The efficacy of wrist protectors in preventing snowboarding injuries

Efficacy of multicomponent interventions on injury risk among ice and snow sports participants-a systematic review and meta-analysis

BACKGROUND

Ice and snow sports, which are inherently high risk due to their physically demanding nature, pose significant challenges in terms of participant safety. These activities increase the likelihood of injuries, largely due to reduced bodily agility and responsiveness in cold, often unpredictable winter environments. The critical need for effective injury prevention in these sports is emphasized by the considerable impact injuries have on the health of participants, alongside the economic and social costs associated with medical and rehabilitative care. In the context of ice and snow sports environments, applying the E principles of injury prevention to evaluate intervention measures can guide the implementation of future sports safety and other health promotion intervention measures in this field. When well executed, this approach can substantially reduce both the frequency and severity of injuries, thereby significantly enhancing the safety and long-term viability of these challenging sports.

OBJECTIVE

The objective of this study was to rigorously assess and statistically substantiate the efficacy of diverse injury prevention strategies in ice and snow sports, aiming to bolster future safety measures with solid empirical evidence.

DESIGN

Systematic review and meta-analysis.

METHODS

The overarching aim of this research was to meticulously aggregate and scrutinize a broad spectrum of scholarly literature, focusing on the quantifiable efficacy of diverse, multicomponent intervention strategies in mitigating the incidence of injuries within the realm of ice and snow sports. This endeavour entailed an exhaustive extraction of data from esteemed academic databases, encompassing publications up to September 30, 2023. In pursuit of methodological excellence and analytical rigor, the study employed advanced bias assessment methodologies, notably the AMSTAR 2 and GRADE approaches, alongside sophisticated random-effects statistical modelling. This comprehensive approach was designed to ensure the utmost validity, reliability, and scholarly integrity of the study's findings.

RESULTS

Fifteen papers, including 9 randomized controlled trials, 3 case‒control studies, and 3 cohort studies with 26,123 participants and 4,382 injuries, were analysed. The findings showed a significant reduction in injury rates through various interventions: overall injury prevention (RR = 0.50, 95% CI 0.42-0.63), educational training (RR = 0.50, 95% CI 0.34-0.73), educational videos (RR = 0.53, 95% CI 0.34-0.81), protective equipment (RR = 0.64, 95% CI 0.46-0.87), and policy changes (RR = 0.28, 95% CI 0.16-0.49). Subgroup analysis revealed potential heterogeneity in compliance (p = 0.347). Compared to controls, multicomponent interventions effectively reduced injury rates.

CONCLUSION

This systematic review and meta-analysis demonstrated that multicomponent interventions significantly prevent injuries in ice and snow sports. By applying the E principles of injury prevention and constructing a framework for practical injury prevention research in ice and snow sports, we can gradually shift towards a systemic paradigm for a better understanding of the development and prevention of sports injuries. Moreover, sports injury prevention is a complex and dynamic process. Therefore, high-quality experiments in different scenarios are needed in future research to provide more reliable evidence, offer valuable and relevant prevention information for practitioners and participants, and help formulate more effective preventive measures in practice.

Consistently High Frequency of Scooter Injuries in Children-Retrospective Data Analysis in a Level I Trauma Centre

The aim of this retrospective study was to present an epidemiological overview of paediatric nonelectric-scooter-related injuries, focusing on changes in injury mechanism and frequency. A retrospective, descriptive data analysis at a Level I trauma centre, including patients aged from 0 to 18 years injured by riding nonelectric scooters, was performed. The observation period ranged from January 2015 to December 2022. The total study population consisted of 983 (mean age: 7.9 ± 4.0 years) children and adolescents, with most patients being male (800/983; 81.4%). The frequency of nonelectric scooter injuries was relatively consistent over the observation period. Patients sustained mostly minor injuries (lacerations, bone contusions, sprains) (527/983; 53.6%), followed by head injuries (238/983; 24.5%), limb fractures (166/983; 16.9%) and trunk injuries (52/983; 5.3%). However, a few patients sustained severe injuries, including skull fractures (7/238; 2.9%), intracranial haematoma (4/238; 1.7%) or lacerations of abdominal organs (4/52; 7.7%). This study presented a consistently high frequency of scooter injuries in children. Children under 15 years were the most affected by scooter-related injuries. Although most injuries were minor, serious injuries occurred that should not be underestimated. Hence, we emphasise the use of protection gear and recommend raising awareness among parents and children.

