Head, face and neck injury in youth rugby: incidence and risk factors.

OBJECTIVES: In this study, the incidence of head, neck and facial injuries in youth rugby was determined, and the associated risk factors were assessed. DESIGN: Data were extracted from a cluster randomised controlled trial of headgear with the football teams as the unit of randomisation. No effect was observed for headgear use on injury rates, and the data were pooled. SETTING: General school and club-based community competitive youth rugby in the 2002 and 2003 seasons. PARTICIPANTS: Young male rugby union football players participating in under-13, under 15, under 18 and under 21 years competitions. Eighty-two teams participated in year 1 and 87 in year 2. MAIN OUTCOME MEASURES: Injury rates for all body regions combined, head, neck and face calculated for game and missed game injuries. RESULTS: 554 head, face and neck injuries were recorded within a total of 28 902 h of rugby game exposure. Level of play and player position were related to injury risk. Younger players had the lowest rates of injury; forwards, especially the front row had the highest rate of neck injury; and inside backs had the highest rate of injuries causing the player to miss a game. Contact events, including the scrum and tackle, were the main events leading to injury. CONCLUSION: Injury prevention must focus on the tackle and scrum elements of a youth rugby game.

Safety aspects of riding with children: Descriptive analysis of adult riders' self-report.

Active transport, including cycling, is promoted as an effective way of increasing children's physical activity and health. Parents can support children's riding by riding with them and it is important to address relevant safety issues. Little is known about parents' experience of safety-relevant aspects of riding with children. Participants in the Safer Cycling Study in New South Wales, Australia, who reported that they had ridden with children in the last 12 months were questioned about how they ride with children, and their experience of safety issues and crashes. Among the 187 respondents who had ridden with children on their bicycle, the most common form of carrier was a rear-mounted seat (48%) followed by a trailer (29%). Many respondents (79%) identified risks specific to riding carrying children, including those linked with specific carrier types and with use of footpaths. Most (92%) indicated that they change their behaviour when carrying a child on their bicycle; for example, riding more slowly, more carefully, and away from roads. Among crashes with a child on the bicycle, most were falls. Among the 345 participants who had ridden to accompany a child on a bicycle, approximately three quarters identified risks specific to accompanying children, such as managing the child's limited skill, awareness and predictability. Ninety-seven percent reported behavioural changes including positioning themselves as a barrier for their child and caution crossing roads. Findings suggest strategies to support parents in riding safely with children.

Elderly unilateral transtibial amputee gait on an inclined walkway: a biomechanical analysis.

The greatest population of amputees in developed nations are elderly dysvascular transtibial amputees. Conventional prostheses, e.g. the solid ankle cushioned heel (SACH) foot, create difficulties in walking on inclines. The aim of this study was to analyse the gait characteristics of elderly amputees walking on an incline, through quantitative three-dimensional biomechanical analysis, by comparing them to age-matched controls. Participants walked up and down an inclined (5 degrees) instrumented walkway at a self-selected pace. A Vicon System 370 was used to acquire gait data, including temporo-spatial characteristics, ground reaction forces (GRF), electromyography (EMG), kinematics, and kinetics of the lower limb. Compared to the age-matched controls, the amputees demonstrated reduced speed, knee and hip range of motion, hip moments, vertical GRF, along with increased amplitude and periods of muscle activation. The residual limb also had shorter single support stance phase, small stance phase knee moments, and the smallest moments and powers. These differences demonstrate instability in stance of the residual limb. The sources of this instability include the prosthesis' limited range of ankle motion and ankle power generation, coupled with the residual limb's limited proprioception and tolerance of force. For these amputees to regain a gait pattern equivalent to their able-bodied counterparts on inclined walkways, they must be equipped with a prosthesis that has a full range of ankle motion and active power generation at the ankle. Prosthesis design and rehabilitation training should also improve the proprioception of their residual limb and increase their tolerance of force through the residual limb.

Use of field-based tests to identify risk factors for injury to fast bowlers in cricket.

