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. 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.