Trampoline safety in childhood and adolescence

Trampolines Versus Playgrounds - A Comparative Assessment of Pediatric Fractures Sustained From Recreational Play

INTRODUCTION

Using the Pediatric Health Information System, this study compared the relative severity of fractures sustained from trampolines with those from other playground equipment.

METHODS

Pediatric patients were identified in the Pediatric Health Information System with trampoline-related injuries (TRIs) or playground-related injuries (PRIs) diagnosed as fractures. Adjustments were made for hospital, year of injury, sex, age, race, median household income, and rurality through propensity score weighting. Four injury-related outcome measures were examined as a proxy for injury severity.

RESULTS

A total of 133,232 patients met inclusion criteria. In unadjusted univariate analyses, TRIs were associated with greater odds of severe fracture and lower odds of receiving surgical treatment (OR = 0.954) compared with PRIs. After adjustment, TRIs sustained in late childhood and adolescence were more likely to receive surgical management (OR = 1.092 and OR = 1.192, respectively) while TRIs sustained in younger children were less likely (OR = 0.607) than PRIs.

DISCUSSION

Youths in late childhood and adolescence are at increased odds of undergoing surgical management after trampoline fractures. Beyond underscoring the risks of trampoline play, our results highlight the importance of considering age in recreational injury epidemiology and the public health safety initiatives aimed at specific age groups.

Trampoline Park Injury Trends

OBJECTIVES

Trampolines are an important cause of childhood injury and focus of injury prevention. Understanding and prevention of trampoline park injury is constrained by inadequate exposure data to estimate the at-risk population. This study aimed to measure trampoline park injury incidence and time trends using industry data.

METHODS

Cross-sectional study to retrospectively analyze reported injuries and exposure in 18 trampoline parks operating in Australia and the Middle East, from 2017 to 2019. Exposure was derived from ticket sales and expressed as jumper hours. Exposure-adjusted incidence was measured using marginalized 0-inflated Poisson modeling and time trends using Joinpoint regression.

RESULTS

There were 13 256 injured trampoline park users reported from 8 387 178 jumper hours; 11% sustained significant injury. Overall, trampoline park injuries occurred at a rate of 1.14 injuries per 1000 jumper hours (95% confidence intervals 1.00 to 1.28), with rates highest for high-performance (2.11/1000 jumper hours, 1.66 to 2.56) and inflatable bag or foam pit (1.91/1000 jumper hours, 1.35 to 2.50) jumping. Significant injuries occurred at a rate of 0.11 injuries per 1000 jumper hours (0.10 to 0.13), with rates highest for high-performance (0.29/1000 jumper hours, 0.23 to 0.36), and parkour (0.22/1000 jumper hours, 0.15 to 0.28) jumping. Overall, injury rates decreased by 0.72%/month (-1.05 to -0.40) over the study period.

CONCLUSIONS

Trampoline park injuries occur in important numbers with sometimes serious consequences. However, within these safety standard-compliant parks, exposure-adjusted estimates show injuries to be uncommon and injury rates to be declining. Further reductions are required, especially severe injuries, and this study can enhance injury prevention initiatives.

Jumping Trends In Trampoline-Related Craniofacial Injuries

INTRODUCTION

In 1990, the American Academy of Pediatrics recommended the sale of trampolines cease in the United States. The risk of traumatic injury is well-documented, yet trampolines remain a growing source of recreation. Trampoline parks, in particular, are becoming a common entertainment attraction that can result in serious injury. There is currently a paucity of literature characterizing craniofacial injuries from trampoline use and plans to prevent these injuries.

METHODS AND MATERIALS

A retrospective review of the National Electronic Injury Surveillance System was conducted to analyze emergency department visits for trampoline-related craniofacial injuries in 1 to 20 year olds between 2013 and 2022.

RESULTS

An estimated 206,866 trampoline-related craniofacial injuries occurred. Males suffered injuries 1.67 times more frequently than females. Injured sites included the head (41.0%), face (23.2%), neck (20.4%), mouth (11.9%), eyeball (2.0%), and ear (1.4%). The most common diagnoses were lacerations (28.9%), internal injuries (23.2%), strain/sprains (14.8%), contusions/abrasions (13.0%), and concussions (8.7%). Head internal injuries and facial lacerations significantly increased over the observed time period.

DISCUSSION

Trampolines are a rising source of craniofacial trauma for America's youth. Children between 3 and 11 years old were disproportionately affected. Regulation over trampoline safety features remains limited in the United States. Future studies should aim to characterize the mechanisms of these injuries for the development of targeted safety measures.

Differences in Trampoline-Related Knee Injuries Between Children and Adults: A Cross-Sectional Study

Background

Little is known about the specific risk of knee injuries due to trampoline accidents in adults compared with children.

Purpose

To investigate the differences in trampoline-related knee injuries between children and adults and identify risk factors and protective strategies to reduce injury incidence.

Study Design

Cross-sectional study; Level of evidence, 3.

Methods

Data on 229 consecutive patients treated for trampoline-related knee injuries in a single institution were prospectively collected, analyzed, and included. Risk factors, injury patterns, and clinical treatments were compared between skeletally immature and skeletally mature patients. Logistic regression was used to determine the odds ratios for specific risk factors for trampoline-related injuries-including body mass index (BMI), trauma mechanism, patient age, and accident location.

Results

A total of 229 patients met the inclusion criteria; 118 (52%) patients (women, 54.2%; mean age, 8.5 ± 4.1 years) were skeletally immature at the time of injury, and 111 (48%) patients (women, 72%; mean age, 31.9 ± 13.1 years) had closed physes on initial presentation and were classified as skeletally mature. A total of 63 patients (28%) required surgical treatment for their knee injury. Overall, 50 anterior cruciate ligament (ACL) tears, 46 fractures, 39 meniscal tears, 31 ligamentous tears other than ACL, 22 patellar dislocations, and 38 soft tissue injuries, such as lacerations, were recorded. Skeletally mature patients had 7.8 times higher odds (95% CI, 1.6-46.8; P < .05) and 19.1 increased odds (95% CI, 5.5-74.9; P < .05) of an ACL tear or another ligamentous tear, respectively, compared with skeletally immature patients. Patients who described instability and giving way of the knee as relevant trauma mechanisms had odds of 3.11 (95% CI, 0.9-14.8; P < .05) of an ACL tear compared with other trauma mechanisms. Meniscal tears were observed more frequently in the skeletally mature cohort (P < .05). An elevated BMI was associated with a significantly higher relative risk of an ACL tear, a ligamentous tear other than the ACL, and an injury requiring surgery. A third of surgically treated patients were subject to a delayed diagnosis.

Conclusion

Adults had a significantly increased risk of ligamentous and meniscal tears and required operative intervention more often than skeletally immature individuals. Elevated BMI, age, and instability events in terms of trauma mechanism conveyed an increased risk of structural damage to the knee.

Trampoline-Associated Cranial and Spinal Injuries: A 10-Year Study in a Pediatric Neurosurgery Center

OBJECTIVE

 There has been an increasing use of trampolines for recreation by children in recent years. Many studies have explored the different types of injuries sustained due to falls from trampolines, but so far none have focused specifically on cranial and spinal injuries. In this study, we describe the pattern of cranial and spinal injuries sustained by pediatric patients that were associated with the use of trampolines and their management in a tertiary pediatric neurosurgery unit over a period of 10 years.

METHODS

 This is a retrospective study of all children less than 16 years of age with suspected or confirmed trampoline-associated cranial or spinal injuries, managed by a tertiary pediatric neurosurgery unit from 2010 to 2020. Data collected included the patient's age at the time of injury, gender, neurological deficits, radiological findings, management, and clinical outcome. The data were analyzed to highlight any trends in the pattern of injuries.

RESULTS

 A total of 44 patients with a mean age of 8 years (ranging from one year and five months to 15 years and five months) were identified. 52% patients were male. 10 patients (23%) had a reduced Glasgow Coma Scale (GCS) score. In terms of imaging findings, 19 patients (43%) had a radiologically positive head injury, nine (20%) had a craniovertebral junction (CVJ) injury, including the first (C1) and second (C2) cervical vertebrae, and six (14%) had an injury involving other parts of the spine. No patient sustained concurrent head and spinal injuries. Eight (18%) patients had normal radiological findings. Two (5%) had incidental findings on radiology that required subsequent surgery. A total of 31 patients (70%) were managed conservatively. 11 patients (25%) underwent surgery for their trauma, of which seven were cranial. Two further patients underwent surgery for their incidental intracranial diagnoses. One child died from an acute subdural hemorrhage.

CONCLUSIONS

 This study is the first to focus on trampoline-associated neurosurgical trauma and report the pattern and severity of cranial and spinal injuries. Younger children (less than five years of age) are more likely to develop a head injury, whereas older children (more than 11 years of age) are more likely to develop a spinal injury following the use of a trampoline. Although uncommon, some injuries are severe and require surgical intervention. Therefore, trampolines should be used prudently with the appropriate safety precautions and measures.

