Severe Musculoskeletal Injuries Research Articles

Evaluation of the Functional Movement Screen and a Novel Basketball Mobility Test as an Injury Prediction Tool for Collegiate Basketball Players.

Bond, CW, Dorman, JC, Odney, TO, Roggenbuck, SJ, Young, SW, and Munce, TA. Evaluation of the functional movement screen and a novel basketball mobility test as an injury prediction tool for collegiate basketball players. J Strength Cond Res 33(6): 1590-1601, 2019-Identifying injury risk and implementing preventive measures can assist in reducing injury occurrence and may ultimately improve athletic performance. Improper movement patterns often contribute to musculoskeletal (MSK) injuries. The validity of the Functional Movement Screen (FMS) as an injury prediction tool for athletes remains unclear. We designed the Basketball-Specific Mobility Test (BMT) to represent the neuromuscular demands of basketball and identify deficiencies that may be indicative of greater MSK injury risk while playing this sport. The aim of this study was to examine the association of FMS and BMT scores with injury occurrence in collegiate basketball players. We hypothesized that the BMT would be a better predictor of injury risk than the FMS, and that scores from both tests would have a higher association with severe MSK injuries than minor, non-MSK injuries. One-hundred nineteen male and female collegiate basketball players from 4 Upper Midwest universities were assessed preseason (PRE) and postseason (POST) using the FMS and BMT. In-season injury records were collected from the schools' athletic trainers and were classified by type and severity. During the season, 56 of 119 players were injured, resulting in 96 total injuries. Injured athletes' PRE FMS scores demonstrated negligible effects compared with uninjured athletes' PRE scores (d < 0.20), whereas some BMT scores showed potentially meaningful effects (d > 0.20). Although specificity of the FMS and BMT to predict injury was relatively high (FMS 85.7-87.6; BMT 42.0-88.0), sensitivity (FMS 14.2-22.7; BMT 11.6-39.1), odds ratios (FMS 1.00-2.08; BMT 0.47-1.06), and injury prediction capacities (area under the curve; FMS 0.43-0.49; BMT 0.49-0.59) of the tests were low. Although the FMS and BMT may be suitable for identifying MSK deficiencies, they do not accurately determine injury risk in collegiate basketball players. Injury risk assessments may be improved by targeting specific injury mechanisms and the conditions in which they occur.

The epidemiology of work-related musculoskeletal injuries among chiropractors in the eThekwini municipality

BackgroundChiropractors are a unique group of health care professionals who are at risk for developing work-related musculoskeletal injuries. Diversity of daily practice imposes different physical demands on the chiropractor. This study aimed to determine the prevalence of work-related musculoskeletal injuries in chiropractors in eThekwini municipality and selected risk factors associated with these work-related musculoskeletal injuries.MethodsThe design was a quantitative, cross-sectional, descriptive study utilising a self-administered questionnaire, developed specifically for this research. The questionnaire contained sections on personal and practice demographics, with questions pertaining to the single most severe work-related musculoskeletal injury, as well as the second and third most severe work-related musculoskeletal injury.ResultsA response rate of 64% was obtained (n = 62). The life-time prevalence of work-related musculoskeletal injuries was 69% with a predominance of injuries to the upper extremity (50%) and lower back (28.3%). The hand/wrist was the most common anatomical site of injury (31.5%) followed by the lower back (28.3%). Number of years in practice was considered a risk factor as most injuries occurred within the first five years of practice (41.6%). The majority of injuries affected the soft tissue, including ligament sprains (27.5%) and muscle strains (26.6%) and occurred while the practitioner was performing manipulation (38.2%) of the lumbosacral (80.8%) area with the patient in the side posture (61.5%).ConclusionsThe results concur with other studies on work-related musculoskeletal injuries in chiropractors and add insight into risk factors predisposing this population to injury.

