Spectrum of injuries from snowboarding

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.

Acromioclavicular joint injuries at a Colorado ski resort

BACKGROUND

Acromioclavicular joint (ACJ) injuries are among the most common injuries in contact and non-contact sports. As winter sports become more popular, there has been an increase in shoulder injuries among recreational skiers and snowboarders.

METHODS

This was a retrospective analysis of all patients who presented to the Denver Health Winter Park Medical Center with ACJ injury from 2012 to 2017. We examined the incidence of ACJ injuries, the injury mechanism, demographics, and type of ACJ injuries among skiers and snowboarders treated at the clinic.

RESULTS

A total of 341 ACJ injuries (6.7% of total visits) were encountered during the study period. The majority of ACJ injures were type I (41.3%) and mainly occurred in men (86.5%). Most (96.8%) of the cases were primary ACJ injuries on the right shoulder (56.9%). The average age of patients with ACJ injuries was 30.0 years (range 10-72). More than half (62.2%) of ACJ injuries occurred while snowboarding. The most common mechanism of injury (93.5%) was fall to the snow while skiing/snowboarding. Women were more likely to have a type I ACJ injury than men (80.4% vs 35.4%; P < 0.001). Women with ACJ injuries were more likely to suffer the injury while skiing than snowboarding (71.7% vs 28.3%; P < 0.001), compared to men who were more likely to suffer the injury while snowboarding than skiing (67.5% vs 32.5%; P < 0.001).

CONCLUSIONS

Most of the ACJ injuries were type I and occurred mostly in men. Snowboarders were more likely to have an ACJ injury than skiers.

LEVEL OF EVIDENCE

Level IV, Epidemeiology Study.

Skiing and snowboarding related deep laceration injuries. A five-season cross-sectional analysis from a level-1 trauma centre in the Swiss Alps

OBJECTIVES

Lacerations comprise 5.6-33.6% of skiing/snowboarding related injuries. This study aimed to investigate the mechanism of injury and the location of these lacerations and propose preventive measures.

METHODS

After our state ethics committee approval, we retrospectively reviewed the medical records and surgical protocols of 46 patients (mean age (±SD) 34.6 (±15.3); 71.4% men) treated for severe skiing/snowboarding lacerations at our level-1 trauma centre between 2016 and 2021. Patients were asked to answer a questionnaire on their skiing experience, equipment used and the circumstances of the accident.

RESULTS

Lacerations around the hip, thigh, and knee accounted for 94%. The latter was the most common location (45%). Although 91.3% of patients wore appropriate clothing and full standard protection equipment, it did not offer any extra-resistance against skiing/snowboarding's edges. Skiers were more affected (91.3%) than snowboarders (8.7%). The most common mechanism of injury was inadvertent release of the bindings (52.2%), followed by insufficient ski level for the slope (21.7%) and collisions (17.4%). Long-term trends demonstrated an increasing incidence.

CONCLUSION

Identification of body areas at risk and the mechanisms of injury were the most significant findings of this work. These data encourage the development of specific injury prevention programs as the occurrence of these lesions tended to increase over the last few years. To reduce their incidence, we propose skiers to have their bindings regularly adjusted and manufacturers to develop cut-resistant skiwear.

LEVEL OF EVIDENCE

IV.

Dental and general injuries among ski and snowboard instructors in Switzerland, Germany, and Austria-A questionnaire-based study

Objectives

Data on the injury rate of skiers and snowboarders are currently limited. The aim of this study was, therefore, to assess the frequency of general and dental injuries among snow sports instructors, to investigate the use of protective gear and mouthguards, and to evaluate snow sports instructors' dental first aid know‐how.

Material and Methods

A questionnaire‐based, cross‐sectional study comprising 603 ski and snowboard instructors from Austria, Germany, and Switzerland was conducted in the timeframe December 2019 to May 2020. The survey gathered data on general and dental injuries sustained by instructors, protective gear usage, and know‐how in dental first aid. The statistical analysis included χ² tests, Wilcoxon rank‐sum and Kruskal–Wallis tests, and linear regression analysis. The level of significance was set at α = .05.

Results

Out of the 603 instructors, 326 (54.1%) sustained an injury while skiing or snowboarding. Forty (6.6%) reported a snow sports‐related dental injury. The rates of injuries related to skiing and snowboarding showed no significant difference (p = .0952). Compared with snowboarding on slopes, backcountry snowboarding entailed fewer risks of injury for snowboard instructors (p = .012). Knowledge of dental first aid was limited, with 45.8% of instructors uninformed about the possibility of replanting avulsed teeth. 10.1% of instructors were familiar with tooth rescue boxes. None of the instructors surveyed had a tooth rescue box in their first aid equipment. Helmet usage was high (95.6%) among snow sports instructors, whereas mouthguard usage was rare (3.5%).

Conclusions

Protective gear usage among snow sports instructors is high. The risk of dental injury while skiing or snowboarding is lower compared with other sports. Dental first aid know‐how ought to be enhanced in snow sports communities to ensure that appropriate first aid is provided in case of a dental injury related to skiing or snowboarding.

Spinal injury in alpine winter sports: a review

INTRODUCTION

Alpine winter sports have become increasingly popular over recent decades, with a similar increase in accident incidence. This review provides an overview of the most recent literature concerning spinal injury epidemiology, mechanisms, patterns and prevention strategies in the context of alpine winter sports.

MATERIAL AND METHODS

The PubMed, Cochrane Library, and EMBASE databases were searched using the keywords spine injury, alpine injury, spine fracture, skiing injuries, snowboard injuries. 64 published studies in English and German met a priori inclusion criteria and were reviewed in detail by the authors.

RESULTS

There are various mechanisms of injury in alpine winter sports (high speed falls in skiing, jumping failure in snowboarding) whilst regionality and injury severity are broadly similar. The thoracolumbar spine is the most common region for spinal injury. Spinal cord injury is relatively rare, usually accompanying distraction and rotation type fractures and is most commonly localised to the cervical spine. Disc injuries seem to occur more commonly in alpine winter sport athletes than in the general population.

DISCUSSION

Despite awareness of increasing rates and risks of spinal injuries in alpine winter sports, there has been little success in injury prevention.

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

PURPOSE

Alpine skiing and snowboarding are both popular winter sports that can be associated with significant orthopaedic injuries. However, there is a lack of nationally representative injury data for the two sports.

METHODS

The National Trauma Data Bank was queried for patients presenting to emergency departments due to injuries sustained from skiing and snowboarding during 2011 and 2012. Patient demographics, comorbidities, and injury patterns were tabulated and compared between skiing and snowboarding. Risk factors for increased injury severity score and lack of helmet use were identified using multivariate logistic regression.

