Open Access Research BMJ Open: first published as 10.1136/bmjopen-2013-002634 on 16 May 2013. Downloaded from Risk factors for hand injury in hurling: a cross-sectional study Éanna Falvey,1,2 Paul McCrory,3 Brendan Crowley,2 Aiden Kelleher,2 Joseph Eustace,2 Fergus Shanahan,2 Michael G Molloy2 To cite: Falvey É, McCrory P, ABSTRACT et al ARTICLE SUMMARY Crowley B, . Risk factors Objectives: Hurling is Ireland’s national sport, played for hand injury in hurling: a with a stick and ball; injury to the hand is common. A cross-sectional study. BMJ Article focus decrease in the proportion of head injury among Open 2013;3:e002634. ▪ The mandatory use of head and face protection doi:10.1136/bmjopen-2013- emergency department (ED) presentations for hurling- in the Irish sport of hurling over the past 002634 related injury has coincided with voluntary use of 10 years has been accompanied by a marked helmet and face protection since 2003. A similar decrease in the presentation of head and facial decrease in proportions has not occurred in hand ▸ Prepublication history and injuries to the emergency department (ED). injury. We aim to quantify hurling-related ED additional material for this ▪ These improved figures have not been seen in paper are available online. To presentations and examine variables associated with hand injury, where presentations to the ED have view these files please visit injury. In particular, we were interested in comparing remained high, despite the availability of a com- the journal online the occurrence of hand injury in those using head and mercially available hand protection device. (http://dx.doi.org/10.1136/ face protection versus those who did not. ▪ This study was designed to quantify the occurrence bmjopen-2013-002634). Design: This study utilised a retrospective cross- of hurling-related hand injury presenting to the ED, sectional study design. to examine some of the variables associated with Received 23 January 2013 Setting: This study took place at a university hospital hurling-related hand injury, as well as to investigate Accepted 9 April 2013 ED over a 3-month period. the impact these injuries had on work and sports Outcome measures: A follow-up telephone interview participation and to assess player attitudes to com- This final article is available was performed with 163 players aged ≥16 years to mercially available hand protection. for use under the terms of reflect voluntary versus obligatory helmet use. Key messages the Creative Commons Results: The hand was most often injured (n=85, ▪ This work emphasises the high proportion of Attribution Non-Commercial 52.1%). Hand injury most commonly occurred from a 2.0 Licence; see hand injury among hurling-related injury presen- blow of a hurley (n=104, 65%), and fracture was http://bmjopen.bmj.com/ http://bmjopen.bmj.com tations to the ED, which continues in hurling. confirmed in 62% of cases. Two-thirds of players ▪ This study highlights a number of factors related (66.3%) had multiple previous (1–5) hand injuries. to hand injury and poses some questions as to Most patients 149 (91.4%) had tried commercially the behavioural changes that may accompany the available hand protection, but only 4.9% used hand introduction of safety equipment. protection regularly. Univariate analysis showed a ▪ This work shows a statistically significant associ- statistically significant association between wearing a ation between helmet and face-guard use and helmet and faceguard and hand injury; OR 2.76 (95% hand injury among hurling-related injury presen- CI 1.42 to 5.37) p=0.003. On further analysis adjusting tations to the ED. simultaneously for age, prior injury, foul play and on October 2, 2021 by guest. Protected copyright. being struck by a hurley, this relationship remained Strengths and limitations of this study significant (OR 3.15 95% CI 1.51 to 6.56, p=0.002). ▪ This study is one of the first to address player Conclusions: We report that hurling-related hand attitudes towards, and acceptance of, available injury is common. We noted the low uptake of hand hand protection in hurling. A causal relationship protection. We found that hand injury was significantly between the use of protective equipment and 1Department of Sport associated with the use of helmet and faceguard Medicine, Sports Surgery injury at a remote site is not established, but this Clinic, Dublin, Ireland protection, independent of the other factors studied. work poses a number of questions, which 2Department of Medicine, Further studies are warranted to develop strategies to warrant further study. Cork University Hospital, minimise the occurrence of this injury. ▪ The retrospective nature of the self-recorded data Cork, Ireland was obtained by telephonic interview but initial ED 3Florey Neurosciences presentation was gathered