Head injuries related to sports and recreation activities in school‐age children and adolescents: Data from a referral centre in Victoria,Australia

Objectives: Head injuries (HI) in children are common and even mild HI can lead to ongoing cognitive and behavioural changes. We set out to determine the causes of sport‐related HI in school‐age children presenting to a large urban ED as a basis for future interventions. Method: Identification and medical record review of all sport‐related HI in children aged 6–16 years at a tertiary children's hospital ED in Victoria, Australia, over a 1 year period. Information was collected on demographics, injury variables and radiology findings. HI were classified as mild, moderate and severe based on GCS and radiography reports. Results: Over 12 months there were 406 HI in school‐age children. Seventy per cent were male. A large number of HI (129; 33%) were related to sports. Of these, most were classified as mild and 13% were classified as moderate or severe. Among a range of sports, Australian Rules football was associated with more than 30% of all HI attributable to a sport and recreation cause. Equestrian activities were the main cause of moderate HI. Conclusion: The present study identified sports as a major cause of HI in the Victorian paediatric emergency setting with Australian Rules football the most commonly involved sport. Further prevention initiatives should consider targeting Australian Rules football and equestrian activities.     

Avulsion de l’insertion fémorale du ligament croisé antérieur chez un adulte de 20 ans. À propos d’un cas

The cruciate ligament (ACL) injury is known in adults and his surgical treatment is often necessary. In addition, avulsion fracture of the ligament's tibial insertion especially interested. Indeed, only a few cases of avulsion or proximal femoral ACL have been reported and always concerned children. Through this article, the authors describe a rare case of femoral osteochondral avulsion fracture of ACL in a young adult of 20 years which followed a sports accident.     

La fracture de fatigue du col fémoral chez le sportif d’endurance : l’importance d’un diagnostic précoce

Stress fractures of the femoral neck are rare traumatic events but they are far from being exceptional within the high level sportsmen community and even less rare within the military. The authors report the case of a 19 years old young man enlisted in the French Foreign Legion. He came up with a right femoral neck stress fracture as a result of intense physical exercices. Although painful prodromic signs had been evolving for 15 days, the right diagnosis wasn’t made until the fracture moved to Garden III. The surgical treatment consisted in a reduction with a triple screwing of the femoral neck. One year later, the fracture was set to anatomic position, the hip function was normal and the femoral head showed no signs of osteonecrosis. The patient was then lost for further follow-up. When there has been no slipping, these fractures develop favourably with an ad integrum hip restoration. On the other hand, a secondary slipping leads to a pathology that has to be taken care of in a quite different way, with an often catastrophic outcome at the functional level. Nearly constant prodromic signs come in usefully for an early diagnosis. Secondary slipping of the femoral neck stress fractures should happen less frequently by an appropriate awareness campaign aimed at all the health professionals including sports trainers.     

Intérêt de l’arthroscopie du poignet dans les lésions du ligament triangulaire

TFCC lesions are common among athletes. They are often overlooked, and entail, if they are not diagnosed and treated, severe functional impairment which results in a lower level of sports or sports stop before seeing appear more serious degenerative lesions, thus, justifying a palliation signing the final judgment of a sport at a high level. The advent of wrist arthroscopy, resulting from the success of arthroscopy of other joints (knee, shoulder) has improved the diagnosis of these lesions, to facilitate the understanding of the pathogenic mechanisms and the development of new treatments and the results look promising.     

L''incontinence urinaire chez la femme sportive nullipare. Enquête épidémiologique. À propos de 105 cas

One hundred and five nulliparous top-level young sportswomen (average age: 21.5 years) responded to an inquiry by means of questionnaire designed to investigate a possible relationship between urinary incontinence due to effort (UIE) and sports activities. Sixty-six sportswomen (62.8%) stated having UIE, which infrequently interfered with their normal sports activities; whereas 63 (60%) declared that they were coping with UIE on a daily basis. These two types of UIE are closely related. A comparative study on a similar population of 105 non-athletic women performed in parallel with this study showed that only 38 (34%) subjects declared having urinary incontinence, confirming therefore the influence of sport practice. Using the χ² and student's t-test, we investigated a relationship between UIE and different factors (age, duration of physical exercise, duration and type of sport practised, abdominal exercises, presence of acuneresis in children, presence of constipation). Only the presence of enuresis in children together with the presence of constipation led to statistically significant relationship. Being frustrated by taboos and considering the troubles as pathological, only a few sportswomen talked openly about this problem. Both information and effective control of the perineum could help prevent this condition. © 1998 Elsevier, Paris     

Une estimation des décès traumatiques liés à la pratique sportive en France métropolitaine,en 2010

Introduction

Physical exercise presents numerous health benefits but it can also lead to accidents, of varying degrees of severity, some of which can result in death. The purpose of this study was to estimate, for the year 2010 in metropolitan France, the number of injury-related deaths linked to sporting practices.

