Eye Trauma in Mixed Martial Arts and Boxing.

PURPOSE: To evaluate and compare eye and face trauma in mixed martial arts (MMA) and boxing. DESIGN: Retrospective cohort study. METHODS: Data from boxing and MMA competitions were extracted from the Nevada Athletic Commission (NAC) between 2000 and 2020. Details of competitions, contestants, outcomes, and injuries were extracted. RESULTS: In total 1539 boxing injuries (from 4313 contests) and 1442 MMA injuries (from 2704 contests) were identified. Boxing had higher eye injury rates compared to MMA ( p < 0.0001), with an odds ratio of 1.268 (95% CI, 1.114-1.444). Eye trauma represented 47.63% of boxing injuries and 25.59% of MMA injuries, with periocular lacerations being the most common eye injury in both. Orbital fractures represented 17.62% of eye injuries in MMA and 3.14% in boxing contests. However, 2%-3% were retinal in both sports, and 3.27% were glaucomatous in boxing. MMA contestants had an odds ratio of 1.823 (95% CI, 1.408-2.359) for requiring physician evaluation following an eye injury compared with boxing. MMA contestants also had a higher rate of face ( p < 0.0001) and body ( p < 0.0001) injuries. For both sports, an increased number of rounds and being the losing fighter were associated with increased odds of eye and face injury. CONCLUSION: Although boxing has a higher rate of eye injuries, MMA eye injuries are more likely to require physician evaluation. MMA contestants also have a higher rate of orbital fractures and face and body trauma. A detailed postfight examination and long-term follow-up of ocular injury in combat sports will be vital in proposing reforms to prevent eye trauma.

Extensor hood injuries in elite boxers: injury characteristics, surgical technique and outcomes.

We describe our experience of managing extensor hood injuries in boxers (57 fingers). The diagnosis was mostly clinical, with imaging only if the diagnosis was equivocal. The middle (61%) and index (26%) digits were most frequently injured. On exploration, 26% had no hood tear, however all required tenolysis from the adherent capsule. Of 42 hood tears, 15 were central splits between adjacent extensor tendons in the index or little fingers,15 tears were on the ulna side of the extensor tendon and 12 tears were on the radial side. A pseudobursa was encountered in 35%, capsular tears in 28% and chondral injury in one patient. Longitudinal curved metacarpophalangeal joint incisions were used, with hood repair performed in flexion using a locked running suture. Mean postoperative metacarpophalangeal joint flexion was 90°. Ninety-eight per cent returned to the same level of boxing at a mean of 8 months (range 1-24) from surgery. One finger was revised for re-rupture 6 months later. A reproducible technique for treating these injuries is described, with patients able to return to boxing with little risk of complications.Level of evidence: IV.

When disaster strikes in the ring: a 20-year study of head and neck injuries secondary to boxing.

The purpose of this study was to explore the patterns of head and neck injuries secondary to boxing. We conducted a 20-year retrospective cross-sectional study using the National Electronic Injury Submission System (NEISS). We derived the predictor variables from both patient and injury characteristics. The principal outcome variable was the probability of hospital admission from the ED. We used bivariate analysis to determine if an association existed between two variables of interest. We created a multiple logistic regression model to model the probability of admission using all significant univariate predictors. The final sample consisted of 1,919 patients. Children were most likely to injure their heads (p < 0.01). Young adults were also most likely to injure their heads (p < 0.05). Adults were most likely to injure their faces (p < 0.01). Children were most likely to incur facial contusions (p < 0.01) and internal organ injuries (p < 0.01). Young adults were most likely to suffer concussions (p < 0.01). Adults were most likely to suffer lacerations (p < 0.01). Certain age groups were more/less likely to injure a particular anatomical site and more/less likely to incur a particular type of injury. Relative to young adults, seniors had an increased odd of admission. Head injuries had an increased odds of admission relative to mouth injuries. Fractures and internal organ injuries proved to be the most dangerous injuries.

Mortality from mental disorders and suicide in male professional American football and soccer players: A meta-analysis.

