Stress fracture of the proximal fibula in a young soccer player: a case report and a review of the literature.

A 14-yr-old soccer player complained of a history of leg pain with activity that had been present for several weeks. There was no history of direct trauma. Tenderness was found over the lateral aspect of the leg, and radiographs showed an area of calcification along the shaft of the proximal fibula. Because of the unusual location of the findings and to exclude a tumor, magnetic resonance imaging (MRI) was obtained which confirmed the diagnosis of a proximal fibular stress fracture. The patient returned to full sport participation with a period of relative rest, splinting, and strengthening and flexibility training. This case describes an injury that has not been reported in young athletes and only rarely described in active adults. The literature regarding this injury is reviewed, and two injury patterns of proximal fibular stress fractures are described.

Overuse injuries in children and adolescents.

With the growth of youth sports programs, overuse injuries in young people have become common. Making the diagnosis can be challenging, but often the real hurdles are in identifying the causes of injury. Growth-related factors require special considerations in injury management. A directed history assessing these and other causative factors and a systematic exam help formulate a comprehensive rehabilitation program. Recommendations for a successful return to activity and prevention of reinjury include avoiding heavy training loads and early sport-specific training, taking adequate rest periods, and ensuring proper supervision.

Distal radial growth plate injury and positive ulnar variance in nonelite gymnasts.

To assess the prevalence of stress injury to the distal radial growth plate and of positive ulnar variance in a nonelite gymnast population, we administered a radiographic survey and questionnaire to 44 skeletally immature nonelite gymnasts (27 girls and 17 boys). The subjects trained an average of 11.9 hours per week. Radiographic findings consistent with stress injury of the distal radial physis were found in 25% (11 of 44) of participants. Ulnar variance was found to be more positive in the gymnasts when compared with age-predicted norms. An average side-to-side difference in ulnar variance of 0.9 mm was observed. Radiographic findings of stress injury to the growth plate and the amount of ulnar variance were not associated with age, sex, training intensity, wrist pain, height, or weight. There was also no significant relationship between ulnar variance and radiographic findings. The mean ulnar variance in nonelite gymnasts was between that measured for elite gymnasts and nongymnasts. These results indicate that stress injury of the distal radial growth plate occurs in a significant percentage of nonelite gymnasts. It also appears that ulnar variance is more positive than would otherwise be predicted, suggesting growth inhibition of the distal radius, a growth stimulation of the ulna, or a combination of both.

Wrist pain in a young gymnast: unusual radiographic findings and MRI evidence of growth plate injury.

A 10-yr-old gymnast, training well below the elite level, reported a 3-wk history of bilateral dorsal wrist pain. Physical examination and radiographic findings were consistent with stress injury to the distal radial growth plates. The patient's radiographs also displayed rare findings including cleft radial and ulnar epiphyses, as well as epiphyseal spur formation. Magnetic resonance imaging (MRI) demonstrated evidence of metaphyseal and epiphyseal ischemia of the growth plate. The patient responded well to conservative treatment, including ice, splinting, and activity modification. This case illustrates several potentially confusing radiographic abnormalities and the emerging role of MRI in evaluating wrist pain in young gymnasts.

Factors associated with wrist pain in the young gymnast.

We conducted a cross-sectional survey of 52 nonelite gymnasts (32 girls, 20 boys; average age, 11.8 years) to assess their history of training and wrist pain within the last 6 months. An intensity index was created using the number of training hours per week and the athletes' skill levels. Wrist pain was prevalent in 38 (73%) of the gymnasts. Gymnasts with wrist pain were older (12.6 years versus 9.7 years; P = 0.0002), trained more hours per week (13.5 versus 7.7; P = 0.0002), trained at a higher skill level (P = 0.01), and began training at an older age (7.0 years versus 5.1 years; P = 0.006). Analysis of intensity versus age suggested that a threshold of training intensity may be important in the development of wrist pain. Logistical regression found these factors to be independently associated with wrist pain: intensity (P = 0.036), age > 10 years (P = 0.018), age < 14 years (P = 0.016), and the age of initiation of training (P = 0.020). This study demonstrates that wrist pain is a common problem among nonelite young gymnasts. Training intensity, relative to the age of the participant and the age when training was initiated, appears to be an important determinant of the development of wrist pain in this population.

Menstrual dysfunction in athletes. How to identify and treat patients at risk for skeletal injury.

Menstrual dysfunction is a common problem in competitive athletes. Exercise intensity, hypothalamic immaturity, and dietary practices are contributing factors. Although the specific mechanism is unknown, disruption of hypothalamic functioning appears to be involved. Women with menstrual dysfunction are at increased risk for bone mineral loss and musculoskeletal injury. Primary care physicians should routinely screen for these abnormalities and should be alert to the possibility of an eating disorder. Treatment options include a reduction in training intensity, improved nutrition and caloric intake, and hormone therapy to prevent bone loss and allow for safe continuation of training.

Sports-related traumatic hyphema.

Traumatic hyphema is a common sports-related eye injury that can cause permanent visual loss. Although referral to an ophthalmologist is advised, the primary care physician is often responsible for making the diagnosis and initiating medical care. A careful history should be taken and a physical examination performed, with attention given to possible accompanying ocular injuries. Proper positioning of the patient and placement of a unilateral eye shield are the first steps in management. Therapy is aimed at preventing secondary hemorrhage, elevated intraocular pressure and corneal blood staining. Surgical intervention may be necessary to preserve vision. Prognosis depends on the size of the hyphema, the development of complications and the presence of associated injuries. Protective eye guards have been shown to be very effective in preventing traumatic hyphema.