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Biomedical subjects

R K Requa

Publications and source records attributed to R K Requa.

At least 19 recordsLinked to original sources

A review of the use of prophylactic knee braces in football.

A review of nine studies of prophylactic knee braces worn by players in American tackle football lends some support for the use of double-hinged braces at the high-school level. Evidence for their use at the college level seems less persuasive. Caution should be exercised in interpreting these studies owing to the probable presence of bias and confounding variables and to difficulty in generalizing results beyond the study populations. The two studies that assigned braces randomly found lower injury rates for knees and knee ligaments among high-school and high-school size players. Conversely, a large, multiteam collegiate study found a significantly higher rate of knee injuries among brace users, a difference that remained when controlled for position, skill, and previous injury.

Adolescent

Clinical significance and evaluation of prophylactic knee brace studies in football.

A review of nine studies of prophylactic knee braces in American tackle football found some support for the use of double-hinge braces in high school but little support for their use at the collegiate level. Problems with bias and confounding make it necessary that caution be exercised in the interpretation of the results of these studies, however,. To which groups these results might apply must also be considered. The two studies that assigned braces randomly found lower injury rates among high school and high-school-sized players for knee injuries and knee ligament injuries. Conversely a large, multiteam collegiate study found a significantly higher rate of knee injuries among brace users, a difference that remained when controlled for position, skill, and previous injury.

Bias

The epidemiology of foot and ankle injuries in sports.

A 6 1/2-year review of 16,754 injuries seen in a multispecialty sports medicine clinic found that 25 per cent of the 12,681 injuries in the top 19 sports occurred at the ankle and foot. The percentages of foot and ankle injuries varied substantially from sport to sport, as did the proportion of sprains versus overuse injuries at each location. An appreciation of the patterns and numbers of injuries presenting can be helpful in patient management and can aid the planning of both clinical investigations and educational programs.

Ankle Injuries

Prophylactic knee bracing.

Six studies to determine the effectiveness of prophylactic knee braces in preventing medial collateral ligament (MCL) injury in football are compared. Criteria useful in evaluating studies are discussed, such as the probability of confounding factors, bias in selecting cases and controls, and variations in defining injury and exposure. Cost, as well as some ethical issues associated with mandated use are discussed. While four of these studies found a reduction in MCL injuries associated with using a brace, two of them reported increases. No consensus arises from these studies, conflicting results as well as methodological problems in some make it impossible to state with assurance the role of prophylactic knee bracing in football at this time.

Athletic Injuries

The epidemiology of foot and ankle injuries in sports.

A 6 1/2-year review of 16,754 injuries seen in a multispecialty sports medicine clinic found that 25 per cent of the 12,681 injuries in the top 19 sports occurred at the ankle and foot. The percentages of foot and ankle injuries varied substantially from sport to sport, as did the proportion of sprains versus overuse injuries at each location. An appreciation of the patterns and numbers of injuries presenting to a sports medicine facility can be helpful in patient management and can aid the planning of both clinical investigations and educational programs.

Ankle Injuries

Noninvasive vascular studies in management of rattlesnake envenomations to extremities.

Twenty-five consecutive patients suffering rattlesnake envenomation to an extremity underwent noninvasive vascular arterial studies using contralateral extremities as controls. All but one received antivenin, and none underwent early surgical decompression. Pulse volume amplitudes in the envenomated extremities, reflecting pulsatile arterial blood flow, were increased in 24 of 25 patients (P less than .02) in spite of edema and discoloration. Ischemia requiring surgical procedures developed in three of seven patients with decreased skin temperatures, as compared to none of 18 with increased or mixed skin temperatures on the envenomated extremity (P less than .02). One of 24 survivors suffered a functional deficit. Most victims of rattlesnake bites have increased arterial pulsatile blood flow in an envenomated extremity and do well with medical therapy. Noninvasive arterial studies help select those who are more likely to require special surgical intervention.

Adolescent

Daily vs alternate day prednisone therapy for stage II sarcoidosis.

Forty-four patients with newly discovered biopsy-proven pulmonary sarcoidosis in roentgenographic stage II (adenopathy and interstitial abnormalities) who also had abnormal pulmonary function (TLC and/or DCO less than 80 percent predicted) were assigned in alternate sequence to either a daily or alternate day prednisone treatment protocol. Both groups showed statistically significant improvement in pulmonary function (TLC, FVC, FEV1, DCO) at three or six months, but there were no significant differences between the two groups. Radiographic adenopathy and interstitial scores (interpreted by blinded readers in random sequence according to a quantitative scale) also showed significant improvement in both groups at three or six months, and again no significant difference was noted between the two groups. Thus, both daily and alternate day prednisone regimens were effective therapy for stage II sarcoidosis. Alternate day therapy may be the treatment of choice for those patients at high risk for significant adverse steroid effects.

