[Injuries in Karate Sports: A Survey Performed During the World Championship 2014]. / Verletzungen im Karatesport ­ eine Umfrage während der Weltmeisterschaft 2014.

Background: In literature, the competitive sport of modern karate is almost always characterised as a combat sport involving injuries caused by impact effects and physical contact with opponents. There is a lack of data regarding the outcome after karate injuries, specifically with a view to the contact-free Kata karate. Methods: Performing a random test using a questionnaire, we collected data concerning regular medical treatment, prior surgeries of the locomotor system, and medical care. This study included 300 athletes from 65 countries (average age: 24.1 years; 176 male, 124 female) participating in the Karate World Cup 2014. Seven participants competed in both disciplines, 87 only in the Kata discipline, and 206 only in Kumite (the discipline involving physical contact with opponents). The statistical analysis was performed using a two-sided Chi-square test and the Fisher's exact test. Results: Recurrent medical treatment was most commonly required for the knee region (Kata 28.7 %, Kumite 26.7 %). In Kata the shoulder region came second (22.9 %), in Kumite the ankle region (21.8 %), followed by hand and foot in both groups. Medical treatment of the elbow area was more frequent in the Kata Group (p = 0.033), while in Kumite athletes' hand (p = 0.002) and foot injuries (p = 0.007) prevailed. Prior surgeries of athletes of both disciplines most commonly concerned the knee, followed by the ankle region in the Kata group and by the hand and head region in the Kumite group. Statistically significant differences between the two disciplines were found in head injuries (p = 0.004), which commonly do not occur in the Kata discipline. During the World Cup, 56.0 % of the athletes had no individual medical care and 24.6 % received no sports-related medical care in their home countries. Conclusion: Although the risk of injuries in Kumite Karate has been reduced by the introduction of gumshields, hand and foot protectors as well as a reform of the scoring system, the potential for chronic physical damage should not be underestimated. Since in athletes competing in the Kata discipline the rate of surgeries and injuries is only slightly lower than in the Kumite group, Kumite Karate may be regarded as a martial arts competitive sport with a relatively low risk of injuries. In contrast, the risk of chronic musculoskeletal damage in Kata athletes seems to be underestimated thus far. Suggested improvements concern the training techniques and conditions (i. e. the tatami material), and there is a need for regular medical care, including preventative care, to be provided for these athletes.

[Bony injuries of the thoracic cage in multiple trauma : Incidence, concomitant injuries, course and outcome]. / Knöcherne Verletzung der Brustwand beim Polytrauma : Inzidenz, Begleitverletzungen, Verlauf und Outcome.

BACKGROUND: Thoracic trauma is considered to be responsible for 25 % of fatalities in multiple trauma and is a frequent injury with an incidence of 50 %. In addition to organ injuries, severe injuries to the bony parts of the thorax also occur and these injuries are described very differently mostly based on single center data. OBJECTIVES: The focus of this study was on a holistic presentation of the prevalence and the incidence of thoracic trauma in patients with multiple trauma from the data of the large collective of the TraumaRegister DGU® (TR-DGU) with the objective of an analysis of concomitant injuries, therapy options and outcome parameters. MATERIAL AND METHODS: A retrospective analysis was carried out based on the data set of the TR-DGU from the years 2009-2013. Inclusion criteria were an injury severity scale (ISS) score ≥ 16 and primary admission to a trauma center but isolated craniocerebral injury was an exclusion criterium. Patients were separated into two groups: those with rib fractures (RF) and those with flail chest (FC). RESULTS: A total of 21,741 patients met the inclusion criteria including 10,474 (48.2 %) suffering from either RF or FC. The mean age was 49.8 ± 19.9 years in the RF group and 54.1 ± 18.2 years in the FC group. Approximately 25 % were female in both groups, 98.1 % were blunt force injuries and the median ISS was 28.0 ± 11.2 in RF and 35.1 ± 14.2 in FC. Shock, insertion of a chest tube, (multi) organ failure and fatality rates were significantly higher in the FC group as were concomitant thoracic injuries, such as pneumothorax and hemothorax. Sternal fractures without rib fractures were less common (3.8 %) than concomitant in the RF (10.1 %) and FC (14 %) groups, as were concomitant fractures of the clavicle and the scapula. Out of all patients 32.6 % showed fractures of the thoracolumbar spine, 26.5 % without rib fractures, 36.6-38.6 % with rib fractures or monolateral FC and 48.6 % concomitant to bilateral FC. Thoracotomy was carried out only in isolated cases in RF and in 10.2 % of the FC group. Operative stabilization of the thoracic cage was carried out in 3.9-9.1 % of patients in the RF group and in 17.9-23.9 % in the FC group.

