Extremity Injuries Research Articles

Supervised vs. Self-Managed Exercise Therapy for Improving Shoulder Function After Traumatic Dislocation and Sprain: A Systematic Review and Meta-Analysis

Trauma-induced shoulder dislocations and sprains rank among the most common upper extremity injuries, with contact sports accounting for the majority of cases. These injuries often lead to substantial impairments in joint function and long recovery times, requiring targeted therapeutic interventions to restore mobility and prevent recurrent injuries. Given the pivotal role of exercise therapy in restoring shoulder function, this study systematically reviews the literature on the comparative effectiveness of supervised versus self-managed exercise therapy following acute shoulder trauma. PubMed, Cochrane CENTRAL, Embase, Web of Science, and Science Direct were searched up to 13 December 2024. Conservative and post-surgical treatment modes were analyzed separately. Five studies with a total 689 participants were included (conservative: n = 538 across two studies; post-surgical: n = 151 across three studies). Both treatment modes showed similar pooled effects (standardized mean difference, SMDconservative: −0.35, 95% CI [−1.39, 0.69]; SMDpost-surgical: −0.23, 95% CI [−1.21, 0.75]), with a marginal improvement in shoulder function favoring supervised therapy. Four studies had some risk of bias, and one had serious risk; GRADE certainty was low. Supervised exercise therapy may offer slightly greater functional improvements over self-managed training, but evidence is limited by heterogeneity and low certainty. Further high-quality trials with standardized protocols and improved adherence tracking are needed to establish more definitive conclusions and guide clinical decision-making.

Risk Factors for Limb Amputations in Modern Warfare Trauma: New Perspectives

Background: In modern conflicts, extremities are mainly affected, with limb amputations required for approximately 5% of severely injured combatants and 7% of those with serious limb injuries. Amputations are some of the most challenging injuries endured by survivors, significantly affecting the patients and the healthcare system. This study aims to describe the rates, characteristics, and risk factors of limb amputations in patients with serious extremity trauma during the 2023 conflict in Israel. Methods: This nationwide retrospective cohort study, based on the Israel National Trauma Registry, includes all patients with serious extremity injuries (abbreviated injury score ≥3) from October 7 to December 31, 2023. Demographic and clinical characteristics, as well as outcomes of patients with limb amputations were compared with those who were not amputated. Multivariable logistic regression was used to identify risk factors for amputations. Results: Among the 1,815 combat-related casualties, 1,318 (72.6%) sustained extremity injuries, and 451 (24.8%) had serious limb injuries. Most patients with severe limb injuries were young males, with 287 of 451 being soldiers. 150 of 451 were injured by explosions, and 158 of 451 had severe and critical injuries (ISS ≥16). Of 451 patients, 52 (11.5%) underwent limb amputations (43 lower limbs, eight upper limbs, and one both). Amputees were significantly more likely to be injured by explosions (76.9% vs. 27.6%, P < 0.001), have an ISS of ≥16 (75.0% vs. 29.8%, P < 0.001), and have polytrauma (46.1% vs. 27.1%, P = 0.004). Independent risk factors for amputation included explosions (adjusted odds ratio [aOR] 9.74, 95% confidence interval [CI] 4.83 to 21.32, P < 0.001), fasciotomy (aOR 8.51, 95% CI 2.82 to 25.74, P < 0.001), and polytrauma (aOR 1.98, 95% CI 1.03 to 3.78, P = 0.04). Vascular injuries were not associated with amputations (aOR 0.87, 95% CI 0.39 to 1.85, P = 0.72). Conclusions: In recent conflicts, amputation rates have risen, likely due to increased tissue destruction from modern weaponry and improved survival rates among severely injured patients. Those with multiple severe injuries, blast injuries, or requiring fasciotomies face a higher risk of amputation.

Leg Dominance Effects During Single- and Dual-Task Modified Balance Error Scoring System Assessment in Collegiate and High School Athletes.

