Leg Injuries Research Articles

Piperacillin-tazobactam fixed dose combination induced skin reaction in a patient with split thickness skin grafting: a case report

Piperacillin is a semi-synthetic ureido-penicillin. It has a broad spectrum against gram negative bacilli particularly P. aeruginosa. It is one of the most broadly active of the currently available penicillin with regard to other bacterial species like proteus, klebsiella, H. influenzae and gonococci. Tazobactam is β-lactamase inhibitor and combined with piperacillin to increase spectrum of the drug. Patient was 25 years old female, admitted in orthopaedic department for treatment of traumatic leg injury of left limb. Leg was amputated in the accident, so after 1-month split thickness skin grafting was done at plastic surgery department. For prophylaxis piperacillin-tazobactam IV 4.5 gm 8 hourly given, on 2nd post operative day patient reported rashes on neck, trunk, both upper and lower extremities, sparing the mucous membrane. Patient was prescribed anti pruritic and anti-allergic medication for ADR management. It is necessary to use such kind of drugs cautiously in patients whose health is deteriorated by this medication.

Differences in Player Performance and Longevity After Achilles Tendon Rupture Between Professional Basketball Players in the NBA and WNBA.

Prior studies in the National Basketball Association (NBA) and Women's National Basketball Association (WNBA) reported worse player performance after Achilles tendon rupture (ATR). The purpose of this study was to compare time to return to play (RTP) and performance after ATR between NBA and WNBA athletes. It was hypothesized that there would be no relative difference between the NBA and WNBA players. Cohort study; Level of evidence, 3. ATRs in the NBA between 1987 and 2017 and WNBA between 2006 and 2017 were identified through a rigorous online search of articles. Included athletes had no prior leg injuries and had played ≥3 seasons before and after ATR. Sex, age, position, body mass index, height, years of experience, time to RTP, and player efficiency rating (PER) were recorded. Relative performance was measured by matching injured athletes to uninjured controls in the same league in a 1:2 ratio. Relative differences were compared between leagues, with adjustment for baseline features. Multiple regression analysis was employed to identify variables correlating with RTP and PER. Included were 102 professional basketball players, of whom 34 sustained ATR (21 male, 13 female). Sex/league correlated with differences in RTP (P < .001). There was a significant difference between the WNBA and NBA in PER when comparing 1 year pre- and 1 year postinjury (1.49 ± 0.25 vs 3.87 ± 0.43, respectively; mean ± SD P < .001). Compared with intraleague controls, the relative difference in PER postinjury was 0.81 ± 0.11 (WNBA) and 3.9 ± 0.89 (NBA) (P < .001). Multiple regression analysis indicated that when controlling for years of experience, player position, and age, NBA players took 126 days longer than WNBA players to RTP (P < .001) and NBA players had 9.96 times increased odds of taking >200 days to RTP compared with WNBA players (P = .006). Sex/league was a significant predictor of RTP after ATR. When compared with their respective controls, NBA players saw a greater decrease in postinjury performance than WNBA players. NBA players took longer to RTP than WNBA players. ATRs appear to more negatively affect NBA players than WNBA players.

A New ‘Stockholm Syndrome’: Physical Impairment and Hospital Confinement as Post-Holocaust Sequelae in Ilona Karmel’s Stephania

Ilona Karmel was a Holocaust victim. She endured diseases, Nazi ‘madness’, and imprisonment in the Krakow Ghetto and in concentration camps in Poland and Germany. At the end of World War II, she was abandoned to die by the retreating German enemy. Nevertheless, Victory Day in 1945 saw the beginning of another period of infirmity and confinement for Karmel, who was hospitalized in Sweden to treat leg injuries she had suffered by the Nazis. This essay, bringing together disability and Holocaust studies, explores harrowing post-Shoah sequelae in Karmel’s life, as reflected in Stephania (1953). To recover her sense of self after the bloodletting and to make visible physical impairment in her novel, Karmel creates the fictional Stephania: A Polish patient with spinal curvature worsened during wartime captivity who seeks medical treatment in Stockholm, all the while refusing to accept her body’s disfigurement. This article examines how disability and voluntary hospital confinement are portrayed in the novel Stephania and connected with Holocaust trauma. Despite memories of pain and incarceration invading their minds as survivors, Karmel and her creation Stephania inescapably must come to terms with their respective postwar impairments, heal from their emotional wounds, and cling to life during and beyond their convalescences.

