2014-‐10-‐06 Click to edit Master /tle style BLESSURES AUX PLAQUES DE CROISSANCE Eric Koelink, BMBS FRCPC Jérôme Ouellet, MD FRCPC 1er octobre 2014 Click to edit Master /tle style PLAN • • • • • • • • Os Croissance osseuse normale chez l’enfant Plaque de croissance Blessures de suruKlisaKon Blessures membre supérieur Blessures tronc Blessures membre inférieur Fractures de Salter-‐Harris 1 2014-‐10-‐06 Click to edit Master /tle style OS Click to edit Master /tle style OS 2 2014-‐10-‐06 Click to edit MOaster CROISSANCE SSEUSE /tle NORMALE style CHEZ L’ENFANT • À la naissance: carKlage > os • Croissance longitudinale: épiphyse – OssificaKon endochondrale-‐> proliféraKon des cellules carKlagineuses dans la plaque de croissance -‐> devient de l’os – Surtout dans les os longs • Croissance transversale : diaphyse – OssificaKon apposiKonnelle-‐> déposiKon d’os sous le périoste – Surtout au pelvis, carpe et tarse Click to edit MOaster CROISSANCE SSEUSE /tle NORMALE style CHEZ L’ENFANT • Généralités: – L’ossificaKon débute plus tôt chez les filles – Le tronc grandit plus dans l’enfance – Les membres grandissent plus à l’adolescence (MS avant MI) – L’accumulaKon minérale osseuse maximum survient à l’adolescence • 90% de la masse osseuse à 18 ans 3 2014-‐10-‐06 Click to eDdit PLAQUE E CM ROISSANCE aster /tle style Click to edit DM BLESSURES E aster SURUTILISATION /tle style • Survient quand une structure est soumise à un stress sous-‐maximal répéKKf, et que le repos n’est pas adéquat pour favoriser l’adaptaKon structurelle – Stress > tolérance de la structure • Facteurs de risque les + communs: augmentaKon rapide de l’entraînement + entraînement de haut niveau prolongé – Autres facteurs de risque: mauvais équipement, mauvaises surfaces d’entraînement, changement récent de surface, mauvaise technique, mauvais équilibre force/flexibilité, variantes de l’alignement anatomique 4 2014-‐10-‐06 Click to edit DM BLESSURES E aster SURUTILISATION /tle style • Physe = risque augmenté – Maillon faible de la structure osseuse – Nécessite un index de suspicion élevé Click to edit Master /tle style ÉPIDÉMIOLOGIE • Entre 45.9% et 54% de toutes les blessures sporKves! 5 most common sites involve the tibia tubercle of the knee (Osgood-Schlatter disease), the calcaneal apophysitis of the heel (Sever’s disease) and the medial epicondylar apophysis of the elbow (often referred to as Little Leaguer’s Elbow). Anterior knee pain is one of the most frequent symptoms in the young athlete.16 In early adolescence, this is usually due to Osgood-Schlatter disease, while in later adolescence, the tibial tubercle apophysis matures and patellofemoral pain syndrome becomes the more common cause of knee pain. Overuse injuries of the physis (eg, proximal humerus in throwers, distal radius in gymnasts) occur in early-to-mid adolescence.14 17–19 As skeletal maturity is achieved, overuse injuries to bone begin to follow adult injury patterns (eg, stress reactions and stress fractures). Click to edit FACTEURS DM E Raster ISQUE /tle style conditioning, biomechanics and a history of prio Extrinsic factors include workload, sport technique environment and equipment. The contribution of an in an extrinsic factor to injury risk is extremely variable d on the individual athlete, the sport environment and action that occurs during participation.35–37 Furtherm important to recognise that many overuse injuries resu complex interaction of multiple risk factors in specifi coupled with an inciting event. Understanding this c necessary for the comprehensive evaluation and trea athletes with overuse injuries.38 39 It is also relevant to note that some risk factors are m (eg, strength and neuromuscular function); whereas o not (eg, age and gender).38 Finally, in young 2014-‐10-‐06 EPIDEMIOLOGY OF OVERUSE INJURIES Overall, there is very little research specifically on the incidence and prevalence of overuse injuries in children and adolescents.20–24 Furthermore, studies of sports injuries in youth are limited by several