Early reports of children’s fractures lumped the areas fractured together, and fractures were reported only as to the long bone involved (e.g., radius, humerus, femur).^{11,49,56,77,81} More recent reports have split fractures into the more specific areas of the long bone involved (e.g., the distal radius, the radial neck, the supracondylar area of the humerus).^{26,56,70,110,157}

In children, fractures in the upper extremity are much more common than those in the lower extremity.^49,56 Overall, the radius is the most commonly fractured long bone, followed by the humerus. In the lower extremity, the tibia is more commonly fractured than the femur (Table 1-2).

Given the fact that different reports classify fractures somewhat differently, it is somewhat of a challenge to distill detailed and accurate prevalence data for specific fractures; in trying to do so, we have identified areas common to a number of recent reports,^{26,56,70,110,157} but have taken some liberties in doing so. For example, distal radial metaphyseal and physeal fractures were combined as the distal radial fractures. Likewise, the carpals, metacarpals, and phalanges were combined to form the region of the hand and wrist. All the fractures around the elbow, from those of the radial neck to supracondylar fractures, were grouped as elbow fractures. This grouping allows comparison of the regional incidence of specific fracture types in children (Table 1-3).

The individual reports agreed that the most common area fractured was the distal radius. The next most common area, however, varied from the hand in Landin’s series to the elbow (mainly supracondylar fractures) in Cheng and Shen’s data (Fig. 1-1).²⁶

Physeal Fractures

The incidence of physeal injuries overall varied from 14.5%³⁰ to a high of 27.6%.⁸⁹ To obtain an overall incidence of physeal fractures, six reports totaling 6,479 fractures in children were combined.^{13,30,89,94,110,157} In this group, 1,404 involved the physis, producing an average overall incidence of 21.7% for physeal fractures (Table 1-4).

Open Fractures

The overall incidence of open fractures in children is consistent. The data were combined from the four reports in which the incidence of open fractures was reported.^26,49,89,157 The incidence in these reports varied from 1.5% to 2.6%. Combined, these reports represented a total of 8,367 fractures with 246 open fractures, resulting in an average incidence of 2.9% (Table 1-5).

Regional trauma centers often see patients exposed to more severe trauma, so there may be a higher incidence of open fractures in these patients. The incidence of open fractures was 9% in a report of patients admitted to the trauma center of the Children’s National Medical Center, Washington, DC.¹⁸

Multiple Fractures

Multiple fractures in children are uncommon: The incidence ranges in the various series from 1.7% to as much as 9.7%. In four major reports totaling 5,262 patients, 192 patients had more than one fracture (Table 1-6).^26,49,56,157 The incidence in these multiple series was 3.6%.

Fractures in Weak Bone

Children with generalized bone dysplasias and metabolic diseases that produce osteopenia (such as osteogenesis imperfecta) are expected to have recurrent fractures. In these patients, the etiology is understandable and predictable. However, some children with normal osseous structures are prone to recurrent fractures for reasons that remain unclear. The incidence of recurrent fractures in children is about 1%.³⁶

Landin and Nilsson⁶⁹ found that children who sustained fractures with relatively little trauma had a lower mineral content in their forearms, but they could not correlate this finding with subsequent fractures. Thus, in children who seem to be structurally normal, there does not appear to be a physical reason for their recurrent fractures.

Repeat Fractures

Failure to find a physical cause for repeat fractures shifts the focus to a psychological or social cause. The one common factor in accident repeaters has been a high incidence of dysfunctional families.⁵⁸ In Sweden, researches found that children who were accident repeaters came from “socially handicapped” families (i.e., those on public assistance or those with a caregiver who was an alcoholic).¹⁰¹ Thus, repeat fractures are probably more because of behavioral or social causes than physical causes. Landin,⁷¹ in his follow-up article, followed children with repeat fractures (four or more) into adolescence and adulthood. He found these children had a significantly increased incidence of convictions for serious criminal offenses when compared with children with only one lifetime fracture.