Platelet-rich plasma and alignment enhance myogenin via ERK mitogen activated protein kinase signaling

Volumetric muscle loss is debilitating and involves extensive rehabilitation. One approach to accelerate healing, rehabilitation, and muscle function is to repair damaged skeletal muscle using regenerative medicine strategies. In sports medicine and orthopedics, a common clinical approach is to treat minor to severe musculoskeletal injuries with platelet-rich plasma (PRP) injections. While these types of treatments have become commonplace, there are limited data demonstrating their effectiveness. The goal of this study was to determine the effect of PRP on myoblast gene expression and protein production when incorporated into a polymer fiber. To test this, we generated extracellular matrix mimicking scaffolds using aligned polydioxanone (PDO) fibers containing lyophilized PRP (SmartPReP® 2, Harvest Technologies Corporation, Plymouth, MA). Scaffolds with PRP caused a dose-dependent increase in myogenin and myosin heavy chain but did not affect myogenic differentiation factor-1 (MyoD). Integrin α7β1D decreased and α5β1A did not change in response to PRP scaffolds. ERK inhibition decreased myogenin and increased Myod on the PDO-PRP scaffolds. Taken together, these data suggest that alignment and PRP produce a substrate-dependent, ERK-dependent, and dose-dependent effect on myogenic differentiation.

LO85: Knowledge, attitudes, and practices regarding opioid use in the pediatric emergency department

Introduction: Inadequate pain management in children is ubiquitous in the emergency department (ED). As the current national opioid crisis has highlighted, physicians are caught between balancing pain management and the risk of long term opioid dependence. This study aimed to describe pediatric emergency physicians (PEPs) willingness to prescribe opioids to children in the ED and at discharge. Methods: A unique survey tool was created using published methodology guidelines. Information regarding practices, knowledge, attitudes, perceived barriers, facilitators and demographics were collected. The survey was distributed to all physician members of Pediatric Emergency Research Canada (PERC), using a modified Dillmans Tailored Design method, from October to December 2017. Results: The response rate was 49.7% (124/242); 53% (57/107) were female, mean age was 43.6 years (+/− 8.7), and 58% (72/124) had pediatric emergency subspecialty training. The most common first line ED pain medication was ibuprofen for mild, moderate and severe musculoskeletal injury (MSK-I)-related pain (94.4% (117/124), 89.5% (111/124), and 62.9% (78/124), respectively). For moderate and severe MSK-I, intranasal fentanyl was the most common opioid for first (35.5% (44/124) and 61.3% (76/124), respectively) and second line pain management (41.1% (51/124) and 20.2% (25/124), respectively). 74.8% (89/119) of PEPs reported that an opioid protocol would be helpful, specifically for morphine, fentanyl, and hydromorphone. Using a 0-100 scale, physicians minimally worried about physical dependence (13.3 +/−19.3), addiction (16.6 +/−19.8), and diversion of opioids (32.8+/−26.4) when prescribing short-term opioids to children. They reported that the current opioid crisis minimally influenced their willingness to prescribe opioids (30.0 +/−26.2). Physicians reported rarely (36%; 45/125) or never (28%; 35/125) completing a screening risk assessment prior to prescribing opioids. Conclusion: Ibuprofen remains the most common medication recommended for MSK-I pain in the ED and at discharge. Intranasal fentanyl was the top opioid for all pain intensities. PEPs are minimally concerned regarding dependence, addiction, and the current opioid crisis when prescribing short-term opioids to children. There is an urgent need for robust evidence regarding the dependence and addiction risk for children receiving short term opioids in order to create knowledge translation tools for ED physicians. Opioid specific protocols for both in the ED and at discharge would likely improve physician comfort in responsible and adequate pain management for children.

Healing of severe polystructural limb wounds using vacuum therapy

Vacuum-assisted wound closure has been known for the last two decades as an economically viable and effective treatment method, but the variety of patient injuries caused by severe polystructural (including combat) injuries requires further re­search into the effect of negative pressure on wound healing.Objective: to study the possibilities of vacuum-assisted wound closure therapy for the early management of patients with se­vere open polystructural injuries of limbs with fragmentation or gunshot character in comparison with conventional therapy.Methods: the results of treatment of 34 patients (men, mean age (30 ± 6) years) with open severe musculoskeletal injuries of the lower and upper extremities, which are accompanied by problems of primary closure of the wound, are analyzed. Be­fore the application of vacuum-assisted wound closure therapy or traditional treatment, all patients had wound sanation and fasciotomy. Eighteen patients were included in the study group who underwent variable negative pressure. Standard wound treatment with antiseptics and the imposition of gauze dressings were applied in 16 affected control group. The condition of the wound was checked on the third and seventh day of treatment. The rate of healing was determined, which was determined by the dif­ference between the initial areas and the areas identified dur­ing the study stage.Results: a significant decrease in the aver­age wound area with Vacuum-assisted wound closure therapy (1.6 cm2 after 3 days, 3.9 cm2 after 7 hours) was recorded in com­parison with the traditional method (0.8 and 3 cm2, respec­tively).Conclusions: a significant increase in the rate of initial healing of complex fragmentation and gunshot wounds in pa­tients with vacuum-assisted wound closure therapy compared with traditional treatment in a control group was demonstrated. Primary application of vacuum-assisted wound closure thera­py is most effective in the period corresponding to the second phase of the wound healing (3–7 days).

