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Study Identifies Activities with Largest Number of Musculoskelatal Injuries Among Children

Bicycles, basketball, football and roller sports top the list

NEW YORK-Bicycles, basketball, football and roller sports top the list of eight recreational activities with the largest number of musculoskeletal injuries among children ages 5-14 years, a new study shows.

An estimated 2.2 million children's fractures, dislocations and soft tissue injuries related to these eight recreational activities were treated at U.S. hospital emergency rooms, doctor's offices and clinics in 2000, according to John M. Purvis, MD, speaking at the American Academy of Orthopaedic Surgeons "Orthopaedics Update" meeting. The cost of these injuries to society is an estimated $33 billion.

For the study, Dr. Purvis and colleague examined special new data supplied to the Academy by the U.S. Consumer Product Safety Commission.

"Leading the musculoskeletal injury list are bicycles with an estimated 415,000 injuries among 5- to 14-year-olds, followed by basketball with 407,000; football, 389,000; and roller sports, 297,000," said Dr. Purvis, clinical assistant professor, orthopaedic surgery and rehabilitation, University of Mississippi Medical School, Jackson, Miss. (See chart below)

Roller sports, which include inline skates, skateboards, scooters and roller skates, share many characteristics. "All have smaller diameter wheels, can achieve fairly high speed and are propelled by lower extremities," said Dr. Purvis. "Their maneuverability and stability depend on operator experience and development. The newer lightweight versions of foot-powered scooters with low friction wheels have been associated with a dramatic increase in injuries for the year 2000."

Fifth on the bone and muscle injury list is the playground with 284,000 injuries. Soccer is sixth with 185,000; baseball/softball is seventh, 160,000; and trampolines, eighth at 135,000.

Among more than 20 recreational activities, the greatest number of fractures occurred with bicycles, playgrounds and roller sports," said Dr. Purvis. "These three sports each had more than 125,000 fractures in the 5- to 14-year-old age group in 2000. Next in line was football, with more than 100,000 fractures."

Fractures related to soccer commonly involve the upper extremity, with wrist and finger fractures the most likely. Indoor soccer players have higher injury rates than outdoor soccer players.

The most common injury sites for children playing basketball are the ankle, hand and knee. Results of the study shows that fractures related to basketball are most frequent in the fingers and ankle. Dr. Purvis said that girls are more likely to sustain ankle sprains.

Young children playing baseball should avoid throwing side arm and curve balls. and it is best to limit pitches thrown in practice and competition to 200 or less for any given week. "It is safer at age 13 or 14 to start throwing a limited number of curve balls if proper mechanics are taught," said Dr. Purvis. "Age 18 is a safer age for throwing a curve ball with regularity. Break-away bases can help reduce the number of base sliding injuries. Face guards on batting helmets and softer balls can help reduce impact injuries, the most common form of injury in children."

Dr. Purvis said that the majority of musculoskeletal injuries in contact sports involve sprains/strains and contusions. Because their muscles, bones, ligaments and tendons are still growing, young athletes are more susceptible to injury.

General strategies to prevent injury in all sports include proper warm-up, stretching, conditioning and use of protective equipment, Dr. Purvis said.

Although the number of injuries for activities such as cheerleading, gymnastics and winter sports may be smaller, the risk of injury may be more significant.

"Recreational activities are important for the healthy development of children," said Dr. Purvis. "With growing populations and greater interest, the number of children and adolescents participating in sports and play activities continues to increase.

"Many injuries could be prevented if current safety guidelines and protective equipment were used," he said. "Patient education, research, community programs and regulatory efforts that promote safe play will help reduce children's sports injuries."

Dr. Purvis noted that the American Academy of Orthopaedic Surgeons has developed advocacy programs that are available to physicians and the public.

To help reduce the risk of children's sports injuries, the Academy launched its Prevent Injuries America!® national injury prevention campaign. Internet users can log onto the Academy's Web site www.aaos.org to download the Prevent Injuries America!® fact sheets.

Co-author of the study with Dr. Purvis is Ronald G. Burke, MD, clinical instructor, orthopaedic surgery and rehabilitation, University of Mississippi Medical School, Pediatric Orthopaedic Specialist of Mississippi, Jackson, Miss.

An orthopaedic surgeon is a medical doctor with extensive training in the diagnosis and nonsurgical as well as surgical treatment of the musculoskeletal system including bones, joints, ligaments, tendons, muscles and nerves.

The 25,500-member Academy (www.aaos.org) is a not-for-profit organization that provides education programs for orthopaedic surgeons, allied health professionals and the public. An advocate for improved patient care, the Academy is participating in the Bone and Joint Decade (www.boneandjointdecade.org), the global initiative in the years 2000-2010 to raise awareness of musculoskeletal health, stimulate research and improve people's quality of life.

Top eight sports/recreational activities that have the most fractures, dislocations, strains/sprains and contusions/abrasions to the extremities and trunk among children age 5 - 14 years:

Musculoskeletal injuries
Bicycles 415,000
Basketball 407,000
Football 389,000
Roller sports 297,000
Playgrounds 284,000
Soccer 185,000
Baseball/softball 160,000
Trampolines 135,000