Retrospective Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Jul 18, 2017; 8(7): 545-552
Published online Jul 18, 2017. doi: 10.5312/wjo.v8.i7.545
Epidemiology of open fractures in sport: One centre’s 15-year retrospective study
Alexander M Wood, Greg A J Robertson, Kirsty MacLeod, Anna Porter, Charles M Court-Brown
Alexander M Wood, Orthopaedic Department, Leeds General Infirmary, Great George St, Leeds LS1 3EX, United Kingdom
Greg A J Robertson, Charles M Court-Brown, Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, Edinburgh, Scotland EH16 4SA, United Kingdom
Kirsty MacLeod, Institute of Naval Medicine, Alverstoke, Gosport PO12 2DL, United Kingdom
Anna Porter, Newcastle University Medical School, Newcastle upon Tyne, NE1 7RU, United Kingdom
Author contributions: Wood AM and Robertson GAJ equally contributed to this manuscript; Wood AW, Robertson GAJ and Court-Brown CM performed data collection; Wood AW, Robertson GAJ, Porter A and Court-Brown CM performed data analysis; Wood AW, Robertson GAJ, Porter A and Court-Brown CM wrote and edited the manuscript.
Institutional review board statement: The study was reviewed and approved by the “Scottish Orthopaedic Research Trust into Trauma” Review Board.
Informed consent statement: The study involved review of patient case notes and entering of relevant data onto a data set. The data was anonymised and there was no patient intervention or involvement required in the research process. As such informed patient consent was not required for the study, in accordance with the “Scottish Orthopaedic Research Trust into Trauma” Institutional Review Board.
Conflict-of-interest statement: The authors have no conflict of interests.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Greg A J Robertson, MBChB, BMedSci (Hons), MSc, MRCSEd, Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, Scotland EH16 4SA, United Kingdom. greg_robertson@live.co.uk
Telephone: +44-131-2423545 Fax: +44-131-2423541
Received: January 28, 2017
Peer-review started: February 12, 2017
First decision: March 7, 2017
Revised: March 30, 2017
Accepted: April 18, 2017
Article in press: April 19, 2017
Published online: July 18, 2017
Processing time: 165 Days and 20 Hours
Abstract
AIM

To describe the epidemiology of sport-related open fractures from one centre’s adult patient population over a 15-year period.

METHODS

A retrospective review of a prospectively-collected database was performed: The database contained information all sport-related open fractures, sustained from 1995 to 2009 in the Edinburgh, Mid and East Lothian Populations.

RESULTS

Over the 15-year period, there were 85 fractures recorded in 84 patients. The annual incidence of open sport-related fractures was 0.01 per 1000 population. The mean age at injury was 29.2 years (range 15-67). There were 70 (83%) males and 14 females (17%). The 6 most common sports were soccer (n = 19, 22%), rugby (n = 9, 11%), cycling (n = 8, 9%), hockey (n = 8, 9%); horse riding (n = 6, 7%) and skiing (n = 6, 7%). The five most common anatomical locations were finger phalanges (n = 30, 35%); tibial diaphysis (n = 19, 23%); forearm (n = 12, 14%); ankle (n = 7, 8%) and metacarpals (n = 5, 6%). The mean injury severity score was 7.02. According to the Gustilo-Anderson classification system, 45 (53%) fractures were grade 1; 28 (33%) fractures were grade 2; 8 (9%) fractures were grade 3a; and 4 (5%) fractures were grade 3b. Out of the total number of fractures, 7 (8%) required plastic surgical intervention as part of management. The types of flaps used were split skin graft (n = 4), fasciocutaneous flaps (n = 2); and adipofascial flap (n = 1).

CONCLUSION

We analysed the epidemiology of open fractures secondary to sport in one centre over a 15-year period. Soccer and rugby were the most common causative sports while fractures of the finger phalanx and of the tibial diaphysis were the most common sites. Open fractures are uncommon in sport; however, when they are sustained they usually occur on muddy sport fields or forest tracks and therefore must be treated appropriately. It is important that clinicians and sports therapists have knowledge of these injuries, in order to ensure they are managed optimally.

Keywords: Open; Fracture; Sport; Epidemiology; Injury; Trauma

Core tip: We reviewed all open sport-related fractures presenting to our trauma centre over a 15-year period to provide comprehensive epidemiological data on this injury type. Open sport-related fractures occurred at an annual incidence of 0.01/1000 population. The mean age at injury was 29.2 years; the gender ratio was 7.4:1 (male:female). The most common causative sports were soccer and rugby. The most common fracture locations were finger phalanx and tibial diaphysis. Fourteen percent of the fractures were Gustilo-Grade 3; 8% required plastic surgical intervention. Open fractures in sport are a rare, but significant, injury; awareness and education is necessary among clinicians to optimize outcome.