Management Of Musculoskeletal Injuries Research Articles

Evaluation of musculoskeletal system injuries after the 2023 Kahramanmaraş Turkey earthquakes: Our single-center experience.

This study aimed to retrospectively analyze patients who presented to the orthopedic and traumatology clinic following the 2023 Kahramanmaraş earthquakes. Over a week after the earthquakes, two hundred and sixty patients were consulted at our clinic. Demographic data of the patients, duration of being under the rubble, fracture locations, types of surgeries performed, number of surgical sessions attended by individuals, and early mortality rate within one month were determined. The mean age of the patients was 40.2 ± 22.4 years. One hundred thirty-eight (53.1%) were female, and 122 (46.9%) were male. The average duration of being under the rubble was determined as 27.1 ± 28.0 hours. Sixteen patients died within one month after the earthquake. The one-month mortality rate among patients with orthopedic injuries was 6.15%. Forty-seven fasciotomies were performed in 35 patients, and 22 amputations were performed in 19 patients. The most injured region was the lower extremity (78 cases, 40%). The ratio of external and internal fixation in extremity fractures was 22%. The management of musculoskeletal injuries can be successful with proper triage and treatment plans. Decisions regarding fasciotomy and amputation in patients with crush syndrome following an earthquake should be individualized. Implant sets should be planned accordingly, especially considering the higher occurrence of lower extremity injuries.

Patient-reported outcomes during telehealth versus in-person follow-up visits for patients treated with extracorporeal shockwave therapy.

The limited research describing clinical outcomes using telehealth for management of musculoskeletal conditions is primarily within orthopedic surgery care. To characterize differences in patient reported outcomes using telehealth compared with in-person follow-up visits in patients with Achilles tendinopathy (AT) or plantar fasciitis (PF) treated using extracorporeal shockwave therapy (ESWT). Retrospective chart review. Outpatient sports medicine clinic. 82 patients with AT and 46 patients with PF. In-person (n = 76) and telehealth (n = 52) follow-up visits. Victorian Institute of Sports Assessment-Achilles (VISA-A) for AT and Foot and Ankle Ability Measure (FAAM) for PF as well as billing level. There was significant improvement from baseline to final VISA-A (p < .01) and FAAM (p < .01) following ESWT. No significant difference existed in the proportion of patients who met the minimal clinically important difference based on in-person (71.1%) versus telehealth (71.2%) follow-up (p = .99). The in-person group demonstrated higher billing levels compared to the telehealth group (Level: 3.5 ± 0.6 vs. 2.8 ± 0.7, p < .01). Given no significant differences in outcomes between two modes of follow-ups, telehealth may serve as an alternative method to guide management of musculoskeletal injuries with ESWT and other procedures.

Initial Assessment and Management of Select Musculoskeletal Injuries: A Team Physician Consensus Statement.

Musculoskeletal injuries occur frequently in sport during practice, training, and competition. Injury assessment and management are common responsibilities for the team physician. Initial Assessment and Management of Musculoskeletal Injury-A Team Physician Consensus Statement is title 23 in a series of annual consensus documents written for the practicing team physician. This statement was developed by the Team Physician Consensus Conference, an annual project-based alliance of six major professional associations. The goal of this document is to help the team physician improve the care and treatment of the athlete by understanding the initial assessment and management of selected musculoskeletal injuries.

Establishing Consensus on Essential Resources for Musculoskeletal Trauma Care Worldwide: A Modified Delphi Study.

