Limb Injuries Research Articles

Effectiveness of physical rehabilitation methods based on the impact of eccentric load in upper limb injuries

To study the effectiveness of isolated therapeutic exercises (TE) with eccentric muscle loads when using rubber cable compared to traditional TE to restore functional capabilities of patients after upper limb injuries. The study included 38 patients with upper limb injuries diagnosed by orthopedic surgeon. Patients were randomly enrolled into group of isolated TE with eccentric muscle loads (group A, 20 patients, mean age 40.2±10.8 years) and group of traditional exercises (group B, 18 patients, mean age 38.6±12.3 years). The study consisted of anamnesis taking, clinical examination, functional tests applying (isometric dynamometry, joint mobility tests, functional scales and questionnaires). The rehabilitation effectiveness was assessed by comparing the indicators before and after treatment course. There has been a significant improvement in muscle strength, movement amplitude and decrease of pain syndrome in patients rehabilitated by eccentric muscle loads. A comparison with a control group using traditional TE methods confirmed the superiority of eccentric exercises in reducing recovery time and improving functional performance. The study confirmed the high effectiveness of eccentric muscular loads in the rehabilitation of patients after upper limb injuries. The method has shown significant improvement in clinical and functional indices, which allows to recommend it for inclusion in standard rehabilitation protocols. Further researches may extend application of this approach and reveal the TE effectiveness in other types of traumas and orthopedic injuries.

Evaluation of the Value of the Y-Balance Test to Predict Lower Limb Injuries in Professional Male Footballers.

The aim of this prospective cohort study was to identify whether Y-Balance Test (YBT) performance and asymmetry are associated with lower limb injury in elite adult football athletes. A prospective cohort study. Preseason YBT measures were obtained from 121 male footballers participating in National League One across the 2021-2022 season. Lower limb injuries were tracked across the season to determine the relationship between YBT variables and injury incidence using logistic regression analysis. The statistical significance level was .05. The average YBT score was 111.0 (5.8)cm on the left limb and 112.0 (5.5)cm on the right limb, with an average asymmetry of 2.3 (1.4)cm. Athletes with lower YBT scores on both the left (odds ratio = 2.9; 95% confidence interval, 1.7 to 4.8: P ≤ .001) and right (odds ratio = 2.3; 95% confidence interval, 1.6 to 3.2: P ≤ .001) limbs were at a greater risk of injury. Similarly, athletes with greater amounts of asymmetry were also more likely to get injured (odds ratio = 2.1; 95% confidence interval, 1.3 to 3.3: P = .002). Results indicate that lower and asymmetrical YBT scores have a significant relationship with future lower limb injuries in professional male footballers. The YBT offers a simple, reliable, and effective screening tool that can be used by practitioners in football to help identify players at a greater risk of injury before the season commences.

Youth Female Field Hockey Players Physical Condition

Introduction: lower limb injuries and low back pain are common injuries in field hockey that have different risk factors. The aim of this study was to characterize youth field hockey players’ physical condition to determine their possible injury risk factors. Methods: youth field hockey players of the Club Deportivo Universidad Católica of Chile were assessed during April and May of the 2022 season. The test used were: Ely’s, Thomas, Ober and AKE for flexibility, Biering Sorensen, Plank Test, Sport Specific Endurance Plank Test, Single Leg Bridge Test, Lunge Test, Hop Test (single, triple and croo-over) and Y Balance Test. Statistical analyses were performed using R Statistical Software (2023.09.0+463; R Core Team 2023). Results: 87 youth field hockey players from the under 14, 16 and 19 were assess (age 15.1 ± 1.5). Poor core and back extensor endurance was found, along with poor hamstring strength and unipodal balance. Significant difference was found between categories in the plank test and sport specific endurance plank test (p<0.001). Conclusion: several impairments were found in chilean youth field hockey players that could pose a risk of injury, however, further research is needed in order to determine if these impairments really are risk factors in this sport and population.