Despite the importance of understanding the epidemiology of pediatric fractures, there are still significant gaps in our knowledge base, and there is much work to be done. There are several challenges to gathering appropriate data in this area: risk factors for pediatric injury are diverse and heterogenous, practice patterns vary across countries and even within countries, and the available infrastructure to support data collection for pediatric trauma is far from ideal.

Patient Factors Influence Fracture Incidence and Fracture Patterns

Age

Fracture incidence in children increases with age. Age-specific fracture patterns and locations are influenced by many factors including age-dependent activities and changing intrinsic bone properties. Starting with birth and extending to age 12, all the major series that segregated patients by age have demonstrated a linear increase in the annual incidence of fractures with age (Fig. 1-2).^{16,25,26,56,70,111,157}

Although there is a high incidence of injuries in children of ages 1 to 2, the incidence of fractures is low with most fractures being related to accidental or nonaccidental trauma from others.⁶⁷ The anatomic areas most often fractured seem to be the same in the major series, but these rates change with age. Rennie et al.¹¹¹ demonstrated in their 2000 study from Edinburgh that the incidence of fractures increased and fracture patterns changed as children aged. Fracture incidence curves for each of the most commonest fractures separated by gender were shown on six basic incidence curves similar to Landin’s initial work (Fig. 1-3).⁷⁰ When Landin compared these variability patterns with the common etiologies, he found some correlation. For example, late-peak fractures (distal forearm, phalanges, proximal humerus) were closely correlated with sports and equipment etiologies. Bimodal pattern fractures (clavicle, femur, radioulnar, diaphyses) showed an early increase from lower energy trauma, then a late peak in incidence caused by injury from high- or moderate-energy trauma likely caused by motor vehicle accidents (MVAs), recreational activities, and contact sports in the adolescent population. Early peak fractures (supracondylar humeral fractures are a classic example) were mainly caused by falls from high levels.

Prematurity may also have some impact on the incidence of fractures in the very young child. Fractures not related to birth trauma reportedly occur in 1% to 2% of low–birth-weight or premature infants during their stay in a neonatal intensive care unit.⁷ A combination of clinical history, radiographic appearance, and laboratory data has shown evidence of bone loss from inadequate calcium and phosphorus intake in these infants. Correcting the metabolic status of these low–birth-weight infants, with special emphasis on calcium and phosphorus intake, appears to decrease the incidence of repeat fractures and to improve the radiographic appearance of their bony tissues. Once the metabolic abnormalities are corrected, this temporary deficiency seems to have no long-term effects. When premature infants were followed into later years, there was no difference in their fracture rate compared with that of children of normal birth weight.³²

Gender

Gender differences can be seen across the incidence of injures, location of injuries, and etiology of injuries across all age groups. For all age groups, the overall ratio of boys to girls who sustain a single fracture is 2.7:1.²⁶ In girls, fracture incidence peaks just before adolescence and then decreases during adolescence.^26,70,110 In the 10-year study from Hong Kong by Cheng et al.,²⁵ the male incidence in the 12- to 16-year age group was 83%. The incidence of fractures in girls steadily declined from their peak in the birth to 3-year age group.

In some areas, there is little difference in the incidence of fractures between boys and girls. For example, during the first 2 years of life, the overall incidence of injuries and fractures in both genders is nearly equal. During these first 2 years, the injury rates for foreign body ingestion, poisons, and burns have no significant gender differences. With activities in which there is a male difference in participation, such as with sports equipment and bicycles, there is a marked increase in the incidence of injuries in boys.^25,112 The injury incidence may not be caused by the rate of exposure alone; behavior may be a major factor.¹⁴⁶ For example, one study found that the incidence of auto/pedestrian childhood injuries peaks in both sexes at ages 5 to 8.¹¹⁶ When the total number of street crossings per day was studied, both sexes did so equally. Despite this equal exposure, boys had a higher number of injuries. Thus, the difference in the rate between the sexes begins to develop a male predominance when behaviors change. The difference in the injury rate between the genders may change in the future as more girls participate in activities with increased physical risk.^25,112,144

