Injury characteristics of young elite inline speed skaters: A one season retrospective study

OBJECTIVES

Determining the rate of injuries related to a certain sport is accepted as the primary step toward designing, implementing and evaluating injury prevention programs. This observational and retrospective study was to examine the injuries sustained by elite young Spanish inline speed skaters during a season.

METHODS

Athletes participating in the national championship (n = 80) were surveyed via an anonymous online questionnaire to screen for injury characteristics: incidence, location, and tissue affected; plus training information and demographics.

RESULTS

A total of 52 injuries were recorded across 33,351 hours of exposure, which gives a rate of 1.65/1,000 h. The lower body comprised 79% of the total amount of injuries (1.3/1000 h), and the main areas affected were the thigh and foot, accounting for 25% and 19.2% of the recorded injuries, respectively. Musculotendinous injuries were the most frequent, with an incidence of 0.92/1000 h. No significant gender differences were observed for any of the variables studied.

CONCLUSION

Speed skating can be considered a low injury rate sport based on our findings. The risk of sustaining an injury was independent of gender, age, and BMI.

Peer and parent influences on youth skateboarding and factors that affect their decision to return to the sport after injury

Skateboarding is an increasingly popular sport among youth, despite the fact that they are a high-risk group for injuries during this activity. The purpose of this study was twofold: to explore youths' perceptions about the influences that peers and parents have on their skateboarding; and to identify factors that affect their decisions about returning to the sport after injury. Virtual semi-structured interviews were conducted with 26 youth, 14-17 years of age, who had experienced a medically-treated injury while skateboarding during the past year. Applying thematic analyses, major findings indicated that sharing the activity with peers fosters psychological well-being, companionship, and a valued sense of community that motivates return to the sport even after serious injury and sometimes before they are fully physically ready to do so safely. Parental concerns about physical injury (vulnerability, severity) were acknowledged but not influential, with youth feeling that parents do not appreciate the valued mental health benefits that they experience from the skateboarding community. Youth reported withholding injury information from parents, hiding injuries and downplaying their severity, and not always disclosing returning to the sport. Youths' decisions to return to the sport after injury was motivated by their feelings that skateboarding enhances their sense of identity, promotes their mental health, and provides respite because it allows them to escape from reality temporarily. Recommendations for reducing risk of injury to youth skateboarders at skateparks are provided.

Performance Increases in Pair Skating and Ice Dance at International Championships and Olympic Games

In pair skating and ice dance, performance seems to have increased at international competitions, which is potentially associated with changes in athlete age. We hypothesized increasing age, numbers of total points and more complex jumps of the best elite couples at international championships in recent years. Corresponding data were assessed via the results databases of the European and World Championships, as well as the Winter Olympics since 2005. Linear regression statistics were conducted, and significance was assessed via one-way ANOVAs. There were no significant changes in age. Increases in total points were found in both disciplines (World and European Championships both p < 0.001 for both disciplines, Olympics pair skating p = 0.003, ice dance n/a). Significant increases were found in the number of double and triple twist jumps at the European Championships (Double p = 0.046, triple p = 0.041), but not at the World Championships or the Olympics. At the World Championships, single solo jumps decreased (p = 0.031) in favor of triple jumps, which increased (p = 0.020), without a similar effect at the European Championships or Olympics. In conclusion, increases in total points and more complex jumps were observed at international championships without associated changes in age. Attention should be given to possible changes in the incidence of acute and overuse injuries following this development.

Skateboard head injuries: Are we making progress?

BACKGROUND

Skateboarding is a popular sport and U.S. trauma centers care for a significant number of skateboard-related injuries (SRIs). However, injury prevention strategies are still underdeveloped. This study was designed to compare the epidemiology, type, and location of skateboard injury as well as the use and influence of protective gear over two time periods.

METHODS

This is a retrospective National Trauma Data Bank study including all patients with SRIs between 2007and 2016. Study groups were divided into two 5-year periods: 2007-2011 and 2012-2016. The incidence and severity of traumatic brain injury (TBI), as well as the compliance and effectiveness of protective gear and skate parks, was assessed in various age groups in the two study periods using univariable and multivariable analyses. Univariable analysis was used to compare the two study periods, logistic regression analysis was performed to identify independent predictors of head injury and severe TBI.

RESULTS

24,903 patients presented with SRIs: 10,594 from 2007 to 2011 and 14,309 from 2012 to 2016. Helmet use was low in both periods (5.7% and 5.4% respectively). The incidence of severe TBI (head AIS≥3) did not change significantly during the two periods (31.6% vs. 30.8%, p = 0.162). In children with severe TBI, there was no significant difference in helmet use across all ages, (10.4% vs. 11.5%, p = 0.467; 6.4% vs. 6.5%, p = 0.753; 4.2% vs. 3.7%, p = 0.201, respectively) with the lowest usage in the older than 16 years age group. On logistic regression, male gender (OR 1.526, 95% CI 1.372-1.698, p<0.001) was associated with increased odds of severe TBI, while helmet use (OR 0.534, 95% CI 0.455-0.627, p<0.001) and injuries at skate parks (OR 0.584, 95% CI 0.541-0.630, p<0.001), near home (OR 0.465, 95% CI 0.418-0.518, p<0.001), and public buildings (OR 0.386, 95% CI 0.440-0.541, p<0.001) were associated with reduced odds of severe TBI.