Lumbar Multifidus Characteristics in University Level Athletes May be Predictors of Low Back Pain and Lower Limb Injury

Introduction: Low back pain (LBP) is highly prevalent in athletes, with decreased lumbar multifidus (LM) crosssectional area (CSA) reported in athletes with LBP and lower limb injury (LLI) as well as decreased LM thickness in athletes with LLI. Previous research has only investigated connections between LM, LBP, and LLI in small samples of athletes in a single sport at a time. This study aimed to (1) examine LM morphology and function across a general sample of male and female university level varsity athletes; (2) investigate whether LM characteristics were predictors of LBP and LLI. Methods: Ultrasound images of LM at L5 were acquired in prone and standing. Body composition was assessed with DEXA and a self-reported questionnaire provided demographics and history of injury. Paired t-tests and independent t-tests compared LM measurements between the sides and sex, respectively. Univariate and multivariate logistic regression analyses were used to assess possible LM characteristic predictors of LBP and LLI. Results: 134 university varsity athletes were evaluated. LM CSA was larger on the non-dominant side in prone. Increased LM thickness was associated with decreased odds of LBP in the previous 4-week (OR=0.49 [0.27, 0.88], p=0.02) and 3-month (OR=0.43 [0.21, 0.89], p=0.02) in the multivariable model, while a greater number of years playing at the university level was associated with increased odds of LBP (OR=1.29 [1.01, 1.65], p=0.04). Greater LM CSA asymmetry (OR=1.14 [1.01, 1.28], p=0.03) and sport (OR=1.44 [1.04, 1.96], p=0.02) were significant predictors of LLI in the previous 12 months. Conclusion: Leg dominance may play a role in unilateral differences. LM thickness and LM CSA asymmetry were predictors of injury. Preseason screening of LM morphology and function could help identify athletes at risk of LBP and LLI, allowing coaches, medical staff, and training staff to target these individuals and provide specific injury prevention programs.

Functional Ipsilateral and Bilateral Strength Ratios in Young Elite Athletes Across Multiple Sports Disciplines

This research investigates functional strength ratios in young elite athletes across different sports disciplines with different movement characteristics, focusing on the relationship between these ratios and physical performance. Purpose: the study aims to examine the differences in functional ipsilateral and bilateral strength ratios among athletes in symmetrical, asymmetrical, and hybrid sports and assess how these disparities impact strength parameters. Material & Methods: the study comprised 56 male athletes aged 18-28, excluding those with lower limb injuries or limitations affecting performance. The participants were divided into symmetrical, asymmetrical, and hybrid sports categories. Strength assessment utilised an isokinetic dynamometer, focusing on quadriceps-to-hamstring strength and bilateral strength ratios. The study employed MANOVA as the major statistical test for the purpose of the study. Results: athletes in asymmetrical sports demonstrated higher bilateral symmetry in knee extensors compared to symmetrical (0.94±5.98) and hybrid sports (4.9±10.32), with values of 12.89±8.56. The functional hamstring to quadriceps (H:Q) strength ratio showed lower ratios in hybrid sports (right limb: 0.60±0.12, left limb: 0.61±0.09) compared to symmetrical (right limb: 0.79±0.16, left limb: 0.94±0.27) and asymmetrical sports (right limb: 1.05±0.26, left limb: 1.03±0.24), yet within normative values. These findings suggest that sport-specific demands significantly influence functional strength ratios, highlighting the importance of tailored training and rehabilitation programs. The observed strength asymmetries, particularly in sports with unilateral movements, underline the need for sport-specific training approaches to address these imbalances. Conclusion: the study revealed that sport-specific training can lead to strength asymmetries within normal ranges, suggesting that they may not substantially induce muscular imbalances. However, the distinct H:Q ratio patterns in hybrid sports emphasise the need for customised training and rehabilitation strategies.

