Background:
There is a paucity of current data regarding the sport-specific injury patterns and epidemiological trends associated with volleyball.
Purpose:
To provide an updated, comparative ...assessment of the epidemiology of volleyball-related injuries among female high school– and college-aged athletes and to characterize the burden of these injuries on emergency departments (EDs) across the United States.
Study Design:
Descriptive epidemiological study.
Methods:
Data were obtained from the National Electronic Injury Surveillance System for volleyball-related injuries between 2012 and 2021 in high school–aged (14-18 years) and college-aged (19-23 years) patients. Incidence, injury characteristics, incident locales, and dispositions were analyzed with weighted population statistics based on National Federation of State High School Associations and National Collegiate Athletic Association data as well as incidence rates and incidence rate ratios (IRRs) and 95% CIs.
Results:
In total, an estimated 214,302 female athletes aged 14 to 23 years were evaluated in EDs across the United States with volleyball-related injuries between 2012 and 2021. Female college-aged athletes were nearly 3 times more likely to be evaluated with these injuries than their high school–aged counterparts, with incidence rates of 12.8 per 100 at-risk individuals among college-aged athletes and 4.3 per 100 at-risk individuals in high school–aged athletes (IRR, 0.338; 95% CI, 0.333-0.342). The ankle, head, and knee were most frequently injured, often involving strains/sprains, contusions, fractures, and concussions. The IRRs of nearly all injuries were higher among collegiate athletes, especially among knee (IRR, 4.56; 95% CI, 4.40-4.72) and shoulder (IRR, 5.07; 95% CI, 4.81-5.35) injuries.
Conclusion:
Among volleyball-related injuries evaluated in EDs between 2012 and 2021, the incidence rates of injuries in college-aged athletes far surpassed those of their high school–aged peers irrespective of injury type or bodily location. While sprains and strains were the most frequent injuries, head injuries accounted for the second most common diagnosis in both groups, suggesting that clinicians should maintain a high index of suspicion for concussion when evaluating players.
Background
This review discusses success, time to healing, and complications of bone morphogenic proteins (BMPs) 7 and 2 in treating upper extremity nonunions.
Methods
Systematic review identified 26 ...of 479 studies that met inclusion criteria. Publications described application of BMPs to acute and chronic upper extremity delayed unions/nonunions. Unions, complications, patient demographics, and fracture/healing patterns were pooled and analyzed.
Results
Nonunions treated with BMP-7 (n=302) involved the humerus (64%), forearm (22%), clavicle (11%), and hand/wrist (3%), with prior surgical correction attempted in 84%. Nonunions treated with BMP-2 (n=96) involved the humerus (58%), hand/wrist (27%), forearm (14%), and clavicle (1%), with prior surgical correction attempted in all. Most nonunions (80%) were present for over 12 months before BMP application. Union rates of BMP-7 varied according to site: hand/wrist (95%), humerus (74%), forearm (29%), and clavicle (6.2%) nonunions achieved union as defined by study authors in 232 days (confidence interval=96-369, Q<0.001) on average. While not significant across studies, BMP-2 union rates were 71% of hand/wrist and 75% of humerus nonunions. Comparison of the BMPs demonstrates different proportions of success in humerus and hand/wrist fractures (P<.001) but not forearm fractures (P<.77) and longer time to radiographic union with BMP-7 (P<.011).
Conclusions
Most hand/wrist and humerus nonunions treated with BMP-7 and BMP-2 achieved union, with significant similarity among BMP-7 studies not observed in BMP-2 studies. Nonunions treated with BMP-7 have longer healing times yet similar complication rates compared with BMP-2. Overall, BMPs are an effective adjunct to fracture healing with acceptable complication profile.
To evaluate the reliability of the “perfect-circle” methodology for measurement of glenoid bone loss with magnetic resonance imaging (MRI) in patients with posterior glenohumeral instability.
