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. 2025 May 13:66:165-172.
doi: 10.1016/j.jor.2025.05.013. eCollection 2025 Aug.

Spinal fractures associated with aquatic accidents

Dustin H Massel  1 , Jaxon D Wagner  2 , Jonathan Weinerman  3 , Joseph P Costello 2nd  2 , Aziz T Shittu  2 , Alexander J Butler  4 , Augustus J Rush 3rd  5 , Chester J Donnally 3rd  5
Affiliations

Spinal fractures associated with aquatic accidents

Dustin H Massel et al. J Orthop. .

Abstract

Study design: Retrospective observational study.

Objective: The purpose of this study was to evaluate the prevalence of aquatic spine injuries presenting to a single academic level 1 trauma center.

Background: Aquatic and high-speed watercraft related accidents are associated with drownings, traumatic brain injuries, infections, extremity fractures, and spinal injury. Few prior studies have evaluated the association of aquatic accidents and spine injuries.

Methods: A prospectively collected database of patients involved in aquatic accidents presenting to a single level 1 trauma center in Miami, Florida between February 7, 1999, and December 30, 2020, was reviewed for patients who sustained spinal fractures. Baseline demographics along with accident and injury characteristics were obtained and statistical analysis was performed.

Results: Of 498 total patients admitted following an aquatic accident, 83 (16.7 %) patients sustained a spinal fracture. Non-locals were more likely to require spine surgery compared to locals (80.8 % versus 19.2 %, p < 0.001). The most common MOI was boating or Personal Watercraft (PWC) accident (33 patients, 39.8 %), followed by shallow water dive (SWD; 20 patients, 24.1 %), fall/ejection (FE; 16 patients, 19.3 %), and direct collision (DC; 14 patients, 16.9 %). Operative spine injuries were significantly associated with subaxial cervical spine injuries (p < 0.001) and Shallow Water Dive mechanism (p < 0.001).

Conclusion: Mechanism-dependent, thoracic and lumbar injuries are common in boating and personal watercraft accidents, while operative subaxial cervical spine injuries are common in shallow water dives. Additional research is needed to enhance safety measures, policies, and overall awareness of aquatic activities.

Keywords: Aquatic fractures; Aquatic injury; Jet-ski; Personal watercraft (PWC); Spinal fractures; Trauma.

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Conflict of interest statement

The authors, their immediate family, and any research foundation with which they are affiliated report no conflicts of interest. The Manuscript submitted does not contain information about medical device(s)/drug(s). All authors significantly contributed to the document and have reviewed the final manuscript.

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