Injuries of Children and Young People in Sports: Stress Fractures and Fracture of the Sleeve Sleeve
Authors: Pinheiro Ana Costa , Ferreira Filomena , Areias Margarida , Oliveira Carolina , Sousa Cristina , Leal Miguel 
Published: June 2018

Introduction: With the dramatic increase in the competitive sports of children and young people, overuse injuries have become more important in the pediatric population. Among these, the most frequent injuries in young athletes are stress fractures. The absence of evident traumatic history and the subtle radiographic changes can cause a diagnostic difficulty and delay the treatment. Fracture of the patella sleeve is a rare fracture only occurs in children. The diagnosis is difficult, both clinically and radiologically. High patella and hemarthrosis are important signs to diagnose this fracture. Presentation of 2 clinical cases of injuries in children and young people in sports: stress fractures and fracture of the patella sleeve. Methods: Retrospective descriptive method with reports of clinical cases based on patients’ electronic clinical processes. Results: We present a case of a child, a 13-year-old soccer practitioner who had mentioned well localized pain in the anterior aspect of the right leg with 5 days of evolution and analgesic gait and no history of trauma. The radiographs and CT showed a juxtaposed cortical lesion with apparent contact with the cortical bone without associated periosteal reaction. NMR confirmed stress fracture of the proximal tibial shaft. It was treated conservatively with immobilization with plaster and discharge. We present the case of an 11-year-old boy who suffered a fracture of the patella sleeve. In the imaging study, a fragment of bone with a displacement from the lower pole of the patella was visible. An open fracture reduction was performed. During the surgery confirmed avulsion fracture of a small osteochondral fragment, configuration of a sleeve-like fracture. The amount of cartilage was small, so it was decided to reinsert the 2 anchorages for patellar tendon. After fracture healing and rehabilitation, both returned to sports activity without sequelae or functional limitations. Discussion/Conclusion: A knowledge of the fracture of the patella sleeve, together with its clinical and radiological features, is important to avoid misdiagnosis and treatment delay. Care should be taken not to disturb the proximal tibial process. Although relatively uncommon in the pediatric age, the incidence of fractures described stress have been increasing in this age group. A high degree of suspicion is required to make the diagnosis and avoid too invasive treatment. REFERENCES Ray JM, Hendrix J. Incidence, mechanism of injury, and treatment of fractures of the patella in children. J Trauma 1992;32:464–7. Bates DG, Hresko MT, Jaramillo D. Patellar sleeve fracture: demonstration with MR imaging. Radiology 1994;193:825–7. Wu CD, Huang SC, Liu TK. Sleeve fracture of the patella in children. A report of five cases. Am J Sports Med 1991;19:525– 8. Houghton GR, Ackroyd CE. Sleeve fractures of the patella in children: a report of three cases. J Bone Joint Surg Br 1979;61:165–8. Shands PA, McQueen DA. Demonstration of avulsion fracture of the inferior pole of the patella by magnetic resonance imaging. A case report. J Bone Joint Surg Am 1995;77:1721–3. Dai LY, Zhang WM. Fractures of the patella in children. Knee Surg Sports Traumatol Arthrosc 1999;7:243–5. Fredericson M, Bergman G, Hoffman KL, et al. Tibial stress reaction in runners: correlation of clinical symptoms and scintigraphy with a new magnetic resonance imaging grading system. Am J Sports Med 1995; 23: 472-81. Hunter-Griffin LY. Clinics in sports medicine: overuse injuries. Philadelphia (PA): W.B. Saunders, 1987. Jackson DW, Bailey D. Shin splints in the young athlete: a non-specific diagnosis. Phys Sports Med 1975; 3: 45-51.