Epidemiology of Lower Leg Soft Tissue Injuries in High School Athletes

Background Annually there are an estimated 4.5 million sports- and recreation-related injuries among children and young adults in the United States. The most common sports-related injuries are to the lower extremities, with two-thirds occurring among children and young adults (age range 5-24 years). The objective is to describe the epidemiology of lower leg injuries across 27 high school (HS) sports over a 3-year period. Methods The Datalys Center for Sports Injury Research and Prevention provided lower leg injury data for 27 sports in 147 high schools for 2011-2012 through 2013-2014 academic years from National Athletic Treatment, Injury and Outcomes Network (NATION) HS Surveillance Program. Results The overall rate of lower leg injuries over this 3-year period was 1.70 per 10 000 acute events (AEs) (95% CI, 1.59-1.82). In men, the highest number of lower leg injuries was in football (n=181), but indoor track had the highest rate of injury at 2.80 per 10 000 AEs (95% CI, 2.14-3.58). In women, the highest number of lower leg injuries and the highest rate of injury were in cross-country (n=76) at 3.85 per 10 000 AEs (95% CI, 3.03-4.81). The practice injury rate was 0.91 times the competition injury rate (95% CI, 0.78-1.07). Conclusion An improved understanding of the most common sports in which lower leg injuries are seen may help direct appropriate resource utilization. Our data would suggest efforts toward prevention of these overuse injuries, especially in football, track, and cross-country may have the greatest impact on the health of student athletes. Level of Evidence: Level IV, case series.

Lower Leg Injury Mechanism Investigation During an IED Blast Under a Vehicle Using an Anatomic Leg Model

Attacks with improvised explosive device (IED) constituted the main threat to, for example, Polish soldiers in Iraq and Afghanistan. Improving safety during transport in an armored vehicle has become an important issue. The main purpose of the presented research is to investigate the mechanism of lower leg injuries during explosion under an armored vehicle. Using a numerical anatomic model of the lower leg, the analysis of the leg position was carried out. In all presented positions, the stress limit of 160 (MPa) was reached, which indicates bone damage. There is a difference in stress distribution in anatomic elements pointing to different injury mechanisms.

A Study into the Pawprints of Urban Dogs

The aim of the article is to present a comprehensive study on specific paw parameters and features, movement peculiarities, leg injuries, hairiness, etc. of dogs that lived in the city of Vilnius and its surroundings and left their marks on clay ware made by local craftsmen. The study was based on 238 clay objects found in Vilnius and dating from the late thirteenth to the eighteenth century. Dogs were found to leave the highest number of pawprints on bricks (90.8%), with significantly lower numbers on floor tiles (8%) and roof tiles (1.2%). The apparent increase in the number of traces is recorded from approximately the fifteenth century due to the steady increase in the quantity of clay products and the accessibility of the production environment to domestic animals. More than 450 dog pawprints in clay were examined using a trasology technique. Most frequently, one, two, or three traces were found on an artefact, while four, five, or six traces on one object were much less frequent. The analysis of trace features showed that 179 of the traces were those of the forepaws and 112 of the hind paws. The assessment of the deformation of the clay articles during firing and the comparison of the data obtained with the parameters of the paws of current breeds of dogs suggest that about 2% of the pawprints were left by small or young dogs. Mediumsized dogs left 70.5% of the traces, 25.7% belonged to dogs resembling current breeds of Doberman or Labrador retriever, 4.7% dogs similar to Borzoi or German shepherd, and 0.9% to Akita or Bobtail. An additional comparison of the pawprints with those of the present-day Lithuanian hounds showed that this type of dog could have left about 22% of the total number of the paw prints studied. It can be concluded that the results of the tracing studies revealed a significantly broader picture than the zooarchaeological material. Pawprint studies show that 25% of the dogs in the city of Vilnius during the period in question were long-haired and 75% were short-haired. The recorded paw pathologies provided information on various nail and toe injuries, tendon pathologies, and one possible case of patella dislocation. Meanwhile, the analysis of the dogs’ speed of movement suggests that at least some of the dogs in Vilnius between the late thirteenth and the eighteenth century were not tied and moved freely in the environment of the craftsmen who manufactured clay ware. In summary, the preliminary results of the pawprint analysis make a significant contribution to the broader knowledge of the history of dogs and provide unique data on urban dogs, which are scarcely recorded in written and zooarchaeological sources.

Analysis of Foot-Ankle-Leg Injuries in Various Under-Foot Impact Loading Environments with a Human Active Lower Limb (HALL) Model

Lower limb injuries caused by under-foot impacts often appear in sport landing, automobile collision, and anti-vehicular landmine blasts. The purpose of the present study was to evaluate a foot-ankle-leg model of the Human Active Lower Limb (HALL) model, and used it to investigate lower leg injury responses in different under-foot loading environments to provide a theoretical basis for the design of physical dummies adapted to multiple loading conditions. The model was first validated in allowable rotation loading conditions, like dorsiflexion, inversion/eversion, and external rotation. Then, its sensitivity to loading rates and initial postures was further verified through experimental data concerning both biomechanical stiffness and injury locations. Finally, the model was used to investigate the biomechanical responses of the foot-ankle-leg region in different under-foot loading conditions covering the loading rate from sport landing to blast impact. The results showed that from -15° plantarflexion to 30° dorsiflexion, the neutral posture always showed the largest tolerance, and more than 1.5 times tolerance gap was achieved between neutral posture and dorsiflexion 30°. Under-foot impacts from 2 m/s to 14 m/s, the peak tibia force increased at least 1.9 times in all postures. Thus, we consider that it is necessary to include initial posture and loading rate factors in the definition of the foot-ankle-leg injury tolerance for under-foot impact loading.