CONCLUSIONS

Helmet use in patients with SRIs is low in all pediatric age groups. Helmet use and skate parks are protective against severe TBI. Older age children and male gender are at increased risk of severe TBI after skateboard-related injuries, and more targeted preventive education and legislation are needed.

Pediatric and Adolescent Figure Skating Injuries: A 15-Year Retrospective Review

OBJECTIVE

To analyze the characteristics of injuries sustained by young figure skaters who were evaluated at regional pediatric sports medicine clinics.

DESIGN

Retrospective chart review (2003-2017).

SETTING

Sports medicine clinics at a tertiary-level pediatric medical center.

PATIENTS

Two hundred ninety-four figure skaters (271 female and 23 male). Age rage: 9 to 19 years. Mean age: 14.2 ± 2.3 years.

INTERVENTIONS

None.

MAIN OUTCOME MEASURES

Mechanism of injury (acute vs overuse), injured body areas, diagnoses for most commonly injured body areas, and distribution of bone stress injuries.

RESULTS

Eight hundred sixty-four figure skating-related injuries were identified. Approximately 68.9% were overuse and 31.1% were acute. In female figure skaters, the most frequently injured body areas were foot/ankle (29.6%), knee (19.3%), and back (15.8%). In male figure skaters, they were foot/ankle (25.4%), hip (16.4%), and knee (14.9%). Most common diagnoses at these body areas were tendinopathy (foot/ankle), extensor mechanism (knee), and posterior column bone stress injuries (back). All injuries to anterior knee structures, excluding bone contusions, were categorized as extensor mechanism injuries. About 11.8% of all injuries were bone stress reactions/fractures with the majority occurring at the back (42.2%), foot/ankle (32.4%), and lower leg (15.7%).

CONCLUSION

Most injuries sustained by figure skaters were overuse and occurred most commonly at the foot/ankle (29.6%), knee (19.3%), and back (15.8%). Approximately 1 in 10 injuries were bone stress reactions/fractures, and nearly 1 in every 3 skaters who presented with back pain was diagnosed with a posterior column bone stress injury. Health care providers who take care of young figure skaters need to maintain a high index of suspicion for overuse injuries, especially bone stress reactions/fractures.

Titanium elastic nailing in femoral diaphyseal fractures in children of 6-14 years age

PURPOSE

The purpose of this study is to report our experience of fractures in children riding Hoverboards.

METHODS

We undertook a prospective review of all children attending our hospital who sustained fractures whilst riding a Hoverboard. Data such as patient demographics, type of fracture sustained, treatment received, complications and outcome were collected.

RESULTS

Twelve children, 5 males and 7 females with ages ranging from 5.5 to 15.3 years were included in this study. All patients sustained upper limb fractures and the distal radius was the commonest fracture site (30%). Surgery was required in 6 (50%) out of the 12 patients because the respective fractures were displaced. No patient had any ongoing complaints or disability at the last clinic review.   Conclusion : Children riding Hoverboards are predisposed to upper limb fractures and parents who purchase Hoverboards should be warned about this.

Renal trauma in adolescent skateboarders

OBJECTIVE

Kidney is the most commonly injured organ of the genitourinary tract after trauma. Half of blunt renal injuries are caused by traffic accidents, but sport activities are also included as frequent causes. Skatebording is popular among young people but it deserves being considered a potential cause of severe injuries. A number of published medical reports mainly refer to bone, joint and head injuries but no cases have been reported on urologic or kidney trauma.

METHODS

We present two cases of renal trauma in adolescent males occurred while doing skateboarding.

RESULTS

The first patient had a grade 3 renal trauma with urinary extravasation, managed conservatively with ureteral stenting. The second patient had a grade 4 to 5 renal trauma with cardiovascular instability requiring an urgent nephrectomy.

CONCLUSIONS

We would emphasize these cases as an emergent urological warning. Scientific information and medical education should be addressed from physicians to a targeted population, in order to reduce among teens the incidence of injuries of such at-risk activity.

Combined Tibial Tubercle Avulsion Fracture and Patellar Avulsion Fracture: An Unusual Variant in an Adolescent Patient

Traumatic extensor dysfunction of the knee in children is a rare injury, with the majority resulting from tibial tubercle avulsion fracture or patellar sleeve fracture. We report a rare case of combined patellar avulsion fracture and tibial tubercle fracture. With open anatomic reduction, both injuries were successfully treated. While many variations of tibial tubercle fracture have been reported, the authors believe this to be the first report in the English-language literature of this particular combined injury to the knee extensor mechanism in an adolescent. Advanced imaging with computed tomography provided vital information to aid with operative planning, especially since the majority of the unossified tubercle was not seen on plain radiographs, and all fracture fragments were originally believed to be from the tibial tubercle. Computed tomography distinguished the patellar fracture from the tibial tubercle fragments, verifying preoperatively the complexity of the injury.

The Biomechanics of Cranial Forces During Figure Skating Spinning Elements

Several facets of figure skating, such as the forces associated with jumping and landing, have been evaluated, but a comprehensive biomechanical understanding of the cranial forces associated with spinning has yet to be explored. The purpose of this case study was to quantify the cranial rotational acceleration forces generated during spinning elements. This case report was an observational, biomechanical analysis of a healthy, senior-level, female figure skating athlete who is part of an on-going study. A triaxial accelerometer recorded the gravitational forces (G) during seven different spinning elements. Our results found that the layback spin generated significant cranial force and these forces were greater than any of the other spin elements recorded. These forces led to physical findings of ruptured capillaries, dizziness, and headaches in our participant.

