Trampoline injuries in children

Trampoline-related injuries in children: a nationwide cross-sectional study in South Korea

Objective

Trampoline-related injuries have increased in South Korea. However, little research has been conducted on this topic. This study aimed to show the characteristics of pediatric trampoline-related injuries in South Korea and to investigate the factors associated with admission.

Methods

A retrospective, cross-sectional study was conducted using data from South Korea’s Emergency Department-based Injury In-depth Surveillance registry for dates between January 2011 and December 2016. All patients under 18 years of age with trampoline-related injuries were included. We divided the patients into two groups based on whether they were admitted or discharged. Odds ratios with 95% confidence intervals were calculated to evaluate the factors associated with hospital admission for pediatric trampoline-related injuries.

Results

A total of 2,745 patients were enrolled and the incidence increased over time (P for trend<0.01). The most common injury site was the lower extremity (45%). Fracture was the most frequent diagnosis (34.3%). Compared to the discharge group, the adjusted odds ratios (95% confidence intervals) for hospital admission were 3.53 (1.73–7.17) for the teenage group, 2.62 (1.82–3.77) for upper extremity injuries, 18.48 (7.95–42.95) for fractures, 2.28 (1.35–3.86) for falls, and 2.04 (1.15–3.60) for collisions.

Conclusion

Trampoline-related injuries in children have increased over time in South Korea. Most occur in children under the age of 12 years, but children between the ages of 13 and 18 years are at a higher risk for hospitalization. Also, injuries of the upper extremity, fracture, falling, and collision are risk factors for admission. Preventive strategies are needed to reduce trampoline-related injuries in children.

Comparative surgical risk between type of trampoline (size and place) and type of patients (age and sex) in trampoline related injury: a systematic review and indirect meta-analysis

Background

Despite its high risk of injury, many people are still favor trampolining. However, currently there is no consensus as to which type of trampoline and which type of participant is more likely to have a trampoline related injury that will require surgical management.

Methods

This systematic review and meta-analysis aims to assess and compare the factors that cause trampoline injuries requiring surgical treatment. These include the place of the trampoline (park versus home), size of the trampoline (full versus mini), the age of the participant (child versus adult) and the sex of the participant (male versus female). The clinical outcomes measured are surgical management after trampoline injury. This systematic review was conducted according to the PRISMA guidelines.

Results

Relevant studies that reported surgery after trampoline injury of either group were identified from Medline and Scopus from inception to May 14, 2019. Sixteen studies were included for the analysis of surgery after trampoline injury; a total of 4491 and 1121 patients were treated conservatively and surgically. The total surgery rate per patient was 31% (95% CI: 16, 46%) in all patients. The surgery rate was 0.3 (95% CI: 0.03, 0.58) and 0.06 (95% CI: 0.04, 0.09) in the full and mini size trampoline groups. There were 0.36 (95% CI: 0.06, 0.67) and 0.11 (95% CI: 0.0, 0.22) in the park and home trampoline groups. The surgery rates were 0.33 (95% CI: 0.14, 0.53), 0.24 (95% CI: 0.07, 0.11), 0.49 (95% CI: 0.47, 0.51) and 0.38 (95% CI: 0.22, 0.53) in children, adults, females and males respectively. Indirect meta-analysis shows that full size trampolines provided a 6.0 times higher risk of surgery (95% CI: 3.7, 9.7) when compared to mini size trampolines. Park trampolines had a higher risk of surgery of 2.17 (95% CI: 1.70, 2.78) when compared to home trampolines. In terms of age and sex of participants, there value was significantly higher at 1.65 (95% CI: 1.35, 2.01) and 1.54 (95% CI: 1.36, 1.74) in children compared to adults and females compared to males. From all the statistical data we summarized that the full size trampoline injuries have a 6 times higher risk of requiring surgery when compared to mini size trampoline injuries. Park trampoline use carries a 2 times higher risk of requiring surgery when compared to home trampoline use. In terms of age and sex of the participant, there is a 1.5 times significantly higher risk of injury in children compared to adults, and females when compared to males.