prospectively with Institutes and the Centre for follow-up performed to investigate injury causation. Health, Exercise and Sports ▪ The 82% response rate may have resulted in Medicine, University of INTRODUCTION selection bias within the responses. Melbourne, Parkville, Hurling is the national sport of Ireland and Australia it is also played throughout the world, Correspondence to among members of the Irish diaspora in Thought to predate Christianity, hurling has Dr Éanna Falvey; North America, Europe, Australia, New been a distinct Irish pastime for at least [email protected] Zealand, South Africa and Argentina.1 2000 years; stories of the hurling feats of Falvey É, McCrory P, Crowley B, et al. BMJ Open 2013;3:e002634. doi:10.1136/bmjopen-2013-002634 1 Risk factors for hand injury in hurling BMJ Open: first published as 10.1136/bmjopen-2013-002634 on 16 May 2013. Downloaded from Irish mythological heroes such as Setanta are recorded occurrence of hand injury in this population, and to in ancient 12th century texts such as Lebor Laignech (The describe the impact that this has had on time lost from Book of Leinster).2 One of Ireland’s native Gaelic play and work. sports, it shares much with Scottish shinty,3 cammag played on the Isle of Man and Bando in Wales and England.4 Hurling was played in Ireland in ancient MATERIALS AND METHODS times by teams representing neighbouring villages. Consecutive hurling-related injuries over a 3-month Games involved hundreds of players, which would last period, July to September, in 2006 presenting to the ED several hours or even days. In 1904, hurling was an of a university hospital were recorded. At the time of unofficial demonstration sport in the St Louis Summer each patient’s assessment, a questionnaire was com- Olympic games and in the final; Chicago (Fenian FC) pleted by their treating emergency room physician defeated St Louis (Innisfails FC).5 regarding the nature and circumstances of their injury Reputedly one of the fastest team field sports, this and their subsequent investigations and management. amateur game is played by two teams of fifteen players In total, 430 hurling-related injuries presented to the ED who compete for a leather-bound ball (sliotar) using a in the defined period. Owing to the enforcement of the metre-long piece of ash wood (hurley)asabat(figure 1). use of a helmet and face protection by many juvenile clubs The standard hurling pitch is 135–145 m long and (catering for players of 16 years and younger), we excluded 80–90 m wide. Two posts, which are set 6.4 m apart, and this population (n=231). This enabled a true reflection of connected above the ground by a crossbar set at a height equipment use in the adult/voluntary setting. The remain- of 2.5 m, form the goals at each end. A ball hit over the ing 199 patients were contacted for a telephone interview. bar is worth one point. A ball that is hit under the bar is Prior to the interview, patients were contacted by telephone called a goal and is worth three points.6 to give their consent to their participation in the study. Hurling differs from field hockey and lacrosse in that Interviews were completed within 90 days of initial presenta- the sliotar can be caught in the hand and carried for not tion to the ED (mean 68 days (15–88)). The participants more than four steps, struck in the air or struck on the also received background information about the study ground with the hurley. Further, when the ball is struck based on the Ethics Committee approval as well as a plain for longer distances, one of the greatest arts of the game language statement. Telephone calls followed a scripted is to jump and field the ball- while opponents are free to protocol to avoid investigator bias. The questionnaire con- strike the ball with their hurley (figure 1). The player sisted of questions focusing on: may kick or slap the ball with an open hand (the hand - Site of injury pass) for short-range passing. - Mechanism of injury In a 1984 study of emergency department (ED) pre- - Protective equipment in use at the time of injury http://bmjopen.bmj.com/ sentations due to hurling injuries, Crowley and Condon7 - Previous injury noted that 28% of presentations were facial and head - Previous use of protective equipment injuries and 36% were hand injuries. Nine years later, - Reasons for discontinuing use of protective following the voluntary introduction of helmet and face equipment. protection, the absolute number of presentations to ED Those who had tried but discontinued hand protec- due to hurling injury had almost halved.8 The ratio of tion were given five potential options as to why they dis- presentations of site of injury had also changed with continued use of hand protection: 20% of presentations due to head injury and 56% due - Discomfort on October 2, 2021 by guest.