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Background: Modern crossbow is a popular weapon used throughout the United States for outdoor recreation. Crossbow mechanics place the hand and digits at significant risk of injury while shooting or handling these weapons; however, injury patterns have been poorly documented. In this study, the authors use a national database to assess patterns of crossbow-related injuries of the hand and digits., Methods: A retrospective review of the National Electronic Injury Surveillance System database was conducted to identify crossbow-related hand and digit injuries over the past 10 years. Demographic data, injury timing, anatomical injury location, specific injury diagnosis, and disposition data were collected., Results: A total of 15 460 crossbow-related hand injuries were identified between 2011 and 2021. A strong temporal relationship was identified, with 89% of injuries occurring between the months of August and December. Male patients sustained most injuries (>85%). Body areas injured were the digits (93.2%) and the hand (5.7%). The most common injuries were laceration (n = 7520, 48.6%), fracture (n = 4442, 28.7%), amputation (n = 1341, 8.7%), and contusion/abrasion (n = 957, 6.2%). More than 50% of cases involved injury to the thumb, with approximately 750 thumb amputations recorded during the time period examined., Conclusions: This study is the first to document the patterns of hand and digit injuries associated with crossbow use on a national scale. These findings have important implications for public health awareness campaigns targeting hunters and support the designation of crossbow "safety wings" as a mandatory feature of crossbow design., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Pneumonia occurs in about 20% of trauma patients with pulmonary contusions. This study aims to evaluate the association between empirical antibiotic therapy and nosocomial pneumonia in this population., Methods: Retrospective cohort of adult patients admitted to a trauma-surgical ICU. The Antibiotic Therapy Group (ATG) was defined by intravenous antibiotic use for more than 48 h starting on hospital admission, while the Conservative Group (CG) was determined by antibiotic use no longer than 48 h. Primary outcome was microbiologically documented nosocomial pneumonia within 14 days after hospital admission. Logistic regression was used to estimate the association between group allocation and primary outcome. Exploratory analyses evaluating the association between resistant strains in pneumonia and antibiotic use were performed., Results: The study included 177 patients with chest trauma and pulmonary contusion on CT scan. ATG were more severely ill than CG, as shown by higher Injury Severity Score, SAPS3, SOFA score, higher rates, and longer duration of mechanical ventilation. In the multivariate analysis, ATG was associated with a lower incidence of primary outcome (OR = 0.25, 95% CI 0.09-0.64; p < 0.01). Similar results were found in the sensitivity analysis with another set of variables. However, each day of antibiotic use was associated with an increased risk of pneumonia by resistant bacteria (OR = 1.18 per day, 95% CI 1.05-1.36; p < 0.01)., Conclusions: Empiric antibiotic therapy was independently associated with lower incidence of nosocomial pneumonia in critically ill patients with pulmonary contusion. However, each day of antibiotic use was associated with increased resistant strains in infected patients., Competing Interests: Conflicts of interest The authors declare no conflicts of interest, (Copyright © 2023. Published by Elsevier España S.L.U.)

We review the spectrum of acute osseous injuries in athletes, ranging from osseous contusion (bone bruise) injuries to nondisplaced cortical fractures. The basic biomechanical concepts, underlying histopathologic changes, and characteristic magnetic resonance imaging (MRI) features of acute osseous injuries are presented. Bone bruise injuries of varying severity are highlighted to showcase the breadth of imaging findings on MRI and methods for characterizing such lesions. We emphasize the importance of accurately assessing patterns of injury on MRI to communicate more effectively with team medical staff and recognize the implications on return to play. This article offers the foundational tools for approaching bone bruise injuries in elite athletes to add value to the diagnosis and treatment of this unique patient population., Competing Interests: None declared., (Thieme. All rights reserved.)

Objective: Systematic summary of the epidemiology of patellar dislocation is rare. This study aims to investigate sex-, age-, type-, injury causing events-, incidence of bone bruise and time from last injury (TFLI)-specific characteristics, and detail the epidemiological characteristics of patellar dislocation., Method: In this descriptive epidemiological study, a total of 743 patients who have a history of lateral patellar dislocation with either first-time patellar dislocation (FPD) or recurrent patellar dislocation (RPD) between August 2017 and June 2022 at our institution met the inclusion criteria and were selected in this study. Patient characteristics including the type, gender, age, events leading to patellar dislocation, incidence of patellar bone bruise, and the time from last injury (TFLI) of patellar dislocation were retrospectively obtained and described. Magnetic resonance imaging scans (MRI) of the knee were reviewed for insuring bone bruise., Results: Among the 743 patients with patellar dislocation who required surgical reconstruction of the medial retinaculum, 418 (56.2%) had RPD and 325 (43.8%) had FPD. There were more females (65.0%) than males (35.0%) in patellar dislocation patients. Among the female patients, those aged <18 years had higher incidence (31.4%) of patellar dislocation. Among the male patients, those aged <18 and 19-28 years had higher incidence (16.8%) of patellar dislocation. Of all age groups, the prevalence rate of patellar dislocation was high in juvenile population and females, but with no statistical significance. The most common patellar dislocation-causing event was sport accidents (40.1%), followed by life accidents (23.2%). The incidence of left-knee patellar dislocation was slightly higher than that of right-knee patellar dislocation. The incidence of patellar bone bruise of RPD (63.2%) was significantly lower (p < 0.05) than that of FPD (82.2%). Patellar dislocation patients with bone bruise had shorter time from last injury (TFLI) than those without patellar bone bruise (p < 0.05)., Conclusions: The incidence of bone bruise of RPD was lower than that of FPD, and patients with patellar bone bruise may have a shorter time from last injury than those without bone bruise., (© 2024 The Authors. Orthopaedic Surgery published by Tianjin Hospital and John Wiley & Sons Australia, Ltd.)

Purpose: To investigate the clinical characteristics of fall-related ocular trauma in patients over 90 years of age., Methods: Retrospective, medical record reviews. Patients over the age of 90 years treated in a tertiary center with fall-related ocular trauma were included in the study., Results: Fifty consecutive patients (fifty eyes) were analyzed. The mean age was 93.6 ± 1.8 years and 41 patients (82%) were female. The most common site of the injuries was orbital fracture (18 patients, 36%), accompanied with open globe rupture (OGR) in three patients, and globe contusion in two patients. Seventeen patients (34%) presented with OGR. Ocular trauma score in those patients was category 1 in 10 patients (58.8%) and category 2 in the others. Conjunctival hemorrhage and/or periocular contusion was seen in 14 patients (28%) and globe contusion in six patients (12%). At the presentation, the mean best corrected visual acuity (BCVA) was 2.82 ± 0.24 logMAR in patients with OGR and 1.98 ± 0.81 logMAR in six patients with globe contusion. Three of the patients with OGR had a final vision of 20/200 or better whereas the remaining patients had hand movements or less. The most common risk factors were female gender (82%) and use of antihypertensive drugs (46%)., Conclusion: Patients with OGR had a poor visual outcome despite the early treatment. It is important to raise public awareness about of the poor prognosis of ocular injuries due to falls in the elderly population in order to establish preventive measures., (© 2023. The Author(s).)

Objective: To determine if posteromedial tibial plateau (PMTP) bone bruising on pre-operative MRI is significantly associated with a ramp lesion identified during arthroscopy in patients with concomitant ACL ruptures., Methods: PubMed, CINAHL, Scopus, Web of Sciences, EMBASE, and Cochrane Library were searched systematically for studies that investigated the association between PMTP bone bruises on preoperative MRI and ramp lesions confirmed during arthroscopy. Eight studies met inclusion criteria. The Methodological Index for Nonrandomized Studies (MINORS) checklist was used to assess quality. A meta-analysis was performed to analyze odds of a ramp lesion after PMTP bone bruising identified on magnetic resonance imaging (MRI). Publication bias was assessed by funnel plot and Egger's linear regression test., Results: There are 2.05 greater odds of medial meniscal ramp lesions in patients with an ACL rupture when PMTP bone bruising is found on preoperative MRI (95% CI, 1.29-3.25; p = 0.002). Heterogeneity of the pooled studies may be substantial ( I 2   = 65%; p = 0.006). Funnel plot analysis and Egger's linear regression test ( p > 0.5) determined no publication bias among the studies included in the meta-analysis., Conclusion: Patients with acute ACL injuries and PMTP bone bruising on MRI have 2.05 times greater odds of a concomitant medial meniscal ramp lesion than those without this bone bruise pattern.

Background and Objective: On March 2020, our country became a protected area due to the COVID-19 pandemic. The consequences of COVID-19 on trauma surgery were great. We aimed to evaluate the activity of the Trauma Centre of a highly populated suburban area over 30 days starting from the first day of restrictions, to compare it with the same period of 2019 and 2022 and to evaluate whether a progressive return to normality has taken place. Materials and Methods : All patients older than 18 years managed in our Trauma Unit between 8 March 2020 and 8 April 2020 (the first COVID-19 period) were compared to the same period of 2019 (a COVID-19 free period) and 2022 (the second COVID-19 period). Clinical records were examined. Five categories of diagnoses and six mechanisms of injury were distinguished. Results : There were 1351 patients [M:719-F:632; mean age (SD):49.9 (18.7)], 451 [M:228-F:223; mean age (SD):55.9 (18.4)] and 894 [M:423-F:471;mean age (SD):54.1 (16.7)] in the COVID-19 free and in the first and second COVID-19 periods, respectively ( p < 0.05). In 2020, the most significant decrease was registered for sprains/subluxations (80%); contusions decrease by 77% while fractures decrease only by 37%. The lowest reduction was found for dislocations (26%). In 2022, dislocations decreased by only 16% and both fractures and sprains decreased by about 30% with respect to the pre-pandemic period. Patients with minor trauma (contusions) were half compared to 2019. Accidental falls remain the most frequent mechanism of injury. The incidence of proximal femur, proximal humerus and distal radius fractures remained almost unchanged during both pre-pandemic and pandemic periods. Conclusions : COVID-19 has markedly altered orthopaedic trauma. Injuries related to sports and high energy trauma/traffic accidents drastically reduced in 2020; however, we are slowly going back to normality: the same injuries increased in 2022 due to the progressive easing of restrictions. Elderly fractures related to accidental falls remained unchanged.

