Unusual injury? Recent injury in normal children and children with suspected non-accidental injury.

Four hundred normal children aged between 2 weeks and 11 years were examined to determine the prevalence and site of recent injury of any type. There was evidence of injury in 37% with a steady increase in prevalence to 60% by the end of the third year of life. Bruising of the hands and feet and of the lower legs was the most frequent type of injury. Head and facial injuries were most common between 18 months and 3 years (17% of children) but were rare at other ages. Injury to the lumbar region was unusual before 5 years but was present in 14% of children of school age. In 84 children of similar age where non-accidental injury was proved or suspected a different pattern of injury was present. Sixty per cent had injuries to the head and face; this increase in prevalence was seen at all ages. These children also had more frequent injuries in the lumbar region, particularly before the age of 5 years.     

The Operative Treatment of Scapula Fractures: An Analysis of 10,097 Patients

BackgroundThe indications for operative treatment of scapula fractures have been debated over the past decade. Our purpose was to determine 1) the incidence and trends in the operative treatment of scapula fractures, 2) the incidence of conversion from operative fixation to total or hemi-shoulder arthroplasty (THSA) and 3) rates of associated injuries in scapula fractures. We hypothesized that the operative treatment of scapula fractures is increasing over time and that scapula fractures treated with open reduction and internal fixation (ORIF) would have increased risk for conversion to THSA.MethodsThe Humana Inc. administrative claims database was queried from 2008 to 2015. Patients with any scapular fracture, ORIF of scapula fracture, total or hemi-shoulder arthroplasty, and associated injuries were identified by ICD-9 and CPT codes. Analysis was performed for 1) all patients with a scapula fracture undergoing operative fixation (i.e. ORIF and THSA), 2) all scapular fractures treated with ORIF with subsequent conversion to ipsilateral THSA, and 3) all associated injuries.ResultsThere were 10,097 scapula fractures (28.4% glenoid, 48% female). 60% occurred in patients 65 years and older. There were 198 (1.96%) fractures (70% glenoid) treated with ORIF. There were 287 (2.84%) fractures (45% glenoid) treated with THSA (76% total shoulder). The rate of ORIF of scapular fractures did not significantly increase (RR=0.87, p=0.58). There was a significant increase in THSA as primary treatment of scapula fractures in 2015 compared to 2007 (RR=0.43, p=0.0016). Conversion from ORIF to THSA was 12.6% (25/198). Scapula fractures treated with ORIF were at significant risk for conversion to THSA (RR=4.77, p<0.0001). Associated injuries occurred in nearly 50% of scapula fractures—other fractures, lung contusion and pneumothorax/hemothorax ranking the highest, accounting for 37%, 14.5% and 8.3% of all associated injuries, respectively.ConclusionThe incidence of operative treatment of scapula fractures was 1.96% and 2.84% for ORIF and THSA, respectively. Scapular fractures previously treated with ORIF were at significant risk for conversion to THSA. Although ORIF in scapular fractures did not significantly increase over time, both THSA and overall (ORIF+THSA) operative treatment of scapula fractures increased significantly. Level of Evidence: IV     

Alterations to movement mechanics can greatly reduce anterior cruciate ligament loading without reducing performance

Anterior cruciate ligament (ACL) injuries are one of the most common and potentially debilitating sports injuries. Approximately 70% of ACL injuries occur without contact and are believed to be preventable. Jump stop movements are associated with many non-contact ACL injuries. It was hypothesized that an athlete performing a jump stop movement can reduce their peak tibial shear force (PTSF), a measure of ACL loading, without compromising performance, by modifying their knee flexion angle, shank angle, and foot contact location during landing. PTSF was calculated for fourteen female basketball players performing jump stops using their normal mechanics and mechanics modified to increase their knee flexion angle, decrease their shank angle relative to vertical and land more on their toes during landing. Every subject tested experienced drastic reductions in their PTSF (average reduction=56.4%) using modified movement mechanics. The athletes maintained or improved their jump height with the modified movement mechanics (an average increase in jump height of 2.5 cm). The hypothesis was supported: modifications to jump stop movement mechanics greatly reduced PTSF and therefore ACL loading without compromising performance. The results from this study identify crucial biomechanical quantities that athletes can easily modify to reduce ACL loading and therefore should be targeted in any physical activity training programs designed to reduce non-contact ACL injuries.     

