In the year 2000, the eight recreational activities that most commonly led to injury in chil-dren aged 5 to 14 years accounted for an estimated 2.24 million medically treated musculoskel
Trang 1Recreational activities are important
for the normal healthy development
of children The number of children
and adolescents participating in
sports and play activities continues to
increase each year In the year 2000,
the eight recreational activities that
most commonly led to injury in
chil-dren aged 5 to 14 years accounted for
an estimated 2.24 million medically
treated musculoskeletal injuries, at a
cost to society of over $33 billion1
(Fig 1) Although many of these
injuries are minor and heal
unevent-fully, some can lead to permanent
impairment Even minor injuries
cause anxiety and pain for both the
child and the parents, incur costs in
terms of time and money, and may
lead to functional restrictions
Orthopaedic surgeons are
fre-quently involved in the diagnosis
and treatment of these injuries, but
less often in their prevention
Parents consider their physicians to
be an important source of safety education; therefore, orthopaedic surgeons have a unique opportunity
to provide injury prevention advice
Analysis of the frequency and cir-cumstances of injuries related to recreational activities has identified areas for research and has led to in-terventions that reduce and prevent injuries in children Such informa-tion can provide physicians with valuable resource materials for patient education about the recre-ational activities with the highest number of injuries, detailing specific hazards and emphasizing preven-tion efforts
Methodology
The most comprehensive statistics
on children’s recreational injuries are available from the United States Consumer Product Safety
Commis-sion (CPSC).1 Since 1978, it has oper-ated a statistically valid injury and review system known as the Na-tional Electronic Injury Surveillance System (NEISS) The NEISS injury data are gathered from a carefully se-lected sample of 100 hospital emer-gency departments in the United States Empirically derived relation-ships between the number of injuries evaluated in emergency departments and those treated in other settings (e.g., doctors’ offices and clinics) are used to estimate the number of in-juries treated outside hospital emer-gency departments The “Injury Cost Model,” a computerized analyt-ical tool designed to measure the direct and indirect costs associated with the reported injuries, is used to estimate the four basic categories of injury costs: medical, parental work losses, pain and suffering, and prod-uct liability and legal costs.2
For the purpose of this article, the term “child” is defined as an
individ-Dr Purvis is Clinical Assistant Professor, De-partment of Orthopaedic Surgery and Rehabili-tation, University of Mississippi Medical School, Jackson Dr Burke is Clinical Instructor, De-partment of Orthopaedic Surgery and Rehabili-tation, University of Mississippi Medical School Reprint requests: Dr Purvis, Pediatric Ortho-paedic Specialists of Mississippi, Suite 204,
1190 North State Street, Jackson, MS 39202 Copyright 2001 by the American Academy of Orthopaedic Surgeons.
Abstract
Participation in eight common types of recreational activities leads annually to
more than 2 million medically treated musculoskeletal injuries in children aged
5 to 14 years Many of these injuries could have been prevented if current safety
guidelines and protective equipment had been used Studies have demonstrated
the value of safety education programs in preventing injuries Parents consider
their child’s physician an important source of safety education, and orthopaedic
surgeons have a unique opportunity to provide injury prevention counseling.
The American Academy of Orthopaedic Surgeons recognizes the importance of
injury prevention and has developed advocacy programs that are readily
avail-able to physicians and the public Individual orthopaedists should be involved
in injury prevention through patient education, research, community programs,
and regulatory efforts that promote safe play for children.
