Risk Of Injury Research Articles

Intraoperative fluid management is not predictive of AKI in major pancreatic surgery: a retrospective cohort study

BackgroundPancreatic surgery is associated with a significant risk for acute kidney injury (AKI) and clinically relevant postoperative pancreatic fistula (CR-POPF). This investigation evaluated the impact of intraoperative volume administration, vasopressor therapy, and blood pressure management on the primary outcome of AKI and the secondary outcome of a CR-POPF after pancreatic surgery.MethodsThis retrospective single-center cohort investigated 200 consecutive pancreatic surgeries (January 2018–December 2021). Patients were categorized for the presence/absence of AKI (Kidney Disease Improving Global Outcomes) and CR-POPF. After univariate analysis, multivariable models were constructed to control for the univariate cofactor differences in the primary and secondary outcomes.ResultsAKI was identified in 20 patients (10%) with significant univariate differences in demographics (body mass index and gender), comorbidities, indices of chronic renal insufficiency, and an increased AKI Risk score. Surgical characteristics, intraoperative fluid, vasopressor, and blood pressure management were similar in patients with and without AKI. Patients with AKI had increased blood loss, lower urine output, and packed red blood cell administration. After multivariate analysis, male gender (OR = 7.9, 95% C.I. 1.8–35.1) and the AKI Risk score (OR = 6.3, 95% C.I. 2.4–16.4) were associated with the development of AKI (p < 0.001). Intraoperative and postoperative volume, vasopressor administration, and intraoperative hypotension had no significant impact in the multivariate analysis. CR-POPF occurred in 23 patients (11.9%) with no significant contributing factors in the multivariate analysis. Patients who developed AKI or a CR-POPF had an increase in surgical complications, length of stay, discharge to a skilled nursing facility, and mortality.ConclusionIn this analysis, intraoperative volume administration, vasopressor therapy, and a blood pressure < 55 mmHg for more than 10 min were not associated with an increased risk of AKI. After multivariate analysis, male gender and an elevated AKI Risk score were associated with an increased likelihood of AKI.

Predicting functional movement capacity in adults: the effect of range of motion and isometric strength

The aim of the study was to determine the role of isometric strength and range of motion in predicting Functional Movement Screen (FMS) scores of adults. A total of 120 participants (age = 34.62 ± 11.82 years; height = 170.56 ± 9.63 cm; weight = 73.62 ± 15.39 kg) volunteered to participate in the study. Anthropometric measurements were performed, including height, body weight, muscle mass, and body fat. Following this, the ranges of motion of the shoulder, hip, knee, and ankle joints were measured sequentially. Isometric strength and FMS tests were then performed. Hip extension isometric strength explained 23% of the variation in FMStotal. The common effect of knee flexion, shoulder flexion, and dorsiflexion joint range of motion explained 34% of the change in FMStotal (F (3−116) = 20.375, p < 0.001). A significant relationship (R = 0.658, R2 = 0.413) was found between hip extension isometric strength, knee flexion, shoulder flexion, and dorsiflexion range of motion and FMStotal (F (4−115) = 21.952, p < 0.001). The common effect of all these variables explains 43% of the change in FMStotal. The results indicate that the FMS test scores, which are utilized to evaluate the risk of injury in sedentary adults, can be significantly predicted by the effect of hip extension isometric strength and parameters related to knee flexion, shoulder flexion, and dorsiflexion joint range of motion. At this time, it is advised that range of motion and isometric strength be taken into account when determining a person’s functional movement capacity.

Monkey Bar-Associated Pediatric Fractures: A National Epidemiologic Study of Emergency Department Visits.

Emergency department (ED) visits because of pediatric fractures are not only burdensome for patients and their families but also result in an increased healthcare expenditure. Almost half of all children experience at least one fracture by the age of 15. Many fractures occur in playgrounds, with monkey bars and other climbing apparatuses noted as frequent mechanisms of injury. Our purpose was to identify the pattern of injury and the population sustaining monkey bar-associated fractures. We queried the National Electronic Injury Surveillance System database for all monkey bar-associated injuries in patients aged 0 to 18 years from January 1, 2009, to December 31, 2019. We described demographic data, patient disposition from the ED, fracture pattern, and injury setting using unweighted and weighted estimates. Weighted results that more closely reflect national estimates were calculated. During the study period, 30,920 (862,595 weighted) monkey bar-associated injuries presented to EDs; 16,410 (53.1%) (weighted injuries: 408,722 [47.4%]) were fracture injuries. The average age of kids sustaining fractures was 6.5 years, with most injuries (66.4%) occurring in kids between 6 and 12 years. A higher percentage of male patients presented to the ED with fractures compared with female patients (53% versus 47%). Upper extremity fractures were most common, 382,672 (94%) with forearm fractures constituting the majority (156,691 [38%]). Most children were treated and released (354,323 [87%]), with only 35,227 children (9%) being admitted for treatment. Places of recreation/sports were the most common setting of fractures (148,039 [36%]), followed by schools (159,784 [39%]). A notable association was observed between year and ethnicity and between month period and injury setting. Monkey bar-associated injuries are a major cause of upper extremity fractures in children, with most injuries occurring in recreational areas or schools. Young elementary school children are at the highest risk of injury. ED visits because of monkey bar-associated fractures have increased over the study period, and these injuries continue to be a major cause of fractures in children. Additional measures should be installed to decrease these preventable fractures among children, with schools as a potential starting point.