Conclusion

In trampoline related injuries, full size, park trampoline, children and females had higher surgery rates when compared to mini size, home trampoline, adult and male majority in indirect meta-analysis methods.

[Characterisation of the impact and features of trampoline park-related injuries]

INTRODUCTION

 Numerous studies have described indoor trampoline park (ITP)-related injury patterns, but they have shown heterogeneous results. No such study has been performed in Germany to date. The aim of this study was to analyse the specific trampoline-related injury patterns found in our population.

METHODS

 This retrospective study included patients suffering from ITP-related injuries between 1 October 2016 and 30 April 2018. 258 patients were included in the analysis. Patients were categorised depending on different variables including age, sex, site of injury, diagnosis, length of admission and treatment using SPSS.

RESULTS

 In the 19-month study period, 258 patients with ITP-related injuries were recruited. Single ITP-related injuries were diagnosed in 250 (96.9 %) patients. The median age of this group was 22 years (IQR 15-28). 126 (50.4 %) injuries were suffered by men and 124 (49.6 %) by women. 168 (67.2 %) injuries occurred in the lower extremity. Sprains (n = 114, 45.6 %) and fractures without joint dislocation (n = 59, 23.6 %) were the most common diagnoses. Males suffered significantly more often from injuries of the upper extremity (26.2 vs. 9.7 %; p = 0.010), while females most commonly suffered from injuries of the lower extremity (79.8 vs. 54.8 %; p < 0.001). 45 (18 %) patients required hospital admission and twenty-five (10.0 %) patients required surgery. Eight (3.1 %) patients suffered from injuries in more than one anatomic location.

CONCLUSIONS

 ITP-related injuries were more prevalent in adults compared with children. The lower limb was the most affected anatomic location in all ages. The pattern of the injuries was heterogeneous, and their respective treatment represents a major challenge for traumatology surgeons.

Demographic changes in US trampoline-related injuries from 1998 to 2017: cause for alarm

BACKGROUND

Recreational sports facilities with trampolines have become increasingly popular, and trampoline-related injuries incurred have been increasing. The goal of this study was to determine impact of recreational sports facilities on trampoline-associated injuries.

METHODS

An epidemiological study was performed using data from the National Electronic Injury Surveillance System (NEISS). All patients in the NEISS database coded for trampoline injury were included. Statistical analyses were performed comparing home trampoline injuries (HTIs) and recreational sports facilities-related trampoline injuries (RSIs) for standard demographic variables using appropriated weighted statistical methods.

RESULTS

There were an estimated 1 376 659 emergency department (ED) visits for trampoline related injuries from 1998 to 2017; 125 811 were RSIs and 1 227 881 were HTIs. Between 2004 and 2017, the number of RSIs increased rapidly, while HTIs decreased. RSIs more often presented to large hospitals and HTIs to smaller ones. Strain/sprains were more associated with RSIs, whereas HTIs sustained more internal organ injuries. Lower extremity fractures occurred more frequently in RSIs and upper extremity fractures in HTIs. There was a greater percentage of RSIs in 15-34 years old age group (28.2% vs 13.6%). There were no differences by gender and race between HTIs and RSIs.

CONCLUSIONS

The rapid expansion in recreational sports facilities with trampolines coincided with increasing RSIs. RSIs differed from HTIs regarding changes over time, hospital size, diagnosis and injury location. Recreational sports facilities with trampolines pose a public health hazard.

Radiological trends in trampoline-related paediatric injuries in a major paediatric trauma centre: a 6-year experience

Aim

Review of visits to the radiology department related to trampoline injuries in a major trauma centre in the UK over a 6-year period, and analysis of imaging performed, injury type, and seasonal trends in children under 18 years of age.

Subject and methods

Retrospective review of the Radiology Information System (RIS) for requests and reports between January 2012 and December 2017 containing the search term “tramp*” with an age of < 18 years.

