The purpose of this review is to summarise a literature survey on thermal thresholds for tissue damage. This review covers published literature for the consecutive years from 2002-2009. The first ...review on this subject was published in 2003. It included an extensive discussion of how to use thermal dosimetric principles to normalise all time-temperature data histories to a common format. This review utilises those same principles to address sensitivity of a variety of tissues, but with particular emphasis on brain and testis. The review includes new data on tissues that were not included in the original review. Several important observations have come from this review. First, a large proportion of the papers examined for this review were discarded because time-temperature history at the site of thermal damage assessment was not recorded. It is strongly recommended that future research on this subject include such data. Second, very little data is available examining chronic consequences of thermal exposure. On a related point, the time of assessment of damage after exposure is critically important for assessing whether damage is transient or permanent. Additionally, virtually no data are available for repeated thermal exposures which may occur in certain recreational or occupational activities. For purposes of regulatory guidelines, both acute and lasting effects of thermal damage should be considered.
Introduction•Comparison of 12 week COVID-19 lockdown period and the same time period in 2019•Aims: to evaluate changes in both mechanism and diagnoses of injuries presenting to the orthopaedic ...department during this lockdown period, as well as to observe any changes in operative case-mix during this time.Methodology•5 NHS Foundation Trusts included in research contributing to the Major Trauma Network of North West London.•Giving a huge number of referrals studied (>6000 referrals); thus giving an acute representation of trauma and injury patterns during the lockdown period.•All data received from one trauma system with consistent data coding.Results•Referral Numbers○Overall referral numbers fell by 35.3% in lockdown period compared to 2019•Mechanism of Injury○All injury patterns reduced in number○Falls remained proportionally the most common injury pattern○Proportion of sports related accidents fell during lockdown○Whilst the proportion of pushbike related accidents increased○Mechanism injury analysis by age group also presented in manuscript (Table 1)•Injury Pattern○Remained consistent with reduced amounts of non-bony injury presentations (Table 2)•Number of Operations○Total number of operations fell by 38.8% during lockdown○Operative Case Mix○Operative case mix remained fairly similar between lockdown period and 2019○Fewer spinal operations were performed during the lockdown period○The proportion of NOF# operations to overall operations increased during the lockdown period•Rates of Operative Intervention○Rates of operative intervention for NOF# and Ankle fractures (open and closed injuries) remained similar between both study periods○Rates of operative intervention for distal radius fractures were reduced – suggesting a more conservative approachConclusions•The nationwide lockdown has led to a decrease in emergency orthopaedic referrals and associated injuries.•There has been a change in mechanism of injuries and a reduction in the overall number of acute trauma procedures performed.•This study should provide some insights to facilitate policy writing during the recovery phase and may help guide decision making regarding orthopaedic trauma care if lockdown measures are re-instated or similar emergency pandemics are encountered in the future.
The aim of this study was to evaluate changes in both mechanism and diagnoses of injuries presenting to the orthopaedic department during this lockdown period, as well as to observe any changes in operative case-mix during this time.
A study period of twelve weeks following the introduction of the nationwide “lockdown period”, March 23rd – June 14th, 2020 was identified and compared to the same time period in 2019 as a “baseline period”. A retrospective analysis of all emergency orthopaedic referrals and surgical procedures performed during these time frames was undertaken. All data was collected and screened using the ‘eTrauma’ management platform (Open Medical, UK). The study included data from a five NHS Foundation Trusts within North West London. A total of 6695 referrals were included for analysis.
The total number of referrals received during the lockdown period fell by 35.3% (n=2631) compared to the same period in 2019 (n=4064). Falls remained proportionally the most common mechanism of injury across all age groups in both time periods. The proportion sports related injuries compared to the overall number of injuries fell significantly during the lockdown period (p<0.001), however, the proportion of pushbike related accidents increased significantly (p<0.001). The total number of operations performed during the lockdown period fell by 38.8% (n=1046) during lockdown (n=1732). The proportion of patients undergoing operative intervention for Neck of Femur (NOF) and ankle fractures remained similar during both study periods. A more non-operative approach was seen in the management of wrist fractures, with 41.4% of injuries undergoing an operation during the lockdown period compared to 58.6% at baseline (p<0.001).
In conclusion, the nationwide lockdown has led to a decrease in emergency orthopaedic referrals and procedure numbers. There has been a change in mechanism of injuries, with fewer sporting injuries, conversely, there has been an increase in the number of pushbike or scooter related injuries during the lockdown period. NOF fractures remained at similar levels to the previous year. There was a change in strategy for managing distal radius fractures with more fractures being treated non-operatively.
