vanderbilt sports medicine common fractures in young athletes february 10, 2012 alex b. diamond,...
TRANSCRIPT
![Page 1: Vanderbilt Sports Medicine Common Fractures in Young Athletes February 10, 2012 Alex B. Diamond, D.O., M.P.H. Assistant Professor of Orthopaedics and Rehabilitation](https://reader030.vdocuments.mx/reader030/viewer/2022032517/56649c7f5503460f94935b1e/html5/thumbnails/1.jpg)
Vanderbilt Sports Medicine
Common Fractures in Young AthletesFebruary 10, 2012
Alex B. Diamond, D.O., M.P.H.Assistant Professor of Orthopaedics and Rehabilitation
Assistant Professor of PediatricsVanderbilt University Medical Center
Co-Chair, Youth Sports Safety TaskforceTeam Physician
Vanderbilt & Belmont UniversitiesNashville Sounds & Nashville Predators
40th Annual MeetingSoutheast Chapter of the American College of Sports Medicine (SEACSM)
![Page 2: Vanderbilt Sports Medicine Common Fractures in Young Athletes February 10, 2012 Alex B. Diamond, D.O., M.P.H. Assistant Professor of Orthopaedics and Rehabilitation](https://reader030.vdocuments.mx/reader030/viewer/2022032517/56649c7f5503460f94935b1e/html5/thumbnails/2.jpg)
Vanderbilt Sports Medicine
Andrew Gregory, MD, FAAP, FACSMAssistant Professor of Orthopedics & PediatricsProgram Director, Sports Medicine Fellowship
Vanderbilt University Medical CenterTeam Physician
Vanderbilt & Belmont UniversitiesNashville Sounds
USA Volleyball
Common Fractures in Young Athletes
![Page 3: Vanderbilt Sports Medicine Common Fractures in Young Athletes February 10, 2012 Alex B. Diamond, D.O., M.P.H. Assistant Professor of Orthopaedics and Rehabilitation](https://reader030.vdocuments.mx/reader030/viewer/2022032517/56649c7f5503460f94935b1e/html5/thumbnails/3.jpg)
Vanderbilt Sports Medicine
Disclosures• Diamond
– NO commercial relationships– Research & Educational funding
• NIH U54 Institutional Clinical & Translational Science Award
• Gregory– No conflict of interest
![Page 4: Vanderbilt Sports Medicine Common Fractures in Young Athletes February 10, 2012 Alex B. Diamond, D.O., M.P.H. Assistant Professor of Orthopaedics and Rehabilitation](https://reader030.vdocuments.mx/reader030/viewer/2022032517/56649c7f5503460f94935b1e/html5/thumbnails/4.jpg)
Vanderbilt Sports Medicine
Objectives• Review briefly the differences of pediatric
bone• Review pediatric fracture classification• Discuss subtle fractures in kids• Discuss a few other pediatric only conditions
![Page 5: Vanderbilt Sports Medicine Common Fractures in Young Athletes February 10, 2012 Alex B. Diamond, D.O., M.P.H. Assistant Professor of Orthopaedics and Rehabilitation](https://reader030.vdocuments.mx/reader030/viewer/2022032517/56649c7f5503460f94935b1e/html5/thumbnails/5.jpg)
Vanderbilt Sports Medicine
Pediatric Skeleton• Bone is relatively elastic and rubbery• Periosteum is quite thick & active• Ligaments are strong relative to the bone• Presence of the physis - “weak link”• Ligament injuries & dislocations are rare –
“kids don’t sprain stuff”• Fractures heal quickly and have the capacity to
remodel
![Page 6: Vanderbilt Sports Medicine Common Fractures in Young Athletes February 10, 2012 Alex B. Diamond, D.O., M.P.H. Assistant Professor of Orthopaedics and Rehabilitation](https://reader030.vdocuments.mx/reader030/viewer/2022032517/56649c7f5503460f94935b1e/html5/thumbnails/6.jpg)
