Research Article: School Playground Surfacing and Arm Fractures in Children: A Cluster Randomized Trial Comparing Sand to Wood Chip Surfaces

Date Published: December 15, 2009

Publisher: Public Library of Science

Author(s): Andrew W. Howard, Colin Macarthur, Linda Rothman, Andrew Willan, Alison K. Macpherson, Theo Vos

Abstract: In a randomized trial of elementary schools in Toronto, Andrew Howard and colleagues show that granitic sand playground surfaces reduce the risk of arm fractures from playground falls when compared with wood fiber surfaces.

Partial Text: Playground fractures—severe upper extremity fractures among 5–9 y olds resulting from a fall off a climbing frame, monkey bar, or similar equipment—are easily recognized by emergency department physicians and orthopaedic surgeons. The irony of injury risk in an environment specifically designed to promote healthy active play is clear.

This study provides empirical evidence that granitic sand playground surfaces are better than engineered wood fibre playground surfaces at preventing upper extremity fractures from equipment falls. The risk of an arm fracture from a fall off playground equipment on to the surface was 4.9 times higher in schools with Fibar (9.4 per 100,000 student-months, 95% CI 3.7–21.4) compared with schools with granitic sand playground surfaces (1.9 per 100,000 student-months, 95% CI 0.04–6.9). This increased risk of arm fracture was also observed when schools were included in an analysis by intervention received. The analysis by intervention received should be interpreted as a prospective cohort study, but not as a randomized study. Risk of other injuries from falling onto the playground surface was also higher among schools with Fibar surfaces. The risk of arm fractures and injuries from mechanisms not involving a fall onto the surface was equal for schools with Fibar or sand surfaces.



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