The modified Balance Error Scoring System (mBESS) incorporates nondominant leg stance for a ceiling effect, but that may not be the worse balancing leg. Updated recommendations call for single- and dual-task tandem gait, but limited research has explored these effects on the mBESS. To compare mBESS performance between dominant and nondominant legs during single and dual tasks and to determine 1-week test-retest reliability. Cross-sectional study; Level of evidence, 3. A total of 119 intercollegiate, collegiate club, and high school athletes were administered a baseline mBESS battery consisting of performance on both legs and during single and dual task at 2 time points, 1 week apart. Measures consisted of mBESS errors and sway index during counterbalanced single- and dual-task conditions on dominant and nondominant legs. Wilcoxon signed-rank tests were conducted to determine differences in errors and sway index between dominant and nondominant legs and single- and dual-task performance. Spearman correlations were used to measure reliability at 1 week ± 2 days. No differences were observed between nondominant and dominant single-leg errors (P = .79) and sway index (P = .98), nor tandem stance errors (P = .95) and sway index (P = .86). Greater errors were committed during dual-task single-leg stance (P = .05) but not on sway index (P = .69). No differences existed between single and dual tasks on tandem errors (P = .63) and sway index (P = .53). Test-retest coefficients were weak to moderate (rs = -0.009 to 0.368) for normal mBESS errors and fair for sway index (rs = 0.389 to 0.442) at a 1-week interval. Our study demonstrated that leg dominance does not appear to affect mBESS errors or sway index, indicating that either leg may be used, in the absence of lower extremity injury history or instability. Incorporation of a dual task provides little clinical utility and may not be specific enough to elicit postural control changes on the mBESS, further indicating the use of optional foam conditions or single- and dual-task tandem gait. Caution is needed when using mBESS after a 1-week time point.

Self-reported injury in ultra-endurance participants with a focus on knee injuries: An exploratory cross-sectional comparative study of running, cycling, and triathlon.

To investigate the frequency and location of reported injuries among ultra-endurance participants competing in different sports. Cross-sectional. Ultra-endurance runners, cyclists and triathletes were recruited via a social media advertisement to participate in a web-based questionnaire. The questionnaire asked for information on demographics, competition history, training characteristics, and self-reported injury. Descriptive analyses and prevalence rates were calculated to determine differences between sports. Of the 258 participants (age:46±11 years; 33% female), 129 (50%) self-reported an injury within the past 12 months. Despite high frequency of reported injury, only 10% of injuries resulted in 'severe' pain and 7% resulted in stopping participation. The lower extremity, and specifically the knee, ankle and foot, were the most common injury locations. Prevalence ratios for injury over the past 12 months was similar across running, cycling, and triathlon, with no statistically significant differences. However, cyclists demonstrated a significantly higher prevalence of knee injuries since starting ultra-endurance participant compared to runners after adjusting for covariates (PR: 1.62; 95% CI: 1.15-2.28, p=0.006). Ultra-endurance participants self-report a considerable number of lower extremity injuries, yet this is similar across sports, and both the level of pain and impact on performance impact is generally low.

The FIFA 11+ injury prevention program reduces the incidence of lower extremity injuries in football players: a systematic review and meta-analysis.

The FIFA 11+ preventive program is designed to reduce the incidence of injury in sports. However, to gain a better understanding of its effect a systematic review and meta-analysis is needed. The current review aims to investigate the effect of the FIFA 11+ preventive program on injury incidence among male and female football players. This study used Scopus, PEDro, SPORTDiscus, and ProQuest as data sources. The initial selection of the studies, thorough assessment of the tile, and abstract. Extraction of the necessary study data was conducted by two independent researchers. Another two independent researchers assessed the quality of each included study against 39 used criteria. These criteria were combined from several popular quality assessment scales. The incidence of injuries measured in the lower extremities in football players after addressing the FIFA11+ was the outcome of interest. This review included 12 trials of variable methodological quality from which 10 trials were selected for the meta-analysis. In general, the FIFA11+ program showed a significant reduction (P<0.1) in lower limb injury incidence for male young and adults in comparison to other programs. However, evidence of its effectiveness in females is lacking and more studies are needed. The FIFA 11+ program is recommended to be used and implemented as a preventive strategy in males. Although, the result showed a significant reduction in injury incidence in adult males, heterogeneity between studies is high which may reduce the generalizability of the results. More studies are needed to investigate the effect of the FIFA 11+ program on females.

