Polodoc: Gut Punch

Dr.med. Andreas Krüger is a Swiss board orthopaedic and trauma surgeon in Zurich, who specialises in knee and shoulder surgery. Andi is a second generation of tournament doctors for equine sports, known as Polodoc since 2013 and affiliated with Polo Park Zurich Under clinical settings emergency examination can precisely differentiate between

Gut Punch

The silent killer

A direct blow to the stomach area can happen fast – mostly without any harm. But with rising blunt forces to these soft and elastic intestinal structures the danger of bleeding increases dramatically.

Since the 1970s the aggressive operative approach to all forms of abdominal trauma was the golden standard until the establishment of formal trauma centres. Due to the fact that the spleen is a solid organ it is the most often injured organ in blunt trauma. In former times the Splenectomy was the only satisfactory treatment for this injury.

Participation in sports that involve the potential for contact or collision needs to be carefully assessed in high velocity accidents.

Spleen function & injury patterns

The spleen is the largest organ in the lymphatic system. It is an important organ for keeping bodily fluids balanced, but it is possible to live without it. The spleen is located under the ribcage and above the stomach in the left upper quadrant of the abdomen. A spleen is soft and generally looks purple. It is made up of two different types of tissue. The red pulp tissue filters the blood and gets rid of old or damaged red blood cells. The white pulp tissue consists of immune cells and helps the immune system fight infection.

Spleen lacerations or ruptures usually occur from a blunt blow to the abdominal region.

These blows can break in the spleen’s surface and can lead to severe internal bleeding and signs of shock (fast heart rate, dizziness, pale skin, fatigue). Without emergency care, the internal bleeding could become life-threatening. On the continuum of spleen breakage, a laceration refers to a lower-grade extent of injury, where just a part of the spleen is damaged. A ruptured spleen is the highest grade of

Diagnostics on & off the field

First responders or in the absence of professional caretakers a teammate can palpate the abdomen.

Symptoms of a lacerated or ruptured spleen include pain or tenderness to the touch in the upper left part of the abdomen, left shoulder and left chest wall, as well as confusion and light-headedness. If any of the symptoms are observed after a trauma, immediate emergency medical attention is life saving.

sonography or abdominal CT (computer tomography with or without contrast fluid) broken spleen injury.

potential sub-capsular injuries as hematomas from life threatening mass bleeding.

Treatment options

Treatment options depend on the condition of the injury. Mostly, a conservative nonoperative treatment regime is recommended.

Photography courtesy of Polodoc

Ultrasound examination can help to identify free fluid which indicates abdominal injury. Even early pitch side examination is possible with handheld devices

The tricky lower-grade lacerations may be able to heal without surgery, though they will probably require hospital stays to observe constantly the clinical condition. Highergrade lacerations or ruptures may require instant surgery to repair the spleen, surgery to remove part of the spleen, or surgery to remove the spleen completely. If only part of the spleen is removed, the procedure is called a partial splenectomy. Unlike some other organs, like the liver, the spleen does not grow back (regenerate) after it is removed.

Up to 30% of people have a second spleen (called an accessory spleen). These are usually very small, but may grow and function when the main spleen is removed. Rarely, a piece of the spleen may break off with trauma. If the spleen is removed, this piece can grow and function

Recovery

After open Splenectomy, a hospital stay of about one week is the average. Those who have a laparoscopic Splenectomy are usually sent home sooner. It will take about four to six weeks to recover from the procedure. Your specialised health care team will tell you when you are ready to start sports, especially riding. Individual return to sport plans are recommended.

Complications

Life without a functional spleen or after removal is possible and may not be recognised by the player. Due to its crucial role in the body’s ability to fight off bacteria, living without the spleen makes the human body more likely to develop infections, especially dangerous ones such as Streptococcus pneumoniae, Neisseria meningitidis, and Haemophilus influenzae. These bacteria cause severe pneumonia, meningitis, and other serious infections. Vaccinations to cover these bacteria should ideally be given to patients about two weeks

Apple Watch 6 has new sensors to measure heart rate, ECG and blood oxygen levels

PD Dr.med. Christoph Karlo Radiologist Hirslanden Klinik Zürich

Radiological department Hirslanden Clinic Zurich High velocity trauma specialist F1 Abdominal trauma is one of the most critical injuries in high velocity sports. Early diagnosis of the full extent of the injury is key to plan the adequate response in the hospital. Initial ultrasound can be very helpful for the trauma team. Secondary examination with high resolution CT of the abdomen in the clinical setting can precisely detect also small injuries, which can be underestimated with ultrasound. Modern ultra selective radiological guided treatments can improve speedy recovery without need for excessive surgery. before planned surgery or roughly two weeks after emergency surgery. Other new immunizations may be recommended as well.

Prevention

When deceleration happens after hitting the ground, only falling techniques can help to transfer the energy with a rolling fall moment. Relevant protection is possible by airbag vest or cushioned safety vest when direct blunt impact to the abdomen

happens.

Apple Watch 6 can help pitchside in first line monitoring of the blood oxygen saturation

For more information on Polodoc contact Andreas Krüger at drmedkrueger@gmail.com or www.polodoc.ch