The cost of sustaining playground related extremity fractures in Singapore.

Purpose: To study the cost of sustaining a fracture of the extremity caused by playground equipment. These costs include financial, psychological, clinical and others like loss of school days.

Method: This is a prospective study of 226 children seen at the Paediatric Orthopaedic Department for a1-year period starting June 2005. Once confirmed to have a playground related fracture by the Orthopaedic specialist, three sets of data are collected. First is the clinical data. Second is the playground related data. This is done on site independently by another investigator. Third is the radiological data,which is assessed independently by an Orthopaedic surgeon to ensure consistency.

Results: Out of the 226 children seen, two-thirds were boys. The average age was 7.5 years. 35.8% were forearm fractures and 28.8% were supracondylar fractures with the rest being mostly fractures in the upper limb. 64.2% were treated with immobilisation only whilst 24.2% required closed manipulation and reduction. 1.2% required admission for treatment of their fractures. The average period of cast immobilisation was 34 days. The average number of consults, including that at the emergency department, was 4 with an average length of follow up of 67.2 days. Based on the above, in our institution, the average cost for outpatient treatment would be about S$680.00 (US$485.71) (US$1.00 = S$1.40; 1/1/2010) per injury. The inpatient cost for non-surgical treatment cost would be S$1000.00 and for surgical stabilisation the average cost would be S$3300.00 (US$2357.14).

Conclusion: Playgrounds are meant for children to play safely. Yet, there appears to be a significant number of injuries sustained. Whilst these fractures are relatively minor, requiring outpatient treatment,there are costs. Besides the financial costs, there are hidden psychological costs of loss of school days and inability to participate in sports. Finally, as with any injury, there can be long-term complications which present further clinical costs.

Significance: Most studies on playground injuries tend to concentrate on the equipment and very superficially cover the clinical aspects, less so the costs. This paper looks at the clinical aspects in greater depth and emphasises that there are significant costs, beyond financial, when a child sustains a playground injury. The next thing to do is to examine what playgrounds factors significantly contribute to these injuries and remedy them when planning the construction of playgrounds.