[Injuries in the Martial Arts Judo, Taekwondo and Wrestling - A Systematic Review]. / Verletzungen in den Kampfsportarten Judo, Taekwondo und Ringen - Eine systematische Übersichtsarbeit.

BACKGROUND: Martial arts such as judo, taekwondo and wrestling are regulated, usually athletic duels. The aim is to score better than your opponent or to win. As with any type of sport, athletes in martial arts sustain minor and major injuries, which may have many negative consequences. In addition, sports injuries and their rehabilitation generate high costs to the healthcare system. In contrast to the FIFA 11+ warm-up program, no preventive programs have been postulated for injury prevention in these martial arts. Therefore, the aim of this systematic review was to summarise the latest research findings and to evaluate whether initial recommendations can be given for the reduction of injuries in the martial arts judo, wrestling and taekwondo. METHODS: To gain an overview of the latest research findings, we searched for systematic reviews in PEDro, PubMed, Cochrane and the internet search engine Google Scholar. The methodological quality of these reviews was assessed using the Critical Appraisal Tool for a Systematic Review (CASP), and data was extracted on the risk of injury, injury location and injury type. RESULTS: It was found that all three review articles are of low to moderate methodological quality. Regarding injury location, it became evident that the extremities are particularly vulnerable to injury in all three martial arts. Effusion was observed to be the most common type of injury. CONCLUSION: Due to the moderate methodological quality and the injury type of effusion, it is not possible to formulate recommendations for injury prevention. Moreover, uniform definitions should be developed to describe sports injuries.

[Hand injuries from combat sports]. / Verletzungen der Hand durch Kampfsport.

BACKGROUND: Each year 3.1% of German adults suffer from accidents related to sports and 75% of the injured athletes are male between 20 and 29 years old. The upper limbs are affected in more than 20% of cases and one third of these injuries involve the hands and fingers. OBJECTIVES: More than half a million athletes are organized in combat sport associations in Germany with an increasing trend. Combat sports are commonly said to have a high risk of injuries to the hand. The aim of this study was to test this hypothesis as well as to describe typical hand injuries associated with combat sports. MATERIAL AND METHODS: A systematic review of literature (up to January 2015) in PubMed/Medline and The Cochrane Library as well as a secondary search in the reference lists were carried out. CONCLUSION: Conclusive comparative studies on the incidence and severity of hand injuries directly related to combat sports action could not be found in the currently available literature. The overall risk of suffering from a sports injury seems to be relatively low in combat sports compared to other sports. Boxing, however, seems to be the most dangerous sport for injuries to the upper extremities and especially the hand. The injury pattern after punching (emergency patients and professional boxers) shows that more than half of these fractures affect the 5th metacarpal and 25% of these are the classical boxer's fracture. This differs significantly from the fracture distribution generally associated with sports, where fractures of the phalanges are the most common. Two rare conditions that may occur as a result of repeated punching are referred to as carpal bossing and boxer's knuckle and excellent results are described for both injury forms after surgical therapy.

Atrial fibrillation increases medical cost and complicates hospital outcome of traffic accident-related physical trauma--a nationwide population-based study.