Vanderbilt Sports Medicine
Anatomy of Pediatric Bone
• Epiphysis• Physis• Metaphysis• Diaphysis• Apophysis
![Page 7: Vanderbilt Sports Medicine Common Fractures in Young Athletes February 10, 2012 Alex B. Diamond, D.O., M.P.H. Assistant Professor of Orthopaedics and Rehabilitation](https://reader030.vdocuments.mx/reader030/viewer/2022032517/56649c7f5503460f94935b1e/html5/thumbnails/7.jpg)
Vanderbilt Sports Medicine
Pediatric Fracture Classification• Plastic Deformation – bowing
– Fibula or ulna common• Buckle/Torus – compression, stable• Greenstick – unicortical tension• Complete
– Spiral, Oblique, Transverse• Physeal = Salter-Harris• Apophyseal avulsion
![Page 8: Vanderbilt Sports Medicine Common Fractures in Young Athletes February 10, 2012 Alex B. Diamond, D.O., M.P.H. Assistant Professor of Orthopaedics and Rehabilitation](https://reader030.vdocuments.mx/reader030/viewer/2022032517/56649c7f5503460f94935b1e/html5/thumbnails/8.jpg)
Vanderbilt Sports Medicine
Plastic Deformation• Bowing without
fracture• Often requiring
reduction
![Page 9: Vanderbilt Sports Medicine Common Fractures in Young Athletes February 10, 2012 Alex B. Diamond, D.O., M.P.H. Assistant Professor of Orthopaedics and Rehabilitation](https://reader030.vdocuments.mx/reader030/viewer/2022032517/56649c7f5503460f94935b1e/html5/thumbnails/9.jpg)
Vanderbilt Sports Medicine
Buckle (Torus) Fracture• Buckled Periosteum
– Metaphyseal/ diaphyseal junction
![Page 10: Vanderbilt Sports Medicine Common Fractures in Young Athletes February 10, 2012 Alex B. Diamond, D.O., M.P.H. Assistant Professor of Orthopaedics and Rehabilitation](https://reader030.vdocuments.mx/reader030/viewer/2022032517/56649c7f5503460f94935b1e/html5/thumbnails/10.jpg)
Vanderbilt Sports Medicine
Greenstick Fracture• Cortex Broken on Only One Side
– Incomplete
![Page 11: Vanderbilt Sports Medicine Common Fractures in Young Athletes February 10, 2012 Alex B. Diamond, D.O., M.P.H. Assistant Professor of Orthopaedics and Rehabilitation](https://reader030.vdocuments.mx/reader030/viewer/2022032517/56649c7f5503460f94935b1e/html5/thumbnails/11.jpg)
Vanderbilt Sports Medicine
Complete Fractures• Transverse
– Perpendicular to the bone
• Oblique– Across the bone at 45-60o
– Unstable
• Spiral – Rotational force
![Page 12: Vanderbilt Sports Medicine Common Fractures in Young Athletes February 10, 2012 Alex B. Diamond, D.O., M.P.H. Assistant Professor of Orthopaedics and Rehabilitation](https://reader030.vdocuments.mx/reader030/viewer/2022032517/56649c7f5503460f94935b1e/html5/thumbnails/12.jpg)
Vanderbilt Sports Medicine
Salter-Harris Classification
I II
III
IV V
![Page 13: Vanderbilt Sports Medicine Common Fractures in Young Athletes February 10, 2012 Alex B. Diamond, D.O., M.P.H. Assistant Professor of Orthopaedics and Rehabilitation](https://reader030.vdocuments.mx/reader030/viewer/2022032517/56649c7f5503460f94935b1e/html5/thumbnails/13.jpg)
Vanderbilt Sports Medicine
Clues• Kids usually poor historians• Mechanism Any Fall
– Trampolines, Monkey Bars, Skating
• May not be swelling, bruising or deformity
