Olympic Class Sailing Injuries and Illness: A 15-Year Study of a World Cup Regatta Venue.

INTRODUCTION: Olympic class sailing injuries are a minimally researched topic. Our study includes 15 y of data from medical coverage of the Miami venue during the Sailing World Cup. The objective was to examine the nature of Olympic class sailing injuries and illnesses during competition. METHODS: The records of the medical clinic encounters of a World Cup Sailing regatta were reviewed. Summary statistics and nominal categorized data regarding demographics, onset, mechanism, nature of condition, and referral were collected. RESULTS: There were 740 clinic encounters, ranging from 20 to 70 annually. Five hundred fifty-five (75%) were musculoskeletal in nature, and 184 (25%) were related to medical concerns. Twelve athletes were referred to the emergency department (ED), averaging <1 per year. However, 6 (50%) of the ED referrals came from NACRA 17, 49er, and 49er F-X classes, representing a 16% ED referral rate by fleet per year. In contrast, the remainder of the classes had a 0.04% ED referral rate. The lumbar spine, cervical spine, and foot/ankle were the most common body regions treated. Laser Radial sailors had 71(10%) visits, the most per class. Coaches and staff represented 59 (8%) visits. CONCLUSIONS: Olympic class sailing venue medical coverage should be equipped to treat a variety of acute and chronic injuries and illnesses among athletes as well as coaches and staff. Overall, rates of ED or other off-site referrals are low but higher for 49er, 49er F-X, and North American Catamaran Racing Association (NACRA)-17 classes.

Common Health Issues Encountered by Ultraendurance Ocean Rowers.

INTRODUCTION: Ocean rowing is an extreme ultraendurance sport in which athletes push themselves to their mental and physical limits while rowing across an ocean. Limited academic attention has meant health issues facing this population are poorly understood. This report provides a descriptive analysis of the injuries and illnesses encountered by ocean rowers at sea and suggests potential preventative measures. METHODS: Retrospective self-reported data were collected from ocean rowers via an online 29-question survey, classified by medical system, and totaled to produce a report of the most frequently encountered symptoms. RESULTS: Seventy-one ocean rowers, accounting for 86 ocean rowing attempts, completed the survey. Dermatologic symptoms formed 52% (n=169) of all reported issues, followed by musculoskeletal injuries (14%; n=45), mental health symptoms (11%; n=36), gastrointestinal symptoms (5%; n=16), and neurologic symptoms (2%). Gluteal pressure sores were the most common dermatologic symptoms (24%; n=40), hallucinations the most common mental health symptoms (69%; n=25), hand and finger issues the most reported musculoskeletal problems (36%; n=16); vomiting (38%) and headaches (50%) were the most common gastrointestinal and neurologic issues, respectively. Seasickness was reported in 42% of expeditions (n=33). CONCLUSIONS: This report presents the physiological, mental, and medical challenges facing ocean rowers. Dermatologic and musculoskeletal issues were most common and varied greatly in severity. Over 90% of reported infections occurred as a dermatologic complaint, demonstrating the importance of preventative measures such as hygiene and wound care. Continued work with a larger population is required to further understand the physiological stress and medical complaints associated with transoceanic rowing.

2021 consensus statement for preventing and managing low back pain in elite and subelite adult rowers.

PURPOSE: To synthesise evidence on low back pain (LBP) in adult rowers and to create a consensus statement to inform clinical practice. METHODS: There were four synthesis steps that informed the consensus statement. In step one, seven expert clinicians and researchers established the scope of the consensus statement and conducted a survey of experienced and expert clinicians to explore current practice. In step two, working groups examined current evidence relating to key scope questions and summarised key issues. In step three, we synthesised evidence for each group and used a modified Delphi process to aid in the creation of the overall consensus statements. Finally, in step four, we combined information from step three with the findings of the clinician survey (and with athlete and coach input) to produce recommendations for clinical practice. RESULTS: The scope of the consensus statement included epidemiology; biomechanics; management; the athlete's voice and clinical expertise. Prevention and management of LBP in rowers should include education on risk factors, rowing biomechanics and training load. If treatment is needed, non-invasive management, including early unloading from aggravating activities, effective pain control and exercise therapy should be considered. Fitness should be maintained with load management and progression to full training and competition. The role of surgery is unclear. Management should be athlete focused and a culture of openness within the team encouraged. CONCLUSION: Recommendations are based on current evidence and consensus and aligned with international LBP guidelines in non-athletic populations, but with advice aimed specifically at rowers. We recommend that research in relation to all aspects of prevention and management of LBP in rowers be intensified.

