A one-year hospital-based analysis of sports injuries

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					Hong Kong Journal of Emergency Medicine

A one-year hospital-based analysis of sports injuries

CT Tsui            , M Leung           , CP Chow               , KH Chan               , ACH Lit

       Objectives: (1) To survey and analyse the pattern of sports injuries; (2) to make implication from the results.
       Methodology: Subjects with sports injuries attending the emergency department of Princess Margaret Hospital
       in 2006 were retrieved via the Injury Surveillance System. The characteristics of the subjects and their
       injuries were evaluated. Results: In 2006, 709 subjects had sports injuries, from which 83% were male. The
       median age was 19. Age below 20 accounted for 53% of the attendance. Football (35%), basketball (25%)
       and cycling (9%) were the three commonest sport-injury activities. All sports injuries had the maximum
       AIS ≤3 and 83% had MAIS of 1 only. Overall, 39% had contusion and scrape, 36% with sprain and strain,
       and 18% had fracture. Nearly half (47%) had lower limb injury; 30% and 24% had upper limb injury and
       head injury respectively. Contusion and scrape of the head, and sprain and strain of the lower limb were the
       two commonest injuries in football and basketball. In cycling, two-thirds suffered from contusion and scrape
       of any body region and 57% of those involved the head. Conclusion: Sports injury surveillance with
       characterised patterns of injuries helped to devise prevention measures. (Hong Kong 2007;14:

                   1                                               2                                    2006
          709                                 83%                                     19      20                   53%
         35%                25%                9%
            3                83%                                       1               39%                     36%
                 18%                             47%                                                    30%      24%


       Keywords: Athletic injuries, sports, sports medicine, wounds and injuries

Correspondence to:                                                         Introduction
Tsui Chee Tat, MBChB, MRCSEd, FHKAM(Emergency Medicine)
Princess Margaret Hospital, Accident & Emergency Department,
Lai Chi Kok, Kowloon, Hong Kong                                            Sport is essential to physical fitness, as well
Email:                                               as mental well-being. Regular physical activity
Leung Ming, MSc(Nursing)                                                   is related to cardiorespiratory fitness in the sense
Chan Kwok Hei, FRCSEd, FHKAM(Emergency Medicine), FHKAM(Surgery)           of reducing the risk from death due to coronary
Lit Chau Hung, Albert, MRCP, FRCSEd, FHKAM(Emergency Medicine)
                                                                           artery disease. Besides, it helps to develop body
Princess Margaret Hospital, Paediatrics Department, Lai Chi Kok,           balance, strength, endurance, flexibility and team
Kowloon, Hong Kong
Chow Chun Pong, FRCP(Edin), FRCPCH, FHKAM(Paediatrics)                     spirit.
Tsui et al./Sports injuries                                                                                                  205

An injury is the physical damage that results when                     injury attendances were assessed by the triage nurses
a human body is suddenly or briefly subjected to                       using the injury classification of WHO and CDC,
intolerable levels of energy. 1 The energy can be                      2001.1 The required information was entered through
mechanical, radiant, thermal, electrical or chemical.                  the preset pull-down menu. Several factors concerning
Any physical activity can result in injury and sport                   the acute injury, e.g. demographic data, mechanism,
i s n o t a n e x c e p t i o n . It c a n b e c o s t l y t o t h e   activities, injury patterns, were recorded. The data
community with loss of productivity as well as                         could be retrieved with different levels of filtering. The
medical expenses.                                                      output data would be in the format of a spreadsheet.