Method

The study consisted in counting the injury-related deaths that occurred in 2010 in metropolitan France following a sporting practice, regardless of the context (professional, leisure or travel). Deaths linked to cycling, deaths in airplanes and deaths by drowning were not considered as sporting practices and so were not included in the study. The figures were collected from documentation compiled by government institutions or available in on-line media and the websites of associations and government organizations involved with sport.

Results

In 2010, 246 people died as a result of a sporting activity in metropolitan France. Mountain sports were the most dangerous (99 deaths), followed by water sports (50), hunting (27), aviation sports (23, of which 22 in ultralight/microlight aircraft), mechanical sports (23) and free flight sports (20, of which 10 were linked to paragliding and five to hang gliding). Seven times more men died than women. The most dangerous periods were summer and winter.

Discussion

Our study missed some cases, which led to an overly low figure for certain sports (horse riding and fishing, etc.), and missed those people who did not die immediately following their accident. This simple study, which remains to be completed, has provided an initial estimate of the number of injury-related deaths linked to sporting activities in metropolitan France.     

Cheville et pied douloureux de l’enfant sportif

We realized an exhaustive review of literature concerning traumatic and microtraumatic lesions of the ankle and foot in sporting children. These pathologies are on the increase due to considering the development of sports activities. They are often considered as benign whereas they require an adequate diagnosis followed by adequate treatment. We thus described four groups of pathologies of the ankle and foot in sporting children: osteodystrophies (disease of Sever, Köhler-Mouchet, Renander, Freiberg, Panner and Iselin), talar diseases (osteochondritis dissecans and osteochondral fractures), sprained ankles (benign, medium and serious) and supernumerary ossifications.     

Use of the fatigue questionnaire (QFES) in child athletes for individual follow-up: two cases.

BACKGROUND: Fatigue is one of the multiple components of the life of an athlete. It may have adverse consequences on the health of child athletes in particular in the short or long term. For the trainer or medical staff, detecting fatigue as fast as possible is therefore advisable. OBSERVATIONS: Two young skiers beginning a sports class at age 11 were followed for 3 years within the framework of their practice for sport competition (1 alpine and 1 cross-country skier). At the same time as medical follow-up organized within the sports classes of the school they attended, the children completed at six times a questionnaire about fatigue, the QFES, (in French: Questionnaire de fatigue de l'enfant sportif). At one precise time during this follow-up, the QFES score for each child, both at age 12, clearly increased, by 175% and 133.3%, respectively, from previous scores. A thorough analysis of data gathered by the QFES allowed for revealing particular parameters of the fatigue: decreased sports performance, difficulties in relations and sleep disorders. CONCLUSIONS: Systematic use of the QFES in parallel with medical consultations for children participating in sport may be an efficient tool to detect the early appearance of fatigue and may therefore be integrated in preventive guidance to protect children in sports practice.     

Comment prévenir l’altération rachidienne lombaire et les blessures chez le jeune sportif

Objectives

The discovery of lumbar damage early in the practice of high level sporting activity led us to propose a simple program for the protection of the lumbar spine, applicable to each training session, since the age of 10 years, to limit the deleterious effects of physical activity.

Patients and method

A previous study realized in 30 young patients with lumbar pain has evidenced the effectiveness of a simple functional restoration program. We used it to propose preventive lumbar injury exercises combined in a comprehensive program with exercises for the prevention of lower limbs injuries.

Discussion

No longitudinal study has been realised on the potentially deleterious effects of early high level sport activity and no program is currently offered in a systematic way to limit its possible harmful effects. The simplicity of the protocol that we propose, validated for the spine allows its integration into a prevention program during the training of youth, since the beginning of rachis growth phase.

Conclusion

The early disc degeneration is a reality in combat and contact sports. Careful clinical monitoring is necessary to detect and take care of these pathologies. But as a priority, it is necessary to integrate since the young age a program of protection of the spine and to adapt it to the growing constraints required in above age categories, depending on the level of practice and this until the age of 18 years. This program is effective in the school rugby of the Association Sportive Montferrandaise and in the training centre.     

L’acide hyaluronique avant l’arthrose : à propos de 339 sportifs

Introduction

Physical activities, through traumas and intensity of practice expose the athletes to cartilage pain caused earlier compared to a population of sedentary people. Lesions at the origin of the pain may be traumatic or microtrauma however without meeting the radio-clinical osteoarthritis criteria defined by the American College of Rheumatology. Hyaluronic acid (HA) is commonly used in the treatment of knee osteoarthritis. It became legitimate to think that the mechanism of action of the product can lead to a pain relief of patients when used in other joints and pre-arthritic stage. As such, we use it in these indications for over 10 years. The objective of this study is to evaluate its effectiveness in the knee, hip and ankle and to identify prognostic factors.

