Hornussen’: first Retrospective Study at a Level I Trauma Centre in Switzerland
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BMJ Open Sport Exerc Med: first published as 10.1136/bmjsem-2016-000122 on 18 August 2016. Downloaded from Open Access Research Severity and pattern of injuries caused by the traditional Swiss team sport ‘Hornussen’: first retrospective study at a level I trauma centre in Switzerland Volkmar Waterkamp,1 Meret Ricklin,2 Benoît Schaller,3 Konstantinos Katsoulis,3 Aristomenis Exadaktylos2 To cite: Waterkamp V, ABSTRACT et al What are the new findings? Ricklin M, Schaller B, . Background: This article addresses typical injury Severity and pattern of patterns related to the traditional Swiss team sport of ▸ injuries caused by the This is the first in-depth assessment of charac- Hornussen. A small plastic disk is struck with a special traditional Swiss team sport teristic Hornussen sport injury cases admitted to ‘Hornussen’: first elastic racket and then intercepted in the field. Severe a level I trauma centre in Switzerland. retrospective study at a level I injuries have occasionally been reported. We present a ▸ Midfacial fractures combined with blunt or per- trauma centre in Switzerland. systematic review of all cases of Hornussen injuries forating ocular traumata were found to be fre- BMJ Open Sport Exerc Med treated in the University Hospital of Bern from 2000 to quent injury patterns. 2016;2:e000122. 2014. ▸ Injuries were mostly severe and the majority of doi:10.1136/bmjsem-2016- Methods: To assess the frequency, type and outcome patients had to be hospitalised and surgically 000122 of Hornussen injuries, we performed a database search treated. of all inpatient and outpatient cases related to ▸ An effective precaution would be helmet protec- by copyright. ▸ Prepublication history for Hornussen and that were admitted to and/or treated in tion for all Hornussen players. this paper is available online. Bern University Hospital from 2000 to 2014. To view these files please Results: A total of 28 such patients could be visit the journal online identified. Apart from 1 woman injured as a bystander (http://dx.doi.org/10.1136/ (‘abgetan’) in the field (‘Ries’) with special and treated as an outpatient, all patients were male and bmjsem-2016-000122). wooden shields (the ‘Schindeln’)by active players. Typical injury patterns comprised – members of the other team (figure 2).1 3 midfacial fractures and severe ocular traumata, very During the match, both teams play both Accepted 19 July 2016 often in combination. Almost all of these patients had to be hospitalised due to the severity of the trauma parts of the game. The team with the better suffered and underwent surgery. 1 patient had to be intercepting performance wins the match. If admitted to the intensive care unit prior to the the interception results are identical, the http://bmjopensem.bmj.com/ operation. team with the greater total flight distances of Conclusions: Eye and face injuries caused by the Nouss wins. Thus, in Hornussen, Hornussen can be devastating. This resembles the ‘defence’ is more important than ‘attack’. potential risk of other bat-and-ball sports, such as The exact roots of Hornussen are cricket and baseball. Apart from the economic loss due unknown. It may have emerged from the to treatment costs and sick leave, these injuries can be heathen custom of hitting burning logs from disabling for life. It should therefore be mandatory for the mountain to the valley to cast out all players to wear protective gear, as is already the demons4 or perhaps from medieval war case for Hornussen players born in 1984 or later. 5 1 games. Hornussen was officially documen- Department of fi on September 30, 2021 by guest. Protected Anaesthesiology, Siloah ted for the rst time in 1625, when four men Hospital, Gümligen, were reprimanded by the consistory of Switzerland INTRODUCTION Lauperswil for playing Hornussen during 2 Department of Emergency Hornussen is an indigenous national team ‘catechisation and prayer service’.67 Medicine, University Hospital, fi Bern, Switzerland sport originating in the Central Swiss Interestingly, the rst Hornussen accident 3 ‘ ’ Department of Cranio- Plateau. A small plastic disk (the Nouss or was reported as early as 1738, after a player Maxillofacial Surgery, ‘Hornuss’) is placed on a launching ramp had been fatally wounded to his carotid University Hospital, Bern, (the ‘Bock’) and struck with a small block artery by a broken Stecken.67 Switzerland made of compressed hardwood (the ‘Träf’), The rules of the game have progressively fi Correspondence to which is xed at the end of a special elastic evolved since the 17th century. Today Dr Volkmar Waterkamp; racket (the ‘Stecken’) by a member of one Hornussen is performed with standardised [email protected] team (figure 1) and then intercepted and highly developed equipment (eg, high- Waterkamp V, et al. BMJ Open Sport Exerc Med 2016;2:e000122. doi:10.1136/bmjsem-2016-000122 