Is there a relationship between lower-extremity injuries and foot postures in professional football players? A prospective cohort study.

BACKGROUND: Lower extremity injuries are an ongoing concern for professional football players. This study aims to evaluate the relationship between foot posture and lower extremity injuries in professional football players. METHOD: In this prospective cohort study, 420 male players of the Iran Premium football league were evaluated during the 2015-2016 season. The players were assessed for their foot types based on optical and static foot scans and foot posture index (FPI). The trained club physicians recorded all injuries during the season. RESULT: The analyzed data of 244 players showed the highest rate of lower extremity injury in hamstrings, ankle, and groin, respectively. These injuries led to 46% of time loss. The probability of hamstrings injuries was higher among pronated players based on static, optic, FPI, and visual examination, 2.1, 1.8, 1.8, and 2.3, respectively. Medial Collateral Ligament (MCL) injuries were associated with subtalar joint abnormality defined by visual observation. An increased relative risk of leading-to-absence injuries among the flat foot group was significant based on optic scanning, FPI, and visual observation. CONCLUSION: Abnormal foot postures in professional football players may increase the risk of hamstring and MCL injuries and time loss due to lower extremity injuries.

Norwegian Emergency Medicine Systems' Training and Equipment for Penetrating Injuries: A National Survey-Based Study.

OBJECTIVE: Recent terror attacks led the Norwegian government to develop a procedure for emergency and law enforcement services cooperation during Active Violent Incidents (AVI, abbreviated PLIVO in Norwegian). To address further national initiatives to improve preparedness for mass casualty events and penetrating injuries among emergency medical services (EMS) in Norway, training and equipment status were mapped. METHODS: All EMS regions in Norway were invited to participate in an electronic nation-wide survey about practical medical training in PLIVO scenario training and specific training in hemorrhage control and penetrating injuries. RESULTS: Ninety percent (842/938) had attended at least 1 PLIVO training scenario. Of these, 76% (642/938) reported only evacuation training during the exercise, while only 20% (168/938) had practiced hemorrhage control. Eighty-one percent (760/938) respondents reported that they were equipped with tourniquets and 91% (853/938) were equipped with gauze to pack wounds. However, only 52% (487/938) and 48% (450/938) reported practical training in tourniquet application and wound packing, respectively, while 30% (280/938) reported that they had no training or only theoretical education in tourniquet application. Supervised practical training on penetrating thoracic injuries was reported by <20%, and <50% reported practical training in needle decompression of a tension pneumothorax. CONCLUSIONS: Enhanced focus on training in hemorrhage control and penetrating injuries is needed. This supports the recent decision from the Norwegian government to strengthen the training for EMS in AVI (PLIVO) exercises, by focusing on medical procedures in addition to evacuation training. Although the estimated response rate is 17%, we believe the large number of respondents still make the results valuable.

Lower Extremity Injury While Undergoing Urology Procedures in the Trendelenburg with Lithotomy Position: Three Case Reports.

PURPOSE: To report and discuss the incidence of severe lower extremity injuries associated with robotic procedures in Trendelenburg with lithotomy position. DESIGN AND METHODS: A case study method was used to describe three cases of patients who underwent robotically assisted urological procedures in Trendelenburg with lithotomy position and developed serious lower extremities injuries resulting in fasciotomies. Furthermore, a literature review was conducted to evaluate risk factors and possible interventions for the prevention of similar injuries. FINDINGS: Case analysis revealed multifactorial causes, including patient comorbidities, long surgical procedures, and blood pressure decreases below the baseline for more than 30 minutes. The severity of lower extremity injury associated with lithotomy position may be underestimated. The etiology of peripheral nerve injury can be attributed to patient comorbidities, positioning, and surgical conditions. Injury prevention should include careful patient and procedural risk assessment, staff education, and communication strategies. CONCLUSIONS: Extreme Trendelenburg with lithotomy position for longer periods can lead to serious lower extremities injuries. Preanesthetic screening and multidisciplinary team discussions for additional precautions for high-risk patients are crucial interventions to decrease incidence and severity of lower extremities injuries.

Tissue Engineered Successful Reconstruction of a Complex Traumatized Lower Extremity.