Despite evidence that formalized trauma systems enhance patient functional outcomes and decrease mortality rates, there remains a lack of such systems globally. Critical to trauma systems are the equipment, materials, and supplies needed to support care, which vary in availability regionally. The purpose of the present study was to identify essential resources for musculoskeletal trauma care across diverse resource settings worldwide. The modified Delphi method was utilized, with 3 rounds of electronic surveys. Respondents consisted of 1 surgeon with expertise in musculoskeletal trauma per country. Participants were identified with use of the AO Trauma, AO Alliance, Orthopaedic Trauma Association, and European Society for Trauma and Emergency Surgery networks. Respondents rated resources on a Likert scale from 1 (most important) to 9 (least important). The "most essential" resources were classified as those rated ≤2 by ≥75% of the sampled group. One hundred and three of 111 invited surgeons completed the first survey and were included throughout the subsequent rounds (representing a 93% response rate). Most participants were fellowship-trained (78%) trauma and orthopaedic surgeons (90%) practicing in an academic setting (62%), and 46% had >20 years of experience. Respondents represented low-income and lower-middle-income countries (LMICs; 35%), upper-middle income countries (UMICs; 30%), and high-income countries (HICs; 35%). The initial survey identified 308 unique resources for pre-hospital, in-hospital, and post-hospital phases of care, of which 71 resources achieved consensus as the most essential. There was a significant difference (p < 0.0167) in ratings between income groups for 16 resources, all of which were related to general trauma care rather than musculoskeletal injury management. There was agreement on a core list of essential musculoskeletal trauma care resources by respondents from LMICs, UMICs, and HICs. All significant differences in resource ratings were related to general trauma management. This study represents a first step toward establishing international consensus and underscores the need to prioritize resources that are locally available. The information can be used to develop effective guidelines and policies, create best-practice treatment standards, and advocate for necessary resources worldwide. This study utilized the Delphi method representing expert opinion; however, this work did not examine patient management and therefore does not have a clinical Level of Evidence.

Update on the Use of Platelet-Rich Plasma Injections in the Management of Musculoskeletal Injuries: A Systematic Review of Studies From 2014 to 2021.

There has been expanding use of platelet-rich plasma (PRP) in the management of musculoskeletal soft tissue injuries. To determine if there are any recent studies that show any clear benefits regarding the use of PRP in the management of soft tissue injuries. Systematic review. This review was conducted according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The EMBASE, MEDLINE, PubMed, and Cochrane Bone, Joint and Muscle Group Specialised Register databases were queried for randomized controlled trials comparing PRP with a non-PRP/placebo in participants >18 years of age with musculoskeletal soft tissue injuries. Exclusion criteria were non-soft tissue injuries and research published in journals with an impact factor <3.5. The main outcome measure analyzed across all injury types was the effect of PRP injections on pain and function. Of the 853 studies initially screened, 32 were included in this review. There were 13 studies that investigated the effects of PRP on the management of rotator cuff injuries; 7 studies that investigated PRP in conjunction with arthroscopy found no significant difference between PRP groups and controls, while 5 of 6 studies that investigated nonsurgical management showed positive results for PRP. Eight studies investigated various tendinopathies; of these, 2 studies demonstrated positive results for PRP in Achilles and gluteal tendinopathy management. Six studies examined PRP in acute soft tissue injuries, with 2 of these reporting significant improvements in recovery time for hamstring injuries and 1 study showing positive results for ankle ligament injuries. Two studies looked at acute rupture of soft tissues and found no benefit to PRP use. Two studies investigated PRP injections for chronic plantar fasciitis, and both reported positive results in pain and function with PRP. Finally, 1 study evaluated the effects of PRP on meniscal injuries and reported significant improvement in the healing rate and a decreased need for surgical repair. Currently, there is no research strongly advocating the use of PRP compared with traditional management strategies (rest, ice, corticosteroid injection, rehabilitation program). No long-term physiological benefits were reported to justify the invasive and costly technique of obtaining, producing, and implementing PRP.

