Spinal injuries in snowboarders: risk of jumping as an integral part of snowboarding

Biomechanical evaluation of Back injuries during typical snowboarding backward falls

To prevent spinal and back injuries in snowboarding, back protector devices (BPDs) have been increasingly used. The biomechanical knowledge for the BPD design and evaluation remains to be explored in snowboarding accident conditions. This study aims to evaluate back-to-snow impact conditions and the associated back injury mechanisms in typical snowboarding backward falls. A previously validated snowboarder multi-body model was first used to evaluate the impact zones on the back and the corresponding impact velocities in a total of 324 snowboarding backward falls. The biomechanical responses during back-to-snow impacts were then evaluated by applying the back-to-snow impact velocity to a full human body finite element model to fall on the snow ground of three levels of stiffness (soft, hard, and icy snow). The mean values of back-to-snow normal and tangential impact velocities were 2.4 m/s and 7.3 m/s with maximum values up to 4.8 m/s and 18.5 m/s. The lower spine had the highest normal impact velocity during snowboarding backward falls. The thoracic spine was found more likely to exceed the limits of flexion-extension range of motions than the lumbar spine during back-to-snow impacts, indicating a higher injury risk. On the hard and icy snow, rib cage and vertebral fractures were predicted at the costal cartilage and the posterior elements of the vertebrae. Despite the possible back injuries, the back-to-snow impact force was always lower than the force thresholds of the current BPD testing standard. The current work provides additional biomechanical knowledge for the future design of back protections for snowboarders.

Acute Vertebral Fractures in Skiing and Snowboarding: A 20-Year Sex-Specific Analysis of National Injury Data

Background:

The epidemiology of acute vertebral fractures (AVFs) sustained while skiing and snowboarding remains poorly defined in the United States.

Hypothesis:

It was hypothesized that there would be no significant differences across sex and a greater number of AVFs in younger age groups associated with skiing and snowboarding.

Study Design:

Descriptive epidemiological study.

Methods:

The authors utilized the National Electronic Injury Surveillance System to identify patients who were reported in emergency departments in the United States from 2000 to 2019. All patients were noted to have sustained AVFs during skiing or snowboarding. National estimates and demographic analysis were performed.

Results:

A total of 466 AVFs were identified, or roughly 23.3 AVFs per year. Compared with women, men accounted for the majority of AVFs sustained in both skiing and snowboarding: 67.8% (95% CI, 62.6%-73.0%) during skiing and 82.1% (95% CI, 76.3%-87.8%) during snowboarding. This represented a significantly larger percentage of AVFs while snowboarding compared with skiing (P = .002). Women accounted for 32.2% (95% CI, 27.0%-37.4%) of AVFs while skiing and 17.9% (95% CI, 12.2%-23.7%) while snowboarding, which indicated a significantly larger percentage of AVFs sustained during skiing compared with snowboarding (P = .002). Snowboarders were more likely than skiers to sustain an AVF in the region of the coccyx (21.5% [95% CI, 14.3%-28.7%] vs 11.5% [95% CI, 3.5%-16.9%], respectively; P = .003) and as a result of a fall at ground level (69.2% [95% CI, 62.1%-76.4%] vs 52.8% [95% CI, 43.2%-62.4%], respectively; P = .009). A significant decrease in the number of snowboarding-related AVFs was identified over the 20-year study period: 899 in 2000-2003 versus 283 in 2016-2019 (P < .01). The change in skiing-related AVFs over the study period was not statistically significant (694 vs 462; P = .5).

Conclusion:

This national study of AVFs sustained while skiing and snowboarding identified critical sex- and age-specific differences in the population at risk, anatomic location of injury, and mechanism of injury. The national data generated from this study over a 20-year period may be utilized to better inform public health injury awareness and prevention initiatives in the rapidly growing sports of skiing and snowboarding.

Removal of the cervical collar from alpine rescue protocols? A biomechanical non-inferiority trial in real-life mountain conditions

Background

Alpine skiing rescues are challenging because of the mountainous environment and risks of cervical spine motion (CSM) induced during victims’ extrications (EXs) and downhill evacuations (DEs). The benefits of applying a cervical collar (CC) over manual in-line stabilization without CC (MILS) in terms of spinal motion restriction during simulated alpine rescues are undocumented. Our hypothesis was that CSM recorded using MILS alone is non-inferior to CSM recorded with a CC according to a 10 degrees margin.

Methods

A total of 32 alpine extrications and 4 downhill evacuations on different slope conditions were performed using a high fidelity mannequin designed with a motion sensors instrumented cervical spine. The primary outcome was the peak extrication 3D excursion angle (Peak 3D θ_EX,) of the mannequin’s head. The secondary objectives were to describe the time to extrication completion (tEX) and to highlight which extrication manipulation is more likely to induce CSM.

