Monkeybar injuries: Complications of play

Background. Playground equipment resulted in >200 000 injuries from 1990 to 1994, according to the Consumer Product Safety Commission; 88% were attrib utable to climbers (monkeybars/jungle gyms [MB/JGs]), swings, and slides. E quipment-specific injury requiring emergency department (ED) evaluation has not been reported previously. Objective. To describe the spectrum of significant MB/JG-related injuries. Methods. A 2-year retrospective chart review was performed using the comput erized charting system at a large urban Children's Hospital/Regional Pediat ric Trauma Center with 50 000 ED visits per year. A telephone survey also w as conducted after the chart review to obtain additional information concer ning the injury location, the surface type below the equipment, and the pre sence of adult supervision. Results. A total of 204 patients were identified. Mean age was 6.2 years (r ange, 20 months to 12 years): 114 (56%) were male. A seasonal variation was noted with June to August accounting for 43% of visits. Injuries included fractures in 124 (61%), contusions in 20 (10%), neck and back strains in 17 (8%), lacerations in 16 (8%), closed held injuries in 10 (5%), abdominal t rauma in 5 (3%), genitourinary injuries in 5 (3%), and miscellaneous injuri es in the remainder. Among fractures, 90% were fractures of the upper extre mity; 48 (40%) were supracondylar fractures. One child sustained a C7 compr ession fracture. Abdominal injuries included 1 child who sustained a spleni c laceration. All genitourinary injuries (2 vaginal hematomas, 1 vaginal co ntusion, 1 penile laceration, and 1 urethral injury) were from straddle-typ e injuries. Fifty-one (25%) patients were admitted to the hospital. Of thes e, 47 (92%) required an operative procedure (orthopedic reduction or vagina l examination under anesthesia). Analysis of the telephone data revealed that the surface did not influence the injury type. Of the 79 fractures, 30 occurred on "soft surfaces." injur y type was associated significantly with chronologic age. Younger children (1 to 4 years of age) sustained more long-bone fractures than did older chi ldren. The presence of adult (at least 18 years of age) supervision, did no t influence the occurrence of fractures. Conclusions. These data suggest that 1) a significant proportion (25%) of M B/JG-related injuries that are evaluated in the ED require hospitalization; 2) most of the injuries resulting in admission will require operative inte rvention (92%); 3) the surface below the equipment has no influence on the type or severity of the injury; 4) younger children are more likely to sust ain long-bone fractures than are older children; and 5) adult supervision d oes not influence the injury pattern. These data identify the need for addi tional investigation of means of making MB/JGs safer for child use.