Injuries in high school sports.

A two-year study was made of injuries received in high school sports. Athletic trainers were placed in four high schools to conduct the investigation. Injuries occurred in women's sports at a rate of 22 per 100 participants; men's injuries occurred at a rate of 39 per 100 participants. Football and wrestling accounted for the highest injury rates; tennis and swimming accounted for the lowest rates for both sexes.

Healing of electrosurgical and scalpel wounds in rabbits.

Skin wounds in rabbits were tested after healing periods of up to three weeks to determine if scalpel wounds differed from those made electrosurgically. Tensile tests showed that the electrosurgical wounds were initially stronger, but at four days there was no difference. Thereafter the scalpel wounds were stronger and their healing progressed much faster. Histological preparations showed more extensive inflammation and necrosis in the electrosurgical wounds.

Non-operative treatment of the torn anterior cruciate ligament.

The purpose of this study was to assess and describe the status of twenty-four patients with a diagnosed tear of the anterior cruciate ligament who participated in a non-operative program of rehabilitation emphasizing strengthening of the hamstrings. The knees were evaluated by testing stability, strength, and range of motion; by roentgenographic examination; and by the patient's level of participation in sports. The patient's uninjured knee was used for comparison. The results showed a high incidence of anterior instability, but no significant differences in degenerative changes or range of motion. All patients returned to some sports participation, with fourteen (59 per cent) returning to their full preinjury level of participation. Higher levels of sports participation were found in the patients whose hamstrings strength was equal to or more than their quadriceps strength.

Orthopedic preparticipation screening examination.

The primary care physician is often called upon to perform a medical examination before the patient may participate in athletic activities. The examination should identify congenital and acquired musculoskeletal problems and the residuals of previous musculoskeletal injuries. This article and its illustrations show the steps of an orthopedic preparticipation screening examination and indicate how some problems may be identified.

Sports medicine.

A product of the recent physical fitness boom has been an increased demand for better care of sport and recreational injuries. This article gives an overview of the care available for such injuries. In addition, it also cautions against the kind of care that will only produce noncompliance in the pediatric patient.

A review of the use of prophylactic knee braces in football.

A review of nine studies of prophylactic knee braces worn by players in American tackle football lends some support for the use of double-hinged braces at the high-school level. Evidence for their use at the college level seems less persuasive. Caution should be exercised in interpreting these studies owing to the probable presence of bias and confounding variables and to difficulty in generalizing results beyond the study populations. The two studies that assigned braces randomly found lower injury rates for knees and knee ligaments among high-school and high-school size players. Conversely, a large, multiteam collegiate study found a significantly higher rate of knee injuries among brace users, a difference that remained when controlled for position, skill, and previous injury.

Injury patterns in children and adolescent skiers.

Over 3,500 students from five major high schools in the Seattle metropolitan area were studied as to skiing injuries. Each had skiied an average of 13.3 days. The average age of t'he group was 13.5 years, the ages ranging from 3 to 19 years. The students 10 years and under had the lowest incidence of injuries, those aged 11 to 14 years had the highest over-all injury rates, and the group 15 years of age and over laid midway between these two groups in injury rate. There was no evidence in the study that the open physis led to a higher incidence of epiphyseal injuries. The knee was more commonly involved than the ankle, and sprains, contusions, and fractures followed in that order as far as injury rates were concerned. The female was more prone to injury than the male. Skiiers with greater ability had fewer injuries than those with less skill in this particular sport.

The functional treatment of a third proximal phalanx fracture.

Aggressive, cool soaks, and buddy taping with thoughtful frequent followups allowed this patient to return to competition safely with full function in a remarkably short period of time. Similar treatment to some soft tissue injuries of the hand and other stable fractures have been done with equal success.

Prophylactic knee bracing.

Six studies to determine the effectiveness of prophylactic knee braces in preventing medial collateral ligament (MCL) injury in football are compared. Criteria useful in evaluating studies are discussed, such as the probability of confounding factors, bias in selecting cases and controls, and variations in defining injury and exposure. Cost, as well as some ethical issues associated with mandated use are discussed. While four of these studies found a reduction in MCL injuries associated with using a brace, two of them reported increases. No consensus arises from these studies, conflicting results as well as methodological problems in some make it impossible to state with assurance the role of prophylactic knee bracing in football at this time.

Ballet injuries. An analysis of epidemiology and financial outcome.

