Lower Leg Injuries Research Articles

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.

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.

Use of negative pressure wound therapy with instillation to salvage infected breast reconstruction implant pockets: a retrospective review of cases

"Introduction: Periprosthetic breast implant infections are a well-known but devastating complication of breast reconstruction, occurring in up to 35 per cent of patients postoperatively. Historically, surgical washout and explantation was common practice to control infection, often sacrificing the reconstruction. Methods: After successfully using negative-pressure wound therapy with instillation (Veraflo, Intermed, Auckland) on lower leg wounds, we transferred the use of this technology to infected breast pockets. Results: In the first year using NPWTi, our department managed seven patients (8 breast reconstructions) presenting with breast device infection at an average of 15.3 days postoperatively. The average length of stay for treatment was 7.4 days with 2.5 operations over this period. Four patients had attempted salvage of their reconstructive pocket and all were discharged with a breast expander in situ. Conclusion: Attempted salvage using negative-pressure wound therapy with instillation may improve rates of reconstruction salvage after periprosthetic infection. We present our current management algorithm for periprosthetic infections."

Опыт применения чрескостного компрессионно-дистракционного остеосинтеза при открытом переломе средней трети костей голени

Abstract. Various lower leg injuries are among the most common injuries among adults, accounting for up to 15 % of the total number of injuries. The research purpose is to demonstrate the effectiveness of treatment of fractures of both tibia bones in the middle third with displacement of fragments using transosseous compression-distraction osteosynthesis. Materials and methods. For a conducted search in the open electronic scientific databases PubMed and Russian scientific electronic library eLibrary we used keywords and phrases: tibia fracture, surgical treatment, transosseous compression-distraction osteosynthesis, Ilizarov apparatus. Results. Transosseous osteosynthesis was performed using the Ilizarov apparatus for fractures of both bones of the middle third of the right leg with displacement of the fragments. On the fourth day after surgery, the patient was discharged for outpatient treatment by a traumatologist at his place of residence in satisfactory condition. Pain, tactile and temperature sensitivity of the lower limb are not impaired, blood supply is preserved. Discussion. Based on the results of surgical treatment in this case report, we can conclude that transosseous compression-distraction osteosynthesis using the Ilizarov apparatus is highly effective in the treatment of open fractures of both tibia bones in the middle third with displacement of fragments. Conclusion. One of the reliable methods for treating tibia bone fractures is the use of the Ilizarov transosseous compression-distraction apparatus. In addition, this method can be used in cases of extensive soft tissue damage. To perform reposition, open surgical access is not required, blood loss is minimal, which can significantly reduce the traumatic nature of the operation and can be performed in elderly and debilitated patients.

2024 TSOC/TSPS Joint Consensus: Strategies for Advanced Vascular Wound Management in Arterial and Venous Diseases.

The Taiwan Society of Cardiology (TSOC) and Taiwan Society of Plastic Surgery (TSPS) have collaborated to develop a joint consensus for the management of patients with advanced vascular wounds. The taskforce comprises experts including preventive cardiologists, interventionists, and cardiovascular and plastic surgeons. The consensus focuses on addressing the challenges in diagnosing, treating, and managing complex wounds; incorporates the perfusion evaluation and the advanced vascular wound care team; and highlights the importance of cross-disciplinary teamwork. The aim of this joint consensus is to manage patients with advanced vascular wounds and encourage the adoption of these guidelines by healthcare professionals to improve patient care and outcomes. The guidelines encompass a range of topics, including the definition of advanced vascular wounds, increased awareness, team structure, epidemiology, clinical presentation, medical treatment, endovascular intervention, vascular surgery, infection control, advanced wound management, and evaluation of treatment results. It also outlines a detailed protocol for assessing patients with lower leg wounds, provides guidance on consultation and referral processes, and offers recommendations for various wound care devices, dressings, and products. The 2024 TSOC/TSPS consensus for the management of patients with advanced vascular wounds serves as a catalyst for international collaboration, promoting knowledge exchange and facilitating advancements in the field of advanced vascular wound management. By providing a comprehensive and evidence-based approach, this consensus aims to contribute to improved patient care and outcomes globally.

