Adolescent injuries Part 2

Fractures

Fractures that occur in the younger athlete usually consist of one of three types;

  1. Fracture to the shaft of the bone
  2. Fracture involving the growth plate – referred to as a Salter-Harris Fracture
  3. Avulsion fracture - where the attachment of ligaments or tendons onto the bone is pulled away from the main body of the bone. 

Due to the relative weakness of the growth plate compared surrounding soft tissue (tendons, ligaments) and adjacent formed bone, fractures occurring at the site of the growth plate or an avulsion fracture is more common adolescents when compared to adults. A similar force or mechanism to an adult will often cause an injury to the associated joint or muscle instead. Because of the location of the injury, these fractures must be management carefully to prevent the risk of further complication later in life.

Management of these injuries: 

Osteochondroses

Osteochondroses is another common injury that occurs in the younger athlete that can affect many different locations around body. This condition again affects the growth plates and can often be linked to overuse/overload in the sporting population.

Common types of osteochondroses include:

Osgood Schlatter’s lesion (knee) 

Osgood schlatter’s lesion is irritation at the site of the growth plate of the tibia at the front of the knee at the attachment of the patella tendon.  It occurs during early adolescence and is generally associated with sports and activity that involves repetitive contraction of the quadriceps muscles (i.e running, jumping/landing)

Treatment:

  • Activity modification and load management – Guided by pain and symptoms
  • Correcting predisposing biomechanical abnormalities
  • Optimising footwear
  • Soft tissue release of tight muscles  
  • Stretching and strengthening exercises as pain allows

Sever’s Lesion (Achilles) – similar to that of Osgood schlatter’s lesion however Sever’s occurs at the site where is Achilles tendon attaches to the heel.

Treatment:

  • Activity modification and load management
  • Correcting predisposing biomechanical abnormalities
  • Heel raises/inserts and orthoses may be beneficial 
  • Soft tissue release of tight muscles  
  • Stretching and strengthening program as pain allows

 

 

Little Leaguer’s elbow

Occurs on the inside aspect of the elbow which common site for attachments of tendons and ligaments.  The growth plate can become irritated with repetitive forces being put through them and can sometimes lead to avulsion fractures where part of the bone where the tendon or ligament attaches to is pulled away from the rest of the bone.  Little leaguers elbow is most commonly seen in throwing sports such as baseball and is usually a result from excessive cumulative load (throwing) or poor throwing technique or both.

Treatment:

  • Modification of activity and management of load – This may begin with a rest from throwing or the aggravating activity completely followed by management of amount of throws allowed as the athlete returns.
  • Correction of throwing technique  
  • Soft tissue release
  • Stretching and strengthening program as pain/symptoms settle down