FRACTURES IN PAEDIATRIC SKATEBOARDERS AND ROLLERBLADERS

Abstract

The number of skate related injuries has seen a resurgence in the western world with almost 51000 patients in 1999 presenting to US hospitals with a skateboard related injury, almost 90% of these being male and almost 70% of these are orthopaedic related injuries. Protection , particularly wrist guards, elbow pads, knee pads and recognized helmets are all necessary in protecting the young child against orthopaedic injuries. However despite these physical barriers little training or supervision exists in adequately educating children as to the dangers of these devices. Having observed an increased number of referrals to our Accident and Emergency Dept with fractures sustained whilst roller-blading and skateboarding we set about prospectively evaluating the epidemiology and nature of such injuries. 100 successive referrals to the orthopaedic service as a result of roller/skate injuries were evaluated. Childs age, sex, time using apparatus, mechanism of injury, and whether the injury occurred in a dedicated skatepark or on the street was recorded. Whether the child was wearing any form of protective gear and what type was also recorded. The type of fracture and its treatment and follow up was evaluated. All results were recorded on standard excel spreadsheets and statistical analysis was performed using Instat statistics (Graphpad USA 2002). The Male to female ratio in street injuries was 1:1, whereas in ramp injuries 4:1. 60 injuries occurred on the street whereas 40 occurred whilst using the ramps. The mean age was 11.4yrs. The mean length of time using rollerblades/skateboards was 20 and 19 months for street and ramps respectively. The number of children wearing some form of protective gear shows only 20 children out of the 100 studied wore gear, of these 15 wore helmets only. The treatment initiated shows almost 80% of ramp related injuries required formal manipulation under general anaesthesia or open reduction and internal fixation, where as only 25% of street fractures required this form of treatment, The usage of ramps demonstrates an increased relative risk of 4.26 (95% CI 3.5–5.1) This study shows that skateboards and rollerblades still constitute a major component of childhood fracture admissions. Only 20% of children use some form of protective gear whilst skating, this needs to be addressed on a national level. The wearing of helmets whilst protecting the child against head injury do not prevent serious orthopaedic injuries. Wrist guards should be worn by all children skating as the fall onto outstretched hand still remains a childs defensive mechanism when thrown off balance. Almost 75% of all fractures involve the wrist or the forearm. We urge better education and a tighter supervision of children whilst skating. Dedicated skateparks should only be used by experienced and older children and they should at least be supervised during their first attempts at using the parks, 85% of ramp injuries occurred during first or second time users. A child using a skatepark particularily for the first time is three times more likely to sustain a fracture, and almost 4 and a half times more likely to require definitive surgical treatment of this fracture. This constitutes a huge orthopaedic burden as well as it’s associated morbidity and financial costs to the health service. Children should be encouraged to use limb protectors as well as helmets whilst skating and should be supervised more closely during their initial attempts.