Endovenous laser ablation of great saphenous vein and pharmacotherapy of acute ascending thrombophlebitis: results of a three-month follow-up

Aim. In patients with acute ascending thrombophlebitis of the great saphenous vein and/or its large tributaries, assess the incidence of venous thrombosis progression over 3 months with 1,5-month fondaparinux sodium therapy and endovenous laser ablation of the saphenofemoral junction in combination with short-term (7-day) anticoagulant therapy or without anticoagulation.Material and methods. This single-center, prospective, randomized, open-label study included data from 91 patients with acute ascending thrombophlebitis of the great saphenous vein and/or its large tributaries, of which 30 were in the group of endovenous laser ablation without anticoagulation, 32 — in the group of endovenous laser ablation in combination with 7-day fondaparinux therapy, and 29 — in the 1,5-month fondaparinux therapy group. Venous thrombosis progression rate within 90±2 days was assessed. Compression ultrasonography of lower limb veins was performed on days 7±2, 45±2 and 90±2 after randomization, as well as in case of thrombosis progression suspicion.Results. The mean age of patients was 49,4±14,2 years. There were more women (73,6%). There was a low prevalence of risk factors for the development and progression of venous thrombosis: obesity — 6,6%, type 2 diabetes — in 2 patients, class 2 heart failure — in 1, autoimmune disease (scleroderma in remission) — in 1, prior cancer — in 1. Previous episodes of thrombophlebitis were noted in 3 cases (3,3%). Following external factors provoking venous thrombosis were identified in 19 patients (20,9%): lower leg injury in 14, high physical activity in 3, long flight in 1, recent coronavirus disease 2019 in 1. Median duration of thrombophlebitis manifestations was 6 days. Thrombosis was located in the trunk of the great saphenous vein in 96,7% of patients, while large tributaries were involved in 29,7%. The median distance from the thrombus proximal part to the saphenofemoral junction was 42,5 cm. Over 90±2 days, there were no cases of involvement of the suprafascial segment of the perforating vein in thrombosis to the fascia level, spread of thrombosis to the deep veins, or pulmonary embolism. Subsequently, a new episode of superficial vein thrombosis was noted only in 2 patients from the pharmacotherapy group with a history of thrombophlebitis.Conclusion. In patients with a low risk of venous thrombosis progression and predominantly distal location of acute ascending thrombophlebitis of the great saphenous vein and/or its large tributaries after endovenous laser ablation, progression of venous thrombosis is not expected over the next 3 months, despite an anticoagulation reduction to 7 days or its refusal.

Lumbar multifidus characteristics and body composition in university level athletes

IntroductionBody composition is well known to affect sport performance and previous studies suggested that structural and functional lumbar multifidus (LM) impairments in athletes were associated with low back pain and lower leg injuries. However few studies have examined the relationship between LM characteristics and body composition in athletic populations.MethodsThis cross-sectional study included a total of 134 university varsity athletes (hockey, soccer, rugby, and football players). Ultrasound imaging was used to examined LM characteristics at the L5 bilaterally [e.g., size, thickness at rest, thickness during contraction, echo-intensity (EI) and % thickness change from rest to contraction] and body composition parameters (dual-energy x-ray absorptiometry). Pearson correlations were used to assess the relationship between LM characteristics and body composition parameters. One-way ANOVA assessed differences in LM characteristics and body composition between sports. All analyses were performed separately by sex.ResultsLM size and thickness were positively correlated with weight, height, lean body mass and total bone mass (male: r = 0.23–0.55, p < 0.01–0.05; female: r = 0.30–0.39, p < 0.01–0.05). LM EI was strongly correlated with % body fat (male: r = 0.62, female: r = 0.71, p < 0.01). LM thickness at rest (r = 0.42, p < 0.01) and contracted (r = 0.27, p < 0.05) were positively correlated and % thickness change was negatively correlated with % body fat in male athletes (r = −0.43, p < 0.01).DiscussionThe significant differences in body composition and LM characteristics between sports may be attributed to sport specific demands. Understanding connections between body composition and LM may aid in preseason screening for athletes at risk of low back pain or lower leg injuries during the season.

Single cells and bacterial biofilm populations in chronic wound infections.

