Abstract
Background:
American football is the most popular sport in the United States, with over 5.6 million people >6 years old playing the sport. Fractures in American football athletes are significant, as they compromise an athlete's performance and can also lead to prolonged recovery periods, affecting team dynamics and player careers. Analyzing these injuries is critical to evaluate preventive measures and tailor rehabilitation strategies to ensure the well-being and sustained peak performance of football athletes on and off the field.
Purpose:
To analyze the trend of American football fractures by body site, sex, and age in amateur athletes over a 20-year period between 2002 and 2021.
Study Design:
Descriptive epidemiology study.
Methods:
The National Electronic Injury Surveillance System (NEISS) database was queried to characterize football-related fractures and injuries from 2002 to 2021 in patients aged 0-99 years old. National injury estimates were calculated using sample weights. Chi-square analysis and one-way ANOVA were performed to compare categorical variables.
Results:
Of 56,809 cases of American football-related fractures over 20 years, patients aged 10 to 14 years had the highest incidence of fractures, composing 41.2% of all fractures (n = 23,389), and patients aged <18 years represented 88.8% of all fractures (n = 50,457). The median age of players when fractures occurred was 13 years. Upper extremity fractures (n = 41,863 [73.7%]) were the most common fracture reported compared with lower extremity and head, neck, and trunk fractures. Among upper extremity fractures, finger fractures had the highest prevalence (35.6%), followed by lower arm fractures (19.9%) and wrist fractures (13%). While most cases resulted in release after treatment (93.1%), 5.9% resulted in treatment and hospitalization. When analyzing trends in American football-related fractures over time, we observed the largest number of fractures in 2006 (n = 3664), while the smallest number of fractures occurred in 2020 (n = 1313). Also, a downward trend was found in American football-related fractures since 2006, with a mean of 101 fewer fractures each year.
Conclusion:
Our analysis showed that American football-related fractures diagnosed in the emergency department in the United States were most likely to occur in pediatric patients (10-18 years old). In addition, patients experiencing American football-related fractures were most likely to have an upper extremity fracture and not require hospitalization. The trend in American football-related fractures has been decreasing since 2006.
Keywords: American football, epidemiology, fractures, general sports trauma, medical aspects of sports, National Electronic Injury Surveillance System, pediatric sports medicine
American football, with anywhere between 390 and 410 million fans worldwide, is the most popular sport in the United States and is enjoyed by 5.6 million players. 14 American football has been related to substantial injuries as a sport that requires numerous high-impact collisions between players. Radelet et al 12 found that while the overall injury rate of children playing organized American football was comparable to that of other sports, the incidence of serious injuries (fractures, dislocations, and contusions) was 5 to 15 times greater for American football than all other sports. Fractures, for example, account for about 10% of all American football injuries; nonetheless, data on the distribution of these fractures are limited. 13
Adickes and Stuart 1 and Stuart et al 15 reported that the incidence of total American football injuries increases in every age group after the age of 9 years, but neither paper elucidated the prevalence of fractures specifically. Furthermore, a study by Montgomery et al 7 found that two-thirds of pediatric American football fractures occurred in the lower extremities, with the tibia (17%) and femoral shaft (14.2%) fractures being the most common. However, a single study has yet to express how the distribution of American football fractures changes from childhood to adulthood. Iobst and Stanitski 3 found that tibial eminence fractures occur more frequently in children aged 8 to 12 years, secondary to hyperflexion, and decrease after the age of 12 years.