New Injury Patterns in Pediatric Supracondylar Fractures During COVID-19: Beds Are the New Monkey Bars

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic drastically altered children's activity patterns. Our goal was to investigate how COVID-19 affected demographics, injury characteristics, treatment patterns, follow-up, and outcomes in pediatric supracondylar humerus (SCH) fractures.

METHODS

This was an Institutional Review Board-approved retrospective analysis of patients undergoing surgery for a SCH fracture from May to November 2019 (pre-COVID-19) and from May to November 2020 (during COVID-19) at 2 tertiary children's hospitals. Demographic information, injury characteristics, hospital course, and follow-up data were collected and compared.

RESULTS

SCH fractures decreased by >50% from 2019 (149) to 2020 (72). Children in the 2020 cohort were younger (mean 5.2 y old) compared with 2019 (6.0 y old) ( P =0.019). Mechanism of injury was significantly different in 2020 ( P <0.001), as the proportion of trampoline and furniture fractures increased from 8% and 17% to 15% and 33%, respectively. The proportion of playground and monkey bar fractures decreased from 20% and 17% to 3% and 4%, respectively. Distribution of Gartland type and neurovascular injury rates were similar in 2019 and 2020 ( P =0.411 and 0.538). Time from emergency department admission to the operating room and duration of hospital admission were both unchanged from 2019 to 2020 ( P =0.864 and 0.363). The duration of postoperative follow-up in 2019 was 94.5 days compared with 72.8 days in 2020 ( P =0.122), as more pandemic patients were lost to follow up (22.5% vs. 35.2%, P =0.049).

CONCLUSIONS

The demographics, mechanism of injury, and follow-up practices of pediatric SCH fractures changed significantly during the pandemic, likely because of school closures and lock-downs changing activity patterns. Different mechanisms of injury affected younger patients and reflected the new ways children played. Trampoline-related and furniture-related injuries overtook the classic playground falls as primary mechanism of injury. Despite the need for COVID-19 testing, there was no delay in time to the operating room. Hospitalization duration did not change, yet postoperative follow-up was shorter, and more patients were lost to follow up. Despite these stressors, outcomes remained excellent in most children.

LEVEL OF EVIDENCE

Level III-Retrospective comparative study.

Trampoline injuries in children: A prospective study

BACKGROUND

Trampolining is popular and widely practiced among children. A literature review has shown a rise in the incidence of trampoline injuries with a concomitant increase in paediatric emergency department visits. The primary objective of this study was to describe the severity of trampoline injuries in children. The secondary objectives were to assess the epidemiology of the study population and injuries and to describe the treatments.

HYPOTHESIS

We hypothesized that over 10% of trampoline injuries were severe.

MATERIAL AND METHODS

We prospectively evaluated consecutive patients seen for surgical conditions at our paediatric emergency department over a 10-month period. Among them, 103 (1.2% of visits) aged 4 months to 16 years (mean, 8 years) had trampoline injuries. We classified trampoline injuries as severe if they required general anaesthesia.

RESULTS

Severe injuries accounted for 16.5% of all trampoline injuries. The upper limb was predominantly affected (70.6% of cases). Overall, 66.7% of fractures were at the upper limb and 76% of contusions at the lower limb. The predominant fracture sites were the supra-condylar humerus (15.3%) and distal radius (15.3%). Among patients with non-severe injuries, four-fifths left the emergency department with a temporary immobilisation system.

DISCUSSION

The proportion of severe injuries was slightly higher in our study than in earlier reports. Trampoline injuries remain uncommon but can be severe. Thus, in our study over one-sixth of patients required surgery under general anaesthesia.

LEVEL OF EVIDENCE

IV, prospective descriptive epidemiological study.

Comparison of Lateral and Crossed K-wires for Paediatric Supracondylar Fractures: A Retrospective Cohort Study

Background

Supracondylar elbow fractures occur most frequently in children aged five to seven years and have equal incidence in both genders. They are classified as flexion or extension type injuries with extension type being more common. We aimed to ascertain radiological stability with lateral and crossed wires in this study. We also identified any complications after operative management of these injuries.

Methods

As part of this retrospective cohort study, we identified all patients who presented with this injury from January 1, 2020, until February 28, 2022. Basic demographic data and type of operation were noted. Baumann angle (BA) and lateral capitellohumeral angle (LCHA) were measured intra-operatively and x-rays were done at the final clinic appointment. The mean of these angles in lateral and crossed wire groups was compared using paired sample t-test. Unpaired t-test was used to compare the means of both groups with normal values for these angles based on previous studies (BA=71.5±6.2 degrees, LCHA= 50.8±6 degrees).

Results

Fifty patients were admitted during this period. Thirty-three patients had lateral wires and 17 had crossed wires for fixation. No significant change was noted in the mean BA and mean LCHA in both groups on x-rays done intra-operatively and final clinic follow-up (no loss of reduction). No significant difference was noted between BA and LCHA noted for both groups at the final clinic follow-up with previous studies outlining normal values for these angles. No cases of iatrogenic neurovascular injury were identified. Four patients (8%) were referred to physiotherapy due to stiffness.

Conclusion

Both lateral and crossed wire configurations led to achievement of good radiological stability with BA and LCHA within normal limits. No loss of reduction was noted with both techniques and no risk of iatrogenic nerve injuries was noted in experienced hands.

Trampoline centre injuries in children and adolescents: a systematic review and meta-analysis

CONTEXT

No evidence-based review has compared injury risks sustained on trampolines at home and in trampoline centres.

OBJECTIVE

To present pooled results for injury type, site and treatment from studies reporting injuries that occurred on trampolines at home and in trampoline centres.

DATA SOURCES

MEDLINE, Scopus, Google Scholar and Embase databases were searched to 31 December 2021.

STUDY SELECTION

Inclusion criteria: (1) assessment of trampoline injuries (home and trampoline centres); (2) children and adolescents; (3) the point estimate was reported as an odds ratio (OR); and (4) an internal comparison was used.

DATA EXTRACTION

Data were reported according to Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. A random-effects model was used to estimate effect.

RESULTS

There were 1 386 843 injuries (n=11 studies). There was an increased likelihood of musculoskeletal and/or orthopaedic injuries (OR 2.45, 95% CI 1.66 to 3.61, p<0.001), lower extremity injury (OR 2.81, 95% CI 1.99 to 3.97, p<0.001), sprains (OR 1.64, 95% CI 1.36 to 1.97, p<0.001) and a need for surgery (OR 1.89, 95% CI 1.37 to 2.60, p<0.001) at trampoline centres compared with home trampolines. Conversely, upper extremity injury (OR 0.49, 95% CI 0.25 to 0.95, p=0.03), concussion (OR 0.48, 95% CI 0.35 to 0.65, p<0.001) and lacerations (OR 0.46, 95% CI 0.35 to 0.59, p<0.001) were less likely to occur at trampoline centres than at home.

CONCLUSIONS

Children using trampoline centres are more likely to suffer severe trauma and require surgical intervention than children using home trampolines. Development and implementation of preventative strategies, public awareness, and mandatory safety standards are urgently required for trampoline centres.

Neck Loads During Head-First Entries into Trampoline Dismount Foam Pits: Considerations for Trampoline Park Safety

Serious cervical spine injuries have been documented from falls into foam pits at trampoline parks. To address the lack of evidence on how foam pits should be designed for mitigating neck injury risk, this study aimed to quantify neck loads during head-first entry into varying foam pit designs. An instrumented Hybrid III anthropomorphic test device was dropped head-first from a height of up to 1.5 m into three differently constructed foam pits, each using a different mechanism to prevent direct contact between the falling person and the floor (foam slab, trampoline or net bed). Measured neck loads were compared to published injury reference values. In the simplest, foam-only pit design, increasing foam depth tended to reduce peak compressive force. At least one injury assessment reference metric was exceeded in all pit conditions tested for 1.5 m falls, most commonly the time-dependent neck compression criterion. The results highlight the importance of adequate foam depth in combination with appropriate pit design in minimizing injury risk. The risk of cervical spine injury may not be reduced sufficiently with current foam pit designs.

Distribution of injury in inflatable jumping amusements in the U.S. over the last 20 years

PURPOSE

To describe the distribution of injuries attributed to inflatable bounce house devices in children 2-18 years old in the United States from 2000 to 2019.

METHODS

The National Electronic Injury Surveillance System (NEISS) was used to identify patients <18 years of age with injuries from activities classified as amusements (NEISS Code 1293 and 3219) during the period from 2000 to 2019.

RESULTS

A weighted estimate of 159,569 injuries was obtained using NEISS statistical weights. Injury estimates and rate of estimated injury per year showed a continued linear increase from 2000-2019 (p<0.0001). Bounce house-related injuries were more common in males (53.9%) than in females (46.1%). The injuries reported most commonly were fracture (25.8%), muscle strain (25.7%), and contusion (14.5%). The factors associated with bounce house-related injury were compared between "younger" patients ≤6 years of age and "older" patients >6 years of age. In both age groups, the patient's residence was the most prevalent location of injury (≤6 yr, 95.6%; >6 yr, 97.2%), and the lower extremity was the most prevalent anatomic site of injury (≤6 yr, 34.6%, >6 yr 35.3%). Concussion was rare in both groups (≤6 yr, 1.6%; >6 yr, 2.9%); however, concussion was 86% more prevalent in those >6 years of age (p<0.0001).

