An Extended Neck Position is Likely to Produce Cervical Spine Injuries Through Buckling in Accidental Head-First Impacts During Rugby Tackling.

Catastrophic cervical spine injuries in rugby often occur during tackling. The underlying mechanisms leading to these injuries remain unclear, with neck hyperflexion and buckling both proposed as the causative factor in the injury prevention literature. The aim of this study was to evaluate the effect of pre-impact head-neck posture on intervertebral neck loads and motions during a head-first rugby tackle. Using a validated, subject-specific musculoskeletal model of a rugby player, and computer simulations driven by in vivo and in vitro data, we examined the dynamic response of the cervical spine under such impact conditions. The simulations demonstrated that the initial head-neck sagittal-plane posture affected intervertebral loads and kinematics, with an extended neck resulting in buckling and supraphysiologic intervertebral shear and flexion loads and motions, typical of bilateral facet dislocation injuries. In contrast, an initially flexed neck increased axial compression forces and flexion angles without exceeding intervertebral physiological limits. These findings provide objective evidence that can inform injury prevention strategies or rugby law changes to improve the safety of the game of rugby.

Influence of muscle activation on lumbar injury under a specific +Gz load.

PURPOSE: The present study aimed to analyze the influence of muscle activation on lumbar injury under a specific +Gz load. METHODS: A hybrid finite element human body model with detailed lumbar anatomy and lumbar muscle activation capabilities was developed. Using the specific +Gz loading acceleration as input, the kinematic and biomechanical responses of the occupant's lower back were studied for both activated and deactivated states of the lumbar muscles. RESULTS: The results indicated that activating the major lumbar muscles enhanced the stability of the occupant's torso, which delayed the contact between the occupant's head and the headrest. Lumbar muscle activation led to higher strain and stress output in the lumbar spine under +Gz load, such as the maximum Von Mises stress of the vertebrae and intervertebral discs increased by 177.9% and 161.8%, respectively, and the damage response index increased by 84.5%. CONCLUSION: In both simulations, the occupant's risk of lumbar injury does not exceed 10% probability. Therefore, the activation of muscles could provide good protection for maintaining the lumbar spine and reduce the effect of acceleration in vehicle travel direction.

An Urgent Call for Concussion Incidence Measures in Para Sport for Athletes with Vision Impairment: A Narrative Review.

Concussion in para athletes with vision impairment (VI) is poorly understood. Recently published studies have suggested that athletes with VI may be more likely to sustain sport-related concussions compared to non-disabled athletes and athletes with other impairment types. There is a critical need for objective concussion incidence measures to determine concussion injury rates and risks more accurately. The aim of this review was to examine the limited available evidence of concussion incidence rates across six different para sports for athletes with VI and encourage the future collection of concussion incidence data and the adoption of injury prevention strategies in VI para sport. A literature search was conducted using four unique databases, which formed the basis of this narrative review. Injury prevention strategies such as modifying sport rules, introducing protective equipment, and incorporating additional safety measures into the field of play have been introduced sporadically, but the effectiveness of most strategies remains unknown. More prospective, sport-specific research examining mechanisms of injury and risk factors for concussion injuries in athletes with VI in both training and competition is needed. This research will help inform the development of targeted injury prevention strategies to reduce the likelihood of concussion for athletes with VI.

Prediction of skull fractures in blunt force head traumas using finite element head models.

