Pediatric Sports Injuries Research Articles

Physical Therapy Case Files: Orthopaedics

Physical Therapy Case Files: Orthopaedics

Pediatric Sports Injuries

Background: There is still much that we do not know about differences in sports injuries between young male and female athletes and the factors that may increase the risk for injuries in this regard. Purpose: To describe and compare differences between males and females in pediatric sports-related injuries. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A retrospective chart review was performed using a 5% random sampling (N = 2133) of medical records of children aged 5 to 17 years seen over 10 years in a sports medicine clinic at a large academic pediatric hospital. Information was collected and analyzed on age, sex, height, weight, injury type (overuse vs acute/traumatic), location of injury, and sports involvement. Results: Overall, female athletes had a higher percentage of overuse injuries (62.5%) compared with traumatic injuries (37.5%); the opposite was seen in male athletes (41.9% vs 58.2%, respectively; P < .001). Looking at specific areas of injury, female athletes sustained more injuries to the lower extremity (65.8%) and spine (11.3%) as compared with male athletes (53.7% and 8.2%, respectively). Male patients had a greater percentage of injuries to the upper extremity (29.8%) as compared with female patients (15.1%). The type of hip/pelvis injuries differed greatly by sex, with females sustaining more overuse (90.9%) and soft tissue injuries (75.3%) versus males, who suffered injuries that tended to be traumatic (58.3%) and bony (55.6%) in nature. Males were more likely than females to participate in team and contact/collision sports. The percentage of females with patellofemoral knee pain was approximately 3 times greater than that of males (14.3% vs 4.0%, respectively; P < .001). Males were twice as likely as females to be diagnosed with osteochondritis dissecans (8.6% vs 4.3%, respectively; P < .001) and fractures (19.5% vs 8.2%, respectively; P < .001). The percentage of males and females who sustained an anterior cruciate ligament injury was almost equal (10.0% and 8.9%, respectively; P = .369). Conclusion: Sports injuries in young males and females differed by injury type, diagnosis, and body area. These results may be related to the referral patterns unique to the division of the hospital, including a high number of female dancers. Further investigation is required to better understand the injury risk in pediatric male and female athletes.

Pediatric Sports Injuries

Background: Significant knowledge deficits exist regarding sports injuries in the young child. Children continue to engage in physically demanding, organized sports to a greater extent despite the lack of physical readiness, predisposing themselves to injury. Purpose: To evaluate sports injuries sustained in very young children (5-12 years) versus their older counterparts (13-17 years) with regard to the type and location of injuries, severity, and diagnosis. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A retrospective chart review was performed on a 5% random probability sample (final N = 2133) of 5- to 17-year-old patients treated for sports injuries in the Division of Sports Medicine at a large, academic pediatric medical center between 2000 and 2009. Using descriptive statistics, correlates of injuries by age group, injury type, and body area are shown. Results: Five- to 12-year-old patients differed in key ways from older patients. Children in this category sustained injuries that were more often traumatic in nature and more commonly of the upper extremity. Older patients (13-17 years) were more likely to be treated for injuries to the chest, hip/pelvis, and spine. A greater proportion of the older children were treated for overuse injuries, as compared with their younger counterparts (54.4% vs 49.2%, respectively), and a much larger proportion of these injuries were classified as soft tissue injuries as opposed to bony injuries (37.9% vs 26.1%, respectively). Injury diagnosis differed between the 2 age groups. The 13- to 17-year age group sustained more anterior cruciate ligament injuries, meniscal tears, and spondylolysis, while younger children were diagnosed with fractures, including physeal fractures, apophysitis, and osteochondritis dissecans. The 5- to 12-year-old patients treated for spine injuries were disproportionately female (75.8%); most of these injuries were overuse (78.8%) and bony (60.6%); over one third of the youngest children were diagnosed with spondylolysis. Surgery was required in 40% of the injuries in the full sample. Conclusion: Sports injuries to children differ by age in injury diagnosis, type, and body area. Older children sustain a greater proportion of overuse injuries classified as soft tissue in nature. Children of all ages are sustaining significant sports injuries that require surgical intervention.

A systematic method for evaluation of pediatric sports injuries of the elbow

We present a compartmentalized approach to sports injuries of the pediatric elbow. Lateral, medial and posterior injuries are considered separately under the unifying umbrella of the common forces projected on the elbow during sports activities and the effect on the separate growth centers and physes of the elbow.