RESULTS

Of the 6055 patients identified, 55.2 % were skiers. Sixty-one percent had fractures. Lower extremity fractures were the most common injury and occurred more often in skiers (p < 0.001). Upper extremity fractures were more common in snowboarders, particularly distal radius fractures (p < 0.001). On multivariate analysis, increased injury severity was independently associated with age 18-29, 60-69, 70+, male sex, a positive blood test for alcohol, a positive blood test for an illegal substance, and wearing a helmet. Lack of helmet use was associated with age 18-29, 30-39, smoking, a positive drug test for an illegal substance, and snowboarding.

CONCLUSIONS

Young adults, the elderly, and those using substances were shown to be at greater risk of increased injury severity and lack of helmet use. The results of this study can be used clinically to guide the initial assessment of these individuals following injury, as well as for targeting preventive measures and education.

LEVEL OF EVIDENCE

Prognostic Level III.

Predictors of falls in recreational snowboard jumping: An observational study

PURPOSE

Jumping is popular in the sport of snowboarding. Epidemiological research has shown an increased risk of injury associated with this activity. Falls are common when jumping and although there is a logical connection between falling and injury occurrence, thus far little attention has been given to factors involved in the jumping-fall relationship. The current study aimed to add to the current knowledge base by identifying predictors of falling during intentional snowboard jumping within terrain park facilities.

METHODS

Seven hundred and four jumps were video recorded and qualitatively coded using a custom template of predetermined parameters related to manoeuvre choice, landing technique and jump success.

RESULTS

Falling was common within the sample population at a rate of one fall for every five jump attempts. Landings made on the flat or knuckle of the snow jump as well as incorrect board positioning at landing were found to be significant predictors of falling. Additionally the choice of manoeuvre was found to influence the risk of falls, with spinning jumps associated with a greater fall risk when compared to non spinning jumps. No clear relationship was identified between jump length measures and falling risk.

CONCLUSION

It is likely that jumping will remain popular in snowboarding and thus research efforts should focus on minimising the risk of injury associated with this skill. Reducing the overall incidence of falling, identified in the current study to be high, is a potential area for improvement. The potential for fall risk reduction through technique and decision making changes provides justification for further research in this area.

Perspectives on injuries in snowboarders

Aims: Adopting effective injury prevention practices continues to be problematic within snowboarding and the participation of older individuals is associated with an appreciable injury burden. The Haddon Matrix provides an important framework for developing injury prevention interventions. Since prevention behaviour must `fit' within individual aspirations, our study investigated the meanings and behaviours associated with snowboarding and injury prevention and then applied the findings to the established Haddon Matrix approach.

Methods: Nine, older adult recreational participants living in south-west England each contributed two interviews. These progressively focused on experiences and reflections. Verbatim transcripts were analysed and interpreted using the hermeneutic phenomenological themes of time, space, body and human relations. A further wave of analysis reinterpreted the findings in relation to the Haddon Matrix.

Findings: Snowboarding was conducted within a holiday when participants were seeking happiness by positively re-evaluating their lives. In a frame of connection-and-disconnection , beginners ( time) were concerned with being- on the slopes ( body and space), while more experienced ( body and time) participants blended this with being-in the mountains ( space). Snowboarding is a bumps-and-bruises activity and this guided the limited prevention practices. Importantly, all prevention practices were time- limited, due to a concern for learning-by-doing within a holiday. At home, more experienced boarders paid careful attention to fitness, whereas in the resorts they actively selected the soft, off-piste areas and wore protective clothing to cushion their inevitable falls. Group experiences were associated with heightened injury risks. Being seen and judged by others helped to determine the quality of the snowboarding experience. Treatment was avoided for all but the most severe injuries.

Conclusion: The findings confirm the exploratory value of mixing van Manen's four-dimensional approach with Haddon's well-established injury prevention framework. The diverse subjective meanings associated with snowboarding limit the potential for prevention approaches and suggest that resort-based `injury control' may be more appropriate for addressing the spectrum of prevention in older snowboarders.

A cause of severe sacral injury, sledding with a plastic bag: Case report

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Skiing accidents can cause life threatening bleeding.

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This is the first case in literature about open sacral trauma due to skiing.

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De-epithelized skin flaps can be preferred in acute open sacral traumas.

Introduction

Various injuries are associated with winter sports, of which the most frequently encountered are traumas to the extremities. Sledding on hills using plastic-based materials appears to be one of the major forms of entertainment for children living in cities during winter. However, this can lead to injury because such areas are inappropriate for winter sports.

Presentation of case

We herein document a case of a 32-year-old male who presented to the emergency department following severe injury to the sacral region, caused by contact with a metal object while sledding with plastic bags. Patient had sacral defect including coccyx and sacral vertebrae and soft tissue. Primary closure, vacuum assisted closure and reconstruction with de-epithelized skin flap techniques were performed in 35 days period after injury.

Discussion

Winter sports are associated with a wide variety of injuries, but tissue defects are rare. Seroma formation due to dead spaces can occur in traumas causing bony and soft tissue loss in sacral region as seen in our case. In order overcome this problem primary closure can be delayed or defect can be filled with a bulky flaps.

Conclusion

This case represents the first report of this particular combination of injury and treatment.

Differences in injury distribution in professional and recreational snowboarding

Introduction

Little is known about the distribution of injuries in competitive snowboarding and there are no reports describing long-term complications of professional snowboarding. To examine the injury distribution and long-term impairments in active and retired professional snowboarders, a retrospective data analysis was performed using a questionnaire. As a control group, injuries of recreational snowboarders of a southern German university clinic were examined.

Methods

Retired and active snowboarders were identified from the result lists of the International Ski Federation (FIS) and from the current team lists of the German-speaking European national snowboard teams. After identification, a questionnaire regarding injury distribution/treatment was sent to the athletes and the filled-in questionnaires were subsequently evaluated. Injuries in recreational snowboarding were evaluated by analyzing the medical records and surgical reports for a seven-year period.

Results

Compared to the available literature, significantly more severe injuries that necessitated surgical treatment in recreational snowboarders were documented. Most injuries accounted for wrist fractures but also many nonunions and spinal fractures were recorded. Between active professionals, distinct differences in injury distribution were found. The number of days off differed greatly with less days in speed disciplines (35.5 days) and the maximum number of days off in snowboardcross (51 days). Injury distribution varied clearly with more injuries of the upper extremity and ankle in speed disciplines compared to snowboardcross and freestyle professionals, who exhibited more injuries to the lower extremity and head. Freestyle athletes used significantly less protectors compared to speed (P=0.01) and snowboardcross athletes (P=0.00). An analysis of retired professionals revealed a higher number of impairments in daily life and a significantly higher number of days off snowboarding (P=0.018).