The development of an injury surveillance system                       All subjects with injury from sport, attending the
defines the problem, the causes and the risk factors                   emergency department of Princess Margaret Hospital
related to injuries. It helps to devise prevention plans               from 1 January 2006 to 31 December 2006, were
or interventions against injuries and evaluate the                     retrieved through the Injury Surveillance System.
effectiveness of the interventions. 1,2                                Characteristics of the subjects, including age, sex, and
                                                                       pattern of injury, were evaluated. Characteristics of
Since September 2003, an Injury Surveillance System                    the injury with respect to the type of sport, severity of
(Figure 1) was piloted at the emergency department                     injury pattern, and body part involvement were
of Princess Margaret Hospital, an acute hospital serving               evaluated.
a population of 500,000 in the Kwai Tsing District in
Kowloon West. The system was to direct resources for
injury prevention and to provide indicators for the                    Results
effectiveness of these programs.
                                                                       Sex and age
                                                                       In 2006, 709 subjects suffered from sports injuries,
Methods                                                                contributing to 4% of the yearly total traumatic cases
                                                                       attending the emergency department of Princess
The Injury Surveillance System captured injuries of                    Margaret Hospital. There were 591 male subjects and
all types presenting to the emergency department. All                  118 female subjects with a male to female ratio of 5:1.

                                                                                                         Figure 1. The Injur y
                                                                                                         Surveillance System.
206                                                         Hong Kong j. emerg. med.         Vol. 14(4)      Oct 2007

The age spanned from 2 to 85 years, with a median of    Injury characteristics
19 (Figure 2). The 25th and the 75th percentiles of     Football was the commonest (35%) sport from which
the age distribution were 14 and 29 respectively. The   the participants suffered injuries and sought emergency
age group of 11-20 made up 44% of the total sports      care (Figure 3). The next was basketball (25%) and
injuries and age below 20 accounted for 53% of the      cycling (9%). All other sports contributed merely a
total.                                                  quarter of the total sports injuries in this study.

                                                        All sports injuries had the maximum AIS (MAIS) ≤3,
                                                        and 83%, 16% and 1% had MAIS of 1, 2 and 3

                                                        Overall, the commonest parts of the body injured were
                                                        lower limbs (47%), upper limbs (30%) and head (24%)
                                                        (Table 1). Truncal injuries accounted for merely 2%.
                                                        There were 8% subjects having more than one part of
                                                        the body injured.

Figure 2. Age distribution.                             Sites at or distal to the elbow and knee joints accounted
                                                        for most (almost 90%) of the upper limb and lower
                                                        limb injuries (Figure 4), and injuries around the wrist
                                                        and the ankle joints were the commonest.

                                                        Table 1. Parts of body injured in sport
                                                        Site of injury                    No. of patients (%)
                                                        Head                                  170 (24.0)
                                                        Neck                                      13 (1.8)
                                                        Chest                                     15 (2.1)
                                                        Abdomen                                    1 (0.1)
                                                        Back / pelvis                             21 (3.0)
                                                        Upper limb                            211 (29.8)
                                                        Lower limb                            335 (47.2)
                                                        >1 site of injury                         54 (7.6)
Figure 3. Types of sport involved.

                                                                            Figure 4. Distribution of upper and lower
                                                                            limb injuries.
Tsui et al./Sports injuries                                                                                              207

Bone fractures accounted for 18% of all injury patterns             Half of the fractures involved the upper limb and nearly
(Figure 5). Dislocations of joint, cartilage, tendon or             half of those upper limb fractures involved the wrist
ligamental ruptures made up 7.5% of cases. Relatively               joint. One third of the fractures involved the lower
minor injury patterns like sprain, strain, contusion or             limb and half of those lower limb fractures involved
scrape filled up around three-quarters of all injury                the ankle joint. Fractures involving the head region
patterns.                                                           (6 out of 7) were relatively minor such as nasal bone
                                                                    fracture. One patient suffered from basal skull fracture.
Football injuries
There were 247 subjects with injuries from playing
football. The commonest were contusion and scrape
of the head region (23% of all), sprain and strain in
the lower limb (20%), and contusion and scrape of
the lower limb (15%) (Figure 6).

Nearly half (47%) had lower limb injuries; upper limb
injuries and head injuries equally shared another half
of all injuries related to football and 6% had more than
one part of the body injured.