J Am Acad Orthop Surg 2001;9:365-374 Incidence and Prevention
John M Purvis, MD, and Ronald G Burke, MD
Trang 2ual between the ages of 5 and 14
years Unless otherwise noted, the
injury statistics are from the 2000
NEISS survey1and are an estimate of
the overall number of injuries treated
in hospitals, doctors’ offices, clinics,
ambulatory centers, and hospital
emergency rooms The recreational
activities discussed specifically are
the eight with the highest total
num-ber of reported injuries but not
nec-essarily the highest rates of injuries
Data on injuries sustained in both
or-ganized and unoror-ganized sports,
team and individual sports, and
in-formal play activities have been
ana-lyzed The injuries included are the
nonfatal, medically treated
contu-sions and abracontu-sions, sprains and
strains, fractures, and dislocations
involving the extremities, neck, and
trunk that resulted from
participa-tion in a given activity in the year
2000 (Fig 2)
General Strategies
Although the number of injuries for
certain activities, such as
cheerlead-ing, gymnastics, and winter sports, may be relatively small, the risk of injury may be quite high For exam-ple, boys’ and girls’ gymnastics have the highest rate of catastrophic injuries compared with all other
sports (Fig 3).3(p14) It is recognized that children and adolescents sus-tain more injuries from free play than from organized sports.4 Also, children are at risk for injury while just attending sporting events (e.g., falling from bleachers), as well as while traveling to and from such events
Injury-prevention strategies de-veloped for the immature athlete should consider the physical, men-tal, and emotional differences be-tween young athletes and their adult counterparts The prepartici-pation physical examination for organized sports is the first step in injury prevention.5 A task force of several medical organizations has developed a standardized form to aid in administering a thorough examination.3(p56) An accurate med-ical history will identify any preex-isting medical problems and should serve as the cornerstone of the examination It is extremely impor-tant that parents contribute to the medical history The American Academy of Pediatrics (AAP) has suggested guidelines for sports
par-$4,500
$4,000
$3,500
$3,000
$2,500
$2,000
$1,500
$1,000
$500
$0
Sprains/strains Contusions/
abrasions Fractures Dislocations
Figure 1 Costs by type of musculoskeletal injuries to the extremities, neck, and trunk
sus-tained by children aged 5 to 14 years from the eight recreational activities with the highest
numbers of injuries during calendar year 2000 Data were obtained from Consumer
Product Safety Commission estimates of medically treated injuries Cost estimates include
medical, parents’ work losses, pain and suffering, product liability, and legal Roller
sports include those involving in-line skates, skateboards, scooters, and roller skates.
250,000 200,000 150,000 100,000 50,000
0
Baseball/ softball
Sprains/strains Contusions/ abrasions Fractures Dislocations
Figure 2 Incidence and type of musculoskeletal injuries to the extremities, neck, and trunk sustained by children aged 5 to 14 years from the eight recreational activities with the highest numbers of injuries during calendar year 2000 Data were obtained from the NEISS report of the CPSC Roller sports include those involving in-line skates, skate-boards, scooters, and roller skates.
Trang 3ticipation for children with certain
medical conditions.3(pp448-453)
Head injuries and cardiac events
are the two most frequent causes of
sports fatalities Therefore,
cardio-vascular screening should be
em-phasized during the
preparticipa-tion physical examinapreparticipa-tion Heart
auscultation during provocative
maneuvers (e.g., Valsalva) may
fa-cilitate the diagnosis of
hyper-trophic cardiomyopathy, the most
common cause of cardiovascular
system–related deaths on the
play-ing field Improper strength
train-ing6and use of anabolic steroids7
are other potential causes of injury
Heat stroke is the third most
common cause of exercise-related
death among high school
ath-letes.3(p65) Children are especially
prone to heat-related illnesses
be-cause their thermoregulatory
mech-anisms are less efficient, they have lower sweating rates, and they accli-matize more slowly than adults If certain commonsense guidelines for preventing heat illness8(Table 1) are followed, the occurrence of heat-related illnesses can be decreased
General strategies to prevent injury in all sports include proper warm-up, stretching, conditioning, and use of protective equipment
Following guidelines based on age, weight, and playing ability is partic-ularly important for children who are participating in team sports
Although the use of braces or taping can decrease ankle injuries, no con-clusive studies demonstrate the effectiveness of functional braces in preventing noncontact anterior cru-ciate ligament (ACL) injuries in the knee.9(p18) It is also important that parents and coaches have realistic
expectations of children’s perfor-mance to avoid early burnout and
to prevent injuries that arise when young athletes attempt to perform beyond their limitations
Basketball
Basketball is the most popular team sport in high schools and is the leading cause of sports-related in-juries in the United States, based on the total number of injuries sus-tained The NEISS statistics con-firm that among children aged 5 to
14 years, basketball is second only
to bicycle riding in recreational in-juries Children playing basketball suffered 407,000 medically treated musculoskeletal injuries in the year
2000 The most common injury sites were the ankles, hands, and
500,000
400,000
300,000
200,000
100,000
0
600,000
700,000
800,000
Musculoskeletal injuries
All injuries
Roller sports Playground
Figure 3 Incidence of musculoskeletal injuries compared with all injuries sustained by children aged 5 to 14 years from all recreational
activities during calendar year 2000 Data were obtained from the NEISS report of the CPSC The musculoskeletal injuries included are contusions/abrasions, sprains/strains, fractures, and dislocations to the extremities, neck, and trunk Roller sports include those involv-ing in-line skates, skateboards, scooters, and roller skates.
