- Email: [email protected]
Review of the literature on sports related clavicle fractures and analysis on the biomechanics of lesion
ARTICLE IN PRESS WISSENSCHAFTLICHER BEITRAG
SPORT OT
rthopadie ¨ raumatologie
Y. Lae Moon et al.
Clavicle fractures through Hapkido training Summary There are many injuries associated with the practice of martial arts. There is a growing population of people who practice various forms of martial arts on a daily basis with improper or insufficient supervision making them prone to execute the techniques in an erroneous manner subsequently leading to injury. Fracture of the clavicle during Hapkido training has been associated directly to incorrect execution of basic techniques. During 1998-2000 twelve black belt level Hapkido athletes were reported to present mid clavicle fractures of the right limb directly associated to the erroneous execution of specific basic Hapkido maneuvers. The erroneous techniques where reproduced with healthy trained athletes under a controlled environment to analyze the error in their execution and the biomechanics correlating to the fracture of the clavicle. All the patients were diagnosed with Allman group Ib/ Robinson type 2 fracture of the dominant limb clavicle, directly associated with incorrect execution of the break falling and roll techniques. These when analyzed reproduced very accurately two distinct models of the biomechanics in the pathology of mid clavicle fractures. The two techniques described are practiced in various other styles of martial arts including Judo. These techniques serve as a precise illustration of two biomechanical models used when describing the forces that produce mid clavicle fractures. The analysis of the various techniques incorrectly done, leading to the fracture of the clavicle, represents in vivo mathematical models explaining the mechanisms of lesion. The major risk factors for injury are improper supervision and/or coaching as well as incorrect level of training of the techniques executed. Keywords Hapkido – martial arts – clavicle fractures – biomechanics
30
Sportorthopa¨die Sporttraumatologie 23, 30–34 (2007) Elsevier – Urban&Fischer www.elsevier.de/orthtr doi:10.1016/j.orthtr.2007.02.001
WISSENSCHAFTLICHER BEITRAG
Review of the literature on sports related clavicle fractures and analysis on the biomechanics of lesion Young Lae Moon, MD1,, Kyoung Il Lee, PhD2, Alberto M. Jacir, MD3, Louis U. Bigliani, MD3 1 Center for elbow, shoulder and sports medicine, Department of Orthopaedic Surgery, Chosun University Hospital, Gwangju, Korea, Korea 2 College of Physical Education, Chosun University, Gwangju, Korea 3 Center for elbow, shoulder and sports medicine, Center for Orthopaedic Research, Department of Orthopaedic Surgery, Columbia-Presbyterian Hospital, Columbia University, New York, USA
Hapkido is a traditional style of
Korean martial art. Its techniques consist of a series of kicks, falls, rolls and self-defense maneuvers that repel the attack of an opponent using expediently his own power (10). Like all other sports flaws in the technique can lead to injury. Clavicle fractures is a common injury in contact sports, described in athletes who are prone to high force impact of the shoulder griddle or falling on the out stretched hand (soccer, rugby, cycling, running). During the practice of hapkido there are certain techniques that if performed incorrectly can cause a high velocity force equal to that of body weight to fracture the clavicle through a direct blow onto the shoulder or indirectly by transmission of a compressive force from the elbow. Today the number of people who routinely practice Hapkido world wide is approximately 5 million, with the United States being second only to Korea in the number of athletes who perform this sport. The aim of this descriptive clinical study is to elaborate the various mechanisms of clavicle fractures rel-
Y. Lae Moon et al. Clavicle fractures through Hapkido training
ated to the practice of Hapkido, specifically describing the technical errors that can lead to injury and the biomechanical explanation of the fracture.
