RESUMO
Dancers are susceptible to relative energy deficiency in sport (RED-S), specifically low bone mineral density (BMD). Little is known about how dancers' BMD compares to other athletic populations. The objective of this study was to examine the association between participant characteristics and total body areal BMD (aBMD) among female pre-professional dancers compared to other female athletes. Two hundred sixty-nine females (132 pre-professional dancers (17.6 (3.2) years) and 137 sport participants (22.8 (2.6) years) were included in this study. aBMD (g/cm2) was estimated using dual X-ray absorptiometry. Multivariable linear regression was used to examine the association between height-adjusted z-scores of total body aBMD (aBMD-Z) and age (years), body mass index (BMI) (z-score), supplement intake, history of stress fracture, irregular menses, MRI/bone scan, 1-year injury history, oral contraceptives, and activity (dance/sport). Total body aBMD and aBMD-Z were lower in dancers than athletes (dancers: aBMD = 1.03 g/cm2 (95% CI: 1.01, 1.05); aBMD-Z = -0.28 (-0.43, -0.12) (p < 0.001); athletes: aBMD = 1.14 g/cm2 (95% CI: 1.12, 1.16); aBMD-Z = 0.41 (0.25, 0.57) (p < 0.001)). aBMD-Z increased with age (ß = 0.054, 95% CI: 0.017, 0.092; p = 0.004) and BMI (ß = 0.221, 95% CI: 0.006, 0.415; p = 0.043). Activity type modified the relationship between BMI and aBMD-Z (ß = 0.323, 95% CI: 0.025, 0.621; p < 0.033) with a stronger positive association in dancers, compared to other female athletes. Dancers had lower total body aBMD and aBMD-Z than other female athletes. aBMD-Z increases with age in female pre-professional dancers and other female athletes. A stronger association exists between aBMD-Z and BMI in dancers than athletes. Future studies should consider changes in aBMD-Z during adolescence and associations with increased risk of bone injury.
Assuntos
Absorciometria de Fóton , Atletas , Índice de Massa Corporal , Densidade Óssea , Dança , Humanos , Feminino , Dança/fisiologia , Densidade Óssea/fisiologia , Adulto Jovem , Adolescente , Atletas/estatística & dados numéricos , Adulto , Fatores Etários , Deficiência Energética Relativa no Esporte , Suplementos Nutricionais , Fraturas de Estresse/epidemiologia , Fraturas de Estresse/etiologia , Estudos TransversaisRESUMO
ABSTRACT: Golf is a popular sport; however, there is a paucity of data in relation to golf-associated fractures, and the rate and timing of returning to golf. The aim of this review is to describe golf-associated fractures, including epidemiology, management, and timing of returning to golf following treatment. A literature search was performed using MEDLINE/PubMed, Embase, and Web of Science. Data were extracted and summarized in a narrative synthesis. A total of 436 articles were identified with an initial search of which 58 met the inclusion criteria. Twelve anatomical sites of golf swing-related fractures were identified, of which 10 sites were specific for stress fractures. The most common sites of golf swing-related stress fractures were the ribs followed by the hook of hamate. There was a common theme of delay to diagnosis, being initially assigned to a soft tissue injury. Most golfers with swing-related stress fractures were able to return to golf with the exception of osteoporotic associated vertebral stress fractures. Timing of returning to golf was between 4 and 12 months for most of the golfers with stress fractures following conservative management. Operative intervention was an option of hook of hamate nonunion, following a stress fracture, and tibial shaft stress fractures. Golf equipment-related fractures were not rare and were associated with major trauma and in some cases associated with significant persistent morbidity. Golf-related stress fractures commonly involve the ribs and hook of hamate; knowledge of this may aid in early diagnosis and appropriate treatment when symptomatic golfers are encountered. Although golf is a noncontact sport, fractures associated with golf equipment can be life changing, and safety training guidelines should be established.
Assuntos
Golfe , Golfe/lesões , Humanos , Fraturas Ósseas/terapia , Fraturas Ósseas/epidemiologia , Volta ao Esporte , Fraturas de Estresse/terapia , Fraturas de Estresse/epidemiologia , Traumatismos em Atletas/epidemiologia , Traumatismos em Atletas/terapiaRESUMO
Although a fifth metatarsal stress fracture is the most frequent stress fracture in soccer players, awareness of fifth metatarsal stress fractures among soccer coaches is unclear. Therefore, we performed an online survey of soccer coaches affiliated with the Japan Football Association to assess their awareness of fifth metatarsal stress fractures. A total of 150 soccer coaches were invited for an original online survey. Data on participants' age, sex, types of coaching licence, coaching category, types of training surface, awareness of fifth metatarsal stress fractures, and measures employed to prevent fifth metatarsal stress fractures were collected using the survey. Data from 117 coaches were analysed. Eighty-seven of the 117 coaches were aware of fifth metatarsal stress fractures; however, only 30% reported awareness of preventive and treatment measures for fifth metatarsal stress fractures. Licensed coaches (i.e., licensed higher than level C) were also more likely to be aware of fifth metatarsal stress fractures than unlicensed coaches were. Furthermore, although playing on artificial turf is an established risk factor for numerous sports injuries, soccer coaches who usually trained on artificial turf were more likely to be unaware of the risks associated with fifth metatarsal stress fractures than coaches who trained on other surfaces were (e.g., clay fields). Soccer coaches in the study population were generally aware of fifth metatarsal stress fractures; however, most were unaware of specific treatment or preventive training strategies for fifth metatarsal stress fractures. Additionally, coaches who practised on artificial turf were not well educated on fifth metatarsal stress fractures. Our findings suggest the need for increased awareness of fifth metatarsal stress fractures and improved education of soccer coaches regarding injury prevention strategies.ã.