OBJECTIVE: To determine the risk of mortality from mental disorders and suicide in professional sports associated with repeated head impacts. METHODS: A systematic search was performed in PubMed, Web of Science, Scopus, and SPORTDiscus (since inception to June 8, 2021) to find studies comparing the incidence of mortality from mental disorders or suicide in former or active professional athletes of sports characterized by repeated head impacts vs athletes with no such exposure or the general non-athletic population. RESULTS: Seven retrospective studies of moderate-to-high quality that included data from boxers and from basketball, ice hockey, soccer, and National Football League (NFL) players, respectively (total = 27 477 athletes, 100% male) met all inclusion criteria. Former male NFL players (n = 13 217) had a lower risk of mortality from mental disorders (standard mortality rate [SMR] = 0.30; 0.12-0.77; p = 0.012) and suicide (SMR = 0.54; 0.37-0.78; p < 0.001) than the general population. This finding was also corroborated in male soccer players (n = 13,065; SMR = 0.55; 0.46-0.67; p < 0.001). Male athletes participating in sports associated with repeated head impacts (n = 18,606) had also a lower risk of all-cause, cardiovascular disease (CVD), and cancer mortality (all p < 0.01) than the general population. CONCLUSIONS: Participation of male athletes in American football or soccer at the professional level might confer a certain protective effect against mortality from mental disorders or suicide, besides its association with a lower risk of all-cause, CVD, or cancer-related mortality.

Surgical Management of Symptomatic Boxing-Induced Spinal Cerebrospinal Fluid Leak After Failed Epidural Blood Patch.

BACKGROUND: Spontaneous spinal cerebrospinal fluid (CSF) leak is an increasingly recognized condition responsible for spontaneous intracranial hypotension. A host of connective tissue disorders and mechanical factors may precipitate the condition. Conservative treatment has limited efficacy, and many patients with persistent symptoms ultimately require epidural blood patch (EBP). However, about 23%-44% of patients experience recurrence of symptoms after EBP. Unidentified or multiple sites of CSF leaks are thought to be responsible for the failure of EBP. Using our previously published technique, we treated a patient who developed a large spontaneous CSF leak in her cervicothoracic spine after a boxing class, offering further evidence of the utility of the technique for select patients. CASE DESCRIPTION: A 28-year-old woman was referred to our center with recurrent, severe headaches and associated nausea and vomiting. She underwent EBP 3 times with no resolution of her symptoms. A right-side partial C7-T1 hemilaminotomy was performed to identify a large meningocele filled with CSF. After dissection, dural sealant was applied using an angled needle with a syringe to buttress the meningocele to allow for normalization of the hydrostatic pressure. At 5-month follow-up, her symptoms have resolved with no headaches and paresthesias in upper limbs. CONCLUSIONS: Commonplace events, such as a boxing/sparring class, may precipitate a spontaneous spinal CSF leak. Our minimally invasive surgical approach can be safely used in patients with spontaneous intracranial hypotension with recurrent symptoms, no identified leak site, and prior failed attempts of EBP.

Magnetic resonance imaging in boxers with repeated traumatic brain injury.

Currently, neuroimaging changes in boxers who have suffered repeated traumatic brain injury (TBI) have not been sufficiently studied and analyzed. To detect such changes, magnetic resonance imaging (MRI) is the most informative. AIM: The aim of study was to investigate the features of MRI changes in boxers with repeated TBI. MATERIALS AND METHODS: An MRI scan of the brain was carried out on 174 amateur boxers aged 16 to 42 years who had a history of repeated TBI. In the control group, 30 practically healthy people of similar age were examined. Patients were analyzed by gender, age, weight category, number of fights conducted. RESULTS: A significant increase in the width of the lateral ventricles (LV) on both sides, 3rd ventricle and cavum septum pellucidum (CSP) was noted in boxers, among whom men dominated. There was an increase in the width of the LV on both sides, 3rd ventricle and CSP with increasing age, weight category, number of fights. A normal MRI scan of the brain was more common in the younger age group female boxers. There has been an increase in the frequency of expansion of the CSP with increasing age, the number of fights held. There was an increase in the frequency of foci of the modified MRI signal (subcortical, periventricular) with increasing age. Frequency of arachnoid cysts increased with an increase in weight category, and the frequency of diffuse expansion of subarachnoid spaces increased with an increase in the number of fights conducted. CONCLUSIONS: In boxers who had a history of repeated TBI, there are changes according to MRI of the brain from both the cerebrospinal fluid pathways and the brain matter. Studying the features of MRI scans of the boxers will make it possible to predict their competitive activity, timely diagnose brain disorders, carry out the necessary treatment and take preventive measures in order to prevent possible long-term effects of trauma.

