Causes of death after sever trauma. An analysis of 298 consecutive medico-legal autopsies in an accident hospital.
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Abdominal Injuries↗
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Equestrian injuries in children and young adults.
We reviewed the English language scientific literature about equestrian injuries among children and young adults. All studies showed that more females than males were injured, with falls from horses being the most common cause of injury. Fractures were common, and head injuries were associated with the vast majority of deaths (72% to 78%) and hospitalizations (55% to 100%). Although the overall injury rate was low, equestrian athletes are at risk for serious injuries. Pediatricians should know the medical contraindications for participation in equestrian sports and encourage riders to obtain horse safety training and use protective headgear (helmets) approved by the American Society for Testing Materials when riding or working around horses. Pediatricians can play an active role in increasing public awareness of equestrian injuries and in reducing risk of injury.
Adolescent↗
Upper limb motor and sensory recovery after multiple proximal nerve injury in children: a long term review in five patients.
Five children who had sustained multiple proximal upper limb nerve injury were reviewed at 18 months to 3 1/2 years after primary repair had been carried out. The findings show that nerve regeneration occurred significantly more rapidly than in adults, with good return of motor and sensory function to the hand, resulting in each of the patients having a useful, painfree and functionally capable upper limb. In two of the cases, the limb had been completely severed. The findings support the view that primary repair of severed proximal nerves in this age group--even in avulsion type injuries--can give good results.
Arm Injuries↗
Upper extremity injuries associated with strength training.
Most injuries sustained during strength training are mild strains that resolve with appropriate rest. More severe injuries include traumatic shoulder dislocations, tendon ruptures of the pectoralis major, biceps, and triceps; stress fractures of the distal clavicle, humerus, radius, and ulna; traumatic fractures of the distal radius and ulna in adolescent weightlifters; and compressive and stretch neuropathies. These more severe injuries are usually the result of improperly performing a strength training exercise. Educating athletes regarding proper strength-training techniques serves to reverse established injury patterns and to prevent these injuries in the first place. Recognizing the association of anabolic steroid use to several of the injury patterns further reinforces the need for medical specialists to counsel athletes against their use. With the increasing use of supplements such as creatine, the incidence and nature of strength-training injuries may change further. Greater emphasis on the competitive performance of younger athletes undoubtedly will generate enthusiasm for strength training at earlier ages in both sexes. The importance of proper supervision of these young athletes by knowledgeable persons will increase. As the popularity of strength training grows, there will be ample opportunity to continue to catalog the injury patterns associated with this activity.
Anabolic Agents↗
Focal upper extremity neuropathy in neonates.
Focal upper extremity neuropathies are common in neonates. The brachial plexus is the most common site involved. Brachial plexus injuries may involve different structures, thus producing different clinical presentations: complete brachial plexus palsy, Duchenne-Erb palsy, upper-middle trunk brachial plexus palsy, Klumpke palsy, fascicular brachial plexus palsy, and bilateral brachial plexus palsy. The causes of brachial plexus palsy are obstetric injury, intrauterine compression, humeral osteomyelitis, hemangioma, exostosis of the first rib, neck compression, and neoplasm. The differential diagnosis of brachial plexus palsy includes pseudoparesis, amyoplasia congenita, congenita varicella syndrome, and neurological lesions at other neuroanatomical levels. The cause and the degree of injury dictate the prognosis. The prognosis of obstetric brachial plexus injury is usually good.
Arm Injuries↗
Automobile carburetor- and radiator-related burns.
Seventy-nine persons who had sustained automobile engine carburetor- and radiator-related burns were admitted to Grady Memorial Hospital Burn Unit between June 1, 1984 and September 30, 1990. Forty patients with carburetor-priming flame burns had a mean age of 31.5 years, a mean burn size of 13.4% total body surface area, and a mean length of stay of 13.8 days. There were 37 male patients. Four patients had an inhalation injury. Twenty-two surgical procedures were performed on 13 patients. One patient was an innocent bystander, and one patient died. The clothing of 16 patients had ignited, which resulted in larger, deeper burns and in one death. Burns predominantly involved the right sides of the face, head, and torso; the right upper extremity; and the right hand. Thirty-nine patients had scald burns that were associated with uncapping a radiator. These patients had a mean age of 29.6 years, a mean burn size of 8.9% total body surface area, and a mean length of stay of 6.4 days. There were 36 male patients and three innocent bystanders. One autografting procedure was performed, and there were no deaths in this group of patients. The burn-prone person is the young adult male. The circumstances that result in such dangerous behavior are predictable, and resultant burn injuries are preventable.
Accidents, Occupational↗
Soft tissue reconstruction of the extremity.
The care of the trauma patient is a challenge to orthopaedic nurses. It is important to be aware of the newer techniques that can be used to provide optimum benefit in reconstruction of soft tissue injuries that frequently accompany a skeletal injury of the extremities following trauma. This article focuses on the nursing care of the trauma patient requiring microvascular muscle and musculocutaneous transplants to reconstruct soft tissue injuries posttrauma.
