Spinal injuries in Canadian ice hockey: an update to 2005

Development, calibration and validation of impact-specific cervical spine models: A novel approach using hybrid multibody and finite-element methods

BACKGROUND AND OBJECTIVE

Spinal cord injuries can have a severe impact on athletes' or patients' lives. High axial impact scenarios like tackling and scrummaging can cause hyperflexion and buckling of the cervical spine, which is often connected with bilateral facet dislocation. Typically, finite-element (FE) or musculoskeletal models are applied to investigate these scenarios, however, they have the drawbacks of high computational cost and lack of soft tissue information, respectively. Moreover, material properties of the involved tissues are commonly tested in quasi-static conditions, which do not accurately capture the mechanical behavior during impact scenarios. Thus, the aim of this study was to develop, calibrate and validate an approach for the creation of impact-specific hybrid, rigid body - finite-element spine models for high-dynamic axial impact scenarios.

METHODS

Five porcine cervical spine models were used to replicate in-vitro experiments to calibrate stiffness and damping parameters of the intervertebral joints by matching the kinematics of the in-vitro with the in-silico experiments. Afterwards, a five-fold cross-validation was conducted. Additionally, the von Mises stress of the lumped FE-discs was investigated during impact.

RESULTS

The results of the calibration and validation of our hybrid approach agree well with the in-vitro experiments. The stress maps of the lumped FE-discs showed that the highest stress of the most superior lumped disc was located anterior while the remaining lumped discs had their maximum in the posterior portion.

CONCLUSION

Our hybrid method demonstrated the importance of impact-specific modeling. Overall, our hybrid modeling approach enhances the possibilities of identifying spine injury mechanisms by facilitating dynamic, impact-specific computational models.

Catastrophic Sports Injuries: Causation and Prevention

➤ Catastrophic injuries in U.S. high school and college athletes are rare but devastating injuries.➤ Catastrophic sports injuries are classified as either traumatic, caused by direct contact during sports participation, or nontraumatic, associated with exertion while participating in a sport.➤ Football is associated with the greatest number of traumatic and nontraumatic catastrophic injuries for male athletes, whereas cheerleading has the highest number of traumatic catastrophic injuries and basketball has the highest number of nontraumatic catastrophic injuries for female athletes.➤ The incidence of traumatic catastrophic injuries for all sports has declined over the past 40 years, due to effective rule changes, especially in football, pole-vaulting, cheerleading, ice hockey, and rugby. Further research is necessary to reduce the incidence of structural brain injury in contact sports such as football.➤ The incidence of nontraumatic catastrophic injuries has increased over the last 40 years and requires additional research and preventive measures. Avoiding overexertion during training, confirming sickle cell trait status in high school athletes during the preparticipation physical examination, and developing cost-effective screening tools for cardiac abnormalities are critical next steps.

Targeting rule implementation decreases neck injuries in high school football: a national injury surveillance study

OBJECTIVES

Neck injuries in football are attributed to helmet-to-helmet contact with youth players being at greatest risk. In 2014, the National Federation of State High School Associations (NFHS) implemented rules defining illegal contact against a defenseless player above the shoulders to reduce head and neck injuries in football players. This study evaluates whether rule implementation decreased rates of high school football neck injuries presenting to the emergency department (ED) pre-rule implementation (2009-2013) to post-rule implementation (2015-2019).

METHODS

Data were queried from the National Electronic Injury Surveillance System for high school football players 14 to 18 years old diagnosed with a neck injury from 1 January 2009 to 31 December 2019. Narratives in the data were reviewed for mechanism of injury, setting, loss of consciousness (LOC), and type of injury.

RESULTS

Between 2009 and 2019, an estimated 47,577 high school football neck injuries were diagnosed in EDs across the United States. 52.0% of neck injuries were sustained during competition compared to 48.0% during practice. A statistically significant (P = 0.004) decrease in neck injuries was realized from pre-rule implementation to post-rule implementation with averages of 5,278 and 3,481 injuries per year, respectively. Helmet-to-helmet neck injuries significantly (P = 0.04) decreased from pre- to post-rule implementation with averages of 851 and 508 injuries per year, respectively. Neck injuries sustained via other mechanisms were not affected by the 2014 rule implementation.

CONCLUSION

This study is the first to identify a decrease in overall and helmet-to-helmet related neck injuries diagnosed in the ED following the 2014 NFHS targeting rule implementation. These findings add to the growing literature regarding the importance and efficacy of rule implementation in reducing sports-related neck injuries.

