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Nguyen JC, Caine D. The Immature Pediatric Appendicular Skeleton. Semin Musculoskelet Radiol 2024; 28:361-374. [PMID: 39074720 DOI: 10.1055/s-0044-1786151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/31/2024]
Abstract
Growth and maturation occur in a predictable pattern throughout the body and within each individual bone. In the appendicular skeleton, endochondral ossification predominates in long bones and growth plates. The ends of these long bones are sites of relative weakness in the immature skeleton and prone to injury from acute insult and overuse. We present the normal histoanatomy and physiology of the growth plate complex, highlighting the unique contribution of each component and shared similarities between primary and secondary complexes. Components of the growth plate complex include the physis proper, subjacent vascularity within the growth cartilage, and the ossification front. The second section describes imaging considerations and features of normal and abnormal growth. Finally, we review the Salter-Harris classification for acute fractures and offer examples of characteristic overuse injury patterns involving the epiphyseal (proximal humerus and distal radius), apophyseal (medial epicondyle and tibial tubercle), and secondary growth plate complexes (medial femoral condyle and capitellar osteochondritis dissecans). This article provides a foundation and basic framework to better understand and anticipate potential complications and growth disturbances and to ensure optimal follow-up and early intervention when treatment can be less invasive.
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Affiliation(s)
- Jie C Nguyen
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Dennis Caine
- Division of Education, Health and Behavior Studies, Kinesiology and Public Health Education, University of North Dakota, Grand Forks, North Dakota
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Caine D, Patel V, Nguyen JC. Overuse Injury of the Epiphyseal Primary Physis. Semin Musculoskelet Radiol 2024; 28:375-383. [PMID: 39074721 DOI: 10.1055/s-0044-1785207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/31/2024]
Abstract
Year-round participation in youth sport that involves high levels of repetitive movement fosters an environment in which overuse injuries are likely to occur. Epiphyseal primary physeal stress injuries (PSIs), unique to skeletally immature athletes, are a particular concern, given their potential for growth disturbance. Initially observed in Little League baseball players, these injuries are now known to affect the long bones around the shoulder, elbow, wrist, hand, knee, ankle, and foot of skeletally immature athletes involved in a variety of sport activities.This article offers an epidemiological and radiologic perspective on the extent and distribution of epiphyseal PSIs in youth sport. We also review a novel framework for understanding the pathophysiologic mechanisms causing these injuries. This information is essential for the early identification of epiphyseal PSIs and devising preventive measures that can reduce a delayed diagnosis and long-term morbidity. Preventing and reducing injury to the epiphyseal growth plates is essential because impairment and dysfunction can result in lifelong morbidity and a risk of premature osteoarthritis.
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Affiliation(s)
- Dennis Caine
- Division of Education, Health and Behavior Studies, Kinesiology and Public Health Education, University of North Dakota, Grand Forks, North Dakota
| | - Vandan Patel
- Department of Radiology, Section of Musculoskeletal Imaging, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Jie C Nguyen
- Department of Radiology, Section of Musculoskeletal Imaging, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
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Ishii T, Hioki S. Apophyseal avulsion fracture of the conjoint tendon of obturator internus and gemellus superior and inferior during apophyseal stage in adolescent athlete. J Orthop Sci 2023; 28:1602-1605. [PMID: 34996700 DOI: 10.1016/j.jos.2021.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 10/12/2021] [Accepted: 12/13/2021] [Indexed: 10/19/2022]
Affiliation(s)
- Tomoo Ishii
- Department of Orthopedic Surgery, Tokyo Medical University Ibaraki Medical Center, 3-20-1 Chuo, Ami, Inashiki, Ibaraki, 300-0395 Japan; Department of Orthopedic Surgery, Miho Clinic, 2500-2 Mikoma, Miho, Inashiki, Ibaraki, 300-0415 Japan.