Female Collegiate Gymnasts’ Perceptions and Beliefs on Preventative Training Programs

Gymnastics has the highest injury rate of all women’s collegiate sports, most occurring to the lower extremity. Preventative training programs (PTPs) effectively reduce lower-extremity injury rates. This study aimed to determine the perceptions and beliefs of female collegiate gymnasts regarding PTPs. Participants reported that they would be more likely to participate in a PTP if it resulted in fewer injury risk factors (p &lt; .001), less likely to suffer an anterior cruciate ligament injury (p &lt; .001), and fewer leg injuries (p &lt; .001). Marketing and education of PTPs should be targeted and focus on what is most important to stakeholders to increase compliance.

Time series generative adversarial network for muscle force prognostication using statistical outlier detection

AbstractMachine learning approaches, such as artificial neural networks (ANN), effectively perform various tasks and provide new predictive models for complicated physiological systems. Examples of Robotics applications involving direct human engagement, such as controlling prosthetic arms, athletic training, and investigating muscle physiology. It is now time for automated systems to take over modelling and monitoring tasks. However, there is a problem with the massive amount of time series data collected to build accurate forecasting systems. There may be inconsistencies in forecasting muscle forces due to the enormous amount of data. As a result, anomaly detection techniques play a significant role in detecting anomalous data. Detecting anomalies can help reduce redundancy and free up large storage space for storing relevant time‐series data. This paper employs several anomaly detection techniques, including Isolation Forest (iforest), K‐Nearest Neighbour (KNN), Open Support Vector Machine (OSVM), Histogram, and Local Outlier Factor (LOF). These techniques have been used by Long Short‐Term Memory (LSTM), Auto‐Regressive Integrated Moving Average (ARIMA), and Prophet models. The dataset used in this study contained raw measurements of body movements (kinematics) and the forces generated during walking (kinetics) of 57 healthy people (29 Female, 28 Male) without walking abnormalities or recent leg injuries. To increase the data samples, we used TimeGAN that generates synthetic time series data with temporal dependencies, aiding in training robust predictive models for muscle force prediction. The results are then compared with different evaluation metrics for five different samples. It is found that anomaly detection techniques with LSTM, ARIMA, and Prophet models provided better performance in forecasting muscle forces. The iforest method achieved the best Pearson's Correlation Coefficient (r) of 0.95, which is a competitive score with existing systems that perform between 0.7 and 0.9. The methodology provides a foundation for precision medicine, enhancing prognostic capability over relying solely on population averages.

PATH-2 TRIAL: PLATELET-RICH PLASMA FOR ACUTE ACHILLES TENDON RUPTURE. TWO-YEAR FOLLOW-UP OF THE RANDOMIZED, PLACEBO-CONTROLLED, SUPERIORITY TRIAL

BackgroundThe PATH-2 trial found no evidence of a benefit of Platelet Rich Plasma (PRP) injection versus a placebo after Achilles tendon rupture (ATR) at six-months. ATR often leave longer-term functional deficiencies beyond six-months. This study aim is to determine if PRP affect tendon functional outcomes at two-years after rupture.Study designRandomised multi-centre two-arm parallel-group, participant- and assessor-blinded, superiority trial.MethodsAdults with acute ATR managed non-surgically were recruited in 19 UK hospitals from 2015 to 2019. Exclusions were insertion or musculotendinous injuries, leg injury or deformity, diabetes, haematological disorder, corticosteroids and anticoagulation therapy. Participants were randomised via an online system 1:1 to PRP or placebo. Primary outcome was Achilles Tendon Rupture Score (ATRS) at two-years. Secondary outcomes were pain, Patient-Specific Functional Scale (PSFS), SF-12 and re-rupture. Assessors were blinded. Intention-to-treat and Compliance Average Causal effects (CACE) analyses were carried out. Consistency of effects across subgroups age, BMI, smoking and gender were assessed using Forest plots. Pearson's correlation was used to explore ATRS correlation with blood and growth factors.Results216/230 (94%) participants completed the 6-months follow-up were contacted. 182/216 (84%) completed the two-year follow-up. Participants were aged mean 46 (SD 13.0), 57 female/159 male. 96% received the allocated intervention. Two-years ATRS scores were 82.2 (SD 18.3) in the PRP group (n=85) and 83.8 (SD 16.0) in the placebo group (n=92). There was no evidence of a difference in the two-years ATRS (adjusted-mean difference −0.752 95%CI −5.523 to 4.020, p=0.757), or in any secondary outcome, and no re-rupture between at two-years. Neither PRP cellular or growth factors correlated with the two-year ATRS.ConclusionPRP did not improve patient-reported function or quality of life two-years after acute Achilles tendon rupture, compared with placebo, indicating that PRP offers no patient benefit in the longer term.

