Michael J. Stuart, MD, Andrew A. Link, BA, Aynsley M. Smith, RN, PhD, David A. Krause, PT, DSc, Matthew C. Sorenson, JD, and Dirk R. Larson, MS
Injuries in ice hockey increase in parallel with player maturation and occur much more frequently in games than in practices.1–4 Injury risk is influenced by individual playing time, contact forces, rule violations, and the absence of protective equipment.5,6 Marked differences in head and facial injuries, including lacerations, have been reported as a function of full, partial, or no facial protection, even when controlled for individual playing time variation.6 Although the risk of sustaining a facial laceration is less for players younger than 18 years due to use of facial protection, head injuries are more common in the younger age groups.7 A neck laceration from a skate blade, defined as a cut to the neck area requiring medical attention, is a potentially catastrophic injury. Neck lacerations presenting to emergency departments in the United States are relatively rare, with no such injuries reported to the National Electronic Injury Surveillance System during 1996 to 1999.8
Neck lacerations occur while players are airborne, skating, standing, sitting, kneeling, or lying on the ice. Sharp skate blade contact in the neck region may injure the airway, nerves, or blood vessels. Neck lacerations have resulted in death,9 including a high school player from the United States in 1975.10 Recently, a neck laceration from a skate blade involving the carotid artery during a televised National Hockey League (NHL) game increased awareness and concern for players, parents, and medical personnel.11
In an effort to prevent neck lacerations, ‘‘neck guards’’ were developed. Because these devices are not designed to prevent throat injury from a puck or stick or prevent spinal cord injury from a force transmitted to the neck, the term ‘‘neck laceration protector’’ is more appropriate.12,13
Currently, neck laceration protectors (Figure 1) adhere only to the Bureau de normalization du Que ́bec Standard.14 Although laboratory testing may not represent actual on-ice mechanisms of injury, neck laceration protectors are currently mandatory for Hockey Canada and are recommended by USA Hockey.
To date, no study has described the prevalence or severity of neck lacerations from a skate blade, thus the effectiveness of neck laceration protectors is unknown.
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