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Agarwal AK, Ali ZS, Shofer F, Xiong R, Hemmons J, Spencer E, Abdel-Rahman D, Sennett B, Delgado MK. Testing Digital Methods of Patient-Reported Outcomes Data Collection: A prospective, cluster randomized trial to test text messaging and mobile surveys. (Preprint). JMIR Form Res 2021; 6:e31894. [PMID: 35298394 PMCID: PMC8972112 DOI: 10.2196/31894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 08/31/2021] [Accepted: 02/07/2022] [Indexed: 11/13/2022] Open
Abstract
Background Health care delivery continues to evolve, with an effort being made to create patient-centered care models using patient-reported outcomes (PROs) data. Collecting PROs has remained challenging and an expanding landscape of digital health offers a variety of methods to engage patients. Objective The aim of this study is to prospectively investigate two common methods of remote PRO data collection. The study sought to compare response and engagement rates for bidirectional SMS text messaging and mobile surveys following orthopedic surgery. Methods The study was a prospective, block randomized trial of adults undergoing elective orthopedic procedures over 6 weeks. The primary objective was to determine if the method of digital patient engagement would impact response and completion rates. The primary outcome was response rate and total completion of PRO questionnaires. Results A total of 127 participants were block randomized into receiving a mobile survey (n=63) delivered as a hyperlink or responding to the same questions through an automated bidirectional SMS text messaging system (n=64). Gender, age, number of comorbidities, and opioid prescriptions were similar across messaging arms. Patients receiving the mobile survey were more likely to have had a knee-related surgery (n=50, 83.3% vs n=40, 62.5%; P=.02) but less likely to have had an invasive procedure (n=26, 41.3% vs n=39, 60.9%; P=.03). Overall engagement over the immediate postoperative period was similar. Prolonged engagement for patients taking opioids past postoperative day 4 was higher in the mobile survey arm at day 7 (18/19, 94.7% vs 9/16, 56.3%). Patients with more invasive procedures showed a trend toward being responsive at day 4 as compared to not responding (n=41, 59.4% vs n=24, 41.4%; P=.05). Conclusions As mobile patient engagement becomes more common in health care, testing the various options to engage patients to gather data is crucial to inform future care and research. We found that bidirectional SMS text messaging and mobile surveys were comparable in response and engagement rates; however, mobile surveys may trend toward higher response rates over longer periods of time. Trial Registration ClinicalTrials.gov NCT03532256; https://clinicaltrials.gov/ct2/show/NCT03532256
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Affiliation(s)
- Anish K Agarwal
- Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA, United States
- Leonard Davis Institute, University of Pennsylvania, Philadelphia, PA, United States
- Penn Medicine Center for Health Care Innovation, University of Pennsylvania, Philadelphia, PA, United States
| | - Zarina S Ali
- Leonard Davis Institute, University of Pennsylvania, Philadelphia, PA, United States
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA, United States
| | - Frances Shofer
- Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Ruiying Xiong
- Behavioral Science and Analytics for Injury Reduction, University of Pennsylvania, Philadelphia, PA, United States
| | - Jessica Hemmons
- Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA, United States
- Behavioral Science and Analytics for Injury Reduction, University of Pennsylvania, Philadelphia, PA, United States
| | - Evan Spencer
- Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA, United States
- Behavioral Science and Analytics for Injury Reduction, University of Pennsylvania, Philadelphia, PA, United States
| | - Dina Abdel-Rahman
- Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA, United States
- Behavioral Science and Analytics for Injury Reduction, University of Pennsylvania, Philadelphia, PA, United States
| | - Brian Sennett
- Department of Orthopedic Surgery, University of Pennsylvania, Philadelphia, PA, United States
| | - Mucio K Delgado
- Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA, United States
- Leonard Davis Institute, University of Pennsylvania, Philadelphia, PA, United States
- Behavioral Science and Analytics for Injury Reduction, University of Pennsylvania, Philadelphia, PA, United States
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Agarwal AK, Lee D, Ali Z, Sennett B, Xiong R, Hemmons J, Spencer E, Abdel-Rahman D, Kleinman R, Lacko H, Horan A, Dooley M, Hume E, Mehta S, Delgado MK. Patient-Reported Opioid Consumption and Pain Intensity After Common Orthopedic and Urologic Surgical Procedures With Use of an Automated Text Messaging System. JAMA Netw Open 2021; 4:e213243. [PMID: 33764425 PMCID: PMC7994954 DOI: 10.1001/jamanetworkopen.2021.3243] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 02/05/2021] [Indexed: 12/22/2022] Open
Abstract
Importance Surgeons must balance management of acute postoperative pain with opioid stewardship. Patient-centered methods that immediately evaluate pain and opioid consumption can be used to guide prescribing and shared decision-making. Objective To assess the difference between the number of opioid tablets prescribed and the self-reported number of tablets taken as well as self-reported pain intensity and ability to manage pain after orthopedic and urologic procedures with use of an automated text messaging system. Design, Setting, and Participants This quality improvement study was conducted at a large, urban academic health care system in Pennsylvania. Adult patients (aged ≥18 years) who underwent orthopedic and urologic procedures and received postoperative prescriptions for opioids were included. Data were collected prospectively using automated text messaging until postoperative day 28, from May 1 to December 31, 2019. Main Outcomes and Measures The primary outcome was the difference between the number of opioid tablets prescribed and the patient-reported number of tablets taken (in oxycodone 5-mg tablet equivalents). Secondary outcomes were self-reported pain intensity (on a scale of 0-10, with 10 being the highest level of pain) and ability to manage pain (on a scale of 0-10, with 10 representing very able to control pain) after orthopedic and urologic procedures. Results Of the 919 study participants, 742 (80.7%) underwent orthopedic procedures and 177 (19.2%) underwent urologic procedures. Among those who underwent orthopedic procedures, 384 (51.8%) were women, 491 (66.7%) were White, and the median age was 48 years (interquartile range [IQR], 32-61 years); 514 (69.8%) had an outpatient procedure. Among those who underwent urologic procedures, 145 (84.8%) were men, 138 (80.7%) were White, and the median age was 56 years (IQR, 40-67 years); 106 (62%) had an outpatient procedure. The mean (SD) pain score on day 4 after orthopedic procedures was 4.72 (2.54), with a mean (SD) change by day 21 of -0.40 (1.91). The mean (SD) ability to manage pain score on day 4 was 7.32 (2.59), with a mean (SD) change of -0.80 (2.72) by day 21. The mean (SD) pain score on day 4 after urologic procedures was 3.48 (2.43), with a mean (SD) change by day 21 of -1.50 (2.12). The mean (SD) ability to manage pain score on day 4 was 7.34 (2.81), with a mean (SD) change of 0.80 (1.75) by day 14. The median quantity of opioids prescribed for patients who underwent orthopedic procedures was high compared with self-reported consumption (20 tablets [IQR, 15-30 tablets] vs 6 tablets used [IQR, 0-14 tablets]), similar to findings for patients who underwent urologic procedures (7 tablets [IQR, 5-10 tablets] vs 1 tablet used [IQR, 0-4 tablets]). Over the study period, 9452 of 15 581 total tablets prescribed (60.7%) were unused. A total of 589 patients (64.1%) used less than half of the amount prescribed, and 256 patients (27.8%) did not use any opioids (179 [24.1%] who underwent orthopedic procedures and 77 [43.5%] who underwent urologic procedures). Conclusions and Relevance In this quality improvement study of adult patients reporting use of opioids after common orthopedic and urologic surgical procedures through a text messaging system, the quantities of opioids prescribed and the quantity consumed differed. Patient-reported data collected through text messaging may support clinicians in tailoring prescriptions and guide shared decision-making to limit excess quantities of prescribed opioids.
