Anatomical Structures at Risk After Medial Column Nailing.

To determine the association between drinking patterns (the volume of drinking and frequency) and injury type (intentional injury and unintentional traffic injury). A total of 1 539 patients (age≥18 years), who were treated for the first time in the emergency room within 6 h after the injury, were included. The American National Institute of Health questionnaire was used to investigate the injury type, time point of drinking, drinking volume, and drinking history in the past years and so on. The case-crossover method and logistic regression was used to analyze the data. Comparing with the control, people with alcohol consuming 6 h before the injury showed a higher risk of intentional injury (OR=3.63). Comparing with people without drinking in the past year, subjects who drank alcohol more than once in the past year displayed a higher risk of intentional injury (OR=1.986). Comparing with non-drinkers, subjects who drank alcohol 5-11 standard drinks or 12 and more drinks on one occasion in the past year had a higher risk of intentional injury (OR=1.854 or 1.572). Comparing with the non-drinkers, victims who drank alcohol 6 h before injury had a higher risk of unintentional traffic injury (OR=2.091). Comparing with non-drinkers in the past year, subjects who drank alcohol more than once in the past year had a higher risk of unintentional traffic injuries (OR=1.533). Comparing with the non-drinkers, subjects who drank alcohol 6 h before injury had a higher risk of injury (OR=5.15). Subjects who drank Less than 6 standard drinks, 6-9 standard drinks and more than 9 standard drinks of alcohol 6 h separately before injury had higher risk than non-drinkers (OR=3.83, 8.64 or 9.58). Drinking alcohol before injury is associated with higher risk of intentional injury and unintentional traffic injury. Over the past year, subjects who drank alcohol at least once have higher risk of intentional injuries and unintentional traffic injury. Drinking alcohol 6 h before injury is associated with higher risk of injuries. The risk is increasing with the volume of drinking before injury. The study demonstrates that drinking 6 h before injury and drinking patterns in the past year are closely associated with injuries, which provides scientific evidences for making policy relevant to alcohol consuming.

The subcutaneous (sensory) portion of the superficial peroneal nerve was dissected in 25 cadaver lower limbs under loupe magnification. Three distinct branching pattern types were noted. Type A (72%) consisted of a pattern where the nerve penetrated the crural fascia to become subcutaneous at an average distance of 12.3 cm proximal to the ankle joint, then divided at a mean distance of 4.4 cm proximal to the ankle into two major branches: a large medial dorsal cutaneous nerve and a smaller more laterally located intermediate dorsal cutaneous nerve. Type B (16%) consisted of a pattern where both the medial and intermediate dorsal cutaneous nerve arose independently from the superficial peroneal nerve, with the medial dorsal cutaneous nerve having a similar course to that found in Type A, while the intermediate dorsal cutaneous nerve penetrated the crural fascia posterior to the fibula 5.5 cm proximal to the ankle joint and coursed medially to cross the lateral aspect of the fibula at mean distance 4.5 cm above the ankle joint. Type C (12%) consisted of a pattern where the medial dorsal cutaneous nerve and the intermediate dorsal cutaneous nerve arose independently and the medial dorsal cutaneous nerve coursed similar to that in Type A; however, the intermediate dorsal cutaneous nerve penetrated the crural fascia anterior to the fibula an average of 4.9 cm above the ankle joint and continued in close proximity to the anterior fibular border. In all patterns the mean diameters of the medial dorsal cutaneous nerve and intermediate dorsal cutaneous nerve at the ankle were 2.9 mm and 2 mm, respectively. At the level of the malleoli, the medial dorsal cutaneous nerve was located approximately one half the distance from the lateral malleolus to medial malleolus while the intermediate dorsal cutaneous nerve was approximately one third the distance. Appreciation of these branch patterns and the quantified relationships should assist nerve protection during surgical procedures as well as aid rapid nerve isolation for exploration or decompression. Branches especially at risk for iatrogenic injury include: (1) the intermediate dorsal cutaneous nerve of Type B where the nerve crosses the lateral surface of the distal fibula; (2) the intermediate dorsal cutaneous nerve of Type C where the nerve travels adjacent to the anterior border of the fibula; and (3) the intermediate dorsal cutaneous nerve and the medial dorsal cutaneous nerve at the level of the ankle, where they are at risk during anterior ankle arthrotomy or arthroscopy.