Correlation Between Pre-Season Single-Leg Hop Testing Data and Lower Extremity Injuries in Collegiate Soccer Players

Correlation Between Pre-Season Single-Leg Hop Testing Data and Lower Extremity Injuries in Collegiate Soccer Players

Three-Year Assault Cases Performed on the Emergency Trauma Center.

This study aims to compare the results of cases with a history of assault presented to our emergency department over a period of three years with literature data and to share our experiences with colleagues. Demographic characteristics, trauma findings, clinical conditions, surgical interventions, mortality, and outcomes of patients with a history of assault to the emergency department between 2020 and 2022 were retrospectively examined. The results were analyzed using the Number Cruncher Statistical System 2007 Statistical Software package program (Utah, USA). A total of 2900 patients, including 1850 males (63.79%) and 1050 females (36.21%), with an average age of 35.53±12.46 years, were included in the study. Most admissions (31.28%) occurred during the summer months and outside working hours. Males inflicted all injuries. The most common injuries occurred in the head-neck region (63.31%) and upper extremities (47.97%) in both sexes. Facial injuries were significantly more common in males (p=<0.05), whereas spinal and pelvic injuries were common in females (p<0.05). Tenderness, edema, hematoma, abrasion, ecchymosis, and soft tissue laceration were the most frequently observed findings. Female patients were more likely to be discharged home (p=0.0001), whereas male patients had a higher hospitalization rate (p=0.0001). Life-threatening ailments were discovered in 23 patients (0.79%). Surgical intervention was performed in 50 patients (1.72%). No patient experienced fatal outcomes. All assaults were committed by males. Males are more frequently and severely assaulted than females. The victims were mainly from young people, and assaults predominantly occurred during the summer months and outside working hours. Head-neck and extremity injuries were the most common. There were no fatal outcomes. Nine of the 10 patients were discharged to home from the emergency department.

The Impact of Perioperative Blood Transfusion on Flap Survival: A Single-Center Review of Limb Salvage in the Trauma Setting.

Limb salvage following traumatic lower extremity (LE) injury often necessitates blood transfusion for adequate tissue perfusion. Appropriate transfusion decision-making via a risk-benefit analysis could maximize the opportunity for flap survival. This study aims to examine the impact of perioperative blood transfusion on postoperative complications in traumatic LE reconstruction. A retrospective review was conducted at a level 1 trauma center on patients who underwent LE reconstruction between January 2007 and October 2023. Patient demographics, comorbidities, perioperative blood transfusions, flap characteristics, and postoperative complications were recorded. Outcomes investigated included postoperative amputation rates, infection, partial flap necrosis, and flap loss. Univariate analysis and multivariable logistic regression were performed to examine the impact of patient factors on flap necrosis. In total, 234 flaps met inclusion criteria. Of these, 149 cases (63.7%) received no transfusion during their hospital stay (Tf - ) and 85 cases (36.3%) received at least one unit of packed red blood cells intraoperatively through 48 hours following flap placement (Tf + ). Overall flap survival rates were similar across both cohorts (Tf + : 92.9 vs. Tf - : 96.6%, p = 0.198). The Tf+ cohort had significantly higher rates of partial flap necrosis (12.9 vs. 2.0.%, p < 0.001), amputation (6.0 vs. 0.7%, p = 0.015), and postoperative hardware infection (10.6 vs. 2.7%, p = 0.011) relative to the Tf- cohort. Multivariable logistic regression demonstrated that transfusion status was independently associated with a 5.1 fold increased risk of flap necrosis (p = 0.033). Transfusions administered intraoperatively through the acute postoperative period were associated with a significantly increased likelihood of flap necrosis. Surgeons should consider a conservative transfusion protocol to optimize flap viability in patients with traumatic LE injuries.

