Injury patterns and risk factors for orthopaedic trauma from snowboarding and skiing: a national perspective

Epidemiology of injuries among snowboarding athletes in the talent transfer program: A prospective cohort study of 39,880 athlete-exposures

BACKGROUND

Talent transfer (TT) program is an appropriate approach to address the talent gap evident in specific sports activities, while little is known about the injury characteristics of snowboarding athletes involved in the TT program.

OBJECTIVE

To determine the epidemiology of injuries among snowboarders involved in the TT program.

METHODS

A total of 244 athletes who were not previously engaged in winter sports were selected for training in snowboarding that lasted for 109 days. The injuries and at-risk exposures (A-Es) data were recorded by physicians. Injury rates (IRs), incidence rate ratios (IRRs), and injury proportion ratios (IPRs) were calculated and compared by sex and age groups.

RESULTS

The overall and time loss (TL) IR were 32.4/1000 A-Es and 12.2/1000 A-Es respectively. The overall and non-time loss (NTL) IRR were higher for female athletes than for male athletes. Additionally, the overall IRR and TL-IRR for female athletes were higher in those athletes who aged ≤15 years old. Over 93% of TL injuries resulted in participation restriction time of ≤7 days (male athletes, 93.94%; female athletes, 94.10%). Trunk (28.43%), knee joints (21.33%), and hand/wrist (16.53%) were found as the common sites of injury in both female and male athletes. The most frequent type of injury was contusion (male athletes: 53.00%, female athletes: 59.10%) resulted from ground/apparatus contact (male athletes: 75.10%, female athletes: 75.20%).

CONCLUSION

The risk injury among snowboarding athletes involved in the TT program during the first snow season training was found noticeable, especially for younger female athletes. The high incidence of ground/apparatus contact-related injuries suggested the necessity of specifically designed training programs and braces for snowboarding athletes involved in the TT program.

An Epidemiologic Comparison of Injuries to Skiers and Snowboarders Treated at United States Emergency Departments, 2000-2019

Skiing and snowboarding are popular competitive and recreational sports that can be associated with significant injury. Previous studies of skiing and snowboarding injuries have been conducted, but studies evaluating injury types and patterns over long periods of time are needed to drive effective injury prevention efforts. We hypothesized that injury patterns would differ among snowboarders and skiers and that the number of injuries remained constant over time. This is a retrospective study of patients presenting with skiing or snowboarding injuries to the United States emergency departments from 2000 to 2019. A total of 34,720 injured skiers (48.0%) and snowboarders (52.0%) presented to US emergency departments over a 20-year period, representing an estimated 1,620,576 injuries nationwide. There is a decreasing trend of the number of injuries over the study period (p=0.012). Males represented the majority (65.7%) of injuries. Skiers were older than snowboarders (mean 30.1 vs. 20.0 years; p<0.001) and patients aged<18 represented more snowboarding (57.0%) than skiing (43.0%) injuries (p<0.001). Common diagnoses included fractures (33.0%) and sprains/strains (26.9%). Snowboarders primarily presented with upper extremity injuries, meanwhile, skiers primarily presented with lower extremity injuries. Most patients (93.2%), were treated and discharged from the emergency departments. Understanding the epidemiology of injuries presenting to emergency departments can help guide prehospital care and medical coverage allocation for resorts and event organizers, as well as identifying areas for targeted injury prevention efforts.

Recreational Skiing- and Snowboarding-Related Extremity Injuries: A Five-Year Tertiary Trauma Center Cohort

INTRODUCTION

Skiing and snowboarding are widely recognized winter sports with a notable risk of sports-related injuries. Comprehensive knowledge of the injuries sustained during skiing and snowboarding is imperative for preventative strategies and for understanding the injury patterns and epidemiological characteristics from surgeons' standpoint, particularly orthopedic surgeons, given that all anatomical regions and systems are susceptible to harm when engaging in these activities.

OBJECTIVE

Our research aims to investigate the injury patterns and epidemiological characteristics of individuals seeking medical attention at Erzincan University Faculty of Medicine Orthopedics and Traumatology Clinic, Erzincan, Turkey, after experiencing recreational skiing or snowboarding injuries.

METHODS

During the period spanning from 2018 to 2023, a retrospective analysis was conducted on patients aged between 18 to 65 years who had sustained isolated extremity injuries while participating in recreational winter sports at the Ergan Mountain Ski Center. The causes of injuries were categorized into two types (skiing and snowboarding) based on the subjective description of the injury scene. The study employed the χ2 test for categorical variables and Student's t-test for continuous variables to conduct subgroup comparisons.

RESULTS

The study results revealed that most patients, precisely 53.2%, sustained injuries in their lower extremities, whereas 46.8% sustained injuries in their upper extremities. The most frequently injured area of the patients presenting with skiing injury was the region around the knee (31.2%), followed by around the shoulder (21.6%) and the foot and ankle (14.9%). The anatomical region most injured among patients who sustained snowboarding injuries was the hand and wrist, accounting for 23.9% of cases.