Assuntos
Fraturas de Estresse , Ossos do Metatarso , Futebol , Humanos , Futebol/lesões , Fraturas de Estresse/prevenção & controle , Fraturas de Estresse/epidemiologia , Japão/epidemiologia , Estudos Transversais , Adulto , Masculino , Ossos do Metatarso/lesões , Feminino , Pessoa de Meia-Idade , Inquéritos e Questionários , Traumatismos em Atletas/prevenção & controle , Traumatismos em Atletas/epidemiologia , Adulto Jovem , Conhecimentos, Atitudes e Prática em SaúdeRESUMO
BACKGROUND: Military recruits and athletes have high occurrence of stress fractures, with very high incidence among military recruits. Symptomatic stress fractures can be disabling in some people. This study aims at identifying pattern and distribution of such fractures in Nepal Police trainee and assess the risk factors and demographics that may help to develop the local guidelines. METHODS: This study analysed 65 police trainees who presented to the orthopaedic Out Patient Department at Nepal Police and Province Police Hospital diagnosed as a case of stress fracture from 29 December, 2020 to 29 December, 2021. Ethical approval was obtained and different variables analysed were age, sex, Body Mass Index, location of fracture, duration of pain, method of treatment, time to heal the fracture and time to pain free mobilisation of patient. RESULTS: There were 65 trainees with 86 sites of fracture at different bones with 50.8% (33) of male population. The majority of fracture was located at tibia (58.1%) followed by pubic rami (33.7%) with potentially debilitating fracture neck of femur seen in 4.6% subjects. Mean duration of pain was 20.7±14.2 days with mean time for pain free mobilisation 42.2±17.7 days after presentation. 96.5% of those recovered with conservative treatment (activity restriction or cast). CONCLUSIONS: The location of stress fracture depends upon the type of training or activities. Modification of activities in early phase of training with early visit for medical care in case of trainees with increasing pain may decrease morbidities and complications requiring operative treatment.
Assuntos
Fraturas de Estresse , Humanos , Masculino , Índice de Massa Corporal , Fraturas de Estresse/epidemiologia , Nepal/epidemiologia , Dor , Polícia , FemininoRESUMO
INTRODUCTION: Fragility fractures without significant trauma of the pelvic ring in older patients have an increasing incidence due to demographic change. Influencing factors other than osteoporotic bone quality that lead to an insufficiency fracture are not yet known. However, it is suspected that the pelvic tilt (PT) has an effect on the development of such an insufficiency fracture. This study explores the influence of the PTs in patients with insufficiency fractures of the posterior pelvic ring. MATERIALS AND METHODS: A total of 49 geriatric patients with fragility fractures of the pelvic ring were treated at a university hospital level-1 trauma center during a period between February and December 2023, and their fractures were classified according to the FFP classification of Rommens and Hofmann. Complete sets of computer tomography (CT) and radiological images were available to determine the PT angle of the patients. RESULTS: 34 FFP type 2 and 15 FFP type 3 classified patients were included in the study. Significant difference was seen in the pelvic tilt (PT) angle between the patient group with insufficiency fractures (n= 49; mean age: 78.02 ± 11.80) and the control group with lumbago patients (n= 53; mean age: 69.23 ± 11.23). The PT was significantly higher in the patients with insufficiency fractures (25.74° ± 4.76; pââââ ≤ 0.0001). CONCLUSIONS: The study demonstrates a significant extension of the PT angle of individuals with insufficiency fractures when compared to those with lumbago. The result suggests a potential association between pelvic tilt and fracture susceptibility. TRIAL REGISTRATION: A retrospective study about the influence of sagittal balance of the spine on insufficiency fractures of the posterior pelvic ring measured by the "pelvic tilt angle", DRKS00032120. Registered 20th June 2023 - Prospectively registered. Trial registration number DRKS00032120.
