PEDIATRICS Vol. 119 No. 6 June 2007, pp. e1294-e1298 (doi:10.1542/peds.2006-2882)
ARTICLE |
Heelys and Street Gliders Injuries: A New Type of Pediatric Injury
Trauma and Orthopaedic Surgery Department, Temple Street Children's University Hospital, Dublin, Ireland
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ABSTRACT |
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OBJECTIVES. Our goals were to highlight an increasing trend in orthopedic injuries in children as a result of "heeling" or "street gliding," to describe injuries sustained by children using Heelys (HSL, Carrollton, TX) and Street Gliders (Glowgadgets Ltd, Bristol, United Kingdom), and to increase public awareness and prevent such injuries.
PATIENTS AND METHODS. We prospectively recorded the data of all roller shoes injuries referred to our department during the summer school holiday. Using a data-collection sheet, we recorded demographic data, type of injury, mechanism and place of injury, heeling or street-gliding experience, use of safety equipment, methods of treatment, and intention to continue heeling or street gliding after recovery from injury.
RESULTS. Over a 10-week period, 67 children suffered orthopedic injuries while using Heelys or Street Gliders. There were 56 girls and 11 boys with a mean age of 9.6 years. Upper limbs were the most common location of injury. Distal radius fractures were the most prevalent, followed by supracondylar fractures, elbow dislocations, and hand fractures. The majority of children suffered the injury while heeling or street gliding outdoors. Interestingly, 20% of the injuries happened while trying Heelys or Street Gliders for the first time, and 36% of the injuries occurred while learning (using 1–5 times) how to use them. None of the children used any sort of protective gear at the time of the injury. The majority of the injured children expressed their intention to continue heeling or street gliding after complete recovery from their injury.
CONCLUSIONS. Our study shows that the majority of children with injuries from heeling or street gliding are girls. We recommend close supervision of children using Heelys or Street Gliders during the steep learning curve and usage of protective gear at all times. These new types of injuries have a serious impact on child health and constitute a burden for the pediatric orthopedic service.
Key Words: roller shoes • pediatric injuries • heelys • street gliders
Heelys (HSL, Carrollton, TX) are the only shoes with a removable wheel in the heel (Fig 1). The innovative shoes with wheels in the heel allow "heelers" to go from a walk to a roll by shifting body weight. They were first launched in 2000 in the United States, and since then, Heelys have become extremely popular among children all over the world. The producing company reports the distribution of >4.5 million pairs in >60 countries worldwide.1 The popularity of the Heelys, also called roller shoes, spawned many imitations, increasing the accessibility of children to this activity. Street Gliders (Glowgadgets Ltd, Bristol, United Kingdom) are a different version in which wheels are strapped to regular running shoes to simply combine walking with rolling only by shifting body weight (Fig 2). With the growing popularity of this new trend, an increasing number of media reports raising the awareness of a high injury risk have been released.
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To change from walking to rolling while using Heelys or Street Gliders, children place 1 foot in front of the other and shift their body weight backward over the wheels in the heels. This is called, in user terms, "crocodile stance" (Fig 3). The skating position of Heelys and Street Gliders is a balanced position of a body that tends to fall backward. This is achieved by contracting the hip extensors muscles, flattening the lumbar lordosis, and pushing the shoulder and neck forward.
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To further report on injury risk of this new trend, we prospectively recorded injuries resulting from "heeling" or "street gliding" that required orthopedic treatment during school summer holiday in 2006. The objective of this article is to describe the orthopedic injuries in children resulting from heeling or street gliding.
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METHODS |
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All of the children presented to the Orthopaedic Surgery Department, Temple Street Children University Hospital, for assessment and additional treatment of fractures resulting from using Heelys and Street Gliders, were eligible for inclusion in the study. Our institution is a tertiary referral pediatric trauma unit covering a population of 130000 children. All of the children in the area requiring orthopedic assessment or treatment are referred to our unit. This is a consecutive series of orthopedic injuries because of heeling or street gliding that we prospectively recorded during school summer holiday (July 1 to September 15, 2006). Using a data-collection sheet, we recorded demographic data (gender and age), type of injury, mechanism and place of injury, heeling or street gliding experience, use of safety equipment, methods of treatment, and intention to continue heeling or street gliding after recovery from injury. We recorded all of the data ourselves. The study was conducted in conformity with the Helsinki II Declaration, and parents of all of the children included in the study gave their consent.