A segmental approach to imaging of sports-related injuries of the pediatric elbow.

Context:The imaging of pediatric sports injuries of the elbow requires an understanding of the interaction between biomechanical forces common in sports and the developing skeleton.Evidence Acquisition:A PubMed search was performed using the terms elbow, radiology, and sports with the search limited to children up to 18 years of age. No limits were set on the range of years searched. Articles were reviewed for relevance with an emphasis of the changing nature of sports injuries about the pediatric elbow.Results:A clear progression of injuries about the elbow can be identified as the skeleton matures. Sports most commonly associated with injuries in the pediatric age group were baseball and gymnastics.Conclusions:Most pediatric sports injuries result from overhand throwing, especially in baseball or gymnastics. The manifestation of the injuries shifts as the physes progress toward closure.

Stopping sports injuries in kids

Sports participation is common among children and adolescents throughout the United States; along with that participation comes risk of injury, sometimes serious. Over 4 million sports or recreational injuries are sustained by school-age children per year in the USA. This injury prevalence has led to significant interest in prevention strategies. In this review, we examine the last year of publications related to sports injury prevention in the pediatric population. Pediatric and adolescent athletes differ from adults in significant ways that often render them more susceptible to injury. Concussion is a particular problem, as are injuries to the thrower's elbow and injury to the female athlete's knee. Recognition, proper rest, and attention to mechanics may assist in decreasing the incidence and severity of these issues. Further inquiry into the nature, prevalence, causes, and, in particular, sequelae of pediatric sports injuries is required. In the interim, attention to proper technique, core and neuromuscular conditioning, and helmet use are important preventive measures; avoidance of overtraining and providing adequate rest for recovery are essential for pediatric and adolescent athletes.

Web Alerts

Orthoseek: http://orthoseek.com/ Description: This site was created by the late Andrew Chong, M.D., a pediatric orthopedic surgeon, to share medical information on pediatric orthopedics and sports injuries with the lay public. It contains brief articles on a wide variety of pediatric orthopedic topics, listed alphabetically, spanning congenital and secondary orthopedic conditions, related medical syndromes, sport-specific injuries, and more. Physicians are invited to share these articles with patients at no cost and to contribute to the Web site if interested. In addition, a message forum provides parents the opportunity to connect through this site. This simple site, with easy navigation and free patient handouts, make it worth perusing for the pediatric provider. The unrestricted message forum is likely a bit of a wild card, however. Cost: Free Spine-health.com: http://www.spine-health.com/ Description: This comprehensive back pain Web site includes a vast array of consumer-targeted back pain articles and videos, with a stated goal of providing highest-quality patient information online. They acknowledge that their business model also includes attracting advertisers as well as physicians who may subscribe to access patient educational materials and a listing in their provider directory. Although clearly a business model, this is a great patient resource with thorough physician peer-reviewed articles on all things back pain related and many articles on other pain syndromes. Treatment from alternative medicine to surgical approaches is covered, and a “Wellness” tab rounds out treatment modalities. The articles on the site are free and worth referring to patients, with the caveat to be wary of the advertising sections scattered throughout the site. Cost: Free. Physicians may subscribe to receive patient education materials and a listing in the Provider Directory for $995 per year. SportsMD: http://www.sportsmd.com/ Description: SportsMD is a Web site dedicated to “educating, inspiring, and connecting athletes with trusted sports health information, doctors, and specialists.” It contains a variety of athlete-focused articles on injuries, injury and illness prevention topics, and nutrition. Articles are written by members of the site’s advisory panel, composed of orthopedic surgeons, physical therapists, athletic trainers, and sports nutritionists. They contain good basic information with links to additional resources. The business end of this Web site includes an online store and advertising space sold on the Web site. In addition, sports medicine physicians who meet the site’s criteria may join the Provider Directory for free or be featured for a cost. Notably, 1% of sales are reported to go toward programs promoting children’s health. Cost: Free. Sports medicine physicians may purchase a premium listing in the Provider Directory for $84 per year; however, it is unclear whether this includes primary care sports medicine physicians in addition to sports medicine orthopedic surgeons. KidsHealth: http://www.kidshealth.org/ Description: Funded by the nonprofit Nemours Foundation, KidsHealth is a rich informational Web site devoted to providing information on children’s health that is free of “doctor speak.” There are separate sections for parents, teens, and kids, each with age-specific articles on a wide array of topics, including fitness, sports, and nutrition. There is both breadth and depth in content, and all articles are reviewed by pediatric medical experts. This is a nice resource in which pediatric patients could be referred, as articles are written at the level of a child or teen for each respective section. Cost: Free International Society of Sports Nutrition: http://sportsnutritionsociety.org/ Description: The International Society of Sports Nutrition is the “only nonprofit academic society dedicated to promoting the science and application of evidence-based sports nutrition and supplementation.” The Web site mainly contains information related to ISSN conferences and certification for the Sports Nutritionist. The most useful area for nonnutritionist providers is the library tab, where a link to the Journal of the ISSN as well as the Sports Nutrition Insider, the society’s trade publication, can be found. Both of these publications contain interesting articles on sports nutrition and supplementation, which can be accessed for free. Unfortunately, neither the ISSN site nor its publications provide an easily searchable database on specific sports supplements or nutrition topics. Cost: Free

