the most common injury location. Fractures was the dominating injury type constituting 87% of all injuries. We also found that half the patients (51%) with spine or extremity injuries had ≥ 2 such injuries.
Topics: Adult; Humans; Sweden; Multiple Trauma; Fractures, Bone; Abbreviated Injury Scale; Spine
PubMed: 37074086
DOI: 10.2340/17453674.2023.11960 -
Physical Therapy in Sport : Official... May 2023To explore schools' rugby players' and their parents' perceptions of injury.
OBJECTIVES
To explore schools' rugby players' and their parents' perceptions of injury.
DESIGN
A qualitative study using focus groups.
SETTING
Schools who compete in the Ulster Schools' Cup competition.
PARTICIPANTS
13 players and 9 parents.
OUTCOME MEASURES
A thematic analysis approach was used to examine players' and parents' beliefs and attitudes towards injury, return to play and injury risk.
RESULTS
Findings suggest schools' rugby players and their parents are aware of injury risk in the schoolboy game. They are aware of concussion injury but are less aware of musculoskeletal injury. Parents' perceptions of injury are based on their experience of their sons' injuries. Parents are unaware of return to play strategies for musculoskeletal injury.
CONCLUSIONS
Schools' rugby players and their parents are aware of injury to some extent, however players' and parents' knowledge and understanding of injury is based on and informed by personal experience, not the evidence base. Whist they are aware of injury, many players will seek to push their fears to the back of their mind. However, for those players who have suffered severe injury, they are concerned about the risk of reinjury.
Topics: Humans; Brain Concussion; Rugby; Football; Parents; Schools; Athletic Injuries
PubMed: 37084665
DOI: 10.1016/j.ptsp.2023.04.005