Conclusion

Knowledge about snowboard-specific injuries is a requirement for an appropriate treatment of these patients. This first description of long-term impairments after professional snowboarding highlights the importance of the development of specific strategies to prevent daily life impairments after a professional sports career.

Clinical Outcomes of Surgical Treatments for Traumatic Spinal Injuries due to Snowboarding

STUDY DESIGN

Retrospective study.

PURPOSE

To assess treatment outcomes of snowboarding-related spinal and spinal cord injuries.

OVERVIEW OF LITERATURE

Snowboarding-related spinal or spinal cord injury have a great impact on social and sporting activities.

METHODS

A retrospective review of 19 cases of surgically treated snowboard-related injury was done. Analyzed parameters included site of injury, type of fracture, peri- and postoperative complications, pre- and postoperative neurological status, activities of daily living, and participation in sports activities at the final follow-up.

RESULTS

The major site of injury was the thoracolumbar junction caused by fracture-dislocation (13/19 cases). The remaining 6 cases had cervical spine injuries. Over 60% of the patients had Frankel A and B paralysis. All patients were surgically treated by posterior fusion with instrumentation. Five underwent additional anterior fusion. Surgical outcome was restoration of ambulatory capacity in 12 patients (63.2%). Ultimately, 15 patients (78.9%) could return to work. Patients with complete paralysis upon admission showed reduced ambulatory capacity compared to those with incomplete paralysis. None of the patients again participated in any sports activities, including snowboarding.

CONCLUSIONS

Snowboarding-related spinal or spinal cord injury has a great impact on social as well as sports activities. It is necessary to enhance promotion of injury prevention emphasizing the snowboarders' responsibility code.

[Bony injuries of the shoulder girdle in snowboarding]

BACKGROUND

The fracture of the clavicle is the second most common fracture in snowboarding after the distal radius fracture. Nonsurgical treatment is frequently the treatment of first choice. For displaced fractures, surgical treatment is recommended.

METHODS

In general, internal fixation can be performed with a plate osteosynthesis or an intramedullary nail. Clinical studies were able to show similar and even slightly better functional results of the intramedullary nail in comparison to plate osteosynthesis. Because of less surgical trauma and better cosmetic results, intramedullary systems are increasingly preferred.

RESULTS

Lateral clavicular fractures are more complex regarding surgical treatment due to their potential for concomitant ligamentous injuries. The hooked plate shows good clinical results with the advantage of addressing the fracture as well as the ligament injury in one step. The limitation of mobility during the first few postoperative weeks is the technique's main disadvantage.

CONCLUSIONS

Ligament reconstruction with suture pulley systems as a stand-alone treatment or in combination with a locking plate osteosythesis are increasingly used due to their excellent clinical results with early postoperative mobilization.

Injury rate and injury pattern among elite World Cup snowboarders: a 6-year cohort study

BACKGROUND

There is limited knowledge on the injury rate and injury pattern in the different disciplines among elite snowboarders.

OBJECTIVE

The aim of this study was to describe and compare the injury rate and injury pattern among the different International Ski Federation (Fédération Internationale de Ski, FIS) World Cup (WC) snowboard disciplines.

METHODS

We conducted retrospective interviews with FIS WC snowboard athletes at the end of each season in the period 2007-2012, to register all acute injuries sustained during training or competition during the competitive season requiring attention by medical personnel. To calculate the exposure, we obtained information from result lists from the FIS competition database for all WC competitions for each of the interviewed athletes.

RESULTS

We registered a total of 574 injuries among 1432 athletes, accounting for an overall injury rate of 40.1 injuries/100 athlete/season. A total of 171 injuries occurred during the FIS WC competitions, corresponding to 6.4 injuries/1000 runs. During competition, injury risk was highest in snowboard cross with 11.9/1000 runs, followed by 6.3 in halfpipe, 3.6 in big air and 2.8 in parallel giant slalom/parallel slalom (PGS/PSL). Snowboard cross also had the highest risk of severe injuries (>28 days absence). No differences in injury risk were detected between male and female snowboarders. The most commonly injured body part was the knee (17.8%), followed by the shoulder/clavicle (13.4%) and head/face (13.2%). The risk of knee injury (the most common injury type) and head injury was significantly higher in snowboard cross and halfpipe compared to PGS/PSL.

CONCLUSIONS

The risk of injuries was higher in snowboard cross than in halfpipe, big air and PGS/PSL. The most commonly injured body part was the knee. Prevention of snowboard injuries among elite snowboarders should focus on knee injuries, severe injuries and snowboard cross athletes.

Skiing and snowboarding injury prevention

Skiing and snowboarding are popular recreational and competitive sport activities for children and youth. Injuries associated with both activities are frequent and can be serious. There is new evidence documenting the benefit of wearing helmets while skiing and snowboarding, as well as data refuting suggestions that helmet use may increase the risk of neck injury. There is also evidence to support using wrist guards while snowboarding. There is poor uptake of effective preventive measures such as protective equipment use and related policy. Physicians should have the information required to counsel children, youth and families regarding safer snow sport participation, including helmet use, wearing wrist guards for snowboarding, training and supervision, the importance of proper equipment fitting and binding adjustment, sun safety and avoiding substance use while on the slopes.

Characterizing the mechanical parameters of forward and backward falls as experienced in snowboarding

Wrist injuries are frequently observed after falls in snowboarding. In this study, laboratory experiments mimicking forward and backward falls were analysed. In six different falling scenarios, participants self-initiated falls from a static initial position. Eighteen volunteers conducted a total of 741 trials. Measurements were taken for basic parameters describing the kinematics as well as the biomechanical loading during impact, such as impact force, impact acceleration, and velocity. The effective mass affecting the wrist in a fall also was determined. The elbow angle at impact showed a more extended arm in backward falls compared to forward falls, whereas the wrist angle at impact remained similar in forward and backward falls. The study results suggest a new performance standard for wrist guards, indicating the following parameters to characterize an impact: an effective mass acting on one wrist of 3-5 kg, an impact angle of 75 degrees of the forearm relative to the ground, and an impact velocity of 3 m/s.

Snowboarding injuries: trends over time and comparisons with alpine skiing injuries

BACKGROUND

Participation in snowboarding as a winter sport is comparable to alpine skiing concerning the demographics of the participants, risk of injury, and variation in types of injuries sustained.

