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To describe the mechanisms, situational patterns, and biomechanics (kinematics) of medial collateral ligament (MCL) injuries in professional male soccer players.Case series.Fifty-seven consecutive MCL injuries across 2 seasons of professional soccer matches were identified. We obtained and reviewed 37 of 57 (65%) injury videos to establish the injury mechanism, situational pattern, and knee flexion angle. We used detailed biomechanical analysis to assess the indirect and noncontact injuries. Injury layoff times, timing of injuries during the match, and location of the injuries on the pitch were also reported.Twenty-three (62%) injuries were direct contact, 9 (24%) were indirect contact, and 5 (14%) were noncontact. Three main sprain mechanisms were noted: (1) direct contact/blow to the knee (n = 16), (2) contact to the leg or foot (lever like) (n = 7), and (3) sliding (n = 9). Seventy-three percent of MCL injuries occurred during 2 main situations: (1) pressing/tackling (n = 14, 38%) and (2) being tackled (n = 13, 35%). For indirect and noncontact injuries, knee valgus loading (100% of cases), hip abduction (73% of cases), and external foot rotation (92% of cases) were prominent injury kinematics, often with lateral trunk tilt (median, 10°; 64% of cases) and rotation (64% of cases). Knee flexion angles were higher for indirect and noncontact injuries (median, 100°) than for direct-contact injuries (median, 22°;Nearly two thirds of MCL injuries occurred after direct contact; 1 in every 4 MCL injuries occurred after indirect contact. Three sprain mechanisms characterized MCL injuries: (1) blow to the knee, (2) contact to the leg or foot (lever like), and (3) sliding.

Purpose Injury prevalence patterns for climbers have been presented in several papers but results are heterogenous largely due to a mix of included climbing disciplines and injury mechanisms. This study describes the distribution and pattern of acute traumatic climbing injuries sustained during outdoor climbing in Sweden. Methods Patients that experienced a climbing related traumatic injury during outdoor climbing between 2008 and 2019 and who submitted a self-reported questionnaire to the Swedish Climbing Association were included in the study. Medical records were retrieved, and the International Climbing and Mountaineering Federation injury classification system was used for injury presentation. Results Thirty-eight patients were included in the study. Seven (18%) injuries occurred during traditional climbing, 13 (34%) during sport climbing and 9 (24%) during bouldering. Varying with climbing discipline, 84–100% injuries were caused by falls. Injuries of the foot and ankle accounted for 72–100% of the injuries. Fractures were the most common injury (60%) followed by sprains (17%) and contusions (10%). Conclusions Traumatic injuries sustained during outdoor climbing in Sweden were predominantly caused by falls and affected the lower extremities in all major outdoor climbing disciplines. Rope management errors as a cause of injury were common in sport climbing and in activity surrounding the climbing, indicating there is room for injury-preventing measures.

Standing balance deficits are prevalent after concussions and have also been reported after subconcussive head impacts. However, the mechanisms underlying such deficits are not fully understood. The objective of this review is to consolidate evidence linking head impact biomechanics to standing balance deficits. Mechanical energy transferred to the head during impacts may deform neural and sensory components involved in the control of standing balance. From our review of acute balance-related changes, concussions frequently resulted in increased magnitude but reduced complexity of postural sway, while subconcussive studies showed inconsistent outcomes. Although vestibular and visual symptoms are common, potential injury to these sensors and their neural pathways are often neglected in biomechanics analyses. While current evidence implies a link between tissue deformations in deep brain regions including the brainstem and common post-concussion balance-related deficits, this link has not been adequately investigated. Key limitations in current studies include inadequate balance sampling duration, varying test time points, and lack of head impact biomechanics measurements. Future investigations should also employ targeted quantitative methods to probe the sensorimotor and neural components underlying balance control. A deeper understanding of the specific injury mechanisms will inform diagnosis and management of balance deficits after concussions and subconcussive head impact exposure.

Traumatic thoracic or chest wall hernias are relatively uncommon but highly challenging injuries that can be seen after a variety of injury mechanisms. Despite their description throughout history there remains scant literature on this topic that is primarily limited to case reports or series. Until recently, there also has been no effort to create a reliable grading system that can assess severity, predict outcomes, and guide the choice of surgical repair. The purpose of this article is to review the reported literature on this topic and to analyze the history, common injury mechanisms, likely presentations, and optimal management strategies to guide clinicians who are faced with these challenging cases. We also report a modified and updated version of our previously developed grading system for traumatic chest wall hernias that can be utilized to guide surgical management techniques and approaches.

Introduction Trauma is among the leading causes of death and disability in both adults and children worldwide. In Malawi, trauma patients are commonly brought in dead (BID). We aimed to describe the prevalence, sociodemographic, and injury-related characteristics of patients BID to Kamuzu Central Hospital (KCH), a referral hospital in Lilongwe, Malawi. Methods We retrospectively reviewed records of all patients BID in the trauma surveillance registry at KCH from February 2008 to September 2019. We excluded patients BID that did not present to the emergency centre, and were instead taken to the mortuary directly. We used descriptive statistics to evaluate the epidemiology of patients BID. Results We reviewed 106,198 trauma records and 1889 (1.8%) were BID patients. Most patients BID were male, in both adult (n = 1337/1528, 88.4%) and children (n = 231/360, 64.9%) cohorts. The mean age was 34.7 (SD 11.9) years in adults and 7.8 (SD 5.4) years in children. Among the adult BID patients, 33.2% were unemployed, 25.6% were construction workers, and 10.1% were small business owners or managers. The common injury mechanisms in adults were road traffic-related injuries (RTIs) (47.1%) and assaults (23.6%). In children, injuries resulted from RTIs (39.7%), with 74.4% of those were pedestrians hit by cars, drowning (22.9%), and burns (12.4%). In both groups, most injuries occurred on roads (60.2%) or at home (22.1%). Reported alcohol use at the time of trauma was present in 6.3%. The police (57.9%) and privately-owned vehicles (26.6%) transported most BID patients to KCH. Conclusion Efforts to reduce prehospital trauma mortality must focus on improving prehospital care, including training the police and community in basic life support and improving resources towards prehospital trauma care. Further efforts to reduce prehospital mortality must aim to decrease injuries on the roads and at home.

Background The unclear mechanisms and severity of injuries in the injury pyramids for Chinese children and adolescents prevent the prioritization of interventions. This study aimed to describe the injury mechanisms and injury pyramids in this population to provide a priority for injury prevention strategies. Methods Death, hospitalization, and outpatient/emergency department visit data from patients aged 0 ~ 17 years with injuries were obtained from January 1, 2013, to December 31, 2017, in Zhuhai City, China. The injury mechanism ratios were calculated, and the injury pyramid ratios were drawn in proportion using injury mortality and the incidence of both injury hospitalizations and outpatient/emergency department injury visits. Results The top three mechanisms for injuries in children and adolescents treated in outpatient/emergency departments were falls (52.02%), animal bites (14.57%), and blunt injuries (10.60%). The top three mechanisms for injury hospitalizations were falls (37.33%), road traffic injuries (17.87%), and fire/burns (14.29%), while the top three mechanisms for injury deaths were drowning (32.91%), road traffic injuries (20.25%) and falls (13.92%). The incidence rate of outpatient/emergency department injury visits for children and adolescents was 11,210.87/100,000; the incidence rate of injury hospitalization was 627.09/100,000, and the injury death rate was 10.70/100,000. For each injury death, there were 59 injury hospitalizations and 1048 outpatient/emergency injury visits. Conclusions The injury mechanisms were different for injury-related outpatient/emergency department visits, hospitalizations, and deaths among children and adolescents. The injury mechanisms by sex at different stages of child development, and interventions should be formulated based on this finding. The ratios of the injury pyramids varied by age, sex, region, and injury mechanisms; minor nonfatal injuries were more common in children and adolescents. The differences in the severity and extent of the injuries suggested that injury interventions in children and adolescents still have a long way to go.