The management of clenched fist 'fight bite' injuries of the hand.

We present a prospective study outlining the management of clenched fist 'fight bite' injuries. Over a 4-year period all patients with such injuries had surgical exploration with further débridements as necessary. For metacarpophalangeal joint injuries, a midline tendon-splitting approach was used. For proximal interphalangeal joint injuries, an approach was made between the lateral band and central slip of the extensor mechanism. A total of 147 patients with 159 joint injuries were treated, with 130 metacarpophalangeal joint and 29 proximal interphalangeal joint injuries. The joint was penetrated in 96% of joints overall. The number of débridements ranged from two to eight. Twenty patients defaulted within 1 week of surgery and were not included in the analysis of the results. All patients with metacarpophalangeal joint injury had satisfactory or good outcomes. A total of 42% of patients with proximal interphalangeal joint injuries had poor results, four requiring amputation and one a fusion. The tendon-splitting approach to the metacarpophalangeal joint allows excellent access and avoids damage to the sagittal bands and consequent instability of the extensor mechanism.

Monitoring concussion in a knocked-out boxer by CSF biomarker analysis.

Concussion is common in many sports, and the incidence is increasing. The medical consequences after a sport-related concussion have received increased attention in recent years since it is known that concussions cause axonal and glial damage, which disturbs the cerebral physiology and makes the brain more vulnerable for additional concussions. This study reports on a knocked-out amateur boxer in whom cerebrospinal fluid (CSF) neurofilament light (NFL) protein, reflecting axonal damage, was used to identify and monitor brain damage. CSF NFL was markedly increased during 36 weeks, suggesting that neuronal injury persists longer than expected after a concussion. CSF biomarker analysis may be valuable in the medical counselling of concussed athletes and in return-to-play considerations.

Combined joint fusion for index and middle carpometacarpal instability in elite boxers.

Isolated instability of the index and middle finger carpometacarpal joints is uncommon. An unpublished injury pattern in a consecutive series of 13 elite boxers is described, with mid-term radiological and functional results of two novel surgical treatments. All the boxers (from Australia and the UK) were unable to compete owing to pain and weakness. Four boxers were managed initially by open reduction and temporary K-wire fixation. Nine boxers underwent primary carpometacarpal arthrodesis. All were able to return to their previous level of competition. One boxer who had undergone a soft tissue reconstruction competed at international level but required an arthrodesis because of recurrent symptoms. In elite boxers, simple reduction and wiring may be appropriate for an acute injury causing index or middle finger carpometacarpal joint instability, however, arthrodesis is the treatment of choice when instability and degenerative changes are present.

Chronic traumatic encephalopathy in sport: a systematic review.

OBJECTIVE: To provide a critical review of chronic traumatic encephalopathy (CTE) by considering the range of clinical presentations, neuropathology and the strength of evidence for CTE as a distinct syndrome. DATA SOURCES: Seven electronic databases were searched using a combination of MeSH terms and key words to identify relevant articles. REVIEW METHODS: Specific inclusion and exclusion criteria were used to select studies for review. Data extracted where present included study population, exposure/outcome measures, clinical data, neurological examination findings, cognitive assessment, investigation results and neuropathology results. RESULTS: The data from 158 published case studies were reviewed. Critical differences between the older descriptions of CTE (the 'classic' syndrome) and the recent descriptions (the 'modern' syndrome) exist in the age of onset, natural history, clinical features, pathological findings and diagnostic criteria, which suggests that modern CTE is a different syndrome. The methodology of the current studies does not allow determination of aetiology or risk factors. CONCLUSIONS: The clinicopathological differences between the 'classic' CTE syndrome and the 'modern' syndrome suggest that the new syndrome needs a different nomenclature. Further research is required to clearly define the clinical phenotype of the modern CTE syndrome and establish the underlying aetiology. Future research needs to address these issues through large-scale, prospective clinicopathological studies.

