Pediatric Sports and Recreation Injuries

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Pediatric Sports and Recreation Injuries Terry A. Adirim, MD, MPH Washington, DC

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Pediatric Sports Injuries Learning Objectives The Score the study of disease transmission of games wounds in youngsters Children are Not Little Adults Differences in physiology and advancement Sports Concussions The most recent in appraisal and administration of mTBI Pop Warner is Hurt- - Sport Specific Injuries Evaluation and administration of the kid competitor Return to play

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Pediatric Sports Injuries Benefits Physical Fitness Motor advancement Learn New Skills Improve Skills To Make Friends Build Self-Esteem Have Fun

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Epidemiology Injury Surveillance Reliable information lacking 40 million individuals > age 6 take an interest in sorted out games 2.6 million ED visits identified with games Ages 5-24 5x ED visits is assessed to be # wounds identified with games Under age 10, most wounds are auxiliary to recreational exercises instead of composed games

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Epidemiology High School Sports with Highest Injury Rates Football- - young men Cross Country- - young ladies Body Part Most Likely Injured Ankle Knee Wrist, hand, elbow Shin, calf Thigh, Groin Head, Neck, Clavicle

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Epidemiology Catastrophic Injuries Most normal non-traumatic demise in games is cardiovascular (e.g. hypertrophic cardiomyopathy) Among H.S. competitors, 90% of traumatic passings included head, neck Football generally the game with the most deadly traumatic passings

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Developmental and Physiological Differences Between Child and Adult Athletes

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Development Differences in musculoskeletal framework Pediatric bone has a higher water substance and lower mineral substance less fragile than grown-up bone Thick periosteum in kids Rich blood supply in pediatric bone The physis (development plate) cartilaginous structure that is weaker than bone inclined to damage

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Development Ligaments in youngsters are practically more grounded than bone; in this way kids will probably maintain cracks instead of sprains Pearl

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Development Most ordinarily broke bone in kids: Clavicle Younger kids break furthest points As kids get more established, more hazard for lower limit breaks Closed decreases of breaks more basic in kids

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Development Greenstick break Torus crack

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Development The Physis Salter-Harris Classification of Fractures High hazard for development capture

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Development Pearl If a tyke is delicate over her physis, however x-beam seems "negative" for break, prop and have kid catch up with games solution doctor or orthopedist.

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Development CRIMeTOLE Capitellum Radius Internal (average) epicondyle Trochlea Olecranon External (parallel) epicondyle Ossification Centers of the Elbow

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Development Supracondylar cracks of the Humerus Most normal component - fall onto outstretched hand 98% are expansion sort Seen in 3-11 year olds Gartland Classification Type I—non-uprooted Type II—dislodged with in place back cortex Type III—finish removal; typically posteromedial or posterolateral

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Development Type II Supracond ylar break pearl Check for back fat cushion in kid with swollen elbow

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Development Pitfall Type III Supracondylar Fracture Children with sort II and III need prompt referral/exchange to pediatric orthopedist

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Development Apophyses Are development plates that include shape and form as opposed to length to a bone. Are frequently destinations of muscle connection Avulsions at the apophysis are normal in more established kids and young people Diagnosis by x-beam Conservative administration

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Development Common Overuse Injuries in Children Traction Apophysitis Sever's Disease (age 8-12) Osteochondrosis of the heel Osgood-Schlatters (age 11-15) Apophysitis of the tibial tubericle Sinding-Larsen Johansson (age 10-15) Apophysitis of the sub-par post of the patella Little League Elbow (age 10-15) Apophysitis of the average epicondyle of the elbow Treatment = relative rest & fortifying

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Sever's Disease

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Osgood Schlatter's Avulsion of tibial tubericle

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Sinding-Larsen-Johansson Distal shaft of patella

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Little League Elbow Medial epicondyle

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Specific Sports and Their Injuries

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Soccer Ankle sprains Bruises ACL Injuries Mechanism of damage is plant and spot of knee Usually non-contact Higher occurrence in young ladies Knee emission basic

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Soccer ACL Injuries Diagnosis can be made clinically on examination with Lachman's test

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Soccer ACL Injuries Anterior Drawer

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Soccer ACL wounds Radiography in the ED AP/Lateral x-beams Look for tibial level fractures ACL is delicate tissue so may not have radiologic findings

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Soccer ACL Injuries Best to permit sports medication consultant or orthopedist to arrange MRIs are performed to rule out related wounds such as meniscal tears