The financial outcome and epidemiology of ballet dancers' injuries were studied by examining workers' compensation insurance records covering 3 seasons (3 years) of activity for a large professional ballet company. One hundred four dancers sustained 309 injuries that resulted in insurance payouts for medical costs of $398,396. The average cost per injury was $1289. Although only 4.2% of the injuries resulted in medical costs exceeding $5000, these represented 60.0% of the total medical costs. Nine injuries resulted in medical costs in excess of $10,000 each. Overall, there were 2.97 injuries per injured dancer. Twenty-four dancers (23.0% of the injured) sustained 5 or more injuries each and thus were responsible for 51.9% (161) of all injuries. The foot (74 injuries, 23.9%), lumbar spine (71, 23.0%), and ankle (41, 13.3%) were the most frequently injured anatomic regions. The experience of this ballet company is similar to that of a college athletic department or a professional sports team. All could employ similar strategies to reduce injuries and associated costs.

Prophylactic knee bracing.

Six studies to determine the effectiveness of prophylactic knee braces in preventing medial collateral ligament (MCL) injury in football are compared. Criteria useful in evaluating studies are discussed, such as the probability of confounding factors, bias in selecting cases and controls, and variations in defining injury and exposure. Cost, as well as some ethical issues associated with mandated use are discussed. While four of these studies found a reduction in MCL injuries associated with using a brace, two of them reported increases. No consensus arises from these studies, conflicting results as well as methodological problems in some make it impossible to state with assurance the role of prophylactic knee bracing in football at this time.

Medial collateral ligament injuries in football. Nonoperative management of grade I and grade II sprains.

During four academic years (1974-1978) at a major university, 51 of 70 knee injuries sustained by football players were Grade I or II sprains of the medial collateral ligament of the knee. All were managed identically with an active rehabilitation program involving partial or no immobilization. Players with Grade I sprains returned to full, unprotected participation after an average of 10.6 days of time loss; those with Grade II sprains returned after 19.5 days. Neither group showed an appreciably increased likelihood of reinjury. The likelihood of sustaining any knee injury was more than three times greater during spring as opposed to fall football.

Epidemiology of women's gymnastics injuries.

Injury information from 98 participants in 2 years of interscholastic women's gymnastics competition in four Seattle area high schools was collected by certified athletic trainers. During the 2nd year of data collection, the study was expanded to include an additional 12-team high school league, 2 college teams, and 3 private clubs. A wide variety of injuries was observed, the total time loss injury rate was 39.8 injuries per 100 participant-seasons. Strains and sprains involving the back, particularly the lumbar region, appeared to occur more frequently than in most other interscholastic athletic activities. Ankle sprains were also common, and a relatively high frequency of thigh and leg strains and overuse problems of the leg were seen. This suggests that there may well be room for improvement in conditioning and other preventive programs in women's gymnastics.

Thoracic outlet compression in athletes a report of four cases.

Four cases of thoracic outlet compression have been presented. The occurrence of this syndrome in athletes has not to our knowledge been previously reported. We do not feel eliminating athletic participation is a viable option for our patients. We have been satisfied with nonoperative treatment but would not hestitate offering surgery if indicated, since most authors have had good results in those who have failed conservative care. Thoracic outlet compression should be considered in all patients with upper extremity pain including athletes.

The epidemiology of aerobic dance injuries.

Aerobic dance is currently the largest organized fitness activity primarily for women in the United States. In an attempt to identify and characterize the health problems associated with it, 351 students and 60 instructors from six facilities were followed for 16 weeks with weekly telephone calls. Of the 327 medical complaints reported during 29,924 hours of documented activity, only 84 (0.28 per hundred hours) resulted in any disability and only 2.1% required medical care. The shin/leg, foot and ankle accounted for nearly two-thirds of the injuries. Instructors were twice as likely to be injured as students. Both a history of prior orthopaedic problems and a lack of involvement in other fitness activities resulted in higher injury rates. Injury rates were influenced by the design and conduct of the aerobic program but not by brand of shoe or type of flooring. Aerobic dance appears to offer students the potential for fitness enhancement with a minimal risk of injury.

Disability days in major league baseball.

We have examined the injury experience in Major League Baseball as reflected by the disabled list, based on data presented by American Specialty Companies in their publications, to examine any changes in injury rates over the past 11 years. It is reasonable to expect that improvements in training and conditioning, diagnostic methods, and surgical treatment over the last 11 years would have reduced injuries and resulted in fewer players on the disabled list. Yet, such does not appear to be the case. There is no evidence that the number of injuries in Major League Baseball has declined over the last decade; on the contrary, it appears that both the number of players and player days on the disabled list have increased. Team membership, injury location, and position do not appear to be related to the increase. Nor does it appear that the increase in injuries is a result of more sensitive diagnostic tests allowing the diagnoses of previously unrecognized injuries. Whatever the reason, it is significant that publicly available data, when viewed over an 11-year period, reveal a gradual and consistent increase in reported injuries--suggesting a problem that deserves attention.