Assuntos
Fraturas de Estresse , Ossos Pélvicos , Sacro , Tomografia Computadorizada por Raios X , Humanos , Feminino , Idoso , Masculino , Ossos Pélvicos/lesões , Ossos Pélvicos/diagnóstico por imagem , Idoso de 80 Anos ou mais , Fraturas de Estresse/diagnóstico por imagem , Fraturas de Estresse/epidemiologia , Fraturas de Estresse/fisiopatologia , Sacro/diagnóstico por imagem , Sacro/lesões , Prevalência , Fraturas por Osteoporose/fisiopatologia , Fraturas por Osteoporose/epidemiologia , Fraturas por Osteoporose/diagnóstico por imagem , Estudos Retrospectivos , Fraturas da Coluna Vertebral/fisiopatologia , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/epidemiologia , Fraturas da Coluna Vertebral/complicações , Pessoa de Meia-Idade , Postura/fisiologiaRESUMO
BACKGROUND: Although stress fractures of the distal femur are rare, symptoms can overlap with other peri-articular knee pathology, delaying diagnosis. Untreated stress fractures have the potential to progress into completed fractures with a higher likelihood for requiring surgery and longer recovery times in otherwise healthy adolescents and young adults. This case series represents the largest cohort of adolescent athletes with distal femoral stress fractures who presented with activity-related knee pain. METHODS: Patients treated nonoperatively and operatively for metaphyseal distal femur stress fractures at a tertiary referral center over a four-year period were retrospectively identified from the medical record. RESULTS: Eight patients (mean age 16.8 y; range 14 to 22 y; 87.5% male; mean body mass index [BMI] 20.9) with a total of 10 distal femur stress fractures were identified. All patients were involved in competitive sports or military training. There was an average of 3.8 encounters with a medical provider between presentation with activity-related knee pain and diagnosis with distal femur stress fracture. All except 1 patient (87.5%) were initially incorrectly diagnosed with another type of peri-articular knee pathology. Six stress fractures (60%) were treated conservatively with protected weight bearing, activity modification, and gradual return to activity. Four completed stress fractures (40%) required operative fixation-3 healed uneventfully, while 1 had an asymptomatic delayed union. Vitamin D insufficiency (<30 ng/mL) was identified in 7 of 8 patients (87.5%) and 3 patients (37.5%) had an underweight BMI (<18.5). The mean clinical follow-up was 13.1 weeks (range, 2.8 to 32.0 wk). CONCLUSIONS: High clinical suspicion for distal femoral stress fractures is needed to avoid misdiagnosis or delayed diagnosis in young, active individuals with activity-related knee pain refractory to conservative management. In this patient population, activity-related knee pain recalcitrant to activity modification, rest, and physical therapy warrants further workup with magnetic resonance imaging and orthopaedic evaluation. Though rare, misdiagnosis can result in catastrophic fractures with prolonged rehabilitation needs. An open line of communication and streamlined access for referral between primary care providers and orthopaedic surgeons is critical in preventing misdiagnosis and delayed treatment. Furthermore, the treatment of concomitant metabolic disorders and nutritional deficiency should not be neglected when treating distal femoral stress fractures. LEVEL OF EVIDENCE: Level-IV (case series).
Assuntos
Fraturas do Fêmur , Fraturas de Estresse , Humanos , Masculino , Adolescente , Adulto Jovem , Feminino , Fraturas de Estresse/epidemiologia , Fraturas de Estresse/cirurgia , Fraturas do Fêmur/etiologia , Fraturas do Fêmur/cirurgia , Fixação Interna de Fraturas/métodos , Estudos Retrospectivos , Atletas , Dor/etiologia , Resultado do TratamentoRESUMO
OBJECTIVES: To determine (1) the incidence rate of lower extremity (LE) bone stress injuries (BSIs) in United States Air Force Special Warfare (AFSPECWAR) trainees during the first 120 days of training, and (2) factors associated with sustaining a LE BSI. DESIGN: Retrospective cohort study. METHODS: AFSPECWAR Airmen (n = 2,290, mean age = 23.7 ± 3.6 years) entering an intensive 8-week preparatory course "SW-Prep" between October 2017 and May 2021. We compared anthropometric measurements, previous musculoskeletal injury (MSKI), fitness measures, and prior high-impact sports participation in those that did and did not suffer a BSI during the 120-day observation period using independent t-tests and chi-square tests. A multivariable binary logistic regression was used to determine factors associated with suffering a BSI. RESULTS: A total of 124 AFSPECWAR trainees suffered a BSI during the surveillance period, yielding an incidence proportion of 5.41% and an incidence rate of 1.4 BSIs per 100 person-months. The multivariate logistic regression revealed that lower 2-minute sit-up scores, no prior history of participation in a high-impact high-school sport, and a history of prior LE MSKI were associated with suffering a BSI. A receiver operator characteristic curve analysis yielded an area under the curve (AUC) of 0.727. CONCLUSION: BSI incidence proportion for our sample was similar to those seen in other military settings. Military trainees without a history of high-impact sports participation who achieve lower scores on sit-ups tests and have a history of LE MSKI have a higher risk for developing a LE BSI during the first 120 days of AFSPECWAR training.