Counterirritants and sensory profiling of pain-relieving patches

Introduction: Musculoskeletal pain is a common medical and socioeconomic problem worldwide. Treatment and management options most commonly include analgesics such as paracetamol, nonsteroidal anti-inflammatory drugs (NSAIDs), and topical over-the-counter (OTC) preparations. Patients often use OTC topical analgesics owing to the benefits shown by clinical studies for the treatment and management of musculoskeletal injuries and disorders. The aim of this study was (1) to review the background, current understanding, and therapeutic usefulness of topical counterirritants for the management of musculoskeletal pain (2) and to evaluate the sensorial characteristics of two prototype patches containing counterirritants, designed to manage pain relief by delivering a warming or cooling sensation. Methods: Detailed literature search was conducted in PubMed, Google Scholar, and Cochrane Library databases for this review. An expert sensory panel study comprising of ten trained sensory experts was conducted to evaluate the performance of prototype patches containing counterirritants for their sensory characteristics including overall sensation, cooling, warming, and tingling sensations, as well as functional parameters such as ease of application and removal, adhesive property, odor intensity, staining on clothes, residue or greasiness, and sweat/moistness on the skin after removal. Results: Topical analgesics containing counterirritants like capsaicin, menthol, and salicylates produce analgesia by activating and then desensitizing epidermal nociceptors. Literature searches provide evidence for their use in the management of musculoskeletal pain. The expert sensory panel study showed that the sensations elicited by the prototype counterirritant patches were predominantly cooling, tingling, and low and short warming in nature, with strong adhesion, ease of application and removal, no staining, little to no residue and grease on the skin, and low lingering odor of menthol. Conclusion: Literature search supports the use of counterirritants in the treatment of musculoskeletal pain like backache, strains, and sprains. In addition, the observations from the expert sensory panel study evaluating sensory and functional parameters of counterirritant patches showed that these patches provide predominantly cooling, tingling and low short lasting warming sensations with strong adhesion, no stain and little to no residue and grease. These results support their potential as a treatment modality with increased consumer acceptance, potentially increasing treatment adherence and maximizing the effectiveness of therapies. And may be used as part of multimodal pain treatment regimens for musculoskeletal conditions.

Trauma System Support to Facilitate Recovery.

Trauma is a major public health issue. Orthopaedic trauma surgeons are skilled in the acute management of musculoskeletal injury; however, formal training and resources have not been devoted to optimizing recovery after trauma. Recovery entails addressing the biomedical aspects of injury, as well as the psychological and social factors. The purposes of this study were to describe existing programs and resources within trauma centers, developed to promote psychosocial recovery. Supporting research data will be referenced, and potential barriers to program implementation will be discussed. The American College of Surgeons has mandated screening and treatment for mental illness after trauma, which will raise the bar to highlight the importance of these social issues, likely enabling providers to develop new programs and other resources within their systems. Provider education will promote the informing of patients and families, with the intent of enhancing the efficiency and scope of recovery.

A comparison of prospective observations and chart audits for measuring quality of care of musculoskeletal injuries in the emergency department

BackgroundAccurate and efficient data collection is crucial for effective evaluation of quality of care. The objective of this study is to compare two methods of data collection used to score quality indicators for musculoskeletal injury management in Emergency departments: prospective observation, and chart audit. MethodsAn analysis was undertaken of data collected from 633 patients who presented with a musculoskeletal injury to eight emergency departments in Queensland, Australia in 2016–17. Twenty-two quality indicators were scored using both prospective observation and chart audit data for each occasion of service. Quality indicators were included if they were originally published with both collection methods. Analyses were performed to compare firstly, the quality indicator denominators, and secondly, the quality indicator trigger rates, scored using each collection method. Chi Square statistics were used to identify significant differences. ResultsProspectively collected data scored quality indicator denominators significantly (p value<0.05) more often than chart audit data for five (22.7 %) of the 22 quality indicators. The remaining 17 quality indicators (77.3 %) showed no statistical differences. When comparing quality indicator trigger rates, 16 (72.7 %) had significantly different results between methods with 12 (54.5 %) scoring higher using prospective data and four (18.2 %) with chart audit data. The remaining six quality indicators (27.3 %) in this comparison showed no significant difference between chart and prospective data. ConclusionQuality indicators including aspects of care associated with patient safety, and those relying on clinician written orders or forms were adequately scored using either prospective observation or chart audit data. Whereas quality indicators relying on time-sensitive information, elements of a social history, general physical exams and patient education and advice scored higher using prospective observation data collection.

