Michael J. Stuart MDMichael J. Stuart MDProfessor of Orthopedic Surgery, Mayo Professor of Orthopedic Surgery, Mayo
ClinicClinicChief Medical Officer, USA HockeyChief Medical Officer, USA Hockey
Michael J. Stuart MDMichael J. Stuart MDProfessor of Orthopedic Surgery, Mayo Professor of Orthopedic Surgery, Mayo
ClinicClinicChief Medical Officer, USA HockeyChief Medical Officer, USA Hockey
Neck LacerationNeck Lacerationfrom a Skate Bladefrom a Skate BladeNeck LacerationNeck Laceration
from a Skate Bladefrom a Skate Blade
Thank YouThank You
Alan AshareAlan Ashare Aynsley Aynsley SmithSmithRae Briggle Rae Briggle Andy Link Andy Link Harry ThompsonHarry Thompson Dirk Dirk LarsonLarson
Matt Matt SorensonSorenson
• USA Hockey USA Hockey • SPECSPEC• Mayo Clinic Sports Medicine CenterMayo Clinic Sports Medicine Center• Mayo Clinic Survey Research CenterMayo Clinic Survey Research Center
• USA Hockey USA Hockey • SPECSPEC• Mayo Clinic Sports Medicine CenterMayo Clinic Sports Medicine Center• Mayo Clinic Survey Research CenterMayo Clinic Survey Research Center
Neck Laceration Neck Laceration
• Caused by a skate bladeCaused by a skate blade• Players standing or lying on Players standing or lying on the icethe ice• Rarely reportedRarely reported• Potentially catastrophicPotentially catastrophic proximity of proximity of
nervesnerves, , arteriesarteries, , veinsveins, , airwayairway
proximity of proximity of nervesnerves, , arteriesarteries, , veinsveins, , airwayairway
Neck Laceration from a Skate Neck Laceration from a Skate
BladeBladeBoston, MABoston, MA
December 2, December 2, 19751975
Neck Laceration from a Skate Neck Laceration from a Skate BladeBlade
Boston, MABoston, MADecember 2, December 2, 19751975
18 year old18 year old defenseman for New defenseman for New Preparatory School Preparatory School of Cambridge of Cambridge died died after falling on a after falling on a skate during a skate during a practice game.practice game.
18 year old18 year old defenseman for New defenseman for New Preparatory School Preparatory School of Cambridge of Cambridge died died after falling on a after falling on a skate during a skate during a practice game.practice game.
Neck Laceration ProtectorNeck Laceration Protector
• Numerous brands & stylesNumerous brands & styles• B.N.Q. StandardB.N.Q. Standard• NoNo injury injury studiesstudies
PrevalencePrevalence IncidenceIncidence EffectivenessEffectiveness
Neck Laceration ProtectorNeck Laceration Protector• may not cover may not cover vulnerable vulnerable areasareas• may may deflect the bladedeflect the blade & & cause a more serious cause a more serious injuryinjury• do not prevent do not prevent throat throat injuryinjury from a puck or stick from a puck or stick• do not prevent do not prevent cervical cervical spinespine or or spinal cord injuryspinal cord injury
• may may deflect the bladedeflect the blade & & cause a more serious cause a more serious injuryinjury• do not prevent do not prevent throat throat injuryinjury from a puck or stick from a puck or stick• do not prevent do not prevent cervical cervical spinespine or or spinal cord injuryspinal cord injury““Heads UpHeads Up Hockey Hockey””““Heads UpHeads Up Hockey Hockey””
Neck Laceration ProtectorNeck Laceration Protector
• mandatorymandatory in Hockey Canada, in Hockey Canada, Ontario Hockey League, IIHF Ontario Hockey League, IIHF ((players under age 18), many players under age 18), many European LeaguesEuropean Leagues• recommendedrecommended by USA Hockey by USA Hockey• not usednot used in NCAA, USA Junior in NCAA, USA Junior Leagues, Professional LeaguesLeagues, Professional Leagues
