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Hurling-related hand injuries
Injury, Int. J. Care Injured 34 (2003) 561–563
Hurling-related hand injuries夽 P.D. Kiely a,∗ , M. Ashraff a , P. O’Grady a , M.J. Dawson b , J.G. O’Beirne c a
Department of Orthopaedic Surgery, The Adelaide and Meath Hospital (AMNCH), Tallaght, Dublin 24, Ireland b Cappagh National Orthopaedic Hospital, Dublin, Ireland c Waterford Regional Hospital, Ardkeen, Waterford, Ireland Accepted 12 February 2002
Abstract Hurling is a contact sport, associated with significant morbidity. We have identified specific hand injuries sustained by participants and quantified the functional and financial implications of these injuries. Over a 3-month period, all hand injuries seen in the fracture clinic of our regional trauma unit were studied prospectively. Of the 123 consecutive injuries, 41 (33%) were sustained during hurling matches. Metacarpal (47%) and proximal phalangeal (37%) fractures were the most frequent. Eight hurlers (20%) required surgical intervention. Only four (10%) of the injured players were wearing hand protection. The mean cost of injury to the player was £615. We suggest the introduction of the mandatory use of hand protection for hurling. © 2002 Elsevier Science Ltd. All rights reserved.
1. Introduction Hurling is one of Ireland’s Gaelic games (Fig. 1), involving over 200,000 male and female players nationally [1]. It is a contact sport, known as “the clash of the ash”, which is contested by two teams of 15 players. Each hurler carries a metre long ash stick (hurl) to hit a hard leather ball (sliothar). Contact between an opponent’s stick and the body of a player holding the ball is, therefore, common. Historically, hand and facial trauma have predominated [2–4]. However, since the advent of the helmet, with the option of a supplementary faceguard, the incidence of facial trauma has decreased by as much as 50% [5].
2. Patients and methods All patients attending Waterford Regional Hospital’s fracture clinic with hand injuries in a three month period were entered into the study. The anatomical location, fracture classification and the management of the injuries were recorded. Functional outcome was assessed by grip strength, the tip, key and palmar pinch [6], and by completing the Jebsen and Taylor test of hand function [7] at clinical review by one of the authors, 24 months after injury. Patients were asked to 夽 Presented at the British Trauma Society Meeting, Norfolk, September 2000. ∗ Corresponding author. Tel.: +353-1-4142000; Fax: +353-1-4144479. E-mail address: [email protected] (P.D. Kiely).
estimate loss of earnings directly attributable to the injury and additional costs incurred during their treatment.
3. Results There were 123 hand injuries seen in the study period. Forty-one were sustained during hurling matches. Forty of the players were male, mean age 20 years (range 9–53 years). Injury to the dominant hand occurred in 23 cases (56%). Fractures of the bones of the hand accounted for 38 of the injuries, with two players suffering dislocations and one player sustaining a laceration of the nail bed. Eighteen patients fractured a metacarpal and 14 fractured a proximal phalanx. The remaining six patients fractured either their middle or distal phalanges. Of the digital fractures, the little finger (seven) and the thumb (six) were the most commonly involved (Table 1). Thirty-three players were managed conservatively, with either neighbour strapping (24) or splinting (nine). Eight players required admission overnight for surgical procedures under general anaesthesia. Two cases had manipulation under anaesthesia, one patient had a nail bed laceration repaired while the remaining five cases necessitated manipulation under anaesthesia plus kirschner wiring. There were no wound infections. Hand strengths (Jamar dynamometer and the B&L pinch gauge) [6] and hand function (Jebsen et al. [7]) were normal. Two patients were disappointed with the cosmetic appearance of their injuries, one due to malrotation of a digit
0020-1383/$ – see front matter © 2002 Elsevier Science Ltd. All rights reserved. PII: S 0 0 2 0 - 1 3 8 3 ( 0 2 ) 0 0 0 5 0 - 5
562
P.D. Kiely et al. / Injury, Int. J. Care Injured 34 (2003) 561–563
Table 1 Distribution of Hurling-related hand fractures Little Netacarpal Proximal phalanx Middle phalanx Distal phlanx Total
Ring
Middle
Index
Thumb
7 4 0 3
0 0 0 0
3 2 0 0
2 5 0 0
6 3 0 3
14
0
5
7
12
and the second due to the result of the repair of a nail bed laceration. The mean cost to each player was £615. The mean loss of earnings was £563 (range £30–3500), and additional expenses were estimated at £50 per player. The cost of treatment has not been estimated.
4. Discussion
Fig. 1. This picture illustrates the potential injury that may occur to the unprotected hand while playing hurling.