Creatine supplementation during college football training does not increase the incidence of cramping or injury

The purpose of this study was to examine the effects of creatine supplementation on the incidence of injury observed during 3-years of NCAA Division IA college football training and competition. In an open label manner, athletes participating in the 1998–2000 football seasons elected to take creatine or non-creatine containing supplements following workouts/practices. Subjects who decided to take creatine were administered 15.75 g of creatine for 5 days followed by ingesting an average of 5 g/day thereafter administered in 5–10 g doses. Creatine intake was monitored and recorded by research assistants throughout the study and ranged between 34–56% of players during the course of the study. Subjects practiced or played in environmental conditions ranging from 8–40°C (mean 24.7 ± 9°C) and 19–98% relative humidity (49.3 ± 17%). Injuries treated by the athletic training staff were recorded and categorized as cramping, heat/dehydration, muscle tightness, muscle strains/pulls, non-contact joint injuries, contact injuries, and illness. The number of missed practices due to injury/illness was also recorded. Data are presented as the total number of treated injuries for creatine users/total injuries observed and percentage occurrence rate of injuries for creatine users for all seasons. The incidence of cramping (37/96, 39%), heat/dehydration (8/28, 36%), muscle tightness (18/42, 43%), muscle pulls/strains (25/51, 49%), non-contact joint injuries (44/132, 33%), contact injuries (39/104, 44%), illness (12/27, 44%), number of missed practices due to injury (19/41, 46%), players lost for the season (3/8, 38%), and total injuries/missed practices (205/529, 39%) were generally lower or proportional to the creatine use rate among players. Creatine supplementation does not appear to increase the incidence of injury or cramping in Division IA college football players.     

Weapons injuries during and after periods of conflict: retrospective analysis.

OBJECTIVE: To assess the relative frequency of weapon injuries during conflict and after periods of conflict in the absence of disarmament. DESIGN: Retrospective analysis of a database of war wounds. SETTING: Region with a protracted conflict between rival combatant groups and a subsequent transition to the uncontested military authority of a single power. SUBJECTS: 2332 people who received weapons injuries during the conflict or post-conflict periods and were admitted to hospital within 24 hours of injury. MAIN OUTCOME MEASURES: Percentage change in mean monthly admission rate by weapon type between conflict and post-conflict periods; annual incidence of injury by weapon type during conflict and post-conflict periods; percentage change in annual incidence by weapon type between conflict and post-conflict periods. RESULTS: Mean monthly admission rates for injuries from fragmentation munitions decreased by 8% between conflict and post-conflict periods and by 23% for injuries from mines and 32% for gunshot injuries. The decline in admissions for all injuries was 23%. After adjustment for population growth over the study period, declines in annual incidence were 22% for fragmentation munitions injuries, 34% for mine injuries, and 40% for gunshot injuries. The decline in incidence for all injuries was 33%. In-hospital mortality from weapons related injuries increased from 2.5% to 6.1% (P < 0.001) between conflict and post-conflict periods. CONCLUSIONS: In this setting, continued availability of weapons is associated with increased mortality and a level of injuries from weapons that is only somewhat reduced from that observed during a period of conflict.     

Orofacial injuries reported by junior and senior basketball players

The increased popularity of sports, apart from being beneficial to health, also results in a larger number of injuries, a part of which are also injuries to the stomatognatic system. According to the data from literature orofacial injuries in basketball are frequent, but relatively minor. The World Dental Federation places basketball into the category of medium-risk sports for the occurrence of injuries to the stomatognatic system. The purpose of this investigation was to determine incidence, type and severity of orofacial injuries during basketball and the frequent of the mouthguard use in a selected sample of basketball players from the City of Zagreb and the Zagreb County. The sample consists of 195 athletes who actively participate in basketball, 61 junior and 134 senior players. A total of 2 615 injuries to the stomatognatic system were documented in this research, 529 (20.2%) of those refer to juniors and 2 086 (79.8%) to seniors. The most common injuries are lacerations and contusions of soft tissue 84.4% (21.5% juniors and 78.5% seniors), followed by temporomandibular joint injuries and oral muscles stiffness 13.4% (14.9% juniors and 85.1% seniors) and 2.2% dental injuries (3.5% juniors and 96.5% seniors). Only 6.7% of players (13 players--2 juniors and 11 seniors) have tried to wear a mouthguard, while only one 1% of them (2 players--one junior and one senior) frequently used it. Total number of injuries shows that sports injuries are common during basketball. Average number of almost 4 injuries per player is relatively high. Dental injuries and temporomandibular joint injuries and oral muscles stiffness are relatively rare, only 16%. Lacerations and contusions of soft tissues represent 84% of all injuries and that minor injuries do not require professional care.     