Chronic wounds and chronic ulcers are an increasing problem associated with high health care burden and patient burden. The arrested healing of chronic wounds has, in part, been attributed to the presence of biofilms. Substantial research has documented the presence of biofilms in chronic wounds, and many mechanisms of host-pathogen interactions have been uncovered to explain the arrested healing. However, the paradigm of whether biofilms are only observed in chronic infections was recently challenged when biofilms were also observed in acute infections. Here, we characterize the distribution of bacteria in lower leg wounds with particular emphasis on Pseudomonas aeruginosa and Staphylococcus aureus by confocal laser scanning microscopy combined with PNA-FISH staining and routine culture of bacteria. We show that 40% of wounds contained either P. aeruginosa or S. aureus biofilms and demonstrate the presence of scattered single cells in tissues stained with a universal bacterial PNA-FISH probe. Thus, we demonstrate that chronic wounds do not only harbor bacteria organized in biofilms, but also carry populations of scattered single cells and small cell clusters of only a few bacteria. Our findings may influence diagnostic tools being developed to only target biofilms, where single-cell subpopulations thus may be overlooked and possibly lead to false-negative results.

Lower Leg Injury - Football

Lower Leg Injury - Football

The Impact of Differential Knee Laxity on Brain Activation During Passive Knee Joint Loading.

Although higher anterior knee laxity is an established risk factor of ACL injury, underlying mechanisms are uncertain. While decreased proprioception and altered movement patterns in individuals with anterior knee laxity have been identified, the potential impact of higher laxity on brain activity is not well understood. Thus, the purpose of this study is to identify the impact of different magnitudes of knee laxity on brain function during anterior knee joint loading. Twenty-seven healthy and active female college students without any previous severe lower leg injuries volunteered for this study. Anterior knee laxity was measured using a knee arthrometer KT-2000 to assign participants to a higher laxity (N=15) or relatively lower laxity group (N=12). Functional magnetic resonance images were obtained during passive anterior knee joint loading in a task-based design using a 3T MRI scanner. Higher knee laxity individuals demonstrated diminished cortical activation in the left superior parietal lobe during passive anterior knee joint loading. Less brain activation in the regions associated with awareness of bodily movements in females with higher knee laxity may indicate a possible connection between brain activity and knee laxity. The results of this study may help researchers and clinicians develop effective rehabilitation programs for individuals with increased knee laxity. This article is protected by copyright. All rights reserved.

Sex differences in musculoskeletal injury epidemiology and subsequent loss of tactical readiness during Marine Corps Officer Candidates School

IntroductionThe US Marine Corps (USMC) Officer Candidates School (OCS) is a 10-week training course for Marine Officer Candidates (MOCs). OCS training is rigorous and demanding, which results in a high...

Injuries in Ballroom DanceSport: A Retrospective Study on Prevalence and Relation With Demographic Data.

DanceSport is a variant of Ballroom dancing, a style that is performed as a couple dancing together. Although there are many participants worldwide, the amount of research on injuries done in this style of dancing is limited. The aim of this study was obtaining information about the DanceSport Athletes in the Netherlands including anthropometrics, level, frequency and duration of dance training per week. Our second objective was to investigate injury prevalence and type of injuries. Retrospective questionnaire study. All 816 registered active dancers within the Dutch DanceSport Association received an online questionnaire with questions on anthropometrics, level of dancing, frequency and duration of dance training, and questions on injuries. The Chi-Square test was used to calculate differences between categorical variables. A total of 218 dancers (33.7%) completed the questionnaire, 107 males (49.1%), and 111 females (50.9%). The mean age for men was 42 ± 15.9 and 36 ± 15.1 for women. 176 dancers (80.7%) reported 1 or more injuries. Foot, ankle, and lower leg injuries were reported most frequently, 49 males (45.8%), and 60 females (54.1%). No significant difference was found in the total number of injuries for the variables sex (P = .761) and discipline (P = .225). Significantly more head and neck injuries were identified in female Standard dancers (P < .001) compared to male dancers. Also, Standard dancers have more back injuries compared to dancers in both disciplines (P < .009). With the described anthropometrics and an 80% lifetime prevalence of injuries, this group can be compared to other dance forms. Significant differences in injuries of the head and neck for female Standard dancers compared to male dancers and significantly more back injuries in Standard dancers compared to dancers in both disciplines were found. Future studies need to translate and validate existing questionnaires in Dutch for use in this population.

