Patterns of Fractures among Children who Fall

Children suffer from falls more commonly than adults. In fact, more than 200,000 children under the age of 14 are seen in emergency rooms for falls in the playground each year in the US. Almost 45 percent of these injuries are rated as “severe” and include internal injuries, concussions, fractures, dislocations and even amputations.

About seventy five percent of all nonfatal injuries related to playing on a playground happened on public playgrounds such as school playgrounds and daycare center playgrounds. About 150 children die per year from injuries sustained on a playground. Fifty six percent of them died from strangulating on playground equipment and 20 percent died from falls from high up on the equipment to the ground. Seventy percent of all deaths from playground equipment occurred on home equipment.

It is estimated that the overall cost of playground injuries in kids aged 14 years and younger is about $1.2 billion USD. This cost is borne by families, insurance companies and companies that make playground equipment.

Of all children playing on the playground, 55 percent of injuries are sustained by girls who have weaker bones and are at greater risk for head injuries. Children who climb on climbers than on any other equipment seem to get injured more often. Kids from 5-9 years of age get injured more often than other age groups. Most of their injuries were school-related. On private (home) playgrounds, swings tend to be the source of most playground injuries. People who play on playgrounds in low income areas get injured more often because these places tend to be maintained less with more broken equipment and worse surfaces to fall on.

When kids fall from heights, their pattern of injury is significantly different from falls in adults. This is so much so that doctors need to use a different imaging protocol in assessing these kids in the emergency room. One study looked at 45 children and infants and found that most kids sustained an extremity injury, occurring in about half of all cases. Head injuries occurred in more than a third of all patients, including skull fractures and internal head injuries. Only one patient had an abdominal injury. Four of these patients had a pneumothorax; half had pulmonary contusions. It was not common to have a spine injury or pelvic injury.

Interestingly, the height of the fall didn’t predict the nature or severity of the fall. Based on these and the above findings, the authors of the research study recommended that all kids who fall should get a cervical spine x-ray and a chest x-ray when first seen. CT scans of the head were recommended with x-rays of the pelvis, the rest of the spine, the abdomen, and the extremities to be done on a case by case basis.

Special attention needs to be taken for rib fractures and skull fractures, both of which can be life threatening injuries. This is why these should be included in a protocol and done for all kids who sustain a fall in the playground or from some other height.