The A B C’s of Playground Bone and Joint Injuries Brett Cascio, MD LTC, US Army Reserve Medical Director, Memorial Sports Medicine LSUHSC and McNeese St. Clinical faculty

Topics Emergencies Fractures Casts Little League/overuse injuries Concussions

Emergencies Dislocations Open fractures Supracondylar elbow fracture SCFE Septic joint Compartment Syndrome - cast

Dislocation Should you reduce?

Open Fracture

Supracondylar elbow fracture 3 types Type 3 can be a vascular emergency

SCFE Slipped Capitol Femoral Epiphysis Can worsen rapidly Can cause necrosis of femoral head Forced ext rot w/ flex

Septic Joint Hip and knee Limping or will not bear weight Fever, effusion Sexually active teens

Compartment syndrome Swollen, tight compartment Usually with trauma but can be exercise induced Tight cast Can lead to kidney failure and permanent disability

Fractures Open (compound) or closed Displaced or nondisplaced

Buckle or Greenstick FRACTURE

Growth Plate Fracture Bones grow longer and wider Growth plates on ends of bones from femur to finger Periosteum – can get entrapped

SALTER HARRIS

SALTER HARRIS I

SCFE – Slipped Capital Femoral Epiphysis

SALTER HARRIS II

SALTER HARRIS III

SALTER HARRIS IV

SALTER HARRIS V Very bad – growth arrest

Triplane Happens because way growth plate fuses

ACL avulsion Swollen painful stiff knee

Tibial tubercle avulsion Patella tendon tears bone Its like Osgood Schlatter’s Disease on steroids Swollen painful stiff knee

Ankle Sprain vs fracture Often it is hard for orthopaedic docs to decifer

Toe/finger injuries Don’t underestimate

5 th Metatarsal Fracture Jone’s Fracture?

Back Stress Fracture? Herniated disc

SUSPICIOUS FRACTURES Recurrent injuries lethal in 10% First born, step, premature, learning disabled Over half of fxs in first year No predominant abuse pattern Chip fracture of distal femur metaphysis Multiple fractures of different stages of healing Femur fxs in pre-ambulatory children Skull rib scapula fxs Ulna nightstick fractures

Splint vs Cast Splint safer Cast stronger Don’t get wet Don’t put anything in cast to scratch

Splint vs Cast

STOP Sports Injuries Sports Trauma and Overuse Prevention Overuse injuries Epidemic “Little league” elbows and shoulders Coaches and PE teachers and PARENTS

Little League Elbow, Shoulder Tommy John Salter 1 fract vs UCL tear Risk factors EwjpwJib7KLLAhVHNSYKHVcfBo4Q9QEIGTAA

Sever’s Disease osteochondritis

Head bone - Concussions Huge increase in public awareness Memorial Sports Program IMPACT testing Find resources in your area

Hip Bone Hip labrum tears Dancers, kickers, Fastest growing type of injury Repair vs. debride Psoas tendon Impingement

Thank you Emergencies Fractures Dislocations Casts Little League/overuse injuries Concussions