Results

The median Peak 3D θ_EX recorded during flat terrain extrications using CC was 10.77° (95% CI 7.31°–16.45°) compared to 13.06° (95% CI 10.20°–30.36°) using MILS, and 16.09° (95% CI 9.07°–37.43°) for CC versus 16.65° (95% CI 13.80°–23.40°) using MILS on a steep slope. Peak 3D θ_EX with CC or using MILS during extrications were equivalent according to a 10 degrees non-inferiority hypothesis testing (p < 0.05). Time to extrication completion (tEX) was significantly reduced using MILS without CC on a flat terrain with a median duration of 237,3 s (95% CI 197.8 s, 272.2 s) compared to 358.7 s (95% CI 324.1 s, 472.4 s). During downhill evacuations, CSM with and without CC across all terrain conditions were negligible (< 5°). When CC is used; its installation manipulation induces the highest CSM. When EXs are done using MILS without CC, the logroll initiation is the manipulation inducing the highest risk of CSM.

Conclusion

For experienced ski patrollers, the biomechanical benefits of spinal motion restriction provided by CC over MILS during alpine skiing rescues appear to be marginal and CC use negatively affects rescue time.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13049-022-01031-3.

Sex- and Sports-Specific Epidemiology of Traumatic Lumbar Spine Injuries Sustained During Sporting Activities: Male Snowboarders and Female Horseback Riders at Greatest Risk

Purpose

To generate national estimates of sports-related traumatic lumbar spine injury incidence rates using the National Electronic Injury Surveillance System (NEISS) database and determine any sports- and sex-specific epidemiologic patterns of these traumatic injuries.

Methods

Data regarding traumatic lumbar spine injuries sustained through sporting activities from 2009 to 2018 were extracted from the NEISS, a database generating nationwide estimates through patient information collected during emergency department visits from 100 NEISS hospitals across the United States. The estimated number of injuries was calculated using weights assigned by the NEISS database depending on the geographic location of the injury.

Results

A total of 497 traumatic lumbar spine injuries were identified over the course of 10 years, suggesting 19,208 estimated injuries. The estimated average injury rate was 6.1 injuries per million persons per year. When analyzed by sex, the incidence rate of traumatic lumbar spine injury was 3.6 injuries per million persons per year for male patients and 2.5 injuries per million persons per year for female patients (P = .663). In male patients, 47% of the injuries occurred in individuals aged between 10 and 29 years, whereas injuries in female patients were more equally distributed across different age groups. Horseback riding (27%), skiing (5%), and roller skating (4%) were the leading causes of traumatic lumbar injuries in female patients. In male patients, most injuries were experienced as a result of snowboarding (13%), weightlifting (10%), and football (6%).

Conclusions

From 2009 to 2018, the estimated incidence of sports-associated traumatic lumbar spine injuries was approximately 6.1 injuries per million persons per year. Male patients experienced a greater number of traumatic lumbar injuries (3.60) than female patients (2.46), with a relative incidence rate of 1.46. The most common source of injury was snowboarding in male patients and horseback riding in female patients.

Level of Evidence

Level III, retrospective comparative study.

Incidence of recreational snowboarding-related spinal injuries over an 11-year period at a ski resort in Niigata, Japan

Background

There is limited knowledge regarding the incidence of recreational snowboarding-related spinal injuries.

Objective

This study investigated the incidence and characteristics of recent recreational snowboarding-related spinal injuries and discussed possible preventive measures to reduce the risk of spinal injuries.

Methods

This descriptive epidemiological study was conducted to investigate the incidence and characteristics of snowboarding-related spinal injuries at the Myoko ski resort in Niigata Prefecture, Japan, between 2006 and 2017. The incidence of spinal injuries was calculated as the total number of spinal injuries divided by the number of snowboarding visitors, which was estimated based on the ticket sales and estimates regarding the ratio of the number of skiers to the number of snowboarders reported by seven skiing facilities.

Results

In total, 124 (72.5%) males and 47 (27.5%) females suffered spinal injuries. The incidence of spinal injuries was 5.1 (95% CI 4.4 to 5.9) per 100 000 snowboarder visitors. Jumps at terrain parks were the most common factor in 113 (66.1%) spinal injuries, regardless of skill level (29/49 beginners, 78/112 intermediates, 6/10 experts). Overall, 11 (including 9 Frankel A) of 14 (78.6%) cases with residual neurologic deficits were involved with jumps.

Conclusions

In recreational snowboarding, jumping is one of the main causes for serious spinal injuries, regardless of skill level. The incidence of spinal injuries has not decreased over time. Individual efforts and educational interventions thus far have proven insufficient to reduce the incidence of spinal injury. Ski resorts and the ski industry should focus on designing fail-safe jump features to minimise the risk of serious spinal injury.

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.