The aim of the study was to examine the effects of some pre-slaughter factors on the total carcass bruise severity score and the presence of carcass bruises. Bruises on 1027 cattle carcasses were evaluated with the "The Australian Carcass Bruise Scoring System," and at least one bruise score was determined in 92.7% of the carcasses. The total carcass bruise severity score increased as the animal's age, transport time, and AWACT (the Welfare Impact Score of Stockperson Actions) score increased (P < 0.001). The probability of the presence of carcass bruising increased 2.751 times in the autumn (P = 0.031) and 2.200 times in the summer (P = 0.072) compared to the winter. Carcass bruises tended to be 1.747 times more common in females than males (P = 0.065), and 65.9% less in the Simmental than Brown Swiss breed (P = 0.060). Human contact (OR = 1.685; P = 0.079) and electric goad using (OR = 1.762; P = 0.069) on the slaughter corridor tended to increase the probability of the presence of carcass bruises. In conclusion, to reduce the presence and severity of carcass bruises, it may be beneficial to focus on the improvement of handling and coercion practices applied by the stock person, to slaughter the cattle in the nearest slaughterhouse, and to pay more care to the handling of culled cattle., Competing Interests: Declaration of Competing Interest None., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Introduction: Elder abuse is common, but many characteristics have not been well-described, including injury mechanisms and weapons in physical abuse. Better understanding of these may improve identification of elder abuse among purportedly unintentional injuries. Our goal was to describe mechanisms of injury and weapons used and their relation to injury patterns., Methods: We partnered with District Attorney's offices in 3 counties and systematically examined medical, police, and legal records from 164 successfully prosecuted physical abuse cases of victims aged ≥60 from 2001 to 2014., Results: Victims sustained 680 injuries (mean 4.1, median 2.0, range 1-35). Most common mechanisms were: blunt assault with hand/fist (44.5%), push/shove, fall during altercation (27.4%), and blunt assault with object (15.2%). Perpetrators more commonly used body parts as weapons (72.6%) than objects (23.8%). Most commonly used body parts were: open hands (55.5% of victims sustaining injuries from body parts), closed fists (53.8%), and feet (16.0%). Most commonly used objects were: knives (35.9% of victims sustaining injuries from objects) and telephones (10.3%). The most frequent mechanism/injury location pair was maxillofacial/dental/neck injury by blunt assault with hand/fist (20.0% of all injuries). The most frequent mechanism/injury type pair was bruising by blunt assault with hand/fist (15.1% of all injuries). Blunt assault with hand/fist injury was positively associated with victim female sex (OR: 2.27, CI: [1.08 - 4.95]; p = 0.031), while blunt assault with object mechanisms was inversely associated with victim female sex (OR: 0.32, CI: [0.12 - 0.81]; p = 0.017)., Conclusion: Physical elder abuse victims are more commonly assaulted with an abuser's body part than an object, and the mechanisms and weapons used impact patterns of injury., Competing Interests: Declaration of Competing Interest None declared., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Methods: Fifty-four male athletes from two different teams were involved. Accidents and injuries were recorded immediately after the incident by a team physician present at every race. Exposure, location, type and cause of injury have been recorded. Incidence was calculated. Severity was measured as a cumulative severity score and burden depicted in a risk matrix., Results: Total time of exposure was 12537 hours over 3524 athlete days and 544002 kilometers of racing. 98 accidents were recorded, with 83 leading to injury. The total number of recorded injuries was 193. Injury incidence for all injuries was 54,8 (±SD 47,7-62,8) /1000 athlete days, 15,4 (±SD 13,4-17,7) /1000 athlete hours and 35,5 (±SD 30,8-40,8) /100.000 km raced. By far the most frequent types of injury were hematomas, contusions and bruising (n = 141, 73%) followed by lacerations (n = 22; 11,4%). Most injuries affected the arm and elbow (n = 34, 17,6%) followed by the shoulder and clavicle (n = 28, 14,5%) and occurred with contact (79%). Fractures pose a high injury burden due to long time loss, whereas hematomas, contusions and bruising showed the highest incidence numbers but comparably less time loss., Conclusion: Road cyclists' injuries have been underestimated in previous studies. Hematomas, contusions and bruising pose the highest number of injuries with a broad degree of severity and range of injury burden. Fractures are less common but show the highest injury burden. The upper extremities are involved the most.

Purpose: To determine the incidence of ramp lesions and posteromedial tibial plateau (PMTP) bone bruising on magnetic resonance imaging (MRI) in patients with multiligament knee injuries (MLKIs) and an intact anterior cruciate ligament (ACL)., Methods: A retrospective review of consecutive patients surgically treated for MLKIs at 2 level I trauma centers between January 2001 and March 2021 was performed. Only MLKIs with an intact ACL that received MRI scans within 90 days of the injury were included. All MLKIs were diagnosed on MRI and confirmed with operative reports. Two musculoskeletal radiologists retrospectively rereviewed preoperative MRIs for evidence of medial meniscus ramp lesions (MMRLs) and PMTP bone bruises using previously established classification systems. Intraclass correlation coefficients were used to calculate the reliability between the radiologists. The incidence of MMRLs and PMTP bone bruises was quantified using descriptive statistics., Results: A total of 221 MLKIs were identified, of which 32 (14.5%) had an intact ACL (87.5% male; mean age of 29.9 ± 8.6 years) and were included. The most common MLKI pattern was combined injury to the posterior cruciate ligament and posterolateral corner (n = 27, 84.4%). PMTP bone bruises were observed in 12 of 32 (37.5%) patients. Similarly, MMRLs were diagnosed in 12 of 32 (37.5%) patients. A total of 8 of 12 (66.7%) patients with MMRLs demonstrated evidence PMTP bone bruising., Conclusions: Over one-third of MLKI patients with an intact ACL were diagnosed with MMRLs on MRI in this series. PMTP bone bruising was observed in 66.7% of patients with MMRLs, suggesting that increased vigilance for identifying MMRLs at the time of ligament reconstruction should be practiced in patients with this bone bruising pattern., Level of Evidence: Level IV, retrospective case series., (Copyright © 2022 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)