Chasing the Cup: A Comprehensive Review of Spinal Cord Injuries in Hockey

Ice hockey is a high-speed sport with a high rate of associated injury, including spinal cord injury (SCI). The incidence of hockey-related SCI has increased significantly in more recent years. A comprehensive literature search was conducted with the PubMed, Medline, Google Scholar, and Web of Science databases using the phrases “hockey AND spinal cord injuries” to identify relevant studies pertaining to hockey-related SCIs, equipment use, anatomy, and biomechanics of SCI, injury recognition, and return-to-play guidelines.

Fifty-three abstracts and full texts were reviewed and included, ranging from 1983 to 2021. The proportion of catastrophic SCIs is high when compared to other sports. SCIs in hockey occur most commonly from a collision with the boards due to intentional contact resulting in axial compression, as well as flexion-related teardrop fractures that lead to spinal canal compromise and neurologic injury. Public awareness programs, improvements in equipment, and rule changes can all serve to minimize the risk of SCI.

Hockey has a relatively high rate of associated SCIs occurring most commonly due to flexion-distraction injuries from intentional contact. Further investigation into equipment and hockey arena characteristics as well as future research into injury recognition and removal from and return to play is necessary.

Imaging of Hockey-related Injuries of the Head, Neck, and Body

Hockey is a demanding contact sport with growing popularity around the world. This article is part of a review series in this issue of Seminars in Musculoskeletal Radiology that summarizes epidemiological research on the patterns of ice hockey injuries as well as provides pictorial examples for a radiologist's perspective. We focus on non-extremity pathologies which encompass many of the most devastating injuries of hockey, namely those involving the head, neck, face, spine, and body.

Cervical Spine Injuries in the Ice Hockey Player: Current Concepts in Epidemiology, Management and Prevention

STUDY DESIGN

This review article examines the biomechanics that underly hockey-related cervical spine injuries, the preventative measures to curtail them, optimal management strategies for the injured player and return to play criteria.

OBJECTIVE

Hockey is a sport with one of the highest rates of cervical spine injury, but by understanding the underlying pathophysiology and context in which these injuries can occur, it is possible to reduce their incidence and successfully manage the injured player.

METHODS

Multiple online databases including PubMed, Google Scholar, Columbia Libraries Catalog, Cochrane Library and Ovid MEDLINE were queried for original articles concerning spinal injuries in ice hockey. All relevant papers were screened and subsequently organized for discussion in our subtopics.

RESULTS

Cervical fractures in ice hockey most often occur due to an increased axial load, with a check from behind the most common precipitating event.

CONCLUSIONS

Despite the recognized risk for cervical spine trauma in ice hockey, further research is still needed to optimize protocols for both mitigating injury risk and managing injured players.

On-Field Management of Suspected Spinal Cord Injury

Acute spinal cord injuries in athletes are rare. However, on-field management of such injuries requires a well-planned approach from a team of well-trained medical staff. Athletes wearing protective gear should be handled with care; a primary survey should be conducted to rule out life-threatening injury while concomitantly immobilizing the spine. Treatment with steroids or hypothermia have not been shown to be beneficial, ultimately time to surgery provides the athlete with the best chance of a good outcome.

Return to Play for Cervical and Lumbar Spine Conditions

Although the safety of contact sports has improved over the years, participation in any sport always carries a risk of injury. When cervical or lumbar spine injuries do occur, prompt diagnosis is essential, and athletes must be held out of the sport if indicated to prevent further harm and allow for recovery. This article highlights some of the most common cervical spine pathologies (stinger/burners, strain, stenosis/cord neuropraxia, disc herniation, and fracture/instability) and lumbar spine pathologies (strain, disc degeneration, disc herniation, fracture, spondylolysis/spondylolisthesis, and scoliosis) encountered in sports and reviews the associated return to play guidelines and expectations for each condition.

Incidence of Head Contacts, Penalties, and Player Contact Behaviors in Youth Ice Hockey: Evaluating the “Zero Tolerance for Head Contact” Policy Change

Background:

To reduce the risk of concussion in youth ice hockey, Hockey Canada implemented a national “zero tolerance for head contact” (HC) policy in 2011. A previous cohort study revealed higher concussion rates after this implementation in players aged 11 to 14 years. However, it is unknown whether the elevated risk was due to higher HC rates or factors such as increased concussion awareness and reporting.