Introduction: Tissue engineered reconstruction is a minimally invasive approach for healing major complex wounds successfully. It combines accurate, conservative debridement with a specially adapted suction method, platelet-rich plasma (PRP) injections, and biomaterial application to salvage injured tissues and grows new soft tissues over wounds. Case Presentation: A healthy young man in his early 30s presented to our emergency department with complex knee-thigh injuries following a high-velocity automobile accident. Degloved anterolateral thigh, severe thigh muscle injuries, and ruptured extensor patellar mechanism were observed. Accurate conservative (as opposed to radical) debridement and PRP injections salvaged the injured muscles and tendons. Specially carved reticulated foam wrapped around the injured ischemic muscles, followed by low negative, short intermittent, cyclical suction therapy. Wound exploration 4 days apart revealed progressive improvements with considerable vascularization of the injured soft tissues within 2 weeks. Thereafter, meticulous reconstruction of the salvaged muscles and tendons restored anatomical congruity. An absorbable synthetic biomaterial covered the sizeable open wound with vast areas of exposed tendons. Five weeks later, exuberant granulating tissue ingrowth within the biomaterial filled up the tissue defect. A split-skin graft covered the remaining raw areas, which "took" completely. Early rehabilitation enabled the patient to return to active work, play contact sports, and perform strenuous activities effortlessly. Conclusion: Minimally invasive tissue engineered reconstruction is a novel approach using a series of simple minimally invasive procedures. It lessens the duration of surgery and anesthesia, maximizes soft-tissue salvage, lowers morbidity, minimizes hospitalization, saves costs, and improves the patient's quality of life significantly.

Lodox/Statscan facilitates the early detection of commonly overlooked extracranial injuries in patients with traumatic brain injury.

INTRODUCTION: Traumatic brain injury (TBI) is a common diagnosis in the emergency department. Brain computed tomography (CT) has become a standard diagnostic tool with which to examine TBI patients. Conventional X-rays are ineffective for the evaluation of torso or extremity injuries. In the current study, we attempted to establish a diagnostic modality to evaluate systemically initially unconscious patients in the emergency department with a rapid screening technique characterized by sufficient information, low cost and low radiation exposure. MATERIALS AND METHODS: From January 2008 to December 2009, patients with diminished level of consciousness received the Lodox/Statscan for evaluation of extracranial injuries were enrolled in this study. The accuracy of this diagnostic modality in detecting torso or extremity injuries in initially unconscious patients was analyzed by comparing the initial diagnosis (by the Lodox/Statscan) with the final diagnosis (confirmed by torso CT scan or after two weeks of follow-up). RESULTS: There were 1,210 patients with TBI whose extracranial injuries were evaluated by the Lodox/Statscan. After excluding intra-abdominal injuries, the overall sensitivity rates of the Lodox/Statscan in diagnosing torso injuries and extremity injuries were 89.7% and 90.2%, respectively. No long bone fracture was missed by the Lodox/Statscan. The sensitivity and specificity of the Lodox/Statscan in diagnosing long bone fractures were both 100%. Most patients with torso injuries that were missed by the Lodox/Statscan could be managed conservatively without further treatment or complications. All of the missed extremity injuries were distal bone fractures. CONCLUSION: The Lodox/Statscan can provide benefits for surveying extracranial injuries in patients with diminished level of consciousness. The Lodox/Statscan also emits a notably low dose of radiation and appears to be a relatively inexpensive adjunct to screen torso or extremity injuries in TBI patients.

A influência das condições de visibilização na análise de radiografias de pacientes vítimas de trauma de extremidade / The impact of visualization conditions on the analysis of radiographies of extremity fracture patients

Para que o tratamento de uma fratura de extremidade seja instituído, é fundamental que se faça minucioso exame físico, complementado pela radiografia. No entanto, não raramente, a análise radiográfica é feita confrontando-se o filme com a luz da janela ou da sala de emergência, e não com o negatoscópio. O presente estudo tem como objetivo observar se as condições da visibilização realmente influenciam na análise radiográfica de pacientes vítimas de trauma de extremidade.

Before prescribing a treatment, physicians are supposed to carry on detailed physical exams complemented with radiography analysis. However, they frequently analyze radiographies against the light shining from the window or in the emergency room, instead of using a negatoscope. This study aims at investigating whether visualization conditions do have an impact on the analysis of radiographies of extremity fracture patients.

Early Changes of Pigs with Hind Leg Wound Inflicted by the Steel Spheres / 第三军医大学学报

After one hind leg of the pig was wounded by the high-speed steel spheres the status of the animals was continuously monitored by determination of hemody-namics, blood gas, chest X-ray, serum T3, T4, fibronectin, protein content of lung lavage, lung weight, light and electromicroscopic examination etc. When the animals died or were killed 72 hours after injury, the pathologic examinations were carried out as soon as possible. It showed that there were various changes in above mentioned parameters, especially in those of the dead animals. The relationship between the incidence of RDS and trauma index-injury severity score (ISS) was discussed. In addition, the subclinical type of RDS was emphasised.