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1.
BMJ ; 368: m336, 2020 03 11.
Artículo en Inglés | MEDLINE | ID: mdl-32161038

RESUMEN

OBJECTIVE: To determine whether bicycle commuting is associated with risk of injury. DESIGN: Prospective population based study. SETTING: UK Biobank. PARTICIPANTS: 230 390 commuters (52.1% women; mean age 52.4 years) recruited from 22 sites across the UK compared by mode of transport used (walking, cycling, mixed mode versus non-active (car or public transport)) to commute to and from work on a typical day. MAIN OUTCOME MEASURE: First incident admission to hospital for injury. RESULTS: 5704 (2.5%) participants reported cycling as their main form of commuter transport. Median follow-up was 8.9 years (interquartile range 8.2-9.5 years), and overall 10 241 (4.4%) participants experienced an injury. Injuries occurred in 397 (7.0%) of the commuters who cycled and 7698 (4.3%) of the commuters who used a non-active mode of transport. After adjustment for major confounding sociodemographic, health, and lifestyle factors, cycling to work was associated with a higher risk of injury compared with commuting by a non-active mode (hazard ratio 1.45, 95% confidence interval 1.30 to 1.61). Similar trends were observed for commuters who used mixed mode cycling. Walking to work was not associated with a higher risk of injury. Longer cycling distances during commuting were associated with a higher risk of injury, but commute distance was not associated with injury in non-active commuters. Cycle commuting was also associated with a higher number of injuries when the external cause was a transport related incident (incident rate ratio 3.42, 95% confidence interval 3.00 to 3.90). Commuters who cycled to work had a lower risk of cardiovascular disease, cancer, and death than those who did not. If the associations are causal, an estimated 1000 participants changing their mode of commuting to include cycling for 10 years would result in 26 additional admissions to hospital for a first injury (of which three would require a hospital stay of a week or longer), 15 fewer first cancer diagnoses, four fewer cardiovascular disease events, and three fewer deaths. CONCLUSION: Compared with non-active commuting to work, commuting by cycling was associated with a higher risk of hospital admission for a first injury and higher risk of transport related incidents specifically. These risks should be viewed in context of the health benefits of active commuting and underscore the need for a safer infrastructure for cycling in the UK.


Asunto(s)
Ciclismo/lesiones , Hospitalización/estadística & datos numéricos , Transportes , Adulto , Anciano , Enfermedades Cardiovasculares/prevención & control , Causas de Muerte , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Neoplasias/prevención & control , Estudios Prospectivos , Factores de Riesgo , Reino Unido/epidemiología , Caminata
2.
BMJ ; 368: m453, 2020 Feb 26.
Artículo en Inglés | MEDLINE | ID: mdl-32102784

RESUMEN

The studyCleland LC, McComb L, Kee F, et al. Effects of 20 mph interventions on a range of public health outcomes: a meta-narrative evidence synthesis. J Transp Health 2019. doi:10.1016/j.jth.2019.100633This project was funded by the NIHR Policy Research Programme (project number 17/149/19).To read the full NIHR Signal, go to: https://discover.dc.nihr.ac.uk/content/signal-000853/twenty-mph-speed-zones-reduce-the-danger-to-pedestrians-and-cyclists.


Asunto(s)
Accidentes de Tránsito/prevención & control , Conducción de Automóvil/legislación & jurisprudencia , Ciclismo/lesiones , Peatones , Heridas y Traumatismos/prevención & control , Ciclismo/legislación & jurisprudencia , Humanos , Reino Unido
4.
Sports Biomech ; 19(2): 245-257, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-29920153