Traumatic head injuries remain a leading cause of death and disability worldwide. Although skull fractures are one of the most common head injuries, the fundamental mechanics of cranial bone and its impact tolerance are still uncertain. In the present study, a strain-rate-dependent material model for cranial bone has been proposed and implemented in subject-specific Finite Element (FE) head models in order to predict skull fractures in five real-world fall accidents. The subject-specific head models were developed following an established image-registration-based personalization pipeline. Head impact boundary conditions were derived from accident reconstructions using personalized human body models. The simulated fracture lines were compared to those visible in post-mortem CT scans of each subject. In result, the FE models did predict the actual occurrence and extent of skull fractures in all cases. In at least four out of five cases, predicted fracture patterns were comparable to ones from CT scans and autopsy reports. The tensile material model, which was tuned to represent rate-dependent tensile data of cortical skull bone from literature, was able to capture observed linear fractures in blunt indentation loading of a skullcap specimen. The FE model showed to be sensitive to modeling parameters, in particular to the constitutive parameters of the cortical tables. Nevertheless, this study provides a currently lacking strain-rate dependent material model of cranial bone that has the capacity to accurately predict linear fracture patterns. For the first time, a procedure to reconstruct occurrences of skull fractures using computational engineering techniques, capturing the all-in-all fracture initiation, propagation and final pattern, is presented.

Modular incorporation of deformable spine and 3D neck musculature into a simplified human body finite element model.

Spinal injuries are a concern for automotive applications, requiring large parametric studies to understand spinal injury mechanisms under complex loading conditions. Finite element computational human body models (e.g. Global Human Body Models Consortium (GHBMC) models) can be used to identify spinal injury mechanisms. However, the existing GHBMC detailed models (with high computational time) or GHBMC simplified models (lacking vertebral fracture prediction capabilities) are not ideal for studying spinal injury mechanisms in large parametric studies. To overcome these limitations, a modular 50th percentile male simplified occupant model combining advantages of both the simplified and detailed models, M50-OS + DeformSpine, was developed by incorporating the deformable spine and 3D neck musculature from the detailed GHBMC model M50-O (v6.0) into the simplified GHBMC model M50-OS (v2.3). This new modular model was validated against post-mortem human subject test data in four rigid hub impactor tests and two frontal impact sled tests. The M50-OS + DeformSpine model showed good agreement with experimental test data with an average CORrelation and Analysis (CORA) score of 0.82 for the hub impact tests and 0.75 for the sled impact tests. CORA scores were statistically similar overall between the M50-OS + DeformSpine (0.79 ± 0.11), M50-OS (0.79 ± 0.11), and M50-O (0.82 ± 0.11) models (p > 0.05). This new model is computationally 6 times faster than the detailed M50-O model, with added spinal injury prediction capabilities over the simplified M50-OS model.

Characteristics of injury mechanisms in children and differences between urban and rural areas in central China.

BACKGROUND: Some studies lack detailed analyses of the differences and characteristics of pediatric injury mechanisms between urban and rural areas. OBJECTIVE: We aim to understand the characteristics, trends, and mortality rates of injury mechanisms in children in urban and rural areas in central China. RESULTS: In a study involving 15,807 pediatric trauma patients, it was observed that boys constituted the majority (65.4%) and those aged ≤ 3 years were the most prevalent (28.62%). Falls (39.8%), burns (23.2%), and traffic accidents (21.1%) were identified as the top three injury mechanisms. The head (29.0%) and limbs (35.7%) were found to be the most susceptible to injury. Additionally, children between the ages of 1-3 years exhibited a higher likelihood of sustaining burn injuries compared to other age groups. The main causes of burn injury were hydrothermal burns (90.3%), flame burns (4.9%), chemical burns (3.5%), and electronic burns (1.3%). In urban areas, the major injury mechanisms were falls (40.9%), traffic accidents (22.4%), burns (20.9%), and poison (7.1%), whereas, in rural areas, they were falls (39.5%), burns (23.8%), traffic accidents (20.8%), and penetration (7.0%). Over the past decade, the overall incidences of pediatric trauma have been decreasing. In the past year, the number of injured children was the highest in July, and the overall mortality rate due to trauma was 0.8%. CONCLUSION: Our findings revealed that in different age groups, the injury mechanisms are different in urban and rural areas. Burns are the second leading cause of trauma in children. A decrease in pediatric trauma over the past 10 years indicates targeted measures and preventive intervention may effectively prevent pediatric trauma.

Insurance cost and injury characteristics of anterior cruciate ligament injuries in sub-elite football: A population analysis involving 3 years of Australian insurance data.