• Limp• Non-weight bearing• Not using the arm
![Page 14: Vanderbilt Sports Medicine Common Fractures in Young Athletes February 10, 2012 Alex B. Diamond, D.O., M.P.H. Assistant Professor of Orthopaedics and Rehabilitation](https://reader030.vdocuments.mx/reader030/viewer/2022032517/56649c7f5503460f94935b1e/html5/thumbnails/14.jpg)
Vanderbilt Sports Medicine
Keep In MindSubtle Fractures
• Salter-Harris I• Buckle• Avulsions• Occult
Mimickers• Nursemaids• Other causes of limp
– Legg-Calve-Perthes– Transient synovitis– Septic arthritis
• Osteomyelitis– Bone pain + Fever
![Page 15: Vanderbilt Sports Medicine Common Fractures in Young Athletes February 10, 2012 Alex B. Diamond, D.O., M.P.H. Assistant Professor of Orthopaedics and Rehabilitation](https://reader030.vdocuments.mx/reader030/viewer/2022032517/56649c7f5503460f94935b1e/html5/thumbnails/15.jpg)
Vanderbilt Sports Medicine
Elbow Fractures• Multiple physes• Look for swelling
– Effusion• Loss of flexion/ extension• No loss of supination/ pronation
• Typical pattern– Supracondylar in the very young– Radial head in the older child
![Page 16: Vanderbilt Sports Medicine Common Fractures in Young Athletes February 10, 2012 Alex B. Diamond, D.O., M.P.H. Assistant Professor of Orthopaedics and Rehabilitation](https://reader030.vdocuments.mx/reader030/viewer/2022032517/56649c7f5503460f94935b1e/html5/thumbnails/16.jpg)
Vanderbilt Sports Medicine
Ossification Centers of the Elbow (CRITOE)
• C = Capitellum• R = Radial Head• I = Internal (Medial)• T = Trochlea• O = Olecranon• E = External (Lateral )
• 2 Years• 4 Years• 6 Years• 8 Years• 10 Years• 12 Years
![Page 17: Vanderbilt Sports Medicine Common Fractures in Young Athletes February 10, 2012 Alex B. Diamond, D.O., M.P.H. Assistant Professor of Orthopaedics and Rehabilitation](https://reader030.vdocuments.mx/reader030/viewer/2022032517/56649c7f5503460f94935b1e/html5/thumbnails/17.jpg)
Vanderbilt Sports Medicine
Ossification Centers Appearance
![Page 18: Vanderbilt Sports Medicine Common Fractures in Young Athletes February 10, 2012 Alex B. Diamond, D.O., M.P.H. Assistant Professor of Orthopaedics and Rehabilitation](https://reader030.vdocuments.mx/reader030/viewer/2022032517/56649c7f5503460f94935b1e/html5/thumbnails/18.jpg)
Vanderbilt Sports Medicine
Elbow Fat Pads• Indicates hemarthrosis
– In the setting of appropriate mechanism = a fracture of the distal humerus, proximal radius or ulna
• Anterior– Normal if laying flat against the humerus– Abnormal if elevated = “sail sign”
• Posterior– Always abnormal
![Page 19: Vanderbilt Sports Medicine Common Fractures in Young Athletes February 10, 2012 Alex B. Diamond, D.O., M.P.H. Assistant Professor of Orthopaedics and Rehabilitation](https://reader030.vdocuments.mx/reader030/viewer/2022032517/56649c7f5503460f94935b1e/html5/thumbnails/19.jpg)
Vanderbilt Sports Medicine
Elbow Fat Pads
![Page 20: Vanderbilt Sports Medicine Common Fractures in Young Athletes February 10, 2012 Alex B. Diamond, D.O., M.P.H. Assistant Professor of Orthopaedics and Rehabilitation](https://reader030.vdocuments.mx/reader030/viewer/2022032517/56649c7f5503460f94935b1e/html5/thumbnails/20.jpg)
Vanderbilt Sports Medicine
