P3A350: A National Twenty-year Analysis of Fractures Related to Weightlifting in the Adolescent Population

Background: Weightlifting has become a core component of competitive sports training, school physical education classes, fitness programs, and recreational exercise amongst adolescents. While many health benefits exist including improved strength, cardiovascular fitness and mental health, there is also concern for injury especially in the setting of improper supervision and accelerated progression of training loads. Though organizations have advocated safe training practices, trends in the national health burden of injuries, specifically fractures, associated with weightlifting in the adolescent population have not been investigated.

Methods: The National Electronic Injury Surveillance System database was queried between 2002 and 2021 for patients aged 11 to 21 years presenting to U.S. Emergency Departments with weightlifting related injuries. The narrative component of each case was analyzed to exclude patients not using weightlifting equipment or free-weights (i.e., barbells, dumbbells, kettlebells) at the time of injury and to note the mechanism of injury and weight being used. National estimates and analyses of injury characteristics were performed with 95% confidence intervals.

Results: While there has been some variability in weightlifting related injuries, the incidence remained roughly constant over the 20-year study period (Figure 1). 14,497 cases were identified, reflecting a national estimate of 540,986 total injuries (Table 1). Fractures made up 9.9% of injuries for an estimated 53,813 fractures. Of all patients diagnosed with fractures, majority were male (82.2%, 79.5% – 84.7%), white (50.3%, 43.2 – 57.4%), and aged 15 to 17 years old (42.1%, 38.7 – 45.6%). Overall, the most fractured body parts were fingers (37.1%, 33.7 – 40.7%) and toes (27.9%, 25.3 – 30.7%). Among males, upper body fractures represented a greater proportion of fractures (59.6%, 56.7 – 62.4%), whereas among females, lower body fractures were most prevalent (49.3%, 41.7 – 56.9%) (p < 0.001). Most fractures occurred at school (25.3%, 21.6 – 29.4%) or places of recreation (24.7%, 20.6 – 29.3%). When reported, fractures in females most often occurred at school (30.3%, 23.3 – 38.3%) whereas in males they most often occurred at places of recreation (25.3%, 21.1 – 30.0%). Accidental release of weight onto the body part was the most frequent mechanism (67%, 64.3 – 70.0%).

Conclusion: The national health burden of weightlifting related fractures amongst adolescents has remained constant over the 20-year period despite guidelines to improve injuries. Given that most of the fractures occur in the distal extremities such as toes and fingers at school and places of recreation, and that most injuries are caused by accidental release of weights, there may be an opportunity to promote safer weightlifting practices and the development of weightlifting equipment with in-built safety mechanisms especially at gyms and schools. Adult supervision to educate adolescents on the importance of safe weightlifting practices and the gradual increase in weight may also help prevent injuries.