Trends in paediatric sport- and recreation-related injuries: An injury surveillance study at the British Columbia Children's Hospital (Vancouver, British Columbia) from 1992 to 2005

Sport- and recreation-related injuries are a major source of morbidity in the paediatric population. Long-term trends for these injuries are largely unknown. A traumatic injury surveillance system (the Canadian Hospitals Injury Reporting and Prevention Program) was used to examine the demographics and trends of paediatric sports injuries in children who presented to or were directly admitted to the British Columbia Children's Hospital (Vancouver, British Columbia) emergency department or intensive care unit from 1992 to 2005. Over the 14-year study period, there was a significant increase in sport- and recreation-related injuries among patients who presented to the British Columbia Children's Hospital. Of 104,414 injuries between 1992 and 2005, 27,466 were related to sports and recreational activities. The number of sport-related injuries increased by 28%, while all-cause injuries did not change significantly. Males comprised 68% of the sport-related injuries, and both sexes displayed an increasing trend over time. Cycling, basketball, soccer and ice hockey were the top four injury-causing activities. The main body parts injured were the face, head and digits. Paediatric sports injuries significantly increased at the British Columbia Children's Hospital over the 14-year study period. This is likely due to increased sport participation, increased risk associated with certain sports, or both. Trends in paediatric sports injury may be predicted by changes in popular media, possibly allowing prevention programs to help to avoid these injuries before they occur.

Pediatric Sports Injuries and Pain Management

Orthopaedic Nursing: March 2009 - Volume 28 - Issue 2 - p 96-100 doi: 10.1097/NOR.0b013e318199ea55

Overuse injuries in children and adolescents

Overuse injuries have become common as more and more children participate in sports. A careful history can identify risk factors; targeted patient education can lead to successful rehabilitation and prevent injuries. Thanks to the growing number of young people participating in sports at an early age, training year-round, and competing at specialized or elite levels, the incidence of overuse injuries has risen in the past decade. Recent studies estimate that 30% to 50% of pediatric sports injuries are caused by overuse, with the frequency of injury equal among boys and girls. For older patients, the proportion of injuries that are due to overuse is even higher. Keywords: Sports; Injuries; Overuse; AdolescentInternet Journal of Medical Update Vol. 3 (2) 2008: pp. 46-52

404 A snapshot of paediatric sports injuries at three types of medical practice

404 A snapshot of paediatric sports injuries at three types of medical practice

Patient and Hospital Characteristics Associated With Length of Stay and Hospital Charges for Pediatric Sports-Related Injury Hospitalizations in the United States, 2000–2003