Subcutaneous epcoritamab (SC epcor) administered outpatient (outpt) for relapsed or refractory (R/R) diffuse large B-cell lymphoma (DLBCL) and follicular lymphoma (FL): Results from phase 2 EPCORE NHL-6.

7029 Background: Epcor is the only SC CD3xCD20 bispecific antibody approved for R/R DLBCL. In initial protocols, hospitalization after the 1st full dose of epcor was required to monitor patients (pts) for and characterize CRS. The EPCORE NHL-6 trial assessed whether R/R DLBCL/FL pts treated with SC epcor across US community and academic sites could be safely monitored in the outpt setting. Methods: Eligible pts had R/R DLBCL or FL and at least 2 prior lines of therapy. Epcor was given in 28-d cycles [C]; C1 SUD: 0.16 mg then 0.8 mg, followed by 48 mg; C1–3: QW; C4–9: Q2W; C≥10: Q4W. Pts received safety education, including early identification and reporting of symptoms of CRS and ICANS, and were required to stay ≤30 min of the site of care for 24 h after the 1st full dose. Based on C1 optimization (OPT) findings from EPCORE NHL-1 (Vose ASH 2023, Abs 1729), the trial was amended to implement C1 OPT with hydration and dexamethasone after enrollment of 34 pts. Results: At data cutoff, 36 pts (23 DLBCL, 13 FL) received ≥1 dose of epcor (median cycles, 3). 13 and 23 pts were from US academic and community sites, respectively. Median age was 65 y, 67% of pts had extranodal disease, and 39% had prior CAR T. Any grade CRS occurred in 47% of pts and were mostly low grade (G1, n=9; G2, n=7; G3, n=1). Median time to onset of CRS after 1st full dose was 23 h. No CRS events led to discontinuation; 11 pts (31%) were treated with tocilizumab, 8 (22%) with corticosteroids, and 5 (14%) with both. ICANS occurred in 8% (all G1-2) with a median time to onset of 20 days from C1D1, and all resolved. Of 31 pts receiving the 1st full dose, 3 pts (10%) received epcor in the inpatient (inpt) setting while admitted for AEs other than CRS (pain management, leg injury, UTI, n=1 each). The remaining 28 pts (90%) received epcor and were monitored in the outpt setting. 12 total pts had 13 CRS events after the 1st full dose with CRS starting in the outpt setting in 10 pts (G1, n=6; G2, n=4). 7/28 (25%) pts initially monitored as outpts were subsequently managed as inpt for CRS. All 12 pts had resolution of CRS with a median time to resolution of 45 h. Conclusions: Pts with R/R DLBCL and FL were successfully treated with SC epcor and monitored in the outpt setting across different types of sites. CRS events occurring in the outpt setting were appropriately managed, and the observed CRS incidence and severity was comparable to that of the pivotal EPCORE NHL-1 trial. These data suggest that SC epcor can be safely administered and pts monitored outpt, and then managed inpt as needed for CRS. Enrollment is ongoing, and a larger dataset with C1 OPT including hydration and dexamethasone, which are anticipated to further lower CRS incidence and severity, will be presented later. Clinical trial information: NCT05451810 . [Table: see text]

Rehabilitative treatment of lower leg injury was studied by using anterolateral free thigh flap with CT scan

ObjectiveIn cases of severe soft tissue loss and deep tissue exposure in the lower part of the leg, microsurgical skin flap transplantation is the primary treatment method. MethodsBased on the anatomy of the descending branch of the lateral circumflex femoral artery and its musculocutaneous perforators, a free, ultra-thin anterolateral thigh perforator flap is designed for the repair of soft tissue defects in hands and feet. This method has been successfully used at our hospital to treat three patients. Postoperative recovery was favorable, with no vascular crises, and all skin flaps survived. ResultsThe aesthetic appearance of the repaired area was approved by patients, and there were no severe complications post-surgery. Patients were followed up for a period ranging from 6 to 24 months, averaging 14 months. The skin flaps were soft and elastic, without swelling, and the color matched that of normal skin, with good sensory function recovery. ConclusionIn surgical treatment of lower leg wounds, prioritizing using a free anterolateral thigh flap can enhance the repair of the wound and expedite functional recovery postoperatively.

