Besides the proven health benefits, the risk of injury represents the major drawback of sportive activities. Injury risk profiles may parallel demographic patterns, as well as social trends [1, 31–33]. In opposite to the United States, where a vast majority of sports-related hand injuries occur during American football, gymnastics, wrestling and basketball , we identified cycling, football and equestrian sports as the major causes of hand injuries in our cohort. Most of the observed injuries occurred in males and within the first two age quartiles, which is in line with previous reports [4, 34]. Ball sports played without an assistive device, climbing and gymnastics were predominantly responsible for hand injuries in the younger population, while a shift towards more cycling-related hand injuries could be observed in the elderly population. Equitation-related hand injuries do not only represent one of the most common sports injuries in our analysis but were also associated with a significantly higher operation and hospitalisation rate. The need for an operative treatment is mostly due to the increased rate of fractures in this sub-cohort. Furthermore, this sub-cohort accounted for 9 out of a total of 14 traumatic finger amputations in this study population. These findings support our clinical notion that complex injury patterns are common in equitation sports. Interestingly, equestrian sports seem to be underrepresented in the current literature, thus these findings might well add relevant information for clinical practice. The 2018 German examination regulations in equestrian sports specify mandatory gloves only in dressage and horse driving sports . Regarding the high incidences of trauma and their severity, a broadening of this rule to all disciplines in equestrian sports, on the basis of the current results, should be discussed.
According to previous studies men represent the greater risk group for sports injuries. These observations can be confirmed by the presented results, where men are affected more than twice as often as women. Younger people, representing the physically most active population group, are at highest risk for sports injuries. 50% of the study population was aged between 19 and 45 years. Participation of young individuals in organized sports and high-frequency trainings are of increasing popularity, especially in the western world [2, 20, 36]. Simultaneously, a rising competitiveness, in terms of force and speed, is observable. Sport is one of the main causes of injuries in adolescents , with an increased risk for complicated injuries and long-term damage . However, risk profiles appear to be dynamic, depending on demographic and social trends. Taking in account rising life expectancy and increasing sports activities throughout life time in developed countries, an increased incidence of sports injuries among the elderly population has to be expected . The dynamics of sports injury risk profiles raises the demand for injury prevention measures. This, however, requires knowledge of sport specific injury risks and injury patterns respectively.
An analysis of injuries occurring in German club sports from 1987 to 2012, without specification on the hand, showed high injury risks in ball sports such as football, handball, basketball or volleyball . These data, however, did not comprise the non-organized leisure sports, such as cycling, which proves to be a major risk sport in our patient population. Further major epidemiologic and demographic surveys about sports injuries in Germany go back to the years 1986 and 1999, already indicating differences of injury-causing sport types between Germany and the USA. Previous national surveys, seeking to assess sports injuries in Germany, are rare and mainly based on questionnaires [39–41]. According to our knowledge, this is the first study analysing sports injuries specifically in the hand in the German population.
A clear limitation of this study is the retrospective character, which does not allow more detailed information about the injury mechanism. Previous operations or re-operations in other hospitals were not reported in the current database and thus cannot be taken into account. As there is no coding for sports injuries available, we utilized an extensive keyword analysis for data collection. Although performed with great care, this approach bears the risk of missing cases of sports-related hand injuries.
These data represent the basic stage within the Translating Research into Injury Prevention Practice framework (TRIPP) . This gradual injury prevention model comprises six stages, leading from injury surveillance up to the implementation of developed prevention measures, and should give researchers support in the successful establishment of injury prevention measures in sports. Given that, a comprehensive monitoring of sports injuries is crucially needed in order to successfully guide and promote injury prevention programs. Supplemental support in this intent can be provided by apps or user friendly computer tools, enabling broadly accessible surveillance participation [25, 26].
The high costs associated with hand and wrist injuries are underlining the economic importance of maximal safety in sports . In addition, the financial burden of these injuries can reach great extent also at individual level. Drop-out rates as well as high direct costs, which might not be covered by insurances, increase the barrier to sports participation among the population. While surveillance programs for road injuries or occupational injuries are already well-established, the only available tool for injury monitoring on a national as well as an European level is the EU Injury Database (EU IDB) [44, 45]. However, a little more than half of the EU member states are contributing to this database. The free accessible EU IDB recorded a total of 235 sports-related hand and wrist injuries for Germany in the year 2016 only, suggesting a significant missing of data . Another obstacle is the difficulty of monitoring hospital discharges due to sports injuries. As hospital statistics are mainly based on the ICD codings, which do not include sports injuries, a reliable monitoring is almost impossible at the moment .