Diagnosis, treatment and prevention of ankle sprains: update of an evidence-based clinical guideline.

This guideline aimed to advance current understandings regarding the diagnosis, prevention and therapeutic interventions for ankle sprains by updating the existing guideline and incorporate new research. A secondary objective was to provide an update related to the cost-effectiveness of diagnostic procedures, therapeutic interventions and prevention strategies. It was posited that subsequent interaction of clinicians with this guideline could help reduce health impairments and patient burden associated with this prevalent musculoskeletal injury. The previous guideline provided evidence that the severity of ligament damage can be assessed most reliably by delayed physical examination (4-5 days post trauma). After correct diagnosis, it can be stated that even though a short time of immobilisation may be helpful in relieving pain and swelling, the patient with an acute lateral ankle ligament rupture benefits most from use of tape or a brace in combination with an exercise programme.New in this update: Participation in certain sports is associated with a heightened risk of sustaining a lateral ankle sprain. Care should be taken with non-steroidal anti-inflammatory drugs (NSAIDs) usage after an ankle sprain. They may be used to reduce pain and swelling, but usage is not without complications and NSAIDs may suppress the natural healing process. Concerning treatment, supervised exercise-based programmes preferred over passive modalities as it stimulates the recovery of functional joint stability. Surgery should be reserved for cases that do not respond to thorough and comprehensive exercise-based treatment. For the prevention of recurrent lateral ankle sprains, ankle braces should be considered as an efficacious option.

Mechanical strain to maxillary incisors during direct laryngoscopy.

BACKGROUND: While most Direct laryngoscopy leads to dental injury in 25-39% of cases. Dental injury occurs when the forces and impacts applied to the teeth exceed the ability of the structures to dissipate energy and stress. The purpose of this study was to measure strain, (which is the change produced in the length of the tooth by a force applied to the tooth) strain rate, and strain-time integral to the maxillary incisors and determine if they varied by experience, type of blade, or use of an alcohol protective pad (APP). METHODS: A mannequin head designed to teach and test intubation was instrumented with eight single axis strain gauges placed on the four maxillary incisors: four on the facial or front surface of the incisors and four on the lingual or back, near the insertion of the incisor in the gums to measure bending strain as well as compression. Anesthesiology faculty, residents, and certified registered nurse anesthetists intubated with Macintosh and Miller blades with and without APP. Using strain-time curves, the maximum strain, strain rate, and strain time integral were calculated. RESULTS: Across the 92 subjects, strain varied 8-12 fold between the 25th and 75th percentiles for all four techniques, but little by experience, while strain rate and strain integral varied 6-13 fold and 15-26 fold, respectively, for the same percentiles. Intubators who had high strain values with one blade tended to have high strains with the other blade with and without the APP (all pairwise correlation rho = 0.42-0.63). CONCLUSIONS: Strain varies widely by intubator and that the use of the APP reduces strain rate which may decrease the risk of or the severity of dental injury.

Injuries can be prevented in contact flag football!

PURPOSE: This original prospective cohort study was conducted in an attempt to significantly reduce the incidence and the severity of injuries in an intervention cohort as compared to a two-season historical cohort, and to provide recommendations to the International Federation of Football (IFAF) pertaining to prevention measures to make the game safer. METHODS: A total of 1,260 amateur male (mean age: 20.4 ± 3.9 years) and 244 female (mean age: 18.5 ± 1.7 years) players participated in the study. Four prevention measures were implemented: the no-pocket rule, self-fitting mouth guards, ankle braces (for those players with recurrent ankle sprains) and an injury treatment information brochure. All time-loss injuries sustained in game sessions were recorded by the off-the-field medical personnel and followed up by a more detailed phone injury surveillance questionnaire. RESULTS: There was a 54 % reduction in the total number of injuries and a significant reduction in the incidence rate and incidence proportion between the intervention cohorts as compared to the historical cohort (p < 0.001). There was no statistically significant reduction in the number of injuries in any of the body parts, except for in hand/wrist injuries related to the use of pockets (p < 0.001), as well as the severity of mild-moderate injuries (p < 0.05). CONCLUSION: This study provided evidence that hand/wrist injuries can be significantly reduced in flag football. Recommendations to the IFAF include strict enforcement of the no-pocket rule, the use of soft headgear, comfortable-fitting ankle braces and mouth guards and additionally, to change game rules concerning blocking. LEVEL OF EVIDENCE: II.