OBJECTIVES: To investigate the injury characteristics and insurance cost of anterior cruciate ligament injuries in sub-elite football players in New South Wales, Australia. DESIGN: Descriptive epidemiological study. METHODS: Three years of insurance records (2018-2020) was used to describe anterior cruciate ligament injury costs and characteristics. Concomitant injuries and the mechanism of injury were determined by analysing the injury descriptions. Claim characteristics and costs are presented by age group (junior = 7-17 years, senior = 18-34 years, and veteran = 35 + years) and sex. Categorical data (including age-groups and sex) are presented as counts and percentages and analysed using a Chi squared or Fisher's exact test. Cost data are reported as means ±â€¯standard deviation with 95 % confidence intervals. RESULTS: Over the course of three football seasons (2018-2020), 786 anterior cruciate ligament injuries were reported to the injury insurance company. The total insurance cost was AU$3,614,742 with direct injury insurance costs accounting for 36.3 % of the total costs. The mean indirect insurance costs were six-fold higher than direct insurance costs (AU$11,458 vs AU$1914). Isolated injuries had an average cost of $4466 whilst concomitant injuries had an average cost of $4951. Surgical costs are excluded from direct cost calculations. The peak injury count occurred in the first month of all three football seasons, immediately after the pre-season. CONCLUSIONS: Anterior cruciate ligament injuries represent a substantial economic burden to the insurer and individual. The cost data provided can be used for future economic and modelling studies.

Analysis of injury mechanism and thoracic response of elderly, small female PMHS in near-side impact scenarios.

OBJECTIVE: In 2020, 17% of all crash fatalities were individuals aged 65 years or older. Crash data also revealed that for older occupants, thoracic related injuries are among the leading causes of fatality. Historically, the majority of near-side impact postmortem human subjects (PMHS) studies used a generic load wall to capture external loads that were applied to PMHS. While these data were helpful in documenting biofidelity, they did not represent a realistic response an occupant would undergo in a near-side crash. The objective of this research was to test small, elderly female PMHS in a repeatable, realistic near-side impact crash scenario to investigate current injury criteria as they relate to this vulnerable population. METHOD: Ten small, elderly PMHS were subjected to a realistic near-side impact loading condition. The PMHS were targeted to be elderly females age 60+, approximately 5th percentile in height and weight, with osteopenic areal bone mineral density. Each subject was seated on a mass-production seat, equipped with a side airbag and standard three-point restraint with a pretensioner. Other boundary conditions included an intruding driver's side door. PMHS instrumentation included strain gages on ribs 3-10 bilaterally to identify fracture timing. Two chestbands were used to measure chest deflection, one at the level of the axilla and one at the level of the xiphoid process. RESULTS: Injuries observed included rib fractures, particularly on the struck side, and in multiple cases a flail chest was observed. Eight of ten subjects resulted in AIS3+ thoracic injuries, despite previously tested ATDs predicting less than a 10% chance of AIS3+ injury. Subjects crossed the threshold for AIS3 injury in the range of only 1% - 9% chest compression. Additionally, mechanisms of injury varied, as some injuries were incurred by door interactions while others came during airbag interactions. CONCLUSIONS: This research points to two areas of concern that likely require further analysis: (1) the appropriateness of potentially oversimplified PMHS testing to establish injury thresholds and define injury criteria for complicated crash scenarios; (2) the importance of identifying the precise timing of injuries to better understand the effect of current passive restraint systems.

Maintaining soldier musculoskeletal health using personalised digital humans, wearables and/or computer vision.