To examine the incidence, characteristics, and economic burden of orbital floor fractures in the United States.Retrospective, longitudinal study of the Nationwide Emergency Department Sample (NEDS).Patients in the Emergency Department (ED).The NEDS, a representative sample of all hospital-based EDs in the US, was used to identify and describe ED visits with a primary diagnosis of orbital floor fracture from 2006 to 2017. Linear regression was used to estimate the trends in annual incidence and inflation-adjusted ED charges. Logistic regression was used to assess variables associated with inpatient admission.Incidence, injury mechanisms, demographics, clinical characteristics, disposition, and economic burden.From 2006 to 2017, there were an estimated 350 379 ED visits in the US with a primary diagnosis of orbital floor fracture. The incidence increased by 47% over the study period (P0.001): from 7.7 (95% confidence interval [CI], 6.9-8.5) to 11.3 (95% CI, 10.0-12.6) per 100 000 population. The majority were male (67%), aged 21 to 44 years (46%), and from low-income households (32%). The most common cause was assault (43%), which was most frequent in young adults (65%) and increased modestly over time (3.5 to 4.5 per 100 000 population; P = 0.02). The second most common cause was falls (26%), most frequent in patients aged ≥65 years (86%) and more than doubled over time (1.6 to 3.5 per 100 000 population; P0.001). The rate of inpatient admission was 14%, with a higher likelihood for patients aged ≥65 years (odds ratio [OR], 2.21; 95% CI, 1.99-2.46; P0.001) and falls (OR, 1.54; 95% CI, 1.27-1.86; P0.001). The total inflation-adjusted ED charges over the study period exceeded $2 billion, with the mean charge per visit increasing 48% (P0.001): from $5881 (95% CI, 5499-6263) to $8728 (95% CI, 8074-9382).Orbital floor fractures are becoming an increasingly common and costly injury in the United States. Preventive strategies aimed at reducing assault and falls will be crucial to mitigate the burden of orbital floor fractures on the healthcare system.

The posterior cruciate ligament (PCL) represents an intra-articular structure composed of two distinct bundles. Considering the anterior and posterior meniscofemoral ligaments, a total of four ligamentous fibre bundles of the posterior knee complex act synergistically to restrain posterior and rotatory tibial loads. Injury mechanisms associated with high-energy trauma and accompanying injury patterns may complicate the diagnostic evaluation and accuracy. Therefore, a thorough and systematic diagnostic workup is necessary to assess the severity of the PCL injury and to initiate an appropriate treatment approach. Since structural damage to the PCL occurs in more than one third of trauma patients experiencing acute knee injury with hemarthrosis, background knowledge for management of PCL injuries is important. In Part 1 of the evidence-based update on management of primary and recurrent PCL injuries, the anatomical, biomechanical, and diagnostic principles are presented. This paper aims to convey the anatomical and biomechanical knowledge needed for accurate diagnosis to facilitate subsequent decision-making in the treatment of PCL injuries.Level of evidence V.

Jump landing is a common situation leading to knee injuries involving the anterior cruciate ligament (ACL) in sports. Although neuromuscular control is considered as a key injury risk factor, there is a lack of knowledge regarding optimum control strategies that reduce ACL forces during jump landing. In the present study, a musculoskeletal model-based computational approach is presented that allows identifying neuromuscular control patterns that minimize ACL forces during jump landing. The approach is demonstrated for a jump landing maneuver in downhill skiing, which is one out of three main injury mechanisms in competitive skiing.

BACKGROUND Demand for travel for both work and leisure continues to rise in the U.S. However, handling luggage subjects the shoulder to excessive physical loads. OBJECTIVE To report national estimates, demographic characteristics, and injury mechanisms of patients presenting to U.S. emergency departments with luggage-associated shoulder injuries. METHODS This cross-sectional, retrospective study analyzes the National Electronic Injury Surveillance System (NEISS) database (2003-2017) to identify annual cases of luggage-associated shoulder injuries presenting to U.S. emergency departments. RESULTS On average, 1,811 luggage-associated shoulder injuries presented to U.S. emergency departments annually (95% Confidence Interval: [C.I.] 1,123-2,499). Patients were commonly females (62.3%; 57.9%-66.8%) sustaining sprains, strains, or muscle tears (60.1%; 52.6%-67.7%). The majority of patients sustained shoulder injuries while lifting their luggage (70.1%; C.I. 64.9%-75.2%). Injuries were most often observed in patients 40-49 (21.5%; C.I. 16.5%-26.5%) and 50-59 (24.9%; C.I. 20.2%-29.6%) years of age. However, those sustaining shoulder injuries due to falls to the ground were significantly older (p

BACKGROUND Global trends of penetrating abdominal trauma (PAT) have seen a shift toward a selectively conservative management strategy. However, its widespread adoption for gunshot injuries has been sluggish. The purpose of this study is to compare the injury mechanisms of gunshot (GSW) and stab wounds (SW) to the abdomen in presentation, management, and outcomes. METHODS Prospective cohort study, set in Cape Town, South Africa, over 2 years. All patients presenting to the center with PAT during this time were included. Presentation, management, and outcomes were compared by injury mechanism, with a focus on the operative strategy (operative vs nonoperative). RESULTS During the study period, 805 patients (SW 37.6%; GSW 62.4%) with PAT were managed. Immediate laparotomies were performed in 119 (39.3%) SW and 355 (70.7%) GSW, with a therapeutic laparotomy rate of 85.7% and 91.8% for SW and GSW, respectively. Nonoperative management (NOM) was implemented in 184 SW (60.7%) and 147 GSW (29.3%) (P < 0.001), with a 92.9% and 92.5% success rate for SW and GSW, respectively. The therapeutic laparotomy rate for the delayed laparotomies (DOM) was 69.2% for SW, and 90.9% for GSW. The accuracy of clinical assessment (with adjuncts) in determining the need for laparotomy was: GSW-92% and SW-91%. Univariate analysis revealed the mechanism not to be associated with DOM. The overall mortality rate was 7.2%, and nonfatal morbidities 22.2%. CONCLUSION Although GSW is a more morbid and often fatal injury, the general principles of selective conservatism hold true for both GSW and SW, equally.

Distinct biologic and mechanical attributes of the pediatric skeleton translate into fracture patterns, complications, and treatment dilemmas that differ from those of adults. In children, increasing participation in competitive sports activities has led to an increased incidence of acute injuries that affect the foot and ankle. These injuries represent approximately 13% of all pediatric osseous injuries. Important posttraumatic complications include premature physeal arrest, three-dimensional deformities and consequent articular incongruity, compartment syndrome, and infection. The authors describe normal developmental phenomena and injury mechanisms of the ankle and foot and associated imaging findings; mimics and complications of acute fractures; and dislocations that affect the pediatric ankle and foot. Treatment strategies, whether conservative or surgical, are aimed at restoring articular congruency and functional alignment and, for pediatric patients specifically, protecting the physis. The different types of ankle and foot fractures are described, and the American College of Radiology guidelines used to determine appropriate imaging recommendations for patients who meet the Ottawa ankle and foot rules are discussed. The systems used to classify clinically important fractures, including the Salter-Harris, Dias-Tachdjian, Rapariz, and Hawkins systems, are described, with illustrations that reinforce key concepts. These classification systems aid in diagnosis and treatment planning, facilitate communication, and help standardize documentation and research. This information is intended to supplement radiologists' understanding of developmental phenomena, anatomic variants, fracture patterns, and associated complications that affect the pediatric foot and ankle. In addition, the role of imaging in ensuring appropriate treatment, follow-up, and patient and parent counseling is highlighted.

