Characteristics of Rodeo Injuries and Suggestions for Injury Prevention: A Systematic Review.

Background: Rodeo is a globally popular sport, with its athletes prone to various types of injuries. There is no systematic review discussing rodeo injuries across all age groups. Purpose: To (1) review the published literature on incidence, types of injuries, and factors leading to injuries in rodeo athletes; (2) provide prevention recommendations for health care providers; and (3) identify gaps in the research. Study Design: Systematic review; Level of evidence, 4. Methods: A comprehensive search of available literature was electronically performed through MEDLINE, Embase, and SPORTDiscus databases using the key terms "rodeo" and "injury" or "trauma" between 1995 and 2021. A systematic review was performed using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, which identified 116 eligible studies. Outcome data included frequency of injuries, risk factors for injury, and types of injury. Results: A total of 23 studies met the inclusion criteria (N = 2105 athletes), of which 13 were retrospective studies. In the included studies, the injury rate per competition exposure (CE) ranged from 4.2 to 19.1 injuries per 1000 CE. Sprains and strains accounted for the highest percentage of injury types, ranging from 15% to 34%. The knee was the most common location of injury, making up 11.1% to 17% of injuries. Concussions occurred in up to 15.3% of injuries for all events and up to 77% of injuries in roughstock events. Of all rodeo events reported, bull riding caused the highest percentage of injuries, making up 19.4% to 58.4% of injuries, and bareback had the second highest at 15.3% to 28.8% of injuries. Conclusion: There was a high prevalence of various injury types and mechanisms in rodeo. Improved injury surveillance and the introduction of a comprehensive standardized injury reporting system would be helpful in the future prevention, diagnosis, and treatment of rodeo injuries.

Intramedullary bone pedestal formation contributing to femoral shaft fracture nonunion: A case report and review of the literature.

BACKGROUND: Femoral shaft fracture is a commonly encountered orthopedic injury that can be treated operatively with a low overall delayed/nonunion rate. In the case of delayed union after antegrade or retrograde intramedullary nail fixation, fracture dynamization is often attempted first. Nonunion after dynamization has been shown to occur due to infection and other aseptic etiologies. We present a unique case of diaphyseal femoral shaft fracture nonunion after dynamization due to intramedullary cortical bone pedestal formation at the distal tip of the nail. CASE SUMMARY: A 37-year-old male experienced a high-energy trauma to his left thigh after coming down hard during a motocross jump. Evaluation was consistent with an isolated, closed, left mid-shaft femur fracture. He was initially managed with reamed antegrade intramedullary nail fixation but had continued thigh pain. Radiographs at four months demonstrated no evidence of fracture union and failure of the distal locking screw, and dynamization by distal locking screw removal was performed. The patient continued to have pain eight months after the initial procedure and 4 mo after dynamization with serial radiographs continuing to demonstrate no evidence of fracture healing. The decision was made to proceed with exchange nailing for aseptic fracture nonunion. During the exchange procedure, an obstruction was encountered at the distal tip of the failed nail and was confirmed on magnified fluoroscopy to be a pedestal of cortical bone in the canal. The obstruction required further distal reaming. A longer and larger diameter exchange nail was placed without difficulty and without a distal locking screw to allow for dynamization at the fracture site. Post-operative radiographs showed proper fracture and hardware alignment. There was subsequently radiographic evidence of callus formation at one year with subsequent fracture consolidation and resolution of thigh pain at eighteen months. CONCLUSION: The risk of fracture nonunion caused by intramedullary bone pedestal formation can be mitigated with the use of maximum length and diameter nails and close follow up.

Baseball Related Injuries: A Case Report on Acute Compartment Syndrome of the Forearm.

Acute compartment syndrome is a difficult diagnosis to make due to its wide range of clinical presentations. Delay or misdiagnosis can cause devastating consequences such as Volkmann's ischemic contracture, permanent nerve damage, amputation, and death. Lower extremity compartment syndrome is more common than upper extremity compartment syndrome, with the forearm being the most common location for upper extremity compartment syndrome. Acute compartment syndrome is most caused by acute fracture trauma but can also be due to soft tissue crush injuries or vascular problems. We report a unique case of a male umpire being struck on the forearm by a baseball with subsequent progression to an acute compartment syndrome that required emergent fasciotomies. The patient made a full recovery with no known long-term sequelae.

Are Routine Follow-up Radiographs Necessary for Extra-articular Scapula Body Fractures Managed Conservatively?