Purpose:

To compare the rates of primary and secondary HCs and HC policy enforcement in elite U15 ice hockey leagues (players <15 years) before (2008-2009) and after (2013-2014) the zero-tolerance policy change.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

A total of 32 elite U15 games before (n_2008-2009 = 16; 510 players) and after (n_2013-2014 = 16; 486 players) HC policy implementation were video recorded. Videos were analyzed with validated criteria for identifying HC types (primary/direct contact by players [HC1], secondary/indirect contact via boards, glass, or ice surface [HC2]) and other player-to-player contact behavior. Referee-assessed penalties were cross-referenced with the official Hockey Canada casebook, and penalty types were displayed using proportions. Univariate Poisson regression (adjusted for cluster by team game, offset by game length [minutes]) was used to estimate HC incidence rates (IRs) and incidence rate ratios (IRRs) between cohorts.

Results:

A total of 506 HCs were analyzed, 261 before HC policy implementation (IR, 16.6/100 team minutes) and 245 after implementation (IR, 15.5/100 team minutes). The HC1 rate (IRR, 1.05; 95% CI, 0.86-1.28) and HC2 rate (IRR, 0.74; 95% CI, 0.50-1.11) did not significantly differ before versus after implementation. Only 12.0% and 13.6% of HC1s were penalized pre- and postimplementation, respectively. Before implementation, HC1s were commonly penalized as roughing or elbowing penalties (59%), while after implementation, HC1s were penalized with the HC penalty (76%), and only 8% as roughing or elbowing.

Conclusion:

Despite implementation of the “zero tolerance for HC” policy, there was no difference in the rate of HC1s and HC2s or the proportion of HC1 penalized from before to after implementation. This research is instrumental in informing Hockey Canada’s future referee training and rule enforcement modifications.

Updated Return-to-Play Recommendations for Collision Athletes After Cervical Spine Injury: A Modified Delphi Consensus Study With the Cervical Spine Research Society

BACKGROUND

Previous studies have attempted to establish return-to-play (RTP) guidelines in collision sport athletes after cervical spine injury; however, recommendations have been limited by scant high-quality evidence and basic consensus survey methodologies.

OBJECTIVE

To create relevant clinical statements regarding management in collision sport athletes after cervical spine injury, and establish consensus RTP recommendations.

METHODS

Following the modified Delphi methodology, a 3 round survey study was conducted with spine surgeons from the Cervical Spine Research Society and National Football League team physicians in order to establish consensus guidelines and develop recommendations for cervical spine injury management in collision sport athletes.

RESULTS

Our study showed strong consensus that asymptomatic athletes without increased magnetic resonance imaging (MRI) T2-signal changes following 1-/2- level anterior cervical discectomy and fusion (ACDF) may RTP, but not after 3-level ACDF (84.4%). Although allowed RTP after 1-/2-level ACDF was noted in various scenarios, the decision was contentious. No consensus RTP for collision athletes after 2-level ACDF was noted. Strong consensus was achieved for RTP in asymptomatic athletes without increased signal changes and spinal canal diameter &gt;10 mm (90.5%), as well as those with resolved MRI signal changes and diameter &gt;13 mm (81.3%). No consensus was achieved in RTP for cases with pseudarthrosis following ACDF. Strong consensus supported a screening MRI before sport participation in athletes with a history of cervical spine injury (78.9%).

CONCLUSION

This study provides modified Delphi process consensus statements regarding cervical spine injury management in collision sport athletes from leading experts in spine surgery, sports injuries, and cervical trauma. Future research should aim to elucidate optimal timelines for RTP, as well as focus on prevention of injuries.

Lumbar Spine Injuries in Sports: Review of the Literature and Current Treatment Recommendations

Low back pain is one of the most prevalent complaints of athletes at all levels of competition. The purpose of this literature review is to provide an overview of sport-specific injuries and treatment outcomes that can be used by healthcare providers to better recognize injury patterns and treatment options for different groups of athletes. To our knowledge, no prior comprehensive review of lumbar spine injuries in sports is currently available in the literature, and it is essential that healthcare providers understand the sport-specific injury patterns and treatment guidelines for athletes presenting with low back pain following an athletic injury. Injury mechanisms were found to vary significantly by sport, although some broad recommendations can be made with regards to optimal treatment for these injuries and return to play. Additionally, it was found that certain treatments were more beneficial and resulted in higher rates of return to play depending on the specific sport of the injured athlete. Healthcare providers need to be aware of the different injury patterns seen in specific sports in order to properly evaluate and treat these injuries. Furthermore, an individualized treatment plan needs to be selected in a sport-specific context in order to meet the needs of the athlete in the short and long term.