PURPOSE

To examine the types of snowboarding injuries and changes in injury patterns over time. We also sought to highlight important differences in injury patterns between snowboarders and alpine skiers as affected by age, experience, and sex.

STUDY DESIGN

Case control; Level of evidence, 3.

METHODS

Data were collected on injured snowboarders and skiers in a base-lodge clinic of a ski resort in Vermont over 18 seasons (1988-2006) and included extensive information about injury patterns, demographics, and experience. Control data were also obtained during this time period to provide information about the population at risk.

RESULTS

The injury rates were assessed as mean days between injuries (MDBI). The average MDBI for all injuries among snowboarders was 345 as compared with 400 for skiers (the lower the number, the higher the injury rate). The most common type of injury for snowboarders was a wrist injury (MDBI, 1258), while for skiers, it was an anterior cruciate ligament (ACL) sprain (MDBI, 2332). Wrist injuries accounted for 27.6% of all snowboard injuries and 2.8% of skiing injuries, and ACL injuries composed 1.7% of all snowboard injuries and 17.2% of skiing injuries. Among snowboarders, more wrist injuries, shoulder soft tissue injuries, ankle injuries, concussions, and clavicle fractures were seen, while skiers had more ACL sprains, medial collateral ligament (MCL) sprains of the knee, lateral collateral ligament (LCL) sprains of the knee, lower extremity contusions, and tibia fractures. The trend analysis revealed an increased incidence of clavicle fractures (P < .01) and a decrease in MCL injuries (P < .01) and ankle injuries (P < .025) among snowboarders over time. Skiers had a decrease in thumb metacarpophalangeal-ulnar collateral ligament (MCP-UCL) injuries (P < .001) and MCL injuries of the knee (P < .001) over time. We found the highest rate of injury among young, inexperienced, female snowboarders. When examining the location of injury, 21.8% of snowboard injuries occurred in the terrain park compared with 6.5% of ski injuries.

CONCLUSION

Injury rates in snowboarders have fluctuated over time but currently remain higher than in skiers. Wrist, shoulder, and ankle injuries are more common among snowboarders, while knee ligament injuries are more common in skiers. Injured snowboarders were significantly younger, less experienced, and more likely to be female than injured skiers or snowboard control participants. We did not find any evidence that those who spend time in terrain parks are overrepresented in the injury population.

Snowboarding-related abdominal trauma in children

OBJECTIVE

Our aim was to identify the demographics, mechanism, and patterns of injury in children presenting with snowboarding injuries.

METHODS

We conducted a retrospective chart review on children aged 6 to 21 years presenting to our level 1 pediatric trauma center between January 2000 and March 2007 with snowboarding-related injury. E-codes for snowboarding injuries identified patients. Statistical analyses included χ and t tests.

RESULTS

Our study identified 213 patients, of whom 79% were male and 55% were in the 12- to 14-year age group. Presenting injuries included those to the head/neck (27%), trunk (19%), upper extremity (58%), or lower extremity (10%). Of the children with abdominal trauma, 74% involved injury to the abdominal organs, most commonly the spleen (n = 11). Falls from an elevation of more than 3 ft were not significantly associated with organ injury. Females were more likely to have pelvic injury (P < 0.001), and males were more likely to have abdominal injury (P < 0.001). Males were more likely to have fractures (P < 0.01) and less likely to have a head injury (P < 0.05). Younger children aged 6 to 14 years were more likely to have abdominal injury (P < 0.05), whereas older patients aged 15 to 21 years were more likely to have pelvic injury (P < 0.05). There is a significant relationship between fractures or dislocations of the upper extremity and associated abdominal or pelvic trauma (P = 0.003).

CONCLUSIONS

Young male snowboarders are at risk for having abdominal organ injury and upper extremity injury. There is a high incidence of children presenting with both upper extremity and abdominal trauma after a fall while snowboarding.

An update on the epidemiology of pediatric fractures

Despite public health measures to prevent childhood injuries, the incidence of pediatric fractures is increasing. This fracture incidence is dependent on many demographic factors, the various contributors to bone health, and an individual's risk-taking behavior. Although traditional play activities continue to be the prevalent causes for fractures, there is an evolving array of new sport and recreation activities that carry significant fracture risk. The following review article outlines the developing epidemiology of pediatric fractures by analyzing some of the individual risk factors that influence fracture incidence as well as the variety of activities that are associated with these fractures.

Characteristics of upper extremity injuries sustained by falling during snowboarding: a study of 1918 cases

BACKGROUND

Little epidemiological research on characteristics of upper extremity injuries resulting from snowboarding has been conducted, particularly in relation to snowboarding stance, falling direction, and the side of the body where the injury occurs.

HYPOTHESIS

Snowboarding stance and the direction of the fall may influence the frequency of the side or the location of the upper extremity injury.

STUDY DESIGN

Descriptive epidemiology study.

METHODS

This study analyzed the information obtained from 1918 patients with fractures or dislocations of the upper extremity (excluding the fingers and scapula) sustained during snowboarding/sliding between 2000 and 2008. Diagnosis, injured part and side, stance (regular or goofy), and falling directions were prospectively analyzed. Associations among these parameters were also analyzed.

RESULTS

As characterized by skill level, patients were beginners (57.9%), intermediates (38.0%), and experts (4.0%). Eighty-eight percent had not received instruction from licensed instructors. Diagnoses included wrist fractures (53.7%), upper arm fractures (16.8%), shoulder dislocations (11.5%), and elbow dislocations (9.8%). In sum, 1742 (90.8%) patients were in regular stance when they fell, whereas 176 (9.2%) were in goofy stance. There was a significant difference in the prevalence of the injured side between the 2 stances. When the injured sides were classified according to the sliding direction, wrist fractures (61.7%) occurred on the side opposite the sliding direction, whereas shoulder dislocations (65.6%), upper arm fractures (82.9%), and elbow dislocations (79.8%) occurred on the same side as the sliding direction. When the injured sides were classified according to the falling direction, wrist fractures (68.1%) and elbow dislocations (63.5%) occurred because of backward falls, and shoulder dislocations (68.9%) and upper arm fractures (60.7%) occurred because of forward falls.

CONCLUSION

Two snowboarding stances as well as 2 falling directions had a significant influence on the frequency of the injured side in the upper extremity.

Ski helmets could attenuate the sounds of danger

OBJECTIVE

To determine whether a ski helmet reduces skiers' hearing particularly sounds that can warn skiers of potentially dangerous situations.

DESIGN

Randomized repeated measures (first part), environmental field measurements (second part).