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Affiliation(s)
- Anish K. Agarwal
- Department of Emergency Medicine, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
- Penn Medicine Center for Health Care Innovation, University of Pennsylvania, Philadelphia
| | - Daniel Lee
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
- Department of Surgery, Division of Urology, University of Pennsylvania, Philadelphia
| | - Zarina Ali
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
- Department of Neurosurgery, University of Pennsylvania, Philadelphia
| | - Brian Sennett
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia
| | - Ruiying Xiong
- Department of Emergency Medicine, University of Pennsylvania, Philadelphia
| | - Jessica Hemmons
- Department of Emergency Medicine, University of Pennsylvania, Philadelphia
| | - Evan Spencer
- Department of Emergency Medicine, University of Pennsylvania, Philadelphia
| | - Dina Abdel-Rahman
- Department of Emergency Medicine, University of Pennsylvania, Philadelphia
| | - Rachel Kleinman
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia
| | - Hannah Lacko
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia
| | - Annamarie Horan
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia
| | - Mary Dooley
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia
| | - Eric Hume
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia
| | - Samir Mehta
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia
| | - M. Kit Delgado
- Department of Emergency Medicine, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia
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Abstract
OBJECTIVE It has been established that most patients prescribed opioids after minor surgery have tablets left over, better understanding the variation in opioid prescribing and variation in dosage of the prescription could guide efforts to reduce prescribing. This study describes the state-level variation in opioid prescribing after a knee arthroscopy among opioid-naïve patients. DESIGN Retrospective cohort study. SETTING Commercial insurance claims data. PARTICIPANTS 98 623 individual across the USA with commercial insurance who were opioid-naïve and had a knee arthroscopy between 2015 and 2019. EXPOSURE Patients who filled an opioid prescription within 3 days of a knee arthroscopy. OUTCOME MEASURES Opioid prescriptions were measured as a pharmacy claim for filling an opioid within 3 days of a knee arthroscopy. We measured the patient and state-level opioid prescribing rate, tablet count, morphine milligram equivalent dose per prescription and risk-adjusted predicted opioid quantity. RESULTS Overall, 72% of patients filled an opioid prescription with a median tablet count of 40 and median morphine milligram equivalent of 250. Patients with an invasive procedure (27.9% vs 22.4%; p<0.001), higher education level (p<0.001) and fewer comorbidities (0.9 vs 1.2, p<0.001) had higher rates of opioid prescribing. The prescribing rate in the highest state, Nebraska (85%), was double the prescribing rate in the lowest state, South Dakota (40%). Comparing the casemix adjusted expected prescribing rate to the observed prescribing rate displayed that 18 states had observed prescribing rates that were higher than their expected prescribing rates. CONCLUSION Wide variation in the likelihood of receiving a prescription, depending on state of residence, was observed. The dosages prescribed were high and have been associated with transition to long-term use. These findings suggest that there is substantial opportunity for the development of guidelines to reduce variability in opioid prescribing for this common ambulatory procedure.
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Affiliation(s)
- Benjamin Ukert
- Department of Health Policy and Management, School of Public Health, Texas A&M University System, College Station, Texas, USA
- Penn Injury Science Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Leonard Davis Institute of Health Economics, University of Pennylvania, Philadelphia, Pennsylvania, USA
| | - Yanlan Huang
- Leonard Davis Institute of Health Economics, University of Pennylvania, Philadelphia, Pennsylvania, USA
- Center for Emergency Care Policy and Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Brian Sennett
- Division of Sports Medicine, Department of Orthopedics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kit Delgado
- Penn Injury Science Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Leonard Davis Institute of Health Economics, University of Pennylvania, Philadelphia, Pennsylvania, USA
- Center for Emergency Care Policy and Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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PONTILLO M, Sennett B. Reduction Of Injury And Related Costs After Implementation Of An Injury Prevention System In Division I Athletes. Med Sci Sports Exerc 2020. [DOI: 10.1249/01.mss.0000686212.10041.e0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Pontillo M, Butowicz CM, Ebaugh D, Thigpen CA, Sennett B, Silfies SP. Comparison of core neuromuscular control and lower extremity postural stability in athletes with and without shoulder injuries. Clin Biomech (Bristol, Avon) 2020; 71:196-200. [PMID: 31775089 DOI: 10.1016/j.clinbiomech.2019.11.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 03/12/2019] [Accepted: 11/12/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND The kinetic chain theory is widely used as a rationale for the inclusion of core stability training in athletes. Core stability (muscle capacity and neuromuscular control) impairments may result in less than optimal performance and abnormal force dissipation to the shoulder complex that could lead to shoulder injuries. However, a paucity of literature exists to support this relationship, and no previous studies have investigated the relationship between isolated core neuromuscular control and shoulder injuries. Additionally, lower extremity postural stability has been associated with athletic function and may also be associated with shoulder injuries. The purpose of this study was to compare biomechanical measures of isolated core neuromuscular control and lower extremity postural stability between athletes with and without non-traumatic shoulder injuries. METHODS Eighty athletes (55 males, age: 21.2 ± 3.3 years, 40 with a current shoulder injury) completed biomechanical measures of isolated core neuromuscular control and lower extremity postural stability. Athletes were matched by age, gender, body mass index, and sport type. MANOVAs were used to assess differences between measures of core neuromuscular control and lower extremity postural stability between groups. FINDINGS There were no statistically significant differences between athletes with and without shoulder injuries for the static core neuromuscular control measures, F(4,75) = 0.45, P = 0.78, η2 = 0.02; dynamic core neuromuscular control measures, F(4,75) = 0.81, P = 0.52, η2 = 0.04; or lower extremity postural stability measures, F(8,61) = 0.85, P = 0.56, η2 = 0.10. INTERPRETATION Although core stability is widely incorporated in rehabilitation of athletes with shoulder injuries, athletes with current non-traumatic shoulder injuries may not present with impairments in core neuromuscular control or lower extremity postural stability.