Severe musculoskeletal time-loss injuries and symptoms of common mental disorders in professional soccer: a longitudinal analysis of 12-month follow-up data

PurposePsychological factors have shown to be predictors of injury in professional football. However, it seems that this is a two-way relationship, as severe musculoskeletal time-loss injuries have shown to be associated with the onset of symptoms of common mental disorders (CMD). There is no longitudinal study performed exploring this interaction between symptoms of CMD and injuries. The purpose of this study was to explore the interaction between severe musculoskeletal time-loss injuries and symptoms of CMD in professional football players over a 12-month period.MethodsPlayers were recruited by their national players’ unions in five European countries. Symptoms of CMD included in the study were related to distress, anxiety/depression, sleep disturbance and adverse alcohol use.ResultsA total of 384 professional football players were enrolled in the study, of whom 262 (68%) completed the 12-month follow-up period. The mean age of the participants at baseline was 27 ± 5 years, and they had played professional football for 8 ± 5 years on average. Symptoms of CMD at baseline were not associated with the onset of severe musculoskeletal time-loss injuries during the follow-up period with relative risks (and 95% CI) ranging from 0.6 (0.3–1.0) to 1.0 (0.5–2.2). In contrast, severe musculoskeletal time-loss injuries reported at baseline were associated with the onset of symptoms of CMD during the follow-up period with relative risks ranging from 1.8 (0.8–3.7) to 6.9 (4.0–11.9).ConclusionNo relationship was found between symptoms of CMD and the onset of severe musculoskeletal time-loss injuries. However, professional football players who suffered from severe musculoskeletal time-loss injuries are likely to develop subsequent symptoms of CMD. This study emphasizes the need for an interdisciplinary medical approach, which not only focuses on the physical but also on the mental health of professional football players. An early identification of players at risk of symptoms of CMD, such as those suffering from severe musculoskeletal injuries, creates the opportunity for an interdisciplinary clinical medical team to treat the players timely and adequately.Level of evidenceProspective cohort study, Level II.

A prospective cohort study on symptoms of common mental disorders among current and retired professional ice hockey players

ABSTRACTObjectives: Scientific knowledge about symptoms of common mental disorders in professional ice hockey is lacking. Consequently, the primary aims of the study were to (i) determine the prevalence, comorbidity and 6-month incidence of symptoms of common mental disorders (distress, anxiety/depression, sleep disturbance, adverse alcohol use, eating disorders) among current and retired professional ice hockey players and (ii) evaluate their potential relation with potential stressors (severe musculoskeletal injuries, surgeries, recent life events, career dissatisfaction).Methods: A prospective cohort study with a 6-month follow-up period was conducted. Using validated questionnaires to assess symptoms of common mental disorders (thus not clinically diagnosed) as well as several stressors, an electronic questionnaire was set up and distributed by the national ice hockey players’ unions from Denmark, Finland, Norway and Switzerland.Results: Prevalence ranged from 8% for adverse alcohol use to 24% for anxiety/depression among current professional ice hockey players, and from 12% for distress to 29% for adverse alcohol among retired professional ice hockey players. Six-month incidence reached up to 22% for eating disorders among current players and 25% for sleep disturbance among retired players. Especially a higher number of surgeries, a higher number of recent life events and higher level of career dissatisfaction was related to symptoms of common mental disorders.Conclusions: Our findings indicate that adequate interventions should be developed to improve not only awareness and psychological resilience of both current and retired ice hockey players but also their performance and quality-of-life. An interdisciplinary approach should be applied in the medical care of ice hockey players by including psychologists/psychiatrists who can provide psychotherapeutic or clinical interventions.