Patients and Methods During 1998 – 2000 a group of 12 athletes from a 500 student Hapkido academy in Gwangju, South Korea were described to have fractures of the clavicle directly related to the practice of this martial art. Their study includes 10 males and 2 females, whose ages ranged from 13–18 years. All the patients sustained middle third fracture of the clavicle corresponding to their dominant limb. The group consisted of first and second-degree black belt level athletes. The athletes were injured when performing either a ‘‘rolling’’ or ‘‘break fall’’ technique. Normally, these techniques are used by Hapkido practitioners to reduce the impact and avoid injury during a fall, when being thrown by an opponent or clearing an obstacle. However, to assess the mechanism
ARTICLE IN PRESS WISSENSCHAFTLICHER BEITRAG
of fracture, the instructor present during the event was asked to describe the exact body position of the athlete at the moment of injury. Taking into account the expertise of the instructor and confirming his observation with the patients, the incorrect body position used at the time of injury was reproduced with the collaboration of healthy well trained athletes to reproduce step by step the technique that led to the fracture. Diagnosis was obtained by clinical examination and confirmation using conventional anterior-posterior Xrays of the affected shoulder. To classify the clavicle fractures in order to evaluate treatment and prognosis the authors used Allman’s and Robinson’s classification for clavicle fractures (1,7). All cases were treated using conservative methods which consisted of a figure 8 brace for an average of 37 days (ranging from 27–48 days), with a first 72 hour follow-up and then weekly evaluations for adjustment and compliance verification of the immobilization bandage. The clinical out come for each patient was standardized using the Weitzman 7 shoulder function scale (11).
Results All the athletes evaluated were diagnosed with Allman group Ib clo-
sed mid-clavicle fractures of the right upper limb, being 10 of these classified as Robinson 2B1; simple or wedged comminuted fractures and the resting 2 as type 2A2; described as angulated fractures of the mid clavicle. Compliance to the method of treatment was well acceptable in all patients, with evidence of consolidation visualized within 10 weeks of initiating treatment on standard radio diagnostics for the shoulder. Clinical improvement and function of the shoulder girdle was objectively evaluated with scores defined as excellent in eight of the patients and good in the resting four. After a 2 years follow-up, all patients presented union and callus formation at the site of fracture with complete return to routine daily activities and a normal Hapkido training schedule. After evaluating the various techniques used at the time of injury, it was concluded that an improper execution of the break fall and roll technique led to the consequent fracture of the clavicle. Reproduction of the break fall technique showed a consistent error that led to compressive forces producing buckling of the fracture under a biomechanical model. The error consisted on falling not on the extended arm at 451 but falling instead on a flexed elbow. Analyzing the roll
Fig. 1 A. Proper roll technique absorbing the energy at fall B. Bad roll technique producing a blunt impact on the shoulder
technique a consistent error was also found, in which the athlete at the time of landing failed to complete the aerial roll with his body that would permit him to detain acceleration, in consequence producing a blunt impact on the shoulder (Fig. 1).
Discussion Hapkido is learned in academies where the level of expertise and training is identified by the belt color tied around at the waist of a traditional Korean uniform, the ‘‘Dobok.’’ Having a white belt designates the beginner level, and the black belt designated the most advanced level. To attain a black belt, a practitioner requires an average of 2 years of training with a consistent frequency of 3 sessions per week. The break fall technique is used to minimize the damage when falling from a certain height or when a throw technique is performed. There are many types of break fall techniques but we shall focus on the most common, those that provoke a side impact of the body with the ground. The correct technique dictates that the forces produced by the fall should be dissipated over a broad body area using the arm fully extended at an angle of 451, as well as the entire side of the body, leg and foot (Fig. 2). The error in the technique that leads to injury is in not fully extending the arm when landing on the ground, but doing so on a flexed elbow. This provokes a direct transmission of force from the elbow to the shoulder generating compressive forces in the clavicle causing it to buckle and subsequently fracture (Fig. 3). The roll techniques are used to escape a certain situation or to incorporate into a fighting stance. Rolls
Y. Lae Moon et al. Clavicle fractures through Hapkido training
31