Acute management of cervical spine trauma

Traumatic cervical spine injuries represent a significant cause of morbidity and mortality in sports. Appropriate management of such injuries is critical to minimizing harm and facilitating optimal long-term recovery and outcome. Management strategies begin with emergency preparedness amongst sideline providers and extends to paramedic services and medical teams in the acute care setting. This chapter outlines the principles of treatment across the care continuum, with a primary focus on hospital-based care. Diagnostic imaging and equipment considerations are reviewed, with discussion of corticosteroid administration, therapeutic hypothermia, and traction of the cervical spine. Approaches to cervical spine stabilization and return to play are also detailed, with an emphasis on patient-centered care and individualized treatment approaches to the athlete.

The epidemiology of back/neck/spine injuries in National Collegiate Athletic Association men's and women's ice hockey, 2009/2010 to 2014/2015

This study describes the epidemiology of back/neck/spine injuries in National Collegiate Athletic Association (NCAA) men's and women's ice hockey. Data from 66 NCAA men's and 29 women's ice hockey programmes (total of 147 and 67 team-seasons, respectively) were analysed from the NCAA Injury Surveillance Program during the 2009/2010-2014/2015 academic years. In the study period, 226 and 97 back/neck/spine injuries were reported in men and women, respectively, for injury rates of 0.56 and 0.65/1000 athlete exposures. Injury rates were higher in competitions than practices in men (injury rate ratio [IRR] = 4.22; 95% confidence interval [CI]: 3.24-5.49) and women (IRR = 2.49; 95% CI: 1.67-3.70). Most injuries occurred in the lower back/lumbar spine (men: 52.2%; women: 48.5%). There were notably low rates of fractures and severe spinal injuries for both sexes. This study enhances our understanding of the incidence, mechanisms and factors influencing these injuries and can ultimately lead to more effective injury prevention.

Forecasting Financial Resources for Future Traumatic Spinal Cord Injury Care Using Simulation Modeling

Survivors of traumatic spinal cord injury (tSCI) have intense healthcare needs during acute and rehabilitation care and often through the rest of life. To prepare for a growing and aging population, simulation modeling was used to forecast the change in healthcare financial resources and long-term patient outcomes between 2012 and 2032. The model was developed with data from acute and rehabilitation care facilities across Canada participating in the Access to Care and Timing project. Future population and tSCI incidence for 2012 and 2032 were predicted with data from Statistics Canada and the Canadian Institute for Health Information. The projected tSCI incidence for 2012 was validated with actual data from the Rick Hansen SCI Registry of the participating facilities. Using a medium growth scenario, in 2032, the projected median age of persons with tSCI is 57 and persons 61 and older will account for 46% of injuries. Admissions to acute and rehabilitation facilities in 2032 were projected to increase by 31% and 25%, respectively. Because of the demographic shift to an older population, an increase in total population life expectancy with tSCI of 13% was observed despite a 22% increase in total life years lost to tSCI between 2012 and 2032. Care cost increased 54%, and rest of life cost increased 37% in 2032, translating to an additional CAD $16.4 million. With the demographics and management of tSCI changing with an aging population, accurate projections for the increased demand on resources will be critical for decision makers when planning the delivery of healthcare after tSCI.

Cervical Spine Injuries in the Athlete

Cervical spine injuries are extremely common and range from relatively minor injuries, such as cervical muscle strains, to severe, life-threatening cervical fractures with spinal cord injuries. Although cervical spine injuries are most common in athletes who participate in contact and collision sports, such as American football and rugby, they also have been reported in athletes who participate in noncontact sports, such as baseball, gymnastics, and diving. Cervical spine injuries in athletes are not necessarily the result of substantial spine trauma; some athletes have chronic conditions, such as congenital stenosis, that increase their risk for a serious cervical spine injury after even minor trauma. Therefore, physicians who cover athletic events must have a thorough knowledge of cervical spine injures and the most appropriate ways in which they should be managed. Although cervical spine injuries can be career-ending injuries, athletes often are able to return to play after appropriate treatment if the potential for substantial re-injury is minimized.