OBJECTIVES: The physical demands of military service place soldiers at risk of musculoskeletal injuries and are major concerns for military capability. This paper outlines the development new training technologies to prevent and manage these injuries. DESIGN: Narrative review. METHODS: Technologies suitable for integration into next-generation training devices were examined. We considered the capability of technologies to target tissue level mechanics, provide appropriate real-time feedback, and their useability in-the-field. RESULTS: Musculoskeletal tissues' health depends on their functional mechanical environment experienced in military activities, training and rehabilitation. These environments result from the interactions between tissue motion, loading, biology, and morphology. Maintaining health of and/or repairing joint tissues requires targeting the "ideal" in vivo tissue mechanics (i.e., loading and strain), which may be enabled by real-time biofeedback. Recent research has shown that these biofeedback technologies are possible by integrating a patient's personalised digital twin and wireless wearable devices. Personalised digital twins are personalised neuromusculoskeletal rigid body and finite element models that work in real-time by code optimisation and artificial intelligence. Model personalisation is crucial in obtaining physically and physiologically valid predictions. CONCLUSIONS: Recent work has shown that laboratory-quality biomechanical measurements and modelling can be performed outside the laboratory with a small number of wearable sensors or computer vision methods. The next stage is to combine these technologies into well-designed easy to use products.

Spinal injury rates and specific causation in motor vehicle collisions.

Motor vehicle collisions (MVCs) are a leading cause of acute spinal injuries. Chronic spinal pathologies are common in the population. Thus, determining the incidence of different types of spinal injuries due to MVCs and understanding biomechanical mechanism of these injuries is important for distinguishing acute injuries from chronic degenerative disease. This paper describes methods for determining causation of spinal pathologies from MVCs based on rates of injury and analysis of the biomechanics require to produce these injuries. Rates of spinal injuries in MVCs were determined using two distinct methodologies and interpreted using a focused review of salient biomechanical literature. One methodology used incidence data from the Nationwide Emergency Department Sample and exposure data from the Crash Report Sample System supplemented with a telephone survey to estimate total national exposure to MVC. The other used incidence and exposure data from the Crash Investigation Sampling System. Linking the clinical and biomechanical findings yielded several conclusions. First, spinal injuries caused by an MVC are relatively rare (511 injured occupants per 10,000 exposed to an MVC), which is consistent with the biomechanical forces required to generate injury. Second, spinal injury rates increase as impact severity increases, and fractures are more common in higher-severity exposures. Third, the rate of sprain/strain in the cervical spine is greater than in the lumbar spine. Fourth, spinal disc injuries are extremely rare in MVCs (0.01 occupants per 10,000 exposed) and typically occur with concomitant trauma, which is consistent with the biomechanical findings 1) that disc herniations are fatigue injuries caused by cyclic loading, 2) the disc is almost never the first structure to be injured in impact loading unless it is highly flexed and compressed, and 3) that most crashes involve predominantly tensile loading in the spine, which does not cause isolated disc herniations. These biomechanical findings illustrate that determining causation when an MVC occupant presents with disc pathology must be based on the specifics of that presentation and the crash circumstances and, more broadly, that any causation determination must be informed by competent biomechanical analysis.

Repeated measurements of Adaptive Force: Maximal holding capacity differs from other maximal strength parameters and preliminary characteristics for non-professional strength vs. endurance athletes.

The Adaptive Force (AF) reflects the neuromuscular capacity to adapt to external loads during holding muscle actions and is similar to motions in real life and sports. The maximal isometric AF (AFisomax) was considered to be the most relevant parameter and was assumed to have major importance regarding injury mechanisms and the development of musculoskeletal pain. The aim of this study was to investigate the behavior of different torque parameters over the course of 30 repeated maximal AF trials. In addition, maximal holding vs. maximal pushing isometric muscle actions were compared. A side consideration was the behavior of torques in the course of repeated AF actions when comparing strength and endurance athletes. The elbow flexors of n = 12 males (six strength/six endurance athletes, non-professionals) were measured 30 times (120 s rest) using a pneumatic device. Maximal voluntary isometric contraction (MVIC) was measured pre and post. MVIC, AFisomax, and AFmax (maximal torque of one AF measurement) were evaluated regarding different considerations and statistical tests. AFmax and AFisomax declined in the course of 30 trials [slope regression (mean ± standard deviation): AFmax = -0.323 ± 0.263; AFisomax = -0.45 ± 0.45]. The decline from start to end amounted to -12.8% ± 8.3% (p < 0.001) for AFmax and -25.41% ± 26.40% (p < 0.001) for AFisomax. AF parameters declined more in strength vs. endurance athletes. Thereby, strength athletes showed a rather stable decline for AFmax and a plateau formation for AFisomax after 15 trials. In contrast, endurance athletes reduced their AFmax, especially after the first five trials, and remained on a rather similar level for AFisomax. The maximum of AFisomax of all 30 trials amounted 67.67% ± 13.60% of MVIC (p < 0.001, n = 12), supporting the hypothesis of two types of isometric muscle action (holding vs. pushing). The findings provided the first data on the behavior of torque parameters after repeated isometric-eccentric actions and revealed further insights into neuromuscular control strategies. Additionally, they highlight the importance of investigating AF parameters in athletes based on the different behaviors compared to MVIC. This is assumed to be especially relevant regarding injury mechanisms.