Assuntos
Militares , Humanos , Incidência , Estudos Retrospectivos , Masculino , Militares/estatística & dados numéricos , Fatores de Risco , Estados Unidos/epidemiologia , Feminino , Adulto , Modelos Logísticos , Fraturas de Estresse/epidemiologia , Estudos de CoortesRESUMO
OBJECTIVES: To describe bone injury patterns in elite track and field athletes. To investigate relationships between bone injury and athlete characteristics to inform future injury prevention strategies. DESIGN: Descriptive epidemiology study. SETTING: Elite athletics training centres across the United Kingdom and internationally, observed between 2012 and 2020. PARTICIPANTS: 207 Olympic programme senior track and field athletes. MAIN OUTCOME MEASURES: Injury number, Incidence, Severity, Burden, Time Loss. RESULTS: There were 78 fractures during the study period. Gradual repetitive bone injuries were the most common type of injury mode. The foot, pelvis and the lumbar spine were the regions with the highest number of bone stress injuries. Stress fractures had a higher burden overall compared to stress reactions. Average return to full training was 67.4 days (±73.1) for stress reactions and 199 (±205.2) days for stress fractures. There was no relationship between bone injury type and age, sex, ethnicity, side dominance or event group. CONCLUSION: Bone stress injuries in athletics have a high severity and burden warranting continued efforts to prevent their occurrence and optimize management. Age, sex, ethnicity, side dominance and event region do not have any relationship with bone injury occurrence and are therefore unlikely to increase risk in this cohort.
Assuntos
Traumatismos em Atletas , Fraturas de Estresse , Atletismo , Humanos , Traumatismos em Atletas/epidemiologia , Traumatismos em Atletas/etiologia , Fraturas de Estresse/epidemiologia , Estudos Prospectivos , Estudos de Coortes , Atletas , IncidênciaRESUMO
OBJECTIVE: To characterise the prevalence, incidence rate (IR) and burden of injuries in elite short-course triathletes over a 4-year training and competition period. METHODS: Fifty elite Australian triathletes were prospectively monitored for injury during four consecutive seasons (2018-2021). Injuries requiring medical attention were prospectively recorded and further subcategorised according to time loss. The IR and burden (injury IR×mean injury severity) were calculated per 365 athlete days, with sex differences in IR compared using IR ratios (IRR) from negative binomial regression models. RESULTS: Two hundred and sixty-six injuries were reported in 46 (92.0%) athletes, of which 67.3% resulted in time loss. The injury IR was 1.87 injuries per 365 athlete days (95% CI 1.70 to 2.80), and comparable between sexes (IRR 0.82, 95% CI 0.64 to 1.04, p=0.109). Most injuries (70.7%) were training related. The most frequently injured body sites were the ankle (15.8%), foot (12.4%) and lower leg (12.0%). Bone stress injuries (BSIs) were the most burdensome injury type with 31.38 days of time loss per 365 days (95% CI 24.42 to 38.34). Twenty athletes (40.0%) reported at least one bone stress injury (BSI) (range 0-3). The rate of BSIs in female athletes was three times greater compared with male athletes (IRR 2.99, 95% CI 1.26 to 7.07, p=0.013). CONCLUSION: Two-thirds of injuries reported in elite short-course triathletes resulted in time loss, with the majority occurring during training activities. Foot, ankle and other lower leg injuries had the highest incidence, with BSIs carrying the highest injury burden. The considerably higher rate of BSI observed in female athletes warrants consideration for future prevention strategies in female triathletes.
Assuntos
Traumatismos em Atletas , Natação , Humanos , Estudos Prospectivos , Feminino , Masculino , Traumatismos em Atletas/epidemiologia , Incidência , Prevalência , Adulto , Natação/lesões , Natação/estatística & dados numéricos , Austrália/epidemiologia , Corrida/lesões , Ciclismo/lesões , Adulto Jovem , Atletas/estatística & dados numéricos , Fraturas de Estresse/epidemiologia , Fatores Sexuais , Condicionamento Físico Humano/efeitos adversosRESUMO
BACKGROUND: Femoral neck stress fractures (FNSFs) are a unique injury pattern not commonly treated in the civilian trauma population; however, it is particularly high with military trainees engaged in basic combat training. To date, no study has surveyed a population of military orthopedic surgeons on treatment preferences for military service members (SMs) with FNSF. QUESTIONS: We aim to evaluate the extent of clinical equipoise that exists in the management of these injuries, hypothesizing that there would be consensus in the factors dictating surgical and non-surgical intervention for FNSF. PATIENTS AND METHODS: A 27-question survey was created and sent to U.S. military orthopedic surgeon members of the Society of Military Orthopaedic Surgeons. The survey was designed in order to gather the experience among surgeons in treating FNSF and identifying variables that play a role in the treatment algorithm for these patients. In addition, seven detailed, clinical vignettes were presented to further inquire on surgeon treatment preferences. Binomial distribution analysis was used to evaluate for common trends within the surgeon's treatment preferences. RESULTS: Seventy orthopedic surgeons completed the survey, the majority of whom were on active duty status in the U.S. Military (82.86%) and having under 5 years of experience (61.43%). Majority of surgeons elected for a multiple screw construct (92.86%), however the orientation of the multiple screws was dependent on whether the fracture was open or closed. Management for compression-sided FNSF involving ≥50% of the femoral neck width, tension-sided FNSF, and stress fractures demonstrating fracture line progression had consensus for operative management. Respondents agreed upon prophylactic fixation of the contralateral hip if the following factors were involved: Complete fracture (98.57%), compression-sided fracture line >75% (88.57%), compression-sided fracture line >50-75% with hip effusion (88.57%), contralateral tension-sided fracture (87.14%), and compression-sided fracture line >50-75% (84.29%). An FNSF < 50% on the contralateral femoral neck or a hip effusion was indeterminate in surgeons indicating need for prophylactic fixation. Majority of surgeons (77.1%) utilized restricted toe-touch weight-bearing for postoperative mobility restrictions. CONCLUSIONS: Consensus exists for surgical and non-surgical management of FNSF by U.S. military orthopedic surgeons, despite the preponderance of surgeons reporting a low annual volume of FNSF cases treated. However, there are certain aspects in the operative and non-operative management of FNSF that are unanimously adhered to. Specifically, our results demonstrate that there is no clear indication on the management of FNSF when an associated hip effusion is involved. Additionally, the indications for surgically treating contralateral FNSF are unclear. LEVEL OF EVIDENCE: IV.