Recent Advances in Exercise Intervention for Athletes with Ankle Injury

Ankle sprain reported among 16%-40% of all sports-related injuries and most common frequent lower limb injury among athletes. It is particularly prevalent in soccer, American football, and basketball. The most commonly injured ligament is the lateral ligaments especially anterior talofibular ligament and quite a large percentage of patients report persistent symptoms and experience recurrent injuries. To prevent injuries and instability around ankle joint, various interventions evidenced are immobilization, cryotherapy, compression, elevation, analgesics, bracing, foot orthosis, exercises, electrophysical methods, and surgical interventions. Among these therapies physical exercises and splints are highly recommended across levels of rehabilitation. PubMed was used for literature search and articles on randomized control trail, systematic reviews and meta-analysis between 2017 to 2022 were included. Articles on advanced physiotherapy management for ankle injuries were included. Results from reviewing 6 RCT reported progressive exercises training significantly improved flexibility, strength, endurance, agility and balance in the ankle complex. Exercise techniques targeting the ligaments, muscle and structures around ankle joint based on the clinical presentation can lead to improved ankle joint performance in individuals diagnosed with ankle instability. Keywords: Ankle injury, Ankle sprain, Exercise, Instablity

The effect of Clarke’s angle variability on the static and dynamic balance of different sports

Background: Flatfoot affects postural control by altering the biomechanics of the lower limb, sensory input, and proprioception. Poor static and dynamic balance can influence the physical performance of competitive sports athletes and increase the risk of lower limb injury. Footprint analysis using Clarke’s angle (CA) is easy to perform and has good diagnostic performance as an alternative flatfoot assessment for a large athlete population. Our study aims to determine the effect of CA variability on the static and dynamic balance of different sports using the one-leg stance (OLS) and star excursion balance test (SEBT). Methods: This is an analytic observational study with a retrospective cohort design. Medical record data from 209 athletes’ feet from 11 sports were collected to determine the subjects’ characteristics and research variables. Curve estimation and regression tests were performed to assess the effect of CA variability on the OLS and normalized reach distance of SEBT (NSEBT). Results: The mean CA of all athletes was 44.82±11.14o. The mean time of OLS of all athletes was 47.78±40.54 seconds. The least and the farthest average normalized reach distance was done in the anterolateral direction (79.06±11.88 %) and posterior direction (93.45±18.98 %). There is no effect of CA variability on the OLS of all sports, male and female athletes. There is an effect of CA variability on the OLS of Wushu athletes, also on the NSEBT of whole athletes (lateral, posterolateral, posterior, posteromedial directions; male athletes (posterolateral direction); female athletes (anteromedial direction); and different sports, includes athletic (anterolateral, lateral, posterolateral, posterior, posteromedial, medial, anteromedial direction); fencing (anterolateral direction); and running (anterolateral, lateral, posterior, posteromedial, medial, anteromedial, composite directions). Conclusion: Clarke’s angle variability significantly affects the static balance of Wushu athletes and the dynamic balance of athletes in athletics, fencing, and running.

On the issue of exoskeletal rehabilitation of shoulder periarthritis after a gunshot wound of the scapular area

Modern comprehensive treatment of wounded and injured with combat injuries of limbs should include not only surgical treatment itself, but also effective rehabilitation for maximum restoration of the function of injured limbs. The use of exoskeletons in the rehabilitation of patients with shoulder blade and shoulder joint injuries can accelerate muscle strengthening, restore motor activity and range of motion, as well as improve the results of treatment and the quality of life of patients. The use of exoskeletons in the rehabilitation of patients with shoulder blade and shoulder joint injuries is an effective and promising approach.

PROBLEMATIC ISSUES OF LIMB AMPUTATION IN WOUNDED WITH COMBAT TRAUMA

Among the wounded with limb injuries admitted to the Military Medical Center of the Western region during the year of Russia’s full-scale war in Ukraine, 29% had a mine-blast injury, 47% had shrapnel wounds, 8% had gunshot bullet wounds, 1.5% – thermal injuries, and14.5% – traumatic injuries. Upper limbs were injured in 22%, lower – in 32%, 15% had two limbs injured, and 31% had combined combat trauma. In all hospitalized with multi-fragment fractures, limbs were fixed with external fixation devices. 2% of patients had vascular damage. All wounded had unhealed wounds with a soft tissue defect. The average age of patients was 30 years. There were no comorbid diseases in the wounded, and concomitant diseases that did not affect the course of injury were found in 10%. Amputations of limbs were performed in 6.5%. Traumatic separation of a limb segment or its destruction with crushed bone and non-viable soft tissues, nerve damage with significant defect, soft tissue and bone defect, as well as thermal ischemia of the limb for more than 6 hours with necrosis of its soft tissues, were indications for primary limb amputation in 3% of wounded and injured, which were in the nature of primary debridement. Progressive wound infection with the development of the septic condition of the wounded despite intensive treatment, total ischemic necrosis, and recrudescent arrosive bleeding from great vessels required a secondary limb amputation in 1.5%. In 1.5% of the wounded, staged operations were performed as re-amputations. Re-amputation had to be performed in 0.6% of patients with an inappropriate limb stump level, which complicated prosthetics. To reduce the number of amputations for secondary indications, a timely diagnosis is needed of compartment syndrome and rational treatment of soft tissue wounds and gunshot fractures with surgical and medical prevention of the infectious process.