SETTING

Audiology Centre of Rijeka Medical School, ski slopes at Platak resort.

PARTICIPANTS

Thirty healthy subjects not used to wearing a helmet each served as their own control.

INTERVENTION

Ski cap, ski helmet, and no intervention in randomized order.

MAIN OUTCOME MEASUREMENTS

Laboratory open-field audiometric testing: bareheaded, ski cap, and ski helmet (0.125-8 kHz protocol), and environmental A-weighted sound measurements on the slope for potentially dangerous situations like snowboarder breaking or skier passing by. In both parts of the study, the sound pressure levels (dB) and sound spectrum frequencies were analyzed.

RESULTS

First part-No differences were found between bare head and wearing only a ski cap. Significant sound attenuation characteristics of the helmet were determined for frequencies 2, 4, and 8 kHz (P < 0.001). Second part-High sound pressure levels were found for all the danger sounds measured on the slope, especially at frequencies that were most affected by helmet sound attenuation (2-8 kHz) in previously conducted laboratory tests.

CONCLUSIONS

Helmets could influence the level of the hearing threshold in frequencies between 2 and 8 KHz. The spectrum of danger sounds on the slope has high pressure levels at frequencies that were most affected by helmet sound attenuation characteristics (2-8 kHz), so the helmet wearers might misinterpret the sounds of potentially dangerous situations because the sound might be distorted.

Epidemiology and risk factors of humerus fractures among skiers and snowboarders

BACKGROUND

The incidence of humerus fractures while participating in snowboarding and skiing is undefined. Very little is known about the risk factors associated with these fractures.

HYPOTHESIS

Snowboarders are at increased risk for sustaining humerus fractures when compared with skiers. In addition, the types of fractures, laterality, and risk factors differ between the 2 groups.

STUDY DESIGN

Case-control study; Level of evidence, 3.

METHODS

At a major ski area clinic, 318 humerus fractures were evaluated over 34 seasons. Radiographs were classified according to the AO and Neer systems. Patient data were analyzed and compared with that of a control population of uninjured skiers and snowboarders to determine incidence and risk factors.

RESULTS

The incidence of humerus fractures among snowboarders (0.062 per 1000 snowboarder days) was significantly higher than that of skiers (0.041 per 1000, P < .05). Skiers were more likely to sustain proximal fractures, and snowboarders were relatively more likely to sustain diaphyseal and distal fractures (P < .05). Of glenohumeral dislocations, 6.56% were associated with proximal humerus fractures among skiers (1.7% among snowboarders). Snowboarders who lead with their left foot were more likely to fracture their left humerus (P = .023). Helmet use and gender were not risk factors for humerus fractures among either skiers or snowboarders. Jumping was involved in 28.3% of humerus fractures among snowboarders and in 5.4% among skiers. Skiers with humerus fractures were more skilled, older, and fell less frequently than controls. Snowboarders were less skilled, younger, and fell at a similar rate compared with controls.

CONCLUSION

Snowboarders are at significantly higher risk of sustaining humerus fractures than skiers. In skiers, humerus fractures show no laterality and most often involve the proximal humerus. In contrast, snowboarders more often fracture the left humerus at the diaphysis.

Snowboarding and ski boarding injuries in Niigata, Japan

BACKGROUND

The purpose of this study was to compare the injury patterns and incidence of snowboarding and ski boarding injuries with that of alpine skiing in 2000 to 2005, as there are few previous studies comparing these 3 sports, especially in Asia.

HYPOTHESIS

The injury patterns are different among the 3 snow sports.

STUDY DESIGN

Descriptive epidemiology study.

METHODS

The subjects were alpine skiers (1240 cases), snowboarders (2220 cases), and ski boarders (132 cases) who were injured in 2 ski resorts located in Niigata prefecture in Japan and visited the authors' clinics in these ski resorts between 2000 and 2005. On visiting the clinics, patients completed a questionnaire reviewing the circumstances surrounding the injury event, and physicians documented the diagnosis.

RESULTS

The injury rate, which was based on all purchased lift tickets, in snowboarding decreased gradually, although it was still 2 times higher than that of alpine skiing. Snowboarding and ski boarding had a higher fracture and dislocation rate. Both sports also had a 4 times higher rate of injuries because of jumping. The characteristics of ski boarding were a lower head and neck injury rate and collision injury rate than those of the other 2 snow sports, as well as a 2 times higher rate of fractures compared with alpine skiing injuries and a 1.4 times higher incidence than that of snowboarding injuries. Of the fractures caused by ski boarding accidents, 39.6% affected the lower leg bones.

CONCLUSION

Injury prevention strategies should focus on jumps for snowboarders and ski boarders.

The effect of wrist guards on wrist and arm injuries among snowboarders: a systematic review

OBJECTIVE

To systematically review studies that examined the effectiveness of wrist guards in preventing wrist injuries among snowboarders.

DATA SOURCE

MEDLINE (1966-March 2005), EMBASE (1988-March 2005), Cochrane (2005 Issue 1), Sport Discus (1975-March 2005) were searched using variations of the term "snowboard." PubMED was searched for the year 2005 to capture any recently published studies not yet indexed in MEDLINE. The reference lists of included studies and conference proceedings were also searched.

STUDY SELECTION

Studies were included if the number of wrist injuries between wrist guarded and unguarded snowboarders could be ascertained. Randomized controlled trials (RCTs), cohort studies, and case-control studies were included. Six studies were included.

DATA EXTRACTION

Information regarding study design, patient characteristics, wrist guard characteristics, data source (for cohort and case-control studies), and results (type and severity of injury, compliance, and adverse events) were extracted. Data were extracted by one reviewer and checked by a second reviewer.

DATA SYNTHESIS

Data from RCTs and cohort studies were expressed as relative risks with odds ratios presented for case-control studies. The risk of wrist injury (RR: 0.23; 95% CI: 0.13, 0.41), wrist fracture (RR: 0.29; 95% CI: 0.10, 0.87), and wrist sprain (RR: 0.17; 95% CI: 0.07, 0.41) was significantly reduced with the use of wrist guards. Among the case-control studies, wrist guards significantly lowered the odds of sustaining a wrist injury (OR: 0.46; 95% CI: 0.35, 0.62). In an RCT, the risk ratio suggested wrist guards protect the shoulder (RR: 0.22; 95% CI: 0.01, 4.60). Nonexperimental data suggested the possibility that wrist guards may increase the risk of finger and elbow-shoulder injuries.

CONCLUSIONS

Wrist guards reduce the risk of wrist injuries among snowboarders. For every 50 snowboarders who were a wrist guard, one wrist injury will be averted. Future research should focus on determining the optimal type of wrist guard and if they increase the risk of other upper extremity injuries.

