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Robertson, Gregory Aidan James (2019) the Epidemiology, Management and Outcome of Acute Fractures in Team Sports

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Robertson, Gregory Aidan James (2019) the Epidemiology, Management and Outcome of Acute Fractures in Team Sports Robertson, Gregory Aidan James (2019) The Epidemiology, Management and Outcome of Acute Fractures in Team Sports. Doctoral thesis, University of Sunderland. Downloaded from: http://sure.sunderland.ac.uk/id/eprint/10866/ Usage guidelines Please refer to the usage guidelines at http://sure.sunderland.ac.uk/policies.html or alternatively contact [email protected]. THE EPIDEMIOLOGY, MANAGEMENT AND OUTCOME OF ACUTE FRACTURES IN TEAM SPORTS Gregory Aidan James Robertson MBChB, BMedSci (Hons), MSc, MRCS Ed A thesis submitted in partial fulfilment of the requirements of the University of Sunderland for the degree of PhD by Existing or Creative Works APRIL 2019 This research programme was carried out in collaboration with the Edinburgh Orthopaedic Trauma Unit at the Royal Infirmary of Edinburgh i Declaration This thesis and its composition are entirely my own work. The contributions and assistance of others in data collection and analysis have been appropriately acknowledged. I confirm that the work within this thesis and its composition is my own and that it has not been submitted for any other degree or professional qualification. Gregory Aidan James Robertson ii Acknowledgements Foremost, I would like to express my sincere gratitude to my supervisor Professor Wilkes for his continuous support for my PhD by publication. His patience, motivation, enthusiasm, and immense knowledge and guidance have helped me formulate and draw together my research to produce this thesis. I could not have imagined having a better adviser and mentor. With this, I would like to thank Dr Innerd for his support during the application procedure and during the subcommittee review process, and for his help composing this thesis for which I am truly grateful. From the Edinburgh Orthopaedic Trauma Unit, I would then like to thank my colleagues form my research. Firstly, I would like thank Professor Charles Court- Brown for his immense knowledge, leadership skills, and research acumen, without which none of this would be possible: one of the foremost world experts in Orthopaedic Trauma, I am dearly grateful of his help with my research projects. Following this, I would like to thank Alexander Wood and Stuart Aitken for each of their significant contributions to my research: their advice, commitment and dedication to the cause was greatly appreciated. Lastly, I would like to thank all my other co-authors and the associated research staff at the SORT-IT Team: much work has gone to the research presented in the thesis, and none of this would have been possible without the input of each involved – thankyou! Last but not the least I would like to thank my family: my parents, Andrew and Margaret, and my brothers, John, Andrew, Francis and Bernard (all fellow surgeons!) for their advice and support during my research and composition of this thesis. One day they may thank me should they ever need a fracture fixed! iii Abstract Introduction Acute fractures are among the most serious injuries incurred by athletes. Of all sports, team sports cause the highest proportion of fracture injuries, accounting for up to 69% of all acute sport-related fractures. Despite the importance of this injury type, the literature describing sport-related fractures has remained limited. Aim The aims were: to describe the epidemiology, management and outcome of acute team-sport related fractures, focussing on the three most common team sports in the Lothian region (football, rugby, hockey); and to ascertain if the outcome of these injuries can be optimised. Methods The thesis is based on a data-mining collective of six descriptive epidemiological papers and one retrospective cohort study, which: describes the epidemiology (Papers I, II, III, V, VI), management trends (Papers I, II, III, V, VI), outcome (Papers I, II, III) of team sport-related fractures (specifically football, rugby, hockey); and assesses whether the outcome of these injuries can be optimised through the judicious choice of management (Papers IV, VII). Patients who experienced a sport-related fracture injury at the Edinburgh Orthopaedic Trauma Unit from the Lothian Population, over the time period January 1995 to December 2009, had pre-determined outcome variables recorded. iv Outcomes comprised: patient demographic data; fracture demographic data; treatment selection data; sporting outcome by fracture type; and symptom-profile post fracture management. Results The incidence of football-related fractures was 0.71/1000 adult population; 0.28/1000 adult population for rugby-related fractures; and 0.04/1000 adult population for hockey-related fractures. Within the adult population: 20% of football-related fractures were treated surgically; 17% of rugby-related fractures were treated surgically; 21% of hockey-related fractures were treated surgically. Eighty-six percent of football-related fractures returned to football; 87% of