The National Federation of State High School Associations has found that participation in high school American football decreased between 2009 and 2019; thus, it is hypothesized the year-to-year prevalence of American football fractures would similarly follow this trend. 9 Moreover, despite several recent protective measures in American football, such as rule changes, practice guidelines, and equipment innovation to reduce serious injuries (specifically, head trauma), Macy et al 5 found that most of these implementations lack the rigorous scientific evidence to support their effectiveness. The authors hope to provide insight into common fractures experienced in different age groups to educate players and coaches to reduce fracture incidence by acknowledging the body parts most vulnerable to fracture; also, additional measures can be taken to reduce the risk of injury, such as by having athletes wear additional padding and being mindful of particular regions when tackling other players. Therefore, this study aimed to utilize the National Electronic Injury Surveillance System (NEISS) to characterize and describe the prevalence of American football fractures between 2002 and 2021 among all ages. We hypothesized that the prevalence of American football fractures varies across age groups and has changed over the years, potentially aligning with trends in high school football participation. By examining NEISS data 8 between 2002 and 2021, this study aimed to bridge gaps in existing research by analyzing the distribution and characteristics of American football fractures and offering valuable insights for injury prevention strategies. These findings may contribute to informed decision-making to enhance safety measures and reduce the incidence of fractures in American football.
Methods
Data Collection
Cases of American football fractures were identified using the Consumer Product Safety Commission's (CPSC) NEISS database. The NEISS represents a national sample of 96 hospital emergency departments in the United States categorized by hospital size and geographic location. Data collection methodologies and general information about the NEISS database are publicly available on the CPSC webpage.9,17 Previous orthopaedic studies have been completed using the NEISS database as a reliable source to analyze injury epidemiology.11,13 This study was exempt from institutional review board review, given the use of deidentified, publicly available data. Each patient interaction was recorded, including the treatment date, age, sex, and race, up to 2 body parts injured, diagnosis, patient disposition, location of the injury, and a descriptive narrative field. Categorization was aided using the 2021 NEISS Coding Manual. 16 In contrast to the International Classification of Disease coding structure, which is commonly used widely in the analysis of health care data, the NEISS Coding Manual utilizes its coding system for data categorization. The NEISS assigns a 2-digit code for each body part affected and additionally assigns a 4-digit code for each consumer product involved in a particular injury. 16 The NEISS Coding Manual 16 was used to categorize American football-related injuries as pertaining to any activity, apparel, or equipment used in American football, which was assigned code “1211.” This included organized football, flag-football, full-contact football, and backyard football as described within the patient injury field. Each variant of American football poses additional injury risks, with organized and full-contact football involving higher-impact collisions, potentially leading to a greater incidence of fractures. Furthermore, backyard football may have decreased safety precautions, as players typically are not under organized supervision or subject to formal regulations. Understanding the prevalence and characteristics of fractures in these diverse football settings is critical for developing injury prevention strategies and promoting safer participation across different forms of the sport. In this study, each yearly sample in the NEISS database was queried for the 20 years between 2002 and 2021. One case did not have a listed affected body part and was excluded from the analysis. For cases in which >1 body part was fractured, both injuries were counted as separate cases to capture the full extent of American football-related fractures.
Data Analysis
Yearly samples of patients meeting the inclusion criteria were merged to create a working dataset combining 2002 through 2021. Years of diagnosis were stratified into categories of 2002 to 2008, 2009 to 2014, and 2015 to 2021 to test differences in age, admission, and injury site over these periods. Variables were compared using Pearson chi-square tests, and P < .05 was considered statistically significant. Analysis was completed using SPSS Version 27 (IBM).
Results
Patient Characteristics for American Football-Related Fractures
A total of 238,643 cases of American football-related injuries and 56,809 cases of football-related fractures were identified over 20 years between 2002 and 2021 in the 96 hospitals included within the NEISS database. Total American football injuries generally increased every year between 2002 and 2006 (11,384-14,041) and generally decreased between 2010 and 2021 (15,003-7981), with the total number of American football fractures following a similar pattern (Table 1). The total number of fractures increased each year between 2002 and 2006 (2839-3664) and decreased each year between 2010 and 2021 (3446-2151) (Figure 1). The number of American football fractures as a percentage of total American football injuries was 23.8% for the entire 20-year period and ranged between 21.1% and 30% yearly (Table 1).