The role of the pressure in the endotracheal tube cuff in the development of iatrogenic tracheal injuries

Background. The endotracheal tube insertion, which is a veritable patient care procedure, carries risks and possible adverse effects. Such complications vary in severity and range from mild symptoms such as sore throat or cough, which are often considered normal post-intubation events, to severe damage, including damage to the vocal cords, trachea, malacia, and fistula formation. A critical factor influencing the manifestation of these complications is the pressure exerted by the endotracheal tube cuff on the trachea. The purpose was to study the influence of high pressure of the intubation tube cuff on the incidence and severity of complications in an in vivo model. Materials and methods. A total of 12 rabbits were studied and divided into three groups according to target cuff pressure: 30, 50, and 100 cm H2O. Sevoflurane was used to maintain anesthesia, monitoring of vital functions included heart rate, pulse oximetry, capnography, and electrocardiography. Intubation was performed after induction with ketamine and administration of relaxants, and cuff pressure was measured with a mechanical manometer. The duration of pressure exposure was 20 minutes for each group, then the degree of tracheal damage was assessed by autopsy. Results. Increasing pressure generally leads to an increased risk of injury. In the third group (pressure of 100 cm H2O), all subjects had damage to the trachea, in 75 % of cases, it was a complete tracheal rupture. However, the dependence on pressure is not unambiguous for all types of injuries: the frequency of pneumothorax does not correlate directionally with the incidence of iatrogenic injuries and does not increase proportionally to pressure. So, for example, subcutaneous emphysema developed only in a third of cases of tracheal rupture. This emphasizes possible difficulties in timely diagnosis of this type of complications. Conclusions. The work highlights the risks associated with endotracheal intubation and emphasizes the need to maintain recommended practices and individual approach to each case. The most severe damage was observed at a pressure of 100 cm H2O, while at a pressure of 30 cm H2O, a smaller proportion of rabbits showed signs of damage.

Strength and clinical test combinations enhance predictions of sagittal and frontal plane biomechanics in single-leg landing

ObjectivesTo determine whether clinical screening tests can predict lower limb joint kinematics and kinetics outcomes eliciting anterior cruciate ligament (ACL) injury risk in single-leg landings. DesignCross-sectional study. SettingLaboratory research. ParticipantsTwenty-six professional male futsal athletes. Main outcome measuresParticipants completed the Modified Star Excursion Balance Test (mSEBT), Lateral Step Down (LSD), Lunge, Hop tests, and isometric strength tests for clinical screening of lower extremity injury risk and performed single-leg landings to assess lower extremity 3D kinematics and kinetics outcomes. ResultsmSEBT, LSD, and isometric strength were the more important tests when constructing the prediction models. The predictive power of clinical tests for screening injury risk significantly increases when combined with strength measurements (p = 0.005, f2 = 0.595). We discerned 11 biomechanical predictions, six explicitly related to the sagittal plane's biomechanics. Some predictions were leg-dependent, with muscle strength tests predominantly predicting biomechanical outcomes of the preferred leg. ConclusionCombining clinical screening tests with strength measures enhances ACL injury risk factors prediction during single-leg landings. Clustering at least two tests improves prediction accuracy, aiding injury prevention planning and decision-making.

Which is the role of driver- or passengers-sex on the severity of road crashes?

