Sex- and Sports-Specific Epidemiology of Traumatic Lumbar Spine Injuries Sustained During Sporting Activities: Male Snowboarders and Female Horseback Riders at Greatest Risk

Low Cognitive Function Is Strongly Associated with The Intake of EPA and DHA in Adolescent Female Football Players in North Sumatra, Indonesia

Background

Cognitive function refers to an individual's ability to process information, influenced by several factors, including genetics, the environment, and key nutrients such as omega-3 fatty acids-specifically Eicosapentaenoic Acid (EPA) and Docosahexaenoic Acid (DHA).

Objective

The purpose of this study was to examine the relationship between EPA and DHA intake on cognitive function of amateur female adolescent football players in North Sumatra in 2024.

Methods

The research design used was observational analytic involving cross-sectional design. The total sample that participated was 79 amateur female youth football players by filling out the Montreal Cognitive Assessment (MOCA) questionnaire as a cognitive assessment and filling out the Food Recall for assessing EPA and DHA intake. The analysis used SPSS 29.0 software and the analysis of EPA and DHA food recall used the NutriSurvey application.

Results

The results of this study indicate that there is a strong positive correlation between EPA and DHA intake and the cognitive function of amateur female adolescent football players, with a strong correlation value of r = 0.676 (p < 0.001).

Conclusion

Eicosapentaenoic Acid and DHA intakes are strongly correlated with cognitive function in amateur female adolescent football players. Focusing on increasing daily EPA and DHA intakes is expected to improve cognitive function, especially in female adolescent athletes.

Decrease in pediatric farm-related injuries presenting to United States emergency departments: A national study from 2014-2023

INTRODUCTION

Pediatric farm-related injuries, while less common than other pediatric injuries, are often more severe. Agricultural youth injuries can require costly treatment and have higher hospitalization rates, often resulting from industrial hazards, unsafe worksites, or agricultural recreational activities. Injuries in rural areas often necessitate travel to larger hospitals for specialized treatment, delaying care.

OBJECTIVE

This study aims to evaluate trends in farm-related injuries among youth presenting to emergency departments (EDs) in the United States (US).

METHODS

The National Electronic Injury Surveillance System (NEISS), a publicly available database representing approximately 100 US EDs, was queried for all injuries among individuals aged 0-18 occurring in farms (land, pasture, farm, barn, outbuildings). Queries were restricted to injuries from 2014 to 2023.

RESULTS

From 2014 to 2023, a total of 750 ED visits from farm-related injuries were identified, resulting in a national estimate (NE) of 33,664 cases. Injury rates decreased significantly across the study period (P=0.012). The most common diagnosis was fracture (NE 7337, 21.8 % of all injuries), with males accounting for 52.1 % and females for 47.9 %. In an age-specific analysis, 12-year-olds experienced more farm-related injuries than any other age group (NE 3185, 9.5 %), followed by 11-year-olds (NE 2769, 8.2 %), who also sustained the highest number of head injuries (NE 711, 13.2 % of all head injuries). The most commonly affected body part across ages was the head (NE 5384, 16 % of all injuries). The most common mechanism of injury was horseback riding (NE 10,691, 31.8 % of all injuries). The overall rate of hospitalization was 13.5 %.

CONCLUSION

The incidence of farm-related injuries in young people has decreased over time. Most injuries are caused by horseback riding, with a majority involving the head and relatively high hospitalization rates. 11-12-year-olds are the most affected, highlighting the importance of continued targeted prevention efforts. Although occupational hazards are a concern, this study demonstrates that younger patients are also frequently affected by farm injuries, emphasizing the need for increased focus on child access and safety in agricultural recreational activities.

The epidemiology of recreation-related cervical and thoracic fractures

CONTEXT

Recreational activities are frequently associated with spinal fracture, yet contemporary characterization of sports-related cervical and thoracic fracture is lacking.

PURPOSE

To characterize cervical and thoracic fractures associated with recreational activities.

STUDY DESIGN/SETTING

Retrospective cohort study.

PATIENT SAMPLE

The National Electronic Injury Surveillance System (NEISS) database.

OUTCOME MEASURE AND COMPARISONS

Recreation-related cervical and thoracic fracture incidence rates per year, stratified by age and sex. Common causative activities were established by demographics.

METHODS

The NEISS database was queried to identify patients with recreation-related cervical fractures between 2003 and 2022 and recreation-related thoracic fractures between 2003 and 2022 in patients aged >2 years-old. United States Census data was utilized to generate incidence rates per year. Data was stratified by demographic variables to assess the impact of age and sex on incidence and causative activity.

