Open fractures are uncommon in the UK sporting population, however because of their morbidity then are a significant patient group. Currently there is very little in the literature describing the epidemiology of open fracture in sport. We describe the epidemiology of sport related open fractures from one centre's adult patient population.

Retrospective analysis of a prospectively collected database recording all sport related open fracture s over a 15 year period in a standard population.

Over the 15 year period, there were 85 fractures in 84 patients. The mean age was 29.2 years (range 15–67). 70 (83%) were male and fourteen female (17%). The six most common sports were football (n=19, 22%), rugby (n=9, 11%), cycling (n=8, 9%), hockey (n=8, 9%); horse riding (n=6, 7%) and skiing (n=6, 7%). The top five anatomical locations were fingers phalanges, 35%; tibia-fibula 23%; foreman 14%; ankle 11% and metacarpals 5%. The mean injury severity score was 7.02. Forty five patients were grade 1; 28 patients were grade 2; 8 patients were grade 3a; and 4 were grade 3b according to the Gustilo-Anderson classification system. Seven patients (8%) required plastic surgical intervention for the treatment of these fractures. The types of flaps used were split skin graft (n=4), fasciocutaneous flaps (n=2); and adipofascial flap (n=1).

We looked at the epidemiology open fractures secondary to sport in one centre over a 15 year period. Football was the most common sport (22%) and within football, the most common site was the tibia and fibula. In contrast, within the cohort a whole the majority of fractures were upper limb, with the hand being the most common site. Whilst not common in sport, when they are sustained they are frequently occur on muddy sport fields or forest tracks and must be treated appropriately. A good understanding of the range and variety of injuries commonly sustained in different sports is important for clinicians and sports therapists.

Freezing cold injuries (Frostnip and Frostbite) (FCI) have become uncommon in UK military personnel relative to non-freezing cold injuries (NFCI, ‘trench foot’). However if unidentified or inappropriately treated they may lead to avoidable medical downgrading or discharge. JSP 539 recommends delay or avoidance of surgical debridement where possible.

An anonymised retrospective audit was performed of FMED7 medical reports of cases seen in the Institute of Naval Medicine Cold Injury Clinic (CIC) between July 2002 and January 2014 inclusive.

In all 149 FCI cases were identified, 71 affected hands only of which 34 were bilateral, and 58 affected feet only, 34 of those being bilateral. A total of 17 patients had injured both hands and feet, with 10 bilateral. Royal Marines accounted for half of these cases, with the Army making up a further third, and the Royal Navy and RAF making up the remainder. Most FCI were found to have occurred in Norway, with Marine ranks being most commonly affected. Ten cases underwent surgery: aspiration of blisters, debridement of tissue, or amputation. Seven of these procedures took place prematurely, which appeared detrimental to recovery. No patients required fasciotomy.

FCI are uncommon, but in arctic conditions their risk rises dramatically. The best treatment is conservative where possible following JSP 539 guidelines and consultation with CIC should occur at the earliest possibility. The Potential benefits of surgery must be weighed against problems of injured tissue healing and expert opinion should be obtained.