[Sensorineural hearing loss after dull head injury or concussion trauma]. / Innenohrschwerhörigkeit nach stumpfem Schädelhirntrauma bzw. Kopfanpralltrauma.

A dull head injury can lead to isolated damage of the inner ear (cochlear labyrinthine concussion) or damage of the otolithe organ (vestibular labyrinthine concussion) due to a bone conduction pressure . A typical sign is a high frequency SNHL in form of a c5-dip. The c5-dip can be bilateral or unilateral or different on each side - dependant on the side of injury. In case of a unilateral skull base fracture a contralateral labyrinthine concussion is also possible. Moreover a lot of cases also show an accompanying tinnitus. This knowledge is based on animal and human experiments, as well as data from clinical and medical report examinations over decades. It is important to differentiate between a SNHL caused by accident or uni- or bilateral endogenic degenerative hearing loss.

[Boxer's fracture: Cost evaluation orthopaedic or surgical treatment]. / Evaluation du coûit des fractures du col du cinquième métacarpien traitement orthopédique et chirurgical.

UNLABELLED: Many methods of treatment have been proposed for fractures of the neck of the fifth metacarpal ranging from early mobilization to various surgical techniques. The aim of this retrospective study was to evaluate the functional results and the costs of closed as opposed to open treatment (Foucher's K-Wire technique). MATERIALS AND METHODS: We conducted a retrospective study on all fractures without rotational deformity and with a palmar angulation less than 40 degrees C. Details of the patients, the fractures, functional results and the cost of management were analyzed. RESULTS: The functional results were similar between the two groups, but surgical treatment increased the cost of treatment to 1100 euros. CONCLUSIONS: We advocate the use of closed treatment for these fractures. The functional results are the same as with surgical management, but the costs are much reduced.

Assessment of metabolic cerebral damage using proton magnetic resonance spectroscopy in mild traumatic brain injury.

AIM: We want to appraise, through proton magnetic resonance spectroscopy (H1-MRI), the NAA's values and it's changing in cerebral tissue in consequence of cranial trauma. METHODS: Six patients with TBI undergo to H1-MRI to asses the changes occurring briefly after trauma in the spectrum's composition. RESULTS: As far as the first two cases we founded a lowering of the NAA's values. In the other four cases the NAA values were normal in all but one, which slightly brought the values of the NAA/Cr and NAA/Cho lower in comparison to the standard values. CONCLUSIONS: Existing a correlation between NAA and ATP it can be drawn that the reduction of NAA is correlated to energetic type damage. Despite the smallness of data, it remains really important that we should have a tool to monitor the cerebral metabolic picture after a mild trauma.

A 9-year controlled prospective neuropsychologic assessment of amateur boxing.

OBJECTIVE: To test the hypothesis that there is an association between amateur boxing and chronic traumatic encephalopathy using neuropsychologic assessments. DESIGN: A prospective, controlled, blinded, observational, neuropsychologic study. SETTING: Amateur boxing clubs in Dublin, Ireland, March 1992 to April 2001. PARTICIPANTS: Twenty randomly selected, actively competing, male amateur boxers and 20 age-matched, socio-economic controls. INTERVENTIONS: The boxers participated in amateur competition and sparring. MAIN OUTCOME MEASURES: Raw scores and changes in scores over time were recorded in the following neuropsychologic tests: Trail Making Tests A and B, Digit Symbol, Finger Tapping (dominant and nondominant hands), modified versions of the Finger Tapping Tests, Paired-Associate Learning, Digit Span, Rey-Osterrieth Complex Figure Tests A and B, and Serial Addition. Raw scores and changes in scores for the two groups were compared, and a regression analysis was performed to detect any association between these values and exposure to boxing. RESULTS: The boxers showed superior performance in the Trail Making Tests A and B at all time points and an inferior performance in both standard Finger Tapping Tests at all time points except baseline for the dominant hand. This inferior performance was not found in the modified versions of the tests. The controls showed significant deterioration in their performance in the Rey-Osterrieth Complex Figure Tests A and B. CONCLUSIONS: In this small controlled, prospective study of competitive amateur boxers, there was no evidence of neuropsychologic deterioration over 9 years. The amateur boxers demonstrated relative preservation and/or improvement of some neuropsychologic skills relative to the socioeconomic controls.

Assessment of cognitive recovery following sports related head trauma in boxers.