Predictors of seeking financial compensation following motor vehicle trauma: inception cohort with moderate to severe musculoskeletal injuries

BackgroundCompensation related factors have been repeatedly associated with poor recovery following orthopaedic trauma. There is limited research into the factors associated with seeking financial compensation. Further understanding of these factors could facilitate injury recovery by purposeful compensation scheme design. The aim of this study was to investigate the predictors of seeking financial compensation, namely making a claim and seeking legal representation, following motor vehicle related orthopaedic trauma. The study was conducted in New South Wales (NSW), Australia, in motor vehicle crash and workers’ compensation schemes.MethodsParticipants were patients admitted with upper or lower extremity factures following a motor vehicle crash to two trauma hospitals. Data were collected at baseline within two weeks of injury. Participants were followed up at six months. Analysis involved: descriptive statistics for baseline characteristics; comparison of compensable and non-compensable participants with Analysis of Variance (ANOVA) and chi-squared tests; and logistic regression for predictor models.ResultsThe cohort consisted of 452 participants with a mean age 40 years; 75% male; 74% working pre-injury; 30% in excellent pre-injury health; 56% sustained serious injuries with an Injury Severity Score (ISS) 9-15; 61% had a low-middle range household income; and 35% self-reported at fault in the crash. There was no significant difference in pre-injury/baseline health between compensable and non-compensable participants. Follow up data was available for 301 (67%) participants.The significant predictor of claiming compensation in the adjusted analysis was higher body mass index (BMI) (overweight Odds Ratio [OR] 3.05, 95% Confidence Interval [CI] 1.63-5.68; obese OR 1.63, 95% CI 0.83-3.20). Participants less likely to claim were: involved in a motorcycle crash (OR 0.47, 95% CI 0.28-0.82); socioeconomically less disadvantaged (OR 0.37, 95% CI 0.17-0.82) or least disadvantaged (OR 0.39, 95% CI 0.17-0.90); at risk for short term harm (injury) due to alcohol consumption (OR 0.56, 95% CI 0.32-0.97); and with fair-poor pre-injury health (OR 0.30, 95% CI 0.09-0.94). The predictors for seeking legal representation were speaking a language other than English at home (OR 2.80, 95% CI 1.2-6.52) and lower household income (OR 3.63, 95% CI 1.22-10.72). Participants less likely to seek legal representation were least socioeconomically disadvantaged (OR 0.15, 95% CI 0.04-0.50).ConclusionsSeeking financial compensation was associated with a higher pre-injury BMI rather than injury-related factors. Seeking legal representation was solely related to socio-economic factors.

Ideal delivery system of rehabilitation medical service

Rehabilitation care requires an organized health care delivery system, stroke, brain injury, spinal cord injury, amputation, severe multiple musculoskeletal injury, and congenital damage to the nervous system frequently result in permanent disability or a temporary serious reduction of bodily function. These diseases or injuries require acute medical treatment at general and tertiary hospitals, but then also require a long period of intensive and comprehensive rehabilitation treatment. Currently, a 3-stage rehabilitation care delivery system, involving acute, subacute (recovery), and chronic (maintenance) rehabilitation, is being considered. Although the concepts underlying this delivery system have not yet been clearly defined, acute rehabilitation should be provided at general and tertiary hospitals for patients with permanent disabilities, an unstable medical condition, and/or a severe temporary reduction of bodily function simultaneously with or immediately after acute medical treatment. Cardiac rehabilitation, respiratory rehabilitation, pressure ulcer management, rehabilitation of severe cerebral palsy, rare diseases, and cancer, for which the cooperation of internal, surgical, and critical care staff is essential, are included in acute rehabilitation. Additionally, intensive and comprehensive inpatient subacute (recovery) rehabilitation should be provided for patients with severely impaired bodily function who are medically stable. Subsequently, chronic rehabilitation may be required for patients who need postural changes throughout the day, those who require rehabilitation treatment intended to prevent long-term complications and to ensure the maintenance of body function, those who show shortness of breath or dysphagia, and those who show little improvements of bodily function, making discharge into the home difficult. These services can be categorized as outpatient, visiting, or long-term rehabilitation services.