| | - Shigeru Hioki
- Department of Orthopedic Surgery, Miho Clinic, 2500-2 Mikoma, Miho, Inashiki, Ibaraki, 300-0415 Japan
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Shafshak T, Amer MA. Focused extracorporeal shockwave therapy for youth sports-related apophyseal injuries: case series. J Orthop Surg Res 2023; 18:616. [PMID: 37608382 PMCID: PMC10464320 DOI: 10.1186/s13018-023-04065-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 08/01/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND Apophyseal overuse injuries are self-limited with skeletal maturity; however, they may be a source of significant pain and time lost from training. There is a lack of consensus for its management with the current available treatment, which might lag behind the ongoing development of regenerative medicine. The current retrospective case study aimed to assess the potential effectiveness and short-term safety of extracorporeal shockwave therapy (ESWT) in apophyseal injuries. METHODS Data from 22 growing athletes [15 patients with Osgood-Schlatter disease and seven patients with Sever's disease] who received ESWT at a sports medicine unit in a university hospital were reviewed. All patients received low energy (= 0.1 mJ/mm2) level-focused ESWT using electrohydraulic generation technology. The clinical focusing technique was used upon applying ESWT. RESULTS The number of sessions received to achieve full recovery ranged from 1 to 3 sessions. The time from treatment initiation to previous activity level was 2 weeks in 14 patients (63.3%), 4 weeks in seven patients (31.8%) and 11 weeks in one patient (4.5%). No adverse events were reported. No recurrence occurred up to 3 months after the last session. CONCLUSION ESWT is a potentially safe and effective treatment for apophyseal injuries. It may facilitate an early return to sport activities.
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Affiliation(s)
- Tarek Shafshak
- Department of Physical Medicine, Rheumatology and Rehabilitation, Faculty of Medicine, Alexandria University, Al-Khartoum Square, Alexandria, 21526, Egypt
| | - Marwa Abdullah Amer
- Department of Physical Medicine, Rheumatology and Rehabilitation, Faculty of Medicine, Alexandria University, Al-Khartoum Square, Alexandria, 21526, Egypt.
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Identeg F, Lagerstrand K, Hedelin H, Senorski EH, Sansone M, Hebelka H. Low occurrence of MRI spinal changes in elite climbing athletes; a cross-sectional study. BMC Sports Sci Med Rehabil 2023; 15:29. [PMID: 36895033 PMCID: PMC9999554 DOI: 10.1186/s13102-023-00637-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 02/24/2023] [Indexed: 03/11/2023]
Abstract
OBJECTIVES To examine the occurrence of magnetic resonance imaging (MRI) changes in the thoracolumbar spine among elite climbing athletes. METHODS All climbers of the Swedish national sport climbing team (n = 8), and individuals having trained for selection to the national team (n = 11), were prospectively included. A control group, matched in age and sex, were recruited. All participants underwent a thoracolumbar MRI (1.5 T, T1- and T2-weighted imaging), evaluated according to Pfirrmann classification, modified Endplate defect score, Modic changes, apophyseal injuries and spondylolisthesis. Pfirrmann ≥ 3, Endplate defect score ≥ 2 and Modic ≥ 1 was defined as degenerative findings. RESULTS Fifteen individuals, 8 women, participated in both the climbing group (mean age 23.1, SD 3.2 years) and the control group respectively (mean age 24.3, SD 1.5 years). In the climbing group, 6.1% of the thoracic and 10.6% of the lumbar intervertebral discs showed signs of degeneration according to Pfirrmann. One disc with a grade above 3 was present. Modic changes in the thoracic/lumbar spine were prevalent in 1.7%/1.3% of the vertebrae. Degenerative endplate changes according to the Endplate defect score were found in 8.9% and 6.6% of the thoracic and lumbar spinal segments of the climbing group, respectively. Two apophyseal injuries were found, while no participants displayed signs of spondylolisthesis. There was no difference in point-prevalence of radiographic spinal changes between climbers and controls (0.07 < p < 1.0). CONCLUSION In this small cross-sectional study, only a low proportion of elite climbers displayed changes of the spinal endplates or intervertebral discs, as opposed to other sports with high spinal loads. Most observed abnormalities were low grade degenerative changes and did not differ statistically compared to controls.
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Affiliation(s)
- Fredrik Identeg
- Department of Orthopaedics, Gothenburg, Sweden. .,Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Kerstin Lagerstrand
- Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, Gothenburg, Sweden.,Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Henrik Hedelin
- Department of Orthopaedics, Gothenburg, Sweden.,Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Eric Hamrin Senorski
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Mikael Sansone
- Department of Orthopaedics, Gothenburg, Sweden.,Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Hanna Hebelka
- Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden.,Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Zebrack JP, Kalisvaart M, O'Mara TJ. Screw Apophysiodesis for Chronic Ischial Apophysitis Refractory to Apophyseal Drilling in a Teenage Athlete: A Case Report. JBJS Case Connect 2023; 13:01709767-202303000-00045. [PMID: 36812356 DOI: 10.2106/jbjs.cc.22.00713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
CASE A 17-year-old elite male soccer player, initially treated for chronic ischial apophysitis with transapophyseal drilling 18 months before, presented with persistent apophysitis symptoms and unfused apophysis on imaging. An open screw apophysiodesis was performed. The patient was able to gradually return to play and, within 8 months, was competing symptom-free at a high-level soccer academy. At 1 year postoperatively, the patient was still playing soccer and continued to be asymptomatic. CONCLUSION In refractory cases not responding to conservative management or transapophyseal drilling, screw apophysiodesis may be used to obtain apophyseal closure with symptom resolution.