ARTICLE IN PRESS WISSENSCHAFTLICHER BEITRAG
Fig. 2 The correct break fall technique absorb energy at the impact
Fig. 3 The bad break fall technique producing indirect mechanism of clavicle fracture
can be performed from aerial, walking, running, kneeling, seated and reclining position. The author’s main interest is the shoulder roll for distance, which is used to clear a
32
certain obstacle by leaping over it (Fig. 4). For the athlete to perform the shoulder roll for distance he must gain sufficient velocity, so when he
Y. Lae Moon et al. Clavicle fractures through Hapkido training
executes the forward diving thrust movement, his trajectory of motion is enough to clear the obstacle. In doing so he creates a momentum in which the force vector must be redirected when landing. To achieve this, the athlete must roll upon landing, not only redistributing the pressure sequentially along the dorsal aspect of the upper limb, torso and the lower extremity, but also creating enough friction to detain acceleration. The error in the technique consists in landing bluntly on the shoulder; this produces a transmission of the full body weight under a high velocity scenario onto the clavicle causing it to fracture (Fig. 5). Clavicle fractures correspond to 5 –15% of all fractures in the body with an incidence of 2.6% (6), they account for 41%-44% of shoulder griddle lesions of which 21.2% to 33% are sport’s related (6–8) and 85% are described to be produced from direct falls (2). The mid clavicle is the primary site for fracture as described by Nordqvist, Pedersen, Robinson, Nowak and Postacchini(3–7). They are classified as Allman group I or Robinson type 2 corresponding to approximately 69–81% of all clavicle fractures6,7. Further subgroup classification of Robertson type 2 or midshaft clavicle fractures shows that angulated 2A2 fractures represent 13.5% of all clavicle fractures and simple or wedged comminuted 2B1 fractures represents the leading type fracture pattern of the clavicle with a total of 37.5% of the population studied. Robinson et al. also reported the incidence (including site, fracture pattern and difference) between genders and outcome of sports related clavicle fractures (7). Of the total sport’s related clavicle fractures described 88.8% are localized in the mid clavicle, of which 45% is type 2B1 and 28.8% are type 2A2
ARTICLE IN PRESS WISSENSCHAFTLICHER BEITRAG
loading and with predisposition for the middle third to be the site of lesion (8,9). The two main mechanisms of lesion are direct blow 94% and falls on out stretched hand 6% (1,9). Stanley and collaborators described the forces that are able to produce clavicle fractures can be summarized using Fc ¼ p2EA/(L/r) 2 either by: a direct blow where the compressive forces are approximate to body weight or falling on an outstretch hand with the arm on coronal plane in relation to the body (9). If the arm is not on a coronal plane in relation to the body the scapula will be pushed upward and back ward producing a more likely a dislocation of the glenohumeral joint than a clavicle fracture. When falling on an out stretched hand or elbow the force is transmitted through the arm, onto the scapula passing through humeral head, the axial loading produces a compressive force between the acromion and sternum producing the clavicle to buckle at its weakest part the middle third and consequently fracture.
Fig. 4 The correct roll technique distribute energy at landing
Conclusion
Fig. 5 The bad roll technique producing direct mechanism of clavicle fracture
with a male to female ratio of 4.2:1 and 2.7:1 respectively, being 6.8:1 the general male to female ratio for sports related clavicle fractures. Approximately 90% of the population with this type of fracture patt-
ern had an uncomplicated outcome with conservative treatment. The anatomical relationships and morphology of the clavicle within the shoulder griddle leaves it at risk to fracture by means of compressive
With the increasing population of people practicing martial arts it is important to make emphasis on training under strict supervision of high ranking professionals in the style interested in. With proper supervision and progressive level of training, the techniques when correctly preformed protect the athlete from injury. The errors in the techniques described illustrate in vivo the 2 mechanisms biomechanically proven to produce fracture of the mid clavicle: a blunt high speed impact equal to body weight illustrated through the rolling technique and a falling on an out stretched hand with the arm on a
Y. Lae Moon et al. Clavicle fractures through Hapkido training
33
ARTICLE IN PRESS WISSENSCHAFTLICHER BEITRAG
coronal plane relative to the body shown using the break fall maneuver. The break fall and rolling techniques are not only practiced in Hapkido, but also are practiced in various other forms of martial arts including Aikido, Jujitsu and the Olympic level sport of Judo. (This study was supported by research funds from Special Fee for Medical Service at Chosun University Hospital, 2003.)