CONCLUSION

Skiing and snowboarding injuries vary anatomically. While individuals with limited experience are at a higher risk of sustaining injuries, no statistically significant disparity was observed regarding the specific body parts affected among individuals of varying skill levels. Recognizing these sports-related injuries, which are growing in young people, will encourage the use of personal protective equipment to avoid injuries, assure ski resorts' environmental safety, and reduce sports-related morbidity.

Clinical characteristics of patients with snow sports trauma transported to a trauma care center: A retrospective observational study

BACKGROUND

Snow sports are a popular recreational activity; however, the incidence of injury of snow sports can be high for skiers and snowboarders. Our hospital receives severe trauma cases from snow resorts and hospitals throughout the region. This study aimed to determine whether the risk of snow sports-related major trauma that requires emergency surgery under general anesthesia varies by the equipment and injury mechanism.

METHODS

This retrospective cohort study included patients with snow sports trauma referred to Gifu University Hospital, Japan between November 2010 and March 2020. We analyzed the need for emergency operation under general anesthesia within 24 h using Fisher's exact test. We identified 106 patients: (1) 90 in the snowboarders' group and 16 in the skiers' group or (2) 46 in the fall after jumping group (jumping group), 27 in the collide with other people and obstacle group (collision group), and 33 in the fall during gliding group (gliding group).

RESULTS

Snowboarders were nearly twice as likely as skiers to require emergency surgery under general anesthesia (44% vs. 25%; p = 0.236]. No significant associations were found between emergency surgery under general anesthesia and injury mechanism, but half of the patients in the jumping group required emergency surgery.

CONCLUSIONS

Snowboard as equipment and falls after jumping as a mechanism of injury tended to be associated with emergency surgery under general anesthesia, with no significant differences. In order to provide adequate resources for snow sports trauma, the cause of the patient's injury is strongly related to the urgency of the condition, and transport to a trauma center should be actively considered. Further studies are warranted with respect to the effects of personal protective equipment and skill level.

[Fractures of tibial shaft and tibial head in winter sports]

BACKGROUND

Injuries in alpine skiing often affect the lower extremities, in particular the knee joint and lower leg. In addition to conventional radiological diagnostics, CT and, in the case of fractures of the knee joint area, MRI also play an important role. In the case of tibial head fractures, especially if there has been a dislocation mechanism, there is an increased risk of vascular and nerve injuries. Lower leg fractures are predestined for the development of a compartment syndrome. For these reasons, an exact survey of the vascular-nerve status and a monitoring of the soft tissues should be carried out.

THERAPY

In the further therapy, whether conservative or surgical, the soft tissue situation must also be included in the planning. In the case of tibial head fractures in particular, the choice of the right approach is essential for a good result in surgical therapy. Angle-stable plate osteosynthesis and screw osteosynthesis play the most important role as osteosynthesis methods in the knee joint area. In the case of fractures in the shaft area, medullary nail osteosynthesis or angle-stable plate systems are primarily used. In the case of severely compromised soft tissue or unstable situations, it may be necessary to apply an external fixator first. The initiated therapy should enable functional follow-up treatment as early as possible.

PREVENTION

Good physical fitness, driving-specific training, but also good core stabilization have a preventative effect against injuries. In addition, the correct material coordination between ski boot, binding and ski is important for accident prevention.

[Knee injuries in winter sports]

Winter sports represent a relevant entity for knee injuries due to their great popularity. In alpine skiing and snowboarding, knee joint injuries are the most common affected body regions, while in ice hockey they are in third place. Various accident mechanisms lead to different injury types and severities. In addition to medial collateral ligament injuries, anterior cruciate ligament injuries are of particular importance. In professional sports, severe combination injuries are more common. Therapy is exemplified using the anterior cruciate ligament rupture. The gold standard is replacement ligament surgery. The return-to-sport rate of 80% for skiing and snowboarding is comparable to summer sports such as football, basketball or baseball. For ice hockey, it is even better. Prevention is possible by targeted training programs, but also by optimizing the equipment and its adjustment.

Winter sport musculoskeletal injuries: epidemiology and factors predicting hospital admission

INTRODUCTION

Participation in winter sports such as skiing, snowboarding and snowmobiling is associated with risk of musculoskeletal injury. The purpose of our study was to describe and quantify emergency department encounters associated with these sports.

METHODS

The National Electronic Injury Surveillance System (NEISS) was queried for skiing-, snowboarding- and snowmobiling-related injuries from 2009 to 2018. Patient demographics and disposition data were collected from emergency department encounters. Descriptive statistics were utilized to describe the trends in injuries from each sport and factors associated with the sports-specific injuries.

RESULTS

From 2009 to 2018, there were an estimated 156,353 injuries related to snowboarding, skiing, or snowmobiling. Estimated injury incidence per 100,000 people decreased over time for skiing (3.24-1.23), snowboarding (3.98-1.22,) and snowmobiling (0.71-0.22,). The most common injury location by sport was shoulder for skiing (29.6%), wrist for snowboarding (32.5%) and shoulder for snowmobiling (21.9%), with fractures being the most common diagnosis. Only 4.5% required admission to the hospital. Fracture or dislocation was associated with highest likelihood of hospital admission (OR 42.34; 95% CI 22.59-79.37). Snowmobiling injuries (OR 1.63; 95% CI 1.20-2.22) and white race (OR 1.42; 95% CI 1.17-1.72) were also both associated with increased risk of hospital admission.

