The Brush Foundation studies on human growth and development, begun in 1931 and terminated in 1942, have been intensively reviewed and studied by Dr Greulich and Miss Pyle in the formulation of this Radiographic Atlas of Skeletal Development of the Hand and Wrist Serial radiographs of from 2 to 20 hand-films made at successive examinations of each of 1000 boys and girls made up the radiographic material Standards were selected that were judged to be the most representative of the central tendency or anatomic mode of each chronologic age group from birth through 18 years

Radiographic Atlas of Skeletal Development of the Hand and Wrist

The increased participation of children and adolescents in organized sports worldwide is a welcome trend given evidence of lower physical fitness and increased prevalence of overweight in this population. However, the increased sports activity of children from an early age and continued through the years of growth, against a background of their unique vulnerability to injury, gives rise to concern about the risk and severity of injury. Three types of injury–anterior cruciate ligament (ACL) injury, concussion, and physeal injury – are considered potentially serious given their frequency, potential for adverse long-term health outcomes, and escalating healthcare costs. Concussion is probably the hottest topic in sports injury currently with voracious media coverage and exploding research interest. Given the negative cognitive effects of concussion, it has the potential to have a great impact on children and adolescents during their formative years and potentially impair school achievement and, if concussion management is not managed appropriately, there can be long term negative impact on cognitive development and ability to resume sports participation. Sudden and gradual onset physeal injury is a unique injury to the pediatric population which can adversely affect growth if not managed correctly. Although data are lacking, the frequency of stress-related physeal injury appears to be increasing. If mismanaged, physeal injuries can also lead to long-term complications which could negatively affect ability to participate in sports. Management of ACL injuries is an area of controversy and if not managed appropriately, can affect long-term growth and recovery as well as the ability to participate in sports. This article considers the young athlete’s vulnerability to injury, with special reference to ACL injury, concussion, and physeal injury, and reviews current research on epidemiology, diagnosis, treatment, and prevention of these injury types. This article is intended as an overview of these injury types for medical students, healthcare professionals and researchers.

/pdf/the-child-and-adolescent-athlete-a-review-of-three-1bur1e2d39.pdf

The child and adolescent athlete: a review of three potentially serious injuries

An increasing number of anterior cruciate ligament (ACL) injuries are seen in children now than in the past due to increased sports participation. The natural history of ACL deficient knees in active individuals, particularly in children is poor. Surgical management of ACL deficiency in children is complex due to the potential risk of injury to the physis and growth disturbance. Delaying ACL reconstruction until maturity is possible but risks instability episodes and intra-articular damage. Surgical options include physeal-sparing, partial transphyseal and complete transphyseal procedures. This article reviews the management of ACL injured skeletally immature patients including the functional outcome and complications of contemporary surgical techniques.

Pediatric anterior cruciate ligament reconstruction

Synopsis Anterior cruciate ligament (ACL) injuries in skeletally immature individuals remain a challenge for the child, the parents, orthopaedic surgeons, and physical therapists. The main challenges are the potential risk of recurrent instability, secondary injuries following nonoperative treatment, and the risks involved with surgical treatment due to the vulnerability of the epiphyseal growth plates. We first present the physiological background for considerations that must be made when advising on treatment alternatives for skeletally immature individuals after ACL injury. The implications of continuous musculoskeletal development for treatment decisions are emphasized. No randomized controlled trials have been performed to investigate outcomes of different treatment algorithms. There is no consensus in the literature on clinical treatment decision criteria for whether a skeletally immature child should undergo transphyseal ACL reconstruction, physeal sparing ACL reconstruction, or nonoperative treatm...

Management of anterior cruciate ligament injuries in skeletally immature individuals.

Anterior cruciate ligament (ACL) injuries have become common in children and adolescents who practice competitive sports, accounting for 0.5–3% of all ACL injuries. Magnetic resonance imaging (MRI) is useful for diagnosis and treatment planning, but is no better than clinical examination, especially when the MRI is interpreted by less experienced health care professionals. Management of ACL deficiency in children is still controversial, but the present trend is towards early reconstruction, because repeated instability episodes may lead to secondary lesions of the knee, and induce meniscal tears and early degenerative alterations of the joint. Postoperatively, complications are rare, and most of the documented growth complications are secondary to avoidable technical errors such as placement of a fixation device across a growth plate. We recommend to reconstruct the ACL paying attention to avoid irreversible damage to the epiphyseal growth plates of the lower femur and upper tibia.

Anterior cruciate ligament tears in children

Immediate full weightbearing after total hip arthroplasty can potentially lead to faster recovery. This cadaver study demonstrated that a proximally coated taper stem and a fully porous coated cylindrical stem did not differ in axial and torsional stability at failure under simulated full weightbearing with force directed both along the stem axis and perpendicular to the plane of the prosthesis. Both the taper stem and the cylindrical stem showed adequate stability for an immediate weightbearing protocol with respect to gross failure in osteoporotic bone.

Longitudinal and axial stability of a cementless metaphyseal versus a fully porous coated cylindrical femoral stem.

Background: There is little age- and sex-specific objective data concerning anterior knee translation in school-aged children. We aimed to establish age- and sex-specific baseline data for anterior knee translation of the knee in girls and in boys in grades 5 to 12. We also investigated whether a correlation exists between anterior knee translation and global joint laxity in girls in grades 5 to 12. Methods: A sample of convenience from a local school was used. Fifteen boys and 15 girls were randomly chosen from each grade, 5 to 12, to undergo anterior translation measurements with the KT2000 knee ligament arthrometer at 15, 20, and 30 lb of force. In addition, Beighton scores and bone age were determined. Results: Anterior knee translation decreased with age in both girls and boys. Girls had greater anterior knee translation and end-point compliance than age-matched boys. In girls, there was a positive correlation between increased global joint laxity and increased anterior knee translation at 20 and 30 lb. However, hyperextension of the knee by itself was not a predictor of greater anterior translation. Conclusions: Anterior translation of the knee showed age and sex variation in school-aged children. These data are important in establishing a foundation of baseline data to understand sex differences in ligament development and function and to help guide injury prevention strategies. Level of Evidence: Level II diagnostic study.

Ligamentous laxity of the knee during childhood and adolescence.

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Longitudinal and axial stability of a cementless metaphyseal versus a fully porous coated cylindrical femoral stem.

Ligamentous laxity of the knee during childhood and adolescence.