Discussion
The aim of this study was to establish the types of MSK hand injuries sustained by players while participating in Gaelic football. The most common of these were intra-articular fractures to the volar base of the middle phalanx, with the little finger being the most commonly affected. This is in keeping with the literature with injuries at this location commonly observed in athletes who participate in ball sports,22 and the little finger is reported as one of the most common digits injured across all sports.3
This is the first study to investigate hand injuries sustained in Gaelic football. However, data may not capture all injuries sustained, as some, such as dislocations to the proximal interphalangeal joint, may have been relocated at the pitch side and never presented to the hospital. This can be an issue as patients may only present when issues such as pain, stiffness or oedema have not been resolved.23 This issue should be considered in Gaelic football because this was the most common injury in this study.
The model of injury causation that considers intrinsic and extrinsic risk factors for injury in sport24 may help understand the statistical differences of injuries by ray and mechanism between male and female players. An intrinsic factor could be anthropometric differences between the sexes, such as the second-to-fourth-digit ratio, whereby the second digit is shorter than the fourth in men. In contrast, in women, the second digit is the same length or longer than the fourth.25 In this study, female players presented with a higher incidence of second, third and fourth injuries than males. For example, when high-catching a ball, the longer second ray of female players compared with male players may result in it being more exposed to hyperextension injuries.
The average age of players injured over 18 was 25 (IQR 21–31). This age is similar to the average age of both men (27.2 years) and women (24.8 years) inter-county players from a survey of 1579 players in 2022,26 implying age is not a risk factor for hand injuries in older adult players. A statistical difference between the average age of injury in female and male players under 18 was observed, with male players being slightly older (14 (IQR 12.5–16)) compared with female players (13 (IQR 12–15)). Differences in ball skills between male and female children have been well documented.27–31 Catching skills are reported to continually develop from age 5 and plateau by 14.32 As so many injuries in this study are related to catching a ball, one possible hypothesis is that girls are more susceptible to these injuries at an early age as these manual skills develop. However, as the development of male and female ball skills converges in the early teens, boys, as they grow, start to be exposed to new injuries due to the more physical components of the male game.
Injuries to the left hand affected younger players more on average (16 (IQR 13–22)) than the right hand (18 (IQR 15–26)). In a review of 1003 hand injuries, Beaton, Williams and Moseley found that right-hand injuries in people aged 12 were more common than left.33 A report of hand injuries in an older population (over 65) reported that injuries were more common on the left side.34 With reference to these studies and the results of this study, it appears that many variables influence the frequency of injury to left and right hands, including age, sex, the cause of injury and hand dominance. Further research is required to understand this relationship in the context of Gaelic football.
Most injuries were due to ball collisions, followed by ‘hyperextension injuries’. It is likely that ‘hyperextension injuries’ also refer to ball collision injuries, as this mechanism of injury is commonly observed when catching a ball and typically results in a volar base of middle phalanx fracture.23 Combining these two categories would account for just over half of all injuries.
The significant relationship between sex, mechanism and type of injury may also be due to extrinsic factors such as the variances in rules between women’s and men’s football. Male players must lift the ball from the ground using their feet, while female players can lift the ball from the ground using their hands, exposing their hands to a higher risk of being kicked. Men’s football allows shoulder-to-shoulder and deliberate body contact; however, both these actions will result in a free, yellow or red card in women’s football. These small differences enable men’s football to be more physical, leading to a greater propensity for hand injuries due to falls, tackles and player collisions. The higher incidence of injuries to the fifth and first rays in male players could also result from more physical contact, as these border rays are more vulnerable to being grasped or struck by other players during tackles. The average age of players with metacarpal fractures was 22.5 (IQR 17.25–28.75), and it affected male players more than female players. Metacarpal fractures to the neck and shaft are observed usually due to a punch, torsion, axial loading or a direct blow35 and to the base due to a ‘violent’ high force such as a fall,36 implying these injuries are also a result of the more physical male game as these players enter adulthood.
Limitations
Data analysed in this study was from 2022, a time when most COVID-19 restrictions in Northern Ireland had come to an end. However, adult players may have been deconditioned, and younger players may have been disadvantaged in developing fundamental movement skills. This may have influenced the number of injuries observed in this study. This study does not capture fractures that required surgical intervention of players under 14, and it is also likely that many of these injuries do not present in hospital departments, limiting an estimation of incidence reporting.
Clinical implications
The Translating Research into Injury Prevention Practice (TRIPP) framework recommends that initial injury surveillance is conducted to understand the aetiology and mechanisms of injuries sustained in a specific sport to ensure an appropriate implementation of injury prevention programmes.37 Regarding hand injuries in Gaelic football, the TRIPP framework32 and the modified Haddon matrix could assist in developing comprehensive injury prevention programmes and help researchers identify gaps in knowledge.
Using external joint supports in sports has been identified as an effective means to prevent injury.38 Gloves are worn in Gaelic football for grip and are not specifically used for injury prevention.1 One important consideration is that grip, sensibility, dexterity and range of movement can be reduced when gloves are used compared with the bare hand.39 Their potential as an injury prevention device in this sport requires further investigation.
It is possible that these injuries are not preventable in most cases due to the nature of the game. However, with the reported high incidence of ‘simple’ injuries to the proximal interphalangeal joint, which can lead to chronic issues, this study reinforces the need for players to seek medical attention as soon as possible to prevent possible long-term complications.