CONCLUSIONS

Upper extremity injuries, particularly those involving fractures, were more common than lower extremity injuries for all three sports, with the shoulder being the most common location of injury for skiing and snowmobiling. This study can serve as the foundation for future research in sports safety and health policy to continue the declining trend of musculoskeletal injuries in the future.

LEVEL OF EVIDENCE

III.

The pivot fracture: an unusual tibial plateau fracture found in association with acute ACL injury

Tibial plateau fractures are common fractures which are often associated with concurrent soft tissue injury and for which accurate preoperative diagnosis is important for development of an appropriate treatment plan and outcome prediction. Here, we present an extreme manifestation of the pivot shift phenomenon with an unusual tibial plateau fracture with flipped component not described by any existing tibial plateau fracture classification system and never reported previously in conjunction with an anterior cruciate ligament injury. We describe the utilization of advanced imaging not typically utilized in the management of tibial plateau fractures in combination with clinical suspicion to diagnose the associated soft tissue injuries and develop an appropriate management plan.

Pelvic ring injuries after alpine ski and snowboard accidents

PURPOSE

The purpose of this study was to analyze the patient/injury characteristics and associated hospital course of patients sustaining traumatic pelvic ring injuries after alpine ski and snowboard accidents at a level one trauma center in the Rocky Mountain region.

METHODS

Patient/injury characteristics were obtained from patients presenting with pelvic ring injuries after alpine ski (n = 55) and snowboard (n = 9) accidents. Characteristics and outcomes analyzed included mechanism of injury, pelvic ring classification (Young-Burgess and Tile), hospital admission, physical therapy (PT) clearance, ambulation, length of stay, inpatient morphine milligram equivalents (MME), and discharges to rehabilitation facility.

RESULTS

Snowboarders were more often younger, male, tobacco/substance users, and more likely to be injured by a fall from height than skiers. There were no differences in injury classification or hospital course outcomes between alpine sports. Most common injuries included lateral compression type 1 (LC1) injuries (37.5%), isolated pubic ramus fractures (31.3%), and isolated iliac wing fractures (15.6%). LC1 injuries were unstable in 50% of cases and associated with increased admissions (proportional difference: 47.5%, CI: 23.8-64.5%, p = 0.0002), longer time to PT clearance (median difference(MD): 1.0 day, CI: 0-2.0, p = 0.03), longer LOS (MD: 2.0, CI: 0-2.0, p = 0.02), and increased inpatient MMEs (MD: 197.9 MME, CI: 30.0-420.0, p = 0.02), as compared to other pelvic ring injuries.

CONCLUSION

The majority of pelvic ring injuries from alpine ski and snowboard accidents were LC1 injuries, half of which were unstable, resulting in longer hospital stays, time to PT clearance/ambulation, and opioid use.

Electric scooters as a source of orthopedic injuries at a Level-I trauma center

Introduction

Electric scooter rentals are offered by major ridesharing companies as a new and alternative method for urban travel in major metropolitan areas. The correlation between motorized electric scooter rental services and orthopedic injuries has not been well scrutinized. The purpose of our study is to evaluate orthopedic injuries sustained by motorized scooter riders and their potential correlation with patient demographics and associated injuries.

Methods

We retrospectively reviewed level 1 trauma center patients with orthopedic injuries sustained while riding motorized electric scooters from 4/2019-11/2019. Demographics, fracture characteristics, and patient management were examined.

Results

Sixty-two patients sustained 86 orthopedic injuries. There were 56 (65.1%) upper extremity and 29 (33.7%) lower extremity injuries. Six patients (9.7%) suffered open injuries and 30 (48.4%) sustained injuries that required surgery. Anatomic location of the injury was associated with both the presence of open fracture and needing surgery (P = 0.016 and P less than 0.001, respectively). Also, the presence of multiple orthopedic injuries was associated with the need for surgery (P less than 0.001). Scooter collision events were significantly associated with multiple orthopedic and the presence of non-orthopedic injuries (P less than 0.01 and P less than 0.01).

Conclusion

Electric scooter accidents can result in orthopedic injuries, many of which require surgery. Caution should be exercised when riding electric scooters, and special attention should be given by trauma centers and emergency departments to patients who present after electric scooter injury as the potential for orthopedic injury is high with this mechanism of injury.

A 40-year Study of the Factors Associated with Diaphyseal Forearm Fractures in Skiers and Snowboarders

BACKGROUND

Skiing and snowboarding are popular sports that are associated with a high number of orthopaedic injuries. Diaphyseal forearm fractures are an important subset of these injuries. To our knowledge, factors associated with these injuries, the mechanisms that cause them, and their relative frequencies in skiers and snowboarders have not been described. In addition, it has been proposed that the use of wrist guards may increase the risk of sustaining a diaphyseal forearm fracture; therefore, we sought to explore the relationship between wrist guard use and diaphyseal forearm fractures.