Epidemiology of sport-related spinal cord injuries: A systematic review

CONTEXT

Despite the recognition of sports as a significant contributor in the etiology of spinal cord injury (SCI), no studies have systematically explored the epidemiology of SCI caused by sports.

OBJECTIVE

This paper aims to give a systematic overview of the epidemiology of sport-related spinal cord injury around the world.

METHODS

A systematic review was conducted to identify published literature reporting the epidemiology of SCI caused by sports. The literature search was conducted in MEDLINE/PubMed, CINAHL, EMBASE, PsycINFO and Sportdiscus with date limits 1980 through to July 2015. Data from 54 studies covering 25 countries was extracted and collated.

RESULTS

Important findings include identification of 6 countries in which sports accounts for over 13% of SCI (highest to lowest: Russia, Fiji, New Zealand, Iceland, France and Canada); individual sports with high risk for SCI (diving, skiing, rugby, and horseback riding); and the most common level of injury for various sports (almost entirely cervical for hockey, skiing, diving and American football, while over half of horseback riding and snowboarding injuries are thoracic or lumbosacral).

CONCLUSION

This paper identifies countries and sports with higher rates of sport-related SCIs where implementation of prevention programs and reporting systems to track SCI epidemiology may be helpful, and highlights gaps in our current knowledge for further investigation. The comparison of SCI occurrence for each sport across countries, as well as examination of the specific characteristics of SCI incurred for individual sports will assist in directing efforts for prevention.

Update and Overview of Spinal Injuries in Canadian Ice Hockey, 1943 to 2011: The Continuing Need for Injury Prevention and Education

OBJECTIVE

To identify spinal injuries in Canadian ice hockey from 2006 to 2011 and to discuss data from 1943 to 2011 and impact of injury prevention programs.

DESIGN

Data about spinal injuries with and without spinal cord injury in ice hockey have been collected by ThinkFirst's (now Parachute Canada) Canadian Ice Hockey Spinal Injuries Registry since 1981 through questionnaires from practitioners, ice hockey organizations, and media.

SETTING

All Canadian provinces and territories.

PARTICIPANTS

All registered Canadian ice hockey players.

ASSESSMENT OF RISK FACTORS

Age, gender, level of play, location, mechanism of injury.

MAIN OUTCOME MEASURES

Incidence, incidence rate, prevalence, and nature (morbidity) of the injuries.

RESULTS

Between 2006 and 2011, 44 cases occurred, 4 (9.1%) of which were severe. The incidence in the recent years continues to be lower than the peak years. From 1943 to 2011, 355 cases have been documented, primarily males (97.7%) and cervical spine injuries (78.9%), resulting from impact with the boards (64.2%). Check or push from behind (36.0%) was still the most common cause of injury, although slightly lower during 2006 to 2011. From 1943 to 2011, Prince Edward Island, New Brunswick, and British Columbia/Yukon had the highest injury rates. Ontario and Quebec continued to show markedly different injury rates, with Ontario more than twice that of Quebec.

CONCLUSIONS

Current data for 2006 to 2011 indicate that spinal injuries in ice hockey continue to occur, although still at lower rates than the peak years 1982 to 1995. It is imperative to continue educating players and team officials about spinal injury prevention and to reinforce the rules against checking or pushing from behind to reduce the incidence of these serious injuries.

Are There Differences in Ice Hockey Injuries Between Sexes?: A Systematic Review

Background:

Men’s ice hockey allows for body checking, and women’s ice hockey prohibits it. Studies have reported injury data on both sexes, but no systematic reviews have compared the injury patterns between male and female ice hockey players.

Hypothesis:

Men’s and women’s ice hockey would have different types of injuries, and this difference would extend across the different age groups and levels of play.

Study Design:

Systematic review; Level of evidence, 4.

Methods:

Three databases, 3 scientific journals, and selected bibliographies were searched to identify articles relevant to this study. Articles were further screened by the use of predetermined inclusion and exclusion criteria. Twenty-two studies met these criteria and were subsequently reviewed.

Results:

Men sustained higher rates of injuries than women at all age levels, and both sexes sustained at least twice as many injuries in games than practices. Both sexes sustained most of their injuries from player contact. Men and women in college sustained most injuries to the head and face, and women suffered from higher percentages of concussion. At all ages and levels of play, men had higher rates of upper extremity injuries (shoulder), while women were found to sustain more injuries to the lower extremity (thigh, knee).