Table 1.
Frequency of American Football-Related Fractures Between 2002 and 2021 a
| Year | No. of Injuries | No. of Fractures | % |
|---|---|---|---|
| 2002 | 11,384 | 2839 | 24.94 |
| 2003 | 11,434 | 2891 | 25.28 |
| 2004 | 11,957 | 3087 | 25.82 |
| 2005 | 13,157 | 3529 | 26.82 |
| 2006 | 14,041 | 3664 | 26.10 |
| 2007 | 14,074 | 3513 | 24.96 |
| 2008 | 14,714 | 3549 | 24.12 |
| 2009 | 14,188 | 3374 | 23.78 |
| 2010 | 15,003 | 3446 | 22.97 |
| 2011 | 14,660 | 3210 | 21.90 |
| 2012 | 14,090 | 3078 | 21.85 |
| 2013 | 12,655 | 2666 | 21.07 |
| 2014 | 11,645 | 2489 | 21.37 |
| 2015 | 11,806 | 2635 | 22.32 |
| 2016 | 11,859 | 2670 | 22.51 |
| 2017 | 10,947 | 2476 | 22.62 |
| 2018 | 9196 | 1992 | 21.66 |
| 2019 | 9472 | 2237 | 23.62 |
| 2020 | 4380 | 1313 | 29.98 |
| 2021 | 7981 | 2151 | 26.95 |
| Total | 238,643 | 56,809 | 23.81 |
Frequency is presented as a percentage of total football-related injuries, including fractures and nonfractures.
Figure 1.
The frequency of football-related fractures per year between 2002 and 2021.
The age of patients ranged from <1 year old to 94 years, with 5994 (10.6%) patients aged <10 years, 23,389 (41.2%) between 10 and 13 years, 21,073 (37.1%) between 14 and 18 years, 2528 (4.5%) between 19 and 22 years, and 3824 (6.7%) ≥23 years (Table 2, Figure 2). Among 74% (n = 42,062) of patients for whom race was specified, most patients were White (41.6%), followed by Black/African American (23.6%), Asian (0.8%), American Indian/Alaska Native (0.2%), Native Hawaiian/Pacific Islander (0.1%), or other races (7.7%) (Table 3). A total of 5.9% of all patients with American football fractures were admitted/hospitalized during the 20-year period, with the percentage of patients being admitted/hospitalized generally increasing each year between 2002 and 2021 from 5.2% to 9.5% (Table 4). No information in the NEISS database was provided regarding the treatment method for each admitted patient, including surgery or closed reduction.
Table 2.
Age Distribution of Patients With American Football-Related Fractures a
| Patient Age, y | All Football Injuries | Fractures | Nonfractures |
|---|---|---|---|
| <10 | 23,396 (9.8) | 5994 (10.6) | 17,402 (9.6) |
| 10-13 | 81,186 (34) | 23,389 (41.2) | 57,797 (31.8) |
| 14-18 | 98,552 (41.3) | 21,073 (37.1) | 77,479 (42.6) |
| >18 | 35,503 (14.9) | 6352 (11.2) | 29,151 (16) |
Data are presented as n (%) of occurrences within the category. All results were set to P < .001.
Figure 2.
The frequency of American football-related fractures between patients aged 1 to 30 years between 2002 and 2021.
Table 3.
Football-Related Fractures by Race a
| Patient Race | Frequency (n = 42,062) | % |
|---|---|---|
| White | 23,658 | 41.6 |
| Black/African American | 13,390 | 23.6 |
| Other | 4390 | 7.7 |
| Asian | 445 | 0.8 |
| American Indian/Alaska Native | 124 | 0.2 |
| Native Hawaiian/Pacific Islander | 55 | 0.1 |
Frequency is presented as a percentage of total football-related fractures with specified patient race.
Table 4.