Olympic Sports Science-Bibliometric Analysis of All Summer and Winter Olympic Sports Research

Introduction: The body of scientific literature on sports and exercise continues to expand. The summer and winter Olympic games will be held over a 7-month period in 2021-2022. Objectives: We took this rare opportunity to quantify and analyze the main bibliometric parameters (i.e., the number of articles and citations) across all Olympic sports to weigh and compare their importance and to assess the structure of the "sport sciences" field. The present review aims to perform a bibliometric analysis of Olympic sports research. We quantified the following topics: (1) the most investigated sports; (2) the main journals in which the studies are published; (3) the main factors explaining sport-specific scientific attractiveness; (4) the influence of being in the Olympic programme, economic weight, and local influences on research output; and (5) which research topic is the most investigated across sports. Methods: We searched 116 sport/exercise journals on PubMed for the 40 summer and 10 winter Olympic sports. A total of 34,038 articles were filtered for a final selection of 25,003 articles (23,334 articles on summer sports and 1,669 on winter sports) and a total of 599,820 citations. Results and Discussion: Nine sports [football (soccer), cycling, athletics, swimming, distance & marathon running, basketball, baseball, tennis, and rowing] were involved in 69% of the articles and 75% of the citations. Football was the most cited sport, with 19.7 and 26.3% of the total number of articles and citations, respectively. All sports yielded some scientific output, but 11 sports (biathlon, mountain biking, archery, diving, trampoline, skateboarding, skeleton, modern pentathlon, luge, bobsleigh, and curling) accumulated a total of fewer than 50 publications. While ice hockey is the most prominently represented winter sport in the scientific literature, winter sports overall have produced minor scientific output. Further analyses show a large scientific literature on team sports, particularly American professional sports (i.e., baseball, basketball, and ice hockey) and the importance of inclusion in the Olympic programme to increasing scientific interest in "recent" sports (i.e., triathlon and rugby sevens). We also found local/cultural influence on the occurrence of a sport in a particular "sport sciences" journal. Finally, the relative distribution of six main research topics (i.e., physiology, performance, training and testing, injuries and medicine, biomechanics, and psychology) was large across sports and reflected the specific performance factors of each sport.

A Comprehensive Summary of Systematic Reviews on Sports Injury Prevention Strategies

Background

A large volume of systematic reviews and meta-analyses has been published on the effectiveness of sports injury prevention programs.

Purpose

To provide a qualitative summary of published systematic reviews and meta-analyses that have examined the effectiveness of sports injury prevention programs on reducing musculoskeletal injuries.

Study Design

Systematic review; Level of evidence, 4.

Methods

We searched the PubMed, CINAHL, EMBASE, and the Cochrane databases for systematic reviews and meta-analyses that evaluated the effectiveness of sports injury prevention programs. We excluded published abstracts, narrative reviews, articles not published in English, commentaries, studies that described sports injury prevention strategies but did not assess their effectiveness, studies that did not assess musculoskeletal injuries, and studies that did not assess sports-related injuries. The most relevant results were extracted and summarized. Levels of evidence were determined per the Oxford Centre for Evidence-Based Medicine, and methodological quality was assessed using the AMSTAR-2 (A MeaSurement Tool to Assess systematic Reviews, revised version).

Results

A total of 507 articles were retrieved, and 129 were included. Articles pertaining to all injuries were divided into 9 topics: sports and exercise in general (n = 20), soccer (n = 13), ice hockey (n = 1), dance (n = 1), volleyball (n = 1), basketball (n = 1), tackle collision sports (n = 1), climbing (n = 1), and youth athletes (n = 4). Articles on injuries by anatomic site were divided into 11 topics: general knee (n = 8), anterior cruciate ligament (n = 34), ankle (n = 14), hamstring (n = 11), lower extremity (n = 10), foot (n = 6), groin (n = 2), shoulder (n = 1), wrist (n = 2), and elbow (n = 1). Of the 129 studies, 45.7% were ranked as evidence level 1, and 55.0% were evidence level 2. Based on the AMSTAR-2, 58.9% of the reviews reported a priori review methods, 96.1% performed a comprehensive literature search, 47.3% thoroughly described excluded articles, 79.1% assessed risk of bias for individual studies, 48.8% reported a valid method for statistical combination of data (ie, meta-analysis), 45.0% examined the effect of risk of bias on pooled study results, and 19.4% examined the risk for publication bias.

Conclusion

This comprehensive review provides sports medicine providers with a single source of the most up-to-date publications in the literature on sports injury prevention.

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

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

Wrist pain in gymnasts: Efficacy of a wrist brace to decrease wrist pain while performing gymnastics

STUDY DESIGN

This was a clinical trial of prospective cohort.

INTRODUCTION

Wrist pain in gymnasts is a global phenomenon. Compression forces acting on wrists while performing gymnastics is a predisposing factor in the development of wrist pain and consequential injury of the distal radial physis in skeletally immature gymnasts. One approach to mitigate these forces is wrist bracing; however, studies on the efficacy of wrist braces to reduce wrist pain experienced by gymnasts are limited.

PURPOSE OF THE STUDY

The purpose of this study was to investigate the efficacy of an innovative design of a wrist brace to decrease gymnasts' wrist pain while performing gymnastics.

METHODS

A wrist brace was designed and trialled over 3 weeks by 48 male gymnasts (aged 8-22 years, levels 4-7) with wrist pain. Wrist pain was recorded on a visual analog scale of 1 to 10 before and after trial. Data analysis was performed using SPSS-22 (IBM Inc). Paired t-tests were performed to compare variables before and after trial, with effect size analyses used to quantify the relative magnitude of any differences.

