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Epidemiology

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Participation in sports carries an inherent risk of head and neck injury. A relatively larger ratio of head to body places children at further risk for injury. This ratio decreases as children approach adolescence. Injuries to the head include scalp lacerations, skull fractures, brain injuries, and intracranial bleeding.

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Of the 6000 neck injuries that occur annually among children a quarter of these are related to sports. High-risk sports are football, rugby, ice and field hockey, soccer, diving, gymnastics, cheerleading, and wrestling. Sports-related catastrophic neck injuries resulting in paralysis are rare with a prevalence of 2 per 100,000.1–7 Head and neck injury risk has long been a concern and cause for injury surveillance in contact sports such as football and hockey. As a result, changes in rules and techniques have helped to decrease injury rates. The National Collegiate Athletic Association (NCAA) injury surveillance system recently reported an injury rate of 2.34 and 0.61 per 1000 athlete-exposures (AE) for head and neck respectively in football.3 These rates were the highest of all sports. Other sports with significant risk were wrestling (1.27 AE head, 0.39 AE neck), lacrosse (1.08 AE head, 0.12 AE neck), and gymnastics (0.4 AE head, 0.28 AE neck). Hockey had an injury rate of 1.47 AE for the head and no significant neck injuries, owing to rule changes regarding checking from behind. While most head injuries were concussions, most neck injuries were strains.

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Definition

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Most sports-related skull fractures occur in the frontal and parietal bones. These fractures can be classified as either linear or depressed.6–9

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Mechanism

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Low-energy blunt trauma over a wide area of the skull can result in a linear fracture. Most of the fractures seen in children are a result of falls and bicycle accidents. These fractures involve the entire thickness of bone and can continue through the vasculature, resulting in the epidural hematoma. Contact of the skull with a projectile, such as a baseball, to the temple can result in a depressed fracture of the frontal or parietal bones. These fractures result from high-energy direct blow to a relatively small surface. The fracture may be comminuted and either open or closed. Since open fractures may need surgical evaluation and management, it is important to evaluate the athlete for associated laceration.

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Clinical Presentation

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While loss of consciousness can occur, these athletes are often lucid. Concussion symptoms can present later. Other complications such as seizures can also occur. Epidural bleeding can be subtle and result quickly in worsening neurological function and even death. For this reason, any athlete who sustains this type of injury should be observed closely.

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Diagnostic Imaging

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The imaging study of choice for severe head injury is a CT scan. Skull CT scan will confirm the fracture and also show evidence of bleeding ...

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