'You're the best liar in the world': a grounded theory study of rowing athletes' experience of low back pain.

OBJECTIVES: Low back pain (LBP) is common in rowers and leads to considerable disability and even retirement. The athlete voice can help clinicians to better understand sport-related pain disorders. We aimed to capture the lived experience of LBP in rowers. METHODS: Cross-sectional qualitative study using a grounded theory approach. Adult competitive rowers with a rowing-related LBP history were recruited in Australia and Ireland. Data were collected through interviews that explored: context around the time of onset of their LBP and their subsequent journey, experiences of management/treatment, perspectives around present beliefs, fears, barriers and expectations for the future. RESULTS: The 25 rowers (12 women/13 men) who participated were aged 18-50 years; they had a mean 12.1 years of rowing experience. They discussed a culture of concealment of pain from coaches and teammates, and fear of being judged as 'weak' because of the limitations caused by LBP. They reported fear and isolation as a result of their pain. They felt that the culture within rowing supported this. They reported inconsistent messages regarding management from medical staff. Some rowers reported being in a system where openness was encouraged-they regarded this a leading to better outcomes and influencing their LBP experience. CONCLUSIONS: Rowers' lived experience of LBP was influenced by a pervasive culture of secrecy around symptoms. Rowers and support staff should be educated regarding the benefits of early disclosure and rowers should be supported to do so without judgement.

Musculoskeletal injuries in athletes from five modalities: a cross-sectional study.

BACKGROUND: Musculoskeletal injuries (MSK-I) are a serious problem in sports medicine. Modifiable and non-modifiable factors are associated with susceptibility to these injuries. Thus, the aim of this study was to describe the prevalence of and identify the factors associated with MSK-I, including tendinopathy and joint and muscle injuries, in athletes. METHODS: In this cross-sectional observational study, 627 athletes from rugby (n = 225), soccer (n = 172), combat sports (n = 86), handball (n = 82) and water polo (n = 62) were recruited at different sports training centres and competitions. Athlete profiles and the prevalence of MSK-I were assessed using a self-reported questionnaire. Only previous MSK-I with imaging confirmation and/or a positive physical exam by a specialized orthopaedist were considered. The association of the epidemiological, clinical and sports profiles of athletes with MSK-I was evaluated by a logistic regression model. RESULTS: The mean age was 25 ± 6 years, and 60% of the athletes were male. The epidemiological, clinical and sports profiles of the athletes were different for the five sport groups. The MSK-I prevalence among all athletes was 76%, with 55% of MSK-I occurring in a joint, 48% occurring in a muscle and 30% being tendinopathy, and 19% of athletes had three investigated injuries. The MSK-I prevalence and injury locations were significantly different among sport groups. There was a predominance of joint injury in combat sports athletes (77%), muscle injury in handball athletes (67%) and tendinopathy in water polo athletes (52%). Age (≥30 years) was positively associated with joint (OR = 5.2 and 95% CI = 2.6-10.7) and muscle (OR = 4.9 and 95% CI = 2.4-10.1) injuries and tendinopathy (OR = 4.1 and 95% CI = 1.9-9.3). CONCLUSION: There is a high prevalence of tendinopathy and joint and muscle injuries among rugby, soccer, combat sports, handball and water polo athletes. The analysis of associated factors (epidemiological, clinical and sports profiles) and the presence of MSK-I in athletes suggests an approximately 4-5-fold increased risk for athletes ≥30 years of age. The identification of modifiable and non-modifiable factors can contribute to implementing surveillance programmes for MSK-I prevention.