Variability of musculoskeletal strain on dentists: an electromyographic and goniometric study.

INTRODUCTION: Dentists and hygienists are strongly affected by musculoskeletal disorders (MSDs). As workstation concepts are supported by subjective arguments only, the aim of this study was to use objective measurements to compare the variability of strain in various concepts: a dental chair equipped with a cart or an over-the-patient delivery system without an assistant, and Dr Daryl Beach's concept with an assistant. METHODS: Goniometric and electromyographic recordings were made on 8 subjects, during a scaling operation. The electrical activity of their trapezius and lumbar muscles was compared, as were their cervical and lumbar ranges of motion. RESULTS: The results showed that there was a wide variability depending on the workstation. However, the Beach concept tended to reduce physical strain on most parameters: duration of left lumbar muscle activity (2% compared to 15% of time spent in > 10% maximal voluntary contraction, MVC), time spent in cervical side bending (4% compared to 30%), cervical flexion of > 20° (9% compared to 40%), and left trapezius activity (9% of time spent > 10% MVC compared to 28%). CONCLUSION: Practitioners and students should adjust their workstations to reduce the prevalence of MSDs.

Biomechanics: rubber bands reduce the cost of carrying loads.

Vertical movement of the hip during locomotion causes a loaded backpack to be accelerated with each step, which imposes large peak forces on the wearer. Here we show that using bungee cords to suspend the load from a backpack frame reduces not only its vertical movement, and hence its vertical force on the carrier, but also the energetic cost of walking with the pack. This permits larger loads to be carried while moving rapidly, and at the same time reduces the risk of orthopaedic and muscular injury.

A study of semi-rigid support on ankle supination sprain kinematics.

Ankle sprain injury is very common in sports and the use of ankle support is crucial. This research investigated the effect of an ankle brace in reducing the ankle angular displacement and angular velocity during sudden supination. In the experiment, 11 healthy males were tested. The bracing condition, semi-rigid ankle braces were investigated. The angular displacement and angular velocity of the ankle were computed. The motion-capture system was adopted to capture the three-dimensional coordinates of the reflective markers. The coordinates of the reflective markers were used to compute the ankle kinematics during simulated ankle supination. A mechanical supination platform was used to simulate the sprain motions. Experimental results showed that the semi-rigid brace tested significantly reduced the ankle angular displacement and angular velocity compared with control conditions during sudden supination. In conclusion, the semi-rigid-type brace can provide significant restriction to reduce the magnitudes of the angular displacement and angular velocity of the ankle during sudden supination sprain. The semi-rigid-type brace is suggested as the prophylactic bracing for the ankle.

Evaluation of protective equipment for prevention of injuries in rugby union.

BACKGROUND: Rugby union has a high rate of injury. The increased use of protective equipment may help mitigate these injuries. This study investigated the injury prevention effectiveness of the protective equipment used in rugby union. METHODS: A cohort of 304 rugby players in Dunedin, New Zealand was followed weekly during the 1993 club season to assess protective equipment use, participation in rugby, and injury outcomes. Generalized Poisson regression was used to model the rate of injury while adjusting for covariates such as level of competition, playing position, and injury history. RESULTS: The use of mouthguards appeared to lower the risk of orofacial injury [rate ratio (RR) = 0.56, 95% confidence interval (CI): 0.07-4.63], and padded headgear tended to prevent damage to the scalp and ears (RR = 0.59, 95% CI: 0.19-1.86). Support sleeves tended to reduce the risk of sprains and strains (RR = 0.58, 95% CI: 0.26-1.27). The risk of concussion was not lessened by the use of padded headgear (RR = 1.13, 95% CI: 0.40-3.16) or mouthguards (RR = 1.62, 95% CI: 0.51-5.11). There was no evidence of protective effects for any other equipment item (taping, shinguards, and grease). CONCLUSIONS: The protective equipment used in rugby union has limited effectiveness in preventing injuries. The results are supportive, however, of a role for mouthguards and padded headgear in preventing orofacial and scalp injuries, respectively, and for support sleeves in preventing sprains and strains.

Ankle disk training influences reaction times of selected muscles in a simulated ankle sprain.