QUESTIONS/PURPOSES

(1) What are the relative frequencies and types of diaphyseal forearm fractures in skiers and snowboarders? (2) What factors are associated with these injuries? (3) Is the use of wrist guards associated with an increased risk of forearm fractures?

METHODS

This was an unmatched case-control study performed with an injury database from a university-run clinic at the base lodge of a major ski resort. Cases were injured skiers and snowboarders; controls were randomly selected uninjured skiers and snowboarders. Data were collected on the mechanism of injury; experience level; equipment; radiographs; skiing or snowboarding habits; and trail type, defined as green circle (easiest), blue square (intermediate), black diamond (difficult), and double black diamond (most difficult). From this database, we identified 84 patients with diaphyseal forearm fractures, one of which was a Monteggia fracture and was excluded. A logistic regression analysis was used to compare the injured and control groups to identify factors associated with diaphyseal forearm fractures, including wrist guard use.

RESULTS

When adjusted for participant days, diaphyseal forearm fractures were more common in snowboarders than skiers (0.03 injuries per 1000 person-days versus 0.004 per 1000 person-days). On multivariable analysis, factors associated with forearm fractures in skiers were younger age (odds ratio 1.08 [95% CI 1.05 to 1.14]; p < 0.01), being a man or boy (OR 11.9 [95% CI 2.5 to 57.2]; p < 0.01), lack of movement at the time of falling (OR 18.2 [95% CI 3.2 to 102.5]; p < 0.01), and skiing on green circle trails compared with black diamond trails (OR 3.6 [95% CI 1.4 to 12.5]; p = 0.04). Factors associated with forearm fractures in snowboarders were younger age (OR 1.08 [95% CI 1.02 to 1.15]; p = 0.01), decreased weight (OR 1.02 [95% CI 1.00 to 1.02]; p < 0.01), snowboarding on gentle terrain (OR 8.4 [95% CI 1.6 to 45.0]; p = 0.01), and snowboarding on groomed terrain compared with other (OR 7.2 [95% CI 1.9 to 28.0]; p < 0.01) or wet, heavy snow (OR 24.8 [95% CI 2.5 to 246.7]; p = 0.01). Wrist guard use was not associated with an increased odds of diaphyseal forearm fracture in skiers or snowboarders.

CONCLUSION

Diaphyseal forearm fractures occur more frequently in snowboarders than in skiers. Despite speculation in prior evidence that wrist guards may paradoxically increase the risk of sustaining these injuries, our study suggests that this is not the case and wrist guards are not unsafe to wear.

LEVEL OF EVIDENCE

Level III, prognostic study.

Motives for the Use or Not of Protective Equipment for the Recreational Practice of Skiing and Snowboarding in Spanish Winter Stations

The objective of this research was to analyze the motives for using or not using protections by recreational ski and snowboard athletes, specifically regarding gender and age in the winter resorts of Sierra Nevada and Alto Campoo (Spain). A total of 520 users participated in Sierra Nevada (n = 306 (58,8%)) and Alto Campoo (n = 214 (42.2%)); 257 of them were men (49.4%) and 263 (50.6%) were women; from 6 to 50 years old; classified by 4 stages of development (Childhood (n = 106 (20.4%); Teenagers (n = 110 (21.2%); Young adults (n = 101 (19.4%); Adults (n = 203 (39.0%)). For the data collection an ad hoc questionnaire was used (socio-demographic data, use/no use of protection, motives for the use). The data revealed that 76.5% used protections equipment, with the women being more likely to use protective equipment than men. Regarding age, young adults and adults were the ones using less protection. In relation to the motives of using protective equipment, security was the main motive for using it, while the reason to avoid using it was, most of the time, discomfort. Additionally, the childhood and teenager groups were the ones who reported, as motivation, family obligation, showing the importance of the influence of the parents.

Gender differences in snowboarding accidents in Austria: a 2005-2018 registry analysis

OBJECTIVES

To elucidate gender differences in snowboarding accidents.

DESIGN

Retrospective registry analysis within the Austrian National Registry of Mountain Accidents.

SETTING

Snowboard-related emergencies between November 2005 and October 2018.

PARTICIPANTS

All injured snowboarders with documented injury severity and gender (3536 men; 2155 women).

PRIMARY AND SECONDARY OUTCOME MEASURES

Gender-specific analysis of emergency characteristics and injury patterns.

