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ORIGINAL ARTICLE
Year : 2019  |  Volume : 22  |  Issue : 4  |  Page : 492-495

Tibial fractures following participation in recreational football: Incidence and outcome


Department of Surgery, Federal Medical Centre, Birnin Kebbi, Kebbi State, Nigeria

Date of Acceptance18-Dec-2018
Date of Web Publication11-Apr-2019

Correspondence Address:
Dr. C Nwosu
Department of Surgery, Federal Medical Centre, Birnin Kebbi, Kebbi State
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/njcp.njcp_148_18

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   Abstract 


Background: Football is responsible for 3.5%–10% of all injuries treated in hospital, but this may reflect the popularity of the sport rather than its dangers. Young people are particularly at risk of sports injury because of high levels of exposure at a time of major physiological change. Soccer players are susceptible to a variety of injuries due to contact, aggressive tackle, and high-speed collisions. Aims: The aim of this study was to determine the pattern of presentation, treatment, and outcome of tibial fractures following participation in recreational football activity; with the hope that knowledge gained from this study will help in preventing or reducing its occurrence. Patients and Methods: This is a retrospective study of all cases of tibial fractures following participation in recreational football presenting to the Orthopedic Unit of Federal Medical Center and Surgery Department of Sir Yahaya Memorial Hospital all in Birnin Kebbi, Kebbi State, north western Nigeria; from January 2012 to December 2017. Data were extracted from the accident and emergency register, operation register, and patients' case folders on biodata, diagnosis, mechanism of injury, associated injuries, type of surgical procedure, site of surgery, date of surgery, and postoperative complications. Data collected were analyzed using the Statistical Package for Social Sciences for Windows version 22. Results were presented with descriptive statistics. Results: In total, 37 patients were included in the study. All of them were males. The age range is from 14 to 33 years with mean age of 23.6. 17 (45.9%) of the patients are in the 21- to 30-year age group. The right tibia was affected in 34 (91.9%) patients. None of the patients used shin guard. The mechanism of injury in all the cases was direct contact. About 31 (83.8%) of the fractures were closed. Seven (18.9%) of these patients were discharged against medical advice. Nineteen (51.3%) patients were managed nonoperatively with plaster of Paris casts. Ten (27.1%) of these patients had internal fixation with locked intramedullary nail. Conclusion: Tibial fractures following football occur mostly in males especially adolescents and youths. The right tibia was commonly affected and most of the injuries are closed. The most common mechanism of injury was direct contact.

Keywords: Football injuries, shin guards, soccer related fracture, tibial fracture


How to cite this article:
Nwosu C. Tibial fractures following participation in recreational football: Incidence and outcome. Niger J Clin Pract 2019;22:492-5

How to cite this URL:
Nwosu C. Tibial fractures following participation in recreational football: Incidence and outcome. Niger J Clin Pract [serial online] 2019 [cited 2019 Jun 17];22:492-5. Available from: http://www.njcponline.com/text.asp?2019/22/4/492/255917




   Introduction Top


Football (soccer) is the most popular sport in the world, with over 270 million participants, and it is also the sport that is most frequently played by people under 18 years of age.[1] Football players are known to suffer relatively high rates of injury compared with participants in other sports.[2] Soccer players are susceptible to a variety of injuries due to contact, aggressive tackle, and high-speed collisions.[3] Young people are particularly at risk of sports injury because of high levels of exposure at a time of major physiological change.[4] Football is not only popular in Africa but is also part of the continent's social fabric.[5] In the UK, it is estimated that about 10% of the adult population play football at least once a year.[6]

Football is responsible for 3.5%–10% of all injuries treated in hospital, but this may reflect the popularity of the sport rather than its dangers.[7] The rise in youth soccer participation, and the subsequent cost associated with injuries, places an enormous economic pressure on the health care system.[8] Although the surgical treatment of tibial shaft fractures has changed considerably over the past 20 years, their management continues to be greatly influenced by the type of fracture, the surrounding soft tissues, the general health of the patient, the motivation and compliance of the patient with rehabilitation, and the expectations of the patient.[9] The treatment of tibial shaft fractures poses a therapeutic challenge to the orthopedic surgeon: operative risks, such as wound infection, delayed union, or non-union, may “raise the price” one may pay for anatomic reduction, early mobilization, and preservation of functional capacity obtained by surgical treatment; on the other hand, the immobilization associated with conservative treatment has its own risks and disadvantages, such as muscle wasting, loss of joint movement, shortening of the leg, malunion, or compartment syndrome of the leg.[10] Athletic patients with undisplaced fractures may benefit from primary surgical management to avoid the deconditioning associated with cast management and to promote earlier return to sporting activities.[11]

A set of programs such as core stability, proprioception and strength training, dynamic stretching, protective and suitable equipment, appropriate surface as well as appropriate training, adequate recovery, psychology, and nutrition have been described as main components of injury prevention and rehabilitation in football.[12] From a player point of view, at whatever level of play, be it at school or as a highly paid professional, avoiding and reducing injury severity is very important; thus, an understanding of injury incidence, mechanisms of injury, and prevention strategies are, therefore, essential to achieve that outcome.[13] Fédération Internationale de Football Association (FIFA), the sport's international governing body, has developed various preventive strategies to control the injury risk through measures directed at the game's physical aspects (the facility, equipment, and environment), management aspects (e.g., laws of the game), or human aspects (e.g., player behavior); one of the strategies was the introduction of the shin guard law in 1990, which made the wearing of shin guards compulsory during matches.[14]

The aim of this study was to determine the pattern of presentation and short-term treatment outcome of tibial fractures following participation in recreational football activity; with the hope that knowledge gained from this study will help in creating awareness for this problem and reduce its occurrence.