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Affiliation(s)
| | - Michael Kalisvaart
- Reno Orthopedic Clinic, Reno, NV; University of Nevada School of Medicine-Reno, Reno, NV
| | - Timothy J O'Mara
- Reno Orthopedic Clinic, Reno, NV; University of Nevada School of Medicine-Reno, Reno, NV
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Schultz K, Stüwe D, Westhoff B. [Juvenile osteochondrosis and osteonecrosis]. ORTHOPADIE (HEIDELBERG, GERMANY) 2022; 51:829-843. [PMID: 36064862 DOI: 10.1007/s00132-022-04305-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/09/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Juvenile osteonecrosis is an important topic in orthopedics. A wide variety of body regions of the growing patient are affected, predominantly during adolescence. All are characterized by a usually unknown aetiology as well as a stadium-like course. The main problem is a local osseous circulatory disorder, which causes osteonecrosis. RISK FACTORS Mechanical overloading due to increased body weight, axial misalignment, and sports activity is discussed as a risk factor. Healing depends on the localization and extent of the osseous necrosis. DIAGNOSTICS Diagnostically, radiologic imaging is used, in which the typical bony remodeling can be followed. THERAPY The therapeutic procedure depends on the affected region but is usually accompanied by a reduction of mechanical loading. If the clinical and radiological findings worsen, surgical treatment must be considered. The recognition and treatment of juvenile osteonecrosis is important and significantly influences the further development of the patient.
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Affiliation(s)
- Katharina Schultz
- Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Deutschland.
| | - Dominique Stüwe
- Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Deutschland
| | - Bettina Westhoff
- Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Deutschland
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Emmet D, Roberts J, Yao KV. Update on Preventing Overuse Injuries in Youth Athletes. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2022. [DOI: 10.1007/s40141-022-00362-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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Gudelis M, Perez LT, Cabello JT, Leal DM, Monaco M, Sugimoto D. Apophysitis Among Male Youth Soccer Players at an Elite Soccer Academy Over 7 Seasons. Orthop J Sports Med 2022; 10:23259671211065063. [PMID: 35097142 PMCID: PMC8796099 DOI: 10.1177/23259671211065063] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 09/16/2021] [Indexed: 11/18/2022] Open
Abstract
Background: Apophyseal injuries are common in children and adolescent athletes. These injuries are believed to be caused by repetitive overloading, which can create inflammatory and degenerative conditions in growing bone prominences. However, their prevalence, diagnosis, and treatment in young soccer players have been understudied. Purpose: To evaluate characteristics of apophyseal injuries in adolescent athletes at an elite soccer academy. Study Design: Case series; Level of evidence, 4. Methods: All apophyseal injuries between July 2008 and June 2015 were evaluated. For each injury, the authors recorded the type and location, age of the player, injury date, imaging modalities, and time absent from training/competition. Results: Over the 7 seasons of this study, 210 apophyseal injuries were documented, including 172 simple apophyseal injuries and 38 apophyseal avulsion fractures. The rate of apophyseal injuries was 0.35 per 1000 hours of training exposure. A total of 196 (93.3%) cases were primary injuries, and the rest (6.7%) were reinjuries. Ultrasonography was the most commonly used imaging modality for diagnosis (172 cases; 81.9%). The most common location of apophyseal injuries was the anterior inferior iliac spine (AIIS). Return to sport was faster in athletes with apophyseal injury at the ischiopubic ramus, those with simple apophyseal injuries, and younger athletes. Conclusion: The most common location for apophyseal injury among soccer players was the AIIS. Return to training and competition differed according to injury location, type of apophyseal injury, and age.
