Pediatric Orthopedic Hoverboard Injuries: A Prospectively Enrolled Cohort Andrew D. Sobel, MD, Daniel B. Reid, MD, MPH, Travis D. Blood, MD, Alan H. Daniels, MD, and Aristides I. Cruz, Jr, MD Hoverboards pose a significant risk of musculoskeletal injury to pediatric riders. A prospectively enrolled cohort yielded 9 pediatric patients injured while riding hoverboards in 2016. Eight of the injuries involved the upper extremity, and one involved the lower extremity. No riders wore any safety equipment and injury patterns modeled those seen in skateboard riders. (J Pediatr 2017;190:271-4). S elf-balancing electric scooters, or “hoverboards,” have become increasingly popular as modes of recre- ational transportation for children and adolescents since 2015 in the US. 1 These devices require a high level of balance, coordination, and strength, and if not properly op- erated by following the instructions in user manuals, 2 may lead to injury. With >2.5 million units sold in 2015, 3 injuries have been on the rise, requiring visits to urgent care centers, emer- gency departments, and clinical practices. Orthopedic injuries due to other low-speed, nonmotorized, wheeled vehicles such as skateboards, in-line skates, bicycles, and scooters typically are low energy in nature, are prevalent in children and adolescents, and often occur in the upper extremity. 4-8 There has been a significant drive to improve the safety of these recreational activities with a focus tar- geted toward the education on proper riding and use of protective gear, including helmets and wrist guards, which may reduce injuries significantly. 9,10 These efforts have reduced dramatically the incidence of preventable injuries 11 ; however, no formal intervention has been put into place for hoverboards. Valdez 12 recommended that providers give patients injured on hoverboards instructions for skateboard safety as a basic guide, input data on the patients into trauma registries, and advocate for legislative guidance to reduce the risk of injuries. The purpose of this investigation was to determine the types of injuries associated with hoverboard use, the characteris- tics of injured riders, and whether safety equipment was used before injury in a pediatric population. In addition, given the similarities between hoverboards and other recreational devices such as skateboards, we sought to compare injury character- istics between the 2 devices. We hypothesized that the injury patterns and patient characteristics would be similar. Methods Approval for review of medical records with a waiver of in- formed consent for record review was granted by our hospi- tal’s institutional review board. From December 2015 through November 2016, patients who sustained an injury while riding a hoverboard requiring orthopedic surgery consultation and who presented to the emergency department in our Level 1 trauma-certified pediatric hospital located in a Northeastern metropolitan area were included in the study. These patients were identified by the research investigators the morning after their presentations, and were prospectively followed. Patients were excluded if they were >19 years of age. The records of our included patients were then followed within our outpatient offices until completion of their care. Care was guided by injury and surgeon-patient discussion and not altered by inclusion in this study. At the completion of care, a review of the electronic medical records was performed by the authors. Demographic data including age, sex, weight, medical comorbidities, and developmental delays were in- cluded. Radiographs and physician progress notes were re- viewed for injury characteristics including location and morphology, skin integrity, neurovascular status, and con- comitant nonorthopedic injuries. Operative and nonoperative treatment modalities used in the emergency department, hos- pital, and outpatient offices were summarized. The use of safety equipment, including helmets, was noted if documented in the medical record from the emergency department or patients or families affirmed their use during office visits. Descriptive sta- tistical analysis was performed to interpret the data. Results A total of 9 patients met the inclusion criteria for this study during the enrollment period (Table). The mean age was 11 years (range 6-15 years), and all patients were male. No patient had a medical or developmental history that would result in decreased bone density, coordination, strength, or intelli- gence. The use of helmets, wrist or shin guards, knee pads, or any other protective equipment was not noted for any patient. The Table details each patient’s injury and treatment. All injuries were considered closed fractures and no adverse events in the care of these patients was noted. Eight (88.9%) of the injuries involved the upper extremity, and one (11.1%) in- volved the lower extremity. Conscious sedation and closed re- duction to improve the fracture alignment was required for 4 of the 9 (44.4%) upper extremity fractures (Figure). In ad- dition, 1 patient sustained a closed distal fibula fracture, which was minimally displaced and casted in situ. All patients were From the Department of Orthopaedic Surgery, Warren Alpert School of Medicine, Brown University, Providence, RI The authors declare no relevant conflicts of interest. 0022-3476/$ - see front matter. © 2017 Elsevier Inc. All rights reserved. https://doi.org10.1016/j.jpeds.2017.07.041 THE JOURNAL OF PEDIATRICS • www.jpeds.com CLINICAL AND LABORATORY OBSERVATIONS 271