The Use of Coupled Plasma Filtration Adsorption in Traumatic Rhabdomyolysis

Severe musculoskeletal injuries induce the release of sarcoplasmic elements such as muscle enzymes, potassium, and myoglobin in the systemic circulation. The circulating myoglobin damages the glomerulus and renal tubules. Conventional haemodialysis is not able to remove myoglobin, due to its high molecular weight (17,8 kilodaltons [kDa]). We treated four traumatic rhabdomyolysis patients with Coupled Plasma Filtration Adsorption (CPFA) in order to remove myoglobin followed by 14 hours of Continuous Veno-Venous Hemofiltration (CVVH). During the treatment, all patients showed clinical improvement with a decrease in muscular (creatine kinase [CK] and myoglobin) and renal (creatinine and potassium) damage indices. One patient, in spite of full renal recovery, died of cerebral haemorrhage on the 26th day of hospital stay.

Surgical Excision of Heterotopic Ossification Leads to Re-Emergence of Mesenchymal Stem Cell Populations Responsible for Recurrence.

Trauma‐induced heterotopic ossification (HO) occurs after severe musculoskeletal injuries and burns, and presents a significant barrier to patient rehabilitation. Interestingly, the incidence of HO significantly increases with repeated operations and after resection of previous HO. Treatment of established heterotopic ossification is challenging because surgical excision is often incomplete, with evidence of persistent heterotopic bone. As a result, patients may continue to report the signs or symptoms of HO, including chronic pain, nonhealing wounds, and joint restriction. In this study, we designed a model of recurrent HO that occurs after surgical excision of mature HO in a mouse model of hind‐limb Achilles’ tendon transection with dorsal burn injury. We first demonstrated that key signaling mediators of HO, including bone morphogenetic protein signaling, are diminished in mature bone. However, upon surgical excision, we have noted upregulation of downstream mediators of osteogenic differentiation, including pSMAD 1/5. Additionally, surgical excision resulted in re‐emergence of a mesenchymal cell population marked by expression of platelet‐derived growth factor receptor‐α (PDGFRα) and present in the initial developing HO lesion but absent in mature HO. In the recurrent lesion, these PDGFRα+ mesenchymal cells are also highly proliferative, similar to the initial developing HO lesion. These findings indicate that surgical excision of HO results in recurrence through similar mesenchymal cell populations and signaling mechanisms that are present in the initial developing HO lesion. These results are consistent with findings in patients that new foci of ectopic bone can develop in excision sites and are likely related to de novo formation rather than extension of unresected bone. Stem Cells Translational Medicine 2017;6:799–806

Epidemiology of symptoms of common mental disorders among elite Gaelic athletes: a prospective cohort study

ABSTRACTObjective: Scientific knowledge about symptoms of common mental disorders among elite Gaelic athletes is lacking. Consequently, this study aimed to (i) determine the prevalence, comorbidity and 6-month incidence of symptoms of common mental disorders (distress, anxiety/depression, sleep disturbance, adverse alcohol use) among elite Gaelic athletes and (ii) evaluate their association with potential stressors (severe musculoskeletal injuries, surgeries, recent life events, career dissatisfaction).Methods: An observational prospective cohort study by means of questionnaires was conducted over six months among elite Gaelic athletes (N=204). Using validated questionnaires to assess symptoms of common mental disorders as well as several stressors, an electronic questionnaire was set up and distributed by the Gaelic Players’ Association.Results: Prevalence ranged from 23% for adverse alcohol use to 48% for anxiety/depression. Around 24% of the participants reported at baseline two symptoms. Six-month incidence ranged from 11% for sleep disturbance to 21% for anxiety/depression. Severe musculoskeletal injury, surgery, recent life events and career dissatisfaction led to an increased risk for common mental disorders.Conclusion: Our findings indicate that raising the self-awareness of all stakeholders in Gaelic sports about common mental disorders should be prioritized, as well as the evidence-based development and application of adequate preventive and supportive measures.

