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Purpose To explore the associations of severe musculoskeletal injuries (joint and muscles) and surgeries with symptoms of common mental disorders (distress, anxiety/depression, sleeping disturbance, adverse alcohol behaviour , smoking, adverse nutrition behaviour) among male European professional footballers. Methods Cross-sectional analyses were conducted on electronic questionnaires completed by professional footballers recruited from the national players’ unions of Finland, France, Norway, Spain or Sweden. The number of severe (time loss of more than 28 days) musculoskeletal injuries (total, joint, muscle) and surgeries during a professional football career was examined through four questions, while symptoms of common mental disorders were evaluated through validated scales. Results A total of 540 professional footballers (mean age of 27 years; 54 % playing in the highest leagues) participated in the study. Sixty-eight per cent of the participants had already incurred one or more severe joint injuries and 60 % one or more severe muscle injuries. Prevalence of symptoms of common mental disorders ranged from 3 % for smoking to 37 % for anxiety/depression and 58 % for adverse nutrition behaviour. The number of severe musculoskeletal injuries during a football career was positively correlated with distress, anxiety and sleeping disturbance, while the number of surgeries was correlated with adverse alcohol behaviour and smoking. Professional footballers who had sustained one or more severe musculoskeletal injuries during their career were two to nearly four times more likely to report symptoms of common mental disorders than professional footballers who had not suffered from severe musculoskeletal injuries. Conclusion It can be concluded that the number of severe musculoskeletal injuries and surgeries during a career is positively correlated and associated with symptoms of common mental disorders among male European professional footballers. This study emphasises the importance of applying a multidisciplinary approach to the clinical care and support of professional footballers, especially when a player faces lengthy periods without training and competition as a consequence of recurrent severe joint or muscle injuries. Level of evidence III.

Background Management of the extensive soft tissue injuries remains a significant challenge in orthopedic and plastic reconstructive surgery. Since the thumb is responsible for 40% of the functions of the hand, saving and reconstructing a mangled thumb is essential for the patient’s future. Case presentation This case report describes the management of a severe occupational thumb injury in a 25-year-old white Persian male who sustained an occupational injury to his left thumb, resulting in extensive burn, crush injury to the distal and proximal phalanx, and severe soft tissue damage to the first metacarpal, thenar, and palmar areas. Necrosis necessitated amputation through the first metacarpophalangeal joint. Postdebridement observation revealed a viable first metacarpal bone but was exposed due to a lack of soft tissue. Given the wound contamination and infection risk, the first metacarpal bone was banked in the distal forearm. After a 4 week period of antibiotics, irrigation, debridement, and vacuum dressing, the thumb and soft tissue reconstruction were performed, retrieving the viable first metacarpal. The first metacarpophalangeal joint fusion was achieved with an intramedullary screw and two K-wires. A reverse adipofascial radial artery forearm flap and skin grafts from the left thigh were used for soft tissue reconstruction. Conclusion This case highlights the importance of a flexible, staged approach to hand trauma, emphasizing the utility of ectopic banking and reconstructive techniques in managing complex hand injuries. This report contributes to the ongoing dialogue on optimal strategies for hand reconstruction, particularly in cases where traditional immediate reconstruction is not feasible.

Forklift trucks can cause serious lower limb trauma with long-lasting sequelae to patients. The aim of this study was to analyse a case series of patients with forklift-related injuries over 7 years at a level 1 major trauma centre in the UK and present their patient-reported outcome measures (PROMs) with long-term follow-up. To the best of the authors' knowledge, this is the largest case series study in the UK describing forklift injuries. Retrospective case note analysis of 19 patients over 7 years. Data including demographics, injury mechanism, pattern of injury, management, length of hospital stay, number of operations and complications were extracted from the notes. We used 'Enneking score' as a validated tool for PROMs. Seventeen men and two women with mean age of 47 years; 20% had bilateral injuries and 34% had multi-level fractures. The mean number of theatre sessions was 5.21, while the mean length of hospital stay was 30.10 days. There was one mortality. Twelve patients (63%) required reconstruction with free tissue transfer, with one flap failure. The mean long-term Enneking percentage score was 57.33%. The mean Enneking score for patients in this study is lower than our institute's score for Gustilo 3B, highlighting the gravity of these injuries. Forklifts can cause grave injuries with massive energy transfer. This study highlights the seriousness of those injuries, thus guiding patient counselling and optimising planning of management.