Method

Retrospective study analysing the effectiveness of the viscosupplementation through a questionnaire assessing pain, athletic/professional level, pain relief on a daily basis and satisfaction. All of the lesions have been classified Kellgren 0 and staging of the ICRS for the knee. Definition of the criteria for response on the sedation of pain, and the maintenance of the sport/professional level. We also searched factors prognostications for the knee, only joint with sufficient sample size expected (biometric data: sex, age, body mass index, sports and professional profile, used presentation and prior injected corticosteroid solution).

Results

Three hundred and thirty-nine protocols have been realized to 332 cartilaginous traumatic or microtraumatic degenerative lesions (279 knees with single cartilaginous injury, 61 patients with associated treated meniscal tear, 29 hips, 31 ankles) and seven painful after-effects of osteochondritis. The average age of patients was 39.30 (± 14.38), 76% male; 83.2% had a sports profile with strong joint solicitation. Overall effectiveness was 49.85% (single chondral injury: 46.26%, chondral injury plus meniscal tear both treated: 60.66%, 44.82% for hip and 57.14% for the ankle). Four patients on seven treated for painful sequela of osteochondritis have been relieved. The rate of adverse events was 4.13%, represented by puncture pain or swelling reaction. In the knee, the stage lesion did not impact on efficiency (P = 0.17), neither the presence of an associated meniscal tear non-treated (P = 0.15); the pursuit of a support activity is correlated with a loss of efficiency (P = 0.039).

Discussion

This study is interesting as far as no study in vivo exists regarding the use of HA in support of isolated microtraumatic or traumatic chondral lesions except in the course of surgery of the meniscus with visualization of an arthroscopic cartilage injury. Efficiency appears interesting, almost equal to that found in the available studies on arthritis in these joints, although, because of the heterogeneity of the protocols and the results obtained, the estimation of a reliable response rate seems delicate.

Conclusion

The use of HA for the treatment of the pain of single traumatic or microtraumatic cartilage injury appears safe, with an interesting efficiency to be confirmed by studies of high level of evidence.     

Le rachis cervical traumatique de l’enfant

The cervical spine lesions are frequent during the sport activities. However, these lesions are less severe than those observed in road accidents. After a trauma, the main sign is the torticolis, due to a muscular contraction. The cervical spine radiological analysis is very difficult in children because of the non-ossified parts of vertebrae. On the other hand, the physiological curves of the cervical spine have many variations during childhood. That is why, it is very important to know the radiological anatomy and their changes to understand and to treat the cervical spine trauma in children.     

Modified CBT for Treatment of OCD in a 7‐Year‐Old Boy With ASD—A Case Report

Children and adolescents with autism spectrum disorder (ASD) frequently experience obsessive–compulsive disorder (OCD). Cognitive behavioral therapy (CBT) is recommended for OCD but may need modification in children and adolescents with ASD because of cognitive differences, but guidance for therapists planning CBT for OCD in young people with ASD is sparse. This report discusses syndromes of OCD and ASD and their overlapping clinical features and etiologies, difficulties in applying CBT in the ASD population, and relevant literature. We present a case report on CBT treatment of a 7‐year‐old boy with ASD and OCD and modifications to CBT that were helpful.     

Intérêt de l’arthroscopie du genou dans le traitement du syndrome de la bandelette iliotibiale

Iliotibial band syndrome is a common cause of lateral knee pain in athletes. The diagnosis is clinical. Surgery can be proposed if well-conducted conservative treatment is unsuccessful for 6 months. We reviewed a retrospective series of seven patients at mean 3.7 years postoperative follow-up. Six practiced sports regularly. The preoperative work-up included a physical examination, standard X-rays and MRI of the knee joint and arthroscopy for all patients. Open surgery was performed with transverse section of the posterior fibers (10 mm). The outcome assessment was based on the pain score, the subjective IKDC score, and resumption of sports activities. Six patients had intra-articular lesions, which for three patients had been missed preoperatively. Arthroscopy was performed for complementary treatments in four patients. In 2008, six patients responded to a telephone interview. Outcome was very satisfactory: mean IKDC score was 84 in five patients who had resumed their sports activities at the same level. One patient underwent arthroscopy to rule out any intra-articular lesion causing lateral pain. Possible intercurrent conditions could be the cause of persistent pain despite adequate medical treatment and physiotherapy. Certain authors propose arthroscopic release. This option enables complementary treatments in the same operative time.     