Methoxyflurane in early analgesic therapy by ski patrol members on Swiss ski slopes – an observational cohort study

BackgroundPain therapy is an important first-response measure in the pre-clinical care of trauma patients. Injured individuals on ski slopes are usually given first aid by members of the ski patrol. The early implementation of adequate pain therapy by these paramedical rescuers can increase patient satisfaction and have a positive effect on the entire treatment process. In this context, we analysed the administration of methoxyflurane by ski patrol members on Swiss ski slopes.MethodsIn this retrospective observational study, we evaluated 172 datasets, of which 149 concerned patients who were administered methoxyflurane. These datasets were taken from a quality-control survey related to the administration of methoxyflurane by members of the ski patrol in seven ski resorts in the Swiss Alps. The data was collected in the winter months of 2022/23. The ski patrol members had been previously trained by medical professionals and employed methoxyflurane following a defined algorithm, according to which patients with an initial numeric pain score of ≥ 4 qualified for the use of methoxyflurane. After each treatment, data on effectiveness and feasibility were collected by means of a standardised questionnaire. The primary outcome was defined as achieving effective pain therapy, which was designated as a reduction on the numerical rating scale of two or more points and a pain score of seven or less after administration. We then performed a linear regression analysis with the relative pain reduction as the outcome and sex, age, ski resort and injury class as covariates.ResultsMethoxyflurane led to effective pain reduction in around two-thirds of patients on the ski slopes and was easy to use for trained ski patrol members. Median pain reduction was 2 points (interquartile range: 1 to 3) on the NRS scale. The regression model showed lower reduction in pain in lower extremity injuries. Sex, age and initial pain score were not associated with the extent of pain reduction. No serious side effects were observed.ConclusionThe administration of methoxyflurane by trained ski patrol members is a safe and effective option for early pain management in ski slope injuries. Methoxyflurane could thus represent a useful bridging measure, enabling the ski patrol to relieve moderate to severe pain until professional rescue services arrive. However, it does not seem ideal for lower leg injuries.

Validity and reliability of the Brief Illness Perception Questionnaire (BIPQ) in adults with chronic isolated extremity injuries

Background High perceived threat of an injury is associated with poor post-injury health outcomes. The Brief Illness Perception Questionnaire (BIPQ) can be used to gauge the level of perceived threat of an injury, however, its psychometric properties have not been tested in people with extremity injuries. Methods We used an observational, cross-sectional study design. Eighty-one adults at least six months post isolated extremity injury completed the BIPQ and measures of psychological distress, disability, somatic symptom burden, and general self-efficacy. To determine test-retest reliability, a subset (n = 42) re-completed the BIPQ. Exploratory factor analysis was used to test the factor structure. Results The BIPQ had adequate face validity. The factor analysis indicated the BIPQ is unidimensional (measuring perceived threat of the injury) with good internal consistency (McDonald’s Omega = 0.91). Five items had strong factor loadings while three items loaded poorly. Most BIPQ items showed moderate-strong positive relationships with disability, psychological distress, and somatic symptom burden, however, three items had weak associations. The BIPQ had good test-retest reliability [intra-class coefficient = 0.89 (95%CI: 0.81, 0.94)] and agreement. These findings should be interpreted with caution and may not generalise to other injured cohorts. Conclusion There is preliminary support for the BIPQ as a valid and reliable measure of perceived injury threat in adults with chronic isolated extremity injuries.

Prolonged post-operative hydrocodone usage due to psychotropic drug interaction.