References 1 Allman Jr. FL (1967): Fractures and ligamentous injuries of the clavicle and its articulation. J Bone Joint Surg Am, 49 (4): 774–784 2 Nordqvist A, Petersson C (1994): The incidence of fractures of the clavicle. Clin Orthop Relat Res (300): 127–132
34
3 Nordqvist A, Petersson CJ, RedlundJohnell I (1998): Mid-clavicle fractures in adults: end result study after conservative treatment. J Orthop Trauma, 12 (8): 572–576 4 Nowak J, Mallmin H, Larsson S (2000): The aetiology and epidemiology of clavicular fractures. A prospective study during a two-year period in Uppsala, Sweden. Injury, 31 (5): 353–358 5 Pedersen MS, Kristiansen B, Thomsen F, Torholm C (1993): [Conservative treatment of clavicular fractures]. Ugeskr Laeger, 155 (47): 3832–3834 6 Postacchini F, Gumina S, De Santis P, Albo F (2002): Epidemiology of clavicle fractures. J Shoulder Elbow Surg, 11 (5): 452–456 7 Robinson CM (1998): Fractures of the clavicle in the adult. Epidemiology and classification. J Bone Joint Surg Br, 80 (3): 476–484 8 Rowe CR (1968): An atlas of anatomy and treatment of midclavicular fractures. Clin Orthop Relat Res, 58: 29–42
Y. Lae Moon et al. Clavicle fractures through Hapkido training
9 Stanley D, Trowbridge EA, Norris SH (1988): The mechanism of clavicular fracture. A clinical and biomechanical analysis. J Bone Joint Surg Br, 70 (3): 461–464 10 Tedeschi, M.: Hapkido: Traditions, Philosophy, Technique : Traditions, Philosophy, Technique Edited, 1136, Trumbull, Weatherhill, 2000. 11 Weitzman G (1967): Treatment of acute acromioclavicular joint dislocation by a modified Bosworth method: Report on twenty-four cases. J.Bone and Joint surg, 49–A: 1167–1178
Korrespondenzadresse: Y. L. Moon, MD Chosun University Hospital Orthopaedic Department 588, Seoseok-dong, Seo-ku, Gwangju, 501–717, South Korea e-mail: [email protected] (Y. Lae Moon).
SPORT OT
rthopadie ¨ raumatologie
Y. Lae Moon et al.
Clavicle fractures through Hapkido training Summary There are many injuries associated with the practice of martial arts. There is a growing population of people who practice various forms of martial arts on a daily basis with improper or insufficient supervision making them prone to execute the techniques in an erroneous manner subsequently leading to injury. Fracture of the clavicle during Hapkido training has been associated directly to incorrect execution of basic techniques. During 1998-2000 twelve black belt level Hapkido athletes were reported to present mid clavicle fractures of the right limb directly associated to the erroneous execution of specific basic Hapkido maneuvers. The erroneous techniques where reproduced with healthy trained athletes under a controlled environment to analyze the error in their execution and the biomechanics correlating to the fracture of the clavicle. All the patients were diagnosed with Allman group Ib/ Robinson type 2 fracture of the dominant limb clavicle, directly associated with incorrect execution of the break falling and roll techniques. These when analyzed reproduced very accurately two distinct models of the biomechanics in the pathology of mid clavicle fractures. The two techniques described are practiced in various other styles of martial arts including Judo. These techniques serve as a precise illustration of two biomechanical models used when describing the forces that produce mid clavicle fractures. The analysis of the various techniques incorrectly done, leading to the fracture of the clavicle, represents in vivo mathematical models explaining the mechanisms of lesion. The major risk factors for injury are improper supervision and/or coaching as well as incorrect level of training of the techniques executed. Keywords Hapkido – martial arts – clavicle fractures – biomechanics
30
Sportorthopa¨die Sporttraumatologie 23, 30–34 (2007) Elsevier – Urban&Fischer www.elsevier.de/orthtr doi:10.1016/j.orthtr.2007.02.001
WISSENSCHAFTLICHER BEITRAG
Review of the literature on sports related clavicle fractures and analysis on the biomechanics of lesion Young Lae Moon, MD1,, Kyoung Il Lee, PhD2, Alberto M. Jacir, MD3, Louis U. Bigliani, MD3 1 Center for elbow, shoulder and sports medicine, Department of Orthopaedic Surgery, Chosun University Hospital, Gwangju, Korea, Korea 2 College of Physical Education, Chosun University, Gwangju, Korea 3 Center for elbow, shoulder and sports medicine, Center for Orthopaedic Research, Department of Orthopaedic Surgery, Columbia-Presbyterian Hospital, Columbia University, New York, USA
Hapkido is a traditional style of