AimThe aim of the study is to quantify the main ways in which the sex of the driver/occupant of a passenger car affects the severity of road crashes. MethodsAll 171 230 cars occupied by the driver and one or more passengers included in the Spanish Register of Victims of Road Crashes from 2014 to 2020 were included. We designed two cohort studies: In the first one, we estimated the Incidence Rate Ratios (IRR) between the sex of the drivers and the occurrence of any death and/or severe injuries among their passengers. In the second one we estimated the conditioned IRR between the sex of the occupants of the same car and their risk of death and/or severe injuries. We used fixed Poisson models to obtain IRR estimates, crude and adjusted by individual- environment- and vehicle-related variables. ResultsA consistent inverse relationship between driver's female sex and passenger's severity was found, (IRR 0.72, 95 % CI 0.68–0.77), stronger for single crashes (IRR 0.67, 95 % CI 0.60–0.65). The magnitude decreased after adjusting for vehicle- and environment-related variables (IRR 0.82, 95 % CI 0.73–0.92). In the second study, the risk of death or hospitalization was higher for occupants of female sex (IRR 1.23, 95 % CI 1.17–1.30). ConclusionsThe risk of death or severe injuries among passengers of cars involved in single crashes is lower for female drivers, probably due to safer driving. On the contrary, in similar crashes, the risk of injuries leading to hospitalization is higher for females.

Risk prediction of kalaemia disturbance and acute kidney injury after total knee arthroplasty: use of a machine learning algorithm

IntroductionTotal knee arthroplasty (TKA) is a procedure associated with risks of electrolyte and kidney function disorders, which are rare but can lead to serious complications if not correctly identified. A routine check-up is very often carried out to assess the seric ionogram and kidney function after TKA, that rarely requires clinical intervention in the event of a disturbance. The aim of this study was to identify perioperative variables that would lead to the creation of a machine learning model predicting the risk of kalaemia disorders and/or acute kidney injury after total knee arthroplasty. HypothesisA predictive model could be constructed to estimate the risk of kalaemia disorders and/or acute kidney injury after total knee arthroplasty. Material and methodsThis single-centre retrospective study included 774 total knee arthroplasties (TKA) operated on between January 2020 and March 2023. Twenty-five preoperative variables were incorporated into the machine learning model and filtered by a first algorithm. The most predictive variables selected were used to construct a second algorithm to define the overall risk model for postoperative kalaemia and/or acute kidney injury (K+ A). Two groups were formed of K+ A and non-K+ A patients after TKA. A univariate analysis was performed and the performance of the machine learning model was assessed by the area under the curve representing the sensitivity of the model as a function of 1 - specificity. ResultsOf the 774 patients included who had undergone TKA surgery, 46 patients (5.9%) had a postoperative kalaemia disorder requiring correction and 13 patients (1.7%) had acute kidney injury, of whom 5 patients (0.6%) received vascular filling. Eight variables were included in the machine learning predictive model, including body mass index, age, presence of diabetes, operative time, lowest mean arterial pressure, Charlson score, smoking and preoperative glomerular filtration rate.Overall performance was good with an area under the curve of 0.979 [CI95% 0.938 - 1.02], sensitivity was 90.3% [CI95% 86.2 - 94.4] and specificity 89.7% [CI95% 85.5 - 93.8]. The tool developed to assess the risk of impaired kalaemia and/or acute kidney injuryafter TKA is available on https://arthrorisk.com. ConclusionThe risk of kalaemia disturbance and postoperative acute kidney injury after total knee arthroplasty could be predicted by a model that identifies low-risk and high-risk patients based on eight pre- and intraoperative variables. This machine learning tool is available on a web platform accessible for everyone, easy to use and has a high predictive performance. The aim of the model was to better identify and anticipate the complications of dyskalaemia and postoperative acute kidney injury in high-risk patients. Further prospective multicentre series are needed to assess the value of a systematic postoperative biochemical work-up in the absence of risk predicted by the model. Level of evidenceIV; retrospective study of case series.

PECARN prediction rule for cervical spine imaging of children presenting to the emergency department with blunt trauma: a multicentre prospective observational study.