The purpose of this study was to investigate the differences in plantar pressure under the lead and trail foot between two lunge tasks to the net in the dominant (LD) and non-dominant (LND) directions, and to explore how fatigue affects the plantar pressure patterns whilst performing movements before and after a competitive match. Peak and mean pressure were measured with the Biofoot-IBV in-shoe system from five repetitions of each task, with sensors positioned under the calcaneus, midfoot and phalanges on the lead and trail foot. Data were collected pre and immediately post-playing an official first national league competition match. The study was conducted with a sample of thirteen first league badminton players. A 2 × 2 repeated ANOVA found significant differences between the two tasks and between pre- and post-match (fatigued state). Players also had different foot pressure distributions for the LD and LND tasks, which indicated a difference in loading strategy. In a fatigued state, the plantar pressure shifted to the medial aspect of the midfoot in the trail limb, indicating a reduction in control and a higher injury risk during non-dominant lunge tasks.

Sudden disturbances (perturbations) to the hand and wrist are commonplace in daily activities and workplaces when interacting with tools and the environment. It is important to understand how perturbations influence forearm musculature and task performance when identifying injury mechanisms. The purpose of this work was to evaluate changes in forearm muscle activity and co-contraction caused by wrist perturbations during a dynamic wrist tracking task. Surface electromyography was recorded from eight muscles of the upper-limb. Participants performed trials consisting of 17 repetitions of ±40° of wrist flexion/extension using a robotic device. During trials, participants received radial or ulnar perturbations that were delivered during flexion or extension, and with known or unknown timing. Co-contraction ratios for all muscle pairs showed significantly greater extensor activity across all experimental conditions. Of all antagonistic muscle pairs, the flexor carpi radialis (FCR)-extensor carpi radialis (ECR) muscle pair had the greatest change in co-contraction, producing 1602% greater co-contraction during flexion trials than during extensions trials. Expected perturbations produced greater anticipatory (immediately prior to the perturbation) muscle activity than unexpected, resulting in a 30% decrease in wrist displacement. While improving performance, this increase in anticipatory muscle activity may leave muscles susceptible to early-onset fatigue, which could lead to chronic overuse injuries in the workplace.

Purpose We describe the medical and surgical treatment outcomes of Syrian civil war pediatric casualties admitted to our tertiary medical center in northern Israel and compare them to reports of pediatric war victims in Iraq and Afghanistan. Methods 117 pediatric casualties up to age 18 (median age: 12 years, 91 males) were admitted from 2013 to 2016. We measured demographics, injury mechanism, wound type, injury severity, surgical interventions, morbidity, and mortality. Results Injury mechanisms were penetrating injuries (n = 87, 74%), blunt (n = 34, 29%) and blast (n = 13, 11%) injuries, caused by fragments (56, 48%), blasts (51, 44%), and gunshot wounds (24, 21%). Most common injuries were head trauma (n = 66, 56%) and lower extremities injury (n = 45, 38%). 51 children (44%) had Injury Severity Score > 25. Surgical procedures, most commonly orthopedic (n = 35) and neurosurgical (n = 27), were performed on 81 children (69%). Average number of procedures per patient was 2 ± 2.5; average hospitalization time was 25.8 days. Mortality rate was 3.4% (four children). Injury characteristics were different from those reported for pediatric war casualties in Iraq and Afghanistan. Conclusions Head trauma was associated with serious injury and mortality; most injuries were penetrating and complex. Collaboration of various hospital departments was often necessary for efficient and successful treatment. Level of evidence III Retrospective comparison study.

AimWe aimed to identify patterns and mechanisms of injury situations in men’s professional handball by means of video match analysis.MethodsModerate and severe injuries (absence of >7 days) sustained in competition in one of six seasons (2010 to 2013 and 2014 to 2017) in men’s professional handball were prospectively analysed with a newly developed standardised observation form. Season 2013 to 2014 was excluded because of missing video material.Results580 injuries were identified: 298 (51.4%) contact injuries, 151 (26.0%) indirect contact injuries and 131 (22.6%) non-contact injuries. Head (87.5%), hand (83.8%), shoulder (70.2%) and ankle (62.9%) injuries were mainly sustained during direct contact. Typical contact injuries included collision with an opponent’s upper extremity or torso, and ankle injuries mainly consisted of foot-to-foot collisions. A large proportion (41.7%) of knee injuries were caused by indirect contact, whereas thigh injuries mainly occurred (56.4%) through non-contact mechanism. Wing (56.9%) and pivot (58.4%) players had the highest proportion of contact injuries, whereas backcourt players had a high proportion of indirect contact injuries (31.5%) and goalkeepers of non-contact injuries (48.9%). The injury proportion of foul play was 28.4%. Most injuries occurred in the central zone between the 6-metre and 9-metre lines (26.1%) and during the last 10 min of each match half (OR 1.71, p=0.016).ConclusionsIn men’s professional handball in a league setting, contact — but not foul play — was the most common mechanism associated with moderate and severe injuries. Head, hand, shoulder and ankle injury were mainly sustained during direct contact.

Joint laxity should be distinguished from instability and its objective assessment is a determinant of safety and effectiveness clinical management of anterior cruciate ligament (ACL) tear and other often injured structures through injury mechanisms as knee sprains. Clinical evaluation is mandatory for all clinicians but requires the addition of medical devices for diagnosis or follow-up workflow objective assessment. Magnetic resonance imaging (MRI) instrumented-assessment of knee joint laxity combines the visual inspection of structural injury and multiplanar joint laxity quantification. The Porto knee Testing Device (PKTD) is an MRI-safe knee arthrometer that provides for accurate measurement of multiplanar joint laxity. Restoration of passive knee sagittal and transversal knee stability is the main objective of surgical interventions addressing ligaments reconstruction as ACL and pre- and post-operative measurements should be systematically performed and support precision orthopedic medicine.

Summary Introduction On January 2011, Tunisia had known a revolution. To move from dictatorship to democraty project, the country suddenly fell into political instability, which was accompanied by a wave of social violence. Traumatology, and, particularly, maxilla-facial traumatology, is usually a reliable indicator of the degree of violence. Aim The aim of this study was to establish the epidemiological profile of facial fractures during the various phases of political transition through which Tunisia has passed since revolution (2012–2016). Patients and methods A retrospective cross-sectional study was conducted among all patients with facial fractures admitted to the department of Oral and Maxillo facial Surgery of University Hospital of Sahloul during five years (2012–2016). Fractures diagnosed late at the sequelae stage were excluded. Data of patients were recorded according to medical files, including cause of injury, age and gender, injury mechanisms and type of facial fracture. Results During the period of the study, a total of 476 patients were identified, with a sex-ratio of 7.2 to 1, patients ranged in age from 1 year to 76-years-old with a mean age of 27 years. Assaults were the most common cause of injury (39.1%). Mandible was fractured in 257 cases (54.2%) followed by zygoma (116 cases, 24.4%), nasal bone (99 cases, 20.8%) and Orbital walls (98 cases, 20.6%). Discussion The epidemiological profile of facial fractures in Tunisia has been changed since 2011. Facial fractures occur mainly after assaults, which are an indicator of increased social violence accompanying political instability present in our country.