OBJECTIVE: To identify risk factors for injury to cricket fast bowlers using field-based tests. DESIGN: Prospective cohort study. SETTING: High performance Australian cricket. PARTICIPANTS: Ninety-one male adolescent and adult fast bowlers (aged 12-33 years). ASSESSMENT OF RISK FACTORS: A field-based pre-participation screening, consisting of musculoskeletal, fitness and anthropometric assessments and analysis of bowling technique was undertaken. Bowlers were prospectively monitored over the 2003-4 season and bowling workload and injuries were recorded. Logistic regression was used to identify injury risk factors. MAIN OUTCOME MEASUREMENT: Repetitive microtrauma injury to the trunk, back or lower limb associated with fast bowling. RESULTS: Two variables were identified as independent predictors of injury in the multivariate logistic regression analysis. Bowlers with hip internal rotation of < or =30 degrees on the leg ipsilateral to the bowling arm were at a significantly reduced risk of injury (OR 0.20, 95% CI 0.06 to 0.73) compared with bowlers with >40 degrees of rotation. Bowlers with an ankle dorsiflexion lunge of 12.1-14.0 cm on the leg contralateral to the bowling arm were at a significantly increased risk (OR 4.03, 95% CI 1.07 to 15.21) than bowlers with a lunge of >14 cm. Bowlers with a lunge of < or =12 cm were also at an increased risk, but not significantly so (OR 1.38, 95% CI 0.40 to 4.84). CONCLUSIONS: Biomechanical research is needed to investigate how these two intrinsic risk factors increase injury risk so that appropriate interventions can be developed.

Near miss experiences of transport and recreational cyclists in New South Wales, Australia. Findings from a prospective cohort study.

This paper investigates events in which cyclists perceive a cycling crash is narrowly avoided (henceforth, a near miss). A cohort of 2038 adult transport and recreational cyclists from New South Wales (Australia) provided self-reported prospectively collected data from cycling diaries to allow the calculation of an exposure-based rate of near misses and investigation of near miss circumstances. During 25,971days of cycling, 3437 near misses were reported. For a given time cycling, cyclists who rode mainly for transport (compared with those who rode mainly for recreation), and cyclists with less experience (compared to those with more experience) were more likely to report a near miss; older cyclists (60+ years) were less likely to report a near miss than younger cyclists (25-59 years). Where type of near miss was recorded, 72.0% involved motor vehicles, 10.9% involved pedestrians and 6.9% involved other cyclists. Results indicate some similarities between near misses and crashes reported by this cohort during the same reporting period. A bias toward reporting near misses with motor vehicles was suggested, which likely reflects cyclists' perceptions that crashes involving motor vehicles are particularly serious, and highlights their impact on perceived safety. Given the relative rarity of crashes, and the limited breadth and depth of administrative data, collection of near miss data may contribute to our understanding of cycling safety by increasing the volume and detail of information available for analysis. Addressing the causes of near misses may offer an opportunity to improve both perceived and actual safety for cyclists.

The Heidelberg foot measurement method: development, description and assessment.

The aim of this study was to develop and evaluate a kinematic measurement method for the foot that could be applied clinically to measure foot function including all typical foot deformities. The ankle was modelled as two anatomically based hinge joints rotating around anatomical axes estimated by the use of projection angles. For the mid- and forefoot a descriptive approach was chosen by defining angles between anatomical landmarks or reference points derived from these landmarks. The motion of 17 markers on the lower leg and foot was measured during walking gait on 10 adult participants with no known abnormalities to determine the pattern of normal foot motion, assess reliability and provide a reference against which pathological foot behaviour could be compared. Functional angles for mid- and forefoot motions were developed to improve clinical applications of the data. The combination of anatomically and technically oriented marker placement on the foot is a reliable basis for reproducible kinematic measurements and the method was shown to be viable for clinical practice.

Injury mechanisms in fatal Australian quad bike incidents.