Epidemiology of injury and illness in 153 Australian international-level rowers over eight international seasons.

AIM: To report the epidemiology of injury and illness in elite rowers over eight seasons (two Olympiads). METHODS: All athletes selected to the Australian Rowing Team between 2009 and 2016 were monitored prospectively under surveillance for injury and illness. The incidence and burden of injury and illness were calculated per 1000 athlete days (ADs). The body area, mechanism and type of all injuries were recorded and followed until the resumption of full training. We used interrupted time series analyses to examine the association between fixed and dynamic ergometer testing on rowers' injury rates. Time lost from illness was also recorded. RESULTS: All 153 rowers selected over eight seasons were observed for 48 611 AD. 270 injuries occurred with an incidence of 4.1-6.4 injuries per 1000 AD. Training days lost totalled 4522 (9.2% AD). The most frequent area injured was the lumbar region (84 cases, 1.7% AD) but the greatest burden was from chest wall injuries (64 cases, 2.6% AD.) Overuse injuries (n=224, 83%) were more frequent than acute injuries (n=42, 15%). The most common activity at the time of injury was on-water rowing training (n=191, 68). Female rowers were at 1.4 times the relative risk of chest wall injuries than male rowers; they had half the relative risk of lumbar injuries of male rowers. The implementation of a dynamic ergometers testing policy (Concept II on sliders) was positively associated with a lower incidence and burden of low back injury compared with fixed ergometers (Concept II). Illness accounted for the greatest number of case presentations (128, 32.2% cases, 1.2% AD). CONCLUSIONS: Chest wall and lumbar injuries caused training time loss. Policy decisions regarding ergometer testing modality were associated with lumbar injury rates. As in many sports, illness burden has been under-recognised in elite Australian rowers.

Rib stress injuries in the 2012-2016 (Rio) Olympiad: a cohort study of 151 Australian Rowing Team athletes for 88 773 athlete days.

AIM: To describe the demographics, frequency, location, imaging modality and clinician-identified factors of rib stress injury in a cohort of elite rowers over the Rio Olympiad (2012-2016). METHODS: Analysis of prospectively recorded medical records for the Australian Rowing Team in 2013-2015 and the combined Australian Rowing Team and Olympic Shadow Squad in 2016, examining all rib stress injuries. RESULTS: 19 rib stress injuries (12 reactions and 7 fractures) were identified among a cohort of 151 athletes and included 12 female and 7 male cases, 11 open weight, 8 lightweight, 12 scull and 7 sweep cases. The most common locations of injury identified by imaging, were the mid-axillary line and rib 6. Period prevalence varied from 4% to 15.4% and incidence ranged from 0.27 to 0.13 per 1000 athlete days. There were no significant differences in prevalence by sex, sweep versus scull or weight class. There was a statistically significant increase in incidence in the pre-Olympic year (2015, p<0.001). MRI was the most commonly used modality for diagnosis. Stress fracture resulted in median 69 (IQR 56-157) and bone stress reaction resulted in 57 (IQR 45-78) days lost to full on water training. CONCLUSIONS: In our 4-year report of rib stress injury in elite rowing athletes, period prevalence was consistent with previous reports and time lost (median ~10 weeks) was greater than previously published literature. Rib stress injury limits training and performance in elite rowers and MRI should be considered as a first line investigation.

Orthopedic Injuries in Professional Surfers: A Retrospective Study at a Single Orthopedic Center.

