Background: Functional training, also known as CrossFit, is a unique sport that combines weightlifting, gymnastics, and metabolic conditioning into a single program. There are an estimated 50 functional training centers in Malaysia. Purpose: To analyze the injury rates, patterns, and risk factors of functional training/CrossFit. Study Design: Descriptive epidemiology study. Methods: Electronic questionnaires were distributed to 244 participants from 15 centers in the country. Descriptive data regarding the athletes, injury occurrence within the past 6 months, injury details, and risk factors were collected. Results: Of the 244 athletes, 112 (46%) developed at least 1 new injury over the previous 6 months. Injury rates were significantly higher in athletes from nonaffiliate training gyms compared with CrossFit-affiliated gyms, in athletes with previous injuries, and in those who perceived themselves as having more than average fitness. Conclusion: Coaches and athletes need to be more aware of risk factors for injury to enable safer and better training strategies.

BackgroundMethicillin-resistant Staphylococcus aureus (MRSA) has of late emerged as a cause of community-acquired infections among immunocompetent adults without risk factors. Skin and soft tissue infections represent the majority of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) clinical presentations, whilst invasive and life-threatening illness like necrotizing pneumonia, necrotizing fasciitis, pyomyositis, osteomyelitis and sepsis syndrome are less common. Although more widely described in the pediatric age group, the occurrence of CA-MRSA osteomyelitis in adults is an uncommonly reported entity.Case presentationWe describe an invasive CA-MRSA infection in a 28 year-old previously healthy male, manifesting with bacteraemia, osteomyelitis of femur, pyomyositis and septic arthritis of the knee. Initially a preliminary diagnosis of osteosarcoma was suggested by imaging studies and patient underwent a bone biopsy. MRSA was subsequently isolated from blood cultures taken on day of admission, bone, tissue and pus cultures. Incision and drainage of abscess was performed and patient was treated with vancomycin, with fusidic acid added later. It took 6 months for the inflammatory markers to normalize, warranting 6-months of anti-MRSA therapy. Patient was a fervent deer hunter and we speculate that he acquired this infection from extensive direct contact with deer.Molecular characterization of this isolate showed that it belonged to multilocus sequence type (MLST) ST30 and exhibited the staphylococcal chromosome cassette mec (SCCmec) type IV, staphylococcus protein A (spa) type t019, accessory gene regulator (agr) type III and dru type dt10m. This strain harbored Panton-Valentine leukocidin (pvl) genes together with 3 other virulent genes; sei (enterotoxin), hlg (hemolysin) and fnbA (fibronectin binding protein).ConclusionThis case study alerts physicians that beyond the most commonly encountered skin and soft tissue infections, pvl positive CA-MRSA can lead to invasive life-threatening disease especially in an immunocompetent adult. Heightened alertness is needed for osteomyelitis of long bones in adults, as it is not uncommon for this disease to mimic primary bone malignancy. Cure is achievable with early appropriate antibiotics guided by inflammatory markers.

Ischaemic time and level of injury are important predictors of success rate of replantation and revascularization of amputated upper limb appendages.

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