RESULTS

Paired t-tests indicated the gymnasts reported significantly reduced pain (P = .002; 53.5%) while wearing the braces for training on the pommel, floor, and parallel bars. The overall large effect size value was practically significant (d = 0.902).

DISCUSSION

For any wrist brace to be effective, it needs to be implemented when the gymnast experiences wrist pain before an injury occurs. This would minimize the development of pain-provoked adaptive movement patterns that perpetuate dysfunction.

CONCLUSIONS

The brace with the volar gel pad is recommended to be worn as an adjunct to current strategies in management of gymnasts' wrist pain or as an injury prevention device in skeletally immature gymnasts.

A Narrative Review of Injury Incidence, Location, and Injury Factor of Elite Athletes in Snowsport Events

Snowsport athletes face a high injury risk both during training and in competitions. Reducing injury incidence is crucial for athletes to achieve breakthroughs. This narrative review aimed to summarize and analyze injury data of elite athletes in snowsports and provide references for injury prevention and health security for these athletes and their coaches. A total of 39 studies that investigated snowsport injury were analyzed in the present study. On the basis of injury data of elite athletes in snowsports events, this narrative review focused on four aspects, namely, injury incidence, severity, location and causes. The findings of this review were as follows. (1) The highest injury incidence was recorded in freestyle skiing, followed by alpine skiing and snowboarding, the majority of which were moderate and severe injuries. (2) The proportion of injury in competitions and during training was similar. However, more injuries occurred in official training during the Winter Olympic Games; by contrast, injury proportion was higher in competitions during World Cup/World Championships. (3) The most commonly and severely injured body parts were the knees (29.9%), head and face (12.1%), shoulders and clavicula (10.5%), and lower back (8.9%). The most common injury types were joint and ligament injury (41.5%), fracture and bone stress (24.4%), concussion (11.1%), and muscle/tendon injury (10.7%). (4) The main causes of snowsport injury were collisions, falls, and non-contact injuries. Snowsport injury was also influenced by the skill level of the athletes, gender, course setup and equipment. Future studies should further explore the influence of event characteristics and intrinsic and extrinsic risk factors on snowsport injury. An injury or trauma reconstruction may be developed to predict athletic injuries and provide effective prevention strategies.

Equestrian Trauma: Injury Patterns Vary among Age Groups

Patients with equestrian injuries were identified in the trauma registry from 2004 to 2007. We a priori divided patients into three groups: 0 to 18 years, 19 to 49 years, and 50 years old or older. There were 284 patients identified with equestrian-related trauma. Injury Severity Score for the three major age categories 0 to 18 years, 19 to 49 years, and 50 years or older, were 3.47, 5.09, and 6.27, respectively. The most common body region injured among all patients was the head (26.1%). The most common injuries by age group were: 0 to 18 years, upper extremity fractures; 19 to 49 year olds, concussions; and 50 years or older, rib fractures. Significant differences were observed among the three age groups in terms of percent of patients with rib fractures: percent of patients with rib fractures was 2, 8, and 22 per cent in age groups 0 to 18, 19 to 49, and 50 years or older, respectively. We found different patterns of injuries associated with equestrian accidents by age. Head injuries were commonly seen among participants in equestrian activities and helmet use should be promoted to minimize the severity of closed head injuries. Injury patterns also seem to vary among the various age groups that ride horses. This information could be used to better target injury prevention efforts among these patients.

Intervention Strategies Used in Sport Injury Prevention Studies: A Systematic Review Identifying Studies Applying the Haddon Matrix

BACKGROUND

Prevention of sport injuries is crucial to maximise the health and societal benefits of a physically active lifestyle. To strengthen the translation and implementation of the available evidence base on effective preventive measures, a range of potentially relevant strategies should be considered.

OBJECTIVE

Our aim was to identify and categorise intervention strategies for the prevention of acute sport injuries evaluated in the scientific literature, applying the Haddon matrix, and identify potential knowledge gaps.

METHODS

Five electronic databases were searched (PubMed, EMBASE, SPORTDiscus, CINAHL, Cochrane) for studies that evaluated the effect of interventions on the occurrence of acute sport injuries. Studies were required to include a control group/condition, prospective data collection, and a quantitative injury outcome measure.

RESULTS

A total of 155 studies were included, mostly randomised controlled trials (43%). The majority of studies (55%) focussed on strategies requiring a behavioural change on the part of athletes. Studies predominantly evaluated the preventive effect of various training programmes targeted at the 'pre-event' phase (n = 73) and the use of equipment to avoid injury in the 'event phase' (n = 29). A limited number of studies evaluated the preventive effect of strategies geared at rules and regulations (n = 14), and contextual modifications (n = 18). Studies specifically aimed at preventing re-injuries were a minority (n = 8), and were mostly related to ankle sprains (n = 5).

CONCLUSIONS

Valuable insight into the extent of the evidence base of sport injury prevention studies was obtained for 20 potential intervention strategies. This approach can be used to monitor potential gaps in the knowledge base on sport injury prevention.