A ...prospective chart review was performed on patients who underwent isolated arthroscopic posterior labral repairs in our institution’s electronic medical records between January 1, 2021, and June 30, 2021. Inclusion criteria included isolated posterior shoulder instability with posterior labral repair and corroborated tears on MRI. A total of 9 raters, either sports or shoulder and elbow fellowship-trained orthopaedic surgeons, each evaluated the affected shoulder MRI scans twice, at over 2 weeks apart. Measurements followed the “perfect-circle” technique and included projected anterior-to-posterior (AP) glenoid diameter, amount of posterior bone loss, and percentage of posterior bone loss.
Ten consecutive patients between the ages of 17 and 46 years with diagnosed posterior glenohumeral instability were selected. The average age was 28 ± 10 years, and 60% of patients were male. The patient’s dominant arm was affected in 40%, and 50% of cases involved the right shoulder. The average glenoid diameter was 29.62 ± 3.69 mm, and the average measured bone loss was 2.8 ± 1.74 mm. The average percent posterior glenoid bone loss was 9.41 ± 5.78%. The inter-rater reliability was poor for the AP diameter and for the posterior glenoid bone loss with intraclass correlation coefficients at 0.30 (0.12-0.62) and 0.22 (0.07-0.54) respectively. The intrarater reliability was poor for AP diameter and moderate for posterior glenoid bone loss, with intraclass correlation coefficients at 0.41 (0.22-0.57) and 0.50 (0.33-0.64), respectively.
Using the “perfect-circle” technique for evaluating posterior glenohumeral bone loss has poor-to-moderate inter- and intrarater reliability from MRI.
Level IV, prospective diagnostic study.
Background:
Glenohumeral instability represents a common cause of shoulder pain and disability among active-duty members of the military and is associated with the development of glenoid ...osteochondral defects.
Purpose:
To report clinical outcomes and survivorship after combined microfracture of isolated chondral lesions of the glenoid and labral repair among young, active-duty military patients and to compare outcomes with those of patients who underwent isolated shoulder stabilization.
Study Design:
Cohort study; Level of evidence, 3.
Methods:
Included were 31 active-duty military patients aged <40 years who underwent simultaneous microfracture of chondral lesions of the glenoid and labral repair for shoulder instability between January 2011 and January 2017 (microfracture group) and 209 patients without chondral defects who underwent shoulder stabilization during the same time period (instability group). Preoperative and 5-year postoperative outcomes (range of motion ROM, visual analog scale VAS for pain, Single Assessment Numeric Evaluation SANE score, American Shoulder and Elbow Surgeons ASES shoulder score, and Rowe instability score) were compared within and between groups, and separate subgroup analyses were performed to determine whether variant of instability and dominant-shoulder involvement were associated with worse outcomes.
Results:
The mean follow-up was significantly longer for the microfracture group versus the instability group (95.58 ± 23.12 vs 83.38 ± 25.93 months; P = .014). Age and sex distributions were similar between groups. In both groups, there was significant pre- to postoperative improvement on all outcomes scores (P = .0001 for all). When compared with the instability cohort, microfracture patients had significantly worse postoperative VAS pain (2.65 ± 1.78 vs 1.55 ± 1.92; P = .003), SANE (79.13 ± 14.43 vs 91.23 ± 13.20; P < .0001), and ASES (79.90 ± 13.87 vs 89.03 ± 14.28; P = .001) scores, as well as decreased ROM in forward flexion (151.29° ± 11.76° vs 155.48° ± 10.3°; P = .039) and external rotation (63.65° ± 8.34° vs 65.17° ± 0.64°; P = .010). At latest follow-up, 58% of microfracture patients had returned to active-duty military service compared with 93.78% of isolated instability patients (P < .0001).
Conclusion:
Combined microfracture and arthroscopic labral repair produced modest, albeit statistically significant, improvements in patient-reported outcome measures and may be a reasonable treatment option for patients with chondral lesions who are not candidates for arthroplasty. However, microfracture patients had significantly worse outcomes than patients who underwent stabilization without concomitant chondral defects.
