With spring approaching and warm weather just around the corner, children will be returning to neighborhood and schoolyard playgrounds. The number of playground injuries each year are high: according to the U.S. Product Safety Commission, in the year 2001 there were more than 509,000 playground-related injuries treated in hospital emergency rooms and doctor's offices. Not only are children sustaining injuries that, in many cases, can be prevented, it costs the U.S. over $11 billion in medical, work loss, pain, suffering and legal liability.

Most injuries occur when a child falls from the equipment onto the ground. Often they are hurt not only by the fall, but by being struck by the equipment as they fall.

"The type of surface on the playground is the most important factor in reducing the number and severity of injuries due to falls," explained Stuart Weinstein, MD, pediatric orthopaedic surgeon.

"Look for softer surfaces such as engineered wood mulch, shredded tires, or cushioned rubber safety surfacing. Asphalt, concrete, soil, packed dirt, grass and turf are not recommended," said Dr. Weinstein. "And, the greater the height of the equipment, the deeper the surfacing material depth must be to provide enough impact absorption in a fall."

Adult supervision is a key component in safe play. Other important factors that can help reduce the incidence of injury are playground design, and equipment installation and maintenance. " Never leave your child unsupervised, Dr. Weinstein said. "Having an adult at the playground to monitor youngsters' behavior will reduce the likelihood that the children will run in front of moving swings or go down the slide when another child is still on it."

A well-designed playground includes separate areas for active play such as swinging, and quiet play, such as digging in sandboxes. Spaces for preschoolers should be located away from areas where older, more active children play. Playground equipment should be made of weather-resistant materials with railings, steps and handholds scaled for children. Manufacturers' instructions for proper installation and spacing should be followed carefully, including recommendations for maintenance.

The American Academy of Orthopaedic Surgeons offers the following lists of items to look for when inspecting your school playground.

* Loose, damaged, or missing supports, anchors, or footings

* Loose or missing nuts, bolts, or other connectors

* Broken or missing rails, steps, rungs, or seats

* Bending, warping, rusting, or breakage of any component

* Protective end caps missing from bolts or tubes

* Sharp edges or points due to wear or breakage

* Deformed hooks, shackles, rings, links, etc.

* Worn swing hangers and chains

* Worn bearings

* Lack of lubrication on moving parts

* Exposed mechanisms such as joints or springs that could result in a "pinch" or "crush injury"

* Splintered and deteriorated wood

* Cracks or hole in surfacing materials

* Trash in area (particularly glass or cans)

* Environment hazards such as roots, rocks, or poor drainage areas

For additional Information on playground safety, call toll-free: 1-800-824-BONES (2663) or send a self-addressed (business size) envelope to Playgrounds, American Academy of Orthopaedic Surgeons, P.O. Box 1998, Des Plaines, Ill. 60017. Internet users can download the Academy's playground safety brochure and fact sheets from the Prevent Injuries America! section of the Academy's web site: http://www.aaos.org or http://orthoinfo.aaos.org.

An orthopaedic surgeon is a physician with extensive training in the diagnosis and non-surgical as well as surgical treatment of the musculoskeletal system, including bones, joints, ligaments, tendons, muscles and nerves.

The 26,047-member American Academy of Orthopaedic Surgeons (www.aaos.org) or (http://orthoinfo.aaos.org ), is a not-for-profit organization that provides education programs for orthopaedic surgeons, allied health professionals and the public. An advocate for improved patient care, the Academy is participating in the Bone and Joint Decade (www.usbjd.org) the global initiative in the years 2002-2011 to raise awareness of musculoskeletal health, stimulate research and improve people's quality of life. President Bush has declared the years 2002-2011 National Bone and Joint Decade in support of these objectives.