Wakeboarding injuries

Telemedicine in Sports under Extreme Conditions: Data Transmission, Remote Medical Consultations, and Diagnostic Imaging

Telemedical technologies provide significant benefits in sports for performance monitoring and early recognition of many medical issues, especially when sports are practised outside a regulated playing field, where participants are exposed to rapidly changing environmental conditions or specialised medical assistance is unavailable. We provide a review of the medical literature on the use of telemedicine in adventure and extreme sports. Out of 2715 unique sport citations from 4 scientific databases 16 papers met the criteria, which included all research papers exploring the use of telemedicine for monitoring performance and health status in extreme environments. Their quality was assessed by a double-anonymised review with a specifically designed four-item scoring system. Telemedicine was used in high-mountain sports (37.5%; n = 6), winter sports (18.7%; n = 3), water sports (25%; n = 4), and long-distance land sports (18.7%; n = 3). Telemedicine was used for data transfer, teleconsulting, and the execution of remote-controlled procedures, including imaging diagnostics. Telemedical technologies were also used to diagnose and treat sport-related and environmentally impacted injuries, including emergencies in three extreme conditions: high mountains, ultraendurance activities, and in/under the water. By highlighting sport-specific movement patterns or physiological and pathological responses in extreme climatic conditions and environments, telemedicine may result in better preparation and development of strategies for an in-depth understanding of the stress of the metabolic, cardiorespiratory, biomechanical, or neuromuscular system, potentially resulting in performance improvement and injury prevention.

Isolated Femoral Shaft Fracture in Wakeboarding and Review of the Literature

Introduction

Wakeboarding is an extreme sport that has shown increasing popularity in recent years, with an estimated 2.9 million participants in 2017. Due to this trend, injuries related to this sport are likely to become more common. Isolated femoral shaft are rare; however, they occur much more frequently in youth as a result of high velocity events, such as dashboard-related injuries. Few studies have addressed injuries related to wakeboarding, and of those that have, most have reported on muscle injuries, ligament ruptures, and sprains. Due to the dearth in literature, we want to present two cases of isolated noncontact femoral shaft fractures that resulted from wakeboarding. Case Presentation. Two 28-year-old, otherwise healthy, wakeboarders-patient A, male, and patient B, female-presented to our Department of Orthopaedics and Sports Medicine with isolated femoral shaft fractures. Both were admitted due to wakeboard-related noncontact injuries, where patient A fell while performing a sit-down start during cable wakeboarding and patient B after attempting a wake-jump. Both patients were being pulled by motorboats at roughly 40 km/h. After clinical examination and radiography, left spiral (AO classification: 32-A1.2) (patient A) and right-sided bending, wedge (AO classification 32-B2.2) (patient B) isolated femoral shaft fractures were diagnosed. No concomitant injuries were reported. For treatment, long reamed locked nails were applied, while the patients were under spinal anaesthesia. Physiotherapy was prescribed postoperatively. Patient A returned to wakeboarding 155 days after the surgery, and patient B returned after approximately half a year.

Conclusion

This case series shows that even in noncontact sports such as wakeboarding, high-energy forces applied to the femur can cause isolated femoral shaft fractures. Despite multiple reports in various sports of stress fractures of the femur, there are few publications of direct trauma.

Head and neck injury potential during water sports falls: examining the effects of helmets

Head and neck injuries sustained during water skiing and wakeboarding occur as a result of falls in water and collisions with obstacles, equipment, or people. Though water sports helmets are designed to reduce injury likelihood from head impacts with hard objects, some believe that helmets increase head and neck injury rates for falls into water (with no impact to a solid object). The effect of water sports helmets on head kinematics and neck loads during simulated falls into water was evaluated using a custom-made pendulum system with a Hybrid-III anthropometric testing device. Two water entry configurations were evaluated: head-first and pelvis-first water impacts with a water entry speed of 8.8 ± 0.1 m/s. Head and neck injury metrics were compared to injury assessment reference values and the likelihoods of brain injury were determined from head kinematics. Water sport helmets did not increase the likelihood of mild traumatic brain injury compared to a non-helmeted condition for both water entry configurations. Though helmets did increase injury metrics (such as head acceleration, HIC, and cervical spine compression) in some test configurations, the metrics remained below injury assessment reference values and the likelihoods of injury remained below 1%. Using the effective drag coefficients, the lowest water impact speed needed to produce cervical spine injury was estimated to be 15 m/s. The testing does not support the supposition that water sports helmets increase the likelihood of head or neck injury in a typical fall into water during water sports.

Aquatic Orthopaedic Injuries

Extremity injuries sustained in aquatic environments require unique considerations compared with injuries sustained on land. Knowledge of these considerations is becoming more important as aquatic recreational activities increase in popularity. Aquatic injuries may occur through mechanical contact with a variety of different objects or surfaces, such as a recreational device or watercraft part, or may occur through contact with marine animals. Marine animal injuries can be further categorized into bites, stings, or blunt contact, as well as venomous or nonvenomous, distinctions that should be used to guide clinical management. Numerous instances of retained foreign bodies after marine animal stings exist, which can result in infection and prolonged envenomization; thus, radiographic examination should be routinely performed in aquatic sting injuries to prevent these harmful sequelae. Any aquatic injury resulting in an open wound has an increased risk for infection, and prophylactic antibiotics must be given with consideration for the unique microbiologic flora of the aquatic environment.

