Musculoskeletal injuries in real tennis

Introduction: Real tennis is a growing, unique, and well-established sport. To date, there has been no epidemiological data on real tennis injuries. The primary aim of this retrospective study is to record the incidence and document any trends in real tennis musculoskeletal injuries, so as to improve injury awareness of common and possibly preventable injuries.

Methods: A surveillance questionnaire e-mailed to 2,036 Tennis & Rackets Association members to retrospectively capture injuries sustained by amateur and professional real tennis players over their playing careers.

Results: A total of 485 (438 males and 47 females) questionnaires were fully completed over 4 weeks. A total of 662 musculoskeletal injuries were recorded with a mean of 1.4 injuries per player (range 0–7). The incidence of sustaining an acute real tennis musculoskeletal injury is 0.4/1000 hrs. The three main anatomical locations reported injured were elbow 15.6% (103/662), knee 11.6% (77/662), and face 10.0% (66/662). The most common structures reported injured were muscle 24% (161/661), tendon 23.4% (155/661), ligament 7.0% (46/661), soft tissue bruising 6.5% (43/661), and eye 6.2% (41/661). The majority of the upper limb injuries were gradual onset (64.7%, 143/221), and the lower limb injuries were sudden onset (72.0%, 188/261).

Conclusion: This study uniquely provides valuable preliminary data on the incidence and patterns of musculoskeletal injuries in real tennis players. In addition, it highlights a number of reported eye injuries. The study is also a benchmark for future prospective studies on academy and professional real tennis players.

The epidemiology and trends in the surgical management of calcaneal fractures in England between 2000 and 2017

Aims

This paper documents the epidemiology of adults (aged more than 18 years) with a calcaneal fracture who have been admitted to hospital in England since 2000. Secondary aims were to document whether publication of the United Kingdom Heel Fracture Trial (UK HeFT) influenced the proportion of patients admitted to hospital with a calcaneal fracture who underwent surgical treatment, and to determine whether there has been any recent change in the surgical technique used for these injuries.

Patients and Methods

In England, the Hospital Episode Statistics (HES) data are recorded annually. Between 2000/01 and 2016/17, the number of adults admitted to an English NHS hospital with a calcaneal fracture and whether they underwent surgical treatment was determined.

Results

During this 17-year period, 62 858 patients were admitted to hospital with a calcaneal fracture. The male-to-female ratio was 2.66:1. The mean annual incidence was 10.5/100 000 for men and 3.8/100 000 for women. The results of the UK HeFT were published in July 2014. The percentage of patients admitted with a calcaneal fracture undergoing internal fixation was 7.31% (3792/51 859) before and 7.38% (534/7229) after its publication. This difference was not statistically significant (p = 0.94). Since 2015, there has been a significant increase in the percentage of calcaneal fractures treated by closed reduction and internal fixation, as opposed to open reduction and internal fixation, from 7.7% (292/3792) to 13.29% (71/534) (p < 0.001).

Conclusion

This study documents the epidemiology and trends in surgical treatment of calcaneal fractures in England. We established that surgeons did not change their practice in terms of offering surgery to these patients in response to the results of the UK HeFT. There has been a significant (p < 0.001) increase in the number of calcaneal fractures being treated surgically using less invasive procedures.

Internal fixation of femoral neck stress fractures in young female athletes with a dynamic locking plate

PURPOSE

Displaced stress fractures of the femoral neck in young female athletes are a rare but a difficult injury to treat with a favourable outcome, as there is a reported high incidence of avascular necrosis. Traditionally they are internally fixed with either cannulated screws or a sliding hip screw. Our study aims to highlight the Targon Femoral Neck (FN, B-Braun, Aesculap Inc, Germany) implant as a safe alternative for fixation of these injuries.

METHODS

Three consecutive young female recreational athletes were reviewed from our institution with a displaced stress fracture of the femoral neck treated with the dynamic locking plate.

RESULTS

Two patients achieved good results with full union and no complications. One patient had a poor result as she developed avascular necrosis 5 months post-operatively requiring revision to a total hip arthroplasty.

CONCLUSION

Our study highlights the Targon FN implant is a safe alternative for internal fixation of displaced stress fractures of the femoral neck in young female recreational athletes.

Surgical excision of ununited hook of hamate fractures via the carpal tunnel approach

INTRODUCTION

Direct excision of a symptomatic ununited hook of hamate fracture is the gold standard, most frequently via a Guyon space approach. The open carpal tunnel approach is another option, which has not previously been commonly considered and not reported in a peer review journal. Our study aims to highlight the carpal tunnel approach as a successful technique in a consecutive series of ununited hook of hamate fractures.

PATIENTS AND METHODS

Seven patients (all male and mean age 30.7 years) were reviewed with symptomatic ununited fractures following a period of cast immobilization. All the patients operated on underwent excision of the hook of hamate fragment via the open carpal tunnel approach.

RESULTS

All patients successfully returned to their pre-injury level of functioning after 8-12 weeks and there were no complications.

