Sports Medicine: Just the Facts

Section 7

SPECIAL POPULATIONS

96 THE PEDIATRIC ATHLETE

Amanda Weiss Kelly, MD

Terry Adirim, MD

EPIDEMIOLOGY

•Twenty to thirty million children participate in organ-
ized athletic programs each year (Radelet et al,
2002).

• About three million pediatric sports injuries occur
  annually in the United States (Hergenroeder, 1998).
  •Twenty-five to thirty percent of these injuries occur
  during participation in organized sports and 40% in
  unorganized sports (Hergenroeder, 1998)

FRACTURES IN THE PEDIATRIC
AT H LETE

PHYSEAL FRACTURES

• The physis is the weakest structure in the growing
  skeleton, making it more susceptible to injury than the
  surrounding muscles, tendons, and ligaments.

SALTER—HARRISCLASSIFICATION

• The Salter—Harris classification is the most widely
  used method of describing physeal fractures
  (Peterson, 1994):
  
  
  1. Type I: Through the physis
  
  
  2. Type II: Through the physis and metaphysis
  
  
  3. Type III: Through the physis and epiphysis
     4.Type IV: Through the metaphysis, across the
     physis, and through the epiphysis
     5. Type V: Crush injury to the physis
     6. Type VI: Injury to the periochondrium
     •Type I fractures have the best prognosis, with the inci-
     dence of growth arrest being rare in these fractures.
  
  
  
  


• In type II fractures, growth arrest may occur, espe-
  cially when the fractures occur in certain areas, like
  the distal femoral physis.


• In type III injuries, growth arrest is rare, but since the
  joint surface is involved anatomic reduction must be
  maintained to ensure articular cartilage congruity and
  prevent future joint degeneration.


• In type IV injuries, there is concern for both growth
  arrest and articular cartilage congruity.
  •Type V injuries are usually diagnosed retrospectively
  after growth arrest or angular deformity has occurred.


• Finally, in type VI injuries, angular deformities may
  occur if a bony bridge develops in the perichondrium
  on one side of the physis.


• Salter-Harris fractures can usually be diagnosed with
  plain films. But magnetic resonance imaging(MRI)
  and computed tomography(CT) are sometimes used
  to more accurately delineate physeal injuries.

APOPHYSEALAVULSIONINJURIES

• Apophyses are growth plates that add shape and con-
  tour, rather than length, to a bone. They are often sites
  for muscle attachment.


• Apophyseal avulsions typically occur as a result of
  violent contraction of the attached muscle (Metzmaker
  and Pappass 1985).


• The pelvis is a common site for avulsion fractures.
  The anterior superior iliac spine (ASIS) can be
  avulsed by the sartorius muscle with violent extension
  of the hip, such as when a sprinter takes off from the
  starting block.
  •Violent extension of the hip can also lead to avulsion
  of the anterior inferior iliac spine (AIIS) by the rectus
  femoris.

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