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

Fracture distribution in alpine skiing - a national population based study of 7,110 fractures in adults and children from the Swedish fracture register

BACKGROUND

Alpine skiing is practiced with speed and forces which entails a risk of injury and fractures. Most studies focus on all injuries in the musculoskeletal system and fractures are only described briefly or lack comparison between children and adults. This study focuses on the national trends of skiing-related fractures in children and adults, detailing fracture localization characteristics and initial treatments.

METHODS

This is a population-based national cohort study using data from the Swedish Fracture Register. The study population includes children and adults with a fracture sustained by alpine skiing between January 2015 and April 2022. Variables of interest were age, sex, localization of the fracture and segment, the number of fractures per patient, injury date, open or closed fracture, energy level, and primary treatment.

RESULTS

In total 7,110 fractures were registered in 6,806 patients. 48.6 % of the fractures were in children The women had a statistically significant higher median age at fracture to men. In children, it was contrary with a statistically lower median age in girls compared to boys. Children most commonly fractured the tibia (48.4 %), the radius (22.2 %), and the hand (7.8 %). The most fractured segment in children was the tibial shaft (38.5 %). Adults most often fractured the tibia (27.6 %), the radius (13.9 %), and the humerus (13.6 %) and had the proximal tibia as the most fractured segment (18.8 %). 82 % (2724) of fractures in children were treated non-surgically. In adults, 54 % (1850) were treated non-surgically.

CONCLUSION

Tibia fractures were predominant, with children frequently experiencing shaft fractures and adults proximal tibia fractures. Younger, lighter children skiing at a slower speed would benefit from improved ski bindings for fracture prevention. Tailoring ski equipment to an individual's age and sex is crucial for enhancing preventive strategies.

Global research trends in skiing from 1974 to 2023: A bibliometric analysis

This study analyzes 1643 documents related to skiing from 1974 to 2023 using the Web of Science Core Collection database, employing CiteSpace and VOSviewer for quantitative analysis. Findings reveal a growing literature output, with the past five years contributing to 36.2 % of publications. Norway leads in total publications and collaboration intensity, with the University of Salzburg and the Norwegian University of Science and Technology as prominent institutions. The research spans a wide range of disciplines such as Sport Sciences, Physiology, etc., and interdisciplinary intersections with engineering, computer science, etc. have become a future research trend. The research focuses on the analysis of skiers' sports performance, the analysis of skiing-induced sports injuries, the biomechanical analysis of skiers' postures, and the analysis of skiing-induced respiratory diseases. The study highlights the evolution of research focus from skiing injuries to injury prevention and sports performance enhancement. This comprehensive overview aids scholars in understanding skiing research hotspots and future trends efficiently.

Epidemiology of injuries among snowboarding athletes in the talent transfer program: A prospective cohort study of 39,880 athlete-exposures

BACKGROUND

Talent transfer (TT) program is an appropriate approach to address the talent gap evident in specific sports activities, while little is known about the injury characteristics of snowboarding athletes involved in the TT program.

OBJECTIVE

To determine the epidemiology of injuries among snowboarders involved in the TT program.

METHODS

A total of 244 athletes who were not previously engaged in winter sports were selected for training in snowboarding that lasted for 109 days. The injuries and at-risk exposures (A-Es) data were recorded by physicians. Injury rates (IRs), incidence rate ratios (IRRs), and injury proportion ratios (IPRs) were calculated and compared by sex and age groups.

RESULTS

The overall and time loss (TL) IR were 32.4/1000 A-Es and 12.2/1000 A-Es respectively. The overall and non-time loss (NTL) IRR were higher for female athletes than for male athletes. Additionally, the overall IRR and TL-IRR for female athletes were higher in those athletes who aged ≤15 years old. Over 93% of TL injuries resulted in participation restriction time of ≤7 days (male athletes, 93.94%; female athletes, 94.10%). Trunk (28.43%), knee joints (21.33%), and hand/wrist (16.53%) were found as the common sites of injury in both female and male athletes. The most frequent type of injury was contusion (male athletes: 53.00%, female athletes: 59.10%) resulted from ground/apparatus contact (male athletes: 75.10%, female athletes: 75.20%).

CONCLUSION

The risk injury among snowboarding athletes involved in the TT program during the first snow season training was found noticeable, especially for younger female athletes. The high incidence of ground/apparatus contact-related injuries suggested the necessity of specifically designed training programs and braces for snowboarding athletes involved in the TT program.

An Epidemiologic Comparison of Injuries to Skiers and Snowboarders Treated at United States Emergency Departments, 2000-2019

Skiing and snowboarding are popular competitive and recreational sports that can be associated with significant injury. Previous studies of skiing and snowboarding injuries have been conducted, but studies evaluating injury types and patterns over long periods of time are needed to drive effective injury prevention efforts. We hypothesized that injury patterns would differ among snowboarders and skiers and that the number of injuries remained constant over time. This is a retrospective study of patients presenting with skiing or snowboarding injuries to the United States emergency departments from 2000 to 2019. A total of 34,720 injured skiers (48.0%) and snowboarders (52.0%) presented to US emergency departments over a 20-year period, representing an estimated 1,620,576 injuries nationwide. There is a decreasing trend of the number of injuries over the study period (p=0.012). Males represented the majority (65.7%) of injuries. Skiers were older than snowboarders (mean 30.1 vs. 20.0 years; p<0.001) and patients aged<18 represented more snowboarding (57.0%) than skiing (43.0%) injuries (p<0.001). Common diagnoses included fractures (33.0%) and sprains/strains (26.9%). Snowboarders primarily presented with upper extremity injuries, meanwhile, skiers primarily presented with lower extremity injuries. Most patients (93.2%), were treated and discharged from the emergency departments. Understanding the epidemiology of injuries presenting to emergency departments can help guide prehospital care and medical coverage allocation for resorts and event organizers, as well as identifying areas for targeted injury prevention efforts.

Trends in Anterior Cruciate Ligament Injury and Recovery in Professional Snowboarders: The Extreme Sport of Snowboardcross

Introduction  An anterior cruciate ligament (ACL) tear is a devastating injury for athletes that is predominantly low energy and non-contact in nature. ACL tears are one of the most well-researched injuries in sports, however, scant research has been done on competitive snowboarders. Boardercross is a relatively new sport introduced to the Winter Olympics in 2006. Initially, it entailed four snowboarders racing head-to-head down a course of obstacles in a race to the finish, with the top two riders advancing to the next rounds. It has since expanded to six racers traveling up to 60 mph and jumps up to 100 feet in length in a head-to-head race to the finish. This extreme sport puts its athletes at risk for serious injury, requiring investigation. Purpose Investigate the prevalence of ACL tears in the extreme sport of boardercross, evaluate sport-specific factors that may put athletes at higher risk, and report return to sport data. Methods An expedited IRB approval was obtained. A survey was distributed to athletes via e-mail to national/regional coaches of countries with competitive boardercross teams. Professional coaches distributed the survey and secondarily distributed it to athletes. Results Sixty-six competitive snowboardcross athletes responded to the email surveys 48.5% of respondents had torn their ACL at least once in their career. Of the female respondents, 55.6% suffered at least one ACL tear, and 43.6% of male respondents suffered at least one ACL tear. 31.2% suffered more than one ACL tear during their career. Of those who tore their ACL, 91.3% (p <0.001) tore their front leg. 100.0% of the respondent athletes returned to sport post-ACL reconstruction. Conclusion Professional boardercross racers are at a higher risk of tearing their ACL than other winter sport athletes, including alpine skiers. A predominance of ACL injuries occurred on the front leg during landing from an aerial maneuver. All respondent athletes returned to the sport after injury, with approximately half returning within six months. Although no statistical significance was achieved, the data provided trends on risk factors related to ACL injuries among snowboardcross athletes.