Children were followed up as outpatients with regular visits to our clinic until full clinical resolution of their respective injuries. There were no patients lost to follow-up.
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RESULTS |
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TOPABSTRACTMETHODSRESULTSDISCUSSIONCONCLUSIONSREFERENCES |
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Demographic Data
Over the 10-week period, 67 children were treated for Heelys- or Street Gliders–related injuries. Ages ranged from 6 to 15 years; the mean age was 9.6 years. The majority of injured children (83.5%) were girls. During this period of time, a total of 830 children were referred to our department for assessment and treatment of traumatic fractures; thus, Heelys and Street Gliders injuries represented 8% of the workload of the orthopedic department during the study period. From the total number of injuries, 78% (50 of 67) were because of heeling, and 22% (17 of 67) were because of street gliding. In our study we did not include children with minor injuries who did not require orthopedic assessment or treatment or those who were treated by the accident and emergency department only.
Mechanism and Location of Injury
The mechanism of injury was falling backward (55%) or forward (32%) as the user was trying to transfer the body weight and find balance on the wheels. In a few cases (13%), the injury was caused by a fall because of jumping or sudden change in direction of motion. The majority of injuries (76%) happened while heeling or street gliding outdoors (road, sidewalk, cycle lane, or playground). From the injuries that took place indoors (24%), 10 (15%) were in a shopping mall, and 7 (9%) were in the family home.
Injury Pattern and Management
The majority of children (58 of 67 [87%]) sustained upper-limb trauma. Distal radial fractures were the most common type of injury encountered. There were 50 distal radius fractures in 49 children (1 child sustained bilateral distal radius fractures). There were also 5 supracondylar fractures, 2 elbow dislocations, and 2 metacarpal fractures. The lower limb was also injured in 9 patients: 6 foot and ankle injuries, 2 tibia/fibula fractures, and 1 knee injury. In the presented series of injuries, there were no head injuries, and none of the injuries were life threatening. From the total number of patients referred to our department, 38% (24 of 67) required admission to the hospital for manipulation under anesthesia and cast application.
Contributing Factors
When asked to rate their own level of experience of heeling or street gliding, the majority (70%) of children considered themselves beginners, having used the Heelys or Street Gliders between 1 and 5 times only; 23 children (34%) were first-time users. There were 8 children (12%) with intermediate experience, and 12 children (18%) were advanced in using roller shoes. The more experienced children suffered an injury while trying to jump or suddenly change direction. None of the injured children were wearing any kind of protective gear at the time of their injury, and only 8 children (12%) were fully familiar with the user instructions provided by the manufacturer.
Interestingly, when asked about their intention of continuing heeling or street gliding after recovery from their injury, 54% (36 of 67) of the children expressed their intention to use the Heelys or Street Gliders again. This was in big disagreement with the view of their parents.
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DISCUSSION |
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TOPABSTRACTMETHODSRESULTSDISCUSSIONCONCLUSIONSREFERENCES |
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Here we present a consecutive series, over 10 weeks, of 67 children who suffered orthopedic injuries while using Heelys or Street Gliders. There were 56 girls and 11 boys with a mean age of 9.6 years of age in our study group. Upper limbs sustained by far the most common type of injury. Distal radius fractures were the most prevalent, followed by supracondylar fractures, elbow dislocations, and hand fractures. The majority (76%) of children suffered the injury while heeling or street gliding outdoors. Interestingly, 20% of the injuries happened while trying Heelys or Street Gliders for the first time, and 36% of the injuries were sustained while learning (using 1–5 times) how to use them. None of the children used any sort of protection gear at the time of the injury, and only 12% were familiar with the instructions of use.
Although Heelys and Street Gliders are dramatically increasing in popularity among children around the world, only 1 study reports on injuries associated with this new sport.1 The authors reported a total of 37 serious orthopedic injuries over 6 months. Their patients suffered mainly upper-limb fractures (only 1 patient had a lower-limb fracture), with high preponderance of distal radius (55%) and elbow (34%) fractures. None of their patients wore any kind of safety or protection gear while heeling. The authors noted that, unlike roller blading and cycling, Heelys provide a built in versatility, allowing children to change from walking to rolling whenever they want to do so. Thus, children are less likely to wear protective gear at all times.