   Patients and Methods Top


This is a retrospective study of all cases of tibial fractures following participation in recreational football presenting to the Orthopedic Unit of Federal Medical Center and Surgery department of Sir Yahaya Memorial Hospital all in Birnin Kebbi, Kebbi State, north western Nigeria; from January 2012 to December 2017. Data were extracted from the accident and emergency register and patients' case folders on biodata, duration of injury, diagnosis, mechanism and site of injury, associated injuries, type of surgical procedure, time between presentation and surgery, and postoperative complications. Only files of patients with complete medical records were included in this study. All information obtained was treated with strict confidentiality. Data collected were analyzed using the Statistical Package for Social Sciences for Windows version 22 (SPSS Inc., Chicago, IL). Results were presented with descriptive statistics.


   Results Top


In total, 37 patients were included in the study. All of them were males. The age range is from 14 to 33 years with mean age of 23.6 years. Seventeen (45.9%) of the patients are in the 21- to 30-year age group. See [Table 1]. All the patients were amateur football players. The right tibia was affected in 34 (91.9%) patients, whereas the left tibia was affected in 3 (8.1%) patients. The fibula was not affected in all the cases. None of the patients used shin guard. The mechanism of injury in all the cases was direct contact. None of the patients presented with other associated injuries. Thirty-five (95.7%) of these patients presented within 48 h from time of injury, whereas 2 (5.4%) presented after 48 h. The average duration of hospital stay was 6 days.
Table 1: Age distribution of the affected patients

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Thirty-one (83.8%) of the fractures were closed, whereas 6 (16.2%) of the fractures were open. The open fractures were all Gustillo Anderson type 1 fractures. All the fractures were diaphyseal in nature.

Seven (18.9%) of these patients were discharged against medical advice. Among these patients, 5 (71.4%) of them were discharged due to preference for traditional bone setter's treatment, whereas 2 (28.6%) was due to financial constraints.

Nineteen (51.3%) patients were managed nonoperatively with plaster of Paris (POP) casts. Above knee POP casts were applied by a qualified plaster technician. They were placed on nonweight-bearing ambulation with bilateral axillary crutches till callus was visible at the fracture site, usually after 6 weeks. This was then converted to patella tendon bearing cast. Patient was then placed on graduated weight bearing till union was achieved with subsequent removal of the patella tendon bearing cast. The patients were instructed by a physiotherapist. The mean time to fracture union was 18 weeks.

Ten (27.1%) of these patients had internal fixation with locked intramedullary nail. See [Table 2]. One of them developed wound infection which was managed conservatively with wound care and antibiotics. All the patients managed nonoperatively and with intramedullary nailing achieved clinical and radiological union.
Table 2: Treatment method

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One of these patients presented with wet gangrene of the right leg after failed intervention by a traditional bone setter as a result of tight splint application. He had above knee amputation. The mean follow-up duration was 14 weeks and all the patients reported good function in the affected limb.


   Discussion Top


Since soccer is a contact sport, the kicking leg can produce severe injuries during missed kicks or slide tackles; the energy may be transmitted to an opponent's lower leg, resulting in a fracture.[15] This study showed some congruity and variance when compared with the few studies available on this widely played sport. All the patients in this study were males. This is similar to the findings of Vriend et al.,[14] but in contrast with the findings of Lenehan et al.,[9] and Cattermole et al.,[7] who reported 4% and 18% female involvement, respectively. This may be due to the conservative nature of the study population whereby female socialization is restricted. The patients consist of adolescents and youths. This is similar to the findings of Chang et al.[6] and Kolstrup.[16] This may be due to the fact that they are the ones mostly involved in recreational football activity.