Emergency laparoscopic partial splenectomy for ruptured spleen: A case report

Splenic rupture is a common consequence of blunt abdominal trauma. Emergency splenectomy is indicated when conservative management is not effective. With better understanding of the immunologic function of the spleen, surgeons have begun to perform the splenic-preserving surgery. However, it is technical challenge to perform emergency laparoscopic partial splenectomy for patient with spleen rupture. A 15-year-old male patient suffered from grade III spleen injury basing on the American association for the surgery of trauma splenic injury scale. Conservative treatment failed to success basing on the dramatically decreased hemoglobin level. During the laparoscopic exploration, we found that two individual ruptures were associated with the upper pole of spleen. An emergency laparoscopic partial splenectomy was successfully carried out. The operative time was approximate 150 min and the estimated blood loss was 200 mL. The post-operative course was uneventful and the patient was discharged on the 7^th post-operative day.

Injuries and helmet use related to non-motorized wheeled activities among pediatric patients

INTRODUCTION

Patients presenting to emergency departments (ED) for injuries resulting from recreational activities represent a unique source of information on important directions for injury prevention efforts. We describe the epidemiology of non-motorized wheeled activity-related injury in pediatric patients presenting to Canadian EDs as well as patients' helmet use.

METHODS

Data for the years 2004 to 2009 were abstracted from the Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP), a national ED injury surveillance program in fifteen hospitals.

RESULTS

Most of the 28 618 children aged 1 to 16 years injured during non-motorized wheeled activities were injured while cycling, followed by skateboarding. Most injuries occurred among boys. Children injured on scooters tended to be younger whereas skateboarders were the oldest. On average, the number of all injuries decreased by 6% over the time period. Falls were the most common mechanism of injury; 8.3% of patients had head injuries, which were seen more often among cyclists than other wheeled-activity users. Helmet use was greatest among cyclists (62.2%) and lowest among skateboarders (32.9%). Injured patients presenting to EDs in jurisdictions with legislation mandating helmet use had 2.12 greater odds of helmet use and 0.86 lesser odds of head injury compared with those presenting in jurisdictions without helmet laws.

CONCLUSION

These results provide further evidence that legislation mandating helmet use may be an effective way of reducing injury among all wheeled-activity users. The small number of patients who presented with helmet use and protective gear (59.4% overall) suggests that this remains an area for intervention.

Editorial. Bicycle injuries and injury prevention

In 1989, long before this journal added injuries to its title, it published two papers on childhood injuries and I was asked to write an editorial for this occasion. I chose the title "Challenges for Injury Prevention: Two Neglected Aspects" because I thought the papers neglected to mention the inadequacy of injury statistics (at the time there were no emergency department data) and also failed to emphasize the public health importance of childhood injuries. It is instructive, therefore, to compare this issue's offerings with how matters stood nearly 25 years ago and see what progress we've made. Papers in this and the previous issue of this journal discuss bicycle safety in general and helmet use in particular. Although this is a somewhat narrow focus, it serves as one indicator of how the field has evolved and what remains to be done to improve both the science and policy in this domain.

The impact of orthopaedic injuries sustained at an urban public ice skating rink: is it really free?

INTRODUCTION

Previous reports in the literature from Europe and Asia cite an increased burden on the local emergency departments and orthopaedic services during the operational period of the ice skating rinks. This retrospective observational study was undertaken in order to report the incidence, characteristic, and severity of injuries during a full season at a large urban ice skating rink, as well as to quantify the added burden the ice skating rink places on the local emergency department and the orthopaedic service.

METHODS

All patients seen at our emergency room who sustained an injury at the neighboring "free" ice rink were identified over the 4-month period when it was open. The data collected included type of injury, demographics, and need for surgical treatment.

RESULTS

Over this period, 118 patients were seen in our ED (of the 135 referrals from the ice rink logbook); Of these, 43 (38%) required an orthopaedic consult and were evenly divided into upper (22) and lower extremity injuries (21). Sixty-seven percent of the patients were adults, and the most common fractures were ankle and distal radius fractures. There were two open fractures of the distal radius seen in the older patients (both in patients > 50). Overall 32% of patients needed operative treatment. Of the non-orthopaedic injuries, the most common was head injury (25%).

CONCLUSIONS

An ice-rink may be "free" but adds significant burden to the healthcare system, and these costs should be factored in by both the sponsoring body and the healthcare system for treatment of these additional patients.

Child non-ischemic priapism, a conservative approach: case report and updated review

Non-ischemic priapism in children is an uncommon entity usually related to blunt trauma in the perineal region and subsequent fistula formation into the corpus cavernosum. In this report we present the case of a 7-year-old boy who had undergone perineal trauma and developed non-ischemic priapism confirmed radiologically. He was treated by conservative measures along with ultrasonographic monitoring. We discuss the diagnostic approach, the radiologic findings and the mainly conservative management of this infrequent pathology.

[Waveboard-related injuries. Greater protection is advised]

OBJECTIVE

Waveboarding, a type of skateboarding, is a new craze among children. The aim of this study is to describe how many children visit the emergency department as a consequence of waveboarding and the types of injury they have.