Trang 4knees Fractures were most
fre-quent in the fingers and ankles
The total rates of injury for girls
and boys playing basketball were
equal for this age group.3(p11)
How-ever, young women aged 15 to 25
were 2.4 to 9.5 times more likely to
sustain a noncontact ACL injury
than young men in the same age
group.9(p7) Girls and young women
are also more likely to have ankle
sprains than boys and young men
are
Key pieces of protective
equip-ment for basketball that have been
shown to reduce injury rates are
mouth guards, eye protection, and
ankle braces.10 Functional knee
braces have not been shown to
reduce the incidence of noncontact
ACL injuries Prevention is
pri-marily based on the development
of training programs aimed at
reducing ACL injuries These
pro-grams emphasize training
regi-mens that target neuromuscular,
proprioceptive, and motor control
factors associated with ACL
in-jury.9(p115)
Football
The collision sport most commonly played by children in the United States is football In the year 2000,
an estimated 389,000 medically treated musculoskeletal injuries occurred in children playing both organized and sandlot football.1 As
in other contact sports, most mus-culoskeletal injuries are sprains, strains, and contusions.11
This high-intensity, high-impact sport also entails the risk of serious head and neck injuries Concus-sions, which result in a transient disruption of cognitive function, occur frequently Any athlete who exhibits the signs and symptoms of
a concussion (Table 2) should be removed from the playing field and closely monitored Return to play can be considered for the athlete with a first-time concussion and no loss of consciousness After 15 min-utes of observation, if the player has
no signs or symptoms of a concus-sion, he should be instructed to per-form an activity that increases
in-tracranial pressure (e.g., sit-ups, push-ups, Valsalva maneuver); if asymptomatic during that activity, the athlete can then return to com-petition Return to play should be prohibited if there is any history of loss of consciousness, recurrent con-cussion, or signs and symptoms that last for more than 15 minutes The
“Standardized Assessment of Con-cussion”3(p175) is a useful sideline examination to help on-field med-ical personnel evaluate for con-cussion
Recognizing head injuries in young athletes is extremely impor-tant because they are more suscep-tible to the rare, but potentially lethal, “second impact” syndrome This may develop if a second head injury occurs before full recovery from an initial head trauma The rapid onset of cerebral edema can lead to death in seconds or min-utes.3(p172)
“Burners” (“stingers”) result from a brachial plexus traction injury or from cervical root com-pression at the intervertebral fora-men Typically, a blow to the head that depresses the shoulder and flexes the neck to the opposite side causes the injury A transient, pain-ful, burning sensation radiates from the neck into the arm and hand of the injured player If the pain re-solves without weakness or neuro-logic deficit, the athlete can return
to play If there are recurrent epi-sodes or persistent symptoms, the athlete should undergo further eval-uation for cervical stenosis and de-generative disk disease before re-turning to the playing field.12 Transient quadriparesis is a spinal cord neurapraxia that leads
to paralysis followed by rapid re-turn to normal function The mech-anism of injury is usually an axial load on the cervical spine with a component of hyperflexion or hyper-extension The athlete should be removed from sports participation until a thorough neurologic and
Table 1
Ensure proper acclimatization at the beginning of the workout session
Evaluate weather conditions for temperature, humidity, and sunlight
Schedule rest in the shade
Identify participants at particular risk
Hydrate before practice and competition
Have chilled fluids readily available at the practice site
Enforce periodic drinking
Never use water restriction as a form of discipline
Discourage deliberate dehydration for weight loss
Make appropriate clothing adjustments
Schedule events to avoid peak hours of heat and sun
Educate players and parents
Record daily weights to ensure adequate rehydration between practices
* Reproduced with permission from Busch MT: Sports medicine in children and
adoles-cents, in Morrissy RT, Weinstein SL (eds): Lovell and Winter’s Pediatric Orthopaedics,
5th ed Philadelphia: Lippincott Williams & Wilkins, 2001, vol 2, p 1275.