Posterior Fat Pad
Anterior Fat Pad
![Page 21: Vanderbilt Sports Medicine Common Fractures in Young Athletes February 10, 2012 Alex B. Diamond, D.O., M.P.H. Assistant Professor of Orthopaedics and Rehabilitation](https://reader030.vdocuments.mx/reader030/viewer/2022032517/56649c7f5503460f94935b1e/html5/thumbnails/21.jpg)
Vanderbilt Sports Medicine
Occult Fracture
![Page 22: Vanderbilt Sports Medicine Common Fractures in Young Athletes February 10, 2012 Alex B. Diamond, D.O., M.P.H. Assistant Professor of Orthopaedics and Rehabilitation](https://reader030.vdocuments.mx/reader030/viewer/2022032517/56649c7f5503460f94935b1e/html5/thumbnails/22.jpg)
Vanderbilt Sports Medicine
Non-Displaced Supracondylar Fracture
Posterior Fat Pad
![Page 23: Vanderbilt Sports Medicine Common Fractures in Young Athletes February 10, 2012 Alex B. Diamond, D.O., M.P.H. Assistant Professor of Orthopaedics and Rehabilitation](https://reader030.vdocuments.mx/reader030/viewer/2022032517/56649c7f5503460f94935b1e/html5/thumbnails/23.jpg)
Vanderbilt Sports Medicine
![Page 24: Vanderbilt Sports Medicine Common Fractures in Young Athletes February 10, 2012 Alex B. Diamond, D.O., M.P.H. Assistant Professor of Orthopaedics and Rehabilitation](https://reader030.vdocuments.mx/reader030/viewer/2022032517/56649c7f5503460f94935b1e/html5/thumbnails/24.jpg)
Vanderbilt Sports Medicine
![Page 25: Vanderbilt Sports Medicine Common Fractures in Young Athletes February 10, 2012 Alex B. Diamond, D.O., M.P.H. Assistant Professor of Orthopaedics and Rehabilitation](https://reader030.vdocuments.mx/reader030/viewer/2022032517/56649c7f5503460f94935b1e/html5/thumbnails/25.jpg)
Vanderbilt Sports Medicine
Nursemaid’s Elbow• Traction injury usually
when it is “time to go”• FOOSH• Child cries and will not
use the arm• No swelling or
deformity• Does not improve with
time
![Page 26: Vanderbilt Sports Medicine Common Fractures in Young Athletes February 10, 2012 Alex B. Diamond, D.O., M.P.H. Assistant Professor of Orthopaedics and Rehabilitation](https://reader030.vdocuments.mx/reader030/viewer/2022032517/56649c7f5503460f94935b1e/html5/thumbnails/26.jpg)
Vanderbilt Sports Medicine
Nursemaid’s Elbow• Subluxation of the radial head• Small tear in the annular ligament which slides
off the radial head and into the joint• Average age 2-4 yr but up to 8 yr• Radial head goes from being shaped like a
pencil eraser to that of a hammer head by about age 5-6 yr
![Page 27: Vanderbilt Sports Medicine Common Fractures in Young Athletes February 10, 2012 Alex B. Diamond, D.O., M.P.H. Assistant Professor of Orthopaedics and Rehabilitation](https://reader030.vdocuments.mx/reader030/viewer/2022032517/56649c7f5503460f94935b1e/html5/thumbnails/27.jpg)
Vanderbilt Sports Medicine1
2
3
![Page 28: Vanderbilt Sports Medicine Common Fractures in Young Athletes February 10, 2012 Alex B. Diamond, D.O., M.P.H. Assistant Professor of Orthopaedics and Rehabilitation](https://reader030.vdocuments.mx/reader030/viewer/2022032517/56649c7f5503460f94935b1e/html5/thumbnails/28.jpg)
Vanderbilt Sports Medicine
Reduction Maneuver: Full supination and flexion
