Sports Injuries in Children and Adolescents: A Case-Based Approach

118 Pages·2014·19.52 MB·English

by  Rosa Mónica Rodrigo

Sports Injuries
in Children and
Adolescents
A Case-Based Approach
Rosa Mónica Rodrigo
Joan C. Vilanova
José Martel
123
Sports Injuries in Children
and Adolescents

Rosa Mónica Rodrigo (cid:129) Joan C. Vilanova
José Martel

Sports Injuries
in Children and
Adolescents
A Case-Based Approach
Rosa Mónica Rodrigo José Martel
Radiology Department Department of Radiology
Resonancia Magnetica Bilbao S.A Hospital Universitario Fundación Alcorcón
Bilbao Madrid
Spain Spain
Joan C. Vilanova
Department of Radiology
Clínica Girona-Hospital
Sta.Caterina University of Girona
Girona
Spain
ISBN 978-3-642-54745-4 ISBN 978-3-642-54746-1 (eBook)
DOI 10.1007/978-3-642-54746-1
Springer Heidelberg New York Dordrecht London
Library of Congress Control Number: 2014941945
© Springer-Verlag Berlin Heidelberg 2014
This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or
part of the material is concerned, specifi cally the rights of translation, reprinting, reuse of
illustrations, recitation, broadcasting, reproduction on microfi lms or in any other physical way,
and transmission or information storage and retrieval, electronic adaptation, computer software,
or by similar or dissimilar methodology now known or hereafter developed. Exempted from this
legal reservation are brief excerpts in connection with reviews or scholarly analysis or material
supplied specifi cally for the purpose of being entered and executed on a computer system, for
exclusive use by the purchaser of the work. Duplication of this publication or parts thereof is
permitted only under the provisions of the Copyright Law of the Publisher's location, in its
current version, and permission for use must always be obtained from Springer. Permissions for
use may be obtained through RightsLink at the Copyright Clearance Center. Violations are liable
to prosecution under the respective Copyright Law.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this
publication does not imply, even in the absence of a specifi c statement, that such names are
exempt from the relevant protective laws and regulations and therefore free for general use.
While the advice and information in this book are believed to be true and accurate at the date of
publication, neither the authors nor the editors nor the publisher can accept any legal responsibility
for any errors or omissions that may be made. The publisher makes no warranty, express or
implied, with respect to the material contained herein.
Printed on acid-free paper
Springer is part of Springer Science+Business Media (www.springer.com)
Contents
1 Head and Spine Trauma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
2 Muscle Strains and Avulsion Injuries . . . . . . . . . . . . . . . . . . . . . 23
3 Bone Fractures. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
4 Overuse Injuries. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
5 Miscellanea. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91
v
1
Head and Spine Trauma
Miguel Ángel López-Pino , Elena García-Esparza ,
and Javier Telletxea-Elorriaga
Contents
1.1 Cervical Fracture with Spinal Lesion .......................................................... 2
1.2 Lumbar Spondylolysis ................................................................................... 4
1.3 Isolated Spinous Process Fracture ............................................................... 6
1.4 Cranial Fracture with Intraparenchymal Contusion/Hematoma ............. 8
1.5 Cranial Fracture with Epidural Hematoma ............................................... 10
1.6 Subarachnoid Hemorrhage (SAH) ............................................................... 12
1.7 Petrous Bone Fracture ................................................................................... 14
1.8 Mandibular Fracture ..................................................................................... 16
1.9 Nasal Fracture ................................................................................................ 18
1.10 Pool Drowning ................................................................................................ 20
Further Reading ........................................................................................................ 22
M.Á. López-Pino (*) (cid:129) E. García-Esparza
Department of Radiology ,
Hospital Universitario “Niño Jesús” , Madrid, Spain
e-mail: [email protected]
J. Telletxea-Elorriaga
Department of Bome Clinic, International SOS ,
Bome Clinic, Bata , Equatorial Guinea
R.M. Rodrigo et al., Sports Injuries in Children and Adolescents, 1
DOI 10.1007/978-3-642-54746-1_1, © Springer-Verlag Berlin Heidelberg 2014
2 M.Á. López-Pino et al.
Case 1.1: Cervical Fracture with Spinal Lesion

F ig. 1.2
F ig. 1.1

F ig. 1.3
F ig. 1.4
1 Head and Spine Trauma 3
A 16-year-old male sustains an impact with a hyper- tool. However, the false negative rate with a single
fl exion cervical injury while performing a somer- lateral study can reach between 21 and 26 %, so
sault during a physical education class. He presents taking the clinical fi ndings into consideration; CT
with severe pain and power loss in both lower should be considered to complete the exam.
extremities. The paraplegia is obvious in the emer- CT with multiplane reformatting plays a fun-
gency room: muscle weakness, loss of sensation, damental role in cervical trauma diagnosis: it
deep tendon hyperrefl exia, and autonomic function adequately shows fracture trajectories and exten-
alteration, all compatible with a spinal cord lesion. sion in a better way than MRI.
M RI is useful in spinal cord evaluation, detect-
ing cord lesion (with or without associated bony
Comments fracture) and possible cord compression. It is also
valuable to assess the extradural space and spinal
I n young children, due to their biomechanical ligaments.
setup leading to greater fl exibility (skeletal
immaturity plus increased laxity in paravertebral
ligaments and muscles), cervical trauma tends to Radiological Findings
occur at higher levels, from the base of the cra-
nium to C3. The greater spine fl exibility relative T he plain lateral view (Fig.1 .1) shows a vertebral
to the cord explains the tendency for cord dam- body fracture in C5 (arrow). Given the clinical and
age without bony lesions. In older children and radiological fi ndings and the incomplete study (no
teenagers, cord injuries are more frequently seen views of the lower spine), a CT was performed.
at C5–C6 level, just like in adults. A cervicothoracic CT with multiplanar refor-
Specifi c facts to be considered in pediatric matting in the sagittal plane (Fig. 1 .2 ) shows C5
cervical trauma: with an anteroposterior fracture line in the upper
(cid:129) C2–C3 subluxation is physiological. cortex following a right inferolateral trajectory in
(cid:129) T he atlantoaxoid distance is greater than in adults. the anterior region of the lower cortex. The frac-
(cid:129) O dontoid fractures tend to affect the basal ture line reaches the posterior wall.
synchondrosis. T he volumetric 3D reconstruction (Fig. 1.3 ),
I n a pediatric sporting activity context, cervical posterior view, shows fracture lines in both C5 lami-
spine fractures with associated cord damage are nae, with greater displacement on the right (arrow)
typical in diving during water sports, to the point of, but without interapophyseal joint disruption.
according to some series, being the most frequent The MRI study (sagittal plane, STIR)
cause for cord injury in this age group. Diving into (Fig. 1 .4 ) shows an increased cord signal from
shallow waters is particularly dangerous. In gym- C4 to C6 consistent with contusion. There are
nastics, the mechanism of injury tends to be extreme signal changes in C5 and C6 vertebral bodies
hyperfl exion with or without associated trauma. compatible with bony edema. There is extensive
Cervical spine radiographs, including lateral soft tissue signal alteration consistent with acute
views up to C7/T1, are usually the initial diagnostic posttraumatic edema.
4 M.Á. López-Pino et al.
Case 1.2: Lumbar Spondylolysis

F ig. 1.6
F ig. 1.5

F ig. 1.8
F ig. 1.7