Results

A total of 1794 children (44% male, mean age 8.15) visited the radiology department 1871 times and received 2343 separate radiographic examinations, ten ultrasound examinations, 20 CT examinations, 19 MR examinations and two nuclear medicine examinations. Seven hundred and eighty-eight children (45.9% male) had injury demonstrated on radiographs (622 fractures and 183 soft-tissue injuries) during 796 visits to radiology. Positive CT, MRI, and US were seen in 55%, 47.3%, and 50% of cases respectively. Children under 7 years of age are more likely to have been injured compared to older children attending for X-rays, with the proportion of injuries seen in 6-year-old children being the highest (63.7%). Trampoline injury-related X-ray requests to radiology rose from 1.7% to 4% per year as a percentage of overall X-ray requests from the emergency department.

Conclusion

Trampoline injury-related visits to the radiology department and the number of injuries demonstrated on imaging studies have increased over the study period, putting greater pressure on the healthcare system. Younger children are especially prone to injury. Public health campaigns and mandatory national safety standards are needed to increase awareness of potential dangers of recreational trampoline use.

Varus shearing force is a main injury mechanism of pediatric trampoline-related injury in addition to compressive axial loading

Background

Many case studies have been published about trampoline-related injury (TRI); however, a comparative study could allow a more specific analysis of the characteristics of TRI, and enable more differentiated approaches to prevent such injuries. We investigated the injury mechanism of TRI in children compared with other pediatric trauma.

Methods

Of 35,653 children (age 0–18 years) who visited the pediatric emergency department after traumatic injuries from January 2011 to June 2017, 372 patients with TRI (TRI group) were retrospectively identified. Among the remaining 35,281 patients with other trauma (non-TRI group), 372 were 1:1 matched to the TRI group according to sex, age, injured body part, and body weight (matched-control group). The patients’ data, injured site, and injury patterns were compared between the groups.

Results

The most frequently injured body part was the knee/lower leg in the TRI group and the head in the non-TRI group. The most frequent injury types were fractures in the TRI group and open wounds in the non-TRI group. In the comparison between the TRI and matched-control groups, the most common lower-extremity fractures were proximal tibial fractures with varus angulation in the TRI group and tibial shaft spiral fractures in the matched-control group. For the upper extremities, the risk of lateral condylar humeral fracture was higher in the TRI group. The TRI group presented more physeal involvements.

Conclusions

The risks of varus stress injury (proximal tibial fracture with varus angulation in lower extremity and lateral condylar humeral fracture in upper extremity) were higher in the TRI group than in matched-control group. Thus, varus shearing force seems to be an important injury mechanism in TRI in addition to compressive force. This varus force may increase the risk of physeal injury by generating additional shear force on the physis.

Rapidly growing pediatric trampoline-related injuries in Korea: a 10-year single center retrospective study

Purpose

Several published policy statements have warned against the risks associated with trampoline use and recommended safety guidelines. However, few studies have focused on trampoline-related injuries in Korea. This study aimed to assess the incidence and characteristics of pediatric trampoline-related injuries presented to Ulsan University Hospital.

Methods

We retrospectively reviewed the medical records of children aged <16 years with trampoline-related injuries who visited our Emergency Department between 2008 and 2017.

Results

Over the 10-year period, 178 trampoline-related injuries were reported, which represented a significant increase (P=0.016). Most (87.6%) of the injuries occurred during the last 5 study years, and a rapid increase in injuries was observed in children aged <6 years. Lower extremity injuries (62.4%) were the most common, followed by injuries of the upper extremities, head and face, and trunk, including injuries to the neck and spine. Sixty-seven children (37.6%) had fractures, and proximal tibia fractures were the most common. Fractures were significantly more common in younger children (<6 years old) than in older children (P=0.026).

Conclusion

In Korea, the mechanism of trampoline injury is similar to that of injuries incurred in indoor trampoline parks but is characterized by smaller spaces and multiple users. Trampoline use and the incidence of trampoline-related injuries in children aged <6 years are increasing rapidly. Prohibiting the use of trampolines for children aged <6 years, restricting simultaneous use by multiple children, and ensuring adult supervision should be strictly emphasized. Public awareness and policy guidelines are needed to reduce the incidence of trampoline-related injuries.