CONCLUSIONS

The frequency and rate of pediatric bounce house injuries has increased steadily since 2000. The most severe injuries occur disproportionately in children > 6 years old.

COVID-19 pandemic restrictions unmasks dangers of frequent injury mechanisms for common surgically treated pediatric fractures

PURPOSE

This study examined the volume and characteristics of common surgically treated fractures in children during the COVID-19 pandemic. The worldwide spread of COVID-19 affected the society in numerous ways. Social distancing led to changes in the types of activities performed by individuals, including children. Physicians saw a shift in orthopedic trauma volume and distribution. We predicted that with the change in activities children participated in, the number or type of injuries sustained would change as well.

METHODS

A retrospective review was performed of children who sustained a surgically treated fracture of the forearm, supracondylar humerus, femur, or any open fracture during the COVID-19 pandemic compared to the previous 2 years (pre-pandemic). Patient demographics, insurance status, and mechanism of injury were recorded. Statistical analysis was performed.

RESULTS

Review of the medical records identified 791 children. The number of fractures decreased from an average of 295 per year pre-pandemic to 201 during the pandemic (p = 0.09). During the pandemic, there was a decrease in injuries resulting from a fall from the monkey bars for supracondylar humerus (21.2% to 8.2%, p < 0.01) and for forearm fractures (15.5% to 4.3%, p = 0.04). In contrast, the frequencies of falls from a skateboard, hoverboard, scooter, or bicycle and falls from household furniture increased during the pandemic.

CONCLUSION

The observed decrease in monkey bar-related injuries provides further evidence as to the dangers of this piece of playground equipment in contributing to upper-extremity fractures in children.

LEVEL OF EVIDENCE

Level III: Prognostic and Epidemiological.

Trampolining Accidents in an Adult Emergency Department: Analysis of Trampolining Evolution Regarding Severity and Occurrence of Injuries

PURPOSE

Only a few studies have been conducted on trampoline-associated injuries in adults, especially in Switzerland. The aim of the present study was to describe the characteristics of trampoline-related injuries in patients older than 16 years of age and track their development over time by comparing two different time periods.

METHODS AND MATERIALS

Data were gathered from the emergency department (ED) of Bern University Hospital. A retrospective design was chosen to allow analysis of changes in trampolining accidents between 2003-2020.

RESULTS

A total of 144 patients were enrolled. The number of ED presentations due to trampoline-related injury rose significantly over time. The most common injuries were sprains to the extremities (age group 31-62: 58.4% and age group 16-30: 50.8%), followed by fractures (age group 31-62: 33.3% and age group 16-30: 32.5%). Lower extremities appeared to be the most frequently injured body region (age group 31-62: 20.8% and age group 16-30: 10.0%), although the differences were not statistically significant, p = 0.363. BMI was significantly higher for older than for younger patients (p = 0.004).

CONCLUSION

Over the last two decades, trampoline-related injuries have become more common in patients older than 16 years of age. These are most common in the lower extremities. While most of the patients in the present study only suffered minor injuries, the occasional severe injury might result in long-term disability. As trampoline-related injuries in adults are becoming more common, prevention strategies in public education and safety instructions must be optimised.

An observational study of trampoline injuries admitted to a Belgian University emergency department between 2011 and 2016

BACKGROUND

Trampoline injuries are a cause for concern and data from different countries indicate that these are increasing. The aim of this study was to collect data in a Belgian University Hospital emergency department.

METHODS

Medical files of patients admitted with a trampoline-related injury between 1st July 2011 and 30th June 2016 were retrospectively analyzed.

RESULTS

One hundred and sixty patients, aged between 2 and 64 years old and predominantly males (57%), were admitted most frequently during the months March until September. An increase was observed during the years 2013-2014. Most injuries (76%) occurred during activity on the trampoline. Fractures occurred in 40% of the patients with the extremities most frequently involved. An X-ray examination and a CT scan was performed in 82 and 3% of the cases, respectively. Surgery was carried out in 12% of the patients. 9% of the patients had to be admitted to hospital.

CONCLUSIONS

Trampoline injuries are increasingly observed in the emergency department. These injuries are important and further research on the circumstances and causes for the accidents is needed. Preventive measures, as proposed in the literature, should be considered.

Seasonal variability and age-related risk in youth trampoline injuries

BACKGROUND

The aim of this work was to estimate the difference in severity between musculoskeletal trampoline park injuries (TPIs) and home trampoline injuries (HTI) and identify the factors that might mediate or modify that effect.

METHODS

The National Electronic Injury Surveillance System database was used to identify musculoskeletal home trampoline injuries and TPIs in pediatric patients occurring in the 2009-2017 period. Injury mechanism and body region were inductively coded. The effect of TPI on risk of admission was estimated using a doubly robust logistic regression model for confounding adjustment. Adjustments were made for date, age, gender, injury mechanism, and body region. The comparative importance of injury mechanism and location and the effect modification of patient characteristics was explored using likelihood ratio tests.

RESULTS

Trampoline park injuries were more likely to result in admission even in the model adjusted for injury mechanism and body region (odds ratio (OR) = 2.12 [1.30, 3.45]). Injuries sustained from falling off the trampoline were associated with significantly fewer hospitalizations (OR = 0.119 [0.029, 0.495]) than injuries from falling while on the trampoline. Patient age significantly modified the effect of setting on risk of admission (P = 0.042). Adolescents demonstrated an increased risk at trampoline parks (15 years old OR = 3.23 [1.38, 7.56]), whereas younger children demonstrated a marginally lower risk (5 years old OR = 0.77 [0.44, 1.35]).

CONCLUSIONS

Trampoline park musculoskeletal injuries demonstrate an increased risk of admission even after rigorous adjustment for confounding. Injuries to the proximal limbs were associated with a much higher risk of admission than distal injuries. Adolescents face an increased risk of admission after TPI, underscoring the importance of public health interventions that target this age group.

Trampoline-related fractures of the proximal tibia in children

Background

Trampoline-related fractures of the proximal tibial metaphysis are common in children and have been linked to subsequent valgus deformity of the tibia. The purpose of this study was to investigate the characteristics of trampoline-related proximal tibial fractures in young children.

Methods

We evaluated 40 patients with proximal tibial fracture after trampolining between 2013 and 2019. The median duration of follow-up was 18 months. Standing long leg radiographs were obtained at the last follow-up to evaluate angular deformity and limb length inequality in the patients. The measurements recorded include the lower limb length, mechanical lateral distal femoral angle (mLDFA), medial proximal tibial angle (MPTA), mechanical axis deviation (MAD), and anatomical tibio-femoral angle (aTFA). The anterior tilt angle (ATA) was measured using a lateral radiograph of the tibia.

Results

The median age at injury was 40.0 months. Using trampoline with a heavier person was the most common mechanism of injury. aTFA and MAD were found to be increased towards the valgus at the last follow-up in our patient; however, the increase was not statistically significant (p = 0.692 and p = 0.973, respectively). The anterior tilt angle was increased in the injured leg at the last follow-up. But the change was not statistically significant (p = 0.09).

Conclusions

Using trampoline with a heavier person carries the risk of trampoline-related proximal tibial fracture in young children. We did not find a significant change in limb alignment at a minimum of one year of follow-up.

Trampolines injuries are bouncing back

Aims

This observational study examines the effect of the COVID-19 pandemic upon the paediatric trauma burden of a district general hospital. We aim to compare the nature and volume of the paediatric trauma during the first 2020 UK lockdown period with the same period in 2019.

Methods

Prospective data was collected from 23 March 2020 to 14 June 2020 and compared with retrospective data collected from 23 March 2019 to 14 June 2019. Patient demographics, mechanism of injury, nature of the injury, and details of any surgery were tabulated and statistically analyzed using the independent-samples t-test for normally distributed data and the Mann-Whitney-U test for non-parametric data. Additionally, patients were contacted by telephone to further explore the mechanism of injury where required, to gain some qualitative insight into the risk factors for injury.

Results

The 2020 lockdown resulted in 30% fewer paediatric trauma presentations (441 vs 306), but no significant change in the number of patients requiring surgery (47 vs 51; p = 0.686). Trampolining injuries increased in absolute numbers by 168% (p < 0.001), almost four times more common when considered as percentage of all injuries observed in 2020 vs 2019. There was a decrease in high energy trauma from road traffic accidents and falls from height (21.5% decrease, p < 0.001). Despite a shift towards more conservative treatment options, trampolining injuries continued to require surgery in similar proportions (19.4 vs 20%; p = 0.708). Qualitative investigation revealed that the most common risk factor for trampolining injury was concurrent usage, especially with an older child.

Conclusion

COVID-19 lockdown has resulted in a decrease in paediatric orthopaedic presentations and high energy trauma. However, due to a marked increase in home trampolining injuries, and their unchanged requirement for surgery, there has been no change in the requirement for surgery during the lockdown period. As home exercise becomes more prevalent, a duty of public health falls upon clinicians to advise parents against trampoline usage.