Repeatability of a bending stiffness test for snowboarding wrist protectors

Snowboarding wrist protectors are typically designed to limit impact forces and prevent wrist hyperextension. The standard for snowboarding wrist protectors (ISO 20320:2020) includes a test for measuring their bending stiffness, when fitted to a wrist surrogate. This test serves as a simple means of assessing the ability of wrist protectors to prevent wrist hyperextension. Wrist protector bending stiffness measurements have been shown to be influenced by surrogate design, protector strapping condition, and surrogate surface compliance. Currently, there is a lack of knowledge on the repeatability of bending stiffness measurements, as previous studies have conducted tests during one session. This study investigated the repeatability of a bending stiffness test, by testing two snowboarding wrist protectors (short and long) on two wrist surrogates (compliant and stiff), under three protector strapping conditions (loose, moderate, tight), across three repeated test sessions. Test session had a significant effect (p < 0.05) on torque values, with a large effect size ($$\eta_{{\text{p}}}^{2}$$ η p 2  > 0.14), indicating the test had limited repeatability between test sessions. Despite this limited repeatability, torque values increased with both wrist angle and strap tightness, as reported before, indicating consistent trends in results. The outer surface compliance of the surrogate did not significantly affect the protector’s sensitivity to test session nor strapping condition.

Austere Diagnosis and Reduction of Anterior Shoulder Dislocations: 10-Year Review of a Ski Patrol-Based Program with Emergency Medical Technicians

INTRODUCTION

Glenohumeral dislocations present a challenging management dilemma in austere settings where patient transport time may be prolonged. Expeditious reduction is preferable, but treatment is commonly expected to take place within a hospital or comparable facility. Through a novel shoulder injury program, professional ski patrollers trained as emergency medical technicians (EMTs) have diagnosed and reduced anterior shoulder dislocations using biomechanical techniques without sedation or analgesia for over 20 y. Summary records have been maintained to track the performance and safety of this program.

METHODS

Five hundred forty-six records of winter sports-related shoulder injuries from 2009-10 to 2019-20 were retrospectively analyzed to determine the assessment performance and dislocation reduction efficacy of EMTs, with the intent of ascertaining whether EMT-trained practitioners can reliably and safely diagnose and reduce anterior shoulder dislocations without premedication in a remote and resource-limited setting.

RESULTS

EMTs identified anterior shoulder dislocations with 98% sensitivity and 96% diagnostic accuracy. The overall success rate of reduction attempts was 86%, or 88% when limited to confirmed anterior dislocations. Two fracture-dislocations and 4 misdiagnoses were manipulated. No instances of iatrogenic harm were identified, and no patients who underwent successful reductions required ambulance transportation.

CONCLUSIONS

With appropriate education and within a structured program, EMT-trained practitioners can reliably and safely diagnose and reduce anterior shoulder dislocations using biomechanical techniques without premedication in remote and resource-limited environments. Implementation of similar programs in austere settings has the potential to improve patient care. Further, using biomechanical reduction techniques may reduce reliance on procedural sedation irrespective of care setting.

Getting Athletes Back on the Field: Management of Clavicle Fractures and Return to Play

This chapter provides an overview of the prevalence of clavicle fractures in athletes. The evaluation and management of clavicle fractures in athletes is summarized, including surgical considerations, rehabilitation protocols, and return to sport guidelines. In this population, high rates of union are observed, but careful timing of return to sport is paramount to optimize performance and prevent reinjury.

Recreational Skiing- and Snowboarding-Related Extremity Injuries: A Five-Year Tertiary Trauma Center Cohort

INTRODUCTION

Skiing and snowboarding are widely recognized winter sports with a notable risk of sports-related injuries. Comprehensive knowledge of the injuries sustained during skiing and snowboarding is imperative for preventative strategies and for understanding the injury patterns and epidemiological characteristics from surgeons' standpoint, particularly orthopedic surgeons, given that all anatomical regions and systems are susceptible to harm when engaging in these activities.

OBJECTIVE

Our research aims to investigate the injury patterns and epidemiological characteristics of individuals seeking medical attention at Erzincan University Faculty of Medicine Orthopedics and Traumatology Clinic, Erzincan, Turkey, after experiencing recreational skiing or snowboarding injuries.

METHODS

During the period spanning from 2018 to 2023, a retrospective analysis was conducted on patients aged between 18 to 65 years who had sustained isolated extremity injuries while participating in recreational winter sports at the Ergan Mountain Ski Center. The causes of injuries were categorized into two types (skiing and snowboarding) based on the subjective description of the injury scene. The study employed the χ2 test for categorical variables and Student's t-test for continuous variables to conduct subgroup comparisons.

RESULTS

The study results revealed that most patients, precisely 53.2%, sustained injuries in their lower extremities, whereas 46.8% sustained injuries in their upper extremities. The most frequently injured area of the patients presenting with skiing injury was the region around the knee (31.2%), followed by around the shoulder (21.6%) and the foot and ankle (14.9%). The anatomical region most injured among patients who sustained snowboarding injuries was the hand and wrist, accounting for 23.9% of cases.

CONCLUSION

Skiing and snowboarding injuries vary anatomically. While individuals with limited experience are at a higher risk of sustaining injuries, no statistically significant disparity was observed regarding the specific body parts affected among individuals of varying skill levels. Recognizing these sports-related injuries, which are growing in young people, will encourage the use of personal protective equipment to avoid injuries, assure ski resorts' environmental safety, and reduce sports-related morbidity.

Acute Thumb Metacarpophalangeal Joint Ulnar Collateral Ligament Injury: Diagnosis, Management, and Return to Sports Considerations

ABSTRACT

Thumb metacarpophalangeal joint ulnar collateral ligament injuries are common in athletes and range from mild sprains to complete retracted tears. The typical injury mechanism of a valgus force directed onto an abducted or extended thumb is frequently seen in certain sporting activities, such as skiing, football, and baseball. Ultrasound and magnetic resonance imaging are excellent imaging supplements to the clinical evaluation for diagnosis confirmation. Positive treatment outcomes have been demonstrated when these injuries are appropriately managed both nonoperatively and surgically. When deciding on a treatment plan, it is paramount to take the athlete's injury severity and sport-specific factors into account. The aim of this review is to summarize the sport epidemiology, diagnosis, treatment options, and return to play considerations for athletes who sustain an acute thumb metacarpophalangeal joint ulnar collateral ligament injury.

Incidence of alpine skiing and snowboarding injuries

BACKGROUND

The incidence of injuries on alpine ski slopes have been assessed using various methods. A decline in injury rate has been observed throughout the literature; however, the actual incidence remains unclear. The purpose of this study was therefore to evaluate the incidence of skiing and snowboarding injuries using large-sample data from an entire geographic state.