医学干预对武警某部军事训练伤的影响

目的：探讨医学干预对南方某武警部队战士训练伤发生情况的影响。方法：随机将南方某武警部队的一大队,按照干预措施施训,作为干预组;另一大队按照以往常规方法进行训练,不加任何干预措施,作为对照组。观察6个月内的两大队（干预组和对照组）的训练伤发生情况。结果：骨关节和软组织损伤为常见。实施医疗干预可有效降低军事训练伤的发生率（17．95％〈29．18％）,其主要效果在于大幅度降低了骨关节损伤的发生率（6．53％〈10.31％）和软组织损伤的发生率（5．59％〈9．92％）。结论：实施医学干预可有效降低我武警部队军事训练伤的发生率。     

Injuries in Runners; A Systematic Review on Risk Factors and Sex Differences

BackgroundThe popularity of running continues to increase, which means that the incidence of running-related injuries will probably also continue to increase. Little is known about risk factors for running injuries and whether they are sex-specific.ObjectivesThe aim of this study was to review information about risk factors and sex-specific differences for running-induced injuries in adults.ConclusionsPrevious injury and use of orthotic/inserts are risk factors for running injuries. There appeared to be differences in the risk profile of men and women, but as few studies presented results for men and women separately, the results should be interpreted with caution. Further research should attempt to minimize methodological bias by paying attention to recall bias for running injuries, follow-up time, and the participation rate of the identified target group.     

Study of the audiospinal effect on the H-reflex

Studies of the audiospinal effect on the H-reflex demonstrated that in normal test subjects and in patients with injuries to the spinal cord coupled with parapareses and in part of patients with paraplegia of the lower limbs, there was a sound-induced 30-70% increase in the amplitude of the H-reflex. As the interval between the conditioning sound and testing electric stimulations was raised, two maxima of the increment of the H-reflex amplitude within 30-40 ms and 80-100 ms were revealed. The increased H-response within these intervals seems likely to be connected with the conduction of excitation from the brain cortex via the pyramidal tract and the reticulospinal tract. Part of the patients with spinal cord injuries and paraplegia of the lower limbs did not manifest any sound-induced increase in the H-reflex. Apparently, such lack of increase is either a consequence of the functional blockade of the afferent conduction tract or that of their anatomical disturbance. The method of the audiospinal effect on the H-reflexes may be used for diagnostic purposes, namely for the determination of the conduction via the afferent cerebrospinal tract.     

Injuries,Death, and Disability Associated with 11 Years of Conflict in Baghdad,Iraq: A Randomized Household Cluster Survey

Background

The objective of this study was to characterize injuries, deaths, and disabilities arising during 11 years of conflict in Baghdad.

Methods

Using satellite imagery and administrative population estimated size for Baghdad, 30 clusters were selected, proportionate to population size estimates. Interviews were conducted during April and May 2014 in 900 households containing 5148 persons. Details about injuries and disabilities occurring from 2003 through May 2014 and resultant disabilities were recorded.

Findings

There were 553 injuries reported by Baghdad residents, 225 of which were intentional, and 328 unintentional. For intentional injuries, the fatality rate was 39.1% and the disability rate 56.0%. Gunshots where the major cause of injury through 2006 when blasts/explosions became the most common cause and remained so through 2014. Among unintentional injuries, the fatality rate was 7.3% and the disability rate 77.1%. The major cause of unintentional injuries was falls (131) which have increased dramatically since 2008, followed by traffic related injuries (81), which have steadily increased. The proportion of injuries ending in disabilities remained fairly constant through the survey period.