Cite this article: Bone Jt Open 2021;2(2):86–92.

Trampoline-related injuries in children: a nationwide cross-sectional study in South Korea

Objective

Trampoline-related injuries have increased in South Korea. However, little research has been conducted on this topic. This study aimed to show the characteristics of pediatric trampoline-related injuries in South Korea and to investigate the factors associated with admission.

Methods

A retrospective, cross-sectional study was conducted using data from South Korea’s Emergency Department-based Injury In-depth Surveillance registry for dates between January 2011 and December 2016. All patients under 18 years of age with trampoline-related injuries were included. We divided the patients into two groups based on whether they were admitted or discharged. Odds ratios with 95% confidence intervals were calculated to evaluate the factors associated with hospital admission for pediatric trampoline-related injuries.

Results

A total of 2,745 patients were enrolled and the incidence increased over time (P for trend<0.01). The most common injury site was the lower extremity (45%). Fracture was the most frequent diagnosis (34.3%). Compared to the discharge group, the adjusted odds ratios (95% confidence intervals) for hospital admission were 3.53 (1.73–7.17) for the teenage group, 2.62 (1.82–3.77) for upper extremity injuries, 18.48 (7.95–42.95) for fractures, 2.28 (1.35–3.86) for falls, and 2.04 (1.15–3.60) for collisions.

Conclusion

Trampoline-related injuries in children have increased over time in South Korea. Most occur in children under the age of 12 years, but children between the ages of 13 and 18 years are at a higher risk for hospitalization. Also, injuries of the upper extremity, fracture, falling, and collision are risk factors for admission. Preventive strategies are needed to reduce trampoline-related injuries in children.

Initial angular deformity and its recovery of the proximal tibial metaphyseal fracture according to the cause: trampoline-related injury versus other injuries

PURPOSE

This study investigated the initial angular deformity of proximal tibial metaphyseal fracture in children and its recovery during follow-up according to the cause of injury.

METHODS

Prospective data about the patients with a proximal tibial metaphyseal fracture at the age less than six years and available follow-up data at two years post-trauma were retrospectively reviewed. They were grouped into trampoline-related injuries (TRI) and non-TRI groups based on the cause of injury. Proximal tibial valgus and recurvatum angles were measured to assess angular deformity on the coronal and sagittal planes, respectively.

RESULTS

A total of 47 patients (33 TRI and 14 non-TRI) were included. Initially, the valgus angles were -1.5° in TRI and 1.6° in non-TRI groups (p < 0.001) and the recurvatum angles were 7.8° in TRI and 4.1° in non-TRI groups (p = 0.048). After two-year follow-up, the valgus angles were 0.2° in TRI and 0.9° in non-TRI groups (p = 0.070), and the recurvatum angles were 6.5° in TRI and 2.3° in non-TRI groups (p = 0.001).

CONCLUSION

For children with a proximal tibial metaphyseal fracture, the initial coronal deformity was different according to the injury cause (varus in TRI whereas valgus in non-TRI). Although there was a near complete recovery after approximately two years of follow-up in the coronal deformities, the sagittal deformity (genu recurvatum) seems to recover incompletely or tardily, especially for those caused by TRI.

LEVEL OF EVIDENCE

III.

Comparative surgical risk between type of trampoline (size and place) and type of patients (age and sex) in trampoline related injury: a systematic review and indirect meta-analysis

Background

Despite its high risk of injury, many people are still favor trampolining. However, currently there is no consensus as to which type of trampoline and which type of participant is more likely to have a trampoline related injury that will require surgical management.

Methods

This systematic review and meta-analysis aims to assess and compare the factors that cause trampoline injuries requiring surgical treatment. These include the place of the trampoline (park versus home), size of the trampoline (full versus mini), the age of the participant (child versus adult) and the sex of the participant (male versus female). The clinical outcomes measured are surgical management after trampoline injury. This systematic review was conducted according to the PRISMA guidelines.

Results

Relevant studies that reported surgery after trampoline injury of either group were identified from Medline and Scopus from inception to May 14, 2019. Sixteen studies were included for the analysis of surgery after trampoline injury; a total of 4491 and 1121 patients were treated conservatively and surgically. The total surgery rate per patient was 31% (95% CI: 16, 46%) in all patients. The surgery rate was 0.3 (95% CI: 0.03, 0.58) and 0.06 (95% CI: 0.04, 0.09) in the full and mini size trampoline groups. There were 0.36 (95% CI: 0.06, 0.67) and 0.11 (95% CI: 0.0, 0.22) in the park and home trampoline groups. The surgery rates were 0.33 (95% CI: 0.14, 0.53), 0.24 (95% CI: 0.07, 0.11), 0.49 (95% CI: 0.47, 0.51) and 0.38 (95% CI: 0.22, 0.53) in children, adults, females and males respectively. Indirect meta-analysis shows that full size trampolines provided a 6.0 times higher risk of surgery (95% CI: 3.7, 9.7) when compared to mini size trampolines. Park trampolines had a higher risk of surgery of 2.17 (95% CI: 1.70, 2.78) when compared to home trampolines. In terms of age and sex of participants, there value was significantly higher at 1.65 (95% CI: 1.35, 2.01) and 1.54 (95% CI: 1.36, 1.74) in children compared to adults and females compared to males. From all the statistical data we summarized that the full size trampoline injuries have a 6 times higher risk of requiring surgery when compared to mini size trampoline injuries. Park trampoline use carries a 2 times higher risk of requiring surgery when compared to home trampoline use. In terms of age and sex of the participant, there is a 1.5 times significantly higher risk of injury in children compared to adults, and females when compared to males.

Conclusion

In trampoline related injuries, full size, park trampoline, children and females had higher surgery rates when compared to mini size, home trampoline, adult and male majority in indirect meta-analysis methods.

[Characterisation of the impact and features of trampoline park-related injuries]

INTRODUCTION

 Numerous studies have described indoor trampoline park (ITP)-related injury patterns, but they have shown heterogeneous results. No such study has been performed in Germany to date. The aim of this study was to analyse the specific trampoline-related injury patterns found in our population.

METHODS

 This retrospective study included patients suffering from ITP-related injuries between 1 October 2016 and 30 April 2018. 258 patients were included in the analysis. Patients were categorised depending on different variables including age, sex, site of injury, diagnosis, length of admission and treatment using SPSS.

RESULTS

 In the 19-month study period, 258 patients with ITP-related injuries were recruited. Single ITP-related injuries were diagnosed in 250 (96.9 %) patients. The median age of this group was 22 years (IQR 15-28). 126 (50.4 %) injuries were suffered by men and 124 (49.6 %) by women. 168 (67.2 %) injuries occurred in the lower extremity. Sprains (n = 114, 45.6 %) and fractures without joint dislocation (n = 59, 23.6 %) were the most common diagnoses. Males suffered significantly more often from injuries of the upper extremity (26.2 vs. 9.7 %; p = 0.010), while females most commonly suffered from injuries of the lower extremity (79.8 vs. 54.8 %; p < 0.001). 45 (18 %) patients required hospital admission and twenty-five (10.0 %) patients required surgery. Eight (3.1 %) patients suffered from injuries in more than one anatomic location.

CONCLUSIONS

 ITP-related injuries were more prevalent in adults compared with children. The lower limb was the most affected anatomic location in all ages. The pattern of the injuries was heterogeneous, and their respective treatment represents a major challenge for traumatology surgeons.

Staying Safe This Summer

The arrival of summer brings more sunshine, more time outside, and more opportunities for recreation and play. Although these activities may look a little different this summer as a result of the coronavirus disease 2019 (COVID-19) pandemic, they also allow us to get outside, interact safely with others, and remain connected to our friends and communities. Along with fun activities and exercise, there also comes a need for heightened awareness of summertime safety. Because so many childhood activities occur during the summer, precautions must be taken to ensure the safety and health of our children. From appropriate sun protection and water safety to insect exposure and recreational precautions, it is important to review key safety points to ensure a happy and healthy season. As the COVID-19 pandemic is still very active, there will also be an added layer of complexity to staying safe this summer, including adapting activities to meet the guidelines of social distancing. This article addresses some of the most common dangers encountered during the summer months and offers protective measures to decrease risk and promote safety. [Pediatr Ann. 2020;49(7):e285-e289.].

Pediatric sternal fractures: A single center retrospective review

PURPOSE

We sought to investigate the diagnosis, management, and outcomes of pediatric sternal fractures.

METHODS

We used ICD codes to search our trauma registry and Hound Dog software to search the hospital data warehouse for all cases of radiologically confirmed sternal fracture in patients <21 years from January 1, 1997 to July 1, 2017. We extracted demographics, mechanism of injury, diagnostic modality, associated injuries, and clinical outcomes.

RESULTS

We identified 65 children with sternal fractures. 46/65 (71%) were male, with median age 11 years. 34/65 (52%) presented to our emergency department (ED) and the remainder to outpatient clinics. 41/65 (63%) were diagnosed by chest X-ray, 11/65 (17%) by chest CT, 7/65 (11%) by sternal X-ray, and 5/65 (8%) by MRI. Mechanism of injury varied by age. The majority, 50/65 (77%), were isolated injuries and there were no cardiac injuries, aortic injuries or deaths. 18/33 (45%) of those who presented initially to the ED were admitted, and of these 7/18 (39%) had isolated sternal fractures.