OBJECTIVES: The ability to determine risk management controls for quad bike use is confounded by limitations in crash and injury information. The aim of this article is to identify the injury mechanisms, crash characteristics, and contributing factors in fatal quad bike incidents in Australia by activity (recreation and work). METHODS: An in-depth case series study was undertaken of 106 Australian quad bike fatalities that had occurred between 2000 and 2013. All case material held by Australian coroners was obtained and reviewed. RESULTS: One hundred and six cases were categorized as occurring during recreation (53) and work (53). Fifty-two of the work cases occurred during farmwork. The mean age for those killed during a work activity was 56 years compared to 27 years for recreational riders. Two children under 16 years died while performing farmwork and 13 children under 16 years during recreational activities. The analyses show a very clear pattern for farmwork-related deaths: quad bike rolls or pitches over (farmworker, 85%; recreational rider, 55%), rider becomes pinned under quad bike (farmworker, 68%; recreational rider, 30%), and death by asphyxia (farmworker, 42%; recreational rider, 11%). In contrast, recreational riders suffered complex impact injuries to the head and chest that occurred when the rider was traveling at speed, lost control, was ejected, and collided with an object in the environment and/or interacted with the moving quad bike. CONCLUSIONS: The analyses support the need to improve safe quad bike operation through consideration of the age of the rider, training, helmet use, reducing the propensity of quad bikes to roll, and improving handling so that loss of control events are reduced and to prevent crushing and pinning by the vehicle during and after a rollover crash.

Preventing head and neck injury.

A wide range of head and neck injury risks are present in sport, including catastrophic injury. The literature since 1980 on prevention of head and neck injury in sport was reviewed, focusing on catastrophic and brain injury and identifying the range of injury prevention methods in use. There have been few formal evaluations of injury prevention methods. Approaches that are considered, or have been proven, to be successful in preventing injury include: modification of the baseball; implementation of helmet standards in ice hockey and American football and increased wearing rates; use of full faceguards in ice hockey; changes in rules associated with body contact; implementation of rules to reduce the impact forces in rugby scrums. Helmets and other devices have been shown to reduce the risk of severe head and facial injury, but current designs appear to make little difference to rates of concussion. Research methods involving epidemiological, medical, and human factors are required in combination with biomechanical and technological approaches to reduce further injury risks in sport.

Rugby World Cup 2003 injury surveillance project.

OBJECTIVES: To study match injury patterns and incidence during the Rugby World Cup 2003 (RWC 2003); to compare these patterns and rates with comparative rugby injury data; and to assess differences between teams playing at different levels (eight finalists v 12 non-finalists). METHODS: Data were collected prospectively during the tournament. All injuries were recorded by the 20 participating team physicians. These were submitted to the tournament medical officer. An injury was defined as an event which forced a player either to leave the field or to miss a subsequent game or both. RESULTS: 189 injuries were recorded over 48 matches. This corresponds to 97.9 injuries per 1000 player-hours. Pool matches yielded a higher injury rate than non-pool matches. The 12 non-finalist teams sustained significantly higher injury rates than the eight finalist teams. The player positions open side flanker, inside centre, and number 8 were the most frequently injured positions. There was a low concussion rate, which may reflect under-reporting. The non-finalist teams had a higher rate of recurrent injury. CONCLUSIONS: The injury rate was higher than comparative data. Mismatches in the areas of skill, fitness, and the availability of resources for medical care of players may explain these differences.

Sensitivity of head and cervical spine injury measures to impact factors relevant to rollover crashes.