BACKGROUND: Literature regarding surfing injuries is scarce and most studies report a high number of minor injuries. Recent literature suggests that musculoskeletal injuries are more common than previously reported. In the mid 2000s, competitive surfing has seen an increase in aerial maneuvers, as they have become more highly rewarded by the judging panel, which may be contributing to a change in injury patterns. Our goal was to evaluate orthopedic injuries in professional surfers. HYPOTHESIS: Orthopedic injuries in professional surfers are diverse and have evolved with skill and technology. STUDY DESIGN: Retrospective observational study. LEVEL OF EVIDENCE: Level 4 Case Series. METHODS: Medical records of professional surfers from a single orthopedic center between 1991 and 2016 were reviewed. Injuries sustained while surfing and chronic injuries related to surfing were included. Site of injury, diagnosis, and treatment were recorded along with demographic data. RESULTS: In total, 163 injuries in 86 athletes were recorded. The median injury age was 28.5 years (range 12-62 years) and 92.6% of patients were male. The most frequently injured body parts were the knee (28.2%), ankle (22.1%), and shoulder (19%). Most knee injuries were of the medial collateral ligament at 49%, with 75% of ankle injuries being sprains, and in shoulder, 48% had instability, 42% had a rotator cuff tear, and 35% had a superior anterior-posterior labral tear. Lower extremity injuries primarily affected the surfers' back leg (72.5%). In all, 34.6% of all injuries required surgical intervention and involved shoulder injuries most the time. CONCLUSIONS: The most common orthopedic injuries in professional surfers involve the knee, ankle, shoulder, hip, and back. Surfers' rear extremities were preferentially injured which is the extremity responsible for power and torque. Shoulder injuries increased the probability of an operative intervention. Last, overuse injuries (femoral-acetabular impingement, rotator cuffs) occurred in the older surf population compared with more acute injuries (ankle sprains/fractures, anterior cruciate ligament tears) which is also consistent with time to surgery.

Musculoskeletal Injury in Paddle Sport Athletes.

INTRODUCTION: Kayak racing has been an Olympic sport since 1936. The sport is evolving with the introduction of ocean skis and stand-up-paddle boards (SUP). Musculoskeletal injury incidence surveys have been conducted for ultra-marathon events, but no data have been published for other racing formats. OBJECTIVE: To identify and compare the rates and types of injuries sustained by paddling athletes as a function of discipline and training parameters in Sprint, Marathon, Ultra-Marathon, and Ocean events. METHODS: Competitors from 6 kayak and/or ocean surf-ski races in Australia were surveyed. Before each race, competitors were asked to complete a questionnaire. The questionnaire investigated paddling-related injuries over the previous 5 years, athlete morphology, flexibility, equipment and its setup, training volume, and environment. RESULTS: Five hundred eighty-three competitors were surveyed. Disciplines included 173 racing-kayak (K1), 202 touring-kayak, 146 ocean-skis, 42 SUP, and 20 other. The top 5 paddling-related injuries were shoulder (31%), low back (23.5%), wrist (16.5%), neck (13.7%), and elbow (11.0%). The highest percentage of injury was found in K1 paddlers for shoulder (40.5%), SUP for low back (33.3%), and ocean-ski for wrist (22.6%). After controlling for on-water training hours, the relative risk (RR) of wrist injury was significantly increased in ocean-ski paddlers (1.86) and in paddlers with decreased flexibility (1.53-1.83). Relative risk of shoulder and low-back injury was significantly increased in athletes with lower training volumes (1.82-2.07). Younger athletes had lower RR of wrist and shoulder injury (0.58-0.62).

Nonfreezing Cold Injuries Among Long-Distance Polar Rowers.

INTRODUCTION: Nonfreezing cold injury (NFCI) is a peripheral cold injury that occurs when the extremities are exposed to cold temperatures, at or near the freezing point, for sustained periods of time (48-96 h at temperatures of usually around 0 to 6°C with associated wind chill). Although NFCI often goes unreported and may be underdiagnosed, it is a cause of significant morbidity in those working in cold conditions, particularly those in the military. Thus, further research into the prevention, recognition, and treatment of NFCI is warranted. METHODS: The height, body weight, and body composition of 6 rowers taking part in 1 or 2 legs of the 2017 Polar Row expedition were measured. The weather conditions of the 2 legs of the journey were recorded, and symptoms relating to NFCI were documented. RESULTS: All incidences of NFCI occurred during Leg 2 of the expedition, which was colder and wetter. Of the Leg 2 rowers, those who developed NFCI had a trend toward higher pre-row body weight and body mass index and a trends toward losing more weight and body water relative to those who did not. CONCLUSIONS: The main factor contributing to the incidence of NFCI appeared to be weather; NFCI only occurred during the colder and wetter leg of the expedition. We also tentatively suggest that nutrition and dehydration may be linked to the incidence of NFCI as predisposing factors. More work, with sample sizes greater than those reported here, is required to investigate these associations to further characterize risk factors.