Trang 5radiographic examination has been
performed.12
Although organized football is a
hazardous sport, rule changes and
better equipment have made it safer
New helmet design has led to a
decrease in head injuries and deaths
Teaching proper tackling techniques
that avoid “spearing” can decrease
the incidence of spinal injuries
Better education, supervision, and
coaching may also decrease the
number of injuries
Baseball and Softball
Although the exact number of
chil-dren who participate in organized
and pickup games of baseball and
softball each year is unknown,
these are obviously extremely
pop-ular activities with wide
participa-tion An estimated 160,000 med-ically treated musculoskeletal in-juries occurred in children in the year 2000 Injuries in younger chil-dren are most often due to impact
by the ball; older children incur more acute injuries while sliding.13 Young children (aged 5 to 10 years) more commonly sustain acute injuries to the head and neck re-gion, whereas older children (aged
11 to 14 years) are more likely to have injuries to their extremities
Girls who play high school softball have a higher injury rate than boys who play high school baseball.3(p11) The most frequent anatomic loca-tion for overuse injuries in children who play baseball is the elbow.14
“Little League elbow” is associated with repetitive throwing and im-proper technique Sidearm throw-ing by Little League pitchers is three times more likely to cause elbow symptoms than overhand throw-ing.15 Curveballs produce more forces on the medial epicondyle and joint area than overhand throw-ing.14 Whether throwing a curve-ball at a young age has a detrimen-tal effect on the elbow later in a pitcher’s career is still controversial
In general, however, young children should avoid throwing sidearm and throwing curveballs At age 13 or
14, throwing a limited number of curveballs is not harmful if there has been adequate training in the correct mechanics By age 18, throw-ing a curveball with regularity does not seem to be associated with an increased rate of injury The associ-ation between pitching frequency and elbow symptoms is well docu-mented Although there are no con-crete guidelines for the number of pitches allowed, a general rule is to limit the number of pitches thrown
at home and in practice and compe-tition each week to 200 or fewer (Table 3)
In 1995, the CPSC collected and analyzed data on 162,100 children treated in hospital emergency rooms
for baseball-related injuries.16 Re-view of these data identified three types of safety equipment that would reduce injuries Face guards
on batting helmets and softer balls can help reduce impact injuries, the most common form of injury in chil-dren Use of breakaway bases can reduce the number of base-sliding injuries Based on a study by Janda
et al,13the Centers for Disease Con-trol and Prevention estimated that
as many as 1.7 million injuries for all age groups could be prevented each year, at a saving of $2 billion,
by using breakaway bases
Although uncommon, baseball-related deaths do occur in children From 1973 to 1995, the CPSC re-ceived reports of the baseball-related deaths of 88 children aged 5 to 14 years.16 Thirty-eight deaths (43%) resulted when ball impact to the chest caused a sudden cardiac ar-rest This condition, known as com-motio cordis, occurs with sudden ventricular fibrillation.17 Rapid rec-ognition and immediate cardiopul-monary resuscitation are necessary
to prevent a fatal outcome
Table 2
Signs and Symptoms of
Headache
Sleep disturbance
Dizziness
Confusion
Unsteadiness
Difficulty in concentrating
Disorientation
Loss of consciousness
Irritability
Amnesia (posttraumatic or
retrograde)
Hyperexcitability
Vomiting
Nausea
Visual disturbances
Tinnitus
Light-headedness
Fatigue
* Reproduced with permission from
Smith BH: Head injuries, in Sullivan
JA, Anderson SJ (eds): Care of the
Young Athlete Rosemont, Ill:
Amer-ican Academy of Orthopaedic
Sur-geons and American Academy of
Pediatrics, 2000, p 172.
Table 3 Pitching Recommendations for
Maximum Maximum Pitches Games Age, yr per Game per Week 8-10 52 ± 15 2 ± 0.6 11-12 68 ± 18 2 ± 0.6 13-14 76 ± 16 2 ± 0.4 15-16 91 ± 16 2 ± 0.6 17-18 106 ± 16 2 ± 0.6
* Reproduced with permission from Pasque CB, McGinnis DW, Yurko-Griffin L: Shoulder, in Sullivan JA,
Anderson SJ (eds): Care of the Young Athlete Rosemont, Ill: American
Academy of Orthopaedic Surgeons and American Academy of Pediatrics,
2000, p 347.
