Matthew T. Provencher, MD; Rachel M. Frank, MD; Daniel J. Shubert, MD; Anthony Sanchez, BS; Colin P. Murphy, BA; Ross D. Zafonte, DO
Orthopedics. 2019;42(1):12-21https://doi.org/10.3928/01477447-20181231-02
Posted January 21, 2019
Abstract
Although concussions are common, they are complex, variable, and not entirely understood in terms of pathophysiology and treatment. The incidence of concussion is expected to continue to rise with the increased participation of youth in sports and improved awareness. The role of orthopedic surgeons in concussion management is murky. However, the existing literature does provide a foundation from which orthopedic surgeons who are exposed to concussed patients can function. [Orthopedics. 2019; 42(1):12–21.]
Numerous definitions have been proposed for the clinical entity known as concussion. The 2016 Berlin Consensus Statement on Concussion in Sport defined concussion as a “traumatic brain injury induced by biomechanical forces,” but notably considered concussion and mild traumatic brain injury (TBI) to be separate entities.1 In contrast, the 2013 American Academy of Neurology guidelines for sports concussion did not separate concussion from mild TBI, defining concussion as “a clinical syndrome of biomechanically induced alteration of brain function, typically affecting memory and orientation, which may involve loss of consciousness.”2
Regardless of the precise definition, an increased awareness of concussions and their potential long-term detrimental effects has led to a surge in their recognition, particularly among individuals participating in sports. The Centers for Disease Control and Prevention currently estimates that between 1.6 and 3.8 million sports-related concussions occur annually—a dramatic increase from the 300,000 concussions reported in 1996.3–5 Concussions are common in young athletes, accounting for an estimated 1.1 to 1.9 million injuries annually6 and representing approximately 8.9% of all high school sports injuries.7 Although these numbers may seem high, the actual numbers are likely higher than this owing to the combination of a lack of awareness among clinicians and a reluctance to report symptoms among athletes.8–10 The number of documented concussions is expected to continue to rise with increased participation of youth in sports and improved concussion awareness and management.11