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Skin antisepsis with iodine povacrylex resulted in fewer surgical-site infections than antisepsis with chlorhexidine gluconate in patients with closed limb fractures but not in those with open fractures.

In a trial in patients with pelvic or acetabular fractures or extremity fractures that were treated operatively, aspirin thromboprophylaxis was noninferior to low-molecular-weight heparin in preventing death at 90 days.

ObjectivesTo evaluate the efficacy of a new multicomponent, exercise-based injury prevention programme in football players 13–19 years old.MethodsTwo-arm cluster-randomised controlled trial with clubs as the unit of randomisation. 55 football teams from Kosovo of the under 15, under 17 and under 19 age groups were randomly assigned to the intervention (INT; 28 teams) or the control group (CON; 27 teams) and were followed for one football season (August 2021–May 2022). The INT group performed the ‘FUNBALL’ programme after their usual warm-up at least twice per week, while the CON group followed their usual training routine. The primary outcome measure was the overall number of football-related injuries. Secondary outcomes were region-specific injuries of the lower limbs (hip/groin, thigh, knee, lower leg, ankle and foot) and injury severity.Results319 injuries occurred, 132 in the INT and 187 in the CON group. The INT group used the ‘FUNBALL’ programme in 72.2% of all training sessions, on average 2.2 times per week. There was a significantly lower incidence in the INT group regarding the overall number of injuries (incidence rate ratio (IRR) 0.69, 95% CI 0.55 to 0.87), the number of thigh injuries (IRR 0.62, 95% CI 0.39 to 0.98), of moderate (time loss between 7 and 28 days) (IRR 0.65, 95% CI 0.44 to 0.97) and of severe injuries (time loss >28 days) (IRR 0.51, 95% CI 0.28 to 0.91).ConclusionThe ‘FUNBALL’ programme reduced the incidence of football-related injuries among male adolescent football players, and its regular use for injury prevention in this population is recommended.Trial registration number NCT05137015.

Background A protective effect on injury risk in youth sports through neuromuscular warm-up training routines has consistently been demonstrated. However, there is a paucity of information regarding the quantity and quality of coach-led injury prevention programmes and its impact on the physical performance of players. Objective The aim of this cluster-randomised controlled trial was to assess whether different delivery methods of an injury prevention programme (FIFA 11+) to coaches could improve player performance, and to examine the effect of player adherence on performance and injury risk. Method During the 2011 football season (May–August), coaches of 31 tiers 1–3 level teams were introduced to the 11+ through either an unsupervised website or a coach-focused workshop with and without additional on-field supervisions. Playing exposure, adherence to the 11+, and injuries were recorded for female 13-year-old to 18-year-old players. Performance testing included the Star Excursion Balance Test (SEBT), single-leg balance, triple hop and jumping-over-a-bar tests. Results Complete preseason and postseason performance tests were available for 226 players (66.5%). Compared to the unsupervised group, single-leg balance (OR=2.8; 95% CI 1.1 to 4.6) and the anterior direction of the SEBT improved significantly in the onfield supervised group of players (OR=4.7; 95% CI 2.2 to 7.1), while 2-leg jumping performance decreased (OR=−5.1; 95% CI −9.9 to −0.2). However, significant improvements in 5 of 6 reach distances in the SEBT were found, favouring players who highly adhered to the 11+. Also, injury risk was lower for those players (injury rate ratio, IRR=0.28, 95% CI 0.10 to 0.79). Conclusions Different delivery methods of the FIFA 11+ to coaches influenced players’ physical performance minimally. However, high player adherence to the 11+ resulted in significant improvements in functional balance and reduced injury risk.

ObjectiveTo evaluate the preventive efficacy of an extended version of the Knee Control injury prevention exercise programme (IPEP) compared with an adductor strength programme and to a comparison group using a self-selected IPEP in amateur adolescent and adult male and female football players.MethodsTwo-armed cluster-randomised trial with an additional non-randomised arm. All 251 amateur teams (players 14–46 years) in one regional football district were approached. Teams meeting inclusion criteria were randomised to (1) extended Knee Control or (2) an adductor strength programme. Teams already using an IPEP were allocated to a comparison group and received no new intervention. Players responded to weekly questionnaires about football exposures and injuries during a 7-month season.ResultsSeventeen teams in the extended Knee Control, 12 in the adductor and 17 in the comparison group participated, with 502 players. For the primary outcomes, no difference in injury incidence in three lower-limb injury locations combined (hamstring, knee and ankle) was seen between extended Knee Control and the adductor group, whereas extended Knee Control had 29% lower incidence than the comparison group (incidence rate ratio 0.71, 95% CI 0.52 to 0.98). No between-group differences in groin injury incidence were seen. The weekly injury prevalence rates in the three lower limb locations combined (hamstring, knee and ankle) were 17% lower (prevalence rate ratio (PRR) 0.83, 95% CI 0.69 to 1.00) and 26% lower (PRR 0.74, 95% CI 0.63 to 0.87) in extended Knee Control compared with the adductor and comparison groups, respectively.ConclusionNo difference in injury incidence was seen between the extended Knee Control and the adductor programme whereas extended Knee Control reduced injury incidence by nearly one-third compared with a self-selected IPEP. Players in extended Knee Control had lower injury prevalence compared with an adductor or self-selected IPEP.Trial registration number NCT04272047; Clinical trials.

