Exploring Injury Profiles in Non-elite Cricketers: Harnessing Online Surveys for Effective Assessment.

Background: An increase in the on-field intensity in modern cricket, results in an increased number of player injuries. Integration and easy access to professional physiotherapy, technology, rehab protocols, and mental/physical conditioning aid in early return to sports in the injured; however, at the grassroots, these facilities may not be available with untrained support staff and limited funds. Injuries can go unnoticed and, therefore, there is a need for an easy process of identification and documentation of such injuries. We devised a questionnaire-based survey to evaluate its effectiveness at the junior level of professional cricket. Materials and Methods: An Online self-administered questionnaire was prepared and the link was given to active Union Territory Cricket Academy (UTCA), Chandigarh, cricketers of any gender between 15 and 35 years of age, through different online platforms like WhatsApp, Telegram and emails, for the submission of their responses. Results: The questionnaire was administered to 98 participants out of which 77 participants' responses were evaluated (41 males and 36 females). 74/77 participants were below 30 years of age. There were 18 wicketkeepers, 33 bowlers and 26 batsmen as per their major role in the team. 37/77 cricketers (20 males, 17 females) had injuries during the previous 2 years; this included 17 bowlers, 11 batsmen and 9 wicketkeepers. The most common body part injured in the survey were fingers (12) followed by the back (7). The amount of training time lost, reported in the survey ranged from a week up to 1 year. Conclusion: Online surveys could be the first step to accumulating data and making initial player profiles, starting even at junior levels of cricket. Further detailed evaluations may be performed after this, and coaches and administrators could potentially profile cricket injuries and identify chronic issues. Supplementary Information: The online version contains supplementary material available at 10.1007/s43465-023-00995-3.

Wound alpha defensin levels are significantly higher in patients with fracture related infection: A pilot, prospective cohort study.

BACKGROUND: In absence of frank purulence, wound cultures represent 'gold-standard' for diagnosis of fracture related infection (FRI). However, these are time-intensive, and may be falsely negative, necessitating the need for accurate and rapid biomarker-based diagnosis. We conducted this study to determine the accuracy of 3 wound-based biomarkers for the diagnosis of FRI. METHODS: This was a prospective cohort study on adult patients who underwent an operative procedure for an upper or lower limb fracture. Wound fluid levels of alpha-defensin (AD), neutrophil elastase (NE) and IL-6 were evaluated on post-operative day 2, and patients were followed up for one month. Patients were categorized as cases (FRI) or controls (no FRI), on the basis of the consensus definition of FRI. Univariate analysis, along with receiver operating characteristic (ROC) analysis was performed. RESULTS: 48 patients were included. AD levels showed a 2.6-fold elevation in cases (n = 26, Median = 23.74 µg/ml) as compared to controls (n = 22, Median = 8.78 µg/ml). The area under the curve for this variable was 0.71 (95% Confidence Intervals = 0.56 - 0.86). The levels of NE and IL-6 were not significantly different between cases and controls. CONCLUSION: Wound AD levels are significantly elevated in patients with FRI. However, these results need to be validated in a larger cohort of patients before it can be used as a biomarker of FRI.

Complications and mid to long term outcomes for hip resurfacing versus total hip replacement: a systematic review and meta-analysis.

INTRODUCTION: The long-term results of total hip replacement (THR) are excellent; however, it has higher failure rates in young and active patients. Hip resurfacing arthroplasty (HRA) is an alternative in such patients and gaining popularity. This review was done to compare complications and outcomes between HRA and THA by assessing the latest level 1 studies comparing the two from the past 10 years. METHOD: A systematic review and meta-analysis was conducted using three databases (PubMed, EMBASE and SCOPUS) to compare the complications between THR and HRA in medium to long term follow up. The primary outcome of interest included the complication and revision rate between the two techniques. Functional outcomes and ionic levels at follow up were also compared as secondary outcomes. Risk of bias assessment was done using the Cochrane risk of bias tool. RESULT: The present review included 6 level 1 studies. These included 308 THR and 304 HRA. On meta-analysis, overall complications rates were significantly lower in HRA compared to the THA group with an Odds ratio (OR) of 2.17 (95% CI 1.21, 3.88; p = 0.009). No difference was seen between the two groups in terms of revision rate (OR 1.06 95% CI 0.57, 1.99; p = 0.85). Functional outcomes in both the groups were satisfactory but the Harris Hip Score was found to be significantly better in the resurfacing group (MD 2.99 95% CI - 4.01, - 1.96, p < 0.00001). There were increased cobalt and chromium ions in the resurfacing group but no detrimental effect was seen in terms of reported poisoning. CONCLUSION: Despite similar function and revision rates, HRA was seen to have lesser associated complications and ionic levels may not be a detrimental issue. Hip resurfacing provides relative ease during revisions, especially in younger patients and it may be an alternative to THR in the younger population.

Does the femoral neck system provide better outcomes compared to cannulated screws fixation for the management of femoral neck fracture in young adults? A systematic review of literature and meta-analysis.

