Injury characteristics of young elite inline speed skaters: A one season retrospective study.

OBJECTIVES: Determining the rate of injuries related to a certain sport is accepted as the primary step toward designing, implementing and evaluating injury prevention programs. This observational and retrospective study was to examine the injuries sustained by elite young Spanish inline speed skaters during a season. METHODS: Athletes participating in the national championship (n = 80) were surveyed via an anonymous online questionnaire to screen for injury characteristics: incidence, location, and tissue affected; plus training information and demographics. RESULTS: A total of 52 injuries were recorded across 33,351 hours of exposure, which gives a rate of 1.65/1,000 h. The lower body comprised 79% of the total amount of injuries (1.3/1000 h), and the main areas affected were the thigh and foot, accounting for 25% and 19.2% of the recorded injuries, respectively. Musculotendinous injuries were the most frequent, with an incidence of 0.92/1000 h. No significant gender differences were observed for any of the variables studied. CONCLUSION: Speed skating can be considered a low injury rate sport based on our findings. The risk of sustaining an injury was independent of gender, age, and BMI.

Peer and parent influences on youth skateboarding and factors that affect their decision to return to the sport after injury.

Skateboarding is an increasingly popular sport among youth, despite the fact that they are a high-risk group for injuries during this activity. The purpose of this study was twofold: to explore youths' perceptions about the influences that peers and parents have on their skateboarding; and to identify factors that affect their decisions about returning to the sport after injury. Virtual semi-structured interviews were conducted with 26 youth, 14-17 years of age, who had experienced a medically-treated injury while skateboarding during the past year. Applying thematic analyses, major findings indicated that sharing the activity with peers fosters psychological well-being, companionship, and a valued sense of community that motivates return to the sport even after serious injury and sometimes before they are fully physically ready to do so safely. Parental concerns about physical injury (vulnerability, severity) were acknowledged but not influential, with youth feeling that parents do not appreciate the valued mental health benefits that they experience from the skateboarding community. Youth reported withholding injury information from parents, hiding injuries and downplaying their severity, and not always disclosing returning to the sport. Youths' decisions to return to the sport after injury was motivated by their feelings that skateboarding enhances their sense of identity, promotes their mental health, and provides respite because it allows them to escape from reality temporarily. Recommendations for reducing risk of injury to youth skateboarders at skateparks are provided.

Distribution and risk factors for stress fractures in competitive figure skaters and association with acute fractures.

INTRODUCTION: Figure skating combines esthetic components with high impact, technically demanding elements requiring high volume repetitive training. The evidence base for the sport is limited, particularly regarding stress fracture injuries. This study aims to describe the prevalence and anatomical distribution of stress fracture injuries and assess for risk factors, as well as associations with acute fractures. METHODS: An online anonymous retrospective survey of competitive figure skaters was distributed through social media networks and e-mail for completion by skaters from all three disciplines of figure skating. RESULTS: In a sample of 164 skaters from novice to Olympic level, career prevalence of stress fractures was 24.4%, most commonly affecting tibia and ankle. There was statistically significant increased risk of stress fracture in those training ≥12 times/week (33.3% vs. 17.8%; P = 0.028) but no increased risk associated with level or gender of skater. There was a higher prevalence of acute fracture in those with a history of stress fracture (45.0% vs. 21.8%; P = 0.007). CONCLUSIONS: Figure skaters are at a high risk of stress fractures, independent of the level performed at. There is a higher risk in those training more frequently and an association with additional acute fractures. Results advocate education on fracture features and bone health measures to skaters, coaches, and physicians, at all levels of the sport to facilitate early diagnosis and management.

Performance Increases in Pair Skating and Ice Dance at International Championships and Olympic Games.

