Varus shearing force is a main injury mechanism of pediatric trampoline-related injury in addition to compressive axial loading.

Abstract

Many case studies have been published about trampoline-related injury (TRI); however, a comparative study could allow a more specific analysis of the characteristics of TRI, and enable more differentiated approaches to prevent such injuries. We investigated the injury mechanism of TRI in children compared with other pediatric trauma. Of 35,653 children (age 0-18 years) who visited the pediatric emergency department after traumatic injuries from January 2011 to June 2017, 372 patients with TRI (TRI group) were retrospectively identified. Among the remaining 35,281 patients with other trauma (non-TRI group), 372 were 1:1 matched to the TRI group according to sex, age, injured body part, and body weight (matched-control group). The patients' data, injured site, and injury patterns were compared between the groups. The most frequently injured body part was the knee/lower leg in the TRI group and the head in the non-TRI group. The most frequent injury types were fractures in the TRI group and open wounds in the non-TRI group. In the comparison between the TRI and matched-control groups, the most common lower-extremity fractures were proximal tibial fractures with varus angulation in the TRI group and tibial shaft spiral fractures in the matched-control group. For the upper extremities, the risk of lateral condylar humeral fracture was higher in the TRI group. The TRI group presented more physeal involvements. The risks of varus stress injury (proximal tibial fracture with varus angulation in lower extremity and lateral condylar humeral fracture in upper extremity) were higher in the TRI group than in matched-control group. Thus, varus shearing force seems to be an important injury mechanism in TRI in addition to compressive force. This varus force may increase the risk of physeal injury by generating additional shear force on the physis.