Only the tibia was fractured in this study. This is in contrast with the findings of Chang et al.[6] and Vanlommel et al.,[17] who reported associated fibular fractures. This may be due to the low-energy nature of the injuries in this study. The right leg was commonly involved in this study. This is similar to the findings of Chang et al.,[6] Lenehan et al.,[9] Vanlommel et al.,[17] and Boden et al.[15] This is probably due to the fact that the right lower limb is the dominant limb in most people. The commonest mechanism of injury was direct contact. This is similar to the findings of Lenehan et al.,[9] Vanlommel et al.,[17] and Boden et al.[15] There was no associated injury in all the patients which is similar to the findings of Chang et al.[6] and Lenehan et al.[9] This may also be due to the low-energy nature of the injury. Most of the patients presented with closed injuries. This is similar to the findings of Boden et al.,[15] but in contrast with the findings of Chang et al.[6] and Vanlommel et al.,[17] who reported closed fractures in all their patients. This may be due to the use of shin guards among their patients. No patient in this study used shin guards. This is in contrast with the findings of Chang et al.,[6] Lenehan et al.,[9] Vanlommel et al.,[17] and Boden et al.,[15] who reported 95%, 36%, 90%, and 83.5%, respectively, use of shin guards among their patients. However, these patients still had fracture of the tibia; suggesting that the use of shin guards does not eliminate the risk of tibial fracture during football matches. The open injuries in this study were all type 1 Gustillo Anderson classification. This is in line with the findings of Lenehan et al.[9] and Boden et al.,[15] further suggesting that they are low-energy injuries.

The most common form of treatment in this study is manipulation under anesthesia and casting. This is similar to the findings of Chang et al.[6] and Boden et al.[15] This is probably because the fractures are not displaced or minimally displaced being low-energy injuries. Ten (27.1%) of the patients in this study had intramedullary nailing for their fractures. This is similar to the findings of Chang et al.,[6] Lenehan et al.,[9] and Vanlommel et al.[17] They also reported using plate and screws to fix some of the tibial fractures, which was not done in this study. The only complication in this study was wound infection. This is at variance with the findings of Chang et al.,[6] Vanlommel et al.,[17] and Boden et al.,[15] who reported anterior knee pain, fracture displacement following POP application, and compartment syndrome, respectively. Some of the patients in this study left the hospital against medical advice due to either preference for traditional bone setter treatment or financial constraint. This is one of the challenges faced by surgeons especially in developing countries. One of the patients in this study presented with right leg and foot gangrene following mismanagement by traditional bone setters. These are part of the peculiarities evident in medical practice especially in resource poor countries.


   Conclusion Top


Tibial fractures following football occurred mostly in males especially adolescents and youths. The right tibia was commonly affected and most of the injuries were closed. The most common mechanism of injury was direct contact and there were no associated injuries. Most of the patients had manipulation and casting followed by intramedullary nailing. Wound infection was the only complication.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

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Faude O, Rößler R, Junge A. Football injuries in children and adolescent players: Are there clues for prevention? Sports Med 2013;43:819-37.  Back to cited text no. 1
    
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Owoeye OB, Akinbo SR, Olawale OA, Tella BA, Ibeabuchi NM. Injury prevention in football: Knowledge and behaviour of players and availability of medical care in a Nigerian youth football league. S Afr J SM 2013;25:77-80.  Back to cited text no. 4
    
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Chang WR, Kapasi Z, Daisley S, Leach WJ. Tibial shaft fractures in football players. J Orthop Surg Res 2007;2:11.  Back to cited text no. 6
    
7.
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8.
Maffulli N, Caine DJ, editors. Epidemiology of Pediatric Sports Injuries: Team Sports. Vol 49. Med Sport Sci. Basel, Karger; 2005. p. 140-6.  Back to cited text no. 8
    
9.
Lenehan B, Fleming P, Walsh S, Kaar K. Tibial shaft fractures in amateur footballers. Br J Sports Med 2003;37:176-8.  Back to cited text no. 9
    
10.
Salai M, Blankstein A, Israeli A, Chechik A, Amit Y, Horoszowski H. Closed intramedullary nailing of tibial fractures in sportsmen. Br J Sports Med 1988;22:82.  Back to cited text no. 10
    
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Robertson GAJ, Aitken SA, Wood AM. The management of sport-related fractures: operative versus non-operative management. Trauma 2017;22:182-9.  Back to cited text no. 11
    
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13.
Demitri C. Football injuries-surveillance, incidence and prevention. Contin Med Educ 2010;28:219-25.  Back to cited text no. 13
    
14.
Vriend I, Valkenberg H, Schoots W, Goudswaard GJ, Meulen W, Backx F. Shinguards effective in preventing lower leg injuries in football: Population-based trend analyses in over 25 cases. J Sci Med Sport 2015;18:518-22.  Back to cited text no. 14
    
15.
Boden BP, Lohnes JH, Nunley JA, Garrett WE. Tibia and fibula fractures in soccer players. Knee Surg Sports Traumatol Arthrosc 1999;7:262-6.  Back to cited text no. 15
    
16.
Kolstrup LA, Koopmann KU, Nygaard UH, Nygaard RH, Agger P. Injuries during football tournaments in 45,000 children and adolescents. Eur J Sport Sci 2016;16:1167-75.  Back to cited text no. 16
    
17.
Vanlommel L, Vanlommel J, Bollars P, Quisquater L, Van Crombrugge K, Corten K, et al. Incidence and risk factors of lower leg fractures in Belgian soccer players. Injury 2013;44:1847-50.  Back to cited text no. 17
    



 
 
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