Developing Physically Active and Sporty Kids - Injuries Specific to Children and Teenagers

Original Editor - Jess Bell based on the course by Tracy Prowse
Top Contributors - Jess Bell, Naomi O'Reilly, Kim Jackson, Wanda van Niekerk, Lucinda hampton and Aminat Abolade

This article or area is currently under construction and may only be partially complete. Please come back soon to see the finished work! (9/11/2021)

Introduction

While physical activity levels are, in general, declining in children, there are still large numbers of children and teenagers who participate in organised sports. And, as is discussed here, participation in formal sports can lead to injuries and burnout. Thus, when working with children and adolescents, it is important to consider how children’s injuries are different to those seen in adults.

Before looking at common injuries in children, this page will introduce some basic measures to assess when working with young people.

Know Your Child’s Age

There are a number of other ages which must be considered when working with children, including their:

• Developmental age
• Skeletal age
• General training age
• Sport-specific training age
• Relative age

It is also useful to monitor a child’s growth. This might include regular (e.g. quarterly) height measurements in standing, crook sitting and arm span. This monitoring can help to identify peak velocity height (i.e. the time when the child is growing the quickest), which is relevant for certain conditions discussed below. Table 1 shows typical growth per year.

Table 1. Typical growth in height per year

Age	6	7	8	9	10	11	12	13	14	15	16	17	18	19	20
Height	5	4.8	5	4.8	5	4.8	8.6	12	7.7	3.3	2.3	1.9	1.3	0.9	0.5

Common Injuries in Children

Figure 1. Anatomy of a long bone.

Apophysitis:

• Caused by traction injuries to the cartilage and bony attachment of tendons

• Often related to overuse in children who are growing
• More common in the lower limb

Osteochondrosis:

• Less common, but osteochondroses are a group of conditions that affect the epiphysis (see Figure 1)

• They occur when there are degenerative changes in the epiphyseal ossification centres of growing bones
• Caused by a temporary disruption of blood supply at the bone-cartilage complex, rather than traction
• They tend to resolve spontaneously, but should be monitored (surgery rarely required)

Metaphyseal fractures:

• Fractures that affect the metaphysis of tubular bones
• Occur most often in the forearm and lower leg

Avulsion fractures:

• Occur when there is a failure of the bone - a bone fragment is: “pulled away from its main body by soft tissue that is attached to it.”

During periods of rapid growth in children, bone lengthens before the muscles and tendons have time to stretch and develop the necessary strength and coordination to control this new longer bone. This can lead to awkwardness in a child’s movement patterns.

• Traumatic injuries lead to fractures of the bone or growth plate

• Strong incoordinated contractions of the muscles lead to avulsion fractures, rather than a tear of the muscle or tendon

Table 2. Common growth plate injuries / osteochondroses.

Non-Articular (related to overuse)	Articular	Physeal
Osgood-Schlatter - tibial tubercle	Perthes - femoral head (ages 4 to 10)	Scheuermann’s disease - thoracic spine
Sinding Larsen Johansson - inferior pole of the patella	Kienbock’s - lunate wrist (more common in individuals aged 20 to 30 years)	Blount’s diease - proximal tibial growth plate (obese children aged 9 to 10 years)
Sever’s - calacaneus	Kohlers - navicular (ages 2 to 8, more commonly 4 to 6 years)	Triangular fibrocartilage complex (TFCC) impingement
	Osteochondritis dessicans: Medial femoral condyle of the knee Talar dome Capitellum elbow - loose bodies - common in gymnasts and throwers

Table 2 above lists common growth plate injuries / osteochondroses. These injuries tend to be treated conservatively except for those which affect the hip and the knee.Table 3 below lists common types of fractures found in children.

Table 3. Common types of fractures found in children.

Metaphyseal Fracture	Avulsion Fracture	Growth Plate Fractures
Mostly occur in the forearm and lower leg	Musculotendinous, with common sites including: ASIS (sartorius) AIIS (rectus femoris) Ischial tuberosity (hamstrings) Lesser trochanter of the femur (iliopsoas) Ligamentous (ACL to tibia)	Salter-Harris Types I and II These injuries tend to heal well Examples include  Slipped Capital Femoral Epiphysis (SCFE)- most common in boys aged 12 to 15 years who are overweight Salter-Harris Types III and IV These involve the joint surface and complications can occur

NB: Even if an x-ray is normal, a history of severe rotational or shear force with localised swelling, bony tenderness and loss of function can indicate a growth plate fracture.

Prevention and Management

Avulsion fractures:

• Musculotendinous avulsion fractures are treated conservatively (i.e. the same as a grade III muscle tear)
• Ligamentous avulsion fractures are treated with surgery

Metaphyseal fractures:

• Must be immobilised
• Tend to heal quickly (3 weeks)

Growth plate:

• Accurate anatomical reduction is required to prevent degenerative changes
• Must be immobilised and often a non-weight bearing cast is applied for 3 to 6 weeks