The majority, nearly three-quarters, had relatively
minor injuries (sprain and strain, contusion and
scrape). However, around one out of five patients had
bone fractures of some kind.                                    Figure 5. Types of injury.
              No. of subjects

                                head     neck    chest/    back/        upper      lower
                                                abdomen    pelvis       limb        limb

          Figure 6. Football injuries.
208                                                                    Hong Kong j. emerg. med.      Vol. 14(4)   Oct 2007

Basketball injuries                                                in 2006. Contusions and scrapes were the commonest
A total of 179 subjects had injuries from basketball               pattern (two-thirds) (Figure 8).
and attended the emergency department in 2006. The
commonest injuries were sprains and strains of the                 The commonest site of injury was the head region
lower limb (36%), and contusions and scrapes of the                (44%), 14% of those had fractures though the majority
head (17%) (Figure 7).                                             (86%) was simply contusions and scrapes. The next
                                                                   commonest were contusions and scrapes of the lower
Forty-seven percent had lower limb injuries, one third             limb (27%) and the upper limb (17%). About three
had upper limb injuries and 3% had more than one                   out of ten patients had more than one body regions
part of the body injured.                                          injured, the commonest among all sports in this study.

Again, nearly three-quarters had relatively minor injury           Other sports injuries
(the same as football) and 18% had bone fracture. It was           In other sports like track and field, hiking, or ball
noted that a higher proportion of patients suffered from           games (both racket and non-racket), the majority of
sprain and strain of the limb due to basketball than due           them had lower limb injuries, and sprain and strain
to football, but fewer had contusion and scrape.                   was the commonest pattern (Figures 9-14).

Sixty-six percent fractures involved the upper limb and            It was interesting that there were far fewer injuries in
nearly half of them were fractures around the wrist                the upper limbs in racket ball games than non-racket
joint. The rest was shared by the lower limb (22%)                 ball games.
and the head (12.5%).
                                                                   In water sports, contusions and scrapes of the head
Cycling injuries                                                   region were the commonest, followed by the lower limb
There were 66 subjects attending for cycling injuries              with the same injury pattern.
                No. of subjects

                                  head   neck    chest/   back/     upper     lower
                                                abdomen   pelvis    limb       limb

             Figure 7. Basketball injuries.
Tsui et al./Sports injuries                                                               209

                 No. of subjects

                                   head     neck     chest/    back/     upper    lower
                                                    abdomen    pelvis    limb      limb

              Figure 8. Cycling injuries.
                 No. of subjects

                                   head     neck     chest/   back/     upper    lower
                                                    abdomen   pelvis    limb      limb

              Figure 9. Track and field injuries.
210                                                                Hong Kong j. emerg. med.   Vol. 14(4)   Oct 2007

        No. of subjects

                          head   neck          chest/    back/      upper     lower
                                              abdomen    pelvis     limb       limb

      Figure 10. Hiking injuries.
        No. of subjects

                          head   neck      chest/       back/     upper     lower
                                          abdomen       pelvis    limb       limb

      Figure 11. Racket ball game injuries.
Tsui et al./Sports injuries                                                              211

                   No. of subjects

                                      head    neck    chest/    back/    upper   lower
                                                     abdomen    pelvis   limb     limb

               Figure 12. Non-racket ball game injuries.
                  No. of subjects

                                     head    neck     chest/   back/     upper   lower
                                                     abdomen   pelvis    limb     limb

               Figure 13. Water sports injuries.
212                                                                       Hong Kong j. emerg. med.         Vol. 14(4)   Oct 2007

  No. of subjects

                    head    neck        chest/   back/        upper         lower
                                       abdomen   pelvis       limb           limb

Figure 14. Injuries related to other sports.

