Adapted marching distances and physical training decrease recruits' injuries and attrition.

There is evidence that progressive loading of physical demands at the beginning of basic military service and specific physical training can reduce injury incidences. Therefore, aim of this study was to measure the effects of a progressive increase in marching distances and an adapted physical training program on injury incidence and attrition rate in a Swiss Army infantry training school. One company reduced the distances covered on foot during the first 4 weeks of basic military training. A second company performed an adapted physical training program for 10 weeks. A third company participated in both interventions combined, and a fourth company served as a control group without any intervention. The injury incidences and attrition rates of 651 male recruits were registered during 21 weeks of military service. Several predictor variables for injury and attrition, such as physical fitness, previous injuries, level of previous physical activity, smoking, motivation, and socioeconomic factors, were assessed as well. The data were analyzed using binary logistic backward regressions. Each intervention separately had a favorable effect on injury prevention. However, combining the 2 interventions resulted in the greatest reduction in injury incidence rate (-33%). Furthermore, the adapted physical training successfully reduced the military service attrition rates (-53%).

Injuries and injury prevention during foot marching.

Since the beginning of recorded history, Soldiers have carried arms and equipment on their bodies. More recently, loads have substantially increased, driven by improvements in weapons technology and personal protection. As Soldier loads increase, there are increases in energy cost, altered gait mechanics, increased stress on the musculoskeletal system, and more rapid fatigue, factors that may increase the risk of injury. Common injuries and symptoms experienced by Soldiers on load-carriage missions include foot blisters, metatarsalgia, knee problems, and back problems. This article discusses these problems, providing diagnoses, injury mechanisms, and preventive measures. In general, lighter loads, improving load distribution, using appropriate physical training, selecting proper equipment, and using specific prevention techniques will facilitate load carriage and provide Special Operations Forces with a higher probability of mission success.

Randomized controlled trial to evaluate the effectiveness of a video game as a child pedestrian educational tool.

BACKGROUND: Injury is the number one cause of death and disability in children in the United States and an increasingly important public health problem globally. While prevention of injuries is an important goal, prevention efforts are currently fragmented, poorly funded, and rarely studied. Among school-aged children, pedestrian crashes are a major mechanism of injury. We hypothesized that we could develop a game-based educational tool that would be effective in teaching elementary school children the principles of pedestrian safety. METHODS: Between November 2011 and June 2013, second- and third-grade children in Los Angeles Unified School District were randomly assigned to play a unique interactive video game (Ace's Adventure) about pedestrian safety or to a traditional didactic session about pedestrian safety. A pretest and posttest were administered to the study participants. Afterward, study participants were observed for appropriate pedestrian behavior on a simulated street set called Street Smarts. All statistical analyses were performed using SAS version 9.2. RESULTS: A total of 348 study participants took the pretest and posttest. There were 180 who were randomized to the didactic and 168 who were randomized to the video game. The didactic group demonstrated a higher mean score increase (1.01, p < 0.0001) as compared with the video game group (0.44, p < 0.0001). However, observation of study participants revealed that participants who played the video game, as compared with the didactic group, more frequently exhibited appropriate behavior during the following: exiting a parked car (p = 0.01), signaling to a car that was backing up (p = 0.01), signaling to a stopped car (p = 0.0002), and crossing the street (p = 0.01). CONCLUSION: Students who played the educational video game about pedestrian safety performed similarly to those who attended a more traditional and labor-intensive didactic learning. Innovative educational methods, such as game playing, could significantly change our approach to injury prevention and have the potential to decrease the burden of injury among children worldwide.

Training children in pedestrian safety: distinguishing gains in knowledge from gains in safe behavior.

Pedestrian injuries contribute greatly to child morbidity and mortality. Recent evidence suggests that training within virtual pedestrian environments may improve children's street crossing skills, but may not convey knowledge about safety in street environments. We hypothesized that (a) children will gain pedestrian safety knowledge via videos/software/internet websites, but not when trained by virtual pedestrian environment or other strategies; (b) pedestrian safety knowledge will be associated with safe pedestrian behavior both before and after training; and (c) increases in knowledge will be associated with increases in safe behavior among children trained individually at streetside locations, but not those trained by means of other strategies. We analyzed data from a randomized controlled trial evaluating pedestrian safety training. We randomly assigned 240 children ages 7-8 to one of four training conditions: videos/software/internet, virtual reality (VR), individualized streetside instruction, or a no-contact control. Both virtual and field simulations of street crossing at 2-lane bi-directional mid-block locations assessed pedestrian behavior at baseline, post-training, and 6-month follow-up. Pedestrian knowledge was assessed orally on all three occasions. Children trained by videos/software/internet, and those trained individually, showed increased knowledge following training relative to children in the other groups (ps < 0.01). Correlations between pedestrian safety knowledge and pedestrian behavior were mostly non-significant. Correlations between change in knowledge and change in behavior from pre- to post-intervention also were non-significant, both for the full sample and within conditions. Children trained using videos/software/internet gained knowledge but did not change their behavior. Children trained individually gained in both knowledge and safer behavior. Children trained virtually gained in safer behavior but not knowledge. If VR is used for training, tools like videos/internet might effectively supplement training. We discovered few associations between knowledge and behavior, and none between changes in knowledge and behavior. Pedestrian safety knowledge and safe pedestrian behavior may be orthogonal constructs that should be considered independently for research and training purposes.