RESUMEN

Knee functional disorders are one of the most common lower extremity non-traumatic injuries reported by cyclists. Incorrect bicycle configuration may predispose cyclist to injury but the evidence of an effect of saddle setback on knee pain remains inconclusive. The aim of this study was to determine the effect of saddle setback on knee joint forces during pedalling using a musculoskeletal modelling approach. Ten cyclists were assessed under three saddle setback conditions (range of changes in saddle position ~6 cm) while pedalling at a steady power output of 200 W and cadence of 90 rpm. A cycling musculoskeletal model was developed and knee joint forces were estimated using an inverse dynamics method associated with a static optimisation procedure. Our results indicate that moving the saddle forwards was not associated with an increase of patellofemoral joint forces. On the contrary, the tibiofemoral mean and peak compression force were 14 and 15% higher in the Backward than in the Forward condition, respectively. The peak compression force was related to neither pedal force nor quadriceps muscle force but coincided with the eccentric contraction of knee flexor muscles. These findings should benefit bike fitting practitioners and coaches in the design of specific training/rehabilitation protocols.


Asunto(s)
Ciclismo/fisiología , Articulación de la Rodilla/fisiología , Equipo Deportivo , Adulto , Artralgia/fisiopatología , Ciclismo/lesiones , Fenómenos Biomecánicos , Diseño de Equipo , Humanos , Masculino , Contracción Muscular/fisiología , Articulación Patelofemoral/fisiología , Músculo Cuádriceps/fisiología
6.
Am J Public Health ; 110(2): 237-243, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-31855486

RESUMEN

Objectives. To quantify the impact of the "Zone 30" policy introduced in September 2011 on the incidence of cyclist and pedestrian injuries in Japan.Methods. This was an interrupted time-series study. We used the data of cyclist and pedestrian injuries recorded by the Japanese police between 2005 and 2016. We evaluated the monthly number of deaths and serious injuries per person-time on narrow roads (width < 5.5 m, subjected to the policy) compared with that on wide roads (≥ 5.5 m) to control for secular trends. We regressed the injury rate ratio on 2 predictors: the numbers of months after January 2005 and after September 2011. Using the regression results, we estimated the number of deaths and serious injuries prevented.Results. There were 266 939 deaths and serious injuries. By 2016, the cumulative changes in the rate ratio spanned from -0.26 to -0.046, depending on sex and age, and an estimated number of 1704 (95% confidence interval = 1293, 2198) injuries were prevented.Conclusions. The policy had a large preventive impact on cyclist and pedestrian deaths and serious injuries at the national level.


Asunto(s)
Accidentes de Tránsito/estadística & datos numéricos , Ciclismo , Peatones/estadística & datos numéricos , Política Pública , Heridas y Traumatismos/epidemiología , Accidentes de Tránsito/prevención & control , Adolescente , Adulto , Anciano , Ciclismo/lesiones , Ciclismo/estadística & datos numéricos , Niño , Preescolar , Femenino , Humanos , Incidencia , Lactante , Recién Nacido , Japón/epidemiología , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Mortalidad/tendencias
7.
Accid Anal Prev ; 134: 105336, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31704640

RESUMEN

Electric two-wheelers (E2Ws) have become newly popular transportation tools with the associated growing traffic safety concerns. E2W riders and bicyclists behave similarly as vulnerable road users (VRUs), while exhibited dissimilarities in riding postures and interactions with the two-wheelers. Existing epidemiology reveals prominent differences in injury risks between E2W riders and other vulnerable road users in collisions with motor vehicles. The objective of this study is to investigate the factors influencing kinematics and head injury risks of two-wheeler rides in two-wheeler-vehicle collisions and compare between E2W-vehicle and bicycle-vehicle collisions. Via multi-body modeling of two two-wheeler types, two vehicle types, and three rider statures in MADYMO, twelve collision scenarios were developed. A simulation matrix considering a range of impact velocities and relative positions was performed for each scenario. A subsequent parametric analysis was conducted with focus on the kinematics and head injury risks of two-wheeler riders. Results show that the head injury risk increased with vehicle moving velocity, while the two-wheeler velocity and relative location between rider and vehicle prior to the collision exhibited highly non-linear influence on the kinematical response. The rider with larger stature had higher possibilities to miss head impact on the vehicle. In collisions with the sedan, E2W riders would sustain lower head injury risks with lower contacting velocity on the windshield than bicyclists. While in collisions with the SUV, E2W riders would sustain increasing head injury risks due to the higher structural stiffness at contact, and the risk level was about the same as bicyclists. The findings revealed the loading mechanisms behind the different head injury risks between E2W riders and bicyclists.


