With the nationwide promotion of sports and increased parental emphasis on children's physical fitness, more children and adolescents are participating in various athletic activities. The rise in exercise intensity and diversity of sports in school programs, extracurricular activities, and athletic meets has led to a corresponding increase in musculoskeletal injuries among this age group. Children are not miniature adults; their ongoing growth and development mean significant anatomical, physiological, and biomechanical differences from adults.Due to these developmental characteristics, the types of bone and joint injuries in children and adolescents, along with their treatment and prognosis, differ from those in adults.Under substantial force, portions of the bone may crease or fracture while other segments remain intact—much like a young branch bending. This phenomenon is medically termed a greenstick fracture.Additionally, children's joint capsules are thick and resilient, offering greater resistance to force than the bones themselves. Consequently, except for specific developmental phenomena like radial head subluxation, children are more prone to fractures than dislocations during violent trauma. However, as bones harden with age, the incidence of joint dislocations increases significantly during adolescence.Growth and development are defining characteristics of childhood, and bones are no exception. The elongation of limb bones relies on the ability of cartilage at the bone ends to continuously form new bone tissue. This regenerative cartilage is called the epiphyseal plate. At a certain age, the epiphyseal cartilage calcifies into bone, halting further skeletal growth.If the epiphysis is damaged due to trauma, disease, or other causes, its growth potential may diminish or even disappear. This impairs skeletal development, leading to limb shortening or deformities. However, to date, there is no fundamental method to prevent or treat epiphyseal damage. Even surgical intervention only creates a favorable growth environment; it cannot directly restore or enhance the epiphysis's growth capacity.
Vitamin D aids fracture healing
Rehabilitation after sports injuries involves physical activities that promote recovery or improve function.Appropriate, scientifically-based rehabilitation plays a positive role in accelerating injury healing and promoting functional recovery. However, it is crucial to recognize that school-age children and adolescents are not miniature adults. Their bodies are still developing, and rehabilitation approaches differ from those for adults. Therefore, a scientifically sound rehabilitation plan must be based on comprehensive understanding and accurate diagnosis.During physical therapy, the range of motion, frequency, duration, and load intensity of rehabilitation exercises should be gradually increased. Failure to do so may aggravate or hinder healing, potentially leading to chronic injuries that resist treatment. For instance, heterotopic ossification is a rare complication of supracondylar humeral fractures, with excessive postoperative manipulation and physical therapy considered the most common contributing factors.
After outpatient removal of casts and steel pins, encourage the child to actively perform elbow flexion, extension, and rotational movements. Apply local heat compresses, but avoid passive or forced exercises. The timing of physical therapy also relates to the closure of growth plates.Inflammation at muscle-bone attachment sites is common in pre-adolescent or adolescent athletes. Symptoms include a painful bony prominence on the anterior aspect of the proximal tibia, intermittent or persistent pain during high-impact activities like running or jumping, and pain when kneeling or climbing stairs. These issues typically resolve after growth plate closure.Patients may be prescribed gentle hamstring and quadriceps stretching exercises. Straight-leg raises help strengthen the quadriceps. Modify or restrict activities during symptomatic periods. Children in growth phases experience rapid skeletal development. Following sports injuries, inadequate nutrition can lead to growth retardation, stunted development, and other adverse outcomes.In northern regions with prolonged winters, children often lack sufficient outdoor sunlight exposure, leading to low vitamin D levels. Several case studies suggest that non-union or delayed healing of fractures may be associated with vitamin D deficiency. Supplementing with vitamin D not only aids fracture repair but also plays a role in restoring muscle strength post-fracture.
Upper Limb Protection for Children Under Ten
With the nationwide promotion of sports and increased parental emphasis on children's physical fitness, more children and adolescents are participating in various athletic activities.The increased volume and variety of sports activities in school programs, extracurricular events, and athletic meets have led to a corresponding rise in musculoskeletal injuries among children and adolescents. Children are not simply smaller versions of adults. Due to their ongoing growth and development, children and adolescents differ significantly from adults in terms of tissue anatomy, physiology, and biomechanics. Consequently, the types of bone and joint injuries they sustain, along with their treatment and prognosis, also differ from those in adults.
For children under 10, injuries primarily involve falls, with the upper limbs being the most common site—particularly the elbow and forearm. Examples include falls from horizontal bars, parallel bars, or wall bars, or accidental tumbles while running. Additionally, high-risk activities like rollerblading, skateboarding, and soccer necessitate proper protection for the wrists, elbows, and knees before participation.
Upper limb injuries in children exhibit seasonal patterns, with both incidence and severity increasing during summer due to heightened outdoor activity. Overweight children face heightened risks of sports injuries and fractures owing to poor balance, ligament laxity, or reduced bone mineralization.Activities like gymnastics or street dance involve repetitive axial loading on the wrists, potentially causing chronic, recurring joint pain. If such symptoms arise, promptly seek medical evaluation for your child.
Lower-body injuries in ball sports
For adolescents aged 10 and above, participation in sports like basketball, soccer, badminton, and table tennis increases.
Lower-body injuries are most common, primarily resulting from sports-related trauma.Injuries primarily occur in the lower limbs and are predominantly sports-related.
In basketball, the most vulnerable areas are the lower back, knees, and ankles, primarily due to falls, jumping for the ball, improper landing techniques, and slippery courts.Adolescents with higher body weight and reduced flexibility are prone to injuries involving the knee meniscus, anterior/posterior cruciate ligaments, patella, and articular cartilage. Since ligaments in children and adolescents are stronger than their growth plates, ankle sprains can also cause separation fractures at the distal ends of the tibia and fibula, potentially affecting limb growth and development.
In soccer, ankle sprains are most common, followed by thigh muscle strains. Knee sprains often result in damage to the meniscus, ligaments, patella, and articular cartilage.
Badminton players are prone to lumbar sprains due to extensive waist mobility, while repetitive shoulder friction may cause shoulder pain and discomfort. Table tennis injuries primarily affect the waist, shoulders, knees, ankles, and wrists.
For overweight adolescents who lack regular exercise, sudden acceleration during annual athletic meets may cause severe pain around the pelvis. Suspect an avulsion fracture of the ilium and seek immediate medical attention.
Additionally, collisions during children's and adolescents' play can cause localized bone and soft tissue injuries.For instance, adolescents over 10 years old often sustain shoulder joint injuries from direct impacts, such as clavicle fractures and proximal humerus fractures. Therefore, school playgrounds should designate activity zones by age group to prevent collisions during recess when children of vastly different heights and weights are running.
Overall, musculoskeletal injuries in children and adolescents primarily include soft tissue contusions, muscle strains, lumbar sprains, knee meniscus tears, ligament tears, articular cartilage damage, epiphyseal injuries, shaft fractures, and joint dislocations.If children or adolescents experience pain, swelling, limited joint mobility, or deformity after physical activity, prompt consultation at a specialized pediatric orthopedic clinic is essential. Open vs. Closed Wounds Require Different Treatment Sports injuries in school-aged children and adolescents are primarily categorized as open or closed injuries, each requiring distinct management principles.
For open injuries, the most common injuries in school and outdoor activities are skin injuries. Examples include scrapes on knees or palms from falls, arm lacerations from thorns, or puncture wounds from sharp objects. In such cases, carefully assess the wound depth, bleeding location, and volume. Treatment varies based on severity.
First, abrasions typically involve only the epidermis, often accompanied by minor bleeding, bruising, or ecchymosis. Immediately clean the wound to remove any grit or debris, pat dry, apply iodine solution, and cover with gauze and a bandage. Keep the area dry, avoid putting pressure on it, and allow it to heal for about a week.