Octogenarian Motor Vehicle Collisions: Injury Patterns Matter

Introduction. Motor vehicle collision (MVC) is the second most common mechanism of injury among octogenarians and is on the rise. These “oldest old” trauma patients have much higher mortality rates than expected. This study examined potential factors influencing this increased mortality including comorbidities, medications, injury patterns, and hospital interventions. Methods. A 10-year retrospective review was conducted of patients aged 80 and over who were injured in a MVC. Data collected included patient demographics, comorbidities, medication use prior to injury, collision details, injury severity and patterns, hospitalization details, outcomes, and discharge disposition. Results. We identified 239 octogenarian patients involved in a MVC. Overall mortality was 18.8%. We recognized an increased mortality for specific injury patterns, patients injured in a rural setting, and those who were transfused, intubated, or admitted to the ICU. We found no correlation between mortality and medications or comorbidities. Conclusions. The high mortality rate for octogenarian patients involved in a MVC is related to injury severity, type of injury, and in-hospital complications, and not due to comorbidities and prior medications.

The Relationship between the Injury Mechanism and the Incidence of ACL Avulsions in Schatzker Type IV Tibial Plateau Fractures: A 3D Quantitative Analysis Based on Mimics Software

Introduction Tibial plateau fractures are often accompanied with ligamental and meniscal injuries. Among which, the combined existence of Schatzker type IV fracture with anterior cruciate ligament (ACL) avulsion has been reported rarely. The purpose of this study was to determine the injury mechanism of Schatzker type IV fracture with ACL avulsion based on Mimics software. Methods Ninety-nine Schatzker type IV tibial plateau fractures were retrospectively analyzed by quantitative three-dimensional measurements. ACL avulsions were diagnosed through the data of computed tomography and magnetic resonance imaging. We simulated the knee posture when an injury occurred and defined different injury patterns. The chi-square test was used for determining the main mechanism which causes Schatzker type IV fractures associated with ACL avulsions. Results There were more ACL avulsions and more displaced ACL avulsions associated with the knee in flexion in the setting of Schatzker type IV fracture (p < 0.05). More ACL avulsions were found in the injury pattern of flexion-valgus than the other injury patterns of the same level (p < 0.05). The rotation of the tibial showed no significant difference in producing ACL avulsion fractures. Conclusion This study found that a flexed knee at the occurrence of a Schatzker type IV tibial plateau fracture is a high-risk factor for causing associated ACL avulsion and producing more displaced avulsions. Flexion-valgus pattern was the main cause of Schatzker type IV fractures associated with ACL avulsions. The findings will help orthopedists understand the injury mechanism and enhance their awareness of such injuries to avoid unfavorable prognosis.

Community-based Study on Hip Fracture in a Rural Area in Northeast Indiana

Background/Objective: There are few studies in the literature focused on rural hip fracture epidemiology, and fewer still that consider hip fractures at a specific county level or trauma center (TC) region. The aim of this study is to elucidate patterns of injury events and injury burden of hip fractures in a rural trauma center in northeast Indiana. Patients and Measurements: We ascertained 2019 hip fracture cases that consisted of three sets of data, namely, emergency department visits (ED), hospitalizations (IP), and deaths from clinical databases. We analyzed the cases by fracture type, measured incidence rates (IRs) per 1,000 county residents and described the injury pattern of hip fractures by variables such as county of residence, age, and sex. We considered the mechanism of injury (cause) of the fractures as well as the injury burden based on the above three sets. Results: A ratio of roughly 2:1 was found for extracapsular to intracapsular hip fractures. Injury patterns showed that the study counties had similar incidence rates with a range of 0.96 to 1.41 per 1,000 residents. Males and females ages 0-69 years had similar incidences of hip fracture. Overall, females had a 41% higher incidence rate of hip fractures than males. Injury burden indicated a similar distribution of ED to IP to mortality cases across the five study counties, and the majority (98.4%) of hip fractures with known causes of injury were due to falls. Conclusions and Potential Impact: We elucidated the injury patterns and burden of hip fractures in a verified level II trauma center region. The results of this study have the potential benefit for the future development of hip fracture prevention programs for rural, elderly populations in northeast Indiana.

Hamstring injury patterns in professional male football (soccer): a systematic video analysis of 52 cas

ObjectiveTo closely describe the injury inciting events of acute hamstring injuries in professional male football (soccer) using systematic video analysis.MethodsVideo footage from four seasons (2014–2019) of the two highest divisions in German male football was searched for moderate and severe (ie, time loss of >7 days) acute non-contact and indirect contact match hamstring injuries. Two raters independently categorised inciting events using a standardised procedure to determine specific injury patterns and kinematics.Results52 cases of hamstring injuries were included for specific pattern analysis. The pattern analysis revealed 25 sprint-related (48%) and 27 stretch-related hamstring injuries (52%). All sprint-related hamstring injuries occured during linear acceleration or high-speed running. Stretch-related hamstring injuries were connected with closed chain movements like braking or stopping with a lunging or landing action and open chain movements like kicking. The kinematic analysis of stretch-related injuries revealed a change of movement involving knee flexion to knee extension and a knee angle of <45° at the assumed injury frame in all open and closed chain movements. Biceps femoris was the most affected muscle (79%) of all included cases.ConclusionDespite the variety of inciting events, rapid movements with high eccentric demands of the posterior thigh are likely the main hamstring injury mechanism. This study provides important data about how hamstring injuries occur in professional male football and supports the need for demand-specific multicomponent risk reduction programmes.

Injury Patterns, Risk Factors, and Return to Sport in Brazilian Jiu Jitsu: A Cross-sectional Survey of 1140 Athletes

Background: Brazilian jiu jitsu (BJJ) is a growing martial art that focuses on grappling techniques. Purpose: To quantify the 3-year incidence of BJJ-related injuries and detect common injury patterns as well as risk factors among those practicing BJJ. It was hypothesized that there would be a high incidence of injuries, they would be caused by submissions in sparring situations, and they would occur predominantly at the extremities. Study Design: Descriptive epidemiology study. Methods: Active BJJ athletes were invited to take an English-language online survey developed by orthopaedic surgeons together with BJJ athletes and a sports scientist. Data were recorded regarding athlete demographics, sporting activity level, injuries within the past 3 years that caused at least a 2-week time loss, injury mechanisms, and return to sport. Results: Overall, 1140 responses were received from 62 different countries; 88.9% of all athletes were male, and 63.9% were regular competitors. Within the investigated cohort, 1052 injuries were recorded in 784 athletes, for an injury incidence of 308 per 1000 athletes per year. The lower extremity (45.7%) and upper extremity (30.2%) were predominant sites of injury, with injuries to the knee (27.1%) being the most common. The most frequent knee injuries were meniscal injuries (n = 65), anterior cruciate ligament (ACL) tears (n = 36), and medial collateral ligament injuries (n = 36). ACL tears were especially associated with long time frames for return to sport. Most injuries occurred during sparring (77.6%) and were caused by submissions (29.7%) and takedowns (26.4%). Competing regularly ( P = .003), older age ( P < .001), and higher belt rank ( P = .003) were significant risk factors for injury. Conclusion: Injury incidence was high among BJJ athletes surveyed, with 2 out of 3 athletes reporting at least 1 injury within a 3-year period that caused a 2-week absence from training. Most injuries occurred during sparring, and we believe that a high potential for injury reduction lies in drawing awareness to common injury patterns and sites in athletes.