CONCLUSIONS

Our study highlights the open carpal tunnel approach as a successful technique for open excision of symptomatic ununited hook of hamate fractures, because of its familiarity, ease of performance, excellent visualization and low morbidity. Level of Evidence IV Case Series.

Cholesterol accumulates in senile plaques of Alzheimer disease patients and in transgenic APP(SW) mice

Mounting evidence suggests that cholesterol may contribute to the pathogenesis of Alzheimer disease (AD). We examined whether cholesterol might be present in senile plaques, a hallmark neuropathological feature of AD. We employed 2 different fluorometric-staining techniques (filipin staining and an enzymatic technique) for the determination of cholesterol in brains of postmortem confirmed AD patients and in nondemented, age-matched histopathologically normal controls. AD patient brains showed abnormal accumulation of cholesterol in congophilic/birefringent dense cores of senile plaques that was essentially absent in histopathologically normal controls. To determine whether increased senile plaque-associated cholesterol occurred generally in all plaques or was restricted to a specific subset, quantitative analysis was performed. Data indicate abnormal accumulation of cholesterol in cores of mature plaques but not in diffuse or immature plaques. Additionally, transgenic mice that overexpress the "Swedish" amyloid precursor protein (Tg APP(SW), line 2576) exhibited a similar pattern of abnormal cholesterol accumulation in mature, congophilic amyloid plaques at 24 months of age that was absent in their control littermates or in 8-month-old Tg APP(SW) mice (an age prior to amyloid deposition). Taken together, our results imply a link between cholesterol and AD pathogenesis and suggest that cholesterol plays an important role in the formation and/or progression of senile plaques.

Women's vulnerability to sexual assault from adolescence to young adulthood

PURPOSE

To study the vulnerability to sexual assault among undergraduate women.

METHODS

The respondents were demographically representative of undergraduate women in state-supported universities in the United States. Participants (N = 1569) were surveyed using the Sexual Experiences Survey at the beginning and end of their 1st year and at the end of each of the next 3 years of their undergraduate career. Survival analysis was used to determine the risk of initial victimization during specific time intervals from the age of 14 years through the collegiate years as a function of prior victimization. Odds analyses were used to analyze the main and interactive effects of victimization at prior time periods on the probability of victimization at subsequent time periods.

RESULTS

Victimization before the age of 14 years almost doubled the risk of later adolescent victimization (1.8). Furthermore, for those with and without childhood victimization, the risk of an initial sexual assault after the age of 14 years occurred most often in late adolescence, and declined each year thereafter (aged 18-22 years). Sexual victimization among university women was highest for those who had been first assaulted in early adolescence (4.6 times nonvictims). Detailed analyses revealed that the more severe the adolescent experience the greater the risk of collegiate revictimization. Adolescent victims of rape or attempted rape, in particular, were 4.4 times more likely to be as seriously assaulted during their 1st year of college.

CONCLUSION

A linear path model is suggested. Childhood victimization increased the risk of adolescent victimization, which in turn significantly affected the likelihood of revictimization among college women.

The onset of drinking and intoxication among university students

To study the effect of the onset of drinking on subsequent alcohol use, self-administered questionnaires were completed by 856 unmarried undergraduate students from two universities in the southeastern region of the United States. The present study focuses on the 524 (61.2%) students who reported using alcohol at least occasionally. In this subsample, the strongest predictors of the extent of undergraduate intoxication are the frequency of intoxication at the onset of drinking and age at the onset. The more often an individual drinks to intoxication and the younger that individual begins to drink, the more frequently he or she will become intoxicated when a university student. Racial differences in the extent of undergraduate intoxication were also found. White students were markedly more prone to intoxication than were Black students. Sex differences, although not statistically significant, showed a tendency for drunkenness among male undergraduates to exceed that among female undergraduates. The implications of the findings for intervention and prevention strategies are discussed.

Race, sex, marihuana use and alcohol intoxication in college students

In college students, alcohol intoxication was more frequent in men than in women, in Whites than in Blacks and in White women than in Black women. The difference between White and Black men was negligible. Only gender differences were noted in marihuana use.

Homicide and suicide among the Cherokee and Lumbee Indians of North Carolina

The Cherokee and Lumbee, the two major Indian populations in North Carolina, have exhibited similarities in patterns of homicide and suicide. Both Indian populations have higher rates of homicidal than of suicidal death. Yet in 1972-73, the Lumbee homicide rates was considerably higher than that for the Cherokee, but the Cherokee's suicide rate exceeded that for the Lumbee. During 1974-1976, the Cherokee manifested excessively high rates of violent death, with suicide increasing faster than homicide. The Lumbee homicide rate declined during this period, while the suicide rate increased. Lumbee violence patterns indicate a slight dissipation of cultural traits that predispose them to aggressive behaviour and the concomitant emergence of a trend toward self-destructive behaviour. The rise in Cherokee suicide rate may be consistent with the harmony Ethic of some tribe members, but the sharp increase in homicide may reflect the erosion of the traditional non-violent ethic among the band as a whole.