Medical and statistical indicators of injuries among servicewomen in the armed forces of the russian federation (2003–2019)

To analyze the rates of injuries in servicewomen in the Russian Armed Forces with injuries in the leading groups for 17 years (20032019). We conducted a selective statistical analysis of reports on the health status of personnel in the form 3/MED of military units, in which about 80% of the total number of servicewomen served. Injury rates by medical statistic reporting were correlated with the 19th-grade groups Injury, poisoning and certain other consequences of external causes (S00T98) by the International Statistical Classification of Health-Related Diseases and Problems, 10th Review. The average annual rate of injuries (primary incidence) of servicewomen in 20032019 was 11.70 0.82, its share in the structure of primary morbidity for all classes of International Statistical Classification of Health-Related Diseases and Problems, 10th Review was 1.7 0.2%, hospitalizations 6.89 0.54 and 2.5 0.2%, days of labor-loss 239.5 17.8 and 3.7 .3%, dismissal 0.11 0.02 and 1.2 0.2%, mortality rate 22.87 4.41 per 100,000 servicewomen and 18.0 1.6%. The dynamics show a decrease in the level and proportion of injuries in the statistical reporting analyses. The most pronounced injuries in servicewomen were with knee and lower leg injuries (International Statistical Classification of Health-Related Diseases and Problems, 10th Review Chapter XIX, block 9, S80S89), ankle and foot injuries (block 10, S90S99), wrist and hand injuries (block 7, S60S69), head injuries (block 1, S00S09), elbow and forearm injuries (block 6, S50S59). The structure of the types of injuries to the areas of the body is presented. Conducted military-epidemiological evaluation of the negative impact of injuries on the health of servicewomen. The found medical and statistical indicators of traumatism can determine the safe conditions of activity, prevention of injuries, health-improving and rehabilitation measures among servicewomen.

Epidemiology of Injuries in National Collegiate Athletic Association Men's Track and Field: 2014–2015 Through 2018–2019

Context College athletes have been competing in championship track and field events since 1921; the numbers of competing teams and participating athletes have expanded considerably. Background Monitoring injuries of men's track and field athletes using surveillance systems is critical in identifying emerging injury-related patterns. Methods Exposure and injury data collected in the National Collegiate Athletic Association Injury Surveillance Program during the 2014–2015 through 2018–2019 academic years were analyzed. Injury counts, rates, and proportions were used to describe injury characteristics; injury rate ratios were used to examine differential injury rates. Results Overall, men's track and field athletes were injured at a rate of 2.37 per 1000 athlete-exposures; injuries occurred at a higher rate during competition compared with practice. Most injuries were to the thigh (26.2%), lower leg (17.3%), or knee (10.7%) and were caused by noncontact (37.2%) or overuse (31.5%) mechanisms. The most reported injury was hamstring tear (14.9%). Summary The etiologies of thigh and lower-leg injuries warrant further attention in this population. Future researchers should also separately examine injury incidence during indoor and outdoor track and field seasons.

The effectiveness of PROLOTHERAPY for recalcitrant Medial TIBIAL Stress Syndrome: a prospective consecutive CASE series

Background Medial tibial stress syndrome (MTSS) is one of the most common lower leg injuries in sporting populations. It accounts for between 6 and 16% of all running injuries, and up to 53% of lower leg injuries in military recruits. Various treatment modalities are available with varying degrees of success. In recalcitrant cases, surgery is often the only option. Objective To evaluate whether ultrasound-guided injection of 15% dextrose for treatment of recalcitrant MTSS decreases pain and facilitates a return to desired activity levels for those who may otherwise be considering surgery or giving up the sport. Method The study design was a prospective consecutive case series involving eighteen patients: fifteen male and three female; (mean age = 31.2 years) with recalcitrant MTSS. They were referred from sports injury clinics across the UK, having failed all available conservative treatment. Intervention An ultrasound-guided sub-periosteal injection of 15% dextrose was administered by the same clinician (NP) along the length of the symptomatic area. Typically, 1 mL of solution was injected per cm of the symptomatic area. Main outcome measures Pain was assessed using a 10-cm visual analog scale (VAS) at baseline, short-term, medium-term (mean 18 weeks), and long-term (mean 52 weeks) follow-up. Symptom resolution and return to activity were measured using a Likert scale at medium and long-term follow-up. Statistical analyses were performed using SPSS for Mac version 19.0.0 (IBM, New York, NY, US). The Shapiro-Wilk test was used to evaluate the normality of the distribution of data. Friedman’s non-parametric test was used to compare the within-patient treatment response over time. Post-hoc Wilcoxon signed-rank tests with Bonferroni corrections were performed to determine VAS average pain response to treatment over five paired periods. Results Patients reported a significant (p < 0.01) reduction in median VAS pain score at medium and long-term follow-up compared to baseline. Median improvement per patient was 4.5/10. Patients rated their condition as ‘much improved’ at medium-term follow-up and the median return to sports score was ‘returned to desired but not pre-injury level’ at medium-term and long-term follow-up. No adverse events were reported. Conclusions Ultrasound-guided 15% dextrose prolotherapy injection has a significant medium-term effect on pain in MTSS. This benefit may be maintained long-term; however, more robust trials are required to validate these findings in the absence of controls. Clinical relevance Clinicians should consider the use of ultrasound-guided injection of 15% dextrose as a viable treatment option to reduce pain and aid return to activity for patients with recalcitrant MTSS.