Originally published at Pediatric EM Morsels on July 21, 2017. Reposted with permission.

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Life is full of dangers, everywhere we go, and the house is certainly not a complete sanctuary. In fact, the home can be quite hazardous (ex, Detergent Pods, Liquid Nicotine, Electricity, Firearms, and Lawn Mowers). While some of these items are obviously dangerous and should be avoided, there are other items that are meant to be fun, like the pool, that can turn out to be common sources of pain and suffering.  One such item (and my all time least favorite neighborhood “toy”) is the trampoline. Let’s take a minute to review Trampoline Injuries:

Trampoline Injuries: Basics

• Trampoline injuries become prominent in the 1990’s (doubling from 1991 to 1996) [Briskin, 2012]
• Hospitalization rates from trampoline injuries range from 3% to 14%.
• Today, in addition to home trampolines, there are commercial trampoline parks.
• Most home trampolines, like swimming pools, are considered to be “attractive nuissances” by insurance companies. [Briskin, 2012]
  • They entice children to jump neighbor’s fences to engage in risky behaviors and become injured.
  • They are often not covered by homeowner insurance policies.
• Inflatable “Bounce” houses are equally dangerous. [Thompson, 2012]

Trampoline Injuries: Potential Hazards

• Immaturity (in both coordination and decision making)
  • Younger children are at the greatest risk for injury:
    • Their skeletal structures often are not mature enough to withstand the forces imparted by the trampoline.
      • Children <6 years of age are at considerable risk. [Briskin, 2012]
      • Fractures are seen in 48% of these younger children with trampoline injuries compared to 29% of older.
    • This is particularly apparent when a smaller child is on the trampoline with a larger child.
    • Even without impact between the two kids, the forces generated from the larger one can injure the smaller one.
  • Coordination is also less developed in children and correcting body position in midair may not be easily accomplished.
  • ~75% of injuries occur when multiple people are using the trampoline at the same time. [Briskin, 2012]

• Falls from the trampoline
  • Often consider the primary concern that is mitigated by the “safety net.”
  • Falls can be severe and account for substantial injuries. [Briskin, 2012]
  • Currently, there is not evidence that netting reduces rate of injuries. [Briskin, 2012]
    • Netting may be incorrectly installed
    • Netting may even encourage even riskier behavior

• Impact with trampoline frame/springs
  • Striking the frame or springs can lead to significant injury.
  • Padding is typically used to cover the edges, but may become worn and/or poorly positioned.
  • No evidence that padding decreases rate of injuries. [Briskin, 2012]

• Poor supervision
  • Sorry parents… it isn’t always the kids’ fault or the manufacturers’ fault.
  • Lack of parental knowledge about continued hazards (despite the presence of padding and a net) is a known issue. [Beno, 2017]

Trampoline Injuries: The Injuries

• Extremity Injuries [Briskin, 2012]
  • Lower extremity injuries are the most prevalent.
    • Proximal tibial fractures
      • Seen in children <6 years of age.
      • Transverse fractures and Torus-type fractures
  • Upper extremity injuries are more common when a child falls off of the trampoline.
    • Surgery is often required for these [Sandler, 2011]

• Head / Neck Injuries [Briskin, 2012]
  • 0.5% of all trampoline injuries result in permanent neurologic damage!
  • Cervical spine injuries happen from falls as well as failed flips (again, these are not super coordinated Olympians).
  • Atlanto-Axial Subluxation – 
    • Cases have occurred in normal children without prior skeletal anomalies.
    • Can present with torticollis or neck pain.

     

  • Vertebral artery dissection – [Casserly, 2015]
    • Often presents 12-24 hours after initial trampoline injury.
    • Abrupt hyperextension and rotation mechanism injures vessel.
    • Intramural thrombus can develop and lead to embolic ischemic events.
    • Neck pain after trampoline injury warrants concern.

Moral of the Morsel

• Educate every chance you get! Injury prevention starts with an educated community! Young children and multiple people should not be on trampolines.
• A false sense of security is no one’s friend. A net does not make a trampoline safe.
• Neck pain is a problem! Be concerned about cervical injury as well as vascular injury if a patient has neck pain associated with a trampoline injury.
• It is costly! Remind families that homeowner’s insurance may not cover trampoline related injuries.

References