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Affiliation(s)
- Marisa Pontillo
- Penn Sports Medicine Center, University of Pennsylvania, 235 S. 33rd Street, Ste 1, Philadelphia, PA 19104, USA.
| | - Courtney M Butowicz
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, 921 Assembly Street, Columbia, SC 29208, USA
| | - David Ebaugh
- Department of Physical Therapy, University of Delaware, 540 South College Avenue, Newark, DE 19713, USA
| | - Charles A Thigpen
- ATI Physical Therapy, 200 Patewood Dr Ste 150C, 29615 Greenville, SC, USA
| | - Brian Sennett
- Penn Sports Medicine Center, University of Pennsylvania, 235 S. 33rd Street, Ste 1, Philadelphia, PA 19104, USA
| | - Sheri P Silfies
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, 921 Assembly Street, Columbia, SC 29208, USA
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Kibler WB, Sennett B, Sciascia A. New Paradigms in the Throwing Shoulder: Pathophysiology and Examination. Instr Course Lect 2019; 68:491-498. [PMID: 32032052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
There continues to be a high incidence of shoulder injuries in throwing athletes, with sometimes disappointing return-to-play outcomes, creating an increased need to understand the pathophysiology of the injury and to better characterize the injury during the clinical examination. Current concepts suggest that the disabled throwing shoulder is a useful construct to develop a more comprehensive view of the complex local and distant musculoskeletal alterations that can be seen associated with the clinical symptoms. The pathophysiology can be seen as a cascade to injury, in which proximal or distal deficits in motion, strength, and strength balance can affect force production, joint position, and joint loads throughout the kinetic chain. Local imbalances between force production and load can create anatomic injury or create distant imbalances that create the injury. The evaluation then becomes a more comprehensive one, necessitating a look at all areas of the kinetic chain and evaluation of them in the context of the requirements on the structures during each of the phases of the throwing motion. Specific testing for core stability, scapular stability and motion, and local muscle strength, strength balance, and flexibility needs to be performed, as well as tests for tissue injury.
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Pontillo M, Silfies S, Butowicz CM, Thigpen C, Sennett B, Ebaugh D. COMPARISON OF CORE STABILITY AND BALANCE IN ATHLETES WITH AND WITHOUT SHOULDER INJURIES. Int J Sports Phys Ther 2018; 13:1015-1023. [PMID: 30534467 PMCID: PMC6253758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND Relationships between core stability and lower extremity injuries have been described in the literature; however, evidence of the relationship between upper extremity injuries and core stability and balance is limited. HYPOTHESIS/PURPOSE The purpose of this study was to compare clinical measures of core stability and balance between athletes with and without non-traumatic shoulder injuries. STUDY DESIGN Cross sectional. METHODS Eighty athletes (54 males, age: 21.2 + 3.3 years) participated in this study. Forty athletes with a current shoulder injury were matched to healthy athletes by age, gender, BMI, and sport. Athletes completed clinical core stability tests including flexor and extensor endurance tests, double leg lower test (°) and balance tests including single leg stance under eyes open and eyes closed conditions, and the Y-balance test. MANOVAs were used to assess group differences. RESULTS No statistically significant differences existed between athletes with and without shoulder injuries for clinical tests of core stability, F(1,78)=0.97, p=0.41; η2 = 0.04. No statistically significant differences existed between injured athletes with and without shoulder injuries for static and dynamic balance measures, F(1,78)=0.86, p=0.53; η2 = 0.07. CONCLUSIONS Although core stability is widely incorporated in rehabilitation of athletes with shoulder injuries, performance on these clinical tests did not differ in the group of athletes assessed in this study. LEVEL OF EVIDENCE 3.
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Affiliation(s)
| | | | | | | | - Brian Sennett
- Penn Orthopedics, University of Pennsylvania Health System, Philadelphia, PA, USA
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Bishop JY, Jones GL, Lewis B, Pedroza A, Kuhn J, Dunn W, Cox C, Wolf B, Hettrich C, Bollier M, Carey J, Kelly J, Sennett B, McCarty E, Vidal A, Bravman J, Poddar S, Spencer E, Holloway B, Ma B, Allen C, Feeley B, Marx R, Miller B, Carpenter J, Wright R, Brophy R, Smith M, Abboud J. Intra- and interobserver agreement in the classification and treatment of distal third clavicle fractures. Am J Sports Med 2015; 43:979-84. [PMID: 25587184 DOI: 10.1177/0363546514563281] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND In treatment of distal third clavicle fractures, the Neer classification system, based on the location of the fracture in relation to the coracoclavicular ligaments, has traditionally been used to determine fracture pattern stability. PURPOSE To determine the intra- and interobserver reliability in the classification of distal third clavicle fractures via standard plain radiographs and the intra- and interobserver agreement in the preferred treatment of these fractures. STUDY DESIGN Cohort study (Diagnosis); Level of evidence, 3. METHODS Thirty radiographs of distal clavicle fractures were randomly selected from patients treated for distal clavicle fractures between 2006 and 2011. The radiographs were distributed to 22 shoulder/sports medicine fellowship-trained orthopaedic surgeons. Fourteen surgeons responded and took part in the study. The evaluators were asked to measure the size of the distal fragment, classify the fracture pattern as stable or unstable, assign the Neer classification, and recommend operative versus nonoperative treatment. The radiographs were reordered and redistributed 3 months later. Inter- and intrarater agreement was determined for the distal fragment size, stability of the fracture, Neer classification, and decision to operate. Single variable logistic regression was performed to determine what factors could most accurately predict the decision for surgery. RESULTS Interrater agreement was fair for distal fragment size, moderate for stability, fair for Neer classification, slight for type IIB and III fractures, and moderate for treatment approach. Intrarater agreement was moderate for distal fragment size categories (κ = 0.50, P < .001) and Neer classification (κ = 0.42, P < .001) and substantial for stable fracture (κ = 0.65, P < .001) and decision to operate (κ = 0.65, P < .001). Fracture stability was the best predictor of treatment, with 89% accuracy (P < .001). CONCLUSION Fracture stability determination and the decision to operate had the highest interobserver agreement. Fracture stability was the key determinant of treatment, rather than the Neer classification system or the size of the distal fragment.