ObjectivesPublic safety personnel (PSP) are responsible for ensuring the safety and security of communities, often putting their own lives and well-being at risk by performing dangerous and demanding work. As a result, these workers are particularly vulnerable to workplace-related physical and mental traumatic injuries. Research is needed to understand the mental health of PSP following traumatic physical injury to inform effective prevention programmes and interventions. The objective of this study was to investigate whether PSP with traumatic physical workplace injuries requiring surgery with anaesthetic have higher post-injury rates of mental disorders compared with the general population with similar non-workplace injuries.DesignRetrospective longitudinal cohort study.SettingPopulation-based study using linked anonymised administrative data for PSP and the general population in Manitoba, Canada.ParticipantsThis study compared two groups hospitalised for a traumatic physical injury requiring surgery with anaesthetic between 1 January 2002 and 31 December 2018: (1) PSP (n=293) injured in the workplace and matched 1:5 on sex, age, geographical region and surgical procedure code with (2) individuals in the general population (GenPop) injured outside the workplace (no Workers Compensation Board claim) (n=1198).Primary and secondary outcomes and measuresAs planned in the study protocol, the prevalence of mental disorders including anxiety, depression and substance use was measured in the cohorts 2 years pre- and post-injury.ResultsThis study found an elevated unadjusted risk of depression in PSP compared with the general population in the 2 years post-injury, adjusting for pre-injury mental health (rate ratio, 1.49; 95% CI, 1.02 to 2.17; p<0.0001). After adjusting, there were no significant differences in rates between the two cohorts; however, the significant group × care interaction term for depression suggests a greater risk for PSP compared with GenPop over time.ConclusionsOur findings indicate that, compared with a matched cohort, PSP have an increased risk of depression from the pre-injury to post-injury period following a traumatic physical workplace injury. PSP have a unique mental health trajectory following workplace injury that should be considered when developing rehabilitation strategies for this important population.

The purpose of this study was to evaluate the outcomes of patients undergoing subpectoral biceps tenodesis for bicipital tendonitis with a superior labral anterior-posterior (SLAP) tear. Patients undergoing primary subpectoral biceps tenodesis for arthroscopically confirmed SLAP tears with signs or findings of bicipital tendonitis were included. An independent observer collected data prospectively as part of a data repository, which was then analyzed retrospectively. Primary outcome measures were the American Shoulder and Elbow Surgeons (ASES) score and pain relief via visual analog scale (VAS). Secondary outcome measures included the Simple Shoulder Test (SST), Constant, Single Assessment Numeric Evaluation (SANE), and Short Form 12 (SF-12) scores. Twenty-eight patients with a mean±SD age of 43.7±13.4 years and a mean±SD follow-up of 2.0±1.0 years met inclusion criteria. Workers’ compensation was involved with 43% of cases, and 46% of the included patients were manual laborers. Eight (32%) patients were athletes, and 88% of the athletes were overhead athletes. Intraoperatively, 15 (54%) patients had type I SLAP tears, 10 (36%) had type II SLAP tears, 1 (3%) had a type III SLAP tear, and 2 (7%) had type IV SLAP tears. Significant improvements were seen in the following outcome measures pre- vs postoperatively: ASES score (58±23 vs 89±18; P=.001), SST score (6.3±3.6 vs 10.6±3.3; P=.001), SANE score (54±24 vs 88±25; P=.003), VAS score (3.8±2.0 vs 1.1±1.8; P=.001), SF-12 overall score (35±6 vs 42±6; P=.001), and SF-12 physical component score (39±6 vs 50±10; P=.001). Overall satisfaction was excellent in 80% of patients. Subpectoral biceps tenodesis demonstrates excellent clinical outcomes in select patients with SLAP tears. [Orthopedics. 2015; 38(1):e48–e53.]

Objective: To determine the impact of surgical procedures and opioids on workers' compensation claim cost. Methods: A cohort of 11,394 lost time claims filed with the Louisiana Workers' Compensation Corporation from 1999 to 2002 was followed for 7 years. Results: Controlling for gender, attorney involvement, and claim duration, multivariate logistic regression analysis indicated that odds ratios (ORs) for a catastrophic claim (final cost ≥ $100,000) associated with short-acting and long-acting opioids (vs no opioids) were 4.28 and 12.19. The ORs for catastrophic claims associated with a spinal surgical procedure or spinal fusion (vs no procedure) were 4.27 and 11.40. Spinal surgical procedures plus opioid use significantly increased the OR for catastrophic claims; for example, spinal fusion plus long-acting opioids had an OR of 138.96. Conclusion: Spinal surgery and opioid utilization are associated with catastrophic claim costs.