INTRODUCTION: Extra-articular scapula body fractures have been shown to have good outcomes with nonsurgical management. What is not known is whether routine postinjury imaging of these fractures is necessary for monitoring healing and alignment. As the shift toward providing cost-effective healthcare continues, we sought to evaluate if routine postinjury imaging of these fractures resulted in any change in management while secondarily evaluating the imaging for fracture patterns at risk of displacement. METHODS: A retrospective review of all extra-articular scapula body fractures managed nonsurgically at our institution was performed from January 2013 to December 2017. We measured the glenopolar angle, lateral border offset, sagittal angulation, and translation on both injury CT scans and follow-up radiographs to evaluate if any displacement occurred. In fractures that displaced more than 10 mm or 10° in any measurement, we evaluated the fracture pattern to see if any particular pattern posed a risk for displacement. In addition, we evaluated the cost of imaging for all radiographs obtained in the follow-up period. RESULTS: A total of 139 patients with 147 extra-articular scapula body fractures were included in our analysis. No patient experienced a change in management based on postinjury radiographs. A total of 120 patients underwent postinjury imaging with a total of 204 radiographic series ordered, equating to $172,769.50 in radiograph expenses. Final radiographs were obtained at an average of 48.4 days postinjury, and overall, no significant difference was observed (P < 0.05) in any radiographic measurement when compared with the initial injury imaging; however, when looking at fractures that displaced, transverse fracture patterns of the scapula body represented a risk factor for displacement (relative risk = 6.5). DISCUSSION: Satisfactory outcomes have previously been demonstrated with nonsurgical management of scapula body fractures and for most of these injuries postinjury imaging may not be necessary or cost effective. LEVEL OF EVIDENCE: Level IV.

Distal Ulna Fracture With Delayed Ulnar Nerve Palsy in a Baseball Player.

We present a case report of a college baseball player who sustained a blunt-trauma, distal-third ulna fracture from a thrown ball with delayed presentation of ulnar nerve palsy. Even after his ulna fracture had healed, the nerve injury made it difficult for the athlete to control a baseball while throwing, resulting in a delayed return to full baseball activity for 3 to 4 months. He had almost complete nerve recovery by 6 months after his injury and complete nerve recovery by 1 year after his injury.

Billing and coding knowledge: a comparative survey of professional coders, practicing orthopedic surgeons, and orthopedic residents.

Medical knowledge and surgical skills are necessary to become an effective orthopedic surgeon. To run an efficient practice, the surgeon must also possess a basic understanding of medical business practices, including billing and coding. In this study, we surveyed and compared the level of billing and coding knowledge among current orthopedic residents PGY3 and higher, academic and private practice attending orthopedic surgeons, and orthopedic coding professionals. According to the survey results, residents and fellows have a similar knowledge of coding and billing, regardless of their level of training or type of business education received in residency. Most residents would like formal training in coding, billing, and practice management didactics; this is consistent with data from previous studies.

Survey of upper extremity injuries among martial arts participants.

PURPOSE: To survey participants at various experience levels of different martial arts (MA) about upper extremity injuries sustained during training and fighting. MATERIALS: A 21-s question survey was designed and utilised. The survey was divided into four groups (Demographics, Injury Description, Injury Mechanism, and Miscellaneous information) to gain knowledge about upper extremity injuries sustained during martial arts participation. Chi-square testing was utilised to assess for significant associations. RESULTS: Males comprised 81% of respondents. Involvement in multiple forms of MA was the most prevalent (38%). The hand/wrist was the most common area injured (53%), followed by the shoulder/upper arm (27%) and the forearm/elbow (19%). Joint sprains/muscle strains were the most frequent injuries reported overall (47%), followed by abrasions/bruises (26%). Dislocations of the upper extremity were reported by 47% of participants while fractures occurred in 39%. Surgeries were required for 30% of participants. Females were less likely to require surgery and more likely to have shoulder and elbow injuries. Males were more likely to have hand injuries. Participants of Karate and Tae Kwon Do were more likely to have injuries to their hands, while participants of multiple forms were more likely to sustain injuries to their shoulders/upper arms and more likely to develop chronic upper extremity symptoms. With advanced level of training the likelihood of developing chronic upper extremity symptoms increases, and multiple surgeries were required. Hand protection was associated with a lower risk of hand injuries. CONCLUSION: Martial arts can be associated with substantial upper extremity injuries that may require surgery and extended time away from participation. Injuries may result in chronic upper extremity symptoms. Hand protection is important for reducing injuries to the hand and wrist.

Intraoperative anterior cruciate ligament graft contamination.

Intraoperative anterior cruciate ligament graft contamination is a rare but potentially devastating occurrence for any surgeon to encounter. Most instances in our experience have happened when a surgeon first enters practice or is operating in a new environment with new staff. Based on the currently available literature and the senior author's personal experience with 3 cases, intraoperative cleansing of the graft followed by implantation is a reasonable option. The protocol used successfully in these 3 cases includes getting the graft off of the floor immediately, removing any suture material in the graft, cleansing the graft for 15 to 30 minutes each in chlorohexidine and triple antibiotic solution, followed by a normal saline rinse. All graft sutures should then be replaced. The graft should then be resized and the tibial and femoral tunnels adjusted if needed. After implantation of the graft, additional intraoperative and postoperative intravenous antibiotic and/or oral antibiotic administration is also recommended for the first 1 to 2 weeks. Close clinical follow-up is also very important the first 6 weeks postoperatively and should include candid communication with the patient and family.

Magnetic resonance imaging of the rotator cuff interval.

The rotator cuff interval (RCI) is an important and anatomically complex region of the rotator cuff that is critically important to normal glenohumeral function. Recognition of common pathologies in this region on imaging examinations is especially important as injuries may be difficult to detect on clinical examination and even at arthroscopy. Familiarity with the magnetic resonance imaging appearance of the normal and abnormal RCI and the ability to convey findings to orthopedic and sports medicine referrers are essential to facilitate prompt creation of effective treatment plans.