Injuries among elite snowboarders (FIS Snowboard World Cup)

BACKGROUND

Although snowboarding is already established as an Olympic sport, it is still a developing sport, with new disciplines, more demanding snow installations, and spectacular tricks. A recent study on subjects at Norwegian national elite level showed that injury risk is high and that injuries among competitive snowboarders differ from those seen in recreational snowboarders, with fewer wrist injuries and more knee and back injuries.

OBJECTIVE

To describe the incidence and type of injuries among female and male snowboarders at international elite level.

METHOD

At the last race of the Fédération Internationale de Ski Snowboard World Cup, acute injuries resulting in missed participation and overuse injuries influencing performance, were recorded during a retrospective interview (91% response rate). The registration period was from April 2002 (end of season) until March 2003. Exposure was recorded as the number of runs in all disciplines, and the incidence was calculated as number of injuries per 1000 runs.

RESULTS

The 258 athletes interviewed reported 3193 competition days (n = 46 879 runs) in all disciplines. In total, 135 acute injuries were recorded; 62 (46%) during competition in the official disciplines. Of the 135 acute injuries, the most common injury locations were knee (n = 24; 18%), shoulder (n = 18; 13%), back (n = 17; 13%), and wrist (n = 11; 8%). The overall incidence during competition was 1.3 (95% confidence interval 1.0 to 1.7) injuries per 1000 runs; 2.3 (0.9 to 3.8) for big air (n = 10), 1.9 (1.1 to 2.8) for halfpipe (n = 21), 2.1 (1.2 to 3.0) for snowboard cross (n = 20), 0.6 (0.2 to 1.0) for parallel giant slalom (n = 8), and 0.3 (0.0 to 0.7) for parallel slalom (n = 3). The severity of injuries was graded based on time loss (27% lost >21 days) and score on the Abbreviated Injury Scale (AIS) (38% AIS 1, 61% AIS 2 and 1% AIS 3). There were 122 overuse injuries, 38 (31%) of these to the knee.

CONCLUSION

The injury risk for big air, snowboard cross, and halfpipe disciplines is high, while that for the snowboard slalom disciplines is lower. The injury pattern is different from recreational athletes, with a greater share of knee injuries and fewer wrist injuries. Compared with national level, the injury risk appears to be lower at World Cup level.

Self-inflicted splenic injury in snowboarders: postural analysis of forward falls of 10 consecutive patients

Splenic injuries are often caused when snowboarders thrust their abdomens with their own left elbows after falling and hitting the ground. We report 10 snowboarders who suffered a splenic injury by accidentally thrusting their own elbow against their abdomen upon falling to the ground. Clinical presentation, postural analysis, and treatment are described. In an attempt to break the force while falling, snowboarders assumed 1 of 2 defensive postures that subsequently induced splenic injury: falling with an outstretched hand or falling with folded arms placed closely to the chest, that is, the fetal tuck posture. Snowboarders who fell in the outstretched hand posture developed more severe symptoms than those who fell in the fetal tuck posture. Herein, we discuss the mechanisms of such snowboarding-related splenic injury in detail and provide a review of the literature.

Boarder belly: splenic injuries resulting from ski and snowboarding accidents

OBJECTIVE

Snowboarding has increased in popularity worldwide, with an associated increase in injuries suffered by its participants with a significant proportion of these injuries being severe. We sought to understand the risk of sustaining a splenic injury in snowboarders as compared to skiers, and whether there are noteworthy differences in their characteristics at hospital admission.

METHODS

A 10-year retrospective review was conducted on patients with splenic injury resulting from snowboarding or skiing, who were admitted to the principle ED and referral hospital servicing several busy downhill skiing areas. Population-based injury rates were calculated for our catchment area, using data provided by the Canadian Ski Council.

RESULTS

Controlling for gender, snowboarders were six times more likely to sustain a splenic injury than skiers (P < 0.0001). The risk of splenic injury was 21.7 times greater for male snowboarders than for female snowboarders (P = 0.002). By contrast, no gender differences were observed for skiers. Snowboarders admitted to hospital with a splenic injury were significantly younger, more likely to present with an isolated injury and to required a shorter hospital stay, as compared to skiers.

CONCLUSION

The risk of sustaining an injury of the spleen resulting from blunt abdominal trauma while snowboarding is significantly greater than the risk while downhill skiing. Male snowboarders have a significantly higher risk of splenic injury than female snowboarders. In the majority of cases, snowboarders sustained their injuries as a result of falls or jumps.

The effect of wrist guard use on upper-extremity injuries in snowboarders

The objective of this investigation was to determine the effect of wrist guard use on all upper-extremity injuries in snowboarders. This matched case-control study was conducted at 19 ski areas in Quebec, Canada. Cases were 1,066 injured snowboarders who reported upper-extremity injuries to the ski patrol during the 2001-2002 season. Controls were 970 snowboarders with non-upper-extremity injuries who were matched to cases on ski area and the nearest date, age, and sex, in that order. The response rate was 71.8% (73.5% for cases and 70.1% for controls). Cases were compared with controls with regard to wrist guard use. The prevalence of wrist guard use among snowboarders with hand, wrist, or forearm injuries was 1.6%; for those with elbow, upper arm, or shoulder injuries, it was 6.3%; and for controls, it was 3.9%. Thus, wrist guard use reduced the risk of hand, wrist, or forearm injury by 85% (adjusted odds ratio = 0.15, 95% confidence interval: 0.05, 0.45). However, the adjusted odds ratio for elbow, upper arm, or shoulder injury was 2.35 (95% confidence interval: 0.70, 7.81). These results provide evidence that use of wrist guards reduces the risk of hand, wrist, and forearm injuries but may increase the risk of elbow, upper arm, and shoulder injuries.

Injuries among competitive snowboarders at the national elite level

BACKGROUND

Little is known about injury risk or the pattern of injuries among competitive snowboarders.

PURPOSE

To describe the incidence and pattern of injuries among female and male snowboard athletes at the highest national level.

STUDY DESIGN

Descriptive epidemiology study.

METHODS

This study consists of 2 parts: prospective registration of injuries at snowboarding national cup events and the national championships during the 2002 season, as well as a retrospective interview of the participants during the national championships in March 2002. All injuries that resulted in missed participation were recorded. Exposure was recorded as the number of runs in all disciplines.