Cervical spine injuries in children are uncommon but potentially devastating; however, indiscriminate neck imaging after trauma unnecessarily exposes children to ionising radiation. The aim of this study was to derive and validate a paediatric clinical prediction rule that can be incorporated into an algorithm to guide radiographic screening for cervical spine injury among children in the emergency department. In this prospective observational cohort study, we screened children aged 0-17 years presenting with known or suspected blunt trauma at 18 specialised children's emergency departments in hospitals in the USA affiliated with the Pediatric Emergency Care Applied Research Network (PECARN). Injured children were eligible for enrolment into derivation or validation cohorts by fulfilling one of the following criteria: transported from the scene of injury to the emergency department by emergency medical services; evaluated by a trauma team; and undergone neck imaging for concern for cervical spine injury either at or before arriving at the PECARN-affiliated emergency department. Children presenting with solely penetrating trauma were excluded. Before viewing an enrolled child's neck imaging results, the attending emergency department clinician completed a clinical examination and prospectively documented cervical spine injury risk factors in an electronic questionnaire. Cervical spine injuries were determined by imaging reports and telephone follow-up with guardians within 21-28 days of the emergency room encounter, and cervical spine injury was confirmed by a paediatric neurosurgeon. Factors associated with a high risk of cervical spine injury (>10%) were identified by bivariable Poisson regression with robust error estimates, and factors associated with non-negligible risk were identified by classification and regression tree (CART) analysis. Variables were combined in the cervical spine injury prediction rule. The primary outcome of interest was cervical spine injury within 28 days of initial trauma warranting inpatient observation or surgical intervention. Rule performance measures were calculated for both derivation and validation cohorts. A clinical care algorithm for determining which risk factors warrant radiographic screening for cervical spine injury after blunt trauma was applied to the study population to estimate the potential effect on reducing CT and x-ray use in the paediatric emergency department. This study is registered with ClinicalTrials.gov, NCT05049330. Nine emergency departments participated in the derivation cohort, and nine participated in the validation cohort. In total, 22 430 children presenting with known or suspected blunt trauma were enrolled (11 857 children in the derivation cohort; 10 573 in the validation cohort). 433 (1·9%) of the total population had confirmed cervical spine injuries. The following factors were associated with a high risk of cervical spine injury: altered mental status (Glasgow Coma Scale [GCS] score of 3-8 or unresponsive on the Alert, Verbal, Pain, Unresponsive scale [AVPU] of consciousness); abnormal airway, breathing, or circulation findings; and focal neurological deficits including paresthesia, numbness, or weakness. Of 928 in the derivation cohort presenting with at least one of these risk factors, 118 (12·7%) had cervical spine injury (risk ratio 8·9 [95% CI 7·1-11·2]). The following factors were associated with non-negligible risk of cervical spine injury by CART analysis: neck pain; altered mental status (GCS score of 9-14; verbal or pain on the AVPU; or other signs of altered mental status); substantial head injury; substantial torso injury; and midline neck tenderness. The high-risk and CART-derived factors combined and applied to the validation cohort performed with 94·3% (95% CI 90·7-97·9) sensitivity, 60·4% (59·4-61·3) specificity, and 99·9% (99·8-100·0) negative predictive value. Had the algorithm been applied to all participants to guide the use of imaging, we estimated the number of children having CT might have decreased from 3856 (17·2%) to 1549 (6·9%) of 22 430 children without increasing the number of children getting plain x-rays. Incorporated into a clinical algorithm, the cervical spine injury prediction rule showed strong potential for aiding clinicians in determining which children arriving in the emergency department after blunt trauma should undergo radiographic neck imaging for potential cervical spine injury. Implementation of the clinical algorithm could decrease use of unnecessary radiographic testing in the emergency department and eliminate high-risk radiation exposure. Future work should validate the prediction rule and care algorithm in more general settings such as community emergency departments. The Eunice Kennedy Shriver National Institute of Child Health and Human Development and the Health Resources and Services Administration of the US Department of Health and Human Services in the Maternal and Child Health Bureau under the Emergency Medical Services for Children programme.

Pool-Based Surfboard Elicits Activation of Posterior Shoulder Muscles During a Surfing Stroke.

Pexa, BS, Johnston, CD, Elder, EE, Ford, KR, Patterson, MQ, and Myers, JB. Pool-based surfboard elicits activation of posterior shoulder muscles during a surfing stroke. J Strength Cond Res 38(7): 1300-1304, 2024-Surfboard paddling may activate posterior shoulder muscles, which are critical to baseball pitchers' injury risk and performance. The purpose of this study was to measure posterior shoulder muscle activation during different phases of the surf stroke (propulsion vs. recovery) on a pool-based surfboard. Twenty healthy active adult subjects completed a familiarization and testing session with the pool-based surfboard. During the testing session, electromyography (EMG) sensors were placed on 6 posterior shoulder muscles: latissimus dorsi, infraspinatus, posterior deltoid, upper trapezius, middle trapezius, and lower trapezius. Subjects completed 4 laps in a pool at 3 separate resistances (low, moderate, and heavy) in a randomized order. The peak EMG signal during each phase (propulsion and recovery) was recorded. A 2-way within subject ANOVA (resistance-by-phase) with post hoc Bonferroni's corrections was used to identify differences in EMG activation. There was a significant main effect of phase for the latissimus dorsi (F = 91.3, p < 0.001), upper trapezius (F = 36.5, p < 0.001), middle trapezius (F = 33.8, p < 0.001), and lower trapezius (F = 21.6, p < 0.001). The latissimus dorsi demonstrated higher activation during the propulsion phase (p < 0.001), and all trapezius muscles demonstrated higher activation during the recovery phase (p < 0.001). There was a significant main effect of resistance for the posterior deltoid (F = 3.4, p = 0.043), with higher muscle activation in the low resistance trials compared with the heavy resistance trials (p = 0.036). Recreationally active individuals demonstrate activation of the posterior shoulder when using a pool-based surfboard. This pool-based surfboard may be beneficial to activate the posterior musculature and may be more accessible than standard surfing to baseball athletes.

