A season of football injuries.

All rugby and soccer players presenting to the Accident & Emergency department during the football season 1992-1993 (a total of 871) were prospectively studied to compare the injuries sustained in the two sports. The nature and site of injury, treatment required, age, fitness, experience and position of the player, situation giving rise to injury, and medical attention at the grounds were all analysed. The results show that rugby and soccer players had the same number of injuries, and while there were some differences in the nature of the injuries, there was no difference in overall severity. Rugby flankers and soccer goalkeepers are particularly at risk. Competitive matches produce more injuries than training sessions. Experience or fitness did not appear to be a factor and 45% of rugby injuries and 15% of soccer injuries were from school matches. Law changes (e.g. the rugby scrum and the use of gum-shields) have reduced some injuries, but other areas (e.g. jumping for the ball in soccer, rucks and mauls in rugby) also warrant consideration. There was one death, but no spinal cord injuries. Medical attention at the grounds was limited. Rugby injuries, therefore, do not appear to be more numerous or severe than soccer injuries. Law changes have been of benefit but they need to be enforced and perhaps more should be considered. Medical attention at sports grounds could be improved and Registers of injuries kept by the sporting bodies would be of benefit.

Clinical assessment of apparently sprained ankle and detection of fracture.

The clinical features of 311 patients with apparently sprained ankles were analysed and compared with radiographs. Measurable swelling was found to be a constant feature of ankle fractures and bruising was very common. The incidence of fractures increased with age. No other physical sign nor the history was useful in predicting fracture in this context. It is concluded that advanced age, bruising and particularly swelling are strong indications for ankle radiography and the absence of swelling is a strong contraindication.

Penetrating left ventricular stab wound: a method of control during resuscitation and prior to repair.

A 34-year-old man with left ventricular stab wounds, suffered cardiac arrest soon after arriving in the Intensive Care Unit from the Accident and Emergency Department. He had cardiac tamponade without elevation of his central venous pressure; this was because of exsanguination into his left hemithorax. Immediate thoracotomy while still in his bed confirmed tamponade and revealed two large left ventricular stab wounds, one anterior and on posterior; the heart was in ventricular fibrillation. As he had already been anoxic for some time, no effort could be made to repair the stab wounds before resuscitating him. It was necessary to control bleeding from two separate injuries while replacing volume, continuing with intracardiac drugs, internal cardiac massage and internal defibrillation. This was achieved by inserting a Foley catheter into each wound, inflating the balloons, clamping the catheters and having the assistant gently retracting the catheters against each other while the operator continued with the resuscitation. When the circulation was restored, pledgeted horizontal mattress sutures were inserted on either side of each Foley catheter, which was withdrawn immediately before tying the suture. The patient was discharged home 12 days later without any complications.