Korean martial art. Its techniques consist of a series of kicks, falls, rolls and self-defense maneuvers that repel the attack of an opponent using expediently his own power (10). Like all other sports flaws in the technique can lead to injury. Clavicle fractures is a common injury in contact sports, described in athletes who are prone to high force impact of the shoulder griddle or falling on the out stretched hand (soccer, rugby, cycling, running). During the practice of hapkido there are certain techniques that if performed incorrectly can cause a high velocity force equal to that of body weight to fracture the clavicle through a direct blow onto the shoulder or indirectly by transmission of a compressive force from the elbow. Today the number of people who routinely practice Hapkido world wide is approximately 5 million, with the United States being second only to Korea in the number of athletes who perform this sport. The aim of this descriptive clinical study is to elaborate the various mechanisms of clavicle fractures rel-
Y. Lae Moon et al. Clavicle fractures through Hapkido training
ated to the practice of Hapkido, specifically describing the technical errors that can lead to injury and the biomechanical explanation of the fracture.
Patients and Methods During 1998 – 2000 a group of 12 athletes from a 500 student Hapkido academy in Gwangju, South Korea were described to have fractures of the clavicle directly related to the practice of this martial art. Their study includes 10 males and 2 females, whose ages ranged from 13–18 years. All the patients sustained middle third fracture of the clavicle corresponding to their dominant limb. The group consisted of first and second-degree black belt level athletes. The athletes were injured when performing either a ‘‘rolling’’ or ‘‘break fall’’ technique. Normally, these techniques are used by Hapkido practitioners to reduce the impact and avoid injury during a fall, when being thrown by an opponent or clearing an obstacle. However, to assess the mechanism
ARTICLE IN PRESS WISSENSCHAFTLICHER BEITRAG
of fracture, the instructor present during the event was asked to describe the exact body position of the athlete at the moment of injury. Taking into account the expertise of the instructor and confirming his observation with the patients, the incorrect body position used at the time of injury was reproduced with the collaboration of healthy well trained athletes to reproduce step by step the technique that led to the fracture. Diagnosis was obtained by clinical examination and confirmation using conventional anterior-posterior Xrays of the affected shoulder. To classify the clavicle fractures in order to evaluate treatment and prognosis the authors used Allman’s and Robinson’s classification for clavicle fractures (1,7). All cases were treated using conservative methods which consisted of a figure 8 brace for an average of 37 days (ranging from 27–48 days), with a first 72 hour follow-up and then weekly evaluations for adjustment and compliance verification of the immobilization bandage. The clinical out come for each patient was standardized using the Weitzman 7 shoulder function scale (11).
Results All the athletes evaluated were diagnosed with Allman group Ib clo-
sed mid-clavicle fractures of the right upper limb, being 10 of these classified as Robinson 2B1; simple or wedged comminuted fractures and the resting 2 as type 2A2; described as angulated fractures of the mid clavicle. Compliance to the method of treatment was well acceptable in all patients, with evidence of consolidation visualized within 10 weeks of initiating treatment on standard radio diagnostics for the shoulder. Clinical improvement and function of the shoulder girdle was objectively evaluated with scores defined as excellent in eight of the patients and good in the resting four. After a 2 years follow-up, all patients presented union and callus formation at the site of fracture with complete return to routine daily activities and a normal Hapkido training schedule. After evaluating the various techniques used at the time of injury, it was concluded that an improper execution of the break fall and roll technique led to the consequent fracture of the clavicle. Reproduction of the break fall technique showed a consistent error that led to compressive forces producing buckling of the fracture under a biomechanical model. The error consisted on falling not on the extended arm at 451 but falling instead on a flexed elbow. Analyzing the roll
Fig. 1 A. Proper roll technique absorbing the energy at fall B. Bad roll technique producing a blunt impact on the shoulder
technique a consistent error was also found, in which the athlete at the time of landing failed to complete the aerial roll with his body that would permit him to detain acceleration, in consequence producing a blunt impact on the shoulder (Fig. 1).