Background:
The surgical management of type II superior labrum anterior and posterior (SLAP) tears in patients younger than 40 years is controversial, but growing evidence suggests comparable ...outcomes between primary SLAP repair and primary biceps tenodesis, with lower rates of reoperations after primary biceps tenodesis. Given the relatively similar patient-reported outcomes, cost-effectiveness analyses of direct and indirect costs associated with the two procedures propound a valuable comparative technique.
Hypothesis:
In this value-based comparison of SLAP repair versus biceps tenodesis, we hypothesized that biceps tenodesis would be more cost-effective than SLAP repair in patients younger than 40 years.
Study Design:
Economic and decision analysis; Level of evidence, 4.
Methods:
A 1-month Markov cycle was simulated to reflect 10 years of health outcomes. Health states were selected based on outcomes that are especially important in assessing indirect costs for a younger, active patient population: return-to-sport rates, which demonstrate a return to baseline function, and reoperation rates. Transition state probabilities were obtained through an index systematic review and meta-analysis comparing labral repair and biceps tenodesis for the treatment of type II SLAP lesions in patients younger than 40 years. Health state utility and cost values were obtained from accepted values denoted in existing literature.
Results:
Both primary SLAP repair and primary biceps tenodesis yielded an average expected 8.1 quality-adjusted life years over the 10-year period. The average cost (in 2021 US$) was $16,619 for biceps tenodesis and $19,388 for SLAP repair.
Conclusion:
In a younger patient population, SLAP repair and biceps tenodesis had comparable quality-adjusted life years and utility in the treatment of type II SLAP tears; however, SLAP repair cost $19,388, while biceps tenodesis cost $16,619, reflecting a 14% cost savings with biceps tenodesis. These findings can be extrapolated to further establish the role for these procedures in treating SLAP tears.
Minimizing pauses in chest compressions during cardiopulmonary resuscitation (CPR) is recommended by the American Heart Association (AHA) and is associated with improved patient outcomes. We studied ...the quality of pediatric CPR performed in a tertiary pediatric emergency department (ED) with a focus on pauses in chest compressions.
We conducted an observational study of CPR quality in two pediatric EDs using video review during pediatric cardiac arrest. Events were reviewed for AHA guideline adherence. Parameters of CPR performance were described according to individual compressor segment. Pauses in compressions were analyzed for duration and pause activities.
From a 30-month period, 81 cardiac arrests were analyzed, including 1003 individual compressor segments and 900 pauses. Median chest compression fraction was 91%, with a median pause duration of 4 s (IQR 2, 10); 22% of pauses were prolonged (>10 s). Pulse checks occurred in 23% of pauses; 62% were prolonged. Checking a single pulse site (p < 0.001) and having fingers ready pre-pause (p = 0. 001) were associated with significantly shorter pause duration. Pause duration was correlated with the number of pause tasks (r = 0.559, p < 0.001). “Coordinated pauses” (pulse check, rhythm check and compressor change) were rare (6%) and long in duration (19 s; IQR 11, 30).
Prolonged pauses in chest compressions occurred frequently during CPR and were associated with pulse checks and multiple simultaneous tasks. Checking a single pulse site with fingers ready on the pulse site pre-pause could decrease pause duration and improve CPR quality.
To report mid-term outcomes of active-duty patients younger than the age of 35 years with shoulder type II SLAP lesions following our technique for double-pulley SLAP repair (DPSR).
All consecutive ...patients aged 18 to 35 years from January 2014 through December 2015 who underwent primary DPSR by the senior surgeon with complete outcome scores were identified. The clinical significance measures (patient acceptable symptomatic state PASS, substantial clinical benefit SCB, minimal clinically important difference MCID) have not yet been fully defined for type II SLAP repair procedures, so the values for biceps tenodesis were used as a stand-in. Patients were excluded if they were lost to follow-up of if they underwent a concomitant rotator cuff repair. Outcome measures were completed by patients within 1 week before surgery and at latest follow-up.