Evaluating the Ergonomic Benefit of a Wrist Brace on Wrist Posture, Muscle Activity, Rotational Stiffness, and Peak Shovel-Ground Impact Force During a Simulated Tree-Planting Task

Background Tree planters are at a high risk for wrist injury due to awkward postures and high wrist loads experienced during each planting cycle, specifically at shovel-ground impact. Wrist joint stiffness provides a measure that integrates postural and loading information. Objective The purpose of this study was to evaluate wrist joint stiffness requirements at the instant of shovel-ground impact during tree planting and determine if a wrist brace could alter muscular contributions to wrist joint stiffness. Method Planters simulated tree planting with and without wearing a brace on their planting arm. Surface electromyography (sEMG) from six forearm muscles and wrist kinematics were collected and used to calculate muscular contributions to joint rotational stiffness about the wrist. Results Wrist joint stiffness increased with brace use, an unanticipated and negative consequence of wearing a brace. As a potential benefit, planters achieved a more neutrally oriented wrist angle about the flexion/extension axis, although a less neutral wrist angle about the ulnar/radial axis was observed. Muscle activity did not change between conditions. Conclusion The joint stiffness analysis, combining kinematic and sEMG information in a biologically relevant manner, revealed clear limitations with the interface between the brace grip and shovel handle that jeopardized the prophylactic benefits of the current brace design. This limitation was not as evident when considering kinematics and sEMG data independently. Application A neuromechanical model (joint rotational stiffness) enhanced our ability to evaluate the brace design relative to kinematic and sEMG parameter-based metrics alone.

Compliance with Sport Injury Prevention Interventions in Randomised Controlled Trials: A Systematic Review

INTRODUCTION

Sport injury prevention studies vary in the way compliance with an intervention is defined, measured and adjusted for.

OBJECTIVE

The objective of this systematic review was to assess the extent to which sport injury prevention randomised controlled trials (RCTs) have defined, measured and adjusted results for compliance with an injury prevention intervention.

METHODS

An electronic search was performed in MEDLINE, PubMed, the Cochrane Center of Controlled Trials, CINAHL (Cumulative Index to Nursing and Allied Health Literature), PEDro (Physiotherapy Evidence Database) and SPORTDiscus. English RCTs, quasi-RCTs and cluster-RCTs were considered eligible. Trials that involved physically active individuals or examined the effects of an intervention aimed at the prevention of sport- or physical activity-related injuries were included.

RESULTS

Of the total of 100 studies included, 71.6 % mentioned compliance or a related term, 68.8 % provided details on compliance measurement and 51.4 % provided compliance data. Only 19.3 % analysed the effect of compliance rates on study outcomes. While studies used heterogeneous methods, pooled effects could not be presented.

CONCLUSIONS

Studies that account for compliance demonstrated that compliance significant affects study outcomes. The way compliance is dealt with in preventions studies is subject to a large degree of heterogeneity. Valid and reliable tools to measure and report compliance are needed and should be matched to a uniform definition of compliance.

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.

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.

Interventions to prevent sports related injuries: a systematic review and meta-analysis of randomised controlled trials

BACKGROUND

The effects of methods to prevent injuries have been studied in several systematic reviews. However, no meta-analysis taking into account all randomised controlled intervention trials aiming at the prevention of sports injuries has been published.

OBJECTIVE

To summarise the effects of sports injury prevention interventions.

DESIGN

Systematic review and meta-analysis of randomised controlled trials.

DATA SOURCES

PubMed, MEDLINE, SPORTDiscus, the Cochrane Central Register of Controlled Trials, CINAHL, PEDro, and Web of Science, searched in September 2013. The reference lists of retrieved articles and reviews were hand searched.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

To be selected articles had to examine the effects of any preventive intervention on sports injuries, be randomised/quasi-randomised and controlled trials, published in a peer-reviewed journal. The outcome of the trial had to be injury rate or the number of injured individuals.

RESULTS

Of the 5580 articles retrieved after a search of databases and the relevant bibliography, 68 randomised controlled trials were included in the systematic review and 60 trials were included in the meta-analysis. Insoles (OR 0.51, 95% CI 0.32-0.81), external joint supports (OR 0.40, 95% CI 0.30-0.53), and specific training programmes (OR 0.55, 95% CI 0.46-0.66) appeared to be effective in reducing the risk of sports injuries. Stretching (OR 0.92, 95% CI 0.80-1.06), modified shoes (OR 1.23, 95% CI 0.81-1.87), and preventive videos (OR 0.86, 95% CI 0.44-1.68) seemed not to be effective.

CONCLUSIONS

This meta-analysis showed that certain interventions can reduce the risk of sports injuries. There were limitations regarding the quality of the trials, generalisability of the results, and heterogeneity of the study designs. In future, the mechanisms behind effective methods and the most beneficial elements of preventive training programmes need to be clarified.

Injury severity in ice skating: an epidemiologic analysis using a standardised injury classification system

PURPOSE

Although injuries sustained during ice skating have been reported to be more serious than other forms of skating, the potential injury risks are often underestimated by skating participants. The purpose of this study was to give a descriptive overview of injury patterns occurring during ice skating. Special emphasis was put on injury severity by using a standardised injury classification system.

