Background Overuse injuries are common in sporting children and adolescents. These injuries are a particular concern when they involve the epiphyseal-physeal-metaphyseal (EPM) complex given their potential to disturb skeletal growth. Specifically, the limits of mechanical tolerance of the EPM complex to repetitive stress may be exceeded by the intense and continuous training characteristic of many youth sports today. Objective This article describes the present status of knowledge on the occurrence and outcome of primary periphyseal stress injuries (PPSIs) affecting the EPM complex in the extremities of children and adolescents involved in youth sports. Methods A comprehensive review of the sports medicine literature was conducted to determine the nature and extent of PPSIs affecting the EPM complex of the extremities among youth sports participants and the potential for consequent skeletal growth disturbance and resultant limb deformity associated with these injuries. Results Our initial search uncovered 128 original published scientific articles reporting relevant data on PPSIs. There were 101 case reports/series, 19 cross-sectional, 1 case-control, and 7 cohort studies with relevant data. The case reports/series studies reported 448 patients with PPSIs involving the extremities. Children and adolescents representing a variety of high impact repetitive youth sports activities-including baseball, badminton, climbing, cricket, dance, gymnastics, rugby, soccer, swimming, tennis, and volleyball-may sustain PPSIs involving the shoulder, elbow, hand and wrist, knee, and ankle and foot. Although incidence data from prospective cohort studies are lacking, data arising from cross-sectional studies suggest that PPSIs may be common in select groups of youth athletes-including the shoulder in baseball players (0-36.6%), wrist in gymnasts (10-83%) and platform divers (52.6%), and fingers in rock climbers (5-58%). Notably, not all stress-related skeletal changes detected on imaging were symptomatic in these studies. When diagnosed and treated with an appropriate period of rest and rehabilitation, most patients studied were able to return to their sport activities. However, our data also show that 57/448 PPSIs (12.7%) produced growth disturbance, and that 28/448 patients (6.2%) underwent surgery for their injuries. Absence of treatment, delayed presentation and diagnosis, and non-compliance with a rest regimen were common in cases that produced growth disturbance. Conclusions PPSIs may affect the extremities of children and adolescents engaged in a variety of youth sports, especially at advanced levels of training and competition. Most skeletally immature patients with PPSIs respond well to timely treatment; however, in extreme cases, PPSIs can progress to produce skeletal growth disruption which may necessitate surgical intervention. Clearly, establishing the early diagnosis of PPSIs and providing timely treatment of these injuries are needed to ensure the skeletal health of youth sports participants. Rigorous prospective lo...

Finger growth plate injuries are the most common youth climbing injuries. The purpose of our study was to understand youth awareness of the most common youth climbing injury and safe training practices. We surveyed climbers, ages eight to 18 years old, at the 2017 USA Climbing Sport and Speed Youth National Championships. A total of 267 climbers completed the survey (mean age = 14 ± 2.7 years; 52% male). The A2 pulley injury was reported as the most common youth climbing injury by the largest portion of participants, 36%. The second most commonly identified injury was at the growth plate of the finger, 15% of participants, which was reported as significantly less than the A2 pulley injury, p < 0.001. Six percent of climbers reported the correct safe age to start double dyno campus board training. Roughly 18% of athletes identified growth plate injuries exclusively as a stress fracture, whereas 29.2% of those climbers self-reported as informed about finger growth plate injuries, but only 7.4% of climbers who self-reported as uninformed answered this question correctly. Misperceptions about skeletally-immature climbing injuries are prevalent amongst youth climbers. Education on the prevalence of finger growth plate injuries and the scarcity of A2 pulley injuries in youth climbers can increase diagnostic accuracy, improve care, and reduce long-term complications.

IntroductiondFinger growth plate injuries are the most common injury among youth climbers, and the association between these injuries and speed climbing, a mandatory discipline in the 2021 Olympics, has not been examined previously. Our primary purpose was to examine the demographic and training characteristics of adolescent competition climbers who reported a history of a finger growth plate injury compared to those who did not report a history of a finger growth plate injury. Our secondary purpose was to determine whether training characteristics differed between adolescent competition climbers who did and did not report speed climbing. MethodsdOur study was a cross-sectional study design. We surveyed adolescent climbers who competed in the 2017 USA Climbing Sport and Speed Youth National Championships. Questions assessed climbing injury history and current rock-climbing training characteristics. ResultsdTwo-hundred sixty-seven adolescent competition climbers, 14±3 (9e18) y of age (mean±SD with range), completed the survey. Those with a history of a finger growth plate injury reported greater approximate time spent speed climbing throughout the year (b=1.28, 95% CI 0.11e2.46, P=0.032) and training regularly on the International Federation of Sport Climbing speed wall (adjusted odds ratio=3.95, 95% CI 1.14e13.7, P=0.031). ConclusionsdTraining regularly at practices on the speed wall was associated with a self-reported history of finger growth plate injuries among elite youth competition climbers. Speed climbing should be limited, especially during periods of rapid growth.

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The number of youth participating in rock climbing has increased over the years. Finger stress epiphyseal fractures are the most common injury among youth climbers. These injuries tend to occur around puberty because this is when the physis is most vulnerable to injury. Additionally, it has been found that intensive finger training (campus boarding, a previously known risk factor for epiphyseal fractures) during adolescence can lead to early-onset osteoarthritis of the hand up to a decade later. There is currently a lack of a return-to-climb protocol for youth climbers following a repetitive stress epiphyseal fracture. Because of this gap in the literature, our purpose was to create a structured return-to-play protocol specific to youth climbers who sustained an epiphyseal fracture to the finger. By establishing these guidelines, medical professionals and coaches may be able to guide their athlete to gradually and safely return to sport.