Trampolines: What's the Harm?

Trampolines hold the promise of fun and enjoyment for many children, but they are associated with a significant number of orthopedic and other injuries. Injuries vary from minor to severe, and the most common are extremity injuries. Although most injuries are associated with residential (ie, backyard) trampolines, a growing number of injuries now occur in trampoline parks. Adult supervision has not been effective for prevention. Emerging data on trampoline park-related injuries indicate that caution should be exercised in these settings as well. [Pediatr Ann. 2018;47(10):e385-e387.].

Parental Knowledge of Trampoline Safety in Children

OBJECTIVE

Recreational trampoline use is increasing in popularity, with a resulting increase in significant trampoline-related injuries in children. Parents are the best advocates for the safety of their children during recreational trampoline use. Our primary objective was to determine the proportion of parents who were aware of 5 key recommendations for safer recreational trampoline use in children.

METHODS

This was a cross-sectional survey of parents whose children presented to a tertiary care pediatric emergency department with an extremity injury. Survey questions were derived and validated using expert opinion, available literature, and pre- and pilot testing of questions on the target audience.

RESULTS

Of the 1415 enrolled parents, 654 (46.2%) had regular access to a trampoline and 125 (8.8%) of their children had a history of trampoline injury. A total of 116 (8.2%; 95% confidence interval, 6.8-9.6) parents were aware of all 5 key safety recommendations for home trampoline use. Specifically, the proportion of parents who reported knowledge of the requirement for active supervision, regularly inspected safety equipment, avoiding stunts, multiple jumpers, and use by children 6 years of age and older was 89.0%, 77.2%, 44.3%, 41.6%, and 18.3%, respectively.

CONCLUSIONS

Trampoline safety knowledge of the 5 key recommendations among parents was low, specifically with respect to recommended age, number of jumpers, and stunts. Because it is unlikely that use of recreational trampolines will decrease, a harm reduction approach that includes a public knowledge translation strategy of recommendations for safer home use of trampolines is necessary.

Trampoline injuries in the world and in Turkey

Trampoline continues to be an activity that individuals in every age, but particularly children, enjoy to do for nearly a hundred years. However, it has some unpleasant effects due to the risk of injury. Safety rules, therefore, need to be followed during trampoline activities. Contemporarily, it is not recommended for small children and purposes other that sportive activities in Western countries. In this review, we discuss the trampoline-related injuries to increase the awareness in the society and to shape the regulations related with the trampoline use in Turkey.

Competitive trampolining influences trabecular bone structure, bone size, and bone strength

BACKGROUND

Trampolining is a form of gymnastics that has increased in popularity over the last decade and due to its concurrence with the formative years of bone development, it may have an important impact on bone health. However, bone density, microarchitecture, and bone strength of competitive trampolinists have not been explored. Therefore, the purpose of this cross-sectional study was to investigate the relationship between trampolining participation and (1) bone density, area, and microarchitecture; and (2) estimated bone strength and the role of muscle and impact loading in young female adults.

METHODS

We recruited 29 female participants aged 16-29 years for this study (n = 14 trampolinists; n = 15 controls). Skeletal parameters were assessed using dual X-ray absorptiometry, high-resolution peripheral quantitative computed tomography (HR-pQCT), and finite element analysis (FEA). Muscle strength was measured using dynamometers.

RESULTS

Trampolinists had higher bone density at the hip and spine, greater trabecular density and thicker trabeculae at the tibia, as well as larger bones at both the tibia and radius than controls (p < 0.05). Trampolinists also had higher muscle strength than controls at the lower body with no difference between groups in the upper body. Estimates of bone strength using FEA were greater for trampolinists than controls at both the radius and tibia.

CONCLUSION

This is the first study to investigate bone density, area, and microarchitecture in female trampolinists using HR-pQCT. Trampolinists had greater bone density, area, microarchitecture, and estimated bone strength than controls.

Trampoline Park and Home Trampoline Injuries

BACKGROUND AND OBJECTIVE

Trampoline parks, indoor recreational facilities with wall-to-wall trampolines, are increasing in number and popularity. The objective was to identify trends in emergency department visits for trampoline park injuries (TPIs) and compare TPI characteristics with home trampoline injuries (HTIs).