The recent dramatic advances in preventing “initial xenograft dysfunction” in pig-to-non-human primate heart transplantation achieved by minimizing ischemia suggests that ischemia reperfusion injury (IRI) plays an important role in cardiac xenotransplantation. Here we review the molecular, cellular, and immune mechanisms that characterize IRI and associated “primary graft dysfunction” in allotransplantation and consider how they correspond with “xeno-associated” injury mechanisms. Based on this analysis, we describe potential genetic modifications as well as novel technical strategies that may minimize IRI for heart and other organ xenografts and which could facilitate safe and effective clinical xenotransplantation.

Primary ObjectiveEstablished literature demonstrates that homeless individuals experience both greater disease burden and risk of experiencing traumatic brain injury (TBI) than the general population. Similarly, shared risk factors for both homelessness and/or TBI may exacerbate the risk of repetitive neurotrauma within homeless populations.Research DesignWe leveraged a state-wide trauma registry, the Pennsylvania Trauma Outcome Study (PTOS), to characterize 609 patients discharged to homeless (58% TBI, 42% orthopedic injury (OI)) in comparison to 609 randomly sampled adult patients discharged to home.Methods and ProceduresWe implemented Chi-square tests to examine preexisting health conditions (PECs), hospital course, and injury mechanisms for both patient groups.Main Outcomes and ResultsHomelessness affects a greater proportion of nonwhite patients, and homeless patients present for care with increased frequencies of psychiatric and substance use PECs, and alcohol-positive TBI. Furthermore, assault impacts a larger proportion of homeless patients, and the window for overnight assault risk resulting in TBI is extended for these patients compared to patients discharged to home.ConclusionGiven the shifting conceptualization of TBI as a chronic condition, identifying homeless patients on admission to trauma centers, rather than retrospectively at discharge, can enhance understanding of the challenges facing the homeless as they age with both a complex neurotrauma history and multimorbidity.

Context: Anterior cruciate ligament (ACL) injury risk reduction programs have become increasingly popular. As ACL injuries continue to reflect high incidence rates, the continued optimization of current risk reduction programs, and the exercises contained within them, is warranted. The exercises must evolve to align with new etiology data, but there is concern that the exercises do not fully reflect the complexity of ACL injury mechanisms. It was outside the scope of this review to address each possible inciting event, rather the effort was directed at the elements more closely associated with the end point of movement during the injury mechanism. Objective: To examine if exercises designed to reduce the risk of ACL injury reflect key injury mechanisms: multiplanar movement, single limb stance, trunk and hip dissociative control, and a flight phase. Data Sources: A systematic search was performed using PubMed, Medline, EBSCO (CINAHL), SPORTSDiscus, and PEDro databases. Study Selection: Eligibility criteria were as follows: (1) randomized controlled trials or prospective cohort studies, (2) male and/or female participants of any age, (3) exercises were targeted interventions to prevent ACL/knee injuries, and (4) individual exercises were listed and adequately detailed and excluded if program was unable to be replicated clinically. Study Design: Scoping review. Level of Evidence: Level 4. Data Extraction: A total of 35 studies were included, and 1019 exercises were extracted for analysis. Results: The average Consensus on Exercise Reporting Template score was 11 (range, 0-14). The majority of exercises involved bilateral weightbearing (n = 418 of 1019; 41.0%), followed by single limb (n = 345 of 1019; 33.9%) and nonweightbearing (n = 256 of 1019; 25.1%). Only 20% of exercises incorporated more than 1 plane of movement, and the majority of exercises had sagittal plane dominance. Although 50% of exercises incorporated a flight phase, only half of these also involved single-leg weightbearing. Just 16% of exercises incorporated trunk and hip dissociation, and these were rarely combined with other key exercise elements. Only 13% of exercises challenged more than 2 key elements, and only 1% incorporated all 4 elements (multiplanar movements, single limb stance, trunk and hip dissociation, flight phase) simultaneously. Conclusion: Many risk reduction exercises do not reflect the task-specific elements identified within ACL injury mechanisms. Addressing the underrepresentation of key elements (eg, trunk and hip dissociation, multiplanar movements) may optimize risk reduction in future trials.

Objetivo: Identificar a prevalência de lesões em atletas adultos da seleção brasileira masculina de taekwondo. Métodos: Onze atletas com idade média de 24±4,5 anos responderam dois questionários semiestruturados e questões objetivas para investigação dos seguintes aspectos: idade; tempo de prática; graduação; região anatômica afetada em treinos e competições; mecanismos de lesão durante campeonato e treinamento; periodização; duração e frequência de treinos e competições no último ano; e se houve interrupção da prática de taekwondo decorrente das lesões. Resultados: A contusão foi o tipo mais frequente e os membros inferiores os mais acometidos; 27% relataram interrupção do treinamento maior ou igual a 1 dia de treino e/ou competição, em decorrência das lesões. A frequência média de competições; frequência semanal de treinamento e meses de treinamento por ano foram: 6±3 vezes/ano; 5±1 dias/semana e 10±3 meses/ano. Conclusão: A lesão mais prevalente dos atletas da seleção brasileira de taekwondo foi a contusão na coxa e no antebraço decorrente de golpe do adversário durante campeonatos. ABSTRACT. Injurie’s prevalence in athletes of the Brazilian national team of taekwondo. Objective: Identify the prevalence of injuries in male adults’ athletes of the Brazilian team of taekwondo. Methods: Eleven athletes aged 24±4.5 years answered two semi-structured questionnaires and questions for investigation of the following aspects: age; time practicing; taekwondo’s graduation; anatomical region injured during training and/or competitions; injury mechanisms during competitions and training; periodization; duration and frequency of training and competitions in the last year; and if there was interruption of taekwondo practice due to injuries. Results: The contusion was the most frequent injury, and the lower limbs were most affected, 27% reported discontinuation of training and/or competition greater than or equal to 1 day due to injuries. The mean frequency of competitions; training days per week and training months per year were: 6±3 times/year; 5±1 days/week and 10±3 months/year. Conclusion: The most prevalent injury of athletes from the Brazilian team of taekwondo was the contusion in the thigh and forearm during competitions.

BackgroundThough rare, rugby union carries a risk for serious injuries such as acute spinal cord injuries (ASCI), which may result in permanent disability. Various studies have investigated injury mechanisms, prevention programmes and immediate medical management of these injuries. However, relatively scant attention has been placed on the player’s experience of such an injury and the importance of context.AimThe aim of this study was to explore the injury experience and its related context, as perceived by the catastrophically injured player.MethodsA qualitative approach was followed to explore the immediate, postevent injury experience. Semi-structured interviews were conducted with 48 (n=48) players who had sustained a rugby-related ASCI.ResultsFour themes were derived from the data. Participants described the context around the injury incident, which may be valuable to help understand the mechanism of injury and potentially minimise risk. Participants also described certain contributing factors to their injury, which included descriptions of foul play and aggression, unaccustomed playing positions, pressure to perform and unpreparedness. The physical experience included signs and symptoms of ASCI that is important to recognise by first aiders, fellow teammates, coaches and referees. Lastly, participants described the emotional experience which has implications for all ASCI first responders.SignificanceAll rugby stakeholders, including players, first responders, coaches and referees, may gain valuable information from the experiences of players who have sustained these injuries. This information is also relevant for rugby safety initiatives in shaping education and awareness interventions.