•Between 2007–2015, out of the one million combat veterans screened for traumatic brain injury (TBI), 8.4% of these Veterans received a diagnosis of TBI after comprehensive evaluation, the majority ...are characterized as mTBI/Concussion (mTBI) and, in great proportion, related to blast exposures.•Mild traumatic brain injury called ‘a signature injury’ also known as ‘the invisible injury’ of war received increased attention during current conflicts.•Specific clinical and research challenges in mTBI include identification and assessment of neuropathological, cellular and resulting cognitive, emotional, behavioral and neurological consequences.•Enhanced research support for understanding TBI promises opportunities for advances in its diagnosis, management as well as for understanding pathogenesis of degenerative brain disease and other brain related disorders.
Between April 2007 and December 2015, the Veterans Health Administration (VHA) screened one million combat veterans for traumatic brain injury (TBI), among 2.6 million deployed during operations Enduring Freedom, Iraqi Freedom and New Dawn (OEF/OIF/OND). Since 2007, among those reporting, screened and referred for definitive evaluation, approximately 8.4% of these Veterans received a diagnosis of TBI, the majority characterized as mTBI/Concussion (mTBI) and, in great proportion, related to blast exposures. Mild Traumatic brain injury called “a signature injury” is also known as ‘the invisible injury’ of these conflicts. Identifying and assessing neuropathological, cellular and resulting cognitive, emotional, behavioral and neurological consequences of mTBI comprise vast clinical and research challenges. We provide a brief overview of current history, injury mechanisms related to blast exposure, coordinated research support, and the need to understand specific cellular and neurological changes occurring with blast injury, particularly mTBI.
Traumatic brain injury (TBI) is an important source of morbidity in the Iraq and Afghanistan wars. Although penetrating brain injuries are more readily identified, closed brain injuries occur more ...commonly. Explosion or blast injury is the most common cause of war injuries. The contribution of the primary blast wave (primary blast injury) in brain injury is an area of active research. Lessons learned from the sports concussion and civilian mild TBI literature are useful. Individuals with TBI and posttraumatic stress disorder require treatment of both conditions. Families and communities need to be cognizant of the needs of these returning veterans.
Information regarding the relative risks of developing knee osteoarthritis (OA) as a result of sport participation is critical for shaping public health messages and for informing knee-OA prevention ...strategies. The purpose of this systematic review was to investigate the association between participation in specific sports and knee OA.
We completed a systematic literature search in September 2012 using 6 bibliographic databases (PubMed; Ovid MEDLINE; Journals@Ovid; American College of Physicians Journal Club; Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Review, Database of Abstracts of Reviews of Effects; and Ovid HealthStar), manual searches (4 journals), and reference lists (56 articles).
Studies were included if they met the following 4 criteria: (1) an aim was to investigate an association between sport participation and knee OA; (2) the outcome measure was radiographic knee OA, clinical knee OA, total knee replacement, self-reported diagnosis of knee OA, or placement on a waiting list for a total knee replacement; (3) the study design was case control or cohort; and (4) the study was written in English. Articles were excluded if the study population had an underlying condition other than knee OA.
One investigator extracted data (eg, group descriptions, knee OA prevalence, source of nonexposed controls).
The overall knee-OA prevalence in sport participants (n = 3759) was 7.7%, compared with 7.3% among nonexposed controls (referent group n = 4730, odds ratio OR = 1.1). Specific sports with a significantly higher prevalence of knee OA were soccer (OR = 3.5), elite-level long-distance running (OR = 3.3), competitive weight lifting (OR = 6.9), and wrestling (OR = 3.8). Elite-sport (soccer or orienteering) and nonelite-sport (soccer or American football) participants without a history of knee injury had a greater prevalence of knee OA than nonexposed participants.
Participants in soccer (elite and nonelite), elite-level long-distance running, competitive weight lifting, and wrestling had an increased prevalence of knee OA and should be targeted for risk-reduction strategies.
Background:
Hamstring injuries are the most common muscle injuries in soccer, and they have a high rate of recurrence. Eccentric hamstrings strength is recognized as an important modifiable risk ...factor. This led to the development of prevention exercises such as the nordic hamstring exercise (NHE). The effectiveness of the NHE on hamstring injury prevention has never been investigated in amateur soccer.
Purpose:
To investigate the preventive effect of the NHE on the incidence and severity of hamstring injuries in male amateur soccer players.
Study Design:
Randomized controlled trial; Level of evidence, 1.
Methods:
Male amateur soccer players (age, mean ± SD, 24.5 ± 3.8 years) from 40 teams were randomly allocated to an intervention (n = 20 teams, 292 players) or control group (n = 20 teams, 287 players). The intervention group was instructed to perform 25 sessions of NHE in a 13-week period. Both the intervention and control groups performed regular soccer training and were followed for hamstring injury incidence and severity during the 2013 calendar year. At baseline, personal characteristics (eg, age, injury history, field position) were gathered from all participants via a questionnaire. Primary outcome was injury incidence. Secondary outcomes were injury severity and compliance with the intervention protocol.