RESULTS

In the prospective study, the competition incidence was 4.0 +/- 0.7 injuries per 1000 runs (n = 32 injuries). Back (22%), knee (16%), and hand/wrist injuries (9%) were the most common. The incidence for the different disciplines was 14.2 +/- 5.3 per 1000 runs for big jump, 6.1 +/- 1.8 for snowboardcross, 3.1 +/- 0.9 for halfpipe, and 1.9 +/- 1.9 for giant slalom. The retrospective interview (n = 163 athletes, 83% response) revealed 84 acute time-loss injuries during the season; knee (16%), back (13%), head (13%), and hand/wrist injuries (12%) were the 4 most common injury types. The overall competition incidence was 3.4 +/- 0.6 injuries per 1000 runs (6.6 +/- 3.0 for big jump, 5.8 +/- 1.7 for snowboardcross, 2.1 +/- 0.7 for halfpipe, and 6.6 +/- 4.7 for giant slalom). No injury was recorded in parallel slalom in either study.

CONCLUSION

The incidence of injuries is high among competitive snowboarders at the elite national level. The injury pattern is different from the panorama seen among less experienced athletes, with fewer wrist injuries and more knee injuries.

Prevalence and diffusion of helmet use at ski areas in Western North America in 2001-02

OBJECTIVE

The purpose of this study was to examine diffusion of and predictors of helmet use among skiers and snowboarders in the Western United States and Canada.

DESIGN

6400 skiers and snowboarders at 29 ski resorts in the Western United States and Canada were interviewed on chair lifts and observed for helmet use during two consecutive ski seasons (winters 2001 and 2002).

SETTING

Skiers and snowboarders were observed and interviewed at 29 ski resorts in Alaska, California, Colorado, Idaho, Montana, New Mexico, Nevada, Oregon, Utah, and British Columbia as part of a sun protection project.

SUBJECTS

Participants completing the survey consisted of 3525 adult skiers and snowboarders in the 2002 season and 2978 adult skiers and snowboarders in the 2001 season.

MAIN OUTCOME MEASURE

The outcome measure for all analyses was prevalence of helmet use by skiers and snowboarders.

RESULTS

Helmet use by skiers and snowboarders is increasing and is most prevalent among snowboarders, experts, and more frequent skiers/snowboarders. No evidence was found for the hypothesis that helmet use is diffusing more rapidly among earlier adopters of helmets than later adopters.

CONCLUSIONS

Although controversy remains, helmets are rapidly diffusing as a safety device at western North American ski resorts. Expert and more frequent skiers and snowboarders are more likely to wear helmets, which may indicate that helmets are recognized as a safety device.

Lumbar chance fracture in an adult snowboarder: unusual mechanism of a chance fracture

STUDY DESIGN

A case of a Chance fracture in an adult snowboarder following a fall is presented. The mechanism of this fracture is reported.

OBJECTIVE

To increase awareness of the spinal injuries in snowboarders and to propose the mechanism of this unusual fracture.

SUMMARY OF BACKGROUND DATA

Chance fractures rarely occur in adults and are very unusual in children. Nearly all of the reported cases are in conjunction with lap-type seat belt injuries. To the authors' knowledge, this is the first reported case of a lumbar Chance fracture in an adult snowboarder.

METHODS

A 25-year-old snowboarder sustained an L1 Chance fracture following a fall backward. The patient was placed in a hyperextension cast, and the cast was changed to a thoracolumbar orthosis after 12 weeks.

RESULTS

Complete bony union was obtained with body cast immobilization, and an excellent functional restoration was obtained.

CONCLUSIONS

Chance fractures are horizontal splitting fractures of the posterior elements of the vertebrae, and the mechanism of the injury is that of a hyperflexion of the spine over a fulcrum. A Chance-type fracture can be seen in an adult snowboarder, when acute hyperflexion of the spine occurs following a fall backward.

Clinical features of snowboarding injuries

A retrospective study of 3102 injured snowboarders from 1992 to 1999 was undertaken using the medical records and questionnaires the patients had been asked to complete at the time of consultation. These cases represent all the injuries with medical treatment that occurred in five skiing and snowboarding resorts in the Nagano area. The total number of the injuries was 3243. The number of patients each year rapidly increased over the eight seasons. In descending order, the injuries were seen in the head and face, left upper extremity, spine, chest and abdomen, left lower extremity, right upper extremity, and right lower extremity. The number of head and face injuries was 829 (25%) followed by 768 (24%) left upper extremity injuries. With regard to the type of injury, fracture was the most frequent injury. There were 998 fractures, of which 625 were fractures of the upper extremity. Contusions were frequent on the head, face, chest, abdomen, and pelvis. Lacerations were frequent on the head and face. Sprains were frequent in the lower extremities, and dislocations were seen frequently in the upper extremities. The sharp increase in the number of patients was thought to reflect the increase in the population of snowboarders in Japan. The reason for the high concentration of injuries to the head and upper extremity is thought to derive from the characteristic riding form of snowboarding, with both legs fixed to one short, wide board. To decrease the injuries and to develop snowboarding as a safe and exciting sport, snowboarders, instructors, slope managers, and equipment manufacturers must comprehend the patterns of snowboarding injuries and cooperate to devise preventive measures.

A 10-year study of snowboard injuries in Lapland Sweden

Snowboard injuries in a Swedish ski area were evaluated from 1989 to 1999. All injured skiers (alpine, telemark, snowboarders) who sought medical attention at the local Medical Center within 48 h of the accident, were asked to answer an injury form. Physicians assessed and treated the injured skiers. There were a total of 1775 injured skiers; 568 injured snowboarders mean age 19 years. The female/male ratio was 34/66%, the injury rate 3/1000 skier days, three times higher than that of alpine skiers. The skill level of the injured snowboard riders improved during the period. The fall/run ratio of the beginners was higher (1.0) and their risk behavior lower (3.9 on visual analogue scale 1-10) in comparison to the advanced riders (0.4 and 6.6, respectively). Injuries were in 54% located to the upper extremity, 35% were wrist/lower arm injuries. Beginners had significantly higher frequency of lower arm/wrist injuries (46%), than average (32%) and advanced riders (20%). The most frequent single diagnosis was wrist/lower arm fracture (20%). Advanced riders tend to have more head/neck injuries than beginners, 17% vs. 13% (NS). Thus, with elevated skill level the injury pattern changed. For injury prevention, wrist guards and helmets are recommended for snowboard riders.

Wrist fractures from snowboarding: a prospective study for 3 seasons from 1998 to 2001

OBJECTIVES

To elucidate the epidemiology and the mechanisms of snowboarding wrist injuries, especially distal radial fractures.

DESIGN

A prospective survey of snowboarders with distal radial fractures.