issues, including injury reporting methodology, injury classification and standardisation of outcomes. In particular, injury definitions that require time loss from sport underestimate the burden of overuse injuries.9 25 A recent study of 100 US high schools reported that the overall injury rate (acute and overuse) in 20 high school sports was 1.71/1000 athlete exposures during the 2010–2011 school year.23 This database estimates 3.7 million injuries occurred that resulted in more than 1 day’s time loss from sports. This estimate does not include injuries seen outside of the high school setting. Importantly, this study further underestimates injury rates since it does not account for injuries which did not result in time loss, as is the case in many overuse injuries.9 Another data source, the National SAFE KIDS Campaign, estimates that more than 3.5 million children are injured annually playing sports or participating in recreational activities.22 Estimates of the proportion of all sports injuries that are due to overuse range from 45.9% to 54%.7 24 26 Although evidence 4 of 15 Box 1 Categorisation of risk factors for overuse i Intrinsic risk factors Growth-related factors Susceptibility of growth cartilage to repetitive stress Adolescent growth spurt Previous injury Previous level of conditioning Anatomical factors Menstrual dysfunction Psychological and developmental factors—athlete-specifi Extrinsic risk factors Training workload (rate, intensity and progression) Training and competition schedules Equipment/footwear Environment Sport technique Psychological factors—adult and peer influences (Adapted from DiFiori.15) DiFiori JP, et al. Br J Sports Med 2014;48:287–288. doi:10.1136/bjsports-2 Overuse injuries and burnout in youth sports: a posiKon statement from the American Medical Society for Sports Medicine Click to edit M BLESSURES MEMBRE aster /Stle UPÉRIEUR style • Anatomie épaule 6 2014-‐10-‐06 Click to edit M BLESSURES MEMBRE aster /Stle UPÉRIEUR style • Lille Leaguer’s Shoulder – Décrit de mulKples blessures survenant à la plaque de croissance proximale de l’humérus – 2 mécanismes chez les lanceurs: • DistracKon: forte contracKon des muscles de la CDR + biceps pour centrer la tête humérale vs glénoïde • Torsion: stress en rotaKon au niveau humérus proximal Click to edit M BLESSURES MEMBRE aster /Stle UPÉRIEUR style • Épidémiologie: adolescents > 12 ans – Pic: 13 ans • Symptômes: – Douleur humérus proximal lors du lancer + manœuvres résistées de l’épaule – Perte de puissance/précision dans le lancer – Peut aleindre n’importe quel athlète lanceur/overhead • Signes: – Douleur localisée à l’humérus proximal – Douleur/diminuKon ROM • DDx: instabilité GH, tendinopathie CDR, abulement, fracture physéale humérus proximal, déchirure labrum, tumeur 7 2014-‐10-‐06 Click to edit M BLESSURES MEMBRE aster /Stle UPÉRIEUR style • InvesKgaKon: RX – Élargissement plaque de croissance proximale humérale – Sclérose métaphysaire/fragmentaKon de l’épiphyse aussi possible Click to edit M BLESSURES MEMBRE aster /Stle UPÉRIEUR style • Traitement – Arrêter de lancer jusqu’à: • ROM épaule complet et sans douleur • RX normal (peut prendre ad 1 an) – Pas d’immobilisaKon!! – Retour graduel au lancer – Temps moyen de résoluKon: ~ 3 mois 8 2014-‐10-‐06 Click to edit M BLESSURES MEMBRE aster /Stle UPÉRIEUR style • Anatomie coude Click to edit M BLESSURES MEMBRE aster /Stle UPÉRIEUR style • Lille League Elbow – UKlisé pour décrire les blessures du côté médian du coude • Apophysite de l’épicondyle, fracture par avulsion de l’épicondyle, blessures UCL – Mécanisme: Stress de tension/cisaillement a/n coude médial 2re au sévère stress en valgus d’un lancer 9 2014-‐10-‐06 Click to edit M BLESSURES MEMBRE aster /Stle UPÉRIEUR style • Épidémiologie: – 8-‐15 ans – Peut aleindre n’importe quel athlète lanceur (+ souvent = lanceurs au baseball) • Symptômes: – Douleur coude médial – DiminuKon de la distance/puissance/précision des lancers • Signes: – Douleur au niveau épicondyle médial – Douleur avec stress