CONCLUSIONS

In this series, most sternal fractures were isolated with low morbidity. Sternal fracture alone should not prompt aggressive workup for intrathoracic injuries and stable patients with isolated sternal fractures can be safely followed without admission.

LEVEL OF EVIDENCE

IV.

Health Supervision for People With Achondroplasia

Achondroplasia is the most common short-stature skeletal dysplasia, additionally marked by rhizomelia, macrocephaly, midface hypoplasia, and normal cognition. Potential medical complications associated with achondroplasia include lower extremity long bone bowing, middle-ear dysfunction, obstructive sleep apnea, and, more rarely, cervicomedullary compression, hydrocephalus, thoracolumbar kyphosis, and central sleep apnea. This is the second revision to the original 1995 health supervision guidance from the American Academy of Pediatrics for caring for patients with achondroplasia. Although many of the previously published recommendations remain appropriate for contemporary medical care, this document highlights interval advancements in the clinical methods available to monitor for complications associated with achondroplasia. This document is intended to provide guidance for health care providers to help identify individual patients at high risk of developing serious sequelae and to enable intervention before complications develop.

Demographic changes in US trampoline-related injuries from 1998 to 2017: cause for alarm

BACKGROUND

Recreational sports facilities with trampolines have become increasingly popular, and trampoline-related injuries incurred have been increasing. The goal of this study was to determine impact of recreational sports facilities on trampoline-associated injuries.

METHODS

An epidemiological study was performed using data from the National Electronic Injury Surveillance System (NEISS). All patients in the NEISS database coded for trampoline injury were included. Statistical analyses were performed comparing home trampoline injuries (HTIs) and recreational sports facilities-related trampoline injuries (RSIs) for standard demographic variables using appropriated weighted statistical methods.

RESULTS

There were an estimated 1 376 659 emergency department (ED) visits for trampoline related injuries from 1998 to 2017; 125 811 were RSIs and 1 227 881 were HTIs. Between 2004 and 2017, the number of RSIs increased rapidly, while HTIs decreased. RSIs more often presented to large hospitals and HTIs to smaller ones. Strain/sprains were more associated with RSIs, whereas HTIs sustained more internal organ injuries. Lower extremity fractures occurred more frequently in RSIs and upper extremity fractures in HTIs. There was a greater percentage of RSIs in 15-34 years old age group (28.2% vs 13.6%). There were no differences by gender and race between HTIs and RSIs.

CONCLUSIONS

The rapid expansion in recreational sports facilities with trampolines coincided with increasing RSIs. RSIs differed from HTIs regarding changes over time, hospital size, diagnosis and injury location. Recreational sports facilities with trampolines pose a public health hazard.

Treatment and outcomes of distal tibia salter harris II fractures

BACKGROUND

Distal Salter-Harris (SH) II fractures of the tibia are common injuries in the pediatric population. The purpose of this study is to evaluate our treatment and outcomes of SH II fractures of the distal tibia.

METHODS

The study was approved by the medical school's institutional review board (IRB). Fifty-one distal tibia SH type II fractures were treated from 2003 to 2017. We performed a retrospective review of all patients. Patients with displacement less than 3 mm, on x-ray, were treated with a cast. Patients with displacement greater than or equal to 3 mm displacement were initially treated with closed reduction in the emergency department with conscious sedation. Patients were also categorized based on the mechanism of injury and complications were noted. Patients were followed for an average of 4 months (range, 4 weeks-28 months).

RESULTS

Fifty-one patients, 28 females and 23 males, were included in the study, with a mean age of 9.4 years (range, 13 months-13 years) at presentation. The most common mechanism of injury was participation in sports (43%). Out of the 51 patients, 45 were minimally displaced and treated with cast. Six displaced fractures were treated with closed reduction. The mean displacement in the closed reduction group at presentation was 5.7 (range, 3- 8.8) mm. Five out of 6 patients had reduction to less than 3 mm. The overall complication rate was 1 out of 51 patients, 2%. When examining displaced fractures, the complication rate was 1 out of 6 patients, 17%.

CONCLUSION

Most SH II fractures of the distal tibia are minimally displaced and do not need a reduction. 6/51 cases (12%) in the current study were displaced and were indicated for a reduction. Displacement greater than or equal to 3 mm can be treated with closed reduction followed by a cast; if closed reduction fails, open reduction is indicated. Displaced fractures have a small risk of growth arrest.

A retrospective review of trampoline-related injuries presenting to a paediatric emergency department in Singapore

INTRODUCTION

Trampolining is a popular activity. However, to our knowledge, no studies on paediatric trampoline-related injuries (TRIs) have been conducted in Asia. We aimed to provide an Asian perspective on paediatric TRIs and evaluate current safety measures.

METHODS

Patients aged under 16 years who presented to the emergency department at KK Women's and Children's Hospital, Singapore, from March 2012 to June 2016 with a TRI were identified from the National Trauma Registry. Data was collated retrospectively focusing on age, location of the trampoline, mechanism and location of injury, treatment, disposition, and follow-up treatment.

RESULTS

137 children were seen for a TRI during this period. There was even representation across age groups (< 6 years, 6-11 years and 11-16 years). 60.6% of these injuries occurred in a public trampoline park, and a smaller proportion involved home and school trampolines. 61.3% of injuries occurred on the trampoline and 25.5% involved a fall off it, while the remaining were incurred by hitting the trampoline frame. The most common injury was soft tissue injury, followed by fractures and dislocations, of which 16.7% required surgical intervention. Most patients were discharged to an outpatient clinic. 14.6% of all patients required admission and 9.5% eventually required surgical intervention. There were three stable head injuries and no cervical spine injuries or deaths.

CONCLUSION

The existence of trampoline parks has contributed to a rise in TRIs. We recommend measures such as general education, changes in the setup around the trampoline, increasing the age limit for trampolining, adult supervision and discouraging double bouncing.

Radiological trends in trampoline-related paediatric injuries in a major paediatric trauma centre: a 6-year experience

Aim

Review of visits to the radiology department related to trampoline injuries in a major trauma centre in the UK over a 6-year period, and analysis of imaging performed, injury type, and seasonal trends in children under 18 years of age.

Subject and methods

Retrospective review of the Radiology Information System (RIS) for requests and reports between January 2012 and December 2017 containing the search term “tramp*” with an age of < 18 years.

Results

A total of 1794 children (44% male, mean age 8.15) visited the radiology department 1871 times and received 2343 separate radiographic examinations, ten ultrasound examinations, 20 CT examinations, 19 MR examinations and two nuclear medicine examinations. Seven hundred and eighty-eight children (45.9% male) had injury demonstrated on radiographs (622 fractures and 183 soft-tissue injuries) during 796 visits to radiology. Positive CT, MRI, and US were seen in 55%, 47.3%, and 50% of cases respectively. Children under 7 years of age are more likely to have been injured compared to older children attending for X-rays, with the proportion of injuries seen in 6-year-old children being the highest (63.7%). Trampoline injury-related X-ray requests to radiology rose from 1.7% to 4% per year as a percentage of overall X-ray requests from the emergency department.

Conclusion

Trampoline injury-related visits to the radiology department and the number of injuries demonstrated on imaging studies have increased over the study period, putting greater pressure on the healthcare system. Younger children are especially prone to injury. Public health campaigns and mandatory national safety standards are needed to increase awareness of potential dangers of recreational trampoline use.

Are safe guards at trampoline parks safe enough?: A case report on a complete spinal cord injury after diving into a trampoline park foam pit

RATIONALE

Recently, commercial indoor trampoline parks have been opened around the globe, and both the number of venues and the park users are increasing. Academic literatures have largely focused on home trampoline related injuries, and less is known about the injuries associated with trampoline parks due to the limited number of studies or cases reported. In this report, we present a complete spinal cord injury sustained at a commercial indoor trampoline park.

PATIENT CONCERNS

A 26-year old male developed tetraplegia after plainly jumping on the trampolines and diving into one of the foam pits head first.

DIAGNOSIS

C-spine CT revealed bilateral interfacetal dislocation on C6-7, and his C-spine MRI showed anterior translational injury at C6-7 with severe cord encroachment and complete discoligamentous complex disruption. He was diagnosed with complete spinal cord injury.

INTERVENTIONS

The patient underwent 30 minutes each of physical therapy and occupational therapy twice a day for a total of 25 days of in-patient rehabilitation. Interventions included tilt table, passive range of motion exercises, functional electrical stimulation, sitting balance training, upper extremity strengthening exercise, and hand manipulation exercises.

OUTCOME

Despite intensive rehabilitation and the patient's good spirit, there was no functional change in all physical examinations between evaluations at initial and at discharge.

LESSONS

In conclusion, we aim to alert the risks associated with improper use of trampolines, promote safer entertainment environment, and aid in developing mandatory safety measures. We hope to alert the risks associated with improper use of trampolines, promote safer entertainment environment, and aid in developing mandatory safety measures.