Hand Dominance

In most series, the left upper extremity demonstrates a slight but significant predominance.^{14,31,32,35,40,45} The ratio of left to right overall averages 1.3:1. In some fractures, however, especially those of supracondylar bones, lateral condyles, and the distal radius, the incidence is far greater, increasing to as much as 2.3:1 for the lateral condyle. In the lower extremity, the incidence of injury on the right side is slightly increased.^49,70

The reasons for the predominance of the left upper extremity have been studied, but no definite answers have been found. Rohl¹¹⁴ speculated that the right upper extremity is often being used actively during the injury, so the left assumes the role of protection. In a study examining the left-sided predominance in the upper extremity, Mortensson and Thonell⁹⁶ questioned patients and their parents on arrival to the emergency department about which arm was used for protection and the position of the fractured extremity at the time of the accident. They found two trends: Regardless of handedness, the left arm was used more often to break the fall, and when exposed to trauma, the left arm was more likely to be fractured.

Socioeconomic and Cultural Differences

The incidence of pediatric fracture varies in different cultural settings. For instance, Cheng and Shen²⁶ studied children in Hong Kong who lived in confined high-rise apartments. Their risk of exposure to injury differed from the study by Reed¹¹⁰ of children living in the rural environment of Winnipeg, Canada. Two separate reviews by Laffoy⁶⁷ and Westfelt¹⁰¹ found that children in a poor social environment (as defined by a lower social class or by dependence on public assistance) had more frequent accidents than more affluent children. In England, children from single-parent families were found to have higher accident and infection rates than children from two-parent families.⁴² In the United States, the increased rate of pediatric femur fractures was influenced by adverse socioeconomic and sociodemographic fractures.⁵⁵

Two additional studies in the United Kingdom looked at the relationship of affluence to the incidence of fractures in children. Lyons et al.⁸⁵ found no difference in the fracture rates of children in affluent population groups compared to those of children in nonaffluent families. On the other hand, Stark et al.¹³⁸ in Scotland found that the fracture rates in children from nonaffluent social groups was significantly higher than those in affluent families.

Clinical Factors

In recent years there has been an attention to a number of clinically related factors in determining children’s fractures, such as obesity, low bone mineral density, and low calcium and vitamin D intake. Obesity is an increasing health problem in children and adolescents representing a complex interaction of host factors, and is the most prevalent nutritional problem for children in the United States. In a retrospective chart review, Taylor et al.¹⁴² noted that overweight children had a higher reported incidence of fractures and musculoskeletal complaints. Although Leonard et al.⁷⁵ found increased bone mineral density in obese adolescents, the lack of physical activity often seen in obesity may in fact lead to reduced muscle mass, strength and coordination resulted in impaired proprioception, balance and increased risk of falling and fracture. In a recent study, Valerio et al.¹⁴⁷ confirmed a greater prevalence of overweight/obesity in children and adolescents with a recent fracture when compared to age- and gender-matched fracture-free children, and found obesity rate was increased in girls with upper limb fractures and girls and boys with lower limb fractures.

Low bone mineral density and decreased bone mass are linked to increased fracture risk in the adult population; however, in children the relationship is less clear with a meta-analysis showing some association between fracture risk and low bone mineral density.²⁹ In 2006, Clark examined in a prospective fashion the association between bone mass and fracture risk in childhood. Over 6,000 children, at 9.9 years of age were followed for 2 years and the study showed an 89% increased risk of fracture per SD decrease in size-adjusted bone mineral density.²⁷ In a follow-up study of this same cohort the risk of fracture following slight or moderate-to-severe trauma was inversely related to bone size relative to body size perhaps reflecting the determinants of volumetric BMD such as cortical thickness on skeletal fragility.²⁸