Design of energy-absorbing bionic workstation table for trains and research on occupant collision injury

Secondary impact is a significant contributor to occupant injuries in train crashes. To mitigate collision injuries, a workbench with energy-absorbing properties was developed, drawing inspiration from leaf-vein and honeycomb structures. A local collision model of a dummy compartment was established to evaluate the impact of different sandwich thicknesses on occupant injuries. By optimizing the wall thickness of the energy-absorbing sandwich, the optimal gradient parameters were determined. The assessment of occupant collision injury from the workstation table with a graded wall thickness sandwich was conducted using the LSTC Hybrid III 50th seating dummy. The results demonstrate that the workstation table influences the occupant's movement posture during a collision, preventing head impact with the tabletop. Apart from slightly elevated leg injuries in the dummy, which remained within permissible values, the head, neck, and chest injuries were reduced by 98.45%, 48.17%, and 81.18%, respectively.

39 Using genetics and technology to improve swine robustness

Abstract Abstract Pig robustness has been an increasing concern in the global swine industry over the last 10 yr. This trend of increased mortality across all phases of production continues to worsen over time despite greater focus on research, management, and other production practices to control it. During this time, dramatic improvements in genetic progress have been realized through the selection of economically important traits. Historically, swine genetic companies have relied on data from their purebred animals reared in high-health and well-managed environments which has proven difficult to provide meaningful insight on variation in robustness traits. More recently, leading genetic companies have invested in large commercial test herds where crossbred pigs and breeding animals are individually identified with pedigree and genomic information. These pigs are reared under challenging and varying commercial conditions and mortality, removals, and reproductive efficiency data are gathered and used to generate crossbred breeding values. This type of data increases the accuracy of genetic estimates as well as creates new traits aimed at improving robustness and ease of management. Further investments have been made in precision livestock farming technologies such as computer vision which is quickly being developed due to the low cost of cameras and the ability to use edge computing to process images in real-time or to transfer images and data to the cloud. These developments are particularly compelling in the genetic improvement space when they can be paired with individual animal identification enabling novel traits to be measured in large populations more consistently and at a reduced cost compared with previous labor-intensive or cost-prohibitive methods. Early examples of this are the use of cameras to score feet and leg soundness in replacement gilts as lameness and associated feet and leg injuries are still one of the largest contributors to sow culls and mortality. This new digital feet and leg soundness scoring method has initially resulted in dramatically greater accuracy and heritability compared with conventional subjective human scoring methods. Other camera-based algorithms have been developed to track individual pigs and assess their daily behaviors and interactions. These developments are key to collecting new phenotypes for the selection of positive behavior traits for genetic selection compared with what was previously possible with human observer or scan sampling methods. Gene editing is another promising technology that has been used in human health and plant breeding but is now being widely researched in livestock. This technology has been used to create the first PRRS-resistant pigs to address one of the most costly diseases in the industry. New sources of data and technologies are key to creating and capturing existing and novel phenotypes on large populations of pigs in commercial environments to aid in the genetic improvement of non-conventional traits.

Exploring the success of fasciocutaneous flap techniques in treating distal leg injuries, a Sub-Saharan African experience from Sudan