In pair skating and ice dance, performance seems to have increased at international competitions, which is potentially associated with changes in athlete age. We hypothesized increasing age, numbers of total points and more complex jumps of the best elite couples at international championships in recent years. Corresponding data were assessed via the results databases of the European and World Championships, as well as the Winter Olympics since 2005. Linear regression statistics were conducted, and significance was assessed via one-way ANOVAs. There were no significant changes in age. Increases in total points were found in both disciplines (World and European Championships both p < 0.001 for both disciplines, Olympics pair skating p = 0.003, ice dance n/a). Significant increases were found in the number of double and triple twist jumps at the European Championships (Double p = 0.046, triple p = 0.041), but not at the World Championships or the Olympics. At the World Championships, single solo jumps decreased (p = 0.031) in favor of triple jumps, which increased (p = 0.020), without a similar effect at the European Championships or Olympics. In conclusion, increases in total points and more complex jumps were observed at international championships without associated changes in age. Attention should be given to possible changes in the incidence of acute and overuse injuries following this development.

Skateboard head injuries: Are we making progress?

BACKGROUND: Skateboarding is a popular sport and U.S. trauma centers care for a significant number of skateboard-related injuries (SRIs). However, injury prevention strategies are still underdeveloped. This study was designed to compare the epidemiology, type, and location of skateboard injury as well as the use and influence of protective gear over two time periods. METHODS: This is a retrospective National Trauma Data Bank study including all patients with SRIs between 2007and 2016. Study groups were divided into two 5-year periods: 2007-2011 and 2012-2016. The incidence and severity of traumatic brain injury (TBI), as well as the compliance and effectiveness of protective gear and skate parks, was assessed in various age groups in the two study periods using univariable and multivariable analyses. Univariable analysis was used to compare the two study periods, logistic regression analysis was performed to identify independent predictors of head injury and severe TBI. RESULTS: 24,903 patients presented with SRIs: 10,594 from 2007 to 2011 and 14,309 from 2012 to 2016. Helmet use was low in both periods (5.7% and 5.4% respectively). The incidence of severe TBI (head AIS≥3) did not change significantly during the two periods (31.6% vs. 30.8%, p = 0.162). In children with severe TBI, there was no significant difference in helmet use across all ages, (10.4% vs. 11.5%, p = 0.467; 6.4% vs. 6.5%, p = 0.753; 4.2% vs. 3.7%, p = 0.201, respectively) with the lowest usage in the older than 16 years age group. On logistic regression, male gender (OR 1.526, 95% CI 1.372-1.698, p<0.001) was associated with increased odds of severe TBI, while helmet use (OR 0.534, 95% CI 0.455-0.627, p<0.001) and injuries at skate parks (OR 0.584, 95% CI 0.541-0.630, p<0.001), near home (OR 0.465, 95% CI 0.418-0.518, p<0.001), and public buildings (OR 0.386, 95% CI 0.440-0.541, p<0.001) were associated with reduced odds of severe TBI. CONCLUSIONS: Helmet use in patients with SRIs is low in all pediatric age groups. Helmet use and skate parks are protective against severe TBI. Older age children and male gender are at increased risk of severe TBI after skateboard-related injuries, and more targeted preventive education and legislation are needed.

Pediatric and Adolescent Figure Skating Injuries: A 15-Year Retrospective Review.