Asunto(s)
Accidentes de Tránsito , Ciclismo/lesiones , Motocicletas , Heridas y Traumatismos/etiología , Fenómenos Biomecánicos , Simulación por Computador , Femenino , Humanos , Masculino , Medición de Riesgo , Seguridad , Heridas y Traumatismos/prevención & control
8.
J Surg Res ; 245: 198-204, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31421362

RESUMEN

BACKGROUND: Race and insurance status have been shown to predict outcomes in pediatric bicycle traumas. It is unknown how these factors influence outcomes in adult bicycle traumas. This study aims to evaluate the association, if any, between race and insurance status with mortality in adults. METHODS: This retrospective cohort study used the National Trauma Data Bank Research Data Set for the years 2013-2015. Multivariate logistic regression models were used to determine the independent association between patient race and insurance status on helmet use and on outcomes after hospitalization for bicycle-related injury. These models adjusted for demographic factors and comorbid variables. When examining the association between race and insurance status with outcomes after hospitalization, injury characteristics were also included. RESULTS: A study population of 45,063 met the inclusion and exclusion criteria. Multivariate regression demonstrated that black adults and Hispanic adults were significantly less likely to be helmeted at the time of injury than white adults [adjusted odds ratio of helmet use for blacks 0.25 (95% CI 0.22-0.28) and for Hispanics 0.33 (95% CI 0.30-0.36) versus whites]. Helmet usage was also independently associated with insurance status, with Medicare-insured patients [AOR 0.51 (95% CI 0.47-0.56) versus private-insured patients], Medicaid-insured patients [AOR 0.18 (95% CI 0.17-0.20)], and uninsured patients [AOR 0.29 (95% CI 0.27-0.32)] being significantly less likely to be wearing a helmet at the time of injury compared with private-insured patients. Although patient race was not independently associated with hospital mortality among adult bicyclists, we found that uninsured patients had significantly higher odds of mortality [AOR 2.02 (AOR 1.31-3.12)] compared with private-insured patients. CONCLUSIONS: Minorities and underinsured patients are significantly less likely to be helmeted at the time of bicycle-related trauma when compared with white patients and those with private insurance. Public health efforts to improve the utilization of helmets during bicycling should target these subpopulations.


Asunto(s)
Ciclismo/lesiones , Disparidades en Atención de Salud/estadística & datos numéricos , Grupos Minoritarios/estadística & datos numéricos , Heridas y Traumatismos/mortalidad , Adolescente , Adulto , Afroamericanos/estadística & datos numéricos , Anciano , Conjuntos de Datos como Asunto , Grupo de Ascendencia Continental Europea/estadística & datos numéricos , Femenino , Dispositivos de Protección de la Cabeza/estadística & datos numéricos , Hispanoamericanos/estadística & datos numéricos , Mortalidad Hospitalaria , Hospitalización/estadística & datos numéricos , Humanos , Puntaje de Gravedad del Traumatismo , Cobertura del Seguro/estadística & datos numéricos , Seguro de Salud/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Sistema de Registros/estadística & datos numéricos , Estudios Retrospectivos , Resultado del Tratamiento , Estados Unidos/epidemiología , Heridas y Traumatismos/diagnóstico , Heridas y Traumatismos/terapia , Adulto Joven
9.
Accid Anal Prev ; 136: 105407, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-31869695