DESIGN

Retrospective, descriptive.

METHOD

All records of children aged 5 to 15 years who had visited the emergency department of the Medical Center Alkmaar in the period March to May 2010 were examined. If a case of waveboard-related injury was found then the type of injury was noted. For all of the injuries a phone call was made to try to find out if protective gear had been worn.

RESULTS

A total of 1418 records from 2010 were investigated. In 132 cases, a waveboard-related injury was found. Contusion was found in 31% of cases and a fracture in 64% of cases. The 2 most frequently occurring sites of injury were the forearm and wrist (53%) and the elbow (14%). In 3% of the waveboard-related injuries the child concerned had worn any protective gear.

CONCLUSION

Children who visited the emergency department due to waveboard-related injuries mainly had injuries to the wrists, forearm and elbow. Only 3% of the children wore protective gear when waveboarding. As effective protection against accident-related injuries exists for skaters, the wearing of protective gear during waveboarding can be expected to lead to a reduced number of injuries.

[Traumatic dissection of extra- and intradural arteries]

Dissection of extra- and intradural arteries is a common cause of cerebral insult in younger patients (<45 years). In patients with corresponding craniocervical injury and symptoms (carotidynie, ipsilateral headache, partial Horner syndrome, cranial nerve palsy) arterial dissection is always to be considered. Essential in diagnosing arterial dissection is the verification of the intramural hematoma and morphologic changes in the vessel (stenosis, pseudoaneurysm) by means of CT/CTA (acute phase) or MRI/MRA (subacute phase). These patients need to be monitored in an intensive care unit setting. The acute therapy includes anticoagulation or inhibition of thrombocyte aggregation. We present two cases with delayed cerebral infarction due to traumatic extra- and intradural arterial dissection after a motor vehicle accident. To perform primary diagnostic quickly and adequately may avoid permanent neurological deficit in these patients.

Personal protective equipment use by in-line skaters in Victoria

OBJECTIVE

To describe use of personal protective equipment (PPE) by in-line skaters at four different skate settings (rink, park, trail and street) in Melbourne and rural Victoria, and to compare local PPE with reported international use.

METHOD

Unobtrusive observations of in-line skaters at four types of skate settings (rinks, parks, trails, street) in Melbourne and rural Victoria.

RESULTS

Two-thirds of 490 observed in-line skaters (66.7%) wore none of the recommended PPE (wrist guards, elbow and knee pads and helmets). Only 2.2% wore all four pieces of PPE. Wrist guards were worn by 25.9% of skaters, knee pads by 23.5%, elbow pads by 6.9% and helmets by 5.5%. Younger skaters were least likely to wear any PPE. Trail skaters were more likely to wear PPE than skaters on rinks, parks and streets. Almost one-third of skaters did not have a heel brake on their skates. Use of PPE was influenced by group norms.

CONCLUSION

Personal protective equipment use is low among in-line skaters in Victoria, and varies according to skate location. The use of PPE in Victoria is much lower than that reported overseas.

IMPLICATIONS

Evidence of the effectiveness and the low use of PPE by skaters highlights the need to better promote the use of wrist guards, elbow and knee pads and helmets to skaters of all ages and abilities. There is opportunity for public health professionals to work in partnership with in-line skating bodies, organisers and sponsors of skating events, skate venue owners and managers, skating equipment manufacturers and hirers to promote PPE use.

Management of a horizontal root fracture: a 17-year follow-up

Intra-alveolar root fractures in immature permanent teeth are relatively uncommon and often present a complicated and unpredictable prognosis. This case report documents how conservative treatment was used for the successful management (and long-term follow-up) of immature teeth with a horizontal root fracture.

[Are ice-skating ramps dangerous?]

INTRODUCTION

Before the new temporary ice rink in Esbjerg was built, opponents feared that it would disproportionately increase the number of traumas needing medical care at the hospital. The reason for this concern was that it was built with ramps.

MATERIAL AND METHODS

During the winter of 2004 an estimated 30,000 people visited the two ice rinks in Esbjerg. The temporary rink had ramps, whereas the permanent rink had no ramps. A total of 104 persons were injured and needed treatment at the emergency room of orthopaedic surgery. They all received a questionnaire in order to obtain information about a) whether the accident took place on one or the other ice rink, and b) how frequently safety equipment was used.

RESULTS

The answers from the questionnaire were used along with information obtained from the emergency room journals. We wanted to establish if accidents on the temporary ice rink were more serious or if the proportion of injuries was higher compared to accidents on the permanent ice rink.

DISCUSSION

There was no significant difference in the number of injuries or in the severity of the traumas resulting from skating on the temporary ice rink compared with the permanent rink. Only 4% used safety equipment.

CONCLUSION

Having ramps on the ice rink produced no significant increase in the proportion of injuries, nor did it produce more severe traumas. Safety equipment protecting hand and wrist would probably decrease the number of soft tissue injuries presented at hospital.