en valgus – Hypertrophie de l’épicondyle • DDx: osteochondriKs dissecans, maladie de Panner – Red flags: Sx mécaniques, déficit d’extension Click to edit M BLESSURES MEMBRE aster /Stle UPÉRIEUR style • InvesKgaKon: RX – Élargissement de l’apophyse – FragmentaKon du centre d’ossificaKon 10 2014-‐10-‐06 softball windmill pitch, especially during the single-leg support component; however, the site of failure (injury) may 10 y and younger 75 pitches per d not be located where the problem 11–12 y 85 pitcher per d 13–16 y 95 pitches per d originates, but at a more remote site 17–18 y 105 pitches per d (the weakest link). This kinetic chain Source: Little League (http://www.littleleague.org/media/ theory produces “culprits” and “vicnewsarchive/2009/Sep-Dec/LLTournamentRegularSeasonClick BLESSURES to edit M MEMBRE aster /Stle UPÉRIEUR style tims” in describing injuries. For exPitchingRulesMadeSame.htm). ample, although 70% of 131 injuries to collegiate softball pitchers were from studies that show increased injury overuse, only 13% were reported in • among Traitement those who throw curve balls the lower extremity.55 The majority The same concerns exist for arm and sliders at early ages, researchers – RICE X 4 -‐6 s emaines occurred in the shoulder or elbow. safety: do not throw when fatigued. As currently continue to recommend deThus, although the “culprit” may be 2011, p inning limitations and grest laying introduction of the curve ball – Si asymptomaKque après ofcele ériode, retour raduel weak gluteal muscles and lack of peldays for softball windmill pitchers in until after age 14 or when pubertal TABLE 1 Little League Baseball 2010 demonstrate injury patterns similar to softball windmill pitch, especially durPitching Guidelines: Maximum au l ancer vicminor stabilization, maysupport pres-component; baseball with several variations. the ing athlete the single-leg the various age divisions of Little development has advanced to the stage Pitches per Game One unique feature of softball, however, however, the site of failure ent with shoulder pain, because the(injury) may League play only. y and younger apply to75tournament pitches per d when the athlete has started to shave 10 11–12 is the nature of pitching; pitchers throw not be located where the problem y 85 pitcher per d “victim” shoulder is inherently “the Many softball 95teams on fewerfrom a flat mound. Although originates, but at a more remote site (sliders should be delayed until age 13–16 y pitches perrely d underhand weakest 17–18 y 105 pitches per dbaseball. the softball pitching link.” motion (the weakest link). This kinetic chain per team than Be- windmill 16).41 The American Academy of Pedi- Source:pitchers Little League (http://www.littleleague.org/media/ may be less stressful topelvis the pitcher’ storso theory produces “culprits” and “vicThe and work to accelerate fore such inning limitations, some newsarchive/2009/Sep-Dec/LLTournamentRegularSeasonatrics endorses this recommendation. PitchingRulesMadeSame.htm). shoulder and elbow than throwing tims” in describing injuries. For exthe there segments upper extremity in injuries to pitchers pitched in multiple gamesoverhand, Finally, on the basis of the increasing a hardball are stillof the ample, although 70% of 131 significant on various collegiate softball retracpitchers were from sequential manner. Scapular during tournaments, runningforces aplaced number of elbow ligament surgeries in studies that weekend show increased injury injury. overuse, only 13% were reported in throwbetween curve balls tion overuse is stimulated by ipsilateral hip exup those pitchwho counts 1500body andstructures 2000 to cause younger and younger pitchers, it is among the lower extremity.55 The majority exist for arm and pitches sliders at early ages, researchers 52 The same concerns tension and trunk extension. stable or elbow. in a 3-day period. clear that players, parents, and coaches currently continue to recommend de- safety: do not throw when fatigued. As occurred in