When epidemiological databases inform injury mechanisms: biomechanical analysis of injury associations.

BACKGROUND: Vehicle accidents are still a heavy social burden despite improvements due the latest technologies and policies. To pursue the trend of decrease, having a more detailed view and understanding of the injury patterns would contribute to inform both the rescue team to optimize victim's management and policymakers in order for them to tackle at best this issue. METHODS: Two complementary analyses of injury associations were performed, one using a biomechanical classification and the other an anatomic one, computed on data stratified by car accident type (lateral or frontal). Our objective is to understand whether these two categories of crash lead to similar or heterogeneous injury association patterns, and analyze these findings from an impact mechanics point of view. Indeed, having an improved understanding of the injury mechanisms would facilitate their diagnosis and prevention. RESULTS: While each type of accident possesses its own injury profile, most injury associations are found for both types. Injuries such as clavicle and rib fractures were identified as involved in a high number of associations. Several associations between fractures and blood vessel injuries were found. CONCLUSIONS: The results suggests three main conclusions: (i) Injury associations are rather independent from crash characteristics, (ii) Clavicle and rib fractures are typical of poly-traumatized victims, (iii) Certain fractures can be used to early detect victims at higher risk of hemorrhage. Overall, this study provide paramedics and doctors with data to orientate them toward a faster and more appropriate decision. Moreover, this exploratory work revealed the potential that injury association analyses have to inform policy-making and issue recommendations to decrease road accident mortality and morbidity.

Review of Mechanisms and Research Methods for Blunt Ballistic Head Injury.

Head injuries account for 15%-20% of all military injuries and pose a high risk of causing functional disability and fatality. Blunt ballistic impacts are one of the threats that can lead to severe head injuries. This review aims to examine the mechanisms and injury risk assessment associated with blunt ballistic head injury (BBHI). The review further discusses research methods and instrumentation used in BBHI studies, focusing on their limitations and challenges. Studies on the mechanisms of focal and diffuse brain injuries remain largely inconclusive and require further effort. Some studies have attempted to associate BBHIs with head mechanics, but more research is required to establish correlations between head mechanics and injury severity. Limited access to experimental models and a lack of instrumentation capable of measuring the mechanics of brain tissue in situ are potential reasons for the lack of understanding of injury mechanisms, injury correlations, and injury tolerance levels specific to this loading regime. Targeted research for understanding and assessing head injuries in blunt ballistic impacts is a necessary step in improving our ability to design protection systems to mitigate these injuries.

Video Analysis of Pectoralis Major Injuries in Professional Australian Football Players.