Discussion                                                            specific age group, educational institutions are probably
                                                                      one of the efficient sites in introducing programmes of
There has been scarcely any report about the demographic              sports injury prevention. The programmes could be the
data and patterns of sports injury in Hong Kong. Despite              presence of certified athletic trainers in physical education
the advantages of regular physical exercise, there were               lessons or sports days, education on the principles of
surveys revealing a low participation rate in our local               exercise training and conditioning, emphasizing topics
population. This report showed that sport constituted                 like warming up before sport, cooling down, hydration,
only 4% of all activities resulting in injury attending our           proper gear and rules of the games. Besides, as children
emergency department in 2006.                                         grow older and play sports later in their life, they can
                                                                      apply what they have learnt at school.
It was noteworthy that more than half of the patients
coming to the emergency department after sports                       Football and basketball were the commonest sports,
injury were aged less than 20 years. It could be related              making up 60% of all emergency department attendance
to several factors: different participation rates in                  with sports injury. Football was reported to have the
different age groups − persons at school age might                    highest injury rate among high school students.4 Both
participate in sports at a higher rate because of                     football and basketball are contact sports with high
compulsory physical education lessons, availability and               incidence of bodily collisions. Nearly half of those injured
affordability of the medical service, and vicinity of the             had lower limb injuries of any kind though the
sports venue or school to the hospital.3                              commonest pattern, 50% of all patterns, would be
                                                                      relatively minor with sprains and strains of joints and
Nevertheless, the figures helped to understand the public             muscles. It was noted that both football and basketball
health care needs in the community in order to distribute             had nearly the same proportion of injuries with fractures
resources in sports injury prevention. Because of this                presenting to the emergency department. The majority
Tsui et al./Sports injuries                                                                                      213

had fractures at or distal to the elbow or knee joints and   occurred, use of protective equipment, warming
fractures around the wrist joints were the commonest. It     up before exercise, level of supervision or coaching
would be apparent that those with fractures around the       lessons before active participation, etc. could not be
wrist joint would be a result of fall and body imbalance.    evaluated.
Therefore, proprioceptive training would be helpful in
preventing injury.                                           Besides, some chronic repetitive motion injuries
                                                             related to sports were not recorded from this study
The commonest site of the body injured was the lower         since injury surveillance data were recorded only if
limb, irrespective of the sport except cycling, in this      acute injuries were present.
study.5 Use of ankle stabilisers showed promising results
in preventing ankle sprain in randomised studies. 6          The incidence and prevalence of injuries for each
Proprioceptive ankle disk training decreased the risk        specific sport were not known. It would be difficult to
of ankle sprains, as well as anterior cruciate ligament      make an accurate comparison with other localities or
injuries among football players.7                            a trend of the problem. A prospective study, preferably
                                                             territory wide, would gain more information, especially
The head was the commonest part of the body injured          risk factors and mechanisms, related to sports injuries.
in cycling in this study. Noting that helmet wearing
while cycling could reduce significant head injury,8 the
practice of wearing helmet in cycling has been made          Conclusion
mandator y by law in some Western countries.
However, this has not been widely accepted in                Studies on patterns of sports injury could help in
recreational participants in our population.                 devising some prevention measures with the Injury
                                                             Surveillance System.
By understanding the characteristics of sports injuries,
some prevention measures could be devised. There
remains a need for studies of high quality on the            Acknowledgements
proposed prevention measures against sports injuries.
Finally, the prevention measures should be monitored         The Occupational Safety and Health Council and the
with assessment of its effectiveness and acceptance          Hong Kong Polytechnic University funded the Injury
levels by the players.                                       Surveillance System of Princess Margaret Hospital. The
                                                             authors would also like to acknowledge the following
                                                             persons who contributed to the survey: Dr Ngan Hung
Limitations                                                  Kwok, Dr Leung Chin San, Mr Philip Choi, Ms
                                                             Mandy So and all triage nurses working in the Accident
The data collection with the Injury Surveillance System      & Emergency Department of Princess Margaret
relied on the triage nurses. There existed the risks of      Hospital.
error and inconsistency of data entry.

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Description: Rowing originated in the United Kingdom. River Thames 17th century, boatmen often boat races. 1715 to celebrate the coronation of England, held its first rowing competition. 1775 British rowing competition rules developed, the same year established rowing club. 1811 Eton College held its first eight rowing competition. 1829, Oxford, Cambridge held its first inter-school rowing competition. Rowing Cup held in 1839. In 1846 the British side in the boat propeller is installed on aircraft, extended the length of the oar, rowing results improved; 1847, overlapping plates in turn converted into a smooth outer keel of the boat keel boats, improve the speed of rowing . Babcock 1857, the United States invented the sliding seat (one that was invented in 1865, Belgian athletes), players move back and forth when rowing, increase leg strength. 1882 Russians will bolt into the moving blade closed loop pulp to improve the range of paddle.