STUDY DESIGN: Retrospective cohort study. OBJECTIVE: To evaluate falls among elective orthopaedic inpatients at a musculoskeletal hospital. BACKGROUND: Falls are the most commonly reported hospital incidents. Approximately 30% of in-hospital falls result in minor injury, and up to 8% of falls result in moderate to severe injury. Given the projected rise in elective orthopaedic procedures, it is important to better understand fall patterns in this population. METHODS: A retrospective review of electronic medical records and patient charts (2000-2009) was conducted to identify falls in patients admitted for elective orthopaedic procedures. RESULTS: There were 868 falls among orthopaedic patients older than 18 years. The fall rate was 0.9% of admissions, or 2.0 falls per 1000 inpatient days. The average age of the patients who had fallen was 68 years, and 57.6% were women. Knee replacements (38.2%), spine procedures (18.5%), and hip replacements (14.7%) were the procedures most commonly associated with falls. Three hundred eighty-six falls (45.8%) involved bathroom usage. One hundred ten first falls (13.1%) resulted in injuries. Twenty-eight falls (3.3%) resulted in serious events, including 5 returns to the operating room, 3 transfers to a higher level of care, 14 prosthesis dislocations, 6 fractures, 2 intracranial bleeds, and 1 hemorrhage. Patients with serious injuries were more likely to fall earlier (mean postoperative days, 2.7 versus 4.1; mean difference, 1.4 days; 95% confidence interval: 0.51, 2.3; P = .003) and to have had hip replacement (odds ratio = 3.7; 95% confidence interval: 1.7, 8.2). Serious injuries were not associated with body mass index, age, gender, hospital location, day, or fall history. CONCLUSION: Falls are avoidable events that are poorly described among orthopaedic patients having elective procedures. This large series identifies hip replacement patients as being at almost 4-fold risk of having a serious adverse event after falling. Larger prospective trials are needed to confirm results and to inform prevention strategies.

J Orthop Sports Phys Ther 2013;43(2):91-96. Epub 14 January 2013. doi:10.2519/jospt.2013.4349

KEY WORDS: adverse event, fear-avoidance, hip replacement, injury, inpatient care, postoperative risk

STUDY DESIGN: Controlled laboratory study. OBJECTIVES: To quantify phase duration and lower extremity muscle activation and alignment during the most common types of soccer kick - the instep kick and side-foot kick. A second purpose was to test the hypotheses that different patterns of lower extremity muscle activation occur between the 2 types of kicks and between the kicking limb compared to the support limb. BACKGROUND: Soccer players are at risk for lower extremity injury, especially at the knee. Kicking the soccer ball is an essential, common, and distinctive part of a soccer player's activity that plays a role in soccer player injury. Regaining the ability to kick is also essential for soccer athletes to return to play after injury. METHODS: Thirteen male soccer players underwent video motion analysis and eletromyography (EMG) of 7 muscles in both the kicking and supporting lower extremity (iliacus, gluteus maximus, gluteus medius, vastus lateralis, vastus medialis, hamstrings, gastrocnemius) and 2 additional muscles in the kicking limb only (hip adductors, tibialis anterior). Five instep and 5 side-foot kicks were recorded for each player. Analysis-of-variance models were used to compare EMG activity between type of kicks and between the kicking and nonkicking lower extremity. RESULTS: Five phases of kicking were identified: (1) preparation, (2) backswing, (3) limb cocking, (4) acceleration, and (5) follow-through. Comparing the kicking limb between the 2 types of kick, significant interaction effects were identified for the hamstrings (P = .02) and the tibialis anterior (P‹.01). Greater activation of the kicking limb iliacus (P‹.01), gastrocnemius (P‹.01), vastus medialis (P = .016), and hip adductors (P‹.01) occurred during the instep kick. Significant differences were seen between the kicking limb and the support limb for all muscles during both types of kick. CONCLUSIONS: Certain lower extremity muscle groups face different demands during the soccer instep kick compared to the soccer side-foot kick. Similarly, the support limb muscles face different demands than the kicking limb during both kicks. Better definition of lower extremity function during kicking provides a basis for improved insight into soccer player performance, injury prevention, and rehabilitation.

J Orthop Sports Phys Ther. 2007;37(5):260-268; published online 15 March 2007. doi:10.2519/jospt.2007.2255

KEY WORDS: football, kicking, motion analysis