ANALYSIS OF CLINICAL AND ANATOMICAL CHARACTERISTICS OF TRAFFIC INJURIES IN THE CONDITIONS OF THE REGIONAL CITY REPORT TWO: ANATOMICAL VERIFICATION OF DAMAGE

Abstract. Traffic injuries are one of the main causes of death of children and youngpeople. About 3,700 people die in traffic accidents worldwide in one day.The aim of the research – to verify the clinical and anatomical characteristics of injuriesresulting from traffic accidents in the conditions of a regional city. Materials and methods. A retrospective analysis of 242 cases of victims who were injuredas a result of a traffic accident and were treated in the emergency medical hospital ofChernivtsi from 2019 to 2020 was conducted. The research array was formed by themethod of irreversible randomization using the methodology of random numbers.Results. As a result of the study, it was established that the head – 75.62 %, the limbs –55.79 %, and the chest – 42.56 % are most often injured in road accidents. In the array ofvictims who survived, a similar rank distribution of victims is observed, and the specificgravity indicators are close in value. In the array of victims, there is a difference in ranking:the head and neck are most often injured – 88.23 %, the pelvis – 70.59 %, and the chest –64.71 %. In drivers, the cranial component is observed in 65.91 %, in passengers – in76.14 %, in pedestrians – in 87.88 % (the first ranking place). Abdomen and pelvis arethe least frequently injured in drivers – 15.91 % each, in passengers – pelvis, 12.50 %,and in pedestrians – abdomen, 18.18 %. In all groups of traffic participants who died, thecoefficient of combination of damages is higher than in the victims who survived, but thisindicator is different in each group. The highest mortality in cranial injuries is observed inpassengers – 10.45 %, vertebral injuries – in pedestrians, 16.67 %, thoracic injuries – ina group of pedestrians, 12.12 %, abdominal injuries – in pedestrians, 33.33 %, in the case ofpelvis injuries – in pedestrians, 42.86 %, in the case of limb injuries – in passengers, 5.56 %.Conclusions. 1. Clinical and anatomical characteristics: victims of traffic accidents havea different frequency of damage to specific anatomical and functional areas. The headis most often injured in victims – 75.62 %, limbs – 55.79 % and chest – 42.56 %. 2.The occurrence of a negative outcome in the course of the traumatic process probablydepends on the damaged clinical and anatomical area and the sign of participation in themovement. The highest mortality is observed in pedestrians, drivers and passengers dueto the pelvis damage(42.86 %, 28.57 % and 18.18 %, respectively). 3. Injuries in victimsof traffic accidents have a multi- component nature. The highest combination ratio fordead pedestrians is 4.17, and the lowest for surviving drivers is 2.06.

Post-Traumatic Osteoarthritis, Psychological Health, andQuality ofLife After Lower Limb Injury inU.S. Service Members.