Lower leg injury in relation to vehicle front end.

OBJECTIVE: To set up a prescreening tool for vehicle front-end design, allowing numerically forecasting of the results of EC directive tests, with reference to pedestrian lower leg impact. METHODS: A numerical legform model has been developed and certified according to EC directive. The frontal end of the vehicle has been simulated through a lumped-parameters model, having considered the predesign stage when the target overall behavior is being established. The stiffness behaviors of the bumper and of the spoiler have been estimated by means of more detailed numerical models. A parametric analysis has been performed to outline the effects of bumper and spoiler stiffness, bumper vertical height, and the longitudinal distance between the spoiler and the bumper. An analytical model has been introduced to predict tibial acceleration, knee shear displacement, and knee lateral bending, given the bumper and spoiler characteristics as input. RESULTS: The parametric analysis has demonstrated that bumper stiffness, bumper profile height, and spoiler stiffness do have an impact on knee lateral bending, knee shear displacement, and peak tibial acceleration. Increasing bumper stiffness can result in higher knee bending, knee shear displacement, and peak tibial acceleration. Increasing bumper profile height produces lower knee bending and shear displacement. Increasing spoiler stiffness can determine higher knee shear displacement and peak tibial acceleration but lower knee bending. Spoiler stiffness and position have a strong correlation: higher bumper stiffness needs to be coupled to a moved forward spoiler position. The mechanical responses of the spoiler and of the bumper can be assumed to be linear: the softening behavior of the expanded polypropylene foam balances the hardening behavior of the fascia (due to contact area increase). The predictive model is well correlated to experimental findings (R (2) > 0.74). CONCLUSIONS: This simplified computer model can be used as a prescreening design tool to demonstrate general vehicle front-end design trade-offs and provide approximate results without physical testing.

Patterns of injury seen in road crash victims in a South African trauma centre.

BACKGROUND: Road traffic crashes (RTCs) account for a significant burden of disease in South Africa. This prospective study reviews basic demographic and outcome data of patients who sustained an RTC-related injury and analyses the common patterns of injury associated with specific mechanisms of injury. METHOD: We reviewed all patients seen at a single regional hospital (Edendale Hospital, Pietermaritzburg, KwaZulu-Natal) with injuries sustained in RTCs over a 10-week period. State mortuary data were gathered on all RTC-related fatalities over the same period. RESULTS: Three hundred and five patients were seen at the hospital over the 10-week period. The average transfer time to hospital was 9.2 hours (range 1 - 17 hours) One hundred patients were admitted and the rest were discharged home from the emergency department. Of the admitted cohort, 59 were motor vehicle occupants (MVC group) and 41 were pedestrians (PVC group). PVC patients commonly had lower limb, head, radio-ulnar and clavicular injuries, while MVC patients commonly had neck and intra-abdominal injuries. Thirty-seven patients had multiple injuries. The in-hospital mortality rate was 5.6%, but the overall mortality rate was 10.0%, as 15 patients died at the scene. CONCLUSIONS: Patterns of injury differ according to the mechanism of injury. Pedestrians impact against various parts of the vehicle and the ground and so sustain injuries to their arms and legs. Occupants of vehicles impact against the dashboard and steering wheel and are more likely to sustain torso injuries. The low number of severe injuries and multiple injuries and the relatively low inpatient mortality rate are a consequence of the triage effect of long delays in transfer. More severely injured patients are more likely to die at the scene.

Blood and oil: vehicle characteristics in relation to fatality risk and fuel economy.

I examined the potential for a lower risk of death compatible with increased fuel economy among 67 models of 1999-2002 model year cars, vans, and sport-utility vehicles (SUVs) during the calendar years 2000 to 2004. The odds of death for drivers and all persons killed in vehicle collisions were related to vehicle weight, size, stability, and crashworthiness. I calculated that fatality rates would have been 28% lower and fuel use would have been reduced by 16% if vehicle weights had been reduced to the weight of vehicles with the lowest weight per size, where size is measured by the lateral distance needed to perform a 180-degree turn. If, in addition, all vehicles had crashworthiness and stability equal to those of the top-rated vehicles, more than half the deaths involving passenger cars, vans, and SUVs could have been prevented by vehicle modifications.

Thorn prick osteomyelitis of the foot in barefoot walkers: a report of four cases.

Walking barefoot is common in developing countries and the feet are therefore exposed to a variety of trivial injuries, some of which lead to cellulitis or abscess formation. If left untreated or improperly managed, osteomyelitis or septic arthritis, usually involving the heel or metatarsals, may follow. In countries with limited resources, the emphasis should be on clinical assessment for diagnosis, and good surgical technique for treatment. We report 4 patients with thorn prick osteomyelitis of the foot due to walking barefoot. All were treated with thorn removal, surgical debridement, and oral ofloxacin. Surgical removal of the thorn is the key to successful treatment and to avoiding recurrent infection.