Hurling is a sport associated with a high incidence of hand injury. The most commonly injured rays in our study were the little finger and thumb usually at the level of the metacarpal or proximal phalanx. This has been attributed to foul play by some authors with rates as high as 41% being recorded [8]. However, in this series, each player was adamant that foul play was not a contributing factor in the mechanism of injury, when questioned specifically by the authors. We demonstrated an alarming quantity of hand morbidity, plus a sizeable proportion of a hospital’s workload secondary to one sport. Thirty-seven of the injured players wore no protection, but the four players who used the commercially available glove (Fig. 2), avoided injury to the specific area protected. We think that the proportion of players wearing the protective device in our series reflects the national trend. Modification of this glove, with reinforcement of the peripheries, perhaps using silicone rubber, may provide a solution. This compound has been used successfully in splints which have facilitated an athlete’s earlier return to sport following injury [9]. It is interesting to note that of the eight players who underwent surgery, seven now wear a protective glove. This compares starkly with the conservatively managed group, with just 6 of the 33 now wearing a glove.
Fig. 2. An example of a protective glove currently available.
P.D. Kiely et al. / Injury, Int. J. Care Injured 34 (2003) 561–563
Players denied any specific limitation or handicap in association with this, glove. The mean financial loss to each player of more than £600 in addition to the significant burden on the health service is considerable. The current rate of glove compliance is unsatisfactory. The glove’s design could also be modified to increase protection. We suggest further investigations by the game’s governing body, the GAA, into improved protection and the introduction, perhaps, on a preliminary trial basis of mandatory glove wear. We believe that this will result in reduced injury rates together with reduced costs for the players and the health service, without diluting any of the sport’s enjoyment. References [1] Gaelic Athletic Association. Croke Park, Dublin. [2] O’Sullivan ME, Curtin J. Hand injuries in Gaelic games. IJMS 1989;158(4):79–81.
563
[3] Crowley PJ, Condon KC. Analysis of hurling and camogie injuries. Br J Sports Med 1989;23(3):183–5. [4] Cuddihy B, Hurley M. Contact sports and injury. IMJ 1990;83(3):98– 100. [5] Crowley PJ, Crowley MJ, Dardouri H, Condon KC. Value of wearing head protection gear while playing hurling. Br J Sports Med 1995;29(3):191–3. [6] Mathiowetz V, Kashman N, Volland G, et al. Grip and pinch strength. Arch Phys Med Rehabil 1985;68:69–74. [7] Jebsen RH, Taylor N, Trieschmann RB, et al. An objective and standardised test of hand function. Arch Phys Med Rehabil 1969;6:311–9. [8] Watson AW. Sports injuries in the game of hurling. Am J Sports Med 1996;24(3):323–8. [9] Canelon MF. Silicone rubber splinting for athletic hand and wrist injuries. J Hand Ther 1995;8(4):252–7.
Hurling-related hand injuries夽 P.D. Kiely a,∗ , M. Ashraff a , P. O’Grady a , M.J. Dawson b , J.G. O’Beirne c a
Department of Orthopaedic Surgery, The Adelaide and Meath Hospital (AMNCH), Tallaght, Dublin 24, Ireland b Cappagh National Orthopaedic Hospital, Dublin, Ireland c Waterford Regional Hospital, Ardkeen, Waterford, Ireland Accepted 12 February 2002
Abstract Hurling is a contact sport, associated with significant morbidity. We have identified specific hand injuries sustained by participants and quantified the functional and financial implications of these injuries. Over a 3-month period, all hand injuries seen in the fracture clinic of our regional trauma unit were studied prospectively. Of the 123 consecutive injuries, 41 (33%) were sustained during hurling matches. Metacarpal (47%) and proximal phalangeal (37%) fractures were the most frequent. Eight hurlers (20%) required surgical intervention. Only four (10%) of the injured players were wearing hand protection. The mean cost of injury to the player was £615. We suggest the introduction of the mandatory use of hand protection for hurling. © 2002 Elsevier Science Ltd. All rights reserved.
1. Introduction Hurling is one of Ireland’s Gaelic games (Fig. 1), involving over 200,000 male and female players nationally [1]. It is a contact sport, known as “the clash of the ash”, which is contested by two teams of 15 players. Each hurler carries a metre long ash stick (hurl) to hit a hard leather ball (sliothar). Contact between an opponent’s stick and the body of a player holding the ball is, therefore, common. Historically, hand and facial trauma have predominated [2–4]. However, since the advent of the helmet, with the option of a supplementary faceguard, the incidence of facial trauma has decreased by as much as 50% [5].
2. Patients and methods All patients attending Waterford Regional Hospital’s fracture clinic with hand injuries in a three month period were entered into the study. The anatomical location, fracture classification and the management of the injuries were recorded. Functional outcome was assessed by grip strength, the tip, key and palmar pinch [6], and by completing the Jebsen and Taylor test of hand function [7] at clinical review by one of the authors, 24 months after injury. Patients were asked to 夽 Presented at the British Trauma Society Meeting, Norfolk, September 2000. ∗ Corresponding author. Tel.: +353-1-4142000; Fax: +353-1-4144479. E-mail address: [email protected] (P.D. Kiely).
estimate loss of earnings directly attributable to the injury and additional costs incurred during their treatment.