BackgroundSoft tissue and bone injuries in the lower extremities associated with high-energy trauma remain a formidable challenge to treat. The timing of the operation, the most suitable type of tissue, and the decision between local or free flap coverage remain under discussion. MethodThis prospective, cohort, multi-center study was conducted in Khartoum, Sudan, from April 2021–September 2021. The study included 70 patients. Data was collected using a questionnaire filled with patients after getting informed consent. ResultsMales were 53(75.7 %) and females were 17(24.3 %). Male to female ratio was 3.1: 1. The mean age of the patients was 27.2 ± 3.4 years. The indications for the use of fascia-cutaneous flap in the management of traumatic soft tissue injuries of distal legs were distal substance loss areas of the leg 55(78.6 %), bone exposure 60(85.7 %), open fracture 29(41.4 %), and tendon exposure 31(44.3 %). The type of fasciocutaneous flap used for the patients in this study was perineal artery flap in 20(28.6 %), sural flap in 19(27.1 %), anterior tibial artery perforator flap in 18(25.7 %), and posterior tibial perforator flap in 13(18.6 %) of the patients in 42(60 %) of the patients, no complications were reported. The reported complications were infection 16(5.7 %), distal flap necrosis 8(11.4 %) and total loss 4(5.7 %). ConclusionDespite advances in microsurgery and free flap use, a fascia-cutaneous flap is still a valid option for distal leg soft tissue reconstruction in settings where this service is unavailable. fasciocutaneous flaps are an excellent option for distal leg defects to cover soft-tissue defects, exposed bones, and tendons.

Injury incidence and prevalence in elite short-course triathletes: a 4-year prospective study

ObjectiveTo characterise the prevalence, incidence rate (IR) and burden of injuries in elite short-course triathletes over a 4-year training and competition period.MethodsFifty elite Australian triathletes were prospectively monitored for injury...

The Impact of Knee and Ankle Injuries on National Basketball Association Player Performance Post-injury.

Athletes in the National Basketball Association (NBA) are subjected to high levels of mechanical stress increasing their risk of injury. The purpose of this study was to see how certain lower extremity injuries affect in-game performance in relation to each NBA athlete's demographics. The hypothesis was that NBA players' post-injury performance would differ depending on their demographics and the type of injury sustained. Descriptive epidemiology study of NBA injury list designations from the 2010/2011 season to the 2018/2019 season. About 255 lower leg injuries that met the inclusion criteria were selected from the injury lists spanning from the 2010/2011 season to the 2018/2019 season. These included ligamentous knee injuries, knee sprains, knee strains, knee hyperextensions, patellar injuries, ankle injuries, and Achilles injuries. The change in performance was determined by comparing mean game scores before and after injury with single-tailed, heteroscedastic t-testing and 95% confidence intervals for mean values. An overall statistically significant decrease in mean game score from 9.82 to 8.75 was seen in all included players (p = 0.01). Only athletes taller than the mean height (199.85 cm; p = 0.01) and heavier than the mean weight (101.63 kg;p = 0.02) showed a significant decline in performance. Ankle and knee injuries both resulted in a significant loss in game score (p = 0.04), with ankle injuries resulting in a greater average decline (-1.76 post-injury) than knee injuries (-1.34 post-injury). These findings suggest that treatment regimens should reflect the type of injury and demographics of the specific NBA player injured. Further research is warranted to determine if treatment may be more efficacious when streamlined based on player size and injury type.

Bone union and mobility outcomes for reconstructed open tibial fractures: a plastic surgical experience from a major trauma center.

The goal in open tibial fracture management is to achieve a united tibia in an extremity that allows pain free mobilization. The objective of this study was to assess factors that lead to this functional outcome in lower limb reconstruction, from a plastic surgical perspective. The Plastic and Reconstructive Surgery lower limb database at a tertiary trauma hospital was searched for open tibial injuries from February 2015 to March 2020. The nature and severity of injury, timing and details of all operations including reconstructions were collected prospectively. Mobility including gait aids, pain, and complications were retrospectively collected. Union was assessed in two ways, depending on fracture location. Metaphyseal and diaphyseal tibial fractures were provided mRUST scores (union defined as RUST > 13) and epiphyseal tibial fractures were categorically classified as "united" or "non-union" by two independent radiologists. During the five-year study period there were 148 open leg injuries in the database. Twenty-one patients underwent a primary amputation due to severity of their initial injury. One hundred patients underwent primary limb salvage. Sixty-one patients in the limb salvage group achieved primary tibial union with a mean follow-up time of 19.4 months post injury. Twenty-three additional patients were confirmed to subsequently unite. Patient who achieved union were more likely to mobilise without gait aids. In this study definitive external fixation and soft tissue infection were both associated with higher rates of non-union. Longer times to soft tissue reconstruction was not associated with an increase in acute soft tissue complications. More importantly bone union, pain and mobility did not decline. After undertaking a primary limb salvage pathway for 100 patients, the ultimate tibial fracture union rate was 84% and the confirmed ambulation rate was 96%.