Pulmonary contusion usually occurs in combination with other injuries and is indicative of a high level of force. Especially in multiply injured patients, pulmonary contusions are frequently detected. The injury is characterised by dynamic development, which might result in difficulties in recognising the actual extent of the injury at an early stage. Subsequently, correct classification of the extent of injury and appropriate initiation of therapeutic steps are essential to achieve the best possible outcome. The main goal of all therapeutic measures is to preserve lung function as best as possible and to avoid associated complications such as the development of pneumonia or Acute Respiratory Distress Syndrome (ARDS).The present report from the interdisciplinary working group "Chest Trauma" of the German Society for Trauma Surgery (DGU) and the German Society for Thoracic Surgery (DGT) includes an extensive literature review on the background, diagnosis and treatment of pulmonary contusion. Without exception, papers with a low level of evidence were included due to the lack of studies with large cohorts of patients or randomised controlled studies. Thus, the recommendations given in the present article correspond to a consensus of the aforementioned interdisciplinary working group.Computed tomography (CT) of the chest is recommended for initial diagnosis; the extent of pulmonary contusion correlates with the incidence and severity of complications. A conventional chest X-ray may initially underestimate the injury, but is useful during short-term follow-up.Therapy for pulmonary contusion is multimodal and symptom-based. In particular, intensive care therapy with lung-protective ventilation and patient positioning are key factors of treatment. In addition to invasive ventilation, non-invasive ventilation should be considered if the patient's comorbidities and compliance allows this. Furthermore, depending on the extent of the lung injury and the general patient's condition, ECMO therapy may be considered as an ultima ratio. In particular, this should only be performed at specialised hospitals, which is why patient assignment or anticipation of early transfer of the patient should be anticipated at an early time during the course., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Background: The incidence of anterior cruciate ligament (ACL) tears in skeletally immature patients with an ACL bone contusion pattern has been sparsely investigated. The purpose of this study is to investigate whether physeal status has an influence on the likelihood of sustaining an ACL tear when classic bipolar ACL bone bruising pattern is present., Methods: Magnetic resonance imaging reports were queried for "contusion" on all patients between 6 and 22 years between 2015 and 2019. Images were reviewed to denote all intra-articular pathology and the physeal status of the femur and tibia. The primary outcome was the incidence of ACL tears in patients with the presence of bipolar bone contusions. Fischer exact testing was used to determine associations., Results: Of 499 patients included, 269 of those had bipolar bone contusions. Patients with bipolar bone contusions and ACL tears had a shorter duration between injury and imaging date compared with patients with ACL tears without bipolar bone contusions (6.9 vs. 38.6 d, P =0.05). Patients with an open femoral physis had a higher likelihood of having an intact ACL despite the presence of bipolar bone contusions than patients with a closed femoral physis (10.8% vs. 1.0%, P <0.001). Of patients with bipolar bone contusions, those with an intact ACL were younger than patients with an ACL tear (14.6 vs. 16.4, P =0.017)., Conclusions: Although bipolar bone contusions of the central lateral femoral condyle and posterior lateral tibial plateau are typically found after ACL injury, these bipolar contusions can be found concomitantly with an intact ACL and were more often found in relatively younger patients. Patients who have an open femoral physis have a higher likelihood to have an intact ACL despite the presence of bipolar bone contusions compared with patients who have a closed femoral physis., Level of Evidence: Level IV-cross-sectional., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Purpose: The purpose of this study was to provide a novel report on the head and neck injuries from the sport of wrestling and their characteristics in the USA., Materials and Methods: This is a 20-year retrospective cross-sectional study conducted using the National Electronic Injury Surveillance System (NEISS). Reports were included in the analysis if the injury stemmed from combat with another person. The predictor variables were obtained from both patient and injury characteristics. The principal outcome variable was admission rate, which was used to proxy the severity of the injury at hand. Bivariate analysis (i.e., chi-square and independent sample tests) was used to determine if an association existed between two variables of interest., Results: The final sample in our study consisted of 4485 cases of craniomaxillofacial injuries secondary to wrestling. The increase in injuries from the year 2000 to 2019 was significant (P < 0.05). The average age of patients was 15.73 (range: 3 to 59 years old). Virtually all of the injuries occurred in males (95.6%). The majority of patients was under the age of 18 (82.3%). With regard to race, white wrestlers (57.1%) comprised the majority of patients. Insight into race was not available for 1245 patients (27.8%). Most wrestling-related injuries took place during the winter season (60.6%). Concussion was the most common primary diagnosis (29.0%). The head (57.1%) was the most commonly injured craniomaxillofacial region. The most common setting in which the injury took place was a place of recreation/sports (49.9%). Among the mechanisms of injuries, the take-down (26.5%) was the most common. Patients who were thrown/taken down (5.04%) were significantly more likely to get admitted (P < 0.01) relative to patients who were injured otherwise (2.6%). Similarly, patients who fell/tripped (6.6%) were significantly more likely to get admitted (P < 0.05) relative to patients who were injured otherwise (3.1%). While cases of concussion (6.0%) were significantly more likely to get admitted (P < 0.01) relative to other cases, cases of contusions/abrasions (0.6%) were significantly less likely to get admitted (P < 0.01) relative to other cases. Similar to contusions/abrasions (0.2%), lacerations were significantly less likely to get admitted (P < 0.01) relative to other cases. Patients aged 12-18 (P < 0.01) were most likely to suffer concussions, whereas patients aged 19-34 (P < 0.01) were least likely to suffer concussions. In contrast to concussions, patients aged 12-18 (P < 0.01) were least likely to suffer lacerations, whereas patients aged 19-34 (P < 0.01) were most likely to suffer lacerations. Patients aged 6-11 (P < 0.01) were most likely to be thrown/taken-down whereas patients aged 19-34 (P < 0.01) were least likely to be thrown. Patients aged 19-34 (P < 0.01) were most likely to be collided against intentionally, while patients aged 6-11 (P < 0.01) were least likely to be collided against intentionally. Patients aged 34 years or older were most likely to fall/trip, while patients aged 12-18 (P < 0.01) were least likely to fall/trip., Conclusions: Certain types of injuries that occur during wrestling are more or less common depending on the age groups involved in the sport. Concussions were the most common injury incurred overall, and the head is the most commonly affected craniomaxillofacial area. Take-downs were the most likely mechanism of injury to lead to hospital admissions. The average number of wrestling injuries increased over 20 years being analyzed in this study. Future studies should investigate methods to lessen concussions in wrestling, decrease the number of illegal moves performed, and look into ways to mitigate harm from take-downs, given the increasing number of injuries acquired from this sport., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: Anterior cruciate ligament (ACL) tears are common injuries; they are often associated with concomitant injuries to other structures in the knee, including bone bruises. While there is limited evidence that bone bruises are associated with slightly worse clinical outcomes, the implications of bone bruises for the articular cartilage and the risk of developing osteoarthritis (OA) in the knee are less clear. Recent studies suggest that the bone bruise pattern may be helpful in predicting the presence of meniscal ramp lesions., Evidence Acquisition: A literature review was performed in EMBASE using the keyword search phrase (acl OR (anterior AND cruciate AND ligament)) AND ((bone AND bruise) OR (bone AND contusion) OR (bone AND marrow AND edema) OR (bone AND marrow AND lesion) OR (subchondral AND edema))., Study Design: Clinical review., Level of Evidence: Level 4., Results: The literature search returned 93 articles of which 25 were ultimately included in this review. Most studies identified a high prevalence of bone bruises in the setting of acute ACL injury. Individual studies have found relationships between bone bruise volume and functional outcomes; however, these results were not supported by systematic review. Similarly, the literature has contradictory findings on the relationship between bone bruises and the progression of OA after ACL reconstruction. Investigations into concomitant injury found anterolateral ligament and meniscal ramp lesions to be associated with bone bruise presence on magnetic resonance imaging., Conclusion: Despite the ample literature identifying the prevalence of bone bruises in association with ACL injury, there is little evidence to correlate bone bruises to functional outcomes or progression of OA. Bone bruises may best be used as a marker for concomitant injury such as medial meniscal ramp lesions that are not always well visualized on magnetic resonance imaging. Further research is required to establish the longitudinal effects of bone bruises on ACL tear recovery., Strength of Recommendation Taxonomy: 2.

Methods: Six children's hospitals identified infants with an initial injury and recurrent injury over a 1-year period using 2 methods: (1) diagnostic code method - infants 6 months or younger presenting with at least 1 diagnostic code for injury were tracked for 12 months to determine the frequency of recurrent injury, and (2) consult method - all available medical records of children 18 months or younger seen for an inpatient consultation for suspected child abuse were reviewed to identify history of a first injury at 6 months or younger., Results: Using the diagnostic code method, 682 unique infants were identified with initial injuries, most commonly fractures (37.0%), bruising/ecchymosis (35.9%), and superficial injuries (28.3%). Forty-two infants (6.2%) returned with a second injury, and no demographic factors were significantly associated with the likelihood of a second injury. Using the consult method, 37 of 342 consults (10.8%) were identified as having a history of at least 1 initial injury. Of the initial injuries identified, the most common was bruising/ecchymosis (64.9%). The number of injuries identified with either method varied significantly across hospitals, as did completion of skeletal surveys for infants with bruising (range, 4.5%-71.1%; P < 0.001) and any injury (range, 4.4%-62.7%; P < 0.001)., Conclusions: Our study demonstrates that young infants who experience 1 injury often experience a second injury. There exists significant variability in the identification of injury and the completion of skeletal surveys across a network of 6 children's hospitals. A standardized quality improvement approach may improve identification of injury and reduce the variability in practice observed., Competing Interests: Disclosure: The authors declare no conflict of interest., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Objectives: The aim of this study was to investigate the incidence and characteristics of match and training injuries in elite-level national male beach soccer players., Method: The incidence, mechanism, location, type, severity, and burden of injuries of the Turkish national beach soccer team were recorded between 2017 and 2019., Results: A total of 136 injuries occurred during the study period. Total injury incidence was 238.9 injuries/1,000 match hours (MHs) and 37.7 injuries/1,000 training hours (THs) (p < 0.001). Twenty-seven injuries led to time-loss, and the incidences for match and training injuries were 36.7 and 7.9 per 1,000 hours, respectively. Of medical attention injuries (MAI) caused by trauma, 54.6% (n = 53) were due to another player and, 60.9% (n = 14) of time-loss injuries (TLI) caused by trauma were due to non-contact trauma (p < 0.001). While 82% (n = 91) of training injuries occurred in lower extremities, 29% (n = 9) of match injuries occurred in the head/neck region (p < 0.001). Head injury incidence was 45.9 per 1,000 match hours. Of MAI, 50% (n = 57) were contusion, and 32.1% (n = 9) of TLI were strain (p < 0.001). Also, the most common injury subtype was foot/toe contusion during match and training (19.4%; n = 6, 27.9%; n = 31, respectively). The majority of injuries 91.9% (n = 125) had slight severity., Conclusion: Head trauma, tendon injury, and foot/toe contusion are important for clinical practice in beach soccer. Protective measures (rule regulation, use of protective equipment, etc.) should be considered to prevent these injuries.

Background: Tibiofemoral bone bruise patterns seen on magnetic resonance imaging (MRI) are associated with ligamentous injuries in the acutely injured knee. Bone bruise patterns in multiligament knee injuries (MLKIs) and particularly their association with common peroneal nerve (CPN) injuries are not well described., Purpose: To analyze the tibiofemoral bone bruise patterns in MLKIs with and without peroneal nerve injury., Study Design: Case series; Level of evidence, 4., Methods: We retrospectively identified 123 patients treated for an acute MLKI at a level 1 trauma center between January 2001 and March 2021. Patients were grouped into injury subtypes using the Schenck classification. Within this cohort, patients with clinically documented complete (motor and sensory loss) and/or partial CPN palsies on physical examination were identified. Imaging criteria required an MRI scan on a 1.5 or 3 Tesla scanner within 30 days of the initial MLKI. Images were retrospectively interpreted for bone bruising patterns by 2 board-certified musculoskeletal radiologists. The location of the bone bruises was mapped on fat-suppressed T2-weighted coronal and sagittal images. Bruise patterns were compared among patients with and without CPN injury., Results: Of the 108 patients with a MLKI who met the a priori inclusion criteria, 26 (24.1%) were found to have a CPN injury (N = 20 complete; N = 6 partial) on physical examination. For CPN-injured patients, the most common mechanism of injury was high-energy trauma (N = 19 [73%]). The presence of a grade 3 posterolateral corner (PLC) injury (N = 25; odds ratio [OR], 23.81 [95% CI, 3.08-184.1]; P = .0024), anteromedial femoral condyle bone bruising (N = 24; OR, 21.9 [95% CI, 3.40-202.9]; P < .001), or a documented knee dislocation (N = 16; OR, 3.45 [95% CI, 1.38-8.62]; P = .007) was significantly associated with the presence of a CPN injury. Of the 26 patients with CPN injury, 24 (92.3%) had at least 1 anteromedial femoral condyle bone bruise. All 20 (100%) patients with complete CPN injury also had at least 1 anteromedial femoral condyle bone bruise on MRI. In our MLKI cohort, the presence of anteromedial femoral condyle bone bruising had a sensitivity of 92.3% and a specificity of 64.6% for the presence of CPN injury on physical examination., Conclusion: In our MLKI cohort, the presence of a grade 3 PLC injury had the greatest association with CPN injury. Additionally, anteromedial femoral condyle bone bruising on MRI was a highly sensitive finding that was significantly correlated with CPN injury on physical examination. The high prevalence of grade 3 PLC injuries and anteromedial tibiofemoral bone bruising suggests that these MLKIs with CPN injuries most commonly occurred from a hyperextension-varus mechanism caused by a high-energy blow to the anteromedial knee.