OBJECTIVE: Serious head and cervical spine injuries have been shown to occur mostly independent of one another in pure rollover crashes. In an attempt to define a dynamic rollover crash test protocol that can replicate serious injuries to the head and cervical spine, it is important to understand the conditions that are likely to produce serious injuries to these 2 body regions. The objective of this research is to analyze the effect that impact factors relevant to a rollover crash have on the injury metrics of the head and cervical spine, with a specific interest in the differentiation between independent injuries and those that are predicted to occur concomitantly. METHODS: A series of head impacts was simulated using a detailed finite element model of the human body, the Total HUman Model for Safety (THUMS), in which the impactor velocity, displacement, and direction were varied. The performance of the model was assessed against available experimental tests performed under comparable conditions. Indirect, kinematic-based, and direct, tissue-level, injury metrics were used to assess the likelihood of serious injuries to the head and cervical spine. RESULTS: The performance of the THUMS head and spine in reconstructed experimental impacts compared well to reported values. All impact factors were significantly associated with injury measures for both the head and cervical spine. Increases in impact velocity and displacement resulted in increases in nearly all injury measures, whereas impactor orientation had opposite effects on brain and cervical spine injury metrics. The greatest cervical spine injury measures were recorded in an impact with a 15° anterior orientation. The greatest brain injury measures occurred when the impactor was at its maximum (45°) angle. CONCLUSIONS: The overall kinetic and kinematic response of the THUMS head and cervical spine in reconstructed experiment conditions compare well with reported values, although the occurrence of fractures was overpredicted. The trends in predicted head and cervical spine injury measures were analyzed for 90 simulated impact conditions. Impactor orientation was the only factor that could potentially explain the isolated nature of serious head and spine injuries under rollover crash conditions. The opposing trends of injury measures for the brain and cervical spine indicate that it is unlikely to reproduce the injuries simultaneously in a dynamic rollover test.

An exposure based study of crash and injury rates in a cohort of transport and recreational cyclists in New South Wales, Australia.

This paper examines self-reported prospectively collected data from 2038 adult transport and recreational cyclists from New South Wales (Australia) to determine exposure-based incident crash and injury rates. During 25,971 days of cycling, 198 crashes were reported, comprising approximately equal numbers of falls and collisions. The overall crash rate was 0.290 (95% CI, 0.264-0.319) per 1000km or 6.06 (95% CI, 5.52-6.65) per 1000h of travel. The rate of crashes causing any injury (self-treated, or medically attended without overnight hospital stay) was 0.148 (95% CI, 0.133-0.164) per 1000km or 3.09 (95% CI, 2.79-3.43) per 1000h of travel. The rate of crashes causing a medically attended injury (without overnight hospital stay) was 0.023 (95% CI, 0.020-0.027) per 1000km or 0.49 (95% CI, 0.43-0.56) per 1000h of travel. No injuries requiring an overnight stay in hospital were reported on days meeting the inclusion criteria. After adjustment for exposure in hours, or for the risks associated with different infrastructure utilisation, the rates of crashes and medically attended injuries were found to be greater for females than males, less experienced than more experienced cyclists, and for those who rode mainly for transport rather than mainly for recreation. Comparison of estimated crash and injury rates on different infrastructure types were limited by the small number of events, however findings suggest that the separation of cyclists from motorised traffic is by itself not sufficient to ensure safe cycling.

Characteristics, cycling patterns, and crash and injury experiences at baseline of a cohort of transport and recreational cyclists in New South Wales, Australia.

This paper examines self-reported retrospective data for a 12 month period from 2038 adult cyclists from New South Wales (Australia), and compares cyclists according to whether they self-identify as riding mainly for transport or mainly for recreation. Statistically significant differences were found in the demographic characteristics, cycling patterns, and crash experiences between these two groups of cyclists. Transport cyclists tended to be younger, travel more days per week, and within morning and evening peak hours than recreational cyclists; recreational cyclists were more likely to identify fitness as a purpose for cycling. The proportion of cyclists experiencing a crash or crash-related injury in the previous 12 months was similar for transport and recreational cyclists, but there were differences in crash types and location which likely reflect different cycling environments. Heterogeneity within transport and recreational cyclists was also found, based on self-reported riding intensity. An understanding of the different cycling patterns and experiences of various types of cyclists is useful to inform road safety, transport and health promotion policy.

The dynamics of concussive head impacts in rugby and Australian rules football.

A study was commenced in 1998 at the University of New South Wales (UNSW) to investigate the dynamics of head impacts in football which resulted in concussion. Sixty-eight cases of medically verified concussion from Australian Rules Football and 32 from Rugby Union and Rugby League were analyzed. Video of each injury event was analyzed to obtain descriptive data regarding the head impact site and striking object. The video was analyzed quantitatively to obtain estimates of the closing speeds. A secondary analysis was undertaken using the conservation of momentum and energy relationships to estimate the change in velocity of the head during the impact, the change in momentum of the head, and the energy imparted to the head. Ninety-seven cases involved direct head contact, whereas three cases involved impulsive loading via the trunk. The majority of impacts were to the tempero-parietal region, and the striking body segment was commonly the arm or shoulder/thorax. The mean change in velocity of the head and head impact energy for all 97 cases of direct head impact were 4 m x s(-1) and 56 J, respectively. Head impact energy can be used as a performance criteria for testing and developing headgear for rugby and Australian rules football.

