Jan 29, 2015
Breaks in the Action

dawncomstock-head.jpgBy Dawn Comstock

The Center for Injury Research and Policy at The Research Institute at Nationwide Children’s Hospital in Cincinnati shares its analysis of fracture rates for high school athletes as they relate to sport and gender.

Despite all our best intentions, we all know that sports-related injuries can and do occur. Even though the positive benefits of sports outweigh negatives of potential injury, much more work can be done to make sports as safe as possible for all children. One important injury of concern to athletes and sports medicine professionals are fractures. Fractures often affect the ability of an athlete to participate in sports and can impose substantial medical costs on the injured athletes’ families.

This concern underscores the need to develop effective fracture prevention programs. However, few researchers have examined fracture incidence and patterns in detail across a wide range of sports and athletes. Recently, the National High School Sports-Related Injury Surveillance Study analyzed fractures in an attempt to uncover new insights that will lead sports medicine professionals towards injury prevention.

Here is a summary of the main findings:


• Fractures account for one in 10 injuries sustained by US high school athletes.

• Fractures were three times more likely to occur in competition compared to practice.

• As expected due to the large amount of physical contact, football had the highest fracture rate. On average, a football player will sustain one fracture every 714 games. In other words, a team of 40 football players will have one player sustain a fracture every 18 games.

• Baseball has the highest proportion of fractures, with one in seven injuries a fracture.

Injury Patterns

• The most frequently fractured body sites were the hand (27 percent), wrist (11 percent), nose (eight percent), ankle (eight percent), lower leg (eight percent), and forearm (eight percent).

• Fractures are serious injuries because they often remove the athlete from play for a long period of time. Over half of all athletes sustaining a fracture missed >3 weeks of play or were medically disqualified for the remainder of their season.

• One in six fractures required surgical treatment.

• In the study, fractures were a leading cause of the use of expensive diagnostic imaging techniques such as MRIs and CT scans. Fractures accounted for 26 percent of all injuries requiring x-ray, 10 percent of all injuries requiring CT scans, with seven percent of all injuries requiring MRI.

• Only three percent of all fractures were recurrent Injury Mechanisms

• Half of all fractures resulted from contact with another player and one-quarter resulted from contact with the playing surface.

• One in 12 fractures resulted from illegal activity. Fractures resulting from illegal activity were most common in girls’ soccer, where one in four fractures were attributed to illegal activity. Illegal activity was also associated with 17 percent of fractures in girls’ basketball and 14 percent of fractures in boys’ basketball. Fractures related to illegal activity were often to the nose (23 percent), lower leg (22 percent), and ankle (17 percent).

• Every sport has unique activities that lead to injury. Here are the two most common activities leading to fractures in the nine sports studied: o Football: Being tackled (26 percent) and tackling (22 percent). o Boys’ soccer: Chasing loose ball (18 percent) and ball handling/dribbling (14 percent). o Girls’ soccer: Defending (19 percent) and goaltending (17 percent). o Volleyball: Blocking (24 percent) and digging (24 percent). o Boys’ basketball: Rebounding (24 percent) and defending (23 percent). o Girls’ basketball: Rebounding (22 percent) and receiving a pass (20 percent). o Wrestling: Takedowns (56 percent) and sparring (13 percent). o Baseball: Fielding (30 percent) and batting (16 percent). o Softball: Fielding (33 percent) and catching (22 percent).

Knowing the incidence and patterns of sports-related fractures will help future researchers focus on ways to prevent these injuries. Preventive measures could include additional/improved protective equipment, such as facemasks among infielders in baseball and softball. Because one in 12 fractures result from illegal activity, adding increased penalties and stricter enforcement to deter actions intended to cause harm is warranted.

Dawn Comstock, PhD, is a principle investigator at the Center for Injury Research and Policy at The Research Institute at Nationwide Children’s Hospital. She is also an assistant professor at The Ohio State University in the College of Medicine and the College of Public Health. Her research interests include the epidemiology of sports, recreation, and leisure activity-related injuries among children and adolescents as well as the life-long health benefits associated with an active childhood. She can be reached at [email protected].

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