We present a retrospective study of the number of arthroscopically verified total meniscus and cruciate ligament tears seen in our Emergency department one year before, and one year after introducing magnetic resonance imaging (MRI) as a diagnostic tool. The number of total ruptures of the anterior cruciate ligament increased from 34 (1.7% of total 2003 patients) to 67 (2.9% of total 2277). The number of ruptures of the medial meniscus increased from 42 (2.1%) to 87 (3.8%). The number of ruptures of the lateral meniscus remained unchanged. In the first 12 months after introducing MRI we ordered 513 (23%) scans of the total number of 2277 patients with an acute knee condition. Thirty-nine (8%) of these were described with no pathology, 227 (44%) showed total meniscus or cruciate ligament tears. The remaining 247 (48%) were mainly degenerative or partial injuries. The cost per additional new diagnosis was approximately USD 800. The introduction of MRI has enabled us to identify a larger number of patients with meniscus and cruciate ligament injuries.
When society introduces and accepts new transportation modes, it is important to map risks and benefits.
Objective
To compare electric scooter (e-scooter) and bicycle injuries.
Design, Setting, and Participants
This cohort study is based on prospectively collected data on Norwegian patients who sustained e-scooter or bicycle injuries and presented to an emergency department affiliated with Oslo University Hospital between January 1, 2019, and March 31, 2020.
Main Outcomes and Measures
e-Scooter and bicycle injuries were evaluated for associations with sex, age, time of injury, helmet use, intoxication, body region, and injury severity. Descriptive statistics are presented as mean (SD) or number with percentage, with significance set atP < .05 (2-tailed).
Results
During the study period, 3191 patients were included (850 e-scooter riders, 2341 bicyclists) with 3839 injuries recorded (997 e-scooter, 2842 bicycle). The mean (SD) age of those injured was 34 (17) years, 2026 riders (63.5%) were male, 1474 (46.2%) were helmeted at the time of injury, and 516 (16.2%) were intoxicated by alcohol or other drugs. The annual incidence of injuries was 120 per 100 000 inhabitants for e-scooters and 340 per 100 000 inhabitants for bicycles. Men were overrepresented in both groups (529 e-scooter riders [62.2%] and 1497 bicyclists [63.9%]). e-Scooter riders were younger than bicyclists (mean [SD] age, 31 [12] vs 35 [18] years). Most injured e-scooter riders were aged 20 to 40 years, whereas injured bicyclists had a broader age distribution. e-Scooter injuries commonly occurred on weekends (378 [46.6%]) and during evening (230 [32.3%]) or nighttime (242 [34.1%]) hours. Most bicycle injuries occurred during weekdays (1586 [69.7%]) and daytime (1762 [61.3%]). e-Scooter riders were more often intoxicated (336 [39.5%] vs 180 [7.7%]) and had a lower rate of helmet use (18 [2.1%] vs 1456 [62.2%]). During nighttime, 230 injured e-scooter riders (91.3%) and 86 bicyclists (69.4%) were intoxicated. e-Scooter riders had more head and neck (317 [31.7%] vs 636 [22.4%]) and lower-limb (285 [28.6%] vs 632 [22.2%]) injuries and fewer upper-limb (341 [34.2%] vs 1276 [44.9%]), thoracic (41 [4.1%] vs 195 [6.9%]), and abdominal, pelvic, and lumbar (13 [1.3%] vs 103 [3.6%]) injuries.
Conclusions and Relevance
In this cohort study, e-scooter riders were younger than bicyclists, did not use helmets, were more often intoxicated, and were more often injured during nighttime. The rate of intoxication among e-scooter riders injured at night was high. Preventive measures, including awareness campaigns, regulating e-scooter availability, improving infrastructure, and implementing stricter helmet and alcohol policies, may prove effective for reducing injuries.
Interest for bicycling is increasing for transport, and also for health promotion. In cities with demanding traffic pattern, bicycling might be a dangerous activity. Due to lack of knowledge health and traffic authority financed an in-depth investigation of bicycle injuries treated in Oslo University Hospital (OUH), both as in and out patients. Continuous injury monitoring in the AED since 2003 gave possibility to follow trends.
Methods
The study was a one-year prospective in-depth investigation with 20 variables. All patients contacting the AED due to a bicycle injury filled in a one-page form with description of 14 variables of the accident and a free text. Health personnel collected relevant information for patients arriving by ambulance and those not able to fill in form themselves. Based on previous studies it is estimated that about 85% of all injured persons from the Oslo population are treated at OUH.