Nutritional factors may also play a role in the incidence of fractures in children. In a study in Spain, a significant difference in fracture rates was found when cities with a higher calcium content in their water were compared with those with a lower calcium content. With all other factors being equal (e.g., fluoride content, socioeconomic background), children who lived in the cities with a lower calcium content had a higher fracture rate.¹⁴⁸ An increase in the consumption of carbonated beverages has also been shown to produce an increased incidence of fractures in adolescents.¹⁵⁸

Environmental Factors Impact on Fractures in Children

Seasonal and Climatic Differences

Fractures are more common during the summer, when children are out of school and exposed to more vigorous physical activities (Fig. 1-4). An analysis of seasonal variation in many studies shows an increase in fractures in the warmer months of the years.^{25,26,52,70,111,114,151,157} The most consistent climatic factor appears to be the number of hours of sunshine. Masterson et al.,⁹⁰ in a study from Ireland, found a strong positive correlation between monthly sunshine hours and monthly fracture admissions. There was also a weak negative correlation with monthly rainfall. Overall, the average number of fractures in the summer was 2.5 times than that in the winter. In days with more sunshine hours than average, the average fracture admission rate was 2.31 per day; on days with fewer sunshine hours than average, the admission rate was 1.07 per day.

In Sweden, the incidence of fractures in the summer had a bimodal pattern that seemed to be influenced by cultural traditions. In two large series of both accidents and fractures in Sweden by Westfelt¹⁰¹ and Landin,⁷⁰ the researchers noticed increases in May and September and significant decreases in June, July, and August. Both writers attributed this to the fact that those children in their region left the cities to spend the summer in the countryside. Thus, the decrease in the overall fracture rate was probably because of a decrease in the number of children at risk remaining in the city.

Masterson et al.⁹⁰ speculated that because the rate of growth increases during the summer, the number of physeal fractures should also increase, as the physes would be weaker during this time. For example, the incidence of slipped capital femoral epiphysis, which is related to physeal weakness, increases during the summer.⁸ However, Landin, in his study of more than 8,000 fractures of all types, found that the overall seasonal incidence of physeal injuries to be exactly the same as nonphyseal injuries.⁷⁰ Thus, it appears that climate, especially in areas where there are definite seasonal variations, influences the incidence of fractures in all children, especially in older children. However, in small children and infants, whose activities are not seasonally dependent, there appears to be no significant seasonal influence.

The climate may be a strong factor as well. Children in colder climates, with ice and snow, are exposed to risks different from those of children living in warmer climates. The exposure time to outdoor activities may be greater for children who live in warmer climates. Pediatric trauma should be viewed as a disease where there are direct and predictable relationships between exposure and incidence.

Time of Day

The time of day in which children are most active seems to correlate with the peak time for fracture occurrence. In Sweden, the incidence peaked between 2 PM and 3 PM.¹⁰¹ In a well-documented study from Texas by Shank et al.,¹²⁴ the hourly incidence of fractures formed a well-defined bell curve peaking at about 6 PM (Fig. 1-5).

Home Environment

Fractures sustained in the home environment are defined as those that occur in the house and surrounding vicinity. These generally occur in a fairly supervised environment and are mainly caused by falls from furniture, stairs, fences, and trees as well as from injuries sustained from recreational equipment (trampolines and home jungle gyms). Falls can vary in severity from a simple fall while running to a fall of great magnitude, such as from a third story window. In falling from heights, adults often land on their lower extremities, accounting for the high number of lower extremity fractures, especially the calcaneus. Children tend to fall head first, using the upper extremities to break the fall. This accounts for the larger number of skull and radial fractures in children. Femoral fractures also are common in children falling from great heights. In contrast to adults, spinal fractures are rare in children who fall from great heights.^{10,91,129,136} In one study, children falling three stories or less all survived. Falls from the fifth or sixth floor resulted in a 50% mortality rate.¹⁰

Interestingly, a Swedish study¹⁰¹ showed that an increased incidence of fractures in a home environment did not necessarily correlate with the physical attributes or poor safety precautions of the house. Rather, it appears that a disruption of the family structure and presence of social handicaps (alcoholism, welfare recipients, etc.) is an important risk factor for pediatric fracture.

