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Epidemiology of US High School Sports-Related Fractures, 2005-2009

Swenson, David M BS*†; Yard, Ellen E PhD; Collins, Christy L MA; Fields, Sarah K JD PhD; Comstock, R Dawn PhD†§¶

Clinical Journal of Sport Medicine: July 2010 - Volume 20 - Issue 4 - p 293-299
doi: 10.1097/JSM.0b013e3181e8fae8
Original Research

Objective: To describe the epidemiology of fractures among US high school athletes participating in 9 popular sports.

Design: Descriptive epidemiologic study.

Setting: Sports injury data for the 2005-2009 academic years were collected using an Internet-based injury surveillance system, Reporting Information Online (RIO).

Participants: A nationally representative sample of 100 US high schools.

Assessment of Risk Factors: Injuries sustained as a function of sport and sex.

Main Outcome Measures: Fracture injury rates, body site, outcome, surgery, and mechanism.

Results: Fractures (n = 568 177 nationally) accounted for 10.1% of all injuries sustained by US high school athletes. The highest rate of fractures was in football (4.61 per 10 000 athlete exposures) and the lowest in volleyball (0.52). Boys were more likely than girls to sustain a fracture in basketball (rate ratio, 1.35,; 95% confidence interval, 1.06-1.72) and soccer (rate ratio, 1.34; 95% confidence interval, 1.05-1.71). Overall, the most frequently fractured body sites were the hand/finger (28.3%), wrist (10.4%), and lower leg (9.3%). Fractures were the most common injury to the nose (76.9%), forearm (56.4%), hand/finger (41.7%), and wrist (41.6%). Most fractures resulted in >3 weeks' time lost (34.3%) or a medical disqualification from participation (24.2%) and were more likely to result in >3 weeks' time lost and medical disqualification than all other injuries combined. Fractures frequently required expensive medical diagnostic imaging examinations such as x-ray, computed tomographic scan, and magnetic resonance imaging. Additionally, 16.1% of fractures required surgical treatment, accounting for 26.9% of all injuries requiring surgery. Illegal activity was noted in 9.3% of all fractures with the highest proportion of fractures related to illegal activity in girls' soccer (27.9%).

Conclusions: Fractures are a major concern for US high school athletes. They can severely affect the athlete's ability to continue sports participation and can impose substantial medical costs on the injured athletes' families. Targeted, evidence-based, effective fracture prevention programs are needed.

From the *Ohio State University, College of Medicine, Columbus, Ohio; †Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio; ‡School of Physical Activity and Educational Services; §Department of Pediatrics, College of Medicine; and ¶Division of Epidemiology, College of Public Health, Ohio State University, Columbus, Ohio.

Submitted for publication March 18, 2010; accepted May 20, 2010.

Funded in part by the Centers for Disease Control and Prevention grant R49/CE000674-01 and grant R49/CE001172-01 and by the Samuel J. Roessler Memorial Scholarship Fund.

The content of this study is solely the responsibility of the authors and does not necessarily represent the official views of the Centers for Disease Control and Prevention.

Reprints: Christy L. Collins, MA, Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital, 700 Children's Dr, Columbus, OH 43205 (e-mail:

© 2010 Lippincott Williams & Wilkins, Inc.