To explore pain outcomes in patients prescribed hydrocodone and psychotropic medications with or without CYP2D6 inhibition activity. Patients hospitalized for lower/limited upper extremity injuries who were prescribed hydrocodone alongside a psychotropic medication were considered for this study (n=224). A subset of these patients (n=178) was prescribed a psychotropic medication known to inhibit CYP2D6, while the remainder (n=46) were prescribed psychotropic medications without CYP2D6 inhibition activity. Patient demographics and pain outcomes were collected by electronic health record review and interviews. Patients taking a psychotropic inhibitor of CYP2D6 exhibited longer duration of opioid use post-discharge (median 33days [IQR 10-99]) compared with patients taking a psychotropic non-inhibitor (4days [2-20], p<0.001). No significant differences were observed with in-hospital pain outcomes, including total dose of hydrocodone administered, duration of hydrocodone use, pain index scores, and the occurrence of common mild/moderate/severe hydrocodone side effects. Patients prescribed at least one psychotropic inhibitor of CYP2D6 were more likely to continue using hydrocodone for up to 3months following surgery. Knowledge of these critical drug-drug interactions could enhance clinical practice and improve patient outcomes. This study highlights negative post-operative pain outcomes in patients prescribed hydrocodone alongside a psychotropic inhibitor of CYP2D6. The results of this study indicate that patients taking psychotropic medications that inhibit CYP2D6 are at increased risk for prolonged hydrocodone use following orthopedic surgery.

Management of Patient with Closed Degloving in the Pelvic Region: a Case Series

Background: Degloving injuries in pelvis, torso and extremities present a challenge in wound management. Current management usually is the effort to provide wound coverage with split thickness skin graft (STSG). Problems arise in the wound bed preparation because the patient is not mobile, urine or feces contamination, and systemic problems such as anemia, hypoalbuminemia and sepsis. After wound coverage with STSG, problems arise during postoperative period caused by dificulty to maintain immobilization of the graft due to the location.Patients and Methods: In January to February 2012, 3 patients were admitted to Cipto Mangunkusumo hospital with degloving in the pelvic region. They were treated with delayed STSG.Results : The first patient underwent delayed STSG with a 75% take. The second patient was treated by serial STSG a month following hospital admission, the result was almost 90% take. The last patient underwent debridement and the wound was closed with STSG 10 days after admission, the result was only 50% take.Summary : Management of degloving patients should include adequate wound bed preparation with dressing that minimize infection and enhance good granulation tissue, maintain good systemic condition by providing adequate nutrition with care to albumin and electrolyte loss. Care should be given to prevent SIRS and sepsis. After wound coverage with STSG, modalities to immobilize the graft and maintain ideal environment for graft take have to be considered.

Health care costs and service utilization in the first year following moderate to severe traumatic injury.

Most of the previous studies on costs following trauma have focused solely on in-hospital costs and costs associated with the acute treatment and early rehabilitation. As a result, post-hospital costs are often neglected in the estimation of total costs. We aimed to describe service utilization and total costs for health care services, rehabilitation services, and social support in the periods 0-6 months and 7-12 months after moderate-to-severe traumatic injury. Further, we explored costs and their associations with sociodemographic, clinical and injury-related variables. Data were obtained from a prospective, 12 months follow-up study of patients in all ages with moderate-to-severe traumatic injury determined by a New Injury Severity Score (NISS) > 9, admitted directly or within 72h to the trauma referral centres in year 2020. Data on utilization of health care and rehabilitation services from the Norwegian Patient Register (NPR), the Municipal patient and user register (KPR), and the Norwegian Control and Payment of Health Reimbursements Database (KUHR) were used. A total of 601 patients were included, 24% with moderate and 76% with severe injuries. The overall mean total health care cost per patient in the first year after traumatic injury was 846,877 (SD 1,042,649) Norwegian Kroner (NOK). The mean total cost of rehabilitation per patient was 251,487 (SD 317,050) NOK. Most costs were attributable to secondary care in the first six months post-injury. Severely injured patients had a higher health care utilization and average cost compared to those with moderate injury. Injury severity factors were the most prominent cost drivers, and number of injuries, severe head, spine, and extremity injuries were significantly associated with higher costs during the first year following trauma. The findings give a holistic insight into health care utilization and costs for patients across all ages with complex needs following trauma and can contribute to the planning and provision of services for this patient group.

Resorcimoline as a Novel Therapeutic Agent Attenuates Ischemia-Reperfusion Injury in Hind Extremities.

