Sports Medicine: Just the Facts

and mouth-breathing making the boxer susceptible to

significant head trauma. This arena is where a ref-

eree’s level of experience should reflect his or her

competence and ability to control the action. The ref-

eree may provide this level of safety by closely

observing the boxers and their eyes, administering

standing “8” counts, and alerting the physicians and

corner when there is a concern. If the referee is con-

cerned, then you, as the ringside caretaker, should be

alert and ready to render care.

• The physician enters the ring on the referee’s request
  to evaluate a boxer after a stoppage or between
  rounds. Even without the referee’s request, if a serious
  injury is suspected during competition, the physician
  should mount the ring apron to suspend or terminate
  the bout.


• When entering the ring, the physician should do so
  quickly and confidently carrying gauze pads and a
  penlight. Remove the boxer’s mouthpiece and assure
  an adequate airway. Though there maybe resistance, a
  disabled fighter should be made to lie down (if
  already on the mat) or sit on a stool until fully reac-
  tive. When capable walk the fighter to their corner.
  Establish a baseline neurologic evaluation. Further
  observation and serial examinations will be necessary
  by the physician to determine appropriate future care.


• If recovery progresses satisfactorily, the boxer can be
  released to the care of the coach or responsible family
  member with instructions on follow-up care and
  warning signs to notice.


• If the boxer is unconscious or has a period of delayed
  mental or neurologic recovery, expedite transportation
  to a hospital using stretcher, supplemental oxygen,
  and emergency medical services.


• When called to the ringside by a referee to evaluate a
  boxer, the competition should be stopped if:
  
  
  1. Airways are compromised by bleeding or swelling
  
  
  2. Significant oral bleeding
  
  
  3. Blood draining in the posterior oropharynx caused
     by epistaxis
  
  
  4. Altered mental status
  
  
  5. Obvious musculoskeletal dysfunction
  
  
  6. Significant facial or lip laceration
  
  
  7. Impaired vision caused by swelling, bleeding, or
     ocular trauma
  
  
  8. Possible nasal fracture
  
  
  9. Obvious loose or newly missing teeth
  
  
  10. A boxer feels he or she cannot continue
  
  
  
  

POST-BOUT EXAMINATION

• Each contestant must be examined after the bout. For
  amateurs, a quick evaluation can be performed as they

exit the ring. For a more thorough evaluation, the

boxer should be taken to the predetermined area away

from ringside. For professional bouts, the examination

can take place in the individual’s locker room.

•Having two to three ringside physicians assure that

the contest can continue on schedule when a more

thorough postbout examination is necessary.

Emergency personnel are a valuable asset in their sup-

port of injury care and medical assessments. They

should remain on site till they are dismissed by the head

physician.

• The brief examination should include observation of
  the boxer exiting the ring, asking questions to assess
  their orientation, noticing speech patterns and
  response, and performing a quick survey of the face,
  head, mouth, and upper extremities. If there are
  nonurgent but suspicious findings, have the coach
  bring the boxer back for a reevaluation after a deter-
  mined amount of time.


• The criteria for transferring the contestant to the emer-
  gency room are as follows:
  
  
  1. Lacerations requiring complex repair or extending
     beyond your level of available care
  
  
  2. Altered mental status suggesting a grade 2 concus-
     sion or greater
  
  
  3. Injuries requiring urgent diagnostic studies such as
     bloodwork, X-rays, or advanced imaging to deter-
     mine the level of severity
  
  
  4. Injuries requiring splinting or casting
  
  
  
  

EPIDEMIOLOGY OF INJURIES

• Depending on the study cited, 27 to 93% of boxing
  injuries involve the head (Caine, Caine, and Linder,
  1996; Jordan, 1998). Concussion is the most
  common neurologic injury while nasal contusion
  with epistaxis and facial lacerations are the leading
  nonneurologic injuries. Acute traumatic brain
  injuries are an unfortunate complication, which
  include cerebral contusions and intracranial hemor-
  rhage. These are a major concern of the attending
  physician who must readily recognize their signs
  and symptoms.


• Musculoskeletal injuries other than the hand and wrist
  are uncommon in boxers. Based on studies 2 to 46%
  of injuries occur in the hand and wrist. The second
  most common is the shoulder. Lower extremity
  injuries are generally caused by overuse incurred
  during training (i.e., jogging and jumping rope.).


• Rare injuries such as renal contusion, splenic or
  hepatic hematomas as well as commotio cordis
  due to chest impact have been documented in case
  studies.

472 SECTION 6 • SPORTS-SPECIFIC CONSIDERATIONS