RESULTS

Over time, the number of mild, severe and fatal injuries per season decreased in men but not in women. Accidents most frequently were interindividual collisions (>80%) and occurred when heading downhill on a slope. Men more often suffered injuries to the shoulder (15.1% vs 9.2%) and chest (6.8% vs 4.4%), were involved in accidents caused by falling (12.9% vs 9.6%) or obstacle impact (4.3% vs 1.5%), while on slopes with higher difficulty levels (red: 42.6% vs 39.9%; black: 4.2% vs 2.5%), while snowboarding in a park (4.8% vs 2.1%) and under the influence of alcohol (1.6% vs 0.5%). Women more often sustained injuries to the back (10.2% vs 13.1%) and pelvis (2.9% vs 4.2%), on easier slopes (blue: 46.1% vs 52.4%) and while standing or sitting (11.0% vs 15.8%). Mild injuries were more frequent in women (48.6% vs 56.4%), severe and fatal injuries in men (36.0% vs 29.7% and 0.9% vs 0.4%). Male gender, age and the use of a helmet were risk factors for the combined outcome of severe or fatal injuries (OR (99% CI): 1.22 (1.00 to 1.48), 1.02 (1.02 to 1.03) and 1.31 (1.05 to 1.63)). When wearing a helmet, the relative risk (RR) for severe injuries increased while that for mild injuries decreased in male snowboarders only (RR (95% CI): 1.21 (1.09 to 1.34) and 0.88 (0.83 to 0.95)).

CONCLUSIONS

Snowboard injuries are proportionally increasing in women and the observed injury patterns and emergency characteristics differ substantially from those of men. Further gender-specific research in snowboard-related injuries should be encouraged.

TRIAL REGISTRATION NUMBER

NCT03755050.

Protections in the Recreational Practice of Ski and Snowboard-An Age and Gender Discussion? A Case Study in Spain

The objective of this research was to evaluate the protections taken by ski and snowboard recreational athletes of the winter stations Sierra Nevada and Alto Campoo (Spain), regarding gender, age, and practiced sport. A total of 520 users participated, Sierra Nevada (n = 306 (58.8%)); Alto Campoo (n = 214 (42.2%)), 257 of them were men (49.4%) and 263 (50.6%) were women, from 6 to 64 years old, classified by 4 stages of development (Childhood (n = 106 (20.4%)); Teenagers (n = 110 (21.2%)); Youth (n = 101 (19.4%)); Adults (n = 203 (39.0%))). For the data collection, an Ad Hoc questionnaire was used (Socio-demographic data, use/no use of protection). The data revealed that 23.5% of the participants did not use any protection. Regarding the development stage, 1% of the children did not use any protection, neither did 3.1% of the teenagers, 6.7% of the youth, or 12.7% of the adults (p < 0.001). Regarding gender, a total of 17.1% of men did not use protection, and regarding women, 6.3% of them did not use it (p < 0.001). In relation to the practiced sport, 15.8% of the skiers did not use it against 7.7% of the snowboarders (p = 0.006). The use of protection for the practice in winter sports is not enough to reduce the injury risk in these sports and, in the worst cases, fatal accidents.

WITHDRAWN: Construction of the evaluation system of snowboarders' motor function and the risk evaluation of health sports

Ahead of Print article withdrawn by publisher.

Epidemiology of Clavicle Fractures Sustained at a Colorado Ski Resort

Background

Although clavicle fractures are a common sports injury, there are limited studies on the incidence and causes of clavicle fractures among winter sports athletes.

Purpose

To evaluate the characteristics and injury mechanisms associated with clavicle fractures among patients evaluated at a Colorado ski resort.

Study Design

Descriptive epidemiology study.

Methods

This was a retrospective descriptive analysis of patients with clavicle fractures at the Denver Health Winter Park Medical Center during the 2012-2013 to 2016-2017 ski seasons. Chart review was performed on the patient cohort to confirm clavicle fracture diagnosis and to evaluate factors associated with clavicle fracture.

Results

A total of 393 clavicle fractures (6.2% of total clinic visits) occurred during the study period, corresponding to an overall clavicle fracture incidence of 8.4 per 100,000 participant-visits. The mean patient age was 26.4 years (range, 5-73 years). The majority were middle-third fractures (85.5%), occurring mainly in men (87.3%). More than half of the fractures were comminuted (54.5%) and occurred in snowboarders (55.0%). The most common mechanism of injury was a fall onto snow while skiing or snowboarding (92.4%). Women sustained more clavicle fractures while skiing compared with snowboarding (82.0% vs 18.0%; P < .001), while men sustained more fractures while snowboarding compared with skiing (60.3% vs 39.7%; P < .001).

Conclusion

Clavicle fractures are relatively common, but there are scant incidence data for clavicle fractures in mountain sports. Consistent with prior studies, clavicle fractures were more common in younger patients and men. The most common anatomic fracture location was the midclavicle. A greater proportion of clavicle fractures among men were sustained during snowboarding and among women during skiing.