PARTICIPANTS

From November 21, 1998, to April 22, 2001, we analyzed and interviewed 5110 injured snowboarders, and a total of 740 snowboarders with distal radial fractures were studied. On the basis of the medical records and radiographs, the severity of distal radial fracture was analyzed according to the AO classification.

RESULTS

Distal radial fractures occurred at a rate of 0.31 per 1000 snowboarder visits and were assessed in 740 snowboarders in this study. Most of the injured snowboarders were either of beginner (42.0%) or intermediate level (48.1%). The most common events leading to an injury in snowboarding were falling (59.6%) and jumping (36.1%). Comminuted and articular fractures classified as AO types A3, B, and C, which required surgical treatment, made up 63.2% of distal radial fractures in snowboarders. The most remarkable differences between the first-time or beginner group and the intermediate or expert group were that the former had a significantly higher proportions of extra-articular fractures classified as AO type A (P < 0.05), and the latter were significantly more likely to have compression or complex intra-articular fractures such as AO type C (P < 0.05). Furthermore, first-time or beginner snowboarders were more likely to be injured because of a simple fall than were the intermediates or experts (P < 0.05). Over 60% of distal radial fractures classified as AO type C in the intermediate or expert group resulted from jumping. Furthermore, the side opposite to the snowboarder's preferred direction of stance was more often affected. A high incidence of injury during opposite-side edging, which is used more frequently in snowboarding, was found in novice female snowboarders.

CONCLUSIONS

This study suggested several patterns in the nature of wrist injuries sustained while snowboarding, and these facts should be taken into consideration in the diagnosis of wrist injuries in snowboarders.

Snowblading injuries in Eastern Canada

OBJECTIVES

To evaluate injury patterns of snowbladers and compare them with those of skiers and snowboarders. To determine possible effects of helmet use in these sports on injury to the head and neck.

METHODS

This prospective case series observational study was conducted by collecting the injury reports from the ski patrol during the 1999-2000 season at Mont Tremblant ski resort, Quebec. All participants in downhill winter sports who presented themselves to the ski patrol with traumatic injury related to their sport were included. A concussion was defined as any loss of consciousness, amnesia, confusion, disorientation, vertigo, or headache that resulted from injury. The ski patroller reported helmet use on the accident report at the time of injury.

RESULTS

Snowbladers present with a unique pattern of injury compared with skiers and snowboarders. The incidence of leg, knee, and ankle/foot injuries were 20.5%, 25.6%, and 10.3% respectively. Concussions represented 11% of all injuries. There was no increase in other injury, including neck injury, related to helmet use.

CONCLUSIONS

Unique injury patterns in snowbladers warrant reconsideration of equipment design. Concussion is a common injury on the ski slope. Although the effects of helmet use on concussion rate are inconclusive based on this study, helmet use did not increase the rate of neck injury, even when adjusted for age.

Snowboarding Injuries

Snowboarding has become one of the premier alpine sports. The past decade has seen the popularity of snowboarding increase dramatically and the recent Winter Olympic Games at Salt Lake City, USA, showcased the strong visual appeal of the sport and the youth-oriented lifestyle and culture that accompanies it. The injury profile of the sport has also undergone change along with technological advances in boot and binding systems and the changing demographics of the sports participants. Central to the development of injury-prevention strategies is knowledge of the profile of injuries that occur, understanding those who are at particular risk and, if possible, the biomechanical factors involved in each injury type. Snowboarding was initially considered a dangerous, uncontrolled, alpine sport - an opinion based on little or no scientific evidence. That evidence has rapidly grown over the past decade and we now know that snowboard injury rates are no different to those in skiing; however, the injury profile is different. The purpose of this review is to give some perspective to the current snowboard injury literature. It discusses not only the demographic profile of those injured and the type of injuries that occur, but also gives some insight into the progress that has occurred in determining the impact of specific prevention strategies, such as splints to prevent injuries to the wrist/forearm. The next decade will also see a greater understanding of the biomechanical forces involved in snowboard injuries, which may well impact on future technological advances. As the literature indicates, however, some things will not change, e.g. injuries are more likely to occur in beginners and lessons need to be reinforced as a fundamental aspect of any injury-prevention strategy.

The Prevalence and Predictors of Helmet Use by Skiers and Snowboarders at Ski Areas in Western North America in 2001

BACKGROUND

Helmets may protect the heads of skiers and snowboarders. The prevalence of helmet use by these groups was estimated.

METHODS

Helmet use was observed in face-to-face surveys (N = 2,978) on sun protection at 28 ski areas in Alaska, California, Colorado, Idaho, Montana, New Mexico, Nevada, Oregon, Utah, and British Columbia (0.7% refusal rate) from January to April 2001.

RESULTS

Helmets were worn by 12.1% (95% confidence interval [CI], 11.0-13.3) of the sample. Use was highest among guests who skied or snowboarded more frequently (fourth quartile vs. first quartile, odds ratio [OR] = 11.998 [95% CI, 6.774-21.251]; third vs. first, OR = 5.556 [95% CI, 3.119-9.896]; second vs. first, OR = 2.186 [95% CI, 1.162-4.112]), were experts (OR = 3.326 [95% CI, 1.297-8.528]), used snowboards (OR = 2.301 [95% CI, 1.731-3.058]), and were more educated (college graduate, OR = 2.167 [95% CI, 1.271-3.695]; some college, OR = 1.969 [95% CI, 1.130-3.431]).

CONCLUSION

Helmet use was generally low but may be high enough by experts, snowboarders, and in the central Rocky Mountains to produce a norm stimulating further adoption.

Winter sports injuries. The 2002 Winter Olympics experience and a review of the literature

Injury patterns at the 2002 Winter Olympics were similar to those in recreational winter athletes, although injury rates were higher. The high rates of injury compared with reported rates in recreational athletes reflect the intensity of the competition and the high speeds of the athletes. In addition, rates are artificially elevated because we were not able to count the number of practice runs by each athlete, only the number of races. The highest rates of injuries resulting in positive MR imaging or plain radiographs were in snowboarders (28/1000 races), followed by alpine skiers (20/1000). In all of the winter sports, the most commonly injured joint was the knee (37 injuries), and the most common knee injury was the ACL tear. Injuries to the foot and ankle were second in frequency (15 injuries). It is interesting that three of the ankle injuries were syndesmosis sprains; this may be an underreported injury in winter sports. There were 12 injuries to the upper extremity, all but two to the shoulder. Back complaints were frequent, but only seven patients had significant imaging abnormalities found in the lumbar spine: two stress fractures of the pedicles, one acute pedicle fracture, one spondylolysis, and four disc protrusions.