Manual physical therapy combined with high-intensity functional rehabilitation for severe lower extremity musculoskeletal injuries: a case series

Objectives: Severe lower extremity trauma accounts for large healthcare costs and often results in elective amputation and poor long-term outcomes. The purpose of this case series is to describe an orthopedic manual physical therapy (OMPT) approach combined with a return to run (RTR) clinical pathway consisting of high-intensity functional rehabilitation with a custom energy-storing orthosis.Methods: Three consecutive male patients, aged 21–23 years, with severe lower extremity musculoskeletal injuries were treated with a combined intervention that included a mean (SD) of 12 (2·1) OMPT sessions and 24 (8·7) functional rehabilitation sessions over a mean of 6 weeks (1·0). Additional training with a custom energy-storing orthosis consisted of a mean of 15 (1·2) additional sessions over 4 weeks. Patient self-report outcome measures and a variety of physical performance tests captured change in function.Results: Baseline lower extremity functional scale (LEFS) and foot and ankle ability measure activities of daily living subscale (FAAM-ADL) scores indicated severe disability. All patients exceeded the minimal clinically important difference (MCID) in at least one self-report outcome or physical performance test without a brace. Two of three patients exceeded the MCID for at least two physical performance tests after training with and utilizing a custom energy-storing orthosis.Discussion: Clinically meaningful changes in self-reported function or physical performance were observed in all patients. A multi-modal approach, including manual therapy and functional exercise, may address the entire spectrum of impairments in patients with severe lower extremity trauma, resulting in improvements in both braced and un-braced function.

Severe Musculoskeletal Injuries due to the use of Cleats Whilst Cycling

In cycling, pedalling symmetry and foot position is paramount for an energy efficient and injury free ride. Traditionally a clipped pedal was used to secure the foot onto the pedal, which was found to be related to a number of overuse knee injuries, leading to the advent of clipless pedals or cleats, which allowed for a more efficient pedal stroke.

Peroneal Nerve Injuries: Repair, Grafting, and Nerve Transfers

Knee dislocations are severe musculoskeletal injuries that are often associated with neurovascular injury. The most common nerve injured with a knee dislocation is the peroneal nerve. Nerve injury can result in severe functional consequences to the injured patient. The purpose of this article is to review the most current literature on treatment options and outcomes when addressing these injuries.

Are severe musculoskeletal injuries associated with symptoms of common mental disorders among male European professional footballers?

PurposeTo explore the associations of severe musculoskeletal injuries (joint and muscles) and surgeries with symptoms of common mental disorders (distress, anxiety/depression, sleeping disturbance, adverse alcohol behaviour , smoking, adverse nutrition behaviour) among male European professional footballers.MethodsCross-sectional analyses were conducted on electronic questionnaires completed by professional footballers recruited from the national players’ unions of Finland, France, Norway, Spain or Sweden. The number of severe (time loss of more than 28 days) musculoskeletal injuries (total, joint, muscle) and surgeries during a professional football career was examined through four questions, while symptoms of common mental disorders were evaluated through validated scales.ResultsA total of 540 professional footballers (mean age of 27 years; 54 % playing in the highest leagues) participated in the study. Sixty-eight per cent of the participants had already incurred one or more severe joint injuries and 60 % one or more severe muscle injuries. Prevalence of symptoms of common mental disorders ranged from 3 % for smoking to 37 % for anxiety/depression and 58 % for adverse nutrition behaviour. The number of severe musculoskeletal injuries during a football career was positively correlated with distress, anxiety and sleeping disturbance, while the number of surgeries was correlated with adverse alcohol behaviour and smoking. Professional footballers who had sustained one or more severe musculoskeletal injuries during their career were two to nearly four times more likely to report symptoms of common mental disorders than professional footballers who had not suffered from severe musculoskeletal injuries.ConclusionIt can be concluded that the number of severe musculoskeletal injuries and surgeries during a career is positively correlated and associated with symptoms of common mental disorders among male European professional footballers. This study emphasises the importance of applying a multidisciplinary approach to the clinical care and support of professional footballers, especially when a player faces lengthy periods without training and competition as a consequence of recurrent severe joint or muscle injuries.Level of evidenceIII.