Modified prolotherapy by 5% dextrose: Two years experiences of a traditional and complementary medicine practice center in Turkey.

Prolotherapy (PrT) is an increasingly popular regenerative injection treatment for the management of musculoskeletal injuries. The diagnostic injection is a method for selecting suitable patients to apply PrT using subcutaneous 5% dextrose solution. The study aims to assess the PrT usage and modifications in the treatment of chronic low back pain and lumbar disc herniation and to define diagnostic injection procedure for PrT. Two thousand three hundred and eighty-two patients with low back pain or lumbar disc herniation were evaluated at the Traditional and Complementary Medicine Practice Center in Ankara, Turkey. Six hundred fifty-four patients were included in the study. Diagnostic injections were performed on all patients who were thought to be eligible candidates for PrT indications. A 4-or-6 week interval was allowed between treatment sessions. Xix hundred and fifty-four patient treatments were completed. The Visual Analogue Scale (VAS) scores decreased to 5.1 ± 1.4 while 7.2 ± 1.1 before the diagnostic injection (p< 000.1). The VAS scores decreased from 7.2 ± 1.1 before the treatment to 0.9 ± 0.9 after 52 weeks of the treatment (p< 000.1). Thirty-four patients' treatments resulted in poor clinical results (5.2%), and 620 of the patients' pain improved (94.8%). PrT can be regarded as a safe way of providing a meaningful improvement in pain and musculoskeletal function compared to the initial status. Diagnostic injection is an easy way to eliminate patients and may become a favorite treatment modality. 5% dextrose is a more simple and painless solution for PrT and also has a high success.

Penatalaksanaan Cedera Muskuloskeletal pada Korban Kecelakaan melalui Simulasi Evaluasi pada Masyarakat Awam

Musculoskeletal injury is an injury to one part of the musculoskeletal system that can be acute or as a result of gradual overuse which usually causes dysfunction of surrounding structures and the structures that are protected or supported, resulting in not being able to function properly in muscles, tendons, ligaments, joints or bones. The general purpose of this study was to determine the level of cedar musculoskeletal management skills in accident victims in the general public. This research is an experimental study with a Pre-Test-Post Test one Group design approach. Through testing research hypotheses. The population of this research is the cloud community totaling 48 respondents. Paired statistical test using nonparametric Wilcoxon test. Based on the results of the Wilcoxon analysis test, it can be concluded that 48 respondents who received training in the management of musculoskeletal injuries in accident victims through evaluation simulations in the general public can be concluded that the majority of ordinary people have good knowledge in terms of the ability to handle musculoskeletal injuries in accident victims through evaluation simulations. with a p value of 0.001 which means that there is a significant difference between before and after training with simulation. Education and training on musculoskeletal injury management actions for accident victims through evaluation simulations in the general public continues to be held to improve the ability of these action skills

Opioid Prescribing Risk Factors in Nonoperative Ankle Fractures: The Impact of a Prospective Clinical Decision Support Intervention

Opioids are frequently used for acute pain management of musculoskeletal injuries, which can lead to misuse and abuse. This study aimed to identify the opioid prescribing rate for ankle fractures treated nonoperatively in the ambulatory and emergency department setting across a single healthcare system and to identify patients considered at high risk for abuse, misuse, or diversion of prescription opioids that received an opioid. A retrospective cohort study was performed at a large healthcare system. The case list included nonoperatively treated emergency department, urgent care and outpatient clinic visits for ankle fracture and was merged with the Prescription Reporting With Immediate Medication Mapping (PRIMUM) database to identify encounters with prescription for opioids. Descriptive statistics characterize patient demographics, treatment location and prescriber type. Rates of prescribing among subgroups were calculated. There were 1,324 patient encounters identified, of which, 630 (47.6%) received a prescription opioid. The majority of patients were 18-64 years old (60.3%). Patients within this age range were more likely to receive an opioid prescription compared to other age groups (p < .0001). Patients treated in the emergency department were significantly more likely to receive an opioid medication (68.3%) compared to patients treated at urgent care (33.7%) or in the ambulatory setting (16.4%) (p < .0001). Utilizing the PRIMUM tool, 14.2% of prescriptions were provided to patients with at least one risk factor. Despite the recent emphasis on opioid stewardship, 14.2% of patients with risk factors for misuse, abuse, or diversion received opioid analgesics in this study, identifying an area of improvement for prescribers.