Conclusion:

Although findings showed men sustaining higher rates of injuries than women, the predominant mechanism of player contact was the same. The most common locations and types of injuries in female ice hockey players are comparable to other sports played by women, and similar interventions could offer protection against injury.

Clinical Relevance:

Further studies that report injury data for women playing ice hockey at all levels will assist in understanding what prevention strategies should be implemented.

Performance-based outcomes after nonoperative treatment, discectomy, and/or fusion for a lumbar disc herniation in National Hockey League athletes

BACKGROUND

Ice hockey players have a high incidence of lumbar spine disorders; however, there is no evidence in the literature to guide the treatment of an ice hockey player with a herniated lumbar disc.

PURPOSE

To determine the performance-based outcomes in professional National Hockey League (NHL) athletes with a lumbar disc herniation after either nonsurgical or surgical treatment.

STUDY DESIGN

Descriptive epidemiological study.

METHODS

Athletes in the NHL with a lumbar disc herniation were identified through team injury reports and archives on public record. The return-to-play rate, games played per season, points per game, and performance score for each player were determined before and after the diagnosis of a lumbar disc herniation. Statistical analysis was used to compare preinjury and postinjury performance measures for players treated with either nonsurgical or surgical treatment.

RESULTS

A total of 87 NHL players met the inclusion criteria; 31 underwent nonoperative care, 48 underwent a discectomy, and 8 underwent a single-level fusion. The return-to-play rate for all players was 85%. There was a significant decrease in performance in all players after a lumbar disc herniation in games played per season, points scored per game, and performance score. A comparison of the posttreatment results for the nonsurgical and surgical patient groups revealed no significant difference in performance measures. Notably, the lumbar fusion group did not show a decrease in games played per season or performance score after surgery, likely secondary to a small sample size.

CONCLUSION

National Hockey League players with a lumbar disc herniation have a high return-to-play rate regardless of the type of treatment; however, performance-based outcomes may decrease compared with preinjury levels. The study data suggest that a lumbar fusion is compatible with a return to play in the NHL, which is in contrast to other professional sports.

Sport Concussion Education and Prevention

There has been a remarkable increase in the past 10 years in the awareness of concussion in the sports and recreation communities. Just as sport participants, their families, coaches, trainers, and sports organizations now know more about concussions, health care professionals are also better prepared to diagnose and manage concussions. As has been stated in the formal articles in this special issue on sport-related concussion, education about concussion is one of the most important aspects of concussion prevention, with the others being data collection, program evaluation, improved engineering, and introduction and enforcement of rules. Unfortunately, the incidence of concussion appears to be rising in many sports and thus, additional sports-specific strategies are required to reduce the incidence, short-term effects, and long term consequences of concussion. Enhanced educational strategies are required to ensure that individual participants, sports organizations, and health care professionals recognize concussions and manage them proficiently according to internationally recognized guidelines. Therefore, this paper serves as a “brief report” on a few important aspects of concussion education and prevention.

Rodeo catastrophic injuries and registry: initial retrospective and prospective report

OBJECTIVE

To introduce the Rodeo Catastrophic Injury Registry (RCIR) and quantify the nature and incidence of catastrophic injury and fatality in rodeo participants across North America.

DESIGN

Retrospective and prospective collection of catastrophic and fatal injury data in rodeo using an online registry (RCIR).

SETTING

Canada and the United States.

PARTICIPANTS

North American rodeo competitors.

ASSESSMENT OF RISK FACTORS

Age, gender, level of competition, rodeo event, mechanism of injury, and use of protective equipment.

MAIN OUTCOME MEASURES

Frequency, incidence, and nature of catastrophic injuries and fatalities among rodeo participants.

RESULTS

The incidence rate of catastrophic injury from 1989 to 2009 was 9.45 per 100 000 (49/518 286). The incidence rate of catastrophic injury during the 2007-2009 study period was 19.81 per 100 000 (19/95 892). The incidence rate of fatality from 1989 to 2009 was 4.05 per 100 000 (21/518 286). The incidence rate of fatality for the 2007-2009 study period was 7.29 per 100 000 (7/95 892).

CONCLUSIONS

Thoracic compression mechanisms of injury are most pervasive and likely to be fatal in rodeo and bull riding. It is unknown whether rodeo protective vests have a protective effect in reducing catastrophic and fatal injuries. On the contrary, helmet use in bull riding and rodeo events seems to have a protective effect in reducing both catastrophic injury and fatality.