The anatomy of sporting injury

Question 1

What are the anatomical components of a child’s/ adolescent’s bone?

Answer 1

• Diaphysis
• Metaphysis
• Epiphysis
• Apophysis
• Physis

Question 2

What is a Metaphyseal injury?

Answer 2

• Tours or “Buckle fracture”

- Thin cortical bone of metaphysis

Question 3

What is the Salter Harris classification of Physeal injuries?

Answer 3

S= slipped (type 1)
-fracture plane passes all the way through the growth plate, not involving bone
-cannot occur if the growth plate is fused
A= above (type 2)
-fracture passes across most of the growth plate and up through the metaphysis
L= lower (type 3)
-fracture plane passes some distance along with the growth plate and down through the epiphysis
T= Through/ Transverse/ Together (type 4)
-fracture plane passes directly through the metaphysis, growth plate and down through the epiphysis
R= Ruined/ Rammed (type 5)
-crushing type injury does not displace the growth plate but damages it by direct compression

Question 4

What structures are at risk from Physeal growth plate injury?

Answer 4

Arteries:
-Femoral in adductor canal or upper popliteal fossa
-Popliteal artery stretched= possible intimal tear= delayed vascular loss
Nerves:
-Peroneal nerve
-Tibial nerve

Question 5

Describe apophyseal injuries

Answer 5

Where tendons stick on bone

• Acute
• Common
• In children, tendons stronger than the bones so in injury bone ripped off rather than disruption to tendon

Question 6

What is chronic apophysitis?

Answer 6

-Painful bony lump over tibial tuberosity
-Patellar tendon tugging on lump
=Osgood-Schlatter’s Disease
/
-Heel, Achilles tendon, growth plate fragments= pain (apophysitis of calcaneus)
=Sever’s Disease
/
-Lower patella pain (inferior pole of patella)
=Sinding-Larsen-Johannsson syndrome (Jumper’s knee)
/
-Medial elbow pain
=Little Leaguer’s Elbow

Question 7

Describe the macroscopic anatomy of the ACL

Answer 7

• 38mm in length
• 11mm in diameter
• Intra-articular but extra synovial

Question 8

What are the functions of the ACL?

Answer 8

1. Resisting anterior tibial translation
2. Prevention of hyperextension
3. Provision of check to tibial rotation
4. Restraint to varus and valgus angulation

Question 9

Describe the anterior cruciate ligament injury in children

Answer 9

Chondro-epiphyseal avulsion of the anterior cruciate ligament
-Pull bone off leg/ ACL

Question 10

What are the causes of ACL injury?

Answer 10

• Hyperextension

- Contact

Question 11

Why are females more vulnerable to ACL injuries after puberty?

Answer 11

-Anatomy
=Lower limb alignment 
=Q-Angle (more knocked kneed)
=Narrow intercondylar notch (less room for ACL to move around)
-Physiology
=Hormonal
=Neuromuscular
-Collapsing Valgus

Question 12

What are the types of shin splints?

Answer 12

1. Chronic Teno-periostitis
   =Flat footed- tension on tendon
2. Chronic exertional compartment syndrome
   =Blood supply to calf muscle increasing, increases pressure until greater than blood supply so ischaemic pain
   =Fasciotomy
3. Stress fracture
   =Don’t train!