METHODS

Data on trampoline injuries from the National Electronic Injury Surveillance System from 2010 to 2014 were analyzed. Sample weights were applied to estimate yearly national injury trends; unweighted cases were used for comparison of injury patterns.

RESULTS

Estimated US emergency department visits for TPI increased significantly, from 581 in 2010 to 6932 in 2014 (P = .045), whereas HTIs did not increase (P = .13). Patients with TPI (n = 330) were older than patients with HTI (n = 7933) (mean 13.3 vs 9.5 years, respectively, P < .001) and predominantly male. Sprains and fractures were the most common injuries at trampoline parks and homes. Compared with HTIs, TPIs were less likely to involve head injury (odds ratio [OR] 0.64; 95% confidence interval [CI], 0.46-0.89), more likely to involve lower extremity injury (OR 2.39; 95% CI, 1.91-2.98), more likely to be a dislocation (OR 2.12; 95% CI, 1.10-4.09), and more likely to warrant admission (OR 1.76; 95% CI, 1.19-2.61). TPIs necessitating hospital admission included open fractures and spinal cord injuries. TPI mechanisms included falls, contact with other jumpers, and flips.

CONCLUSIONS

TPI patterns differed significantly from HTIs. TPIs are an emerging concern; additional investigation and strategies are needed to prevent injury at trampoline parks.

Trampoline related injuries in adults

INTRODUCTION

Trampoline-related injuries in adults are uncommon. Participation in trampolining is increasing following its admission as a sport in the Olympics and the opening of local recreational trampoline centres. The aim of this study was to assess the number and outcomes of adult trampoline-related orthopaedic injuries presenting to four trauma hospitals in Victoria.

METHODS

A cohort study was performed for the period 2007-2013. Adult patients registered by the Victorian Orthopaedic Trauma Outcomes Registry (VOTOR) who had sustained a trampolining related injury were included in this study. Descriptive analyses were used to describe the patient population, the injuries sustained and their in-hospital and 6-month outcomes.

RESULTS

There was an increase in trampolining injuries from 2007 (n=3) to 2012 (n=14) and 2013 (n=18). Overall, fifty patients with a median age of 25 (range 16-66) were identified. Thirty-five patients (70%) had lower limb injuries, 20 patients (40%) had spinal injuries and one patient had an upper limb injury. Thirty-nine patients (78%) required surgery. Fractures of the tibia (n=13), ankle fractures (n=12) and cervical spine injuries (n=7) were the most common injuries; all of which required surgery. Complications included death, spinal cord injuries, compartment syndrome and open fractures. At 6 months post injury, more than half (52%) of the patients had not achieved a good recovery, 32% had some form of persistent disability, 14% did not get back to work and overall physical health for the cohort was well below population norms for the SF-12.

CONCLUSION

Adult trampoline-related injuries have increased in the last few years in this cohort identified through VOTOR. Lower limb and spinal injuries are most prevalent. Public awareness and education are important to reduce the risk for people participating in this activity.

Fractures from trampolines: results from a national database, 2002 to 2011

BACKGROUND

No study specifically analyzes trampoline fracture patterns across a large population. The purpose of this study was to determine such patterns.

METHODS

We queried the National Electronic Injury Surveillance System database for trampoline injuries between 2002 and 2011, and the patients were analyzed by age, sex, race, anatomic location of the injury, geographical location of the injury, and disposition from the emergency department (ED). Statistical analyses were performed with SUDAAN 10 software. Estimated expenses were determined using 2010 data.