The objectives of this study were to describe the patient and hospital characteristics of pediatric sports injury hospitalization and to determine the hospital characteristics that are associated with length of stay and total hospital charges (per discharge). Children who were aged 5 to 18 years and had a diagnosis of a sports injury in the Nationwide Inpatient Sample between 2000 and 2003 were included. National estimates of pediatric sports injury hospitalization, including the average and median of length of stay and total hospital charges, were computed. The relationship of hospital characteristics to length of stay and total hospital charges were assessed using linear regression, adjusting for patient characteristics and sample weight. A total of 7979 pediatric sports injury hospitalizations among children who were aged 5 to 18 were identified during 4 years, approximately 10,000 per year, nationwide. More than half of the hospitalizations were attributed to fractures. The mean and median of length of stay for pediatric sports injuries was 2.4 and 1.1 days, respectively. When weighted, the estimated total hospital charges for sports injury hospitalizations among 5- to 18-year-olds were $485 million during 4 years, with a steady increase each year. Urban hospitals had 46.1% higher total hospital charges than rural hospitals. Hospitals in the western United States had significantly greater total hospital charges than those in other regions. The findings provide an empirical basis for future research on the magnitude of sports-related injuries that result in hospitalization among children. More research is needed to identify contributing factors that are associated with length of stay and total hospital charges for sports injury hospitalization. Intervention efforts also should be directed toward preventing severe sports injuries and to reducing the hospitalization and cost.

Incidence and Distribution of Pediatric Sport-Related Injuries

To provide a critical review of the available literature on the descriptive epidemiology of pediatric sport-related injuries. MEDLINE (1966 to 2006) and SPORTDiscus (1975 to 2006) were searched to identify potentially relevant articles. A combination of medical subject headings and text words was used (epidemiology, children, adolescents, athletic injuries, sports, injury, and injuries). Additional references from the bibliographies of retrieved articles were also reviewed. Published research reports on the incidence and distribution of injury in children's and youth sports. Specific emphasis was placed on reviewing original studies, which report incidence rates (rate of injuries per unit athlete time). Forty-nine studies were selected for this review. Data summarized include incidence of injury relative to who is affected by injury (sport, participation level, gender, and player position), where injury occurs (anatomical and environmental location), when injury occurs (injury onset and chronometry), and injury outcome (injury type, time loss, clinical outcome, and economic cost). There is little epidemiological data on injuries for some pediatric sports. Many of the studies retrieved were characterized by methodological short-comings and study differences that limit interpretation and comparison of findings across studies. Notwithstanding, the studies reviewed are encouraging and injury patterns that should be studied further with more rigorous study designs to confirm original findings and to probe causes of injury and the effectiveness of preventive measures. Incidence and severity of injury are high in some child and youth sports. This review will assist in targeting the relevant groups and in designing future research on the epidemiology of pediatric sports injuries. Well-designed descriptive and analytical studies are needed to identify the public health impact of pediatric sport injury.

The modern neurological sports medicine physician—the neurosurgeon

The care of the athlete with central or peripheral nervous system or spinal injuries has undergone a revolution in our generation. Regardless of a relative lack of interest or involvement by our neurosurgical colleagues at times, we should embrace the significant improvements in our understanding of sports-related neurological clinical syndromes and in our ability to make diagnoses by using neuroimaging and other ancillary testing. Consider the advanced concept in understanding that a more severe concussion may not involve a brief period of loss of consciousness, but instead may be determined subsequently by identifying ongoing symptoms such as amnesia, deficits in concentration, and headaches. Neuropsychological testing, advanced magnetic resonance imaging techniques, and other ancillary modalities have all enhanced our ability to determine who has suffered a cerebral concussion. In addition, in recent publications the question has been posed whether, in common with boxing, prolonged exposure to football may lead to chronic brain effects in a small minority. 2,3,5 Neurosurgeons are often asked to consult and offer their expert opinion concerning vertebral column injury presenting either with pain syndromes or with spinal cord or peripheral nerve involvement. There are numerous issues and factors that often intersect with the clinical picture, creating a difficult management decision for the athlete, especially for one who aspires to return to contact or collision sports. Emerging concepts and research are welcomed to assist us in formulating the correct advice for all of those who are involved. In this issue of Neurosurgical Focus, Dr. Nugent reflects on his 40 years as a sideline physician, and offers us key pearls of wisdom from this unprecedented experience. In his 2006 Schneider lecture for the American Association of Neurological Surgeons, Dr. Day recounts the milestones in the field and contributions from several neurosurgeons who have been leaders in neurological sports medicine. Contributors to this issue have focused on important and esoteric aspects of neurological decision making, including return to sports following spinal surgery, craniotomy, or discovery of other brain abnormalities; issues related to pediatric sports injuries; spinal problems particular to triathletes; and lumbar spine injury management. There has been much confusion surrounding the numerous concussion classification guidelines, and Dr. Cantu summarizes the consensus of the most recent international sports concussion conferences. New data are presented describing the spectrum of presentation, consequences, and implications of brain injuries, particularly subdural hematomas, in boxers. Current management protocols from the perspective of the sideline and ringside physician and the athletic trainer are provided by authors with professional, National Collegiate Athletic Association, and Olympic experience. Drs. Pellman and Viano summarize the extensive findings of the NFL Committee on Mild Traumatic Brain Injury concerning the multiple aspects of clinical and laboratory research in professional football players. Maroon, et al., eloquently discuss the emerging interest in and knowledge of the use of alternatives to pharmaceutical intervention in the athlete, by using omega-3 fatty acids and compounds of natural or botanical origin. Because of recent scandals in sports related to doping, cheating, and drug abuse, this will continue to be an important area of awareness for all