COMPARISON OF BUNGEE-AIDED AND FREE-BOUNCING ACCELERATIONS ON TRAMPOLINE

Trampolines remain the single best apparatus for the training of aerial acrobatics skills.  Trampoline use has led to catastrophic injuries from poor landings.  Passive injury prevention countermeasures such as specialized matting have been largely ineffective.  Active injury countermeasures such as hand spotting, “throw-in” mats, and overhead spotting rigs provide the most effective methods.  The recent addition of several bungee cords between the ropes and the gymnast’s spotting harness has resulted in altered teaching and coaching of trampoline-related acrobatics.  Bungee cords have eliminated the need for a coach/spotter to manage the ropes during skill learning.  The purpose of this study was to assess the influence of the addition of bungee cords with a traditional rope-based overhead spotting rig.  There is a paucity of any research involving trampoline injury countermeasures.  Ten experienced trampoline acrobatic athletes (5 males, 5 females) from the U.S. Ski and Snowboard Association Aerials National Team performed 10 bounces as high as they could control.  A triaxial accelerometer (200 Hz) characterized 10 bungee cord aided bounces and 10 free-bounces on a trampoline from each athlete.  Bed contact times, peak accelerations, and average accelerations were obtained.  The results supported our hypotheses that the bungee-aided bounces achieved only 40% (average) to 70% (peak) of the free-bouncing accelerations (all ρ < 0.001 and all ƞ2partial >0.092).  The bed contact time was approximately 65% longer during the bungee-aided bounces (ρ < 0.001).  Bungee cords may reduce the harshness of landings on trampoline.

Buckle fracture of the proximal tibia in children and frequency of association with trampoline and inflatable bouncer use

BACKGROUND

Proximal tibial buckle fractures are often called "trampoline fractures," but mechanisms are more varied.

OBJECTIVE

To assess the frequency of trampoline or bouncer etiology among children with buckle fracture of the proximal tibia, characterizing demographics, alternative etiologies, and fracture patterns.

MATERIALS AND METHODS

We performed retrospective chart review of mechanisms, age and gender of children with radiographs interpreted as proximal tibial buckle fracture between 2010 and 2016. Two pediatric radiologists assessed presence of cortical impaction, cortical break, increased anterior scoop deformity, and oblique extension of fracture toward the physis. We studied the associations among demographics, etiology and fracture appearance using analysis of variance and chi-square/Fisher exact tests.

RESULTS

We identified 145 exams interpreted as proximal tibial buckle fracture (median age 34 months, 64% girls). Bouncing surface was the most common mechanism (44%), and 80% of those cases reported multiple people on the bouncing surface. Falls were the second most common mechanism (30%). Children injured while bouncing were older (median 41 months) than others (median 21 months, P<0.005) and more likely to have oblique extension of fracture toward the physis (P<0.05). Buckle deformity was associated with a younger age (F=8.67; P<0.01), while oblique extension to the physis and concurrent fibula fracture were associated with older age (F=18.62, P<0.001; and F=8.02, P<0.01, respectively).

CONCLUSION

Trampoline use was the most common single mechanism of injury in children with proximal tibial fracture interpreted as buckle deformity. However, non-bouncing mechanisms were overall more common and occurred in a younger age group at risk for "toddler fractures."

Characteristics and trends of traumatic injuries in children visiting emergency departments in South Korea: A retrospective serial cross-sectional study using both nationwide-sample and single-institutional data

We investigated the incidences and characteristics of pediatric traumatic injuries requiring emergency department visits, through a complementary approach using both nationwide-sample and single-institutional data. Data for children (aged <15 years) identified with traumatic injuries during a 10-year period from the Korean National Health Insurance Sharing Service (n = 35,064 among 10,114,909 randomly sampled cases from the claim records of the National Health Insurance) and the authors' institute (n = 39,228) were retrospectively reviewed. The incidences and characteristics of the injuries were investigated using both datasets; additionally, detailed information regarding the injury environments was investigated using the single-institutional data. The findings were similar across both datasets. The incidence of injuries increased during the study period; the head was most commonly injured, whereas the trunk or proximal extremities were rarely injured; low-energy head injuries accounted for >50% of the cases in children aged <5 years, although the incidences of lower-extremity injuries and fractures increased in older children. Single-institutional data demonstrated that the proportion of indoor playground and trampoline-related injuries increased rapidly during the study period, and outdoor injuries and seasonal variation (with peak incidences in May and June) were more prominent in older children. Based on similarities between both datasets, the detailed results regarding pediatric traumatic injuries obtained from the single-institutional data could be generalized nationally with adequate external validity. To prevent traumatic injuries, it may be more effective to wear protective equipment covering the head and distal extremities rather than the trunk or proximal extremities; simple clothing, such as caps, could prevent many injuries in preschoolers. Among older children, safety guidelines for outdoor sports/leisure activities are needed. The increase in pediatric traumatic injuries may be partially explained by the increased availability of indoor playgrounds and installation of trampolines. Stricter adherence to the preventive guidelines is needed.

Trampoline injuries compared with other child activities

INTRODUCTION

Trampolines are responsible for specific injuries. We examined the severity of these injuries in children compared with those occurring in other activities. Our primary goal was to compare the injury severity between trampolining and other activities. Our secondary goal was to evaluate risk factors for severity in order to establish preventative measures and, third, to evaluate the increased prevalence of these injuries in our hospital from 2008 to 2016.

MATERIAL AND METHODS

Our study was a retrospective, comparative, descriptive, and epidemiological research. Children aged 2-15 years admitted to our traumatology emergency services between June and October 2016 were included in the study. Non-sport-related injuries were excluded. Serious injuries were classified as fractures and admissions to the operating room.

RESULTS

In total, 1106 children were admitted including 107 trampoline accidents. The fracture rate was similar in the two groups: 34 (31.78%) vs. 309 (30.93%), OR=1.039, 95% CI [0.65, 1.62] P=0.91. Surgical treatments were more frequent in the trampoline group: 4 (3.74%) vs. 18 (1.80%) OR=2.114, 95% CI [0.51, 6.58] P=0.156. Several people jumping simultaneously on the trampoline was a risk factor (OR=1.56, 95% CI [1.0908, 2.308], P=0.018). Parental supervision was a protective factor (OR=0.271, 95% CI [0.08, 0.80], P=0.023). Trampolining accidents were 9.7 times more common in our center in 2016 compared with 2008.

DISCUSSION

To our knowledge, no study has compared trampoline injuries with those stemming from other activities. Awareness campaigns are needed as well as information from sellers, who have to be trained.

CONCLUSION

Surgical treatments are twice as likely in trampoline accidents. Prevention is simple: Children should be alone on the trampoline and supervised by an adult.

Effect of 12-Week Rebound Therapy Exercise on Static Stability of Patients With Spinal Cord Injury

Background: To resolve the impairments associated with spinal cord injury (SCI), such as decreased balance, patients have been recommended to undergo various therapeutic strategies, including the use of different physical exercise methods. The aim of this study was to evaluate the efficiency of using rebound therapy (exercise on a trampoline) on SCI individuals' static stability. Methods: Sixteen people with SCI (American Spinal Cord Association classification: A = 6, B = 6, C = 2, and D = 2) were randomly assigned to an experimental (rebound exercise) group or a control group. The rebound therapy exercise program, lasting 12 weeks, was performed by means of a modified trampoline. During the said period, the experimental group received rebound therapy exercise for 10 to 30 minutes 3 sessions a week. Standing stability parameters (ie, excursion, velocity, and path length of the center of pressure in mediolateral and anteroposterior plane) were assessed before and after the exercise intervention by Kistler force plate (50 × 60 cm). Data were analyzed by repeated measures analysis of variance. Results: Significant interactions were observed for all 6 dependent variables except excursion of the center of pressure in mediolateral and the path length of center of pressure in anteroposterior plane (P < .01). This means that the control group had no progress, whereas the experimental group made a significant improvement in terms of static stability. Conclusion: The results of this study confirmed that rebound therapy could reinforce the static stability of individuals with SCI during motionless standing. It suggests that rebound exercise is a useful sports rehabilitation method for patients with SCI and other wheelchair-bound individuals.

Varus shearing force is a main injury mechanism of pediatric trampoline-related injury in addition to compressive axial loading

Background

Many case studies have been published about trampoline-related injury (TRI); however, a comparative study could allow a more specific analysis of the characteristics of TRI, and enable more differentiated approaches to prevent such injuries. We investigated the injury mechanism of TRI in children compared with other pediatric trauma.

Methods

Of 35,653 children (age 0–18 years) who visited the pediatric emergency department after traumatic injuries from January 2011 to June 2017, 372 patients with TRI (TRI group) were retrospectively identified. Among the remaining 35,281 patients with other trauma (non-TRI group), 372 were 1:1 matched to the TRI group according to sex, age, injured body part, and body weight (matched-control group). The patients’ data, injured site, and injury patterns were compared between the groups.

