BACKGROUND
Physical activity in adolescence has been reported to enhance physical activity in adulthood, but detailed information on the enhancing effect of different types of adolescent sports is lacking. We evaluated the association between participation in different types of adolescent sports and physical activity in adulthood.


METHODS
The sample comprised 7794 males and females who responded to the mailed questions on physical activity status at age 14 years and at age 31 years in follow-up surveys of the Northern Finland 1966 birth cohort. The associations between adolescent participation in different sports and adult physical activity was examined by multinomial logistic regression.


RESULTS
Frequent participation in sports after school hours in adolescence was associated with a high level of physical activity in adulthood. In males, adolescent participation in ball games, intensive endurance sports, track and field, and combat sports was associated with a high or very high level of adult activity. In females, the same applied to adolescent participation in running, orienteering, track and field, cycling, gymnastics, and riding. Adolescent participation in ball games increased participation in ball games in adulthood, especially in males, while participation in cross-country skiing, running, and orienteering provided the greatest stimulation to carry over of some endurance sport to adulthood.


CONCLUSIONS
Participation in sports at least once a week among females and twice a week among males was associated with high level of physical activity in later life. Adolescent participation in the intensive endurance sports, and some sports that require and encourage diversified sports skills, appeared to be most beneficial with respect to the enhancement of adult physical activity.

Adolescent Participation in Sport and Adult Physical Activity

Slipped capital femoral epiphysis (SCFE) is a common adolescent hip disorder. The etiology of SCFE includes biomechanical and biochemical factors. SCFEs are classified as stable and unstable and are more common in boys than girls and in certain racial groups; most children with SCFEs are obese. Bilateral SCFEs may have a simultaneous or sequential presentation. Imaging studies show a posterior slip of the epiphysis relative to the metaphysis, seen early on lateral radiographs. The most common and effective initial treatment for stable SCFEs is in situ central single-screw fixation; other options include epiphysiodesis, and osteotomy with or without surgical dislocation of the hip. Later reconstruction options, typically reserved for the child with functional abnormalities, include proximal femoral osteotomy, or surgical dislocation of the hip with removal of metaphyseal prominent bone to remove the source of femoroacetabular impingement. Unstable SCFEs have an increased risk of osteonecrosis; the role of reduction, methods of fixation, and decompression are controversial. The natural history of untreated SCFEs is associated with the risk of progression and later degenerative joint disease. Based on treatment methods of 30 to 40 years ago, in situ fixation provided the best long-term function with the lowest risk of complications and the most effective delay of degenerative arthritis regardless of the severity of the SCFE. Newer technologies and techniques are allowing the reevaluation of the role of either acute or later reconstructive osteotomy. It has not yet been determined if these improved techniques will result in better outcomes than in the past. Surgical dislocation of the hip with epiphyseal orientation is a considered treatment option for those technically adept at the procedure; however, the long-term outcome compared with in situ fixation is still unknown.

Slipped Capital Femoral Epiphysis

BACKGROUND: Fractures in children are an important public health issue and a frequent cause of emergency room visits. The purpose of this descriptive epidemiological study was to identify the most frequent pediatric fractures per 1000 population at risk in the United States using the 2010 National Electronic Injury Surveillance System (NEISS) database and 2010 US Census information. METHODS: The NEISS database was queried for all fractures in 2010 in children between the ages of 0 and 19 years. The NEISS national estimates were compared with the 2010 US Census data to extrapolate national occurrence rates. RESULTS: The annual occurrence of fractures increased from ages 0 to 14, peaking in the 10 to 14 age range (15.23 per 1000 children). The annual occurrence rate for the entire pediatric population (0 to 19 y) was 9.47 per 1000 children. Fractures of the lower arm (forearm) were the most common among the entire study population, accounting for 17.8% of all fractures, whereas finger and wrist fractures were the second and third most common, respectively. Finger and hand fractures were most common for age groups 10 to 14 and 15 to 19 years, respectively. The overall risk of a fracture occurring throughout childhood and adolescence was 180 per 1000 children, or just under 1 in every 5 children. CONCLUSIONS: Pediatric fractures represent a significant proportion of pediatric emergency department visits in the United States. Children between 10 and 14 years of age have the highest risk of having fractures. Overall, forearm fractures were the most common pediatric fractures. Most pediatric fractures can be treated on outpatient basis, with only 1 of 18 fractures requiring hospitalization or observation. LEVEL OF EVIDENCE: Level III-Retrospective comparative study. Language: en

Epidemiology of pediatric fractures presenting to emergency departments in the United States

Slipped capital femoral epiphysis occurs during the adolescent growth spurt and is most frequent in obese children. Up to 40 percent of cases are bilateral. Recent classification methods emphasize epiphyseal stability rather than symptom duration. Most cases of slipped capital femoral epiphyses are stable and have a good prognosis if diagnosed early. Unstable slipped capital femoral epiphysis has a much poorer prognosis because of the high risk of avascular necrosis. Early radiographic clues are the metaphyseal blanch sign and Klein's line. Once diagnosed, treatment should begin immediately. The most widely accepted treatment for a stable slipped capital femoral epiphysis is in situ fixation with a single central screw. The treatment for an unstable slipped capital femoral epiphysis is much more controversial. Corrective osteotomy is usually reserved for treatment of severe deformities after the patient has stopped growing.

Slipped capital femoral epiphysis.