METHODS

Over a six month period, all patients treated with ice-skating-related injuries at Europe's largest hospital were included. Patient demographics were collected and all injuries categorised according to the Abbreviated Injury Scale (AIS) 2005. A descriptive statistic and logistic regression analysis was performed.

RESULTS

Three hundred and forty-one patients (134 M, 207 F) were included in this study. Statistical analysis revealed that age had a significant influence on injury severity. People > 50 years had a higher risk of sustaining a more severe injury according to the AIS compared with younger skaters. Furthermore, the risk of head injury was significantly lower for people aged between 18 and 50 years than for people < 18 years (p = 0.0007) and significantly higher for people > 50 years than for people aged between 18 and 50 years (p = 0.04).

CONCLUSION

The severity of ice-skating injuries is associated with the patient's age, showing more severe injuries in older patients. Awareness should be raised among the public and physicians about the risks associated with this activity in order to promote further educational interventions and the use of protective gear.

Feature-specific terrain park-injury rates and risk factors in snowboarders: a case-control study

Background

Snowboarding is a popular albeit risky sport and terrain park (TP) injuries are more severe than regular slope injuries. TPs contain man-made features that facilitate aerial manoeuvres. The objectives of this study were to determine overall and feature-specific injury rates and the potential risk factors for TP injuries.

Methods

Case–control study with exposure estimation, conducted in an Alberta TP during two ski seasons. Cases were snowboarders injured in the TP who presented to ski patrol and/or local emergency departments. Controls were uninjured snowboarders in the same TP. κ Statistics were used to measure the reliability of reported risk factor information. Injury rates were calculated and adjusted logistic regression was used to calculate the feature-specific odds of injury.

Results

Overall, 333 cases and 1261 controls were enrolled. Reliability of risk factor information was κ>0.60 for 21/24 variables. The overall injury rate was 0.75/1000 runs. Rates were highest for jumps and half-pipe (both 2.56/1000 runs) and lowest for rails (0.43/1000 runs) and quarter-pipes (0.24/1000 runs). Compared with rails, there were increased odds of injury for half-pipe (OR 9.63; 95% CI 4.80 to 19.32), jumps (OR 4.29; 95% CI 2.72 to 6.76), mushroom (OR 2.30; 95% CI 1.20 to 4.41) and kickers (OR 1.99; 95% CI 1.27 to 3.12).

Conclusions

Higher feature-specific injury rates and increased odds of injury were associated with features that promote aerial manoeuvres or a large drop to the ground. Further research is required to determine ways to increase snowboarder safety in the TP.

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.

Biomechanical study of the efficacy of a new design of wrist guard

BACKGROUND

Upper extremity injuries are frequent in the elderly or those undertaking extreme sporting activities. Commercially available wrist guards reduce the frequency of wrist fractures but are not widely used as they greatly restrict movement.

METHODS

A new wrist guard was developed which provided protection to the "impact area" but does not restrict wrist or digital movement. A human hand model and a biomechanical test rig, which allowed the simulation of an adult fall from height, were developed. The ability of the new guard, which was tested with different levels of padding, to reduce peak impact forces and absorb energy on impact was measured and compared to a commercially available wrist guard.

FINDINGS

The use of any guard reduced peak impact forces by a minimum of 31.8%. The new guard, despite a substantially reduced impact surface area, demonstrated the same reductions in peak force (48%) and ability to absorb energy on impact as the standard guard when fitted with comparable levels of padding.

INTERPRETATION

These results indicate that the new guard, which allows movement of the wrist and digits, demonstrates the same ability to reduce impact forces and absorb energy as a commercially available guard despite its substantially reduced impact area. Such a guard may provide a better compromise between joint flexibility and protection than the status quo.

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.

Fractures in children: epidemiology and activity-specific fracture rates

BACKGROUND

Approximately one-third of pediatric fractures occur during sport or recreational activity. In this paper, we investigate the incidence and causes of pediatric fractures in our region and quantify the fracture rate per exposure time for the most common sport and recreational activities.

METHODS

We prospectively evaluated all children younger than sixteen years who presented to our institution with a new fracture within a twelve-month period. Exposure time to the most common childhood activities was measured by means of interviewing random parents from the study population. The main outcome measures were the annual fracture incidence in the population and fracture rates per 10,000 hours of exposure to various sports and recreational activities.

RESULTS

A total of 1403 fractures were included. The overall annual incidence was 180.1 fractures per 10,000 children younger than sixteen years. The distal part of the radius was most often fractured (436 fractures, 31.1%). Snowboarding was associated with the highest activity-specific fracture rate, estimated to be 1.9 (95% confidence interval [CI], 1.16 to 2.60) fractures per 10,000 hours of exposure. In comparison, the fracture rate per 10,000 hours of exposure was 0.79 (CI, 0.42 to 1.09) for handball, 0.44 (CI, 0.35 to 0.52) for soccer, and 0.35 (CI, 0.23 to 0.47) for trampolining.