Enhanced in vivo and ex vivo thrombin generation after lower-leg trauma, but not after knee arthroscopy

BackgroundThere is room for improvement of prevention of venous thromboembolism (VTE) after lower-leg cast application or knee arthroscopy. Information about the mechanism of clot formation in these patients may be useful to identify new prophylaxis targets. We aimed to study the effect of 1) lower-leg injury and 2) knee arthroscopy on thrombin generation.MethodsA cross-sectional study was conducted using plasma samples of POT-(K)CAST trials to measure ex vivo thrombin generation (Calibrated Automated Thrombography [CAT]) and plasma levels of prothrombin fragment 1 + 2 (F1 + 2), thrombin-antithrombin (TAT), fibrinopeptide A (FPA). Plasma was obtained shortly after lower-leg trauma or before and after (< 4 h) knee arthroscopy. Participants were randomly selected from those who did not develop VTE. For aim 1, samples of 88 patients with lower-leg injury were compared with 89 control samples (i.e., preoperative samples of arthroscopy patients). Linear regression was used to obtain mean differences (or ratios if ln-retransformed because of skewedness) adjusted for age, sex, body mass index, comorbidities. For aim 2, pre- and postoperative samples of 85 arthroscopy patients were compared, for which mean changes were obtained.ResultsIn patients with lower-leg injury (aim 1), endogenous thrombin potential, thrombin peak, velocity index, FPA and TAT were increased as compared with controls. In arthroscopy patients (aim 2), pre- and postoperative levels were similar for all parameters.ConclusionLower-leg trauma increases thrombin generation both ex vivo and in vivo, in contrast to knee arthroscopy. This may imply that the pathogenesis of VTE is different in both situations.

Lower Quarter Y-Balance Test Anterior Reach Asymmetry and Noncontact Lower Limb Injury in Subelite Young Male Soccer Players With Different Training Experiences

Poor single-leg balance performance is associated with an increased risk of sustaining lower limb injuries in team sports. However, it is unclear whether this relationship is modified by the level of training experience (years of training experience). The objective of the present study was to evaluate whether soccer players’ single-leg balance performance is related to lower limb injuries in noncontact situations with different levels of training experience. Subelite young male soccer players performed the Lower Quarter Y-Balance Test with the dominant and the nondominant leg at the beginning of the preseason. Due to COVID-19 rules, the occurrence of lower limb injuries during the second half of the competitive season was documented. The odds of injury were calculated based on a previously reported Lower Quarter Y-Balance Test cut-off score for side-to-side anterior reach difference (≥4 cm). Twelve soccer players sustained a lower leg injury in noncontact situations. Only four of them had an anterior reach difference equal to or above the cut-off score. Soccer training experience has no significant influence on the association between Lower Quarter Y-Balance Test anterior reach asymmetry and noncontact lower limb injury in young male players.

Examining Location of Injuries of Upper and Lower Body Extremities in Volleyball Players within the Zambezi Volleyball Association

Injuries of upper and lower body extremities are very common among volleyball players and their impact on sports has numerous effects in training sessions and competitive games. The purpose of this study was to examine the location of injuries of upper and lower body extremities in volleyball players within the Zambezi Volleyball Association. The study employed quantitative research methods to explore more on injuries of upper and lower body among participants. The study population consisted of (n = 141) participants (n = 37 female, n = 104 male) with 10 teams (n = 3 female, n = 7 male). The participants were purposively selected based on their experience and involvement in volleyball training sessions and games. The data was analyzed using SPSS software programme. The result percentages and frequencies were presented in tables. A total number of 293 injuries (73 female, 220 male) were sustained during the 2021-2022 season from these body locations: shoulder injuries 63 (44.6%), Hand/wrist injuries 51 (36.0%), Ankle injuries 47 (33.0%), Head/face injuries 29 (20.5%), knee 26 (18.4%), trunk injuries 20 (14.1%), arm/elbow injuries 15 (10.6%), foot injuries 14 (9.9%), lower leg injuries 11 (7.8%), hip/thigh/upper leg injuries 9 (6.3%) and 8 neck injuries (5.6%). This study concludes that there are more injury occurrences sustained among male compared to female participants within the same injury locations. Moreover, common locations of injuries were sustained in shoulders, wrists and ankles in most volleyball players (20% - 63%) in one season.