The aims of this project were to assess (1) the prevalence and timing of post-traumatic osteoarthritis (PTOA) after a traumatic lower limb injury, (2) the risk of PTOA based on injury type, and (3) the association of PTOA with psychological health and quality of life (QoL). The Wounded Warrior Recovery Project (WWRP) database and the Expeditionary Medical Encounters Dataset were queried to identify service members injured during deployment. The Military Health System Data Repository was utilized to extract medical record data to identify individuals with PTOA. Data on PTSD, depression symptoms, and QoL were extracted from the WWRP. Of the 2,061 WWRP participants with lower limb injuries, 124 (6%) were diagnosed with PTOA, with first PTOA diagnosis occurring 3.8 ± 3.1 years after injury. Of the injury categories identified, only fractures were associated with high odds of lower limb PTOA (adjusted odds ratio [OR] = 3.92, 95% confidence interval [CI]: 2.38, 6.44). Individuals with PTOA diagnoses reported lower QoL scores relative to those without PTOA (F(1,2057) = 14.21, B = -0.05, P < .05). Additionally, rates of PTSD and depression symptoms were high but not different between those with or without PTOA. Despite a low prevalence of lower limb PTOA in our study, fractures increased the risk of PTOA after deployment-related injuries. Additionally, those with PTOA reported lower QoL scores relative to those without PTOA. The findings of this study highlight the personalized needs of patients with trauma beyond just the repair of the immediate injury.

Acute biomechanical responses to wearing a controlled ankle motion (CAM) Walker boot during walking

BackgroundControlled ankle motion (CAM) boots are often prescribed during the rehabilitation of lower limb injuries and pathologies to reduce foot and ankle movement and loading whilst allowing the patient to maintain normal daily function. Research questionThe aim of this study was to quantify the compensatory biomechanical mechanisms undergone by the ipsilateral hip and knee joints during walking. In addition, the compensatory mechanisms displayed by the contralateral limb were also considered. MethodsTwelve healthy participants walked on an instrumented treadmill at their preferred walking speed. They underwent kinematic and kinetic analysis during four footwear conditions: normal shoes (NORM), a Malleo Immobil Air Walker on the right leg (OTTO), a Rebound® Air Walker on the right leg with (EVEN) and without (OSS) an Evenup Shoelift™ on the contralateral leg. ResultsCAM boot wear increased the relative joint contribution to total mechanical work from the ipsilateral hip and knee joints (p < 0.05), which was characterised by increased hip and knee abduction during the swing phase of the gait cycle. EVEN increased the absolute work done and relative contribution of the contralateral limb. CAM boot wear reduced walking speed (p < 0.05), which was partially compensated for during EVEN. SignificanceThe increased hip abduction in the ipsilateral leg was likely caused by the increase in effective leg length and limb mass, which could lead to secondary site complications following prolonged CAM boot wear. Although prescribing an even-up walker partially mitigates these compensatory mechanisms, adverse effects to contralateral limb kinematics and kinetics (e.g., elevated knee joint work) should be considered.

COMPARATIVE ANALYSIS OF ORTHOPEDIC TRAUMA INTERVENTIONS: A REGISTRY-BASED STUDY ON TREATMENT OUTCOME

Musculoskeletal injuries represent a substantial public health challenge, significantly burdening healthcare providers and hospitals in developing nations. Efficiently managing the diagnosis and treatment of these injuries can result in cost savings in healthcare and a reduction in the duration of preventable disabilities among affected patients. This study aimed to analyze and compare the treatment outcomes of various orthopedic trauma interventions. In this retrospective cohort study conducted at the SMBB Institute of Trauma, a Tertiary Care Hospital, between January 2017 and December 2021, 4557 limb injuries sustained by 4557 patients were investigated. The study included patients with both upper and lower limb trauma. Detailed information regarding the injuries, trauma management strategies, and subsequent outcomes was meticulously extracted from the patient's medical records. Data analysis was conducted using SPSS version 27 to uncover relevant patterns and insights in the management and outcomes of these limb injuries. A total of 4557 patients with 4557 limb injuries were enrolled in the study. The incidence of upper and lower limb injuries was 24.5% (n=1108) and 75.5% (n=3449), respectively. Surgical intervention was employed in 4191 (92%) cases, while the remaining 366 (8%) were managed conservatively. Open reduction and internal fixation (ORIF) were the most common surgical procedure performed, accounting for 1441 cases (34.4%), followed by Intramedullary Nailing with 491 cases (11.7%) and external fixation in 434 cases (10.4%). The overall mortality rate was 16 (0.35%), among which 10 cases were not associated with either the trauma itself or its management. The assessment of outcomes associated with injuries identifies potential areas of trauma care that require enhancement and suggests strategies to reduce the mortality rate. Registry data has the potential to aid in the formulation of preventative strategies and enhance the effectiveness of management protocols.