Background Non-unions, defined as fractures not healed after at least 6 months, are a multifactorial complication occurring in 2–10% of all fractures and in up to 30% of patients with certain risk factors. Treatment costs are markedly higher than those associated with normal fracture healing and patients often suffer from pain and loss of function. Surgical revision is the gold standard for treatment; however, the disadvantages are re-hospitalization, possible secondary diseases and side effects such as post-operative infections, complications of anesthesia and embolisms. Low-intensity pulsed ultrasound (LIPUS) is a low-risk procedure, with skin reactions being the only side effect experienced by a very small number of patients. Patients can use the treatment independently at home, eliminating the need for repeated hospital visits. This study aims to show that LIPUS treatment is not inferior to surgical intervention by a threshold of -25 percentage points in terms of fracture healing in non-unions of the upper or lower extremity. Methods PiNGUin will be a five-year national, prospective, controlled, randomized, open-label, multicenter study with a medical device. Patients are randomized into one of two groups: patients in the intervention group will receive daily 20-min LIPUS treatment for 200 days or undergo standard surgical intervention in the control group. Follow-up for both groups will be 12 months. The primary endpoint is fracture healing 12 months after treatment start, defined as bony consolidation of at least 3 out of 4 cortices and functional recovery. Secondary endpoints include time to fracture healing and to full weight bearing, incidence and intensity of pain, functional complaints/activities of daily living, health-related quality of life, complications, adverse events, re-operations or re-osteosyntheses and (re-) hospitalizations, hospital stays, duration and reasons for inability to work. With a one-sided significance level of 2.5%, a power of 90% and an assumed drop-out rate of 10% 184 patients will be required per treatment group. Discussion As LIPUS is a low-complication procedure with good results to date, this treatment is considered a potential alternative to surgery. If non-inferiority is proven, patients will have a choice of both invasive and non-invasive procedures in the future. Trial registration DRKS00034357 (German Clinical Trials Register, registered March 11th, 2025).

Out-of-hospital analgosedation in trauma patients is challenging for emergency physicians due to associated complications. We compared peripheral nerve block (PNB) with analgosedation (AS) as an analgetic approach for patients with isolated extremity injury, assuming that prehospital required medical interventions (e.g. reduction, splinting of dislocation injury) using PNB are less painful and more feasible compared to AS. Thirty patients (aged 18 or older) were randomized to receive either ultrasound-guided PNB (10 mL prilocaine 1%, 10 mL ropivacaine 0.2%) or analgosedation (midazolam combined with s-ketamine or with fentanyl). Reduction-feasibility was classified (easy, intermediate, impossible) and pain scores were assessed using numeric rating scales (NRS 0-10). Eighteen patients were included in the PNB-group and twelve in the AS-group; 15 and 9 patients, respectively, suffered dislocation injury. In the PNB-group, reduction was more feasible (easy: 80.0%, impossible: 20.0%) compared to the AS-group (easy: 22.2%, intermediate: 22.2%, impossible: 55.6%; p = 0.01). During medical interventions, 5.6% [1/18] of the PNB-patients and 58.3% [7/12] of the AS-patients experienced pain (p<0.01). Recorded pain scores were significantly lower in the PNB-group during prehospital medical intervention (median[IQR] NRS PNB: 0[0-0]) compared to the AS-group (6[0-8]; p<0.001) as well as on first day post presentation (NRS PNB: 1[0-5], AS: 5[5-7]; p = 0.050). All patients of the PNB-group would recommend their analgesic technique (AS: 50.0%, p<0.01). Prehospital ultrasound-guided PNB is rapidly performed in extremity injuries with high success. Compared to the commonly used AS in trauma patients, PNB significantly reduces pain intensity and severity.