Trang 6In the year 2000, soccer participation
resulted in an estimated 185,000
children’s musculoskeletal injuries,1
with the most common diagnoses
being sprains and strains, followed
by contusions and fractures Sprains
and strains frequently involve the
lower extremities, predominantly in
the ankle and knee The upper
extremities are the site of most
frac-tures, with the majority occurring in
the wrists and fingers Indoor
soc-cer players have higher injury rates
than outdoor soccer players.18
Interestingly, female soccer
play-ers have higher injury rates than
male players,19 with notably higher
rates of noncontact ACL injuries.9(p5)
This is felt to be related to both
dif-ferences in anatomy and difdif-ferences
in training Boys’ and girls’ ACL
injuries occur more frequently in
soccer than in basketball.3(p12)
Methods for decreasing soccer
injuries include the use of shin
guards, adequately secured and
padded goalposts, nonabsorbent
balls for wet playing fields, and
proper cleat selection When young
athletes are playing in ideal weather
conditions, screw-in cleats are
asso-ciated with a higher risk of injury
compared with molded cleats or
ribbed soles However, screw-in
cleats offer more traction on a wet
field with high grass
The technique of “heading” the
ball has led to concerns about
per-manent cognitive impairment.18
Further research is necessary before
a definitive recommendation can be
made about the safety of heading
Coaches should minimize the use of
this technique in young athletes
until more information is available
Fatalities from soccer-related
injuries are infrequent When they
do occur, it is usually as a result of
player impact with a goalpost
Falling goalposts accounted for 21
fatal injuries between 1979 and
1994.18 Guidelines developed by
manufacturers and the CPSC should
be followed for properly securing and padding goalposts
Bicycling
Bicycle riding led to more muscu-loskeletal injuries in children than any other recreational activity in the year 2000.1 The CPSC estimated that 415,000 musculoskeletal inju-ries in children were associated with bicycle riding However, the actual rate of participation is unknown;
thus, the rate of injury per partici-pant or duration of participation cannot be established Boys had the highest rate of injury Contusions were most common, followed by fractures of the forearm and wrist
A 1991 CPSC study of bicycle-related injuries found that 17 of every 1,000 riders aged 5 to 14 years were treated in hospital emergency rooms.20 The most frequent hazard patterns identified as being related
to injury were riding on uneven or slippery surfaces, in nondaylight hours, on city streets, and at exces-sive speeds Although most bicycle injuries are related to falls, striking fixed objects, and collisions with other bicycles, 90% of deaths from bicycle injuries are the result of col-lisions with motor vehicles.21 Most injuries are attributable to rider error due to lack of experience and skill, rather than bicycle defects or motorist error.22 Community pro-grams that emphasize bicycle safety, teach riding skills, and increase hel-met use can lower injury rates in children.23
Bicycle-related head trauma is an important source of disability and death Helmets can decrease the severity and incidence of head in-juries Studies show uniformly low (1.4% to 16%) rates of helmet use among children riding bicycles.21,24
In states with mandatory helmet laws, an association between a de-cline in the proportion of severe
head injuries and increased helmet use has been confirmed.25 The Amer-ican Academy of Orthopaedic Sur-geons (AAOS) has issued a position statement on bicycle and motorcycle helmets, encouraging their utiliza-tion and supporting laws that man-date their use
Playgrounds
Playgrounds developed from an effort to keep children safely away from city traffic One of the first public playgrounds was created in
1886 in Boston.26 Current statistics confirm that playgrounds are sec-ond only to the home as the site
of unintentional injuries to chil-dren.26 In a study of playground equipment–related injuries and deaths, Tinsworth and McDonald,27
of the Directorate for Epidemiology
at CPSC, estimated that of the 280,000 playground equipment– related injuries treated in hospital emergency rooms in 1999, 254,000 were musculoskeletal injuries The incidence was 34.8 injuries per 10,000 children Fractures were the most commonly reported injuries (39% of the total number), with three fourths involving the arm or hand Between 1990 and 2000, 147 deaths associated with playground equip-ment were reported to the CPSC.27 The most frequent hazards were hanging (82 deaths), falls (31), and tip-over or collapse of equipment (24) Seventy percent of the deaths oc-curred at home while using back-yard play equipment, not on public playgrounds The hanging deaths involved entanglement in items such as clothing drawstrings and ropes that were not designed to be part of the equipment
Most injuries on public play-grounds involve climbing equip-ment; most of those at home loca-tions involve swings In the study