USA HockeyUSA Hockey Position Statement Position Statement
““USA Hockey is very concerned USA Hockey is very concerned about neck lacerations and the about neck lacerations and the potential catastrophic involvement potential catastrophic involvement of arteries, veins and nerves. To of arteries, veins and nerves. To date there are no data to describe date there are no data to describe the prevalence of such an the prevalence of such an occurrence, the severity, or occurrence, the severity, or whether or not a neck laceration whether or not a neck laceration protector (‘neck guard’) reduces protector (‘neck guard’) reduces risk or severity.risk or severity.““
““USA Hockey is very concerned USA Hockey is very concerned about neck lacerations and the about neck lacerations and the potential catastrophic involvement potential catastrophic involvement of arteries, veins and nerves. To of arteries, veins and nerves. To date there are no data to describe date there are no data to describe the prevalence of such an the prevalence of such an occurrence, the severity, or occurrence, the severity, or whether or not a neck laceration whether or not a neck laceration protector (‘neck guard’) reduces protector (‘neck guard’) reduces risk or severity.risk or severity.““
USA HockeyUSA Hockey Position Statement Position Statement
““Some teams/leagues/districts Some teams/leagues/districts have mandatory use rules in place. have mandatory use rules in place. All USA Hockey players can choose All USA Hockey players can choose to wear one of several available to wear one of several available designs, preferably those that cover designs, preferably those that cover as much of the neck area as as much of the neck area as possible.possible.““
USA HockeyUSA Hockey 20082008
““Some teams/leagues/districts Some teams/leagues/districts have mandatory use rules in place. have mandatory use rules in place. All USA Hockey players can choose All USA Hockey players can choose to wear one of several available to wear one of several available designs, preferably those that cover designs, preferably those that cover as much of the neck area as as much of the neck area as possible.possible.““
USA HockeyUSA Hockey 20082008
Facial InjuriesFacial InjuriesPREVALENCE OF NECK PREVALENCE OF NECK
LACERATIONS FROM A SKATE LACERATIONS FROM A SKATE BLADE IN USA ICE HOCKEY BLADE IN USA ICE HOCKEY
REGISTERED PLAYERS:REGISTERED PLAYERS: ““Neck Lacerations from a Skate Neck Lacerations from a Skate
Blade SurveyBlade Survey””
PREVALENCE OF NECK PREVALENCE OF NECK LACERATIONS FROM A SKATE LACERATIONS FROM A SKATE
BLADE IN USA ICE HOCKEY BLADE IN USA ICE HOCKEY REGISTERED PLAYERS:REGISTERED PLAYERS:
““Neck Lacerations from a Skate Neck Lacerations from a Skate Blade SurveyBlade Survey””
Michael J. Stuart MDMichael J. Stuart MDAynsley M. Smith RN, PhDAynsley M. Smith RN, PhD
David A. Krause DScDavid A. Krause DScMatthew Sorenson MAMatthew Sorenson MA
Andrew Link BAAndrew Link BA
Michael J. Stuart MDMichael J. Stuart MDAynsley M. Smith RN, PhDAynsley M. Smith RN, PhD
David A. Krause DScDavid A. Krause DScMatthew Sorenson MAMatthew Sorenson MA
Andrew Link BAAndrew Link BA
Neck Laceration SurveyNeck Laceration SurveyNeck Laceration SurveyNeck Laceration Survey
A B C
1.1. Do you or your child wear a Neck Do you or your child wear a Neck Laceration Protector (neck guard) while Laceration Protector (neck guard) while playing Ice Hockey? playing Ice Hockey?
○ ○ Yes Yes ○ ○ NoNo
1.1. Do you or your child wear a Neck Do you or your child wear a Neck Laceration Protector (neck guard) while Laceration Protector (neck guard) while playing Ice Hockey? playing Ice Hockey?