RESULTS

There were an estimated 1,002,735 ED visits for trampoline-related injuries; 288,876 (29.0%) sustained fractures. The average age for those with fractures was 9.5 years; 92.7% were aged 16 years or younger; 51.7% were male, 95.1% occurred at home, and 9.9% were admitted. The fractures were located in the upper extremity (59.9%), lower extremity (35.7%), and axial skeleton (spine, skull/face, rib/sternum) (4.4%-spine 1.0%, skull/face 2.9%, rib/sternum 0.5%). Those in the axial skeleton were older (16.5 y) than the upper extremity (8.7 y) or lower extremity (10.0 y) (P<0.0001) and more frequently male (67.9%). Lower extremity fractures were more frequently female (54.0%) (P<0.0001). The forearm (37%) and elbow (19%) were most common in the upper extremity; elbow fractures were most frequently admitted (20.0%). The tibia/fibula (39.5%) and ankle (31.5%) were most common in the lower extremity; femur fractures were most frequently admitted (57.9%). Cervical (36.4%) and lumbar (24.7%) were most common locations in the spine; cervical fractures were the most frequently admitted (75.6%). The total ED expense for all trampoline injuries over this 10-year period was $1.002 billion and $408 million for fractures.

CONCLUSIONS

Trampoline fractures most frequently involve the upper extremity followed by the lower extremity, >90% occur in children. The financial burden to society is large. Further efforts for prevention are needed.

[Safety measures for trampolines cannot prevent severe injuries]

BACKGROUND

The number of injuries caused by accidents while springing on a trampoline has increased significantly. This study therefore focused on the incidence, morbidity and circumstances of the accidents in pediatric patients.

METHODS

The children admitted to this hospital from 2002 to 2010 were re-examined and the children injured during trampolining were asked to fill out a questionnaire focusing on the mechanism of the injury and the circumstances.

RESULTS

A total of 268 accidents were included in the study and 28% of the injuries were severe (e.g. fracture, luxation and rupture). If there were special safety measures (e.g. safety net, floor mats, surrounding water 63%) 28.4% of the injuries were severe and without safety measures 28.6% were severe. Safety measures did not influence the incidence of severe trauma (p=1). If a trampoline was equipped with a safety net (53%) 31% of the injuries were severe and without a safety net 25% were severe (p=0.473).

CONCLUSION

Pediatric accidents on a trampoline result in severe injuries in 28% of cases. There is no difference in the severity of the injury regarding trampolines with or without special safety measures. Safety nets do not reduce the risk of severe injury.

Trampoline related injuries in children: risk factors and radiographic findings

BACKGROUND

Backyard trampolines are immensely popular among children, but are associated with an increase of trampoline-related injuries. The aim of this study was to evaluate radiographs of children with trampoline related injuries and to determine the risk factors.

METHODS

Between 2003 and 2009, 286 children under the age of 16 with backyard trampoline injuries were included in the study. The number of injuries increased from 13 patients in 2003 to 86 in 2009. The median age of the 286 patients was 7 years (range: 1-15 years). Totally 140 (49%) patients were males, and 146 (51%) females. Medical records and all available diagnostic imaging were reviewed. A questionnaire was sent to the parents to evaluate the circumstances of each injury, the type of trampoline, the protection equipment and the experience of the children using the trampoline. The study was approved by the Institutional Ethics Committee of the University Hospital of Bern.

RESULTS

The questionnaires and radiographs of the 104 patients were available for evaluation. A fracture was sustained in 51 of the 104 patients. More than 75% of all patients sustaining injuries and in 90% of patients with fractures were jumping on the trampoline with other children at the time of the accident. The most common fractures were supracondylar humeral fractures (29%) and forearm fractures (25%). Fractures of the proximal tibia occurred especially in younger children between 2-5 years of age.

CONCLUSIONS

Children younger than 5 years old are at risk for specific proximal tibia fractures ("Trampoline Fracture"). A child jumping simultaneously with other children has a higher risk of suffering from a fracture.

Trampoline safety in childhood and adolescence

Despite previous recommendations from the American Academy of Pediatrics discouraging home use of trampolines, recreational use of trampolines in the home setting continues to be a popular activity among children and adolescents. This policy statement is an update to previous statements, reflecting the current literature on prevalence, patterns, and mechanisms of trampoline-related injuries. Most trampoline injuries occur with multiple simultaneous users on the mat. Cervical spine injuries often occur with falls off the trampoline or with attempts at somersaults or flips. Studies on the efficacy of trampoline safety measures are reviewed, and although there is a paucity of data, current implementation of safety measures have not appeared to mitigate risk substantially. Therefore, the home use of trampolines is strongly discouraged. The role of trampoline as a competitive sport and in structured training settings is reviewed, and recommendations for enhancing safety in these environments are made.