Assuntos
Fraturas do Colo Femoral , Fraturas de Estresse , Militares , Cirurgiões , Humanos , Fraturas de Estresse/cirurgia , Fraturas de Estresse/epidemiologia , Colo do Fêmur , Consenso , Fraturas do Colo Femoral/cirurgia , Inquéritos e QuestionáriosRESUMO
BACKGROUND: An acromial stress fracture (ASF) is an uncommon complication after reverse total shoulder arthroplasty (RTSA) that can have severe clinical consequences on shoulder function. Although patient-specific factors have been identified to influence the risk of ASF, it is unclear whether modifying these factors can minimize risk. Moreover, there is limited information on the treatment outcomes of these fractures. Therefore, the purpose of this study was to determine modifiable risk factors for ASFs and the complication and revision rates of conservatively and operatively managed ASFs. METHODS: The PearlDiver database was queried to identify a cohort of patients who underwent RTSA with minimum 2-year follow-up. Current Procedural Terminology and International Classification of Diseases codes were used to compare the demographic characteristics, comorbidities, and medication use of patients with and without ASFs. Surgical complication and revision rates were compared between operatively and conservatively treated fractures. RESULTS: The overall incidence of ASFs was 1.4%. Patient-specific factors that were independently associated with the occurrence of an ASF included osteoporosis, rheumatologic disease, shoulder corticosteroid injection within 3 months before surgery, and chronic oral corticosteroid use. Among patients with osteoporosis, the initiation of physical therapy within 6 weeks after surgery also increased the risk of ASF. Patients who underwent surgical treatment of ASFs had a revision arthroplasty rate of 7.0% compared to a rate of 3.2% among those with conservatively managed fractures. CONCLUSION: ASFs are infrequent complications that can occur after RTSA. Preoperative factors that affect the quality of bone independently increase the fracture risk. Moreover, this risk can be minimized by avoiding shoulder corticosteroid injections 3 months before surgery and delaying physical therapy exercises among patients with osteoporosis. Surgical fixation of these fractures should be reserved for instances when conservative management has failed given high rates of infection, instability, and revision shoulder arthroplasty.
Assuntos
Artroplastia do Ombro , Fraturas de Estresse , Osteoporose , Fraturas por Osteoporose , Fraturas do Ombro , Articulação do Ombro , Humanos , Artroplastia do Ombro/efeitos adversos , Fraturas de Estresse/epidemiologia , Fraturas de Estresse/etiologia , Incidência , Estudos Retrospectivos , Complicações Pós-Operatórias/etiologia , Resultado do Tratamento , Fraturas por Osteoporose/etiologia , Fatores de Risco , Osteoporose/complicações , Corticosteroides , Articulação do Ombro/cirurgia , Fraturas do Ombro/cirurgiaRESUMO
Previous research has shown a discrepancy in incidences of knee injuries, stress fractures, and concussions between cisgender men and women. Little is known regarding the incidence of musculoskeletal injuries among patients on gender-affirming hormone therapy (GAHT). This retrospective cohort study examines cumulative incidence of knee injuries, concussions, and stress fracture injuries among transgender patients on GAHT at one health system from 2011-2020. Using relevant ICD-9 and 10 codes, incidences of knee injury, concussion, and stress fracture were calculated. Cohorts included 1971 transgender and 3964 cisgender patients. Transgender patients had significantly higher incidence of all-cause knee injuries over the study period, 109 (5.5%) versus 175 (4.4%) (p < 0.001; OR: 2.14, 95% CI [1.17-3.92]). Subgroup analysis showed significantly higher incidence of knee injuries among cisgender men (5.6%) versus cisgender women (4.1%) (p = 0.042) and among transgender women (6.6%) versus cisgender women (4.1%) (p = 0.005). There were no significant differences between incidences of concussion and stress fracture between groups. This sample showed that patients on GAHT had increased cumulative incidences of all-cause knee injury compared to controls but similar cumulative incidences of concussion and bone-stress injuries. Transgender women on exogenous estrogen had significantly higher cumulative incidences of all-cause knee injuries compared to cisgender women.