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Affiliation(s)
- Julie Y Bishop
- Department of Orthopaedics, The Ohio State University, Columbus, Ohio, USA
| | - Grant L Jones
- Department of Orthopaedics, The Ohio State University, Columbus, Ohio, USA
| | - Brian Lewis
- Department of Orthopaedics, The Ohio State University, Columbus, Ohio, USA
| | - Angela Pedroza
- Department of Orthopaedics, The Ohio State University, Columbus, Ohio, USA
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Opar D, Drezner J, Shield A, Williams M, Webner D, Sennett B, Kapur R, Cohen M, Ulager J, Cafengiu A, Cronholm PF. Acute injuries in track and field athletes: a 3-year observational study at the Penn Relays Carnival with epidemiology and medical coverage implications. Am J Sports Med 2015; 43:816-22. [PMID: 25560540 DOI: 10.1177/0363546514562553] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Few studies have examined acute injuries in track and field in both elite and subelite athletes. PURPOSE To observe the absolute number and relative rates of injury in track and field athletes across a wide range of competition levels and ages during 3 years of the Penn Relays Carnival to assist with future medical coverage planning and injury prevention strategies. STUDY DESIGN Descriptive epidemiology study. METHODS Over a 3-year period, all injuries treated by the medical staff were recorded on a standardized injury report form. Absolute number of injuries and relative injury rates (number of injuries per 1000 competing athletes) were determined and odds ratios (ORs) of injury rates were calculated between sexes, competition levels, and events. Injuries were also broken down into major or minor medical or orthopaedic injuries. RESULTS Throughout the study period, 48,473 competing athletes participated in the Penn Relays Carnival, and 436 injuries were sustained. For medical coverage purposes, the relative rate of injury subtypes was greatest for minor orthopaedic injuries (5.71 injuries per 1000 participants), followed by minor medical injuries (3.42 injuries per 1000 participants), major medical injuries (0.69 injuries per 1000 participants), and major orthopaedic injuries (0.18 injuries per 1000 participants). College/elite athletes displayed the lowest relative injury rate (7.99 injuries per 1000 participants), which was significantly less than that of high school (9.87 injuries per 1000 participants) and masters athletes (16.33 injuries per 1000 participants). Male athletes displayed a greater likelihood of having a minor orthopaedic injury compared with female athletes (OR, 1.36 [95% CI, 1.06-1.75]; χ2 = 5.73; P = .017) but were less likely to sustain a major medical injury (OR, 0.33 [95% CI, 0.15-0.75]; χ2 = 7.75; P = .005). Of the 3 most heavily participated in events, the 4 × 400-m relay displayed the greatest relative injury rate (13.6 injuries per 1000 participants) compared with the 4 × 100-m and 4 × 200-m relays. CONCLUSION Medical coverage teams for future large-scale track and field events need to plan for at least 2 major orthopaedic and 7 major medical injuries per 10,000 participants. Male track and field athletes, particularly masters male athletes, are at greater risk of injury compared with other sexes and competition levels.
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Affiliation(s)
- David Opar
- School of Exercise and Nutrition Sciences & Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia School of Exercise Science, Australian Catholic University, Melbourne, Australia
| | - Jonathan Drezner
- Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | - Anthony Shield
- School of Exercise and Nutrition Sciences & Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Morgan Williams
- Faculty of Health, Sport and Science, University of South Wales, Pontypridd, Wales, UK
| | - David Webner
- Crozer-Keystone Health System, Philadelphia, Pennsylvania, USA
| | - Brian Sennett
- Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Rahul Kapur
- Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Marc Cohen
- Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - James Ulager
- Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Anna Cafengiu
- Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Peter F Cronholm
- Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, Pennsylvania, USA Center for Public Health Initiatives, University of Pennsylvania, Philadelphia, Pennsylvania, USA Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Opar DA, Drezner J, Shield A, Williams M, Webner D, Sennett B, Kapur R, Cohen M, Ulager J, Cafengiu A, Cronholm PF. Acute hamstring strain injury in track-and-field athletes: A 3-year observational study at the Penn Relay Carnival. Scand J Med Sci Sports 2013; 24:e254-9. [DOI: 10.1111/sms.12159] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2013] [Indexed: 11/28/2022]
Affiliation(s)
- D. A. Opar
- School of Exercise and Nutrition Sciences and Institute of Health and Biomedical Innovation; Queensland University of Technology; Brisbane Queensland Australia
- School of Exercise Science; Australian Catholic University; Fitzroy Victoria Australia
| | - J. Drezner
- Department of Family Medicine; University of Washington; Seattle Washington USA
| | - A. Shield
- School of Exercise and Nutrition Sciences and Institute of Health and Biomedical Innovation; Queensland University of Technology; Brisbane Queensland Australia
| | - M. Williams
- Faculty of Health, Sport and Science; University of Glamorgan; Wales UK
| | - D. Webner
- Crozer-Keystone Health System; Springfield Pennsylvania USA
| | - B. Sennett
- Department of Family Medicine and Community Health; University of Pennsylvania; Philadelphia Pennsylvania USA
| | - R. Kapur
- Department of Family Medicine and Community Health; University of Pennsylvania; Philadelphia Pennsylvania USA
| | - M. Cohen
- Department of Family Medicine and Community Health; University of Pennsylvania; Philadelphia Pennsylvania USA
| | - J. Ulager
- Department of Family Medicine and Community Health; University of Pennsylvania; Philadelphia Pennsylvania USA
| | - A. Cafengiu
- Department of Family Medicine and Community Health; University of Pennsylvania; Philadelphia Pennsylvania USA
| | - P. F. Cronholm
- Department of Family Medicine and Community Health; University of Pennsylvania; Philadelphia Pennsylvania USA
- Center for Public Health Initiatives; University of Pennsylvania; Philadelphia Pennsylvania USA
- Leonard Davis Institute of Health Economics; University of Pennsylvania; Philadelphia Pennsylvania USA
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Opar D, Drezner J, Shield A, Sennett B, Kapur R, Cohen M, Ulager J, Cafengiu A, Cronholm P. A 5-year study into hamstring strain injuries at the Penn Relay Carnivala. J Sci Med Sport 2012. [DOI: 10.1016/j.jsams.2012.11.316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Sennett B, Taylor D. Graft choice for a high-level athlete. Orthopedics 2012; 35:700-1. [PMID: 22868595 DOI: 10.3928/01477447-20120725-09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Brian Sennett