Tracking algorithm of snowboard target in intelligent system

Snowboarding is a kind of sport that takes snowboarding as a tool, swivels and glides rapidly on the specified slope line, and completes all kinds of difficult actions in the air. Because the sport is in the state of high-speed movement, it is difficult to direct guidance during the sport, which is not conducive to athletes to find problems and correct them, so it is necessary to track the target track of snowboarding. The target tracking algorithm is the main solution to this task, but there are many problems in the existing target tracking algorithm that have not been solved, especially the target tracking accuracy in complex scenes is insufficient. Therefore, based on the advantages of the mean shift algorithm and Kalman algorithm, this paper proposes a better tracking algorithm for snowboard moving targets. In the method designed in this paper, in order to solve the problem, a multi-algorithm fusion target tracking algorithm is proposed. Firstly, the SIFT feature algorithm is used for rough matching to determine the fuzzy position of the target. Then, the good performance of the mean shift algorithm is used to further match the target position and determine the exact position of the target. Finally, the Kalman filtering algorithm is used to further improve the target tracking algorithm to solve the template trajectory prediction under occlusion and achieve the target trajectory tracking algorithm design of snowboarding.

Sex differences in the knee orthopaedic injury patterns among recreational alpine skiers

Background

Although studies have reported the sex differences in injury patterns among recreational skiers, the findings are still conflicting. This study aims to analyse the sex differences of orthopaedic knee injuries that occurred during alpine skiing.

Methods

A total of 306 recreational alpine skiers (125 females and 181 males) who sustained knee surgeries between June 2016 and December 2018 participated in this study. Age, height, weight, and physical activity level of the patients were recorded. The orthopaedic knee injury patterns were analysed based on the diagnosis given by the physicians.

Results

Male skiers (17.13%) had a higher proportion of multiple knee ligament injuries than females (6.40%). The combined anterior cruciate ligament (ACL) and medial collateral ligament injury were the most common injury types in both females and males, with ACL injury being more prevalent for females (79.20%) than that in males (56.35%). The proportion of female skiers (17.6%) with vigorous-intensity activity level was significantly lower than that of males (30.9%). Female skiers had lower body height, body weight, and body mass index than male skiers (P <  0.001).

Conclusions

ACL injury is the most common orthopaedic injury among both female and male knee-injured recreational skiers. The proportion of females with an ACL injury is higher than that of males, but the proportion of multiple knee ligament injuries is lower than that of males. More male recreational skiers have vigorous-intensity activity level habits in daily life than females.

Three-Column Classification System for Tibial Plateau Fractures: What the Orthopedic Surgeon Wants to Know

Recent orthopedic surgical literature emphasizes a three-column approach to understand and guide the treatment of tibial plateau fractures. This three-column classification system published in 2010 relies on preoperative CT images to depict injuries to the medial, lateral, and posterior columns of the tibial plateau and improves surgical outcomes in complex tibial plateau fractures with coronal fracture planes and posterior plateau fracture fragments requiring dorsal plating. Tibial plateau fracture classification systems traditionally used by radiologists and orthopedic surgeons, including the Schatzker and the Arbeitsgemeinschaft für Osteosynthesefragen-Orthopedic Trauma Association (AO-OTA) classification systems, rely on findings at anteroposterior radiography and lack the terminology to accurately characterize fractures in the coronal plane involving the posterior tibial plateau. Incorporating elements from the contemporary three-column classification system into radiology reports will enhance radiologists' descriptions of these injuries. It is essential for radiologists to understand the role of clinical assessment and the pertinent imaging findings taken into consideration by orthopedic surgeons in their management of these injuries. This understanding includes familiarity with injury patterns and how they relate to mechanism of injury, patient demographics, and underlying pertinent comorbidities. Evaluating findings on initial radiographs is the basis of tibial plateau fracture diagnosis. Additional information provided by preoperative cross-sectional imaging, including two-dimensional and three-dimensional CT and MRI in specific circumstances, aids in the identification of specific soft-tissue injuries and fracture morphologies that influence surgical management. These specific fracture morphologies and soft-tissue injuries should be identified and communicated to orthopedic surgeons for optimal patient management. Online DICOM image stacks are available for this article. ^©RSNA, 2020.

Geriatric Skiers: Active But Still at Risk, a National Trauma Data Bank Study

BACKGROUND

Downhill skiing accounts for a large portion of geriatric sport-related trauma. We assessed the national burden of geriatric versus nongeriatric ski trauma.

MATERIALS AND METHODS

Adults presenting to level 1/2 trauma centers after ski-associated injuries from 2011 to 2015 were identified from the National Trauma Data Bank by ICD-9 code. We compared demographics, injury patterns, and outcomes between geriatric (age ≥65 y) and nongeriatric adult skiers (age 18-64 y). A multiple regression analysis assessed for risk factors associated with severe injury (Injury Severity Score >15).

RESULTS

We identified 3255 adult ski trauma patients, and 16.7% (543) were geriatric. Mean ages for nongeriatric versus geriatric skiers were 40.8 and 72.1 y, respectively. Geriatric skiers more often suffered head (36.7 versus 24.3%, P < 0.0001), severe head (abbreviated injury scale score >3, 49.0 versus 31.5%, P < 0.0001) and thorax injuries (22.2 versus 18.1%, P = 0.03) as compared with nongeriatric skiers. Geriatric skiers were also more often admitted to the ICU (26.5 versus 14.9%, P < 0.0001), discharged to a facility (26.7 versus 11.6%, P < 0.0001), and suffered higher mortality rates (1.3 versus 0.4%, P = 0.004). Independent risk factors for severe injury included being male (OR: 1.68, CI: 1.22-2.31), helmeted (OR: 1.41, CI: 1.07-1.85), and having comorbidities (OR: 1.37, CI: 1.05-1.80). Geriatric age was not independently associated with severe injury.