Background: There is little evidence regarding the mechanisms of pectoralis major (PM) injury and player outcomes in Australian Football League (AFL) players. Purposes/Hypothesis: The study aims were to investigate (1) the mechanisms of PM muscle injury in elite AFL players via video analysis and (2) the player profile, method of management, and clinical outcomes of the PM injuries sustained. We hypothesized that the majority of PM tears would occur in outer-range PM positions (hyperextension of the glenohumeral joint). Study Design: Case series; Level of evidence, 4. Methods: We analyzed video of the precipitating event for traumatic PM injuries during AFL competition or training over a 20-year period (2002-2021). The footage was analyzed by 4 experienced assessors, and the following were evaluated: mechanism of injury, injury variables (arm position, initial contact point, visual awareness, and use of taping), player characteristics (age at the time of injury, hand dominance, and history of injury), injury profile (location and size of tear), method of management (operative vs nonoperative), patient outcomes (time to return to full senior training/match play), and complication rates. Results: The mean ± standard deviation age of the players was 26.5 ± 3.1 years (range, 21-32 years). Overall, 22 PM injuries were identified in the AFL injury database for a rate of 1.1 per year; 16 of these injuries had accompanying video footage. We identified 3 mechanisms for PM injury: horizontal hyperextension (62.5%), hyperflexion-abduction (25.0%), and horizontal adduction (sustained tackling; 12.5%). The most common site of the tear was the insertion point of the sternocostal head (91.0%). Twenty players (91.0%) required surgical repair, with 75% undergoing surgery within 1 week (range, 0-26 weeks). The mean return to competition for the surgical repair group was 11.1 weeks (range, 8-15 weeks). The rerupture rate was 5.0% (1 repair; <4 weeks postoperatively in 2004). Conclusion: PM tears in elite male AFL players were due to 1 of 3 distinct mechanisms: horizontal hyperextension, hyperflexion-abduction, and horizontal adduction (sustained tackling). Players returned to play on average 11 weeks after injury. Knowledge regarding mechanisms of injury, player profile, and return-to-sport timelines is important for appropriate medical management and provides potential areas to target for prevention of PM injuries.

Effects of a soccer-specific vertical jump on lower extremity landing kinematics.

Anterior cruciate ligament (ACL) injury frequently occurs in female soccer athletes during deceleration movements such as landings. In soccer, landings mostly occur following jumping headers. Little research has been done to determine the mechanics that follow and how they compare to standard drop vertical jumps (DVJ). The purpose of this study was to analyze differences in kinematics between the DVJ and the soccer-specific vertical jump (SSVJ) in female soccer athletes to better assess the sport-specific risk for ACL injury. A secondary aim was to compare second landings (L2) to first landings (L1). Eight female recreational soccer athletes performed DVJs and SSVJs initiated from a 31 â€‹cm height. Motion capture was performed during landings and data were analyzed using repeated-measures ANOVA. SSVJs produced less peak hip flexion (p â€‹= â€‹0.03) and less peak knee flexion (p â€‹= â€‹0.002) than DVJs. SSVJs also demonstrated increased ankle plantarflexion at initial contact (IC) than DVJs (p â€‹= â€‹0.005). L2s produced less peak hip (p â€‹= â€‹0.007) and knee flexion (p â€‹= â€‹0.002) than L1s. SSVJs and L2s displayed a more erect landing posture than the DVJs and L1s at the hip and knee, a known ACL risk factor. The significant results between jump styles show that the SSVJ displays mechanics that are different from the DVJ. The SSVJ may be a better sport-specific screening tool for ACL injury mechanisms than the DVJ in soccer athletes as it has a more direct translation to the sport.

The Use of Wearable Sensors for Preventing, Assessing, and Informing Recovery from Sport-Related Musculoskeletal Injuries: A Systematic Scoping Review.

Wearable technologies are often indicated as tools that can enable the in-field collection of quantitative biomechanical data, unobtrusively, for extended periods of time, and with few spatial limitations. Despite many claims about their potential for impact in the area of injury prevention and management, there seems to be little attention to grounding this potential in biomechanical research linking quantities from wearables to musculoskeletal injuries, and to assessing the readiness of these biomechanical approaches for being implemented in real practice. We performed a systematic scoping review to characterise and critically analyse the state of the art of research using wearable technologies to study musculoskeletal injuries in sport from a biomechanical perspective. A total of 4952 articles were retrieved from the Web of Science, Scopus, and PubMed databases; 165 were included. Multiple study features-such as research design, scope, experimental settings, and applied context-were summarised and assessed. We also proposed an injury-research readiness classification tool to gauge the maturity of biomechanical approaches using wearables. Five main conclusions emerged from this review, which we used as a springboard to propose guidelines and good practices for future research and dissemination in the field.

