Sports traumatology

Historical background and development of subdisciplines

Traumatology and orthopedics have come a long way in their evolution, during which a number of highly specialized subdisciplines emerged. Russian scientists have made a tremendous contribution to the development of this discipline. For instance, the problem of arthroplasty was successfully developed thanks to the works of A.V. Kaplan, Ya.L. Tsivyan, and A.A. Korzh. The fundamental research of K.M. Sivash, which laid the modern foundations for total hip arthroplasty, received worldwide recognition.

Concurrently, pediatric traumatology and orthopedics developed, inextricably linked with the names of N.N. Priorov, M.V. Volkov, P.Ya. Fishchenko, V.D. Dedova, and O.P. Malakhov. Due to demographic changes and the relevance of the issue in the modern world, special attention began to be paid to gerontology in traumatology (A.V. Kaplan, M.O. Fridland, V.A. Chernavsky, V.G. Vainshtein, F.R. Bogdanov, I.V. Shumada).

In the 1990s, disaster medicine was formed based on the experience of mitigating the consequences of emergencies (natural and man-made) and local military conflicts. Its pioneers were orthopedic traumatologists V.V. Azolov, V.M. Rozinov, A.V. Garkavi, and L.L. Silin. Mechanical and thermal injuries play a leading role in this branch.

Meanwhile, sports and ballet injuries emerged as an independent branch much earlier: in 1952, the first specialized department was opened at CITO, led by Z.A. Mironova.

The concept of injury and injury mechanisms

The discipline is based on the concept of injury. This is the impact of various external factors on the body that inevitably leads to a disruption of the anatomical integrity of tissues, changes in their structure, and a failure of physiological functions.

Depending on the timing and frequency of exposure to the damaging agent, injuries are divided into two main groups:

• Acute injuries — develop as a result of a sudden and simultaneous impact of an external factor on tissues.
• Chronic injuries — are the consequence of repeated, constant, but low-intensity exposure of the exact same agent to a strictly defined part of the body.

According to the type of damaging factor, injuries are classified into mechanical (which are the main focus of study within sports traumatology), thermal, chemical, radiation, biological, and others.

The final effect and severity of the external damaging agent's action are determined by four key factors:

1. Nature of the impact.
2. Duration of contact.
3. Direction of the traumatic force.
4. Kinetic energy of the agent.

Mechanical injuries are also classified depending on the point of force application. In a direct injury, the damage occurs immediately at the zone of force application. In an indirect injury, anatomical disruptions are localized away from the site of the direct impact of the traumatic force.

Patient management specifics and return to physical activity

A critical aspect of sports traumatology is determining rehabilitation timelines. Returning to full sports activities after major injuries is recommended no earlier than 10–12 weeks later. At the same time, some authors adhere to a more conservative approach and do not recommend returning to sports earlier than 4 months.

Using patellar dislocation as an example, we can examine approaches to prevention and risk assessment. Specific prevention for this pathology has not been developed to date. Patients are given a basic recommendation: strictly adhere to general rules of injury prevention in everyday life, at work, and during sports. This recommendation has a level of conviction of C (level of evidence reliability — 5).

To objectively assess the risk of recurrent patellar dislocation in clinical practice, a specialized Patella Instability Severity Score (PISS [Patella Instability Severity Score]) is used. This tool falls under additional information that directly influences the prognosis of the disease outcome.

Organization of medical care and quality criteria

The provision of care to injured athletes is strictly regulated. There are clear indications for hospitalization in a medical organization:

• Emergency hospitalization is indicated in the presence of hemarthrosis or a justified suspicion of osteochondral injuries of the knee joint structures.
• Scheduled hospitalization is performed to carry out surgical treatment in cases where there are no indications for emergency intervention.

Discharge of a patient from the inpatient facility is possible only upon achieving the following criteria: successful reduction of the patellar dislocation, reliable immobilization of the knee joint, general stabilization of the condition, complete absence of early postoperative complications, and sufficient patient mobilization.

At the primary health care stage, the main quality assessment criterion (evaluated as "Yes/No") is the fact of scheduling an initial appointment, which includes an examination and consultation with a relevant specialist. Such a specialist can be an orthopedic traumatologist, a surgeon, or a pediatric surgeon.

Class and exam questions

What else to study on this topic

• Total hip arthroplasty and the contribution of K.M. Sivash
• Specifics and history of the development of pediatric traumatology and orthopedics
• The role of gerontology in modern traumatology
• The formation of disaster medicine: treatment of combined mechanical and thermal injuries
• Assessment of the quality of primary health care provided for injuries

Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.