The neck visceral space is a complex region housing several vital structures. Diagnostic imaging plays an important role in the evaluation of neck visceral injuries. Many injuries are initially missed by both clinicians and radiologists because of their infrequency and the high likelihood of other more obvious injuries. Understanding which diagnostic modality to apply at given point in the work-up; recognizing relevant clinical signs, symptoms, and injury mechanisms; and knowing pertinent direct and indirect imaging findings of injury allow radiologists to either directly render the correct diagnosis or choose the most appropriate tool for doing so.

Abdominal hollow viscus trauma represents an important cause of pediatric morbidity, following head, vertebral column, spinal cord and thoracic injuries, whose main mechanisms of production are road traffic accidents, falls with abdominal impact, sports injuries, physical aggression and explosions. If there is a penetrating abdominal trauma, most frequently it associates hollow organ injuries, while abdominal blunt trauma is associated more often with parenchymal injuries, with effects on the hemodynamic status. Imaging and paraclinical investigations used to evaluate an abdominal trauma consist of thoraco-abdominal radiography in orthostatic position, abdominal ultrasonography, diagnostic peritoneal lavage, abdominal computed tomography and exploratory laparoscopy. Unlike penetrating injuries, when surgical exploration is obvious, in the case of young children with abdominal contusions, the injuries involving hollow viscus can be overlooked at time of the initial assessment, because of a poor communication between doctor and patient, difficult interpretation of symptoms when there are other injuries associated, but also because of the initial lack of ultrasound signs of perforation. Delayed diagnosis and adequate treatment lead to extended duration of hospitalization, to elevated costs and rates of morbidity. The incidence of mortality caused by abdominal trauma associated with hollow viscus penetration is approximately 10%, being more elevated as the digestive injuries are multiple or associated with other lesions.

Background: Most lateral extra-articular tenodesis (LET) procedures rely on passing a strip of the iliotibial band (ITB) under the fibular (lateral) collateral ligament and fixing it proximally to the femur. The Ellison procedure is a distally fixed lateral extra-articular augmentation procedure with no proximal fixation of the ITB. It has the potential advantages of maintaining a dynamic element of control of knee rotation and avoiding the possibility of overconstraint. Hypothesis: The modified Ellison procedure would restore native knee kinematics after sectioning of the anterolateral capsule, and closure of the ITB defect would decrease rotational laxity of the knee. Study Design: Controlled laboratory study. Methods: Twelve fresh-frozen cadaveric knees were tested in a 6 degrees of freedom robotic system through 0° to 90° of knee flexion to assess anteroposterior, internal rotation (IR), and external rotation laxities. A simulated pivot shift (SPS) was performed at 0°, 15°, 30°, and 45° of flexion. Kinematic testing was performed in the intact knee and anterolateral capsule–injured knee and after the modified Ellison procedure, with and without closure of the ITB defect. A novel pulley system was used to load the ITB at 30 N for all testing states. Statistical analysis used repeated measures analyses of variance and paired t tests with Bonferroni adjustments. Results: Sectioning of the anterolateral capsule increased anterior drawer and IR during isolated displacement and with the SPS (mean increase, 2° of IR; P < .05). The modified Ellison procedure reduced both isolated and coupled IR as compared with the sectioned state ( P < .05). During isolated testing, IR was reduced close to that of the intact state with the modified Ellison procedure, except at 30° of knee flexion, when it was slightly overconstrained. During the SPS, IR with the closed modified Ellison was less than that in the intact state at 15° and 30° of flexion. No significant differences in knee kinematics were seen between the ITB defect open and closed. Conclusion: A distally fixed lateral augmentation procedure can closely restore knee laxities to native values in an anterolateral capsule–sectioned knee. Although the modified Ellison did result in overconstraint to isolated IR and coupled IR during SPS, this occurred only in the early range of knee flexion. Closure of the ITB defect had no effect on knee kinematics. Clinical Relevance: A distally fixed lateral extra-articular augmentation procedure provides an alternative to a proximally fixed LET and can reduce anterolateral laxity in the anterolateral capsule–injured knee and restore kinematics close to the intact state.

Despite increased knowledge on anterior cruciate ligament (ACL) injury mechanisms, improved surgical techniques, improved understanding of ACL biomechanics and enhanced knowledge in rehabilitation practice, return-to-sport (RTS) rates and subsequent second ACL re-injury rates after ACL reconstruction are not optimal. This narrative review discusses factors that may be highly relevant for RTS training and testing after ACL reconstruction, but which have received limited research attention to date or do not form part of the standard approach to rehabilitation. These factors include (1) explosive neuromuscular performance; (2) movement quality deficits associated with re-injury risk, particularly the need to re-train optimal sport-specific movement patterns; (3) the influence of fatigue; and (4) a lack of sport-specific re-training prior to RTS, with particular attention to an insufficient development of chronic training load. In addition, incorporating performance re-training and ensuring an athlete has restored their sport-specific profile is important. The relevance of these variables for RTS training and testing is discussed, with a new recommended model of late-stage rehabilitation and RTS training presented. Additional testing to support RTS decision making is also presented. This paper contains important information for practitioners and researchers to support optimised late-stage rehabilitation and RTS programmes and RTS testing with a view to enhancing patient outcomes after ACL reconstruction.

Among the carpal bones the scaphoid (Os scaphoideum) is the most important. The most frequent fracture of the carpus is a fracture of the scaphoid bone. The frequently occurring absence of healing of these fractures as well as unhealed ruptures of the ligament complex between the scaphoid and lunate, lead to the most severe biomechanical and thus the most severe clinical changes of the wrist. The detailed anatomy of the scaphoid, blood flow, ligament attachments, injury mechanisms and pathobiomechanics are described and illustrated.

Iatrogenic nerve injury is a rare but potentially devastating complication in total joint arthroplasty of the hip and the knee. Multiple previous studies have evaluated the incidence, mechanisms of injury, recovery, and potential treatments for this complication. Injury in total hip arthroplasty generally involves direct injury of sensory nerves from the incision, direct or traction injury of during exposure, or limb lengthening. Injury in total knee arthroplasty generally involves direct injury of sensory nerves from incision, injury due to errant placement of retractors, during balancing, or from traction because of deformity correction. Treatment of iatrogenic nerve injuries has ranged from observation, intraoperative prevention by nerve monitoring, limb shortening postoperatively, medications, and decompression. The orthopaedic surgeon should be versed in these etiologies to advise their patients on the incidence of injury, to prevent occurrence by understanding risky intraoperative maneuvers, and to select appropriate interventions when nerve injuries occur.

Neurointensive care (NIC) has contributed to great improvements in clinical outcomes for patients with severe traumatic brain injury (TBI) by preventing, detecting, and treating secondary insults and thereby reducing secondary brain injury. Traditional NIC management has mainly focused on generally applicable escalated treatment protocols to avoid high intracranial pressure (ICP) and to keep the cerebral perfusion pressure (CPP) at sufficiently high levels. However, TBI is a very heterogeneous disease regarding the type of injury, age, comorbidity, secondary injury mechanisms, etc. In recent years, the introduction of multimodality monitoring, including, e.g., pressure autoregulation, brain tissue oxygenation, and cerebral energy metabolism, in addition to ICP and CPP, has increased the understanding of the complex pathophysiology and the physiological effects of treatments in this condition. In this article, we will present some potential future approaches for more individualized patient management and fine-tuning of NIC, taking advantage of multimodal monitoring to further improve outcome after severe TBI.