Interpretation

Intentional injuries added substantially to the burden of unintentional injuries for the population. For Baghdad, the phases of the Iraqi conflict are reflected in the patterns of injuries and consequent deaths reported. The scale of injuries during conflict is most certainly under-reported. Difficulties recalling injuries in a survey covering 11 years is a limitation, but it is likely that minor injuries were under-reported more than severe injuries. The in- and out-migration of Baghdad populations likely had effects on the events reported which we could not measure or estimate. Damage to the health infrastructure and the flight of health workers may have contributed to mortality and morbidity. Civilian injuries as well as mortality should be measured during conflicts, though not currently done.     

Bicycle accidents in childhood.

The results of a 10 year study of bicycle fatalities and an eight year study of serious non-fatalities are reported for urban Brisbane (population 1,000,000). There were 845 serious non-fatal bicycle accidents and 46 fatalities during the study. Boys were involved in 86% of accidents. Boys have an accident rate of 134.21 per 100,000 population at risk and a fatality rate of 5.06 per 100,000 at risk. Serious bicycle accidents have increased by 50% in this decade; but considering fatal cases alone, no secular trend was evident over the 10 year period of the study. This suggests that an increase in the overall rate of bicycle accidents has been in part compensated by less serious injuries. In 70% of fatalities children had head injuries, and 87% of fatalities followed a collision between a cyclist and a motor vehicle or a train. Bicycle accidents on the roads most commonly occur to boys aged between 12 and 14 years on a straight road at "mid-block" between 3 and 5 pm in clear weather conditions and in daylight. It is concluded that injuries and fatalities after bicycle accidents can be reduced by protecting children''s heads, separating child cyclists from other road traffic, or educating and training both cyclists and other road users in safe behaviour. The compulsory use of helmets and the restriction of access to the roads by child cyclists to reduce injuries are, however, still controversial in many areas.     

Early and late results of treating peripheral arterial injuries]

Forty six patients with injuries to the great peripheral arteries were treated at the III Department of Surgery, Medical Academy in Cracow in 1968-1987. An injury to the blood vessels was accompanied by bone fractures or joint dislocation in 9 (19.5%) patients whereas 35 (76%) patients suffered also from vein injuries and nervous trunks trauma. In 13 (28%) cases an accident took place when the victims were drunk. Favourable result of the treatment, i.e. return of peripheral pulse, was achieved in 33 (75%) patients, acceptable result, i.e. an increase in limb temperature, in 11 (23%) patients. Two patients underwent an amputation of the limb because of its necrosis. One patient died. Anti-thrombolytic agents were given intra- and postoperatively, and in 9 patients with extensive contusions fasciotomy proved successful. Late results were similar to early ones.     

Skeletal evidence for Inca warfare from the Cuzco region of Peru

This article addresses the bioarchaeological evidence for Inca warfare through an analysis of 454 adult skeletons from 11 sites in the Inca capital region of Cuzco, Peru. These 11 sites span almost 1000 years (AD 600-1532), which allows for a comparison of the evidence for warfare before the Inca came to power (Middle Horizon AD 600-1000), during the time of Inca ascendency in the Late Intermediate Period (AD 1000-1400), and after the Inca came to power and expanded throughout the Cuzco region and beyond (Inca Imperial Period, AD 1400-1532). The results indicate that 100 of 454 adults (22.0%) showed evidence of cranial trauma. Of these, 23 individuals had major cranial injuries suggestive of warfare, consisting of large, complete, and/or perimortem fractures. There was scant evidence for major injuries during the Middle Horizon (2.8%, 1/36) and Late Intermediate Period (2.5%, 5/199), suggesting that warfare was not prevalent in the Cuzco region before and during the Inca rise to power. Only in the Inca Imperial Period was there a significant rise in major injuries suggestive of warfare (7.8%, 17/219). Despite the significant increase in Inca times, the evidence for major cranial injuries was only sporadically distributed at Cuzco periphery sites and was entirely absent at Cuzco core sites. These findings suggest that while the Inca used warfare as a mechanism for expansion in the Cuzco region, it was only one part of a complex expansion strategy that included economic, political, and ideological means to gain and maintain control.     