Although recreational skating can improve the health of children through exercise, participation in skating activities exposes children to a risk of injury. Multiple studies have explored pediatric injuries associated with roller skating and in-line skating.2–5 Our institution previously published 2 articles reporting on roller blade injuries.6,7 In 1998, the American Academy of Pediatrics issued a recommendation that children and adolescents wear full protective gear, including a helmet, wrist guards, knee pads, and elbow pads, during in-line skating. A decrease in injuries related to in-line skating started in 1999. The trend of decreasing in-line skating–related injuries may reflect more children wearing protective gear and/or the popularity of in-line skating decreasing.8 The National Safe Kids Campaign in the United States estimated that, in 2002, the number of children treated for roller skating–related injuries remained largely the same, at 
28400, and the number treated for in-line skating–related injuries declined from 42800 to 36300.9
The Canadian Safety Council issued a consumer alert (January 2006) advising children and parents of children using Heelys to wear protective gear and to avoid heeling on roads, sidewalks, and wet surfaces. They recommended a ban on heeling in public buildings and malls, as well as school hallways and playgrounds.10 In Europe and the United States there is no official regulation or public health alert concerning the safety of using Heelys or Street Gliders.
The most common mechanism of injury is falling backward or forward. The majority of injuries occurred while children were learning how to use roller shoes. Control and balance of the body's center of gravity is very important in wearing these roller shoes. The Canadian Safety Council, in a consumer safety alert, estimated that a month with daily practice is required to master this technique.10 At the time of the injury, none of our patients used any sort of protective gear, and only 12% were familiar with the instructions for use that were provided. The alternative mechanism of injury was falling while trying different tricks, such as jumping or suddenly changing direction while rolling. These injuries were encountered in children with advanced heeling or street-gliding skills. We noticed that a higher percentage (7 of 15 [47%]) of street gliding–related fractures required manipulation under anesthetic than did heeling-related injuries (11 of 52 [21%]). Street gliding–related fractures are higher energy injuries than heeling-related injuries. This is because of the larger diameter of the wheels in Street Gliders, allowing rolling at a higher speed than with Heelys. Most injuries happened outdoors, on streets, footpaths, or playgrounds. The majority of injured children in our study were girls. Although we do not have data on gender distribution of users of roller shoes, this could explained by a higher number of girls using Heelys or Street Gliders.
It seems that the new "walk-and-roll" generation is really enjoying the development of roller shoes. Despite their parents' intention that their children stop using Heelys or Street Gliders, 54% of the injured children expressed their intention to continue using them after recovery of their injury.
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CONCLUSIONS |
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TOPABSTRACTMETHODSRESULTSDISCUSSIONCONCLUSIONSREFERENCES |
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We report the single largest prospective epidemiologic study of orthopedic injuries in children that resulted from the increasingly popular new activities heeling and street gliding during the school summer holiday. We highlight the need for regulatory and safety recommendations to be issued by governmental bodies and agencies regarding marketing and safe use of Heelys and similar roller shoes.
To reduce the rate of such injuries, parents buying roller shoes need to understand both the benefits and risks of this activity. Children and their parents should appreciate that injuries are particularly common in novice users and those more adventurous advanced users. Full protective gear needs to be used at all times, including a helmet, wrist guards, knee pads, and elbow pads, when using roller shoes. Wrist guards should always be worn to reduce impact forces and distribution when a child falls on the outstretched hand, because upper-limb trauma constitutes 86.5% of our cases. Special attention should be paid to the needs of novice skaters to avoid injuries. We recommend that a safe-use guide be provided with each pair of roller shoes. An induction demonstration on safe use should be provided by retail outlets at the time of purchase of these roller shoes.
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FOOTNOTES |
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Accepted Nov 21, 2006.
Address correspondence to Mihai Vioreanu, MRCSI, 30 Ticknock Way, Ticknock Hill, Kingston, Ballinteer, Dublin 18, Ireland. E-mail: mihaiv{at}eircom.net
The authors have indicated they have no financial relationships relevant to this article to disclose.
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REFERENCES |
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TOPABSTRACTMETHODSRESULTSDISCUSSIONCONCLUSIONSREFERENCES |
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- American Academy of Pediatrics, Committee on Injury and Poison Prevention and Committee on Sports Medicine and Fitness. In-line skating injuries in children and adolescents.
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PEDIATRICS (ISSN 1098-4275). ©2007 by the American Academy of Pediatrics
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