Objectives Heterogeneous patient factors and injury mechanisms result in a great variety of injury patterns encountered in knee dislocations (KD). Attempts to improve outcome can focus on a wide range of challenges. The aim of this study was to establish and prioritise a list of challenges encountered when treating patients with acute KD. Methods A modified Delphi consensus study was conducted with international knee specialists who generated a prioritised list of challenges. Selected priorities were limited to half of the possible items. Agreement of more than 70% was defined as consensus on each of these items a priori. Results Ninety-one international surgeons participated in the first round. The majority worked in public hospitals and treated patients from low-income and middle-income households. Their propositions were prioritised by 27 knee surgeons from Europe, Africa, Asia, as well as North and South America, with a mean of 15.3 years of experience in knee surgery (SD 17.8). Consensus was reached for postoperative stiffness, obesity, delay to presentation and associated common peroneal nerve injuries. Challenges such as vascular injuries, ipsilateral fractures, open injuries as well as residual laxity were also rated high. Most of these topics with high priority are key during the initial management of a patient with KD, at presentation. Topics with lower priority were postsurgical challenges, such as patient insight, expectations and compliance, rehabilitation programme, and pain management. Conclusion This consensus study has a wide geographical footprint of experts around the world practising in various settings. These participants prioritised stiffness, obesity, treatment delays and associated limb-threatening injuries as the most important challenges when managing a patient with acute KD. This list calls for applicable and feasible solutions for these challenges in a global setting. It should be used to prioritise research efforts and discuss treatment guidelines. Level of evidence V.

Background Trauma centers are charged with identifying injury prevention priorities in the community. Hospitals frequently use system and regional injury data based on frequency of injury mechanisms to establish injury prevention priorities. Objective This study was conducted to provide insight into how the Injury Prevention Priority Score (IPPS) can be utilized to prioritize injury prevention activities with considerations of both frequency and severity of injury. Methods This descriptive study utilizes a retrospective review of 6,824 patients 15 years and older at one Level I trauma center between July 1, 2014, and June 30, 2019. A previously described and validated IPPS was calculated for injury mechanisms to compare the overall trauma burden for each cause. The IPPS is presented as a T-score with a mean of 50 and a standard deviation of 10. Results In this sample, most injuries (57.1%) occur to those 65 years or older, and the most common injuries are from a fall (66.5%) or were from a motor vehicle occupant (13.3%). The fall group had an average severity of injury, but the frequency was five times higher than the next highest group. The pedestrian and firearm groups had the highest severity, and their IPPSs were the second and third highest. Conclusions Injury priorities should not be based on frequency of injury alone. Use of the IPPS provides additional objective data regarding injury prevention priorities in the community. The IPPS has most commonly been used to evaluate pediatric injury prevention needs but effectively evaluates injury prevention needs throughout the lifespan.

PURPOSE OF REVIEW: Weighted baseball throwing programs have gained significant attention recently. They have been promoted as proven option for pitchers wishing to increase their throwing velocity and improve throwing mechanics. However, there is some concern that, if not applied properly, they may increase injury risk. In this review, we aim to (1) give a brief description of the potential mechanisms through with weighed ball programs that could improve throwing velocity, (2) summarize the available evidence regarding their effectiveness in increasing throwing velocity, (3) summarize the evidence on injury risk, and (4) propose directions for future studies. RECENT FINDINGS: Initial research on weighted ball programs was published in the 1960s. Recently there has been an increase in research as interest from baseball organizations, instructors, players, and medical providers has grown. A recent randomized controlled trial demonstrated that pitching velocity can be increased through a 6-week weighted ball program; however, with that, they found that the rate of injury also increased. An earlier systematic review outlined 10 studies that evaluated weighted ball programs effect on pitching velocity and reported that 7 studies described increases in throwing velocity, while most studies did not comment on injury risk. They note that the results on rate of injury have been variable, likely secondary to the variability in time and intensity of different programs. SUMMARY: The inconsistency in the methodology of weighted ball programs and studies has made it challenging to draw (scientifically) meaningful conclusions. Nevertheless, several studies have offered empirical evidence in support of the claim that weighted ball programs can increase pitching velocity through improved throwing mechanics. At the same time, these studies have emphasized the improvements in performance, while the potential effects on injury mechanisms have been less well understood. There is a need for improved standardization of these programs to allow for future study and subsequent modification to optimize performance.

Objectives: Although calcaneal fractures are relatively uncommon, they are among injuries that may lead to short- and long-term morbidity regardless of the treatment. The Saudi Arabian literature showed a shortage of studies that analyzed the epidemiology of this fracture. This study aimed to analyze the epidemiology and characteristics of patients with calcaneus fractures. Methods: A retrospective study of all patients with calcaneal fractures admitted to King Fahd Hospital in Almadinah Almunawwarah City, Saudi Arabia, over a 4-year-period (January 2016–December 2019). Data such as age, gender, trauma mechanism, laterality of fracture, and associated injuries, were extracted from patients' medical files and analyzed using appropriate statistical tests. Results: The study analyzed data of 130 patients with calcaneal fractures (156 calcaneal fractures). Male patients (86.2%) were more commonly affected than females, at a ratio of 6.2:1. Ninety-three (71.5%) of the cases resulted from low-energy falls and road traffic accidents (RTA). Low-energy falls and falling from a height as injury mechanisms were higher in female patients, while RTA was more frequent in males. Bilateral fractures were found in 20% of cases, with a significantly higher rate in male patients. The associated skeletal injuries were more frequent in females than male patients (66.7% vs. 43.8%), while associated nonskeletal injuries were only found in 15 male patients, particularly those aged

Background Ankle syndesmosis injury is a common condition, and the injury mechanism can be sorted into pure syndesmosis injury, Weber-B, and Weber-C type fractures. This study aims to evaluate the treatment outcomes and stability of suture-button fixation for syndesmosis injury with different injury mechanisms. We hypothesized that injury mechanisms would alter the stability of suture-button fixation. Methods We retrospectively reviewed 63 patients with ankle syndesmosis injury who underwent surgery with TightRope (Arthrex, Naples, FL, USA) from April 2014 to February 2019. The stability of suture-button fixation with TightRope was evaluated by comparing the preoperative, postoperative, and final follow-up measurements of tibiofibular clear space (TFCS), tibiofibular overlap (TFO), and medial clear space (MCS). A subgroup analysis for each demographic group and injury type including pure syndesmosis injury, Weber-B, and Weber-C type fractures were performed. Results Syndesmosis was effectively reduced using TightRope. After the index surgery, the tibiofibular clear space was reduced from 7.73 to 4.04 mm, the tibiofibular overlap was increased from 3.05 to 6.44 mm, and the medial clear space was reduced from 8.12 to 3.54 mm. However, syndesmosis widening was noted at the final follow-up, especially in Weber-C type fractures (TFCS 3.82 to 4.45 mm, p < 0.01 and TFO 6.86 to 6.29 mm, p = 0.04). Though widened, the final follow-up values of tibiofibular clear space and tibiofibular overlap were in the acceptable range. Postoperatively and at the final follow-up, medial clear space was found to be significantly larger in the Weber-C group than in the pure syndesmosis and Weber-B groups (p < 0.05). Conclusions Suture-button fixation can offer anatomic reduction and dynamic fixation in syndesmosis injuries. However, when using this modality for Weber-C type fractures, more attention should be focused on the accuracy of reduction, especially of medial clear space, and rediastasis should be carefully monitored. Trial registration This trial was retrospectively approved by TMU-JIRB. Registration number N202004122, and the date of approval was May 06, 2020. Level of evidence III