Subscapularis tendon injuries in adolescents: a report of 2 cases.

BACKGROUND: Although shoulder injuries in adolescents are relatively common, injuries to the rotator cuff are relatively rare and not well characterized in the literature. We review 2 cases of adolescent subscapularis tendon avulsions treated surgically. METHODS: The 2 patients were high-level athletes, 1 is a baseball pitcher and the other is a boxer. Both were injured during participation in their respective sports. In each case, the diagnosis was made by magnetic resonance imaging. Patients underwent an open repair by a deltopectoral approach, using suture anchors for fixation. RESULTS: After surgery both patients regained full range of motion and returned to their previous levels of activity. Both patients scored 30 and 35 on the American Shoulder and Elbow Surgeons and University of California, Los Angeles shoulder instruments, respectively. CONCLUSIONS: Subscapularis tendon injuries in adolescents are rare. Diagnosis requires careful attention to the physical examination and imaging. A positive lift-off test, belly-press test, or increased passive external rotation should prompt an early magnetic resonance imaging. Good results and return to previous levels of activity can be achieved with open repair. LEVEL OF EVIDENCE: IV.

Female boxing in Italy: 2002-2007 report.

OBJECTIVE: To collect medical data on women's boxing. DESIGN: Cross-sectional and longitudinal study. SETTING: Medical examinations requested by Italian laws. PARTICIPANTS: A retrospective study was conducted on all female boxing competitions in Italy from April 2001 to December 2007. Sixty-one amateur female boxers were evaluated longitudinally. INTERVENTIONS: (1) Retrospective study: All pre-/postmatch medical reports were analysed. (2) Prospective study: Breast, gynaecologic, brain, eyes, ear, nose and throat examinations were carried out. MAIN OUTCOME MEASUREMENTS: (1) Retrospective study: Any injury assessed before/after the match. (2) Prospective study: Health problems which could be related to boxing activity. RESULTS: (1) Retrospective study: Data from 5600 examinations were collected. Precompetition, a medical problem was recorded in three athletes (one conjunctiva hyperemia, one zygomatic bruise, one eyelid haematoma). Post competition, 51/2800 medical checks showed mild common injuries, such as soft tissue facial lesions, epistaxis and hand-wrist problems. Only one concussion was recorded with hospitalisation (for a thorough evaluation). Another athlete was hospitalised for a nasal fracture. (2) Prospective study: Two fibroadenomas, three ovarian cysts and one intramural uterine myoma were diagnosed. In four boxers, non-specific electroencephalographic abnormalities were detected, however, with a normal brain MRI in three (the fourth is still waiting for the radiologic procedure). Nasal septum deviation was common (42.6%) and a transmissive hypoacusia was observed in two athletes. No major eye injuries were reported. CONCLUSIONS: Female boxing seems to be a safe sport with a very low incidence of events requiring hospitalisation. No specific diseases in female boxers could be observed, in particular regarding the breast and reproductive system.

Standards and interdisciplinary treatment of boxing injuries of the head in professional boxing on the basis of an IBF World Championship Fight.

