What is the management for a trampoline-related arm injury?

Management of Trampoline-Related Arm Injuries

Trampoline-related arm injuries require prompt medical evaluation and appropriate management based on injury type, with upper extremity fractures accounting for approximately 60% of arm injuries and requiring specific treatment protocols. 1

Types of Trampoline-Related Arm Injuries

• Upper extremity injuries account for 24-36% of all trampoline injuries 1, 2
• Common fracture sites include:
  • Supracondylar humerus fractures (15.3%) 2
  • Distal radius fractures (15.3%) 2
  • Elbow fractures (7%) 3
• Nerve injuries can accompany fractures (e.g., ulnar nerve neuropathy with elbow fractures) 3
• Soft tissue injuries including sprains, strains, and contusions 2

Diagnostic Approach

Initial Assessment

1. Mechanism of injury - determine if injury occurred from:

   • Fall on the trampoline mat (most common)
   • Collision with another jumper
   • Fall onto frame or springs
   • Fall off the trampoline
   • Performing tricks/somersaults 1, 3

2. Physical examination focusing on:

   • Deformity, swelling, ecchymosis
   • Range of motion
   • Neurovascular status (particularly with elbow injuries)
   • Associated injuries (cervical spine, other extremities)

Imaging

1. Plain radiographs as initial imaging for suspected fractures
2. MRI when:
   • Plain radiographs are negative but clinical suspicion remains high
   • Soft tissue injury is suspected
   • Delayed onset of symptoms occurs after trampoline use 4

MRI detected injuries in 75% of children with trampoline-related pain even when radiographs were negative 4

Treatment Algorithm

Non-Severe Injuries (80-85% of cases)

1. Soft tissue injuries:

   • RICE protocol (Rest, Ice, Compression, Elevation)
   • Temporary immobilization (used in 80% of non-severe injuries) 2
   • Analgesics as needed
   • Follow-up to ensure proper healing

2. Simple/stable fractures:

   • Appropriate casting/splinting
   • Regular follow-up to monitor healing
   • Rehabilitation after immobilization period

Severe Injuries (15-16.5% requiring general anesthesia) 2

1. Displaced fractures:

   • Closed or open reduction
   • Internal fixation as needed
   • Post-operative immobilization
   • Structured rehabilitation program

2. Elbow fractures with nerve involvement:

   • Urgent orthopedic consultation
   • Surgical intervention with careful attention to ulnar nerve 3
   • Close monitoring of neurological status

Special Considerations

• Children under 5 years are at increased risk for fractures and dislocations 1
• Multiple jumpers significantly increase injury risk - 74% of injuries occur with more than two people on the trampoline 3
• Delayed presentation - some injuries, particularly tibial fractures in young children, may present hours to days after the activity 4

Prevention Strategies

The American Academy of Pediatrics recommends:

• Single jumper on the trampoline at any given time
• Adult supervision (only 22% of injuries in children under 11 had adult supervision) 3
• Proper protective padding in good condition
• No somersaults or flips (major cause of cervical spine injuries)
• Ground-level placement of trampolines when possible 1

Follow-up Care

• Regular assessment of healing
• Rehabilitation focused on:
  • Restoring range of motion
  • Rebuilding strength
  • Proprioceptive training
• Return to activity only when full function is restored

Pitfalls to Avoid

• Missing associated injuries - carefully assess for concurrent injuries, especially neck injuries which may present with delayed symptoms
• Underestimating severity - MRI may be necessary even with negative radiographs 4
• Inadequate immobilization - particularly important with unstable fractures
• Delayed treatment of nerve injuries - can lead to permanent neurological deficits
• Premature return to activity - ensure complete healing before resuming normal activities