theAshoulder Thus, although the “culprit” scapula is vital for optimal rotator cuff may be of 2011, inning limitations and rest require more respect for the limits of layingThe drivingof force introduction the curveofballthe windmill weak gluteal muscles and lack of pelfor53softball windmill pitchers in after agepitch 14 or is when pubertal function that helps to keep the humerus the developing child’s arm to withstand untilsoftball ; 1 in the lower days body vic stabilization, the athlete may presthe various age divisions of Little development has advanced to the stage in the glenoid fossa avoiding im-because the the forces incurred while pitching and whenstudy ent (thus with shoulder pain, reported more than 50% of apply the to tournament League play only. the athlete has started to shave “victim” shoulder is inherently “the pingement). Many softball teams rely on fewer should understand that the conse- (sliders totalshould kinetic energyuntil of upper extremity be delayed age weakest link.” pitchers per team than baseball. BeThe American Academy of Pediquence of overload causing overuse 16).41during overhead movementsforeis such sup-inning Accordingly, examination and treatment The pelvis and torso work to accelerate limitations, some atrics endorses this recommendation. 54 injuries which can permanently dam- Finally, plied bybasis theof the trunk and legs. of multiple shoulder pain the in segments softballof windmill the upper extremity in pitchersThe pitched in games on the increasing a sequential manner. Scapular retracduring weekend tournaments, running include age anatomic structures.35 softball engages gluteal pitchers should an assessment number of elbowpitcher ligament surgeries in the tion is stimulated by ipsilateral hip exup pitch counts between 1500 and 2000 younger and younger pitchers, it is muscles to achieve stabilization of the of and rehabilitation for pelvic stability tension and trunk extension. A stable pitches in a 3-day period.52 that players, parents, and coaches OVERUSE INJURY FROM SOFTBALL clearpelvis, helps gluteal strength. stabi-rotator cuff scapulaScapular is vital for optimal require morewhich respect in forturn the limits of the Thescapula driving forceand of the windmill PITCHING function that helps to keep 53; 1 also achieve child’ adequate control. softball pitch is in lization must be evaluated andthe humerus the developing s arm to withstand the lower body in the glenoid fossa (thus avoiding imthe forces incurred while pitching and study reported more than 50% of the as the treated as well affected shoulder Data injuries/were included in should Theunderstand lower extremity supportstotal thekinetic me-energy of upper extremity pingement). that the conseClick BLESSURES to onesoftball dit M MEMBRE aster Stle UPÉRIEUR style or elbow.is Off-season and examination preseason the previous sections; in general, these quence chanics of the upper body during the of overload causing overuse during overhead movements supAccordingly, and treatment injuries which can permanently damconditioning plied by the trunk and legs.54 Theprograms of shoulderfor pain softball in softball windmill 35 age anatomic structures. softball pitcher engages the pitchers gluteal pitchers includegluan assessment windmill shouldshould include muscles to achieve stabilization of the of and rehabilitation for pelvic stability • TABLE PrévenKon -‐ L ille L eague s houlder/elbow teal strengthening and pelvic stabiliOVERUSE INJURY FROM SOFTBALL pelvis, which in turn helps the scapula and gluteal strength. Scapular stabi2 Little League Baseball 2010 Pitching Guidelines: Rest Requirements for Pitchers PITCHING zation exercises. lization must also be evaluated and achieve adequate control. demonstrate injury patterns similar to baseball with several minor variations. One unique feature of softball, however, is the nature of pitching; pitchers throw underhand from a flat mound. Although the softball windmill pitching motion may be less stressful to the pitcher’s shoulder and