Ankle disk training has been used as an exercise in sports medicine clinics to help protect against ankle sprains. This study investigated the effects of ankle disk training on the contraction pattern of the anterior tibialis, posterior tibialis, peroneus longus, and flexor digitorum longus muscles in a simulated ankle sprain. Twenty adults were recruited and divided into a control group and an experimental group. A platform with a trapdoor was used to simulate a lateral ankle sprain. Electromyographic data were recorded from each subject in pretraining and posttraining tests. The experimental group underwent ankle disk training for 8 weeks between the pretraining and posttraining tests. In the pretraining test, the four muscles started to contract simultaneously; in the posttraining test, the contractions of the anterior and posterior tibialis muscles were delayed. This delay favors the correction of excessive ankle inversion. This study examined the effects of one form of proprioceptive training on muscle reaction times, and its results may explain why such training can help protect against ankle sprains.

A stem design change to reduce peak cement strains at the tip of cemented total hip arthroplasty.

A series of 3-dimensional finite element models was created to assess different designs of the tip of the stems of cemented femoral components of total hip arthroplasty that would decrease the peak axial tensile cement strains developed near the tip. Features of stem design that would facilitate positioning the femoral component in a neutral position centered in uniform cement mantle of adequate thickness also were evaluated. These studies showed that a stem that had a narrow tip profile that would accept an externally applied polymethyl methacrylate centralizer shaped similar to a napkin ring and had a gradual transition zone to join the body of the implant achieved these objectives. Such a combination resulted in the reduction of the peak axial strains to less than half the magnitude of the peak strains around a conventional tip (830 vs 1,868 microstrain). The reduction in peak axial strains was to one third the magnitude of the strains developed adjacent to a stem with a hole drilled into the tip to accept the commonly used fin-type polymethyl methacrylate centralizer (830 vs 2,466 microstrain). These goals were achieved because a stem that is designed to accept a napkin ring-style centralizer i) has a lower bending stiffness at the tip of the implant, ii) allows room for a thicker cement mantle, and iii) avoids creating a stress riser adjacent to the edge of the drill hole. The peak cement strains adjacent to a stem of this design are well below the endurance limit of cement as long as the transition zone where the narrow tip meets the body of the implant is gradual.

Lesiones accidentales en la práctica del fútbol soccer: estudio realizado en un centro de atención de emergencias / Accidental lesions produced during the soccer fooball practice: a study realized in an emergency assistance center

La naturaleza violenta del fútbol soccer hace que quienes lo practican estén expuestos a lesiones accidentales. Este trabajo busca una primera aproximación a este problema de salud en Guadalajara. La información proviene del formato médico correspondiente a las atenciones de primera vez ocurridas del 1 de marzo de 1989 al 29 de febrero de 1992 en alguna de las unidades Cruz Verde Guadalajara. De 1,215 lesionados identificados 97.2 por ciento pertenecen al sexo masculino; 30 por ciento tienen una edad de 15 a 19 años; la extremidad inferior se reportó lesionada en el 42.1 por ciento. Las lesiones más frecuentes fueron: esguince de tobillo y pie (11.8 por ciento); fracturas de cúbito y radio (5.1 por ciento). Se concluye que estas lesiones representan un problema de salud pública que amerita ser más estudiado en nuestro medio. Se brindan algunas medidas preventivas que pueden limitar la magnitud y frecuencia de lesiones durante la práctica del fútbol.

Revisión de 414 casos de lesiones producidas en la práctica del fútbol rápido, su prevención y tratamiento / Review of 414 cases of sports injuries produced in indoors soccer football, prevention and treatment

Se presenta un estudio retrospectivo de 414 casos de lesiones producidas en la práctica de fútbol rápido. Durante 7 años hemos realizado la atención médica y quirúrgica en las lesiones que han sufrido 406 deportistas de dicha liga, entre los años 1989 a 1995. La mayoría de las lesiones se valoraron bajo parámetros de la práctica clínica y sólo algunas requirieron de estudios auxiliares de diagnóstico (los casos que por su severidad, así lo ameritaron). Se revisan lesiones como contracturas musculares, contusiones, desgarro, distensiones, esguinces, fisuras óseas, fracturas, heridas cortantes, punzantes y punzocortantes; casos de hipoglicemia, laceraciones, luxaciones, meniscopatías agudas y crónicas agudizadas, subluxaciones, tendinitis y traumatismos craneoencefálicos. De todas ellas se habla en el desarrollo de este trabajo con el fin de estandarizar los procedimientos más idóneos para su prevención y tratamiento