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
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14
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Galetta KM, Brandes LE, Maki K, Dziemianowicz MS, Laudano E, Allen M, Lawler K, Sennett B, Wiebe D, Devick S, Messner LV, Galetta SL, Balcer LJ. The King–Devick test and sports-related concussion: Study of a rapid visual screening tool in a collegiate cohort. J Neurol Sci 2011; 309:34-9. [PMID: 21849171 DOI: 10.1016/j.jns.2011.07.039] [Citation(s) in RCA: 197] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2011] [Revised: 07/21/2011] [Accepted: 07/22/2011] [Indexed: 10/17/2022]
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15
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Pandya NK, Colton A, Webner D, Sennett B, Huffman GR. Physical examination and magnetic resonance imaging in the diagnosis of superior labrum anterior-posterior lesions of the shoulder: a sensitivity analysis. Arthroscopy 2008; 24:311-7. [PMID: 18308183 DOI: 10.1016/j.arthro.2007.09.004] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2007] [Revised: 08/31/2007] [Accepted: 09/06/2007] [Indexed: 02/02/2023]
Abstract
PURPOSE The overall purpose of our study was to examine the sensitivity of physical examination, magnetic resonance imaging (MRI), and magnetic resonance (MR) arthrogram for the identification of arthroscopically confirmed SLAP lesions of the shoulder. METHODS An analysis of 51 consecutive patients with arthroscopically confirmed SLAP lesions and no history of shoulder dislocation was performed. Before undergoing surgery, all patients underwent a standardized physical examination and had either an MRI and/or MR arthrogram performed. Sensitivity analysis was then performed on the results of both the physical examination maneuvers and the radiologic imaging compared to the arthroscopic findings at surgery. RESULTS The sensitivity of O'Brien's (active compression) test was 90%, whereas the Mayo (dynamic) shear was 80% and Jobe's relocation test was 76%. The sensitivity of a physical examination with any 1 of these 3 SLAP provocative tests being positive was 100%. Neer's sign (41%) and Hawkin's impingement tests (31%) each had low sensitivity for SLAP lesions. The sensitivity of MRI for SLAP lesions was 67% when interpreted by the performing surgeon, 53% when read by a radiologist. When the MR arthrograms were analyzed alone, the sensitivity was 72% (surgeon) and 50% (radiologist), respectively. CONCLUSIONS All 3 physical examination maneuvers traditionally considered provocative for SLAP pathology (O'Brien's, Mayo shear, and Jobe's relocation) were sensitive for the diagnosis of SLAP lesions. MRI and MR arthrogram imaging had lower sensitivity than these physical examination tests in diagnosing SLAP lesions. Patient history, demographics, and the surgeon's physical examination should remain central to the diagnosis of SLAP lesions. LEVEL OF EVIDENCE Level II, development of diagnostic criteria on basis of consecutive patients with universally applied gold standard.
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Affiliation(s)
- Nirav K Pandya
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA 19104, USA
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16
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Abstract
We report a patient with a recurrent stress fracture and subsequent nonunion around an intramedullary nail placed for treatment of a more proximal, chronic tibial stress fracture. After 9 months of failed nonoperative treatment, we performed an exchange intramedullary nailing with open bone graft. At 8 months postoperatively, the patient showed clinical and radiographic signs of healing.
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Affiliation(s)
- Nirav K Pandya
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia 19104, USA
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17
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Webner D, Sennett B, Huffman R, Roberts WO. Vertebral Fracture in a Rock Climber – Neurological Sequelae? Med Sci Sports Exerc 2006. [DOI: 10.1249/00005768-200605001-01636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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18
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Sheth NP, Sennett B, Berns JS. Rhabdomyolysis and acute renal failure following arthroscopic knee surgery in a college football player taking creatine supplements. Clin Nephrol 2006; 65:134-7. [PMID: 16509464 DOI: 10.5414/cnp65134] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
We describe a college football player and weight-lifter who unexpectedly developed rhabdomyolysis and nonoliguric acute renal failure (ARF) following arthroscopic knee surgery. There was swelling and pain without evidence of a compartment syndrome postoperatively. The patient reported that he was an avid weight-lifter and that he was taking up to 10 g/d of a creatine supplement during the 6 weeks prior to this surgery. His ARF resolved over several days, with a peak serum creatinine of 2.3 mg/dl and peak creatine kinase (CK) of 194,000 U/l, following administration of intravenous fluids, mannitol, and sodium bicarbonate. Given the rarity of clinically significant rhabdomyolysis with this type of operation, we suggest that the patient's use of creatine increased the risk of skeletal muscle injury due to ischemia from intra-operative tourniquet application.
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Affiliation(s)
- N P Sheth
- Department of Orthopaedic Surgery, University of Pennsylvania School of Medicine, Philadelphia 19104, USA
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19
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Affiliation(s)
- Kenneth Tuan
- Department of Orthopedics, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA
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20
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Abstract
The validation of two noninvasive methods for measuring the dynamic three-dimensional kinematics of the human scapula with a magnetic tracking device is presented. One method consists of simply fixing a sensor directly to the acromion and the other consists of mounting a sensor to an adjustable plastic jig that fits over the scapular spine and acromion. The concurrent validity of both methods was assessed separately by comparison with data collected simultaneously from an invasive approach in which pins were drilled directly into the scapula. The differences between bone and skin based measurements represents an estimation of skin motion artifact. The average motion pattern of each surface method was similar to that measured by the invasive technique, especially below 120 degrees of elevation. These results indicate that with careful consideration, both methods may offer reasonably accurate representations of scapular motion that may be used to study shoulder pathologies and help develop computational models.