METHODS

Data on alpine injuries over the course of five winter seasons between 2017 and 2022 were prospectively collected from the emergency service dispatch center of Tyrol (Austria). The incidence of injuries was assessed in relation to the number of skier days, which was obtained from the chamber of commerce.

RESULTS

A total of 43,283 cases were identified, and a total of 98.1 Mio skier days were registered during the inclusion period of our study, resulting in an overall incidence of 0.44 injuries per 1,000 skier days. This is significantly less than reported from previous studies. From 2017/18 to 2021/22 there was a slight increase in injuries per 1000 skier days with an exception only for the COVID-19 related season 2020/21.

CONCLUSION

Our study showed a significant reduction in the incidence of alpine skiing and snowboarding injuries in comparison with previous studies and should be considered a benchmark for future studies. Long-term studies on the efficacy of safety gear, as well as the influence of ski patrol and air-borne rescues on patient outcome are warranted.

Association of personal and equipment-related factors on ACL injury risk in alpine skiers with cautious or risk-taking behaviour: A case-control study

Background

In recreational alpine skiing ACL injury risk depends on the interaction of individual characteristics and behaviours as well as on equipment-related factors.

Aim

to evaluate if and to what extent personal characteristics and equipment-related parameters are associated with ACL injury risk in cautious and risk-taking recreational alpine skiers.

Methods

A retrospective questionnaire-based, case-control study of ACL-injured and uninjured in a cohort of cautious as well as risk-taking recreational skiers was conducted. Participants self-reported their demographics, skiing skill level, and risk-taking behaviour. Ski length, side-cut radius, widths of the tip, waist, and tail were recorded from each participant's skis. Standing heights at the front and rear components of the ski binding were measured with a digital sliding caliper, and a standing height ratio between the front and rear components was calculated. Ski boot sole abrasion at the toe and heel pieces was also measured with the digital sliding caliper.

Results

In total, 1068 recreational skiers (50.8% females) with a mean age of 37.8 ± 12.3 years participated, of whom 193 (22.0%) sustained an ACL injury, and 330 (30.9%) participants reported a risk-taking behaviour. Results of the multiple logistic regression analyses revealed that a higher age, a lower skill level, a higher standing height ratio, and greater ski boot sole abrasion at the toe as well as heel pieces were independently associated with an increased ACL injury risk in both the cautious and the risk-taking group. Among cautious skiers, a longer ski length was an additional significant risk factor for sustaining an ACL injury. In conclusion, the same personal and equipment related characteristics contribute to an increase in the ACL injury risk regardless of risk-taking behaviour, with the only difference that longer skis represent an additional risk factor in cautious skiers.

Description of Telemark Skiing Technique Using Full Body Inertial Measurement Unit

Researchers involved in skiing investigations postulate Telemark skiing as an alternative technique to Alpine skiing, which may be associated with lower injury risk. A free heel of the boot, and a boot that enables flexion of the toe, are characteristic features. The aim of this research was to compare three types of turns on Telemark skis, through a biomechanical description of each skiing technique. Seven professional skiers were investigated. Two cameras and the MyoMotion Research Pro system were utilized. Eighteen wireless IMU sensors were mounted on each skier's body. For every skier, five runs were recorded for each of the three turning techniques. Velocity of run, range of movement, angular velocity in joints, time sequences, and order of initialization of movement were obtained. A higher velocity of skiing was obtained during the parallel (14.2 m/s) and rotational turns (14.9 m/s), compared to a low-high turn (8.9 m/s). A comparison of knee angles, revealed similar minimum (18 and 16 degrees) and maximum (143 and 147 degrees) values achieved during the parallel and rotational techniques, which differed considerably from the low-high technique (27 and 121 degrees, respectively). There were no significant differences in trunk rotation angles. A detailed analysis of the Telemark skiing technique revealed novel information on how turns are executed by well-trained skiers and the impact of different approaches.

Are Different Aged Youth Skiers and Snowboarders Experiencing Different Injury Characteristics?

INTRODUCTION

Skiing and snowboarding are popular winter sports with significant youth participation and inherent potential for injury. We investigated the relationship between age and injury characteristics exhibited by youth skiers and snowboarders.

METHODS

In this cross-sectional study, we investigated injury characteristics among youth skiers and snowboarders at a ski resort, examining the association between age and injury type. We compared injury characteristics among young children (aged 3-6 y), school-aged children (aged 7-14 y), and older adolescents (aged 15-17 y) using χ2, and examined predictive variables for injuries at different anatomical locations using logistic regression.

RESULTS

Compared with snowboarding, skiing was associated with greater odds of lower extremity (adjusted odds ratio [aOR]=6.8, 95% confidence interval [CI]: 4.89, 9.47, P<0.001) and head/face/neck (aOR=1.63, 95% CI: 1.20, 2.21, P=0.002) injuries. Compared with skiing, snowboarding was associated with greater odds of upper extremity injury (aOR=5.9, 95% CI: 4.6, 7.6, P<0.001). Age group significantly affected injury mechanism (χ2 [df=12, n=1129]=42.882, P<0.0001) and diagnosis (χ2 [df=12, n=1129]=43.093, P<0.0001). Young child skiers had the highest proportion of injuries to the head/neck/face and lower extremities and a significantly higher proportion of collision injuries and fractures than older skiers. Young child skiers most frequently injured the lower leg/ankle, while older skiers most frequently injured the knee.

CONCLUSIONS

Youth skiers exhibited predominately lower extremity injuries, while snowboarders exhibited predominately upper extremity injuries. Age significantly affected injury mechanism and injury diagnosis in youth skiers. Specifically, younger skiers tended to suffer more fractures and collision injuries than older youth skiers.

Medial-Sided Ligamentous Injuries of the Athlete's Knee: Evaluation and Management

The superficial medial collateral ligament (sMCL) is the most commonly injured ligamentous structure in the knee. The other medial knee stabilizers include the deep medial collateral ligament, the posterior oblique ligament, and the medial meniscus. Medial collateral ligament injuries frequently occur in young athletes. As a result of the good healing capacity of the sMCL, the majority of acute medial-sided knee injuries can be treated nonoperatively with good outcomes. However, missed concomitant injuries can lead to residual laxity and instability of the knee when treated conservatively. When surgical management is warranted, numerous techniques exist, including repair, augmentation, and reconstruction. Recent anatomic and biomechanical studies defining the attachment sites and functional roles of the individual medial knee structures have led to advancements in diagnosis, treatment, and rehabilitation. These studies have allowed for the development of an anatomic reconstruction technique that restores the native stability and load-sharing relationships among the medial knee structures. The purpose of this narrative review is to summarize the recent updates in the anatomy, biomechanics, evaluation, and treatment of ligamentous injuries on the medial side of the athlete's knee.

Comparison and analysis of skiing injuries at ski resorts in Chongli, China and Japan

PURPOSE

The rapid development of winter sports requires investigation on injuries in Chongli district, Zhangjiakou city, one of the ski sites of the 2022 Winter Olympics. Careful evaluation is required to observe which injuries are caused under what circumstances, and then we can make corresponding preventive measures and recommendations based on the results.