Medium-Term Outcome after Multidisciplinary Management in Polytrauma Patient: a Case Report

Summary Previously healthy young patients having survived after multiple severe musculoskeletal injuries and undergone trauma-related amputation of lower limb have a long life expectancy. This case shows the role of multidisciplinary approach in severely injured polytrauma patient managed by traumatologists-orthopaedists, anesthetists-resuscitators, radiologists, general surgeons, microsurgeons, thoracic surgeons, urologists, neurologists, physical therapy rehabilitators, physiotherapists, technical orthopaedists, prosthetists. Majeed score demonstrates ability to perform work and to walk. Amputation affects the quality of life with a certain negative somatic and functional impact. Microprocessor controlled knee joint in patients after transfemoral amputation allows more precise adjustment of knee resistance, providing an increased walking velocity, reduction in stumble and falls, however the final outcome depends also on patients’ own motivation and readiness to regain previous quality of life.

The association between the ACTN3 R577X polymorphism and noncontact acute ankle sprains

Ankle sprains are one of the most severe musculoskeletal soft tissue injuries during physical activity. Although many risk factors have been offered, it is unclear why some individuals develop noncontact ankle sprains when participating in comparable levels of physical exertion under identical environmental conditions and others do not. The ACTN3 gene that encodes the α-actinin-3 protein, which is, only expressed in the Z line of fast glycolytic muscle fibres was found to associate with power/strength performance. The aim of this study was therefore to investigate whether the ACTN3 gene polymorphism is associated with noncontact acute ankle sprains. One hundred and forty-two participants with clinically diagnosed noncontact acute ankle sprains as well as 280 physically active controls participants without any history of ankle sprains were included in this case–control genetic association study. The RR genotype (odds ratio (OR) = 0.56; 95% confidence interval (CI), 0.32–0.65, P = 0.011) and R allele (OR = 0.64; 95% CI, 0.37–0.68, P = 0.002) of the ACTN3 were significantly low-represented in the acute ankle sprains group compared with the control group. The ACTN3 R577X is associated with acute ankle sprains in Chinese participants in this study. This is the first study to suggest that an individual with a RR genotype is at a decreased risk of acute ankle sprains.

Thalidomide prolongs survival after experimental musculoskeletal injury, through an effect on mononuclear apoptosis

BackgroundThis study was conducted to investigate the effects of intravenous thalidomide administration in an experimental model of musculoskeletal trauma. We hypothesized that because thalidomide inhibits secretion of tumor necrosis factor alpha (TNF-α), survival of animals that received thalidomide would be significantly prolonged. Material and methodsAfter an open fracture of the right femur, 24 rabbits were randomly assigned to control and thalidomide groups. Intravenous therapy with thalidomide was started 30 min after fracture. Hemodynamic monitoring of all animals was performed for 4 h. Survival was recorded and bacterial growth in blood and organs was measured after animal death or sacrifice. Blood was sampled for TNF-α measurement and for isolation of peripheral blood mononuclear cells (PBMCs). Apoptosis of PBMCs was measured by flow cytometry. ResultsSurvival was significantly prolonged in the thalidomide group. Apoptosis of PBMCs was increased in the control group compared with the thalidomide group at 24 h. There were no differences in vital signs, blood and tissue cultures, and serum TNF-α concentration between the two groups. ConclusionsIntravenous thalidomide prolonged survival in an experimental model of severe musculoskeletal injury in rabbits. Its mechanism of action did not involve TNF-α suppression but prevention of mononuclear apoptosis. In view of these promising results, further research is needed to clarify the immunomodulatory mechanism of action of thalidomide and its potential use for the management of severe trauma.

Prevention and rehabilitation of musculoskeletal injuries during military operations and training.

Injuries are a major impacting factor for a military organization. Injuries may be the result of direct combat, or noncombat, and may be incurred during deployment, other military operations and training. The impact of injuries is the loss of manpower (e.g., lost duty days), medical costs for treatment, and the influence that an injury may have on an individual's quality of life. To address this issue, it is essential to understand the types of injuries that are occurring, and the mechanisms responsible for those injuries, to develop strategies to reduce injury incidence and to allocate the resources required for rehabilitation to return the individual to duty. This article will review the most common medical injury being incurred by our present warfighter; namely, musculoskeletal injuries (MSIs). The number, types, and causal mechanisms of MSIs will be reviewed. Risk factors for MSIs will be identified and the various interventions being used to prevent or mitigate the severity of MSIs will be discussed. Lastly, the programs that have been developed within the U.S. Department of Defense and the U.S. Army for the assessment, care, and rehabilitation of the most severe MSIs incurred while deployed will be described.