Massive transfusion protocol reactivation as a novel marker of physician team under-triage after injury.

Large trauma centers have protocols for the assessment of injury and triaging of care with attempts to over-triage to ensure adequate care for all patients. We noted that a significant number of patients undergo a second massive transfusion protocol (MTP) activation in the first 24 h of care and conducted a retrospective cohort study of patients involved over a 3-year period. Transfusion service records of MTP activations 2019-2021 were linked to Trauma Registry records and divided into cohorts receiving a single versus a reactivation of the MTP. Time of activation and amounts of blood products issued were linked to demographic, injury severity, and outcome data. Categorical and continuous data were compared between cohorts with chi-squared, Fisher's, and Wilcoxan tests as appropriate, and multivariable regression models were used to seek interactions (p < .05). MTP activation was recorded for 1884 acute trauma patients over our 3-year study period, 142 of whom (7.5%) had reactivation. Factors associated with reactivation included older age (46 vs. 40 years), higher injury severity score (ISS, 27 vs. 22), leg injuries, and presentation during morning shift change (5-7 a.m., 3.3% vs. 7.7%). Patients undergoing MTP reactivation used more RBCs (5 U vs. 2 U) and had more ICU days (3 vs. 2). Older patients and those presenting during shift change are at risk for failure to recognize their complex injury patterns and under-triage for trauma care. The fidelity and granularity of transfusion service records can provide unique opportunities for quality assessment and improvement in trauma care.

Defective Assistive Device Involvement in Older Adult Emergency Department Visits.

Many older adults adopt equipment to address physical limitations and reduce dependence on others to complete basic activities of daily living. Although a few prior studies have considered injuries associated with assistive devices for older adults, those studies focused on older adults' health and functional risks for injury. There is limited analysis of older adult injuries involving defective or malfunctioning assistive devices. Data from this study are from the National Electronic Surveillance System All Injury Program which collected data on consumer product-related injuries from a probability sample of 66 hospital Emergency Departments across the United States. Data from 30776 older adult Emergency Department (ED) injury narratives from 2016 to 2020 were coded according to the assistive device involved and whether malfunctioning led to the injury. The study team manually examined all narratives in which the assistive device was coded to have malfunctioned. A total of 10974 older adult ED cases were treated for 12488 injuries involving a defective device. Injuries included 4212 head and neck injuries (eg, concussion), 4317 trunk injuries (eg, hip fractures), and 3959 arm or leg injuries (eg, leg fracture). Of these patients, 4586 were admitted to a hospital ward for further evaluation and treatment. Seventy percent of these patients were injured while using a walker; in contrast, wheelchairs were implicated in only 4% of the above cases. Design flaws were identified in 8158 cases and part breakage/decoupling incidents in 2816 cases. Our findings provide evidence that assistive devices are actively involved in older adult injuries. Further research is needed to reduce injuries associated with assistive devices by educating patients and their careproviders about device use and assembly and developing effective methods for informing manufacturers about malfunctioning devices.

Functional and Psychological Preparedness of Athletes Post ACL Repair.

This study was conducted to see whether those who had anterior cruciate ligament (ACL) reconstructions on their dominant legs performed better than those who had them on their nondominant legs 1-10 years after the surgery. An examination of people who sustained injuries to their dominant (n = 25) and nondominant (n = 25) legs between 1 and 10 years after ACL repair was undertaken in a cross-sectional research with 50 people aged 20-38. Everyone takes the fear avoidance belief questionnaire for physical activity (FABQ-PA), the lower extremity functional scale (LEFS), and the anterior cruciate ligament return to sport after injury (ACL-RSI) survey. There was no statistically significant difference between the groups on the ACL-RSI, LEFS, and FABQ-PA (U = 254, P = 0.26; U = 314.4, P = 0.95; and U = 279.4, P = 0.53 correspondingly). Functional performance and patient mental health should be evaluated 1-10 years after ACL surgery. However, there is no correlation between which leg was the dominant one and the results. As a result, it has been shown that both dominant and nondominant leg injuries heal similarly over time. Future studies should examine additional variables that affect healing and return-to-sport results to improve rehabilitation and optimize long-term functional outcomes for individuals after ACL repair.