METHODS

In this retrospective study, the data of injury cases at ski resorts in China (Chongli district) and Japan were analyzed to provide a reference for the ongoing injury prevention at ski resorts. We collected data on injuries at Wanlong and Fulong ski resorts in Chongli district during the 2017-2018 and 2018-2019 ski seasons. We referred to the skiing injury report issued in February 2020 of a nationwide ski safety statistical service - Japan Ski Safety Association. The causes of injury and specific injured body parts were analyzed based on the data of Chinese and Japanese ski resorts. Statistical significance has been calculated using the Chi-square test.

RESULTS

During the 2019-2020 ski season in Japanese ski resorts, the number of reported injuries per 10,000 skiers was 0.93, of which 457 (17.3%) were over 50 years old, accounting for a large proportion of injuries, meanwhile in Chongli ski resort, the injury rate of skiers aged 50 and over was 7.1%. The knee joint (23.7% at Wanlong ski resort and 28.4% in Japanese ski resorts) was the most injured body part among Chongli and Japanese skiers. Among snowboarders, shoulder joint injury (17.7% in Japanese ski resorts) was the most common, and injury on hands and fingers (16.3% in Wanlong ski resorts) was the most common. Head injury rates are similar in Chongli, China and Japanese ski resorts (8.2% and 8.7%, respectively).

CONCLUSION

Our analysis demonstrated that injury data recorded among young skiers was higher in Chinese ski resorts (Chongli district) than that in Japanese ski resorts, and elderly skiers made up a larger proportion of skiing injuries in Japanese resorts. Thus, according to our research, the protection of knee joints, shoulder joints, and hands and fingers should be taken seriously. It should pay attention to the teaching of ski poles (for finger protection), and use protective devices such as knee pads, helmets, etc.

Acromioclavicular joint injuries at a Colorado ski resort

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

LEVEL OF EVIDENCE

Level IV, Epidemeiology Study.

[Injuries of the foot and ankle in winter sports]

Winter sports injuries of the foot and ankle are a relevant entity due to the high enthusiasm for alpine skiing and snowboarding. The condition of the footwear and rigidity of the binding have a significant influence on the pathobiomechanics of fracture development and have been shown to influence the frequency of knee and ankle injuries. Foot injuries are rare due to the sport-specific footwear with good padding and frequent hard shell casings.

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.

[Fractures of tibial shaft and tibial head in winter sports]

BACKGROUND

Injuries in alpine skiing often affect the lower extremities, in particular the knee joint and lower leg. In addition to conventional radiological diagnostics, CT and, in the case of fractures of the knee joint area, MRI also play an important role. In the case of tibial head fractures, especially if there has been a dislocation mechanism, there is an increased risk of vascular and nerve injuries. Lower leg fractures are predestined for the development of a compartment syndrome. For these reasons, an exact survey of the vascular-nerve status and a monitoring of the soft tissues should be carried out.

THERAPY

In the further therapy, whether conservative or surgical, the soft tissue situation must also be included in the planning. In the case of tibial head fractures in particular, the choice of the right approach is essential for a good result in surgical therapy. Angle-stable plate osteosynthesis and screw osteosynthesis play the most important role as osteosynthesis methods in the knee joint area. In the case of fractures in the shaft area, medullary nail osteosynthesis or angle-stable plate systems are primarily used. In the case of severely compromised soft tissue or unstable situations, it may be necessary to apply an external fixator first. The initiated therapy should enable functional follow-up treatment as early as possible.

PREVENTION

Good physical fitness, driving-specific training, but also good core stabilization have a preventative effect against injuries. In addition, the correct material coordination between ski boot, binding and ski is important for accident prevention.

[Knee injuries in winter sports]

Winter sports represent a relevant entity for knee injuries due to their great popularity. In alpine skiing and snowboarding, knee joint injuries are the most common affected body regions, while in ice hockey they are in third place. Various accident mechanisms lead to different injury types and severities. In addition to medial collateral ligament injuries, anterior cruciate ligament injuries are of particular importance. In professional sports, severe combination injuries are more common. Therapy is exemplified using the anterior cruciate ligament rupture. The gold standard is replacement ligament surgery. The return-to-sport rate of 80% for skiing and snowboarding is comparable to summer sports such as football, basketball or baseball. For ice hockey, it is even better. Prevention is possible by targeted training programs, but also by optimizing the equipment and its adjustment.

Emergency Service Assistance for Injuries on Alpine Ski Slopes: A Cross-Sectional Study

OBJECTIVES

Injuries on alpine ski slopes have been described in cohorts of a reasonable sample size, but constant improvements in safety gear, increased use of airborne rescue, and safety measures during the coronavirus disease 2019 (COVID-19) pandemic mandate re-evaluation. Therefore, the purpose of this study was to evaluate skiing and snowboarding injuries, effectiveness of airborne rescue, and impact of the COVID-19 pandemic on a large sample size.

METHODS

Data on alpine injuries were prospectively collected from the state emergency services dispatch center in the state of Tyrol (Austria). A total of 10,143 patients were identified, with an average age of 33.5 years (SD = 20.36). The ski patrol was involved in 8,606 cases (84.9%) and some patients (n = 1,536; 15.1%) required helicopter rescue.

RESULTS

A total of 10,143 patients were identified from the dataset of the emergency dispatch center. The most frequently injured region was the knee (30.2%), and it was followed by the shoulder (12.9%), the lower leg (9.5%), and the head/skull (9.5%).

CONCLUSION

The present findings indicate that the most frequent site of injuries on alpine slopes is the knee, and life-threatening injuries are rare. Airborne rescue is very time-effective, however clinical studies with patient follow-up should be emphasized to determine the impact of airborne rescue on patient outcome. The present findings indicate that the duration of all rescue operations has been prolonged as a result of the introduction of safety measures during the COVID-19 pandemic.

A Comparison of ACL Injury Risk, Ski Geometry and Standing Height Parameters between Skiers with Rented and with Owned Skis

to evaluate if ACL injuries are associated with recreational skiers using rented skis and whether individual factors, ski geometry parameters and standing heights differ between skiers who rented or owned skis. A retrospective questionnaire-based, case-control study of ACL-injured and uninjured recreational skiers was conducted during six winter seasons. Age, sex, body height, body weight, nationality, ownership of skis, skill level, risk-taking behavior, ski length, side-cut radius, widths of the tip, waist, and tail, and the standing heights at the front and rear components of the ski binding were assessed. Additionally, ratios between ski widths and a standing height ratio were calculated. Altogether, 1780 skiers (48.9% females) with a mean age of 39.2 ± 13.0 years participated, of whom 22.0% sustained an ACL injury and 32.3% rented skis. ACL injury risk was significantly associated with rented skis (OR 3.2, 95% CI 2.5-4.0). Compared to skiers using own skis, participants who rented skis were more likely female, smaller and lighter, tourists, less skilled and more cautious. In comparison to owned skis, rented skis showed significantly lower mean values in ski length, side-cut radius, ski widths, and for the three ski widths ratios. Additionally, standing heights were significantly lower while standing height ratio was higher for rented skis. Beside individual factors, equipment-related factors should be considered when renting skis in order to reduce ACL injury risk.

