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 ¬ 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