Motor vehicle injuries in childhood: a hospital-based study in Saudi Arabia.

Motor vehicles are a major cause of injury-related deaths in children and may also result in temporary or permanent disability. A retrospective analysis of the medical charts of children aged 12 years and younger, who were involved in motor vehicle injuries during a 10-year period, was undertaken. All children who were admitted and treated at King Fahad National Guard Hospital, Riyadh from January 1994 to December 2003 were included in this study. Data analyzed included age, gender, and mechanism of injury, type of injury, management and outcome. Motor vehicle injuries accounted for approximately 42% of all pediatric traumas. There were 664 children, 469 (71%) male and 195 (29%) female and a male: female ratio 2.4:1. Four hundred and seventy two children were injured as pedestrians (71%), 177 as auto passengers (27%), 11 as bicyclists (1.5%), and 4 as motorcyclists (0.5%). Five hundred and sixty two injured children (85%) were between the ages of 1 and 8 years. The most common injuries were to the head and extremities. Thirty-four children (5.1%) died from their injuries, 30 from head trauma. Thirty-five children (5.3%) were discharged home with neurological impairment from head trauma. In this study, the risk factors associated with high volume of motor vehicle injuries in children include, male, 1-8 years, and pedestrian. Head trauma is the most common cause of morbidity and mortality. This study suggests that nationwide programs should target the use of seatbelts and helmets, and dangerous driving practices.

Risk factors for ankle fracture requiring operative fixation.

BACKGROUND: Ankle fractures are common and expensive injuries, particularly the injuries that require operative intervention. However, epidemiological research on the causative factors is sparse. This study aims to identify the groups at risk of ankle fracture requiring operative fixation, and to suggest directions for further study. METHODS: The clinical data on 336 patients with ankle fractures admitted to an urban hospital in New Zealand in 1994 were reviewed. Statistical analysis was carried out on the 252 patients with ankle fractures requiring operative fixation. RESULTS: Those at highest risk of ankle fracture are young male rugby players and middle-aged women who sustain injury while walking. Young males have a similar incidence of AO Type B and C fractures, while Type B fractures predominate strongly in older women. CONCLUSIONS: The groups at risk of ankle fracture requiring operative fixation, and the activities predisposing these groups to injury have been identified. More work is required to define the specific risk factors and biomechanical mechanisms that lead to these debilitating injuries.

Injuries in Australian Army recruits. Part III: The accuracy of a pretraining orthopedic screen in predicting ultimate injury outcome.

Three hundred fifty male recruits were divided into two groups: Walk (N = 170) and Run (N = 180). A physical screen was performed before the commencement of recruit training consisting of a visual assessment of the feet looking for pes planus, pes cavus, and deformities of the toes. Each recruit was also asked if he had sustained any injury in the preceding 2 years. The visual findings and history of prior injury were noted and compared with actual injuries sustained during the 12-week training course. Fifty-three subjects in the Walk group and 54 in the Run group were identified as being at risk as a consequence of the screen. The sensitivity of the screen for predicting the subsequent injury was 34.4% in the Walk group and 31.8% in the Run group. The specificity was 72.6 and 77.4% in the Walk and Run groups, respectively. The predictive value of the test was 44.9% in the Walk group and 50.9% in the Run group. When reinjury was examined, the sensitivities fell to 9.4% (Walk) and 4.7% (Run) and the specificities to 57.5% (Walk) and 50.5% (Run). The screen correctly identified only 1 of 10 medical discharges in the Walk group and 2 of 16 in the Run group. The screening examination had poor sensitivity, specificity, and predictive value, and more than half of those thought to be at risk did not subsequently sustain an injury. Anecdotal beliefs that improvements in medical screening would reduce recruit wastage were not borne out. Abnormalities of the foot (pes planus, pes cavus, hallux valgus) were not significant factors in the development of injury during recruit training.

Effects of retroreflector positioning on nighttime recognition of pedestrians.

This field study investigated potential effects of retroreflector positioning on recognition of nighttime pedestrians. The subject's task was to press a response button whenever he/she recognized a pedestrian on or alongside the road, while in a car with low-beam lamps on that was driven at a constant speed on a dark road. The results showed that each retroreflector configuration yielded significantly longer recognition distances than the no-retroreflector configuration. More importantly, the retroreflective markings attached to the limbs led to significantly longer (about 60-80%) recognition distances than when the retroreflective markings were attached to the torso. Furthermore, a pedestrian was more recognizable while crossing the road than while approaching the subject vehicle, except for configurations involving no retroreflective markings.

Chronic compartment syndrome caused by aberrant fascia in an aerobic walker.

The following is a case presentation of a 36-yr-old female athlete who presented with the symptoms and signs of chronic anterior compartment syndrome. Pre-exercise and post-exercise tissue pressure measurements revealed increased compartment pressures in both of her anterior leg compartments. Aberrant fascial bands overlying and compressing the anterior compartments were discovered at the time of surgery. Fasciotomies led to complete recovery and return to previous levels of athletic activity. This is the first report of aberrant fascia as a cause of chronic anterior compartment syndrome.