![Page 29: Vanderbilt Sports Medicine Common Fractures in Young Athletes February 10, 2012 Alex B. Diamond, D.O., M.P.H. Assistant Professor of Orthopaedics and Rehabilitation](https://reader030.vdocuments.mx/reader030/viewer/2022032517/56649c7f5503460f94935b1e/html5/thumbnails/29.jpg)
Vanderbilt Sports Medicine
Forearm Fractures• Most common fracture in pediatrics
– Becoming more common
• FOOSH• May not have swelling, bruising or deformity• Tender 1” proximal to the RC joint• FROM or loss of supination
![Page 30: Vanderbilt Sports Medicine Common Fractures in Young Athletes February 10, 2012 Alex B. Diamond, D.O., M.P.H. Assistant Professor of Orthopaedics and Rehabilitation](https://reader030.vdocuments.mx/reader030/viewer/2022032517/56649c7f5503460f94935b1e/html5/thumbnails/30.jpg)
Vanderbilt Sports Medicine
Volar Bruise
![Page 31: Vanderbilt Sports Medicine Common Fractures in Young Athletes February 10, 2012 Alex B. Diamond, D.O., M.P.H. Assistant Professor of Orthopaedics and Rehabilitation](https://reader030.vdocuments.mx/reader030/viewer/2022032517/56649c7f5503460f94935b1e/html5/thumbnails/31.jpg)
Vanderbilt Sports Medicine
![Page 32: Vanderbilt Sports Medicine Common Fractures in Young Athletes February 10, 2012 Alex B. Diamond, D.O., M.P.H. Assistant Professor of Orthopaedics and Rehabilitation](https://reader030.vdocuments.mx/reader030/viewer/2022032517/56649c7f5503460f94935b1e/html5/thumbnails/32.jpg)
Vanderbilt Sports Medicine
![Page 33: Vanderbilt Sports Medicine Common Fractures in Young Athletes February 10, 2012 Alex B. Diamond, D.O., M.P.H. Assistant Professor of Orthopaedics and Rehabilitation](https://reader030.vdocuments.mx/reader030/viewer/2022032517/56649c7f5503460f94935b1e/html5/thumbnails/33.jpg)
Vanderbilt Sports Medicine
![Page 34: Vanderbilt Sports Medicine Common Fractures in Young Athletes February 10, 2012 Alex B. Diamond, D.O., M.P.H. Assistant Professor of Orthopaedics and Rehabilitation](https://reader030.vdocuments.mx/reader030/viewer/2022032517/56649c7f5503460f94935b1e/html5/thumbnails/34.jpg)
Vanderbilt Sports Medicine
Splint vs. Cast for Buckle Fractures of the Distal Radius
• LOE 1– Splint as good as a cast for
prevention of re-fracture or loss of alignment
– No difference in pain– Easier to bathe, better
function– No need for return for cast
removal or re-xray
Plint AC et al. Pediatrics, 2006.
![Page 35: Vanderbilt Sports Medicine Common Fractures in Young Athletes February 10, 2012 Alex B. Diamond, D.O., M.P.H. Assistant Professor of Orthopaedics and Rehabilitation](https://reader030.vdocuments.mx/reader030/viewer/2022032517/56649c7f5503460f94935b1e/html5/thumbnails/35.jpg)
Vanderbilt Sports Medicine
Navicular Fractures can happen in Skeletally Immature
![Page 36: Vanderbilt Sports Medicine Common Fractures in Young Athletes February 10, 2012 Alex B. Diamond, D.O., M.P.H. Assistant Professor of Orthopaedics and Rehabilitation](https://reader030.vdocuments.mx/reader030/viewer/2022032517/56649c7f5503460f94935b1e/html5/thumbnails/36.jpg)
Vanderbilt Sports Medicine
Avulsion Fx common in the Fingers
![Page 37: Vanderbilt Sports Medicine Common Fractures in Young Athletes February 10, 2012 Alex B. Diamond, D.O., M.P.H. Assistant Professor of Orthopaedics and Rehabilitation](https://reader030.vdocuments.mx/reader030/viewer/2022032517/56649c7f5503460f94935b1e/html5/thumbnails/37.jpg)