Winter sport musculoskeletal injuries: epidemiology and factors predicting hospital admission

INTRODUCTION

Participation in winter sports such as skiing, snowboarding and snowmobiling is associated with risk of musculoskeletal injury. The purpose of our study was to describe and quantify emergency department encounters associated with these sports.

METHODS

The National Electronic Injury Surveillance System (NEISS) was queried for skiing-, snowboarding- and snowmobiling-related injuries from 2009 to 2018. Patient demographics and disposition data were collected from emergency department encounters. Descriptive statistics were utilized to describe the trends in injuries from each sport and factors associated with the sports-specific injuries.

RESULTS

From 2009 to 2018, there were an estimated 156,353 injuries related to snowboarding, skiing, or snowmobiling. Estimated injury incidence per 100,000 people decreased over time for skiing (3.24-1.23), snowboarding (3.98-1.22,) and snowmobiling (0.71-0.22,). The most common injury location by sport was shoulder for skiing (29.6%), wrist for snowboarding (32.5%) and shoulder for snowmobiling (21.9%), with fractures being the most common diagnosis. Only 4.5% required admission to the hospital. Fracture or dislocation was associated with highest likelihood of hospital admission (OR 42.34; 95% CI 22.59-79.37). Snowmobiling injuries (OR 1.63; 95% CI 1.20-2.22) and white race (OR 1.42; 95% CI 1.17-1.72) were also both associated with increased risk of hospital admission.

CONCLUSIONS

Upper extremity injuries, particularly those involving fractures, were more common than lower extremity injuries for all three sports, with the shoulder being the most common location of injury for skiing and snowmobiling. This study can serve as the foundation for future research in sports safety and health policy to continue the declining trend of musculoskeletal injuries in the future.

LEVEL OF EVIDENCE

III.

Collisions with another person while skiing and snowboarding: A 13-year national registry analysis

INTRODUCTION

Interindividual collisions while skiing or snowboarding occur regularly, they can be associated with severe injuries.

OBJECTIVE

To elucidate causes of accidents, injury patterns and potential risk factors for injury severity in interindividual collisions of skiers and snowboarders.

MATERIAL AND METHODS

Retrospective analysis of the Austrian Registry for Mountain Accidents within a 13-year timeframe (2005-2018) with regard to on- or off-piste collisions of skiers and snowboarders.

RESULTS

A total of 30,503 collisions, involving 52,430 (85.9%) skiers and 8,576 (14.1%) snowboarders were analysed. Denominators are lacking, since total numbers of skiers and snowboarders were not available. Compared to skiers, snowboarders were younger (23 vs. 42 years; p<0.001), predominantly male (77.4% vs. 61.0%; p<0.001) and less often severely injured (46.8% vs. 26.2%; p<0.001). Most accidents occurred on slopes (>95%). Collisions involving two snowboarders occurred proportionally more often in terrain parks (4.1% of 1,664 injured snowboarders; p<0.001) and while one victim was standing or sitting (9.7%; p<0.001). Contusions/strains/sprains were most prevalent (>23%), as were head injuries (>12%). In skiers, chest, shoulder, hip, thigh and knee injuries occurred more often, leading to fractures, dislocations, concussions and internal injuries more frequently. In snowboarders, spine/back, elbow, forearm, wrist and lower leg injuries were more prevalent. Female gender and standing or sitting prior to the accident was a risk factor for being more severely injured in collisions involving i) two skiers (OR: 4.02 (3.79-4.26) and 3.91 (3.26-4.68)), ii) a skier and a snowboarder (OR: 4.50 (3.95-5.14) and 11.49 (8.04-16.41)) or iii) two snowboarders (OR: 2.85 (2.12-3.84) and 12.47 (6.17-25.20)). Wearing a helmet increased the risk when two skiers collided (OR: 1.10 (1.03-1.17)). In skier vs. snowboarder collisions, the skier had a higher risk of being injured more severely (OR: 7.93 (6.98-9.01)).

CONCLUSIONS

In interindividual collisions of skiers and snowboarders, injury patterns and preceding causes differ substantially. Skiers are more likely to be severely injured. Awareness of an increased risk of injury should be raised particularly while standing or sitting on the slope.

A 40-year Study of the Factors Associated with Diaphyseal Forearm Fractures in Skiers and Snowboarders

BACKGROUND

Skiing and snowboarding are popular sports that are associated with a high number of orthopaedic injuries. Diaphyseal forearm fractures are an important subset of these injuries. To our knowledge, factors associated with these injuries, the mechanisms that cause them, and their relative frequencies in skiers and snowboarders have not been described. In addition, it has been proposed that the use of wrist guards may increase the risk of sustaining a diaphyseal forearm fracture; therefore, we sought to explore the relationship between wrist guard use and diaphyseal forearm fractures.

QUESTIONS/PURPOSES

(1) What are the relative frequencies and types of diaphyseal forearm fractures in skiers and snowboarders? (2) What factors are associated with these injuries? (3) Is the use of wrist guards associated with an increased risk of forearm fractures?

METHODS

This was an unmatched case-control study performed with an injury database from a university-run clinic at the base lodge of a major ski resort. Cases were injured skiers and snowboarders; controls were randomly selected uninjured skiers and snowboarders. Data were collected on the mechanism of injury; experience level; equipment; radiographs; skiing or snowboarding habits; and trail type, defined as green circle (easiest), blue square (intermediate), black diamond (difficult), and double black diamond (most difficult). From this database, we identified 84 patients with diaphyseal forearm fractures, one of which was a Monteggia fracture and was excluded. A logistic regression analysis was used to compare the injured and control groups to identify factors associated with diaphyseal forearm fractures, including wrist guard use.

RESULTS

When adjusted for participant days, diaphyseal forearm fractures were more common in snowboarders than skiers (0.03 injuries per 1000 person-days versus 0.004 per 1000 person-days). On multivariable analysis, factors associated with forearm fractures in skiers were younger age (odds ratio 1.08 [95% CI 1.05 to 1.14]; p < 0.01), being a man or boy (OR 11.9 [95% CI 2.5 to 57.2]; p < 0.01), lack of movement at the time of falling (OR 18.2 [95% CI 3.2 to 102.5]; p < 0.01), and skiing on green circle trails compared with black diamond trails (OR 3.6 [95% CI 1.4 to 12.5]; p = 0.04). Factors associated with forearm fractures in snowboarders were younger age (OR 1.08 [95% CI 1.02 to 1.15]; p = 0.01), decreased weight (OR 1.02 [95% CI 1.00 to 1.02]; p < 0.01), snowboarding on gentle terrain (OR 8.4 [95% CI 1.6 to 45.0]; p = 0.01), and snowboarding on groomed terrain compared with other (OR 7.2 [95% CI 1.9 to 28.0]; p < 0.01) or wet, heavy snow (OR 24.8 [95% CI 2.5 to 246.7]; p = 0.01). Wrist guard use was not associated with an increased odds of diaphyseal forearm fracture in skiers or snowboarders.

CONCLUSION

Diaphyseal forearm fractures occur more frequently in snowboarders than in skiers. Despite speculation in prior evidence that wrist guards may paradoxically increase the risk of sustaining these injuries, our study suggests that this is not the case and wrist guards are not unsafe to wear.