Overall, 22 of 41 (53.7%) patients met the inclusion criteria for the study, and all were active-duty military at time of surgery. In total, 21 of 22 (95.5%) patients met the PASS, whereas 20 of 22 (90.9%) achieved SCB and 22 of 22 (100.0%) exceeded the MCID for their operative shoulder as determined by the American Shoulder and Elbow Surgeons score. In total, 19 of 22 (86.4%) patients met the PASS, whereas 22 of 22 (100.0%) achieved SCB and exceeded the MCID for their operative shoulder as determined by the Single Assessment Numeric Evaluation. In addition, 21 of 22 (95.5%) met the PASS, whereas 22 of 22 (100%) achieved SCB and exceeded the MCID for their operative shoulder as determined by the pain visual analog scale. Pre- and postoperative range of motion did not vary significantly. In total, 18 of 22 (81.8%) of patients remained on active duty and were able to return to preinjury work and recreation activity levels. In 2 patients (9.09%), the repair did not heal.
Mid-term outcomes in this population of young, active-duty patients undergoing DPSR for type II SLAP tears demonstrate a statistically and clinically significant improvement in patient-reported outcomes and an overall return to active-duty rate of 81.8%.
Level IV, therapeutic case series.
•A new framework MxDRNN learns the feature robust to category-irrelevant attributes.•Proposed MxDRNN can be used as end-to-end learning, or post- network component for existing networks.•Proposed ...MxDRNN achieves superior results on eight datasets from five different fields.•Few (if any) existing studies deployed the RNN framework to unordered intra-class images for classification.
With the rapid development of image acquisition and storage, multiple images per class are commonly available for computer vision tasks (e.g., face recognition, object detection, medical imaging, etc.). Recently, the recurrent neural network (RNN) has been widely integrated with convolutional neural networks (CNN) to perform image classification on ordered (sequential) data. In this paper, by permutating multiple images as multiple dummy orders, we generalize the ordered “RNN+CNN” design (longitudinal) to a novel unordered fashion, called Multi-path x-D Recurrent Neural Network (MxDRNN) for image classification. To the best of our knowledge, few (if any) existing studies have deployed the RNN framework to unordered intra-class images to leverage classification performance. Specifically, multiple learning paths are introduced in the MxDRNN to extract discriminative features by permutating input dummy orders. Eight datasets from five different fields (MNIST, 3D-MNIST, CIFAR, VGGFace2, and lung screening computed tomography) are included to evaluate the performance of our method. The proposed MxDRNN improves the baseline performance by a large margin across the different application fields (e.g., accuracy from 46.40% to 76.54% in VGGFace2 test pose set, AUC from 0.7418 to 0.8162 in NLST lung dataset). Additionally, empirical experiments show the MxDRNN is more robust to category-irrelevant attributes (e.g., expression, pose in face images), which may introduce difficulties for image classification and algorithm generalizability. The code is publicly available.
Distal humerus elbow fractures are one of the most common traumatic fractures seen in pediatric patients and present as three main types: Supracondylar (SC), lateral condyle (LC), and medial ...epicondyle (ME) fractures.
To evaluate the epidemiology of pediatric distal humerus fractures (SC, LC, and ME) from an American insurance claims database.
A retrospective review was performed on patients 17 years and younger with the ICD 9 and 10 codes for SC, LC and ME fractures based on the IBM Truven MarketScan
Commercial and IBM Truven MarketScan Medicare Supplemental databases. Patients from 2015 to 2020 were queried for treatments, patient age, sex, length of hospitalization, and comorbidities.
A total of 1133 SC, 154 LC, and 124 ME fractures were identified. SC fractures had the highest percentage of operation at 83%, followed by LC (78%) and ME fractures (41%). Male patients were, on average, older than female patients for both SC and ME fractures.
In the insurance claims databases used, SC fractures were the most reported, followed by LC fractures, and finally ME fractures. Age was identified to be a factor for how a pediatric distal humerus fractures, with patients with SC and LC fractures being younger than those with ME fractures. The peak age per injury per sex was similar to reported historic central tendencies, despite reported trends for younger physiologic development.
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