3. Results There were 123 hand injuries seen in the study period. Forty-one were sustained during hurling matches. Forty of the players were male, mean age 20 years (range 9–53 years). Injury to the dominant hand occurred in 23 cases (56%). Fractures of the bones of the hand accounted for 38 of the injuries, with two players suffering dislocations and one player sustaining a laceration of the nail bed. Eighteen patients fractured a metacarpal and 14 fractured a proximal phalanx. The remaining six patients fractured either their middle or distal phalanges. Of the digital fractures, the little finger (seven) and the thumb (six) were the most commonly involved (Table 1). Thirty-three players were managed conservatively, with either neighbour strapping (24) or splinting (nine). Eight players required admission overnight for surgical procedures under general anaesthesia. Two cases had manipulation under anaesthesia, one patient had a nail bed laceration repaired while the remaining five cases necessitated manipulation under anaesthesia plus kirschner wiring. There were no wound infections. Hand strengths (Jamar dynamometer and the B&L pinch gauge) [6] and hand function (Jebsen et al. [7]) were normal. Two patients were disappointed with the cosmetic appearance of their injuries, one due to malrotation of a digit
0020-1383/$ – see front matter © 2002 Elsevier Science Ltd. All rights reserved. PII: S 0 0 2 0 - 1 3 8 3 ( 0 2 ) 0 0 0 5 0 - 5
562
P.D. Kiely et al. / Injury, Int. J. Care Injured 34 (2003) 561–563
Table 1 Distribution of Hurling-related hand fractures Little Netacarpal Proximal phalanx Middle phalanx Distal phlanx Total
Ring
Middle
Index
Thumb
7 4 0 3
0 0 0 0
3 2 0 0
2 5 0 0
6 3 0 3
14
0
5
7
12
and the second due to the result of the repair of a nail bed laceration. The mean cost to each player was £615. The mean loss of earnings was £563 (range £30–3500), and additional expenses were estimated at £50 per player. The cost of treatment has not been estimated.
4. Discussion
Fig. 1. This picture illustrates the potential injury that may occur to the unprotected hand while playing hurling.
Hurling is a sport associated with a high incidence of hand injury. The most commonly injured rays in our study were the little finger and thumb usually at the level of the metacarpal or proximal phalanx. This has been attributed to foul play by some authors with rates as high as 41% being recorded [8]. However, in this series, each player was adamant that foul play was not a contributing factor in the mechanism of injury, when questioned specifically by the authors. We demonstrated an alarming quantity of hand morbidity, plus a sizeable proportion of a hospital’s workload secondary to one sport. Thirty-seven of the injured players wore no protection, but the four players who used the commercially available glove (Fig. 2), avoided injury to the specific area protected. We think that the proportion of players wearing the protective device in our series reflects the national trend. Modification of this glove, with reinforcement of the peripheries, perhaps using silicone rubber, may provide a solution. This compound has been used successfully in splints which have facilitated an athlete’s earlier return to sport following injury [9]. It is interesting to note that of the eight players who underwent surgery, seven now wear a protective glove. This compares starkly with the conservatively managed group, with just 6 of the 33 now wearing a glove.
Fig. 2. An example of a protective glove currently available.
P.D. Kiely et al. / Injury, Int. J. Care Injured 34 (2003) 561–563
Players denied any specific limitation or handicap in association with this, glove. The mean financial loss to each player of more than £600 in addition to the significant burden on the health service is considerable. The current rate of glove compliance is unsatisfactory. The glove’s design could also be modified to increase protection. We suggest further investigations by the game’s governing body, the GAA, into improved protection and the introduction, perhaps, on a preliminary trial basis of mandatory glove wear. We believe that this will result in reduced injury rates together with reduced costs for the players and the health service, without diluting any of the sport’s enjoyment. References [1] Gaelic Athletic Association. Croke Park, Dublin. [2] O’Sullivan ME, Curtin J. Hand injuries in Gaelic games. IJMS 1989;158(4):79–81.
563
[3] Crowley PJ, Condon KC. Analysis of hurling and camogie injuries. Br J Sports Med 1989;23(3):183–5. [4] Cuddihy B, Hurley M. Contact sports and injury. IMJ 1990;83(3):98– 100. [5] Crowley PJ, Crowley MJ, Dardouri H, Condon KC. Value of wearing head protection gear while playing hurling. Br J Sports Med 1995;29(3):191–3. [6] Mathiowetz V, Kashman N, Volland G, et al. Grip and pinch strength. Arch Phys Med Rehabil 1985;68:69–74. [7] Jebsen RH, Taylor N, Trieschmann RB, et al. An objective and standardised test of hand function. Arch Phys Med Rehabil 1969;6:311–9. [8] Watson AW. Sports injuries in the game of hurling. Am J Sports Med 1996;24(3):323–8. [9] Canelon MF. Silicone rubber splinting for athletic hand and wrist injuries. J Hand Ther 1995;8(4):252–7.