Pelvic Ring Fracture During a Professional Surfing Event at the Banzai Pipeline.

We present a case of a 32-y-old male professional surfer who sustained an isolated pelvic ring fracture after wiping out on a large wave and striking the ocean floor during a world championship tour surfing competition in Hawaii. The surfer was rescued by the water patrol lifeguards, evaluated by onsite medical staff, and stabilized for transfer and subsequent surgical management. As surfing and surfing competitions become increasingly popular, medical staff and event organizers must be aware of the possibility for severe, life-threatening injuries during surfing events. Although infrequent, staff must be prepared to manage these injuries, including immediate resuscitation, stabilization, analgesia, and transfer to definitive care. We hope this case encourages not only surf event organizers and medical staff, but also staff of all professional and recreational water sports, to increase their preparedness to stabilize and treat both life-threatening and minor injuries. Expeditious and appropriate treatment of an injured athlete has the potential to decrease morbidity and mortality while maximizing the athletes' functional outcome after injury.

Common Injuries in Whitewater Rafting, Kayaking, Canoeing, and Stand-Up Paddle Boarding.

Paddle sports continue to be popular forms of outdoor recreation in the United States and around the world. This includes not only the more traditional sports of rafting, kayaking, and canoeing but also the newer and growing sport of stand-up paddle boarding. Because these sports are based in an aquatic environment, and frequently whitewater, there are unique, significant risks of injury. Overall, injuries in paddling sports are mostly musculoskeletal and are both acute and chronic in nature. Some injuries, such as environmental and head injuries, are especially problematic because they can lead to serious morbidity and mortality, most importantly drowning. This review describes the epidemiology, type, and location of injuries across paddle sports. It not only focuses on whitewater injuries but also includes information on injuries sustained in other aquatic paddling environments.

Athletes Play Through Pain-What Does That Mean for Rehabilitation Specialists?

CONTEXT: Pain in sport has been normalized to the point where athletes are expected to ignore pain and remain in the game despite the possible detrimental consequences associated with playing through pain. While rehabilitation specialists may not have an influence on an athlete's competitive nature or the culture of risk they operate in, understanding the consequences of those factors on an athlete's physical well-being is definitely in their area of responsibility. OBJECTIVE: To explore the factors associated with the experiences of subelite athletes who play through pain in gymnastics, rowing, and speed skating. DESIGN: The authors conducted semistructured interviews with subelite athletes, coaches, and rehabilitation specialists. They recruited coach participants through their provincial sport organization. Athletes of the recruited coaches who were recovering from a musculoskeletal injury and training for a major competition were then recruited. They also recruited rehabilitation specialists who were known to treat subelite athletes independently by e-mail. SETTING: An observation session was conducted at the athlete's training facility. Interviews were then conducted either in a room at the university or at a preferred sound-attenuated location suggested by the participant. PARTICIPANTS: The authors studied 5 coaches, 4 subelite athletes, and 3 rehabilitation specialists. INTERVENTIONS: The authors photographed athletes during a practice shortly before an important competition, and we interviewed all the participants after that competition. Our photographs were used during the interview to stimulate discussion. RESULTS: The participant interviews revealed 3 main themes related to playing through pain. They are: Listening to your body, Decision making, and Who decides. CONCLUSION: When subelite athletes, striving to be the best in their sport continue to train with the pain of an injury, performance is affected in the short-term and long-term consequences are also possible. Our study provides some insight into the contrasting forces that athletes balance as they decide to continue or to stop.

Injuries in Male and Female Elite Aquatic Sports Athletes: An 8-Year Prospective, Epidemiological Study.