DIFFERENCES IN DYNAMIC BALANCE SCORES IN ONE SPORT VERSUS MULTIPLE SPORT HIGH SCHOOL ATHLETES

Purpose/Background:

Researchers have previously reported on the importance of dynamic balance in assessing an individual''s risk for injury during sport. However, to date there is no research on whether multiple sport participation affects dynamic balance ability. Therefore, the purpose of this study was to determine if there was a difference in dynamic balance scores in high school athletes that competed in one sport only as compared athletes who competed in multiple sports, as tested by the Lower Quarter Y Balance Test (YBT-LQ).

Methods:

Ninety-two high school athletes who participated in one sport were matched, by age, gender and sport played, to athletes who participated in the same sport as well as additional sports. All individuals were assessed using the YBT-LQ to examine differences in composite reach score and reach direction asymmetry between single sport and multiple sport athletes. The greatest reach distance of three trials in each reach direction for right and left lower-extremities was normalized by limb length and used for analysis. A two-way ANOVA (gender x number of sports played) was used to statistically analyze the variables in the study.

Results:

No significant interactions or main effects related to number of sports played were observed for any YBT-LQ score (p>0.05). Male athletes exhibited significantly greater normalized reach values for the posteromedial, posterolateral, and composite reach while also exhibiting a larger anterior reach difference when compared to the females. Athletes who participated in multiple sports had similar performances on the YBT-LQ when compared to athletes who participated in a single sport.

Conclusions:

The findings of this study suggest that the number of sports played by a high school athlete does not need to be controlled for when evaluating dynamic balance with the YBT-LQ.     

Coalitions du tarse ou « fausses entorses » de l’enfant et de l’adolescent. À propos d’un cas

Tarsal coalitions, also called synostoses, are a cause of pain and gait disturbance in children and adolescents. They are often diagnosed as tarsal sprains, leading to an inappropriate functional prognosis. This is the case of an 8-year-old child with talo-calcaneum synostosis, presenting pain, hind-foot stiffness and marked disability in daily life activities and sports.     

Arrachements des épines iliaques antérosupérieures et antéro-inférieures chez l’enfant et l’adolescent sportifs. À propos de dix cas

The avulsions of anterior-iliac spines in child and adolescent athletes are rare injuries. All children have been treated as orthopaedic with strict rest, nonsteroidal anti-inflammatory substances and dispensation of sport for three months. No subsequent sequelae has been reported, all patients who got back to a sporting activity identical to that practiced before accident. It seems that the orthopaedic treatment among adolescents and children victims of avulsions of anterior-iliac apophysis, superior or inferior, is sufficient and does not involve any subsequent sequelae.     

Les traumatismes sportifs dans un service d’urgences (étude prospective sur 310 cas)

Physical activity is a well-known mechanism for health prevention; nevertheless, injuries may occur, but in most cases are not severe. We perform a prospective study about 310 injuries sustained during sport practice and treated in an emergency department. Soccer is the most frequent sport followed by basketball, horseback riding, rugby, fighting sports, gymnastics, skating, etc. These traumas occur essentially in a club (60%), concern young people (68.6% of the patients are between 11 and 30 years old), lower-limbs lesions are most often concerned (43%) with frequently bruises (27%), fractures (26%) and sprains (24%). Sixteen percent of the 310 patients were hospitalised and we could not demonstrate if one of the three following situations (sport in a club, at school or in a recreative context) was most often liable of severe injuries.     

Prevalence of Sport Injuries among Middle School Children and Suggestions for Their Prevention

[Purpose] The purpose of this study was to determine the incidence of injuries of children participating in sports, and to present advice on injury prevention. [Subjects and Methods] The study subjects were 445 children involved in sports with a mean age of 12.74±1.03 years, a mean height of 156.56±10.82 cm, and a mean weight of 45.39±10.29 kg; 52.8% of the study subjects were male, and 47.2% were female. The subjects were surveyed using a questionnaire developed by the author. [Results] The highest incidence of sport injury was in the foot-ankle region, and the lowest incidence was in the hip-femur region. The incidences of injuries to the neck, shoulder, elbow, hand, wrist, superior dorsal region, waist, hip-femur region, knee, and foot-ankle regions weren’t statistically significant. [Conclusion] This study established that children participating in competitive sports are at risk of injury. The causes of injuries were examined to propose preventive measures to minimize their occurrence and severity. It should not be overlooked that injuries can occur more easily among children because their musculoskeletal system is not fully developed, and coaches should be educated in the appropriate training intensities for children.Key words: Children, Sport injuries