Chemometrics in pharmaceutical analysis.

Pharmaceutical analysis is undergoing a slow revolution as chemometric principles become increasingly incorporated. This paper reviews some of the more recent advances, with particular focus on spectrophotometry, chromatography and expert systems.

Sodium nitroprusside: pharmacological aspects of its interaction with hydroxocobalamin and thiosulphate.

Hydroxocobalamin (HOCb), when mixed with sodium nitroprusside (SNP) in a 10:1 or 1:1 molar ratio and injected (i.v.) into the anaesthetized rat, prolonged the depressor response to SNP by 25-50%, but did not affect the degree of blood pressure lowering. Both the 'onset' and 'offset' components of the response were prolonged. Injecting [14C]SNP along with a 10-fold molar excess of HOCb resulted in a 2- to 3-fold elevation of plasma radioactivity which was maintained during the first 10 min of a 40 min experimental period. These effects of HOCb on the pharmacodynamics and pharmacokinetics of SNP are probably due to complex formation between the two compounds. Sodium thiosulphate (ST) added to SNP (12:1 molar ratio) had no effect on the depressor response to SNP. This mixing of ST and SNP had a less-marked influence on the plasma [14C] SNP-derived radioactivity than occurred with HOCb. There was no initial elevation of radioactivity, but the levels were raised by 50-60% at 4, 6 and 10 min. Since the depressor response to SNP was unaffected by ST, it is presumed that the higher concentrations of radioactivity were due to inactive degradation products rather than the active species itself.

A pilot study of the attitudes of Australian Rules footballers towards protective headgear.

Despite a relatively high risk of injury to participants of Australian Rules football, very few players report wearing protective equipment. The aim of this paper is to describe the results of a pilot survey of the attitudes of community-level Australian Rules football players towards protective headgear and the risk of head injury. Seventy players from four purposefully chosen clubs in metropolitan Melbourne completed a self-report questionnaire at the end of the 2000-playing season. Almost all players (91.4%) reported they did not wear protective headgear during the 2000 season. Non-headgear users said that headgear was too uncomfortable (47.4%) and they didn't like it (42.1%). However, 80.0% of non-users said they would wear it if it prevented injury. The major motivation for wearing headgear was to prevent injury. Players considered rugby, boxing and driving a car, to be associated with a higher-risk of head injury than Australian Rules football. As a group, the players perceived the risk of head injury in Australian Rules football to be low to moderate when compared to other sports and activities. This partially explains why so few players wore protective headgear. Repeat surveys on a larger sample should be conducted to further understand the attitudes towards protective headgear and perceptions of risk in community-level Australian football players.

Rugby headgear study.

A two year randomised controlled trial of headgear in Rugby Union football is being conducted in Sydney, Australia. This paper gives an overview of this study in progress and presents results related to the development and laboratory performance of the headgear. The study commenced in 2002. Participants recruited to the study are in the under 13, 15, school open (U18) and colts age groups. There are three study arms: control, IRB-approved headgear, and modified headgear. The IRB approved headgear is a popular model in rugby, the Canterbury Honeycomb model manufactured by BodyArmour in New Zealand. The dimensions of this model were altered by increasing foam density and thickness to produce the modified headgear. In impact energy attenuation tests of 15 and 20 Joules onto a flat anvil, the modified headgear demonstrated average maximum headform accelerations of 23% and 33% of the standard model, respectively. Whether or not this improvement translates into reductions in injury will be determined by a comparison of the rates and severities of head injuries across study arms. Furthermore, these dimensional changes may not be acceptable to rugby players. Player attitudes towards safety and the use of protective clothing, injury history, experience and on-field behaviour will be examined via structured pre- and end of season surveys and analysis of match video.