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Affiliation(s)
- A R Karduna
- Department of Rehabilitation Sciences, MCP Hahnemann University, Philadelphia, PA 19102, USA.
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21
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Lukasiewicz AC, McClure P, Michener L, Pratt N, Sennett B. Comparison of 3-dimensional scapular position and orientation between subjects with and without shoulder impingement. J Orthop Sports Phys Ther 1999; 29:574-83; discussion 584-6. [PMID: 10560066 DOI: 10.2519/jospt.1999.29.10.574] [Citation(s) in RCA: 394] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Nonrandomized 2 group post-test only. OBJECTIVE To compare scapular position and orientation between subjects with and without impingement syndrome. BACKGROUND Abnormal scapular motion is commonly believed to be a contributing factor to shoulder impingement syndrome. METHODS AND MEASURES Twenty nonimpaired subjects with a mean age of 34.3 (+/- 7.5 years) and 17 patients with impingement syndrome with a mean age of 45.8 (+/- 11.0) participated. A 3-dimensional electromechanical digitizer was used to measure scapular position and orientation in 3 planes. Measurements were taken with the arm at the side, elevated in the scapular plane to horizontal, and at maximum elevation. One-way analysis of variance was used to compare nonimpaired subjects to the impingement group and the symptomatic and asymptomatic sides within the impingement group. Five scapular kinematic variables were assessed at each arm position. Orientation was described by posterior tilting angle, upward rotation angle, and internal rotation angle. Position was described by medial-lateral position and superior-inferior position and determined by the distance from the scapula centroid to the seventh cervical vertebra (C7). RESULTS During scapular plane elevation of the arm, the scapula showed a general pattern of increasing posterior-tilt angle, increasing upward-rotation angle, and decreasing internal-rotation angle in both impingement and nonimpaired groups. Also, the scapula moved to a more superior position and a slightly more medial position with increasing arm elevation. Compared to nonimpaired subjects (34.6 degrees +/- 9.7), those with impingement demonstrated a significantly lower posterior tilting angle of the scapula in the sagittal plane (25.1 degrees +/- 9.1). Subjects with impingement also demonstrated higher superior-inferior scapular position with maximal arm elevation (5.2 cm +/- 1.6 below the first thoracic vertebrae) compared to nonimpaired subjects (7.5 cm +/- 1.5). CONCLUSIONS These results suggest that altered scapular kinematics may be an important aspect of the impingement syndrome.
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22
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Abstract
Studies of the passive support provided by ankle braces have focused primarily on inversion support. The goal of this study was to develop a technique to measure the support provided by ankle braces in all rotational directions and to use this technique to compare four common braces (Ascend, Swede-O, Aircast, and Active Ankle). For this purpose, a 6 degrees-of-freedom linkage was used to measure the flexibility of the ankle complex in 10 healthy subjects. Each subject was tested without brace support and with each of the four braces. Testing was repeated on each subject on two different occasions. The angular displacement at specified moment values and the four segmental flexibility values obtained from the loading portion of the moment-angular displacement data were used in the data analysis. Repeated measure analysis of variance followed by a Student Neuman-Keuls test at p < 0.05 was performed. This statistical analysis was used to identify significant differences among the braces and differences between each brace and the no brace condition. Each of the four braces provided significant support in inversion, eversion, and internal rotation, but the amount of support varied significantly among the braces. In external rotation, only the stirrup braces provided significant support. The braces also varied significantly in the amount of interference with dorsiflexion and plantar flexion. Clinicians may be assisted by objective data on the amount and nature of passive support when prescribing braces to their patients.
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Affiliation(s)
- S Siegler
- Department of Mechanical Engineering and Biomedical Engineering, Drexel University, Philadelphia, PA 19104, USA
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23
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Torg JS, Thibault L, Sennett B, Pavlov H. The Nicolas Andry Award. The pathomechanics and pathophysiology of cervical spinal cord injury. Clin Orthop Relat Res 1995:259-69. [PMID: 7497678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Cervical cord injuries caused during American football games have resulted in reversible, incompletely reversible, and irreversible neurologic deficits. An explanation for this variable response to injury has been obtained from the study of the histochemical responses of a squid axon injury model to mechanical deformation. Data obtained indicate that recovery or lack thereof is directly proportional to the intracellular calcium concentration which in turn is directly proportional to the amount and rate of tension applied to the axon. It is concluded that in most instances of acute spinal injury, disruption of cord function is a result of the effects of local cord anoxia and the increased concentration of intracellular calcium. It is proposed that implementation of therapeutic measures that restore blood flow and reduce cytosolic calcium will increase neurologic recovery.
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Affiliation(s)
- J S Torg
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, USA
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Torg JS, Sennett B, Pavlov H, Leventhal MR, Glasgow SG. Spear tackler's spine. An entity precluding participation in tackle football and collision activities that expose the cervical spine to axial energy inputs. Am J Sports Med 1993; 21:640-9. [PMID: 8238702 DOI: 10.1177/036354659302100502] [Citation(s) in RCA: 95] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
We describe spear tackler's spine, a clinical entity that constitutes an absolute contraindication to participation in tackle football and other collision activities that expose the cervical spine to axial energy inputs. A subset of football players were identified who demonstrated: 1) developmental narrowing (stenosis) of the cervical canal; 2) persistent straightening or reversal of the normal cervical lordotic curve on erect lateral roentgenograms obtained in the neutral position; 3) concomitant preexisting posttraumatic roentgenographic abnormalities of the cervical spine; and 4) documentation of having employed spear tackling techniques. From data obtained by the National Football Head and Neck Injury Registry and the senior author's practice, 15 cases of spear tackler's spine were identified during 1987 to 1990. All 15 cases were evaluated because of complaints referable to the cervical spine or brachial plexus resulting from football injuries. Of these, 11 had complete neurologic recovery without permanent sequelae. Four cases resulted in permanent neurologic deficits: quadriplegia, 2; incomplete hemiplegia, 1; and residual long track signs, 1. Permanent neurologic injury occurred as the result of axial loading of a persistently straightened cervical spine from use of head-impact playing techniques. We suggest that individuals who possess the aforementioned characteristics of spear tackler's spine be precluded from participation in collision activities that expose the cervical spine to axial energy inputs.