RESUMEN

Faced with the current growth and change to Western Australia's road network as well as the promotion and increased uptake of cycling, further investigation into crash, injury and road infrastructure characteristics is necessary. An in-depth study was conducted of 100 cyclists who were injured due to involvement in a crash that occurred on-road and resulted in an admission to a hospital. Information collected included a researcher-administered questionnaire, crash details from the Integrated Road Information System (IRIS), injury information from the State Trauma Registry and a virtual on-line site inspection. Overall, 42 % of crashes involved a motor vehicle and 58 % did not involve a motor vehicle. Twenty-one percent of all crashes involved cyclist loss of control, 18% were crashes with another cyclist, 18% involved hitting an object and 1% involved a pedestrian. . Bicycle crashes were severely under-reported with only 40 percent reported to the Police. Approximately half of crashes occurred at intersections (51 %) and half at midblock (non-intersection) sites (49 %). Fifty-seven percent of crashes that occurred at intersections involved a motor vehicle, whereas only 27% of crashes that occurred at midblocks involved a motor vehicle. The majority of cyclists' injuries were classified as minor according to the Injury Severity Score with the mean number of body regions injured being 4.5 (SD = 2.2). The mean number of days in hospital care was 5.2 days (SD = 5.6, range: 1-33). These findings can be used to guide road infrastructure treatments that reduce the risk of bicycle crashes in Western Australia and insights may inform action in other jurisdictions where cycling is increasing in popularity.


Asunto(s)
Accidentes de Tránsito/estadística & datos numéricos , Ciclismo/lesiones , Entorno Construido/estadística & datos numéricos , Tiempo de Internación/estadística & datos numéricos , Humanos , Puntaje de Gravedad del Traumatismo , Masculino , Sistema de Registros , Australia Occidental , Heridas y Traumatismos/epidemiología , Heridas y Traumatismos/etiología
11.
Artículo en Inglés | MEDLINE | ID: mdl-31877756

RESUMEN

This study analyses factors associated with cyclist injury severity, focusing on vehicle type, route environment, and interactions between them. Data analysed was collected by Spanish police during 2016 and includes records relating to 12,318 drivers and cyclist involving in collisions with at least one injured cyclist, of whom 7230 were injured cyclists. Bayesian methods were used to model relationships between cyclist injury severity and circumstances related to the crash, with the outcome variable being whether a cyclist was killed or seriously injured (KSI) rather than slightly injured. Factors in the model included those relating to the injured cyclist, the route environment, and involved motorists. Injury severity among cyclists was likely to be higher where an Heavy Goods Vehicle (HGV) was involved, and certain route conditions (bicycle infrastructure, 30 kph zones, and urban zones) were associated with lower injury severity. Interactions exist between the two: collisions involving large vehicles in lower-risk environments are less likely to lead to KSIs than collisions involving large vehicles in higher-risk environments. Finally, motorists involved in a collision were more likely than the injured cyclists to have committed an error or infraction. The study supports the creation of infrastructure that separates cyclists from motor traffic. Also, action needs to be taken to address motorist behaviour, given the imbalance between responsibility and risk.


Asunto(s)
Accidentes de Tránsito/estadística & datos numéricos , Ciclismo/lesiones , Ambiente , Vehículos a Motor/estadística & datos numéricos , Adolescente , Adulto , Anciano , Teorema de Bayes , Niño , Preescolar , Femenino , Humanos , Lactante , Masculino , Persona de Mediana Edad , Vehículos a Motor/clasificación , Policia , España , Adulto Joven
13.
Medicine (Baltimore) ; 98(41): e17268, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31593080

RESUMEN

Soft-tissue defects overlying the Achilles tendon are common complications after bicycle or motorcycle spoke injuries in children and usually require surgical management by various flaps. There is no apparent consensus on the optimal choice of flaps for these injuries. We designed a novel step-advanced rectangular flap to reconstruct small to moderate soft-tissue defects around the Achilles tendon. This study was performed to review our experience and evaluate the clinical effectiveness of the step-advanced rectangular flap.From May, 2014 to September, 2016, 12 consecutive children with soft-tissue defects overlying the Achilles tendon caused by spoke injuries were treated with the step-advanced rectangular flap. The patients' general information, surgical details, and postoperative complications were recorded. The Mazur evaluation system was used to assess clinical outcomes.All patients were followed up for ≥12 months (range 12-38 months). All flaps survived completely. Superficial infection occurred in 2 patients and healed by second intention after dressing changes; the other patients' surgical wounds healed by primary intention. The scars around the flaps in 2 patients were remarkable, and all others showed good results in terms of flap color and texture. Ankle function was normal, and satisfactory results were obtained in all cases. According to the Mazur evaluation system, the results were excellent in 9 patients and good in 3, with an excellent and good rate of 100% at 12 months postoperatively.The rectangular advancement flap appears to be a simple and reliable method for small to moderate soft tissue defects overlying the Achilles tendon in children.