Purpose Significant differences occur in the return-to-work (RTW) period amongst workers with an acute traumatic occupational hand injury. This study aimed to develop and test a comprehensive multivariate conceptual biopsychosocial model to predict RTW outcome. Method Patients presenting with an occupational hand injury were interviewed 7–10 days after their injury ( N  = 192) and again at 4 weeks after their injury ( n  = 150). Potential determinants from biomedical, work-related, demographic and psychosocial categories were studied simultaneously. Results A small sub-set of workers with an acute traumatic hand injury experienced chronic disability beyond 12 weeks. Analyzing the relationship between predictor variables and work absence resulted in the identification of the most important determinants of recovery. During the acute stages of recovery, injury severity, pain, self-efficacy, and living alone were the most important determinants of delayed RTW outcome. At 4 weeks post-injury, locus of control, injury severity, negative affect and living alone were the most important predictors of delayed RTW. Conclusion A number of prognostic variables were identified that influenced RTW outcome, which offer new and unique contributions to the field. Injury severity was not the most important determinant of RTW outcome; neither were factors identified in previous hand injury research, such as attribution of blame, significant predictors. Factors not examined in previous research, such as negative affect, were more important determinants of delayed RTW.

Background Replantation in the upper extremity is a well-established microsurgical procedure. Many have reported patients’ satisfaction and functional measurements. The aim was to investigate the long time consequences as activity limitations in hand/arm, the general health and cold sensitivity after a replantation or revascularization in the upper extremity and to examine if sense of coherence (SOC) can be an indicator for rehabilitation focus. Methods Between 1994–2008, 326 patients needed replantation/revascularization in the upper extremity. 297 patients were followed up. Information was collected from the medical notes and by questionnaires [Quick-DASH (disability hand/arm), EuroQ-5D (general health), CISS (cold sensitivity) and SOC (sense of coherence)]. Severity of injury was classified with the modified Hand Injury Severity Score (MHISS). Results The patients [272 (84%) men and 54 (16%) women; median age 39 years (1–81 years)], where most injuries affected fingers (63%) and thumb (25%), commonly affecting the proximal phalanx (43%). The injuries were commonly related to saws (22%), machines (20%) and wood splints (20%). A direct anastomosis (30%) or vein grafts (70%) were used. The overall survival was 90%. 59% were classified as Major. Equal parts of the injuries took part during work and leisure, DASH scores at follow up were worse (p = 0.005) in the former. Twenty percent changed work and 10% retired early. Patients with early retirement were significantly older, had a more severe injury, worse disability, quality of life and functional outcome. Median DASH score was low [11.4 (0–88.6)] and correlated with severity of injury. Abnormal cold sensitivity (CISS > 50) was seen in 51/209 (24%) and they had a worse disability, quality of life, functional outcome and lower SOC. Patients with a low SOC had on the whole a worse outcome compared to patients with a high SOC and with significant differences in age, EQ-5D, Quick-DASH and CISS. Conclusions A high MHISS, abnormal cold intolerance and a low SOC seems to be factors influencing the patients’ outcome and might be relevant in the rehabilitation of the patients. Also, those who had to retire early had a worse disability, quality of life and functional outcome.

Background Penetrating neck and chest trauma is a very common entity in emergency medicine that usually requires surgical treatment. Our case report illustrates the case of a 27-year-old Arabian man with hemopneumothorax associated with pneumomediastinum due to an unusual occupational injury. Case presentation A metal sliver, coming from an axe using for wood chopping, penetrated the neck of a 27-year-old Arabian man in the left supraclavicular region mimicking a gun bullet; the entrance hole was at the left pleural dome where the sliver had just penetrated the apex of the lung passing through the upper lobe of his left lung creating an exit wound in the dorsal segment of the same lobe arriving in the posterior thoracic wall. Biportal video-assisted thoracic surgery was performed to remove blood clots and the unusual foreign body.  Conclusion In the literature, there are several case series about this topic, with some of them reporting unusual foreign bodies that lead to penetrating trauma. However, to the best of our knowledge, no cases like the one we have reported are described in the current literature.

OBJECTIVE:Determine the relationship between time to surgery, lost time, and insurance costs. METHOD:A cohort of 582 claimants undergoing lumbar spine surgery (1999 to 2002) in the state of Louisiana was observed for 7 years. RESULTS:The shorter the time interval between injury and first lumbar surgery, the lower the cost and time lost from work. Average days lost from work and claim costs for 42% of those undergoing early lumbar surgery did not differ from injured workers who lost time from work for claims not involving lumbar surgery. Claim cost for the remaining 58% who had delayed surgery was 5.7 times greater than that for the early surgery cohort. CONCLUSION:The decision to perform lumbar surgery is not necessarily associated with high claim costs or longer time out from work, provided that the determination to operate is early.