Post traumatic prepubertal high-flow priapism: a rare occurrence

High-flow or arterial priapism is an uncommon condition resulting from perineal or penile trauma. The classical features are a painless erection of the cavernous bodies while the corpus spongiosum stays flaccid. This case highlights a 11-year-old boy who presented with painless semi rigid erection of 3 days duration following a blunt skateboard injury to his perineum. Following failed conservative treatment, the patient underwent bilateral internal pudendal angiography with localization and embolization. Follow up in 1 month showed patient to have normal nocturnal and reflexogenic erections. Medical and surgical treatments for high-flow priapism have been described in literature with varying degree of success and complications. The current accepted standard of care is pelvic angiography and super-selective embolization of internal pudendal artery.

Associated economic impact of skatepark-related injuries in Southern California

OBJECTIVE

To correlate the types of skatepark-related injuries with medical expenses and the monetary effects of time missed from work or school.

DESIGN

Prospective case series and survey with repeat measures over 1 year.

SETTING

Southern California Level I Trauma Center and Emergency Department.

PARTICIPANTS

Subjects age 7 years or older who sustained an injury at a local skatepark and treated in the emergency department were included in the study.

METHODS

A skatepark-related injury survey was conducted at the time of the subject's emergency department evaluation. Thereafter, subjects were contacted by telephone at 1 week and 1, 3, 6, 9 and 12 months post-injury to assess the extent of ongoing follow-up medical care, time lost from work and school for both the subject and parents, and the degree of self-reported disability. The costs of injury were estimated using accepted econometric methods. The cost of medical care and lost household productivity were estimated using data specific to the nature of the injury and the body part injured.

RESULTS

Skatepark-related injuries resulted in a mean loss of 1.1 school days and 5.5 work days to the subject and family. The mean total injury costs were $3,167, of which 64% were medical costs and 28% were wages lost by the subject and family. Costs were much greater for subjects aged 26 years and older than for younger subjects and for those with more severe injuries than for less severe injuries.

CONCLUSION

Skatepark injuries resulted in substantial medical costs and lost wages. Injured skatepark users 26 years and older and those with more severe injuries had the highest cost.

Sport-specific injuries and medical problems of figure skaters

Figure skating is becoming increasingly popular as both a recreational and competitive sport. As the number of figure skating participants increases, so will the number of active patients who present to their primary care physician with sport-related injuries and medical problems. Figure skating is a unique sport that continues to evolve and progress with participants partaking in more difficult moves and more rigorous training programs. Common problems in figure skating include acute musculo-skeletal injuries and chronic overuse injuries, which primarily occur in the foot, ankle, knee, leg, hip, and lower back. Figure skaters are also more likely to endure specific medical problems such as exercise-induced bronchospasm and eating disorders. Primary care physicians are able to contribute to their figure skating patient's health by recognition and appropriate treatment of acute injuries and prevention of chronic injuries and other medical problems.

Inline skating injuries: medical and sociological aspects

INTRODUCTION

Inline skating is becoming more and more popular all over the world. This results in a rapid increase in sports injuries. The aim of our study was to analyse injury patterns and injury causes as well as the influence of the social status on possessing and using protective equipment.

PATIENTS AND METHODS

We recorded and evaluated 76 accidents in our outpatient department by means of standardised questionnaires over a period of 18 months. We checked the direct circumstances of the accident, social situation and aspects of the family's social status.

RESULTS

The average age of the injured person was 12.5 years. The most common injury localisations were the distal forearm (39.5 %) and the wrist (9.2 %), the most common types of injuries were fractures (51.9 %, especially upper extremity) and distortions (17.6 %). Most injuries happened in easy driving situations, like gliding, turning and braking. The injured children did not differ significantly from the general population. The willingness of children to wear special safety gear increased with the social status of their family.

CONCLUSION

Learning the fundamental techniques can improve driving skills and reduce the number of injuries. Integration of skating lessons in physical education at school is desirable, especially regarding the injured person's age and would improve their willingness to wear protectors, independent of the social status.

Heely injuries: a new epidemic warranting a government health warning!

INTRODUCTION

Heelys, the new craze gripping the nation, were first introduced to Ireland in 2005 having been available in the United States since 2000. Designed as "the only shoe with a removable wheel in the sole" and initially marketed among rollerbladers and skateboarders they have been adopted by children as contemporary footwear.

MATERIAL AND METHODS

From April to June 2006, all patients presenting to trauma orthopaedic services at our institutions with injuries sustained while wearing Heelys were included in this study.

RESULTS

Thirty-nine patients are included in this study. The mean age was 9.1 years (range 7-13, median 9 years). Of the 39 patients referred to the orthopaedic service, 8 required admissions to hospital. One patient admitted following a head injury, required craniotomy and evacuation of an extradural haematoma.

CONCLUSION

The significance of the injuries encountered demonstrates the potentially devastating results from the use of Heelys. The public perception of safety is incorrect and manufacturers rightly recommend strongly the use of safety gear.

Dental injuries in inline skating ? level of information and prevention

Inline skating belongs like ice hockey, rugby, and boxing to sporting activities with high-risk of suffering tooth accidents. Because of high velocity and loss of balance, especially on uneven ground, the injury potential in inline skating is higher. The objective of this work was to conduct a comparative study between Switzerland and Germany. The questions focussed on the frequency of tooth accidents, their prevention by mouthguard and the level of information about emergency measures after dental trauma and the resulting consequences for athletes. Using a standardized questionnaire totally 612 individuals, 324 men and 288 women, in two countries belonging to three different divisions (fun, fitness and speed) were surveyed. Fifty-six (9.2%) of these 612 interviewees have already experienced a tooth injury while inline skating. More than half of all interviewed players (68.3%) were aware of the possibility of replanting avulsed teeth. Only 32.4% were familiar with the tooth rescue kit. Just 65.4% knew mouthguard and only 1.9% of those athletes (n = 12) wore a mouthguard while inline skating. The results show that the area of inline skating requires more information about preventing dental trauma through sports associations and dentists.