Asunto(s)
Tendón Calcáneo/cirugía , Procedimientos Quirúrgicos Reconstructivos/métodos , Traumatismos de los Tejidos Blandos/cirugía , Colgajos Quirúrgicos , Traumatismos de los Tendones/cirugía , Tendón Calcáneo/lesiones , Ciclismo/lesiones , Niño , Preescolar , Femenino , Humanos , Masculino , Resultado del Tratamiento
14.
Artículo en Inglés | MEDLINE | ID: mdl-31569583

RESUMEN

It is an objective of transport policy in many countries and cities to promote walking, cycling and the use of public transport. This policy seeks to improve public health and reduce emissions contributing to global warming. It is, however, very likely that more walking, cycling and use of public transport will be associated with an increase in traffic injury. Moreover, it is likely that most of this increase will go unnoticed and not be recorded in official road accident statistics. Official statistics on traffic injury are known to be very incomplete as far as injuries to pedestrians, cyclists and public transport passengers are concerned. This incompleteness is a problem when assessing health impacts of more walking, cycling and travel by public transport. In this paper, studies made in the city of Oslo, Norway (population 700,000) are used to develop numerical examples showing how the estimated real and recorded number of injuries may change when 10% of person km of travel performed by car are transferred to walking, cycling or public transport. It is shown that not more than about 2% of the estimated change in the actual number of injured road users will be recorded by official statistics on traffic injury.


Asunto(s)
Accidentes de Tránsito/estadística & datos numéricos , Ciclismo/lesiones , Peatones/estadística & datos numéricos , Transportes/legislación & jurisprudencia , Caminata/lesiones , Ciclismo/legislación & jurisprudencia , Ciudades , Humanos , Noruega , Transportes/clasificación , Caminata/legislación & jurisprudencia
15.
Orthopade ; 48(12): 1019-1029, 2019 Dec.
Artículo en Alemán | MEDLINE | ID: mdl-31659425

RESUMEN

During the past decade, technical innovations (e.g., carbon as a new material, disk brakes, hydraulic shock absorbers, electric transmissions) and lifestyle changes have significantly influenced recreational and professional cycling. In contrast to the past, where ambitious leisure cyclists were primarily interested in the recreational value of nature and landscape, cyclists of all ages are nowadays increasingly focused on performance and self-optimization. Simultaneously, manufacturers have adapted to differing customer requirements: besides the traditional extremities of road and mountain bikes, many specialized models have been designed for special applications: trekking, cyclocross, gravel, full-suspension, single-track, hardtail, downhill, fatbike, etc. For biking fans who are no longer able to meet their own demands due to individual physical restrictions or defined health problems, electric-assist bikes (pedelecs or "e-bikes") were recently introduced. While these are becoming increasingly popular, they have also increased the number of accidents and injuries. The current work provides an update on relevant sport medical and orthopaedic challenges brought on by these developments in cycling.


Asunto(s)
Traumatismos en Atletas , Ciclismo/lesiones , Traumatismos en Atletas/clasificación , Ciclismo/tendencias , Humanos
17.
Tidsskr Nor Laegeforen ; 139(12)2019 09 10.
Artículo en Inglés, Noruego | MEDLINE | ID: mdl-31502796