Concentric and eccentric hip musculotendon work depends on backpack loads and walking slopes

Hip muscle weakness is associated with low back and leg injuries. In addition, hiking with heavy loads is linked to high incidence of overuse injuries. Walking with heavy loads on slopes alters hip biomechanics compared to unloaded walking, but individual muscle mechanical work in these challenging conditions is unknown. Using movement simulations, we quantified hip muscle concentric and eccentric work during walking on 0° and ±10° slopes with, and without 40% bodyweight added loads, and with and without a hip belt. For gluteus maximus, psoas, iliacus, gluteus medius, and biceps femoris long head, both concentric and eccentric work were greatest during uphill walking. For rectus femoris and semimembranosus, concentric work was greatest during uphill and eccentric work was greatest during downhill walking. Loaded walking had greater concentric and eccentric work from rectus femoris, biceps femoris long head, and gluteus maximus. Psoas concentric work was greatest while carrying loads regardless of hip belt usage, but eccentric work was only greater than unloaded walking when using a hip belt. Loaded and uphill walking had high concentric work from gluteus maximus, and high eccentric work from gluteus medius and biceps femoris long head. Carrying heavy loads uphill may lead to excessive hip muscle fatigue and heightened injury risk. Effects of the greater eccentric work from hip flexors when wearing a hip belt on lumbar spine forces and pelvic stability should be investigated. Military and other occupational groups who carry heavy backpacks with hip belts should maintain eccentric strength of hip flexors and hamstrings.

Phenomenology &amp; Ethnography: Examining Hospital Cultures and the Lived Experiences of Patients Interacting with Healthcare Professionals

This exploratory ethnographic and phenomenological study examined hospital cultures, primarily emergency rooms, and the lived experiences of patients interacting with healthcare professionals in the United States. The salient themes that emerged from the thematic analysis of the narratives shared by a woman living with asthma in conjunction with the lived experiences articulated by five other patients coming to emergency rooms for stomach pain/pregnancy, arthritis/joint pain, leg injury, depression, etc., were: 1) Long wait times, 2) Poor and Unprofessional Attitude, 3) Neglect, 4) Feeling Rushed, 5) Having to Ask for Care, 6) Discrimination, and 7) Support from Hospital Patient Advocates and Other Patients. While the patients in this study endured marginalization and microaggressions, those challenges often were overcome with assistance from hospital patient advocates as well as other patients. Ultimately, patients in this study empowered themselves to achieve their healthcare goals.

Epidemiology and Characteristics of Ankle and Foot Injuries in Electric Scooter-Related Accidents.

The use of electric scooters (e-scooters) continues to increase as a simple, inexpensive means of transport, resulting in a sharp increase in the incidence of scooter-related accidents. No study to date has closely examined the injury extent to the lower leg, joints, and extremities from e-scooter-related accidents. Here, we investigated the epidemiology and injury patterns of such accidents, focusing on injuries to the ankle and foot. Based on data from a single tertiary hospital's database, the demographics of 563 patients with scooter-associated injuries were analyzed retrospectively. Among the patients, 229 patients who were injured by e-scooter riding were further investigated. Based on the data, the general demographics of whole scooter-associated injuries and the injury characteristics and fracture cases of the lower leg, ankle, and foot were analyzed. During the 4-year study period, the number of patients injured by e-scooters increased every year. Lower extremities were the most common injury site (67.2%) among riders, whereas injuries to the head and neck (64.3%) were more common in riders of non-electric scooters. Among the lower leg, ankle, and foot injuries of riders (52 cases), the ankle joint (53.8%) was the most commonly injured site, followed by the foot (40.4%) and lower leg (21.2%). The fracture group scored significantly higher on the Abbreviated Injury Scale than the non-fracture group (p < 0.001). Among the fracture group (20 cases), ankle fractures (9 cases) were most common, including pronation external rotation type 4 injuries (4 cases) and pilon fractures (2 cases). Five patients (25%) had open fractures, and 12 patients (60%) underwent surgical treatment. The ankle and foot are the most common injury sites in e-scooter-related accidents. Given the high frequency and severity of e-scooter-related ankle and foot injuries, we suggest that more attention be paid to preventing these types of injuries with greater public awareness of the dangers of using e-scooters.