School Environment

The supervised environments at school are generally safe, and the overall annual rate of injury (total percentage of children injured in a single year) in the school environment ranges from 2.8% to 16.5%.^{15,74,101,126} Most injuries occur as a result of use of playground or recreational equipment or participation in athletic activity. True rates may be higher because of inaccurate reporting, especially of mild injuries. In one series, the official rate was 5.6%, but when the parents were closely questioned, the incidence of unreported, trivial injuries was as much as 15%.⁴⁰ In 2001 to 2002, a review of the National Electronic Injury Surveillance System (NEISS) demonstrated that 16.5% of the nearly 15 million injuries resulting in ED visits in school-aged children occurred at school.⁷⁹ The annual fracture rate of school injuries is thought to be low. Of all injuries sustained by children at school in a year, only 5% to 10% involved fractures.^40,74,126 In Worlock and Stower’s series of children’s fractures from England,¹⁵⁷ only 20% occurred at school. Most injuries (53%) occurring in school are related to athletics and sporting events,⁷⁴ and injuries are highest in the middle school children with one study citing a 20% fracture rate in school-aged children of those injured during physical education class.¹⁰² The peak time of day for injuries at school is in the morning, which differs from the injury patterns of children in general.^42,74

ETIOLOGY OF FRACTURES IN CHILDREN

Three Broad Causes

Broadly, fractures have three main causes: (i) Accidental trauma, (ii) nonaccidental trauma (child abuse), and (iii) pathologic conditions. Accidental trauma forms the largest etiologic group and can occur in a variety of settings, some often overlapping others. Nonaccidental trauma and fractures resulting from pathologic conditions are discussed in later chapters of this book.

Sports-Related Activities

The last two decades have seen an increase in youth participation in organized athletic participation, especially among younger children. Injuries in this population can occur in team or individual, organized or nonorganized, and contact and noncontact sporting activities. Wood et al. studied at the annual incidence of sports-related fractures in children 10 to 19 years presenting to hospitals in Edinburgh. The overall incidence was 5.63/1,000/year with males accounting for 87% of fractures. Soccer, rugby, and skiing were responsible for nearly two-thirds of the fractures among the 30 sporting activities that adolescents participated in. Upper extremity fractures were by far the most common injury accounting for 84% of all fractures with most being low-energy injuries and few requiring operative intervention.¹⁵⁶ A retrospective study over a 16-year time period from an emergency department at a level 1 trauma center in the Netherlands examined risk factors for upper extremity injury in sports-related activities. Most injuries occurred while playing soccer and upper extremity injuries were most common. Risk factors for injury were young age and playing individual sports, no-contact sports, or no-ball sports. Women were at risk in speed skating, in-line skating, and basketball, whereas men mostly got injured during skiing and snowboarding.¹⁴¹ In Canada, soccer accounted for a significant proportion of injuries presented to Canadian Hospitals Injury Reporting and Prevention Program emergency departments during 1994 to 2004 with over 30% of these injuries presenting as fractures or dislocations.⁴⁸ A study using data from the Dutch Injury Surveillance System revealed a substantial sports-related increase in the incidence rate of wrist fractures in boys and girls aged 5 to 9 and 10 to 14 years in the period from 1997 to 2009. The authors concluded that incidence rate of wrist fractures in childhood in this study population is increasing, mainly as a result of soccer and gymnastics at school and recommended that future sport injury research and surveillance data are necessary to develop new prevention programs based on identifying and addressing specific risk factors, especially in young athletes.³⁴