Vanderbilt Sports Medicine
Slipped Capital Femoral Epiphysis (SCFE)
• SH Fracture through proximal femoral physis• High index suspicion
– Consider in any child with limp or hip/knee pain• Xray: AP/Frogleg pelvis• Catch before the slip• Can be bilateral• ORIF
![Page 38: Vanderbilt Sports Medicine Common Fractures in Young Athletes February 10, 2012 Alex B. Diamond, D.O., M.P.H. Assistant Professor of Orthopaedics and Rehabilitation](https://reader030.vdocuments.mx/reader030/viewer/2022032517/56649c7f5503460f94935b1e/html5/thumbnails/38.jpg)
Vanderbilt Sports Medicine
SCFE
![Page 39: Vanderbilt Sports Medicine Common Fractures in Young Athletes February 10, 2012 Alex B. Diamond, D.O., M.P.H. Assistant Professor of Orthopaedics and Rehabilitation](https://reader030.vdocuments.mx/reader030/viewer/2022032517/56649c7f5503460f94935b1e/html5/thumbnails/39.jpg)
Vanderbilt Sports Medicine
Toddler’s Fracture• Suspect
– Any toddler with a mechanism who refuses to bear weight
– Regardless of exam or xray
• SLWC x 2-3 weeks
![Page 40: Vanderbilt Sports Medicine Common Fractures in Young Athletes February 10, 2012 Alex B. Diamond, D.O., M.P.H. Assistant Professor of Orthopaedics and Rehabilitation](https://reader030.vdocuments.mx/reader030/viewer/2022032517/56649c7f5503460f94935b1e/html5/thumbnails/40.jpg)
Vanderbilt Sports Medicine
Distal Metaphyseal/Supracondylar
• Slipped while running• Tender above the physis• Minimal swelling• Refusal to bear weight• No effusion• A form of Toddler’s fracture
![Page 41: Vanderbilt Sports Medicine Common Fractures in Young Athletes February 10, 2012 Alex B. Diamond, D.O., M.P.H. Assistant Professor of Orthopaedics and Rehabilitation](https://reader030.vdocuments.mx/reader030/viewer/2022032517/56649c7f5503460f94935b1e/html5/thumbnails/41.jpg)
Vanderbilt Sports Medicine
SHII Proximal Tibia - Periosteal Recoil
![Page 42: Vanderbilt Sports Medicine Common Fractures in Young Athletes February 10, 2012 Alex B. Diamond, D.O., M.P.H. Assistant Professor of Orthopaedics and Rehabilitation](https://reader030.vdocuments.mx/reader030/viewer/2022032517/56649c7f5503460f94935b1e/html5/thumbnails/42.jpg)
Vanderbilt Sports Medicine
Ankle Fractures• Physis located 1” above distal maleolar tip• SH I of the fibula common with inversion
injury• ER stress test useful in distinguishing fracture
from sprain• Tibia closes medial to lateral before the fibula
![Page 43: Vanderbilt Sports Medicine Common Fractures in Young Athletes February 10, 2012 Alex B. Diamond, D.O., M.P.H. Assistant Professor of Orthopaedics and Rehabilitation](https://reader030.vdocuments.mx/reader030/viewer/2022032517/56649c7f5503460f94935b1e/html5/thumbnails/43.jpg)
Vanderbilt Sports Medicine
Distal Fibula Salter-Harris I
![Page 44: Vanderbilt Sports Medicine Common Fractures in Young Athletes February 10, 2012 Alex B. Diamond, D.O., M.P.H. Assistant Professor of Orthopaedics and Rehabilitation](https://reader030.vdocuments.mx/reader030/viewer/2022032517/56649c7f5503460f94935b1e/html5/thumbnails/44.jpg)
Vanderbilt Sports Medicine
8 y/o male soccer player