Background:  Thorax trauma frequently occurs in which injuries to the bony chest, lung contusions (LCs), and others are diagnosed. The significance of this violation is described very differently and is mostly based on monocentric data., Methods:  A retrospective analysis of the TraumaRegister DGU ® (TR-DGU) dataset (Project 2014-062) was performed between 2009 and 2014 (injury severity score [ISS] ≥ 16, primary admission to a trauma center, no isolated traumatic brain injury). Patients with LC (Abbreviated Injury Scale [AIS] 3 + 4) were compared with the control group, and an analysis of different age groups was performed., Results:  A total of 49,567 patients were included, thereunder 14,521 (29.3%) without relevant thoracic trauma (TT); 95.9% blunt traumas. 18,892 patients (38.1%) had LC and 14,008 (28.3%) had severe LC with AIS 3 + 4; thereunder 72.7% males. For severe LC, the average age was the lowest (44.7 ± 19.7 years) and ISS the highest (30.4 ± 12.1 points).Intubation, intensive care, (multi-) organ failure, sepsis, and extrathoracic injuries were most common in severe LC. Shock, chest tubes, further thoracic injuries, and patient death occurred most frequently in TT without LC.Younger patients showed a higher incidence of LC than the older ones; however, high patient age was a highly significant risk factor for the development of complications and poor outcome., Conclusion:  Since LC was present in almost 40% of the severely injured and was related to higher morbidity, LC should be detected and managed at the earliest possible time. Proper follow-ups employing chest X-rays and computed tomography (CT) scans are recommended., Competing Interests: Dr. Schulz-Drost reports personal fees from DePuy Synthes, AO Foundation, and AUC Germany, outside the submitted work. Dr Krinner reports personal fees, outside the submitted work. Dr. Lefering reports and his institute (IFOM) has an ongoing service agreement with AUC GmbH (Akademie der Unfallchirurgie) who is owner of the TraumaRegister DGU data. This agreement includes statistical support for scientific analyses based on these data., (Thieme. All rights reserved.)

Aims: Rib fractures occur in up to 10% of hospitalised trauma patients and are the most common type of clinically significant blunt injury to the thorax. There is strong evidence that elderly patients have worse outcomes compared with younger patients. Evolving evidence suggests adverse outcomes start at a younger age. The aim of this study was to explore the effect of age on outcomes in patients with rib fractures in Northland, New Zealand., Method: A two-year retrospective study of patients admitted to any Northland District Health Board hospital with one or more radiologically proven rib fracture was performed. Patients with an abbreviated injury scale score >2 in the head or abdomen were excluded. The study population was stratified by age into three groups: >65, 45 to 65 and <45 years old., Results: 170 patients met study inclusion criteria. Patients <45 had a significantly shorter length of stay (LOS) and lower rates of pneumonia compared to patients 45 and older, despite a higher Injury Severity Score and pulmonary contusion rate. There was no difference seen between groups in rates of intubation, ICU admission, mortality, empyema or acute respiratory distress syndrome., Conclusion: This study found higher rates of pneumonia and an increased LOS in patients 45 and older despite their lower overall injury severity when compared to patients under 45. Patients aged 45-64 had outcomes similar to patients >65. Future clinical pathways and guidelines for patients with rib fractures should consider incorporating a younger age than 65 in risk stratification algorithms., Competing Interests: Nil.

Background: Video analysis is one of the most commonly applied methods for analysing football injuries., Purpose: The objective of this study was to assess the accuracy of video analysis for recording head injuries in professional football from official matches in the four highest men's professional football leagues in Germany., Methods: In this cohort study, head injuries detected by means of video analysis of all official matches over one season (2017-18) were compared to head injuries registered with the German statutory accident insurance., Results: Our video analysis yielded 359 head injuries of 287 players. The comparison of head injuries found in our video analysis to those registered with the accident insurance only yielded a match in 23.1% (n = 83), which presents a rather low verification rate. The verification rates varied between the leagues (7.0-30.8%). All injuries documented in the accident insurance registry were found in the video analysis (100%). The types of head injury most often verified by the accident insurance registry (n = 83) were contusion (43.4%), bone fractures (19.3%) and skin lacerations (18.1%). Only 66 of the 359 head injuries (18.4%) resulted in absence from at least one training session and involved a mean time loss of 18.5 days (1-87 days)., Conclusion: The mismatch between the number of head injuries found in the video analysis and head injuries registered with the accident insurance is an important methodological issue in scientific research. The low verification rate seems to be due to the unclear correlation between injury severity and clinical consequences of head injuries detected by means of video analysis and the failure of football clubs to register minor head injuries with the accident insurance., Competing Interests: The authors have declared that no competing interests exist.

Immune thrombocytopenia (ITP) is an acquired immune-mediated disorder. Bleeding is the primary symptom that presents in varying severities. ITP has a negative impact on health-related quality of life (HRQoL). The ITP Life Quality Index (ILQI) was developed as a 10-item patient-reported outcome measure to assess impact on HRQoL in ITP. The objective of the present study was to confirm the content validity of the ILQI with a qualitative interview study in the UK involving 15 adult participants with ITP. Combined concept elicitation (CE) and cognitive debriefing (CD) interviews were conducted to explore the symptoms and impacts associated with ITP and confirm content validity of the draft ILQI. The CE phase elicited 14 ITP symptom concepts, including: bruising (all 15 patients, 100%), fatigue (14, 93·3%) and bleeding gums/blood blisters (13, 86·7%). Impacts included decreased ability to participate in sport (all 15 patients, 100%) and anxiety (12, 80%). The CD phase resulted in an adjustment to the ILQI recall period from 1 week to 'the past month'. Updates were made to improve relevance and response options. The qualitative interviews support the content validity of the ILQI and confirm that the concepts assessed are relevant and consistently understood and interpreted by adult patients with ITP., (© 2021 British Society for Haematology and John Wiley & Sons Ltd.)

Objectives: Tennis participation continues to increase amongst adults across the United States. The purpose of this study was to analyze trends in adult tennis-related facial injury epidemiology, demographics, diagnoses, and locations of injury. Materials and methods : The National Electronic Injury Surveillance System was evaluated for tennis-related facial injuries in adults from 2009 through 2018. Number of injuries were extrapolated, and data were analyzed for age, sex, specific injury diagnoses, locations, and discharge disposition. Descriptive statistics were used to present and describe variables of interest. Chi-squared testing (χ2) was performed to compare categorical variables. Results : During the study period, 342 tennis-related facial trauma ED visits were analyzed. Lacerations were the most common injury (45%), followed by contusions or abrasions (33.3%), concussions (11.7%), and fractures (8.5%). The most common sites of injury were the face (47.4%) and head (27.2%) regions. Males accounted for 62.0% of injuries, while females accounted for the remaining 38.0%. Patients between 34-65 years-old accounted for 47.7% of all injuries, and athletes over 65 years-old had the highest rate of fractures (10.1%). Conclusions : Facial trauma incurred secondary to tennis may follow patient-specific patterns. The incidence of tennis-related facial trauma is smaller compared to other sports, but the severity of such injuries remain a danger. Facial protection and enforcement in tennis is virtually absent, and these findings strengthen the need to educate athletes, families, and physicians on injury awareness and prevention.

