Pediatric Sports Medicine

Question 1

Salter-Harris Fracture Type I

Answer 1

Physis fracture

Question 2

Salter-Harris Fracture Type II

Answer 2

Metaphysis and physis fracture

Question 3

Salter-Harris Fracture Type III

Answer 3

Epiphysis and physis fracture

Question 4

Salter-Harris Fracture Type IV

Answer 4

Epiphysis to metaphysis fracture

Question 5

Salter-Harris Fracture Type V

Answer 5

Crush Fracture

Question 6

Supracondylar fracture of the humerus - Gartland Classification

Answer 6

• Type I: Non-displaced
• Type II: Displaced with intact posterior cortex
• Type III: Complete displacement; usually posteromedial or posterolateral

Question 7

Common Overuse Inuries: Traction Apophysitis

Answer 7

• Sever’s Disease (8-12yr): Osteochondritis of the heel
• Osgood-Schlatters (11-15yr): Apophysitis of the tibial tubercle
• Little League elbow (10-15yr): Apophysitis of the medial epicondyle of the elbow

Question 8

Soccer: Common Injuries

Answer 8

• ACL

Question 9

ACL Injuries

Answer 9

• Mechanism is usually plant and twist
• Usually non-contact
• Higher incidence in girls
• Knee effusion common
• Dx with Lachman’s test; anterior drawer; posterior drawer; MRI

Question 10

Football Common Injuries

Answer 10

• Head and neck
• Acromioclavicular sprains
• Stingers, burners
• Finger injuries: Jersey finger, Mallet finger
• C-Spine injuries

Question 11

C-Spine Injury

Answer 11

• C-spine straight with axial loading on top of head

Question 12

Acromioclavicular Sprains

Answer 12

• Direct hit to top of shoulder

- Point tenderness at AC joint

Question 13

Burners or Stingers

Answer 13

• Stretch or compression of the brachial plexus
• Sudden pain, tingling, radiating from neck to fingers
• Typically transient
• Tx: ROM, strengthening, protective gear

Question 14

Jersey Finger

Answer 14

• Injury to flexor digitalis profundus (FDP)
• Occurs during tackling in football
• History of failure to grab an object
• Painful, swollen finger, especially at the volar DIPJ
• Ring finger commonly involved
• Inability to flex at DIPJ; PIPJ and MIPJ flexion preserved
• X-rays to assess for tendinous rupture or bony avulsion fracture
• Splint finger
• Refer to hand surgeon

Question 15

Mallet finger

Answer 15

• Flexion deformity of the DIPJ
• Painful, swollen fingertip
• Commonly occurs when catching a ball
• Inability to extend the distal phalanx at the DIPJ
• 2 forms: tendinous (extensor tendon rupture); Bony (bony avulsion Fx of the distal phalanx)
• Splint 6-8wk
• Refer failed non-surgical Tx

Question 16

Common Baseball/Softball Inuries

Answer 16

• Little League Elbow

- Panner’s disease (<12yr)

Question 17

Little League Elbow

Answer 17

• Apophysitis of the medial epicondyle
• Overuse injury secondary to throwing mechanics
• Tender directly over medial aspect of elbow
• Will often elicit a Hx of pitching
• Need to differentiate LLE from Panner’s disease and osteochondritis Dissecans (OCD)

Question 18

Panner’s Disease

Answer 18

• Avascular necrosis of the cepitellum of teh humerus
• Affects mostly boys
• Common Sx: pain and stiffness; restricted extension motion of the elbow; local tenderness of the capitellum

Question 19

Osteochondritis Dissecan’s (OCD)

Answer 19

• Usually affects adolescents and young adults
• Involves separation of a segment of cartilage and subchondral bone
• The area most frequently affected is the anterolateral surface of the humeral capitellum

Question 20

Common Basketball Injuries

Answer 20

• ACL
• Patellar tendonitis (Jumper’s knee)
• Ankle sprains

Question 21

Ankle sprain

Answer 21

• Very commonly injured joint
• Most commonly lateral ankle sprain
• In child with open physis, if tender over malleolus, then splint and refer
• Mechanism: inversion, plantar flexion

Question 22

High Ankle Sprain

Answer 22

• syndesmosis injury
• Ligament between tibia and fibula tears
• Mechanism: twisting outward of ankle
• Squeeze test: grab calf just above the ankle joint and squeeze it; hallmark sign
• Refer
• Surgery often necessary

Question 23

Common Gymnastics Injury

Answer 23

• Spondylosis

- Spondylolisthesis

Question 24

Spondylolysis

Answer 24

• Stress fracture or defect of the pars interarticularis in a vertebra
• Due to repetitive increase in shear forces in the lumbar spine

Question 25

Spondylolisthesis

Answer 25

- Movements of extension and rotation leading to: * slipping of all or part of one vertebra forward on another * Slipping occurs as a result of repetitive hyperextension which causes a shear stress at the pars interarticularis

Question 26

S/S Gymnastics Injury

Answer 26

- Insidious onset - Pain with hyperextension - Initially pain with sports, then increases to pain with ADLs and progressing to pain interfering with sleep - A hyperlordotic (increased curvature, not scoliotic) lower back - Relative tightness on the hamstring muscles