Disposition of Patients With Football Fractures
| Disposition | Frequency (n = 56,804) | % |
|---|---|---|
| Treated/examined and released | 52,869 | 93.1 |
| Treated and transferred | 408 | 0.7 |
| Treated and admitted/hospitalized | 3324 | 5.9 |
| Treated and held for observation | 143 | 0.3 |
| Left without being seen | 60 | 0.1 |
Fracture Injury Site
Of the 41,863 (73.7%) upper extremity fractures, 35.6% were finger fractures, representing most of the upper extremity fractures (Tables 5 and 6). A total of 1573 (3.76%) patients with upper extremity fractures were admitted for treatment (Table 6). Fractures of the elbow, upper arm, and lower arm had the highest proportions of patients admitted (14.4%, 13.3%, and 10.4%, respectively). Lower extremity fractures constituted 11,885 cases (20.9%), with the lower leg representing most of the lower extremity fractures (36.1%). Among those with lower extremity fractures, 1908 (16.1%) were admitted for treatment, and the highest proportion of patients with lower extremity fractures admitted were those with fractures of the upper leg (74.3%). Head, neck, and trunk fractures made up 2994 (5.3%) cases, with facial fractures representing most of the fractures in this category (52.3%). Among patients with head/neck/trunk fractures, 394 (13.16%) were admitted for treatment, with 60.8% head fractures, 57% neck fractures, and 25% pubic region fractures. Of all football-related fractures, 94.4% occurred in men, while 5.6% occurred in women (Table 7). A significant association was found between sex and injury site (P < .001). Female patients were more likely to have an upper extremity fracture (82.1% of female vs 73.3% of male patients) and less likely to have a lower extremity or head/neck/trunk fracture (13.8% and 4.1% for female and 21.4% and 5.4% for male patients) (P < .001).
Table 5.
Prevalence of American Football Fractures by Age and Body Part a
| Body Part | Total Fractures (N = 56,809) | Age <10 y (n = 5994) | Age 10-13 y (n = 23,389) | Age 14-18 y (n = 21,073) | Age >18 y (n = 6352) |
|---|---|---|---|---|---|
| Upper extremity | 41,910 (73.8) | 4925 (82.2) | 18,315 (78.3) | 14,843 (70.4) | 3827 (60.2) |
| Lower extremity | 11,893 (20.9) | 978 (16.3) | 4523 (19.3) | 4901 (23.3) | 1490 (23.5) |
| Head/neck/trunk | 3005 (5.3) | 91 (1.5) | 551 (2.4) | 1328 (6.3) | 1035 (16.3) |
Data are presented as n (%).
Table 6.
Prevalence of American Football Fractures by Body Region and Admittance a
| Body Part | Total Fractures (n = 56,808) | Total Admitted (n = 3875) |
|---|---|---|
| Upper extremity | 41,910 (73.8) | 1573 (3.8) |
| Finger | 14,917 (35.6) | 61 (0.4) |
| Lower arm | 8338 (19.9) | 866 (10.4) |
| Shoulder | 6939 (12.2) | 68 (1) |
| Wrist | 5428 (13) | 162 (3) |
| Hand | 3439 (8.2) | 20 (0.6) |
| Elbow | 1629 (3.9) | 234 (14.4) |
| Upper arm | 1220 (2.9) | 162 (13.3) |
| Lower extremity | 11,893 (20.9) | 1908 (16.1) |
| Lower leg | 4296 (36.1) | 814 (19) |
| Ankle | 3477 (29.3) | 316 (9.1) |
| Foot | 1674 (14.1) | 13 (0.8) |
| Upper leg | 906 (7.6) | 672 (74.3) |
| Toe | 872 (7.3) | 11 (1.3) |
| Knee | 668 (5.6) | 82 (12.3) |
| Head/neck/trunk | 3005 (5.3) | 394 (13.2) |
| Face | 1566 (52.3) | 109 (7) |
| Upper trunk | 710 (23.6) | 65 (9.2) |
| Lower trunk | 511 (17) | 98 (19.2) |
| Neck | 158 (5.3) | 90 (57) |
| Head | 51 (1.7) | 31 (60.8) |
| Pubic region | 4 (0.1) | 1 (25) |
Data are presented as n (%), of 56,089 patients, 1 was missing a large body part group and 2 were missing a small body part group, which is why upper extremity+lower+head/neck/trunk will have 1 more patient than the subgroups added together.
