Abstract
Supracondylar fractures of the humerus (SCH) are the most common fractures sustained following a fall on an outstretched hand in healthy children, and one of the leading causes of hospital admission and surgical intervention. With increasing severity of injury, treatment options become more invasive and the potential for long lasting complications increases. The aim of this study is to examine the causes and circumstances surrounding SCH in public play spaces particularly to determine whether or not the playground equipment implicated in injurious falls is compliant with Canadian Standards Association (CSA) standards.
Children aged 6–12 years who sustained SCH while playing at a public play space between 2017 and 2019 were recruited from the paediatric orthopaedic clinic. Public playgrounds within a 50 km radius of the clinic were visited by research assistants. Using GPS coordinates from photographs taken by the children at the site of injury or play structures identified by the children using Google Maps, play structure type, dimensions, height of fall, and the type and depth of the surface material were collected from each site and compared to the relevant CSA standard.
Of the 89 SCH injuries reported during the recruitment period, 49 (55%) occurred on public play structures. Thirty-nine injury sites, representing 42 SCH cases, were accessible to conduct site visits and were included in the analysis. Thirteen children (31%) sustained Type One, 19 (45%) were Type Two, and 10 (24%) were Type Three SCHs. The mean child age at injury was 7.13 years. Of the 42 SCH cases, 37 sites had woodchips surfacing (88%); three had rubber (7%), one had cement (2%), and one had sand (2%). Of the 36 sites where woodchip depth measurements could be obtained, only seven (19%) met the minimum CSA depth. Out of the 42 SCH cases, 29 injuries (69%) involved upper body equipment (i.e. monkey bars or similar) and track rides. Fourteen of these 29 injuries (48%) occurred on structures that did not meet CSA standards for fall height. All rotating play structures had less than half of the required clearance between the components.
Eighty-six percent of SCH cases occurred in playgrounds where at least one of the required CSA standards was not met. Woodchip surfacing was of particular concern because 81% of woodchip surface depths failed to meet CSA standards. Of the 14 injuries where fall height did not meet CSA standards, 11 (79%) also did not meet minimum CSA surface depth. Field investigation into the characteristics of playgrounds in which children sustain SCH can guide preventative policy and practice measures. Municipalities and school boards should be alerted to the need for regular maintenance of woodchip playground surfacing, in order to remain compliant with the minimum surface depth and prevent serious injuries. Additionally, compliance with minimum surface depths can also decrease fall heights to meet CSA standards. By minimizing the prevalence of SCH injuries occurring on play structures and the need for emergency department visits, the burden to healthcare systems and families of injured children can potentially be reduced.