ВЛИЯНИЕ ДЕФИЦИТА ВИТАМИНА Д НА ФИЗИЧЕСКУЮ ФОРМУ И РАБОТОСПОСОБНОСТЬ СПОРТСМЕНОВ

Purpose: Study of the effect of vitamin D deficiency on the physical fitness and performance of athletes, as well as providing up-to-date information on the diagnosis and treatment of this hypovitaminosis. Material and methods: The data of domestic and foreign literature on the effect of vitamin D deficiency on the physical form and performance of athletes were analyzed. The search was carried out using electronic databases MEDLINE, Embase, Scopus, Web of Science, eLIBRARY for the period from 2007 to 2022. For the search, we used keywords and their combinations: “athletes”, “physical performance”, “stress fracture “, “vitamin D”. A total of 33 sources were analyzed. Results: Vitamin D plays an important role in the human body. With its deficiency in athletes, there is an increase in the risk of injury, a decrease in the functional abilities of muscles and an increase in the risk of stress fractures of bones. A prolonged and pronounced deficiency of this vitamin in athletes leads to a deterioration in general well-being, a disruption in the functioning of almost all body systems, a decrease in the level of working capacity and sports performance. The fundamental method of treatment and prevention of vitamin D deficiency in athletes is the correction of lifestyle, training schedule and the use of specialized supplements containing cholecalciferol. Discussion: The required amount of cholecalciferol intake varies from 400 to 2000 IU / day, depending on many factors, including the amount of sun exposure during the day, age, gender, severity of deficiency, ethnicity, etc. Athletes also need to consume sufficient amounts of micro- and macronutrients, especially calcium and magnesium. When taking cholecalciferol, one should take into account the possibility of intoxication, which occurs due to the consumption of excessive amounts of supplements of this vitamin. Conclusions: At the moment, due to the widespread prevalence of vitamin D deficiency in athletes and its negative impact on the health and performance of an athlete, there is a need for more active measures aimed at the timely diagnosis of this hypovitaminosis and its treatment.

Perspectives on reasons why football and handball players sustain acute and severe knee injuries: a mixed-methods concept mapping study

BackgroundThe high incidence of knee injuries in football/handball challenges effective prevention. Identifying tangible and modifiable factors associated with a knee injury may innovate preventive actions. Engaging key stakeholders can reveal...

Comparing the Scores of The Functional Movement Screen™ in Individuals with Low Back Pain versus Healthy Individuals: A Systematic Review and Meta-Analysis.

The Functional Movement Screen™ (FMS™) is widely used to assess functional movement patterns and illuminate movement dysfunctions that may have a role in injury risk. However, the association between FMS™ scores and LBP remains uncertain. The purpose of this systematic review and meta-analysis was to examine functional movement scores among patients with low back pain (LBP) and healthy subjects with no LBP and review the validity of the FMS™ tool for screening functional movement among LBP patients. The systematic review and meta-analysis included papers assessing functional movement among adult patients with LBP using the FMS™ through a literature review of five databases. The search strategy focused used relevant keywords: Functional movement screen AND low back pain. The review included all papers assessing functional movement among LBP adult patients (>18 years old) using the FMS™ published between 2003 to 2023. The risk of bias in the involved studies was evaluated using the updated Cochrane ROB 2 tool. Statistical analysis was conducted using Review Manager software, version 5.4. The meta-analysis included the total FMS™ score and the scores of the seven FMS™ movement patterns. Seven studies were included in this systematic review were considered to have low to unclear risk of bias. The meta-analysis revealed that the LBP group had a significantly lower total FMS™ score than the control group by 1.81 points (95% CI (-3.02, -0.59), p= 0.004). Patients with LBP had a significantly lower score than the control group regarding FMS™ movement patterns, the deep squat (p <0.01), the hurdle step (p <0.01), the inline lunge (P value <0.01), the active straight leg raise (p <0.01), the trunk stability push-up (p=0.02), and the rotational stability screens (p <0.01). Lower scores on the FMS™ are associated with impaired functional movement. Identifying the specific functional movement impairments linked to LBP can assist in the creation of personalized treatment plans and interventions. Further research is needed to assess the association of cofounders, such as age, gender, and body mass index, with the FMS™ score among LBP patients and controls. 1.

