Nearly 40 million children and teenagers in the United States belong to a sports team. Identifying which young athletes to refer for advanced orthopaedic care
is essential to helping them return to competition as quickly as possible and to avoid long term consequences of injury.
While the ubiquity of sports in many young people’s lives is a welcome counter to the obesity epidemic among youth, a combination of inadequate conditioning, improper technique, incorrect equipment, and overuse makes sports-related injuries the most common reason for visits to primary care physicians’ offices, according to the National Institute of Arthritis and Musculoskeletal and Skin Diseases.
This time of year, with children back on the field and court, young athletes experience a variety of injuries, including concussions, fractures of the wrist and femur, growth plate injuries, meniscus and anterior cruciate ligament (ACL) tears, patellofemoral pain, sprains, and strains.
Certain injuries seem to be part of emerging trends, such as stress fractures related to the rise of year-round competition through traveling teams. Increases in other types of injuries may be due to changing participation patterns.
“Of late, we have seen increases in ligamentous injuries of the knee, including patellar subluxations and ACL injuries, in girls,” says Matthew Oetgen, MD
, attending pediatric orthopaedic surgeon and Director of Orthopaedic Research at Children’s National. “More girls are playing vigorous sports such as soccer and lacrosse, leading to more opportunities for injury and heightened awareness of female injuries from those sports in the medical community. Back pain among boys and girls also seems to be on the rise, especially when school starts, possibly due to increases in activity following rather sedentary summer breaks.”When Does A Patient Need Specialized Care?
Pediatricians are well positioned to counsel patients and their parents about treating minor injuries, such as mild sprains and strains. These problems often resolve within a week through rest, ice, compression, and elevation—the RICE method.
“Pediatricians do an excellent job treating basic, initial injuries,” says John Lovejoy, III, MD, pediatric orthopaedic surgeon and sports medicine physician at Children’s National.
“Referral becomes important when an injury doesn’t present in a standard manner, when a problem is something the pediatrician isn’t used to seeing, or when a patient doesn’t recover in a timely fashion and the physician thinks the injury could be severe, possibly warranting specialized therapeutics or surgery.”
Injuries that typically recessitate referral include fractures, severe sprains, and knee problems, such as ACL tears and osteochondritis dissecans. Pediatric orthopaedic surgeons at Children’s National treat sports-related injuries using state-of-the-art protocols and technology. Case in point: ACL tears.
“Historically, skeletally immature athletes with ACL tears were told to wait until their growth plates were closed before undergoing reconstruction, necessitating years of avoiding sports and putting them at risk of sustaining more knee damage,” says Suzanne Jaffe Walters, MD, attending orthopaedic surgeon specializing in pediatric and adolescent sports medicine at Pediatric Specialists of Virginia. “We perform a specialized technique of reconstructing the ACL while avoiding these athletes’ growth plates, thereby giving patients stable knees, allowing them to return to sports, and minimizing the risk of further intra-articular damage to the knee."
Read more about hand surgery in the fall 2013 issue of Advancing Pediatrics. Download the app on iTunes to receive the latest issue to your iPad.