CONCLUSIONS

The distal part of the radius is the most common fracture site in childhood. Fracture rates differ between various physical activities. The fracture rate for snowboarding was four times higher compared with that for other common childhood sport and recreational activities in our region.

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.

Glenohumeral dislocations in snowboarding and skiing

BACKGROUND

Glenohumeral dislocations occurring during snowboarding and skiing are severe and often leave after effects. However, little is known about their aetiology and injury pattern. The purpose of this study was to elucidate the feature of glenohumeral dislocations in these winter sports.

METHODS

The injuries sustained by snowboarders and skiers, who were admitted to our hospital during five ski seasons from 2004 to 2009, were analysed using questionnaires and patients' records. A retrospective cohort study and a multivariate regression analysis were performed to reveal the epidemiology and injury pattern of glenohumeral dislocations.

RESULTS

The overall rate of glenohumeral dislocation was 0.0583 per 1000 participant days (0.0676 per 1000 participant days in snowboarders and 0.0295 per 1000 participant days in skiers). Glenohumeral dislocations in snowboarding were significantly more common in higher age, male gender, injuries resulting more from falls, wet snow conditions, injuries of the leading-side joint and engaging the toe-side edge of the snowboard. Similarly, in skiers, glenohumeral dislocations were significantly more common in higher age, male gender, higher skill level, injuries resulting more from falls and injuries occurring on steep slopes. Nearly all (95.8%) of the glenohumeral dislocations were of the anterior type, and the prevalence of fracture-dislocations of the glenohumeral joint was higher in skiing (33.9%) than in snowboarding (12.4%). The variables strongly associated with glenohumeral dislocations in snowboarding and skiing were age, gender, snow condition and skiing speed.

CONCLUSION

Snowboarding and skiing are sports with increased risk of glenohumeral dislocation compared with the general population, and the injury pattern differs between them. In snowboarding, injury patterns seem to be influenced by performance style.

Skateboarding injuries in Vienna: location, frequency, and severity

OBJECTIVE

To describe injury patterns of skateboard-associated injuries (SAIs) and to assess the frequency and severity of SAIs depending on an athlete's skateboarding experience.

DESIGN

Cross-sectional observation.

SETTING

Skating areas.

PARTICIPANTS

A total of 100 Viennese skateboarders.

INTERVENTIONS

No intervention.

MAIN OUTCOME MEASURES

The participants filled in a questionnaire that was used to assess selected sociodemographic data; duration and frequency of skateboarding; "stance"; and localization, rate, as well as the severity of SAIs during the past 24 months. Skating behavior and sociodemographic data were compared with frequency and severity of SAIs.

RESULTS

Response rate of questionnaires was 75% (n=75) of the participants. Duration of skateboarding was 8+/-5 years, and training time was 18+/-11 hours/week. A total of 97% (73) of the respondents reported at least one injury: in 52% (39) of the respondents the most serious injury was mild to moderate (laceration, contusion, strain/sprain, and bruise), whereas in 45% (34) it was severe (ligament rupture, fracture). A total of 33% (13) of participants experiencing only mild-to-moderate injuries consulted a physician compared with 94% (32) with at least one serious injury. The most severely affected regions were lower leg/ankle/foot in 32% (24) of all respondents who experienced at least one severe injury and forearm/wrist/hand in 16% (12) who experienced at least one severe injury. Only 13% (10) used protective equipment. Multivariate logistic regression for the occurrence of at least one severe injury with all socioeconomic and sport-relevant data investigated revealed significant positive correlations with weekly training time (P=.037) and years of experience (P=.021). However, after correcting for multiple testing (Bonferroni adjustment for 8 tests), no significances remained.

CONCLUSION

More experienced skateboarders seem to have a greater risk of incurring severe SAIs, but sociodemographic factors seem to have no influence on injury risk in this population. Only a minority of skateboarders used protective equipment.

Upper extremity sports injury: risk factors in comparison to lower extremity injury in more than 25 000 cases

OBJECTIVE

To analyze differences in sports injury characteristics of the upper and lower extremity and to identify factors that contribute to the risk of sustaining an upper extremity injury compared with the risk of sustaining a lower extremity injury.

DESIGN

Retrospective cohort study.

SETTING

An emergency department of a large European level I trauma center.

PATIENTS

A total of 25 120 patients with a simple sports injury, attending during 1990-2005.

ASSESSMENT OF RISK FACTORS

Independent variables used to assess risk factors were extracted from a local database. These include age, sex, type of injury, site and side of the injury, type of sport, injury mechanism, and data on admission.

MAIN OUTCOME MEASURES

Main outcome measure was the relation of various risk factors to the occurrence of either upper or lower extremity injury. Logistic regression analysis was used to identify predictors for upper extremity injury.

RESULTS

Thirty-five percent upper and 53% lower extremity injuries were recorded. Most injuries were sustained when playing soccer (36%). Fractures were more frequently diagnosed in the upper than in the lower extremities (44% and 14%, respectively), especially in children. Falling was the main cause of upper extremity injury. Further risk factors were young age and playing individual sports, no-contact sports, or no-ball sports. Women were at risk in speed skating, inline skating, and basketball, whereas men mostly got injured during skiing and snowboarding.