The complete reconstruction of any soft tissue defect includes even the sensory recovery which is very significant aspect pertaining to prognosis. Superficial nerves in the vicinity of the vascular axis can be considered as vascular relays and neuroskin grafts can be constructed on them. Variations in innervation to various part of the dorsum of the foot by this nerve should be kept in mind while making these grafts. Authors dissected 50 formalinized cadaveric feet and studied normal anatomy and variations in origin, course, branching pattern, communications, and any other variations in medial, intermediate and lateral dorsal cutaneous nerve. The intermediate dorsal cutaneous nerve was innervating larger area of the skin around 3rd and 4th web spaces in 60% of cadaveric feet. The 2nd web space was innervated by medial dorsal cutaneous nerve in 92% of cadaveric feet. In 52% of cadaveric feet communicating branches were found between intermediate dorsal cutaneous nerve and lateral dorsal cutaneous nerve. In 63% cadaveric feet communicating branches were found between medial dorsal cutaneous nerve and branch of deep peroneal nerve to 2nd web space. The mean distance between lateral malleolus and intermediate dorsal cutaneous nerve was 4.05cm. These all observations can provide anatomical basis at the time of preparing medial dorsal cutaneous nerve flaps and intermediate dorsal cutaneous nerve flaps and also can minimize morbidity at donor site. KEY WORDS: Medial Dorsal Cutaneous Nerve, Intermediate Dorsal Cutaneous Nerve, Lateral Dorsal Cutaneous Nerve, Medial Dorsal Cutaneous Nerve Flap, Intermediate Dorsal Cutaneous Nerve Flap, Soft Tissue Defects, Open Reduction And Internal Fixation Of Fibula, Arthroscopy, Local Anesthetic Block, First Dorsal Metatarsal Artery Flap, Defects In Distal Dorsalis Pedis, Compression And Entrapment Neuropathies.

The dose-response relationship of alcohol and injury and the effects of country-level detrimental drinking pattern (DDP) and alcohol control policy on this relationship are examined for specific causes of injury. The dose-response risk of injury is analyzed on 18,627 injured patients in 22 countries included in the International Collaborative Alcohol and Injury Study, using case-crossover analysis by cause of injury (traffic, violence, falls, other), DDP, and the International Alcohol Policy and Injury Index. Risk of all injury was higher at all volume levels in higher DDP countries compared to lower DDP countries and for each cause of injury. Risk of injury from traffic was significantly greater in higher DDP than lower DDP countries at 3.1 to 6 drinks (odds ratio (OR)=2.64, confidence interval (CI)=1.17 to 5.97) and at ≤3 drinks for falls (OR=2.51, CI=1.52 to 4.16) and injuries from other causes (OR=1.72, CI=1.10 to 2.69). Countries with higher restrictive alcohol policy were at a lower risk of injury at lower levels of consumption (≤3 drinks) for all injuries (OR=0.72, CI=0.56 to 0.92) and for injuries from other causes (OR=0.46, CI=0.29 to 0.73) and at a lower risk of traffic injuries at higher levels of consumption (≥10 drinks). At higher levels of consumption (≥10 drinks), countries with higher alcohol policy restrictiveness were at greater risk of all injuries (OR=2.03, CI=1.29 to 3.20) and those from violence (OR=9.02, CI=3.00 to 27.13) and falls (OR=4.29, CI=1.86 to 9.91). Countries with high DDP are at higher risk of injury from most causes at a given level of consumption, while countries with low restrictiveness of alcohol policy are at higher risk of injury at lower levels of consumption and at higher risk of traffic injuries at high levels of consumption. These findings underscore the importance of aggregate-level factors which need to be considered in developing effective intervention and prevention strategies for reducing alcohol-related injury.