Battling fire and ice: remote guidance ultrasound to diagnose injury on the International Space Station and the ice rink

BACKGROUND

National Aeronautical and Space and Administration (NASA) researchers have optimized training methods that allow minimally trained, non-physician operators to obtain diagnostic ultrasound (US) images for medical diagnosis including musculoskeletal injury. We hypothesize that these techniques could be expanded to non-expert operators including National Hockey League (NHL) and Olympic athletic trainers to diagnose musculoskeletal injuries in athletes.

METHODS

NHL and Olympic athletic trainers received a brief course on musculoskeletal US. Remote guidance musculoskeletal examinations were conducted by athletic trainers, consisting of hockey groin hernia, knee, ankle, elbow, or shoulder evaluations. US images were transmitted to remote experts for interpretation.

RESULTS

Groin, knee, ankle, elbow, or shoulder images were obtained on 32 athletes; all real-time US video stream and still capture images were considered adequate for diagnostic interpretation.

CONCLUSIONS

This experience suggests that US can be expanded for use in locations without a high level of on-site expertise. A non-physician with minimal training can perform complex, diagnostic-quality examinations when directed by a remote-based expert.

Using PEACE to target helmet legislation involving nonmotorized wheeled sports in Canada

Current Canadian helmet bylaws focus mainly on bicycle helmet use. In this way, law makers are ignoring head injuries associated with other wheeled sports. Cycling, in-line skating, skateboarding, and scootering can all cause serious injury to participants if proper protective gear is not worn. Legislation has been shown to work in promoting helmet use and decreasing injuries. Nurses, using theory and research to guide practice, can be key players in advocating for healthy public policies and amendments to provincial legislation. Nurses have the opportunity to play an active leadership role that can be guided by PEACE, a philosophy that encompasses praxis, empowerment, awareness, cooperation, and evolvement.

The impact of a temporary ice-rink on an emergency department service

BACKGROUND

A temporary ice-rink opened close to Cork city for 6 weeks from 30 November 2003. During this time, a number of patients presented to the local emergency departments with ice-skating-related injuries. We documented these injuries.

METHODS

All patients presenting to emergency departments in Cork city with ice-skating-related complaints were included. Information on age and sex, mechanism of injury, diagnosis, follow-up/disposition and ambulance service utilization was recorded.

RESULTS

One hundred and twenty-five ice-rink-related attendances were reported at Cork emergency departments, representing 1.25% of total attendances. One hundred and twenty-three patients presented with skating-related injuries and two with medical complaints occurring at the ice-rink: 70.8% were female patients and 29.2% were male patients. In the 4-14-year age group, however, 48.5% were girls and 51.5% were boys. Most injuries were directly due to falls; 5.6% were due to skate blades. The commonest site of injury was the upper limb. Fractures and dislocations accounted for 53.9% of injuries, with 20.5% of these requiring orthopaedic admission. Lacerations and digital injuries accounted for 7.1%, with 11% of these required admission for surgery. One minor head injury was reported. 38.1% had soft tissue injuries. Fifteen patients were transported by ambulance. These attendances represented a minimum overall cost of 77,510 euro to the local health service.

CONCLUSIONS

A temporary ice-rink had a significant impact on local emergency departments. Currently, there is no specific legislation in Ireland relating to public health and safety in ice-rinks. We recommend consultation with local public bodies before opening such facilities, and appropriate regulation.

Injuries in synchronized skating

Synchronized skating is a relatively new competitive sport and data about injuries in this discipline are lacking. Therefore the purpose of this study was to investigate the frequency and pattern of acute and overuse injuries in synchronized skaters. Before and during the World Synchronized Skating Championship 2004, a questionnaire inquiring about the frequency of injuries in this skating discipline was given to 23 participating teams. A total of 514 women and 14 men senior skaters completed the questionnaires (100 % response). Two hundred and eighteen (42.4 %) female and 6 (42.9 %) male skaters had suffered from acute injuries during their synchronized skating career. As some skaters had suffered from more than one injury, the total number of acute injuries in females was 398 and in males 14. In female skaters 19.8 % of acute injuries were head injuries, 7.1 % trunk, 33.2 % upper, and 39.9 % lower extremity injuries. In male skaters 14.3 % were head injuries, 28.6 % upper, and 57.1 % lower extremity injuries, with no report of trunk injuries. Sixty-nine female and 2 male skaters had low back problems and 112 female and 2 male skaters had one or more overuse syndromes during their skating career. Of 155 overuse injuries in female skaters, 102 (65.8 %) occurred during their figure skating career, while 53 injuries (34.2 %) only occurred when they skated in synchronized skating teams. In male skaters, out of 5 overuse injuries, 4 (80 %) occurred in their figure skating career, while 1 (20 %) occurred during their synchronized skating career. Out of the total of 412 injuries, 338 (82 %) occurred during on-ice practice, while 74 (18 %) happened during off-ice training. Ninety-one (26.9 %) acute injures occurred while practicing individual elements, and 247 (73.1 %) on-ice injuries occurred while practicing different team elements. We conclude that injuries in synchronized skating should be of medical concern due to an increasing number of acute injuries, especially those that go beyond the soft tissue and include head injuries and fractures. We feel that these more significant injuries MAY TO SOME EXTENT BE attributable to the increasing physical demands and technical difficulty required of the teams now participating in a more competitive environment over the last four years.