Acute ischemia in the hind extremities is a dangerous disease that causes irreversible damage. Revascularization procedures are important to prevent muscle damage, but these treatments may induce additional damage, also known as ischemia-reperfusion injury. The role of free radicals as pivotal mediators of ischemia-reperfusion injury remains a prominent hypothesis. We have recently revealed potent antioxidative activities of a novel free radical scavenger named resorcimoline (RML). The present study aims to investigate RML as a new therapeutic agent to reduce muscle damage and prevent motor dysfunction of the hind extremities caused by acute limb ischemia. Ischemia was induced in rats by occluding the femoral arteries in both hind limbs for 120 min with nylon bands, followed by reperfusion for 24 h. The RML group (n = 9) received an intravenous injection of RML immediately before reperfusion, whereas the saline group (n = 9) received an equivalent volume of saline. Motor function was evaluated by counting the number of steps required to return to normal gait. Serum biomarkers, including creatine kinase (CK) and lactate dehydrogenase (LDH), were measured to evaluate muscle injury. Muscle damage was assessed histologically with hematoxylin and eosin staining. Oxidative damage to DNA in muscle was evaluated by measuring the proportions of 8-hydroxy-2'-deoxyguanosine (8-OHdG)-positive cells by immunohistochemistry. The average number of steps required to return to normal gait in the RML group was significantly smaller compared to the saline group (p = 0.04). Serum CK and LDH levels were significantly lower in the RML group than in the saline group (p = 0.03, p = 0.005). Histologically, the RML group demonstrated a significantly lower proportion of muscle damage (p = 0.004) and positivity of 8-OHdG (p = 0.01). RML attenuated muscle damage and demonstrated protective effects against motor dysfunction after limb ischemia-reperfusion injury by reducing free radical-induced DNA damage. RML can be a novel therapeutic agent that attenuates ischemia-reperfusion injury after acute limb ischemia.

Prevalence of Upper Extremity Volleyball Injuries Within Different Adult Age Groups: A Comprehensive Analysis of National Data From 2013-2022.

The mean age of volleyball athletes has increased over the past decade, raising concerns about musculoskeletal injuries. There is no literature on how different mechanisms of injury (MOI) affect different adult age groups. To evaluate epidemiologic trends, diagnoses, and mechanisms of volleyball-related upper extremity injuries within different adult age groups. Descriptive epidemiology study. Data from the National Electronic Injury Surveillance System for volleyball-related upper extremity injuries in patients aged between 19 and 79 years, between January 1, 2013, and December 31, 2022, were analyzed. Data included body parts, diagnosis, MOI, and disposition. Calculations used corresponding hospital sample weights for national estimates (NEs). Patients were divided into either 20-39, 40-59, or 60+ years age groups. Linear regressions were used to analyze annual trends, chi-square tests were used to analyze categorical variables, and the Holm P value adjustment method was utilized in post hoc analysis. A weighted NE of 41,164 volleyball-related upper extremity injuries occurred in the study period. The mean age was 35.8 ± 14 years, and male patients constituted 49.4% of all patients. The most injured body parts of all age groups were fingers (33.2%), shoulders (28.9%), and wrists (16%). The most common identifiable MOI were impacts with the floor (24%), impacts with the ball (18.7%), and spikes/serves (6.9%). The 20-39 age group experienced shoulder dislocations at the greatest rate of all age groups (NE = 3362 [37%]) and sustained injuries from spike/serve movements at the greatest rates (NE = 2214 [8.2%]; P < .01). Of the 3362 shoulder dislocations in the 20-39 age group, 1445 (43%) were during spikes/serves. The 60+ age group had the greatest rates of sprains/strains (NE = 1353 [41.1%]). Additionally, the 60+ age group suffered from injuries secondary to impacts on the floor (NE = 1242 [37.7%]) and impacts with the ball (NE = 769 [23.4%]) at the greatest rates (P < .01). Our study demonstrated that adult populations are at risk for volleyball-related upper extremity injuries, specifically affecting the finger, wrist, and shoulder. MOI among age groups differed, as younger adults more often sustained injuries from dynamic movements, whereas older adults sustained injuries from trauma.

