Am Fam Physician. 2022;106(5):543-548
Related letter to the editor: Helmet and Pad Removal for Football Head and Neck Injuries
Author disclosure: No relevant financial relationships.
Although rare, sport-related injuries to the head and neck can be life threatening; therefore, timely and appropriate treatment is critical. Preparation is key for the sideline physician and begins well before arriving on the sideline. Knowing the athletic trainer and support staff, establishing a chain of command and emergency action plan, and having all the appropriate equipment readily available are important for game or practice preparedness. At the athletic event, physicians should have a clear line of sight to the field of play and easy access to reach the field when necessary. When performing an on-field assessment of any athlete who is not moving, whether conscious, unconscious, or with decreased consciousness, head and neck injury must be assumed, and the injured athlete should be placed on a spine board with cervical spine stabilization and transported to the emergency department for further evaluation. Generally, helmets and pads are left on while the injured athlete is being transported. Concussion is among the most common head and neck injuries in athletes, and if concussion is suspected, the athlete cannot return to the game on the same day. Nasal fractures do not always require immediate closed reduction; however, orbital, maxillary, or mandibular fractures require transport to the emergency department. For tooth avulsion, time is important; reimplantation should be attempted within 30 minutes of injury.
Head, neck, and cervical spine injuries are common in athletes of all ages, and the incidence seems to increase with age.1,2 Soft tissue injuries such as neck sprains and strains or facial lacerations are much more common than vertebral fractures and spinal cord injury.1–3 Many of these injuries are self-limited and can be managed on the sideline or in the training room.3 Although catastrophic cervical spine injuries are uncommon, they are associated with significant morbidity and mortality and can have significant lifetime costs.4 When an athlete appears to be injured, the sideline physician must be prepared to provide a focused assessment and treatment plan.
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