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Pediatric Sports Injuries: Lower Extremity Injuries
Frederick C. Balduini, MD is a board certified orthopedic surgeon in private practice in Bonita Springs Florida. Previously, Dr. Balduini was the Director of Sports Medicine at Graduate Hospital in Philadelphia, PA. He received his medical degree from the University of New Mexico, completed an internship at Parkland Memorial Hospital in Dallas Tx, and completed an orthopedic residency at the University of New Mexico. Dr. Balduini completed a Fellowship at the University of Pennsylvania Sports Medicine Center in Philadelphia. He has lectured and written extensively on sports injuries. John Gregg, MD, was a clinical assistant professor and senior surgeon at the Children's Hospital of Philadelphia. Here, he discusses how and where pediatric sports injuries of the lower extremities manifest themselves and how they're diagnosed and treated. With an accompanying set of more than 60 illustrations and x-rays, the author describes the types and locations of pediatric sports injuries of the lower extremities and the kinds of sports activities that cause them. He discusses common acute fractures of the pelvis and the classification, presentation, and diagnosis of hip-slipped capital femoral epiphysis and its association with Trendelenburg gait in adolescents. Stress fractures of the femoral neck occur mainly in long-distance runners ... and are susceptible to complications, thus making early and correct diagnosis imperative. Eliminating the cause, says Dr. Gregg, is the first line of treatment, and then replacing it with low impact aerobics or bike riding. He describes three types of anterior cruciate ligament fractures and their differing presentation and treatment. In patella dislocation, an MRI will reveal a tear in the patellofemoral ligament, medial retinaculum, medial patellotibial ligament, or the tendon of vastis medialis obliquis; the author suggests conservative treatment by aspiration and splintage. Predisposing factors for recurrent cases include Ehlers-Danlos syndrome ... and surgical treatment when necessary is by Insall quadricepsplasty. The lecture covers Osgood-Schlatter's disease, its presentation, its common causes from running and jumping sports, and its treatment by icing and a neoprene knee sleeve. The author provides the linguistic derivation for osteochondritis dissecans, its presenting complaint of pain and how that pain is alleviated by external rotation of the leg. Running and jumping sports may also account for calcaneal apophysitis (Sever's disease). The lecture concludes with a discussion of pediatric ankle injuries, especially of how Salter fractures of the distal tibia and the distal fibula are recognized and treated. |
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