Fairway to fractures: Income inequality and violent crime as the driving factors for golf club-related assaults – a case series of 21 compound skull fractures
DOI:
https://doi.org/10.7196/SAMJ.2024.v114i11.2268Keywords:
Golf club, Assault, Head Trauma, Skull FractureAbstract
Background. Golf club-related traumatic brain injuries are an uncommon occurrence in adults, and the use of golf clubs as a weapon of interpersonal assault resulting in compound skull fractures is rare.
Objective. To present a case series of golf club-related compound skull fractures in adults secondary to assault, representing the largest study of this entity to date.
Methods. A retrospective analysis was performed of a prospectively maintained database for patients admitted to Tygerberg Academic Hospital in Cape Town, South Africa, with golf club-related compound skull fractures between 1 January 2018 and 31 December 2021. Data on demographic details, computed tomography brain image findings, presenting Glasgow Coma Scale, surgical operative notes, septic complications and outcomes at discharge were collected.
Results. A total of 21 patients were included. The majority were male (95.2%) and the mean age was 32.6 years. Fractures were most commonly seen in the frontal bone (n=9), followed by parietal (n=8), temporal (n=3) and occipital (n=1) bones. Depressed skull fractures were the most common type of injury, and local pneumocephalus was present in the majority of patients. The mean presenting Glasgow Coma Scale was 14, and most patients had no focal neurological deficits. Surgical debridement was required in the majority of patients, with a high rate of septic complications (33.3%). However, most patients had good neurological outcomes at discharge, and the mean length of stay was 11.9 days.
Conclusion. This study highlights the potential dangers of golf clubs as a weapon of interpersonal assault, and the need for prompt and appropriate management of compound skull fractures to reduce the risk of complications.
References
1. Pennycook A, Morrison WG, Ritchie DAW. Accidental golf club injuries. Postgrad Med J 1991;67(793): 982-983. https://doi.org/10.1136/pgmj.67.793.982
2. Hance K. Golf club-related basal skull fracture – a case study. Int Emerg Nurs 2011;19(4):206-208.
https://doi.org/10.1016/j.ienj.2011.06.005
3. Rahimi S, Singh H, Yeh D, Shaver EG, Flannery AM, Lee MR. Golf-associated head injury in the pediatric population: A common sports injury. J Neurosurg Pediatr 2005;102(2):163-166. https://doi. org/10.3171/ped.2005.102.2.0163
4. Brennan PO. Golf-related head injuries in children. BMJ 1991;303(6793):54. https://doi.org/10.1136/ bmj.303.6793.54-b
5. Fountas KN, Kapsalaki EZ, Machinis TG, et al. Pediatric golf-related head injuries. Child Nerv Syst 2006;22(10):1282-1287. https://doi.org/10.1007/s00381-006-0077-8
6. McHardy A, Pollard H, Lo K. Golf injuries: A review of the literature. Sports Med 2006;36(2):171-187.
https://doi.org/10.2165/00007256-200636020-00006
7. Sulaiman NA, Osman K, Hamzah NH, Amir SPAA. Blunt force trauma to skull with various instruments. Malays J Pathol 2014;36(1):33-39
8. Rehman L, Ghani E, Hussain A, et al. Infection in compound depressed fracture of the skull. J Coll Physicians Surg Pak 2007;17(3):140-143. https://doi.org/03.2007/JCPSP.140143
9. Heary RF, Hunt CD, Krieger AJ, Schulder M, Vaid C. Nonsurgical treatment of compound depressed skull fractures. J Trauma Injury Infect Crit Care 1993;35(3):441-447. https://doi.org/10.1097/00005373- 199309000-00018
10. Bayston R, de Louvois J, Brown EM, Johnston RA, Lees P, Pople IK. Use of antibiotics in penetrating craniocerebral injuries. Lancet 2000;355(9217):1813-1817. https://doi.org/10.1016/S0140-6736(00)02275-3
11. Agha RA, Sohrabi C, Mathew G, et al. The PROCESS 2020 Guideline: Updating consensus preferred reporting of case series in surgery (PROCESS) Guidelines. Int J Surg 2020;84:231-235. https://doi.
org/10.1016/j.ijsu.2020.11.005
12. Norman R, Matzopoulos R, Groenewald P, Bradshaw D. The high burden of injuries in South Africa. Bull World Health Org 2007;85(9):7505. https://doi.org/10.2471/BLT.06.037184
13. Clark C, Mole CG, Heyns M. Patterns of blunt force homicide in the West Metropole of the City of Cape Town, South Africa. S Afr J Sci 2017;113(5-6):1-6. https://doi.org/10.17159/sajs.2017/20160214
14. Groenewald P, Bradshaw D, Daniels J, et al. Cause of death and premature mortality in Cape Town, 2001 - 2006. Western Cape Government, 2001. https://www.westerncape.gov.za/Text/2008/11/cause_ of_death_and_premature_mortality_in_cape_town_5_november_2008.pdf (accessed 31 March 2023).
