Development of calcium phosphate cement for the augmentation of traumatically fractured porcine specimens using vertebroplasty

The study aim was to develop and apply an experimental technique to determine the biomechanical effect of polymethylmethacrylate (PMMA) and calcium phosphate (CaP) cement on the stiffness and strength of augmented vertebrae following traumatic fracture. Twelve burst type fractures were generated in porcine three-vertebra segments. The specimens were randomly split into two groups (n=6), imaged using microCT and tested under axial loading. The two groups of fractured specimens underwent a vertebroplasty procedure, one group was augmented with CaP cement designed and developed at Queen's University Belfast. The other group was augmented with PMMA cement (WHW Plastics, Hull, UK). The specimens were imaged and re-tested . An intact single vertebra specimen group (n=12) was also imaged and tested under axial loading. A significant decrease (p<0.01) was found between the stiffness of the fractured and intact groups, demonstrating that the fractures generated were sufficiently severe, to adversely affect mechanical behaviour. Significant increase (p<0.01) in failure load was found for the specimen group augmented with the PMMA cement compared to the pre-augmentation group, conversely, no significant increase (p<0.01) was found in the failure load of the specimens augmented with CaP cement, this is attributed to the significantly (p<0.05) lower volume of CaP cement that was successfully injected into the fracture, compared to the PMMA cement. The effect of the percentage of cement fracture fill, cement modulus on the specimen stiffness and ultimate failure load could be investigated further by using the methods developed within this study to test a more injectable CaP cement.

A novel device to measure acetabular inclination with patients in lateral decubitus

The ability to measure acetabular cup orientation accurately during total hip arthroplasty represents a significant challenge. The aim of this research was to develop and evaluate a novel low cost mechanical device for measuring operative acetabular inclination. Cup implantation was simulated in two trials using the novel device: firstly involving surgeons and engineers orientating acetabular cups with sawbone pelves at a range of inclination angles (20°-55° in 5° increments); secondly in a simulated intra-operative scenario with surgeons. Target angles were compared with achieved angles and deviations from desired angles were recorded. In addition, all participants orientated cups under the same conditions using two other techniques: freehand and with a propriatory Mechanical Alignment Guide. In the first trial, the mean errors (deviations) using freehand technique, the mechanical alignment guide and the new device were 5.2° +/- 4.3° (range 0.1-22.0), 3.6° +/- 3.9° (range 0.1°-33.6°) and 0.5° +/- 0.4° (range 0.0-1.9) respectively. In the second trial, the mean error for freehand technique, mechanical alignment guide and the new device were 6.2° +/- 4.2° (range 0.2-18.2), 3.8° +/- 3.3° (range 0.0-19.1) and 0.6° +/- 0.5° (range 0.0-1.8) respectively. The new device has the potential to allow the surgeon to choose and record operative inclination accurately during total hip arthroplasty in the lateral decubitus position.

Where are all the female participants in sports and exercise medicine research?

The aim of this study is to estimate the ratio of male and female participants in Sports and Exercise Medicine research. Original research articles published in three major Sports and Exercise Medicine journals (Medicine and Science in Sport and Exercise, British Journal of Sports Medicine and American Journal of Sports Medicine) over a three year period were examined. Each article was screened to determine the following: total number of participants, the number of female participants and the number of male participants. The percentage of females and males per article in each of the journals was also calculated. Cross tabulations and Chi square analysis were used to compare the gender representation of participants within each of the journals. Data were extracted from 1, 382 articles involving a total of 6, 076, 705 participants. 2, 366, 998 (39%) participants were female and 3, 709, 707 (61%) male. The average percentage of female participants per article across the journals ranged from 35-37%. Females were significantly under-represented across all of the journals (X2 =23566, df=2, p<0.00001). There were no significant differences between the three journals. In conclusion, Sports and Exercise Medicine practitioners should be cognisant of sexual dimorphism and gender disparity in the current literature.

An examination of the role of the sports and exercise medicine specialist in Ireland- from epidemiology to treatment