A landing error scoring system (LESS) is widely used to evaluate landing maneuvers. Poor landing maneuvers, such as lateral bending of the trunk, are thought to be associated with a risk of lower-extremity injury. However, no studies have examined the association between landing and trunk muscle function, which is associated with a high risk of lower-extremity injury. This study examined whether an association exists between landing movements and a high risk of lower-extremity injury and trunk muscle function. It was hypothesized that athletes with poor activation of deep trunk muscle (transversus abdominis and internal oblique) would have lower LESS scores. Cross-sectional study. The trunk muscle thickness at rest and during the plank was measured using ultrasonography. The percent of change in muscle thickness (during plank/at rest) was calculated. The LESS was measured using the Physimax. Based on the LESS scores, patients were divided into high- (LESS > 6) and low-risk (5 > LESS) groups for lower extremity injury. The relationship between the high-risk group and trunk muscle thickness was examined using a stepwise regression analysis. The high-risk group had significantly lower muscle thicknesses of the transversus abdominis (p=0.02) and transversus abdominis plus internal oblique abdominis (p=0.03) muscles during the plank. Additionally, the high-risk group showed significantly lower percent of change in muscle thickness of the internal oblique (p=0.02) and transversus abdominis plus internal oblique (p=0.01) muscles. Only the percentage of change in the thickness of the internal oblique and transverse abdominal muscles was extracted from the regression as a factor. The findings indicated that athletes with landing movements and a high risk of injury, as determined based on the LESS results, had low trunk muscle function, and a relationship was observed between the change in thickness of transversus abdominis and internal oblique abdominis muscles. 3B.

Objective. The automotive safety community is questioning the impact of obesity on the performance and assessment of occupant protection systems. This study investigates fatality and serious injury risks for front-seat occupants by body mass index (BMI) using a matched-pair analysis. It also develops a simple model for the change in injury risk with obesity. Methods. A simple model was developed for the change in injury risk with obesity. It included the normal mass (m) and stiffness (k) of the body resisting compression during a blunt impact. Stiffness is assumed constant as weight is gained (Δ m). For a given impact severity, the risk of injury was assumed proportional to compression. Energy balance was used to determine injury risks with increasing mass. NASS-CDS field data were analyzed for calendar years 1993–2004. Occupant injury was divided into normal (18.5 kg/m 2 ≤ BMI < 25.0 kg/m 2 ) and obese (BMI ≥ 30 kg/m 2 ) categories. A matched-pair analysis was carried out. Driver and front-right passenger fatalities or serious injuries (MAIS 3+) were analyzed in the same crash to determine the effect of obesity. This also allowed the determination of the relative risk of younger (age ≤ 55 years), older (age >55years), male, and female drivers that were obese compared to normal BMI. The family of Hybrid III crash test dummies was evaluated for BMI and the amount of ballast was determined so they could represent an obese or morbidly obese occupant. Results. Based on the simple model, the relative injury risk (r) for an increase in body mass is given by: r = (1 + Δ m / m) 0.5 . For a given stature, an obese occupant (BMI = 30–35 kg/m 2 ) has 54–61% higher risk of injury than a normal BMI occupant (22 kg/m 2 ). Matched pairs showed that obese drivers have a 97% higher risk of fatality and 17% higher risk of serious injury (MAIS 3+) than normal BMI drivers. Obese passengers have a 32% higher fatality risk and a 40% higher MAIS 3+ risk than normal passengers. Obese female drivers have a 119% higher MAIS 3+ risk than normal BMI female drivers and young obese drivers have a 20% higher serious injury risk than young normal drivers. This range of increased risk is consistent but broader than predicted by the simple injury model. The smallest crash test dummies need proportionately more ballast to represent an obese or morbidly obese occupant in the evaluation of safety systems. The 5% female Hybrid III has a BMI = 20.4 kg/m 2 and needs 22 kg of ballast to represent an obese and 44.8 kg to represent a morbidly obese female, while the 95% male needs only 1.7 and 36.5 kg, respectively. Conclusions. Obesity influences the risk of serious and fatal injury in motor vehicle crashes. The effect is greatest on obese female drivers and young drivers. Since some of the risk difference is related to lower seatbelt wearing rates, the comfort and use of seatbelt extenders should be examined to improve wearing rates. Also, crash testing with ballasted dummies to represent obese and morbidly obese occupants may lead to refined safety systems for this growing segment of the population.