Adult↗
Epidemiology of collegiate baseball injuries.
OBJECTIVE: We sought to establish injury incidence, onset, location, type, and severity for a collegiate baseball team. The second objective was to compare the number of musculoskeletal problems for which baseball players sought treatment with those that resulted in time lost or modified participation. METHODS: This was a prospective, epidemiologic study. A complaint was defined as any evaluation by a player to the medical staff that required either evaluation or treatment. An injury was defined as any complaint that resulted in altered participation or time lost from practice or game participation. Participants were Division I collegiate baseball team with one athletic trainer and one academic sports medicine specialist. All members of the collegiate baseball team were studied over a 3-year period to determine the overall incidence of injury per 1,000 exposures (A-E) to practice or participation, injuries sustained over 3 years by collegiate baseball players. RESULTS: Overall there were 277 complaints and 52 injuries (19%). The A-E rate was 5.83. Forty-six percent of the injuries occurred in practice and 54% in games. Seventy-three percent of the injuries resulted in < 7 days lost from sport, and 25% resulted in > 21 days lost participation. The most common origin of injury was strains (23%), sprains (19%), and contusions (17%). Fifty-eight percent of the injuries were to the upper extremity, 15% to the trunk/back, and 27% to a lower extremity. Upper extremity injuries accounted for 75% of the total time lost from the sport. When divided by position, the shoulder injuries occurred in pitchers (69%), infielders (19%), and outfielders (12%). Rotator cuff tendinitis was the most frequent complaint, was the most frequent injury, and resulted in the most time lost from the sport. CONCLUSIONS: Defining injury as time lost or as altered participation underestimates the frequency with which players seek evaluation and treatment. Injuries are divided widely across anatomic site, but upper extremity injuries cause the most time lost from the sport. Further study of the origin and prevention of upper extremity injuries in baseball is warranted.
Adult↗
Upper extremity injuries in snow skiers.
All skiers with upper extremity injuries seen at the Henry Ford Hospital between 1983 and 1986 were evaluated in terms of age, sex, skill of the skier, type of snow conditions, pole type, grip type, direction of fall, and mechanism of injury. Our primary objective was to evaluate whether the type of pole used had an effect on the injury rate. We found that the strap handled pole without any platform had the lowest injury rate. The saber type pole handle had the highest injury rate. Other observations showed ulnar collateral ligament injury of the thumb to be the most common upper extremity injury to skiers. A proportionally high number of skiers with upper extremity injuries were advanced skiers.
Arm Injuries↗
Ice hockey injuries in Finland. A prospective epidemiologic study.
In this prospective study of ice hockey injuries in Finland we have investigated the incidence of injury at two playing levels and the causal factors, mechanisms, types, and consequences of the injuries. Seven Finnish ice hockey teams were observed during the 1988 to 1989 season. There were a total of 189 injuries. There were 134 injuries in 4 teams of the highest level, the Finnish National League, and 55 injuries in 3 teams of the second highest level, Division I. The incidence of injuries during games was 66 per 1000 player-game hours in the National League and 36 per 1000 player-game hours in Division I. As for severity, 10 (5%) injuries were classified as major. Of all injuries, 15 (8%) were fractures and 34 (18%) were to the head or face. The most severe injuries were tears of a knee ligament or fractures of an upper extremity. Ongoing surveillance and an exact reporting system are needed for establishing the trends in the number and severity of the injuries.
Adolescent↗
Pre-competition habits and injuries in Taekwondo athletes.
BACKGROUND: Over the past decade, there has been heightened interest in injury rates sustained by martial arts athletes, and more specifically, Taekwondo athletes. Despite this interest, there is a paucity of research on pre-competition habits and training of these athletes. The purpose of this pilot study was to assess training characteristics, competition preparation habits, and injury profiles of Taekwondo athletes. METHODS: A retrospective survey of Canadian male and female Taekwondo athletes competing in a national tournament was conducted. Competitors at a Canadian national level tournament were given a comprehensive survey prior to competition. Items on training characteristics, diet, and injuries sustained during training and competition were included. Questionnaires were distributed to 60 athletes. RESULTS: A response rate of 46.7% was achieved. Of those that responded, 54% dieted prior to competition, and 36% dieted and exercised pre-competition. Sixty-four percent of the athletes practised between 4-6 times per week, with 54% practicing 2 hours per session. Lower limb injuries were the most common (46.5%), followed by upper extremity (18%), back (10%), and head (3.6%). The majority of injuries consisted of sprains/strains (45%), followed by contusions, fractures, and concussions. More injuries occurred during training, including 59% of first injuries. CONCLUSION: More research needs to be conducted to further illustrate the need for appropriate regulations on weight cycling and injury prevention.