CONCLUSIONS

At level 1/2 trauma centers, geriatric age in ski trauma victims was associated with unique injury patterns, higher acuity, increased rates of facility care at discharge, and higher mortality as compared with nongeriatric skiers. Our findings indicate the need for specialized care after high impact geriatric ski trauma.

Events Due to Snowblower Use Seen in US Emergency Departments From 2003 Through 2018

Objective To comprehensively analyze emergency department (ED) visits associated with snowblower use in the United States. Methods Data on National Electronic Injury Surveillance System ED visits due to snow blowers from 2003 through 2018 were analyzed by age, sex, diagnosis, anatomic location of the injury, and year, month, or weekday. The mechanism of injury and alcohol use were noted. Statistical analyses were performed, accounting for the weighted, stratified nature of the data. Results There were an estimated 91,451 patients with an average age of 51 years; 91.2% were male. Amputation, fracture, or laceration accounted for 43,524 (47.6%) of the ED visits. The mechanism of injury was placing the hand into the chute (44.5%), a fall/slip (13.3%), medical events (6.1%), and miscellaneous (33.8%). Most (68.9%) occurred at home. Alcohol was rarely involved (0.4%). There were 648 deaths; 647 were due to cardiac events. The five major injury diagnoses were fracture (25.9%), laceration (20.2%), strain/sprain (15.0%), amputation (11.2%), and contusion/abrasion (10.2%); 99.8% of the amputations involved fingers. The incidence of ED snowblower visits was 1.845 per 100,000 US population with no change over time. There was a general correlation between the number of visits and the annual snow cover. Conclusions Ample opportunity for injury prevention exists, as there was no change in the incidence over time. Cardiac events accounted for essentially all of the deaths.

Ski and Snowboard - Related Orthopedic Injuries

Participation in skiing and snowboarding continues to increase. Both sports are associated with unique equipment and movement patterns, placing athletes at risk for several characteristic injuries. Although the axial skeleton and extremities are at risk for injury in both sports, skiing and snowboarding are associated with distinctive injury patterns. This article summarizes the epidemiology, risk factors, and specific injuries associated with skiing and snowboarding to better educate orthopedic surgeons regarding diagnosis and treatment of athletes partaking in these sports.

Common Skiing and Snowboarding Injuries

Participation in skiing, and especially snowboarding, continues to rise. As participation and level of competition in these winter sports increases, the number of injuries increases as well. Upper-extremity injuries are more common in snowboarding, whereas lower-extremity injuries are more common in skiing. Head injuries, particularly concussions, are common in both sports. Special consideration in these sports should be given to environmental conditions, such as high altitude and ultraviolet radiation. The purpose of this review is to discuss the most common musculoskeletal injuries seen in skiing and snowboarding, as well as considerations for initial assessment of these injuries and triage to the appropriate level of care. It is important for sports medicine physicians covering these sports to understand initial assessment and treatment of these injuries. Due to the potential for severe injuries in these sports, it is important to be able to quickly recognize an injury that needs to be assessed and treated urgently or emergently. With the increased participation and number of injuries in these sports, it also is important to consider prevention strategies that may minimize risk of injury.

Injury patterns after skiing and snowboarding sports accidents

BACKGROUND

Alpine sports are associated with risk of serious injuries. To gain insight into factors that may help reduce injury severity, accident characteristics and injury patterns were analyzed in a cohort of injured skiers and snowboarders.

METHODS

All patients with Alpine sports-related injuries, reporting the injury to a leading medical assistance organization in the Netherlands in the period of 2013-2016, were contacted. Medical data were collected from the patients' files. Only ski and snowboard incidents were included. Injuries were classified according to the Abbreviated Injury Scale (AIS) and Injury Severity Scale (ISS). Data on the accident conditions, i.e. risk factors, were collected using retrospective patient-reported questionnaires. Risk factors for injuries with ISS≥9 were analysed by multivariate modelling.

RESULTS

Of the 1588 included patients, 421 patients filled out the questionnaire. Skiers (N.=1370) had more knee injuries (20.4% vs. 7.4%, P<0.001), femur fractures (5.3% vs. 0.5%, P=0.002) and lower leg fractures (27.5% vs. 11.5%, P<0.001) compared to snowboarders (N.=218). Skiers were also more seriously injured (ISS>9) (P=0.01). Injured snowboarders sustained more brain concussions (8.8% vs. 15.7%, P=0.003) and lower arm fractures (5.4% vs. 16.1%, P<0.001). Only 'a higher skills level' was borderline significant for predicting serious injury (OR: 4.0 95% CI: 0.86-18.50; P=0.08). No additional risk factors were identified.