To determine the relationship between injury risk and alcohol drinking. Totally 531 patients (age ≥18 years) who were treated for the first time and came to the emergency room within 6 h after the injury were included. The American National Institute of Health questionnaire was used to investigate the trauma type, intentional injury, drinking before the injury, drinking volume, and drinking history in the past years and so on. The case-crossover method was used to analyze the data and relationship between alcohol drinking and injury. Compared with the non-drinkers, subjects who drank alcohol 6 h before the injury had a higher risk of intentional injury (OR=2.79, 95%CI: 1.61-4.84). Male, drunken, patients with positive alcohol test results were more likely to suffer from intentional injury. Compared with the nondrinkers, victims who drank alcohol 6 h before injury had a higher risk of injury in traffic accidents (OR=2.41, 95%CI: 1.29-4.51). Compared with the non-drinkers, subjects who drank alcohol 6 h before injury had a higher risk of injury (OR=11.86, 95%CI: 5.48-25.65). Subjects who drank more than 6 standard drinks of alcohol 6 h before injury had much higher risks than non-drinkers (OR=24.52, 95%CI: 5.84-102.86). Alcohol drinking before injury is associated with increased the risk of trauma, intentional injury and injury related to traffic accidents.

Minimally invasive subtalar joint and talonavicular joint preparation for hindfoot arthrodesis: A Cadaveric study evaluating structures at risk

Introduction: Several variations in the course and branching pattern of the Superficial Peroneal Nerve (SPN) have been reported. Knowledge of the different course of SPN is essential in reducing the risk of iatrogenic injury during the orthopaedic foot and ankle surgery and various other procedures. Aim: To observe any variations in the course, and level of termination of SPN. Materials and Methods: This descriptive analytical study was conducted on 50 lower limb specimens in the Department of Anatomy, Bangalore Medical College and Research Institute Bengaluru from January 2013 to January 2016. Dissection kit was used for dissection, digital camera was used for photography of specimens, measuring tape was used to measure the distance at which the SPN became cutaneous with respect to the tip of lateral malleolus and the distance at which SPN terminated into medial and Intermediate Dorsal Cutaneous Nerve (IDCN) with reference to the tip of lateral malleolus. Descriptive statistics was used and results were expressed as Mean±SD. Results: It was observed that the distance at which SPN became cutaneous with respect to tip of lateral malleolus was 10±2.82 cm. The level of termination of SPN into Medial Dorsal Cutaneous Nerve (MDCN) and IDCN with reference to tip of lateral malleolus was 4.7±2.08 cm. In 5 (10%) of 50 specimens the SPN terminated at a higher level before piercing the deep fascia. Out of these 5 specimens, it was observed that in one specimen the SPN terminated above the head of fibula before piercing Peroneus Longus (PL) muscle. In another specimen, the SPN terminated near the head of fibula before piercing PL muscle. In one of the specimens SPN terminated near head of fibula after piercing PL, in two specimens SPN terminated in upper third of the leg after piercing PL muscle and their terminal branches pierced the deep fascia and emerged out at different level with respect to tip of lateral malleolus. Conclusion: SPN became cutaneous and terminated in the distal third of the leg in most cases. This knowledge is very helpful to surgeons and orthopaedists in performing fasciotomy, and ankle arthroscopy to prevent iatrogenic injury to the nerve.

Overuse Injuries and Burnout in Youth Sports

BackgroundObesity and overweight are suggested to increase the risk of occupational injury but longitudinal evidence to confirm this is rare. We sought to evaluate obesity and overweight as risk factors for occupational injuries.Methodology/Principal FindingsA total of 69,515 public sector employees (80% women) responded to a survey in 2000–2002, 2004 or 2008. Body mass index (kg/m2) was derived from self-reported height and weight and was linked to records of subsequent occupational injuries obtained from national registers. Different injury types, locations and events or exposures (the manner in which the injury was produced or inflicted) were analyzed by body mass index category adjusting for baseline socio-demographic characteristics, work characteristics, health-risk behaviors, physical and mental health, insomnia symptoms, and sleep duration. During the mean follow-up of 7.8 years (SD = 3.2), 18% of the employees (N = 12,204) recorded at least one occupational injury. Obesity was associated with a higher overall risk of occupational injury; multivariable adjusted hazard ratio (HR) 1.21 (95% CI 1.14–1.27). A relationship was observed for bone fractures (HR = 1.37; 95% CI: 1.10–1.70), dislocations, sprains and strains (HR = 1.36; 95% CI: 1.25–1.49), concussions and internal injuries (HR = 1.26; 95% CI: 1.11–1.44), injuries to lower extremities (HR = 1.62; 95%: 1.46–1.79) and injuries to whole body or multiple sites (HR = 1.37; 95%: 1.10–1.70). Furthermore, obesity was associated with a higher risk of injuries caused by slipping, tripping, stumbling and falling (HR = 1.55; 95% CI: 1.40–1.73), sudden body movement with or without physical stress (HR = 1.24; 95% CI: 1.10–1.41) and shock, fright, violence, aggression, threat or unexpected presence (HR = 1.33; 95% CI: 1.03–1.72). The magnitude of the associations between overweight and injuries was smaller, but the associations were generally in the same direction as those of obesity.Conclusions/SignificanceObese employees record more occupational injuries than those with recommended healthy weight.

Background: Alcohol is an important risk factor for road transport injuries. Road traffic crashes attributable to alcohol, are primarily associated with this high risk hazardous drinking behavior. In this study, ways to deal with alcohol-related injuries in driving have been investigated. Methods: In this overview, 60 articles with keyword prevention, alcohol consumption, injuries, and driving were investigated in the data bases of the PubMed, Elsevier and Google Scholar. Results: Linda J Cobiac study showed Raising alcohol excise tax in this high-income country would be highly cost-effective and could lead to substantial cost-savings for society. James Damsere-Derry study showed because alcohol consumption is increasing currently with motorization, it is necessary to educate alcohol users about the number of drinks required to stay below the legal limit if they are motorists as well as other road users or to prevent long-term illnesses associated with excessive alcohol use. Cheryl J. Cherpitel study showed countries with high detrimental drinking pattern (DDP) are at higher risk of injury from most causes at a given level of consumption, while countries with low restrictiveness of alcohol policy are at higher risk of injury at lower levels of consumption and at higher risk of traffic injuries at high levels of consumption. Conclusion: To reduce alcohol-related injuries in driving, it is important to increase alcohol taxes, driver training, and alcohol-restricting policies.

:Background:Alcohol is an important risk factor for road transport injuries. Road traffic crashes attributable to alcohol, are primarily associated with this high risk hazardous drinking behavior. In this study, ways to deal with alcohol-related injuries in driving have been investigated.Methods:In this overview, 60 articles with keyword prevention, alcohol consumption, injuries, and driving were investigated in the data bases of the PubMed, Elsevier and Google Scholar.Results:Linda J Cobiac study showed Raising alcohol excise tax in this high-income country would be highly cost-effective and could lead to substantial cost-savings for society. James Damsere-Derry study showed because alcohol consumption is increasing currently with motorization, it is necessary to educate alcohol users about the number of drinks required to stay below the legal limit if they are motorists as well as other road users or to prevent long-term illnesses associated with excessive alcohol use. Cheryl J. Cherpitel study showed countries with high detrimental drinking pattern (DDP) are at higher risk of injury from most causes at a given level of consumption, while countries with low restrictiveness of alcohol policy are at higher risk of injury at lower levels of consumption and at higher risk of traffic injuries at high levels of consumption.Conclusions:To reduce alcohol-related injuries in driving, it is important to increase alcohol taxes, driver training, and alcohol-restricting policies.Keywords:Alcohol, Injuries, Traffic

Up to 37% of children admitted to the PICU develop acute kidney injury as defined by Kidney Disease: Improving Global Outcomes criteria. We describe the prevalence of acute kidney injury in a mixed pediatric intensive care cohort using this criteria. As tools to stratify patients at risk of acute kidney injury on PICU admission are lacking, we explored the variables at admission and day 1 that might predict the development of acute kidney injury. Single-center retrospective observational study. Thirty-six-bed surgical/medical tertiary PICU. Children from birth to less than or equal to 16 years old admitted between 2015 and 2018. None. Clinical data were extracted from the PICU clinical information system. Patients with baseline creatinine at admission greater than 20 micromol/L above the calculated normal creatinine level were classified as "high risk of acute kidney injury." Models were created to predict acute kidney injury at admission and on day 1. Out of the 7,505 children admitted during the study period, 738 patients (9.8%) were classified as high risk of acute kidney injury at admission and 690 (9.2%) developed acute kidney injury during PICU admission. Compared to Kidney Disease: Improving Global Outcomes criteria as the reference standard, high risk of acute kidney injury had a lower sensitivity and higher specificity compared with renal angina index greater than or equal to 8 on day 1. For the admission model, the adjusted odds ratio of developing acute kidney injury for high risk of acute kidney injury was 4.2 (95% CI, 3.3-5.2). The adjusted odds ratio in the noncardiac cohort for high risk of acute kidney injury was 7.3 (95% CI, 5.5-9.7). For the day 1 model, odds ratios for high risk of acute kidney injury and renal angina index greater than or equal to 8 were 3.3 (95% CI, 2.6-4.2) and 3.1 (95% CI, 2.4-3.8), respectively. The relationship between high risk of acute kidney injury and acute kidney injury needs further evaluation. High risk of acute kidney injury performed better in the noncardiac cohort.

Tiernan, C, Comyns, T, Lyons, M, Nevill, AM, and Warrington, G. The association between training load indices and injuries in elite soccer players. J Strength Cond Res 36(11): 3143-3150, 2022-To investigate the association between contact injuries, noncontact injuries, and training load indices, across different lag periods in elite soccer players. Internal load (session rate of perceived exertion) was collected from 15 elite soccer players over 1 season (40-weeks). Acute (7 days), chronic (28 days), acute:chronic workload ratio (ACWR) (uncoupled), exponentially weighted moving averages (EWMA) ACWR, and 2-, 3-, and 4-week cumulative load were calculated on a rolling weekly basis. Multilevel logistic regression was used to analyze the associations between contact, noncontact injuries, and training load indices, across different lag periods (5 and 7 days). A player was at a significantly higher risk of a noncontact injury 5 days later, if week-to-week acute load changes increased (odds ratio [OR] = 1.97). An increase in EWMA ACWR was associated with an increased risk of both a contact (OR = 1.30) and noncontact injury (OR = 1.35), 5 days later. An increase in 2-week cumulative load (OR = 1.77) was associated with an increased risk of a contact injury 7 days later and 3-week cumulative load (OR = 1.55) 5 days later. These findings suggest that to reduce the potential risk of a noncontact injury, training load should be gradually increased, avoiding an increase in week-to-week acute load change (≥9%) or EWMA ACWR (>1.20). Findings indicated that EWMA ACWR may be a more sensitive measure for detecting a player at a higher risk of an injury than ACWR. Furthermore, a high 2- and 3-week cumulative load was associated with an increased risk of a contact injury, which may indicate accumulated fatigue. Practitioners must note that this study investigated associations with injury risk and not injury prediction.