○ ○ Yes Yes ○ ○ NoNoIf yesIf yes, please select the corresponding , please select the corresponding letter letter ((AA, , BB, or , or CC) ) for the type for the type of Protectorof Protector::
If yesIf yes, please select the corresponding , please select the corresponding letter letter ((AA, , BB, or , or CC) ) for the type for the type of Protectorof Protector::
Neck Laceration SurveyNeck Laceration Survey
328,821328,821 registered USA registered USA Hockey players- 12 questions e-Hockey players- 12 questions e-mail surveymail survey
328,821328,821 registered USA registered USA Hockey players- 12 questions e-Hockey players- 12 questions e-mail surveymail survey
26,58926,589 responses ( responses (8.18.1%)%) 247247 excluded ( excluded (<1<1%)%)26,58926,589 responses ( responses (8.18.1%)%) 247247 excluded ( excluded (<1<1%)%)
Neck Laceration SurveyNeck Laceration Survey
26,34226,342 study populationstudy population 26,34226,342 study populationstudy population
8888% % male male 1212% % femalefemale8888% % male male 1212% % femalefemale
Neck Laceration SurveyNeck Laceration Survey
26,34226,342 study populationstudy population 26,34226,342 study populationstudy population
0
500
1000
1500
2000
2500
3000
3500
4000
4500
5000
>=6 7&8 9&10 13&14 15&16 17-19 >20
8888% % male male 1212% % femalefemale8888% % male male 1212% % femalefemale
CurrentlyCurrently wear a Protector wear a Protector
0
2000
4000
6000
8000
10000
12000
14000
16000
Yes No
4545%%4545%% 5555%%5555%%
Protector UsageProtector Usage by Age Groupby Age Group
6468 67
62
51
3528
22
0
10
20
30
40
50
60
70
80
Percent
<7 7,8 9,10 11,12 13,14 15,16 17,18 19,20+
Age Group
Current Current Protector TypeProtector Type
1212%%1212%%44%%44%% 8484%%8484%%
Neck LacerationNeck Laceration from a Skate from a Skate BladeBlade
0
10000
20000
Yes No
98.298.2%%98.298.2%%1.81.8%%1.81.8%%
485485485485
Protector Protector at the Time of Injuryat the Time of Injury
0
50
100
150
200
250
300
350
400
Yes No
2727%%2727%%
7373%%7373%%
Protector Type Protector Type at Time of Injuryat Time of Injury
1111%%1111%%55%%55%% 8484%%8484%%
If Cut,If Cut, Currently Currently wearwear ProtectorProtector
100
200
300
400
Yes No
5353%%5353%% 4747%%4747%%
Follow-upFollow-up Phone Interview Phone Interview
33 players33 players cut on the neck by cut on the neck by a skate blade were contacted by a skate blade were contacted by phonephone• 32 male, 1 female32 male, 1 female
• 2 mite, 6 squirt, 5 peewee, 5 2 mite, 6 squirt, 5 peewee, 5 bantam, 14 midget or older, 1 bantam, 14 midget or older, 1 U12U12• Injury occurred Injury occurred 11--2424 years years agoago
• 32 male, 1 female32 male, 1 female• 2 mite, 6 squirt, 5 peewee, 5 2 mite, 6 squirt, 5 peewee, 5 bantam, 14 midget or older, 1 bantam, 14 midget or older, 1 U12U12• Injury occurred Injury occurred 11--2424 years years agoago
Position Position when Laceration when Laceration OccurredOccurred
20
8
4 10
2
4
6
8
10
12
14
16
18
20
Lying Kneeling Standing Don'tKnow
Location Location on the Neckon the Neck
Side67%
Front 33%
Back0%
MedicalMedical Treatment Treatment
4
16
10
2
1
0
5
10
15
None Bandage Stitches Glue Surgery
Neck LacerationNeck Laceration from a Skate from a Skate BladeBlade
““slight scrape”slight scrape”““just a red mark”just a red mark”““not a cut, just an indentation”not a cut, just an indentation”““slight abrasion”slight abrasion”““very minor, returned to the game”very minor, returned to the game”““deflected off the cuff”deflected off the cuff”““cut the neck guard in half”cut the neck guard in half”““cut through the neck guard”cut through the neck guard”
““slight scrape”slight scrape”““just a red mark”just a red mark”““not a cut, just an indentation”not a cut, just an indentation”““slight abrasion”slight abrasion”““very minor, returned to the game”very minor, returned to the game”““deflected off the cuff”deflected off the cuff”““cut the neck guard in half”cut the neck guard in half”““cut through the neck guard”cut through the neck guard”
Neck LacerationNeck Laceration from a Skate from a Skate BladeBlade• typically occur to the typically occur to the side side of the of the
