Foto: Amy Timacheff. Dr. Ezequiel R. Rodríguez Rey Emergency Dept. 30th FIMS World Congress Barcelona Nov. 2008

Transcription

1 Acute Injuries in Olympic Fencing: Athens 2004 and Beijing 2008 Foto: Amy Timacheff Dr. Ezequiel R. Rodríguez Rey Emergency Dept. 30th FIMS World Congress Barcelona Nov. 2008

2 1. Introduction Fencing: an armed combat sport International Olympic Committee (IOC) and International Fencing Federation/ Fédération internationale d escrime (FIE) Combat sport, one on one (individual and team events) 10 titles in Athens 2004, 10 titles in Beijing Three weapons, 3 sets of rules, 3 different tactics: 1. Foil: tip hit, valid only on torso. 2. Epée: tip hit, whole body is valid. 3. Sabre: tip, edge and counteredge hit, valid only from the waist up.

3 FIE-specified Protective Equipment FIE-specific weapon blades and Protective Equipment for head, body, extremities- except unarmed hand. Mandatory for international competition. Mask with metal grid or transparent polycarbonate plastic of 1600 N resistance. Kevlar Pants, half-sleeve and jacket with 800 N resistance. Padded gloves, padded socks and shoes. Hits are scored with tip or blade on valid surfaces. In case of injury, the team doctor or local healthcare team has a maximum of 10 min. to either enable the fencer to continue or to have to abandon competition due to this injury.

4 Competition pattern Fencer 1 Fencer 8 Fencer 3 Fencer 6 Fencer 4 Fencer 5 Fencer 2 Fencer 7 Gold Silver Bronze Photo: Serge Timacheff Qualified athletes trim down by Direct Elimination (DE) to field of 32 DE fencers: 1 st ranked vs. 32 nd ranked, 2 nd vs. 31 st, 3 rd vs. 30 th, etc. Bouts of 3 periods of each 3 combat time and 1 rest or 15 hits scored. Sudden death pattern and at most 5 bouts for the medal finalists set the scene for a very short, but very intense competition.

5 2. Objectives The study aimed at identifying the injury pattern of the specific Olympic Games competition. Statistics collected at the Athens 2004 O.G. were compared with those of the Beijing 2008 O.G., to update information. Once identified, suggestions concerning the improvement of athlete safety would be issued.

6 3. Material and Methods Standard International Fencing Federation (FIE)- Competition Healthcare Register in cooperation with the local medical teams (ATHOC 2004 and BOCOG 2008): sequential number, date, weapon, diagnosis and hospital referral, if necessary. Athens 2004 Olympic Games Organizing Committee (ATHOC 2004): N = 324 and 10 Olympic titles (Gold medals) in competition (no Women s Team Foil nor Women s Team Sabre). Beijing 2008 Olympic Games Organizing Committee (BOCOG 2008): N = 335 and 10 Olympic titles (Gold medals) in competition (no Men s Team Foil nor Women s Team Epée). Only trauma cases in competition have been included: excluded were all cases during training sessions unreported by the team doctors and all medical cases. Main injury types, anatomic distribution and relative percentages were noted: Head and neck (H), Spine (SP), Upper Extremity (UE), Lower Extremity (LE).

7 4. Results I OLYMPIC GAMES ATHENS 2004 (A) Anatomic Distribution Diagnosis Grand Total Lower Extremity Cramps LE 1 Foot blunt trauma 1 Knee sprain 4 Ankle sprain 5 Knee pain 2 Incisive/ blunt wound LE 2 Mialgy LE 1 Achillean Tendinitis 1 LE Total 17 Spine Neck pain 1 Lower back pain 4 SP Total 5 Upper Extremity Hand blunt trauma 1 Elbow sprain 3 Wrist sprain 1 Wrist fracture 1 Hand incisive/ blunt wound 3 Shoulder Tendinitis 2 UE Total 11 Head Ocular foreign body 1 Head Total 1 Trauma Care Total 34

8 Results II OLYMPIC GAMES BEIJING 2008 (B) Anatomic Distribution Diagnosis Grand Total Lower Extremity Ankle sprain 6 LL contusion 3 Muscle tear 1 Knee meniscus laesion 1 Forefoot sprain 1 LE Total 12 Spine 0 Spine Total 0 Upper Extremity Shoulder dislocation 1 Wrist arthritis 1 Hand Laceration/abrasive wound 5 Thumb sprain 1 Hand contusion 5 UE Total 13 Head 0 Head Total 0 Trauma Care Total 25 Previous Injury

9 Results III Olympic Games Athens 2004 Olympic Games Beijing % 32% 48% 0% 50% 52% 15% Top 5 injury types Total recorded: 34 cases 5 ankle sprains 4 knee sprains 4 lower back pains 3 elbow sprains 3 hand lacerations Head/neck UE Spine LE 0% Top 5 injury types Total recorded: 25 cases 6 ankle sprains 5 hand lacerations 5 hand contusions 3 lower extrem. contusion 1 shoulder dislocation

10 5. Discussion No life-threatening injuries were recorded in either competition: no penetrating wounds to head, neck, thorax nor abdomen. Most injuries only required minimum intervention by the team doctors and the athletes were able to continue fencing. Despite similar N, (A) Athens 324, (B) Beijing 335, an important decrease in recorded injuries was observed: A 34, B 25. The most frequent classic injury in Fencing, the ankle sprain, mostly of the posterior and thrusting foot, appeared as foremost in both competitions (percentages regarding the total recorded injuries): A 14,7%, B 24%. A sharp rise in the percentage of hand lacerations (mostly of the unarmed and unprotected hand) was observed in the Beijing Games, were Sabre was the weapon with complete medal titles (4): A 8,8%, B 20%. A classic frequent injury type in Fencing, lower back pain, recorded in Athens, where Epée was the complete medal weapon, disappeared from the records in the Beijing Games.

11 Discussion II Three cases registered in Beijing 2008 which required abandon of competition (shoulder dislocation, hamstring muscle tear, meniscus laesion) were relapses of previous injury. The most serious injury recorded in Athens was in the Men s Team Sabre: a laceration of the gloved hand which was dressed in the 10 min. period, the fencer finishing the bout. Suture of the wound followed and the fencer competed in the final 6 hours later, winning the Gold medal. The most serious injury recorded in Beijing was in the Women s Individual Sabre: the anterior shoulder dislocation of the unarmed UE (!): this was the 4 th episode of the injury, all previous 3 having been only reduced, without observing orthopaedic treatment. The 10 min. period allowed by the rules was insufficient to solve the case and the fencer was unable to continue. Hospital transfer ensued, with reduction of the dislocation with pre- and post- reduction X-rays and Velpeau dressing. The fencer underwent surgery after the Olympiad.

12 Conclusions Olympic Fencing is a safe armed combat sport, provided the required equipment is used. The FIE-approved equipment has been proven effective in curbing the incidence of life-threatening, penetrating laesions to head, neck, thorax and abdomen. Despite the large volume of competitors, injuries are few and mostly minor, allowing the athlete to continue fencing. More serious injures, forcing a drop out of competition, are often a relapse of previous injury. The Ankle Sprain is still the most frequent injury, probably requiring future modification of the (posterior) shoe ankle support. The absence of lower back pain in events where Epée has a reduction of competition might point out the relation between increased flexo-extensionextension in this weapon as compared to others. Specific back and abdomen strengthening exercises might be indicated. The increase of hand lacerations, mostly in the uncovered hand and most in Sabre, may indicate future addition of protection to the FIE equipment list.