Summary Burns of the limbs affect 48.6% of burn patients. Injury mechanisms condition their depth and degree of extension. Injury of the hands and/or the joint areas entails considerable risk of retraction. Coverage is consequently doubly challenging, it is a matter not only of compensating for a soft tissue defects, but also of striving to prevent early (infectious) and late (amplitude limitation, pain, loss of function…) complications. Thoroughgoing assessment of the initial injury and associated lesions is conducive to rapid determination of a therapeutic strategy tailored to the relevant functional issues and subsequent rehabilitation. Following a summary of the epidemiological elements and the medical context of management, a review of existing treatments has been drawn up based on the data in the literature and current professional recommendations. Emergency procedures, the different types of excision and the possibilities of autologous covering and skin substitutes are reported. Last but not least, routinely validated indications are synthesized.

Learning from history is of crucial importance. This chapter deals with the historical background of pelvic ring fracture diagnosis and treatment, starting in the time before radiological diagnostics was available. By detailed clinical and postmortem examination, a comparable knowledge to recent times was already available. Early experimental data focused on a basic understanding of injury mechanisms. After detecting the value of X-rays, early treatment modifications, including surgery were developed, but for more than one century, conservative treatment was dominant until the late 80s.

Radiation treatments often unfavorably damage neighboring healthy organs and cause a series of radiation sequelae, such as radiation-induced hematopoietic system diseases, radiation-induced gastrointestinal diseases, radiation-induced lung diseases, and radiation-induced skin diseases. Recently, emerging nanomaterials have exhibited good superiority for these radiation-induced disease treatments. Given this background, the rational design principle of nanomaterials, which helps to optimize the therapeutic efficiency, has been an increasing need. Consequently, it is of great significance to perform a systematic summarization of the advances in this field, which can trigger the development of new high-performance nanoradioprotectors with drug efficiency maximization. Herein, this review highlights the advances and perspectives in the rational design of nanomaterials for preventing and treating various common radiation-induced diseases. Furthermore, the sources, clinical symptoms, and pathogenesis/injury mechanisms of these radiation-induced diseases will also be introduced. Furthermore, current challenges and directions for future efforts in this field are also discussed.

Background: Multiligament knee injuries (MLKIs) can result from high-energy injury mechanisms such as motor vehicle accidents or low-energy injury mechanisms such as activities of daily living or sports. Purpose/Hypothesis: The purpose was to conduct a systematic review on postoperative patient-reported outcomes after MLKIs and to conduct a meta-analysis of comparable outcome variables based upon high- versus low-energy injury mechanisms. It was hypothesized that MLKIs with low-energy injury mechanisms would demonstrate significantly improved subjective clinical outcome scores compared with high-energy injuries. Study design: Meta-analysis and systematic review. Methods: A systematic review was performed with the inclusion criteria of postoperative MLKI outcomes based upon high-versus low-energy mechanisms of injury with a minimum 2-year follow-up. Outcome scores included were the Lysholm knee scoring scale, Tegner activity scale, and the International Knee Documentation Committee (IKDC) score. High-energy mechanisms included motor vehicle accidents or falls from a height >5 feet; low-energy mechanisms included sports-related injuries, activities of daily living, or falls from Results: Overall, 1214 studies were identified, 15 of which were included in the systematic review and meta-analysis. Thirteen studies included surgical reconstructions of all injured ligaments. A total of 641 patients with 275 high-energy and 366 low-energy injuries were grouped for comparison in the meta-analysis. No significant differences in Lysholm scale (78.6 vs 78.0) or IKDC scores (69.0 vs 68.4) were found between high- and low-energy groups at a minimum of 2 years (range, 2-10 years) postoperatively ( P > .05). The low-energy injury group demonstrated significantly higher Tegner activity scale scores (5.0 vs 3.9; P = .03). There was no significant difference in failure rates between groups (3.5% vs 2.0%; P = .23). Conclusion: We found in this systematic review and meta-analysis that patients with low-energy mechanisms of MLKI surgery had improved postoperative Tegner activity scores compared with those patients with high-energy mechanisms after MLKI surgery. However, there were no differences in Lysholm score, IKDC score, or failure rates between high- and low-energy MLKI patients at an average of 5.3 years postoperatively.

Purpose Hip fractures are a major cause of morbidity and mortality in the elderly; however, the current literature on the injury patterns of hip fractures in India is lacking. Understanding the injury profile of these patients is important to develop targeted interventions to prevent hip fractures. Materials and Methods This was a prospective study of all hip fracture patients aged 50 years or older admitted from February 2019 to December 2019. Details about the injury were recorded by an in-person interview. Multivariate logistic regression analysis was used to identify the factors associated with any particular injury mechanism. Results Two hundred and eighty-three hip fractures were included. The mechanism of injury for the majority of patients was a fall from a standing height (n=217, 76.7%) while 60 patients (21.2%) were injured as the result of a road traffic accident (RTA). Slipping on a wet floor (n=49, 22.6%) and change in posture (n=35, 16.1%) were the most commonly reported reasons for falling. Pedestrian injuries were the most common form of RTA (n=29, 48.3%). Increasing age (P

BackgroundThe mechanisms of acute ankle syndesmosis ligament injuries in professional rugby union are not well understood.AimTo describe the mechanisms of acute ankle syndesmosis ligament injuries in male professional rugby union players using systematic visual video analysis.MethodsAll time-loss acute ankle syndesmosis ligament injuries identified via retrospective analysis of the Leinster Rugby injury surveillance database across the 2013/2014 to 2017/2018 seasons were considered as potentially eligible for inclusion. Three Chartered Physiotherapists (analysts) independently assessed all videos with a final consensus meeting convened to describe the injury mechanisms. One of the analysts developed a qualitative description of each injury mechanism.ResultsThirteen acute ankle syndesmosis injuries were included in this study. The most common biomechanical presentation of the injured limb was characterised by hip flexion, knee flexion, knee valgus, ankle dorsiflexion, pronation and external rotation of the foot. Six of the included injuries (46%) were the result of an external load application to the injured limb (ie, direct contact injuries). In the other seven instances (54%), the injury was the result of a collapse of the injured player’s body mass over the injured ankle joint, while tackling or being tackled, without direct contact to the injured limb (ie, indirect contact injuries).ConclusionInjuries incurred while tackling were exclusively the result of suboptimal tackle mechanics. A majority of injuries incurred while being tackled involved a posterior tackle, which often resulted in a posterior collapse of the injured player’s centre of mass over a fixed externally rotated foot.

Spinal cord injury (SCI) is a debilitating condition which often leads to a severe disability and ultimately impact patient’s physical, psychological, and social well-being. The management of acute SCI has evolved over the couple of decades due to improved understanding of injury mechanisms and increasing knowledge of disease. Currently, the early management of acute SCI patient includes pharmacological agents, surgical intervention and newly experimental neuroprotective strategies. However, many controversial areas are still surrounding in the current treatment strategies for acute SCI, including the optimal timing of surgical intervention, early versus delayed decompression outcome benefits, the use of methylprednisolone. Due to the lack of consensus, the optimal standard of care has been varied across treatment centres. The authors have shed a light on the current updates on early treatment approaches and neuroprotective strategies in the initial management of acute SCI in order to protect the early neurologic injury and reduce the future disability.

