We have all enjoyed watching Michael Phelps and Gabrielle Douglas compete in this summer’s Olympics. Many of us hope that with the proper encouragement and coaching our children can one day compete at this level. We encourage our children to warm-up, play fair, and enjoy athletic competition. Parents and coaches should be aware that sports injuries are common in young athletes.
Children are not “little adults.” Many of the pediatric injuries seen on the field are unique to children. Their bones have growth plates at both ends that are active up until the age of 18. These growth plates can see injuries from high impact repetitive activities. Children who are involved with jumping sports (volleyball, basketball) can have traction injuries to the growth plates in the front of their knees, leading to Osgood-Schlatter disease. This condition usually improves with anti-inflammatory medications and rest.
Traction injuries to the growth plates of the elbow and shoulder can occur with repetitive pitching. Coaches should follow the rules regarding total number of pitches per game to avoid injury in young athletes. Elbow dislocations in young children can also be associated with a fracture through one of the growth plates of the elbow. Depending on the degree of displacement, the fracture may require surgical stabilization.
Ligament injuries are common in children. Adolescent girls are at increased risk for tears of the anterior cruciate ligament (ACL). Such an injury can lead to instability of the knee and early arthritis. Many orthopaedic surgeons are now using cadaver tendon to replace the torn ligament. The athlete is allowed to return to full sports 6 months after the surgery. Young children with ACL tears who have not hit their adolescent growth spurt may require bracing to delay surgery while their growth plates are still active. It is thought that proper conditioning and stretching may protect the young knee from ACL tears.
Shoulder dislocations in adolescent males under the age of 16 can lead to recurrent shoulder instability. With many shoulder dislocations, the anterior labrum (soft tissue socket) is frequently torn off of the bony socket of the shoulder. Surgery involves repairing the labrum back to the bony socket. This can be done arthroscopically (minimally invasive technique), but requires 6 months of rehabilitation.
Fractures can occur on the playing field. I have treated a fractured femur (thigh bone) in a young football player who was tackled on the field. I have also operated on a fractured tibia (shin bone) in a young baseball player sliding into home plate. Two high performance adolescent gymnasts presented to me with upper extremity fractures, one with a broken elbow and another with a broken forearm. Trampolines were involved in both of these gymnastics injuries.
Before the orthopaedic issues are addressed, it is important to evaluate the “ABC’s” of injury: airway, breathing and circulation. It is also critical to assess the condition of consciousness and the spinal cord. The young athlete with a concussion should be taken off the field immediately for further evaluation. Coaches should not hesitate to call “911” if there are any concerns about the condition of the injured athlete.
Athletic competition is an important part of a child’s development. Sports participation teaches the child coordination, comradery, and fitness. It also builds self-esteem. Parents and coaches should look out for the child’s best interest when an injury occurs. It is more important to listen to the child than focus on the score of the game. The sports injury may require the child to leave the playing field. Orthopaedic surgeons can assess the injury so that the child can return back to play. With early recognition, many of these conditions can be treated successfully without long-term disability.