Regional variations in the characteristics of victims of violence

This paper investigates variations in the characteristics of victims of violence in the four regions of North Carolina: the mountains, piedmont, coastal plains, and tidewater. Distinct patterns of homicide and suicide are found in each of these regions. The montains are characterized by high rates of suicide and low rates of homicide, while the coastal plains are marked by an opposite pattern, high homicide and low suicide. The two remaining regions of North Carolina, the piedmont and tidewater, have similar violence patterns. The piedmont has slightly higher rates of both homicide and suicide than the tidewater; however, both exhibit positive relationships between homicide and suicide rates. Socio-cultural dimensions of each of these regions are outlined. Those variables which differentiate areas having opposite violence patterns are isolated. Also, similarities between other regions manifesting comparable rates of homicide and suicide are cited. Within the socio-cultural context of each region, an examination of the variations in the characteristics of victims of violence is made. These characteristics include:. age, sex, marital status, race, occupation, time of injury, means of death type of premise of injury and, where applicable, type of weapon used.

Offender-victim relationships in criminal homicide followed by offender's suicide, North Carolina, 1972-1977

An analysis of 90 cases of criminal homicide followed by suicide in North Carolina, 1972 to 1977. Homicidal victim-offender relationships were investigated in regard to age, sex, race and whether victim and offender were member of the same family, friends, acquaintances, or strangers. These results were compared with victim-offender relationships in 994 criminal homicide cases in North Carolina in which offenders did not commit suicide. Married white males over 30 years were much more involved in homicide-suicide than they were in homicide alone. In these homicide-suicide cases, the victim was usually the spouse. Except for marital status, characteristics of homicide offenders who killed themselves resembled those of suicide-only individuals much more than those of homicide-only offenders. In the homicide-suicide cases, the killing of someone in close relationship to the offender, often a wife, appeared to be part of the evolving process of suicide. This clearly has implications for intervention into marital strife and also for immediate treatment of homicide offenders who kill spouses and other family members.

Role interference: an analysis of suicide victims, homicide offenders, and non-violent individuals

The relationship between role interference and suicidal, homicidal and non-violent behavior is investigated. Interference obtains to the extent that enactment of certain roles tends to impede the enactment of others. High degrees of interference in the performance of roles is generally frustrating to individuals and is a potential generator of outwardly directed violence. Low degrees of role interference is likewise disconcerting to persons but in the absence of an external target for aggression may lead to self deprecation and ultimately suicide. Detailed life histories of 98 suicide victims, 62 homicide offenders, and 76 non-violent individuals having no history of homicidal or suicidal behavior were studied. Homicide offenders suffered a higher incidence of role interference than the suicide or non-violent samples. Suicide victims tended to experience low degrees of such interference.

A study of the etiology of sociopathic behavior

The purpose of this study is to attempt to indicate a possible process by which a sociopathic personality emerges. It is contended that sociopathic behavior can be understood in relation to the emergence of the self and the concomitant ability to take the role of the other. For the purposes of this study the sociopath is conceptualized as one who is deficient in role-taking ability, that is, he is unable to judge his own behavior from the viewpoint of another person. The socialization process is considered crucial in the emergence of the self and the ability to take the role of the other. Adequate socialization is that which take place under conditions of primary relations between the socializing agents and the person(s) being socialized. It is assumed therefore that socialization which occurs under conditions of secondary relations is inadequate. Socialization marked by secondary relations characteristically occurs within institutions. This study specifically focuses on the relationship between childhood institutionalization and sociopathic behavior in later life. The samples consisted of 50 sociopaths and 59 non-sociopaths (32 paranoid schizophrenics and 27 psychoneurotics) randomly drawn from the resident male caucasian population of the New Hampshire Hospital. Although age was not consciously controlled, each of the samples had similar age distributions with the majority of the patients falling between the ages of 20 and 34. The major hypothesis was: the incidence of early institutionalization (before the age of 16) among the sociopaths will be significantly higher than for mental patients diagnosed other than sociopathic. The data were classified as follows: institutionalization was divided into two types; orphanages and "other residential institutions" solely responsible for the care of the child. The findings indicate that there is a statistically significant association between early institutionalization and sociopathic behavior in later life. The incidence of institutionalization was consistently higher for the sociopaths than for the total non-sociopathic sample and for each sub-set of that sample. The findings of this study seem to support the theoretical assumption that childhood socialization that takes place under conditions of secondary relations between the child and the socializing agents will be ineffective for the development of a self with adequate role-taking ability. Sociopathic behavior may be a consequence of such socialization experiences.

The process of suicide: the sequence of disruptive events in the lives of suicide victims

Certain disruptions in social relations or loss of social roles tend to precede the act of suicide. In general, this study has attempted to demonstrate the sequential ordering of these social losses and otherdisruptive events. It has been shown that loss of roles irn childhood and early adolescence, parents, home, sibilings, close relatives, and student role tends to be followed by chaotic marriages, loss of occupation role(s), and loss of one's own health either physical or mentalor, in some cases, both. Also parental roles tend to be lost through the death of a child. Take away one's social roles and you take away his humanity (See Palmer, 1970). An individual with nowhere to turn and having lost all, tends to be highly vulnerable to suicide.