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Deep Learning Technology: Sebastian Arnold, Betty van Aken, Paul Grundmann, Felix A. Gers and Alexander Löser. Learning Contextualized Document Representations for Healthcare Answer Retrieval. The Web Conference 2020 (WWW'20)
Funded by The Federal Ministry for Economic Affairs and Energy; Grant: 01MD19013D, Smart-MD Project, Digital Technologies
Women in sports such as association football, basketball, and tennis are significantly more prone to ACL injuries than men. The discrepancy has been attributed to gender differences in anatomy, general muscular strength, reaction time of muscle contraction and coordination, and training techniques.
Gender differences in ACL injury rates become evident when specific sports are compared. A review of NCAA data has found relative rates of injury per 1000 athlete exposures as follows:
- Men's basketball 0.07, women's basketball 0.23
- Men's lacrosse 0.12, women's lacrosse 0.17
- Men's football 0.09, women's football 0.28
The highest rate of ACL injury in women occurred in gymnastics, with a rate of injury per 1000 athlete exposures of 0.33
Of the four sports with the highest ACL injury rates, three were women's – gymnastics, basketball and soccer.
According to recent studies, female athletes are two to eight times more likely to strain their anterior cruciate ligament (ACL) in sports that involve cutting and jumping as compared to men who play the same particular sports (soccer, basketball, and volleyball). Differences between males and females identified as potential causes are the active muscular protection of the knee joint, the greater Q angle putting more medial torque on the knee joint, relative ligament laxity caused by differences in hormonal activity from estrogen and relaxin, intercondylar notch dimensions, and muscular strength.
The consequences of whiplash range from mild pain for a few days (which is the case for most people), to severe disability. It seems that around 50% will have some remaining symptoms.
Alterations in resting state cerebral blood flow have been demonstrated in patients with chronic pain after whiplash injury. There is evidence for persistent inflammation in the neck in patients with chronic pain after whiplash injury.
There has long been a proposed link between whiplash injuries and the development of temporomandibular joint dysfunction (TMD). A recent review concluded that although there are contradictions in the literature, overall there is moderate evidence that TMD can occasionally follow whiplash injury, and that the incidence of this occurrence is low to moderate.
In humans, the midfoot consists of five bones that form the arches of the foot (the cuboid, navicular, and three cuneiform bones) and their articulations with the bases of the five metatarsal bones. Lisfranc injuries are caused when excessive kinetic energy is applied either directly or indirectly to the midfoot and are often seen in traffic collisions or industrial accidents.
Direct Lisfranc injuries are usually caused by a crush injury, such as a heavy object falling onto the midfoot, or the foot being run over by a car or truck, or someone landing on the foot after a fall from a significant height. Indirect Lisfranc injuries are caused by a sudden rotational force on a plantar flexed (downward pointing) forefoot. Examples of this type of trauma include a rider falling from a horse but the foot remaining trapped in the stirrup, or a person falling forward after stepping into a storm drain.
In athletic trauma, Lisfranc injuries occur commonly in activities such as windsurfing, kitesurfing, wakeboarding, or snowboarding (where appliance bindings pass directly over the metatarsals). American football players occasionally acquire this injury, and it most often occurs when the athlete's foot is plantar flexed and another player lands on the heel. This can also be seen in pivoting athletic positions such as a baseball catcher or a ballerina spinning.
In 2010 national statistics was done by Agency for Healthcare Research and Quality for posterior cruciate ligaments injuries. They found that 463 patients were discharge for having some type of PCL injury. The 18- to 44-year-old age group was found to have the highest injuries reported (figure 1). One reason why this age group consists of the majority of injuries to the PCL is because people are still very active in sports at this age. Men were also reported having more injuries to the PCL (figure 3).