A high incidence of injury among male university student rugby players requires urgent injury prevention strategies

ObjectivesDetermine the epidemiology and clinical characteristics of training and match injuries in university student rugby players over a two-season period. DesignProspective cohort. SettingVarsity Cup (VC) and Young Guns (YG) rugby tournaments (2018 and 2019). Participants171 male university student rugby players. Main outcome measuresFor time-loss injuries: injury incidence (injuries per 1000 player-hours), injured player proportion (% of injured players) and the frequency (n, %) of injury characteristics (new or recurrent, anatomical region, body area, severity. ResultsThe injury incidence was 2.4 per 1000 player-hours for training injuries and 131.1 per 1000 player-hours for match injuries. The overall injured player proportion was 59.6%. New injuries (83.9%) were more frequent than recurrent injuries. Most injuries occurred in the lower limb involving muscle/tendon (56.7%) and ligament/joint capsule (27.2%). The shoulder (19.6%) and ankle (15.7%) were the most common body areas of injury during matches and training, respectively. ConclusionsThere was a high injured player proportion and match injury incidence among university student rugby players. Most injuries were new. Lower limb injuries were most common in training whereas upper limb injuries were most common in matches. These findings highlight the need to prioritise future injury prevention among university student rugby players.

Cross-cultural Adaptation and Psychometric Evaluation of the Kurdish Version of the Disabilities of Arm, Shoulder, and Hand (DASH-KU) Scale

Abstract Background The disabilities of arm, shoulder, and hand (DASH) questionnaire addresses the patient's disabilities and symptoms to evaluate the extent and the impact of injuries in the patient's daily-life activities. This study aims to develop a valid and reliable adaptation of DASH into the Kurdish language and culture (DASH-KU). Methods American Association of Orthopedic Surgeons Outcomes Committee guideline was used for the cross-cultural adaptation of DASH to the Kurdish version. This study was conducted at the Shahid Saifaddin consultation clinic in Sulaymaniyah, Iraq between April and October 2022. A total of 300 participants, who were included in the study using an available sampling method, completed the self-report DASH-KU questionnaire during two consecutive assessments with a 24-hour interval. Results The DASH-KU questionnaire demonstrated excellent internal consistency (Cronbach's α = 0.99) and test–retest reliability (intraclass correlation = 0.99). A strong correlation between DASH-KU scores and the patient-rated wrist/hand evaluation tool (r = 0.792) supported its construct validity. Bland–Altman plots showed good agreement between assessments with no floor (3%) or ceiling (0%) effects. Factor analysis found the scale had high adequacy (0.700) and significant sphericity (p &lt; 0.001). The major factor explained 40% of variance with an eigenvalue of 13.14. Additionally, a five-item model explained 81.23% of DASH-KU variance, though responsiveness was suboptimal, possibly due to the short 24-hour interval between measurements. Conclusion Our results demonstrate that DASH-KU has excellent reliability and validity in identifying upper limb injuries, and the psychometric properties of DASH-KU were similar to its original version.

Effects of combined traditional Chinese medicine therapy in patients of lower limbs injuries with osteoporosis: A retrospective paired cohort study.