Adding to the story, did penetrating trauma really increase? changes in trauma patterns during the COVID-19 pandemic: A multi-institutional, multi-region investigation.

BACKGROUND: Results from single-region studies suggest that stay at home orders (SAHOs) had unforeseen consequences on the volume and patterns of traumatic injury during the initial months of the Coronavirus disease 2019 (COVID-19). The aim of this study was to describe, using a multi-regional approach, the effects of COVID-19 SAHOs on trauma volume and patterns of traumatic injury in the US. METHODS: A retrospective cohort study was performed at four verified Level I trauma centers spanning three geographical regions across the United States (US). The study period spanned from April 1, 2020 - July 31, 2020 including a month-matched 2019 cohort. Patients were categorized into pre-COVID-19 (PCOV19) and first COVID-19 surge (FCOV19S) cohorts. Patient demographic, injury, and outcome data were collected via Trauma Registry queries. Univariate and multivariate analyses were performed. RESULTS: A total 5,616 patients presented to participating study centers during the PCOV19 (2,916) and FCOV19S (2,700) study periods.  Blunt injury volume decreased (p = 0.006) due to a significant reduction in the number of motor vehicle collisions (MVCs) (p = 0.003). Penetrating trauma experienced a significant increase, 8% (246/2916) in 2019 to 11% (285/2,700) in 2020 (p = 0.007), which was associated with study site (p = 0.002), not SAHOs. Finally, study site was significantly associated with changes in nearly all injury mechanisms, whereas SAHOs accounted for observed decreases in calculated weekly averages of blunt injuries (p < 0.02) and MVCs (p = 0.003). CONCLUSION: Results of this study suggest that COVID-19 and initial SAHOs had variable consequences on patterns of traumatic injury, and that region-specific shifts in traumatic injury ensued during initial SAHOs. These results suggest that other factors, potentially socioeconomic or cultural, confound trauma volumes and types arising from SAHOs. Future analyses must consider how regional changes may be obscured with pooled cohorts, and focus on characterizing community-level changes to aid municipal preparation for future similar events.

Traumatic Hip Dislocations in Major Trauma Patients: Epidemiology, Injury Mechanisms, and Concomitant Injuries.

INTRODUCTION: Traumatic hip dislocations (THDs) are severe injuries associated with considerable morbidity. Delayed recognition of fracture dislocations and neurovascular deficits have been proposed to cause deleterious long-term clinical outcomes. Therefore, in this study, we aimed to identify characteristics of epidemiology, injury mechanisms, and associated injuries to identify patients at risk. METHODS: For this study based on the TraumaRegister DGU® (January 2002-December 2017), the inclusion criterion was an Injury Severity Score (ISS) ≥9 points. Exclusion criteria were an isolated head injury and early transfer to another hospital. The THD group was compared to a control group without hip dislocation. The ISS and New ISS were used for injury severity and the Abbreviated Injury Scale for associated injuries classification. Univariate and logistic regression analyses were performed. RESULTS: The final study cohort comprised n = 170,934 major trauma patients. We identified 1359 individuals (0.8%) with THD; 12 patients had sustained bilateral hip dislocations. Patients with THD were predominantly male (79.5%, mean age 43 years, mean ISS 22.4 points). Aortic injuries (2.1% vs. 0.9%, p ≤ 0.001) were observed more frequently in the THD group. Among the predictors for THDs were specific injury mechanisms, including motor vehicle accidents (odds ratio (OR) 2.98, 95% confidence interval (CI) 2.57-3.45, p ≤ 0.001), motorcycle accidents (OR 1.99, 95% CI 1.66-2.39, p ≤ 0.001), and suicide attempts (OR 1.36, 95% CI 1.06-1.75, p = 0.016). Despite a lower rate of head injuries and a comparable level of care measured by trauma center admission, both intensive care unit and total hospital stay were prolonged in patients with THD. CONCLUSIONS: Since early diagnosis, as well as timely and sufficient treatment, of THDs are of high relevance for long-term outcomes of severely injured individuals, knowledge of patients at risk for this injury pattern is of utmost importance. THDs are frequently related to high-energy mechanisms and associated with severe concomitant injuries in major trauma patients.