Table 7.
American Football-Related Fractures by Patient Sex
| Patient Sex | Frequency (N = 56,809) | % |
|---|---|---|
| Male | 53,647 | 94.4 |
| Female | 3157 | 5.6 |
| Unknown | 5 | >0.001 |
Age was significantly associated with injury site, with upper extremity fractures occurring more often in younger patients. In comparison, lower extremity and head/neck/trunk fractures occurred more often in older patients (Table 5; P < .001). Fractures occurred in the upper extremity, lower extremity, and head/neck/trunk injury sites at the following rates: ages <10 years: 82.2%, 16.3%, and 1.5%; ages 10 to 13 years: 78.3%, 19.3%, and 2.4%; ages 14 to 18 years: 70.4%, 23.3%, and 6.3%; and ages >18 years: 60.2%, 23.5%, and 16.3%. Age also showed a significant association with hospital admission, with patients aged <10 years and 14 to 18 years being most likely to be admitted for treatment (P < .001). Proportions of admitted patients were 7.8% of those aged <10 years, 6.6% of those aged 10 to 13 years, 7.2% of those aged 14 to 18 years, and 5.6% of those aged >18 years.
Changes in American football-related fractures were also explored in 2002 through 2008, 2009 through 2014, and 2015 through 2021. Admission rates increased over the year categories from 5.3% in 2002 to 2008 to 7.4% in 2009 to 2014 and to 8.5% in 2015 to 2021 (P < .001). Fracture cases changed over time concerning age (P < .001), with cases increasing among age groups <10 years and 10 to 13 years and decreasing in the >18 years age group (Table 8). No significant changes were observed in injury sites in the 3 periods (P = .337).
Table 8.
American Football Fractures by Year Categories a
| 2002-2008 (n = 23,072) |
2009-2014 (n = 18,263) |
2015-2021 (n = 15,474) |
P | |
|---|---|---|---|---|
| Admitted | 1213 (5.3) | 1343 (7.4) | 1319 (8.5) | <.001 |
| Injury site | .337 | |||
| Upper extremity | 17,089 (74.1) | 13,387 (73.3) | 11,434 (73.9) | |
| Lower extremity | 4787 (20.7) | 3867 (21.2) | 3239 (20.9) | |
| Head/neck/trunk | 1195 (5.2) | 1009 (5.5) | 801 (5.2) | |
| Age, y | <.001 | |||
| <10 | 2243 (9.7) | 1954 (10.7) | 1797 (11.6) | |
| 10-13 | 9402 (40.8) | 7480 (41.0) | 6507 (42.1) | |
| 14-18 | 8636 (37.4) | 6672 (36.5) | 5765 (37.3) | |
| >18 | 2791 (12.1) | 2157 (11.8) | 1404 (9.1) |
Data are presented as n (%). Some sample sizes may have 1 missing value due to being missing in the database or not recorded for 1 patient.
Discussion
Our study identified 238,643 American football-related injuries and 56,809 fractures across 96 hospitals between 2002 and 2021. Total injuries peaked in 2006 (14,041) and decreased after that to 7981 in 2021, and fractures mirrored this trend. There were body region-specific variations in these fractures; 73.8% were upper extremity fractures and were mostly finger fractures. Of all fractures, 10.6% occurred in patients aged <10 years, 41.2% in patients aged between 10 and 13 years, 37.1% in patients aged between 14 and 18 years, 4.5% in patients aged between 19 and 22 years, and 6.7% in patients aged ≥23 years. This distribution emphasizes the prevalence of injuries among youth and young adults, highlighting the importance of age-specific injury prevention measures in American football.