LEVEL OF EVIDENCE

Level III, prognostic study.

Imaging Review of Snowboard Injuries

Snowboarding and skiing remain the two most popular winter sports worldwide. Musculoskeletal (MSK) injuries are common in snowboarding, and the number has increased significantly since the advent of snow parks. The number of injuries is the highest for novice snowboarders; more experienced boarders generally sustain more severe injuries. Snowboarders can experience a wide array of MSK injuries, but some injury types are more frequently encountered because of the specific injury mechanism unique to snowboarding. This article reviews the most common snowboarding injuries with a focus on the current understanding of the injury mechanism and provides an approach to imaging.

Imaging Review of Alpine Ski Injuries

Skiing is a continuously evolving winter sport, responsible for a considerable number of musculoskeletal injuries. Specific injury patterns and mechanisms in the upper and lower extremities, head, and spine are influenced by skier expertise and skill, position during injury, and environmental conditions. Predilection for certain joints and injury patterns have changed over time, largely due to technological advancements in equipment, increased awareness campaigns, and preventive protocols. Knowledge and understanding of these trends and developments can aid the radiologist to reach a timely and accurate diagnosis, thereby guiding clinical management and potentially reducing the overall incidence of debilitation and death.

Ski-geometric parameters do not differ between ACL injury mechanisms in recreational alpine skiing

PURPOSE

It is not known so far if ski-equipment-related factors differ between the ACL injury mechanisms, potentially influencing the circumstances and causes of falling, finally resulting in ACL injury. More specifically focusing on the injury mechanisms will provide a deeper understanding of injury causation. The aim of the study was to evaluate whether ACL injury mechanisms in recreational alpine skiing differ with regard to ski-geometric parameters, self-reported circumstances and causes of accident and injury severity.

METHODS

Among a cohort of 392 ACL-injured (57.9% females) skiers, age, sex, height, weight, skill level, risk-taking behavior, circumstances and causes of accident, and ACL injury severity were collected by questionnaire. Additionally, patients had to recall their type of fall (ACL injury mechanism) by classifying forward and backward falls with and without body rotation. Ski length, side cut radius and widths of the tip, waist and tail were directly notated from the ski.

RESULTS

The forward fall with body rotation was the most common reported ACL injury mechanism (63%). A riskier behavior was associated with forward falls without body rotation. Ski-geometric parameters did not significantly influence the type of ACL injury mechanism. Regarding accident characteristics, catching an edge of the ski was more frequent (p < 0.001) the cause for forward falls (75% and 67%) when compared to the backward falls (46 and 15%) and executing a turn was the most frequent action in all falls (39-68%). A complete rupture of the ACL (66-70%) was more commonly reported than a partial tear (30-34%) among all four non-contact ACL injury mechanisms (n.s.).

CONCLUSION

In contrast to risk-taking behavior and accident characteristics, ski-geometric parameters and injury severity do not significantly differ between ACL injury mechanisms in recreational skiing. Thus, an individual skiing style seems to have more impact on ACL injury mechanisms than ski equipment. Future studies should evaluate potential effects of ski geometry on the incidence of ACL injury.

LEVEL OF EVIDENCE

III.

Incidence of injuries in professional snow sports: A systematic review and meta-analysis

PURPOSE

The study aimed to conduct a comprehensive systematic review and meta-analysis of injury incidence in professional skiers and snowboarders.

METHODS

We systematically searched PubMed, Web of Science, and MEDLINE for studies on injury incidence published from inception to April 2020. Injury data were extracted, alongside information on injury location, severity, type, cause, and sport discipline. Incidence of injuries was presented per 1000 athlete-days, with 95% confidence intervals (95%CIs).

RESULTS

The search identified 462 articles, and 22 were included in our review. The overall incidence of injuries among professional skiers and snowboarders was 3.49 per 1000 athlete-days (95%CI: 2.97-4.01). Lower extremity had the highest injury incidence (1.54 per 1000 athlete-days, 95%CI: 1.24-1.84). Incidence rates of slight, mild, moderate, and severe injuries were 0.26, 0.31, 0.57, and 0.59 per 1000 athlete-days, respectively. Contusion had the highest incidence rate (1.82 per 1000 athlete-days, 95%CI: 1.01-2.63). The most common cause of injury was contact trauma (3.20 per 1000 athlete-days, 95%CI: 1.32-5.08). Freestyle skiing had the highest incidence rate (6.83 per 1000 athlete-days, 95%CI: 4.00-9.66), and Nordic skiing had the lowest rate (2.70 per 1000 athlete-days, 95%CI: 1.94-3.46).

CONCLUSION

Professional skiers and snowboarders have a substantial risk of sustaining injuries. Our findings can be used to inform the planning and provision of healthcare for elite participants in different snow sports.

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

Objectives

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

Material and Methods

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

Results

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

Conclusions

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

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.

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.

Thumb Injuries and Instabilities. Part 2: Spectrum of Lesions

The motor function of the thumb and its alignment with regard to the hand make it particularly vulnerable to trauma. Pathology encountered in this joint is varied, and imaging techniques play a crucial role in the diagnosis and characterization of injury. Despite advances in imaging technology, acute thumb injuries remain a challenge for radiologists. Currently, standard radiography and ultrasonography are frequently used first-line imaging techniques. Computed tomography is most often indicated for complex fractures and dislocations. Magnetic resonance imaging may be used to optimally characterize soft tissues and bone marrow. In this article, we cover the most common traumatic injuries: fractures, dislocations, collateral ligament injuries of the metacarpophalangeal joint, as well as soft tissue lesions.

Ski- and snowboard related open peroneal nerve injury: A 20-year retrospective case series study

Introduction

Traumatic peroneal nerve injury (PNI) caused by ski or snowboard edges is a severe but scarcely reported accident.

Methods

In a 20-year retrospective study, all skiers and snowboarders with this injury treated surgically at the Department of Plastic, Reconstructive and Aesthetic Surgery at the Medical University of Innsbruck, Austria, were included, covering a period from 1999/2000 to 2018/2019.

Results

In total, 34 patients were included in this study (30 males (88.2%) and 4 (11.8%) females). Of these 34 injured skiers or snowboarders, 33 (97.1%) were recreational athletes and Non-Austrian citizens, and 21 (61.8%) patients sustained accidental injuries without collision. All of the injuries under investigation, i.e., open lacerations, most often with complete transection, were the patients’ main injuries. Surgery was performed with direct coaptation in 24 patients (70.6%), and with a suralis nerve graft in the other 10 patients (29.4%).

Conclusion

Traumatic laceration of the peroneal nerve at the knee level by sharp ski or snowboard edges is a rare but severe injury. Causes for this injury may be multifactorial. Recommendations to reduce the risk of such an injury may follow general instructions and warnings to skiers and snowboarders regarding equipment, familiarity with the region, as well as appropriate skills and training.

•

In accidents of skiers and snowboarders traumatic laceration of the peroneal nerve is a severe, but rare injury.

•

This injury type is rarely reported.

•

The injuries are caused by the sharp edges of modern skies or snowboards and require urgent microsurgical intervention.

•

Our 20 years study shows that this injury type primarily affects recreational athletes and guest skiers.