In the United States, football- and basketball-related injuries are common complaints presenting to pediatric emergency departments, with fractures occurring more frequently in football.⁹⁵ In a 5-year survey of the NEISS-All Injury Program, injury rates ranged from 6.1 to 11 per 1,000 participants/year as age increased, with fractures and dislocations accounting for nearly 30% of all injuries receiving emergency room evaluation.⁹²

Recreational Activities and Devices

In addition to increasing participation in sports, new activities and devices have emerged that expose children to increased fracture risk. Traditional activities such as skateboarding, roller skating, alpine sports, and bicycling have taken on a new look in the era of extreme sports where such activities now involve high speeds and stunts. In addition, several recreational devices have been the focus of public health interventions and legislation because of their association with injuries in children. Many of these activities have safety equipment available but that does not assure compliance. Organizations such as the American Academy of Pediatrics and the American Academy of Orthopaedic Surgeons (AAOS) have issued position statements regarding the proper use and supervision of such devices, but it remains within the duty of the physician to educate and reinforce to patients and families to promote safety around these activities.⁸²

Playground Equipment

Play is an essential element of a child’s life. It enhances physical development and fosters social interaction. Unfortunately, unsupervised or careless use of some play equipment can endanger life and limb. When Mott et al.⁹⁷ studied the incidence and pattern of injuries to children using public playgrounds, they found that approximately 1% of children using playgrounds sustained injuries. Swings, climbers, and slides are the pieces of playground equipment associated with 88% of the playground injuries.⁸⁶

In a study of injuries resulting from playground equipment, Waltzman et al.¹⁵⁰ found that most injuries occurred in boys (56%) with a peak incidence in the summer months. Fractures accounted for 61% of these injuries, 90% of which involved the upper extremity and were sustained in falls from playground equipments such as monkey bars and climbing frames. Younger children (1 to 4 years old) were more likely to sustain fractures than older children.

Similar observations were made in a study by Lillis and Jaffe⁷⁸ in which upper extremity injuries, especially fractures, accounted for most of hospitalizations resulting from injuries on playground equipment. Older children sustained more injuries on climbing apparatus, whereas younger children sustained more injuries on slides.

Loder⁸⁰ utilized the NEISS dataset to explore the demographics of playground equipment injuries in children. Monkey bars were the most common cause of fractures. In another study looking specifically at injuries from monkey bars, the peak age group was the 5- to 12-year-old group, with supracondylar humeral fractures being the most common fracture sustained.⁸⁷

The correlation of the hardness of the playground surface with the risk of injury has been confirmed in numerous studies.^68,80,98,99 Changing playground surfaces from concrete to more impact-absorbing surfaces such as bark reduced the incidence and severity of head injury but increased the tendency for long bone fractures (40%), bruises, and sprains. Chalmers et al.²³ determined that the height of the equipment was just as great a risk factor as the surface composition. Using a novel composite playground safety score, researchers from Hasbro Children’s Hospital in Rhode Island found that the incidence of supracondylar humerus fractures was increased in their community with playgrounds with lower composite safety scores and suggested that improvements in playground infrastructure may potentially reduce the incidence of supracondylar humerus fractures, and other injuries in children.¹⁰⁵

Public playgrounds appear to have a higher risk for injuries than private playgrounds because they usually have harder surfaces and higher pieces of equipment,¹⁰⁶ although playground injury was most likely to occur at school compared to home, public, and other locations.¹⁰⁷

