...literature to help define the epidemiology and identify possible prevention strategies. Common fracture locations include the distal radius, hand, elbow, and clavicle, 90% of fractures involve the upper limb. Males sustain fractures twice as often as females. The highest numbers of injuries occur in bicycle riding, basketball, football, and roller sports. Prospective studies of preventive strategies for pediatric sport fractures are urgently needed.

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The pediatric population is becoming more and more involved in sports activities, (1) including classic sports (eg, football, basketball, and soccer) and newer sports (eg, inline skating and skateboarding). (2) Although most sports-related injuries are minor events, such as strains and sprains, perhaps 15% to 25% of these injuries result in fractures. (3,4)

Sports-related injuries constitute a major portion of pediatric injuries, but there is little epidemiological information about pediatric sports injuries, particularly fractures. (5) In this article, we provide an overview of the epidemiology of pediatric fractures in sports and point to areas for future research that would suggest evidence-based interventions to prevent these serious and costly injuries.

METHODS

This study involved a broad search of databases and analysis of the current literature on pediatric sports fractures. Three electronic databases were searched: Medline, Cochrane Database of Systematic and Complete Reviews, and Cochrane Controlled Trials Registry. The results revealed a total of 166 articles; 24 articles were population-based studies. The age range of the subjects in the studies was to 21 years; the sports activities included were both competitive and recreational.

RESULTS

Epidemiology

An estimated 30 million children in the United States are active in organized sports programs. (6) As this number has increased, so too has the number of acute and chronic sports-related injuries. There are an estimated 2.6 million pediatric emergency department (ED) visits each year, at an estimated annual cost of $1.8 billion. (6)

In a study that used National Health Interview Survey data from 1987 through 1994, Danseco and colleagues' estimated the overall injury incidence rates in children aged to 21 years. Injuries occurred at higher rates in white children than in others. Children whose families were at very low and somewhat high income levels were at highest risk for injury. Males consistently had higher injury rates than females in every investigation (ratio, 2:1).

Injury rates in children, estimated overall at 25/100, or 20.6 million injuries per year, increased with age; children aged to 9 years had the lowest rate of injury. This increase with age was linear, with a drop-off at age 15 years for boys and 12 years for girls. The age-specific decline probably was related to physeal closure for the respective sexes.

Some age-specific "sports" have peaks in lower age groups. For example, the rate of falls in playground games is highest in the 1- to 4-year-old group. Agran and associates' reported that the rates of unintentional injuries, such as being struck by an opponent in sports activity or with bicycling, are highest in the 10- to 19-year-old range.

The most frequently injured areas of the body are the ankle and knee, followed by the hand, wrist, elbow, shin, calf, head, neck, and clavicle. Common fracture locations are the distal radius, hand, elbow, and clavicle; 66% to 90% of fractures involve the upper...

NOTE: All illustrations and photos have been removed from this article.



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