Discussion Hapkido is learned in academies where the level of expertise and training is identified by the belt color tied around at the waist of a traditional Korean uniform, the ‘‘Dobok.’’ Having a white belt designates the beginner level, and the black belt designated the most advanced level. To attain a black belt, a practitioner requires an average of 2 years of training with a consistent frequency of 3 sessions per week. The break fall technique is used to minimize the damage when falling from a certain height or when a throw technique is performed. There are many types of break fall techniques but we shall focus on the most common, those that provoke a side impact of the body with the ground. The correct technique dictates that the forces produced by the fall should be dissipated over a broad body area using the arm fully extended at an angle of 451, as well as the entire side of the body, leg and foot (Fig. 2). The error in the technique that leads to injury is in not fully extending the arm when landing on the ground, but doing so on a flexed elbow. This provokes a direct transmission of force from the elbow to the shoulder generating compressive forces in the clavicle causing it to buckle and subsequently fracture (Fig. 3). The roll techniques are used to escape a certain situation or to incorporate into a fighting stance. Rolls
Y. Lae Moon et al. Clavicle fractures through Hapkido training
31
ARTICLE IN PRESS WISSENSCHAFTLICHER BEITRAG
Fig. 2 The correct break fall technique absorb energy at the impact
Fig. 3 The bad break fall technique producing indirect mechanism of clavicle fracture
can be performed from aerial, walking, running, kneeling, seated and reclining position. The author’s main interest is the shoulder roll for distance, which is used to clear a
32
certain obstacle by leaping over it (Fig. 4). For the athlete to perform the shoulder roll for distance he must gain sufficient velocity, so when he
Y. Lae Moon et al. Clavicle fractures through Hapkido training
executes the forward diving thrust movement, his trajectory of motion is enough to clear the obstacle. In doing so he creates a momentum in which the force vector must be redirected when landing. To achieve this, the athlete must roll upon landing, not only redistributing the pressure sequentially along the dorsal aspect of the upper limb, torso and the lower extremity, but also creating enough friction to detain acceleration. The error in the technique consists in landing bluntly on the shoulder; this produces a transmission of the full body weight under a high velocity scenario onto the clavicle causing it to fracture (Fig. 5). Clavicle fractures correspond to 5 –15% of all fractures in the body with an incidence of 2.6% (6), they account for 41%-44% of shoulder griddle lesions of which 21.2% to 33% are sport’s related (6–8) and 85% are described to be produced from direct falls (2). The mid clavicle is the primary site for fracture as described by Nordqvist, Pedersen, Robinson, Nowak and Postacchini(3–7). They are classified as Allman group I or Robinson type 2 corresponding to approximately 69–81% of all clavicle fractures6,7. Further subgroup classification of Robertson type 2 or midshaft clavicle fractures shows that angulated 2A2 fractures represent 13.5% of all clavicle fractures and simple or wedged comminuted 2B1 fractures represents the leading type fracture pattern of the clavicle with a total of 37.5% of the population studied. Robinson et al. also reported the incidence (including site, fracture pattern and difference) between genders and outcome of sports related clavicle fractures (7). Of the total sport’s related clavicle fractures described 88.8% are localized in the mid clavicle, of which 45% is type 2B1 and 28.8% are type 2A2
ARTICLE IN PRESS WISSENSCHAFTLICHER BEITRAG
loading and with predisposition for the middle third to be the site of lesion (8,9). The two main mechanisms of lesion are direct blow 94% and falls on out stretched hand 6% (1,9). Stanley and collaborators described the forces that are able to produce clavicle fractures can be summarized using Fc ¼ p2EA/(L/r) 2 either by: a direct blow where the compressive forces are approximate to body weight or falling on an outstretch hand with the arm on coronal plane in relation to the body (9). If the arm is not on a coronal plane in relation to the body the scapula will be pushed upward and back ward producing a more likely a dislocation of the glenohumeral joint than a clavicle fracture. When falling on an out stretched hand or elbow the force is transmitted through the arm, onto the scapula passing through humeral head, the axial loading produces a compressive force between the acromion and sternum producing the clavicle to buckle at its weakest part the middle third and consequently fracture.