OBJECTIVE: To analyze the characteristics of injuries sustained by young figure skaters who were evaluated at regional pediatric sports medicine clinics. DESIGN: Retrospective chart review (2003-2017). SETTING: Sports medicine clinics at a tertiary-level pediatric medical center. PATIENTS: Two hundred ninety-four figure skaters (271 female and 23 male). Age rage: 9 to 19 years. Mean age: 14.2 ± 2.3 years. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Mechanism of injury (acute vs overuse), injured body areas, diagnoses for most commonly injured body areas, and distribution of bone stress injuries. RESULTS: Eight hundred sixty-four figure skating-related injuries were identified. Approximately 68.9% were overuse and 31.1% were acute. In female figure skaters, the most frequently injured body areas were foot/ankle (29.6%), knee (19.3%), and back (15.8%). In male figure skaters, they were foot/ankle (25.4%), hip (16.4%), and knee (14.9%). Most common diagnoses at these body areas were tendinopathy (foot/ankle), extensor mechanism (knee), and posterior column bone stress injuries (back). All injuries to anterior knee structures, excluding bone contusions, were categorized as extensor mechanism injuries. About 11.8% of all injuries were bone stress reactions/fractures with the majority occurring at the back (42.2%), foot/ankle (32.4%), and lower leg (15.7%). CONCLUSION: Most injuries sustained by figure skaters were overuse and occurred most commonly at the foot/ankle (29.6%), knee (19.3%), and back (15.8%). Approximately 1 in 10 injuries were bone stress reactions/fractures, and nearly 1 in every 3 skaters who presented with back pain was diagnosed with a posterior column bone stress injury. Health care providers who take care of young figure skaters need to maintain a high index of suspicion for overuse injuries, especially bone stress reactions/fractures.

Managing head injury risks in competitive skateboarding: what do we know?

OBJECTIVES: The broad objective of this paper is to inform policy, practice and research regarding the management of head injury risks in competitive skateboarding. The main motivation for the current study was the question of mandating helmet use in competitive skateboarding. The specific aims are to present current knowledge on (A) head injury risks in skateboarding, (B) preliminary biomechanical data on falls and head injury risks in a selection of competitive skateboarding events similar to those planned for the Summer Olympics, (C) standards for skateboard-styled helmets and (D) impact performance of helmets commonly used in skateboarding. METHODS: A narrative review of the published literature on head injuries in skateboarding was conducted. Videos of skateboarding competitions from Vans Park Professional League, Street League Skateboarding and Dew Tour were reviewed to describe crashes and falls. Standards databases including the International Organization for Standardization (ISO), British Standards Institution (BSI), Snell, United States Consumer Product Safety Commission (CPSC) and American Society for Testing and Materials (ASTM) were searched for skateboarding-styled helmet standards. A sample of helmets considered suitable for skateboarding was tested in standard impact tests. RESULTS: The majority of previous literature focused on the paediatric population in a recreational setting with little data from competitive skateboarding. Head injuries comprised up to 75% of all injuries and helmet use was less than 35%. Video analysis identified high rates of falls and crashes during competitive skateboarding, but also a capacity for the athletes to control falls and limit head impacts. Less than 5% of competitive skateboarders wore helmets. In addition to dedicated national skateboard helmet standards, there are several national standards for skateboard-styled helmets. All helmets, with the exception of one uncertified helmet, had similar impact attenuation performance; that is, at 0.8 m drop height, 114-148 g; at 1.5 m, 173-220 g; and at 2.0 m, 219-259 g. Impact performance in the second impact was degraded in all helmets tested. CONCLUSION: Helmets styled for skateboarding are available 'off the shelf' that will offer protection to the head against skull fractures and intracranial injuries in competitive skateboarding. There is an urgent need to commence a programme of research and development to understanding and control head injury risks.

Isolated Trans-syndesmotic Fibular Fracture in a Skateboarder.

A 20-year-old male military technician reported to a direct-access physical therapy clinic 1 week after falling off a skateboard. His primary complaint was left lateral ankle pain. Following examination, the physical therapist ordered ankle radiographs, which revealed a minimally displaced oblique trans-syndesmotic fibular fracture. J Orthop Sports Phys Ther 2020;50(7):410. doi:10.2519/jospt.2020.9355.

Grade IV Renal Laceration in a 13-Year-Old Boy With Cross-fused Renal Ectopia.

A 13-year-old boy presented with gross hematuria following a skateboarding accident and was found to have cross-fused renal ectopia of the left kidney with a grade IV right renal laceration and urinary extravasation. Despite a double-J ureteral stent, urinoma drain, and indwelling bladder catheter, his urinoma drain maintained high output. He underwent a ureteral stent exchange and upsizing. A percutaneous nephrostomy tube was subsequently placed for maximal urinary diversion, which ultimately led to the resolution in his urinary leak. This case highlights our endourologic approach to manage a severe urinary leak despite conservative measures in a pediatric patient with a renal anomaly.