Lumbar Spine Injuries in Sports: Review of the Literature and Current Treatment Recommendations

Low back pain is one of the most prevalent complaints of athletes at all levels of competition. The purpose of this literature review is to provide an overview of sport-specific injuries and treatment outcomes that can be used by healthcare providers to better recognize injury patterns and treatment options for different groups of athletes. To our knowledge, no prior comprehensive review of lumbar spine injuries in sports is currently available in the literature, and it is essential that healthcare providers understand the sport-specific injury patterns and treatment guidelines for athletes presenting with low back pain following an athletic injury. Injury mechanisms were found to vary significantly by sport, although some broad recommendations can be made with regards to optimal treatment for these injuries and return to play. Additionally, it was found that certain treatments were more beneficial and resulted in higher rates of return to play depending on the specific sport of the injured athlete. Healthcare providers need to be aware of the different injury patterns seen in specific sports in order to properly evaluate and treat these injuries. Furthermore, an individualized treatment plan needs to be selected in a sport-specific context in order to meet the needs of the athlete in the short and long term.

Modeling and simulation of the impact behavior of soft polymeric-foam-based back protectors for winter sports

OBJECTIVES

Winter sports are high-energy outdoor activities involving high velocities and acrobatic maneuvers, thus raising safety concerns. Specific studies on the impact mechanics of back protectors are very limited. In this study analytical and numerical models are developed to rationalize results of impact experiments and propose new design procedures for this kind of equipment.

DESIGN

Different soft-shell solutions currently available on the market are compared. In particular, the role of dynamic material constitutive properties and of environmental temperature (which affects mainly material stiffness) on energy absorption capability are evaluated.

METHODS

Starting from dynamic mechanical-thermal characterization of the closed-cell polymeric foams constituting the protectors, we exploited analytical modeling and Finite Element Method simulations to interpret experimental data from drop weight impact test and to characterize protectors at different temperatures and after multiple impacts.

RESULTS

The temperature and frequency dependent properties of these materials characterize their impact behavior. Modeling results are in good agreement with impact tests. Results demonstrate how ergonomic soft-shell solution provides an advantage with respect to traditional hard-shell in terms of impact protection. Moreover, it can maintain nearly unaltered its protective properties after multiple impacts on the same point.

CONCLUSIONS

The coupled analytical-simulation approach here presented could be extensively used to predict the impact behavior of such equipment, starting from material characterization, allowing to save costs and time for physical prototyping and tests for design and optimization.

Spinal injury analysis for typical snowboarding backward falls

Spinal injury (SPI) often causes death and disability in snow-sport accidents. SPIs often result from spinal compression and flexion, but the injury risks due to over flexion have not been studied. Back protectors are used to prevent SPIs but the testing standards do not evaluate the flexion-extension resistance. To investigate SPI risks and to better define back-protector specifications, this study quantified the flexion-extension range of motions (ROMs) of the thoracic-lumbar spine during typical snowboarding backward falls. A human facet-multibody model, which was calibrated against spinal flexion-extension responses and validated against vehicle-pedestrian impact and snowboarding backward fall, was used to reproduce typical snowboarding backward falls considering various initial conditions (initial velocity, slope steepness, body posture, angle of approach, anthropometry, and snow stiffness). The SPI risks were quantified by normalizing the numerical spinal flexion-extension ROMs against the corresponding ROM thresholds from literature. A high risk of SPI was found in most of the 324 accident scenarios. The thoracic segment T6-T7 had the highest injury risk and incidence. The thoracic spine was found more vulnerable than the lumbar spine. Larger anthropometries and higher initial velocities tended to increase SPI risks while bigger angles of approach helped to reduce the risks. SPIs can result from excessive spinal flexion-extension during snowboarding backward falls. Additional evaluation of back protector's flexion-extension resistance should be included in current testing standards. An ideal back protector should consider the vulnerable spinal segments, the snowboarder's skill level and anthropometry.

Management of injuries in snowboarders: rehabilitation and return to activity

Snowboarding has seen a continuous increase in popularity, leading to an increase in the number of snowboarding injuries seen in orthopedic practice. Upper-extremity injuries are more common than lower-extremity, spine, and pelvis injuries. In this review, we focus on the most common snowboarding injuries of the extremities, spine, and pelvis and provide an overview of their respective rehabilitation and return-to-sport protocols. Despite many of the injuries seen in snowboarding also occurring in other sports, objective data about rehabilitation and return to sport are lacking for many injuries. This provides an opportunity for research in the area with regard to many sports and many different injuries.

