Hockey Injury Handbook
By Shelly Maltz, M.D.
Pediatric sport injury can occur very easily when
children are playing hockey. The
manufactures have done very well in devising equipment that protects our
children, but some children will still get hurt.
Besides the childs parent, the closest adult to these injured children
are their coaches. The coaches must
be aware of many dimensions of injury: signs
and symptoms, the degree of severity, treatment, comfort and follow-up of the
child when he or she may play again.
Musculoskeletal
Injuries
Principles
of extremity protection are as follows: P.R.I.C.E.
P
-
Protection of extremity via splinting
R
-
Rest of extremity to avoid further pain and injury
I
-
Ice or cold therapy to control swelling
C
-
Compression usually associated with splinting
E
-
Evaluation of injured extremity above heart
Types of
Musculoskeletal Traumatic Injuries
1)
Contusion
-
is trauma to the skin and underlying soft tissues.
Excessive swelling can be indicator of severe injury.
A painful contusion warrants radiological (x-ray)
to
rule out associated bone injury.
2)
Sprain
-
injury to a joint ligament. Ligamentous
disruption can mimic fractures and may be a dislocation.
The
diagnosis of sprain cannot be made until a fracture has been rule out.
3)
Strain
-
is injury to the muscle-tendon unit.
Strains do not involve injury to joints.
The diagnosis of strain cannot
be made until fractures and ligaments injuries have been ruled out.
4)
Dislocation -
complete displacement of two articular surface relative to each other.
Dislocation can often be
associated with fractures.
EMERGENCY
SPLINTS
Principles
A.
Splint them where they lie
B.
Splints should immobilize the joints above and below the site of
suspected injury
C.
Why Splint?
1)
Immobilization
2)
Injury to nerves and blood vessels may be prevented.
3)
Prevent closed fractures from becoming open
4)
Decrease the amount of bleeding and the incidence of fat embolism
5)
Transporting is easier and immobilization decreases the pain from the
fracture
Upper Extremity Splinting (see figures
5 2 54)
A.
Figure of 8 splint - for
clavicle fracture
B.
Sling and swathe used for shoulder dislocation, humeral fractures and
elbow fractures
Lower Extremity Splinting (see figures 5 6, 5 7)
A.
Pillow splint
B.
Board splint
MANAGEMENT OF MILD TRAUMATIC BRAIN INJURY
Mild Traumatic
Brain Injury (MTBI) = Concussion
Definition
-
blunt acceleration/deceleration forces which produce a period of
unconsciousness for 20 minutes or less and brief retrograde amnesia Glasgow Coma
Scale Score of 13 15. No focal
finding on brain C.T.
Who
gets a head C.T.?
Meeting the above criteria all patients received a
head C.T. A patient with normal
head C.T. has a 0-3% probability of neurological deteriation usually in patients
with GCS 13 & 14.
CONCUSSION
IN SPORTS
Grade I (Mild)
-
Confusion with no amnesia or LOC and confusion clears within 20
30 minutes return to game
-
2nd mild concussion same season out of action
greater than 2 weeks as long as asymptomatic for 1 week and had a negative head
C.T.
-
3rd mild concussion season terminated
Grade II
(Moderate)
Confusion with amnesia, no LOC.
-
No symptoms for 1 week then return to play
-
2nd Moderate Concussion
ุ
Asymptomatic for 1 month
ุ
negative head C.T. of head
-
3rd Moderate Concussion
ุ
season terminated possible consideration of terminating contact
sports indefinitely.
Grade III
(Severe)
Positive LOC immediate head C.T.
LOC < 1 minute, asymptomatic for 2 weeks and negative C.T. may return
to sport
LOC > 1 minute no sport for 1 month
2nd severe concussion season terminated
SYNOPSIS OF NONOPERATIVE MANAGEMENT OF BLUNT SPLEEN
AND LIVER INJURIES
1.
Nonoperative (observation) management is the treatment of choice in
hemodynamically stable patients irrespective of injury grade
2. Conservation
Management does not:
a)
increase the complication or death rate from these injuries
b)
Hospitalization is not increased
c)
No need for increase blood transfusion
3.
There is no need for routine repetitive imaging (U.S. or C.T.) of
clinically improving patients.
4.
No evidence to support keeping patient at bedrest who is stable.
CERVICLE SPINE
WHO NEEDS X-RAYS?
No significant cervical spine
injury if there was:
1)
no neck pain
2)
no distracting pain
3)
no neurological deficits and
4)
the patients were alert, awake, oriented and not intoxicated do not need
cervical x-ray.
Mechanism of injury has not been shown to be a predictor
of clinically significant injuries independent of any risk factor.
Patient with altered level of consciousness neck pain,
distracting pain, neurological deficits should have 3-view spine series with
thin cut axial CT scan with sagittal reconstruction through suspicious areas.
Adequate cervical spine x-ray
are defined as:
ุ
Lateral view C2 T1
ุ
Open mount odontoid view examined lateral masses of C1
and entire
ุ
Visualization of whole odontoid process.
Addition of oblique cervical
films are not helpful.
ุ
Plain films normal, but patient has neurological deficit.
ุ
MRI of whole c-spine done with c-collar left in place for
immobilization
ุ
MRI can detect soft tissue injuries including ligaments,
compression of spinal cord or nerve roots with disc herniation and hemorrhage.
All screening tests including MRI are normal and patient
still complains of neck pain, then lateral flexion/extension cervical films
should be done. These films detect
pure ligamentous disruption that results in cervical spine instability detected
only on stress studies.
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