Assuntos
Concussão Encefálica , Fraturas de Estresse , Traumatismos do Joelho , Pessoas Transgênero , Masculino , Humanos , Feminino , Incidência , Fraturas de Estresse/epidemiologia , Estudos Retrospectivos , Concussão Encefálica/epidemiologia , EstrogêniosRESUMO
INTRODUCTION: Every year, approximately 35,000 recruits enter the United States Air Force Basic Military Training (BMT). Musculoskeletal problems are particularly vexing for BMT because a broad array of differentials render definitive diagnosis burdensome and while most sufferers will fully recover, healing often requires protracted training delays resulting in increased unrecoverable training costs to the program. The purpose of this study is to conduct a case-control study of basic military trainees entering service from 2012 to 2015 to assess detectable differences in demographics, retention, and health care utilization. MATERIALS AND METHODS: This is a retrospective case-control study of existing data and records obtained from existing and active information record systems for individuals who attended BMT between the years 2012 and 2015. Cohort assignment was based on incidence of first stress fracture diagnosis (i.e., having a select diagnosis code in one's medical record) relative to arrival at BMT. Health care utilization is operationalized as medical encounter frequencies and associated international classification of disease (ICD) codes occurring for all patients from BMT recruit date of arrival to 6 months post-graduation (i.e., 180 days). RESULTS: The primary dataset includes 132,359 distinct individuals, of which 129,637 (98%) had no history of stress fracture diagnosis and 1,487 (1%) of which have a diagnosis of stress fracture more than 60 days after arrival at BMT; these are assigned to the CONTROL group. There are 1,235 (0.9%) assigned to the CASE group. CASE members presented with 30.1 unique ICD-10 codes post-graduation compared to 6.3 in the CONTROL group. Six of the top thirteen ICD-10 codes were musculoskeletal in nature and all presented significantly higher rates for the CASE group. CONCLUSIONS: Trainees who suffered a bone stress injury (BSI) during the United States Air Force BMT advanced in rank on par with trainees who did not, but BSI sufferers exhibited greater health care utilization than those who did not suffer BSI. The cost to replace a trainee unable to complete BMT is considerable; however, it is also important to consider the reduction in resiliency and readiness to the Department of Defense and the financial burdens from increased health care utilization. The 2-fold increase in BSI presentation in the graduated control group reflects that more needs to be done for all populations to identify better proactive efforts to foundationally support wellness and prevention rather than accept injury as the status quo.
Assuntos
Fraturas de Estresse , Militares , Humanos , Estados Unidos/epidemiologia , Fraturas de Estresse/epidemiologia , Estudos Retrospectivos , Estudos de Casos e Controles , Aceitação pelo Paciente de Cuidados de SaúdeRESUMO
PURPOSE: The purpose of this study was to characterize the impact of detraining due to the COVID-19 pandemic on incidence of bony injuries and stress fractures in collegiate athletes. METHODS: A comprehensive collegiate athletic conference injury database was queried for all in-season, sport-related bony injuries (defined as all stress reactions and fractures) that occurred across all sports from January 2016 to June 2021. The bony injury rate per 1000 athlete exposure hours (AEH) was calculated and compared between the immediate post-hiatus season and historic rates from pre-hiatus seasons (2016-2019). Injury characteristics were also compared between the pre- and post-hiatus time periods. RESULTS: A total of 868 bony injuries across 23 sports were identified. The sports with highest overall baseline bony injury rates in historic seasons were women's cross country (0.57 injuries per 1000 AEH) and men's cross country (0.32). Compared to historic pre-hiatus rates, female cross-country runners demonstrated a significantly lower bony injury incidence rate in the post-hiatus season (0.24 vs. 0.57, p = 0.016) while male swimming athletes demonstrated a statistically significant increase in bony injury rate (0.09 vs. 0.01, p = 0.015). The proportion of bony injuries attributed to repetitive trauma increased; while, the proportion of injuries attributed to running decreased between the pre- and post-hiatus seasons. CONCLUSION: Across all sports, there was no consistent trend toward increased rates of bony injury in the immediate post-hiatus season. However, female cross-country runners demonstrated lower rates of bony injury in the post-hiatus season while male swimmers demonstrated higher rates. Furthermore, bony injuries in the post-hiatus season were more likely to be the result of repetitive trauma and less likely to be from running. LEVEL OF EVIDENCE: Level III, retrospective, cross sectional study.