Injuries in extreme sports

Extreme sports (ES) are usually pursued in remote locations with little or no access to medical care with the athlete competing against oneself or the forces of nature. They involve high speed, height, real or perceived danger, a high level of physical exertion, spectacular stunts, and heightened risk element or death.Popularity for such sports has increased exponentially over the past two decades with dedicated TV channels, Internet sites, high-rating competitions, and high-profile sponsors drawing more participants.Recent data suggest that the risk and severity of injury in some ES is unexpectedly high. Medical personnel treating the ES athlete need to be aware there are numerous differences which must be appreciated between the common traditional sports and this newly developing area. These relate to the temperament of the athletes themselves, the particular epidemiology of injury, the initial management following injury, treatment decisions, and rehabilitation.The management of the injured extreme sports athlete is a challenge to surgeons and sports physicians. Appropriate safety gear is essential for protection from severe or fatal injuries as the margins for error in these sports are small.The purpose of this review is to provide an epidemiologic overview of common injuries affecting the extreme athletes through a focus on a few of the most popular and exciting extreme sports.

Characteristics and Risk Factors of Spinal Fractures in Recreational Snowboarders Attending an Emergency Department in Japan

OBJECTIVE

The purpose of this study was to elucidate the characteristics of spinal fractures during recreational snowboarding and to determine the risk factors for these fractures.

DESIGN

Case series study.

SETTING

The Oku-mino ski area during the 7-year period between the 2005 to 2006 and 2011 to 2012 skiing seasons.

PARTICIPANTS

Eight thousand seven hundred twenty-three snowboarders with injures.

INTERVENTIONS

Cases involved snowboarders with spinal fractures; controls were snowboarders without spinal fractures.

MAIN OUTCOME MEASURES

The characteristics of spinal fractures were assessed using a standard form and patient records, including radiographs. Multivariate regression analysis was performed to investigate risk factors for spinal fractures, including age, type of slope, snow condition, accident cause, self-reported skill level, experience level, and the use of protective equipment.

RESULTS

Of 8723 snowboarders with injuries, 431 snowboarders presented with spinal fractures (4.9%). The most common spinal fracture was isolated transverse process fracture in the lumbar spine (33.2%, n = 143), followed by compression type fracture in the lumbar spine (25.1%, n = 108). Age (20-39 years), terrain slopes (half-pipe/box/kicker/rail), and jump-landing failure were associated with a significantly high risk of spinal fracture.

CONCLUSIONS

Among the recreational snowboarders, isolated transverse process fracture in the lumbar spine was the most frequent spinal fracture. Age (20-39 year old), terrain slopes, and jump-landing failure were found to be risk factors for spinal fracture.

CLINICAL RELEVANCE

Identification of characteristics and risk factors for spinal fractures during snowboarding is useful information to create a preventive strategy for the fractures and make snowboarding a safer sport.

Epidemiology of sport-related spinal cord injuries: A systematic review

CONTEXT

Despite the recognition of sports as a significant contributor in the etiology of spinal cord injury (SCI), no studies have systematically explored the epidemiology of SCI caused by sports.

OBJECTIVE

This paper aims to give a systematic overview of the epidemiology of sport-related spinal cord injury around the world.

METHODS

A systematic review was conducted to identify published literature reporting the epidemiology of SCI caused by sports. The literature search was conducted in MEDLINE/PubMed, CINAHL, EMBASE, PsycINFO and Sportdiscus with date limits 1980 through to July 2015. Data from 54 studies covering 25 countries was extracted and collated.

RESULTS

Important findings include identification of 6 countries in which sports accounts for over 13% of SCI (highest to lowest: Russia, Fiji, New Zealand, Iceland, France and Canada); individual sports with high risk for SCI (diving, skiing, rugby, and horseback riding); and the most common level of injury for various sports (almost entirely cervical for hockey, skiing, diving and American football, while over half of horseback riding and snowboarding injuries are thoracic or lumbosacral).

CONCLUSION

This paper identifies countries and sports with higher rates of sport-related SCIs where implementation of prevention programs and reporting systems to track SCI epidemiology may be helpful, and highlights gaps in our current knowledge for further investigation. The comparison of SCI occurrence for each sport across countries, as well as examination of the specific characteristics of SCI incurred for individual sports will assist in directing efforts for prevention.

Head injury predictors in sports trauma--a state-of-the-art review

Head injuries occur in a great variety of sports. Many of these have been associated with neurological injuries, affecting the central nervous system. Some examples are motorsports, cycling, skiing, horse riding, mountaineering and most contact sports such as football, ice and field hockey, soccer, lacrosse, etc. The outcome of head impacts in these sports can be very severe. The worst-case scenarios of permanent disability or even death are possibilities. Over recent decades, many In recent decades, a great number of head injury criteria and respective thresholds have been proposed. However, the available information is much dispersed and a consensus has still not been achieved regarding the best injury criteria or even their thresholds. This review paper gives a thorough overview of the work carried out by the scientific community in the field of impact biomechanics about head injuries sustained during sports activity. The main goal is to review the head injury criteria, as well as their thresholds. Several are reviewed, from the predictors based on kinematics to the ones based on human tissue thresholds. In this work, we start to briefly introduce the head injuries and their mechanisms commonly seen as a result of head trauma in sports. Then, we present and summarize the head injury criteria and their respective thresholds.

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.