15. Du Toit F, Griffith-Richards SB, van Zyl BC, Pitcher RD. Advanced radiological investigations and findings amongst community assault victims admitted to a tertiary South African hospital. S Afr J Surg 2019;57(2):54-60. https://doi.org/10.17159/2078-5151/2019/V57N2A2972
16. Moser C. Violence and poverty in South Africa: Their impact on household relations and social capital. Washington, DC: World Bank, 1999. http://documents1.worldbank.org/curated/en/269231468759567389/ pdf/multi-page.pdf (accessed 31 March 2023).
17. PlüddemannA,ParryC,DonsonH,SukhaiA.AlcoholuseandtraumainCapeTown,DurbanandPort Elizabeth, South Africa: 1999 - 2001. Injury Control Safety Promotion 2004;11(4): 265-267. https://doi. org/10.1080/156609704/233/289599
18. Rosenow JM, Hahn MS, Moore KD, Benzil DL, Couldwell WT. Pediatric cranial golf injuries–an emerging contemporary phenomenon? Surg Neurol 1998;50(6):608. https://pubmed.ncbi.nlm.nih. gov/9870826/ (accessed 31 March 2023).
19. Dawkins M, Kinloch G. African American Golfers during the Jim Crow Era. Westport, CT: Praeger Publishers, 2000.
20. Hundley HL. Keeping the score: The hegemonic everyday practices in golf. Int J Phytoremediation 2004;21(1):39-48. https://doi.org/10.1080/08934210409389372
21. Cock J. Caddies and ‘cronies’: Golf and changing patterns of exclusion and inclusion in post-apartheid South Africa. S Afr Rev Sociol 2008;39(2):183-200. https://doi.org/10.1080/21528586.2008.10425085
22. Franken N. McLuhan plays golf: Optimizing technology to make golf more accessible, affordable, and sustainable. J Commun Inquiry 2022;46(4):344-360. https://doi.org/10.1177/01968599221112112
23. AgherdienN.Annualreportofthepresident.GolfRSA,2019:1-5.https://www.golfrsa.com/wp-content/ uploads/2024/01/2019-SAGA-Presidents-Report-Naadir-Agherdien.pdf (accessed 31 March 2023).
24. Tichaawa TM, Harilal V. Golf tourism in South Africa: Profiling attendees at a major championship event.
Afr J Phys Activity Health Sci 2016;22(3:1):795-807. https://journals.co.za/doi/abs/10.10520/EJC195984
(accessed 31 March 2023).
25. Harmse L. South Africa’s Gini coefficient: Causes, consequences and possible responses. MBA
dissertation. Pretoria: University of Pretoria, 2014. https://repository.up.ac.za/handle/2263/40181
(accessed 31 March 2023).
26. Mosala S. The South African Economic Reconstruction and Recovery Plan as a response to South
African economic crisis. J BRICS Studies 2022;1(1):55-67. https://doi.org/10.36615/jbs.v1i1.637
27. Professional Golf Association and Mzansi Golf. Briefings on developing golf. Parliamentary Monitoring
Group, 15 May 2007. https://pmg.org.za/committee-meeting/8172/ (accessed 31 March 2023).
28. World Population Review. Golf popularity by country 2023. https://worldpopulationreview.com/
country-rankings/golf-popularity-by-country (accessed 7 October 2023).
29. United Nations Office on Drugs and Crime. Crime and violent offences data. UNODC Data Portal,
2023. https://dataunodc.un.org/dp-crime-violent-offences (accessed 7 October 2023).
30. Aron DV, Aguilar AC, Diaz-Bonilla C, et al. Update to the Poverty and Inequality Platform (PIP).
What’s New. World Bank Group: Global Poverty Monitoring Technical Note, September 2023.