The Influence of Sports-Related Concussion on Cognition and Landing Biomechanics in Collegiate Athletes.

Injury surveillance data indicate that collegiate athletes are at greater risk for lower extremity (LE) injuries following sports-related concussion (SRC). While the association between SRC and LE injury appears to be clinically relevant up to 1-year post-SRC, little evidence has been provided to determine possible mechanistic rationales. Thus, we aimed to compare collegiate athletes with a history of SRC to matched controls on biomechanical and cognitive performance measures associated with LE injury risk. Athletes with a history of SRC (n = 20) and matched controls (n = 20) performed unanticipated bilateral land-and-cut tasks and cognitive assessments. Group-based analyses (ANOVA) and predictive modeling (C5.0 decision tree algorithm) were used to compare group differences on biomechanical and cognitive measures. Collegiate athletes with a history of SRC demonstrated approximately six degrees less peak knee flexion on both dominant (p = 0.03, d = 0.71) and nondominant (p = 0.02, d = 0.78) limbs during the land-and-cut tasks compared to controls. Verbal Memory, knee flexion, and Go/No Go total score (C5.0 decision tree algorithm) were identified as the strongest indicators of previous SRC injury history. Reduced knee flexion during sport-specific land-and-cut tasks may be a mechanism for increased LE injury risk in athletes with a history of SRC. There appears to be multiple biomechanical and cognitive predictors for identifying previous SRC in collegiate athletes, providing evidence to support a multifactorial SRC management strategy to reduce future injury risk.

Is There a Relationship Between Grip Strength and Injuries in Professional Baseball Players?

Injuries in professional baseball players have become exceedingly common. Efforts to mitigate injury risk have focused on the kinetic chain, shoulder motion, and so forth. It is unclear whether grip strength is related to injury risk in professional baseball pitchers. The purpose of this study was to determine if grip strength was a risk factor for injury. It was hypothesized that pitchers with weaker grip strength would have a higher likelihood of sustaining a shoulder or elbow injury compared with pitchers with stronger grip strength. Case-control study; Level of evidence, 3. All professional pitchers from a single Major League Baseball organization were included. Dominant and nondominant grip strength were measured after each pitching outing throughout the 2022 season. Injuries over the course of the season were recorded, and data were compared between pitchers who sustained a shoulder or elbow injury and those who did not. Overall, 213 pitchers were included, of whom 53 (24.9%) sustained a shoulder or elbow injury during the season. The mean grip strength for all pitchers was 144.0 ± 20.8 lb (65.3 ± 9.4 kg). The mean dominant-arm grip strength was 142.6 ± 20.8 lb (64.7 ± 9.4 kg) for pitchers who did not sustain a shoulder or elbow injury and 148.2 ± 20.9 lb (67.2 ± 9.5 kg) for pitchers who did sustain an injury, with no significant group difference in grip strength (P > .05). Furthermore, there were no significant differences in change in grip strength over the course of the season between the groups. There was no significant difference in mean grip strength or change in grip strength over the course of a single season between professional baseball pitchers who sustained a shoulder or elbow injury and those who did not.

Task-specific differences in lower limb biomechanics during dynamic movements in individuals with chronic ankle instability compared with controls

BackgroundChronic ankle instability (CAI) has been associated with lower limb deficits that can lead to altered biomechanics during dynamic tasks. There have been contradictory findings in terms of ankle and hip joint biomechanics to date, influenced by the variety of movement tasks and varying definitions of the CAI condition. Research QuestionHow do biomechanical variables of the lower extremity differ during walking, running, and jump-landing in individuals with CAI compared with those without CAI? MethodsThirty-two individuals (17 CAI and 15 controls) participated in this retrospective case-control study. Sagittal and frontal plane ankle and hip joint angles and moments, and mediolateral foot balance (MLFB) were calculated during the tasks. Statistical parametric mapping (SPM) was used for the whole trajectory analysis to detect group differences. Discrete variables, including initial contact (IC) and peak angles and moments, were additionally compared. ResultsNo differences were found between groups during walking. During running, the CAI group exhibited a lower plantar flexor moment (p < 0.001) and more laterally deviated MLFB (p = 0.014) during mid-stance when compared to controls. Additionally, participants with CAI had a significantly greater peak plantar flexion angle in early stance (p = 0.022) and a reduced peak plantar flexor moment (p = 0.002). In the jump-landing, the CAI group demonstrated an increased hip extensor moment (p = 0.008), and a greater peak hip adduction angle (p = 0.039) shortly after ground contact compared to the control group. SignificanceDifferences in ankle and hip biomechanics were observed between groups during running and jump landing, but not during walking. These differences may be indicative of impairments in the sensorimotor system or of learnt strategies adopted to try to minimise instability and injury risk and can help to inform future intervention design.