Orthopaedic Trauma Research Priorities in Latin America: Developing Consensus Through a Modified Delphi Approach.

Despite a substantial burden of musculoskeletal injury, orthopaedic trauma studies in Latin America are lacking. The purpose of the present study was to identify research priorities among orthopaedic trauma surgeons in Latin America. Research questions were solicited from members of the Asociación de Cirujanos Traumatólogos de las Américas. Participants rated questions by importance from 1 to 9. All questions were redistributed with an aggregate rating, and participants rerated questions with knowledge of group responses. Seventy-eight participants completed the first survey and were included in subsequent surveys. The mean age was 51.8 years, and most participants were male (92%), had completed an orthopaedic trauma fellowship (60.3%), and participated in research (80.8%). Seventeen countries were represented; 5 respondents were from a high-income country, 67 were from an upper middle-income country, and 6 were from a lower middle-income country. Sixty-five questions were identified. Six questions were rated from 1 to 3 ("more important") by >70% of participants: (1) What is the optimal treatment protocol for elderly patients with hip fracture? (2) What is the most effective initial and definitive management of musculoskeletal injury, including timing and surgical strategy, for the polytraumatized patient? (3) What is the ideal state of open fracture treatment, including timeliness and method of antibiotics, debridement, surgical fixation, and closure or coverage, at each hospital level in the health-care system? (4) What patient and fracture characteristics predict infection after musculoskeletal injury? (5) What is the current state of treatment for fracture-related infection, including timeliness and method of antibiotics and surgical intervention, at each hospital level in the health-care system? (6) What is the optimal protocol for temporary management for the hemodynamically unstable patient with a pelvic or acetabular fracture? This modified Delphi study of orthopaedic trauma surgeons in Latin America identified geriatric hip fractures, polytrauma, open fractures, musculoskeletal infection, and pelvic and acetabular fractures as top research priorities. This information is important for resource allocation and goal setting for orthopaedic trauma in the region.

The Effects of a Medial Heel Wedge on the Weight-Bearing Response of Hindfoot Valgus and the Total Weight-Bearing Responses of the Navicular and Talus Bones

OBJECTIVES Medial heel wedges are commonly prescribed to manage the weight-bearing response of hindfoot valgus and the total weight-bearing responses of the navicular and talus bones. Previous studies have reported that a medial heel wedge is effective in the management of musculoskeletal injuries. However, it remains unclear the effect of a medial heel wedge on the weight-bearing responses of footarch bones in vivo. To clarify the effects of a medial heel wedge on the weight-bearing response of hindfoot valgus and the total weight-bearing responses of the navicular and talus bones is necessary to understand how best to treat musculoskeletal injuries clinically. The purpose of our study was to clarify the effects of a medial heel wedge on the weight-bearing response of hindfoot valgus and the total weight-bearing responses of the navicular and talus bones.METHODS Twenty-five healthy males were analyzed. We obtained MRI scanning of the right foot under non-loading (NL) and full weight-bearing (FW) conditions. Participants wore two insole types, a flat insole and a medial heel wedge. To evaluate the weight-bearing response in hindfoot valgus, the hindfoot alignment view (HAV) was measured. We also measured navicular and talus bone positions and calculated the total positional changes of the navicular and talus bones (ΔTPCN, ΔTPCT) from the vertical and medial displacements using the Pythagorean theorem.RESULTS Significant interactions were observed with the HAV. Under both NL and FW conditions, the HAV was smaller on the medial heel wedge than on the flat insole. In addition, the ΔTPCN was significantly smaller on the medial heel wedge than on the flat insole. However, no significant differences were observed for ΔTPCT.CONCLUSIONS Our results suggest that use of a medial heel wedge decreases hindfoot valgus values under both NL and FW conditions and stabilizes the total weight-bearing response of the navicular bone.