Results
2184 persons were treated due a bicycle accident in 2014, 71% were single accidents. 65% were men. Median age was 34 years, for women 32 years. 20% were head injuries, 33% fractures, higher than average fracture rate in all injuries. 80 injuries were serious (AIS 3), 8 severe (AIS 4) and 3 critical (AIS 5). 60% of the injured had used helmet, and got fewer head injuries than those without helmets. 10% were influenced by alcohol/drugs. 77% (N = 1673) happened in "inner" city, 13% in wooden areas in the city, 7% in other municipalities, and 3% abroad. In 10% (N = 164) of injuries in "inner city", tram rails were involved. Police registered 125 bicycle injuries in "inner city" during 2014, 7% of injuries treated at OUH. Since 2003, population of Oslo has increased by 22%, bicycle injuries by 21%.
Conclusions
Incidence of bicycle injuries in the population of Oslo seems to be rather stable during the last 12 years. They are more severe than injuries in average. Patients without helmets have more head injuries than patients with helmets.
Abstract Background The physical examination is one of the cornerstones of the diagnostic process in patients with acute shoulder injuries. The discriminative properties of a given examination test depend both on its validity and reliability. The aim of the present study was to assess the interrater reliability of 13 physical examination manoeuvres for acute rotator cuff tears in patients with acute soft tissue shoulder injuries. Methods In a large walk-in orthopaedic emergency department, 120 consecutive patients ≥40 years of age were included in a diagnostic study. Patients who had follow-up within three weeks of an acute shoulder injury without fracture on radiographs were eligible. Four emergency department physicians participated as examiners. In a subset of 48 patients, the physical examination tests were performed by two physicians, randomly chosen by their work rotation. The physicians were blinded to the findings of each other and the results of the ultrasound screening. The interrater reliability was assessed by Cohen’s kappa, intraclass correlation coefficient (ICC), standard error of measurement (SEM) and Bland-Altman plots depending on whether the examination test result was registered as a binary, ordered categorical or continuous numerical variable. Results The median age was 55.5 years, 46% were female. Twenty-seven percent had a rotator cuff full-thickness tear on ultrasound screening; all but one involved the supraspinatus tendon. Cohen’s kappa for binary tests ranged from excellent to fair. Excellent agreement (kappa > 0.8) was found for the inability to abduct above 90° and abduction strength. External rotation strength expressed substantial agreement (kappa 0.7). The lowest scores were registered for Hawkins` test and the external rotation lag sign (kappa 0.25 and 0.40, respectively). The ICCs for active range of abduction and external rotation were 0.93 (0.88–0.96) and 0.84 (0.72–0.91), whereas the SEM was 15 and 9, respectively. Conclusions The results indicate that examination manoeuvres assessing abduction and external rotation range of motion and strength are more reliable than manoeuvres assessing pain in patients in the acute phase of traumatic shoulder injury. The poor agreement observed is likely to limit the validity in the present setting of two commonly used tests. Trial registration The Norwegian Regional Ethics Committee South East ( 2015/195 ).
More than a third of sports injuries involve the upper extremity. The primary aim was to quantify and describe sports-related shoulder injuries in a general population cohort. A secondary aim was to compare aspects of these injuries to those that were not sports-related.We performed a prospective registration of the activity at the time of shoulder injury in all cases admitted during 1 year in a combined primary care and orthopaedic emergency department serving a defined population. The electronic patient records and patient reported questionnaires were reviewed.Twenty-nine per cent (n=781) of 2650 registered shoulder injuries were reported to be sports-related, with the highest proportion in acromioclavicular injuries (>50%). Patients with sports injuries were younger than those injured during other activities (median age 28 and 43 years, respectively, p<0.001), and more often male (78% and 52%, respectively, p<0.001). There was a strong gender disparity in incidence of sports-related shoulder injuries in adolescents and young adults, which was not observed in non-sports shoulder injuries. Football (soccer) (6-29 years), cycling (30-49 years), skiing (50-69 years) and martial arts were the dominating sports activities. Fractures were more common in skiing and cycling than in other major sports in the study.Almost a third of the shoulder injuries occurred during sports. The types of sports involved varied with age and gender. The comparison of sport to non-sport shoulder injury incidence rates suggests that the increased risk of shoulder injuries in young males is mainly attributable to sports injuries.