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Football Head and Neck Acromioclavicular Sprains Stingers, Burners Finger wounds Jersey finger Mallet finger

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Mechanism of C-Spine Injury C-Spine straight with pivotal stacking on top of head

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Football Acromioclavicular Sprains ("AC Sprains") Mechanism is immediate hit to top of shoulder Point delicacy at AC joint Rx: Ice, Anti-inflammatories, dynamic rest Clavicle Acromion

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Football Burners, Stingers Stretch or pressure of the brachial plexus Sudden torment, shivering transmitting from neck to fingers Typically transient Tx = ROM, reinforcing, defensive apparatus (e.g. neck move, cattle rustler neckline)

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Football Finger Injuries "Jersey finger"— harm to flexor digitalis profundus (FDP) FDP causes flexion of the DIP joints Occurs amid handling in football History of inability to snatch a question (e.g., football pullover or auto entryway handle) Painful, swollen finger, particularly at the volar DIPJ Ring finger usually included

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Football Finger Injuries—"Jersey Finger" Inability to flex at the DIPJ PIPJ and MCPJ flexion safeguarded Radiographs (AP, sidelong, diagonal) to evaluate for tendinous burst or hard separation break Splint finger in agreeable position; allude to hand specialist as quickly as time permits.

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Football Mallet Finger Flexion disfigurement of the DIPJ Painful, swollen fingertip May have happened when attempting to get a ball Inability to amplify the distal phalanx at the DIPJ Radiographs (AP, horizontal, angled) Two types of hammer finger: Tendinous- - extensor ligament break Bony- - hard separation crack of the distal phalanx

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Football Mallet Finger Treatment Continuous propping 6 to 8 weeks DIPJ must not be permitted to drop in flexion Bony separations < 1/3 of articular surface can be decreased with dorsal weight and dorsal bracing - 6 to 8 weeks. Post-lessening radiographs are key Refer fizzled non-surgical treatment, hard separations that are irreducible or include 1/3 or more of the articular surface, or volar subluxation of the distal phalanx

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Baseball/Softball Elbow Injuries Little class elbow (age 10-15) Apophysitis of the average epicondyle Overuse damage optional to tossing mechanics Tender straightforwardly over the average part of elbow Will regularly inspire a background marked by tyke pitching "too much" innings or "too much" pitches every week (> 200) Need to separate Little group elbow from Panner's illness and OCD

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Baseball/Softball Panner's Disease (< age 12) Avascular rot of the capitellum of the humerus Affects for the most part young men Common side effects Pain and firmness limited augmentation movement of the elbow neighborhood delicacy over the capitellum

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Baseball/Softball Panner's Disease Usually determines on claim Need to separate amongst this and OCD (MRI)

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Baseball/Softball Osteochondritis Dissecans (OCD) for the most part influences teenagers and youthful grown-ups includes partition of a section of ligament and subchondral bone The range most often influenced is the anterolateral surface of the humeral capitellum

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Baseball/Softball Osteochondritis Dissecans (OCD) Dx: introductory radiographs, MRI for organizing, free body Rx: Rest, allude to games drug master

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Basketball ACL wounds Patellar tendonitis ("Jumper's knee") Ankle sprains ordinarily harmed joint Most basic is parallel lower leg sprains In kid with open physis, if delicate over horizontal malleolus, then brace and allude for development

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Basketball Lateral lower leg sprains Mechanism is reversal, plantar flexed

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Basketball "High lower leg sprain" Syndesmosis damage tendon amongst tibia and fibula tears Mechanism is outward winding of lower leg

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Basketball Syndesmosis Injury Associated harm—maisonneuve crack Radiographs: AP, Lateral and Mortise sees Treatment Most of the time surgery vital Refer to orthopedist Proximal tibia break

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Gymnastics Back Injuries Spondylolysis stretch crack or imperfection of the standards interarticularis in a vertebra because of dull increment in shear constrains in the lumbar spine Spondylolisthesis developments of expansion and revolution prompting to slipping of all or a portion of one vertebra forward on another slippage happens as a consequence of dreary hyperextension which causes a shear push at the standards interarticularis .

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Gymnastics Symptoms include: Insidious onset Pain with hyperextension (e.g. back walkover) Initially torment with games, then increments to torment with ADLs and advancing to torment meddling with rest A hyperlordotic (expanded ebb and flow, not scoliotic) bring down back Relative snugness of the hamstring muscles.

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Gymnastics Spondyl