The promotion of sport and physical activity (PA) for children is widely recommended to support a healthy lifestyle, but being engaged in sport bears the risk of sustaining injuries. Injuries, in turn, can lead to a reduction in current and future involvement in PA and, therefore, may negatively affect future health as well as quality of life. Thus, sports injury prevention is of particular importance in youth. The aim of this systematic review was to quantify the effectiveness of exercise-based injury prevention programs in child and adolescent sport in general, and with respect to different characteristics of the target group, injury prevention program, and outcome variables. An Internet-based literature search was conducted in six databases (CINAHL, Cochrane, EMBASE, ISI Web of Science, PubMed, SPORTDiscus) using the following search terms with Boolean conjunction: (sport injur* OR athletic injur* OR sport accident*) AND (prevent* OR prophylaxis OR avoidance) AND (child* OR adolescent OR youth). Randomized controlled trials and controlled intervention studies in organized sport, published in English in a peer-reviewed journal, analyzing the effects of an exercise-based injury prevention program in athletes younger than 19 years of age. Two reviewers evaluated eligibility and methodological quality. Main outcome extracted was the rate ratio (RR). Statistical analyses were conducted using the inverse-variance random effects model. Twenty-one trials, conducted on a total of 27,561 athletes (median age 16.7 years [range 10.7–17.8]), were included. The overall RR was 0.54 (95 % CI 0.45–0.67) [p < 0.001]. Girls profited more from injury prevention than boys (p = 0.05). Both prevention programs with a focus on specific injuries (RR 0.48 [95 % CI 0.37–0.63]) and those aiming at all injuries (RR 0.62 [95 % CI 0.48–0.81]) showed significant reduction effects. Pre-season and in-season interventions were similarly beneficial (p = 0.93). Studies on programs that include jumping/plyometric exercises showed a significant better (p = 0.002) injury preventive effect (RR 0.45 [95 % CI 0.35–0.57], Z = 6.35, p < 0.001) than studies without such exercises (RR 0.74 [95 % CI 0.61–0.90], Z = 3.03, p = 0.002). The results provide good evidence and clearly demonstrate beneficial effects of exercise-based injury prevention programs in youth sports as they can result in statistically significant and practically relevant injury reduction. In particular, multimodal programs including jumping/plyometric exercises can be recommended. However, there is a considerable lack of data for children (under 14 years of age) and for individual sports in general. Future research should include these groups and focus on the effect of specific exercises and compliance.

Exercise-Based Injury Prevention in Child and Adolescent Sport: A Systematic Review and Meta-Analysis

Background and purpose Fractures are most common in youth and in the elderly, with differences in incidence over time and between regions. We present the fracture pattern in a population of youths ...

Epidemiology of fractures in children and adolescents

Background and purpose Fractures are most common in youth and in the elderly, with differences in incidence over time and between regions. We present the fracture pattern in a population of youths ≤ 19 years of age, who were seen at Umea University Hospital, Sweden. Material and methods All injuries seen at the hospital have been recorded in a database since 1993. The data include variables such as age, sex, date, type of injury, mechanism of injury, and treatment. For the period 1993–2007, there were 10,203 injury events that had resulted in at least 1 fracture. Results The incidence for the whole period was 201/10 4 person years. The incidence increased by 13% during the period 1998–2007, when we were able to control for registration errors. The most common fracture site was the distal forearm. The most common type of injury mechanism was falling. The peak incidence occurred at 11–12 years in girls and at 13–14 years in boys, with a male-to-female incidence ratio of 1.5. We found variations in mechanisms and activities at injury with age, and over time. Interpretation Fractures are caused by a combination of intrinsic and extrinsic factors that vary with age. We believe the increase in incidence is partly explained by changes in children’s activity patterns over time. Further research may help to identify preventive measures to reduce the number of fractures, in particular those involving hospital care, surgical treatment, and—most importantly—long-term impairment.

Increased incidence over the past decade: a population-based study from northern Sweden

Objectives: We present an overview of the injuries seen at the emergency department of a regional hospital in northern Sweden and the variations in the injury pattern with age, sex and time. Method ...

Injuries in children and adolescents : analysis of 41,330 injury related visits to an emergency department in northern Sweden

Forty-six septic shoulders in 42 patients < 18 months old at diagnosis were followed for an average of 6 + 10 years. Eight were not diagnosed at the time of infection. Five patients complained of intermittent, mild pain with use. All could touch their mouth and back of their head with the hand on their affected side. Flexion and abduction averaged 150°; internal and external rotation averaged 60°. Nineteen percent of the shoulders had < 130° of flexion. Discrepancy in humeral length was 0-9 cm (average 2.4 cm). Only 7% of the humeral heads were entirely normal. The shapes of the remainder were quite variable, and range of motion could not be predicted from these shapes

Septic arthritis of the shoulder during the first 18 months of life.

Fifty septic knees in patients younger than 2 years old at diagnosis were examined. Follow-up ranged from 1.1 to 21.3 years (average, 6.2). Twenty-four knees were deformed in varus or valgus of 5-40 degrees. Deformity was present within 10 months of infection and thereafter was stable. It was due to displacement of the epiphysis into a metaphyseal defect, loss of epiphyseal cartilage, or both. Growth did not compensate for deformity. Ossific nuclei partly or completely disappeared after infection. They were slow to reappear, and until maturity, their size and shape did not represent the cartilaginous epiphysis. Arthrograms were necessary to evaluate accurately the epiphyseal shape and volume.

Michno P

Papers

Epidemiology of fractures in children and adolescents

Increased incidence over the past decade: a population-based study from northern Sweden

Injuries in children and adolescents : analysis of 41,330 injury related visits to an emergency department in northern Sweden

Septic arthritis of the shoulder during the first 18 months of life.

Sequelae from septic arthritis of the knee during the first two years of life.