Assuntos
Traumatismos em Atletas , COVID-19 , Fraturas de Estresse , Corrida , Humanos , Masculino , Feminino , Estados Unidos , Incidência , Estudos Retrospectivos , Estudos Transversais , Pandemias , COVID-19/epidemiologia , Traumatismos em Atletas/epidemiologia , Traumatismos em Atletas/etiologia , Atletas , Fraturas de Estresse/epidemiologia , Fraturas de Estresse/etiologiaRESUMO
BACKGROUND: Pelvic insufficiency fractures (PIFs) are a late complication of radiotherapy for pelvic malignancies. We evaluated the incidence, radiologic findings, clinical course, and outcome of PIFs in patients treated with neoadjuvant (chemo)radiotherapy ((C)RT) for rectal cancer. MATERIAL AND METHODS: Data of patients diagnosed with rectal cancer from a large teaching hospital treated from 2002 to 2012 were extracted from the Dutch Cancer Registry. All hospital records were reviewed for the diagnosis of PIFs or pelvic bone metastases. An expert radiologist reassessed all imaging procedures of the lower back, abdomen, and pelvis. RESULTS: A total of 513 rectal cancer patients were identified of whom 300 patients (58.5%) were treated with neoadjuvant (C)RT (long- vs. short-course radiotherapy: 91 patients [17.7%] vs. 209 [40.7%], respectively). Twelve PIFs were diagnosed initially according to hospital records and imaging reports of all 513 patients. These 12 patients were treated with neoadjuvant (C)RT. After reassessment of all pelvic imaging procedures done in this patient group (432 patients (84.2%)), 20 additional PIFs were detected in patients treated with neoadjuvant (C)RT, resulting in a 10.7% PIF rate in irradiated patients. One PIF was detected in the group of patients not treated with neoadjuvant (C)RT for rectal cancer. This patient had palliative radiotherapy for prostate cancer and is left out of the analysis. Median follow-up time of 32 PIF patients was 49 months. Median time between start of neoadjuvant (C)RT and diagnosis of PIF was 17 months (IQR 9-28). Overall median survival for patients with PIF was 63.5 months (IQR 44-120). CONCLUSION: PIFs are a relatively common late complication of neoadjuvant (C)RT for rectal cancer but are often missed or misdiagnosed as pelvic bone metastases. The differentiation of PIFs from pelvic bone metastases is important because of a different treatment and disease outcome.
Assuntos
Fraturas de Estresse , Ossos Pélvicos , Neoplasias Retais , Masculino , Humanos , Fraturas de Estresse/epidemiologia , Fraturas de Estresse/etiologia , Fraturas de Estresse/patologia , Terapia Neoadjuvante/efeitos adversos , Ossos Pélvicos/patologia , Pelve/patologia , Neoplasias Retais/patologia , Quimiorradioterapia/efeitos adversos , Estudos Retrospectivos , Estadiamento de NeoplasiasRESUMO
INTRODUCTION: Stress fractures (SFx) represent a significant proportion of injuries in military recruits internationally. Stress fractures disproportionately affect female recruits, a disparity that has similarly been consistently demonstrated in female athletes. Stress fractures result in medical morbidity, financial burden, and medical discharge from military service. This review presents current literature regarding SFx risk factors to identify and/or mitigate in this high-risk population. METHODS: A literature review was conducted using PubMed to find relevant articles. We utilized keywords stress fracture, military, recruits, female, risk factors, modifiable, non-modifiable, overuse, nutrition, and/or prevention. Articles older than 10 years (published before 2010) were not considered. Review articles were considered, but if a research article was cited by a review, the research was included directly. Articles with primary military data, members of the military as subjects, especially when female recruits were included, were strongly considered for inclusion in this review. RESULTS: Modifiable risk factors for SFx include nutritional deficiency, especially of iron, vitamin D, and possibly calcium, poor physical fitness, suboptimal training programming for injury development and recovery, load carriage, and military footwear. Non-modifiable risk factors include female sex, greater height, lower weight and body mass index in females but lower or higher weight and body mass index in males, lower body fat percentage, and lower bone mineral density. In addition, menstrual dysfunction, low energy availability, later age at menarche, and iron deficiency pose unique risks to female recruits. Preventive measures include leadership education, programs with recovery considerations, and risk factor screening. CONCLUSION: This review, Part II of a two-part series, guides multidisciplinary management of military recruits, especially females, who are at risk for developing SFx. Unique nuances of the military recruit require specific knowledge to reduce high incidence rates of injury internationally.