Neck injury is one of the most frequent spine injuries due to the complex structure of the cervical spine. The high incidence of neck injuries in collision accidents can bring a heavy economic burden to the society. Therefore, knowing the potential mechanisms of cervical spine injury and dysfunction is significant for improving its prevention and treatment. The research on cervical spine dynamics mainly concerns the fields of automobile safety, aeronautics, and astronautics. Numerical simulation methods are beneficial to better understand the stresses and strains developed in soft tissues with investigators and have been roundly used in cervical biomechanics. In this article, the simulation methods for the development and application of cervical spine dynamic problems in the recent years have been reviewed. The study focused mainly on multibody and finite element models. The structure, material properties, and application fields, especially the whiplash injury, were analyzed in detail. It has been shown that simulation methods have made remarkable progress in the research of cervical dynamic injury mechanisms, and some suggestions on the research of cervical dynamics in the future have been proposed.

Objectives Current best evidence has reported that therapeutic exercise programs that are designed to treat patellofemoral pain (PFP) should include both hip and knee specific exercises. The purpose of this review was to (1) examine the quality/comprehensiveness of exercise reporting in this field; (2) quantify the extent to which individual exercises comprised task-specific elements (single limb stance; eccentric control of the hip; rotational z-axis control) most likely to address key pathomechanics associated with PFP. Design Systematic review: a systematic survey of RCTs. Methods PubMed, CINAHL, Medline, Physiotherapy Evidence Database (PEDro) and SPORT Discus databases were searched for randomized controlled trials that addressed PFP utilizing a proximal control hip focused rehabilitation paradigm. The therapeutic exercise programs were evaluated, and each individual exercise was extracted for analysis. Quality assessments included the PEDro Scale and the Consensus on Exercise Reporting Template (CERT) was utilized to score the reporting of the interventions. Results 19 studies were included in the final analysis. 178 total exercises were extracted from the proximal hip and knee rehabilitation programs. The exercises were analyzed for the inclusion of elements that align with reported underlying biomechanical mechanisms. Conclusions The vast majority of the exercises were sagittal plane, concentric, non-weight bearing exercises, whereas multiplanar exercises, single limb weightbearing, and exercises where loading was directed around the longitudinal z-axis, were considerably under-represented. Current exercises for PFP utilize simplistic frameworks that lack progression into more task specific exercise, and are not reflective of the complex injury etiology.

Objective: The European Union (EU) has adopted the Vision Zero and Safe System approach to eliminate deaths and serious traffic injuries on European roads by 2050. Detailed information on serious injuries, injury mechanisms and consequences are needed. The aim of this study was to describe and compare by injury mechanism the demographics, injuries, injury severity, and treatment of seriously injured road traffic trauma patients. Material and methods: We analysed data on severe traffic injury trauma patients aged >= 16 years of the Helsinki Trauma Registry (HTR) covering the years 2009 -2018. The variables analysed were basic patient demographics, injury mechanism, Abbreviated Injury Scale (AIS) codes, injured body regions, patient Injury Severity Score (ISS) and New Injury Severity Score (NISS) values, NISS groups (NISS 16 -24 and NISS >= 25), AIS 3 + injuries, trauma bay and 30-day mortality, length of stay (LOS) at ICU and in hospital, surgeries performed, pre-injury classification, and intention of injury. Results: A total of 1 063 traffic injury patients were analysed; 38.6% were motor vehicle occupants, 28.5% motorcyclists or moped drivers, 17.2% bicyclists, and 15.7% pedestrians. The mean age of patients was 44.3 years (SD 20.2). Median ISS score was 22 and median NISS score was 27. Both scores were highest in pedestrians. Among all patients, total hospital LOS was 12 517 days (median 9) and total ICU LOS was 6 311 days (median 5). The most common AIS 3 + injuries according to ISS body regions were chest injuries (60%) and head or neck injuries (43.7%). Chest injuries occurred more frequently in motorcyclists and motor vehicle occupants, whereas head or neck injuries were most common among bicyclists and pedestrians. Conclusions: Severely injured pedestrians and bicyclists were older and they had higher mortality than motorcyclists and motor vehicle occupants. According to NISS, the overall severity was highest among pedestrians followed by bicyclists. However, the both median ICU LOS and hospital LOS were highest for pedestrians but lowest for bicyclists. The most common AIS 3 + injuries were chest and head or neck injuries. To specify effective injury prevention measures, hospital data should be complemented with information on the circumstances of the accident. (C) 2020 Elsevier Ltd. All rights reserved.

Abusive intra-abdominal injuries are less common than other types of injuries, such as fractures and bruises, identified in victims of child physical abuse, but they can be deadly. No single abdominal injury is pathognomonic for abuse, but some types and constellations of intra-abdominal injuries are seen more frequently in abused children. Identification of intra-abdominal injuries can be important clinically or forensically. Injuries that do not significantly change clinical management can still elevate a clinician's level of concern for abuse and thereby influence subsequent decisions affecting child protection efforts. Abusive intra-abdominal injuries can be clinically occult, necessitating screening laboratory evaluations to inform decisions regarding imaging. Once detected, consideration of developmental abilities of the child, type and constellation of injuries, and the forces involved in any provided mechanism of trauma are necessary to inform assessments of plausibility of injury mechanisms and level of concern for abuse. Here we describe the clinical, laboratory and imaging evaluation of the abdomen in the setting of suspected child abuse.

We reviewed the patient demographics, injury mechanisms, fracture characteristics, treatment modalities, and outcomes of incarcerated patients who were referred for metacarpal fracture evaluation and treatment to our high-volume tertiary care center from a New York City Department of Correction infirmary facility. There is a scarcity of information in the orthopedic and plastic surgery literature on treating these common fractures in this vulnerable population. We conducted a basic statistical analysis and discuss the potential implications of these findings. We found a high incidence of stiffness that may relate to the high rates of follow-up noncompliance coupled with prolonged immobilization. Awareness of these findings may influence treating hand specialists to use less restrictive immobilization devices such as functional bracing, elastic bandage, or neighbor strapping as an effort to promote bony union without the risk of developing stiffness and the potential to compromise general hand function when treating non-thumb metacarpal fractures.

Introduction Although concussion continues to be a major source of acute and chronic injuries, concussion injury mechanisms and risk functions are ill-defined. This lack of definition has hindered efforts to develop standardized concussion monitoring, safety testing, and protective countermeasures. To overcome this knowledge gap, we have developed, tested, and deployed a head impact monitoring mouthguard (IMM) system. Materials and Methods The IMM system was first calibrated in 731 laboratory tests. Versus reference, Laboratory IMM data fit a linear model, with results close to the ideal linear model of form y = x + 0, R2 = 1. Next, during on-field play involving n = 54 amateur American athletes in football and boxing, there were tens of thousands of events collected by the IMM. A total of 890 true-positive head impacts were confirmed using a combination of signal processing and National Institute of Neurological Disorders and Stroke/National Institutes of Health Common Data Elements methods. Results The median and 99th percentile of peak scalar linear acceleration and peak angular acceleration were 20 and 50 g and 1,700 and 4,600 rad/s2, respectively. No athletes were diagnosed with concussion. Conclusions While these data are useful for preliminary human tolerance limits, a larger population must be used to quantify real-world dose response as a function of impact magnitude, direction, location, and accumulation. This work is ongoing.