The Safe Landing warm up technique modification programme: An effective anterior cruciate ligament injury mitigation strategy to improve cutting and jump-movement quality in soccer players.

The objective of the study was to evaluate the effectiveness of the Safe Landing (SL), a 6-week technique-modification (TM) programme, on cutting and jump-landing movement quality in football players. In a non-randomized design, 32 male semi-professional football players from two Spanish clubs participated in the study: one served as the control group (CG, n = 11), while the other performed the SL (n = 15). Performance and movement quality of drop vertical jump and 70º change of direction (COD70) were evaluated through 2D video footage pre- and post-intervention. In such tasks, the Landing Error Scoring System for first (LESS1) and second (LESS2) landings, and the Cutting Movement Assessment Score (CMAS) were used for assessing movement quality. Pre-to-post changes and baseline-adjusted ANCOVA were used. Medium-to-large differences between groups at post-test were shown in CMAS, LESS1 and LESS2 (p < 0.082, Õ²2 = 0.137-0.272), with small-to-large improvements in SL (p < 0.046, ES=0.546-1.307), and CG remaining unchanged (p > 0.05) pre-to-post. In COD70 performance, large differences were found between groups (p < 0.047, Õ²2 = 0.160-0.253), with SL maintaining performance (p > 0.05, ES=0.039-0.420), while CG moderately decreasing performance (p = 0.024, ES=0.753) pre-to-post. The SL is a feasible and effective TM program to improve movement quality and thus potential injury risk in cutting and landing, while not negatively affecting performance.

Ski-geometric parameters do not differ between ACL injury mechanisms in recreational alpine skiing.

PURPOSE: It is not known so far if ski-equipment-related factors differ between the ACL injury mechanisms, potentially influencing the circumstances and causes of falling, finally resulting in ACL injury. More specifically focusing on the injury mechanisms will provide a deeper understanding of injury causation. The aim of the study was to evaluate whether ACL injury mechanisms in recreational alpine skiing differ with regard to ski-geometric parameters, self-reported circumstances and causes of accident and injury severity. METHODS: Among a cohort of 392 ACL-injured (57.9% females) skiers, age, sex, height, weight, skill level, risk-taking behavior, circumstances and causes of accident, and ACL injury severity were collected by questionnaire. Additionally, patients had to recall their type of fall (ACL injury mechanism) by classifying forward and backward falls with and without body rotation. Ski length, side cut radius and widths of the tip, waist and tail were directly notated from the ski. RESULTS: The forward fall with body rotation was the most common reported ACL injury mechanism (63%). A riskier behavior was associated with forward falls without body rotation. Ski-geometric parameters did not significantly influence the type of ACL injury mechanism. Regarding accident characteristics, catching an edge of the ski was more frequent (p < 0.001) the cause for forward falls (75% and 67%) when compared to the backward falls (46 and 15%) and executing a turn was the most frequent action in all falls (39-68%). A complete rupture of the ACL (66-70%) was more commonly reported than a partial tear (30-34%) among all four non-contact ACL injury mechanisms (n.s.). CONCLUSION: In contrast to risk-taking behavior and accident characteristics, ski-geometric parameters and injury severity do not significantly differ between ACL injury mechanisms in recreational skiing. Thus, an individual skiing style seems to have more impact on ACL injury mechanisms than ski equipment. Future studies should evaluate potential effects of ski geometry on the incidence of ACL injury. LEVEL OF EVIDENCE: III.