Injury in kite buggying: the role of the 'out-of-buggy experience'

BACKGROUND

The purpose of this descriptive, epidemiological study is to classify injury patterns and determine dynamics of injuries, possible causes and preventive measures.

METHODS

A questionnaire was filled in by 127 kite buggying enthusiasts in 17 countries. Injuries were classified by type and anatomical site. Incident causes were analysed using the Haddon matrix.

RESULTS

Injuries classified as moderate or severe (AIS score ≥ 2) were sustained by 26% of kite buggy enthusiasts. The most common incident dynamic (61.8%) was the OBE (an acronym for 'out-of-buggy experience'). Causal factors were largely equipment-related (42.3%), with remaining incidents being equally attributable to environmental and human factors. While upper and lower limbs were equally involved in incidents, the most frequently affected anatomical site was the shoulder (23%).

CONCLUSION

Kite buggying can be considered a sport with the potential for serious injury. Injury prevention in this sport needs to be approached from several angles and should include the development and adoption of automatic release systems and shoulder guards, the establishment of formal training programs covering the subject of meteorology and the establishment of secure, designated kite buggying areas. Findings from this study are important for two reasons. First, they demonstrate the significance of understanding specific sports when considering health and safety, and second, the study provides specific data for the fast growing extreme sport of kite buggying.

Predictors of falls in recreational snowboard jumping: An observational study

PURPOSE

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

METHODS

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

RESULTS

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

CONCLUSION

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

Flexor Digitorum Superficialis Tear in a Wakeboarder: An Unusual Clinical Case

Tears in the flexor digitorum superficialis muscle belly are rare injuries with one single case reported in the literature. In this article, we describe the first case of muscle tear of the flexor digitorum superficialis resulting from a wakeboarding trauma. The wakeboarder presented with pain localized in the anterior forearm, and early symptoms of carpal tunnel syndrome. Ultrasonography demonstrated an intramuscular hematoma of the flexor digitorum superficialis myotendinous junction, which compressed the median nerve. After conservative treatment, the patient was asymptomatic and returned to his usual daily activities and sports within 5 weeks of the injury. In patients with a wakeboard trauma and similar presentations, a tear in the flexor digitorum superficialis muscle belly should be suspected.

Anterior cruciate ligament injuries in wakeboarding: prevalence and observations on injury mechanism

Background:

Wakeboarding is an increasingly popular sport that involves aggressive stunts with high risk for lower extremity injury, including anterior cruciate ligament (ACL) rupture. Little has been reported on prevalence or mechanism of ACL injury while wakeboarding.

Hypothesis:

The prevalence of ACL injury in wakeboarding approaches that of other high-risk sports. Analyzing the mechanism of ACL injury may aid in future efforts of prevention.

Study Design:

Descriptive epidemiology study.

Methods:

In sum, 1580 surveys were sent internationally to professional and amateur wakeboarders. The survey questioned the participants on their history of an ACL tear while wakeboarding and asked them to describe the mechanism of injury and treatment.

Results:

A total of 123 surveys were returned. Of this group, 52 (42.3%) acknowledged having had an ACL tear while wakeboarding. The majority described feeling a pop or buckle after attempting to land a high jump. Only 5 participants (13.5%) described a rotational mechanism created by catching the board edge in the water. Thirty-seven participants (71.15%) said that the injury ruined their ability to wakeboard before reconstruction, and 41 (78.85%) had the injury repaired surgically.

Conclusion:

The prevalence of ACL tears in this data set, 42.3%, is the highest reported in the literature for wakeboarding and one of the highest for any sport. The main mechanism of injury appears to involve axial compression while one lands in a provocative position; it is not related to a rotational force created by fixed bindings. The injury should be surgically repaired to effectively continue the sport. Further study is needed to determine if wakeboarding represents a high-risk sport for ACL injury.

Clinical Significance:

Wakeboarding may be a high-risk sport for ACL injury. Noncontact axial compression appears to be the main mechanism of injury.

Snowboarder's fracture caused by a wakeboarding injury: a case report

OBJECTIVE

The purpose of this case report is to describe the clinical presentation of a patient who had a lateral talar process fracture due to a wakeboarding injury.

CLINICAL FEATURES

A 29-year-old male patient sustained a left ankle injury when the front edge of his wakeboard became immersed in the water. As he fell forward, his foot remained attached to the board, leading to inversion and dorsiflexion stress of the ankle. He presented to a chiropractic clinic with diffuse ankle swelling, tenderness, and pain at the distal aspect of the lateral malleolus. Mild ligamentous laxity of the lateral supporting structures was observed during the physical examination.