Athletes Play Through Pain-What Does That Mean for Rehabilitation Specialists?

CONTEXT: Pain in sport has been normalized to the point where athletes are expected to ignore pain and remain in the game despite the possible detrimental consequences associated with playing through pain. While rehabilitation specialists may not have an influence on an athlete's competitive nature or the culture of risk they operate in, understanding the consequences of those factors on an athlete's physical well-being is definitely in their area of responsibility. OBJECTIVE: To explore the factors associated with the experiences of subelite athletes who play through pain in gymnastics, rowing, and speed skating. DESIGN: The authors conducted semistructured interviews with subelite athletes, coaches, and rehabilitation specialists. They recruited coach participants through their provincial sport organization. Athletes of the recruited coaches who were recovering from a musculoskeletal injury and training for a major competition were then recruited. They also recruited rehabilitation specialists who were known to treat subelite athletes independently by e-mail. SETTING: An observation session was conducted at the athlete's training facility. Interviews were then conducted either in a room at the university or at a preferred sound-attenuated location suggested by the participant. PARTICIPANTS: The authors studied 5 coaches, 4 subelite athletes, and 3 rehabilitation specialists. INTERVENTIONS: The authors photographed athletes during a practice shortly before an important competition, and we interviewed all the participants after that competition. Our photographs were used during the interview to stimulate discussion. RESULTS: The participant interviews revealed 3 main themes related to playing through pain. They are: Listening to your body, Decision making, and Who decides. CONCLUSION: When subelite athletes, striving to be the best in their sport continue to train with the pain of an injury, performance is affected in the short-term and long-term consequences are also possible. Our study provides some insight into the contrasting forces that athletes balance as they decide to continue or to stop.

Sideline Coverage of Figure Skating Events.

The sport of figure skating has evolved to include various disciplines and athletes continue to push the limits of the skills they perform, thus increasing the potential for injury in practice, as well as in competition. To provide optimal rink side coverage, health care professionals must be aware of the elements skaters perform and the injuries to be expected. Appropriate planning and coordination of medical services is required to ensure adequate and timely care of injured figure skaters. Protocols developed for local, national, and international events are available to assist in this process.

Changing Incidence and Nature of Injuries Caused by Falls From Skateboards in the United States.

Since 2000, the number of emergency department visits and hospital admissions for children who have sustained a fall from a skateboard has undergone a noticeable decline. One possible explanation for this decline is that children today lead a more sedentary lifestyle and are not as engaged in outdoor physical activities as were children in previous generations. The profile of patients injured in skateboarding-related accidents has also changed since 2000. The percent minority, percent residents of large metropolitan areas, and percent who incur an injury on a street or highway have all increased during this time period. Data based on observations of riders in skateboard parks indicate that the overwhelming majority do not wear protective gear such as helmets, elbow/knee pads, or wrist guards, and that a sizable segment of riders compound their risk of injury by using headphones or earbuds when performing maneuvers.

Injuries associated with hoverboard use: A review of the National Electronic Injury Surveillance System.