Characteristics of injuries sustained by snowboarders in a terrain park

OBJECTIVE

To determine injured body regions and injury type resulting from snowboarding on aerial and nonaerial terrain park features and the accuracy of ski patrol assessments compared with physician diagnoses.

DESIGN

Case series study.

SETTING

An Alberta terrain park during the 2008-2009 and 2009-2010 seasons.

PATIENTS

There were 333 snowboarders injured on features (379 injuries).

ASSESSMENT OF RISK FACTORS

Aerial or nonaerial terrain park feature used at injury, injured body region, injury type, and additional risk factors were recorded from ski patrol Accident Report Forms, emergency department medical records, and telephone interviews.

MEASURES

Odds of injury to body regions and injury types on aerial versus nonaerial features were calculated using multinomial logistic regression. Accuracy of ski patrol injury assessments was examined through sensitivity, specificity, and kappa (κ) statistics.

RESULTS

The wrist was the most commonly injured body region (20%), and fracture was the most common injury type (36%). Compared with the upper extremity, the odds of head/neck [odds ratio (OR), 2.58; 95% confidence interval (CI), 1.37-4.85] and trunk (OR, 3.65; 95% CI, 1.68-7.95) injuries were significantly greater on aerial features. There was no significant association between aerial versus nonaerial feature and injury type. The accuracy of ski patrol injury assessment was higher for injured body region (κ = 0.65; 95% CI, 0.54-0.75) than for injury type (κ = 0.29; 95% CI, 0.22-0.37).

CONCLUSIONS

Snowboarders were significantly more likely to sustain head/neck or trunk injuries than upper extremity injuries on aerial features. Investigators should acknowledge potential misclassification when using ski patrol injury assessments.

Spinal injury patterns among skiers and snowboarders

OBJECT

Skiing and snowboarding injuries have increased with the popularity of these sports. Spinal cord injuries (SCIs) are a rare but serious event, and a major cause of morbidity and mortality for skiers and snowboarders. The purpose of this study is to characterize the patterns of SCI in skiers and snowboarders.

METHODS

The authors queried the Nationwide Inpatient Sample for the years 2000-2008 for all patients admitted with skiing or snowboarding as the mechanism of injury, yielding a total of 8634 patients. The injury patterns were characterized by the ICD-9 diagnostic and procedure codes. The codes were searched for those pertaining to vertebral and skull fracture; spinal cord, chest, abdominal, pelvic, and vessel injuries; and fractures and dislocations of the upper and lower extremity. Statistical analysis was performed with ANOVA and Student t-test.

RESULTS

Patients were predominantly male (71%) skiers (61%), with the average age of the skiers being older than that of snowboarders (39.5 vs 23.5 years). The average length of stay for patients suffering from spine trauma was 3.8 days and was increased to 8.9 days in those with SCI. Among hospitalized patients, SCI was seen in 0.98% of individuals and was equally likely to occur in snowboarders and skiers (1.07% vs 0.93%, p < 0.509). Cervical spine trauma was associated with the highest likelihood of SCI (19.6% vs. 10.9% of thoracic and 6% of lumbar injuries, p < 0.0001). Patients who were injured skiing were more likely to sustain a cervical spine injury, whereas those injured snowboarding had higher frequencies of injury to the lumbar spine. The most common injury seen in tandem with spine injury was closed head injury, and it was seen in 13.4% of patients. Conversely, a spine injury was seen in 12.9% of patients with a head injury. Isolated spine fractures were seen in 4.6% of patients.

CONCLUSIONS

Skiers and snowboarders evaluated at the hospital are equally likely to sustain spine injuries. Additionally, participants in both sports have an increased incidence of SCI with cervical spine trauma.

Thoracic and lumbar fractures associated with skiing and snowboarding injuries according to the AO Comprehensive Classification

BACKGROUND

The incidence of spinal fractures varies from 1% to 17% in alpine skiing injuries. Distinctions have been made regarding the differences in the mechanisms of injury and fracture types between skiing and snowboarding. Although fracture patterns have been described, there have not been any detailed descriptions of the specific fracture types and subgroups.

PURPOSE

To address the patterns of spinal fractures associated with these sports and to determine the incidence of various fracture groups and subgroups as well as to determine whether the fracture patterns differ between skiing and snowboarding injuries.

STUDY DESIGN

Descriptive epidemiology study.

METHODS

This is a retrospective review of thoracic and lumbar spinal fractures associated with either skiing or snowboarding over a period of 5 years. The injuries were classified according to the AO Comprehensive Classification. In addition, isolated transverse process fractures and isolated spinous process fractures were included. Cervical spine fractures were excluded from this study.