Results

The most frequently injured body part was the knee/lower leg in the TRI group and the head in the non-TRI group. The most frequent injury types were fractures in the TRI group and open wounds in the non-TRI group. In the comparison between the TRI and matched-control groups, the most common lower-extremity fractures were proximal tibial fractures with varus angulation in the TRI group and tibial shaft spiral fractures in the matched-control group. For the upper extremities, the risk of lateral condylar humeral fracture was higher in the TRI group. The TRI group presented more physeal involvements.

Conclusions

The risks of varus stress injury (proximal tibial fracture with varus angulation in lower extremity and lateral condylar humeral fracture in upper extremity) were higher in the TRI group than in matched-control group. Thus, varus shearing force seems to be an important injury mechanism in TRI in addition to compressive force. This varus force may increase the risk of physeal injury by generating additional shear force on the physis.

Trampoline Park Injuries and Their Burden on Local Orthopaedic and Emergency Services

OBJECTIVE

To investigate the incidence of trampoline park injuries (TPIs) at a local recreational facility and to quantify the burden on emergency and orthopaedic services at our institute.

METHODS

All patients that presented to the Emergency Department (ED) from the trampoline park via ambulance from July 2014 to November 2015 were included in the study. Patients' medical records were reviewed for clinical details including date, location and type of injury, treatment received, length of stay and outpatient follow-up. A cost analysis was performed to estimate the financial impact of each injury.

RESULTS

A total of 71 patients were included in the study, with a mean age of 20 (7-48). Soft tissue sprains (n=29, 41%) and fractures (n=25, 35%) were the most common injuries, with the majority occurring in the lower limb. Two patients sustained open tibial fractures necessitating transfer to level 1 trauma centres. Fourteen patients (20%) underwent surgery, predominantly requiring open reduction and internal fixation. Overall, 18 patients (25%) required admission to hospital with mean length of stay of 2 days. The cost for pre-hospital, emergency and in-patient care amounted to over £80,000.

CONCLUSION

TPIs pose a significant financial cost for local orthopaedic and emergency services. Contrary to studies evaluating home trampoline injuries, the majority of fractures at trampoline parks occurred in the lower limbs. Improved injury prevention strategies are required to help reduce morbidity and lower the financial implications for local NHS trusts.

The ups and downs of trampolines: Injuries associated with backyard trampolines and trampoline parks

Objective

To compare characteristics associated with backyard trampoline injuries (BTI) and trampoline park injuries (TPI) using records from the electronic Canadian Hospitals Injury Reporting and Prevention Program (eCHIRPP).

Methods

eCHIRPP records for trampoline injuries (2012 to 2016) were extracted using variable codes and narratives, and injuries were examined among individuals 17 years and younger. Descriptive estimates for BTI and TPI, as well as age and sex adjusted odds ratios (OR) for the mechanism, source, body part and type of injury associated with TPIs relative to BTIs, are presented.

Results

Trampoline injuries are increasing in Canada (P<0.01). Patients with TPIs were older than those with BTIs. Relative to BTIs, TPIs were more associated with impact as the mechanism (OR 2.6, 95% CI: 2.2 to 3.1), trampoline beds as the source (OR 1.7, 95% CI: 1.4 to 2.1), lower extremity as the body part (OR 3.7, 95% CI: 3.0 to 4.4) and sprains as the type of injury (OR 2.0, 95% CI: 1.6 to 2.4). In contrast, another jumper (OR 0.5, 95% CI: 0.4 to 0.6) or fall (OR 0.4, 95% CI: 0.4 to 0.6) as the mechanism, surface (OR 0.7, 95% CI: 0.5 to 0.9) or another jumper (OR 0.5, 95% CI: 0.4 to 0.7) as the source, face or neck (OR 0.6, 95% CI: 0.4 to 0.7) as the body part, and lacerations (OR 0.6, 95% CI: 0.3 to 0.9) or soft tissue injury (OR 0.7, 95% CI: 0.6 to 0.9) as the type of injury were more associated with BTIs relative to TPIs.

Conclusion

Trampoline parks result in injuries different than those from backyard trampolines. This examination into the distinct injury characteristics can help to inform future prevention measures.

Children bouncing to the emergency department: Changes in trampoline injury patterns

AIM

To compare trampoline injuries and injury costs sustained at a commercial trampoline park versus private homes presenting to a major Australian children's hospital over a 12-month period.

METHODS

Children presenting with a trampoline injury to the paediatric emergency department in 2015 were identified using a keyword search of triage information. A comparison of injuries sustained at a commercial trampoline park and private homes was performed.

RESULTS

A total of 392 children presented with injuries, and the majority of injuries (68.9%) occurred at a private home; 19.4% were from a commercial trampoline park. Significant differences were seen between patients from a private home and commercial park for median age (5.6 vs. 12.8 years; P < 0.001), gender (48.2 vs. 61.8% female; P = 0.03) and season of injury. Of the injuries, 27.3% occurred when children fell off the trampoline, and fractures (39.5%) were the most common injury; 17.4% required hospital admission, and 12.8% required surgical intervention. Commercial park injuries had a significantly longer median length of stay (37.4 vs. 22.8 h; P = 0.03). The estimated total acute cost for these trampoline injuries in 1 year was $546 786. Commercial trampoline park injuries accounted for 21.7% of the estimated cost and private homes for 68.2%.

CONCLUSIONS

Paediatric trampoline injuries remain a common source of hospital presentation and admission, despite the introduction of a Voluntary Australian Standard. Paediatric trampoline injuries usually occur in private homes; however, the increasing popularity of commercial trampoline parks contributes to a change in the profile of trampoline injuries. Commercial park injuries were more expensive to treat.

Rapidly growing pediatric trampoline-related injuries in Korea: a 10-year single center retrospective study

Purpose

Several published policy statements have warned against the risks associated with trampoline use and recommended safety guidelines. However, few studies have focused on trampoline-related injuries in Korea. This study aimed to assess the incidence and characteristics of pediatric trampoline-related injuries presented to Ulsan University Hospital.

Methods

We retrospectively reviewed the medical records of children aged <16 years with trampoline-related injuries who visited our Emergency Department between 2008 and 2017.

Results

Over the 10-year period, 178 trampoline-related injuries were reported, which represented a significant increase (P=0.016). Most (87.6%) of the injuries occurred during the last 5 study years, and a rapid increase in injuries was observed in children aged <6 years. Lower extremity injuries (62.4%) were the most common, followed by injuries of the upper extremities, head and face, and trunk, including injuries to the neck and spine. Sixty-seven children (37.6%) had fractures, and proximal tibia fractures were the most common. Fractures were significantly more common in younger children (<6 years old) than in older children (P=0.026).

Conclusion

In Korea, the mechanism of trampoline injury is similar to that of injuries incurred in indoor trampoline parks but is characterized by smaller spaces and multiple users. Trampoline use and the incidence of trampoline-related injuries in children aged <6 years are increasing rapidly. Prohibiting the use of trampolines for children aged <6 years, restricting simultaneous use by multiple children, and ensuring adult supervision should be strictly emphasized. Public awareness and policy guidelines are needed to reduce the incidence of trampoline-related injuries.

Pediatric Trampoline-Related Injuries in a Nationwide Registry in South Korea, 2011 to 2016

PURPOSE

Trampoline-related injuries are steadily increasing. To our knowledge, there have been very few studies on trampoline injuries in Asia. The purpose of this study is to report the characteristics of pediatric trampoline injuries in Korea.

MATERIALS AND METHODS

We conducted a nationwide retrospective cohort study. Data were collected from prospective nationwide databases (Emergency Department-based Injury In-depth Surveillance databases of the Korea Centers for Disease Control and Prevention) for patients who visited emergency departments (EDs) after injuries during 2011-2016.

RESULTS

Of 263712 patients between 0 and 17 years of age, 2799 patients with trampoline injuries visited EDs. The median age of the patients was 5 years (interquartile range, 3-8 years), and 63% of the patients were under 6 years old. Of the patients, 1526 (54.2%) were male. Seventy-six percent of injuries occurred at trampoline parks. Trampoline injuries and trampoline park injuries have increased steadily, while ages at injury have gradually decreased year by year (p<0.001). Injury locations included the lower extremity (47%), head and face (24%), and upper extremity (24%). A fracture was sustained by 886 (31.7%) patients. The distal humerus and proximal tibia were the most common fracture sites (34% and 23%, respectively). Fractures occurred more commonly in trampoline parks than in homes (33.7% vs. 21.1%, p<0.001).

CONCLUSION

In Korea, pediatric trampoline injuries and trampoline park injuries have tended to increase, while ages at injury have tended to decrease. Policies to prevent trampoline injuries are needed.

Trampolines: What's the Harm?

Trampolines hold the promise of fun and enjoyment for many children, but they are associated with a significant number of orthopedic and other injuries. Injuries vary from minor to severe, and the most common are extremity injuries. Although most injuries are associated with residential (ie, backyard) trampolines, a growing number of injuries now occur in trampoline parks. Adult supervision has not been effective for prevention. Emerging data on trampoline park-related injuries indicate that caution should be exercised in these settings as well. [Pediatr Ann. 2018;47(10):e385-e387.].