rugby- related fractures returned to rugby; 89% of hockey-related fractures returned to hockey. Primary surgical management of undisplaced unstable fractures (tibial diaphyseal fractures, scaphoid waist fractures) can improve return rates and return times to sport over conservative management. Conclusion This thesis provides the first comprehensive description of the epidemiology, management and outcome of acute team-sport related fractures in the current literature. With a world-wide interest in sport, this data provides key clinical information on the management and prognosis of sport-related fractures, and serves as the most comprehensive resource on the topic at present. v Published papers upon which this thesis is based The Epidemiology, Morbidity and Outcome of Soccer-Related Fractures in a Standard Population Robertson GA, Wood AM, Bakker-Dyos J, Aitken SA, Keenan AC, Court Brown CM. Published in the American Journal of Sports Medicine. 2012 Aug; 40(8):1851-7. Impact factor: 6.06 Citation Count: 30 Appendix I Novel question: What is the incidence of football-related fractures within a standard adult population? Who is most likely to sustain these and what are the common fracture locations? What are the trends in management of these injuries? When can athletes expect to return to football following these? Original finding: Within a standard adult population, the incidence of football-related fractures was 0.71 per 1000 population. These were most common in young (mean age, 27 years), male (98% male: 2% female) non-professional (95% non- professional: 5% professional) football players. 68% of the fractures were recorded in the in the upper limb, with 32% recorded in the lower limb: the most common fracture types were finger phalanx (21%), distal radius (20%) and ankle (13%). 80% of fractures were managed conservatively, with 20% managed surgically. From the cohort, the mean return rate to football was 86%; and the mean return time to football was 15 weeks. vi The Epidemiology, Morbidity and Outcome of Fractures in Rugby Union from a Standard Population Robertson GA, Wood AM, Heil K, Aitken SA, Court Brown CM. Published in Injury 2014 Apr;45(4):677-83. Impact factor: 2.20 Citation Count: 15 Appendix II Novel question: What is the incidence of rugby-related fractures within a standard adult population? Who is most likely to sustain these and what are the common fracture locations? What are the trends in management of these injuries? When can athletes expect to return to rugby following these? Original finding: Within a standard adult population, the incidence of rugby-related fractures was 0.28 per 1000 population. These were most common in young (mean age, 22 years), male (94% male: 6% female) non-professional (93% non- professional: 7% professional) rugby players. 83% of the fractures were recorded in the in the upper limb, with 17% recorded in the lower limb: the most common fracture types were finger phalanx (28%), metacarpal (19%) and clavicle (17%). 83% of fractures were managed conservatively, with 17% managed surgically. From the cohort, the mean return rate to rugby was 87%; and the mean return time to rugby was 16 weeks. vii The Epidemiology, Management and Outcome of Field Hockey Related Fractures in a Standard Population Robertson GA, Wood AM, Aitken SA, Court Brown CM. Published in the Archives of Trauma Research 2017 Oct;6(4):76-81. Impact factor: N/A Citation Count: 0 Appendix III Novel question: What is the incidence of field hockey-related fractures within a standard adult population? Who is most likely to sustain these and what are the common fracture locations? What are the trends in management of these injuries? When can athletes expect to return to field hockey following these? Original finding: Within a standard adult population, the incidence of field hockey- related fractures was 0.04 per 1000 population. These were most common in young (mean age, 25 years), male (53% male: 47% female) non-professional (95% non- professional: 5% professional) field hockey players. 89% of the fractures were recorded in the in the upper limb, with 11% recorded in the lower limb: the most common fracture types were finger phalanx (42%), metacarpal (37%) and ankle (5%). 79% of fractures were managed conservatively, with 21% managed surgically. From the cohort, the mean return rate to field hockey was 89%; and the mean return time to field hockey was 11 weeks. viii The Epidemiology, Management and Outcome of Sport-Related Ankle Fractures in a Standard UK Population Robertson GA, Wood AM, Aitken SA, Court Brown CM. Published in Foot and Ankle International 2014 Nov;35(11):1143-52 Impact factor: 2.65 Citation Count: 16 Appendix IV Novel question: What is the incidence of sport-related ankle fractures within a standard adult population? Who is most likely to sustain these and what are the common causative sports? What are the trends in management of these injuries? When can athletes expect to return to sport following these? What is the optimal mode of management? Original finding: Within a standard adult population, the incidence of sport-related ankle fractures was 0.19 per 1000 population.
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