Fractures in young field hockey players: the importance of early detection

As field hockey is a sport in which players can reach impressive skating speeds, collisions between two players or between a player and the boards are frequent and, above all, can cause serious injuries. A study by Matic G.T. et al (2015) indicates that 81.6% of injuries occur when the player is tackled, and that 12.7% of field hockey injuries are actually fractures (1). A high proportion of these fractures (51%) occur in the forearm and hand. Deits et al (2010) studied the injuries sustained by field hockey players presenting to the emergency department and also noted that 14.1% of injuries occurred in the wrist, hand or fingers (2). There is, however, an important difference between young, growing players and adults. In fact, in young field hockey players, fractures most often occur at the growth plate, the most fragile zone of the bone at this age (3). This section of growing bone is actually more vulnerable to tensile and compressive forces than mature bone. Also, the growth plate is 2 to 5 times less resistant to this type of force than adjacent fibrous tissue (3). Ligament sprains are therefore less likely than growth plate fractures.

What is a growth plate fracture?
Growth plate fractures mainly affect the long bones, especially the distal radius, a bone in the forearm near the hand. The typical production mechanism for this type of injury is when the player is tackled by another player and tries to hold on by pressing his hands against the tape. For some young people, the fracture will appear as a simple contusion or even a sprain. The player may complain of localized pain in the growth plate and difficulty gripping his bat, a sign of weakness. However, these fractures often go unnoticed, and failure to detect them can have serious consequences. Among the possible sequelae, premature closure of the growth plate is certainly the one that will have the greatest influence on the youngster’s development. In fact, this closure could lead to a delay in bone growth, resulting in a probable inequality between the two forearms.

In conclusion, a player showing the following signs and symptoms should automatically be removed from the game:

• Has suffered a trauma that could lead to a growth plate fracture
• Complains of severe pain on palpation of growth plate
• Has difficulty pronating and/or supinating the arm
• Complains of severe lack of arm strength

Secondly, it is very important that the player is referred to a doctor for x-rays (3). Although radiography can identify the majority of growth plate fracture types, it cannot identify Type I fractures, which account for around 5% of fractures (4). We must therefore rely on a good clinical examination to apply the necessary precautions, even if the X-ray is negative.

Contact sports obviously carry a risk of injury. The important thing is to understand the mechanism by which certain injuries are produced, so that we can act more effectively to promote better healing and a safe return to play.

Written by Ève Poisson, Physiotherapist

References:
1. Matic G.T. et al. (2015) Ice field hockey injuries among United States high school athletes from 2008/2009-2012/2013, The Physician and Sportsmedicine, 43(2); 119-125
2. Deits J. et al. (2010) Patients With Ice Hockey Injuries Presenting to US Emergency Departments 1990-2006, Journal of Athletic Training, 45(5); 467-474
3. Caine, D., DiFiori, J., Maffulli, N. (2006) Physiological injuries in children’s and youth sports: reasons for concern? British journal of sports médecine, 40(9); 749-760
4. Brown J.H. and DeLuca S.A. (1992) Growth plate injuries: Salter-Harris classification. American Family Physician, 46(4); 1180-1184.