The Effects of Articulated Figure Skates on Jump Landing Forces

Lower extremity injuries in figure skating have long been linked to skating boot stiffness, and recent increases in jump practice time may be influencing the frequency and seriousness of these injuries. It is hypothesized that stiff boots compromise skaters' abilities to attenuate jump landing forces. Decreasing boot stiffness by adding an articulation at the ankle may reduce the rate and magnitude of landing forces. Prototype articulated figure skating boots were tested in this study to determine their effectiveness in enabling skaters to land with lower peak impact forces. Nine competitive figure skaters, who trained in standard boots and subsequently in articulated boots, performed off-ice jump simulations and on-ice axels, double toe loops, and double axels. Analysis of the off-ice simulations showed decreases in peak heel force and loading rate with use of the articulated boot, although the exact kinematic mechanisms responsible for these decreases are still unclear. Analysis of the on-ice jumps revealed few kinematic differences between boot types, implying that the skaters did not use the articulation. Greater adaptation and training time is likely needed for the results seen off-ice to transfer to difficult on-ice jumps.

Prevention and treatment of foot and ankle injuries in figure skaters

Participation in the sport of figure skating has more than doubled in the past 10 years. The sport has changed with an increased emphasis on free skating, which includes jumps and spins. The actual art of "figure" skating has been eliminated from the sport. With this change, there is an increased volume of foot and ankle injuries in figure skaters. This report outlines common foot and ankle injuries in figure skaters, discusses possible causes, and outlines treatment options.

Nonoperative management of delayed splenic rupture in a patient with hemophilia B

Nonoperative management of splenic lacerations has become the standard of care in hemodynamically stable patients. The decision to manage a patient nonoperatively is much more difficult when the patient has a known bleeding disorder. There are a few case reports in the literature describing nonoperative management of splenic trauma in children with hemophilia A (factor VIII deficiency), but only one case report of a patient with hemophilia B (factor IX deficiency) and a splenic laceration successfully managed nonoperatively. We present the case of a 13-year-old boy who presented with a grade 4 splenic laceration, acute blood loss anemia, and hypotension that was managed nonoperatively.

Differences in the risk associated with head injury for pediatric ice skaters, roller skaters, and in-line skaters

OBJECTIVE

The goals were to describe the epidemiologic features of pediatric skating-related injuries sustained from 1993 to 2003 and to compare ice skating-related injuries with roller skating--and in-line skating-related injuries.

METHODS

An analysis of pediatric skating-related injury data from the National Electronic Injury Surveillance System of the US Consumer Product Safety Commission was performed.

RESULTS

An estimated 1 235 467 pediatric skating participants presented to hospital emergency departments with injuries between 1993 and 2003. These children had a mean age of 10.9 years (SD: 3.2 years; range: 1-18 years), and 50.0% were male. The most common mechanism of injury was a fall (83.1%). Ice skaters sustained a greater proportion of head injuries (13.3%), compared with roller skaters (4.4%) and in-line skaters (5.0%). Ice skaters also experienced a greater proportion of concussions (4.3%), compared with roller skaters (0.6%) and in-line skaters (0.8%). The proportion of facial injuries among ice skaters was greater than the proportions among roller skaters and in-line skaters. The majority of roller skating-and in-line skating-related injuries were upper-extremity fractures (53.9% and 59.7%, respectively). Children < or = 6 years of age experienced a greater proportion of head and facial injuries than did older children in each skating activity.

CONCLUSIONS

The epidemiologic features of pediatric ice skating-related injuries differ from those of roller skating--and in-line skating-related injuries. Children should wear helmets during all recreational skating activities, especially ice skating, because of the risk of serious head injuries. Wrist guards should be worn to protect against the common upper-extremity fractures sustained during skating.

Video analysis of falls experienced by paediatric iceskaters and roller/inline skaters

OBJECTIVES

To evaluate differences in the way iceskaters and roller/inline skaters fall.

METHODS

Children's falls related to skating were videotaped and categorised based on type of skating activity, child's estimated age, direction of fall, whether the child attempted to break the fall, and whether the head struck the skating surface.

RESULTS

In total, 216 iceskating and 201 roller/inline skating falls were captured on videotape. In both iceskating and roller/inline skating, the majority of falls were forward in direction. The skaters attempted to break the falls with their arms or hands in over 90% of falls in both iceskating (93.1%) and roller/inline skating (94.5%). A greater proportion of falls in iceskating resulted in the head striking the skating surface (13.0%) than did those in roller/inline skating (3.0%) (odds ratio = 4.8; 95% confidence interval 1.9 to 13.3; p<0.001).

CONCLUSIONS

This study found that paediatric iceskaters and roller/inline skaters fall similarly and that both types of skaters try to break their falls with their arms or hands; however, because iceskating takes place on a low friction surface, attempts to break falls with the arms or hands are often unsuccessful, leading to head and face injuries. The development of a new type of protective gear, a wrist guard with a non-slip palm, should stop iceskaters from striking the head, protect against upper extremity fractures, and unlike a bulky helmet, should not discourage children from skating.