Stress fractures can occur at many sites in the body; "march fracture" simply refers to a stress fracture specifically of the metatarsals, so named because the injury is sometimes sustained by soldiers during sustained periods of marching. Although march fractures can occur to the 5th metatarsal, fractures of this bone are more likely to be trauma-related fractures to the diaphysis, termed Jones fractures. In runners, march fracture occurs most often in the metatarsal neck, while in dancers it occurs in the proximal shaft. In ballet dancers, fracture mostly occurs at the base of the second metatarsal and at Lisfranc joints. This fracture always occurs following a prolonged stress or weight bearing, and the history of direct trauma is very rare. Consideration should always be given to osteoporosis and osteomalacia. Cavus feet are a risk factor for march fracture.
High school athletes are at increased risk for ACL tears when compared to non-athletes. This risk increases with certain types of sports. Among high school girls, the sport with the highest risk of ACL tear is soccer, followed by basketball and lacrosse. The highest risk sport for boys was basketball, followed by lacrosse and soccer. Children and young athletes may benefit from early surgical reconstruction after ACL injury. Young athletes who have early surgical reconstruction of their torn ACL are more likely to return to their previous level of athletic ability when compared to those who underwent delayed surgery or nonoperative treatment. They are also less likely to experience instability in their knee if they undergo early surgery.
Whiplash is the term commonly used to describe hyperflexion and hyperextension, and is one of the most common nonfatal car crash injuries. More than one million whiplash injuries occur each year due to car crashes. This is an estimate because not all cases of whiplash are reported. In a given year, an estimated 3.8 people per 1000 experience whiplash symptoms. "Freeman and co-investigators estimated that 6.2% of the US population have late whiplash syndrome". The majority of cases occur in patients in their late fourth decade. Unless a cervical strain has occurred with additional brain or spinal cord trauma mortality is rare.
Whiplash can occur at speeds of fifteen miles per hour or less; it is the sudden jolt, as one car hits another, that causes ones head to be abruptly thrown back and sideways. The more sudden the motion, the more bones, discs, muscles and tendons in ones neck and upper back will be damaged. Spinal cord injuries are responsible for about 6,000 deaths in the US each year and 5,000 whiplash injuries per year result in quadriplegia.
After 12 months, only 1 in 5 patients remain symptomatic, only 11.5% of individuals were able to return to work a year after the injury, and only 35.4% were able to get back to work at a similar level of performance after 20 years. Estimated indirect costs to industry are $66,626 per year, depending on the level and severity. Lastly, the total cost per year was $40.5 billion in 2008, a 317% increase over 1998.
According to the posterior cruciate ligament injuries only account for 1.5 percent of all knee injuries (figure 2). If it is a single injury to the posterior cruciate ligament that requires surgery only accounted for 1.1 percent compared to all other cruciate surgeries but when there was multiple injuries to the knee the posterior cruciate ligament accounted for 1.2 percent of injuries.
Lisfranc injury, also known as Lisfranc fracture, is an injury of the foot in which one or more of the metatarsal bones are displaced from the tarsus. The injury is named after Jacques Lisfranc de St. Martin (2 April 179013 May 1847), a French surgeon and gynecologist who described an amputation of the foot through the tarsometatarsal articulation, in 1815, after the War of the Sixth Coalition.
A Chance fracture is a flexion injury of the spine, first described by G. Q. Chance in 1948. It consists of a tension-failure injury to the anterior column of the vertebral body and a transverse fracture through the posterior elements of the vertebra and the posterior portion of the vertebral body. It is caused by violent forward flexion, causing distraction injury to the posterior elements.
The most common site at which Chance fractures occur is the thoracolumbar junction (T12-L2) and midlumbar region in pediatric population. This fracture initially became known as a "seat belt injury" due to its association with the sudden forward flexion that occurs when one is involved in a head-on automobile collision while being restrained by a lap belt. With the advent of both lap and shoulder belts in the 1980s, Chance fractures have become less common especially now that lap-belt-only seat belts have been almost entirely phased out.
Up to 50% of Chance fractures have associated intraabdominal injuries. Injuries associated with Chance fractures include contusions and/or lacerations of the pancreas, duodenum, and mesentery.
