Abstract
Objectives: To investigate and quantify fall height, surface depth, and surface impact attenuation as risk factors for arm fracture in children who fall from playground equipment.
Design: Unmatched case control study.
Setting: Five case hospitals and 78 randomly selected control schools.
Participants: Children aged less than 13 years in Victoria, Australia who fell from school playground equipment and landed on their arm. Cases sustained an upper limb fracture and controls had minor or no injury. A total of 402 cases and 283 controls were included.
Interventions: Children were interviewed in the playground as soon as possible after their fall.
Main outcome measures: Falls were recreated on site using two validated impact test devices: a headform (measuring peak G and HIC) and a novel anthropometric arm load dummy. Equipment and fall heights, as well as surface depth and substrate were measured.
Results: Arm fracture risk was greatest for critical equipment heights above 1.5 m (OR 2.39, 95% CI 1.49 to 3.84, p<0.01), and critical fall heights above 1.0 m (OR 2.96, 95% CI 1.71 to 5.15, p<0.01). Peak headform deceleration below 100G was protective (OR 0.67, 95% CI 0.45 to 0.99, p = 0.04). Compliance with 20 cm surface depth recommendation was poor for both cases and controls.
Conclusions: Arm fracture-specific criteria should be considered for future standards. These include surface and height conditions where critical headform deceleration is less than 100G. Consideration should also be given to reducing maximum equipment height to 1.5 m. Improved surface depth compliance and, in particular, guidelines for surface maintenance are required.
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Selected References
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- Chalmers D. J., Marshall S. W., Langley J. D., Evans M. J., Brunton C. R., Kelly A. M., Pickering A. F. Height and surfacing as risk factors for injury in falls from playground equipment: a case-control study. Inj Prev. 1996 Jun;2(2):98–104. doi: 10.1136/ip.2.2.98. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Chiu J., Robinovitch S. N. Prediction of upper extremity impact forces during falls on the outstretched hand. J Biomech. 1998 Dec;31(12):1169–1176. doi: 10.1016/s0021-9290(98)00137-7. [DOI] [PubMed] [Google Scholar]
- DeGoede Kurt M., Ashton-Miller James A. Biomechanical simulations of forward fall arrests: effects of upper extremity arrest strategy, gender and aging-related declines in muscle strength. J Biomech. 2003 Mar;36(3):413–420. doi: 10.1016/s0021-9290(02)00396-2. [DOI] [PubMed] [Google Scholar]
- Gunatilaka A. H., Sherker S., Ozanne-Smith J. Comparative performance of playground surfacing materials including conditions of extreme non-compliance. Inj Prev. 2004 Jun;10(3):174–179. doi: 10.1136/ip.2003.004010. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Laforest S., Robitaille Y., Lesage D., Dorval D. Surface characteristics, equipment height, and the occurrence and severity of playground injuries. Inj Prev. 2001 Mar;7(1):35–40. doi: 10.1136/ip.7.1.35. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Lewis L. M., Naunheim R., Standeven J., Naunheim K. S. Quantitation of impact attenuation of different playground surfaces under various environmental conditions using a tri-axial accelerometer. J Trauma. 1993 Dec;35(6):932–935. doi: 10.1097/00005373-199312000-00020. [DOI] [PubMed] [Google Scholar]
- Macarthur C., Hu X., Wesson D. E., Parkin P. C. Risk factors for severe injuries associated with falls from playground equipment. Accid Anal Prev. 2000 May;32(3):377–382. doi: 10.1016/s0001-4575(99)00079-2. [DOI] [PubMed] [Google Scholar]
- Mack M. G., Sacks J. J., Thompson D. Testing the impact attenuation of loose-fill playground surfaces. Inj Prev. 2000 Jun;6(2):141–144. doi: 10.1136/ip.6.2.141. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Robinovitch S. N., Chiu J. Surface stiffness affects impact force during a fall on the outstretched hand. J Orthop Res. 1998 May;16(3):309–313. doi: 10.1002/jor.1100160306. [DOI] [PubMed] [Google Scholar]
- Sherker S., Ozanne-Smith J., Rechnitzer G., Grzebieta R. Development of a multidisciplinary method to determine risk factors for arm fracture in falls from playground equipment. Inj Prev. 2003 Sep;9(3):279–283. doi: 10.1136/ip.9.3.279. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Sherker Shauna, Ozanne-Smith Joan. Are current playground safety standards adequate for preventing arm fractures? Med J Aust. 2004 Jun 7;180(11):562–565. doi: 10.5694/j.1326-5377.2004.tb06092.x. [DOI] [PubMed] [Google Scholar]