Risk of acute kidney injury after lower urinary tract reconstruction with early NSAID therapy: A propensity matched retrospective analysis

The opioid epidemic response led to increased use of postoperative, non-opioid analgesia. Some pediatric urologists do not routinely use non-steroidal anti-inflammatory drugs (NSAIDs) for fear of causing acute kidney injury (AKI). While previous studies have demonstrated the safety and efficacy of NSAIDs in children, safety after lower urinary tract reconstruction has not been well characterized. ptUsing the Kidney Disease: Improving Global Outcomes (KDIGO) criteria for AKI (increase in creatinine ≥0.3mg/dL or increase in creatinine ≥1.5x baseline or urine output <0.5mL/kg/hr for 6h), we hypothesized there would be a difference in the incidence of postoperative AKI between patients who did and did not receive NSAIDs following surgery. Patients 2-18 years old who underwent lower urinary tract reconstruction (i.e., bladder augmentation and/or creation of a catheterizable channel) from 2009 to 2021 and had documented urine output were retrospectively reviewed. Chronic kidney disease (CKD) stage was calculated from creatinine and cystatin C within 6 months of surgery using the CKiD U25 equations. Patients who received NSAIDs were propensity matched on 11 characteristics with patients undergoing similar surgeries who did not receive NSAIDs. The primary outcome was incidence of AKI within 48h of surgery. The unmatched cohorts included 243 patients. Propensity matching identified 166 patients in the NSAID arm and 41 in the no NSAID arm. 26 patients with CKD stage 2-3 were included. There was no significant difference in the incidence of postoperative AKI based on any KDIGO criteria (17.1% no NSAID versus 16.3% NSAID, p=0.87). Median postoperative opioids fell from 0.88mg/kg in the no NSAID arm to 0.37mg/kg morphine equivalents in the NSAID arm, although this was not statistically significant. Log-rank testing by Kaplan-Meier analysis demonstrated no difference in time to incidence of low urine output between the groups (p=0.32). In the whole population not stratified by NSAID use, no differences were seen in AKI between those with and without CKD (16.7% with versus 17.9% without CKD). There was no difference in the incidence of postoperative AKI among patients who did and did not receive NSAIDs after lower urinary tract reconstruction, excluding those with advanced CKD. These results support that postoperative NSAIDs were an unlikely source of AKI. However, AKI remained a risk following these surgeries, regardless of NSAID use, likely owing to underlying disease, longer operations, and fluid shifts.

Full-Endoscopic Posterior Lumbar Interbody Fusion: A Review and Technical Note

Remarkable innovations in spinal endoscopic surgery have broadened its applications over the past 20 years. Full-endoscopic fusions have been widely reported, and several full-endoscopic approaches for interbody fusion have been published. In general, full-endoscopic lumbar interbody fusion (LIF) is called Endo-LIF, and facet-preserving endo-LIF through the transforaminal route is called trans-Kambin’s triangle LIF, which has a relatively longer history than facet-sacrificing endo-LIF via the posterolateral route. Both approaches can reduce intraoperative and postoperative bleeding. However, there is a higher risk of subsidence and exit nerve root injury. There is no direct decompression in either of the interbody fusions, and additional decompression is required if there is severe lumbar bony canal stenosis. However, the posterior interlaminar approach, which is a well-known standard in full-endoscopic spine surgery, has rarely been applied in the field of endoscopic lumbar fusion surgery. Full-endoscopic posterior LIF (FE-PLIF) via an interlaminar approach can accomplish direct decompression of bony canal stenosis and safe interbody fusion. FE-PLIF via an interlaminar approach demonstrated a longer operation time, less blood loss, and shorter hospitalization duration than minimally invasive transforaminal LIF. FE-PLIF, which can accomplish direct decompression for bony spinal canal stenosis, is superior to other Endo-LIFs. However, FE-PLIF requires technical dexterity to improve efficiency and reduce technical complexity.

Thirty-Day Surgical Morbidity and Mortality in Pelvic and Acetabular Fracture Patients Presenting to a Tertiary Care Hospital in Karachi, Pakistan.

