Permanent sequelae in sports injuries: a population based study

AIM

To identify permanent sequelae after sports injuries in children and adolescents.

METHODS

In 1985, a prospective register was drawn up of all sports related injuries reported that year by the residents of Trieste, Italy aged 6-15 years. Moderate to severe injuries (scoring >/= 2 on the abbreviated injury scale (AIS)) were the object of a longitudinal clinical study. In 1988, 30.9% of the 220 subjects enrolled had sequelae. A further follow up was undertaken in 1997.

RESULTS

The follow up in 1997 involved 54 subjects (26 girls; average age 24.5 years). Subjective and objective sequelae, by now considered to be permanent, were found in 61.1%, corresponding to 15% of the AIS >/= 2 injuries recorded in 1985. The prevalence of sequelae was similar in the two sexes, in relation to the child's age at time of injury, and in the different sports practised. It was higher in relation to the severity of the lesion (89% of AIS 3 injuries examined, 56% of AIS 2 injuries) and to the type of lesion and its location. With regard to AIS >/= 2 injuries, permanent sequelae were found in 50% of ankle fractures, 43% of elbow fractures, 33% of leg/foot fractures, 25% of knee sprains, and 23% of ankle sprains.

CONCLUSIONS

The frequency of sequelae in sports injuries in children and adolescents is high. The risk appears to be connected to certain anatomical and functional age characteristics. Prevention strategies should include specific assessment of physical fitness and adequate follow up after the accident, particularly rehabilitation.

[The sports, the child and accidents. III. Long-term sequelae]

Sports-related injuries in children and adolescents are an emergent health problem in our country, because of their incidence and severity. Nevertheless information is lacking on possible long term sequelae. This topic has been studied in 220 out of 1040 6-15 years old children, prospectively registered during 1985 in our hospital because of acute sports injuries. Selection for the follow-up was based on injuries severity, assessed according to the Abbreviated Injury Scale. Subjective and/or objective sequelae have been observed at a clinical control three years after the accident, in 68 out of the 220 controlled children (30.9%). The prevalence of the sequelae was similar in males and females, but quite different according to the age, being higher in children older than 14, the type of sports activity and the site of the injuries, with higher prevalence of those of the ankle and knee rather than of the wrist. Prevention of sports-related injuries and their possible sequelae is well established in Sports Medicine, but not yet fully applied to children. Pediatricians must sensitize the school and sports clubs to the problem.

Immunological patterns in monoarticular juvenile rheumatoid arthritis

Seven pediatric patients with monoarticular arthritis, three of whom had a recent onset form and the remaining four a disease of longer duration, were examined for possible modifications of their immunological parameters. The diagnosis of JRA was made on all these patients according to the ARA criteria after a follow-up of at least two years. Humoral and cellular abnormalities of the immune system were searched for in peripheral blood, synovial fluid and synovial membrane. No evidence for complement consumption and for increased levels of immune-complexes was found in the sera and in the synovial fluids of these patients, who were all seronegative. Some patients had antinuclear antibodies in their sera and synovial fluids. With regard to the lymphocyte distribution, whereas only some patients had an increased number of circulating B cells, the majority had a decreased CD4+/CD8+ ratio in the synovial fluid compared to the ratio found in the peripheral blood. A massive infiltration of CD4+ cells and macrophages and the presence of a substantial number of OKT9+ cells was found in the synovial membranes.

Role of chronic hepatitis in development of thalassaemic liver disease

Liver function and the presence of HBsAg and anti-HBsAg were studied in 90 hypertransfused thalassaemic children. Increased serum transaminases were found in 62 patients, and persisted from more than 6 months in 45 cases. Liver biopsy in this latter group led to a diagnosis of 14 cases of chronic persistent hepatitis, 9 cases of aggressive hepatitis, and 3 cases of hepatic fibrosis. In Italy thalassaemic children undergoing hypertransfusion therapy frequently encounter SH virus infection, with a consequent hepatitis that is generally anicteric and unrecognized unless systematically sought. In a liver already stressed by the concomitant iron overload, hepatitis infection might thus play a key role in the evolution of cirrhosis which frequently affects thalassaemics.

[Regulation of amino acid transport in avian fibroblasts from growing and quiescent cell cultures (author's transl)]

The regulation of amino acid transport across the cell membrane by adaptive mechanisms has been studied in chick embryo fibroblasts obtained from growing and quiescent cell cultures. Changes in transport activity as a function of time under various in vitro conditions (amino acid dependence, active and inhibited protein synthesis) have been evaluated by measurements of initial entry rates with representative amino acids.