Adolescent↗
11. Fractures and minor head injuries: minor injuries in children II.
Fractures in children are common, but the plasticity of children's bones means that they may be incomplete. If a child has deformity, swelling or bony point tenderness in a limb after a fall, it is likely to be fractured. A fractured limb that appears deformed will most probably need to be reduced. Effective splinting, using whatever means is readily available, and early, adequate analgesia, can ameliorate the severe pain associated with a fracture. In young children with open growth plates, Salter-Harris type I injuries of the distal fibula are more common than ligament injuries of the ankle. After an ankle ligament injury, functional treatment--brace or tapes, with active physiotherapy--results in a better outcome than immobilisation. A child with a head injury, who does not lose consciousness, has only one or no episodes of vomiting, and is stable, alert and interactive, and neurologically normal, is extremely unlikely to have sustained an intracranial injury.
Arm Injuries↗
Preventing upper extremity overuse injuries in child and adolescent athletes.
Physicians who treat young athletes must not only correctly diagnose specific musculoskeletal injuries but also pay attention to factors that predispose the patient to the injury. This article reviews the intrinsic and extrinsic factors that can lead to upper extremity overuse injury in child and adolescent athletes and describes the physician's role in preventing injury in this population.
Adolescent↗
[Formation of functional stumps of the extremities in severe mechanical trauma].
The authors analyze the treatment of 54 patients with 65 limb stumps resultant from injuries to the limbs in 41 patients shortly exposed to traumatic agents and in 13 patients after a prolonged crushing of the limb during the earthquake in Armenia. Amputations were carried out as primary surgical wound treatment followed by open healing of the wound. To prevent infections, 12 patients were treated with the use of a local gnotobiologic isolation, the rest by traditional methods with due consideration for the wound process. Local treatment of stump wounds in the patients with the crush syndrome involved some specific measures because of massive necroses and deep suppuration. For the early formation of functional stumps of the limbs, wound treatment was followed by reconstructive surgery by closing the stump wound defect with massive removed skin and subcutaneous fat flaps and subsequent active drainage of the wound. Postoperative treatment was aimed at improving the microcirculation in the skin grafts. The status of the stump soft tissues and bone was assessed over the course of treatment by limb scintigraphy with 99mTc-labeled pyrophosphate. Such investigation helps determine the optimal terms for reconstructive surgery and predict its outcome. Good results were achieved: 80.6% of patients were supplied with prostheses within 3-4 months after the injury.
Amputation Stumps↗
[Post-traumatic carpal tunnel syndrome].
In the course of a ten months study on 508 patients with CTS a trauma as a possible causal factor was observed in 22 cases. In none of these cases did the other hand show normal electroneurographic parameters. The mean values of distal motor latency were among 5.5 ms (3.7-9.2 ms) on the injured side and 4.6 (3.5-6.7 ms) on the other. The relatively seldom occurrence of CTS in connection with a trauma requires therefore strict criteria for the evaluation of the casual context. A traumatic etiology can only be recognised if a close temporal relation exists (beginning of the symptomatology during immobilisation or after removal of the cast) or a special tendency to swelling or a dislocation as well as a clear difference in electroneurographic values of the two sides can be observed. Depending on the degree of this difference in latency one can maintain criteria for evaluating the question of causality or of transient or permanent deterioration. Finally in case of CTS the treatment should be given primary importance ahead of reimbursement for the injury.
Adult↗
Problems of the upper extremity in gymnastics.
The majority of upper extremity problems experienced by gymnasts are not considered injuries but are regarded as consequences of the sport. Treatment of these problems should include treatment of not only the injury but also the cause. This requires the cooperation of the gymnast, his or her coach, and a physician familiar with the demands placed upon the upper extremity in gymnastics. The level of a gymnast's capabilities must be recognized. Improper techniques must be corrected. Emphasis must be placed on rehabilitation for shoulder problems and strengthening exercises for the elbow and wrist in attempt to decrease the symptoms from repeated forced extension. In the words of Peter Kormann, an Olympic medalist in gymnastics, "All gymnasts work out and compete with ongoing problems in their upper extremities. These problems are only considered serious injuries when the gymnast can no longer compete."
Arm Injuries↗
[Snowboard sports technique, injury pattern, prevention].
Although, in Europe, snowboarding is a young sport, it has already established itself and, in common with Alpine skiing, is represented in the Olympics. Its biomechanical aspects (technique, shoeboard connection), lead not only to a typical pattern of movements, but also to a snowboard-specific pattern of injuries, which differs from that seen with Alpine skiing. In the case of snowboarding, the upper limbs are appreciably more often involved in injuries than are the lower extremities. The most common injuries are fractures of or close to the wrist. Since many children and adolescents are to be found among snowboarding fans, the percentage of epiphyseal injuries is high. Depending on the style employed-Alpine or freestyle-the risk of lower limb injuries differ in terms of ankles and knee injuries. Through the use of special protective equipment, such as gloves provided with extra protection for wrist and fingers, (possibly also helmets, knee and elbow protectors for beginners), together with improvements in technique in a snowboard school, and the optimisation of the materials used by the industry, the risk of injury can be reduced.
Arm Injuries↗
Wringer injuries in children.
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Accidents↗