•

Current equipment, e.g. ski trousers do not protect the affected region on the lateral side of the knee.

Epidemiology of Clavicle Fractures Sustained at a Colorado Ski Resort

Background

Although clavicle fractures are a common sports injury, there are limited studies on the incidence and causes of clavicle fractures among winter sports athletes.

Purpose

To evaluate the characteristics and injury mechanisms associated with clavicle fractures among patients evaluated at a Colorado ski resort.

Study Design

Descriptive epidemiology study.

Methods

This was a retrospective descriptive analysis of patients with clavicle fractures at the Denver Health Winter Park Medical Center during the 2012-2013 to 2016-2017 ski seasons. Chart review was performed on the patient cohort to confirm clavicle fracture diagnosis and to evaluate factors associated with clavicle fracture.

Results

A total of 393 clavicle fractures (6.2% of total clinic visits) occurred during the study period, corresponding to an overall clavicle fracture incidence of 8.4 per 100,000 participant-visits. The mean patient age was 26.4 years (range, 5-73 years). The majority were middle-third fractures (85.5%), occurring mainly in men (87.3%). More than half of the fractures were comminuted (54.5%) and occurred in snowboarders (55.0%). The most common mechanism of injury was a fall onto snow while skiing or snowboarding (92.4%). Women sustained more clavicle fractures while skiing compared with snowboarding (82.0% vs 18.0%; P < .001), while men sustained more fractures while snowboarding compared with skiing (60.3% vs 39.7%; P < .001).

Conclusion

Clavicle fractures are relatively common, but there are scant incidence data for clavicle fractures in mountain sports. Consistent with prior studies, clavicle fractures were more common in younger patients and men. The most common anatomic fracture location was the midclavicle. A greater proportion of clavicle fractures among men were sustained during snowboarding and among women during skiing.

A Biomechanical Comparison Shows No Difference Between Two Knee Braces used for Medial Collateral Ligament Injuries

Purpose

The purpose of this study was to assess the ability of 2 commonly used knee braces to control knee valgus motion and subsequent strain on the medial collateral ligament (MCL) in a laboratory-controlled environment.

Methods

Twenty healthy individuals (6 male, 14 female; mean age, 23 ± 3 years) with no history of knee injury or brace use performed a jump landing task while wearing either no brace or 1 of 2 braces: the Playmaker and Total Range of Motion . Three-dimensional joint kinematics and kinetics were measured in our biomechanics laboratory.

Results

Significantly less knee dynamic valgus angulation was noted when using either brace (−0.51° ± 3.9° and −1.3° ± 3.2°) compared no brace (4.8° ± 3.0°). Dynamic valgus angulation did not differ significantly between the 2 braces tested, which were both not statistically different from baseline alignment. There were significant differences seen in peak knee flexion angle between each brace (77.9° ± 8.8°and 83.1° ± 8.4°), as well as between both braces and no brace (90.6° ± 11.1°). There was no significant difference in knee frontal plane moment or peak vertical ground reaction force loading among all 3 testing conditions.

Conclusions

Compared to no brace, both braces allowed significantly less dynamic valgus angulation of the knee under physiological vertical loads but were not significantly different from one another.

Clinical Relevance

Knee braces are commonly used to protect the MCL when placed under physiological loads. It is important to know which braces effectively reduce valgus stress to provide the best outcomes.

Method to Investigate Multi-Axis Release Action of Ski Safety Bindings: A New Approach for Testing in Research and Development

The authors developed and elaborated on a new method to release ski bindings by utilizing an industrial robot to simulate release movement showing a spatial repeatability of ± 0.06 mm. The parametric programming of the release parameters gave free control while executing repeatable release tests. A series of different motion patterns were performed, on the one hand, to test the applicability of the setup to the simulation of motion patterns and, on the other, to check for the impact of the ski deformations like ski deflections within the range of −5 mm to −85 mm, on the safety bindings' release forces. As certain falling mechanisms are related to knee injury, which is the most common severe injury in alpine skiing, this testing method can be used to develop related displacement movements in future. This movements do not necessarily accord with the directional release mechanics of safety ski bindings. The authors specify the developed testing apparatus as device for force measurements in 3D with an accuracy of ± 0.5% in boot-sole-plane. The intention behind this development is to enable faster, more versatile and adaptive testing procedures in R&D.

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.

In recreational alpine skiing, the ACL is predominantly injured in all knee injuries needing hospitalisation

PURPOSE

The knee joint still represents the most frequent anatomical injury location accounting for about one-third of all injuries in recreational alpine skiers. However, comprehensive information on current knee injury patterns in this populations is sparse.

METHODS

During the winter seasons 2016/17 and 2019/20, this retrospective questionnaire-based study was conducted in an Austrian sportclinic situated in a large ski area. Among a cohort of 282 recreational skiers (51.8% females), all injuries were diagnosed by the use of magnetic resonance imaging. Additionally, data were recorded on anthropometric characteristics, the perceived speed at the moment of injury, type of fall, physical fitness, self-reported skill level and risk-taking behaviour.

RESULTS

The anterior cruciate ligament (ACL) was injured in all knee injuries recorded. Of the total study sample, 64.5% (n = 182) were ACL injuries with concomitant injuries and about 35.5% (n = 100) were isolated ACL injuries, not involving any other structures of the knee joint. In general, most common concomitant injury diagnoses among ACL-injured recreational alpine skiers were injuries of the medial collateral ligament (MCL) (n = 92, 50.5%), medial meniscus (MM) (n = 73, 40.1%) and lateral collateral ligament (LCL) (n = 41, 22.5%). No significant differences regarding additionally recorded characteristics were found between ACL-injured individuals with concomitant injuries and those with isolated ACL injury.

CONCLUSIONS

Whereas, before the introduction of carving skis, the MCL was reported being the most common injured part of the knee, currently, the majority of knee injuries are ACL injuries accompanied by injury of other knee joint structures, i.e. the MCL, MM and LCL.

LEVEL OF EVIDENCE

Level III.

Injury trends in alpine skiing and a snowboarding over the decade 2008-09 to 2017-18

OBJECTIVES

This research explores snowsport injury trends in western Canadian resorts over the decade 2008-2018.

DESIGN

Ecological study.

METHODS

Injury and participation data on alpine skiing and snowboarding was provided by the Canada West Ski Areas Association for 2008-2018. Inclusion criteria were met by 29 of 52 resorts, resulting in the analysis of 107,540 injury reports via SPSS 24, using descriptive statistics and chi-squared analysis.

RESULTS

Over the decade: there was a gradual decline in the injury rate, averaging 2.24 injuries per 1000 skier days. Male snowboarders accounted for 1/3 of all injured participants, females were 42% of all. Day-ticket holders were the most injured of all customer-types, with most injuries occurring as the result of falls on marked, green/easiest terrain. For skiers, injuries to lower limbs, and especially knees, were most common. For snowboarders, upper limb injuries, especially wrists, were most common. 12.8% of the injured population required emergency transport. Advanced slopes/terrain had the highest proportion requiring emergency transport. Fewer skiers experienced head injuries than snowboarders. Snowboarders experienced a higher proportion of serious injuries.