While several studies have characterized and described the prevalence of American football fractures at the professional and collegiate levels, few studies have extended their analysis to children and teenagers playing the sport.4,6,10 This is significant, as pediatric fractures are associated with considerable effects that lead to significant activity restriction. 12 Pediatric fractures commonly occur in children while their growth plates are still open. Thus, interruption of growth plates may cause functional abnormalities at a young age, including growth arrests and malunion. Furthermore, fractures have been associated with season-ending injuries among high school American football players; thus, their prevention is important. 17 A study by Iobst and Stanitski showed that children of a certain age are more prone to certain fractures, but a study has yet to follow the distribution of fractures through adulthood. 3 This epidemiological study agrees with previous literature exploring the prevalence of American football fractures based on age, sex, body part affected, and severity determined by hospital admission status. In addition, this study includes a temporal breakdown of the prevalence of football fractures and total American football injuries to determine whether the fracture reduction strategies implemented between 2002 and 2021 impacted the relative prevalence of American football fractures.
It was found that the total number of American football injuries had generally dropped between 2010 and 2021 (15,003-7981), with a significant drop in 2020 likely due to COVID-19; however, we did not look at this in detail. This trend falls in line with the drop in American football participation. 7 The number of American football fractures follows a similar trend to the number of American football injuries, with fractures representing 23.8% of all injuries within the 20 years, ranging between 21.1% and 30%. The prevalence of fractures compared with all injuries does not follow any particular trend, suggesting that measures such as rule changes, practice guidelines, and equipment innovation to reduce serious injuries were not effective at reducing the prevalence of fractures, as predicted by Macy et al. 5 These rule changes include prohibition of a forceful blindside block; ban of full-speed, head-on blocking or tackling drills, where players are positioned >3 yards apart; and the invention of the Guardian Cap—a protective cover attached to the helmet to lessen trauma to the player's head—among many other guidelines that had been changed since 2010. 6 Regarding the severity of these injuries, the authors found the proportion of admitted patients with fractures doubled between the 7 year periods from 2002-2008 and 2015-2021 (5.3% to 9.5%), which may be related to hospitals broadening the criteria to admit a patient with a fracture rather than serving as a direct predictor for injury severity.
The overwhelming majority (94.4%) of American football fracture cases were found to be male patients, which aligns with data regarding much higher American football participation rates in male than female individuals. 9 Regarding age, the greatest incidence of fractures occurred between the ages of 10 and 13 and of 14 and 18 years, representing 41.2% and 37.1% of all American football fractures, respectively, as explained by broad participation in American football through middle and high school.
The prevalence of upper extremity fractures among all fractures within an age category decreased with increasing age. Upper extremity fractures represented 82.2%, 78.3%, 70.4%, and 60.2% of all fractures within the age categories of <10 years, 10 to 13 years, 14 to 18 years, and >18 years, respectively. The inverse was true of lower extremity fractures and head/neck/trunk fractures, with decreasing prevalence of these fractures among all fractures within an age category with increasing age. This trend could be explained by younger participants being more prone to upper extremity American football fractures due to improper catching techniques or falls with an outstretched arm, leading to lower arm fractures, as well as improper safety precautions or concerns within these age groups. Campolettano et al 2 highlighted that within American youth football, coaching and practice intensity have an effect on the magnitude of impact players experience, which results in severe injury and concussions. We would emphasize that if coaches or parents were aware of common injury patterns players experience in a particular age group, they might adjust their coaching style and practice intensity to prevent players from tackling or falling incorrectly onto a specific part of their body likely to fracture during play. Protective equipment or training exercises during the offseason may prove instrumental in reducing injury incidence, especially if informed by detailed mechanisms of injury. Unfortunately, our data do not include precise details on mechanisms of injury, emphasizing the necessity for thorough injury surveillance. Comprehensive data collection regarding injury mechanisms is imperative to improve preventive measures and ensure a safer environment for participants in American football.
