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Pediatric Sports Injuries: Introduction & Soft Tissue Injuries
John R. Gregg, MD, a former clinical professor of medicine at the University of Pennsylvania, and Theodore Ganley, MD, orthopedic director of sports medicine at the Children's Hospital of Philadelphia, point out that "children are not just small adults" and they discuss how children's injuries and treatment differ from those of their elders. Using an extensive set of x-rays and diagrams, Drs. Gregg and Ganley discuss the particular anatomy of children and how it differs substantially from that of adults. Equally, the effects and treatment call for different approaches since children don't sprain ligaments or dislocate joints as adults do; rather they fracture through the physis or the epiphysis, thus making x-rays a first line of diagnosis. The authors even describe children's bones as looking "like Swiss cheese, while adult bone appears like parmesan." Drs. Gregg and Ganley go on to describe and illustrate six types of Salter fractures, discuss their diagnosis and note that most heal within three weeks. The important thing here is the extensive use of x-ray photographs and diagrams ... truly an example of a picture being worth a thousand words. The same is true for avulsion fractures, common at the patella and the tibial spine ... and compression injuries. Soft tissue injuries, which make up half of all injuries seen in the pediatric population, are initially treated with RICE (rest, ice, compression, and elevation). The authors discuss whether anti-inflammatory drugs should also be a part of treatment, and conclude that while the jury is still out on that debate it's at least a given that any drug that interferes with clotting should be avoided in the acute stage. The difference between strains, which affect muscle, and sprains, which affect ligaments is discussed along with the various approaches to treatment and rehabilitation. The authors conclude with discussion, description, illustration, and treatment of compartment syndrome, lumpy shin bones, and myositis ossificans. |
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