RESULTS

Between 2003 and 2022, an estimated 13,823 recreation-related cervical fractures occurred with an average annual incidence of 2.20±0.35 per 1 million person-years, while 24,236 estimated recreation-related thoracic fractures occurred from 2003 to 2022 with an average incidence of 3.85±1.26. Males experienced a 3.51 times higher (95% CI 3.38-3.66) rate of cervical fracture, but thoracic fracture rates were similar between sexes. Individuals under 18 experienced a 2.15 times higher rate of thoracic fractures than those aged 18-64 (95% CI 1.85-2.50) and 1.93 times higher rate than those over 65 (95% CI 1.68-2.22). Recreation-related cervical fracture rates in individuals 18-64 was 1.186 (95% CI 1.14-1.23) times higher than those under 18 and rates in those under 18 were 1.15 (95% CI 1.09-1.22) times higher than those over 65. Football (26.6%), horseback riding (19.7%), and skiing (8.35%) were the primary causes of cervical fractures, and horseback riding (46.8%), football (11.2%), and skiing (10.3%) primarily caused thoracic fractures. Cervical fractures resulted primarily from football in males (24.7%) and horseback riding in females (44.0%). Horseback riding primarily caused thoracic fractures in both sexes (males=21.5%, females=74.7%). Football led causative activities for individuals under 18 (Cervical=42.4%, Thoracic=40.7%), while horseback riding dominated among those aged 18-64 (26.7%, 56.7%) and over 65 (52.8%, 67.9%).

CONCLUSIONS

This investigation revealed epidemiological trends in cervical and thoracic spinal fractures and underscore the need for targeted preventive measures and safety interventions to mitigate the burden of these fractures particularly in horseback riding and American football.

LEVEL OF EVIDENCE

Level III.

Return to Play Criteria After Adult Lumbar Spinal Fractures: A Review of Current Literature and Expert Recommendations

PURPOSE OF REVIEW

Understanding the management of lumbar spinal fractures and return to play (RTP) criteria is an essential component of care for adult athletes. Appropriate management of lumbar spinal fractures must balance minimizing time away from physical activity while also minimizing risk of reinjury. The purpose of this review is to summarize current recommendations on lumbar spinal fracture management and RTP guidelines and to provide expert opinion on areas of discrepancy in the field.

RECENT FINDINGS

There is a paucity of high-level evidence on the management and return to play criteria for adult lumbar spine fractures in athletes. Much of the data and recommendations are based on expert opinion and studies in pediatric or osteoporotic patients, which may not be applicable to adult athletes. These data presented here may be used to aid patient-physician conversations and provide guidance on expectations for patients, coaches, and athletic trainers. In general, we recommend that patients be free of lumbar pain, neurologically intact, and have full strength and motion of the lumbar spine and lower extremities before returning to play. Adequate protective equipment is recommended to be worn at all times during practice and play.

The Spine is the Tree of Life: A Systematic Review and Meta-Analysis of the Radiographic Findings Related to Spinal Injuries in Athletes

This review article explores spinal injuries in athletes participating in various sporting activities. It also highlights the various mechanisms of injuries that contribute to spinal injuries in each sport. Electronic databases such as PubMed, Cochrane Library, Web of Science, Embase, MEDLINE Ovid, and Google Scholar were searched for articles from 2000 to 2022 on spine injuries in sports and radiological studies discussing the various injury patterns among athletes. Studies were scoured in accordance with the inclusion criteria, and relevant data such as the number of participants, sporting activities, spine injuries, and outcomes were retrieved. Fifteen articles that met the inclusion criteria were included in the study. Cervical spine injuries are common in athletes who participate in contact sports such as football. Similarly, athletes in collision sports such as football, rugby, and hockey are likely to suffer stingers due to traction and compression injuries. Players engaged in such as soccer, baseball, and swimming, are likely to suffer from spondylolysis. Soccer players are more prone to multiple lesions compared to athletes in sports such as baseball because the sport involves training exercises such as jogging and running without kicking any ball. In swimmers, spondylolysis is common in breaststroke and butterfly styles since they involve repeated flexion and hyperextension of the lumbar spine. CT is essential for diagnosing spondylolysis as it demonstrates the lesions more accurately. Ice hockey is associated with a significant incidence of cervical spine injuries, mostly due to players being constantly checked/pushed from behind. Spine injuries are common in elite athletes across several sports. About 10% of spinal injuries in the United States result from sports activities. In diagnosing spine injuries, imaging modalities such as MRI, CT, or plain radiographs are essential. From a radiologist's perspective, these tests help immensely in deciding which treatment is required for a particular athlete or how the injury can be optimally managed. Achieving recovery from a specific spine injury usually depends on the kind of injury and the rehabilitation process the athletes undergo before returning to play.

Gender equality challenges in orthopaedic surgery: a systematic review

PURPOSE

Several studies have examined gender-equality challenges and ways to improve women's representation and management. Orthopaedic surgeons and patients are less gender equitable than them of other surgical disciplines. This systematic review summarizes these findings and highlights orthopaedic surgery gender inequality.

METHODS

Search of the PubMed, Embase, and Cochrane databases was carried out to extract human studies investigating the gender gap in orthopaedics, trying to highlight the equality challenges orthopaedic surgery faces. Studies incorporating patients with comorbidities in which gender is a proven risk factor, and pregnant women were excluded.

