Sports-related injuries requiring surgery on the rise among high school athletes

Results from research published in the September edition of The American Journal of Sports Medicine show the cost of fractures, which account for more than approximately 10 percent of all high school sports injuries, can severely impact athletes physically, emotionally and financially, underscoring the need for fracture prevention programs.

The study, supported by funding in part from the Ohio State Center for Clinical and Translational Science (CCTS) was conducted using data collected from the National High School Sports-Related Injury Surveillance System. Researchers explored fracture rates among 20 boys' and girls' high school sports from 2008-2009 to 2010-2011 to identify rates of fracture by sport, fracture pattern and severity, as well as factors associated with fractures.

"As we continue to see a rise in U.S. high school students playing sports, it's likely we will see a continued trend of increased injuries among these same athletes, including fractures," said lead researcher, David Swenson, an MD/MPH candidate at the Ohio State Colleges of Medicine and Public Health. "Unless we change our approach to the way these athletes are trained, players and their families will continue to be faced with the unpleasant reality of fractures which include expensive surgeries, diagnostic testing and restricted sports participation."

While the study looked at both boys' and girls' sports, fracture rates were highest in boys' sports, including football, ice hockey and lacrosse. Boys also sustained 79 percent of all fractures reported, with majority taking place during competition caused by contact with another player. The most common sites of fractures included the hand/finger, lower leg and wrist. Approximately 17 percent of fractures required surgery, a rate higher than all other injuries combined. Researchers also found fracture rates were inversely correlated to players' ages, with varsity athletes showing lower rates of fractures compared to junior varsity players. No correlation was found between players' age and gender-adjusted body mass index.

While girls' sports showed lower fracture rates, researchers were surprised to find a high proportion of fractures caused by person-to-person contact, as well as contact with sports equipment, among female lacrosse players.

"Because girls' lacrosse is a noncontact sport we didn't expect to identify contact as the number one cause of fractures in the sport," said Swenson. "What we found was eye opening and highlighted the need for closer adherence to the rules of the game, as well as the potential for new rules like requiring protective equipment to keep these athletes safe on the field."

Researchers are hopeful their results will inspire coaches, athletes and officials to make a commitment to preventing fractures during competition, as well as practice, cutting down on the number of athletes who are sidelined by the injuries each year.

Meanwhile, Timothy Hewett, PhD, director of research in Sports Medicine at The Sports Health & Performance Institute and professor in the Departments of Physiology and Cell Biology, Orthopaedic Surgery and Biomedical Engineering at OSU has developed an ACL prevention program called P4ACL, tailored to high school and college athletes. Currently, the program screens athletes at risk for first-time ACL injuries by evaluating their neuromuscular control factors, BMI and other biological attributes.

"The good news is athletes' greatest contributor to ACL injuries- neuromuscular control factors- can be modified," said Hewett. "By participating in a prevention program before, during and after the sports season, high school and college athletes can reduce their risk of first-time ACL injuries by 60 to 70 percent."

Hewett's program includes an emphasis on injury preventing exercises, biofeedback and patient education. Last year, Hewett participated in an innovation series created by the CCTS and the Ohio State Fisher College of Business that gave researchers the chance to compete for additional funding to bring an idea to fruition.

The program was selected by the CCTS and innovation leaders at the business school to receive funding for the development of a business plan to promote awareness of the importance of preventing ACL injuries. Currently one in 40 to 100 athletes suffer from ACL injuries, a condition that typically costs $25,000 in treatment and side lines athletes for anywhere from six to 12 months.

Hewett's future research goals include conducting a study that can predict and prevent secondary ACL injuries in athletes. Currently, the risk of secondary ACL injuries average between one in four or five.