Wrestling game injuries among children in Dakar: a report on 172 cases

Introduction The objective was to report epidemiological and lesional features among children practicing wrestling as a game in Dakar, Senegal. Methods It was a retrospective study including all patients under 16, victims of wrestling game injuries. We studied epidemiological and lesional aspects in children: frequency of wrestling game injuries among all games, age, sex, geographic origin, place of injury, parent’s socioeconomic status, nature of the injury and location. Results Wrestling game injuries represented 19.9% injuries in all games. Sex-ratio was 33.4. The most affected age group was the 6-10 years old age group. The majority of children are from suburban Dakar (64%). Injuries occurred most often at home and in the street. Most children are from low socioeconomic status (64%). Fractures predominated and were localized almost exclusively on the elbow. Conclusion Wrestling game injuries in Dakar occur among older children from the suburbs, living in the neighborhood of great wrestling champions’ districts of residence. Wrestling game cause injuries, consisting mostly of elbow fractures.


Introduction
Four types of wrestling are practiced in the world, each with its specificity. These are: Olympic wrestling, freestyle wrestling, women's wrestling and traditional and folk wrestling [1,2].
Senegalese wrestling is a traditional wrestling [2]. In Senegal, traditional wrestling was practiced in villages to celebrate the end of the harvesting season [3]. It aimed at assessing the strength of men before designating the village champion, the winner of the tournament [3]. Today, there is a special form of wrestling, which is only practiced in Senegal and finds its specificity in the acceptance of bear-hand boxing. This type of wrestling, which is operated for commercial purposes, has become a social phenomenon. Wrestlers can win up to 76,335 euros in a single fight. They represent their places of origin or residence, in the eyes of the population; and a social role model of success. Children practice this type of wrestling to impersonate their idols, to become like those wrestlers one day. They are exposed to trauma due to their fragility and their lack of technicity in this game. The aim of this study was to report the epidemiological and lesional aspects of accidents due to wrestling game, referred to the Pediatric Surgery Department of Aristide Le Dantec Hospital in Dakar, Senegal.

Methods
This is a retrospective study conducted between January the 1st,

Epidemiological aspects
One hundred and seventy-two cases of wrestling game injuries were identified among 863 cases of game injuries (19.9%). The series consisted of 167 boys and 5 girls (sex ratio of 33.4). The mean age was 9 and the most affected age group was the 6-10 years old group ( Figure 1 Figure   4. Contusions were predominant at the elbow with 72% of the cases. All dislocations were localized at the elbow (7 cases). Two sprains occurred at the elbow and one occurred at the ankle. A wound was located at the elbow.

Discussion
Wrestling is the most popular sport in Senegal while in the world, football is still ahead. This popularity of wrestling is explained by the over-inflated media coverage but also by the huge amount of money that a wrestler can win in seconds in fight. Children practice wrestling to mimic wrestlers, to be like them one day and be able to Page number not for citation purposes 3 support their families. They are exposed to accidents because of their fragility and their lack of technical mastery of the game. In our series, wrestling game injuries mainly affect older children.
According to Thélot [4], it is at that age that physical activity is the most intense, with a desire for autonomy, resulting in aggressiveness responsible for game-related injuries. Injuries due to wrestling are almost exclusively encountered among boys. Three aspects may explain this male predominance: the physical characteristics of boys, the almost non-existence of female wrestling in Dakar, and the fact that, in our context, girls often help their mothers with household work and are less exposed to risks of game injuries. In Western studies, game injuries occur most frequently at school and in playgrounds [5,6]. In our study, wrestling game the fact that this region is often used as shield and therefore serves as cushion during falls. We do not find maxillofacial trauma, as in the study of Seck [9] conducted in adults practicing wrestling as a sport. In fact, children who practice wrestling favor blow-free fights and do not make use of punches as adults do. We also note that all lesions are closed injuries. We can explain this result by the tendency of children to choose sandy wrestling grounds to practice this game ( Figure 5).

Conclusion
Wrestling game injuries in Dakar occur among older children from the suburbs, and living next to the great wrestling champions.
Wrestling game cause injuries, consisting mostly of elbow fractures.     Page number not for citation purposes 5 Figure 1: Distribution of wrestling game injuries to age groups