Stress fractures of the distal radius in adolescent gymnasts.

Adolescent -girl gymnasts sustained stress fractures of the distal end of the radius i-n the wrist on which a rotational vault was performed. The history and clinical progress were typical of stress fractures. Spectacular displays of gymnastics, especially on television, have encouraged children to take up this sport. The young age of Olympic gymnasts has encouraged 10 to 14 year old children to train six to seven times a week. Technically complex rotational vaults are being attempted at an even younger age and because it is only by constant repetition that the skill is learnt, the gymnast always rotates in the same direction. Three gymnasts developed stress fractures of the distal radius. CASE 1 A thirteen year old girl presented with several months history of a painful swollen left wrist, most movements of which were painful. She had started rotational vaults some three months before the symptoms started. Rotation was towards the left. There was no history of injury. On examination the wrist was tender and slightly swollen over the radial styloid and the anterior aspect of the distal radius for about one inch. The posterior radius was not tender. She had full wrist movements, but extension was painful as was most resisted movement. The radiographs (Fig. 1) showed the stress fracture in the metaphysis of the left radius which healed 10 weeks later (Fig. 2). CASE 2 A twelve year old girl complained of a painful left wrist particularly over the anterior aspect of the radius and full extension caused pain. She had been doing rotational vaults amongst other gymnastics, and radiographs taken of the left wrist showed a stress fracture in the radius just proximal to the epiphysis (Fig. 3) Diagram showing forces around the fulcral wrist. which healed 7 weeks later (Fig. 4). She had a history of having had pain in both wrists some seven months previously but radiographs at that time showed nothing abnormal of note. CASE 3 A 16 year old girl complained of pain in the right wrist. She had a history of wrist pain 9 months previously when levering into a handstand. She had recently been doing intense practice of twisting vaults, and the wrist 272 group.bmj.com on April 14, 2017 Published by http://bjsm.bmj.com/ Downloaded from