Skateboard injuries by bestt571


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									   With regard to the use of commercially available         References
dietary fluids, the message from Wendland and Arbus         1. ROHDE JE, NORTHRUP RS: Taking science where the
should be clear: Don't administer unspecified "clear"          diarrhoea is, in A cute Diarrhoea in Childhood, Ciba
fluids to babies with diarrhea. The administration of          Foundation Symposium 42, Elsevier, New York, 1976,
some prepared clear soups can be hazardous because             p 339
                                                            2. GALL DG, HAMILTON JR: Infectious diarrhoea in infants
of their high salt content. In theory, many products           and children. Cliii Gastroenterol 6: 431, 1977
that are hyperosmolar or have a high sugar content           3. CARLSON JAK, MIDDLETON PJ, SZYMANSKI MT, et al:
can worsen and prolong diarrhea unless they are                 Fatal rotavirus gastroenteritis - analysis of 21 cases.
diluted to the point where their osmolarity approaches          Am J Dis Child 132: 477, 1978
that of plasma. Thus, many soft drinks and fruit juices      4. BISHOP RF, DAVIDSON GP, HOLMES IH, et al: Virus
                                                                particles in epithelial cells of duodenal mucosa from
should be diluted to at least half-strength.                    children with acute non-bacterial gastroenteritis. Lancet
                                                                2: 1281, 1973
   None of these dietary fluids can meet the nutritional     5. MIDDLETON PJ, SZYMANSKI MT. ABBOTT GD, et al:
requirements of the infant, but during the acute phase          Orbivirus acute gastroenteritis in infancy. Lancet 1: 1241,
of severe infectious diarrhea one has no practical op-          1974
                                                             6. DAVIDSON GP, GALL DG, BUTLER DG, et al: Human
tion other than to restrict energy and protein intake.          rotavirus enteritis induced in conventional piglets - in-
However, nutritional reserves are limited in infants,9          testinal structure and transport. J Clin invest 60: 1402,
and, undoubtedly, nutrients are important for repair            1977
after enteric infection.10 Within 24 to 48 hours ade-        7. TELCH J, SHEPHERD RW, BUTLER DG, et al: Jejunal
quate energy and protein intake should be provided.             glucose transport in acute invasive viral enteritis (abstr).
                                                                Cliii Res 26: 852A, 1978
These objectives are met not by giving hyperosmolar          8. TALLETT 5, MACKENZIE C, MIDDLETON P, et al: Clinical,
sugar solutions but by instituting a balanced diet.             laboratory and epidemiologic features of a viral gastro-
Fortunately, there seems to be a considerable margin            enteritis in infants and children. Pediatrics 60: 217, 1977
for error and most sick babies, even those with acute        9. HEIRD WC, DRISCOLL JM JR, SCHULLINGER JN, et al:
enteritis, recover, whatever their treatment. Neverthe-         Intravenous alimentation in pediatric patients. J Pediatr
                                                                80: 351, 1972
less, in this "modern" era of nutritional ignorance a       10. HAMILTON JR, GALL DG, BUTLER DG, et al: Viral gastro-
careful assessment of what we feed these fragile pa-            enteritis: recent progress, remaining problems, in A cute
tients seems appropriate.                                       Diarrhoea in Childhood, op cit, p 209

                                          Skateboard injuries
                                          ROBERT G. SMITH,* MD, FRCP[C]

