Acute Sporting Injuries in the Teenager
Over recent years, participation in organized sports for children and adolescents has risen considerably. This rise in participation has brought about an associated increase in both traumatic and overuse injuries in the young athlete between 7 and 17. Additionally pressure to perform at high levels affect both coaches and athletes and has lead to inappropriate levels of training intensity, frequency, and duration. In this environment high physiologic stresses are applied to their immature skeletons causing injury.
Typically, since bone is the weakest link in the incomplete ossified skeleton, the majority of traumatic injuries result in fractures that occur both at mid‐shaft and at the growth centers of bone.
During early childhood bones are weaker than their associated ligaments and tendons. Stresses placed across these structures produce bone failure and resultant fractures in children and adolescents, rather than soft tissue damage seen in the adult. The presence of the physis, referred to as the growth plate, is the most significant anatomical difference between children and adults The potential for growth disturbance at these growth plates makes identifying and appropriately managing a physeal injury a high priority.
The most common traumatic injuries in the upper body are clavicular or collar bone fractures and anterior shoulder dislocations. Traumatic elbow injuries and dislocations are less common but accompanying compartment syndrome must be looked out for.
Hand and wrist injuries are also common in collision sports and gymnasts.
In addition to the numerous possible lower extremity growth plate fractures, underlying joint pathology needs to be ruled out as a cause. Avulsion fractures about the pelvis are prevalent in the older adolescent and fractures occur at the sites of ligament or tendon insertions, referred to as the apophysis, and are caused by a sudden, powerful muscle contraction or stretch.These injuries are often misdiagnosed as a muscle strain, particularly ischial tuberosity avulsions, which are commonly viewed as hamstring injuries. Femoral neck fractures tend to occur in the long distance runner.
In the knee the mechanism of injury for traumatic disorders in the young athlete is often similar to the skeletally mature athlete, but the diagnosis can be vastly different. Patella dislocations are more common in the female athletes and we are seeing many more ACLs than previously noted, again especially in girls. It is vital that coaches and parents are familiar with the ACL preventative programs designed to help prepare young sports people for the tasks of their sports.
In the younger athlete with an immature skeleton, the ankle is also highly susceptible to physical injury and an acute ankle physeal injury is frequently misdiagnosed as an ankle sprain.
The mechanisms of injury for acute traumatic disorders of the adolescent are often similar to those of adult athletes, however, the injured structure is often very different. The young athlete with an immature skeleton has open growth plates and weaker bones which are prone to failure with excessive stress, therefore leading to more frequent fractures and cartilage injuries than muscular and ligamentous injuries that would occur in an adult. The young athlete needs to be evaluated for a possible fracture prior to being given a diagnosis of a soft tissue injury.
A good rule of thumb for caring for the young athlete is “when in doubt sit them out” keeping in mind the increased potential for possibility of sustaining a fracture as compared to a soft tissue injury.
There is never a great time for an injury. But we do know that most sports injuries occur over the weekend. To cater for this we always try to keep appointments available on Mondays and Tuesdays for acute injury assessment and management. Call us on 8346 2000 Hindmarsh or 8342 2233 Fitzroy / Prospect for an appointment so we can help you as soon as possible.
If you would like a copy of our Free E-book on understanding and preventing ACL injuries, just click the link below.ACL Prevention E- Book