neck while neck while lyinglying on the ice on the ice• allall lacerations were superficiallacerations were superficial
No neurovascular involvementNo neurovascular involvement No serious or catastrophic injuriesNo serious or catastrophic injuries No permanent deficits or No permanent deficits or symptomssymptoms 1/21/2 treated with a bandage only treated with a bandage only 1/31/3 required sutures required sutures
• typically occur to the typically occur to the side side of the of the neck while neck while lyinglying on the ice on the ice• allall lacerations were superficiallacerations were superficial
No neurovascular involvementNo neurovascular involvement No serious or catastrophic injuriesNo serious or catastrophic injuries No permanent deficits or No permanent deficits or symptomssymptoms 1/21/2 treated with a bandage only treated with a bandage only 1/31/3 required sutures required sutures
SummarySummary
26,34226,342 USA Hockey Players USA Hockey Players 26,34226,342 USA Hockey Players USA Hockey Players
SummarySummary
26,34226,342 USA Hockey Players USA Hockey Players• 45%45% currently wear a neck currently wear a neck
laceration protectorlaceration protector- - 2/32/3rdsrds of of players 12 & underplayers 12 & under• 485485 players (players (1.8%1.8%) cut in the ) cut in the neck area by a skate blade while neck area by a skate blade while playing hockeyplaying hockey• 27%27% were wearing a neck were wearing a neck laceration protector laceration protector at the time of at the time of the injurythe injury
26,34226,342 USA Hockey Players USA Hockey Players• 45%45% currently wear a neck currently wear a neck
laceration protectorlaceration protector- - 2/32/3rdsrds of of players 12 & underplayers 12 & under• 485485 players (players (1.8%1.8%) cut in the ) cut in the neck area by a skate blade while neck area by a skate blade while playing hockeyplaying hockey• 27%27% were wearing a neck were wearing a neck laceration protector laceration protector at the time of at the time of the injurythe injury
SurveySurvey LimitationsLimitations
• Selection BiasSelection Bias: individuals with the : individuals with the condition may be more motivated to condition may be more motivated to return the study return the study (falsely elevating injury (falsely elevating injury prevalence)prevalence)• Attrition BiasAttrition Bias: missing date due to : missing date due to the 8.1% response rate the 8.1% response rate • Sampling ErrorSampling Error: personally : personally interviewing only 33 of the 285 interviewing only 33 of the 285 injured players does not allow injured players does not allow generalization of their responsesgeneralization of their responses
• Selection BiasSelection Bias: individuals with the : individuals with the condition may be more motivated to condition may be more motivated to return the study return the study (falsely elevating injury (falsely elevating injury prevalence)prevalence)• Attrition BiasAttrition Bias: missing date due to : missing date due to the 8.1% response rate the 8.1% response rate • Sampling ErrorSampling Error: personally : personally interviewing only 33 of the 285 interviewing only 33 of the 285 injured players does not allow injured players does not allow generalization of their responsesgeneralization of their responses
ConclusionsConclusions
• A neck laceration from a skate A neck laceration from a skate blade while playing ice hockey is blade while playing ice hockey is an an uncommon occurrenceuncommon occurrence..• The reported injuries are The reported injuries are mildmild, , but the potential for serious but the potential for serious consequences due to nerve, consequences due to nerve, artery or vein involvement remain artery or vein involvement remain a concern.a concern.
• A neck laceration from a skate A neck laceration from a skate blade while playing ice hockey is blade while playing ice hockey is an an uncommon occurrenceuncommon occurrence..• The reported injuries are The reported injuries are mildmild, , but the potential for serious but the potential for serious consequences due to nerve, consequences due to nerve, artery or vein involvement remain artery or vein involvement remain a concern.a concern.