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Affiliation(s)
- Mindaugas Gudelis
- Barça Innovation Hub, Medical Department, Futbol Club Barcelona, Barcelona, Spain
| | - Luis Til Perez
- Barça Innovation Hub, Medical Department, Futbol Club Barcelona, Barcelona, Spain
| | | | - Daniel Medina Leal
- Athlete Care and Performance Department, Washington Wizards, Washington, DC, USA
| | | | - Dai Sugimoto
- The Micheli Center for Sports Injury Prevention, Waltham, Massachusetts, USA
- Faculty of Sport Sciences, Waseda University, Tokyo, Japan
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Abstract
This article reviews injuries encountered in active pediatric patients and discusses common presentations, diagnostic criteria, treatment modalities, and prevention. An emphasis is placed on overuse injuries, including a review of physeal and apophyseal injuries encountered in skeletally immature, active patients as well as back disorders often encountered in adolescents. This article is not meant to be comprehensive, but it offers directions for management of these patients in the outpatient primary care setting.
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Affiliation(s)
- Brittney M Richardson
- Department of Family and Geriatric Medicine, University of Louisville School of Medicine, 215 Central Avenue, Suite 205, Louisville, KY 40208, USA.
| | - Meghane E Masquelin
- University of Louisville Family Medicine Residency Program, 201 Abraham Flexner Way, Suite 690, Louisville, KY 40202, USA
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Youth Distance Running and Lower Extremity Injury: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18147542. [PMID: 34299992 PMCID: PMC8306621 DOI: 10.3390/ijerph18147542] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 06/29/2021] [Accepted: 07/11/2021] [Indexed: 11/20/2022]
Abstract
Distance running is a popular youth sport. This systematic review identified and examined the effects of youth distance running and lower extremity musculoskeletal injury. Scientific databases were searched from database inception to May 2020. Two hundred and fifty-eight full texts were screened, with nine articles retained for data extraction. Seven of the studies were case reports or case series. Two case reports involved an apophyseal hip fracture. No correlation was found between running mileage or gender and sustaining an injury. Middle school runners reported fewer injuries than high school runners. Cross country accounted for less than 10% of injuries in youth under 15 compared to other track activities. The main finding was a paucity of research. Available literature suggests youth can participate in distance running with minimal adverse effects. One exception may be increased vulnerability to growth plate injury. Additional research is needed, especially in those under 10, as literature in this population is nonexistent.
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Materne O, Chamari K, Farooq A, Weir A, Hölmich P, Bahr R, Greig M, McNaughton LR. Association of Skeletal Maturity and Injury Risk in Elite Youth Soccer Players: A 4-Season Prospective Study With Survival Analysis. Orthop J Sports Med 2021; 9:2325967121999113. [PMID: 33869641 PMCID: PMC8020116 DOI: 10.1177/2325967121999113] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 01/05/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The association between injury risk and skeletal maturity in youth soccer has received little attention. PURPOSE To prospectively investigate injury patterns and incidence in relation to skeletal maturity in elite youth academy soccer players and to determine the injury risks associated with the skeletal maturity status, both overall and to the lower limb apophysis. STUDY DESIGN Descriptive epidemiology study. METHODS All injuries that required medical attention and led to time loss were recorded prospectively during 4 consecutive seasons in 283 unique soccer players from U-13 (12 years of age) to U-19 (18 years). The skeletal age (SA) was assessed in 454 player-seasons using the Fels method, and skeletal maturity status (SA minus chronological age) was classified as follows: late, SA >1 year behind chronological age; normal, SA ±1 year of chronological age; early, SA >1 year ahead of chronological age; and mature, SA = 18 years. An adjusted Cox regression model was used to analyze the injury risk. RESULTS A total of 1565 injuries were recorded; 60% were time-loss injuries, resulting in 17,772 days lost. Adjusted injury-free survival analysis showed a significantly greater hazard ratio (HR) for different status of skeletal maturity: early vs normal (HR = 1.26 [95% CI, 1.11-1.42]; P < .001) and early vs mature (HR = 1.35 [95% CI, 1.17-1.56]; P < .001). Players who were skeletally mature at the wrist had a substantially decreased risk of lower extremity apophyseal injuries (by 45%-61%) compared with late (P < .05), normal (P < .05), and early (P < .001) maturers. CONCLUSION Musculoskeletal injury patterns and injury risks varied depending on the players' skeletal maturity status. Early maturers had the greatest overall adjusted injury risk. Players who were already skeletally mature at the wrist had the lowest risk of lower extremity apophyseal injuries but were still vulnerable for hip and pelvis apophyseal injuries.
