Stress changes of the distal radial growth plate

Abstract

We conducted a radiographic survey to determine skel etal age and the nature and prevalence of stress-related changes affecting the distal radial growth plate in 60 young competitive gymnasts (39 females, 21 males). Comparison of results for chronological and skeletal age revealed a significant delay in maturation for girls (P < 0.001). Radiographic evaluation revealed 5 gym nasts (4 girls and 1 boy) with stress-related changes of the left wrist, and four of these were considered to be minimal. These results, in conjunction with our previous find ings and the review of related literature, reveal three important observations. First, the widening and irregu larities of the distal radial physis that we described previously appear to be the first in a spectrum of abnormal changes secondary to overuse and probably represent a stress fracture of the distal radial growth plate. The radiographic changes associated with this injury are not the normal adaptive changes seen in young, competitive gymnasts. Secondly, more serious long-term abnormality may result even though the injury may initially resemble a Salter-Harris type I or II stress fracture. Long-term complications may include symmetrical or asymmetrical retardation or halted growth at the affected site, posi tive ulnar variance, and associated pathoanatomic se quelae. Thirdly, the incidence of distal radial growth plate stress injury remains unclear; we recommend a further, large-scale prospective epidemiologic study in volving both male and female gymnasts. We urge that physicians and other health professionals associated with gymnastics clubs educate coaches about the pos sibility of significant injury to the distal radial physis, risk factors, and suggested preventive measures.