by Tinsworth and McDonald,27falls were the most common mechanism
Trang 7of injury on both public equipment
(79%) and home equipment (81%)
In general, higher proportions of
arm and hand injuries occurred on
nonprotective surfaces than on
loose-fill surfaces or resilient mats
The CPSC statistics point to the high
incidence of injuries from falls and
underscore the importance of
pro-tective surfacing beneath the
equip-ment
In the past 20 to 30 years, there
has been greater emphasis on
play-ground safety Several national
or-ganizations and agencies are actively
involved with investigating and
pro-moting playground safety (Table 4)
Trampolines
In the year 2000, children sustained
135,000 medically treated
muscu-loskeletal injuries while playing on
trampolines.1 The overall usage of
trampolines is far lower than that of
all other recreational activities, but
the rate of injury is quite high The
rates of injuries on large and small
trampolines were equal Injuries
were most frequent on home
tram-polines Sprains and strains occurred
predominantly in the lower
extrem-ities and were more frequent than
fractures, which had a higher
inci-dence in the upper extremities In
general, lower-extremity injuries
were more common than
upper-extremity injuries
The risk of serious injury to
chil-dren playing on trampolines has led
the AAP to recommend that
tram-polines never be used in the home
environment, in routine physical
education classes, or on outdoor
playgrounds.28 The AAOS has
issued a position statement on
tram-polines and trampoline safety,
rec-ommending that trampolines should
be used only with parental
super-vision, that the jumping surface
should be at ground level, and that
all supporting bars and surrounding
landing surfaces should be padded
Larson and Davis29recommend that only one participant be on the tram-poline at a time; that spotters should
be present when participants are
jumping; and that somersaults and high-risk maneuvers should be avoided unless there is proper su-pervision and instruction
Table 4 Sources of Information on Playground Safety
AAOS American Academy of Orthopaedic Surgeons
847-823-7186 www.aaos.org ASTM American Society for Testing and Materials
610-832-9585 www.astm.org Boundless Boundless Playgrounds
860-243-8315 www.boundlessplaygrounds.org CPSC Consumer Product Safety Commission
301-504-0990 800-638-2772 (toll-free) 800-638-8270 (TTY) www.cpsc.gov IPEMA International Play Equipment Manufacturers Association
301-495-0240 800-395-5550 (toll-free) www.ipema.org KaBOOM! KaBOOM!
312-360-9520 www.kaboom.org NPCA National Playground Contractors Association
888-908-9519 (toll-free) www.playground-contractors.org NPPS National Program for Playground Safety
800-554-7529 (toll-free) www.uni.edu/playground/home.html NRPA National Recreation and Park Association
National Playground Safety Institute 703-858-0784
www.nrpa.org NCIPC National Center for Injury Prevention and Control
Centers for Disease Control and Prevention 770-488-1506
www.cdc.gov/ncipc SAFE KIDS The National SAFE KIDS Campaign
Children’s National Medical Center 202-662-0600
www.safekids.org
Trang 8Roller Sports
Roller skates, in-line skates,
skate-boards, and scooters share many of
the same physical characteristics
All have small-diameter wheels, can
achieve fairly high speeds, and are
propelled by the lower extremities
In addition, their maneuverability
and stability depend a great deal on
operator experience and
develop-ment Skateboards were first
mar-keted in the 1960s, and their
utiliza-tion and popularity have waxed
and waned since then, as have the
number of injuries.30 In-line skating
was introduced in 1980 and has
become one of the fastest growing
recreational sports for children and
teenagers in the United States, with
a notable increase in related
inju-ries.31 Foot-powered scooters were
first marketed in the 1960s The
newer lightweight versions with
low-friction wheels have been
asso-ciated with a dramatic increase in
injuries for the year 2000.32
The current NEISS data confirm
that 297,000 children sustained
mus-culoskeletal injuries from these four
activities in the year 2000.1 The
highest number of injuries were due
to in-line skating Of these, nearly
half were fractures, with most of
them occurring in the younger age
group (5 to 10 years) The most
fre-quent skateboard injuries were also
fractures, but these occurred more
frequently in the older age group
(11 to 14) Sprains and strains,
con-tusions, and fractures all had roughly
equal rates of occurrence for both
roller skating and riding on scooters
The forearm and wrist were the most
common fracture locations for all
four activities, which emphasizes the
importance of wearing wrist guards
Wrist guards have been proved
effective in protecting in-line skaters
in both case-control31 and
biome-chanical studies.33 Wearing helmets
that meet existing standards for
bicycle helmets has been
recom-mended for in-line skaters, as such
helmets have been proved to be strongly protective against head injuries in physical environments quite similar to those of skaters.31 Both the AAP34 and the AAOS advise the use of protective gear by in-line skaters at all times, as well as proper instruction, protected envi-ronments for the novice, and avoid-ance of traffic and road debris