Studies have confirmed that the health hazards of patients with lower limb injuries combined with osteoporosis are more obvious. This study is mainly based on the Taiwan National Health Insurance Database, and through big data analysis, it shows that the combined treatment of traditional Chinese medicine (TCM) is helpful to the health of patients with lower limb injuries combined with osteoporosis. A total of 9989 combined TCM-treated patients and 19,978 2:1 sex-, age-, and index-year-matched controls who did not receive TCM treatment were selected from the Taiwan National Health Insurance Database. Cox proportional hazards analyzes were performed to compare fracture surgery, inpatient, and all-cause mortality during a mean follow-up period of 17 years. A total of 5406/8601/2564 enrolled-subjects (14.11%/25.46%/5.53%) had fracture surgery/inpatient/all-cause mortality, including 1409/2543/552 in the combined TCM group (14.11%/25.46%/5.53%) and 3997/6058/2012 in the control group (20.01%/30.32%/10.07%). Cox proportional hazard regression analysis showed a lower rate of fracture surgery, inpatient and all-cause mortality for subjects in the combined TCM group (adjusted hazard ratios [HR] = 0.723; 95% confidence intervals [CI] = 0.604-0.810, P < .001; adjusted hazard ratios [HR] = 0.803; 95% CI = 0.712-0.950, P = .001; adjusted HR = 0.842; 95% CI = 0.731-0.953, P = .007, respectively). After 10 years of follow-up, the cumulative incidence of fracture surgery in patients combining TCM treatment seems to be half of that without combining TCM treatment those are shown in Kaplan-Meier analysis with statistically significant (log rank, P < .001, P < .001, and P = .010, respectively). This study hopes to provide clinicians with the option of combined TCM treatment for patients of lower limbs injuries combined with osteoporosis, so that such patients will be associate with a lower risk of fracture surgery, inpatient or all-cause mortality.

Investigating the value of balance and proprioception scores to predict lower limb injuries in professional judokas

We investigated the ability of balance and proprioception screening tests to predict lower limb injuries in professional male judokas. Fifty-three male judokas of the national teams (Mean ± SD, age 18.68 ± 3.08 years, weight 75.34 ± 11.62 kg, height 175.28 ± 7.24 cm) participated in this study. Limits of stability (LOS), single leg stability (SLS), and knee joint position sense (JPS) was recorded as the screening tests before starting the 10 month follow up. Lower limb injury was recorded all through the follow up. Fifteen lower limb sport injuries were recorded for 53 judokas during the follow-up recordings. Significant accuracy of SLS, overall bilateral ratio (AUC 0.646, 95% CI 0.452–0.839, p = 0.046), as well as JPS 60° bilateral ratio (AUC 0.657, 95% CI 0.480–0.834, p = 0.044), and LOS overall (AUC 0.696, 95% CI 0.551–0.840, p = 0.031) were revealed discriminating between injured and uninjured judokas. The optimum cut-off of SLS, overall bilateral ratio, JPS 60° bilateral ratio, and LOS overall associated with belonging to uninjured judokas group was ≤ 1.15%, ≤ 1.09%, and ≤ 1.09 respectively (sensitivity, 0.763, 0.711, 0.789 respectively; specificity, 0.600). Although the absolute unilateral balance and proprioception scores were almost the same between injured and non-injured judokas, the bilateral ratio of both these indices were different between the two groups. Lower limbs bilateral balance and proprioception asymmetries is a more important risk factor than the absolute unilateral balance and proprioception scores for sustaining lower limb injuries in professional male judokas. Medical professionals and coaches are suggested to use these findings as pre-participation screening tools identify injury-prone athletes.

Treatment of patients with gunshot traumatic amputations of the lower limbs due to explosive injury in the conditions of today’s war in Ukraine

Annotation. In the conditions of today's war, limb injuries due to explosive injuries and wounds reach 63.9%, of which gunshot traumatic limb amputations account for an average of 5.0%. The goal is to analyze the results of the treatment of the wounded with gunshot traumatic amputations of the lower limbs in case of an explosive injury and to identify their shortcomings and propose ways to eliminate them. The results of treatment of 306 patients with traumatic amputations of the lower limbs from February 24, 2022 to August 1, 2023 were analyzed. Complete detachment of the limb occurred in 162 patients, massive destruction of the limb with soft tissue defects – in 79, and explosive injury of the limb with damage to the main vessels with the subsequent development of decompensated ischemia, which required amputation – in 48, wounded with prolonged tourniquet time, which led to irreversible changes in the limb – in 17 cases. At the third level of medical care, 105 patients were operated on urgently. The reasons were damage to the main vessels of the limb, which led to decompensated ischemia of the limb in 28 cases, pronounced necrotic changes of the stump of the limb – in 67, and erosive bleeding – in 8. 201 patients underwent planned surgery in the form of radical complex repeated (secondary) surgical treatment of defects of the tissues of amputated limb stumps. In the early postoperative period suppuration of amputation stumps occurred in 67 patients, bleeding occurred in 8. In the late postoperative period defective stumps were observed in 23, ligature fistulas – in 9, osteophytes – in 4, neurilemmoma formation – in 6 patients. Thus, purulent-inflammatory complications associated with non-radical primary surgical treatment, suturing of tissues for the formation of a stump, by increasing the time interval between surgical treatments. Primary surgical treatment should be radical without suturing the limb stump. For their prevention and treatment at the tertiary level, it is advisable to use the proposed radical complex repeated (secondary) surgical treatment.

