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A How-To for Orthopedic Surgeons When Concussion is Suspected

by Elizabeth Hofheinz, M.P.H., M.Ed.

Who better to detect any affective changes in an athlete than a team orthopedic surgeon?

With the rate of sports-related concussions on the rise1, it is important that team physicians are as educated on these situations as much as possible.

In new work from the Department of Orthopaedic Surgery at Henry Ford Health System in Detroit, Michigan, researchers tackled this topic in a study titled, “Concussion Management for the Orthopaedic Surgeon.” Their work appears in the November 2020 edition of JBJS Reviews.

Indicating that concussion was formally defined by the Concussion in Sport Group (CISG) as “traumatic brain injury induced by biomechanical forces,2” the authors have created a guide as to how to diagnose a concussion, including pre-game readiness assessments and concussion education for athletes.

This guide further gives information on what to do on the field in the event that a team orthopedic surgeon suspects a concussion. If a traumatic event occurs, say the authors, physicians should begin by assessing airway, breathing, and circulation. This and other frontline measures will help determine if transfer to the local ED is necessary.

Co-author Toufic Jildeh, M.D. is a 5th year resident at Henry Ford. Dr. Jildeh told OSN, “There is a paucity of data guiding orthopaedic surgeons in the correct management and recognition of concussions. This is particularly important as orthopaedic surgeons often are on the sidelines during competition and are often the first responders to athletic injuries. Team physicians are in a unique position to recognize subtle changes in an athlete’s behavior or personality, as they are familiar with the athlete at baseline.”

In this guide, the authors draw a distinction between on-field and sideline evaluations, the latter being recommended in the event that the on-field assessment remains unclear with regard to concussion. Neurocognitive tests—such as the Sport Concussion Assessment Tool, Fifth Edition (SCAT5) and the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT)—may be appropriate, they say.

This paper delves into the phases of recovery from concussion—acute rest, relative rest, graduated exertion—and provides details on determining return-to-sport decisions.

Finally, the paper addresses the ongoing legal aspects of concussions, giving yet another reason why care providers need to be up-to-date on the latest aspects of concussion care.

“It was surprising to find out how much the management of concussions has evolved in the last decade, particularly with greater emphasis on an appropriate time of rest prior to return-to-play,”

Dr. Jildeh told OSN. “I hope this research will serve as basis for research articles further optimizing the recognition and management of concussions.”

References:

  1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2987636/
  2. https://bjsm.bmj.com/content/51/11/838
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Elizabeth Hofheinz

Two time winner of the MORE award Ms. Hofheinz was the first writer employed by Orthopedics This Week. The MORE award is granted annually by the American Academy of Orthopaedic Surgeons to recognize excellence in journalism. Ms. Hofheinz is currently the Director of Communications for Ortho Spine Partners (OSP).

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