Epidemiology of training injuries in amateur taekwondo athletes: a retrospective cohort study

The objectives of this study were to estimate the incidence and describe the pattern and severity of training injuries in taekwondo, and to compare pattern and severity of training injuries with competition injuries. One hundred and fifty-two active Australian amateur taekwondo athletes, aged 12 years or over, completed an online survey comprising questions on training exposure and injury history over the preceding 12 months. The main outcome measures were: overall injury incidence rate per athlete-year; training injury incidence rate per athlete-year, per 1000 athlete-training-sessions, and per 1000 athlete-hours of training; injury severity; and injury proportions by anatomical region and by type of injury. Injury incidence rates were calculated with 95% confidence intervals using standard methods, while injury proportions were compared using Fisher''s exact test. The vast majority (81.5%) of taekwondo injuries in an average athlete-year occurred during training. The training injury incidence rate was estimated to be 1.6 (95% CI: 1.4, 1.9) per athlete-year, 11.8 (95% CI: 10.4, 13.4) per 1000 athlete-training-sessions, and 7.0 (95% CI: 6.1, 7.9) per 1000 athlete-hours of training. Among athletes with five or fewer injuries, the severity and injury pattern of training injuries were, by and large, the same as for competition injuries. Approximately sixty percent (60.3%) of training injuries required treatment by a health professional. Considering the burden of training injuries exceeds that of competition injuries, taekwondo governing bodies and stakeholders are encouraged to devote more efforts towards the identification of risk factors for, and prevention of, training injuries in the sport of taekwondo.     

The Effects of Human Age,Group Composition,and Behavior on the Likelihood of Being Injured by Attacking Pumas

ABSTRACT

Documentation from the years 1890 to 2000 of 185 instances of pumas (Puma concolor) attacking humans in the United States and Canada has provided statistical evidence that pumas are less likely to kill or injure humans in certain circumstances. We identified incidents of fatal attacks, severe injuries, light injuries, and no injuries as a function of human age class, group size, body posture, and conspicuous action, such as noise making, running, or shooting. Ordinal multinomial regression revealed that age class (< 13 years old vs. older) was not a statistically reliable predictor of attack severity. This statistical method also revealed that there was no reliable association between the number of individuals present during the attack and attack severity. Nevertheless, examination of specific attack outcomes indicated that the likelihood of escaping injury increased when two or more people were present. The speed that individuals moved during the attack did not predict attack severity, but it was apparent that the lowest likelihood of escaping injury (26%) and greatest frequency of severe injuries (43%) occurred when individuals remained stationary. In contrast, half of the individuals who ran when they were attacked escaped injury, whereas running was associated with only a small increase in the frequency of fatal attacks (28%), compared with remaining stationary (23%). Evidence that half of the individuals who ran escaped injury suggests that pumas are assessing immobility in humans as they might with other prey, using it as an index of prey inattention or disablement and hence greater vulnerability.     

Comparison of injuries to New Zealand rock lobsters (Jasus edwardsii) caused by hand versus snare collection

Abstract

Following the prohibition in New Zealand of lobster snares in late 2005, we undertook research to compare the frequency and extent of injuries to rock lobsters (Jasus edwardsii) (Hutton) caused by recreational SCUBA divers using lobster snares compared with hand collection. Rock lobsters were sampled between January 2006 and October 2006 from multiple dive sites around the North Island of New Zealand. Of the 124 rock lobsters caught, 20.9% were in a soft shell state. Female rock lobsters constituted 43.5% of the catch, but only one was carrying eggs. Female mean tail width was 72.2 mm; male mean tail width was 71.9 mm. We found that hand collection caused significantly more injuries than snare collection, to both soft shell and hard shell animals. Hand collection also resulted in more major injuries, with 18% of hard shell animals and 31% of soft shell animals losing two or more limbs. We recommend that the prohibition on the use of rock lobster snares be lifted, as their use appears to significantly reduce injury and stress to rock lobsters in recreational dive areas, and increase the survival of undersized individuals released after capture.     