This study aimed to determine the injury patterns associated with training activities in elite South Korean aquatic sports athletes training for the Olympic Games. From 2012 to 2019, we prospectively collected data on elite aquatic sports athletes at the Korea National Training Center. The athletes were assessed by four sports medicine doctors, and data were stratified according to sex, aquatic style, injury body location, and injury severity. Chi-square tests were used to compare groups. Injury rates was expressed as rate ratios with 95% confidence intervals. Annually, the center hosts an average of 42 elite aquatic athletes spread over four aquatic styles. We recorded 797 injuries in total (annual average: 2.37 injuries/athlete), during training sessions, 57.1% of which were mild injuries. For all athletes, most injuries occurred in the upper limb (35.9%), followed by the lower limb (31.0%), the trunk (24.5%), and the head and neck (8.7%). Aquatic style significantly influenced injury body location and severity for both male and female athletes (injury body location: p < 0.001 and p < 0.010, respectively; injury severity: p = 0.027 and p < 0.001, respectively). In general, male and female athletes experienced a comparable risk of injury (rate ratio: 1.15; 95% confidence intervals: 0.53-2.46). Among the male and female South Korean elite aquatic athletes training for the Olympic Games, most injuries were mild and occurred in the upper limb, and aquatic style influenced injury body location and severity.

Shoulder internal and external rotation strength and prediction of subsequent injury in water-polo players.

Water-polo players have greater isokinetic shoulder strength than age-matched controls. Due to the repetitive demands of throwing, however, water-polo players demonstrate an altered strength ratio, with greater internal rotation (IR) strength relative to external rotation (ER). The relationship between shoulder strength and risk of shoulder injury is unknown. In addition, the effect on test position for strength testing on the reliability of handheld dynamometry (HHD) in this population is not known. The aims were to determine the: (a) Inter-rater reliability of HHD testing of IR and ER strength in two positions: neutral and 90°abduction-90°ER (90-90) and (b) relationship between preseason shoulder strength and occurrence of future injury in sub-elite water-polo players. Two assessors measured shoulder IR and ER strength using HHD in 15 water-polo players across two testing days. Athletes were followed over a 6-month period, and injury was assessed and recorded by the team physiotherapist. Measurement of water-polo players' isometric IR and ER strength in the clinical setting had good to excellent inter-rater reliability; however, systematic error was observed in the neutral position but not the 90-90 position. Irrespective of testing position, the neutral and 90-90 test position showed a significant difference (P = 0.01) in absolute preseason IR and ER mean strength between prospectively injured and non-injured players. There was no significant difference in strength ratio or strength normalized for body mass index. These results suggest that preseason strength testing may help identify players at risk of in-season shoulder injury.

A summer wave of vertebral fractures: the "deck-slap" injury.

BACKGROUND: Every summer, several patients who suffer from vertebral fractures are hospitalized at the Sainte-Anne Military Hospital after going on a boat trip around the French Riviera. The uniqueness of these fractures lies in their mechanism of injury, called the "deck-slap" injury. The aim of this study is to describe the characteristics of the "deck-slap" injury. METHODS: The data of 26 vertebral fractures that occurred during boat trips between January 2010 and September 2017 were collected and analyzed. RESULTS: The mechanism of injury observed was similar for every patient. Patients sitting on the front of the boat, or bow, (77% of cases, n = 20); patients being on a rigid-inflatable boat (65% of cases, n = 17); and when the sea state was calm (62% of cases, n = 16). The patients were bounced up in the air because of a strong wave and landed in a sitting position. The affected population was young (mean age of 42.5 years) and women were the main victims (sex ratio of 0.3). The lesion topography was found near the thoracolumbar junction in each case. It was always a vertebral body compression. Twenty-three percent of them (n = 6) suffered from neurologic complications. CONCLUSION: This type of fractures, frequently encountered during the summer, has not previously been described in the literature, yet is a relevant cause of hospital admissions to the emergency departments of the south of France. A better knowledge of this mechanism would provide a more efficient approach to prevention measures that should be imposed to potential boat passengers.

Analysis of water polo injuries during 8904 player matches at FINA World Championships and Olympic games to make the sport safer.

