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Pediatric Upper Extremity Fractures Associated with Sports Participation: Incidence, Etiology, and Prevention
Xuyang Song, MD; Brandon Schwartz, MD; Joshua M. Abzug, MD
University of Maryland Medical Center, Baltimore, MD

Introduction: Sports related injuries are extremely common in the pediatric and adolescent population. The purpose of this study was to evaluate the incidence of sport participation related upper extremity fractures as well as to assess which sports cause upper extremity fractures and whether protective equipment or formal training makes an impact on their occurrence.

Materials & Methods: A questionnaire was administered to all pediatric and adolescent patients (or their parents) who presented for evaluation of a sports-related injury. Data collected included patient demographics, the sport they were playing when the injury occurred, the injury location, the years of experience playing that sport, the amount of formal training in that sport, the competitive setting at the time of injury, and whether or not the appropriate protective equipment was utilized. The diagnoses were recorded and simple statistical analysis was performed.

Results: 339 patients were surveyed over a 12 month period. The majority of injuries involved the upper extremity 56% (191/339) with fractures accounting for 80% (153/191) of these cases. Football 48% (72/153) was the most common sport causing a patient to sustain a upper extremity fracture, followed by basketball 18% (27/153) and soccer 9% (14/153). Among football related fractures, 64% (43/72) occurred in participants with 2 or more years of formal training. Furthermore, this group who had more training wore protective equipment 67% (29/43) of the time while participants with 1 or fewer years of training used protective gear only 3% (1/29) of the time. The hand, 49% (75/153) was the most frequently fractured location followed by the wrist 26% (40/153) and shoulder 9% (14/153). The setting where fractures occurred was unorganized play 46% (70/153) of the time, followed by organized recreational play 31% (47/153) of the time, with the remainder of fractures occurring at high school junior varsity, varsity, or official club/travel team games or practice.

Conclusions: Pediatric and adolescent patients frequently sustain fractures during sports participation with football causing three times as many fractures as the next most common sport (basketball) and accounting for nearly half of all pediatric sports related fractures. In football neither increased formal training nor the use of protective equipment seems to help reduce fracture incidence. Increased awareness and possible new protective equipment is needed for football to reduce the risk for fracture in the pediatric population.

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