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LEARNING OBJECTIVES
Upon completion of this chapter, the reader will be able to:
Understand skeletal developmental issues and effect on rehabilitation.
Discuss how open growth plates change the rehabilitation process.
Discuss progression of rehabilitation for general orthopedic injuries.
Create and structure physical therapy interventions for children with orthopedic injuries.
Evaluate and provide treatment to individuals with sports injuries.
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Orthopedic injuries in the pediatric population require several considerations that differ from an adult with a mature musculoskeletal system. As the child grows, there are physiologic differences in bone development, cognitive development, neurological development, and biomechanical alignment. An estimated 30 million American youths participate in organized sports. This number is in part driven by public health initiatives that promote sports participation for physical and psychological benefits.1–3 Sports participation has been linked to improved self-esteem and school outcomes, as well as decreased alcohol and drug use among youths.4,5 However, sports are one of the leading causes of injury in adolescents.6,7
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Once played recreationally, youth sports have become increasingly competitive. Training camps for sports performance are targeting an even younger population. The prevalence of year-round sports participation is also increasingly popular. There is no longer an off season to build strength and coordination. The popularity of youth sports has created many challenges for the physical therapist. It is important to have a greater understanding of developmental changes and how overuse often plays a direct role in injuries that occur.
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Child abuse can be a cause of orthopedic injuries. Common injuries are skull, facial, sternum, rib, and spinous fractures. There can be multiple fractures in different healing stages. Burns and bruising as different stages of healing should also be considered.
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PHYSIOLOGIC CONSIDERATIONS IN SKELETAL DEVELOPMENT AND DYSFUNCTIONS
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Skeletal development can be seen in the skeletal maturity and remodeling of the bones, muscles, tendons, and ligaments. In child development, there is chronologic age but also biologic or physiologic age. Skeletal maturation is different within each child and occurs differently between males and females. Females have an earlier onset of puberty than males. Females usually start puberty around age 11, a year or 2 earlier than males. Puberty can last between 2 and 5 years. Peak bone mass is usually seen in the early 20s in females and later 20s for males. During this development, there are changes in the shape and strength of the bones.
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BONE DEVELOPMENT AND INJURIES
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Major regions of the bone include the epiphysis (end of the bone), physis (growth plate), metaphysis (region between the growth plate and the shaft of the bone), and the diaphysis (shaft of the long bone). Ossification of the bones is a gradual process that can be seen on x-ray as growth plates close. Within these changes of ossification and ...