OBJECTIVE: To analyse injuries of water polo players reported during four Summer Olympic Games (2004, 2008, 2012, 2016) and four Federation Internationale de Natation World Championships (2009, 2013, 2015, 2017). METHODS: Injuries during training and matches were reported daily by the team physicians and the local medical staff at the sports venues using an established surveillance system. RESULTS: A total of 381 injuries were reported, equivalent to 14.1 injuries per 100 players (95% CI ±1.42). The most frequent diagnoses were laceration (12.7%) and contusion (10.9%) of head, followed by (sub-)luxation/sprain of hand (9.5%) and contusion of trunk (6.5%) or hand (6.2%). More than half of the injuries (57.0%) occurred due to contact with another player. A quarter of the injuries (25.4%) were expected to result in absence from training or match; 10 (2.9%) resulted in an estimated time-loss of 3 or more weeks. About three-quarters of injuries (75.6%) occurred during matches, 86 during training. The incidence of match injuries was on average 56.2 injuries per 1000 match hours (95% CI ±6.74). The incidence of time-loss match injuries (14.7; 95% CI ±3.44) was significantly higher in men than in women. CONCLUSIONS: A critical review of water polo in-competition rules and the implementation of a Fair Play programme may help to mitigate the high incidence of contact injuries incurred during matches. A water polo-specific concussion education programme including recognition, treatment and return to play is recommended. Finally, a prospective injury surveillance programme would help to better define water polo injuries outside of the competition period.

The speedboat vertebral fracture: a hazard of holiday watersports.

PURPOSE: The purpose of this study was to describe and characterise spinal fractures sustained by watercraft occupants due to splashdown of light watercraft when riding over uneven water surfaces. METHODS: A retrospective review of all patients presenting with these injuries to St Luke's and Mater Dei state hospitals in Malta over a 10-year period was undertaken to determine patient demographics, the nature of spinal injuries sustained and the incidence of any associated extra-spinal injuries. RESULTS: Twenty-one patients (mean age 41.2 years) suffered 25 fractures. Injuries were seasonal, occurring exclusively between the months of May and October. One patient was local whilst 20 were from other countries. All fractures were Magerl type A fractures and occurred around the thoracolumbar junction. The L1 vertebra was most commonly affected (12 patients). Four patients sustained two vertebral fractures. There were no extra-spinal injuries. CONCLUSIONS: Watercraft splashdown can transmit significant forces to occupants, resulting in Magerl type A vertebral fractures around the thoracolumbar junction. These injuries occur under compression. They are highly consistent in their morphology and localisation and should be excluded in individuals complaining of back pain after watercraft use. Almost all patients were from outside Malta and injuries were seasonal, providing opportunities for targeted injury prevention campaigns.

Optic Nerve Avulsion After Finger-Poke Injury.

We present a case of optic nerve avulsion as a result of finger-poke injury to the eye. Spectral domain optical coherence tomography demonstrated a plunging cup indicative of the avulsion, a finding not previously described. Optic nerve avulsion is a form of anterior indirect traumatic optic neuropathy evoked by a sudden severe rotation at the junction of the optic nerve and globe induced, in this case, by penetration of the finger into the nasal orbit.

Water-Related Vaginal Injury: A Case Report and Review of the Literature.

BACKGROUND: Vaginal injury can result from entry of water into the vagina under high pressure. Previously reported cases describe water-jet vaginal injuries in women participating in water-related activities, including: water skiing, personal watercraft use, waterslides, water hose and fountains, with and without foreign body in situ. CASE: We describe the case of a severe vaginal laceration and hemorrhage in a 44-year-old female from a high-pressure water-jet generated during a water-ski fall requiring operative repair. Timely management resulted in excellent patient outcome. CONCLUSION: A literature review demonstrated that, although uncommon, watersport-related gynaecologic injuries can be life-threatening, and women who regularly engage in watersports can be counselled regarding potential preventative measures. Physicians encountering patients with these injuries should rule out intraperitoneal injury and consider benefits of antibiotics.