BACKGROUND: Traffic accidents account substantially for premature disability and deaths in the modern world. Whether atrial fibrillation complicates the outcome of traffic injury remains under-investigated. METHODS: From 1998 to 2010, all inpatient records stored in the Taiwan National Health Insurance database were screened. Those related with traffic accidents were aggregated to individuals and enrolled. The medical expenses and hospital outcomes were compared between patients with atrial fibrillation (AF group) and either the rest patients (No-AF group) or the propensity-matched patients without atrial fibrillation (No-AF-matched group). Prognostic predictive variables for adverse in-hospital events were further identified by multivariate regression analysis. RESULTS: Within the 13-year time span, of the 776,620 individuals ever admitted for traffic accidents, there were 1233 patients with AF. Compared with No-AF and No-AF-matched groups respectively, AF patients stayed longer in hospital (10.9 ± 10.6 vs. 6.8 ± 7.2 and vs. 8.2 ± 8.7 days, both p < 0.001), more often required surgical operations (73.2% vs. 69.5%, p = 0.006 and vs. 68.9%, p = 0.021), and consumed larger medical expenses (US$ 2384 ± 3174 vs. 1246 ± 2024, or 91.3% higher; and vs. 1406 ± 2172, or 69.6% higher, both p < 0.001), yet developed more postoperative complications (8.8% vs. 1.2% and vs. 3.2%, both p<0.001) and deaths (2.5% vs. 0.9%, p < 0.001 and vs. 1.6%, p = 0.015). Identified by regression analysis, CHA2DS2-VASC score and representative demographic/injury-related variables predict in-hospital adverse events in these AF group patients. CONCLUSIONS: For patients suffering traffic accidents, those with AF consume more surgical resources and medical expenses yet end up with poorer hospital outcome, especially those with higher CHA2DS2-VASC scores and other relevant variables.

Epidemiology of hospitalized traumatic pelvic fractures and their combined injuries in Taiwan: 2000-2011 National Health Insurance data surveillance.

BACKGROUND: From the viewpoint of prehospital emergency medicine, a greater proportion of pelvic fractures not of a life-threatening status but combined with other injuries need more comprehensive recognition. METHODS: A 12-year nationwide health database of inpatients was reviewed. All cases diagnosed as pelvic fractures were enrolled. The associated injuries classified into 20 categories were further analyzed. RESULTS: During 2000-2011, the hospitalized incidence of pelvic fractures in Taiwan ranged from 17.17 to 19.42 per 100,000, and an increasing trend with age was observed. The mean case-fatality rate was 1.6% for females and 2.1% for males; male patients with pelvic fractures had a significantly higher risk of death than female patients after adjusting for other covariates. 74.2% of these cases were combined with other injuries. The most common associated injuries in an identified body region were other orthopedic fractures of the lower limbs (21.50%), spine/trunk (20.97%), or upper limbs (18.18%), followed by significant head injuries (17.59%), intra-abdominal injuries (11.00%), and thoracic injuries (7.20%). CONCLUSION: The incidence of hospitalized pelvic fractures in Taiwan was low and the case-fatality rate was lower than those of other countries. Concurrently, coexistence of major combined injuries with pelvic fractures was easily treated at medical centers.

[Sport injuries in full contact and semi-contact karate]. / Sportverletzungen im Vollkontakt- und Semikontaktkarate.

BACKGROUND: Karate enjoys great popularity both in professional and recreational sports and can be classified into full, half and low contact styles. The aim of this study was the analysis of sports injuries in Kyokushinkai (full contact) and traditional Karate (semi-contact). METHODS: In a retrospective study design, 215 active amateur karateka (114 full contact, 101 semi-contact) were interviewed by means of a standardised questionnaire regarding typical sport injuries during the last 36 months. Injuries were categorised into severity grade I (not requiring medical treatment), grade II (single medical treatment), grade III (several outpatient medical treatments) and grade IV (requiring hospitalisation). RESULTS: In total, 217 injuries were reported in detail. 125 injuries (58%) occurred in full contact and 92 (42%) in semi-contact karate. The time related injury rate of full contact karateka was 1.9/1000 h compared to 1.3/1000 h of semi-contact karateka (p < 0.05). The most common types of injuries were musculoskeletal contusions (33% full contact, 20% semi-contact), followed by articular sprains with 19% and 16%. The lower extremity was affected twice as often in full contact (40%) as in semi-contact (20%) karate. Training injuries were reported by 80% of the full contact and 77% of the semi-contact karateka. Most injuries, both in training and competition, occurred in kumite. 75% of the reported injuries of full contact and 70% of semi-contact karateka were classified as low grade (I or II). CONCLUSION: The high rate of injuries during training and kumite (sparring) points to specific prevention goals. The emphasis should be put on proprioceptive training and consistent warm-up. In the actual competition the referees play a vital role regarding prevention.