With summer in full swing the fractures and sprains         information about the dangers of skateboarding, pro-
from winter skiing have been replaced in hospital           pose tactics to reduce the frequency of injury and
emergency departments by skateboard injuries. In            consider the wisdom of restricting the use of skate-
1977, 184 persons with skateboard injuries were             boards.
treated at the Hospital for Sick Children in Toronto1          Half of all reported skateboard injuries are fractures
and 53 were seen during a 4-month period at the             of limbs. Fatalities are rare, but in the United States
Children's Centre in Winnipeg (The Medical Post, Feb.       there were 24 deaths in a 3-year period, most due
14, 1978, p 63). No cross-Canada figures are avail-         to head injuries or contact with moving vehicles.2
able, but it has been estimated that more than 87 000          Further analysis of injuries reveals some interesting
skateboard injuries were treated in emergency depart-       facts.2 One third of accident victims had been skate-
ments in the United States in 1978.2 Because of our         boarding for less than 1 week, and most of them were
colder climate and the availability of other attractive     injured the first time they tried skateboarding. Two
summer activities, the Canadian rate of skateboard          of five injured persons had borrowed skateboards. One
injuries is probably less than the customary 10% of         third of accidents occurred when a board struck irre-
the American figure. However, skateboard accidents          gularities in the riding surfaces; in one quarter of
are still a cause for concern among parents and pedia-      accidents the victims lost their balance. Most skate-
tricians, some of whom are putting pressure on legisla-     boarders, it is believed, are between 10 and 17 years
tors to "ban the boards".                                   of age; 14- and 1 5-year-olds are the primary users of
   Before someone sums up this summer's skateboard          skateboards. Of all persons injured 45% are between
injuries toll it would be wise to review the available       10 and 14 years of age. Thus, the inexperienced young
                                                            skateboarder who tests his or her skill on an irregular
                                                            riding surface, or on unfamiliar or unrepetitive terrain,
*Member, child health committee, Manitoba Medical           is at the greatest risk of injury.
Association                                                    Are skateboards safe to use? Some may validly
Reprint requests to: Dr. Robert G. Smith, Selkirk Medical   argue that skateboards are inherently unstable and
Centre, 353 Eveline St., Selkirk, Man. RiA lN1              are thus unsafe to use. Be that as it may, product
failure accounts for only 1 % of all injuries.2 Some        larity of such parks shows that the idea is a good one.
features, nevertheless, do make some skateboards safer      It matters not that the parks are soon abandoned by
to use than others. Basically, skateboards consist of       many experienced skaters because the repetitive sur-
three parts: the deck, the wheels and the trucks.           faces no longer challenge their skills. At least for
    The deck of the skateboard is usually 60 to 75 cm       inexperienced and part-time skaters the environment
long and is constructed of wood, plastic, fibreglass or     is controlled and reasonably safe. In Canada, however,
aluminum. The more flexible the deck, the more skill        such parks are scarce. The climate in most parts of
needed to maneuver the skateboard. Fibreglass decks         Canada makes skateboarding a seasonal sport. Indoor
are the most flexible and wooden ones the least.            parks are expensive to build and insure, and private
Skateboards with short decks are the best for doing         entrepreneurs have not rushed to fill the demand.
tricks and gaining speed. Those with relatively long        Some cities in Canada are in the process of establishing
inflexible decks and a nonslip covering are the safest      small outdoor public parks, but there are problems
for beginners. The aluminum boards are not recom-           not only in the reluctance of those who control the
mended because the edges of their decks wear to a           public purse, but also in the free exchange of ideas
razor-like sharpness.                                       on the most functional and safest designs. For example,
    Wide wheels (stokers) are from 5 to 6 cm wide and       when individuals in Winnipeg were attempting to
make the board more stable; although narrow wheels          design outdoor parks, they could not, after several
(slicks), which are from 3 to 4 cm wide, are less stable,   enquiries, obtain any information from those who had
they increase maneuverability. The best wheels are          established parks in the United States. The industry
made of plastic or polyurethane, not rubber. The            is competitive and secretive.
wheels should have sealed steel bearings and should             What are the answers? At present, parents and con-
be held on the axle by lock nuts that can be tightened      cerned groups can only ensure that the sport is made
without limiting the motion of the wheel and will not       safer. In other words, parents should insist that their
loosen with use.                                            children have the most reliable skateboards and that
    The trucking mechanism is the device by which the       they use safety equipment. Safe skating areas (e.g.,
wheels are attached to the deck. It should be so con-       temporarily closed residential streets and supermarket
structed as to allow side-to-side movement and there-       parking lots) must be provided until parks can be
fore steering. Trucks should be adjustable according        established. An ongoing program of consumer educa-
 to the weight of the rider and should be attached to        tion should be initiated. Rather than pressuring gov-
 the deck with lock nuts.                                    ernments to attain unreachable objectives such as ban-
    Experience notwithstanding, riders can make skate-      ning the use of skateboards from the streets, we should
boarding safer by using a helmet, knee and elbow            pressure them to study the phenomenon of skateboard-
 pads, and heavy gloves. These may be ineffective in         ing in Canada and determine the problem areas and
 reducing the incidence of fractures, but they can reduce    the risks, to promote consumer education and, finally,
 the incidence of head injuries, contusions and abra-       to set safety standards regarding the construction of
 sions. Thus, the incidence of injuries due to skate-        skateboards sold in Canada. At present, we allow the
boarding can be reduced, perhaps by as much as one           sale of unsafe equipment, we make no demands that
 third,2 if skateboard riders use their equipment in a       manufacturers package their product with warnings or
 controlled environment such as an area where they           instructions on its safe use and we raise no objections
 will not come into contact with automobiles, where          when the media show persons skateboarding without
 there are smooth riding surfaces, and where the riding      safety equipment or in an unsafe environment. These
 surface is repetitive and familiar, and if riders can       are areas in which governments can act and in which
be encouraged to wear protective equipment and have          we should encourage them to do so.
periodic safety checks of their equipment. With the             Perhaps skateboards will go the way of the hula-
 use of helmets and the avoidance of collision with          hoop. I don't think so and I hope not. For the present,
 automobiles, death can be eliminated. Since experience      however, let us encourage participants to use them
 plays an important part in the prevention of injury,        safely.
 consumer education is obviously important.
    Should skateboards be banned? No, they should not.      References
 Certainly attempts should be made to discourage their
                                                            1. HAFFEY H: Annual Report - Accident Survey, Hospital
 use on dangerous surfaces such as roadways. Attempts          for Sick Children, Toronto, 1978
 have been made to ban the use of skateboards on            2. Hazards Analysis Reports. Injuries Associated with Skate-
 the streets, but the regulations have proved unenforce-       boards (product code 1333), economic analysis, hazard
 able. However, the goal should be to encourage riders         identification and analysis directorate, US Consumer Prod-
 to enjoy and develop this sport safely. After all,            uct Safety Commission, Washington, 1977
 doesn't skateboarding develop the attributes we would      Recommended reading
 like to see our children attain - grace of motion,         MADDOX D: Skateboarding: the spill-and-skill sport. Physician
 agility, coordination and a sense of achievement in          Sports Med 6: 108, 1978
 a sport they enjoy?                                        Idem: Skateboards: zip-and-zap riders. Physician Sports Med
     The means to achieve safety may seem simple -            4: 24, 1976
 the development of parks for skateboarding compar-         ATIENZA F, SIA C: The hazards of skateboard-riding. Pedia-
                                                              trics 57: 793, 1976
 able to ice-skating rinks, where the rigid regulation of   JACOBS RA, KELLER EL: Skateboard accidents. Pediatrics
 safety standards and the compulsory use of safety            59: 939, 1977
  equipment are enforced. In the United States the popu-    Skateboards. Which Dec: 643, 1977

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