Background: Management of neck of femur fractures depend upon the age of presentation and it ranges from internal fixation to arthroplasty. In a relatively young population, anatomical reduction with stable internal fixation is the preferred treatment modality; the choice of implants available are multiple cannulated cancellous screws, dynamic hip screws, and the newly devised femoral neck system. The fracture configuration and pattern dictate the ideal implant to be utilized, with the femoral neck system documented to be apt for all the fracture types, while the cannulated screws are deemed better for stable fractures. Methods: A primary electronic search was conducted on databases of Medline, Scopus, Scopus, Cochrane Library, and Embase, to look for articles published between 1st January 2010 to 22nd November 2021. Studies including adults with femoral neck fractures treated with internal fixation with femoral neck system and comparing them with internal fixation with cannulated cancellous screws in terms of variables like mean surgical duration, loss of blood, length of incision, fluoroscopy time, duration of hospital stay and outcomes like union time, complications, functional outcomes, Visual Analogue Score, and femoral neck shortening, were included. Results: 6 retrospective studies with 371 patients (224 males,147 females) (164: FNS; 207: CCS) were included. Our analysis demonstrated no statistically significant difference in terms of duration of surgery, incision length, and length of hospital stay, there was more blood loss in FNS, but less fluoroscopy time. The fracture union time was lesser for the FNS group and also the femoral shortening was lesser in it. There was no difference in terms of complications, pain relief, and functional outcomes. Conclusion: Femoral neck system is a new and effective implant for femoral neck fractures in the young with faster union rates and lesser neck shortening through an incision similar to the conventional multiple cancellous screws. It has additional advantages of lesser fluoroscopy exposure to the patient and the OT personnel. However, the rates of complications like implant failure, non-unions, and avascular necrosis are similar to the cannulated screws and either of the implants do not offer any advantage in the final functional status and pain relief to the patient over each other.

GeoGebra: A reliable and free software for measuring acetabular cup anteversion on digitalized plain radiographs.

OBJECTIVE: Although accurate measurement of cup anteversion in hip replacement requires CT scans, however, its routine application, especially during follow-up, remains economically and ethically unreasonable. Thus, several methods have been devised for making this measurement on plain radiographs. In recent years, several ways have been adopted using software on digital radiographs. We present one such method which uses open access mathematical software GeoGebra. METHODS: Anteversion was measured on 72 radiographs (36 cemented; 36 uncemented) by three different observers using this software. One observer repeated measurements at three weeks interval. RESULTS: The intraclass correlation coefficient for interobserver variability and intraobserver variability was 0.982 (0.973-0.989) and 0.986 (0.978-0.991) respectively. There was a significant difference in the reliability of the method for cemented and uncemented cups with higher reliability for cemented cups (p < 0.001). CONCLUSION: GeoGebra software can be used as a reliable alternative for measuring acetabular cup anteversion on good quality well centred digital radiographs of the pelvis.

High prevalence of vitamin D deficiency and osteoporosis in patients with fragility fractures of hip: A pilot study.

BACKGROUND: Vitamin D deficiency (VDD) is a major cause of poor bone health that could lead to fragility fractures, however, there is paucity of literature on prevalence of VDD and associated bone mass in patients of fragility fractures. Hip and spine are the commonest region affected by these fractures and the present study was conceptualised to ascertain the prevalence of VDD and bone mass in patients of hip fragility fractures (proximal femur) to evaluate their role in incidence of these fractures. METHODS AND MATERIALS: Between January 2013 and December 2013, 66 patients of fragility fractures around hip with age more than 50 years presented to our out patient department. Baseline evaluation of calcium profile, renal function tests, parathyroid hormone and 25(OH)D were done. All patients underwent DXA scan of the non -fractured hip. RESULTS: Total number of male patients was 29 and females was 37, with mean age of 64.1 and 70.3 years, respectively. Intertrochanteric femur fractures were the most common type with 35 cases. Fall in bathroom was the most common mode of injury with 36 cases (54.5%). VDD was found in 74.2% of all patients. Prevalence of secondary hyperparathyroidism was observed in 27 patients. Osteopenia, osteoporosis and severe osteoporosis were observed in 15.2%, 62.1% and 18.2% of patients respectively. Sun light exposure was inadequate in 59% of patients with only 1 female patient having adequate exposure. CONCLUSION: Prevalence of Vitamin D deficiency is very high in patients with hip fragility (proximal femur) fractures with secondary hyperparathyroidism and osteoporosis commonly associated. These fractures in our part of the world, occur at a younger age group as compared to the Western population. Majority of the patients sustain in-house fractures.

Quality of life following total hip arthroplasty in patients with acetabular fractures, previously managed by open reduction and internal fixation.

PURPOSE: Total hip replacement (THR) is one of the most successful and cost-effective surgical procedures and remains the treatment of choice for long-term pain relief and restoration of function for patients with diseased or damaged hips. Acetabular fractures managed either conservatively or operatively by fixation tend to present later with secondary joint changes that require THR. In this study we evaluated the functional outcome and quality of life achieved by such patients. METHODS: Our study was carried out as a retrospective trial by recruiting patients who underwent THR from June 2006 to May 2012. A total of 32 patients were included with a mean age of 46.08 years ranging from (25-65) years. We evaluated the quality of life in the patients using scoring techniques of Short Musculoskeletal Functional Assessment (SMFA) and the 12-Item Short Form Health Survey (SF-12). Functional outcome was assessed using Harris Hip Score (HHS). RESULTS: The mean HHS of the patients was 84.3 with a range from 56 to 100. The SMFA averaged 13.3. The SF-12 score averaged 49.1. The correlation of the HHS with SF-12 was positive (p =0.001) while with SMFA there was a negative correlation (p =0.001). CONCLUSION: From this study it is inferred that the functional outcome of THR and quality of life in patients who had acetabular fractures and were initially managed by open reduction and internal fixation is good.