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

PURPOSE OF REVIEW

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

RECENT FINDINGS

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

Epidemiology and trends of adult ice hockey injuries presenting to United States emergency departments: A ten-year analysis from 2007-2016

Purpose

The adult population is under-represented in existing ice hockey injury studies, despite the number of United States (US) adult ice hockey players increasing from 103,533 in 2007 to 180,400 in 2016 (74%). This study establishes trends in demographics, injury location, and injury type for adult ice hockey players (≥19 years old) in the United States.

Methods

The National Electronic Injury Surveillance System (NEISS) was queried for all ice hockey injuries from January 1, 2007 to December 31, 2016. Cases under age 19 were excluded. Each injury's narrative text field was reviewed to determine mechanism of injury.

Results

A total of 1,653 patients, representing an estimated 68,786 ice-hockey related injuries, presented to NEISS-participating US EDs. The most commonly injured body parts were the face (n = 12,432, 18.1%), head (n = 10,201, 14.8%), shoulder (n = 9,654, 14.0%) and ankle (n = 5,389, 7.8%). The most common diagnoses made were laceration (n = 18,153, 26.4%), strain/sprain (n = 12,202, 17.7%), fracture (n = 10,079, 14.7%), contusion (n = 9,283, 13.5%) and concussion (n = 4,794, 7.0%). The most common mechanisms of injury were falling (n = 11,786, 18.7%), puck contact (n = 10,544, 15.3%) and player contact (n = 9,449, 13.7%). Concussions increased from 46 in 2007 to 928 in 2016 (R² = 0.8, β = 0.9, p < 0.001). Females (n = 1,852, 32%) had a higher proportion of head injuries than males (n = 8,349, 13.3%) (IPR = 2.4, p < 0.0001). The 50+ year old cohort showed a significant increase in injuries during the study period (n = 146 vs. 982, R² = 0.75, β = 0.87, p = 0.001).

Conclusions

Despite changing trends in age and sex-related demographics, the majority of injuries in this population may be preventable with adequate enforcement of protective gear use. Increased education amongst players, coaches, trainers, orthopaedic surgeons and primary care physicians should be encouraged to minimize injuries.