[Guidelines for specialized nutritional and metabolic support in the critically-ill patient. Update. Consensus of the Spanish Society of Intensive Care Medicine and Coronary Units-Spanish Society of Parenteral and Enteral Nutrition (SEMICYUC-SENPE): patient with polytrauma]. / Recomendaciones para el soporte nutricional y metabólico especializado del paciente crítico. Actualización. Consenso SEMICYUC-SENPE: paciente politraumatizado.

Patients with polytrauma can be viewed as paradigmatic of the critically-ill patient. These previously healthy patients undergo a life-threatening aggression leading to an organic response that is no different from that in other types of patients. The profile of trauma patients has changed and currently corresponds to patients who are somewhat older, with a higher body mass index and greater comorbidity. Severe injuries lead to intense metabolic stress, posing a risk of malnutrition. Therefore, early nutritional support, preferentially through the enteral route, with appropriate protein intake and glutamine supplementation, provides advantages over other routes and types of nutritional formula. To avoid overnutrition, reduced daily calorie intake can be considered in obese patients and in those with medullary lesions. However, little information on this topic is available in patients with medullary lesions.

Prevalence of associated injuries of spinal trauma and their effect on medical utilization among hospitalized adult subjects--a nationwide data-based study.

BACKGROUND: This study was wanted to investigate the prevalence of concomitant injuries among hospitalized acute spinal trauma patients aged 20 and over and the effects of those injuries on medical utilization in Taiwan. METHODS: Nationwide inpatient datasets of Taiwan's National Health Insurance (NHI) database from between 2000 and 2003 were used. The major inclusion criteria used to select cases admitted due to acute spinal trauma were based on three diagnostic International Classification of Disease, 9th Version (ICD-9) codes items: (1) fracture of vertebral column without mention of spinal cord injury; (2) fracture of vertebral column with spinal cord injury; or (3) spinal cord lesion without evidence of spinal bone injury. To investigate the associated injuries among the eligible subjects, the concomitant ICD-9 diagnosis codes were evaluated and classified into six co-injury categories: (1) head trauma; (2) chest trauma; (3) abdominal trauma; (4) pelvic trauma; (5) upper extremities trauma; (6) lower extremities trauma. RESULTS: There were 51,641 cases studied; 27.6% of these subjects suffered from neurological deficit, but only 17.3% underwent a surgical procedure for spinal injury. Among them, the prevalence of associated injuries were as follows: head trauma, 17.2%; chest injury, 2.9%; abdominal trauma, 1.5%; pelvic injury or fracture, 2.5%; upper limb fracture, 4.4%; lower limb fracture, 5.9%. The three major locations of acute spinal injury (cervical, thoracic, or lumbar spine) were found to be combined with unequal distributions of associated injuries. By stepwise multiple linear regression, gender, age, location of spinal injury, neurological deficit, surgical intervention and the six combined injuries were identified significantly as associated factors of the two kinds of medical utilization, length of stay (LOS) and direct medical cost. The combinations of acute spinal trauma with lower extremity injury, pelvic injury, chest injury, abdominal injury and upper extremity injury resulted in of the highest utilization of medical resources, the estimated additional LOS being between 4.3 and 1.2 days, and the extra medical cost calculated as being between $1,230 and $320. CONCLUSION: The occurrence of associated Injuries among hospitalized acute spinal trauma patients in Taiwan is not uncommon, and results in an obvious effect on medical utilization.

Alendronate reduces the risk of multiple symptomatic fractures: results from the fracture intervention trial.