Introduction: With the emergence of blunt-tipped microcannulas, there is a hypothesis that these could cause less damage and reduce pain as compared to conventional sharp needles in eyelid surgery. The purpose is to determine whether an 18G blunt-tipped cannula can be better than a 26G needle., Methods: This prospective, observer-blinded, randomized clinical trial was conducted from June 2017 to December 2018. Sixty-eight patients were randomized to receive local anesthesia injections for upper blepharoplasty. Infiltration was performed by using a 26-gauge sharp needle on one side and on the other side, infiltration was performed by using an 18-gauge stainless-steel blunt-tipped microcannula. A numeric rating scale (NRS) from 0 to 10 was used to blindly assess pain in patients receiving anesthesia injections with both needle types. Photographs of the eyelids of each patient were taken in five different periods and used by three blinded observers to identify bruise or ecchymoses., Results: A total of 136 eyelid operations were performed. There was no statistically significant difference when both groups were compared; however, the average score of pain was higher in patients taking the infiltration through the needle (2.85 versus 2.50). Regarding the evaluation of bruising and ecchymoses, the results showed that, in the five periods evaluated, there was no statistical difference in bruising and ecchymosis in the eyelids when taking the infiltration through a sharp needle when compared with that of the eyelids taking infiltration through a (blunt-tipped) microcannula., Conclusion: The evaluation of the blunt-tipped microcannula showed a lower pain score mean than that obtained for the sharp needle (2.5 versus 2.85) (p > 0.05). There was no statistically significant difference in the bruising and ecchymosis courses., Competing Interests: Declaration of Competing Interest None declared., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Background: Electric scooters (e-scooters) are becoming increasingly common in major urban areas worldwide. Cities in some countries have even piloted programmes to promote their use to reduce general vehicular traffic. There have, however, been widespread media reports outlining concerns about their safety. We decided to investigate these concerns by reviewing the records of patients who presented to our center, a Level 1 Major Trauma Center in the United Kingdom, with orthopedic injuries associated with e-scooter use., Methods: We reviewed the electronic medical records of all patients who presented to our center from January 2018 to January 2020 with e-scooter associated fractures. Demographic, injury, and surgical data were collected to characterize the types of e-scooter-related fractures and to investigate the frequency of such injuries over the duration of our search. A literature review of MEDLINE and EMBASE was performed to investigate specifically orthopedic injuries caused by electric scooter use., Results: Six patients were identified (3 male, 3 female; mean age 35.43 years) who had sustained a variety of injuries. The presentation and clinical outcomes are presented. Three patients required operative management, and three patients were managed conservatively., Conclusion: This case series demonstrates an increasing frequency of significant orthopedic injury associated with e-scooter use treated at our center over the course of two years. This small series highlights an important problem given that this increase has occurred despite electric scooter usage in public spaces being illegal. Legalization might result in further increase in the incidence of injury.

Determining the rate and severity of injuries incurred through sport is accepted as the primary step towards designing, implementing and evaluating injury prevention programmes. The aim of this study was to determine the injury incidence rate and characteristics of male field hockey athletes participating in the Irish Hockey League. Athletes from eight field hockey teams were assigned to an online reporting system, where they logged injuries as they were incurred. Injuries were defined as any physical complaint. Coaches and physiotherapists were contacted weekly to corroborateinjuries. Overall 323 injuries were reported across 34,449 exposure hours, giving rise to an incidence rate of 9.4/1000 h. On average, athletes sustained one injury over the course of two seasons. Muscle strains, pain and contusions were the most common types of injury, while the hamstring, knee and hip/groin were the most frequently reported locations. While 66.9% of injuries occurred through non-contact mechanisms, contact injuries were also common. Injury recurrences accounted for 16.1% of injuries. In conclusion, the incidence of injury in field hockey is high, occurring from a variety of mechanisms. Future injury prevention strategies should prioritise injuries to the hamstring, knee and ankle, and be specific to particular playing positions.

Objectives: Cricket is a popular sport enjoyed worldwide. Injuries in cricket are not well understood at community level but are important to understand for prevention to ensure the game continues to be enjoyed safely. This systematic review was designed to assess the quality of data collection and reporting, and to summarise the injury data, in studies of community cricket players., Design: Systematic review., Methods: Nine databases were searched to November 2018 using the terms "cricket*" and "injur*". A nine-item critical appraisal and three-item likelihood-of-bias evaluation was conducted on included studies. Data completeness was evaluated against recommendations in the international cricket consensus statement for recording/reporting injury and the Australian Sports Injury Data Dictionary (ASIDD). Descriptive injury data (n,%) are presented in tabular format for different subgroups (activity, position, population)., Results: Thirteen studies were included, of which eight were rated as unclear, one as high and three having a low likelihood-of-bias. The mean score for completeness of data against the consensus statement was 3.5/10 (95%C.I. 2.8-4.2). The mean score for completeness of data against the ASIDD was 4.4/6 (95%C.I. 3.9-5.0). Bruising and inflammation was the most common injury in junior cricket. Stress fractures were most common in studies of bowlers. Where studies included all activities, batting accounted for most injuries (7-49%)., Conclusions: The included studies inconsistently addressed recommended items for injury surveillance in community sport and cricket. Most studies focused on junior levels or adolescent bowlers, with bruising/inflammation and stress fractures being most common, respectively., (Copyright © 2020 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.)

Objective: To analyze injury frequency, density, location, type, mechanism of injury (MOI), activity phase of injury, and injury risk in professional rodeo., Design: Retrospective epidemiological review., Setting: Professional Rodeo Cowboys Association sanctioned rodeos from 2011 to 2014., Participants: Professional Rodeo Cowboys Association competitors competing in bull riding, bareback riding, saddle bronc riding, team roping, tie-down roping, and steer wrestling., Main Outcome Measures: Injury reports were documented by sports medicine personnel. Variables assessed include event, frequency, density, location, type, MOI, activity phase of injury, and injury density., Results: A total of 2305 injuries from 139,098 competitor exposures (CEs) were reported, demonstrating overall injury density of 16.6 injuries per 1000 CEs (95% confidence interval, 0.016-0.017) and overall risk of injury of 1.69%. Rough stock riders accounted for 88.7% of all injuries. Bull riders, bareback riders, and saddle bronc riders demonstrated injury densities of 48.2, 41.1, and 23.2 injuries per 1000 CEs, respectively. Most injuries (62.9%) were sustained by collisions with the ground or animal, or being stomped on by the animal. Contusions, sprains, and concussions were the most frequent injury types (23.1%, 13.6%, and 11.6%, respectively). Neurological components, knees, and shoulders were the most injured body parts (13.4%, 11.1%, and 11.0%, respectively). Most injuries (36.8%) occurred during or immediately after the dismount., Conclusions: Rough stock events have the greatest risk of injury in professional rodeo, whereas steer wrestling has the greatest risk of injury for timed event athletes. Medical professionals should use these findings to implement prevention programming where possible.

Objective: To report the epidemiology of injuries in Olympic-style karate competitions., Design: Systematic review and meta-analysis. Pooled estimates of injury incidence rates per 1000 athlete-exposures (IIR AE ) and per 1000 min of exposure (IIR ME ) were obtained by fitting random-effects models., Data Sources: MEDLINE, Embase, AMED, SPORTDiscus and AusportMed databases were searched from inception to 21 August 2019., Eligibility Criteria: Prospective cohort studies published in peer-reviewed journals and reporting injury data (ie, incidence, severity, location, type, mechanism or risk factors) among athletes participating in Olympic-style karate competition., Results: Twenty-eight studies were included. The estimated IIR AE and IIR ME were 88.3 (95%CI 66.6 to 117.2) and 39.2 (95%CI 30.6 to 50.2), respectively. The most commonly injured body region was the head and neck (median: 57.9%; range: 33.3% to 96.8%), while contusion (median: 68.3%; range: 54.9% to 95.1%) and laceration (median: 18.6%; range: 0.0% to 29.3%) were the most frequently reported types of injury. Despite inconsistency in classifying injury severity, included studies reported that most injuries were in the least severe category. There was no significant difference in IIR ME between male and female karate athletes (rate ratio 1.09; 95%CI 0.88 to 1.36)., Conclusion: Karate athletes sustain, on average, 1 injury every 11 exposures (bouts) or approximately 25 min of competition. The large majority of these injuries were minor or mild in severity., Competing Interests: Competing interests: DC is a member of the Technical Commission of the European Karate Union and RA is the Chair of Medical Commission of the World Karate Federation; however, neither DC nor RA receive any remuneration from the European Karate Union or the World Karate Federation to conduct this study, and neither the European Karate Union nor the World Karate Federation have had any influence on this work., (© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.)

Traumatic bifrontal contusions (TBC) form a recognised clinical entity among patients with traumatic brain injury (TBI). This study aims to systematically review current literature on demographics, management, and predictors of outcomes of patients with TBC. A multi-database literature search (PubMed, Cochrane, OVID Medline/Embase) was performed using PRISMA as a search strategy. Studies were selected by predefined selection criteria (PROSPERO: CRD42018055390), and risk of bias was assessed using an adapted form of ROBINS-I tool. Of the 275 studies yielded by the literature search, seven articles met the criteria for inclusion, all of which were level III evidence. Total cohort consisted of 468 patients; predominantly male (n = 5; 303/417 patients) with average age 44.3 years (range, 7-81). Falls (44.9%) and road traffic accidents (46.6%) were the commonest mechanisms of injury with an average presentation GCS of 9.2 (n = 3, 119 patients). GCS on admission of ≤ 13.1 and contusion volume at day 2 post-injury of ≥ 62.9cm 3 were associated with increased risk of deterioration needing surgical interventions (n = 1, 7 patients). The majority of patients underwent surgery; the average GOS was 4, at an average follow-up duration of 11.7 months (n = 6, 356 patients). The currently available evidence on the management of TBC is scarce. Larger multicentre well-designed studies are needed to further delineate the factors behind acute deterioration, the effectiveness of management options. Once in place, this can be used to develop and test an algorithmic approach to management of TBC resulting in consistently improved outcomes.

Aim: To analyse factors that may predict the appearance of rib fracture complications during the first days of evolution and determine whether the number of fractures is related to these complications., Method: Retrospective case-control study of patients admitted with a diagnosis of rib fractures between 2010 and 2014. Two groups were established depending on the appearance or not of pleuropulmonary complications in the first 72 h, and the following were compared: age, sex, Charlson comorbidity index (CCI), number and uni- or bilateral involvement, mechanism of trauma, days of hospital stay, haemoglobin on discharge minus haemoglobin on admission, pleuropulmonary complications during admission (pneumothorax, haemothorax or pulmonary contusion) and placement of pleural drainage., Results: One hundred and forty-one cases of rib fractures were admitted in the period mentioned. There were no differences in the patients' baseline characteristics (age, sex and Charlson Comorbidity Index) between the two groups. Differences were found in the number of fractures (2.98 ± 1.19 in the group without complications vs 3.55 ± 1.33 in the group with complications, p = 0.05) and in the drop in the level of haemoglobin (0.52 ± 0.91 mg/dl vs 1.22 ± 1.29 mg/dl, p = 0.01). The length of hospital stay varied considerably in each group (5.35 ± 4.05 days vs 7.86 ± 6.96 days), but without statistical significance (p = 0.11)., Conclusions: The number of fractured ribs that best predicted the appearance of complications (delayed pleuropulmonary complications and greater bleeding) was 3 or more.

