Athletic competition, be it Little League, Junior Varsity, Varsity, or collegiate sports, can often result in athletic injury. Some injuries are easy to recognize; however, there may be a few that are difficult to recognize and, if left untreated, can have potentially devastating consequences. Overuse injuries, scaphoid fractures, and growth plate fractures represent injuries that should be diagnosed and treated in a timely manner.

Overuse injuries, which include tendonitis, apophysitis, and stress fractures, can occur with excessive sports participation. While still growing and developing, young athletes can be particularly predisposed to injuries from repetitive use sports (e.g., running, pitching). These injuries can include traction apophysitis (e.g., Osgood-Schlatter disease, a tibial tubercle apophysitis), medial epicondylitis (e.g., Little League elbow, caused by the traction and compression forces from repetitive and forceful throwing on the medial and lateral parts of the elbow), injuries to developing joint surfaces (e.g., osteochondritis dissecans, collapse and deformity of part of the joint, also seen in Little League elbow), and injuries of the immature spine (e.g., spondylolysis, a defect in the pars interarticularis, caused by repetitive hyperextension of the spine, often seen in gymnasts). Early recognition of an overuse injury can help to avoid future chronic joint disease and disability. Depending on when they are diagnosed, the management of overuse injuries ranges from rest and bracing to surgical correction.

The scaphoid bone, also called the carpal navicular bone, is a frequent site of fracture in adolescents and adults, and should be considered in someone who falls on an outstretched hand and has pain over the anatomic snuffbox. An untreated fracture through the waist of the scaphoid bone, due to its unique blood supply, could result in nonunion, wrist arthrosis, and avascular necrosis of the proximal fragment. Fortunately, most pediatric fractures of the scaphoid bone occur through the distal third of the bone. Once suspected, and even without radiographic confirmation, a scaphoid fracture should
be treated with a thumb spica or cast. Once confirmed via scaphoid view radiographs (anteroposterior view of the wrist held at 30 degrees supination and ulnar deviation), a scaphoid fracture should be treated with 8 to 12 weeks of immobilization for waist fractures and with 6 to 8 weeks of immobilization for distal pole fractures. Due to the seriousness of the consequences of delayed treatment, an orthopedic consult is warranted for all suspected or confirmed scaphoid fractures.