RESUMEN

BACKGROUND: It is a policy objective to increase the percentage of journeys made by bicycle in Norway from the current 5 % to 10 %. Kristiansand is one of the most active cities in Norway in terms of cycling. We wished to identify the extent of injuries among cyclists admitted to the hospital. MATERIAL AND METHOD: We reviewed the medical records of patients with cycling-related injuries who were admitted to Sørlandet Hospital, Kristiansand in the period 1 January 2012 to 31 December 2015. Patient, accident, injury and treatment characteristics were recorded, as well as any sequelae after 12 months. RESULTS: Altogether 224 adults and 53 children (<16 years) were registered with cycling-related injuries, most of which (n=192, 69 %) were mild/moderate. Very severe and critical injuries were recorded in 6 (11 %) children and 22 (10 %) adults. Fractures (n=179, 65 %) and minor head injuries (n= 78, 28 %) dominated the injury panorama. Surgical treatment was undertaken in 107 (48 %) adults and 19 (36 %) children. A total of 12 (4 %) patients were transferred to the trauma centre at Oslo University Hospital Ullevål. Four adults had significant sequelae after 12 months, all related to severe head/neck injury. INTERPRETATION: A considerable proportion of serious and complex injuries require that the national guidelines for use of a trauma team be followed. Systematic and ongoing registration of cyclists' injuries in the form of a national registry could help increase our insight into the circumstances surrounding accidents and the extent of injuries related to these.


Asunto(s)
Accidentes de Tránsito/estadística & datos numéricos , Ciclismo/lesiones , Adolescente , Adulto , Ciclismo/estadística & datos numéricos , Niño , Traumatismos Craneocerebrales/epidemiología , Servicios Médicos de Urgencia , Femenino , Fracturas Óseas/epidemiología , Humanos , Tiempo de Internación , Masculino , Registros Médicos , Persona de Mediana Edad , Noruega/epidemiología , Estaciones del Año , Procedimientos Quirúrgicos Operativos/estadística & datos numéricos , Factores de Tiempo , Transporte de Pacientes , Índices de Gravedad del Trauma
18.
Traffic Inj Prev ; 20(sup1): S7-S12, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31381450

RESUMEN

Objective: The objective of this article is to describe the characteristics of fatal crashes with bicyclists on Swedish roads in rural and urban areas and to investigate the potential of bicycle helmets and different vehicle and road infrastructure interventions to prevent them. The study has a comprehensive approach to provide road authorities and vehicle manufacturers with recommendations for future priorities. Methods: The Swedish Transport Administration's (STA) in-depth database of fatal crashes was used for case-by-case analysis of fatal cycling accidents (2006-2016) on rural (n = 82) and urban (n = 102) roads. The database consists of information from the police, medical journals, autopsy reports, accident analyses performed by STA, and witness statements. The potential of helmet use and various vehicle and road infrastructure safety interventions was determined retrospectively for each case by analyzing the chain of events leading to the fatality. The potential of vehicle safety countermeasures was analyzed based on prognoses on their implementation rates in the Swedish vehicle fleet. Results: The most common accident scenario on rural roads was that the bicyclist was struck while cycling along the side of the road. On urban roads, the majority of accidents occurred in intersections. Most accidents involved a passenger car, but heavy trucks were also common, especially in urban areas. Most accidents occurred in daylight conditions (73%). Almost half (46%) of nonhelmeted bicyclists would have survived with a helmet. It was assessed that nearly 60% of the fatal accidents could be addressed by advanced vehicle safety technologies, especially autonomous emergency braking with the ability to detect bicyclists. With regard to interventions in the road infrastructure, separated paths for bicyclists and bicycle crossings with speed calming measures were found to have the greatest safety potential. Results indicated that 91% of fatally injured bicyclists could potentially be saved with known techniques. However, it will take a long time for such technologies to be widespread. Conclusions: The majority of fatally injured bicyclists studied could potentially be saved with known techniques. A speedy implementation of important vehicle safety systems is recommended. A fast introduction of effective interventions in the road infrastructure is also necessary, preferably with a plan for prioritization.


