Supracondylar fractures of the humerus (SCH) are the most common fractures sustained following a fall on an outstretched hand in healthy children, and one of the leading causes of hospital admission and surgical intervention. With increasing severity of injury, treatment options become more invasive and the potential for long lasting complications increases. The aim of this study is to examine the causes and circumstances surrounding SCH in public play spaces particularly to determine whether or not the playground equipment implicated in injurious falls is compliant with Canadian Standards Association (CSA) standards.

Children aged 6–12 years who sustained SCH while playing at a public play space between 2017 and 2019 were recruited from the paediatric orthopaedic clinic. Public playgrounds within a 50 km radius of the clinic were visited by research assistants. Using GPS coordinates from photographs taken by the children at the site of injury or play structures identified by the children using Google Maps, play structure type, dimensions, height of fall, and the type and depth of the surface material were collected from each site and compared to the relevant CSA standard.

Of the 89 SCH injuries reported during the recruitment period, 49 (55%) occurred on public play structures. Thirty-nine injury sites, representing 42 SCH cases, were accessible to conduct site visits and were included in the analysis. Thirteen children (31%) sustained Type One, 19 (45%) were Type Two, and 10 (24%) were Type Three SCHs. The mean child age at injury was 7.13 years. Of the 42 SCH cases, 37 sites had woodchips surfacing (88%); three had rubber (7%), one had cement (2%), and one had sand (2%). Of the 36 sites where woodchip depth measurements could be obtained, only seven (19%) met the minimum CSA depth. Out of the 42 SCH cases, 29 injuries (69%) involved upper body equipment (i.e. monkey bars or similar) and track rides. Fourteen of these 29 injuries (48%) occurred on structures that did not meet CSA standards for fall height. All rotating play structures had less than half of the required clearance between the components.

Eighty-six percent of SCH cases occurred in playgrounds where at least one of the required CSA standards was not met. Woodchip surfacing was of particular concern because 81% of woodchip surface depths failed to meet CSA standards. Of the 14 injuries where fall height did not meet CSA standards, 11 (79%) also did not meet minimum CSA surface depth. Field investigation into the characteristics of playgrounds in which children sustain SCH can guide preventative policy and practice measures. Municipalities and school boards should be alerted to the need for regular maintenance of woodchip playground surfacing, in order to remain compliant with the minimum surface depth and prevent serious injuries. Additionally, compliance with minimum surface depths can also decrease fall heights to meet CSA standards. By minimizing the prevalence of SCH injuries occurring on play structures and the need for emergency department visits, the burden to healthcare systems and families of injured children can potentially be reduced.

Supracondylar fractures of the humerus (SCH) are the most common fractures sustained following a fall among children. The majority of these fractures are mild, but the most severe injury types can result in a disruption to the nerves and blood supply resulting in limb threatening injuries and potential life-long disability. Better understanding of mechanisms of injury and child-related factors that influence injury, especially for severe cases, is crucial to identifying best practices and informing policy. We aim to stratify fractures and examine the associated mechanisms and circumstances of injury to identify best practices and inform supportive policy. In doing so, we plan to investigate why some children sustain more severe fractures than others by exploring mechanisms and locations of injury, and risk-taking behaviours.

A prospective, mixed-methods pilot study employing a child-led research design. Our approach links narratives from qualitative photo elicitation interviews (PEI) to mapped images of the locations of injury using geotagged photographs children have taken themselves, complications and injury outcomes, and an assessment of overall risk-taking tendencies.

Participants aged six-12, with the help of their photographs, were able to lay out the events leading up to, including, and following their injury. Much of this information was either not included in their medical charts or was markedly different. Themes included not being able to prevent the injury and being adventurous, as well as becoming more cautious afterwards. These can have applications to the necessity of exploration as well as possibilities to prevent injury or not. Thus, the in-depth, first-person retelling of injury mechanism illustrated the need for mechanistic data and statistics beyond injury location alone. Risk-taking behaviours, as scored by the Sensation Seeking Scale for Children, correlated to injury severity, which is known to be associated with poorer outcomes and long-lasting complications.

PEI of children sustaining SCH fractures in Vancouver reveals mechanisms of injury beyond those previously reported in literature and suggest the feasibility of a large-scale study. PEI in this age group allows for clarifications and a clearer picture of injury mechanism as well as context of injury. These aspects significantly affect our ability to determine the relationship between injury mechanism and injury severity. Mixed-methods analysis of child-directed data as well as quantitative injury demographics reveals unique translational knowledge which can be shared with clinicians, patients/care-givers, community-based health teams, and local policy makers to make timely and impactful improvements in injury prevention, clinical practice, and play structure safety.