Stress changes of the distal radial growth plate. A radiographic survey and review of the literature.

We conducted a radiographic survey to determine skeletal age and the nature and prevalence of stress-related changes affecting the distal radial growth plate in 60 young competitive gymnasts (39 females, 21 males). Comparison of results for chronological and skeletal age revealed a significant delay in maturation for girls (P less than 0.001). Radiographic evaluation revealed 5 gymnasts (4 girls and 1 boy) with stress-related changes of the left wrist, and four of these were considered to be minimal. These results, in conjunction with our previous findings and the review of related literature, reveal three important observations. First, the widening and irregularities of the distal radial physis that we described previously appear to be the first in a spectrum of abnormal changes secondary to overuse and probably represent a stress fracture of the distal radial growth plate. The radiographic changes associated with this injury are not the normal adaptive changes seen in young, competitive gymnasts. Secondly, more serious long-term abnormality may result even though the injury may initially resemble a Salter-Harris type I or II stress fracture. Long-term complications may include symmetrical or asymmetrical retardation or halted growth at the affected site, positive ulnar variance, and associated pathoanatomic sequelae. Thirdly, the incidence of distal radial growth plate stress injury remains unclear; we recommend a further, large-scale prospective epidemiologic study involving both male and female gymnasts. We urge that physicians and other health professionals associated with gymnastics clubs educate coaches about the possibility of significant injury to the distal radial physis, risk factors, and suggested preventive measures.

Maturity Assessment: A Viable Preventive Measure Against Physical and Psychological Insult to the Young Athlete?

In brief: Maturity assessment is often cited as an important part of the preparticipation health examination (PHE) for student-athletes. However, maturity assessment apparently is not routinely included in the PHE in most states. This literature review indicates the value of maturity assessment as a way to reduce the risk of physical and psychological insult to young athletes. Maturity assessment can be used to match adolescents for participation in contact sports and to determine when a youth is experiencing the growth spurt, which may make him or her more susceptible to injury. Accordingly, maturity assessment should be included in the PHE, and schools and community organizations should develop procedures for requesting and using maturity information.