The transverse humeral ligament: a separate anatomical structure or a continuation of the osseous attachment of the rotator cuff?

BACKGROUND: No study to date has isolated the anatomical nature of the transverse humeral ligament and its relationship to the biceps tendon and the anterosuperior portion of the rotator cuff. HYPOTHESIS: There is no separate identifiable transverse humeral ligament, but rather the fibers covering the intertubercular groove are composed of a sling formed by fibers from the subscapularis and supraspinatus tendons. STUDY DESIGN: Descriptive laboratory study. METHODS: A total of 14 shoulder examinations were performed on 7 matched pairs of fresh-frozen cadaveric shoulders. Magnetic resonance imaging scans were performed, followed by gross and microscopic anatomical dissection. RESULTS: In the location of the transverse humeral ligament, magnetic resonance imaging and gross dissection revealed the continuation of superficial fibers of the subscapularis tendon from the tendon body across the intertubercular groove to attach to the greater tuberosity, whereas deeper fibers of the subscapularis tendon inserted on the lesser tuberosity. Longitudinal fibers of the supraspinatus tendon and the coracohumeral ligament were also noted to travel the length of the groove, deep to the other interdigitating fibers but superficial to the biceps tendon. Histologic studies confirmed these gross dissection patterns of fiber attachment and also revealed the absence of elastin fibers, which are more commonly seen in ligamentous structures and are typically absent from tendinous structures. CONCLUSION: There is no identifiable transverse humeral ligament, but rather the fibers covering the intertubercular groove are composed of a sling formed mainly by the fibers of the subscapularis tendon, with contributions from the supraspinatus tendon and the coracohumeral ligament. CLINICAL RELEVANCE: According to our findings, dislocations of the long head of the biceps must disrupt at least the deep fibers of the annular sling created mainly by the subscapularis tendon insertion. This finding provides anatomical support for the findings of a positive biceps tendon subluxation or dislocation and subscapularis tear during glenohumeral arthroscopy with a normal-appearing subscapularis during open surgery or subacromial arthroscopy.

Transtibial tubercle fixation without hardware for anterior cruciate ligament and posterior cruciate ligament reconstruction: A new technique.

Tibial fixation with implants for both anterior and posterior cruciate ligament reconstructions (ACLR and PCLR) can be associated with a wide variety of problems. Common problems encountered include graft-tunnel mismatch when using grafts with bone blocks, graft damage or poor graft fixation using metal or absorbable implants, painful retained hardware requiring removal, and hardware interference during revision surgery. A new technique is presented using transosseous graft suture passage across the tibial tubercle followed by knot tying over a bone bridge. The technique provides a quick, simple, safe, and reproducible alternative for primary or supplemental tibial graft fixation without hardware in ACLR and PCLR.

Spinal cord injuries due to falls from hunting tree stands in Oklahoma, 1988-1999.

Serious injuries resulting in paralysis or death have been shown to occur to hunters who have sustained falls from tree stands. A total of sixteen spinal cord injuries or deaths among Oklahoma hunters falling from tree stands were reported between 1987 and 1999. The mean height of the falls was 16.4 feet. Three (18.8%) of the cases were related to substance use. None of the patients were using a safety restraint. Nearly 90% of the injuries resulted in paraplegia/paresis; two (12.5%) of the injuries resulted in death. Forty-four percent of the spinal injuries occurred at the thoraco-lumbor junction (T12 or L1). Burst fractures were the most common fracture pattern. Hospitalizations averaged 19.6 days (range 3 to 73 days) and eight (50%) were discharged to inpatient rehabilitation facilities. Falls from tree stands can result in serious injuries or death. Hunter education and the use of safety harnesses for prevention of injuries related to tree stands are paramount.

Orthopedic injuries during carrier battle group deployments.

Orthopedic injuries account for a large number of sick call visits during carrier battle group (CBG) deployments. The purpose of this study was to profile the orthopedic injuries during two CBG deployments to help both the line and medical communities better prepare their personnel and supplies. The current study confirmed that orthopedic injuries resulted in the greatest number of sick call visits to the CBG medical departments. Injury analysis revealed a significant number of hand/wrist and back/neck injuries during both carrier deployments. The groups with the highest number of injuries were the air squadrons and aircrews. These findings support the need for continued increased training and supplies for the care of orthopedic injuries. Emphasis should be placed on the care of hand/wrist and back/neck injuries. In addition, all CBG personnel should continue to improve their safety standards, especially in high-risk areas such as the aviation departments.

Medial clavicle physis fracture with posterior displacement and vascular compromise: the value of three-dimensional computed tomography and duplex ultrasound.

Fractures of the medial clavicle are rare, and most usually displace anterior or superior. Due to the structures in the mediastinum, accurate diagnosis of posterior fractures or dislocations is vital, but diagnosis can be difficult and delayed. Duplex ultrasound and three-dimensional computed tomography can be helpful in making the diagnosis.