The Correlation between Lower Extremity Fracture and Subsequent Arterial Embolism and Thrombosis—A National Population Cohort Study

The hazard of subsequent arterial embolism and thrombosis (SAET) in patients with lower leg fractures is not yet well demonstrated. The purpose of this study is to determine the correlation between lower leg fracture and SAET in Taiwan. A total of 134,844 patients with lower leg fractures (ICD-9-CM: 823) and chronological diagnosis as SAET (ICD-9-CM: 444.22) was matched (1:1) to the non-fracture cohort according to their propensity score (data coming from the National Health Insurance database between January 2000 to December 2012). Patients were matched by age, gender, and comorbidities. The incidence of SAET and correlation between SAET development and lower leg fracture was statistically analyzed, and subgroup analysis categorized by characteristics and comorbidities was conducted as well. The cumulative incidence of SAET was calculated by Kaplan–Meier analysis. Kaplan–Meier analysis plot showed that, by the end of the ten-year follow-up period, the cumulative incidence of SAET was significantly higher for the lower leg fracture cohort than for the non-fracture cohort (log-rank test: p < 0.001). The lower leg fracture, male, elder age (45–64-year-old; ≥65-year-old), hypertension, diabetes mellitus, and gout were significantly associated with lower extremity SAET risk compared with the matched group. There was an inseparable correlation between the lower leg fracture group and the risks of SAET; subgroup analysis by gender (male, female), age (age < 40 years, age 40–64 years, and age > 65 years) and comorbidities (hypertension, diabetes mellitus, and gout) show compatible results as well. Patients with lower leg fracture have a significantly increased risk of SAET since then two years after the fracture. The hazard of SAET was significantly higher in patients with lower leg fracture than in the non-fracture cohort, and the high incidence was found since then two years after fracture. Further studies are warranted.

Traumatic Leg Fractures in UEFA Football Athletes: A Matched-Cohort Analysis of Return to Play, Reinjury, Player Retention, and Performance Outcomes

Background: The average professional soccer team experiences 1 to 2 traumatic leg fractures per season, with unknown effects on player performance. Purpose: To (1) determine the rate and time to return to play (RTP) following leg fracture, (2) investigate the rate of reinjury following RTP, and (3) investigate long-term effects that lower extremity (LE) fracture may have on elite soccer player performance. Study Design: Cohort study; Level of evidence, 3. Methods: Using publicly available records, we identified athletes sustaining a traumatic leg fracture across the 5 major European soccer leagues (English Premier League, Bundesliga, La Liga, Ligue 1, and Serie A) between 2000 and 2016. Athletes with leg fracture (femur, tibia, and/or fibula) were matched 1:2 to controls by demographic characteristics and performance metrics 1 season before the index timepoint. Investigations included the RTP rate, reinjury rate, player characteristics associated with RTP within 2 seasons, long-term player retention, performance metrics during the 4 following seasons, and subgroup analysis by player position. Results: A total of 112 players with LE fracture and 224 controls were identified. Players with LE fractures were absent for a mean of 157 days (range, 24-601 days) and 21 games (range, 2-68 games). The rate of RTP within 1 season was 80%, with 4% experiencing subsequent refracture. Injured players remained active in the league at a higher rate than their uninjured counterparts. As compared with controls, injured athletes played 309 fewer total minutes ( P < .05), scored 0.09 more assists per game ( P < .01) 1 season after injury, and scored 0.12 more points per game 4 seasons after injury ( P < .01). Defenders were most affected by an LE fracture, playing 5.24 fewer games ( P < .05), 603 fewer total minutes ( P < .01), and recording 0.19 more assists per 90 minutes of play as compared with controls 1 season after injury ( P < .001). Attackers and midfielders demonstrated no significant difference in metrics after RTP when compared with controls. Conclusion: Most players sustaining an LE fracture returned to elite soccer at the same level after a significant loss of playing time, with a 4% rate of refracture. Player retention was higher for those sustaining an LE fracture versus uninjured controls. Overall, injured players did not experience a decline in performance after recovery from an LE fracture.

A Delayed Presentation of Diffuse Axonal Injury

Diffuse axonal injury is one of the most common and debilitating pathologies resulting from mechanical deformation of the brain. The current case involves a 19-year-old female involved in a high velocity ski crash. The accident resulted in a right lower leg fracture, with no loss of consciousness or evidence of head trauma. Approximately 6.5 hours after her admission, the neurological status of the patient deteriorated markedly, and magnetic resonance imaging findings were consistent with diffuse axonal injury. This presentation illustrates a case of delayed diffuse axonal injury, a phenomenon not commonly described. Diffuse axonal injury involves rapid inertial forces causing strain to brain tissue. This strain results in various stages of diffuse axonal damage and inflammation. This article highlights a case of delayed onset diffuse axonal injury, describes the progression of neural sequelae post-injury resulting in axonal damage and explores proposed therapeutic targets.

Movement parameters of persons with disabilities on evacuation by lifts

In 2010 it was defined five challenges for the solution of evacuation of persons in buildings to 2020. One of the challenges is to implement helpfull technologies during evacuations from buildings – lifts. Needed steps for fulfilling this challenge are also quantification of missing data which are dealing with evacuation of persons with disabilities. From 2002 all public buildings in Slovak Republic have to be also accessible to persons with disabilities, but it is also a global problem. In present exists just small number of informations of movement parameters of persons with disabilities during evacuation by lift. There for, this work was focused on collecting these informations. The data collection was realized by using an in-situ experiment. The aim of the work was to quantify the phase stages of evacuation by elevators for persons with disabilities (speed, time, movement and capacity parameters). Person's movements were monitored during the measurements, arrival to lift, cabin entry and exit from the cabin, including leaving the bounded area. Arrival to lift included movement in the bounded area in front of the lift, until the moment of pushing the button was pressed to call the lift. The time of cabin entering includes the time from the beginning of opening the lift doors to the beginning of closing of the lift doors. The exit from the cabin includes the time from opening the lift doors, passing through the lift doors to leaving the bounded area. In total, ten participating persons in the experiments imitated wheelchair movement and movement with leg fracture. Measurements were made on two lifts, where person evacuating himself or with the help of another person. Everyone performed each measurement three times. A total of 720 measurements were performed in the work. According to the results of the experiment it can be stated that cabin entry is longer for a person on the wheelchair than for a person with a leg fracture, but the difference is even bigger during exit from the cabin, including leaving the bounded area. During the experiment, various movement techniques have been observed that may affect their overall the time of cabin entry and exit from the cabin. Obtained results can extend existing evacuation model to the possibility of using the lift. The obtained results quantify the individual phase stages of entering to the lift and exiting of the lift for persons with limited movement.