Asunto(s)
Accidentes de Tránsito/mortalidad , Accidentes de Tránsito/prevención & control , Ciclismo/lesiones , Planificación Ambiental/estadística & datos numéricos , Vehículos a Motor/estadística & datos numéricos , Accidentes de Tránsito/estadística & datos numéricos , Bases de Datos Factuales , Dispositivos de Protección de la Cabeza , Humanos , Estudios Retrospectivos , Población Rural/estadística & datos numéricos , Seguridad , Suecia/epidemiología , Población Urbana/estadística & datos numéricos
19.
BMJ Case Rep ; 12(8)2019 Aug 04.
Artículo en Inglés | MEDLINE | ID: mdl-31383681

RESUMEN

Capitellum fractures represent 1% of elbow fractures. A coronal shear fracture which involves the trochlea is classified as a type IV McKee fracture. The combination of its rarity in the paediatric population as well as its unique appearance on X-ray make diagnosis of this fracture a challenge. We present the case of a 14-year-old boy who sustained this fracture falling from his bike. It was diagnosed from the double arc sign on X-ray. In addition, a CT scan was obtained to aid preoperative planning. It was treated by open reduction and fixation with two headless compression screws. Follow-up at 6 months showed no avascular necrosis. The patient could achieve full extension, while flexion was reduced only by 5°. Final follow-up was conducted at 15 months. Anatomic reduction and stable internal fixation are essential for a good outcome in these uncommon paediatric fractures.


Asunto(s)
Ciclismo/lesiones , Codo/lesiones , Fijación Interna de Fracturas/métodos , Fracturas del Húmero/cirugía , Reducción Abierta/métodos , Adolescente , Tornillos Óseos , Codo/cirugía , Humanos , Fracturas del Húmero/etiología , Masculino
20.
Medicina (Kaunas) ; 55(9)2019 Aug 25.
Artículo en Inglés | MEDLINE | ID: mdl-31450705

RESUMEN

Background: Cycling is a popular source of recreation and physical activity for children and adults. With regard to the total number of sports injuries, cycling has the highest absolute number of injuries per year in the United States population. Cycling injuries can be classified into bicycle contact, traumatic, or overuse injuries. Aim of this study: The aims of this case report are to report a rare clinical complication of glenohumeral joint anterior dislocation that resulted in a patient experiencing continuous GHJ dislocations secondary to involuntary violent muscular spasms and emphasize the role of the physical therapist's differential diagnosis and clinical decision-making process in a patient following direct access referral. Case presentation: A professional 23-year-old cyclist presented to a physical therapist with spontaneous multidirectional dislocations to the right shoulder after the recurrence of trauma occurred during a recent cycling race. The dislocations do not occur at night, but occur during the day, randomly, and mostly associated with changes in the patient's psychological conditions. Directly from the clinical history, the physical therapist identified a neuro-physiological orange flag as well as an orthopedic red flag and, therefore, decided it was appropriate to refer the patient to a neurologist. It was determined by the physical therapist to be a priority to focus on the patient's neurologic status and then to evaluate the orthopedic problem. The neurological examination revealed a condition of spontaneous multidirectional dislocation associated with recurrent antero-posterior pain spasms of the shoulder joint. The neurologist prescribed medication. Following the second cycle of medication assumption, the patient was able to continue physiotherapy treatment and was referred to the orthopedic specialist to proceed with shoulder stabilization surgery. Discussion and conclusion: Currently, the diagnosis of this unusual clinical condition is still unclear. It is a shared opinion of the authors that the trauma during the past bicycle race awakened an underlying psychological problem of the patient that resulted in a clinical condition of weakness of all the structures of the shoulder, such that these spasms could result in multiple multidirectional dislocations.


Asunto(s)
Ciclismo/lesiones , Luxación del Hombro/diagnóstico , Accidentes por Caídas , Atletas , Ciclismo/estadística & datos numéricos , Humanos , Italia , Imagen por Resonancia Magnética/métodos , Masculino , Luxación del Hombro/complicaciones , Luxación del Hombro/diagnóstico por imagen , Espasmo/etiología , Heridas y Traumatismos/complicaciones , Heridas y Traumatismos/fisiopatología , Adulto Joven
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