INTRODUCTION: Hoverboards have become popular since they became available in 2015. We seek to provide an estimate of the number of injuries in the United States for 2015 and 2016, and to evaluate differences between adult and pediatric injury complexes. METHODS: We performed a retrospective analysis of the National Electronic Injury Surveillance System (NEISS) from January 1, 2015 to December 31, 2016. Using the weighted design of the NEISS, a nationally representative sample could be determined. RESULTS: During the 2 year period, there were 24,650 hoverboard related injuries (95% confidence interval [Cl], 17,635-31,664) in the US. The average age was 20.9 years old. There were 15,134 pediatric injuries (95%CI 9980-20,287) and 9515 adult injuries (95%CI 7185-11,845). Female patients compromised 51.2% of the sample. The upper extremity was the most common region injured [13,080 (95% CI 8848-17,311)] and fracture was the most common type of injury [10,074 (95% CI 6934-13,213)]. Hoverboard injuries increased from 2416 (95% CL 575-4245) in 2015 to 22,234 (95% CI 16,446-28,020) in 2016. Pediatric patients were more likely to be injured in the upper and lower extremity when compared to their adult cohort (p = 0.0031). Six percent of the cohort [1575 (95% CI 665-2485)] sustained critical injuries with pediatric patients being at 1.46 times higher risk for life threatening injuries. CONCLUSION: Emergency department (ED) visits for hoverboard related injuries appear to be increasing. Pediatric patients are more at risk for hoverboard related injuries than adults and almost 6% of ED visits involved critical injuries, highlighting that hoverboards may be more dangerous than previously recognized.

Longboard injuries treated at a level 1 pediatric trauma center.

INTRODUCTION: Recreation on longboards is gaining in popularity. The purpose of this study is to detail the injury patterns, treatment and management of children with longboarding injuries seen at a level 1 pediatric trauma center. METHODS: A retrospective review using our trauma registry from 2006 to 2016 of pediatric patients who sustained injuries while riding a longboard. RESULTS: Of 12,920 injured children, 64 (0.5%) were treated for injuries that occurred while riding a longboard. Median age was 14.5 years (IQR 13.6, 15.4) and 84% were male. Fifty-one (80%) suffered a traumatic brain injury (TBI) including 32 intracranial hemorrhages (ICH), 17 concussions, and 31 skull fractures. Seven (11%) were wearing helmets. Three patients required neurosurgical intervention. Extremity fractures were the most common reason for surgery. Ninety-six percent of patients were admitted to the hospital with a median length of stay of 1 day (IQR 1, 3). All children survived to discharge. Compared with skateboard injuries during the same period, TBI, ICH, concussion, and skull fractures were all greater. CONCLUSIONS: TBI ranging from concussion to ICH requiring craniotomy is common in children injured while riding a longboard, and greater than rates after skateboarding injuries. Extremity fracture was the most common reason for operative intervention. LEVEL OF EVIDENCE: III.

Pediatric and adolescent injury in skateboarding.

Skateboarding has become an international action sport attractive to young people. For this reason, skateboarding has been promoted by some researchers as important for encouraging young people to become more physically active. However, skateboarding is also considered to be inherently dangerous by the medical and broader community and as a result skateboarding is banned in many places. This paper reviews scientific literature on the features, outcomes and risk factors related to skateboarding injuries. Findings suggest that while skateboarding injuries can be severe, skateboarding is not as dangerous as it might appear if appropriate risk management steps are taken. Skateboarding should be encouraged as a worthy physical activity and local communities should consider providing specialised, supervised spaces for young people to practice this sport.

Dripped Lidocaine: A Novel Approach to Needleless Anesthesia for Mucosal Lacerations.

BACKGROUND: Oral lacerations represent a unique challenge for anesthesia in the emergency department. Many options exist for local anesthesia, but these options are often associated with pain from injections or anxiety from anticipated needle injection. CASE SERIES: We introduce a novel and needleless approach to achieving local anesthesia for oral mucosa repair by dripping injectable lidocaine directly onto mucosal wounds prior to repair. This method is well tolerated and achieves appropriate anesthesia without undesirable side effects. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Dripped injectable lidocaine may be an alternative method for mucosal anesthesia in the pediatric population.

Epidemiology of Figure Skating Injuries: A Review of the Literature.