Objective: This study had 2 objectives. First, to determine the behavior of physicians evaluating premobile infants with bruises. Second, and most importantly, to learn whether infants with unexplained bruising who had been initially evaluated by primary care and emergency department (ED) physicians are as likely to have their bruises attributed to child abuse as those children evaluated by child abuse physicians., Methods: Primary care, ED, and child abuse pediatricians (CAPs) in King County, Washington, San Mateo, Calif, Albuquerque, NM, La Crosse, Wis, and Torrance, Calif prospectively identified and studied infants younger than 6 months with less than 6 bruises, which were judged by the evaluating clinician to be explained or unexplained after their initial clinical examination., Results: Between March 1, 2010, and March 1, 2017, 63 infants with initially explained and 46 infants with initially unexplained bruises were identified. Infants with unexplained bruises had complete coagulation and abuse evaluations less frequently if they were initially identified by primary care pediatricians or ED providers than by CAPs. After imaging, laboratory, and follow-up, 54.2% (26) of the infants with initially unexplained bruises, including 2 who had been initially diagnosed with accidental injuries, were diagnosed as abused. Three (6.2%) infants had accidental bruising, 6 (12.4%) abuse mimics, 1 (2.5%) self-injury, 1 (2.5%) medical injury, and 11 (22.9%) remained of unknown causation. None had causal coagulation disorders. A total of 65.4% of the 26 abused infants had occult injuries detected by their imaging and laboratory evaluations. Six (23.1%) abused infants were not diagnosed until after they sustained subsequent injuries. Three (11.5%) were recognized abused by police investigation alone. Thirty-eight percent of the abused, bruised infants had a single bruise. Clinicians' estimates of abuse likelihood based on their initial clinical evaluation were inaccurate. Primary care, ED, and child abuse physicians identified abused infants at similar rates., Conclusions: More than half of premobile infants with initially unexplained bruises were found to be abused. Abuse was as likely for infants identified by primary care and ED providers as for those identified by CAPs. Currently, physicians often do not obtain full abuse evaluations in premobile infants with unexplained bruising. Their initial clinical judgment about abuse likelihood was inadequate. Bruised infants often have clinically occult abusive injuries or will sustain subsequent serious abuse. Bruised infants should have full abuse evaluations and referral for Protective Services and police assessments.

Context: Most studies of injury trends associated with softball focus on injuries requiring at least 24 hours of missed participation time (time-loss [TL] injuries), with little focus on those that do not (non-time-loss [NTL] injuries). A better understanding of injury trends associated with softball will improve athlete care., Objective: To describe NTL and TL injuries experienced by secondary school girls' softball players., Design: Descriptive epidemiology study., Setting: Secondary school athletic training clinics., Patients or Other Participants: Secondary school girls' softball players., Main Outcome Measure(s): Aggregate data were collected from schools participating in the National Athletic Treatment, Injury, and Outcomes Network surveillance program during the 2011-2012 through 2013-2014 academic years. Frequencies and rates of injuries (NTL and TL) according to time of season, event type, body part injured, and diagnosis were analyzed., Results: In total, 1059 injuries were reported during 140 073 athlete-exposures (AEs): overall injury rate = 7.56/1000 AEs. Of these injuries, 885 (83.6%) were NTL (NTL rate = 6.32/1000 AEs) and 174 (16.4%) were TL (TL rate = 1.24/1000 AEs). Of the NTL and TL injuries, the largest numbers occurred during the regular season (NTL: n = 443 [50.1%]; TL: n = 131 [75.3%]). Injuries sustained during practices accounted for the majority of NTL and TL injuries (NTL: n = 631 [71.3%]; TL: n = 104 [59.8%]). The NTL injuries occurred most often at the shoulder (n = 134 [15.1%]) and hand/fingers (n = 109 [12.3%]) and were diagnosed as contusions (n = 316 [35.7%]), strains (n = 157 [17.7%]), and abrasions (n = 151 [17.1%]). The largest numbers of TL injuries were to the head/face (n = 71 [40.8%]) and diagnosed as concussions (n = 50 [28.7%]) and strains (n = 28 [16.1%])., Conclusions: Secondary school softball players sustained a larger proportion of NTL injuries than TL injuries. Although NTL injuries may be less severe, they are numerous. Efforts are needed to ensure that injury-prevention programs are incorporated into the care of softball athletes to promote health and reduce injury occurrence.

Context: Researchers analyzing data from the National Collegiate Athletic Association Injury Surveillance Program have not considered the differences in foot injuries across specific sports and between males and females., Objective: To describe the epidemiologic differences in rates of overall foot injuries and common injuries among sports and between sexes., Design: Descriptive epidemiology study., Setting: Online injury-surveillance data from 15 unique sports involving males and females that demonstrated 1967 injuries over 4 821 985 athlete-exposures., Patients or Other Participants: Male and female athletes competing in National Collegiate Athletic Association sports from the 2009-2010 through 2014-2015 seasons., Main Outcome Measure(s): Foot injury rates (per 10 000 athlete-exposures) and the proportion of foot injuries were calculated for each sport. The effect of sex was calculated using Poisson-derived confidence intervals for 8 paired sports. A risk analysis was performed using a 3 × 3 quantitative injury risk-assessment matrix based on both injury rate and mean days of time loss., Results: Foot injury rates differed between sports, with the highest rates in female gymnastics, male and female cross-country, and male and female soccer athletes. Cross-country and track and field had the highest proportions of foot injuries for both female and male sports. The 5 most common injuries were foot/toe contusions, midfoot injuries, plantar fascia injuries, turf toe, and metatarsal fractures. Only track and field athletes demonstrated a significant sex difference in injury rates, with female athletes having the higher rate. The quantitative injury risk-assessment matrix identified the 4 highest-risk injuries, considering both rate and severity, as metatarsal fractures, plantar fascia and midfoot injuries, and foot/toe contusions., Conclusions: Important differences were present among sports in terms of injury rates, the most common foot injuries, and the risk (combination of frequency and severity) of injury. These differences warrant further study to determine the mechanisms of injury and target intervention efforts.

Aim: To evaluate outcomes of a cohort of infants born at 23 weeks' gestational age after introducing a new selection score for resuscitation in the delivery room (DR)., Methods: This was a retrospective charts review study using data from the maternal and newborn registry funded by the Qatar National Research Fund. Parents were consulted prenatally and their wishes were honored. The plan of resuscitation was based on the new selection score. The seven components of the score were four antenatal and three immediate postnatal in the DR. Each component received a score of zero, one, or two according to its presence, uncertainty or absence, respectively. Only a score of≥7 would receive active resuscitation unless specified otherwise during prenatal consultation., Results: The study reviewed 60 infants that were delivered over a two year period. The DR death rate was 23 of 60 (38%). Thirty-seven infants (61%) were admitted to the NICU. The score was applied only on 37 infants where all score criteria were reported in their files. Twenty infants had score <7; of them 13 (65%) died in the DR and 7 were admitted to NICU of whom two (29%) survived to discharge. Seventeen babies with scores≥7 admitted to NICU of whom nine (51%) survived to discharge. The survival rate to discharge was 13 of 37(35%). A satisfaction survey included 33 neonatal physicians; 32 neonatologists stated the score was easy to comprehend, 26 voted for easy to implement, and 30 voted for ethical relief and moral comfort., Conclusions: Using a resuscitation score of seven was associated with improved survival until the discharge of those infants resuscitated. NICU physicians described the score as functional and convenient.

Introduction: Accidental head injuries are known to cause serious traumatic brain injury (TBI). Children younger than 2 years of age build a separate group that is more difficult to assess clinically. Investigations targeting TBIs in pediatric cases, particularly in those between 0 and 2 years of age, are limited., Objective: In this study, we reviewed a number of severe accidental head injuries in a cohort of children aged 0-2 years to evaluate the relative incidence, distribution, and clinical success in determining the nature of the cases in the Kars Province of Turkey., Methods: The study targeted 26 -cases who presented to the Emergency Department of Kars Harakani Hospital for TBI between 2017 and 2019 through retrospective chart review., Results and Conclusions: Among the children who presented to the emergency clinic, 2 were newborns, 7 were <1 year of age, and the remaining 17 cases were between 1 and 2 years old. The number of male and female patients was equal, and 5 fatality cases were observed. The most frequent cause of head trauma were falls. We deduced that 6 cases had subarachnoid hemorrhage, 2 cases had subdural hemorrhage, 3 cases had epidural hemorrhage, and 4 cases had contusion. We compared the mean level of the two blood parameters hemoglobin (HGB) and hematocrit (HCT) between fatal and surviving cases and detectedthat both values decreased dramatically in exitus cases. The higher fatality rate in the present study could be attributed to the fact that we targeted only the severe TBI cases. Severe TBI in children younger than 2 years results in a life-threating situation. The risk of fatality might be deduced from the reduction of the HGB and HCT levels as it is significantly lower in fatal cases than in surviving cases., (© 2020 S. Karger AG, Basel.)