Football (soccer) is the world’s most popular sport with most players being younger than 18 years. Playing football can induce beneficial health effects, but there is also a high risk of injury. Therefore, it is necessary to implement measures for preventing injuries. The present review analyzes and summarizes published scientific information on the incidence and characteristics of football injuries in children and adolescent players to arrive at sound conclusions and valid considerations for the development of injury-prevention programs. A literature search was conducted up to November 2012. Fifty-three relevant scientific publications were detected. Thirty-two studies fulfilled the inclusion criteria for pooled analysis. Additional information from the remaining 21 studies was considered where appropriate to obtain a broader perspective on the injury problem in children and youth football. Training injury incidence was nearly constant for players aged 13–19 years, ranging from 1 to 5 injuries per 1,000 h training. Match injury incidence tended to increase with age through all age groups, with an average incidence of about 15 to 20 injuries per 1,000 match hours in players older than 15 years. Between 60 and 90 % of all football injuries were classified as traumatic and about 10–40 % were overuse injuries. Most injuries (60–90 %) were located at the lower extremities with the ankle, knee, and thigh being mostly affected. The frequency of upper-extremity and head/face injuries was higher in those studies that analyzed match injuries only. The most common injury types were strains, sprains, and contusions (10 up to 40 % each). There is some evidence that the risk of traumatic injuries and, in particular, of sustaining a fracture, contusion, or concussion was higher during match play than in practice sessions. Fractures were more frequent in children younger than 15 years than in older players. About half of all time-loss injuries led to an absence from sport of less than 1 week, one third resulted in an absence between 1 and 4 weeks, and 10 to 15 % of all injuries were severe. Separate data for players under the age of 11 years are almost absent. Maturation status seems to have an influence on injury characteristics, although evidence is not conclusive at this time. Three main areas seem to be of particular relevance for future prevention research in young football players: (1) the substantial number of severe contact injuries during matches, (2) the high number of fractures in younger players, and (3) the influence of maturation status and growth spurts.

Purpose The 11+ injury prevention program has been shown to decrease injury rate. However, few studies have investigated compliance and if it is correlated to time loss. The purpose of this study was to (1) analyze how differences in compliance may impact injury rate and (2) if compliance may impact time loss due to injury. Methods This study was a Level 1 prospective cluster randomized controlled trial conducted in NCAA men’s football (soccer) teams that examined the efficacy of the 11+ injury prevention program. The two outcome variables examined were number of injuries and number of days missed from competition. Twenty-seven teams ( n  = 675 players) used the 11+ program. Compliance, injuries and time loss were recorded. There were three compliance categories, low (LC, 1–19 doses/season), moderate (MC, 20–39 doses/season), and high (HC, > 40 doses/season). Results There was a significant difference among the groups for injuries, p  = 0.04, p η 2  = 0.23. The LC group [mean ( M ) = 13.25, 95% confidence interval (CI) 9.82–16.68, injury rate (IR) = 10.35 ± 2.21] had a significantly higher injury rate than the HC group ( M  = 8.33, 95%CI 6.05–10.62, IR = 10.35 ± 2.21), p  = 0.02. The MC group ( M  = 11.21, 95%CI 9.38–13.05, IR = 8.55 ± 2.46) was not significantly different than the LC group, p  = 0.29, but was significantly greater than the HC group, p  = 0.05. When examined as a continuous variable, compliance was significantly negatively related to injury rate ( p  = 0.004). It was also significantly negatively related to number of days missed ( p  = 0.012). Conclusions When compliance was high, there was a significant reduction in injury and time loss. This evidence reinforces the importance of consistent injury prevention program utilization. Clinically, these findings have important implications when discussing the importance of consistent utilization of an injury prevention protocol in sport. Level of evidence Level 1—Randomized controlled trial (RCT).

Secondary lymphedema is a very common clinical issue with millions of patients suffering from pain, recurrent skin infections, and the constant need for a decongestive therapy. Well- established because of oncologic procedures, secondary lymphedema is also a well-known phenomenon after trauma. However, precise epidemiological data of posttraumatic lymphedema upon severe extremity injuries are rare. In the present study, we analyzed a patient cohort of 223 individuals who suffered closed fractures of the upper and lower extremity between 2016 and 2020. All of them simultaneously had a soft tissue injury, of 2nd and 3rd grade according to Tscherne classification. Typical symptoms of lymphedema were recorded in a retrospective cohort analysis through patient anamnesis and compared with documented clinical examination findings. Previous illnesses and trauma-specific characteristics were determined from patient files. Of all patients, 36% showed symptoms of secondary lymphedema and 8,5% reported recurrent skin infections, indicating severe lymphedema. Furthermore, comparing patients with and without lymphedema, additional trauma-associated parameters, such as total number of surgeries, degree of soft tissue damage, localization of the fracture in lower extremity, related to lymphedema progress could be identified. According to these data, posttraumatic secondary lymphedema has even in closed fractures, especially of the lower extremity, a highly underestimated clinical prevalence. Further prospective studies are required to validate these findings, identify high-risk groups, and guide early prophylactic and therapeutic interventions.