Cross-cultural adaptation, reliability and validity of the persian version of the functional assessment scale for acute hamstring injuries

BackgroundThe Functional Assessment Scale for Acute Hamstring Injuries (FASH) which measure symptom’s severity and impact on physical activity and sports ability in individuals with acute hamstring muscle injury, is not available in Persian. The aim of this study was to translate and cross-culturally adapt the FASH questionnaire to Persian and to assess the psychometric properties of the translated version.MethodsThe Persian-translation and cross-cultural adaptation processes were based on World Health Organization method. A total of 160 participants compromising of four groups: (1) acute hamstring injury (N = 40), (2) other lower extremity injury (N = 40), (3) risk of acute injury (N = 40), and (4) healthy control (N = 40) were recruited to complete the Persian version of FASH (FASH-P) questionnaire twice with an interval of 48–60 h. The Short Form Health Survey (SF-36) and Lower Extremity Functional Scale (LEFS) were used to assess the criterion validity. Test-retest reliability, internal consistency, criterion validity, Dimensionality and floor/ceiling effects were evaluated to assess the FASH-P psychometric properties.ResultsThe FASH questionnaire were translated to Persian without any major problems. The FASH-P showed excellent power of differentiation because the scores were significantly different among the four groups. Regarding psychometric performances, excellent test–retest reliability (Intraclass correlation coefficient of 0.997) and a high level of internal consistency (Cronbach’s alpha of 0.966) were observed. The FASH-P total score was significantly correlated with SF-36 and LEFS questionnaires representing an excellent criterion validity. No floor or ceiling effect were found for total score in Hamstring muscle injury group.ConclusionsDue to the excellent psychometric performance, the FASH-P can be used as a reliable and valid tool for evaluating the severity of symptoms and sports ability in Persian-speaking patients with hamstring muscle injury.

Insights Into the Epidemiology of Peripheral Nerve Injuries in the United States: Systematic Review.

Peripheral nerve injuries (PNI) range from mild neurapraxia to severe transection, leading to significant morbidity. Despite their impact, the societal implications of PNI in the United States are not well understood. This study aims to systematically review the literature on PNI epidemiology in the United States. We hypothesize that this review will reveal significant gaps in the understanding of PNI incidence, demographics, and economic impact. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we queried the literature for studies on PNI that reported at least one of the following: incidence rates, demographics, affected nerve distribution, injury mechanisms, surgical intervention rates, and associated direct costs. Exclusion criteria included non-English publications, abstracts, conference proceedings, reviews, or editorials, studies published before 2000, non-US studies, or studies focusing solely on digital nerves or plexus injuries. Fifteen studies met the inclusion criteria. Data indicate a higher incidence of upper extremity nerve injuries compared with lower extremity injuries. The literature lacks comprehensive reporting on surgical intervention rates, with no recent data since 2013. There is a notable absence of nationwide epidemiological data on PNI mechanisms and recent cost data, with most information over a decade old and primarily focused on inpatient costs, neglecting outpatient visits, physical therapy, and medication expenses. The epidemiological data on PNI are limited and outdated, highlighting the need for further research. Future studies should focus on recent trends in PNI incidence, injury mechanisms, and financial burden, including comprehensive reporting on surgical interventions, to inform strategies aimed at improving patient outcomes and health care resource allocation.

