In total,
1795 children visited radiology 1871 times with 2418 total radiological examinations for analysis between 2012 and 2017.
The RIS search yielded 1820 x-ray visits (2343 separate radiographic examinations),
10 ultrasound visits,
2 nuclear medicine studies,
20 CT visits and 19 MRI visits after exclusions for non-trampolining injuries.
Cross-sectional imaging accounted for 2.1% (39/1871 visits) of imaging carried out in trampoline-related injuries, at our institution.
Over half of these patients had abnormalities identified.
CT
20 children (35% male,
mean age 10.9 years,
range 2 - 17 years) had CT scans of 28 different body parts.
No child atteneded twice.
17 CT scans (85%) were carried out acutely,
the remaining 3 in the sub-acute setting.
Positive findings were seen in 11 patients (55%).
Injuries included:
5 head injuries (figure 1 and 2):
- Orbital fracture (2 patients)
- Basal skull fracture
- Comminuted skull base fracture with inco-malleolar dislocation
- Ping-pong type skull fracture
1 spinal fracture (figure 3):
- T12 superior end plate depression
5 limb fractures:
- Complex distal tibia/fibula
- Proximal tibia
- Complex midfoot
- Displaced distal tibia
- Medial proximal tibia
No patients required general anaesthesia.
All negative (9/20) scans were performed in the acute setting.
MR
19 children (15.8% male,
mean age 11.4 years,
range 3 -16 years) had MR scans imaging 28 body parts.
No child attended more than once.
2 MR scans (10.6%) were undertaken acutely (spinal imaging).
9 children (47.3%) had positive findings with 7 (77.8%) of these performed sub-acutely;
Injuries included:
2 spinal injury (figure 4 and 5):
- Fracture-dislocation C5-C6
- C1-C2 subluxation
5 limb injuries:
- Patella tendinopathy (2 patients)
- Proximal tibia fracture
- Obturator externus tear
2 incidental findings:
- Inflammatory joint disease (1 patient)
One 3-year-old patient required general anaesthesia.
DISCUSSION
Recreational trampolining is dangerous and can lead to life-altering injuries.
Lack of supervision,
multi-user use and age of user are all strong risk factors for injury.
[1-3]
In this study,
cross-sectional imaging use has shown a general rise over the study period but is often not required.
- CT scans perfomed increased from 2 in 2012 to 6 in 2017.
- 13/20 CT scans were performed during 2016-2017,
suggesting a shift in imaging practice and availability.
Diagnosis of intra-cranial trauma is important in the acute setting and can be complimented by MRI in cases of doubt,
especially for ligamentous injury of the spine.
Its availability and speed in the acute setting makes it a useful tool for quickly excluding important injuries.
In the sub-acute setting,
CT can be used to confirm subtle orthopaedic injury,
which can be difficult to exclude on plain radiography,
especialy when clinical signs are not in keeping with initial radiological findings. We did not include any CT scans used for surgical planning,
but this is also a prevalent use for CT in the sub-acute setting.
MR imaging has also increased.
- 2 scans performed in 2012 rising to 5 in 2017.
- 11/19 scans performed were during the last 2 years of the study period also (2016-2017).
The indication for MR in the acute setting was primarily to evaluate spinal injuries,
which required neurosurgical input.
In the sub-acute setting,
indications were for persistent pain with no clear clinical or radiological cause identified.
It is thought that because of these more unclear mechanisms of injury that more incidental findings were seen i.e.
tendinopathy,
arthropathy,
and where trampolining was not the true underlying cause of the patients' pain.