Who are less likely to return to work after getting injured on duty? A 12-month epidemiological evaluation in an orthopedic and traumatology center in Hong Kong.

OBJECTIVES: Cases of injury on duty (IOD) are common in Hong Kong, but literature on this group of patients is limited. This study aims to describe local IOD cases' epidemiological characteristics and identify factors affecting return to work (RTW) outcomes. METHODS: This is a retrospective epidemiological study of IOD patients in the orthopedic and traumatology center of Yan Chai Hospital in 2016, using the hospital's electronic clinical record analysis and reporting system; 323 out of the 10 730 patients (M:F = 206:117; mean age 46.9 ± 11.3) were included. Data on demographics, the injury episode, administrative procedures, treatment and rehabilitation were collected. Outcomes were measured by "RTW" and "time to RTW from injury." RESULTS: Around 80% of patients had a successful RTW and the mean time to RTW was 10.6 ± 9.0 months. Patients who were female, divorced or widowed and living alone in a public rental flat were less likely to RTW. Psychiatric consultations (OR 13.70, P < .001), legal disputes (OR 8.20, P < .001) and more than 5 months of waiting time for physiotherapy (OR 3.89, P = .002) were the strongest among the numerous risk factors for non-RTW. An increase in one visit to the general outpatient clinic and the presence of legal disputes had lengthened the time to RTW by 4.8 days (P < .001) and 18.0 months (P < .001), respectively. CONCLUSIONS: Several demographic, psychosocial and administrative factors were negatively associated with RTW in the local population. Recommendations were made for healthcare providers and policymakers accordingly.

What and who should we focus in pediatric injury prevention - An analysis of critical pediatric trauma in a major trauma center in Hong Kong.

BACKGROUND: Understanding trauma epidemiology is essential in formulating region-specific strategies for injury prevention. Our study aimed to evaluate the characteristics and clinical outcomes of critical pediatric trauma requiring intensive care in Hong Kong. METHODS: A retrospective analysis was performed on pediatric patients who were injured and admitted to the pediatric intensive care unit (PICU), Queen Elizabeth Hospital, Hong Kong between 2014 and 2018. Clinical features of patients who sustained injuries before and after 2 years old were compared. RESULTS: 141 patients were admitted to the PICU due to trauma during the study period. Most patients sustained injuries due to fall (48.2%) or road traffic injuries (34.0%), with the latter more common in older patients. Two (1.4%) patients died due to the trauma. The majority (95.0%) of the survivors had good recovery assessed by Glasgow Outcome Scale. Patients younger than 2 years old were mostly injured at home due to fall while left unattended. Children in this age group were more likely to receive interventions, including mechanical ventilation (OR 2.61; 95% CI 1.15-5.95), anti-epileptic medications (OR 2.61; 95% CI 1.17-5.83), blood transfusion (OR 5.37; 95% CI 2.29-12.60) and inotropic support (OR 4.08; 95% CI 1.31-12.70), and require longer hospitalization (PICU stay 2.5 vs. 1.5 days, p = 0.011; hospital stay 10.9 vs. 6.9 days, p = 0.012). CONCLUSION: Fall injuries and road traffic injuries were common etiologies of critical pediatric trauma in Hong Kong. Patients younger than 2 years old had worse clinical outcomes. Parental education on home safety and importance of close supervision should be emphasized in this age group.

A randomized controlled trial on the effect of focal thermal therapy at acupressure points treating osteoarthritis of the knee.

BACKGROUND: Osteoarthritis of the knee is a common degenerative joint disorder in our ageing population. A combination of thermal therapy with a self-management exercise have shown a positive effect in the management of osteoarthritis of the knee. This study aimed to compare the effectiveness of topical heat pack versus focal application of heat therapy at the acupressure points in the treatment of osteoarthritis of the knee. METHODS: A randomized controlled trial was conducted in 76 patients with osteoarthritis of the knee, diagnosed by an experienced orthopedic surgeon. Following inclusion and exclusion selection, patients were randomly allocated to group 1 (Heat pack) or group 2 (Thermal gun). All patients received 30 min of treatment in each session, twice a week for 4 weeks. They also received an education program and taught home knee exercises. Outcome measurements were the visual analog scale (VAS) for pain intensity, muscle power, knee ROM, WOMAC and SF-12v2. RESULTS: In the Thermal gun group, function and total scores (WOMAC) and Physical Composite Scale (SF-12v2) were significantly improved after 8 sessions. Quadriceps strength was significantly improved after 8 weeks (from 4.42 to 4.63; p = 0.02). In the Heat pack group, flexion was significantly improved after 8 sessions (p = 0.02). Mean VAS scores after Heat pack treatment was consistently better (lower) than mean VAS scores after Thermal gun treatment. CONCLUSION: The combination of focal thermal therapy at acupressure points is a viable conservative treatment in osteoarthritis of the knee. The pressure at the acupressure points has a synergistic benefit than topical thermal therapy alone. TRIAL REGISTRATION: ClinicalTrials.gov , NCT04735029 Date of registration: February 2, 2021 (Retrospectively registered).

Kinematics of the lumbar spine in elderly subjects with decreased bone mineral density.

Lumbar spine kinematics was studied in subjects with normal bone mineral density, osteopenia and osteoporosis to determine the effect of bone mineral density and morphology on the flexion-extension movement patterns of the lumbar spine. Lateral radiographs and skin-mounted electromagnetic motion tracking sensors were employed to study lumbar spine kinematics using a Bayesian Belief Network model. The predicted angular displacement of the vertebrae had a high correlation (r = 0.91, p < 0.001) with the actual movements. The overall mean error was -0.51 degrees +/- 3.11 degrees. Intervertebral angular displacement and velocity consistently increased from L1/L2 to L5/S1. Differences were observed in the movement pattern between normal subjects and those with decreased bone density. In normal subjects, vertebral angular acceleration consistently decreased from the upper to the lower vertebrae but the same consistent predictable pattern was not observed in the subjects with decreased bone mineral density. It is possible that these changes in kinematic behaviours are related to morphological changes as well as altered neuromuscular functions.

Effect of vertebral morphology on lumbar kinematics in elderly subjects with decreased bone mineral density.

Correlation between kinematics and morphological characteristics of lumbar spine was studied in subjects with varying bone mineral density. Effect of morphological characteristics and bone mineral density on the lumbar spine movement was investigated. Morphology parameters were measured from radiographs and a high-frequency motion tracking device were employed to detect surface movement of lumbar spine. Multiple regression analysis identified factors influencing lumbar kinematics while ANOVA examined differences in morphology with normal bone mineral density, osteopenia and osteoporosis. The results show that morphological characteristics, such as wedging deformity, are indeed influential to the kinematics. Related to our previous report, abnormal lumbar kinematic pattern in the subjects with osteoporosis, this study shows although morphological characteristics were found significantly different among normal, osteopenia, and osteoporosis subjects, the change in lumbar kinematic pattern could not be fully explained by the altered vertebral or disc morphology.