Pelvic fractures, encompassing a spectrum from minor to life-threatening injuries, pose challenges in trauma management. This study focuses on short-term outcomes, exploring morbidity and mortality within 30 days postoperative, among pelvic fracture patients at a tertiary care hospital in Karachi, Pakistan. The majority of pelvic injuries result from intense blunt trauma, with associated risks of concomitant injuries. Pelvic fractures are linked to early complications such as hemorrhage, thromboembolism, and infections, influencing mortality rates. A prospective cohort study involving 53 surgically managed pelvic fracture patients was conducted at Aga Khan University Hospital, Karachi. Variables such as age, gender, comorbidities, mechanism of injury, associated injuries, and presenting vitals were documented. Thirty-day morbidity included surgical site infections, hemorrhagic shock, nerve injuries, and others. Statistical analyses assessed associations between patient characteristics and morbidity. The study revealed a median age of 37 years, with 77% male patients. Most fractures result from motor vehicle accidents. Morbidity occurred in 31.6% of cases, primarily associated with the presence of associated injuries. Postoperative complications included neurological deficits (15.1%) and pulmonary complications (9.4%). No 30-day mortality was reported. The study highlights the importance of a multidisciplinary approach in managing pelvic fractures, emphasizing the association between associated injuries and postoperative morbidity. Comorbidities did not significantly impact morbidity, emphasizing the traumatic nature's independent contribution. Timely presentation (median 20 hours) and efficient trauma systems are crucial for optimal outcomes. This research contributes insights into short-term outcomes following pelvic fracture fixation in a Pakistani tertiary care setting. By exploring a range of parameters, the study emphasizes the need for comprehensive management strategies to minimize complications and improve patient outcomes. Bridging critical knowledge gaps, this research informs clinical decision-making for pelvic fracture patients in this region.

Impact of Calcium Phosphate Product on Acute Kidney Injury and Mortality: A Retrospective Cohort Study.

This study aims to assess the association between admission-corrected serum calcium phosphate (CaPO4) levels and the risks of in-hospital acute kidney injury (AKI) and mortality, hypothesizing a dose-dependent relationship between serum CaPO4 concentrations and the likelihood of developing AKI. This large retrospective cohort study analyzed hospitalized adult patients who had serum calcium, phosphate, and albumin levels measured within 24 hours of admission between January 2014 and December 2018. Piecewise regression was employed to identify the optimal CaPO4 cutoff values for predicting in-hospital AKI and mortality. Subsequently, the odds ratios (ORs) and 95% confidence intervals (CIs) were calculated to assess the risks of in-hospital AKI and mortality associated with these cutoff values. A total of 2,116 patients were included in the study. The incidence rates of AKI for patients with CaPO4 levels ≤27 and >27 mg2/dL2 were 9.6% and 10.9%, respectively. The bilinear association pattern revealed the lowest risk of AKI at a CaPO4 level of 27 mg2/dL2. Piecewise regression analysis showed that each 1 mg2/dL2 increase in CaPO4 level above the 27 mg2/dL2 cutoff was associated with increased risks of in-hospital AKI and mortality, with OR of 1.048 (95% CI: 1.030-1.065) and 1.048 (95% CI: 1.032-1.065), respectively. Our findings indicate a critical relationship between elevated serum CaPO4 levels and increased risks of in-hospital AKI and mortality, with a notable cutoff at CaPO4 >27 mg2/dL2.

Robot-assisted Exploration of the Alcock Canal: A Novel Surgical Technique

ObjectiveTo demonstrate a safe and reproducible surgical approach to the Alcock canal with a full decompression of the pudendal nerve. SettingPudendal neuralgia, a condition causing debilitating pelvic pain, is traditionally managed through a trans-gluteal incision.1-2 This surgical approach offers limited visualization and ability for nerve decompression.3 With the current technique, a full exposure and decompression of the pudendal nerve was achieved. ParticipantsA 44-year-old para 2 with symptoms of left pudendal neuralgia. InterventionsA 44-year-old para 2 presented with burning vaginal pain radiating to the left groin that was aggravated with sitting. She underwent a robotic-assisted left sacrospinous ligament transection and fasciotomy of the obturator internus muscle for suspected pudendal neuralgia. The surgery was performed with three robotic ports using the daVinci® Xi robotic system. ConclusionWith the enhanced access to the pudendal nerve provided by the novel surgical technique demonstrated in this study, a more comprehensive nerve decompression can be performed. This technique was successfully applied to a patient with pudendal neuralgia. There were no immediate intra-operative or post-operative complications. In short-term follow-up, the patient had significant relief of preoperative symptoms. While all surgical procedures for pudendal neuralgia have a risk of pudendal nerve and vessel injury,4 the presented technique has the potential to limit these risks by providing an enhanced view of the relevant anatomy. Future adaptation and refinement of this technique may contribute to the advancement of the surgical management of pudendal neuralgia.