November 2005 Book Reviews

JOSPT offers invited reviews of current titles. The November 2005 column includes 7 reviews of the following books: AO Manual of Fracture Management: Hand and Wrist; Epidemiology of Pediatric Sports Injuries: Individual Sports; Injury Prevention and Rehabilitation of Active Older Adults; Therapeutic Exercise for Musculoskeletal Injuries, 2nd Edition; Research Methods in Biomechanics; Athletic Taping and Bracing, 2nd Edition; and Atlas of Amputations and Limb Deficiencies: Surgical, Prosthetic, and Rehabilitation Principles, 3rd Edition. J Orthop Sports Phys Ther 2005;35(11):774–777. doi:10.2519/jospt.2005.35.11.774

Prevention of pediatric sports injuries.

With over 30 million children participating in sports each year across the United States, a number of significant injuries are to be expected. Although mild injuries such as strains, sprains, and contusions predominate, catastrophic injuries do occur. Young athletes are at an increased risk for growth plate and apophyseal injuries, overuse injuries, and heat illness. Many of these sports injuries can be prevented. Prevention strategies include protective equipment, rule changes, preseason and season prevention interventions, safety measures, better coaching, education, and a societal awareness of injury and prevention. This article discusses current injury prevention for children participating in baseball, football, soccer, and ice hockey.

Pediatric Sports Injuries

Pediatric Sports Injuries

Overuse injuries in the pediatric athlete: Evaluation, initial management, and strategies for prevention

The emergency physician will be asked to evaluate student athletes who have sustained injuries related to participation in either organized sports or physical play. It is important to identify these injuries accurately and to institute initial therapeutic interventions in the emergency department while minimizing diagnostic interventions when approapriate. By applying knowledge of normal development and maturation of the musculoskeletal system to the assessment of these injuries, an initial plan for management and rehabilitation may be developed. Finally, the emergency physician should be able to review with the patient the anticipated course of healing and should give directions related to the student athlete's ability to return to moderate or high levels of activity. Involvement of sports medicine specialists or orthopedists with an interest in pediatric sports injuries in the follow up of these patients is crucial.

4. Miscellaneous sports medicine topics

This self-directed learning module highlights new advances in this topic area. It is part of the chapter on musculoskeletal rehabilitation and sports medicine in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This article discusses physiatric duties as a team physician, preparticipation physical examinations, ergogenic aids, heat-related illness, pediatric sports injuries, female sports injuries, and sports medicine topics pertinent to geriatric and physically or mentally challenged athletes. New advances covered in this section include use of creatine, guidelines for the preparticipation examination, sudden cardiac athletic death, pediatric and female anterior cruciate ligament injuries, the female athlete triad, spine screening in Down syndrome athletes, and “boosting” in athletes with spinal cord injury.

Common Pediatric Sports Injuries.

This article reviews the common acute and overuse injuries encountered in the pediatric athlete. Acute injuries are usually physeal or avulsion fractures relating to a single traumatic event. Overuse injuries are the result of repetitive stress and include the common traction apophysitis, osteochondritis dissecans, and stress fractures. Sports-related injuries most frequently involve the lower extremity with injury patterns and frequencies relative to the athlete's age, size, and type of sport. Indeed, an alternative title for this review might be Òthe adolescent athlete as the changing biomechanics and psychosocial stresses of adolescence are inherent risk factors for sports-related injuries. An estimated seven million adolescents currently play high school sports with an increasing number becoming interested in extreme sports. It is hoped that this review will assist your future encounters with the injured pediatric athlete or Òweekend warrior.