elbow than throwing a hardball overhand, there are still significant forces placed on various body structures to cause overuse injury. TABLE 1 Little League Baseball 2010 Pitching Guidelines: Maximum Pitches per Game – Bonne bioméchanique (chaîne kinéKque, équilibre musculaire, technique) – Décompte des lancers Pitchers 14 y and younger treated as well as the affected shoulder Data on softball injuries were The lower extremity supports the me66 or more pitches in a day Four (4) calendar daysincluded in or elbow. Off-season and preseason the previous sections; in general, these chanics of the upper body during the 51–65 pitches in a day Three (3) calendar days conditioning programs for softball 36–50 pitches in a day Two (2) calendar days of rest must be observed ROLE OF EQUIPMENT INpitchers INJURY windmill should include glu21–35 pitches in a day One (1) calendar day of rest must be observed teal strengthening and pelvic stabiliRISK AND PREVENTION TABLE 2 Little League Baseball 2010 Pitching Guidelines: Rest Requirements for Pitchers 1–20 pitches in a day NO (0) calendar day of rest must be observed zation exercises. Pitchersb14asées y and younger • RecommandaKons AAP/SCP sur Medical and Four Safety Pitchers 15–18 y 66 or more pitches in a day (4) calendar days Playing Equipment 76 or moreAdvisory pitches in a C day Four (4)incalendar days 51–65 a day (2006) Three (3) calendar days ommilee de USA Bpitches aseball The of baseball playing 36–50 pitches(3) in acalendar day Two (2) calendar days of rest game must be observed 61–75 pitches in a day Three days ROLErequires OF EQUIPMENT IN INJURY 21–35 pitches a day Oneobserved (1) calendar day of rest must be observed 46–60 pitches in a day Two (2) incalendar days of rest must be RISKgloves, AND PREVENTION (ball, bat, bases), as 1–20 pitches in a day NO (0) calendar day of equipment rest must be observed 31–45 pitches in a day One (1)y calendar day of rest must be observed Pitchers 15–18 Equipment well as equipmentPlaying to dress and protect 76 orNO more in a day (4) calendar days 1–30 pitches in a day (0)pitches calendar day of rest must be Four observed The game of baseball requires playing 61–75 pitches in a day Three (3) calendar daysthe athlete. Although there are overSource: Little League (http://www.littleleague.org/media/newsarchive/2009/Sep-Dec/LLTournamentRegularSeasonPitching46–60 pitches in a day Two (2) calendar days of rest must be observed (ball, bat, gloves, bases), as RulesMadeSame.htm). concernsequipment about equipment 31–45 pitches in a day One (1) calendar day ofarching rest must be observed well as equipment to dress and protect 1–30 pitches in a day NO (0) calendar day of rest must be observed the athlete. Although there are overSource: Little League (http://www.littleleague.org/media/newsarchive/2009/Sep-Dec/LLTournamentRegularSeasonPitchingRulesMadeSame.htm). arching concerns about equipment e848 FROM THE AMERICAN ACADEMY OF PEDIATRICS e848 FROM THE AMERICAN ACADEMY OF PEDIATRICS Downloaded from pediatrics.aappublications.org by guest on March 17, 2012 11 2014-‐10-‐06 Click to edit M BLESSURES MEMBRE aster /Stle UPÉRIEUR style • PrévenKon -‐ Lille League shoulder/elbow – Éviter de lancer pour plusieurs équipes avec saisons qui se chevauchent – Éviter de lancer compéKKvement pour > 8/12 mois, avec 3 mois consécuKfs de repos complet de lancer par année – Lanceur ≠ receveur – Programme de condiKonnement pré-‐saison (core, CDR…) Click to edit M BLESSURES MEMBRE aster /Stle UPÉRIEUR style • PrévenKon -‐ Lille League shoulder/elbow – Développement séquenKel des lancers • Rapide à Contrôle à Off-‐speed pitch à Δ vitesse/localisaKon • Retarder la balle courbe après l’âge de 14 ans ou quand l’athlète a commencé à se raser • Retarder la balle glissante après l’âge de 16 ans 12 2014-‐10-‐06 Click to edit M BLESSURES MEMBRE aster /Stle UPÉRIEUR style • Épiphysite radiale distale – Blessure commune au poignet associée à la MEC sur un os non conçu à cet effet – Peut avoir conséquences dramaKques • Arrêt de