Biologics in professional and Olympic sport: a scoping review.

The aim of this study was to prepare a scoping review to investigate the use of biologic therapies in the treatment of musculoskeletal injuries in professional and Olympic athletes. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews and Arksey and O'Malley frameworks were followed. A three-step search strategy identified relevant published primary and secondary studies, as well as grey literature. The identified studies were screened with criteria for inclusion comprising clinical studies evaluating the use of biologic therapies in professional and Olympic athletes, systematic reviews, consensus statements, and conference proceedings. Data were extracted using a standardized tool to form a descriptive analysis and a thematic summary. A total of 202 studies were initially identified, and 35 met criteria for the scoping review; 33 (94.3%) were published within the last eight years, and 18 (51.4%) originated from the USA. Platelet rich plasma was the most studied biologic therapy, being evaluated in 33 (94.3%) studies. Ulnar collateral ligament and hamstring injuries were the conditions most studied (nine (25.7%) studies and seven (20.0%) studies, respectively). Athletes most frequently participated in baseball, soccer, and American football. Only two (5.7%) studies were level 1 evidence, with interpretation and comparison between studies limited by the variations in the injury profile, biologic preparations, and rehabilitation protocols. There is diverse use of biologic therapies in the management of musculoskeletal injuries in professional and Olympic athletes. There is currently insufficient high-level evidence to support the widespread use of biologic therapies in athletes. Further research priorities include the development of condition/pathology-specific preparations of biologic therapies, and of outcome measures and imaging modalities sufficiently sensitive to detect differences in outcomes, should they exist. Cite this article: Bone Joint J2021;103-B(7):1189-1196.

A novel coupled musculoskeletal finite element model of the spine – Critical evaluation of trunk models in some tasks

Spine musculoskeletal (MS) models make simplifying assumptions on the intervertebral joint degrees-of-freedom (rotational and/or translational), representation (spherical or beam-like joints), and properties (linear or nonlinear). They also generally neglect the realistic structure of the joints with disc nuclei/annuli, facets, and ligaments. We aim to develop a novel MS model where trunk muscles are incorporated into a detailed finite element (FE) model of the ligamentous T12-S1 spine thus constructing a gold standard coupled MS-FE model. Model predictions are compared under some tasks with those of our earlier spherical joints, beam joints, and hybrid (uncoupled) MS-FE models. The coupled model predicted L4-L5 intradiscal pressures (R2 ≅ 0.97, RMSE ≅ 0.27 MPa) and L1-S1 centers of rotation (CoRs) in agreement to in vivo data. Differences in model predictions grew at larger trunk flexion angles; at the peak (80°) flexion the coupled model predicted, compared to the hybrid model, much smaller global/local muscle forces (~38%), segmental (~44%) and disc (~22%) compression forces but larger segmental (~9%) and disc (~17%) shear loads, ligament forces at the lower lumbar levels (by up to 57%) and facet forces at all levels. The spherical/beam joints models predicted much greater muscle forces and segmental loads under larger flexion angles. Unlike the spherical joints model with fixed CoRs, the beam joints model predicted CoRs closer (RMSE = 2.3 mm in flexion tasks) to those of the coupled model. The coupled model offers a great potential for future studies towards improvement of surgical techniques, management of musculoskeletal injuries and subject-specific simulations.

Patterns and management of musculoskeletal injuries in attempted suicide by jumping from a height: a single, regional level I trauma center experience.