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Affiliation(s)
- Olivier Materne
- ASPETAR, Orthopaedic and Sports Medicine Hospital, Doha, Qatar
- Aspire Health Centre, Aspire Academy, Doha, Qatar
- Rangers Football Club, Glasgow, Scotland
| | - Karim Chamari
- ASPETAR, Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | | | - Adam Weir
- ASPETAR, Orthopaedic and Sports Medicine Hospital, Doha, Qatar
- Sport Medicine and Exercise, Clinic Haarlem (SBK), Haarlem, the
Netherlands
- Department of Orthopaedics, Erasmus MC University Medical Centre,
Rotterdam, the Netherlands
| | - Per Hölmich
- ASPETAR, Orthopaedic and Sports Medicine Hospital, Doha, Qatar
- Sports Orthopaedic Research Center, Copenhagen (SORC-C), Copenhagen
University Hospital, Amager-Hvidovre, Denmark
| | - Roald Bahr
- ASPETAR, Orthopaedic and Sports Medicine Hospital, Doha, Qatar
- Department of Sports Medicine, Oslo Sports Trauma Research Center,
Norwegian School of Sport Sciences, Oslo, Norway
| | - Matt Greig
- Department of Sport and Physical Activity, Edge Hill University, Ormskirk, UK
| | - Lars R. McNaughton
- Department of Sport and Physical Activity, Edge Hill University, Ormskirk, UK
- Department of Sport and Movement Studies, Faculty of Health
Science, University of Johannesburg, Auckland Park, South Africa
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Neubauer M, Nehrer S. [Apophyseal injuries in sports]. DER ORTHOPADE 2021; 50:163-171. [PMID: 33512561 PMCID: PMC7862193 DOI: 10.1007/s00132-021-04074-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The number of adolescents and children in elite and high-intensity mass sports is increasing, with respect to industrial nations. High-intensity training can cause overload due to the increased traction effect, particularly on tendon and muscle insertion sites. Apophyses are the center for ossification in tendon and muscle insertions and are therefore particularly vulnerable in youths to overload-related pathologies. Core measures in the prevention are a systematic planning of training and the avoidance of mechanical overstraining in the growth period. An exact imaging enables the diagnosis of apophyseal structural damage at an early stage, which in this phase can be healed by a pause in training and conservative measures.
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Affiliation(s)
- Markus Neubauer
- Zentrum für Regenerative Medizin, Donau Universität Krems, Dr. Karl-Dorrek-Str. 30, 3500, Krems, Österreich
- Universitätsklinik für Orthopädie, Universitätsklinikum Krems, Karl Landsteiner Privatuniversität für Gesundheitswissenschaften, Dr. Karl-Dorrek-Straße 30, 3500, Krems, Österreich
| | - Stefan Nehrer
- Zentrum für Regenerative Medizin, Donau Universität Krems, Dr. Karl-Dorrek-Str. 30, 3500, Krems, Österreich.
- Universitätsklinik für Orthopädie, Universitätsklinikum Krems, Karl Landsteiner Privatuniversität für Gesundheitswissenschaften, Dr. Karl-Dorrek-Straße 30, 3500, Krems, Österreich.
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Kotob MA, Negaard M, Thomsen TW. Coracoid Apophysiolysis in an Adolescent Softball Pitcher. Curr Sports Med Rep 2020; 19:522-523. [PMID: 33306514 DOI: 10.1249/jsr.0000000000000783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- M Atef Kotob
- Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
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Zaki P, Khakimov S, Hess J, Hennrikus W. Femur, Tibia, and Fibula Fractures Secondary to Youth Soccer: A Descriptive Study and Review of the Literature. Cureus 2020; 12:e8185. [PMID: 32566426 PMCID: PMC7301417 DOI: 10.7759/cureus.8185] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objectives Soccer is the most popular sport in the world and is one of the top sports with increased participation. Despite the vast and increasing numbers of soccer players, limited data are available on pediatric lower extremity injuries. In particular, the purpose of the study is to describe the epidemiology of femur, tibia, and fibula fractures secondary to youth soccer. Methods A retrospective review concerning soccer-related femur, tibia, and fibula fractures was conducted in children under the age of 18 years from January 1, 2000 to December 31, 2015 with statewide data from the Pennsylvania Trauma Systems Foundation (PTSF), Mechanicsburg, PA. Results A total of 258 youth soccer players were admitted for femur, tibia, and fibula fractures from 2000 to 2015. These fractures constituted 33% of soccer-related injuries in youth admitted at trauma centers. Sixty-five percent of the fractures involved the tibia and 34% involved the femur. Body contact injury resulted in 54% of the fractures and non-body contact injury resulted in 46% of the fractures. Athletes the age of 13 and older sustained 67% of the fractures and were more likely to incur contact injuries (p-value=0.000041) than those less than 13. Males sustained 67% of the fractures, and gender was not associated with the mechanism of injury (p-value=0.43). Open fractures included 10% of tibia fractures and did not occur in femur fractures. The growth plate was involved in 24% of the femur fractures and 17% of the tibia fractures. Conclusion Youth soccer has the potential for serious femur, tibia, and fibula fractures. Intervention programs should aim at reducing non-body contact mechanism in children < 13 years of age and body contact mechanism in children ≥ 13 years of age. Further research should investigate injury prevention methods such as potentially reducing body contact mechanism by improving the effectiveness of shin guards.