Assuntos
Fraturas de Estresse , Militares , Masculino , Humanos , Feminino , Fraturas de Estresse/epidemiologia , Fraturas de Estresse/etiologia , Fatores de Risco , Vitamina D , Índice de Massa CorporalRESUMO
INTRODUCTION: Stress fractures (SFx) represent a significant proportion of musculoskeletal injuries in military recruits internationally. Incidence rates as high as 40% have been reported, varying by country and branch of military cohorts. Tibial SFx are the most common, followed by other lower extremity sites, and are related to the emphasis on running during training. SFx disproportionately affect female recruits, similarly to a disparity demonstrated in female athletes. METHODS: A literature review of articles relevant to our review was conducted using PubMed, utilizing keywords stress fracture, military, recruits, diagnosis, management, treatment, prevention, epidemiology, background, and/or female. Articles older than 10 years old (prior to 2010) were not considered. Review articles were considered, but if a research article was cited by a review, the research was included directly. Articles with primary military data, members of the military as subjects, especially when female recruits were included, were strongly considered for inclusion in this review. RESULTS: SFx can cause medical morbidity and financial burden and can require discharge from military service. SFx management in the military has cost the United States approximately $100 million annually, which may be underestimated due to lost duty hours or medical discharge with resulting compensation. However, SFx incidence rates have been demonstrated to be reducible with concerted efforts in military cohorts. CONCLUSION: This review, Part I of a two-part series, provides updated information for multidisciplinary management of SFx in female military recruits. There are many similarities to management in athletes, but unique nuances of the military recruit require specific knowledge to reduce the high incidence rates of injury.
Assuntos
Fraturas de Estresse , Militares , Doenças Musculoesqueléticas , Humanos , Feminino , Estados Unidos/epidemiologia , Criança , Fraturas de Estresse/epidemiologia , Fraturas de Estresse/etiologia , Fatores de Risco , Doenças Musculoesqueléticas/complicações , Extremidade Inferior/lesõesRESUMO
INTRODUCTION: Figure skating combines esthetic components with high impact, technically demanding elements requiring high volume repetitive training. The evidence base for the sport is limited, particularly regarding stress fracture injuries. This study aims to describe the prevalence and anatomical distribution of stress fracture injuries and assess for risk factors, as well as associations with acute fractures. METHODS: An online anonymous retrospective survey of competitive figure skaters was distributed through social media networks and e-mail for completion by skaters from all three disciplines of figure skating. RESULTS: In a sample of 164 skaters from novice to Olympic level, career prevalence of stress fractures was 24.4%, most commonly affecting tibia and ankle. There was statistically significant increased risk of stress fracture in those training ≥12 times/week (33.3% vs. 17.8%; P = 0.028) but no increased risk associated with level or gender of skater. There was a higher prevalence of acute fracture in those with a history of stress fracture (45.0% vs. 21.8%; P = 0.007). CONCLUSIONS: Figure skaters are at a high risk of stress fractures, independent of the level performed at. There is a higher risk in those training more frequently and an association with additional acute fractures. Results advocate education on fracture features and bone health measures to skaters, coaches, and physicians, at all levels of the sport to facilitate early diagnosis and management.
Assuntos
Fraturas de Estresse , Patinação , Esportes , Humanos , Fraturas de Estresse/epidemiologia , Fraturas de Estresse/etiologia , Estudos Retrospectivos , Patinação/lesões , Fatores de RiscoRESUMO
Isolated first rib stress fractures in athletes are thought to be rare. In this case series, 3 National Collegiate Athletic Association Division I athletes developed isolated first rib stress fractures over the span of 1 year, indicating that these injuries may occur more often than previously understood. These fractures can be easily missed because of the low incidence, lack of clinical suspicion, and vague presentation. Further, radiographs can fail to reveal such fractures. To our knowledge, this is the largest case series of athletes with first rib stress fractures presenting with vague rhomboid interscapular pain. We also demonstrated that ultrasound successfully visualized these injuries; in the hands of an ultrasonographer or clinical provider trained in musculoskeletal ultrasound, this technique offers an advantageous point-of-care screening imaging modality.
Assuntos
Traumatismos em Atletas , Fraturas de Estresse , Esportes , Humanos , Traumatismos em Atletas/epidemiologia , Fraturas de Estresse/diagnóstico por imagem , Fraturas de Estresse/epidemiologia , Costelas , AtletasRESUMO
BACKGROUND: Female soccer players are often diagnosed with medial shin pain, which includes tibial stress fracture, medial tibial stress syndrome, and chronic exertional compartment syndrome. As the possibility of varied sites of pain affecting sports activities has not been fully researched, an urgent discussion and evidence is required. This study investigates the prevalence and effect of sites of pain on the sports activities of female soccer players with medial shin pain. METHODS: A questionnaire survey was conducted for 196 female soccer players with medial shin pain to assess symptom duration, the effect of practice and performance, and sites of pain. The players were classified into three conditions (tibial stress fracture, medial tibial stress syndrome, or medial shin pain with neurological symptoms) and compared based on sites of pain. RESULTS: We observed that medial tibial stress syndrome had a lower impact on performance compared to that of tibial stress fracture and medial shin pain with neurological symptoms. While participants with tibial stress fracture had to suspend practice sessions more frequently, the difference in symptom duration between the classified groups was not statistically significant. The effect of sites of pain on sports activities was not significantly different in participants with medial tibial stress syndrome. CONCLUSIONS: Medial shin pain should be evaluated carefully to differentiate between medial tibial stress syndrome and medial shin pain with neurological symptoms. Restriction of sports activities may help improve the patient's condition early, regardless of the presentation.