CONTEXT:: As the popularity and technical demands of figure skating increase, so will the number of athletes presenting with sport-related problems. EVIDENCE ACQUISITION:: Searches were performed across PubMed from 1980 to 2017. The keywords searched were skating, skaters, incidence, and injuries. The search was limited to English-language articles and human participants. Relevant articles were cross-referenced. STUDY DESIGN:: Clinical review. LEVEL OF EVIDENCE:: Level 5. RESULTS:: Previous studies suggest an increase in incidence of figure skating injuries from 1982 to 2003. When combining all disciplines of figure skating, there is a similar proportion of acute and overuse injuries. Within disciplines, overuse injuries appear to be more common in singles skating, while acute injuries are more common in pairs skating, ice dancing, and synchronized skating. Lower extremity injuries are more common than upper extremity injuries in all disciplines, and pairs skating accounts for the majority of upper extremity injuries. Ankle sprains are the most common skating injury, and patellar tendinitis is the most common overuse injury across all disciplines. Stress fractures are the most common overuse injury in female singles skaters. CONCLUSION:: The predominance of overuse injuries in singles disciplines reflects their increasing technical difficulty, with more difficult jumps and longer training hours. Partner disciplines are more likely to involve acute injuries and upper extremity injuries due to high-risk throws and lifts. Emphasis should be placed on properly fitting skating boots, intrinsic foot and ankle strengthening, and lower extremity flexibility, which may prevent many of the common lower extremity and back injuries in figure skating.

Helmet use in bicycles and non-motorised wheeled recreational vehicles in children.

AIM: Injuries involving non-motorised wheeled recreational vehicles (NMWRV) and bicycles are a common cause for hospitalisation in children. Studies show that helmet use whilst bicycle riding can decrease mortality and morbidity due to head injury. However, there remains an important proportion of children who are non-helmet users (NHU). This study aims to investigate helmet use and attitudes and injury patterns in children presenting with trauma after riding bicycles and other NMWRVs. METHODS: A prospective cohort study was undertaken over 8 months of children aged 0-16 years, who presented with injury secondary to bicycle or NMWRV to the emergency department of two tertiary paediatric centres. Demographics, incident, injury severity and attitudes towards helmet use were compared between helmet users and NHU. RESULTS: A total of 342 children were included - 41% (n = 139) scooter riders, 39% (n = 133) bicyclists, 18% (n = 61) skateboarders and 2% (n = 9) in-line skaters. Of those interviewed (n = 161), 58% (n = 93) wore a helmet, with children riding bicycles significantly more likely to be helmeted than NMWRV (75 vs. 48%, P = 0.01). NHU were more likely to be admitted to hospital (P = 0.05) and to sustain a major head injury (P = 0.009). The main influence on helmet use was parental rules. The biggest factor influencing non-helmet use was perceived low levels of danger. CONCLUSIONS: Despite legislation mandating this, helmet use is not universal in cyclists, particularly younger riders. Even fewer NMWRV riders use them. To promote helmet use, a multifaceted approach aimed at altering community norms and individual behaviours and attitudes is required.

Neurological injuries from skateboards in paediatric and adolescent populations: injury types and severity.

BACKGROUND: Skateboarding is a popular recreation among children and adolescents. Injuries that result in presentation to emergency departments are varied including head injuries. The study aims to assess the type and severity of neurological damage to the brain and spine in children from injuries incurred while using a skateboard. METHODS: After obtaining Ethics approval, a retrospective case review was performed of all admissions to all Brisbane, Australia public hospital neurosurgery departments of children 18 years and less who experienced injuries to the brain and spine for the years 2010-2014. RESULTS: There were 51 skateboard-related admissions over the study period of which 94% were male. The mean age was 14.3 years. The Injury Severity Score (ISS) ranged from 1 to 38 with a mean of 11.4. A total of 70.5% of the ISS scores fell within the minor or moderate categories and 29.5% fell within the serious and severe categories. There were no ISS scores in the critical category. A total of 16 skull vault fractures and 14 skull base fractures were recorded. There were 13 extradural haematomas of which five were evacuated by craniotomy and one of whom experienced hemiplegia. There was a spinal cord injury with paraplegia. A range of other neurological complications occurred. There were no deaths. CONCLUSION: Uncommon but serious neurological morbidity accompanies skateboard use. Concerns remain about the level of helmet use and choice of unsafe locations for skateboarding.