Steps you can take to reduce the occurrence of typical wounds your active, sporty children may sustain.

Children and adolescents go through periods of rapid growth. It is also during this time that they are especially active and will take an interest in sporting activities.

Indeed, sports injuries can account to up to a quarter of injuries in children and adolescents.

Certain physiological features in children’s and adolescents’ musculoskeletal systems predispose them to a certain pattern of injuries.

Why children’s bones are different

The growth plates (or physes) in children are still open to allow bones to grow and lengthen. However, they are also soft and cartilaginous, and thus, may be more prone to injury.

As children’s bones are less brittle, they can “break” by bending, otherwise known as “greenstick” fractures. They are also less likely to suffer ligament ruptures than adults, which also helps to protect growth plates. Most children’s fractures can be treated with a cast and they generally heal well because of the immature bones’ ability to remodel. However, if the fracture occurs in the growth plates, the child might need surgery to prevent long-term deformity of the affected limb.

As children’s bones are less brittle, they can “break” by bending, otherwise known as “greenstick” fractures.

Common injuries in children and adolescents

* Osgood-Schlatter Disease

When it comes to sports injuries, the most common overuse injury occurs around the knees of young athletes, also known as Osgood-Schlatter Disease. They will complain of pain over the bony prominence at the front of the knee, known as the tibial tubercle. Instead of developing an inflammation of the tendon, or tendonitis, the way adults do, adolescents will develop an inflammation at the junction between the tendon and the bone.

Children who do high-impact running or jumping sports will complain of pain over the front of their knee when they kneel or in severe cases, even when climbing stairs. A contributing factor is tight hamstrings or quadriceps, which commonly happens as teenagers go through a growth spurt around the knee region. X-rays can be done to confirm the diagnosis, which would show bony fragments at the front of the knee.

The condition is treated by stretching the tight hamstrings and quadriceps, and strengthening the quadriceps muscles progressively. The child should also avoid jumping and running activities while still showing symptoms of the ailment. Most patients with this condition recover over time without surgery. Occasionally, if the bony protrusion remains painful even after their skeletons have matured, they might have to consider surgically removing the bone fragment.

* Osteochondral lesions

If the knee also swells, in addition to the knee pain, and especially if your teenager complains that their knee is getting “locked”, then he/she may have osteochondral lesions (a tear/small fracture) of the knee. This condition happens when the cartilage separates from the underlying bone at the surface of the knee joint. As this condition needs to be detected and treated early to prevent recurrent symptoms in adulthood, MRIs will be necessary to evaluate its severity.

* Patellar dislocations

The patella is the large round bone in front of the knee it’s most easily felt when the knee is bent. Young athletes, especially those involved in contact sports or those with underlying bony deformities of the lower limb, may suffer from patellar dislocation. These patients would have significant knee swelling, and might even have trouble walking.

Most of the time, the patella dislocation would improve on its own but an MRI evaluation would be required to locate loose bony-cartilaginous fragments that might need to be removed surgically. The child would need to wear a knee brace for two to four weeks ― they will start rehabilitation once the swelling and pain subsides. If the patellar dislocation recurs, the orthopaedic surgeon might have to consider reconstructing the torn ligaments surgically.


* Anterior cruciate ligament (ACL) and meniscus injuries

Though not as common as in adults, anterior cruciate ligament (ACL) injuries and meniscus injuries are becoming more common as more young adults now start professional training early.

The patient would experience a “pop” or “crack” in the knee, which would then be followed by a large swelling. Subsequently, the patient would have trouble putting weight on the affected leg, and feels that the knee is unstable. Managing ACL injuries in adolescents is more challenging as the growth plates around the knee might still be open. If these patients intend to return to sports before their skeletons reach maturity, they might need to undergo growth-plate-sparing ACL reconstruction.

Make sure your child has sufficient rest to ensure healthy muscle recovery. Fatigued muscles are less able to protect the affected joints.

* Ankle injuries

The area around the ankle is another common injury site among young athletes. This happens when there is an inward twisting of the ankle (or inversion) during sports. The child would then complain of pain over the outer part of the ankle (the distal fibula) and be limping. I would recommend that the ankle be X-rayed. Most of the time, the injury occurs at the growth plate of the distal fibula, which can be treated with a cast for three to four weeks. Occasionally, surgery might be required if the fracture at the growth plate is displaced or involves the joint surface.

All said, exercise and sports benefits every child and adolescent and is generally risk-free. It helps produce strong bones, reduces the risk of obesity, and improve mental health. Parents should allow their children to enjoy the benefits of sports, as long as they know what precautions to take and when to seek medical attention.

Prevention tips

I would advise a good training programme in order to prevent sports injuries:

* Include a warm-up of at least 20 minutes incorporating stretches, as well as flexibility and core-training exercises (such as planks).

* Graduated strength or resistance training is also important. Do also make sure the lower limbs are correctly aligned during such exercises.

* Kids with poorer neuromuscular control should put in additional sessions to work on proprioceptive^ strengthening (such as leg presses and squats) before taking part in competitive games.

* Make sure your child has sufficient rest to ensure healthy muscle recovery. Fatigued muscles are less able to protect the affected joints.

Practical advice

* Make sure your child stops carrying out the aggravating activity immediately.

* Apply ice or cold packs over the affected area.

* Keep the injured limb elevated.

* Use gentle compression in the form of a bandage or a soft brace, but make sure this isn’t too tight don’t cause a depression on the surface of the skin or worsen your child’s pain.

If your child is unable to place weight onto the affected limb, do seek medical help immediately. Should the pain persist beyond two weeks despite rest, or if the recovery is longer than usual, seek medical attention early.

^ The body’s ability to sense its location, movements, and actions. It’s why we can move freely without consciously thinking about our environment, such as walking or kicking without looking at our feet or being able to touch our noses with our eyes closed.

Dr Tan Sok Chuen is a consultant orthopaedic surgeon at Thomson Surgical Centre.

Photos: iStock

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