7/11/2016 1 Common Fractures and Musculoskeletal Injuries on the Field Jason Kennedy,M.D. Department of Orthopedics Cook Children’s Medical Center Fort Worth, Texas Overuse Injuries Sprains(ligaments) and Strains(muscles) Ligament Tears Fractures 2 Epidemiology Straccolini et.al. Boston 2013 2133 pts 10 year period 5-12 year olds upper extremity fractures, apophysitis, OCD 13-17 year olds more overuse ACL, meniscus, spondylolysis Surgery in 40% of sample 3
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6. What are the Most Common Fractures and Musculoskeletal ......Common Fractures and Musculoskeletal Injuries on the Field Jason Kennedy,M.D. Department of Orthopedics Cook Children’s
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7/11/2016
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Common Fractures and Musculoskeletal Injuries on the Field
Jason Kennedy,M.D.Department of Orthopedics
Cook Children’s Medical CenterFort Worth, Texas
Overuse Injuries
Sprains(ligaments) and Strains(muscles)
Ligament Tears
Fractures
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Epidemiology
Straccolini et.al. Boston 20132133 pts 10 year period5-12 year oldsupper extremityfractures, apophysitis, OCD13-17 year oldsmore overuseACL, meniscus, spondylolysis
Surgery in 40% of sample3
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Injury Prevention Programs
Multi faceted IPPwarm-up, neuromuscular strength,
proprioception training
Meta-AnalysisSoomro N, et.al.10 studies combined32-40% reduction in Injury Rate Ratio
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Overuse Injuries
Risk FactorsMultiple sports
Year-round training
Sport Specialization
Growing Skeleton
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Upper Extremity
“Little League Shoulder” proximal humeral physis
“Little League Elbow” medial epicondyle apophysis
Olecranon stress fracture
Capitellar OCD6
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Little League Shoulder
Little League Elbow
widened medial epicondylar apophysis
widened lateral epiphysis
Can result rarely in osteonecrosisand Limb Length Inequality
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Olecranon Stress Fracture
Capitellar OCD
Mechanism
Young Throwers Periscapular weakness and fatigue Transfers stress from the trunk to the
throwing arm Valgus load and rapid extension tensile forces medially shear stress posterior compression to radiocapitellar joint
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Treatment
Activity restriction
Physical therapy including scapular stabilization for dyskinesis
Return to throw program - long toss
Surgery - screw for medial epicondyle or olecranon, scope/microfracture for OCD