The expansion of the specialty of sports and exercise medicine (SEM) is a relatively recent development in the medical community and the role of the SEM specialist continues to evolve and develop. The SEM specialist is ideally placed to care for all aspects of physical activity not only in athletes but also in the general population. As an advocate for physical activity the SEM specialist plays a broad role in advising safe effective sports and recreation participation; screening for disease related to sports participation; examining and contributing to the evidence behind treatment strategies and evaluating any potential negative impact of sports injury prevention measures. In this thesis I will demonstrate the breadth of the role the Sports and Exercise Medicine Specialist from epidemiology to in-depth examination of treatment strategies. In Chapter 2, I examined the epidemiology of sports and recreation related injury (SRI) in Ireland, an area that has previously been poorly studied. We report on 3,172 SRI (14% of total presentations) presentations to the ED over 6 months. Paediatric patients (4-16 yrs) were over represented comprising 39.9% of all SRI presentation compared to 16% of total ED presentations and 18% of the general population. These injuries were serious (32% fractures) and though 49% of injuries occurred during organised competition/practice, 41.5% occurred during recreation-most often at home. In Chapter 3, I examined risk factors associated with hand injury in hurling. The previous chapter highlighted the importance of a firm evidence base underpinning treatment strategies. When measures to improve welfare are introduced not only must potential benefits be measured, so too must potential unwanted adverse outcomes. In this study I examined a cohort of adult hurlers who had presented to the ED with a hurling related injury in order to highlight the variables associated with hand injury in this population. I found the athletes who wore a helmet were far more likely (OR 3.15 95% CI (1.51-6.56) p= 0.002) to suffer a hand injury than athletes who did not. Very few of those interviewed (4.9%) used hand protection compared to 65% who used helmet and faceguard. The introduction of the helmet and faceguard in hurling has undeniably decreased the incidence of head and face injury in hurling. However in tandem with this intervention several observational studies have demonstrated an increase in the occurrence of hurling related hand injuries. This study highlights the importance of being cognisant of unanticipated or unintended consequences when implementing a new treatment or intervention. In Chapter 4, I examined the role of population screening as applied to sport and exercise. This is a controversial area –cardiac screening in the exercising population has been the subject of much debate. Specifically I define the prevalence of exercise induced bronchoconstriction (EIB) using a specifically designed sports specific field-testing protocol. In this study I found almost a third (29%) of a full international professional rugby squad had confirmed asthma or EIB, as compared with 12-15% of the general population. Despite regular medical screening, 5 ‘new’ untreated cases (12%) were elicited by the challenge test and in the group already on treatment for asthma/EIB; over 50% still displayed EIB. In Chapter 5, I examined the evidence supporting current treatment options for iliotibial band friction syndrome (ITBFS). The practice of sports medicine has traditionally been ‘eminence based’ rather than ‘evidence based’. This may be problematic as some of these practices are based upon flawed principles- for example the treatment of iliotibial band friction syndrome (ITBFS). In this chapter, using cadaveric and biomechanical studies I expand upon the growing base of evidence clarifying the anatomy and biomechanics of the area-thereby re-examining the principles on which current treatments are based. The role of the SEM specialist is broad; we chose to examine specific examples of some of the roles that they execute. An understanding of the epidemiology of SRI presenting to the ED has implications for individual patients, sports governing bodies and health resource utilisation. Population screening is an important tool in health promotion and disease prevention in the general population. Screening in SEM may have similar less well-recognised benefits. The SEM specialist needs to be conversant in screening for medical conditions concerning physical activity. A comprehensive understanding of the pathophysiology of a disease is required for its diagnosis and treatment. Due to the ongoing evolution of SEM many treatments are eminence-based rather than evidence‐based practice. Continued re-examination of the fundamentals of current practice is essential. An awareness of potential unwanted side effects is essential prior to the introduction of any new treatment or intervention. The SEM specialist is ideally placed to advise sports governing bodies on these issues prior to and during their implementation.

What do we mean by the term "inflammation"? A contemporary basic science update for sports medicine

Most practicing sports medicine clinicians refer to the concept of "inflammation" many times a day when diagnosing and treating acute and overuse injuries. What is meant by this term? Is it a "good" or a "bad" process? The major advances in the understanding of inflammation in recent years are summarised, and some clinical implications of the contemporary model of inflammation are highlighted.

Descriptive epidemiology of Australian football injuries presenting to sports medicine clinics