croissance avec raccourcissement du radius décrit ++ dans la lilérature Click to edit M BLESSURES MEMBRE aster /Stle UPÉRIEUR style • Épidémiologie: – + commun chez les gymnastes • Symptômes: – AppariKon graduelle de douleur poignet, pire avec MEC sur poignet en extension • Signes: – ROM normal – Léger œdème radius distal – Douleur localisée plaque de croissance radiale dorsale > palmaire – Vérifier tabaKère anatomique (possibilité d’aleinte du carpe) 13 2014-‐10-‐06 Click to edit M BLESSURES MEMBRE aster /Stle UPÉRIEUR style • InvesKgaKon: RX – Sclérose (habituellement pire côté métaphysaire) – Élargissement physe Épiphysite radius distal Click to edit M BLESSURES MEMBRE aster /Stle UPÉRIEUR style • Traitement: – Arrêt des acKvités impliquant: • MEC • UKlisaKon de dowel grips • TracKon excessive avec poignet extension – ImmobilisaKon plâtrée préférable – Retour aux acKvités quand aucune douleur + RX normal • La plus lente des blessures aux plaques de croissance à guérir! 14 2014-‐10-‐06 Click to edit TM BLESSURES RONC aster /tle style • Blessures colonne vertébrale – Épiphysite processus épineux • Habituellement non-‐progressif + auto-‐résoluKf • Sx ressemblent à spondylolyse Click to edit TM BLESSURES RONC aster /tle style • Histoire: – Douleur lombaire diffuse lors d’hyperextension – Mal localisé • Examen: – Douleur palpaKon processus épineux – Peu de douleur avec flexion antérieure/latérale – Douleur +++ extension résistée depuis posiKon fléchie 15 2014-‐10-‐06 Click to edit TM BLESSURES RONC aster /tle style • InvesKgaKons: – RX normal – ScinK osseuse vs SPECT • Traitement: – Éviter hyperextension – Corset lombaire élasKque – Renforcement tronc Épiphysite processus épineux Click to edit TM BLESSURES RONC aster /tle style • Blessures aussi à considérer avec clientèle ped: – Spondylolyse • Fracture de stress de l’isthme interarKculaire vertébral • 2re extension/rotaKon colonne répétée • Douleur en extension, diminuKon flexibilité ischio, lordose augmentée • InvesKgaKon: RX, CT/IRM, scinK osseuse • Tx précoce avec repos, renforcement tronc, éKrement MI +/-‐ corset 16 2014-‐10-‐06 Click to edit TM BLESSURES RONC aster /tle style • Blessures aussi à considérer avec clientèle ped: – Spondylolisthésis TranslaKon antérieur d’un corps vertébral sur un autre Survient lorsque spondylolyse mal prise en charge Peut être traumaKque GradaKon de 1 à 4 selon le % de translaKon Tx dépend du grade, management prolongé comparé à spondylolyse • Peut nécessiter fusion • • • • • Click to edit TM BLESSURES RONC aster /tle style • Apophysite crête iliaque – TracKon répéKKve des muscles s’insérant a/n apophyse crête iliaque • Gluteus medius, transversus abdominis et tensor fascia latae – Apophyse demeure carKlagineuse ad adolescence 17 2014-‐10-‐06 BLESSURES TRONC Click to edit Master /tle style Apophysite crête iliaque BLESSURES TRONC Click to edit Master /tle style Apophysite crête iliaque 18 2014-‐10-‐06 BLESSURES TRONC Click to edit Master /tle style Apophysite crête iliaque Click to edit M BLESSURES MEMBRE aster /Itle NFÉRIEUR style • Syndrome d’Osgood-‐ Schlaler – Apophysite de tracKon a/n tubercule Kbial proximal (inserKon tendon patellaire) – + commun chez 9-‐14 ans – Bilatéral chez 25-‐50% des cas 19 2014-‐10-‐06 Click to edit M BLESSURES MEMBRE aster /Itle NFÉRIEUR style – Fréquent dans acKvités avec course, changements de direcKon et sauts (basket, soccer, gym, ballet, etc.) – Examen: douleur localisée tubercule Kbial, proéminence tubercule – Douleur reproducKble avec contracKon isométrique quadriceps BLESSURES MM EMBRE Click to edit aster INFÉRIEUR /tle style Syndrome d’Osgood-‐SchlaQer 20 2014-‐10-‐06 Click to edit M BLESSURES MEMBRE aster /Itle NFÉRIEUR style • Syndrome de Sinding-‐Larsen-‐Johansson – Mécanisme + présentaKon idem à Osgood-‐Schlaler, mais symptomatologie a/n pôle inférieur de la patella Click to edit M BLESSURES MEMBRE aster /Itle NFÉRIEUR style • Syndrome de Sever – Apophysite au niveau du calcanéum proximal (inserKon du tendon d’Achille) – Fréquent