CONCLUSIONS

A high percentage of sports injuries are sustained to the upper extremity. Different risk factors were identified for both sexes. These risk factors should be taken into account when designing preventive measures.

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.

Skating on thin ice: a study of the injuries sustained at a temporary ice skating rink

In recent years, ice skating and temporary ice skating rinks have become increasingly popular. Regular elite competitors are known to be at risk of both acute and chronic injuries. It may be postulated that skaters at the temporary rinks are at high risk of acute injuries from falls due to both their lack of expertise and the inherent dangers of ice skating. Injuries sustained at skating rinks present a significant burden to local healthcare resources, in particular orthopaedic departments. For the first time, Cambridge hosted such a facility from November 24, 2007 through January 6, 2008. We sought to identify the most common injuries encountered and to quantify the orthopaedic burden. All Emergency Department or Fracture Clinic attendances for an eight-week period from the opening of the rink were investigated. Details of age, sex, injury and management were recorded for the 84 patients who sustained ice rink related injuries. A total of 85 injuries were recorded in 84 patients. Of these injuries 58% were fractures, of which 98% involved the upper limbs. Seven patients (8% of all injuries) required admission for operative fixation. On average, two injuries per day were seen in the Emergency Department or Fracture Clinic, with an average of one orthopaedic admission per week. It is evident that the ice rink in Cambridge has had an impact on local healthcare resources. The vast majority of injuries affected the upper limbs and were sustained following a fall on the out-stretched hand. We therefore encourage the education of skaters as to how to break their falls more safely and recommend the use of wrist protectors as a primary preventative measure.

Use of protective equipment by adolescents in inline skating, skateboarding, and snowboarding

OBJECTIVES

Determine the frequency of personal protective equipment (PPE) use in adolescent inline skaters, skateboarders, and snowboarders; explore factors influencing PPE use; identify factors that would influence use; and examine the association of high-risk behaviors and PPE use.

DESIGN

Cross-sectional survey.

SETTING

Central/southeast Wisconsin.

PARTICIPANTS

Participants 13-18 years-old.

INTERVENTIONS

None. Independent variables = age, gender, sport.

MAIN OUTCOME MEASUREMENTS

None. Dependent variables = PPE use, factors influencing use, and frequency of other high-risk behaviors.

RESULTS

The mean age of 333 participiants was 14.9 years. Adolescents wore considerably less PPE than recommended. Inline skaters wore the most; snowboarders the least. The most common reasons adolescents wore PPE were parents, peers, and rule/requirement. Younger adolescents cited parents more often than older adolescents as a factor for PPE use. Discomfort and lack of perceived need were the most common reasons for nonuse. Sustaining/witnessing an accident was the most common reason that would convince adolescents to wear PPE. Almost half of adolescents reported nothing would convince them to wear PPE. Younger adolescents wore more PPE than older adolescents. An association was seen between PPE use in all sports and bicycle helmets. An inverse relationship was found for tobacco and helmet use among skaters, as well as alcohol and helmet use in skateboarders.

CONCLUSIONS

Adolescents underuse PPE. PPE reinforcement by parents/peers, encouraging bike helmets, manufacturing more comfortable gear, educating adolescents, and instituting PPE requirements in public areas may increase compliance. This could lead to decreased injuries. Physicians should discuss PPE with their patients/families. There may be an association between PPE use in extreme sports and decreased high-risk health behaviors.

Displaced paediatric fractures of the distal radius

INTRODUCTION

The purpose of this study was to review, over a fixed period of time and in a geographically defined area, all paediatric fractures of the distal radius that were initially reduced. We wished to assess the fracture pattern at different ages, the seasonal variation, the severity of the initial angulation, and the radiological outcome in terms of reangulation, remodelling, refracture, growth disturbance, and functional outcome.

MATERIALS AND METHODS

A total of 88 patients were followed in a prospective setting (11 fractures of the distal radial physis). The pre- and post-reduction and follow-up radiological variables were measured. Patients with significant malangulation at union were re-examined after 7 years to assess the degree of spontaneous remodelling.

RESULTS

The mean malangulation before reduction was 19 degrees , after reduction 5 degrees and at union 4 degrees . Eight patients had secondary displacement during the casting period. Fractures with more than 15 degrees of malangulation at union had completely remodelled and had normal function at final follow-up.

CONCLUSION

Conservative treatment may still be regarded as the gold standard for closed paediatric fractures of the distal radius. In the present series, the remodelling capacity was excellent.