Does Exercise Testing with Arm Crank Ergometer Substitute for Cycle Ergometer to Evaluate Exercise Capacity?

Using the upper limbs to test cardiopulmonary exercise can be a useful option in the case of individuals who are unable to pedal a bicycle due to lower limb injury or disability. We evaluated whether exercise testing with the upper limbs can be used equivalently to that of the lower limbs in assessing exercise capacity. Nine collegiate rowers and eight collegiate cyclists underwent incremental exercise testing with an arm crank ergometer (ACE) and cycle ergometer (CE). Heart rate (HR) and oxygen uptake (VO2) were monitored throughout the tests. Segmental muscle mass and flow-mediated dilation of brachial artery were measured to assess the training status of the upper limbs. The muscle mass of the brachium, upper limb, and trunk were greater in the rowers than in the cyclists (p &lt; 0.05). The correlations between HR and VO2 was significantly different depending on exercise modalities, ACE and CE, in both groups (p &lt; 0.001). The estimated maximal VO2 using the correlation formula and age-predicted maximal HR was significantly lower in the exercise testing group with ACE than in the group with CE in rowers and cyclists (41.7 ± 7.3 vs. 52.6 ± 8.6 mL/kg/min, p = 0.010 and 35.5 ± 14.2 vs. 50.4 ± 13.4 mL/kg/min, p = 0.011, respectively). The results suggested that exercise capacity assessed by exercise testing with ACE is underestimated, regardless of the training status of the upper limbs. Further research is needed to verify factors which affect the correlations between HR and VO2 during upper- and lower-limb exercise.

Effects of Balance and Proprioceptive Exercises on the Balance of Ice Hockey Players and the Risk of Lower Limb Injuries

Background. Most ice hockey injuries are contact, but about 15% are non-contact musculoskeletal injuries and lower body injuries account for 30-45% of all injuries in ice hockey players. It is believed that proprioception and balance training can improve neuromuscular control, improve its ability to synchronise the muscle joint to improve dynamic stability and improve human performance, so balance and proprioception are suggested exercises as a regular part of training. The aim. To determine the effects of a 6-week balance and proprioception training exercises on balance and lower extremity injury risk in ice hockey players. Material and methods. 20 men were randomly divided into experimental and control groups. Six weeks were applied to the research group balance and proprioception exercises, twice a week for 45 minutes next to their regular training. The control group continued with regular training. Before and after the study, static balance was assessed by the flamingo test, dynamic balance and lower extremity injury risk by the modified star excursion test, and injury risk assessment using the Functional Movement Assessment. Results. In the intervention group after 6 weeks the static balance of the right and left leg improved statistically significantly (p&lt;0,05), the dynamic balance of the right and left leg in the front, posteromedial, posterolateral directions (p&lt;0,05), but functional movement patterns did not change statistically significantly (p&gt;0,05). A statistically significant difference was found between the groups in the dynamic balance of the left and right leg in the front, posteromedial, and posterolateral directions (p&lt;0,05) and the static balance of the right leg (p&lt;0,05). The results of the intervention group were better compared to the control group. Conclusions. After the application of balance and proprioception training exercises, the static and dynamic balance of ice hockey players improved and the risk of injury in ice hockey players decreased. Recommendations. Balance and proprioception exercises should be included in hockey physical training to improve static and dynamic balance and reduce the risk of injury. When performing balance and proprioception exercises, we recommend incorporating a variety of specific movements that are similar to those performed by athletes during training and competition. In order to determine the cause of injuries and their risk, it is very important to carry out regular tests, store them and analyse them. Keywords: balance, proprioception, hockey, injury risk