BACKGROUND: Boxing injuries are well known in hobby boxing as well as in professional boxing. Especially in professional boxing it is of great importance to implement and follow prevention-, diagnosis- and therapy-standards in order to prevent or at least to minimize injuries of the athlete. The utmost aim would be to establish international prevention-, diagnosis- and therapy-standards for boxing injuries in professional boxing. However, this aim is on a short run unrealistic, as there are too many different professional boxing organisations with different regulations. A realistic short term aim would be to develop a national standard in order to unify the management and medical treatment of boxing injuries in professional boxing. CASE REPORT: We present the management and interdisciplinary treatment of a professional boxer with a bilateral open fracture of the mandible during a middle weight IBF World Championship Fight. On the basis of this case we want to present and discuss the possibilities of an interdisciplinary and successful medical treatment. CONCLUSIONS: In order to prevent or minimize boxing injuries of professional boxers, annual MRI-Scans of the head and neck have to be performed as prevention standard. Furthermore, neurocognitive tests must be performed on a regular basis. Boxing injuries in professional boxing need an interdisciplinary, unbiased and complex analysis directly at the boxing ring. The treatment of the injuries should be only performed in medical centres and thus under constant parameters. The needed qualifications must be learned in mandatory national licence courses of boxing physicians, referees and promoters.

Lesões esportivas durante lutas no boxe amador / Sports injuries during fights in amateur boxing

Introdução: As patologias que acometem os atletas do boxe são, na maioria, traumáticas e acometem principalmente as extremidades superiores e a face. A supervisão médica aos atletas aprimorou o aprendizado sobre as lesões específicas do boxe. A partir dos conhecimentos adquiridos, foram estabelecidas medidas profiláticas para preservar a saúde do atleta e evitar afastamentos do esporte. Objetivo: Descrever as lesões ocorridas durante as lutas de boxe amador masculino sob supervisão médica, a fim de promover um melhor entendimento dessas patologias. Método: Entre 2000 e 2009, por meio da aplicação de um protocolo padronizado, descrevemos as lesões nos atletas masculinos do boxe amador, durante as lutas realizadas pela Confederação Brasileira de Boxe, Federação Paulista de Boxe, Confederação Pan-Americana de Boxe e Associação Internacional de Boxe. Resultados: No total, foram realizadas 1.446 lutas, com 291 lesões, como nocautes (48,8%), sangramentos nasais (23,5%), lesões musculoesqueléticas (15,5%), ferimentos cortocontusos (8,6%) e hematoma palpebral (3,6%). Das lesões musculoesqueléticas, 5,8% foram lesões ligamentares nas mãos e punhos, 3,7% fraturas nas mãos e punhos e 2% luxações glenoumerais. Conclusões: As principais lesões durante as lutas da equipe nacional de boxe foram os nocautes, seguidas de sangramentos nasais, lesões musculoesqueléticas e ferimentos cortocontusos. As lesões mais comuns foram na face e nas mãos.

Introduction: Most of the pathologies that attack boxing athletes are traumatic and occur in the superior extremities and in the face. The medical supervision to the athletes improved the learning about specific lesions of boxing. Starting from the acquired knowledge, prophylactic measures were instituted in order to preserve athlete’s health and to avoid removals from the sport. Objective: To describe the injuries occurred during male amateur boxing under medical supervision in order to promote a better understanding of these pathologies. Methods: Between 2000 and 2009, by applying a standardized protocol, we described the injuries in male athletes of amateur boxing during the struggles waged by the Brazilian Boxing Confederation, São Paulo Boxing Federation, Pan-American Boxing Confederation and International Boxing Association. Results: The total of 1.446 fights were accomplished, with 291 lesions as knockouts (48.8%), nasal bleeding (23.5%), musculoskeletal lesions (15.5%), open wounds (8.6%) and palpebral bruise (3.6%). Among the musculoskeletal lesions, 5.8% were ligament lesions in hands and wrists, 3.7% were fractures in hands and wrists, and 2% were glenohumeral dislocation. Conclusions: The main lesions during the fights of the Brazilian boxing team were knockouts, nasal bleeding, musculoskeletal lesions and open wounds. The most common lesions occured in the face and in the hands.

Anterior dislocation of the shoulder associated with Bankart lesion in a patient with Poland's syndrome: a case report and review of the literature.