31. Leibbrandt M, Ranchhod V, Green P. Taking stock of South African income inequality. UNU-WIDER
Working Paper, 2018;184. https://doi.org/10.35188/UNU-WIDER/2018/626-5
32. TheEditorsofEncyclopaediaBritannica.Momentofinertia.EncyclopaediaBritannica,18September2023.
https://www.britannica.com/science/moment-of-inertia (accessed 7 October 2024).
33. McNally W, Balzerson D, Wilson D, McPhee J. Effect of clubhead inertial properties and driver face geometry on golf ball trajectories. Procedia Engineering 2016;147:407-412. https://doi.org/10.1016/j.
proeng.2016.06.312.
34. Kuninaka H, Hayakawa H. Anomalous behavior of the coefficient of normal restitution in oblique impact. Phys Rev Lett 2004;93(15):154301. https://doi.org/10.1103/PhysRevLett.93.154301
35. Henrikson E, Wood P, Hart J. Experimental investigation of golf driver club head drag reduction through the use of aerodynamic features on the driver crown. Procedia Engineering 2014;72:726-731. https://doi.org/10.1016/j.proeng.2014.06.139
36. TrackMan. Performance of the average male amateur golfer. TrackMan Golf Blog, 2023. https://blog. trackmangolf.com/performance-of-the-average-male-amateur/ (accessed 31 March 2023).
37. Kieck CF, de Villiers JC. Vascular lesions due to transcranial stab wounds. J Neurosurg 1984;60(1):42-46. https://thejns.org/view/journals/j-neurosurg/60/1/article-p42.xml (accessed 31 March 2023).
38. Eggensperger N, Smolka K, Zimmermann H, Iizuka T. A 3-year survey of assault-related maxillofacial fractures in central Switzerland. Br J Oral Maxillofac Surg 2007;45(1):62-64. https://doi.org/10.1016/j. bjoms.2006.01.007
39. Shepherd JP, Al-Kotany MY, Scully C, Smith AJ. Assault and facial soft tissue injuries. Br J Oral Maxillofac Surg 1987;25(3):232-241. https://doi.org/10.1016/0007-1226(87)90157-3
40. Bullock MR, Chesnut R, Ghajar J, et al. Surgical management of depressed cranial fractures. Neurosurgery 2006;58(Suppl 3):S52-S56. https://doi.org/10.1227/01.NEU.0000210367.14043.0E
41. Braakman R. Depressed skull fracture: Data, treatment, and follow-up in 225 consecutive cases.
J Neurol Neurosurg Psychiatr 1972;35(3):395-402. https://doi.org/10.1136/jnnp.35.3.395
42. Maharaj P, Enicker B. Compound elevated skull fractures: A retrospective descriptive study.
Br J Neurosurg 2022;36(4):422-428. https://doi.org/10.1080/02688697.2022.2063256
43. Enicker B, Madiba TE. Cranial injuries secondary to assault with a machete. Injury 2014;45(9):1355-
1358. https://doi.org/10.1016/j.injury.2014.04.036
44. Kelly A, Lekgwara P. Evaluating patient epidemiology and clinical practice on the outcome of
patients admitted with skull fractures secondary to assault. Clin Pract 2018;15(SII):992-993. https://
doi.org/10.4172/clinical-practice.1000436
45. Grobler R, Harrington B, Vlok A. Factors influencing septic complications in open skull fractures. Brain Spine 2023;3(1):101878. https://doi.org/10.1016/J.BAS.2023.101878
46. Suliman A, Jayakumar N, Chaurasia B, Holliman D. The management of depressed skull fractures in adults: An international survey. Brain Spine 2021;1(1):100628. https://doi.org/10.1016/J. BAS.2021.100628
47. Al-HaddadSA,KirollosR.A5-yearstudyoftheoutcomeofsurgicallytreateddepressedskullfractures. Ann Royal Coll Surg 2002;84(3):196-200.
48. Jennett B, Miller JD. Infection after depressed fracture of skull: Implications for management of nonmissile injuries. J Neurosurg 1972;36(3):333-339. https://doi.org/10.3171/JNS.1972.36.3.0333
49. Harrington BM, Gretschel A, Lombard C, Lonser RR, Vlok AJ. Complications, outcomes, and
management strategies of non-missile penetrating head injuries. J Neurosurg 2020;134(5):1658-1666.
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