Copy of Sports Injuries in Children

7/29/2019 Copy of Sports Injuries in Children

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Injuries amongst children

participating in exercise and sports

T Vishvanathan

Dept of Orthopaedic

School of Medical Sciences

USM Kubang Kerian


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Questions

Are sports injuries common in children?

Are the injuries similar as in adults?

Are children more prone for injuries?

Is there a difference in the outcome?

Are the injuries in children preventable?


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Introduction

Sports benefits children- fitter& stronger

Injury can occur in organized sports or in the

backyard at times inevitableRate of injury on the rise with increasing no.participating children

In the US 775 000 children treated at theemergency dept. each yr. for sports injuries

25% of them are serious injuries


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Are children more prone for injury?

Young athletes are not small adults

Anatomical & physiological differences exists between

adult and children:- physically weaker & skeletally

immature (growth plates)

- less coordinated- slower reaction times

- metabolically less efficient


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Distribution of sites injury in adults and

children

Site of injury Adult (%) Children (%)

Foot & ankle 6 1

Lower leg 10 23

Knee 31 30

Femur 2 7

Trunk 6 1

Neck & back 3 7

Head & face 12 13

Upper limb 30 11

total 100 100


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Frequency of the 5 most common injuries in

adults compared

Injury type Adults (%) Children

(%)

Knee sprain 25 28

Shoulder dislocation 5 12

Shoulder sprain 4.5 9

Fractured wrist 3.5 5

Sprained wrist 3.5 5

Others 58.5 41


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Age, size, maturity vs injury

As size & age increases, sports injuries

increases peak 15- 17 ( speed & violence of

collision and contact greater)Boys > prone for injury than girls

Rate and severity of injury related to inherent

violence of sports the itself


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Common type of injuries

Injury type Frequency

(%)

Bruising 36Ligament sprain 32

Joint injuries 20

Bleeding 16Fractures 11

Dislocations 8


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Common sites of injury

Site of injury Frequency(

%)

Ankle 32

Knee 30

Leg 24

Finger 15

Back 11

Head 10

Neck 4


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Extrinsic factors contributing to injuries in

children

Recklessness

Foul or illegal play

Poor playing area / equipment

Inappropriate body size/strengthLack of fitness

Lack of/defective protective gear

Poor footwear/sports gearIncomplete recovery from injury/inadequate rehab

Lack of warm up

Poor supervision


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Classification of sports injuries in children

Microtrauma(overuse)

Stress fractures

TendinitisBursitis

Apophysitis

Macrotrauma(acute)

Contusions

SprainsStrains

Fractures

Dislocations


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Causes of overuse injuries

Results from unresolved submaximal stress inpreviously normal tissues

Anatomic considerations:

1.Differential growth patterns in the length ofbones relative to muscles

2.Presence of apophysis & epiphysis act as weak

links

3.Looser periosteum & tendinous attachment in

growing bones


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Stress fractures

Direct relationship to age

young children

(9%),adolescents(32%),adults (59%)

Commonest site - tibia

(50%)

Other sites ulna,humerus

& distal radius

Diagnosis- clinical

suspicion

X- ray not helpful inearly stage

Tech 99 bone scan - +ve

in 2 weeks


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Bursitis & tendonitis

Less common than in adults

Common sites

- elbow

- hip

- knee- ankle


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Apophysitis & osteochondritis

Elbow- little leaguers elbow

Hip muscle avulsion

Knee patellofemoral stress syndrome

- Osgood-Schlatters disease

- Osteochondritis dissecansAnkle & footSevers disease


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Principles of treatment of overuse

injuriesRelative inactivity

Splinting

RICE

Analgesics / NSAIDS

Early dynamic eccenteric trainingNO STEROID CREAM IN YOUNG ATHLETES


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Acute injuries / macrotrauma

Soft tissue

Contusion/bruising

Sprain

Strain

Bone & joint

Long bone fractues

Physeal fractures

Dislocations


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Facts about fractures in children

Accounts for 20% of sports injuries

Upper limb more frequently involved

The bones fracture easily but unites readilyDeformities due to fractures are wellcompensated remodeling

Physeal(growth plate) fractures if noadequately treated results in irreversibledeformity and stunted growth


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Fracture (long bone) patterns in children

Plastic bowing

Buckling/torus

GreenstickComplete


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Physeal fractures

Peak incidence 12-13

coincides with growth

spurtHigh turnover of cells

Less resistant to shear &

tensile forces


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Dislocations & subluxations

Rare compared to adults

When present need TRO

congenital causesUsually involve elbow &

patella

May be associated with

fractures


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Contusions , sprains & strains

Commonest sports injury 60%

Contusion- injury to the muscle belly

Sprain- injury to ligamentsStrain injury to junctional areas ie:-bone/muscle, muscle/tendon or tendon/bone

interfacesSprain & strain sometimes may represent anoveruse injury


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Principles of treatment

RICE

Physical modalities, ultrasound,heat&

interferential therapy enhances recovery

Isometric exercises- as pain permits

Range of movement(ROM) exercises

Resistance exercises

Avoid passive stretching in early stages


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Knee -anatomy


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Regional injuries

Knee injuries:

- osteochondral fractures

- collateral ligament injuries- cruciate ligament injuries

- meniscus injuries

- patellar problems, patellarmaltracking,patellar subluxation & patellar

dislocation


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Is childs bone different than that of adults?

More porous

More elastic

Presence of growthcentres epiphysis &

physis


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Prevention of sports injuries in children

Use of proper equipment- attire,shoes,safety gearMaintenance and appropriateness of playing surfaces

Adequate adult supervision

Commitment to safety-upgrade coaches knowledge onfirst aid&CPR,coachs philosophy should promoteplayers wellbeing &not win at all costs,enforcementsof playing rules & use of safety equipments& ensurechildren are matched for sports

Proper preparation of child athletes for sports & not thesports to shape the child !


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Summary

Sports injuries in children are common &

majority of them are preventable

Injury patterns significantly different than adults

Prepare the child for the sports

Do not assume a child as a small adult

Outcome generally better than in adults except

in growth plate injuries


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Thank you

Documents

Copy of Sports Injuries in Children