CONCLUSIONS

Injury patterns after skiing and snowboarding accidents differ, injury severity differed not. Preventive measures should therefore aim to protect specific body parts depending on the type of Alpine sport. Experienced skiers and snowboarders may be more at risk for serious injuries.

Effect of environmental conditions on injury rates at a Colorado ski resort

OBJECTIVE

To determine the effect of daily environmental conditions on skiing and snowboarding-related injury rates.

METHODS

Injury information was collected from a mountainside clinic at a large Colorado ski resort for the 2012/2013 through 2016/2017 seasons. Daily environmental conditions including snowfall, snow base depth, temperature, open terrain and participant visits were obtained from historical resort records. Snowpack and visibility information were obtained for the 2013/2014 through 2014/2015 seasons and included in a subanalysis. Negative binomial regression was used to estimate injury rate ratios (IRRs) and 95% CIs.

RESULTS

The overall injury rate among skiers and snowboarders was 1.37 per 1000 participant visits during 2012/2013 through 2016/2017. After adjustment for other environmental covariates, injury rates were 22% higher (IRR=1.22, 95% CI 1.14 to 1.29) on days with <2.5 compared with ≥2.5 cm of snowfall, and 14% higher on days with average temperature in the highest quartile (≥-3.1°C) compared with the lowest (<-10.6°C; IRR=1.14, 95% CI 1.03 to 1.26). Rates decreased by 8% for every 25 cm increase in snow base depth (IRR=0.92, 95% CI 0.88 to 0.95). In a subanalysis of the 2013/2014 and 2014/2015 seasons including the same covariates plus snowpack and visibility, only snowpack remained significantly associated with injury rates. Rates were 71% higher on hardpack compared with powder days (IRR=1.71, 95% CI 1.18 to 2.49) and 36% higher on packed powder compared with powder days (IRR 1.36, 95% CI 1.12 to 1.64).

CONCLUSIONS

Environmental conditions, particularly snowfall and snowpack, have a significant impact on injury rates. Injury prevention efforts should consider environmental factors to decrease injury rates in skiers and snowboarders.

Trends of snowboarding-related fractures that presented to emergency departments in the United States, 2010 to 2016

Background

Since it was introduced as an Olympic sport in 1998, snowboarding has drawn the participation of individuals of all ages. Despite the growing popularity of this sport, individuals can suffer from a number of musculoskeletal injuries. The specific goals of the study were to: (I) compare the number of injuries and trends of snowboarding injuries; (II) identify the injury occurrences, trends, and incidence of snowboarding-related fractures; and (III) identify the injury occurrences and trends of snowboarding-related fractures by body part.

Methods

The National Electronic Injury Surveillance System (NEISS) database was queried for snowboarding injuries and snowboarding-related fractures treated in US emergency departments (EDs) from 2010-2016. The weighted estimate of the number of injuries were obtained by using the NEISS statistical weight calculations that were provided in the data. An estimated total of 248,388 patients (mean age =20 years) experienced a snowboarding-related injury. Linear regression analysis was used to analyze annual trends of snowboarding-related fractures and the snowboarding-related fractures by body part; reported as the correlation coefficient (r) and the coefficient of determination (R²).

Results

The estimated annual number of injuries decreased from 56,223 injuries in 2010 to 17,667 injuries in 2016 (r=-0.967, R²=0.936, P<0.001). The most common types of injuries were fractures (31.7%), strains/sprains (25.2%), contusions (10.9%), concussions (10.0%), internal injuries (7.2%), and dislocations (4.0%). From 2010 to 2016, the estimated annual number of fractures decreased from 18,757 in 2010 to 4,539 in 2016 (r=-0.978, R²=0.957, P<0.001), and the annual incidence of snowboarding-related fractures decreased by 23.1%. The most common location of snowboarding-related fractures was the upper extremity, more specifically the wrist (32.3%). There was a decrease in the estimated annual number of fractures of the wrist (r=-0.965, R²=0.932, P<0.001), forearm (r=-0.821, R²=0.861, P=0.023), shoulder (r=-0.872, R²=0.760, P=0.011), elbow (r=-0.901, R²=0.813, P=0.006), and lower leg (r=-0.929, R²=0.864, P=0.002).

Conclusions

With the growing popularity of snowboarding in the US, it is important to know the common types of injuries that occur. This study found that fractures were the most common injuries, especially of the upper extremity.

Distal radius fractures in the athlete

PURPOSE OF REVIEW

Distal radius fractures are one of the most common upper extremity fractures. Athletes with distal radius fractures are treated according to the same principles as non-athletes but present several unique considerations. At all levels of sport, injured athletes desire to return to play as rapidly as possible.

RECENT FINDINGS

Earlier operative fixation may allow an athlete to return to play more quickly. Volar locking plates are most commonly used for operative treatment of distal radius fractures due to their stability and low incidence of complications. Although the majority of distal radius fractures in athletes are treated non-operatively, operative intervention is offered when required to restore and maintain acceptable skeletal alignment. Return to sport is individualized guided by fracture stability, athlete age, and wrist-specific demands for competition.