OBJECTIVE: To prospectively examine recovery of cognitive function within one month following subconcussive sports related head trauma. DESIGN: A prospective study of New York State licensed professional boxers who underwent testing of cognitive functioning before and after (within days, one week, and one month) a professional bout. SETTING: Male professional athletes recruited from the New York State Athletic Commission and local boxing gyms. PARTICIPANTS: Twenty-six licensed professional boxers were enrolled in the protocol. Data is presented on the 18 participants who completed testing on at least three of the four time points. INTERVENTIONS: Serial neuropsychological assessment before and after the athletes engaged in competition. MAIN OUTCOME MEASURES: Neuropsychological measures of cognitive functioning, including new learning and memory, information processing speed, and mental flexibility. RESULTS: A series of repeated measures MANOVAS revealed significant within subject differences across testing on complex information processing and verbal fluency. Post hoc analyses indicated significant differences between time 1 (baseline) and time 4 (one month post), with scores one month following the bout indicating significantly improved performance. Memory scores did not change significantly across testing; however, prior boxing exposure measured by total number of professional bouts was associated with poorer memory performance. CONCLUSIONS: Cognitive testing one month following participation in a professional boxing bout yielded scores suggestive of recovery to a level above the baseline. We conclude that baseline assessment taken during periods of intense training are likely confounded by other pre-bout conditions (i.e., sparring, rapid weight loss, pre-bout anxiety) and do not represent true baseline abilities. Instability of performance associated with mild head injury may complicate the interpretation of post-injury assessments. Practice effects may also confound the interpretation of serial assessments, leading to underestimation of the effects of sports related head trauma. Poorer cognitive performance was evident during the presumed recovery period in boxers with greater exposure to the sport (>12 professional bouts). This finding is consistent with reports of a cumulative effect of repetitive head trauma and the subsequent development of chronic traumatic brain injury. These data have implications for assessing recovery of function following head injury in players of other contact sports as well as determination of return-to-play following an injury.

[15 years insurance statistics of incidents and accident types of combat sports injuries of the Rhineland-Pfalz Federal Sports Club]. / 15jährige Versicherungsstatistik zu Inzidenzen und Unfallhergangstypen von Kampfsportverletzungen im Landessportbund Rheinland-Pfalz.

The primary intention of this study is the grouping of sports accidents, being described by the athletes in their own words in a classification system of specific accident classes with regard to specific motions and topography. The investigation is based on the data of the sports insurance Gerling-Konzern during a 15-year period in Rhineland Palatinate (1981-1995). The study is based on the insurance documents and clinical protocols if available. 137 accident protocols were related to this 15-year period including weight lifting (n = 1) and martial arts (n = 136). Listed in hierarchical order we received the following results: judo (n = 47), karate (n = 44), wrestling (n = 22), taekwondo (n = 9), boxing (n = 7), ju-jutsu (n = 5), fencing (n = 1) and aikido (n = 1). In accordance to accident types there were no sex related differences. As special preventive measures we suggest the use of protective mouthguards and solid glasses, proprioceptive training and physiological taping for knee, ankle and elbow joints.

Controlled prospective neuropsychological assessment of active experienced amateur boxers.

OBJECTIVE: To use a practical battery of eight neuropsychological tests for the detection of an association between amateur boxing and chronic traumatic encephalopathy. DESIGN: A controlled prospective neuropsychological study over a 15-18-month period. SETTING: Dublin, Ireland. March 1992 to September 1993. PARTICIPANTS: Twenty experienced actively competing amateur boxers and 20 controls matched for age and socioeconomic status. INTERVENTIONS: Participation in competitive amateur boxing and training. MAIN OUTCOME MEASURES: Absolute scores, and changes in scores, in the neuropsychological tests. RESULTS: At the end of the study period, the boxers performed significantly better then the controls in both the Trail-Making Tests A and B (TMT-A, TMT-B), whereas the control group's scores for the Finger Tapping Tests (FTT) were significantly higher than those of the boxers. The boxer's scores for the dominant-hand FTT showed a significant deterioration, but there was no association between this change and boxing exposure. CONCLUSIONS: There was no evidence of neuropsychological impairment in the boxers as compared with socioeconomically, educationally and age-matched controls, and there was no association between boxing exposure and performances in any of the neuropsychological tests used. There is accumulating evidence that amateur boxing is not associated with chronic traumatic encephalopathy but longer term prospective studies are needed.

The "Buy-Max" mouthguard: oral, peri-oral and cerebral protection for contact sports.

Protective equipment plays an important role in the reduction of certain sports injuries. Mouthguards have been shown to reduce the number of orafacial and cerebral injuries in a variety of contact sports including rugby, hockey and boxing. The varieties of mouthguards available are discussed. The most effective, but also the most expensive, is the "Bimaxillary" mouthguard popularised by Chapman. It covers both dental arches and as the jaws are held in the position of heavy breathing, air flow is not impeded. The advantages and disadvantages of the various types of mouthguard are discussed.

Event-related potential assessment of attention and the orienting reaction in boxers before and after a fight.

Boxers' attention and orienting mechanisms were investigated using event-related brain potential recordings, before and after a fight. This study did not reveal any abnormalities of attention or detection processes. However, a slight deficit in the orienting reaction towards stimuli delivered in the right ear, related to a greater number of blows delivered on the left side of the head, was observed.