Despite the greater prevalence of upper extremity American football fractures, these fracture types resulted in the lowest admittance rate of all fracture types at 3.8% compared with a 16.1% admittance rate for lower extremity fractures and a 13.2% admittance rate for head/neck/trunk fractures. This relationship can be explained by the most prevalent upper extremity fractures, specifically finger and shoulder fractures, with some of the lowest admittance rates at 0.4% and 1%, respectively. Thus, within American football-related fractures specifically, upper extremity fractures typically represent less severe injuries as opposed to facial fractures and lower leg fractures.
Limitations
There are a few limitations of this study that require acknowledgment. The data provided by the NEISS database represent visits from approximately 96 hospitals nationwide, which may cause inconsistencies in reporting data. Moreover, there are inherent limitations of any large database study depending on user entry for quality of data. We verified all data collected with 2 statisticians (E.C., R.M.) to increase the reliability of this study. While the NEISS data set effectively captures an accurate snapshot of emergency department visits across the United States, it fails to account for injuries noted in medical visits outside the emergency department. For example, patients visiting an urgent care or a walk-in clinic after their injury would not be reported in this analysis. Furthermore, the NEISS data set does not consider patients avoiding medical treatment for their injuries. Pertaining to this study, patients are unlikely to avoid the emergency department for most types of fractures. In addition, it would be useful to have an accurate number of American football athletes each year to determine whether the incidence of fractures is truly decreasing as the number of players changes. Because of the limitations of the NEISS database, although the number of athletes could not be determined, the number of fractures each year could be compared with total number of American football-related injuries, showing a useful trend in the prevalence of fractures as a percentage of overall injuries each year. Furthermore, acknowledging the lack of details on fracture characteristics, such as distinguishing between an avulsion fracture of the distal fibula and a Salter-Harris II distal fibula fracture, underscores the need for more nuanced injury data to enhance the precision of preventive strategies. Despite these shortcomings, the NEISS offers the best data regarding the epidemiology of American football fractures between 2002 and 2021 across age, sex, and injury sites.
Conclusion
The overall prevalence of fractures generally decreased each year between 2010 and 2021. The prevalence of American football fractures as a proportion of all football injuries stayed relatively consistent between 2002 and 2021. The admittance rate for American football players with fractures almost doubled between 2002 and 2021. American football fractures were found to be most prevalent among male patients between the ages of 10 and 18 years. Most fractures were in the upper extremities, and the prevalence of these fractures decreased with age. Patients with upper extremity fractures also had a lower admittance rate than those with lower extremity or head/neck/trunk fractures.
Footnotes
Final revision submitted November 20, 2023; accepted February 2, 2024.
The authors have declared that there are no conflicts of interest in the authorship and publication of this contribution. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.
Ethical approval was not sought for the present study.