OBJECTIVES: To evaluate the effect of alendronate on the occurrence rate of multiple svmptomatic fractures and on the risk of multiple symptomatic fractures (likelihood of having more than one fracture diagnosed because of the symptoms the fractures caused over the study period) among women with osteoporosis. DESIGN: Primary analysis of data from a randomized, placebo-controlled, double-blind trial. SETTING: Eleven community-based clinical research centers. PARTICIPANTS: Subset of women enrolled in the Fracture Intervention Trial: aged 55 to 81 and having at least one morphometric vertebral fracture at baseline (n=2,027) or having no vertebral fracture but meeting prevailing World Health Organization bone mineral density criteria for osteoporosis (T-score < or =2.5 at the femoral neck)(n = 1,631). INTERVENTION: All participants reporting calcium intake of 1,000 mg/day or less received a supplement of 500 mg calcium and 250 IU cholecalciferol. Participants were randomly assigned to placebo or alendronate sodium (5 mg/day for 2 years and 10 mg/day for the remainder of the study). Average total follow-up was 4.3 years. MEASUREMENTS: Symptomatic fractures were diagnosed by personal physicians and confirmed by review of radiological data by an expert committee blinded to treatment assignments. RESULTS: Eighty-six of 1,817 women receiving placebo experienced multiple symptomatic fractures during the follow-up period, compared with 51 of 1,841 receiving alendronate. Reduction of risk for multiple symptomatic fractures combined was 42% (relative risk (RR) = 0.58, 95% confidence interval (CI) = 0.41, 0.81) and for multiple symptomatic vertebral fractures was 84% (RR = 0.16,95% Cl = 0.05, 0.42). Cumulative incidence curves showed divergence after as little as 3 months of treatment, with a statistically significant (P = .044) reduction at 6 months for multiple symptomatic vertebral fractures. When all fractures over the follow-up period were included, the occurrence rates of all symptomatic fractures and symptomatic vertebral fractures were 34% and 63% lower, respectively, with alendronate than with placebo. These reductions were sustained during the follow-up period. All reductions in risk were consistent across predefined subgroups: age (<75 vs > or =75), morphometric vertebral fracture(present vs absent), prior clinical fracture since age 45 (yes vs no), and whether the subject had fallen in the 12 months before randomization. CONCLUSIONS: These data demonstrate that treatment with alendronate reduces the risk of multiple symptomatic fractures during a treatment period averaging 4.3 years. The reductions were consistent across prespecified sub-groups. This effect is evident early in treatment and is sustained.

5196 mandible fractures among 4381 active duty army soldiers, 1980 to 1998.

OBJECTIVE: We present the frequencies of various types of mandibular fractures along with associated mechanisms and injuries. METHODS: Retrospective analysis of 5196 mandible fractures in 4381 patients extracted from the Total Army Injury and Health Outcomes Database (TAIHOD), a comprehensive database developed by the U.S. Army Research Institute of Environmental Medicine (USARIEM) that links population data to all hospitalizations among active duty army soldiers. The database is based on the ICD-9 CM coding system. RESULTS: We found the following frequencies for specific mandible fracture locations: angle 35.6%, symphysis 20.1%, subcondylar 14.2%, body 12.7%, condylar process 9.1%, ramus 4.5%, alveolar border 2.7%, and coronoid process 1%. The mechanisms of injury were separated into seven categories. Fighting accounts for 36.2%, automobile accidents for 18.6%, athletics for 13.6%, falls for 9.7%, motorcycle accidents for 3.1%, other land transport accidents for 3%, and miscellaneous causes for 15.8%. A few fracture locations appear to be associated with specific mechanisms. Of 82 alveolar border fractures with known mechanisms, 37% resulted from automobile accidents. Of 1094 angle fractures with known mechanisms, 48.6% resulted from fighting. Our data show that the majority of fractures were isolated to one location. Only one fracture was recorded for 70.6%, 29.2% have two fractures recorded, 0.2% have three or more fractures recorded. Associated injuries were common and include facial lacerations 1236 (28.2%), non-mandible facial bone fractures 733 (16.7%), intracranial injury 403(9.2%), internal injuries 229 (5.2%), fractures of the upper limb 295 (6.7%), fractures of the lower extremity 302 (6.9%), and cervical fractures 34 (0.8%). CONCLUSIONS: The mechanism of injury is important in determining the most likely resultant mandible fracture in the case of angle of mandible and alveolar ridge fractures. The clinician should maintain a high level of suspicion for associated injuries that occur more than one fourth of the time and even more frequently in motor vehicle accident victims. Associated intracranial injury is particularly important to rule out. Associated facial fractures, intracranial injury, internal injuries, and extremity injuries are all more common than cervical fractures.