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This study evaluated the effects of competitive intensity, represented by the variables time in competition, phase of play, and field location, on injury severity in U.S. high school football. The injury rate was higher in competition than practice (RR = 4.75, 95% CI: 4.34-5.20). Mild and moderate injuries were frequently lower leg/foot/ankle sprains/strains and concussions. Severe injuries were frequently knee Sprains/strains and arm fractures. Severe injuries composed a greater proportion of injuries sustained during the beginning and middle of competition compared with injuries sustained during the end/overtime (IPR = 1.83, 95% CI: 1.25-2.69). Compared with injuries sustained during general play, a greater proportion of kickoff/punt injuries were severe (IPR = 1.69, 95% CI: 1.07-2.68) or were concussions (IPR = 1.86, 95% CI: 1.05-3.30). Identifying factors contributing to severe injury is a crucial first step toward developing targeted evidence-based interventions aimed at reducing the incidence of severe injuries among the millions of high school football players. [ABSTRACT FROM AUTHOR]

Background: Despite the frequency of distal fibula fractures in elite athletes and the significant potential impact on the athletes' season and future careers, little data exist characterizing the epidemiology of these injuries or, more importantly, return to competition., Purpose: To (1) evaluate the incidence of acute distal fibula fractures in National Football League (NFL) athletes, including isolated distal fibula and combined ankle fracture patterns; (2) analyze distal fibula fracture rates in NFL athletes by position, type of play, and contact type; (3) determine the rates of distal fibula fracture surgery in NFL athletes; and (4) report the days missed due to distal fibula fractures in NFL athletes., Study Design: Descriptive epidemiology study., Methods: A retrospective review of distal fibula fractures reported to the NFL from 2000 to 2014 was performed using the NFL Injury Surveillance System. All distal fibula fractures were included, along with isolated and combined fracture patterns. Stress fractures and proximal fibula fractures were excluded. Epidemiological data and rates of surgery were determined. Return to sport was calculated and stratified by injury pattern and management., Results: Overall, 237 distal fibula fractures in NFL athletes from 2000 to 2014 were included; 197 (83%) were isolated distal fibula fractures. A mean of 16 distal fibula fractures occurred each year (median, 16 per year). Fractures occurred most frequently on running (38%) and passing (24%) plays, but the frequency was next highest on kickoffs (16%), despite the relative infrequency of kickoffs during the average game compared with other play types. Surgery was reported for more than half of all distal fibula fractures (n = 128, 54%). Overall, patients who underwent surgery missed significantly more days (mean, 123.8 days) than players who did not undergo surgery (mean, 75.3 days) ( P < .001). Players with isolated distal fibula fractures had significantly fewer days missed (mean, 93.6 days) compared with those with combined patterns (mean, 132.3 days) ( P = .0004)., Conclusion: Fibula fractures affect a number of NFL athletes and result in significant time missed from competition. Further research is required to determine the optimal management of fibula fractures in NFL athletes. In this study, time to return to play depended on both the fracture pattern and whether surgery was required and ranged from 72 to 145 days., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: R.F.W. has stock/stock options in Ivy Sports Medicine and OrthopNet. C.M. and K.F. are employees of QuintilesIMS, a research organization that performs work for pharmaceutical companies and professional sports leagues, including the National Football League. S.A.R. is a consultant for the Joint Restoration Foundation and has stock/stock options in Ortho RTI and Rotation Medical.