Scientific data about the efficacy
of safety equipment to protect against scooter-related injuries are lacking.32 However, lessons learned from similar activities, such as skat-ing, suggest that reasonable safety precautions should be observed, such as wearing a helmet, using protective knee and elbow pads, riding on smooth surfaces without traffic, and providing supervision and training
Summary
Play activities are important to the healthy development of children
However, injuries to children during recreational activities frequently result from their lack of physical skills and cognitive development
Therefore, their injury patterns are different from those of adolescents and adults In general, children are more likely to sustain upper-extremity injuries, and lower-extremity inju-ries are more frequent in adolescents and adults Children less than 10 years old incur more fractures and catastrophic injuries (head injuries) with individual recreational activi-ties than they do with organized sports.3(p10) Because their immaturity limits their ability to learn the skills that can help avoid accidents, fol-lowing specific rules and using pro-tective equipment are essential.20 Epidemiologic studies have con-firmed that injuries to children that occur during recreational activities can have marked consequences, and that prevention methods can be suc-cessful Although the data from the
NEISS surveys are extremely valu-able, they do not include direct reporting from doctors’ offices and urgent care centers, nor do they include data on children who are injured but do not seek medical care The NEISS data seldom in-clude repetitive stress injuries and,
as is the case with other such sur-veys, do not clearly identify injury severity Furthermore, comparable data regarding numbers of partici-pants in these activities are not read-ily available to provide accurate rate
or incidence data Therefore, the ex-posure to risk for these injuries is difficult to determine.35
By assessing risks and trends that impact children’s injuries, guide-lines can be suggested that allow parents, coaches, and physicians to make informed choices about chil-dren’s participation in sports Safety research as well as laboratory testing
of equipment could be most ef-fectively guided by the analysis of such data, particularly if there were more extensive reporting and injury severity classification Intervention
in the form of equipment modifica-tions, rule changes, safety guidelines, product recalls, and legislation could
be based on such studies The ulti-mate benefit of these data is to reduce and prevent injuries in children Estimates from the CPSC con-cerning the total costs of children’s recreational injuries are staggering (Fig 1) The projected amounts (parents’ lost work, liability, pain and suffering) beyond the medical costs are frequently not appreciated
by treating physicians As an exam-ple, so-called “minor” sprains and strains incurred by children playing basketball in the year 2000 had an estimated total cost of $2.2 billion.1 Physicians can play a key role in both the management and the pre-vention of recreational injuries in children For the primary-care phy-sician, it is important to promptly determine the nature and extent of the injury so that appropriate care
Trang 9can be given and the risk of
perma-nent disability can be lessened.36
Even though primary-care
physi-cians and pediatriphysi-cians are more
fre-quently in a position to provide
anticipatory counseling,
orthopae-dic surgeons should also be
in-volved in safety education, both at
the time of treatment and on a
pro-active basis Furthermore,
counsel-ing about prevention of further
in-jury should be an integral part of
the treatment of the index injury
Effective injury prevention
pro-grams for children’s recreational
activities should be based on
com-munity coalitions of physicians, health-care organizations, public and private agencies, manufacturers, retail outlets, and the media.37 Phy-sicians can add validity to media coverage by acknowledging the importance of using protective gear and other safety measures Manu-facturers and retailers can increase the use of protective equipment by lowering the cost and making it more attractive and comfortable
Prevention of injuries to children
is everyone’s responsibility and can
be achieved through a variety of means, including patient education,
research, community programs, and regulatory efforts, all of which pro-mote safe play for children
The AAOS recognizes the impor-tance of injury prevention and has developed advocacy programs that are readily available to both physi-cians and the public The staff and fellowship organize, sponsor, and actually construct safe, accessible playgrounds each year in host cities
of the AAOS Annual Meeting The AAOS also produces educational materials that enable individual orthopaedists to educate their com-munity and patients
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