Thoracic injuries to contained and restrained occupants in single-vehicle pure rollover crashes.

Around one in three contained and restrained seriously injured occupants in single-vehicle pure rollover crashes receive a serious injury to the thorax. With dynamic rollover test protocols currently under development, there is a need to understand the nature and cause of serious thoracic injuries incurred in rollover events. This will allow decisions to be made with regards to adoption of a suitable crash test dummy and appropriate thoracic injury criteria in such protocols. Valid rollover occupant protection test protocols will lead to vehicle improvements that will reduce the high trauma burden of vehicle rollover crashes. This paper presents an analysis of contained and restrained occupants involved in single-vehicle pure rollover crashes that occurred in the United States between 2000 and 2009 (inclusive). Serious thoracic injury typology and causality are determined. A logistic regression model is developed to determine associations between the incidence of serious thoracic injury and the human, vehicle and environmental characteristics of the crashes. Recommendations are made with regards to the appropriate assessment of potential thoracic injury in dynamic rollover occupant protection crash test protocols.

Cervical and thoracic spine injury from interactions with vehicle roofs in pure rollover crashes.

Around one third of serious injuries sustained by belted, non-ejected occupants in pure rollover crashes occur to the spine. Dynamic rollover crash test methodologies have been established in Australia and the United States, with the aims of understanding injury potential in rollovers and establishing the basis of an occupant rollover protection crashworthiness test protocol that could be adopted by consumer new car assessment programmes and government regulators internationally. However, for any proposed test protocol to be effective in reducing the high trauma burden resulting from rollover crashes, appropriate anthropomorphic devices that replicate real-world injury mechanisms and biomechanical loads are required. To date, consensus regarding the combination of anthropomorphic device and neck injury criteria for rollover crash tests has not been reached. The aim of the present study is to provide new information pertaining to the nature and mechanisms of spine injury in pure rollover crashes, and to assist in the assessment of spine injury potential in rollover crash tests. Real-world spine injury cases that resulted from pure rollover crashes in the United States between 2000 and 2009 are identified, and compared with cadaver experiments under vertical load by other authors. The analysis is restricted to contained, restrained occupants that were injured from contact with the vehicle roof structure during a pure rollover, and the role of roof intrusion in creating potential for spine injury is assessed. Recommendations for assessing the potential for spine injury in rollover occupant protection crash test protocols are made.

Head injuries to restrained occupants in single-vehicle pure rollover crashes.

OBJECTIVE: Studies performed previously of seat-belted occupants in real-world passenger vehicle rollover-only crashes have identified the head as one of the body regions most often seriously injured. However, there have been few studies investigating how these head injuries occur in any detail. This study aims to investigate the characteristics and patterns of head injury to seat-belted occupants in real-world rollover-only crashes and to identify possible biomechanical mechanisms responsible for head injury to aid in the development of a dynamic rollover test protocol. METHODS: National Automotive Sampling System-Crashworthiness Data System (NASS-CDS) data were used to generate summary statistics and perform logistic regression analysis of restrained and contained occupants in U.S. pure trip-over rollover crashes. Specific information from selected CDS cases focused on identifying potential mechanisms and patterns of serious head injury and the rollover conditions under which the injury occurred are also presented. RESULTS: Twenty-one percent of seriously injured occupants in pure trip-over rollovers had a serious head injury. On average, occupants seated on the far side of the rollover sustained serious head injuries more frequently and were more likely to receive injuries to the inboard side of the head than near-side occupants. Serious head injuries appear to be decoupled from serious injuries to other body regions except for a relationship found between basal skull fractures and cervical spine fractures. Serious head injuries were sustained by some occupants who had less than 15 cm of roof crush above their seated position. CONCLUSIONS: Serious brain injuries appear to occur frequently as a result of loading to the periphery of the head from contact with the roof assembly. Two mechanisms of injury for basal skull fractures in rollover crashes were identified. The injury patterns and locations of contact to the head are sensitive to the seated position of the occupant.