Background: Design changes of nonpowder guns, including BB and air guns, have significantly increased their potential to injure. We sought to characterize the demographics of children injured with nonpowder weapons and the specific injuries suffered., Methods: A cross-sectional analysis of the study years 2006, 2009, and 2012 was performed by combining the Kids' Inpatient Database into a single dataset. We identified cases (age < 21 years) of air gun injuries using external cause of injury codes. Patient characteristics and injuries were analyzed using ICD-9 codes, and national estimates were obtained using case weighting., Results: There were 1028 pediatric admissions for nonpowder weapon related injuries. The victims were predominately male (87.0%), non-Hispanic white (52.3%), resided in the South (47.3%), and in the lowest income quartile (39.2%). Half required a major surgical procedure. The predominant injuries were open wounds to the head, neck, or trunk (40.3%), and contusion (22.5%). Notable other injuries were intracranial injury (9.1%) and blindness or vision defects (3.3%)., Conclusions: The nonpowder weapons available to this generation can paralyze, blind, and cause lasting injury to children. Injuries frequently require surgical intervention, and these weapons should no longer be considered toys. Further research and legislation should be aimed at limiting children's access to these weapons., Level of Evidence: III., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Objectives: To investigate nonpowder firearm injuries treated in US emergency departments among children <18 years old., Methods: National Electronic Injury Surveillance System data from 1990 through 2016 were analyzed., Results: An estimated 364 133 (95% confidence interval 314 540-413 727) children <18 years old were treated in US emergency departments for injuries related to nonpowder firearms from 1990 to 2016, averaging 13 486 children annually. From 1990 to 2016, the number and rate of nonpowder firearm injuries decreased by 47.8% ( P < .001) and 54.5% ( P < .001), respectively. Most injuries occurred among 6- to 12-year-olds (47.4%) and 13- to 17-year-olds (47.0%). Boys accounted for 87.1% of injured children, the most common diagnosis was foreign body (46.3%), and 7.1% of children were admitted. BB guns accounted for 80.8% of injuries, followed by pellet guns (15.5%), paintball guns (3.0%), and airsoft guns (0.6%). The rate of eye injuries increased by 30.3% during the study period. Eye injuries accounted for 14.8% of all injuries and the most common diagnoses were corneal abrasion (35.1%), hyphema (12.5%), globe rupture (10.4%), and foreign body (8.6%)., Conclusions: Although the number and rate of nonpowder firearm injuries declined during the study period, nonpowder firearms remain a frequent and important source of preventable and often serious injury to children. The severity and increasing rate of eye injuries related to nonpowder firearms is especially concerning. Increased prevention efforts are needed in the form of stricter and more consistent safety legislation at the state level, as well as child and parental education regarding proper supervision, firearm handling, and use of protective eyewear., Competing Interests: POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose., (Copyright © 2019 by the American Academy of Pediatrics.)

Introduction: Burn trauma-related hypothermia is a frequent observation but risk factors and impact on patient related outcome are ambiguously reported. It is expected that hypothermia is associated with increased mortality and reduced overall outcome in severely burned patients, but available evidence is limited., Methods: This retrospective single-center-study reviewed preclinical service protocols and medical records of patients sustaining a burn with a total body surface area (TBSA) ≥15% from 2008 to 2012. General patient and burn specific characteristics, outcome parameters as well as body temperature at admission measured via urine catheter or nasal temperature probe were recorded and statistically analyzed comparing normothermic (≥36 °C), mild hypothermic (<36 °C) and severely hypothermic (<34.5 °C) patients. Chi-square test was performed to demonstrate impact of hypothermia on primary outcome parameters and to reveal risk factors for developing hypothermia. To assess independent influences on mortality, a multivariate logistic regression analysis was performed., Results: Out of 300 patients matching inclusion criteria, a sufficient record of temperature was found in 144 patients (48%). Out of 141 eligible patients with an average burn extent (SD) of 33.38% (24.5%) TBSA, 31.9% (n = 45) suffered from severe hypothermia (<34.5 °C) and 28.4% (n = 40) showed mild hypothermia. Total burn extent, presence of full thickness burns, presence of inhalation injury, preclinical mechanical ventilation and administration of sedative drugs were risk factors for developing hypothermia. Patients' age, total burn extent and presence of full thickness burns could be identified as independent factor for mortality. Although a trend towards an independent positive influence of normothermia at admission on mortality was seen, it was not statistically significant., Conclusion: Incidental hypothermia of burned patients is associated with an increased mortality and needs to be addressed by emergency health care providers and immediately at the burn center. Especially patients with extensive burns, full-thickness burns, inhalation injury or patients undergoing preclinical intubation are at risk for hypothermia and benefit from any measures for temperature preserving., (Copyright © 2019 Elsevier Ltd and ISBI. All rights reserved.)

Background: Bone bruise characteristics after anterior cruciate ligament (ACL) injury have been correlated with the level of joint derangement in adults. However, the literature lacks information about younger patients, whose higher ligamentous laxity may lead to different lesion patterns., Purpose: To investigate the prevalence, size, location, and role of bone bruise associated with ACL rupture in the pediatric population., Study Design: Cross-sectional study; Level of evidence, 3., Methods: Knee magnetic resonance imaging scans (MRIs) of patients aged 8 to 16 years with ACL tears from 2010 to 2018 were selected from the institution database. Inclusion criteria were open or partially open physes, less than 90 days between trauma and MRI, and no history of injury or surgery. Presence, localization, and size of bone bruise were analyzed by 2 blinded researchers and scored with the Whole-Organ Magnetic Resonance Imaging Score (WORMS) bone bruise subscale. Ligamentous, cartilaginous, meniscal, and other lesions were documented., Results: Of the 78 pediatric patients selected from the database, 54 (69%) had bone bruise. The mean area of bone bruise was larger in males than in females (femur, 3.8 ± 2.8 vs 2.2 ± 1.4 cm 2 , respectively, P = .006; tibia, 2.6 ± 1.6 vs 1.5 ± 0.8 cm 2 , respectively, P = .007). The subregions most affected by bone bruise were the lateral posterior tibia and the lateral central femur (in 83% and 80% of the knees affected, respectively). A low correlation was found between age and bone bruise area (biggest areas r = 0.30, P = .03, and sum of areas r = 0.27, P = .04), but no correlation was found between age and WORMS (femur, r = -0.03, P = .85; tibia, r = -0.04, P = .76). The injuries most associated with bone bruise were 23 meniscal lesions (43%), 10 lesions of other ligaments (19.0%), 2 cartilage lesions (3.7%), and 2 patellar fractures (3.7%)., Conclusion: The prevalence of bone bruises in pediatric patients with ACL tears is high, although it seems slightly lower than the prevalence documented in adults but with similar localization. The area and the distribution pattern of bone bruises are similar among different ages. The pediatric patients had a lower presence of cartilage and meniscal lesions compared with that reported in adults, which suggests a different effect of this trauma on the knee of pediatric patients.

Context: Hockey is a skillful contact sport with an elevated injury risk at higher levels of play. An understanding of injury incidence, type, mechanism, and severity at various levels of competition aids the clinician treating these athletes. The purpose of this clinical review is to discuss the epidemiology of hockey injuries at various levels of participation, including youth, high school, junior, college, and professional., Evidence Acquisition: A literature search was performed by a review of PubMed, Embase, and Cochrane databases and included articles published from 1988 to 2017. Studies were included in this review if determined to be of high quality and containing injury data relevant to the levels of competition. Pertinent data regarding ice hockey injury epidemiology and prevention at various levels of competition were analyzed., Study Design: Clinical review., Level of Evidence: Level 4., Results: Youth, high school, junior, college, and professional hockey players have unique injury patterns. Injuries occur much more often in a game compared with a practice, and injury risk increases with each level of competition. Preventative measures, such as mandatory facial protection and delayed body checking in games until age 13 years, are proven strategies to reduce the risk of facial injury and concussion., Conclusion: An understanding of common injury types and mechanisms according to age and level of play aids the clinician in diagnosis and management. This information can also guide preventative strategies in the areas of education, coaching, rule enforcement, rule modifications, equipment improvement, and sportsmanship.

Background: More than 3 billion passengers are transported every year on commercial airline flights worldwide, many of whom are children. The incidence of in-flight medical events (IFMEs) affecting children is largely unknown. This study seeks to characterize pediatric IFMEs, with particular focus on in-flight injuries (IFIs)., Methods: We reviewed the records of all IFMEs from January 2009 to January 2014 involving children treated in consultation with a ground-based medical support center providing medical support to commercial airlines., Results: Among 114 222 IFMEs, we identified 12 226 (10.7%) cases involving children. In-flight medical events commonly involved gastrointestinal (35.4%), infectious (20.3%), neurological (12.2%), allergic (8.6%), and respiratory (6.3%) conditions. In addition, 400 cases (3.3%) of IFMEs involved IFIs. Subjects who sustained IFIs were younger than those involved in other medical events (3 [1-8] vs 7 [3-14] y, respectively), and lap infants were overrepresented (35.8% of IFIs vs 15.9% of other medical events). Examples of IFIs included burns, contusions, and lacerations from falls in unrestrained lap infants; fallen objects from the overhead bin; and trauma to extremities by the service cart or aisle traffic., Conclusions: Pediatric IFIs are relatively infrequent given the total passenger traffic but are not negligible. Unrestrained lap children are prone to IFIs, particularly during meal service or turbulence, but not only then. Children occupying aisle seats are vulnerable to injury from fallen objects, aisle traffic, and burns from mishandled hot items. The possible protection from using in-flight child restraints might extend beyond takeoff and landing operations or during turbulence.

