Imaging of Sports-related Injuries of the Lower Extremity in Pediatric Patients

Abstract

With increasing participation and intensity of training in youth sports in the United States, the incidence of sports-related injuries is increasing, and the types of injuries are shifting. In this article, the authors review sports injuries of the lower extremity, including both acute and overuse injuries, that are common in or specific to the pediatric population. Common traumatic injuries that occur in individuals of all ages (eg, tears of the acetabular labrum and anterior cruciate ligament) are not addressed, although these occur routinely in pediatric sports. However, some injuries that occur almost exclusively in high-level athletes (eg, athletic pubalgia) are reviewed to increase awareness and understanding of these entities among pediatric radiologists who may not be familiar with them and thus may not look for them. Injuries are described according to their location (ie, hip, knee, or foot and ankle) and pathologic process (eg, apophysitis, osteochondritis dissecans). Examples of abnormalities and normal variants of the anatomy that are often misdiagnosed are provided. The injuries reviewed represent a common and growing subset of pathologic processes about which all pediatric and musculoskeletal radiologists should be knowledgeable. Understanding physeal injury is especially important because missed diagnoses can lead to premature physeal closure and osteoarthritis. RSNA, 2016.

Ankle and Foot Injuries in the Young Athlete

“…Tillaux fractures are caused by an external rotation force about the ankle. 25 AP radiographs demonstrate a vertical line within the distal tibial epiphysis with and then extending laterally. The lateral radiograph shows the avulsed fragment displaced anteriorly.…”

“…3). 25 Careful inspection should be made to assess for injury of the poster-ior tibial tendon because fibers typically insert on both the ossicle and the navicular bone. 8…”

“…Approximately 90% of fifth metatarsal fractures occur in children < 10 years of age. 25 Fractures occur due to an inversion-type injury and are thought to be due to either stress from the peroneus brevis tendon avulsing the base of the fifth metatarsal or stress of the tendinous portion of the abductor digiti minimi and the lateral cord of the aponeurosis. 5,40 Radiographs demonstrate a fracture that is transverse along the bone and usually intra-articular, as opposed to the apophysis that lies parallel to the base (►Fig.…”

“…A non-weightbearing cast is used for 6 to 8 weeks, and patients with nonhealing fractures undergo screw fixation. 5,9,25 Lateral Process of the Talus Fracture…”

Lower Limbs Trauma in Pediatrics

“…In this scenario diagnostic imaging plays a very important role, taking advantage of different types of techniques that could confirm the clinical data and follow up the injury. 6,7 Radiographs are usually the first technique to study the bone component, even though they are not fully satisfying with respect to soft tissue injuries. Ultrasound (US) and magnetic resonance imaging (MRI) are the main imaging modalities to evaluate tendons, ligaments, muscles, and osteochondral cartilage.…”