Population-based analysis of severe injuries from nonmotorized wheeled vehicles

BACKGROUND

Bicycling, skateboarding, and inline skating are popular recreational activities, with the potential of causing severe injury.

METHODS

A retrospective, population-based, trauma registry analysis of severe injuries and deaths from nonmotorized wheeled vehicles (NMWV) over a 10-year period was performed.

RESULTS

During the study period, 1475 cyclists, 141 skateboarders, and 112 inline skaters sustained injury meeting registry criteria (length of stay > or = 3 days or death). The majority were male. Lone crashes were the most common mechanism of injury, although collisions with motor vehicles accounted for 63.6% (n = 44) of observed deaths. Thoracic trauma and head injuries were more common in nonsurvivors.

CONCLUSION

NMWV injuries pose a public health concern. We recommend enforcement of mandatory helmet laws and expansion of the existing law to include skateboarders and inline skaters. Education initiatives should also be expanded to include the adult population. NMWV should be separated from motorized vehicles as much as possible.

Skimboarding: a new danger in the surf?

Skimboarding is an increasingly popular activity on the beach. Over a six week period we saw 10 patients with fractures or dislocations, half of whom required operative intervention. The majority (80%) were of the lower limb, some of which were severe.

A new skatepark: the impact on the local hospital

BACKGROUND

There has been a resurgence of skateboarding, rollerblading and BMX riding in recent years and in response dedicated skateparks have opened in many cities across the UK. It is acknowledged that these sports are associated with risk of injury and it is recommended that participants wear protective clothing.

OBJECTIVE

We aimed to determine if the opening of a skatepark near our hospital had any effect on the number of skatepark related injuries attending the emergency department and to describe the types of injuries sustained.

METHODS

All patients attending the emergency department with sports injuries were identified over 24 consecutive weeks. At the end of the 12th week a skatepark opened nearby. Data recorded prospectively included age and sex of subjects, the delay from injury to presenting to hospital, whether or not protective equipment was worn and if first aid was administered before attending hospital. The investigations performed in the emergency department, the diagnosis, treatment received and disposal from the hospital were also recorded.

RESULTS

After the skatepark opened there was a significant increase in the number of skatepark related attendances from 7 to 32. Protective clothing was only worn by 9 out of 39 of those with injuries. The commonest injuries were musculoskeletal and the limbs were injured more frequently than the head and trunk.

CONCLUSION

We demonstrated a significant increase in the number of skatepark related injuries attending the emergency department following the opening of a nearby skatepark.

Cast Abscess

This report describes a case in which a pediatric patient wounded his ankle when he stuck an object inside the cast while trying to scratch himself. The wound became infected and resulted in a limb-threatening abscess. Although most patients treated with casts do not have any significant problems, it is important to emphasize cast care instructions to young patients and their parents. In addition, it may be equally important to advise patients about safe methods to alleviate itching, such as blowing cool air under the cast. In this way, the risk of serious infectious complications can be minimized.

The impact of ice-skating injuries on orthopaedic admissions in a regional hospital

Since the opening of a temporary ice-rink in our hospital's catchment area, we have observed an increase in patients requiring in-patient treatment for orthopaedic intervention. The authors performed a prospective analysis of all patients admitted to our unit over a one-month period. Epidemiological data, wearing of protective gear and skater experience were collected. Fracture type, treatment required, average length of hospital stay and number of days missed from work was also recorded. Ice-skating injuries accounted for 7.7% of our total admissions over the study period. There was a significant variation noted in the types of fracture sustained ranging from comminuted fractures of the radial head to spiral fractures of the tibia. The average length of hospital stay was 2.6 days and average time missed from work was 6.1 weeks. This paper highlights the potential serious injuries that can occur in ice-skating and their impact on admissions to our orthopaedic unit.

A randomized controlled trial of sport helmet interventions in a pediatric emergency department

OBJECTIVE

To evaluate the effectiveness of 3 competing pediatric emergency department (ED) interventions aiming to increase sport helmet use in a state without helmet legislation.

METHODS

A randomized controlled clinical trial was conducted during the 7-month period between April and October 2003 at an urban pediatric ED in a state without current helmet legislation. We enrolled 200 assenting English-speaking children aged 5 to 16 years, admitted to the ED for treatment, and who did not currently own a helmet. Participants were randomized into 3 experimental arms. A control group received usual care, that is, verbal counseling regarding helmet use. Subjects in one treatment arm received a voucher to receive a free helmet that could be redeemed at a different location within the hospital. Subjects in a second treatment arm actually received a free helmet directly in the ED. The main outcome measure was reported helmet use at follow-up, assessed by telephone interviews of both the child and a parent.

RESULTS

Directly receiving a free helmet in the ED significantly increased reported helmet use relative to the control group; the odds that a parent reported helmet use were nearly 16 times higher (P < 0.01), and the odds that a child reported helmet use were nearly 10 times higher (P < 0.01). Receiving a free helmet also significantly increased reported helmet use when compared with the voucher intervention group. Reported use between the control group and the voucher intervention group was not significantly different.

CONCLUSIONS

Directly receiving a free helmet in the pediatric ED appears to be an effective hospital-based strategy to increase pediatric helmet use.