![Page 45: Vanderbilt Sports Medicine Common Fractures in Young Athletes February 10, 2012 Alex B. Diamond, D.O., M.P.H. Assistant Professor of Orthopaedics and Rehabilitation](https://reader030.vdocuments.mx/reader030/viewer/2022032517/56649c7f5503460f94935b1e/html5/thumbnails/45.jpg)
Vanderbilt Sports Medicine
![Page 46: Vanderbilt Sports Medicine Common Fractures in Young Athletes February 10, 2012 Alex B. Diamond, D.O., M.P.H. Assistant Professor of Orthopaedics and Rehabilitation](https://reader030.vdocuments.mx/reader030/viewer/2022032517/56649c7f5503460f94935b1e/html5/thumbnails/46.jpg)
Vanderbilt Sports Medicine
Salter-Harris II
Distal Tibia
![Page 47: Vanderbilt Sports Medicine Common Fractures in Young Athletes February 10, 2012 Alex B. Diamond, D.O., M.P.H. Assistant Professor of Orthopaedics and Rehabilitation](https://reader030.vdocuments.mx/reader030/viewer/2022032517/56649c7f5503460f94935b1e/html5/thumbnails/47.jpg)
Vanderbilt Sports Medicine
12 yo football player
SH III
![Page 48: Vanderbilt Sports Medicine Common Fractures in Young Athletes February 10, 2012 Alex B. Diamond, D.O., M.P.H. Assistant Professor of Orthopaedics and Rehabilitation](https://reader030.vdocuments.mx/reader030/viewer/2022032517/56649c7f5503460f94935b1e/html5/thumbnails/48.jpg)
Vanderbilt Sports Medicine
SH IV Tibia
![Page 49: Vanderbilt Sports Medicine Common Fractures in Young Athletes February 10, 2012 Alex B. Diamond, D.O., M.P.H. Assistant Professor of Orthopaedics and Rehabilitation](https://reader030.vdocuments.mx/reader030/viewer/2022032517/56649c7f5503460f94935b1e/html5/thumbnails/49.jpg)
Vanderbilt Sports Medicine
Calcaneal Fractures• Jump from height• Jump into shallow
water• Xrays sometimes
negative, subtle• Occasionally bilateral
![Page 50: Vanderbilt Sports Medicine Common Fractures in Young Athletes February 10, 2012 Alex B. Diamond, D.O., M.P.H. Assistant Professor of Orthopaedics and Rehabilitation](https://reader030.vdocuments.mx/reader030/viewer/2022032517/56649c7f5503460f94935b1e/html5/thumbnails/50.jpg)
Vanderbilt Sports Medicine
Metatarsals• Physis proximal on the
1st and distal on the others
• 1st MT epiphysis often bipartite
![Page 51: Vanderbilt Sports Medicine Common Fractures in Young Athletes February 10, 2012 Alex B. Diamond, D.O., M.P.H. Assistant Professor of Orthopaedics and Rehabilitation](https://reader030.vdocuments.mx/reader030/viewer/2022032517/56649c7f5503460f94935b1e/html5/thumbnails/51.jpg)
Vanderbilt Sports Medicine
5th Metatarsal Apophysis
![Page 52: Vanderbilt Sports Medicine Common Fractures in Young Athletes February 10, 2012 Alex B. Diamond, D.O., M.P.H. Assistant Professor of Orthopaedics and Rehabilitation](https://reader030.vdocuments.mx/reader030/viewer/2022032517/56649c7f5503460f94935b1e/html5/thumbnails/52.jpg)
Vanderbilt Sports Medicine
www.vanderbiltsportsmedicine.com
Please Visit
![Page 53: Vanderbilt Sports Medicine Common Fractures in Young Athletes February 10, 2012 Alex B. Diamond, D.O., M.P.H. Assistant Professor of Orthopaedics and Rehabilitation](https://reader030.vdocuments.mx/reader030/viewer/2022032517/56649c7f5503460f94935b1e/html5/thumbnails/53.jpg)
Vanderbilt Sports Medicine
Thank You