In children, whose bones are still developing, there are risks of either a growth plate injury or a greenstick fracture.
- A greenstick fracture occurs due to mechanical failure on the tension side. That is, since the bone is not so brittle as it would be in an adult, it does not completely fracture, but rather exhibits bowing without complete disruption of the bone's cortex in the surface opposite the applied force.
- Growth plate injuries, as in Salter-Harris fractures, require careful treatment and accurate reduction to make sure that the bone continues to grow normally.
- Plastic deformation of the bone, in which the bone permanently bends, but does not break, also is possible in children. These injuries may require an osteotomy (bone cut) to realign the bone if it is fixed and cannot be realigned by closed methods.
- Certain fractures mainly occur in children, including fracture of the clavicle and supracondylar fracture of the humerus.
Although strains are not restricted to athletes and can happen while doing everyday tasks, however, people who play sports are more at risk for developing a strain. It should also be noted that it is common for an injury to develop when there is a sudden increase in duration, intensity, or frequency of an activity.
Smokers generally have lower bone density than non-smokers, so have a much higher risk of fractures. There also is evidence that smoking delays bone healing.
Although the precise mechanism of injury is unclear, the injury occurs in children who have fallen heavily with their arm trapped under the body. In his original description of the injury, Hume suggested that the injury occurred as a result of hyperextension of the elbow leading to fracture of the olecranon, with pronation of the forearm leading to the radial head dislocation.
Acute injury to the internal carotid artery (carotid dissection, occlusion, pseudoaneurysm formation) may be asymptomatic or result in life-threatening bleeding. They are almost exclusively observed when the carotid canal is fractured, although only a minority of carotid canal fractures result in vascular injury. Involvement of the petrous segment of the carotid canal is associated with a relatively high incidence of carotid injury.
The radial head fracture is usually managed by open reduction internal fixation; if the fracture is too comminuted, a radial head implant can be used. Excision of the radial head should be avoided, as the radius will migrate proximally leading to wrist pain and loss of pronation and supination of the wrist. Delayed treatment of the radial head fracture will also lead to proximal migration of the radius.
The distal radio-ulnar joint dislocation can be reduced by supination of the forearm, and may be pinned in place for 6 weeks to allow healing of the interosseous membrane.
Turf toe is named from the injury being associated with playing sports on rigid surfaces such as artificial turf and is a fairly common injury among professional American football players. Often, the injury occurs when someone or something falls on the back of the calf while that leg's knee and tips of the toes are touching the ground. The toe is hyperextended and thus the joint is injured. Additionally, athletic shoes with very flexible soles combined with cleats that "grab" the turf will cause overextension of the big toe. This can occur on the lesser toes as well. It has also been observed in sports beyond American football, including soccer, basketball, rugby, volleyball, and tae kwon do. This is a primary reason why many athletes prefer natural grass to turf, because it is softer.
March fracture, also known as fatigue fracture or stress fracture of metatarsal bone, is the fracture of the distal third of one of the metatarsals occurring because of recurrent stress. It is more common in soldiers, but also occurs in hikers, organists, and even those, like hospital doctors, whose duties entail much standing. March fractures most commonly occur in the second and third metatarsal bones of the foot. It is a common cause of foot pain, especially when people suddenly increase their activities.
In the original description by Hume, where the olecranon fractures were not displaced, treatment consisted of closed reduction of the radial head dislocation under general anaesthesia by supination of the forearm. This was followed by immobilisation of the arm in a plaster cast with the elbow flexed at 90° and the forearm in supination for 6 weeks.
Where the olecranon fracture is displaced, open reduction internal fixation is recommended. Once the olecranon has been repaired, closed reduction of the radial head dislocation is usually possible. This is followed by immobilisation with the elbow flexed to 90° and the forearm in the neutral position. The duration of immobilisation depends on clinical assessment of the joint, and mobilisation may be possible after as little as 4 weeks.