Single-Use Detergent Sacs: A Retrospective Multicenter Canadian Review of Emergency Department Cases

BACKGROUND

Single-use detergent sacs (SUDS) are widely used in North America and Europe with emerging literature on their toxicity. This is the first Canadian multicenter study aimed to quantify and compare SUDS exposures to traditional detergent exposures.

METHODS

A retrospective review of the Canadian Hospitals Injury Reporting and Prevention Program databases was conducted at the Hospital for Sick Children in Toronto, Alberta Children's Hospital in Calgary and the Stollery Children's Hospital in Edmonton. All exposures presenting to these 3 centers between 2009 and 2014 were identified, a case form was completed, and data were analyzed.

RESULTS

Forty cases of SUDS exposure were identified alongside 35 cases of traditional detergent exposure during the study period resulting in an incidence of 3.16 SUDS exposures per million children per year presenting to tertiary pediatric emergency departments (EDs). In contrast, traditional detergent exposures had an incidence of 2.78 exposures per million children per year presenting to tertiary pediatric EDs over the study period. Although there was no change in incidence of exposure to traditional detergent over the study period, there was an increase in the incidence of SUDS exposures from 2010 to 2013, with a decrease seen in 2014. There was no significant difference seen in age, sex, location of exposure, transportation to hospital, morbidity, or mortality associated with SUDS exposures compared with traditional detergent exposure. Although not statistically more likely to cause long-term complications, SUDS-exposed children required more follow-up visits to health care providers than traditional detergents.

CONCLUSIONS

This multicenter study is the first to establish the incidence of SUDS and traditional detergent exposure in 3 Canadian cities. Overall, the frequency of exposure to detergents-both traditional and SUDS-is very low. Given the increase in SUDS exposure seen from 2011 to 2013, alongside larger sales of SUDS, continued efforts are required to monitor exposures, and reduce potential exposures to SUDS and traditional detergents in the future.

Are inflatable play structures really safe for our children?

PURPOSE

The frequency of injuries sustained while playing on inflatable toys such as bouncy castles have rapidly increased. These supposedly safe structures are likely unsafe. The objective of this review was to investigate the risk that these attractions represent and the necessary measures to minimize risk of accidents.

METHODS

We conducted a prospective study of 114 patients over a period of one year (2015 to 2016). Demographic data collected included: age, gender, anatomical location and side of involvement as well as supervision of the child whilst on the bouncy castle. The extracted data include mechanism of injury and risk factors, i.e. lack of supervision of the child, amounts of users jumping at the same time.

RESULTS

The injuries were slightly more frequent in male than female children; 2:1 up to six years of age. From the age of ten to 14 years the ration evened to 1:1, the higher incidence in female children was between the ages of six to eight years.The most common injuries were to the humerus, followed by the distal radius. Only 28% of the parents said they were supervising while the child was jumping.

CONCLUSION

Injuries associated with inflatable bouncers have increased over time. The main risk factors: were lack of effective adult supervision and the shared use by an excessive number of participants of different ages and weights.These considerations lead to the conclusion that there is a necessity to enhance child health surveillance and to consider limiting bouncer usage to children over the age of six years, to prevent and control injuries and to minimize their consequences.

LEVEL OF EVIDENCE

II - prospective study.

Pediatric falls ages 0-4: understanding demographics, mechanisms, and injury severities

Background

Pediatric unintentional falls are the leading cause of injury-related emergency visits for children < 5 years old. The purpose of this study was to identify population characteristics, injury mechanisms, and injury severities and patterns among children < 5 years to better inform age-appropriate falls prevention strategies.

Methods

This retrospective database study used trauma registry data from the lead pediatric trauma system in Georgia. Data were analyzed for all patients < 5 years with an international classification of disease, 9th revision, clinical modification (ICD-9 CM) external cause of injury code (E-code) for unintentional falls between 1/1/2013 and 12/31/2015. Age (months) was compared across categories of demographic variables, injury mechanisms, and emergency department (ED) disposition using Kruskal-Wallis ANOVA and the Mann Whitney U test. The relationships between demographic variables, mechanism of injury (MOI), and Injury Severity Score (ISS) were evaluated using multinomial logistic regression.

Results

Inclusion criteria were met by 1086 patients (median age = 28 months; 59.7% male; 53.8% White; 49.1% <  1 m fall height). Younger children, < 1-year-old, primarily fell from caregiver’s arms, bed, or furniture, while older children sustained more falls from furniture and playgrounds. Children who fell from playground equipment were older (median = 49 months, p < 0.01) than those who fell from the bed (median = 10 months), stairs (median = 18 months), or furniture (median = 19 months). Children < 1 year had the highest proportion of head injuries including skull fracture (63.1%) and intracranial hemorrhage (65.5%), 2-year-old children had the highest proportion of femur fractures (32.9%), and 4-year-old children had the highest proportion of humerus fractures (41.0%). Medicaid patients were younger (median = 24.5 months, p < 0.01) than private payer (median = 34 months). Black patients were younger (median = 20.5 months, p < 0.001) than White patients (median = 29 months). Results from multinomial logistic regression models suggest that as age increases, odds of a severe ISS (16–25) decreased (OR = 0.95, CI = 0.93–0.97).

Conclusions

Pediatric unintentional falls are a significant burden of injury for children < 5 years. Future work will use these risk and injury profiles to inform current safety recommendations and develop evidence-based interventions for parents/caregivers and pediatric providers.

Electronic supplementary material

The online version of this article (10.1186/s40621-018-0147-x) contains supplementary material, which is available to authorized users.

Do Professional Society Advocacy Campaigns Have an Impact on Pediatric Orthopaedic Injuries?

PURPOSE

The American Academy of Orthopaedic Surgeons (AAOS) and the American Academy of Pediatrics (AAP) both advocate for childhood injury prevention by publishing recommendations to orthopaedic surgeons, pediatricians, and the public. Popular topics of advocacy campaigns have included trampolines, all-terrain vehicles (ATVs), and lawnmowers. The purpose of this study was to investigate the temporal relationship between AAOS/AAP advocacy and pediatric orthopaedic injury rates, using these topics as examples. We hypothesized that pediatric orthopaedic injury rates decline in years, following related AAOS/AAP recommendations.

METHODS

A retrospective review of fractures associated with trampolines, lawnmowers, and ATVs among patients aged 2 to 18 years from 1991 to 2014 was performed using the National Electronic Injury Surveillance System (NEISS). Fracture rates and percent changes year-to-year were calculated. A timeline of AAOS and AAP advocacy statements published on the products was created.

RESULTS

Trampoline-related fractures rose 14% yearly from 1991 to 1999, reached a plateau from 1999 to 2003, corresponding with a 1999 AAP statement. Injury rates dropped 4.3% from 2006 to 2010 after 2005 and 2006 statements, and reached another plateau thereafter, as 2010 and 2012 statements were published. ATV-related fractures rose 14% yearly between 1997 and 2002, then dropped 15% from 2007 to 2010 following yearly AAP or AAOS statements from 2004 to 2007. From 2010 to 2014, the injury rate held constant during which time 2010, 2013, and 2014 statements were published. Lawnmower injury rates did not fall despite statements in 1998 and 2001 and a poster campaign in 2001. A 25% drop from 2007 to 2008 coincided with an AAOS statement in 2008. Fracture rates further dropped 31% from 2009 to 2011 and 21% from 2012 to 2014, amidst 2012 and 2014 statements. For ATV-related and lawnmower-related injuries, more male individuals were affected than female individuals, and for ATVs alone, injury rates increased with age.

CONCLUSIONS

Although AAOS/AAP statements did not universally coincide with dropping fracture rates, statements often were associated with substantial decreases in following years. This is likely because injury prevention messages are dispersed from providers to the public over time and outcomes depend on highly variable patient behaviors.

LEVEL OF EVIDENCE

Level V-systematic review of descriptive data.

Parental Knowledge of Trampoline Safety in Children

OBJECTIVE

Recreational trampoline use is increasing in popularity, with a resulting increase in significant trampoline-related injuries in children. Parents are the best advocates for the safety of their children during recreational trampoline use. Our primary objective was to determine the proportion of parents who were aware of 5 key recommendations for safer recreational trampoline use in children.

METHODS

This was a cross-sectional survey of parents whose children presented to a tertiary care pediatric emergency department with an extremity injury. Survey questions were derived and validated using expert opinion, available literature, and pre- and pilot testing of questions on the target audience.

RESULTS

Of the 1415 enrolled parents, 654 (46.2%) had regular access to a trampoline and 125 (8.8%) of their children had a history of trampoline injury. A total of 116 (8.2%; 95% confidence interval, 6.8-9.6) parents were aware of all 5 key safety recommendations for home trampoline use. Specifically, the proportion of parents who reported knowledge of the requirement for active supervision, regularly inspected safety equipment, avoiding stunts, multiple jumpers, and use by children 6 years of age and older was 89.0%, 77.2%, 44.3%, 41.6%, and 18.3%, respectively.

CONCLUSIONS

Trampoline safety knowledge of the 5 key recommendations among parents was low, specifically with respect to recommended age, number of jumpers, and stunts. Because it is unlikely that use of recreational trampolines will decrease, a harm reduction approach that includes a public knowledge translation strategy of recommendations for safer home use of trampolines is necessary.