Injuries in racket sports among Slovenian players

On the sample of 83 top Slovenian athletes we have studied the frequency of injuries among table tennis, tennis and badminton players, types of injuries and severity of injuries--the latter based on data of players absences from training and/or competition processes. The most liable parts to injuries are shoulder girdle (17.27%), spine (16.55%) and ankle (15.83%), while foot (10.07%) and wrist (12.23%) are slightly less liable to injuries. The most frequent injuries in racket sports pertain to muscle tissues. According to this data, the majority of injuries occur halfway through a training session or a competition event, mostly during a competition season. The injuries primarily pertain to muscle tissues; these are followed by joint and tendon injuries. There are no differences between male and female players. Compared to other racket sports players, table tennis players suffer from fewer injuries.     

Injuries to the Liver: Analysis of 20 Cases

Twenty cases of liver injury among 55 consecutive cases of abdominal injury submitted to laparotomy over a four-year period are reported. Forty-four of the cases were blunt injuries, and the cases of liver injury were in this group. Road traffic accidents accounted for 37 of the 44 cases and 17 of the 20 liver injuries. Except in two cases injury to the liver was associated with injury to other organs. Severe chest injury was found in 40% of the cases and serious skeletal injury in 45%. The overall mortality in blunt injury to the liver was 20% (4 cases) and was directly attributable to the liver injury in only one case.Liver injuries are classified as minor or major according to the depth of the wound and the associated destruction of liver tissue. Liver resection is advocated for major injuries. Right hepatic lobectomy was performed on five occasions and three of the patients survived. Death in the other two was due to associated injuries. The remarkable regenerative capacity of the liver is emphasized.     

Obesity and Occupational Injury: A Prospective Cohort Study of 69,515 Public Sector Employees

Background

Obesity and overweight are suggested to increase the risk of occupational injury but longitudinal evidence to confirm this is rare. We sought to evaluate obesity and overweight as risk factors for occupational injuries.

Methodology/Principal Findings

A total of 69,515 public sector employees (80% women) responded to a survey in 2000–2002, 2004 or 2008. Body mass index (kg/m²) was derived from self-reported height and weight and was linked to records of subsequent occupational injuries obtained from national registers. Different injury types, locations and events or exposures (the manner in which the injury was produced or inflicted) were analyzed by body mass index category adjusting for baseline socio-demographic characteristics, work characteristics, health-risk behaviors, physical and mental health, insomnia symptoms, and sleep duration. During the mean follow-up of 7.8 years (SD = 3.2), 18% of the employees (N = 12,204) recorded at least one occupational injury. Obesity was associated with a higher overall risk of occupational injury; multivariable adjusted hazard ratio (HR) 1.21 (95% CI 1.14–1.27). A relationship was observed for bone fractures (HR = 1.37; 95% CI: 1.10–1.70), dislocations, sprains and strains (HR = 1.36; 95% CI: 1.25–1.49), concussions and internal injuries (HR = 1.26; 95% CI: 1.11–1.44), injuries to lower extremities (HR = 1.62; 95%: 1.46–1.79) and injuries to whole body or multiple sites (HR = 1.37; 95%: 1.10–1.70). Furthermore, obesity was associated with a higher risk of injuries caused by slipping, tripping, stumbling and falling (HR = 1.55; 95% CI: 1.40–1.73), sudden body movement with or without physical stress (HR = 1.24; 95% CI: 1.10–1.41) and shock, fright, violence, aggression, threat or unexpected presence (HR = 1.33; 95% CI: 1.03–1.72). The magnitude of the associations between overweight and injuries was smaller, but the associations were generally in the same direction as those of obesity.

Conclusions/Significance

Obese employees record more occupational injuries than those with recommended healthy weight.     

水杨酸和阿斯匹林对小麦盐害的缓解作用

盐胁迫条件下水杨酸和阿斯匹林能提高小麦种子发芽率、发芽指数和活力指数,降低幼苗叶片质膜透性和盐胁迫对细胞膜的伤害,提高幼苗体内超氧化物歧化酶、过氧化物酶等细胞保护酶的活性,减少膜脂过氧化作用产物丙二醛的积累,降低根系Ｎａ＋和提高根系Ｋ＋ 的向上运输选择性。所有这些变化都有利于缓解盐胁迫对小麦的伤害,提高其对盐胁迫的适应性。