A study containing 100 consecutive patients with a recent anterior cruciate ligament injury were examined with respect to type of sports activity that caused the injury. Of the 100 consecutive ACL injuries, there were also 53 medial collateral ligament injuries, 12 medial, 35 lateral and 11 bicompartmental meniscal lesions. 59/100 patients were injured during contact sports, 30/100 in downhill skiing and 11/100 in other recreational activities, traffic accidents or at work.
An associated medial collateral ligament tear was more common in skiing (22/30) than during contact sports (23/59), whereas a bicompartmental meniscal lesion was found more frequently in contact sports (9/59) than in skiing (0/30). Weightbearing was reported by 56/59 of the patients with contact sports injuries whereas 8/30 of those with skiing injuries. Non-weightbearing in the injury situation led to the same rate of MCL tears (18/28) as weightbearing (35/72) but significantly more intact menisci (19/28 vs 23/72). Thus, contact sports injuries were more often sustained during weightbearing, with a resultant joint compression of both femuro-tibial compartments as shown by the higher incidence of bicompartmental meniscal lesions. The classic "unhappy triad" was a rare finding (8/100) and Fridén T, Erlandsson T, Zätterström R, Lindstrand A, and Moritz U. suggest that this entity should be replaced by the "unhappy compression injury".
Vertebral fractures of the thoracic vertebrae, lumbar vertebrae or sacrum are usually associated with major trauma and can cause spinal cord injury that results in a neurological deficit.
The injury can be debilitating for athletes of many sports who need to accelerate, quickly change direction, or jump. Use of the toes is not possible during the healing process. Since the toes are necessary for proper push-off when accelerating, those sorts of athletic activities should be almost completely curtailed. An extended healing period of one or more months is often required.
Because of the anatomy of the distal foot and the unique use of the foot, it is often impossible to properly tape or brace the joint. Although difficult, it is not impossible to tape the toe to limit extension (upward bend of toe). Additionally, wearing a shoe with a rigid sole (often a metal plate) and cushioned innersole will help minimize extension of the joint. Anti-inflammatory medication as well as physical therapy is recommended.
Turf toe is usually healed in about 2–3 weeks. It can become more serious if left untreated, and may cause serious problems for the athlete. Treating the injury includes icing of the area, elevating the foot, or possibly the use of custom orthotics.
The Essex-Lopresti fracture is a fracture of the radial head with concomitant dislocation of the distal radio-ulnar joint and disruption of the interosseous membrane. The injury is named after Peter Essex-Lopresti who described it in 1951.
A stinger is an injury that is caused by restriction of the nerve supply to the upper extremity via the brachial plexus. The brachial plexus is formed by the anterior rami of the nerves at the 5th cervical level of the spinal cord all the way to the nerves at the 1st thoracic level of the spinal cord. The brachial plexus innervates the upper extremity as well as some muscles in the neck and shoulder. Damage to the brachial plexus can occur when the nerves are stretched too far from the head and neck; specifically the upper trunk of the plexus –nerve roots at the 5th and 6th cervical level –are primarily affected. The upper trunk provides part of the nerve to supply to the upper extremity via the Musculocutaneous, Axillary, Radial and Median nerves. It is for this reason that stingers do not affect both arms simultaneously, however it is possible for both arms to accrue injuries. Repeated nerve trauma can cause recurring stingers, chronic pain, and muscle weakness, while recovery can take weeks to months in severe cases.
The broken bone pieces or the dislocated head of the femur may injure the sciatic nerve, causing paralysis of the foot; the patient may or may not recover sensation in the foot, depending on the extent of injury to the nerve. The posterior wall fragment may be one large piece, or multiple pieces, and may be associated with impaction of the bone. Sciatic nerve injury and stoppage of blood supply to femoral head at the time of accident or during surgery to treat may occur. Deep vein thrombosis and pulmonary embolism are other complications that may occur in any type of injury to the acetabulum.