References
- 1. Adickes MS, Stuart MJ. Youth football injuries. Sports Med. 2004;34(3):201-207. doi: 10.2165/00007256-200434030-00005 [DOI] [PubMed] [Google Scholar]
- 2. Campolettano ET, Gellner RA, Rowson S. High-magnitude head impact exposure in youth football. J Neurosurg Pediatr. 2017;20(6):604-612. doi: 10.3171/2017.5.PEDS17185 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3. Iobst CA, Stanitski CL. Acute knee injuries. Clin Sports Med. 2000;19(4):621-635, vi. doi: 10.1016/s0278-5919(05)70229-5 [DOI] [PubMed] [Google Scholar]
- 4. Knapik DM, Mack CD, Lee R, et al. Epidemiology of tibial fractures in professional American football athletes from 2013 to 2019. Orthop J Sports Med. 2021;9(11):23259671211040878. doi: 10.1177/23259671211040878 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5. Macy JT, Kercher K, Steinfeldt JA, Kawata K. Fewer US adolescents playing football and public health: a review of measures to improve safety and an analysis of gaps in the literature. Public Health Rep. 2021;136(5):562-574. doi: 10.1177/0033354920976553 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6. McAdams TR, Deimel JF, Ferguson J, Beamer BS, Beaulieu CF. Chondral rib fractures in professional American football: two cases and current practice patterns among NFL team physicians. Orthop J Sports Med. 2016;4(2):2325967115627623. doi: 10.1177/2325967115627623 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 7. Montgomery C, Porter A, III, Parks C, Sachleben B, Blasier RD, Rabenhorst B. Football-related pediatric extremity fractures and dislocations: size matters. Orthopedics. 2018;41(4):216-221. doi: 10.3928/01477447-20180628-03 [DOI] [PubMed] [Google Scholar]
- 8. National Electronic Injury Surveillance System (NEISS). CPSC.gov. April 5, 2018. Accessed March 16, 2023. https://www.cpsc.gov/Research–Statistics/NEISS-Injury-Data
- 9. Neihoff Karissa. While total 2019-20 participation is unavailable, high school football shows promising results. 2019 NFHS News. Accessed March 16, 2023. https://www.nfhs.org/articles/while-total-2019-20-participation-is-unavailable-high-school-football-shows-promising-results/ [Google Scholar]
- 10. Olson D, Sikka RS, Labounty A, Christensen T. Injuries in professional football: current concepts. Curr Sports Med Rep. 2013;12(6):381-390. doi: 10.1249/JSR.0000000000000015 [DOI] [PubMed] [Google Scholar]
- 11. Pirruccio K, Selemon NA, Ahn J, Cahill PJ, Baldwin KD. American football is the youth sporting activity most commonly associated with acute vertebral fractures. Phys Sportsmed. 2021;49(3):348-354. doi: 10.1080/00913847.2020.1838874 [DOI] [PubMed] [Google Scholar]
- 12. Radelet MA, Lephart SM, Rubinstein EN, Myers JB. Survey of the injury rate for children in community sports. Pediatrics. 2002;110(3):e28. doi: 10.1542/peds.110.3.e28 [DOI] [PubMed] [Google Scholar]
- 13. Saal JA. Common American football injuries. Sports Med. 1991;12(2):132-147. doi: 10.2165/00007256-199112020-00005 [DOI] [PubMed] [Google Scholar]
- 14. Seifert K. American football making worldwide inroads. ESPN.com. Updated May 5, 2016. Accessed March 16, 2023. https://www.espn.com/nfl/story/_/id/15273529/how-american-football-becoming-worldwide-sport-europe-china-beyond
- 15. Stuart MJ, Morrey MA, Smith AM, Meis JK, Ortiguera CJ. Injuries in youth football: a prospective observational cohort analysis among players aged 9 to 13 years. Mayo Clin Proc. 2002;77(4):317-322. doi: 10.4065/77.4.317 [DOI] [PubMed] [Google Scholar]
- 16. U.S. Consumer Product Safety Commission (CPSC). National Electronic Injury Surveillance System (NEISS) Coding Manual: January 2021. Accessed June 7, 2022. https://www.cpsc.gov/s3fs-public/January-2021-NT-CPSC-only-NEISS-Coding-Manual.pdf?xa_nMM1kB4SGpuSMOwf0NHkkkIqNcn8F
- 17. Willigenburg NW, Borchers JR, Quincy R, Kaeding CC, Hewett TE. Comparison of injuries in American collegiate football and club rugby: a prospective cohort study. Am J Sports Med. 2016;44(3):753-760. doi: 10.1177/0363546515622389 [DOI] [PubMed] [Google Scholar]