Adult

Girls' sports injuries in high school athletics.

Because of appreciable increases in the number of participants, injuries resulting from girls' interscholastic athletic activities have become a concern for school administrators and medical care providers. Four girls' high school athletic programs were prospectively studied for two years. Specially trained athletic trainers placed at each school examined each injured athlete and collected epidemiologic data. The 870 participant-seasons in nine sports resulted in 192 injuries. Three times more injuries occurred in practices than in competitive events. Although more than one third required a physician's services, the majority (59%) had returned to full athletic activity within a week of injury. Strains and sprains accounted for nearly two thirds of the injuries. Generally, the type and frequency of injuries were comparable with those seen in noncontact boys' interscholastic sports.

Adolescent

Injuries in high school sports.

A two-year study was made of injuries received in high school sports. Athletic trainers were placed in four high schools to conduct the investigation. Injuries occurred in women's sports at a rate of 22 per 100 participants; men's injuries occurred at a rate of 39 per 100 participants. Football and wrestling accounted for the highest injury rates; tennis and swimming accounted for the lowest rates for both sexes.

Athletic Injuries

Parameters of injury reporting in skiing.

An injury survey of 505 skiers from the 1971-72 and 5,459 skiers from thh 1972-73 season collected 601 time loss injries for a rate of 9.31000 skier days. Forty percent of these injuries were reported to a ski patrol and almost 60 to physicians. Fractures and lacerations were reported to the patrol more frequently than other injury types, bruises and strains less commonly. Injuries not reported to patrols and physicians were primarily bruises, sprains and strains. Although fractures were almost invariably reported to physicians, one in four was not seen by the ski patrol. Patrol-only or physician only reported injuries thus do not represent the full spectrum of time loss skiing injuries.

Adolescent

Injury patterns in children and adolescent skiers.

Over 3,500 students from five major high schools in the Seattle metropolitan area were studied as to skiing injuries. Each had skiied an average of 13.3 days. The average age of t'he group was 13.5 years, the ages ranging from 3 to 19 years. The students 10 years and under had the lowest incidence of injuries, those aged 11 to 14 years had the highest over-all injury rates, and the group 15 years of age and over laid midway between these two groups in injury rate. There was no evidence in the study that the open physis led to a higher incidence of epiphyseal injuries. The knee was more commonly involved than the ankle, and sprains, contusions, and fractures followed in that order as far as injury rates were concerned. The female was more prone to injury than the male. Skiiers with greater ability had fewer injuries than those with less skill in this particular sport.

Adolescent

Prophylactic knee bracing.

Six studies to determine the effectiveness of prophylactic knee braces in preventing medial collateral ligament (MCL) injury in football are compared. Criteria useful in evaluating studies are discussed, such as the probability of confounding factors, bias in selecting cases and controls, and variations in defining injury and exposure. Cost, as well as some ethical issues associated with mandated use are discussed. While four of these studies found a reduction in MCL injuries associated with using a brace, two of them reported increases. No consensus arises from these studies, conflicting results as well as methodological problems in some make it impossible to state with assurance the role of prophylactic knee bracing in football at this time.

Athletic Injuries

Injuries in the 1987 national amateur volleyball tournament.

In a prospective study of injuries in the 1987 United States Volleyball Association's national tournament, we found 154 injuries in 1520 participants during 7812 hours of play. The injury rate in this study was 1.97/100 hours of play. Before the tournament, the participants' history was taken, and during the week of participation, records were kept of every player who presented with an injury. Players ranged in age from 17 to 60 and competed in five age/gender groups. Females had an injury rate of 2.3 and males had an injury rate of 1.7. The highest injury rate was seen in the men's open division, ages 17 to 35 (2.7), and the lowest rate was seen in the men's Golden Masters, ages 46 and up (1.5). Seventy-nine percent of the injuries occurred during the tournament and 21% were considered to be chronic injuries with an acute exacerbation. The upper extremities accounted for 20% of the injuries. The ankle (17.6%), low back (14.2%), and knee (11%) were the most common injury sites. Strains (36%) and sprains (28%) were the most frequent types of injury. Only eight (5.2%) injuries resulted in more than 5 days of time loss. Two of these injuries involved the knee and two others required surgery. It is likely that in studies relying upon retrospective methods, fewer of the less severe injuries are found, thereby leading to an overestimation of the percentages of knee and ankle injuries and the proportion of severe injuries. The clinician contemplating providing care for a high-level tournament should expect a preponderance of minor injuries occurring in a variety of anatomical locations.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent