Injury Prevalence of the Lower Limbs in Handball Players: A Systematic Review

Lower limb injuries are frequent in handball and a serious hindrance to athletic performance. The aim of this systematic review was to synthesize the available research on the prevalence of lower limb injuries in handball players according to sex and competitive level. According to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis, 19 studies were selected after a systematic search and selection process of three digital databases: Scopus, PubMed, and Web of Science. Furthermore, a study quality analysis using an ‘Extension for Sports Injury and Illness Surveillance of the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE-SIIS)’ was carried out. The sample consisted of 7110 male and female handball players registering 4483 injuries in their lower limbs. The results showed a high incidence of knee injuries (30.23%) and ankle injuries (24.80%), especially in the ligaments, such as the talofibular and the anterior cruciate ligaments. Considering sex and competitive level, knee injuries accounted for 47.02% of injuries among women, while among men, ankle injuries were most prevalent (34.22%) in international competitions. Additionally, the most common cause of injuries was trauma (85.61%). The findings highlighted that the prevalence of lower limb injuries varies greatly according to the characteristics of the sample and injury. Therefore, the study underlines the importance that sports practitioners (physical trainers, readapters, and physiotherapists) adapt training protocols to reduce injury incidence in the most affected body areas or tissues.

Association Between Cognitive Function and Mechanical Pattern of Landing

Introduction: In examining the factors affecting sports injuries, the emphasis is always on physical variables, while cognitive and psychological characteristics can also be effective. Hence, the present study aimed to investigate the relationship between sustained attention as a neurocognitive function and landing error as a mechanical factor associated with lower limb injuries. Materials and Methods: 44 female basketball players aged 18-25 years at the national league level participated in this study. The participants were assessed using the continuous performance test, and their landing-jumping was evaluated by the landing error scoring system in two conditions of high and low cognitive load. Results: The results showed that people’s landing errors increased significantly as a result of increased cognitive needs (P=0.0001). Also, the findings revealed a positive correlation between omission and commission errors with landing error scores in both low and high cognitive load conditions (P<0.05). Conclusion: Sustained attention could predict the landing error score that is considered a key risk factor of lower limb injuries. It is recommended that multiple cognitive and physical assessments be used to identify athletes at risk of injury. Hence, cognitive enhancement protocols may be effective along with physical preparation programs.

Retrospective study of Parajump injuries in Indian Armed Forces

Introduction: A number of studies on military and civil parachuting injuries have been published in the past. Most of the studies place the incidence of parachuting injuries to vary between 0.22% and 0.89%. The profile of injuries sustained during jumps by Indian paratroopers from Paratrooper Training School (PTS), Agra, between 2013 and 2019 was analyzed. Material and Methods: A retrospective analysis of Indian military parachuting injuries was done to assess injury patterns from the records of static line and combat free fall jumps, available at the PTS. The data pertaining to 270 injuries sustained from 256 jumps were analyzed in terms of number of jumps by each paratrooper, type of course/ mission, age, time of the of jump (day/ night), type of parachute used, wind speed at the time of drop, terrain on which the paratrooper landed, the location / part of body injured, the diagnosis, and finally the possible modality of injury using descriptive statistics. Results: The incidence of injuries ascertained from the records varied from 0.054% to 0.10% with a mean incidence of 0.083% from 306,986 jumps recorded over 7 years. Most injuries were related to refresher jumps and static line jumps. There were three fatalities recorded in this period, all due to failure of main and standby parachutes. Most of the injuries were sustained at the time of landing (218, 86.17%). Lower limb injuries accounted for maximum injuries (109, 40.37%), followed by truncal injuries 95 (35.19%) and upper limb injuries 33 (12.22%). Conclusion: The study brings out an interesting aspect of significantly less military parachuting injuries seen in the present study vis-à-vis reported in literature. A high degree of physical fitness and rigorous training are probably responsible for this low incidence. Increasing the duration of refresher training and physical conditioning may further reduce the occurrence of injuries. A cost-efficacy analysis of the same may be done before effecting changes in the training programme.

EP.FRI.771 National audit on VTE prophylaxis for lower limb injuries treated in a plaster cast

Aims Audit to assess Orthopaedic departments’ compliance with NICE guidelines on Venous thromboembolism (VTE) prophylaxis published in 2010, specifically looking at VTE practices for patients with lower limb injuries treated in a plaster cast. Methods A telephonic survey was carried out on junior doctors within orthopaedic departments of 66 hospitals across all regions of England. A questionnaire was completed regarding VTE risk assessment, prophylaxis and hospital guidelines etc. Data collected from August 2016 till February 2017. Results 83% (n = 55) of trusts routinely give VTE prophylaxis to these patients. 96% (n = 64) give Chemoprophylaxis of some sort. Formal VTE assessments are performed in 81% (n = 54) and 77% (n = 51) have a local VTE prophylaxis policy. Conclusions We conclude that Orthopaedic departments across England have increased compliance with NICE guidelines for VTE prophylaxis. However there is considerable variation in practice, especially in duration and chemoprophylaxis agent. We attribute this to the lack of specific NICE guidelines for this cohort of patients. We aim that this study can influence NICE to introduce added guidance that will standardise practice.

Evaluation of the force applied by the adductor muscles in a healthy student population performing an adduction task

Background The adduction and abduction movement (closing and open the legs) are important tasks in daily activities. The evaluation and monitor of the force exerted by the adductor muscles can be used as a rehabilitation progress indicator, particularly in people with injuries in the central nervous system or motor neurons. The development of biomechanical devices to quantify and identify patterns in this type of force with healthy people can be a contribution in this domain. This work, approved by the Ethical Committee of IPC, aims to evaluate the force applied by the adductor muscles from a healthy group of students, performing the closing legs task. Methods The study was carried out at Applied Biomechanics Laboratory of IPC, with a group of 32 healthy volunteers from the student community (19-26 yo), half men - half women, without lower limb injuries, 59,38% with a prevalence of sedentary lifestyle. Volunteers, sitting in a comfortable position, press a biomechanical device placed between the legs. The time-force was registered for four discrete open-leg positions. Results The maximum mean forces were 199N in women and 257N in men, both in the shorter range of the open-leg position. The peak of force decreases with open leg distance for both genders and was achieved between 34%–54% of the performance time ([3, 28] seconds). Moderate correlations were identified between forces applied and skeletal muscles and resting metabolism. Conclusion The time-force applied was identified and registered with a developed biomechanical device. Obtained values are reliable and can be a support for future investigations.

Classification of lower limb trauma

Accurate, simple, and reproducible classification of lower limb injuries facilitates communication between healthcare professionals, allows application of a standard treatment algorithm, and provides a platform for conducting detailed audit. The Gustilo and Anderson grading is widely used and is relatively simple but has poor inter-rater reliability and is best applied after wound excision. Other more comprehensive classifications (such as the AO system) are best used for audit and in outcomes databases.

Relationship between Posture and Non-Contact Lower Limb Injury in Young Male Amateur Football Players: A Prospective Cohort Study

Posture, a potentially modifiable injury risk factor, is considered important in injury screening/prevention in athletes, yet few studies investigate relationships between posture and injury. This prospective cohort study investigated whether static posture is associated with lower limb injury risk in male football players (n = 263). Nine aspects of static standing posture (left and right rearfoot, knee interspace, lateral knee, lumbar lordosis, thoracic kyphosis, scoliosis S and C, forward head) were assessed from photographs during the pre-season using the modified Watson and Mac Donncha scale, which was dichotomised for analysis (deviated or normal). Player characteristics (age, height, mass, body mass index, competition level), match/training exposure, and previous and in-season non-contact lower limb injuries were recorded. Binary logistic regression investigated relationships between posture and injury (previous and in-season). Eighty previous and 24 in-season lower limb injuries were recorded. Previous injury was not associated with any postural variable. In-season injury was associated with previous injury (OR = 3.04, 95% CI 1.20–7.68, p = 0.02) and having a normal thoracic curve compared to kyphosis (OR = 0.38, 95% CI 0.15–1.00, p = 0.05) but no other postural variables. Static postural deviations observed in male football players in the pre-season are not typically associated with non-contact lower limb injury risk; thus, they are unlikely to add value to pre-season screening programs.