Results:
A total of 38 hamstring injuries were recorded, affecting 36 of 579 players (6.2%). The overall injury incidence rate was 0.7 (95% CI, 0.6-0.8) per 1000 player hours, 0.33 (95% CI, 0.25-0.46) in training, and 1.2 (95% CI, 0.82-1.94) in matches. Injury incidence rates were significantly different between the intervention (0.25; 95% CI, 0.19-0.35) and control groups (0.8; 95% CI, 0.61-1.15), χ2(1, n = 579) = 7.865; P = .005. The risk for hamstring injuries was reduced in the intervention group compared with the control group (odds ratio, 0.282; 95% CI, 0.110-0.721) and was statistically significant (P = .005). No statistically significant differences were identified between the intervention and control groups regarding injury severity. Compliance with the intervention protocol was 91%.
Conclusion:
Incorporating the NHE protocol in regular amateur training significantly reduces hamstring injury incidence, but it does not reduce hamstring injury severity. Compliance with the intervention was excellent.
The number of anterior cruciate ligament (ACL) injuries reported in athletes younger than 18 years has increased over the past 2 decades. Reasons for the increasing ACL injury rate include the ...growing number of children and adolescents participating in organized sports, intensive sports training at an earlier age, and greater rate of diagnosis because of increased awareness and greater use of advanced medical imaging. ACL injury rates are low in young children and increase sharply during puberty, especially for girls, who have higher rates of noncontact ACL injuries than boys do in similar sports. Intrinsic risk factors for ACL injury include higher BMI, subtalar joint overpronation, generalized ligamentous laxity, and decreased neuromuscular control of knee motion. ACL injuries often require surgery and/or many months of rehabilitation and substantial time lost from school and sports participation. Unfortunately, regardless of treatment, athletes with ACL injuries are up to 10 times more likely to develop degenerative arthritis of the knee. Safe and effective surgical techniques for children and adolescents continue to evolve. Neuromuscular training can reduce risk of ACL injury in adolescent girls. This report outlines the current state of knowledge on epidemiology, diagnosis, treatment, and prevention of ACL injuries in children and adolescents.
In Spain, the number of aged persons is increasing. By the year 2066, it is expected that 34.6% of the Spanish population will be over 65 years of age. Elderly people present a higher burning risk ...owing in part to impaired balance and decreased physical strength, lower cognitive abilities, or socioeconomic context.
Burns to the upper body body are common and affect both emotional state and physical function, thus leading to reduced quality of life (QoL). Our objective was to determine the influence of age on the QoL of patients who experienced burns to the upper body, with burns with 2 years.
This is an observational study with a sample of 58 patients with burns only on the upper body. Patients were divided into two groups: 29 patients of age over 65 years and 29 patients under 65 years; all of them attended the Vall d’Hebron Burn Center, Barcelona, between 2011 and 2014. From the original sample, 45 patients had survived by the time the information was gathered. The QoL of these individuals was evaluated with the Spanish version of the Burn Specific Health Scale. Demographic data (sex, age, total burn surface area TBSA, burn mechanism, pathological history, length of hospital stay, and rehabilitation duration) were collected. Statistical analysis included parametric and nonparametric tests as appropriate with R3.3.3.
There were no differences between groups regarding the mechanism of burn, TBSA, length of hospital stay, and the domains of QoL test. High blood pressure, diabetes, and other comorbidities were significantly more common in the elderly group than in the younger group. Eleven patients died in the elderly group and two in the younger group (p=0.012).
As opposed to what could be expected, in this study, there were no significant differences between surviving patients in both age groups in terms of perceived QoL. Nevertheless, mortality after a burn in the upper side of the body was significantly higher in elderly people than in younger people. The present study results do not support the use of different rehabilitation approaches in elderly patients.
Explosive blast has been extensively used as a tactical weapon in Operation Iraqi Freedom (OIF) and more recently in Operation Enduring Freedom(OEF). The polytraumatic nature of blast injuries is ...evidence of their effectiveness,and brain injury is a frequent and debilitating form of this trauma. In-theater clinical observations of brain-injured casualties have shown that edema, intracranial hemorrhage, and vasospasm are the most salient pathophysiological characteristics of blast injury to the brain. Unfortunately, little is known about exactly how an explosion produces these sequelae as well as others that are less well documented. Consequently, the principal objective of the current report is to present a swine model of explosive blast injury to the brain. This model was developed during Phase I of the DARPA (Defense Advanced Research Projects Agency) PREVENT (Preventing Violent Explosive Neurotrauma) blast research program. A second objective is to present data that illustrate the capabilities of this model to study the proximal biomechanical causes and the resulting pathophysiological, biochemical,neuropathological, and neurological consequences of explosive blast injury to the swine brain. In the concluding section of this article, the advantages and limitations of the model are considered, explosive and air-overpressure models are compared, and the physical properties of an explosion are identified that potentially contributed to the in-theater closed head injuries resulting from explosions of improvised explosive devices (IEDs).
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