RESULTS

There were a total of 119 patients with thoracic and lumbar fractures that were identified after 1,283,348 skiing/snowboarding days. There were a total of 146 fractures, of which 114 were classified according to the AO Comprehensive Classification, with the remaining fractures (n = 32) consisting of isolated transverse or spinous process fractures. The preponderance of these injuries (94.7%) was compression injuries. Burst fractures (A3.1 and A3.2) made up 23%, and simple compression fractures (A1.1, A1.2, and A1.3) made up 71% of the total. Distraction injuries composed only 4.4%, and rotation injuries composed 0.9% of the total. The snowboarders incurred only compression fractures, whereas the 5 distraction injuries and the 1 rotational injury were noted only in the skier population. There were no patients with neurological deficits in this review. Fourteen skiers (14%) and 10 snowboarders (8%) were found to have isolated transverse process fractures. All 6 isolated spinous process fractures (4% of all fractures) were in the thoracic spine.

CONCLUSION

Thoracic and lumbar fractures caused by skiing and snowboarding are mainly stable injuries, composed of either compression fractures, mostly simple compression injuries, or isolated transverse and spinous process fractures. Neurological injury was not seen in this study.

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.

Evaluation of skiing and snowboarding injuries sustained in terrain parks versus traditional slopes

This study compares skiing and snowboarding injuries in terrain parks versus slopes at two ski areas, 2000-05. A total of 3953 (26.7%) injuries occurred in terrain parks, predominantly among young male snowboarders. Terrain park injuries were more likely to be severe, involving head (RR 1.31, 95% CI 1.16 to 1.48) or back (RR 1.96, 95% CI 1.67 to 2.29).

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.

Pelvic fractures resulting from snowboarding

BACKGROUND

Information regarding pelvic fractures sustained during snowboarding is scant.

PURPOSE

To analyze the epidemiologic data, injury patterns, and types of pelvic fractures sustained during snowboarding.

STUDY DESIGN

Case series; Level of evidence, 4.

METHODS

We analyzed the epidemiologic factors, injury patterns, and types of pelvic fractures in 145 patients with snowboarding-related pelvic fractures who were admitted to our institution from the 1998-1999 to the 2006-2007 ski season.

RESULTS

The incidence of snowboarding-related pelvic fractures was 0.102 per 10 000 ski lift tickets, which amounted to 2% of all snowboarding-related fractures (fifth most common type of fracture among all snowboarding-related fractures). Of the pelvic fractures, 85.5% were stable (type A according to the Tile classification) and 14.5% were unstable (types B and C according to the Tile classification). Isolated sacral fractures had the second-highest incidence (24.1%) after pubic bone and/or ischium fractures (46.9%). A distinct female prevalence was seen (52.4%). Jumps and isolated falls were the main mechanisms of injury (80%), and the incidence of collision was significantly higher in the unstable group than in the stable group (P = .037). In all, 57.9% patients classified their skill level as "intermediate," and only 9.7% of patients had received professional snowboarding lessons. A total of 30 subjects (20.8%) had other injuries along with pelvic fractures; the patients with multiple injuries were significantly more frequent in the unstable group than in the stable group (P = .035).

CONCLUSION

Pelvic fractures resulting from snowboarding accidents included a higher proportion with isolated sacral fractures in the stable group and a lower prevalence of associated injuries in the unstable group compared with those resulting from other causes.

Skill level-specific differences in snowboarding-related injuries

BACKGROUND

Snowboarding-related injuries have been associated with specific snowboarding skill levels, but differences in specific skill level have not been identified.

HYPOTHESIS

Injury patterns are different among skill levels.

STUDY DESIGN

Descriptive epidemiology study.

METHODS

The subjects were 19 539 snowboarders from the Oku-Mino region in Gifu Prefecture, Japan, who were admitted to our hospital during the 12 snowboarding seasons from 1996 to 2008. They were asked to complete a questionnaire regarding age, gender, self-estimated skill level, injury location, injury type, mechanism of injury, and protective gear. Physicians documented diagnostic variables and injury severity score; these variables were compared among the self-estimated skill levels.

RESULTS

Of the total 19 539 injured snowboarders, 1204 (6.2%) were novices, 6409 (32.8%) were beginners, 9260 (47.4%) were intermediates, 1918 (9.8%) were experts, and the skill level was not known in 748 (3.8%). Proportions of the trunk and multiple injuries increased with increases in skill level; however, the number of head/face injuries decreased with increase in skill level. Upper extremity injuries also decreased with increase in skill level, except in novices. Dislocations and multiple injuries increased with increase in skill level, while lacerations/contusions, fractures, and bruises decreased. The mean overall injury severity score was 3.28 + or - 0.02, and the value increased significantly with increase in skill level. The proportion of collision and isolated fall injuries significantly decreased with increase in skill level, but that of jump injuries significantly increased. The percentage of protective gear use increased with the increase in skill level.

CONCLUSION

Prevalence of injury type, injury location, mechanism of injury, and percentage of protective gear use varied according to skill level, and the severity of the injury increased with increase in skill level. On the basis of our observations, we believe that snowboarding injury prevention strategies should be formulated according to skill level.