The influence of lower-leg injury and knee arthroscopy on natural anticoagulants and fibrinolysis

BackgroundPatients with lower-leg injuries and those undergoing knee arthroscopy are at increased risk of developing venous thromboembolism. The mechanism is unknown, including the influence of lower-leg injury and knee arthroscopy on natural anticoagulant factors and fibrinolysis. ObjectivesTo study the effect of lower-leg injury and knee arthroscopy on plasma levels of anticoagulant and fibrinolytic factors. MethodsWe applied the following 2 designs to investigate this effect: a cross-sectional study for lower-leg trauma and a before-and-after study for knee arthroscopy. Plasma samples of POT-CAST– and POT-KAST–randomized clinical trial participants (collected shortly after lower-leg trauma or before or after arthroscopy) were analyzed for clot lysis time and levels of antithrombin, tissue factor pathway inhibitor, protein C, free protein S, plasminogen, tissue plasminogen activator, plasminogen activator inhibitor 1, antiplasmin, thrombin activatable fibrinolysis inhibitor, plasmin-antiplasmin, and D-dimer. For the effect of lower-leg injury, samples of 289 patients were compared with preoperative samples of 293 arthroscopy patients, acting as controls using linear regression and adjusting for age, sex, body mass index, comorbidities, and diurnal variation. For the effect of knee arthroscopy, mean changes were calculated for 277 patients using linear mixed models adjusted for diurnal variation. Parameters other than CLT and D-dimer were measured in smaller subsets. ResultsIn lower-leg injury patients, most parameters were stable, whereas D-dimer increased. After arthroscopy, most parameters decreased (especially clot lysis time, D-dimer, plasminogen, and anticoagulant factors), whereas tissue plasminogen activator and thrombin activatable fibrinolysis inhibitor slightly increased. ConclusionIn contrast to lower-leg injury, knee arthroscopy was associated with decreased natural anticoagulant factor levels. Neither lower-leg injury nor knee arthroscopy affected in vivo fibrinolysis.

Comparison of compression therapy use, lower limb wound prevalence and nursing activity in England: a multisite audit

This audit was designed to identify the need of the population and the clinical activity associated with wounds and the management of lower limb swelling. The exploration focused on lower leg wound management, access to diagnostics and compression therapy across each audit site. The variation across the sites was explored to gather insight into the real-world barriers to providing evidence-based management for leg ulceration. We undertook wound prevalence audits across six diverse community provider sites in England. The audit was undertaken by the local providers, with the inclusion of tissue viability and podiatry leads and key local stakeholders, often local quality leads, primary care leads and nursing directors. Each audit was undertaken with full engagement of local clinicians. Data were collected centrally, and each audit site received their own local analysis and report, with additional analytical support from the local tissue viability lead to ensure the feedback was contextualised for their stakeholders. Analysis was provided by Accelerate CIC Lymphoedema & Leg Ulcer Clinic. A total of 2885 patients were reviewed via an online or a paper audit tool. In total, 2721 patients had one or more active wounds. However, 1350 patients had one or more lower leg wounds, with 164 patients being managed for lower limb swelling or prevention of leg ulceration; bilateral conditions ranged from 11-43% across audit sites. Of the six sites, two included both community and primary care providers, thus generating wound point prevalence data. The remaining four sites audited community nursing and podiatry services only, with two sites collecting data on lower limb wounds only rather than all wounds, generating point prevalence for their services only. Compression usage varied across care locations, with the greatest use being seen in community leg ulcer clinics, where it was >96% for 234 residents. Compression usage was lower in the home with a range of 14-62% among 692 residents. For 263 residents, where the cause of their lower leg wound was unknown, compression usage was very low at 12%. Compression usage decreased with age; for three audit sites this was noteworthy, with 65% of those aged >80 years not in receipt of compression. Compression usage had a direct impact on nursing activity; non-use of compression increased activity by 37%. Through the identification of wound location, this series of wound prevalence audits identified a greater number of patients with lower limb wounds than those recognised and classified as a leg ulcer. Substantial variation in access to diagnostics and compression therapy was observed between audit sites, and also between locations within their boroughs. The factors that reduced access to compression therapy included not classifying the lower leg wound as a leg ulcer, being cared for in the home and increasing age of the patient. Lack of compression usage increased nursing activity. Where there is lack of access to therapeutic intervention, the resultant patient harm is not systematically recognised or documented.