RESULTS

This systematic review included 59 studies involving 692,435 people (mean females/males ratio: 4.44), spanning the years 1987-2023. Regarding the targeted population, 35 (59.32%) studies focused on patients, while 24 (40.68%) on physicians. Orthopaedic surgery is described as an unfriendly career field for women as surgeons or sports leading physicians while women are generally under represented in the academic field of orthopaedics. Regarding patients, female gender consists both a risk and prognostic factor influencing the prevalence of degenerative disease and the outcome of the operative treatment in reconstructive orthopaedics. Female gender is a risk factor for multiple sports injuries and influences the pathogenetic mechanisms resulting in ACL reconstruction. Regarding spine surgery, women are less likely to have surgery suggested, and such suggestion underlines severe disease's progression.

CONCLUSIONS

Gender differences affect orthopaedic patient-physician-healthcare system interactions. Recognizing biases and their patterns is useful to improve the actual situation. By preventing those an unbiased, tolerant, and egalitarian workplace for physicians and a healthcare system that provides the best treatment to patients could be created.

Epidemiology of C2 fractures in the United States: A National Electronic Injury Surveillance System database study

Introduction

C2 fractures are one of the most common traumatic injuries of the cervical spine, with high rates of morbidity and mortality. Current literature on the incidence of C2 fractures is limited to populations outside of the United States (US), prior to 2014, or specific age cohorts. The purpose of this study is to report the incidence rate (IR) of C2 fractures and associated patient demographics in the US between 2002 and 2021 using the National Electronic Injury Surveillance System (NEISS) database.

Methods

This study analyzed the NEISS database to identify cases of C2 fractures presenting to US Emergency Departments (EDs) from 2002 to 2021. Annual and overall numbers of fractures, IR, and patient demographics were analyzed. IR is expressed as the number of fractures per 100,000 person-years at risk (PYR). Patients were split into three different age groups for comparison (children and young adults, 0-64 years; older adults, 65-79 years; elderly individuals, 80 + years).

Results

A national estimate of n = 72,764 patients (95% confidence interval [CI] = 54,371-91,156) presented to US EDs with a C2 fracture (IR was 1.17/PYR; 95% CI = 0.87-1.46), and elderly individuals had the highest IR overall (IR = 15.9; P < 0.05). The IR of C2 fractures between 2002 and 2021, reported as average annual percent change (AAPC), increased significantly, regardless of age or sex (AAPC = 10.9; 95% CI = 6.3-15.6; P < 0.0001).

Conclusion

C2 fractures occur at higher rates than previous years, with especially high IR in elderly individuals. Emphasis of public health efforts toward osteoporosis and coordination difficulties in elderly individuals would likely significantly reduce the overall IR of these injuries.

Epidemiology of Sports-Related Traumatic Hip Dislocations Reported in United States Emergency Departments, 2010-2019

Background:

Traumatic hip dislocations are rare injuries that most commonly occur in motor vehicle accidents. There is a paucity of literature that describes sports-related hip dislocations.

Purpose:

To estimate the incidence of sports-related hip dislocations and determine any sport- or sex-related epidemiological trends using the National Electronic Injury Surveillance System (NEISS) database.

Study Design:

Descriptive epidemiology study.

Methods:

Data regarding sports-related hip dislocations from 2010 to 2019 were retrieved from the NEISS, a database that catalogs injury information during emergency department visits from 100 hospitals across the United States to produce nationwide estimates of the injury burden. The estimated number of injuries was calculated using weights assigned by the NEISS database. The injuries were then stratified by sport and sex to determine any epidemiological patterns.

Results:

A total of 102 hip dislocation injuries were identified over the surveyed 10 years, indicating 2941 estimated injuries nationwide. Overall, 10 (9.8%) of 102 sports-related hip dislocations presented with concomitant acetabular fractures, representing an estimated 288 injuries nationally over 10 years. Male athletes sustained more sports-related hip dislocations than female athletes, with a relative incidence of 12.51 (P < .001). Adolescents aged 15 to 19 years recorded the highest number of hip dislocations. There were 17 sports identified as having caused at least 1 hip dislocation over the 10-year period. More hip dislocation injuries were sustained from contact sports (91.2%) than noncontact sports (8.8%) (P < .001). Football (estimated 164 injuries per year; 55.6%), snowboarding (28 per year; 9.5%), skiing (26 per year; 8.8%), and basketball (21 per year; 7.1%) had the highest rates of hip dislocation. Additionally, 43 (82.7%) football-related injuries were caused by tackling mechanisms, and 9 (17.3%) were caused by nontackling mechanisms (P < .001).

Conclusion:

The incidence of traumatic sports-related hip dislocations was extremely low in the United States during the study period. Male adolescents, aged 15 to 19 years, sustained the greatest number of injuries during football. Significantly more hip dislocations occurred in contact sports, most commonly football, snowboarding, skiing, and basketball, compared with noncontact sports. As adolescent athletes may have limited treatment options if osteonecrosis occurs, these data serve to increase the clinical awareness of these injuries.