Preventing fall-related vertebral fractures: effect of floor stiffness on peak impact forces during backward falls

STUDY DESIGN

In vivo biomechanical study of 11 male volunteers.

OBJECTIVE

To measure the peak forces applied to the buttocks in a backward fall from standing, and to determine whether this force is lowered by reductions in floor stiffness.

SUMMARY OF BACKGROUND DATA

Fall-related vertebral fractures are common and backward falls result in impact to the buttocks. Compliant flooring may reduce impact force and risk for vertebral fracture during a fall. However, we have little knowledge of the peak forces applied to the body during a backward fall, or how floor stiffness affects this force.

METHODS

Eleven males, mean age 25 +/- 5 (SD) years, were suddenly released from a backward lean of 15 degrees , falling backward onto the ground which was covered with 4.5, 7.5, or 10.5 cm of ethylene vinyl acetate foam rubber. We measured 3-dimensional impact forces applied to the buttocks at 960 Hz with a force plate. We used repeated measures analysis of variance and post hoc t tests to compare peak forces between conditions. We also modeled peak vertical force for falls onto a bare floor. RESULTS.: There was a significant difference in peak vertical force between falls onto the 10.5 cm foam condition compared with the 7.5 cm (P = 0.002) and 4.5 cm (P < 0.001) conditions. Peak vertical force (N) was (mean +/- SD) 5099 +/- 868, 4788 +/- 702, and 4544 +/- 672 for the 4.5, 7.5, and 10.5 cm foam conditions, respectively, and estimated at 6027 +/- 988 for the rigid (bare floor) condition. Compared with the bare floor, these foam floors provided, on average, 24, 20, and 15% force attenuation respectively.

CONCLUSION

In a backward fall onto the buttocks, peak impact forces are 6.4 to 9.0 times body weight in a fall onto a bare floor. Reducing floor stiffness using even a thin (4.5 cm) layer of foam may provide 15% vertical force attenuation during a fall onto the buttocks.

An international review of head and spinal cord injuries in alpine skiing and snowboarding

BACKGROUND

Alpine skiing and snowboarding are popular winter activities worldwide, enjoyed by participants of all ages and skill levels. There is some evidence that the incidence of traumatic brain injury (TBI) and spinal cord injury (SCI) in these activities may be increasing. These injuries can cause death or severe debilitation, both physically and emotionally, and also result in enormous financial burden to society. Indeed, TBI is the leading cause of death and catastrophic injury in the skiing and snowboarding population. Furthermore, there are severe limitations to therapeutic interventions to restore neurological function after TBI and SCI, and thus the emphasis must be on prevention.

OBJECTIVES

(1) To examine the worldwide epidemiology of TBI and SCI in skiing and snowboarding; (2) to describe and examine the effectiveness of prevention strategies to reduce the incidence of TBI and SCI in skiing and snowboarding.

SEARCH STRATEGY

Searches were performed on a variety of databases to identify articles relevant to catastrophic central nervous system injury in skiing and snowboarding. The databases included PubMed, Medline, EMBASE, CDSR, ACP Journal Club, DARE, CCTR, SportDiscus, CINAHL, and Advanced Google searches. SELECTION CRITERIA AND DATA COLLECTION: After initial prescreening, articles included in the review required epidemiological data on SCI, TBI, or both. Articles had to be directly associated with the topic of skiing and/or snowboarding and published between January 1990 and December 2004.

RESULTS

24 relevant articles, from 10 different countries, were identified. They indicate that the incidence of TBI and SCI in skiing and snowboarding is increasing. The increases coincide with the development and acceptance of acrobatic and high-speed activities on the mountains. There is evidence that helmets reduce the risk of head injury by 22-60%. Head injuries are the most common cause of death among skiers and snowboarders, and young male snowboarders are especially at risk of death from head injury.

CONCLUSIONS

There should be enhanced promotion of injury prevention that includes the use of helmets and emphasizes the skier's and snowboarder's responsibility code.

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.

Characteristics of helmet or knit cap use in head injury of snowboarders

The rate of head injury is 1.86-6 times higher for snowboarding than for skiing. Detailed data about the usefulness of a helmet or knit cap for protecting against serious head injuries have not been reported. The present study evaluated the use of a helmet or knit cap for preventing head injuries. Questionnaire data were collected from 1,190 consecutive patients in a hospital during the 1999/2000-2002/2003 winter seasons at Uonuma ski resort, Niigata, Japan. Patients were divided into the helmet, knit cap, and no cap groups. Upper technical level was highest and jumping as the cause of injury was most frequent in the helmet group. After adjustment for other confounders, there was a significant negative association between the occurrence of serious head injury during snowboarding and female sex (adjusted odds ratio 0.55, 95% confidence interval 0.421-0.718, p < 0.0001) and a significant positive association between serious head injury and jumping (adjusted odds ratio 2.25, 95% confidence interval 1.48-3.43, p = 0.0001). Among snowboarding maneuvers, only jumping showed a significant negative association between wearing of a helmet or knit cap and the occurrence of serious head injury (p = 0.036). Snowboarders who wear helmets might attempt dangerous maneuvers causing injuries. Wearing of a helmet or knit cap protected against serious head injuries on jumping. Every snowboarder should wear a helmet or knit cap on jumping to prevent head injury.

