Deep cutting injury from the edges of a snowboard

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.

Severe Lacerations in Alpine Ski Racing: A Case Series and Review of the Literature

STUDY DESIGN

Case series.

LEVEL OF EVIDENCE

Level 4C.

An Extensive Volar Forearm Laceration - The Spaghetti Wrist: A Systematic Review

Purpose

'Spaghetti wrist' is an extensive laceration that involves multiple structures in the volar wrist, including tendons, nerves and arteries. This injury is frequently encountered in trauma units, but despite its complex nature, management is often handled by junior surgeons.Furthermore, the guidance on how to approach these injuries is limited, with a relatively poor evidence base on management and outcomes.

Methods

In this article, we perform a systematic review of the literature on the management and outcomes of the spaghetti wrist injury. Patient demographics, definitions of spaghetti wrist, mechanism of injury, operative and rehabilitative techniques and surgical outcomes are discussed.

Results

Results from this study show significant physical, functional, psychological and financial impacts of spaghetti wrist injuries. Operative technique appears relatively consistent; even though reporting of injuries and outcomes was heterogeneous, no current classification system is in common usage.

Conclusions

An increased focus on the standardisation of assessment, management and rehabilitation and on overcoming the obstacles to care will serve as a guidance to the operative and post-operative management of the spaghetti wrist injury. The use of a single definition and classification system has been proposed to standardise outcome measures and improve inter-observer reliability.

Type of study/level of evidence

Systematic Review: Level IIa evidence.

Injury patterns at a large Western United States ski resort with and without snowboarders: the Taos experience

BACKGROUND

Differences in injury patterns among alpine skiers and snowboarders have previously been recognized, and controversy remains about the safety implications that snowboarding may pose to a ski resort. A change of policy at Taos Ski Valley provides a unique and modern perspective on the effect that snowboarders have on ski resort injuries.

HYPOTHESIS

The addition of snowboarders to a large ski resort may result in a significant change in both the rate and pattern of injuries treated.

STUDY DESIGN

Descriptive epidemiology study.

METHODS

Patient records from the Mogul Medical Clinic at Taos Ski Valley were reviewed from the 2006-2007 ski season through the 2009-2010 season (approximately 2 years before and after snowboarding was allowed) and recorded for age, sex, diagnosis, body region, anatomic location, injury type, and sport (skiing, snowboarding). The total numbers of mountain visits for the time periods with and without snowboarding were used to determine injury rates.

RESULTS

The overall rate of persons injured increased from 206.7 per 100,000 mountain visits without snowboarders to 233.8 with snowboarders. The relative risk ratio was 1.131, also represented as a 13.1% increased risk of injury (IRI) (statistically significant; 95% CI, 3.5%-23.6%). Increases were seen in the rate of upper extremity injuries (IRI, 39.1%; 95% CI, 14.3-69.4) and head/neck injuries (IRI 30.8%; not significant), while lower extremity and trunk/pelvis injuries remained relatively constant. Distal radius fractures, closed head injuries, and acromioclavicular separations showed statistically significant increases with the addition of snowboarding. The most frequent injuries among snowboarders were distal radius fractures, wrist sprains, closed head injuries, and acromioclavicular separations. The most frequent injuries among skiers were anterior cruciate ligament tears, knee sprains, closed head injuries, and gastrocnemius tears. The median age of injured persons decreased from 39 years (range, 4-100 years) without snowboarders to 31 years (range, 4-99 years) with snowboarders, and this was significant. Approximately 45% of injured persons were female, and this did not change with the addition of snowboarders.

CONCLUSION

In this study, there was a small but statistically significant increase in the likelihood of injury with the addition of snowboarding to a large ski resort. It is likely that factors such as younger demographic, elevated risk-taking behavior, or increased mountain crowding are involved. The difference in injuries is largely because of a significant increase in distal radius fractures, closed head injuries, and acromioclavicular separations. On mountain safety precautions such as widening of runs and streamlining of high traffic areas, training medical providers to recognize and treat sport-specific injuries, and promoting the use of wrist guards and helmets may be useful in reducing the effect that snowboarders have on ski resort injuries.

Median and ulnar nerve injuries: a meta-analysis of predictors of motor and sensory recovery after modern microsurgical nerve repair

BACKGROUND

The aim of this study was to quantify variables that influence outcome after median and ulnar nerve transection injuries. The authors present a meta-analysis based on individual patient data on motor and sensory recovery after microsurgical nerve repair.

METHODS

From 130 studies found after literature review, 23 articles were ultimately included, giving individual data for 623 median or ulnar nerve injuries. The variables age, sex, nerve, site of injury, type of repair, use of grafts, delay between injury and repair, follow-up period, and outcome were extracted. Satisfactory motor recovery was defined as British Medical Research Council motor scale grade 4 and 5, and satisfactory sensory recovery was defined as British Medical Research Council grade 3+ and 4. For motor and sensory recovery, complete data were available for 281 and 380 nerve injuries, respectively.

RESULTS

Motor and sensory recovery were significantly associated (Spearman r = 0.62, p < 0.001). Multivariate logistic regression analysis showed that age (< 16 years versus > 40 years: odds ratio, 4.3; 95 percent confidence interval, 1.6 to 11.2), site (proximal versus distal: odds ratio, 0.46; 95 percent confidence interval, 0.20 to 1.10), and delay (per month: odds ratio, 0.94; 95 percent confidence interval, 0.90 to 0.98) were significant predictors of successful motor recovery. In ulnar nerve injuries, the chance of motor recovery was 71 percent lower than in median nerve injuries (odds ratio, 0.29; 95 percent confidence interval, 0.15 to 0.55). For sensory recovery, age (odds ratio, 27.0; 95 percent confidence interval, 9.4 to 77.6) and delay (per month: odds ratio, 0.92; 95 percent confidence interval, 0.87 to 0.98) were found to be significant predictors.

CONCLUSIONS

In this individual patient data meta-analysis, age, site, injured nerve, and delay significantly influenced prognosis after microsurgical repair of median and ulnar nerve injuries.