INTERVENTION AND OUTCOME

Static and stress radiographs of the left ankle demonstrated a small (McCrory-Bladin type 1) lateral talar process fracture without evidence of gross instability. The patient was referred to a local orthopedic medical specialist for immobilization of the ankle. The patient was treated conservatively with an air cast walking boot for 2 weeks (non-weight-bearing) followed by a 2-week period of partial weight-bearing. At 6 weeks following the injury, a repeated radiographic examination demonstrated complete healing of the fracture. The patient reported minimal tenderness and normal ankle function.

CONCLUSION

Because of the similar mechanism of injury to those sustained in snowboarding, this case demonstrates the need for increased awareness of lateral process fractures in wakeboarders.

Juvenile wakeboarder locks ankle on shore

This report presents an adolescent wakeboarder with persistent pain after conservative treatment of a Salter Harris type II distal fibular fracture. On physical examination the pain was localised over the anterior inferior tibiofibular ligament. Additional imaging revealed that this syndesmotic impingement was caused by a loose body caught in the syndesmotic area. The loose body was successfully removed from the anterior inferior tibiofibular ligament by anterior ankle arthroscopy. With functional aftertreatment, the patient had resumed full sports activities after 8 weeks. At 1-year follow-up there were no persistent symptoms.

Compartment Syndrome of the Arm After Cable-Wakeboard Accident

A compartment syndrome is an increased tissue pressure within a closed osteofascial compartment. This compromises blood flow to the muscles and nerves within that compartment, which -if not treated adequately in an early stage-results in permanent tissue and nerve damage. It most frequently occurs in the lower leg, but can also occur elsewhere when muscles are enclosed in tight fascial compartments, such as the forearm and hand. In this report a patient is described who developed an acute compartment syndrome of the arm after a cable-wakeboard accident in which his arm was strangulated. Cable-wakeboarding is an extreme sport that has become very popular over the last years. Early recognition and treatment of an acute compartment syndrome is of extreme importance since in short term necrotic muscles can lead to severe irreversible complications. Accidents with cable-wakeboarding often occur during the start. This is caused by the strong forces that are on the cable during the start. Strangulation injuries of the arm can cause a compartment syndrome of the arm. Possibly a wet-suit or dry-suit offers some protection. However, the duration of strangulation determines much of the damage. Although diagnosis of a compartment syndrome can be difficult, a high index of suspicion combined with fast and adequate treatment with a fasciotomy improve outcome and prognosis.

A wakeboarding injury presented as acute carpal syndrome and median nerve contusion after wrist strangulation: a case report

BACKGROUND

We present a case of combined median nerve contusion with immediate loss of sensation after the strangulation with a wakeboarding rope and prolonged referral to our department 72 hours after the injury accompanied by an acute carpal tunnel syndrome with immediate relief of numbness of a significant proportion of the median nerve following surgical decompression.

CASE PRESENTATION

The palmar branch of the median nerve was surrounded by a significant haematoma in addition to the strangulation damage caused by its more superficial location in contrast to the median nerve.

CONCLUSION

In case of acute median neuropathy, urgent surgical intervention with exploration, decompression of both, the median nerve and the superficial branch of the median nerve, accompanied by compartment measurements of the forearm should be performed to regain or re-establish neurological integrity.

Characteristics of water skiing-related and wakeboarding-related injuries treated in emergency departments in the United States, 2001-2003

BACKGROUND

Water skiing and wakeboarding are popular sports with high potential for injury due to rapid boat acceleration, lack of protective gear, and waterway obstacles. However, trends in water skiing- and wakeboarding-related injuries in the United States have not been described using national data.

HYPOTHESIS

The number of injuries, injury diagnoses, and body regions injured vary by sport.

STUDY DESIGN

Descriptive epidemiology study.

METHODS

Data regarding water skiing- and wakeboarding-related injuries presenting to 98 hospital emergency departments in the United States between January 1, 2001, and December 31, 2003, were extracted from the National Electronic Injury Surveillance System. Data included demographics, injury diagnosis, and body region injured.

RESULTS

Data were collected for 517 individuals with water skiing-related injuries and 95 individuals with wakeboarding-related injuries. These injuries represent an estimated 23 460 water skiing- and 4810 wakeboarding-related injuries treated in US emergency departments in 2001 to 2003. Head injuries represented the largest percentage of injuries for wakeboarders (28.8% of all injuries) and the smallest percentage for water skiers (4.3%) (P < .01; relative risk [95% confidence interval], 6.73 [3.89-11.66]). Analysis of injury diagnosis was consistent as wakeboarders had significantly more traumatic brain injuries (12.5% of all injuries) than did water skiers (2.4%) (P < .05; relative risk [95% confidence interval], 5.27 [2.21-12.60]). Strains or sprains were the leading injury diagnoses for water skiing (36.3% of all injuries), and the majority (55.7%) were to the lower extremity. Lacerations were the most common diagnoses for wakeboarders (31.1% of all injuries), and the majority (59.6%) were to the face.

CONCLUSION

The analyses of water skiing- and wakeboarding-related injuries treated in US emergency departments in 2001 to 2003 highlight the differences in injury patterns for these 2 sports. The substantial number of head and facial injuries among wakeboarders underscores the need for research on the potential role of helmets or other protective gear to reduce these common injuries.