Objectives: To explore the epidemiological patterns and musculoskeletal characteristics of lower limb injuries in Major League Baseball (MLB)., Design: Descriptive epidemiological study., Setting: The MLB was screened for injuries between 2010 and 2016, inclusive., Participants: Players that were placed on the Disabled List (DL) and had lower limb injuries., Main Outcome Measures: Our database entailed the player's position, injury location, injury cause, and time spent on the DL. Analysis of characteristics and mean incidence rates (MIR) were conducted, and P values<0.05 were considered significant (CI 95%)., Results: A total of 3546 injuries were recorded; 1053 injuries (29.7%) affected the lower limbs (n = 1053). On average, 150.4 players per season were placed on the DL for a mean of 45.7 days. Thighs were the most common site of injury, whereas hip injuries had the highest average days on DL (62 days). Fielders had a significantly higher MIR of lower leg injuries when compared to pitchers (P = 0.007) and catchers (P = 0.024), and a significantly higher MIR of foot injuries than that of pitchers (P = 0.035). April was the month with the highest number of injuries (224 injuries, 21.3%). Only 43(4%) injuries required surgical intervention., Conclusion: Lower limb injuries are increasing in the MLB. Understanding the neuromuscular patterns of injuries will help in extrapolating better prevention policies., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Background: Absolute numbers of head injuries in football (soccer) are considerable because of its high popularity and the large number of players. In 2006 a rule was changed to reduce head injuries. Players were given a red card (sent off) for intentional elbow-head contact., Aims: To describe the head injury mechanism and examine the effect of the rule change., Methods: Based on continuously recorded data from the German football magazine "kicker", a database of all head injuries in the 1 st German Male Bundesliga was generated comprising seasons 2000/01-2012/13. Injury mechanisms were analysed from video recordings. Injury incidence rates (IR) and 95% confidence intervals (95% CI) as well as incidence rate ratios (IRR) to assess differences before and after the rule change were calculated., Results: 356 head injuries were recorded (IR 2.22, 95% CI 2.00 to 2.46 per 1000 match hours). Contact with another player caused most head injuries, more specifically because of head-head (34%) or elbow-head (17%) contacts. After the rule change, head injuries were reduced by 29% (IRR 0.71, 95% CI 0.57 to 0.86, p=0.002). Lacerations/abrasions declined by 42% (95% CI 0.39 to 0.85), concussions by 29% (95% CI 0.46 to 1.09), contusions by 18% (95% CI 0.43 to 1.55) and facial fractures by 16% (95% CI 0.55 to 1.28)., Conclusions: This rule change appeared to reduce the risk of head injuries in men's professional football., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2019. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Background: We investigated the impact of blunt pulmonary contusion (BPC) in patients with rib fractures., Methods: Adult patients with rib fractures caused by blunt mechanisms were enrolled over 3 years at a Level 1 trauma center. BPC was defined according to percentage of lung affected as: moderate (1-19% contusion) or severe (≥20% contusion)., Results: In total, 1448 of the 7238 admitted patients had rib fractures. Of these, 321 (22.2%) had BPC: 236 moderate and 85 severe. Patients with BPC were more likely to be admitted to the ICU (moderate: OR 1.55, 95% CI 1.10-2.19; severe: OR 2.74, 95% CI 1.41-5.32). Significantly increased rates of pneumonia (OR 2.52, 95% CI 1.43-4.90) and empyema (OR 4.80, 95% CI 1.07-21.54) were found for moderate and severe BPC, respectively., Conclusions: ICU admission and infectious pulmonary complications were more likely with BPC. The presence of BPC on admission CT is also prognostic of increased resource utilization., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Purpose: The purpose of this study was to describe the epidemiology and evaluate the clinical significance of traumatic sternal fractures., Methods: Patients age ≤18 years with sternal fractures in the National Trauma Database research datasets from 2007-2014 were identified. Patient demographics, injuries, procedures, and outcomes were analyzed using descriptive statistics and logistic regression., Results: Three thousand one hundred sixty patients with sternal fracture were identified. Ninety percent of injuries occurred in patients between 12 and 18 years old. Median injury severity score (ISS) was 17 [9,29]. Exploratory thoracotomy was performed in 1%. Thirty-nine percent were admitted to the intensive care unit (ICU). On multivariate regression, predictors of ICU stay >1 day were increasing ISS, lack of the use of protective devices, decreasing Glasgow Coma Score (GCS), tachycardia, and pulmonary contusion. Median hospital length of stay was 4 [2, 9] days. In-hospital mortality was 8%. Predictors of mortality were lower GCS, increasing ISS, decreasing oxygen saturation, hypotension, and cardiac arrest. Use of protective devices and seat belts did not affect mortality., Conclusion: Sternal fractures in patients increase in incidence with age, and poor outcomes are impacted by associated injuries and complications. The presence of a sternal fracture should trigger a careful diagnostic evaluation., Level of Evidence: III STUDY TYPE: Treatment Study., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Introduction: Prehospital and hospital emergency care guidelines have been developed for patients with suspected hip fracture. Initial radiography can identify a number of patients with other injuries, generally pelvic fractures and hip contusions. Little is known about the prognosis for these patients. The aim of this study is twofold: i) to investigate the injury pattern of patients assessed in prehospital emergency care as suffering from a suspected hip fracture and ii) to compare clinical outcomes between patients with verified hip fracture (HF) and those with other hip injuries (OHI)., Method: The study design was prospective. Older patients with suspected HF after low-energy trauma were identified in prehospital emergency care. Injury type was determined by radiological imaging. Comparisons of length of stay, adverse events, repeated prehospital emergency care and mortality were made between verified HF and OHI cases., Results: 449 patients were included, 400 in the HF and 149 in the OHI group (86 hip contusions, 46 pelvic fractures and 17 other injuries/diseases). The HF group had a significantly longer hospital stay (9.5 days vs. 6.3 for the OHI group; p < 0.001) and more adverse events while in hospital (34% vs. 19%; p < 0.001). We found no evidence that the groups differed with regard to other outcomes: mortality during hospital stay (4% vs. 2%, p = 0.42), at 4 (16% vs. 13%; p = 0.35) and 12 months (21 vs. 23%; p = 0.64), the proportion that experienced an adverse event (24% vs. 22%; p = 0.65) and the proportion that required another ambulance transport within 6 months after discharge (40% vs. 34%; p = 0.16). The results were not strongly affected by adjustments for possible confounders., Conclusion: Older patients who suffer a low-energy pelvic fracture or a hip contusion are common in prehospital and hospital emergency care. These patients need attention as they have poor outcomes in terms of adverse events, mortality and recurrent need for ambulance transport after discharge from hospital. While individualized multidisciplinary care is recommended for hip fracture patients, it might also be suitable for other geriatric hip injuries., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

In developed countries, violence is the main cause of oral maxillofacial (OMF) injuries. In Brazil, there are scant records of such lesions. The scope of this study was to detail the OMF injuries resulting from physical aggression in a capital of the Brazilian northeast and analyze gender differences. The Forensic Medicine Institute of São Luís, state of Maranhão, featured 15,847 reports, which occurred in 2012, and they were investigated. Socioeconomic, demographic data and OMF characteristics were analyzed. The Chi-square and Fisher's Exact tests were applied to assess gender differences. Of the cases examined, 1977 were OMF. Female victims, aged 20-59, dark-skinned, without a partner and maids were the most affected. Ecchymosis-type lesions, in the mouth and lip regions arising from the use of blunt instruments, causing permanent functional impairment, were the most prevalent in women (P < 0.05), whereas dental fracture and contusion arising from sharp instruments causing permanent deformity, occupational disability, and threat to life were detected in men (P < 0.05). The conclusion drawn is that the incidence of OMF due to physical aggression is high in São Luís, state of Maranhão, and although women are the most affected, the OMF in men are more severe.

Background: Although data exist on injuries in youth football leagues, there are limited recent data on injury incidence in middle school football. Updated injury incidence estimates can help drive the development of injury prevention strategies., Purpose: Describe the epidemiology of injuries in middle school football during school years 2015-2016 to 2017-2018., Study Design: Descriptive epidemiology study., Methods: Data originated from 9 public middle schools in Virginia during school years 2015-2016 to 2017-2018. Certified athletic trainers collected injury and athlete-exposure (AE) data from school-sanctioned games and practices in boys', football. Injury counts and rates per 1000 AEs were calculated. Injury rate ratios with 95% CIs compared rates between games and practices., Results: Overall, 664 middle school boys', football injuries were reported, leading to an overall injury rate of 20.54 per 1000 AEs (95% CI, 18.98-22.11). The time loss injury rate (inclusive of injuries with participation restriction time ≥24 hours) was 9.28 per 1000 AEs (95% CI, 8.23-10.33). The injury rate was higher in competition than practice (36.19 vs 17.97 per 1000 AEs; injury rate ratio, 2.01; 95% CI, 1.69-2.40). Most injuries were to the head/face (competition, 20.6%; practice, 15.8%) and hand/wrist (competition, 18.8%; practice, 16.4%) and were diagnosed as contusions (competition, 30.9%; practice, 25.9%) and sprains (competition, 19.4%; practice, 12.6%). Competitions also had a large proportion of concussions (10.3%). Overall, 80.0% and 66.9% of injuries were due to contact in competition and practice, respectively; of these contact-related injuries, 62.1% and 41.6% were specifically player contact., Conclusion: Injury distributions parallel those found in previous research from middle school and other sport settings. Injury rates in middle school football were higher than those reported in previous findings in high school and college. However, caution must be taken when interpreting findings in relation to other surveillance systems with varying methodologies. Still, the findings highlight the need for injury prevention strategies within middle school football, particularly as related to contact-related mechanisms.