ConclusionsConclusions
• Current neck laceration Current neck laceration protector designs protector designs do not eliminate do not eliminate the riskthe risk of a neck laceration. of a neck laceration.• Design enhancementsDesign enhancements to to maximize coverage of the maximize coverage of the vulnerable anatomic regions & vulnerable anatomic regions & better materials are necessary for better materials are necessary for improved effectiveness. improved effectiveness.
• Current neck laceration Current neck laceration protector designs protector designs do not eliminate do not eliminate the riskthe risk of a neck laceration. of a neck laceration.• Design enhancementsDesign enhancements to to maximize coverage of the maximize coverage of the vulnerable anatomic regions & vulnerable anatomic regions & better materials are necessary for better materials are necessary for improved effectiveness. improved effectiveness.
ConclusionsConclusions
•Further Further researchresearch & & improved improved standardsstandards testing will determine testing will determine the effectiveness of these devicesthe effectiveness of these devices..
•Further Further researchresearch & & improved improved standardsstandards testing will determine testing will determine the effectiveness of these devicesthe effectiveness of these devices..
USA HockeyUSA Hockey Position Statement Position Statement
Revised versionRevised version endorsed endorsed by theby the
Safety and Protective Safety and Protective Equipment Equipment CommitteeCommittee
Revised versionRevised version endorsed endorsed by theby the
Safety and Protective Safety and Protective Equipment Equipment CommitteeCommittee
USA HockeyUSA Hockey Position Statement Position Statement
““USA Hockey is USA Hockey is very concernedvery concerned about neck lacerations and the about neck lacerations and the potential catastrophic involvement potential catastrophic involvement of arteries, veins and nerves. To of arteries, veins and nerves. To date, there is date, there is sparse datasparse data to to describe the prevalence of such an describe the prevalence of such an occurrence, the severity, or occurrence, the severity, or whether or not a neck laceration whether or not a neck laceration protector (neck guard) protector (neck guard) reduces risk reduces risk oror severity severity..““
““USA Hockey is USA Hockey is very concernedvery concerned about neck lacerations and the about neck lacerations and the potential catastrophic involvement potential catastrophic involvement of arteries, veins and nerves. To of arteries, veins and nerves. To date, there is date, there is sparse datasparse data to to describe the prevalence of such an describe the prevalence of such an occurrence, the severity, or occurrence, the severity, or whether or not a neck laceration whether or not a neck laceration protector (neck guard) protector (neck guard) reduces risk reduces risk oror severity severity..““
USA HockeyUSA Hockey Position Statement Position Statement
““Based on a survey of USA Based on a survey of USA Hockey players, neck lacerations Hockey players, neck lacerations from a skate blade are from a skate blade are rarely rarely seriousserious, but the potential for severe , but the potential for severe consequences due to nerve, artery consequences due to nerve, artery or vein involvement remain a or vein involvement remain a concern. In addition, current neck concern. In addition, current neck laceration protector designs laceration protector designs do not do not eliminate the riskeliminate the risk of a neck of a neck laceration.laceration.““
““Based on a survey of USA Based on a survey of USA Hockey players, neck lacerations Hockey players, neck lacerations from a skate blade are from a skate blade are rarely rarely seriousserious, but the potential for severe , but the potential for severe consequences due to nerve, artery consequences due to nerve, artery or vein involvement remain a or vein involvement remain a concern. In addition, current neck concern. In addition, current neck laceration protector designs laceration protector designs do not do not eliminate the riskeliminate the risk of a neck of a neck laceration.laceration.““
USA HockeyUSA Hockey Position Statement Position Statement
““USA Hockey USA Hockey recommends that recommends that players wear a neck lacerationplayers wear a neck laceration protector, choosing a design that protector, choosing a design that cover as much of the neck area as cover as much of the neck area as possible.possible. Further Further researchresearch & & improved standardsimproved standards testing will testing will determine the effectiveness of determine the effectiveness of these devicesthese devices..““
““USA Hockey USA Hockey recommends that recommends that players wear a neck lacerationplayers wear a neck laceration protector, choosing a design that protector, choosing a design that cover as much of the neck area as cover as much of the neck area as possible.possible. Further Further researchresearch & & improved standardsimproved standards testing will testing will determine the effectiveness of determine the effectiveness of these devicesthese devices..““
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