Self-estimation of ability among skiers and snowboarders in alpine skiing resorts

Skiing ability is thought to be an important risk factor for injuries, but the best method to classify skiing ability is not known. The objective of this study was to validate five different questions designed to self-report skiing ability for ski injury surveillance. To this end 512 alpine skiers, Telemark skiers, snowboarders and skiboarders were asked to selfestimate their skiing ability using five different questions based on skiing skill, piste difficulty, turning technique, skiing experience and falling frequency, each with four categories. The participants then made a test run to test their skiing ability. Observed and self-reported skiing ability were compared using kappa statistics. The correlation between observed and self-reported skiing ability was low to fair, with kappa values of 0.34 for skiing skill), 0.33 for piste difficulty, 0.38 for turning technique, 0.26 for experience and 0.16 for falling frequency. However, the sensitivity and specificity for each of the questionnaires in discriminating between individuals in the poorest skiing ability category on the test and the rest of the group was relatively good (skiing skill: sensitivity 75%, specificity 91%; piste difficulty 68, 96%; turning technique 75, 91%; experience 75, 90%; falling frequency 61, 97%). The results show that the capacity to self-assess skiing ability is limited, but estimation based upon turning technique or skiing skill seem to be best methods for epidemiological studies on injuries in snow sports.

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 caused by small wheel devices

We wanted to look for characteristics in injuries caused by rollerblades, skateboards and unmotorized kick scooters in order to recommend more targeted injury prevention. From September 2000 we did a two-year prospective registration of all small wheel device injuries attending Bergen Accident and Emergency Department's surgical unit. We registered a total of 273 injuries, and found an obvious difference in injury pattern between the three. Rollerbladers were more prone to fractures in their hands and arms, especially distal radial fractures, but also scaphoid fractures. This fracture is seldom in children, but not in child injuries caused by small wheel devices. Skateboarders were susceptible to ankle sprains and had the lowest injury severity among the three activities. Kick scooter users got mostly wound injuries, but had a high frequency of distal radial fractures with volar angulation, the Smith-type of fracture. There were also differences in user groups; 2/3 of injured rollerbladers were boys, mostly aged 12, a typical, injured skateboarder was a young male aged 13, and an injured kick scooter user was either an 11-year-old girl or boy. The use of effective wrist braces could have prevented most injuries in both rollerblading and kickscootering. Due to the high susceptibility of small wheel devices to uneven grounds resulting in falls, these activities should be prohibited in traffic and darkness. Preventive advice should preferably reach children aged 11 to 13.

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.

Wrist pain, distal radial physeal injury, and ulnar variance in the young gymnast

In gymnastics, the wrist joint is subjected to repetitive loading in a weightbearing fashion. In this setting, chronic wrist pain is quite common. Because gymnasts ordinarily enter the sport at very young ages and train for several years before skeletal maturity is attained, the growth plates of the wrist are at risk for injury. In addition, imaging studies have identified evidence of injury to the distal radial physis and the development of positive ulnar variance. Recent studies provide more information on the relationships between these findings, as well as factors that may predispose some gymnasts to wrist pain. This article provides a comprehensive review of these issues and offers suggestions for management, preventive measures, and future research.

Shock attenuation of various protective devices for prevention of fall-related injuries of the forearm/hand complex

BACKGROUND

Attenuation of the peak impact force is essential in any protective devices for prevention of fall-related injuries.

HYPOTHESIS

Common wrist guards have limited effectiveness because of the multifaceted nature of wrist injury mechanisms, and other modalities may provide enhanced shock-absorbing functions.

STUDY DESIGN

Controlled laboratory study.

METHODS

A free-fall device was constructed using a mechanical surrogate to simulate falling impact. At 4 different falling heights, 5 different hand conditions were tested: bare hand, a generic-brand wrist guard, a Sorbothane glove, an air cell, and an air bladder condition. The impact force from the ground and the transmitted impact force to the forearm/hand complex were simultaneously measured.

RESULTS

The falling height and hand condition significantly modulated the impact responses. The padded conditions always had significantly smaller peak impact forces compared with the bare-hand condition. The wrist guard became ineffective in impact force attenuation beyond the falling height of 51 cm. On the other hand, the air bladder condition maintained less than 45% of the peak impact force of the bare-hand condition and remained below the critical value, whereas other conditions were all ineffective.

CONCLUSION

It was reconfirmed that common wrist guard design could provide limited impact force attenuation, whereas damped pneumatic springs would provide substantially enhanced shock-absorbing functions.

CLINICAL RELEVANCE

A wrist guard incorporating volar padding with the pneumatic spring design principle might be more effective at preventing injuries than are currently available designs.

Biomechanical Efficiency of Wrist Guards as a Shock Isolator

Despite the use of wrist guards during skate- and snowboard activities, fractures still occur at the wrist or at further proximal locations of the forearm. The main objectives of this study were to conduct a human subject testing under simulated falling conditions for measurement of the impact force on the hand, to model wrist guards as a shock isolator, to construct a linear mass-spring-damper model for quantification of the impact force attenuation (Q-ratio) and energy absorption (S-ratio), and to determine whether wrist guards play a role of an efficient shock isolator. While the falling direction (forward and backward) significantly influenced the impact responses, use of wrist guards provided minimal improvements in the Q- and S-ratios. It was suggested based on the results under the submaximal loading conditions that protective functions of the common wrist guard design could be enhanced with substantial increase in the damping ratio so as to maximize the energy absorption. This would bring forth minor deterioration in the impact force attenuation but significant increase in the energy absorption by 19%, which would help better protection against fall-related injuries of the upper extremity.