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

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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.