chez coureurs/sauteurs – Calcanéus = forces d’opposiKon 21 2014-‐10-‐06 Click to edit M BLESSURES MEMBRE aster /Itle NFÉRIEUR style • Symptômes: – Douleur localisée – Pire avec acKvités/impacts répéKKfs • Signes: – Signes inflammatoires locaux possibles – Douleur localisée inserKon tendon d’Achille Click to edit M BLESSURES MEMBRE aster /Itle NFÉRIEUR style • InvesKgaKon: RX?? – Pas de critères francs – Peu être normal avec la maladie… ou anormal sans la maladie! – Sclérose/fragmentaKon possible 22 2014-‐10-‐06 Click to edit M BLESSURES MEMBRE aster /Itle NFÉRIEUR style • Traitement – RICE – Heel pads – ModificaKon des acKvités – ImmobilisaKon en dernier recours Click to edit SMALTER-‐HARRIS FRACTURES aster /tle style Anatomie pédiatrique: de peKts adultes? – Présence d’une plaque de croissance (maillon faible) • Os + poreux et pliable • Ligaments + tendons = + forts que l’os pédiatrique • Périoste biologiquement acKf chez l’enfant, demeure souvent intact lors d’une blessure • Stabilise la fracture et favorise la guérison • PotenKel de remodelage incroyable! 23 2014-‐10-‐06 Click to edit SMALTER-‐HARRIS FRACTURES aster /tle style Click to edit SMALTER-‐HARRIS FRACTURES aster /tle style -‐ I 24 2014-‐10-‐06 Click to edit SMALTER-‐HARRIS FRACTURES aster /tle style -‐ II Click to edit SMALTER-‐HARRIS FRACTURES aster /tle style -‐ III 25 2014-‐10-‐06 Click to edit SMALTER-‐HARRIS FRACTURES aster /tle style -‐ IV Click to edit SMALTER-‐HARRIS FRACTURES aster /tle style -‐ V 26 2014-‐10-‐06 Click to edit SMALTER-‐HARRIS FRACTURES aster /tle style II = + commun Ensuite: I, III, IV et V Référer III, IV et V à orthopédiste I et II habituellement efficacement traité avec immobilisaKon • Arrêt de croissance + fréquent avec plus haut degré de S-‐H, mais peut survenir avec toute blessure de la plaque de croissance • • • • Click to edit SMALTER-‐HARRIS FRACTURES aster /tle style InvesKgaKon – RX à faire si: • • • • • • Douleur focale Douleur avec compression axiale/transverse Œdème ++ ROM diminué/absent Symptômes persistents Mécanisme de blessure à haut risque – Considérer: • ArKculaKon au-‐dessus/en-‐dessous • Comparer avec côté sain 27 2014-‐10-‐06 Click to edit SMALTER-‐HARRIS FRACTURES aster /tle style Management – ABC – Évaluer le membre pour R/O complicaKon • Compromis neurovasculaire • Fractures ouvertes/ Syndrome comparKmental (6 P) R/O blessures associées Contrôle douleur + immobilisaKon Click to edit ÀM MESSAGES Raster ETENIR /tle style 1) Considérer blessure à plaque de croissance si usage répéKKf combiné avec augmentaKon rapide de l’entraînement ou entraînement élite prolongé 3) Plaque de croissance = maillon faible 4) Sx souvent d’appariKon insidieux 5) Douleur localisée à l’examen (importance de l’anatomie) 6) Traitement avec repos ad asymptomaKque en général 28 2014-‐10-‐06 Click to edit Master /tle style MERCI! QuesKons? Click to edit Master /tle style RÉFÉRENCES • • • • • • • • • • Arnaiz, J., Piedra, T., de Lucas, E. M., Arnaiz, A. M., Pelaz, M., Gomez-‐Dermit, V., & Canga, A. 2011. Imaging Findings of Lower Limb ApophysiKs. American Journal of Roentgenology, 196(3), W316–W325 Council on Sports Medicine and Fitness. Baseball and So…ball. Pediatrics 2012;129:e842-‐56 Fleisher & Ludwig, eds. Textbook of Pediatric Emergency Medicine, 6th ed. Lippincol, 2010 Frush and Lindenfeld. Peri-‐epiphyseal and Overuse Injuries in Adolescent Athletes. Sports Health 2009;1:201-‐11 Kliegman et al. Nelson Textbook of Pediatrics 19th EdiKon. Elsevier, 2011 Harris and Anderson. Care of the Young Athlete 2nd EdiKon. AAP/AAOS, 2010 Purcell L. Causes and prevenKon of low back pain in young athletes. Paediatr Child Health 2009;14(8): 536-‐8 Sarwark and al. Pediatric Orthopaedics and Sports Injuries, a quick reference guide 1st EdiKon. AAP, 2010 DiFiori et al. Overuse injuries and burnout in youth sports: a posi4on statement from the American Medical Society for Sports Medicine. Br J Sports Med 2014;48:287-‐8 www.orthobullets.com 29
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