Trampoline trauma in children: is it preventable?

OBJECTIVES

Trampoline injuries represent a preventable cause of injury in children. This study identified the characteristics of children injured while using trampolines who presented to a pediatric trauma center in Sydney, Australia.

METHODS

The Pediatric Trauma Database at our institution was reviewed to identify children with trampoline-related injuries between January 1999 and June 2008. Data collected included age, sex, Injury Severity Score, anatomical region injured, type of injury, mechanism of injury, site of injury and surface fallen onto, level of supervision, treatment, and hospital length of stay.

RESULTS

Over the 9.5-year review period, 383 children presented with trampoline-related injuries: 193 (50.4%) were female. Just over a quarter (n = 106, 27.7%) were treated and discharged the same day. The remaining patients accounted for 725 hospital bed days with a mean length of stay of 2.3 days. The most common area of the body injured was the upper limb (n = 246, 64.2%), with a fall from the trampoline to the ground being the most frequent mechanism of injury (n = 257, 67.1%). The majority (n = 345, 90.1%) of children were injured in their home or at the home of a friend or relative. Surgery was required in 236 (61.6%), with closed reduction of an upper limb fracture being the most common procedure (n = 107, 27.9%).

CONCLUSIONS

Trampoline-related injuries remain common in children. Implementation of current guidelines and the introduction of innovative trampoline designs should reduce the risk of this injury in children.

Trampolining injuries

Trampoline-related injuries have increased dramatically over the last few years. This article presents a review of the literature summarizing the different types and mechanisms of sustaining such injuries and looks at current recommendations to prevent them.

Trampoline-related injuries in childhood

Recommendations to prevent trampoline injuries were given since the 1970s. However, despite these educational efforts, safety recommendations seem to be ignored and the number of trampoline injuries is increasing. All children referred to our department for injuries related to trampolines over a period of 3 years were included. The patients' records were reviewed and a questionnaire was sent out in order to gain additional information. Injuries were classified as severe and mild. A total of 265 children (46% m, 54% f) with a median age of 8.2 years (range 1 to 14) were included. The injury rate was continuously growing from the year 2005 (10.6%) to 2007 (58.1%). Most of the injuries were recorded between April and September with a peak of injuries in August. Seventy-five percent of all accidents happened in the afternoon; 40% of the injuries were classified as severe, 60% as mild. Nets or equal security devices were used in 56.6%. Trampolining is associated with a significant risk for bodily harm at any age and results in severe injuries in 40% of cases. Though there may be still room for improvement in safety recommendations, all attempts over a period of more than 30 years to reduce the number of trampoline-related backyard injuries failed and the incidence is still increasing. At present, trampolines cannot be made safe for recreational activities and are of an unacceptable risk even under supervision.

Heely injuries: a new epidemic warranting a government health warning!

INTRODUCTION

Heelys, the new craze gripping the nation, were first introduced to Ireland in 2005 having been available in the United States since 2000. Designed as "the only shoe with a removable wheel in the sole" and initially marketed among rollerbladers and skateboarders they have been adopted by children as contemporary footwear.

MATERIAL AND METHODS

From April to June 2006, all patients presenting to trauma orthopaedic services at our institutions with injuries sustained while wearing Heelys were included in this study.

RESULTS

Thirty-nine patients are included in this study. The mean age was 9.1 years (range 7-13, median 9 years). Of the 39 patients referred to the orthopaedic service, 8 required admissions to hospital. One patient admitted following a head injury, required craniotomy and evacuation of an extradural haematoma.

CONCLUSION

The significance of the injuries encountered demonstrates the potentially devastating results from the use of Heelys. The public perception of safety is incorrect and manufacturers rightly recommend strongly the use of safety gear.