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Objectives: To investigate and quantify fall height, surface depth, and surface impact attenuation as risk factors for arm fracture in children who fall from playground equipment. Design: Unmatched case control study. Setting: Five case hospitals and 78 randomly selected control schools. Participants: Children aged less than 13 years in Victoria, Australia who fell from school playground equipment and landed on their arm. Cases sustained an upper limb fracture and controls had minor or no injury. A total of 402 cases and 283 controls were included. Interventions: Children were interviewed in the playground as soon as possible after their fall. Main outcome measures: Falls were recreated on site using two validated impact test devices: a headform (measuring peak G and HIC) and a novel anthropometric arm load dummy. Equipment and fall heights, as well as surface depth and substrate were measured. Results: Arm fracture risk was greatest for critical equipment heights above 1.5 m (OR 2.39, 95% CI 1.49 to 3.84, p,0.01), and critical fall heights above 1.0 m (OR 2.96, 95% CI 1.71 to 5.15, p,0.01). Peak headform deceleration below 100G was protective (OR 0.67, 95% CI 0.45 to 0.99, p = 0.04). Compliance with 20 cm surface depth recommendation was poor for both cases and controls. Conclusions: Arm fracture-specific criteria should be considered for future standards. These include surface and height conditions where critical headform deceleration is less than 100G. Consideration should also be given to reducing maximum equipment height to 1.5 m. Improved surface depth compliance and, in particular, guidelines for surface maintenance are required. P lay is essential to child development; however playgrounds can also pose serious safety risks. Where contributing factors are known, falls from playground equipment are the leading cause of all child fall related hospitalization in Australia.1 Upper limb fracture is the most common playground injury, accounting for 43% of emergency department presentations and 74% of hospital admissions.2 3 Playground injury is moderately severe, with 22% of children presenting to emergency departments and 32% of those with arm fracture requiring hospitalization.

The analyses support the need to improve safe quad bike operation through consideration of the age of the rider, training, helmet use, reducing the propensity of quad bikes to roll, and improving handling so that loss of control events are reduced and to prevent crushing and pinning by the vehicle during and after a rollover crash.

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