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Affiliation(s)
- Peter Zaki
- Orthopaedic Surgery, Penn State College of Medicine, Hershey, USA.,Radiation Oncology, University of Washington, Seattle, USA
| | - Sayyar Khakimov
- Orthopaedic Surgery, Penn State College of Medicine, Hershey, USA
| | - Joseph Hess
- Pediatric Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, USA
| | - William Hennrikus
- Orthopaedic Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, USA
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Abstract
With increasing pediatric participation in organized sport and the early specialization of children in single sports, the number of injuries seen in the pediatric and adolescent athletic population continues to increase. Children experience acute traumatic injuries during practice and competition as well as chronic overuse injuries secondary to the repetitive stress on their developing bodies. The unique nature of the pediatric patient often requires a different diagnostic, prognostic, and treatment approach to sports injuries compared with their adult counterparts.
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Brigham E, Brady J, Olympia RP. School Nurses on the Front Lines of Medicine: Emergencies Associated With Sport and Physical Activities: Part 1. NASN Sch Nurse 2019; 34:155-161. [PMID: 30741088 DOI: 10.1177/1942602x18819223] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Illness and injury associated with sport and physical activities may occur in the school setting. Although most sport-related illness and injury in students are considered minor emergencies, life- and limb-threatening illnesses or injuries may occur, such as sudden cardiac arrest, heat stroke, status asthmaticus, catastrophic brain or cervical spine injuries, hypoglycemia, blunt chest/abdominal injuries, or extremity fractures requiring surgery. It is important for the school nurse to recognize potential life- and limb-threatening emergencies associated with sport and physical activity, to initiate stabilization of the student with life- and limb-threatening symptoms, and to triage these students to an appropriate level of care (back to the classroom, home with their guardian with follow up at their primary healthcare provider's office, or directly to the closest emergency department via emergency medical services). This article describes the initial assessment and management of three common emergencies associated with sport and physical activities.
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Affiliation(s)
- Elizabeth Brigham
- General Pediatrics Resident Physician, Penn State Hershey Children's Hospital, Hershey, PA
| | - Jodi Brady
- Attending Physician, Division of Adolescent Medicine, Department of Pediatrics, Penn State Hershey Children's Hospital, Hershey, PA
| | - Robert P Olympia
- Professor, Departments of Emergency Medicine and Pediatrics, Penn State College of Medicine
- Attending Pediatric Emergency Medicine physician, Penn State Hershey Medical Center, Hershey, PA
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Abstract
PURPOSE OF REVIEW Provide the reader with an evidence-based update on the importance of accurate diagnosis of commonly missed avulsion fractures of pelvis apophyses, the necessary imaging studies, the feared complications and the recent treatment recommendations. RECENT FINDINGS Accurate diagnosis of avulsion fractures of pelvis apophyses is high yield as misdiagnosis leads to improper treatment. They should be differentiated from muscle strain and apophysitis. These fractures are usually associated with good outcomes; however, missed diagnosis can lead to further displacement, nonunion, functional limitation, femoroacetabular impingement and infection. A/P and frog lateral pelvis radiograph show the fracture and its displacement in the majority of cases. Conservative treatment, consisting of a short period of rest and immobilization followed by passive stretching then progressive resisted activity before return to sports, is recommended in minimally displaced avulsions. Surgical treatment is favored in displaced fractures (>15 mm), as it is associated with quicker return to sports. SUMMARY Treating physicians should keep a high index of suspicion in pediatric and adolescent patients presenting with typical clinical exam findings. Pelvic Anteroposterior and frog leg radiographs are often diagnostic. Missed diagnosis can aggravate the prognosis of a usually benign condition. Adequate medical or surgical treatment should then be administered.
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