Suicide is a common cause of death in Brazil, with an overall increase of 62.5% during the last 30-year period. The study aims to determine overall patient characteristics and symptomatic indicators of complications among survivors. In this retrospective cross-sectional study, we collected and analyzed clinical information of all patients aged > 10years who presented to our hospital with a history of attempted suicide by jumping from a height in a 7-year period. Records were searched for primary demographic data, radiographs and CT scans were reviewed to determine injury characteristics, and records and operative notes were searched to look for symptomatic indicators of complications among survivors. Baseline demographics and the distribution on skeletal injuries were compared between the survivor and non-survivor patients using the Chi-squared for categorical variables and the Student's t-test for continuous variables. Among survivors, univariate and multivariate analysis were performed to investigate independent risk factors of attempted suicide and complications. A total of 222 patients attempted suicide by jumping from a height. At multivariate analysis, the middle-aged patient was the unique identified risk factor for suicide by jumping from a height. Overall mortality was 67.6%. The main independent cause for death was traumatic brain injury. Among survivors, there was a higher incidence of foot and ankle fractures, and pelvic ring injuries. The overall complication rate for survivor patients was 51.4%, with acute infection being the most prevalent complication. At multivariate analysis, middle-aged men, foot and ankle injuries, open pelvic injuries, and open fractures were identified as risk factors for acute complications. Middle-aged people are at significant risk for attempting suicide by jumping from a height in Brazil, independently of gender, with 67.6% deaths. Traumatic brain injury, higher ISS, and more than 3 skeletal injuries are independent variables related to this fatal outcome. Acute complications occur in approximately 50% of survivors. Middle-aged men, foot and ankle injuries, open pelvic injuries, and open fractures are risk factors for complications.

Communicating traumatic pathology to ensure shared understanding: is there a recipe for the perfect preliminary image evaluation?

Medical imaging and emergency departments work collaboratively to interpret trauma radiographs. In addition to accurate radiographic interpretation, clear communication is crucial to ensure appropriate and timely management of musculoskeletal injuries. This two‐step ‘how to guide’ provides the reviewer with a recipe for effectively evaluating trauma radiographs for traumatic pathology and succinctly documenting the findings. Step 1 is a systematic search of the radiograph: soft tissues, bones, alignment of joints and satisfaction of search (SBASS). Utilising SBASS increases reviewer confidence in identifying traumatic pathology of the appendicular and axial skeleton. Step 2 is a streamlined communication model for the documentation of pathological findings. The WWW acronym (What is it? Where is it? What is it doing?) can be adapted to describe simple or complex traumatic pathology.

Optimizing Health, Wellness, and Performance of the Tactical Athlete

Tactical athletes are individuals in service occupations with significant physical fitness and performance requirements such as law enforcement, firefighters, emergency responders, and military service members. Tactical athletes also may have specific administrative requirements related to documenting physical injuries. Musculoskeletal injuries are a large burden on the tactical athlete population, with incident rates varying based on the specific profession. Chronic exertional compartment syndrome (CECS) is difficult to manage in the tactical athlete population due to their limited ability to reduce impact activities and poor surgical outcomes. Botulinum neurotoxin-A and gait retraining show promise as alternative treatments for CECS. Heat injuries are frequent in the tactical athlete populations, and a graduated return to play process helps to prevent morbidity. Management of musculoskeletal injuries in tactical athletes requires consideration of operational schedules and adequate reconditioning, in addition to traditional injury evaluation.

Understanding the barriers affecting psychologists’ adherence to evidence-based treatment guidelines from a stakeholder standpoint

AbstractPsychologists’ adherence with evidence-based guidelines based on the biopsychosocial premise in the management of musculoskeletal injuries is influenced by the actions by General Practitioners (GPs), insurers, and injured patients’ actions. For data collection, we interviewed GPs (n = 6), insurers (n = 6), and injured people (n = 15) from the two personal injury compensation schemes in New South Wales. Thematic analysis yielded the following: GPs were reticent to access psychological services that represented a poor fit between their practice and treatment guidelines, insurers lacked trust in the validity of “secondary psychological injury” claims’. Injured peoples’ willingness to engage with treatment was impaired by a poor fit between the treatment guidelines and their experience of insurers’ and psychologists’ practices.

Process quality indicators for musculoskeletal injuries in the emergency department

ObjectivesMeasuring quality of care for musculoskeletal injuries presenting to the ED is important given their prevalence, variations in care, the associated morbidity and financial impacts and pressure to achieve time-based...