1 BMJ Open Sport Exerc Med: first published as 10.1136/bmjsem-2016-000122 on 18 August 2016. Downloaded from Open Access Figure 1 Hornussen player driving the Nouss off the Bock. (Inlay: Träf at the end of the Stecken approaching the Nouss). by copyright. tech Steckens made of carbon fibre), as an organised aforementioned historic reference of 1738, severe injur- team sport with championships in different leagues ies have been reported in two scientific publications12 13 – under the aegis of the national Swiss Hornusser and occasionally in the daily press,14 16 especially devas- 8 Association (Eidgenössischer Hornusserverband) with tating ocular injuries. These injuries can be avoided by http://bmjopensem.bmj.com/ currently 7411 licensed members (Eidgenössischer wearing protective equipment, depending on the type of Hornusserverband, personal communication). Up to injury. 80% of these fall within the scope of our hospital’s Bearing this in mind, we retrospectively evaluated the catchment area (Eidgenössischer Hornusserverband, type and severity of the injuries caused by this sport. To personal communication).9 The number of unorganised the best of our knowledge, there has been no systematic casual players is unknown. review of Hornussen accidents before. This is therefore The Nouss itself weighs 78 g and is 62×32 mm. It is the first in-depth study of injuries and injury patterns placed and fixed on the Bock with a small piece of clay caused by Hornussen. (figure 1). When struck with the Stecken’s Träf, the on September 30, 2021 by guest. Protected Nouss reaches initial velocities of 80–85 m/s (ie, around 300 km/hour), with an initial energy of about 250 J.510 METHODS After a flight of ∼300 m, the impact energy of the Nouss Hospital unit and patient population is still about 60–70 J, resulting in energy density values The University Department of Emergency Medicine of between 0.15 and 0.3 J/mm² when hitting soft or hard the Inselspital Bern serves as a level I centre for patients tissue (eg, skin or bones). This is more than sufficient to older than 16 years, and commands a catchment area of cause contused lacerations or fractures of thinner bones, 1.5 million people. It treats more than 38 000 patients for example, those in the midface.511 each year. These hazards resemble those in better known Our study was performed as a retrospective database bat-and-ball sports like cricket or baseball. However, query of all patients admitted to or initially treated in Hornussen is mostly performed without any protective the Emergency Department from 1 January 2000 to 31 measures such as helmets. Apart from the December 2014. The software used was Qualicare17 2 Waterkamp V, et al. BMJ Open Sport Exerc Med 2016;2:e000122. doi:10.1136/bmjsem-2016-000122 BMJ Open Sport Exerc Med: first published as 10.1136/bmjsem-2016-000122 on 18 August 2016. Downloaded from Open Access Figure 2 Hornussen players intercepting the Nouss (upper left corner) in the Ries with their Schindeln. by copyright. http://bmjopensem.bmj.com/ (Qualidoc AG, Trimbach, Switzerland) and E.Care (FISS; table 1). FISS was introduced in 2006, primarily as (E.Care BVBA, Turnhout, Belgium). Case files related to a tool for the assessment and management of maxillo- Hornussen were identified by corresponding search facial trauma.18 19 It was subsequently adopted for terms and exported anonymously. Restriction to active research and has become the most frequently cited tool players was not intended. for scoring maxillofacial trauma.20 FISS yields a numer- The database entries comprise basic demographic data ical value composed of the sum of individual fractures (eg, age and gender), as well as relevant historical details and/or fracture patterns. It ranges from 0 to over 25 in of medical symptoms or the type of accident (eg, direct theory, but the highest FISS reported in the initial publi- on September 30, 2021 by guest. Protected or ricocheted hits by a Hornuss or hits by the Stecken). cation with 1115 patients was 13.18 The database also provided the results of clinical consul- Our database entries proved to be complete enough to tations and radiological examinations, together with allow reliable determination of each patient’s FISS. The medical and traumatological diagnoses and information exact extent of facial lacerations was not recorded in all on treatment after admission. The short-term outcome cases, but never came close to a combined length of was defined by the type of care given to each patient (out- 10 cm. Consequently, we decided always to assign 0 points patient, inpatient, intensive care unit (ICU), surgery or for this item, although it remains possible that the FISS no surgery) and recorded as well. of a very few patients was then under-rated by 1 point. Data were fully anonymised before analysis and there- Application of the FISS fore, according to local law, no prior consent was neces- In so far as was retrospectively possible, we also classified sary.