The effects of telehealth running gait retraining on biomechanics, pain, and function in patients with lower extremity injuries: A randomized clinical trial

BackgroundIn-clinic gait retraining has been effective in modifying suspected biomechanical risk factors for running injury, but its feasibility is often limited by multiple clinic visits. This randomized clinical trial investigated the effects of a telehealth-based gait retraining intervention on running biomechanics, pain, and function in previously injured runners. MethodsTwenty-three participants recovering from lower extremity injuries were randomized to a control or intervention group. The intervention group completed 4 to 6 telehealth gait retraining sessions over 8 to 10 weeks, consisting of visual and verbal cues to transition to a non-rearfoot strike pattern and increase step rate. The control group received standard physical therapy. Biomechanics, pain, and function were assessed pre- and post-intervention using a 2 × 2 mixed model analysis of variance. FindingsHalf of the participants (55 %) in the intervention group successfully transitioned to a non-rearfoot strike pattern. No significant differences were observed between groups in step rate, biomechanics, or function. A significant group-by-time interaction for pain was observed (F = 10.55, P = 0.004), with the intervention group reporting greater reductions in pain compared to the control group (mean difference 2.52, 95 % CI 0.91 to 4.12). InterpretationDespite only half of participants adopting the desired gait pattern, telehealth gait retraining may offer a low-risk, accessible, and convenient alternative for select patients who lack in-person care options or have not responded to other pain reduction methods when returning to running from a lower extremity injury.

Integrating Motion Intention and Impedance Control in Teleoperated Robotic Rehabilitation for Upper Extremity Disorders

Abstract Due to the global pandemic in 2020, rehabilitation services had to adapt to virtual care to meet the needs of patients with a diversity of upper extremity disorders and injuries, from simple fingertip injuries to replanted extremities, while mitigating the spread of COVID-19. For patients who require occupational therapy in their rehabilitation, teleoperated robotic care can fulfill this need. Moreover, some clinical studies show that incorporating the active intention of patients into rehabilitation training enhances the effectiveness of therapies. This research aims to develop a bilateral impedance controller with a Franka Emika 7 DOF (degree-of-freedom) articulated robot using MATLAB, facilitating upper limb occupational therapy. Through this setup, the Franka robot will lead patients through various therapeutic exercises based on their motion intention, such as a pick-and-place exercise. The exercises’ efficacy is assessed through evaluations of torque, muscle strength, and jerking performance. During patients’ rehabilitation exercises with the Franka Robot, we anticipate observing decreased muscle activity alongside a smooth, assist-as-needed trajectory. This method will allow a patient to perform complex movements essential for daily activities quicker than traditional occupational therapy.

Patterns of orthopedic injuries associated with increasing e-scooter-related trauma: A retrospective observational study with a 4-year evaluation from a tertiary center in Istanbul, Turkey.

The increasing use of electric scooters (e-scooters) has been accompanied by an increase in the number of traumas. Noncompliance with regulations and the effectiveness of legal measures remain subjects of ongoing debate. This study aimed to investigate the demographic characteristics of patients with e-scooter-related orthopedic injuries, temporal distribution of trauma, and patterns of these injuries. We retrospectively evaluated 534 patients with e-scooter-related injuries who were referred to the Department of Orthopedics and Traumatology between January 2020 and October 2023. Variables such as patient sex, age, time of trauma, type of hospital transfer, mechanism of trauma, injury location and type, accompanying head trauma in extremity injuries, and treatment approach were recorded. Temporal analysis was performed by hour, day, month, season, and weekday versus weekend. The majority of patients were male (80.0%), with injuries most common in the 25 to 39 age group (33.7%). Trauma was frequent in the summer (45.7%), especially in July (16.5%), with most hospital visits occurring on Fridays (18.2%) and weekends (32.2%). Blunt soft tissue injuries (47.3%) and fractures (42.4%) were prevalent, particularly in the elbow (18.4%), wrist (16.9%), and knees (14.3%). A total of 247 fractures were identified, with the radial head (17.0%) and distal radius (10.9%) being the most common fractures. Fracture rates have increased in 2022 and 2023 compared to those in previous years. While 86.0% of patients received nonsurgical treatment, 14.0% underwent surgery, with a rise in surgical cases in 2022 and 2023. Elbow (19.0%), knee (16.7%), and wrist (16.7%) were the most frequent surgical sites. The increasing use of e-scooters among young people has increased trauma cases, with a growing proportion of fractures over time. The higher incidence of injuries, particularly in the elbow and knee joints, underscores the importance of protective equipment. Therefore, additional legal regulations can help to prevent such injuries.