RETURN TO PLAY GUIDELINES AFTER A HEAD INJURY - 09/09/11

Doi : 10.1016/S0278-5919(05)70060-0

Robert C. Cantu, MD, FACS, FACSM ^{^{*
Neurosurgery Service and the Service of Sports Medicine, Emerson Hospital, Concord, Massachusetts}}

Résumé

The brain and spinal cord are incapable of regeneration. Although many parts of the body can now be replaced with organ transplantation or artificial hardware, this is not possible for the brain. Brain injuries are one of the most common catastrophic athletic injuries and the leading cause of athletic death.

According to the catastrophic sports injury registry, sports that have the greatest chance of causing catastrophic head injury per 100,000 participants include football, gymnastics, ice hockey, and wrestling.^{6 Cantu R.C., Mueller F. Catastrophic spine injury in football 1977–1989 J Spinal Disord 1990 ; 3 : 227-231

Cliquez ici pour aller à la section Références} In football, the use of the head in making a tackle is the most common cause of head injury; in gymnastics, it is the dismount in which one accidentally lands on the head; in wrestling, it is landing on the head in the process of the take-down; and in ice hockey, it is striking the boards head first. Other school sports that entail a significant chance for head injury include the pole vault in track and the head-first slide in baseball.

Although the risk of death appears a third that of football, boxing, especially professional boxing (see the article by Dr. Allan Ryan elsewhere in this issue) is the other sporting activity with a high number of deaths recorded.

Other sporting activities with significant risk for head injury include equestrian sports, especially horse racing^{3 Barber H.M. Horse-play: Survey of accidents with horses BMJ 1973 ; 3 : 532-534 [cross-ref]

Cliquez ici pour aller à la section Références, 4 Barclay W.R. Equestrian Sports JAMA 1978 ; 240 : 1892-1893

Cliquez ici pour aller à la section Références}; motorcycle, automobile, and boat racing^{5 Bodnar L.M. Sports medicine with reference to back and neck injuries Current Practice of Orthopedic Surgery 1977 ; 7 : 116-153

Cliquez ici pour aller à la section Références, 7 Clarke K., Braslow A. Football fatalities: Actuarial perspective Med Sci Sports Exerc 1979 ; 10 : 94

Cliquez ici pour aller à la section Références}; sky diving^{20 Krel F.W. Parachuting for sport—study of 100 deaths JAMA 1965 ; 194 : 264-268

Cliquez ici pour aller à la section Références, 27 Petras A.F., Hoffman E.P. Roentgenographic skeletal injury patterns in parachute jumping Am J Sports Med 1983 ; 11 : 325-328 [cross-ref]

Cliquez ici pour aller à la section Références}; boxing^{28 Putnam P. Going-going-gone Sports Illustrated June 1983 ; 6 : 23-46

Cliquez ici pour aller à la section Références}; the martial arts^{24 McLatchie G.R., Davies J.E., Caulley J.H. Injuries in karate, a case for medical control J Trauma 1980 ; 2 : 956-958 [cross-ref]

Cliquez ici pour aller à la section Références}; and rugby.^{23 McCoy G.F., Piggot J., Macafee A.L. , et al. Injuries of the cervical spine in schoolboy rugby football J Bone Joint Surg 1984 ; 66B : 500-503

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Sports that carry a risk for catastrophic head injury pose an even greater risk for minor head injuries. Football, because it is participated in by more than 1.5 million high school and college athletes, causes more minor head injuries than any other single sport. The incidence is estimated to be 250,000 per year or approximately 20%.^{10 Gerberich S.G., Priest J.D., Boen J.R. , et al. Concussion incidences and severity in secondary school varsity football players Am J Public Health 1983 ; 73 : 1370-1375 [cross-ref]

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