Risk factors associated with serious ski patrol-reported injuries sustained by skiers and snowboarders in snow-parks and on other slopes

BACKGROUND

Over the past years, the rate of injuries sustained at the alpine ski hills in Québec significantly increased. This raises concern over a possible increase in risk of severe injuries associated with snow-park use. The main objective of this study was to examine the severity of injuries sustained by skiers and snowboarders in snow-parks compared with other slopes from 2001 to 2005.

METHODS

A case-control study design was used. Subjects were injured skiers and snowboarders who reported to the ski patrol with an injury. Two sets of severely injured cases were defined based on the type of injury and ambulance evacuation. Injured controls were those who did not sustain severe injuries. 50,593 injury report forms were analyzed. A logistic regression analysis was performed to relate the severity of injury to the type of slope used when the injury occurred. All analyses were controlling for age, sex, skill level, helmet use, season, and type of activity.

RESULTS

There was evidence to suggest that, for skiers (adjusted OR = 1.36; 95% CI: 1.21-1.53) and snowboarders (adjusted OR = 1.14, 95% CI: 1.05-1.23), participation in a snow-park increased the risk of being evacuated by ambulance. Severe injuries in skiers were also more likely to occur in snow-parks, but snowboarders had similar risk of severe injury in snow-parks and on other slopes.

CONCLUSIONS

These results provide evidence that the type of activities performed in snow-parks may increase the risk of sustaining a severe injury compared with participation on other slopes.

Traumatic spinal cord injuries from snowboarding

BACKGROUND

Little information has yet been made available on the types and mechanisms of snowboard-related spinal cord injuries or their neurologic involvement.

PURPOSE

To review the cause and types of spinal cord injuries seen in snowboarders.

STUDY DESIGN

Case series; Level of evidence, 4.

METHODS

The subjects were 18 patients (mean age, 24.0 years) referred to the authors' institution for neurologic deficits associated with spinal injuries between November 1, 1995, and April 9, 2005. The clinical features of these patients were reviewed with respect to epidemiologic factors, mechanism of injury, fracture pattern, and neurologic status.

RESULTS

The 18 snowboarders with spinal cord injuries constituted a very homogeneous group. First, almost all patients (94.4%) were young men. Second, most of the patients were intermediate or expert boarders. Third, the most common cause of injury was a failure of intentional jumping (83.3%). Fourth, the most commonly affected site was the thoracolumbar junction (66.7%), and the most common type of fracture was an anterior dislocation fracture (66.7%). Finally, in the thoracolumbar group, most patients (83.3%) were classed as Frankel grade A or B.

CONCLUSION

It is fundamentally important that snowboarders, especially young men, be made aware of the spinal injury risk associated with jumping.

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.

Central nervous system injuries in sport and recreation: a systematic review

Many sports have been associated with a variety of neurological injuries affecting the central nervous system (CNS), with some injuries specific to that sport. A systematic review of sport-specific CNS injuries has not been attempted previously, and could assist in the understanding of morbidity and mortality associated with particular sporting activities, either professional or amateur. A systematic review of the literature was performed using PubMed (1965-2003) examining all known sports and a range of possible CNS injuries attributable to that sport. Numerous sporting activities (45) have associated CNS injuries as reported within the literature. The sports most commonly associated with CNS injuries are: football, boxing, hockey, use of a trampoline, and various winter activities. A number of sporting activities are associated with unique CNS injuries or injury-related diseases such as heat stroke in auto racing, vertebral artery dissection in the martial arts, and dementia pugilistica in boxing. Neurological injuries of the CNS due to sport comprise a wide collection of maladies that are important for the neurologist, neurosurgeon, orthopaedic surgeon, physiatrist, sports medicine doctor, athletic trainer and general physician to recognise.

Snowboarden

Since the 1998 Olympic Winter Games in Nagano, snowboarding has been established as a popular winter sport for youth and adults. The most frequently affected body region reported in many studies on snowboarding injuries are the wrists accounting for more than 50% of severe injuries, especially in beginners. Wrist braces are effective in protecting snowboarding beginners against wrist injuries. Male snowboarders up to the age of 16 and female snowboarders over the age of 25 have a higher risk of injury. Snowboarders should not use ski boots and should be careful with rented equipment. Systems providing body and limb protection and also snowboard-specific helmets can reduce the injury risk for alpine racers, freestylers, and also freeriders. Snowboard training is important to prevent injuries especially for beginners, and icy slopes should be avoided.

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.

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.