Sports injury prevention has been the focus of a number of recent public health initiatives due to the acknowledgement that sports injuries are a significant public health problem in Australia Whilst Australian football is one of the most popular participation sports in the country, only very limited data is available about football injuries The majority of sports injury data available for this sport is from hospital emergency departments and elite-level injury surveillance Overall there is a paucity of data from treatment settings other than hospitals In particular, there is a lack of information about the injuries sustained by community-level, junior and recreational Australian football participants. One good potential source of football injury data is sports medicine clinics. Analysis of injury presentations to sports medicine clinics was undertaken to provide a detailed description of the epidemiology of Australian football injuries that present to this treatment setting and to determine the implications for injury prevention in this sport. In addition, the data from sports medicine clinics was compared with existing sources of Australian football injury data to determine how representative sports medicine clinic data is of other football injury data sources and to provide recommendations for future injury surveillance n Australian football. The results contained in this thesis show that Australian football is the sport most associated with injury presentation at sports medicine clinics. The majority of injured Australian football players presenting to sports medicine clinics are community-level or junior participants which suggests that sports medicine clinics are a good source of information on the injuries sustained by sub-elite football participants. Competition is the most common context in which Australian football players presenting to sports medicine clinics are injured. The major causes of injuries to Australian football players are being struck by another player, collisions and overuse. Injuries to Australian football players predominantly involve the lower limb. Adult players, players who stopped participating immediately after noticing their injury and players with overuse injuries are the most likely to sustain a more severe injury (i.e. more than four weeks before a full return to football participation and a moderate/significant amount of treatment expected). The least experienced players (five or less years of participation) are more likely to require a significant amount of treatment than the more experienced players. The prevention of lower limb injuries, injuries caused by body contact and injuries caused by overuse should be a priority for injury prevention research in Australian football due to the predominance of these injury types in the pattern of Australian football injuries Additionally, adult players, as a group, should be a focus of injury prevention activities in Australian football due to the association between age and injury severity. Overall, the pattern of Australian football injuries presenting to sports medicine clinics appears to be different than reported by club-based and hospital emergency department injury surveillance activities. However, detailed comparison of sports medicine clinic Australian football data with other sources of Australian football injury data is difficult due to the variable methods of collecting and reporting injury information used by hospital emergency department and club-based injury surveillance activities. The development of a standardised method for collecting and reporting injury data in Australian football is strongly recommended to overcome the existing limitations of data collection in this sport. In summary, sports medicine clinics provide a rich source of Australian football injury data, especially from the community and junior levels of participation. The inclusion of sports medicine clinic data provides a broader epidemiological picture of Australian football injuries. This broader understanding of the pattern of Australian football injuries provides a better basis for the development of injury prevention measures in this sport.

Implementation of concussion guidelines in community Australian Football and Rugby League– the experiences and challenges faced by coaches and sports trainers

Objectives

While guidelines outlining the appropriate management of sport-related concussion have been developed and adapted for use within community sport, it remains unknown how they are experienced by those responsible for implementing them.
Design

Longitudinal study.
Methods

111 coaches and sports trainers from community-level Australian Football and Rugby League teams completed pre- and post-season surveys assessing their attitudes towards using concussion guidelines. Participants also provided post-season feedback regarding their experiences in using the guidelines.
Results

71% of participants reported using the guidelines in the preceding season. Post-season attitude was related to pre-season attitude (p = 0.002), football code (p = 0.015), and team role (p = 0.045). An interaction between team role and guideline use (p = 0.012) was also found, with coaches who had used the guidelines, and sports trainers who had not, reporting more positive post-season attitudes towards using the concussion guidelines. Implementation challenges included disputing of decisions about return-to-play by players, parents, and coaches, and a perceived lack of time. Recommendations for improved guideline materials included using larger fonts and providing for witnessing of advice given to players.
Conclusions

This is the first study to examine the implementation of concussion guidelines in community sport. Training of coaches/sports trainers needs enhancement. In addition, new education should be developed for parents/players about the importance of the return-to-play advice given to them by those who follow these guidelines. Information provided by those who attempted to use the guidelines will assist the refinement of implementation and dissemination processes around concussion guidelines across sports.

Possible underestimation by sports medicine of the effects of early physical exercise practice on the prevention of diseases in adulthood

In modern society, combatting cardiovascular and metabolic diseases has been highlighted as an urgent global challenge. In recent decades, the scientific literature has identified that behavioral variables (e.g. smoking, unhealthy diet and physical inactivity) are related to the development of these outcomes and, therefore, preventive actions should focus on the promotion of physical exercise practice and a healthy diet, as well as combatting the smoking habit from an early age. The promotion of physical exercise in the general population has been suggested as a relevant goal by significant health organizations around the world. On the other hand, recent literature has indicated that physical exercise performed in early life prevents the development of diabetes mellitus, dyslipidemia and arterial hypertension during adulthood, although this protective effect seems to be independent of the physical activity performed during adulthood. Apparently, the interaction between physical exercise and human growth in early life constitutes an issue which is not completely understood by sports medicine. The aim of the present review was therefore to discuss recent evidence on the effects of physical exercise performed during childhood and adolescence on cardiovascular and metabolic outcomes in adulthood.

Physical fitness/sports medicine.

"A bibliographic service encompassing exercise physiology, sports injuries, physical conditioning and the medical aspects of exercise".