Injuries in recreational adult fitness activities.

Volunteers (986) from fitness clubs and studios were recruited and followed for a 3-month period to document the injury consequences of adult recreational fitness participation. Participants were telephoned each week and their activities as well as any injuries that occurred were recorded. Of the 525 injuries and complaints reported during 60,629 hours of activity, 475 occurred as a result of sports participation for an overall rate of 7.83 per 1000 hours of participation. Seventy-six percent of these episodes caused the patient to alter or miss 1 or more activities, while 9.5% involved a physician visit. The rate for time-loss injuries was less than 2 per person per year (1.76 per 298 hours) or 5.92 per 1000 hours. Running had a higher risk of injury compared with most other individual sports. Cardiovascular fitness activities had low to medium rates, as did weight work; competitive sports were higher. For 6 of the most commonly injured areas, the reinjury rate was about twice that reported for those with no history of previous injury. The risks of injury from most recreational fitness activities were relatively modest, particularly if the activities were not competitive. Physicians might help patients reduce their risks of injury by encouraging suitable activities and by reducing the risks of reinjury by implementing appropriate rehabilitation programs.

Injuries to pitchers in women's collegiate fast-pitch softball.

An injury survey of eight college softball teams ranked among the top 15 during the 1989 women's NCAA tournament championship by their athletic trainers found 26 injuries and complaints in 20 of 24 players. There were 15 grade I (nontime-loss) injuries, all musculotendinous except for a leg contusion and an ankle sprain. The 6 grade II injuries (altered play) were also musculotendinous except for 2 sprains to the hand and wrist. The 5 grade III (stopped play) injuries were somewhat more varied in type and resulted in an average of almost 7 weeks of time lost per injured player. Eighty-two percent of the time-loss injuries (grades II and III) involved the upper extremity. This survey suggests that there are likely to be a significant number of injuries involving loss of time from practice or games among elite women's fast-pitch softball pitchers.

Injuries in the 1987 national amateur volleyball tournament.

In a prospective study of injuries in the 1987 United States Volleyball Association's national tournament, we found 154 injuries in 1520 participants during 7812 hours of play. The injury rate in this study was 1.97/100 hours of play. Before the tournament, the participants' history was taken, and during the week of participation, records were kept of every player who presented with an injury. Players ranged in age from 17 to 60 and competed in five age/gender groups. Females had an injury rate of 2.3 and males had an injury rate of 1.7. The highest injury rate was seen in the men's open division, ages 17 to 35 (2.7), and the lowest rate was seen in the men's Golden Masters, ages 46 and up (1.5). Seventy-nine percent of the injuries occurred during the tournament and 21% were considered to be chronic injuries with an acute exacerbation. The upper extremities accounted for 20% of the injuries. The ankle (17.6%), low back (14.2%), and knee (11%) were the most common injury sites. Strains (36%) and sprains (28%) were the most frequent types of injury. Only eight (5.2%) injuries resulted in more than 5 days of time loss. Two of these injuries involved the knee and two others required surgery. It is likely that in studies relying upon retrospective methods, fewer of the less severe injuries are found, thereby leading to an overestimation of the percentages of knee and ankle injuries and the proportion of severe injuries. The clinician contemplating providing care for a high-level tournament should expect a preponderance of minor injuries occurring in a variety of anatomical locations.(ABSTRACT TRUNCATED AT 250 WORDS)

Noncontact anterior cruciate ligament injuries: risk factors and prevention strategies.

An estimated 80,000 anterior cruciate ligament (ACL) tears occur annually in the United States. The highest incidence is in individuals 15 to 25 years old who participate in pivoting sports. With an estimated cost for these injuries of almost a billion dollars per year, the ability to identify risk factors and develop prevention strategies has widespread health and fiscal importance. Seventy percent of ACL injuries occur in noncontact situations. The risk factors for non-contact ACL injuries fall into four distinct categories: environmental, anatomic, hormonal, and biomechanical. Early data on existing neuromuscular training programs suggest that enhancing body control may decrease ACL injuries in women. Further investigation is needed prior to instituting prevention programs related to the other risk factors.