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Affiliation(s)
- J S Torg
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia
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25
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Abstract
The anteroinferior cervical vertebral body corner fracture was originally described by Schneider and Cann as the "teardrop" fracture. This report analyzes the biomechanical, clinical, and roentgenographic features of 55 such fractures obtained from the National Football Head and Neck Injury Registry. Teardrop fractures resulting from tackle football characteristically occurred in players attempting to make a tackle in which initial contact was made with the top or crown of the helmet. There were two fracture patterns associated with the anteroinferior corner (teardrop) fracture fragment: 1) the isolated fracture, which is usually not associated with permanent neurologic sequelae; and 2) the three-part, two-plane fracture in which there is an associated sagittal vertebral body fracture as well as fracture of the posterior neural arch. This latter pattern was almost always associated with permanent neurologic sequelae, specifically quadriplegia. Axial loading of the cervical spine was clearly identified as a mechanism of injury for both fracture patterns. Roentgenographic examination must include both anteroposterior and lateral views with computed tomography or tomography as necessary to determine the presence of the sagittal vertebral body fracture and the integrity of the posterior neural arch.
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Affiliation(s)
- J S Torg
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia
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26
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Abstract
Injuries to the cervical spine at the C3-C4 level involving the bony elements, intervertebral disks, and ligamentous structures are rare. We present 25 cases of traumatic C3-C4 injuries sustained by young athletes and documented by the National Football Head and Neck Injury Registry. Review of the cases reveals that the response of energy inputs at the C3-C4 level differ from those involving the upper (C1-C2) and lower (C4-C5-C6-C7) cervical segments. Specifically, the C3-C4 lesions appear to be unique with regard to the infrequency of bony fracture, difficulty in effecting and maintaining reduction, and a more favorable recovery following early, aggressive treatment. In the majority of instances, injury at this level results from axial loading of the cervical spine. Lesions were distributed into specific categories: 1) acute intervertebral disc herniation (N = 4), 2) anterior subluxation of C3 on C4 (N = 4), 3) unilateral facet dislocation (N = 6), 4) bilateral facet dislocation (N = 7), and 5) fracture of vertebral body C4 (N = 4). Analysis of these 25 cases suggests that traumatic lesions of the cervical spine in general can be classified as involving the upper (C1-C2), middle (C3-C4), or lower (C4-C7) segments. This is based on our observations from this series that C3-C4 lesions 1) generally do not involve fracture of the bony elements; 2) acute intervertebral disc herniations are frequently associated with transient quadriplegia; 3) reduction of anterior subluxation of C3 on C4 is difficult to maintain; 4) reduction of unilateral facet dislocation is difficult to obtain by skeletal traction and is best managed by closed manipulation and reduction under general anesthesia; and 5) reduction of bilateral facet dislocation is difficult to obtain by skeletal traction and is best managed by open methods. The more favorable results observed in this series of immediate reduction of both unilateral and bilateral facet dislocations deserves emphasis. In two cases of unilateral facet dislocation reduced within 3 hours of injury and subsequently fused anteriorly, significant neurologic recovery occurred. The other four patients, two who underwent an open reduction and laminectomy and two treated closed with skeletal traction, remained quadriplegic. In the four instances of bilateral facet dislocation where reduction was achieved by either closed or open methods, although there was no neurologic recovery, all four patients survived their injuries. However, the three patients who were not successfully reduced died.
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Affiliation(s)
- J S Torg
- University of Pennsylvania Sports Medicine Center, Philadelphia 19104
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27
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Esterhai JL, Sennett B, Gelb H, Heppenstall RB, Brighton CT, Osterman AL, LaRossa D, Gelman H, Goldstein G. Treatment of chronic osteomyelitis complicating nonunion and segmental defects of the tibia with open cancellous bone graft, posterolateral bone graft, and soft-tissue transfer. J Trauma 1990; 30:49-54. [PMID: 2296067 DOI: 10.1097/00005373-199001000-00008] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Forty-two consecutive patients with chronic osteomyelitis complicating persistent tibial nonunion and chronic osteomyelitis complicating tibial fracture with segmental bone loss were treated from January 1979 through December 1986 using a protocol including either open cancellous bone grafting (Friedlaender-Papineau technique), posterolateral bone grafting (Harmon technique), or local or microvascular soft-tissue transfer before cancellous bone grafting. Each patient had undergone surgical debridement and intravenous antibiotic therapy before inclusion in this study. Patients were classified using a staging system which included consideration of anatomic location of the infection within the bone; extent of bone involvement; quality of soft-tissue envelope and vascular integrity; and generalized host status. The overall success rate for arresting the osteomyelitis and healing the nonunion was 62% (26/42). If the six patients who refused additional bone graft surgery, the one patient who represented poor patient selection, and the patient who refused ankle arthrodesis are eliminated, the success rate for healing of the nonunion and resolving the osteomyelitis in this difficult patient population is: open bone cell graft, 66% (12/18); soft-tissue transfer 87.5%, (7/8); and posterolateral bone grafting, 87.5% (7/8). Use of a standardized classification system allows comparison of treatment results. Adequate debridement is crucial in treating osteomyelitis complicating established long bone fractures and nonunions. Determining the extent of debridement has proven to be the single most difficult aspect technically. Patient selection and pretreatment education are crucial. Caring for these patients is not only labor intensive and demanding of personnel and hospital resources, but demanding of the patients as well.
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Affiliation(s)
- J L Esterhai
- Department of Orthopedic Surgery, University of Pennsylvania School of Medicine, Philadelphia 19104
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28
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Abstract
Epidemiologic, pathologic, biomechanical, and cinematographic data on head and neck injuries occurring in tackle football have been compiled since 1971 by the National Football Head and Neck Injury Registry. Preliminary analysis performed in 1975 indicated that the majority of serious cervical spine football injuries were caused by axial loading. Based on this observation, the National Collegiate Athletic Association (NCAA) and National Federation of High School Athletic Associations (NFHSAA) implemented rule changes banning "spearing" and the use of the top of the helmet as the initial point of contact in striking an opponent during a tackle or block. Between 1976 and 1987, as a result of these rule changes, the Registry has documented a dramatic decrease in both the total number of cervical spine injuries and those resulting in quadriplegia at both the high school and college level. It is suggested that development and implementation of similar preventative measures based on clearly defined injury mechanisms would decrease injury rates in diving, rugby, ice hockey, trampolining, wrestling, and other high-risk sports as well.