Lower-leg injury and knee arthroscopy have distinct effects on coagulation

AbstractIt is unknown how lower-leg injury and knee arthroscopy, both associated with venous thromboembolism (VTE), affect coagulation. To study the effect of (1) lower-leg trauma and (2) knee arthroscopy on coagulation, plasma samples of the Prevention of Thrombosis following CAST immobilization (POT-CAST, #NCT01542762) and Prevention of Thrombosis following Knee Arthroscopy (POT-KAST, #NCT01542723) trials were used, which were collected shortly after lower-leg trauma and before/after (<4 hours) knee arthroscopy. For aim 1, 1204 lower-leg injury patients were compared with preoperative samples of 1001 controls. Mean differences/ratios (if ln-retransformed because of skewedness) were adjusted for sex, age, body mass index, comorbidity, malignancy, and oral contraceptives using linear regression. For aim 2, perioperative mean changes of 715 arthroscopy patients were calculated. Plasma levels of fibrinogen, factor (F)VIII, FIX, FXI, von Willebrand Factor (VWF), and D-dimer were measured in all individuals. Parameters of underlying mechanisms (tissue factor, interleukin-6 [IL-6], myeloperoxidase DNA, cell-free DNA) were measured in random subsets. In lower-leg injury patients, coagulation parameter levels increased, especially FVIII, VWF, and D-dimer, that is, adjusted mean differences: FVIII 26.8% (95% confidence interval [CI], 23.7-29.9), FIX 13.8% (95% CI, 11.9-15.6), FXI 5.1% (95% CI, 3.3-7.0), VWF 29.8% (95% CI, 26.0-33.6), fibrinogen 32.5 mg/dL (95% CI, 25.8-39.2), and D-dimer (mean ratio) 3.3 (95% CI, 3.1-3.6). Remaining parameters were unchanged, except for increased IL-6 levels. After arthroscopy, all parameters decreased. Lower-leg trauma is associated with increased procoagulant factor levels in contrast to knee arthroscopy. This suggests that, in both situations, different pathways are involved in development of VTE.

Collisions with another person while skiing and snowboarding: A 13-year national registry analysis

IntroductionInterindividual collisions while skiing or snowboarding occur regularly, they can be associated with severe injuries. ObjectiveTo elucidate causes of accidents, injury patterns and potential risk factors for injury severity in interindividual collisions of skiers and snowboarders. Material and MethodsRetrospective analysis of the Austrian Registry for Mountain Accidents within a 13-year timeframe (2005–2018) with regard to on- or off-piste collisions of skiers and snowboarders. ResultsA total of 30,503 collisions, involving 52,430 (85.9%) skiers and 8,576 (14.1%) snowboarders were analysed. Denominators are lacking, since total numbers of skiers and snowboarders were not available. Compared to skiers, snowboarders were younger (23 vs. 42 years; p<0.001), predominantly male (77.4% vs. 61.0%; p<0.001) and less often severely injured (46.8% vs. 26.2%; p<0.001). Most accidents occurred on slopes (>95%). Collisions involving two snowboarders occurred proportionally more often in terrain parks (4.1% of 1,664 injured snowboarders; p<0.001) and while one victim was standing or sitting (9.7%; p<0.001). Contusions/strains/sprains were most prevalent (>23%), as were head injuries (>12%). In skiers, chest, shoulder, hip, thigh and knee injuries occurred more often, leading to fractures, dislocations, concussions and internal injuries more frequently. In snowboarders, spine/back, elbow, forearm, wrist and lower leg injuries were more prevalent. Female gender and standing or sitting prior to the accident was a risk factor for being more severely injured in collisions involving i) two skiers (OR: 4.02 (3.79–4.26) and 3.91 (3.26–4.68)), ii) a skier and a snowboarder (OR: 4.50 (3.95–5.14) and 11.49 (8.04–16.41)) or iii) two snowboarders (OR: 2.85 (2.12–3.84) and 12.47 (6.17–25.20)). Wearing a helmet increased the risk when two skiers collided (OR: 1.10 (1.03–1.17)). In skier vs. snowboarder collisions, the skier had a higher risk of being injured more severely (OR: 7.93 (6.98–9.01)). ConclusionsIn interindividual collisions of skiers and snowboarders, injury patterns and preceding causes differ substantially. Skiers are more likely to be severely injured. Awareness of an increased risk of injury should be raised particularly while standing or sitting on the slope.