Bicycle Injuries

Bicycle injuries are a significant cause of mortality and morbidity for children.¹⁰⁹ Bicycle mishaps are the most common causes of serious head injury in children.¹⁵⁴ Boys in the 5- to 14-year age group are at greatest risk for bicycle injury (80%). Puranik et al.¹⁰⁹ studied the profile of pediatric bicycle injuries in a sample of 211 children who were treated for bicycle-related injury at their trauma center over a 4-year period. They found that bicycle injuries accounted for 18% of all pediatric trauma patients. Bicycle/motor vehicle collisions caused 86% of injuries. Sixty-seven percent had head injuries and 29% sustained fractures. More than half of the incidents occurred on the weekend. Sixteen percent were injured by ejection from a bicycle after losing control, hitting a pothole, or colliding with a fixed object or another bicycle. Fractures mainly involved the lower extremity, upper extremity, skull, ribs, and pelvis in decreasing order of incidence. Over the last decade, youth participation in mountain biking has seen an increase and with that so has the number of injuries related to mountain biking increased with many caused by unpredictable terrain and falls as one rides downhill.^3,4

The study by Puranik et al.¹⁰⁹ pointed out an equally important issue related to bicycle safety as they detected that helmet use was disturbingly low (<2%). Other studies confirm the observation that fewer than 13% to 15% of children wear helmets while riding bicycles.^41,113 The Year 2000 Health Objectives called for helmet use by 50% of bicyclists.²¹ Even as recently as 2003, the use of bicycle helmets was still below 20%.⁵⁰ Research has shown that legislation, combined with education and helmet subsidies, is the most effective strategy to increase use of safety helmets in child bicyclists.¹⁹ As public awareness of both the severity and preventability of bicycle-related injuries grows, the goal of safer bicycling practices and lower injury rates can be achieved.¹⁰⁹

Bicycle spokes and handlebars are also responsible for many fractures and soft tissue injuries in children. D’Souza et al.³⁹ and Segers et al.¹²³ found that bicycle spoke injuries are typically sustained when the child’s foot is caught in the spokes of the rotating wheel. Of 130 children with bicycle spoke injuries, 29 children sustained fractures of the tibia, fibula, or foot bone. Several had lacerations and soft tissue defects. D’Souza et al.³⁹ suggested that a mesh cover to prevent the toes from entering between the spokes and a plastic shield to bridge the gap between the fork and horizontal upright could substantially decrease the incidence of these injuries.

Skateboarding

Skateboarding and in-line skating have experienced a renewed surge in popularity over the past three decades. With the increasing number of participants, high-tech equipment development, and vigorous advertising, skateboard and skating injuries are expected to increase. There was an initial increase in the early 1980s, with a decrease after 1993. Since 1998, there has been an increase in the number of skateboard injuries.⁶⁶ Because the nature of skateboarding encompasses both high speed and extreme maneuvers, high-energy fractures and other injuries can occur, as highlighted by several studies.^43,104,108 Studies have shown that skateboarding-related injuries are more severe and have more serious consequences than roller skating or in-line skating injuries.¹⁰⁴ In a study of skateboarding injuries, Fountain et al.⁴³ found that fractures of the upper or lower extremity accounted for 50% of all skateboarding injuries. Interestingly, more than one-third of those injured sustained injuries within the first week of skateboarding. Most injuries occurred in preadolescent boys (75%) from 10 to 16 years of age; 65% sustained injuries on public roads, footpaths, and parking lots. In a study over a 5-year period of time using data from the National Trauma Data Bank, skateboarding injuries were associated with a higher incidence of closed head injuries and long bone fractures with children under age 10 more likely to sustain a femur fracture.⁸³ Several reports^43,122 have recommended safety guidelines and precautions such as use of helmets, knee and elbow pads, and wrist guards, but such regulations seldom are enforced.

It was thought that formal skate parks could decrease the injury rate. However, a study by Sheehan et al.¹²⁵ demonstrated that dedicated skate parks led to an increase in pediatric fractures referred to the hospital. The authors suggested that there should be closer supervision and training of children and more emphasis on limb protective gear. Lustenberger et al.⁸³ did however find that helmet use and designated skateboarding areas decreased the incidence of serious head injury (Table 1-7).

Stay updated, free articles. Join our Telegram channel

Join