Poland's syndrome is a rare congenital entity characterized by unilateral partial or total hypoplasia of the major pectoralis muscle, breast and/or ipsilateral hand abnormalities. It has been reported in association with various structural and functional abnormalities. We report about a 23-year-old male kick-boxer with Poland's syndrome who presented in our department the history of two traumatic anterior shoulder dislocations due to boxing and self-reductions. Physical examination showed an instability of the left shoulder, and the MRI scans demonstrated a Bankart lesion. The patient had been treated with an arthroscopic Bankart repair; reattachment of the detached antero-inferior labrum down to the glenoid and repairing of the inferior gleno-humeral ligament complex. To our knowledge this is a first case report of a patient presenting with traumatic anterior shoulder dislocations due to kick-boxing associated with Poland's syndrome.

Investigation of antihypothalamus and antipituitary antibodies in amateur boxers: is chronic repetitive head trauma-induced pituitary dysfunction associated with autoimmunity?

OBJECTIVE: Current data clearly demonstrate that sports-related chronic repetitive head trauma due to boxing might result in hypopituitarism. However, the mechanism of sports-related traumatic brain injury-induced pituitary dysfunction is still unclear. In order to understand whether autoimmune mechanisms could play a role in the pituitary dysfunction due to sports-related head trauma, we investigated the presence of antipituitary antibodies (APAs) and antihypothalamus antibodies (AHAs) in amateur boxers. PATIENTS AND DESIGN: Sixty-one actively competing (n=44) or retired (n=17) male boxers (mean age, 26 years; range, 17-53) who had been evaluated regarding pituitary functions previously were included in the study. In all boxers and in 60 age/sex-similar normal controls, AHAs and APAs were investigated by an indirect immunofluorescence method. RESULTS: AHAs were detected in 13 of 61 boxers (21.3%), and APAs were detected in 14 of 61 boxers (22.9%), but in none of the normal controls. Pituitary dysfunction was significantly higher in AHA-positive boxers (46.2%) than in AHA-negative boxers (10.4%) (P=0.003). There was a significant association between AHA positivity and hypopituitarism due to boxing (odds ratio: 7.37, 95% confidence interval 1.8-30.8). There was no significant association between APA positivity and hypopituitarism. CONCLUSIONS: This study demonstrates for the first time the presence of AHAs and APAs in boxers who were exposed to sports-related head trauma. Moreover, the present investigation provides preliminary evidence that AHAs are associated with the development of pituitary dysfunction in boxers, thus suggesting that autoimmunity may have a role in the pathogenesis.

Hypopituitarism due to sports related head trauma and the effects of growth hormone replacement in retired amateur boxers.

Traumatic brain injury (TBI) has been recently recognized as a leading cause of pituitary dysfunction. Current data clearly demonstrated that sports related head trauma due to boxing, kickboxing, and soccer might results in pituitary hormone deficiencies, isolated growth hormone (GH) deficiency in particular. In the present report physiologic dose GH replacement therapy (GHRT) was performed in two GH deficient retired amateur boxers for the first time. The boxers received recombinant GH for 6 months. After 6 months of GHRT there were substantial improvements, but not complete normalization, in the body composition parameters, lipid profiles and quality of life scores in both boxers. These preliminary results suggest that GHRT may have beneficial effects in retired boxers with severe isolated GH deficiency due to sports related head trauma. But more data with higher number of boxers and longer GHRT duration are warranted.

Cardiovascular issues in boxing and contact sports.

Despite the inherent risks associated with exercise in general and boxing in particular, the sport has had a limited number of catastrophic cardiovascular events. Screening should be based on risks involved and become more extensive with the advancement of the athlete. Anatomic and electrophysiologic risks need to be assessed and may preclude participation with resultant life style and economic complications. There should be adequate preparation for the rare potential cardiovascular complication at all events, with the ability to rapidly assess and treat arrhythmias.

Eye trauma in boxing.

In boxing, along with a few other sports, trauma is inherent to the nature of the sport; therefore it is considered a high-risk sport for ocular injuries. The long-term morbidity of ocular injuries suffered by boxers is difficult to estimate due to the lack of structured long-term follow-up of these athletes. Complications of blunt ocular trauma may develop years after the athlete has retired from the ring and is no longer considered to be at risk for boxing-related injuries. This article describes the wide range of eye injuries a boxer can sustain, and their immediate and long-term clinical management.