Fig. 4 The correct roll technique distribute energy at landing
Conclusion
Fig. 5 The bad roll technique producing direct mechanism of clavicle fracture
with a male to female ratio of 4.2:1 and 2.7:1 respectively, being 6.8:1 the general male to female ratio for sports related clavicle fractures. Approximately 90% of the population with this type of fracture patt-
ern had an uncomplicated outcome with conservative treatment. The anatomical relationships and morphology of the clavicle within the shoulder griddle leaves it at risk to fracture by means of compressive
With the increasing population of people practicing martial arts it is important to make emphasis on training under strict supervision of high ranking professionals in the style interested in. With proper supervision and progressive level of training, the techniques when correctly preformed protect the athlete from injury. The errors in the techniques described illustrate in vivo the 2 mechanisms biomechanically proven to produce fracture of the mid clavicle: a blunt high speed impact equal to body weight illustrated through the rolling technique and a falling on an out stretched hand with the arm on a
Y. Lae Moon et al. Clavicle fractures through Hapkido training
33
ARTICLE IN PRESS WISSENSCHAFTLICHER BEITRAG
coronal plane relative to the body shown using the break fall maneuver. The break fall and rolling techniques are not only practiced in Hapkido, but also are practiced in various other forms of martial arts including Aikido, Jujitsu and the Olympic level sport of Judo. (This study was supported by research funds from Special Fee for Medical Service at Chosun University Hospital, 2003.)
References 1 Allman Jr. FL (1967): Fractures and ligamentous injuries of the clavicle and its articulation. J Bone Joint Surg Am, 49 (4): 774–784 2 Nordqvist A, Petersson C (1994): The incidence of fractures of the clavicle. Clin Orthop Relat Res (300): 127–132
34
3 Nordqvist A, Petersson CJ, RedlundJohnell I (1998): Mid-clavicle fractures in adults: end result study after conservative treatment. J Orthop Trauma, 12 (8): 572–576 4 Nowak J, Mallmin H, Larsson S (2000): The aetiology and epidemiology of clavicular fractures. A prospective study during a two-year period in Uppsala, Sweden. Injury, 31 (5): 353–358 5 Pedersen MS, Kristiansen B, Thomsen F, Torholm C (1993): [Conservative treatment of clavicular fractures]. Ugeskr Laeger, 155 (47): 3832–3834 6 Postacchini F, Gumina S, De Santis P, Albo F (2002): Epidemiology of clavicle fractures. J Shoulder Elbow Surg, 11 (5): 452–456 7 Robinson CM (1998): Fractures of the clavicle in the adult. Epidemiology and classification. J Bone Joint Surg Br, 80 (3): 476–484 8 Rowe CR (1968): An atlas of anatomy and treatment of midclavicular fractures. Clin Orthop Relat Res, 58: 29–42
Y. Lae Moon et al. Clavicle fractures through Hapkido training
9 Stanley D, Trowbridge EA, Norris SH (1988): The mechanism of clavicular fracture. A clinical and biomechanical analysis. J Bone Joint Surg Br, 70 (3): 461–464 10 Tedeschi, M.: Hapkido: Traditions, Philosophy, Technique : Traditions, Philosophy, Technique Edited, 1136, Trumbull, Weatherhill, 2000. 11 Weitzman G (1967): Treatment of acute acromioclavicular joint dislocation by a modified Bosworth method: Report on twenty-four cases. J.Bone and Joint surg, 49–A: 1167–1178
Korrespondenzadresse: Y. L. Moon, MD Chosun University Hospital Orthopaedic Department 588, Seoseok-dong, Seo-ku, Gwangju, 501–717, South Korea e-mail: [email protected] (Y. Lae Moon).