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Affiliation(s)
- J S Torg
- University of Pennsylvania Sports Medicine Center, Philadelphia 19104
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29
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Torg JS, Sennett B, Vegso, MS JJ. Spinal Injury at the Level of the Third and Fourth Cervical Vertebrae Resulting from the Axial Loading Mechanism: An Analysis and Classification. Clin Sports Med 1987. [DOI: 10.1016/s0278-5919(20)31065-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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30
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Torg JS, Sennett B, Vegso JJ. Spinal injury at the level of the third and fourth cervical vertebrae resulting from the axial loading mechanism: an analysis and classification. Clin Sports Med 1987; 6:159-83. [PMID: 3508101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The traumatic C3-C4 level injuries sustained by young athletes and documented by the National Football Head and Neck Injury Registry are discussed. Twenty-eight of 885 (2.8 per cent) injuries involved the C3-C4 vertebrae. Review of these cases reveals that the response to energy inputs at the C3-C4 level differ from that of those involving the upper (C1-C2) and lower (C5-C6) cervical segments. Specifically, these lesions appear unique with regard to infrequency of bony fracture, difficulty in effecting and maintaining reduction, and their more favorable response to early aggressive treatment. It is the authors' belief that these lesions resulting from athletic activity are due to axial loading.
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Affiliation(s)
- J S Torg
- Sports Medicine Center, Department of Orthopaedic Surgery, University of Pennsylvania School of Medicine, Philadelphia
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Torg JS, Vegso JJ, Sennett B. The National Football Head and Neck Injury Registry: 14-year report on cervical quadriplegia (1971-1984). Clin Sports Med 1987; 6:61-72. [PMID: 3509870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The specter of catastrophic cervical neurotrauma resulting from athletic participation, although infrequent, has been consistently associated with football, water sports, gymnastics, rugby, and ice hockey. Injury involving intracranial hemorrhage can result in death or permanent neurologic impairment, whereas certain fractures and dislocations of the cervical spine are associated with quadriplegia. Athletic injuries to both the central nervous system and spinal cord demand our attention as an active area of clinical and basic injury. A review of the available literature reveals changing injury patterns as well as current concepts regarding the mechanism responsible for most athletic injuries to these structures. Accurate descriptions of the mechanism(s) responsible for a particular injury transcend simple academic interest. In order that preventive measures be implemented, the manner in which injury occurs must be accurately defined. The purpose of this article is to describe how the application of this principle resulted in the significant reduction of cervical spine injuries associated with quadriplegia that have occurred in tackle football since 1976.
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Affiliation(s)
- J S Torg
- Sports Medicine Center, Department of Orthopaedic Surgery, University of Pennsylvania School of Medicine, Philadelphia
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33
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Torg JS, Pavlov H, Genuario SE, Sennett B, Wisneski RJ, Robie BH, Jahre C. Neurapraxia of the cervical spinal cord with transient quadriplegia. J Bone Joint Surg Am 1986; 68:1354-70. [PMID: 3782207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The purpose of this study was to define as a distinct clinical entity the syndrome of neurapraxia of the cervical spinal cord with transient quadriplegia. The sensory changes include burning pain, numbness, tingling, and loss of sensation, while the motor changes range from weakness to complete paralysis. The episodes are transient and complete recovery usually occurs in ten to fifteen minutes, although in some patients gradual resolution occurs over a period of thirty-six to forty-eight hours. Except for burning paresthesia, pain in the neck is not present at the time of injury and there is complete return of motor function and full, pain-free motion of the cervical spine. In our series, routine roentgenograms of the cervical spine were negative for fractures or dislocations in all patients. However, the roentgenographic findings did include developmental spinal stenosis in seventeen patients, congenital fusion in five patients, cervical instability in four patients, and intervertebral disc disease in six patients. Spinal stenosis was determined by two different roentgenographic methods. The first was the standard method, and the second was a ratio method devised by us. Both measurements were made at the level of the third through the sixth vertebral body on a routine lateral roentgenogram of the cervical spine that was available for twenty-four of the thirty-two patients and for a control group of forty-nine male subjects of similar age who did not have any neurological complaints. Using the ratio method, a measurement of less than 0.80 indicated significant spinal stenosis in the group of twenty-four patients for whom roentgenograms were available, as compared with a ratio of approximately 1.00 or more in the control group. There was statistically significant spinal stenosis (p less than 0.0001) in all of the patients as compared with the control subjects by both methods of determining spinal stenosis. A survey of 503 schools participating in National Collegiate Athletic Association (NCAA) football in the 1984 season found that 1.3 per 10,000 athletes had a history that was suggestive of neurapraxia of the cervical spinal cord. The phenomenon of neurapraxia of the cervical spinal cord occurs in individuals with developmental stenosis of the cervical spine, congenital fusion, cervical instability, or protrusion of an intervertebral disc in association with a decrease in the anteroposterior diameter of the spinal canal. We postulate that in athletes with diminution of the anteroposterior diameter of the spinal canal the spinal cord can, on forced hyperextension or hyperflexion, be compressed, causing transitory motor and sensory manifestations.(ABSTRACT TRUNCATED AT 400 WORDS)
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34
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Torg JS, Vegso JJ, Sennett B, Das M. The National Football Head and Neck Injury Registry. 14-year report on cervical quadriplegia, 1971 through 1984. JAMA 1985; 254:3439-43. [PMID: 4068184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Data on cervical spine injuries resulting from participation in football have been compiled by a national registry. Analysis of epidemiologic data and cinematographic documentation clearly demonstrated that the majority of cervical fractures and dislocations were due to axial loading. On the basis of this observation, rule changes banning both deliberate "spearing" and the use of the top of the helmet as the initial point of contact in making a tackle were implemented at the high school and college level. Subsequently, a marked decrease in cervical spine injury rates has occurred. The occurrence of permanent cervical quadriplegia decreased from 34 in 1976 to five in the 1984 season. It is suggested that axial loading of the cervical spine is also responsible for the catastrophic injuries in diving, rugby, ice hockey, and gymnastics. Implementation of appropriate changes in playing techniques and/or equipment modifications could possibly reduce the incidence of cervical spine injuries in these activities.
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