CONCLUSIONS

Snowsport injuries are relatively rare when compared to other sports. Skiers were most prone to knee injuries and snowboarders to wrist injuries. Emergency transport was proportionally needed more from advanced slopes/terrain. Further research is needed into why and how participants make decisions around risk. Future injury prevention strategies should be evaluated in light of potential risk factors such as, social determinants of injury, fall mechanisms, changing participation patterns, age, snowsport discipline, and legal cannabis use.

Sex differences in the knee orthopaedic injury patterns among recreational alpine skiers

Background

Although studies have reported the sex differences in injury patterns among recreational skiers, the findings are still conflicting. This study aims to analyse the sex differences of orthopaedic knee injuries that occurred during alpine skiing.

Methods

A total of 306 recreational alpine skiers (125 females and 181 males) who sustained knee surgeries between June 2016 and December 2018 participated in this study. Age, height, weight, and physical activity level of the patients were recorded. The orthopaedic knee injury patterns were analysed based on the diagnosis given by the physicians.

Results

Male skiers (17.13%) had a higher proportion of multiple knee ligament injuries than females (6.40%). The combined anterior cruciate ligament (ACL) and medial collateral ligament injury were the most common injury types in both females and males, with ACL injury being more prevalent for females (79.20%) than that in males (56.35%). The proportion of female skiers (17.6%) with vigorous-intensity activity level was significantly lower than that of males (30.9%). Female skiers had lower body height, body weight, and body mass index than male skiers (P <  0.001).

Conclusions

ACL injury is the most common orthopaedic injury among both female and male knee-injured recreational skiers. The proportion of females with an ACL injury is higher than that of males, but the proportion of multiple knee ligament injuries is lower than that of males. More male recreational skiers have vigorous-intensity activity level habits in daily life than females.

The Incidence of Pediatric and Adolescent Concussion in Action Sports: A Systematic Review and Meta-Analysis

BACKGROUND

This was a systematic review and meta-analysis of the incidence of concussion risk in youth athletes involved in action sports (AS).

METHODS

A search of PubMed and Web of Science (from January 1980 to August 2020). Titles, abstracts, and full text were screened according to predefined inclusion criteria to find relevant studies. Moreover, the methodological quality of the studies selected was assessed.

RESULTS

Nineteen of 1.619 studies were included in the systematic review and 14 in the meta-analysis. Motocross, sailing and snowboarding presented the highest incidence rates per 1000 athlete exposure at 39.22, 3.73 and 2.77 respectively, whereas alpine skiing had the lowest incidence rates resulting in 0.30. Overall risk of concussion was estimated at 0.33 (CI: 0.22, 0.45). Regarding the methodological quality, we have to report that 26.3% of the studies reported the definition of concussion while 36.8% presented age and gender-specific incidence rates. The mechanism of injury and follow up were reported only in one study.

CONCLUSIONS

There are significant differences in the rates of incident youth concussion across AS. Despite some limitations, the data from this research can serve as the current sport-specific baseline risk of concussion among youth athletes who practice action sports.

Injury patterns in a large-scale ski resort in the host city of 2022 Winter Olympic Games: a retrospective cross-sectional study

OBJECTIVES

The aims of the study are to describe the injury patterns among recreational skiers and snowboarders in China and to provide primary data to guide the reconstruction of regional healthcare facilities to deal with the increasing number of participants in snow sports.

DESIGN

Retrospective cross-sectional study.

METHODS

A retrospective study was performed in Wanlong Ski Resort in Chongli, China. Data of all injured skiers and snowboarders treated in the resort clinic during the 2018-2019 season were collected. Patients' information, including sex, age, equipment, skill level and injured body part, was analysed.

RESULTS

A total of 753 sports injuries were recorded. The estimated incidence of injury was 1.98 per 1000 skier days. 453 cases (60.2%) were associated with skiing. The mean age of skiers was older than snowboarders (35.1±14.5 vs 29.0±8.9, p<0.01). Injury not involving others constituted 67.9% of all injuries. The most common injured body part among skiers was lower extremity, contrary to injury in the upper extremity among snowboarders. Head and cervical injury was identified in 13.7% of skiers and 13.6% of snowboarders.

CONCLUSION

The incidence of skiing/snowboarding injury in China was similar to other countries. Injury pattern differed among different sports and causes of injury.

Wrist Fractures in Skiers and Snowboarders: Incidence, Severity, and Risk Factors Over 40 Seasons

PURPOSE

To determine and compare the incidence and severity of wrist fractures in skiers and snowboarders.

METHODS

A university-run orthopedic clinic at the base of a major ski resort has maintained an injury database spanning the years 1972 to 2012. Demographic information, equipment type, ability level, trail type and conditions, number of falls, circumstances surrounding the injury, and radiographs were collected on participants sustaining wrist fractures and compared with uninjured control participants asked the same questions, but in reference to their last fall where no injury resulted. A risk factor model for wrist fracture and severity in alpine sports was developed.

RESULTS

During the 40-year period, 679 wrist fractures were identified. The incidence of wrist fracture per 1,000 days was 0.447 in snowboarders and 0.024 in skiers. In comparison with a representative sample of uninjured skiers, bivariate analyses revealed that skiers who experienced fractures were less experienced, had a greater number of falls, were on green or double black trails, and were injured owing to jumping or other reason related to technique. A higher risk for fracture was found for beginners, males younger than age 16, women older than age 50, and 4 or fewer days skiing that season. Bivariate analyses found that injured snowboarders were more likely to be female, younger, less experienced and had received less instruction than uninjured snowboarders. Higher risk for wrist fracture among snowboarders was found to be associated with age younger than 18 and less experience.

CONCLUSIONS

Wrist fractures occur at an 18 times greater incidence in snowboarders than in skiers. Skiers with wrist fractures were beginners, males younger than 16, women older than 50, or those who had less participation. Snowboarders sustaining wrist fractures were younger than 18 or had less experience.

TYPE OF STUDY/LEVEL OF EVIDENCE

Prognostic III.

Ski and Snowboard - Related Orthopedic Injuries

Participation in skiing and snowboarding continues to increase. Both sports are associated with unique equipment and movement patterns, placing athletes at risk for several characteristic injuries. Although the axial skeleton and extremities are at risk for injury in both sports, skiing and snowboarding are associated with distinctive injury patterns. This article summarizes the epidemiology, risk factors, and specific injuries associated with skiing and snowboarding to better educate orthopedic surgeons regarding diagnosis and treatment of athletes partaking in these sports.

[Analysis of the mass skiers' injury in a large ski resort in Chongli, China]

OBJECTIVE

To make a retrospective analysis of the injuries of skiing population in a large ski resort in Chongli, China and provide a basis for predicting the rapidly increasing medical needs for ski injuries in the context of the 2022 Winter Olympic Games.

METHODS

The basic data of all injured skiers who were treated in a medical station of a large ski resort in Chongli during the snow season from November 2017 to March 2018 and from November 2018 to March 2019 were collected. The number of skiers, the number of injuries, the causes of injuries, the types of injuries and the locations of injuries were compared.

RESULTS

A total of 753 skiers were injured in two snow seasons, and the estimated average incidence of injury was 4.53 and 4.46 per 1 000 skier days at the resort respectively. The average daily injury rate per 1 000 skiers in November of the two snow seasons was relatively low, with 2.20 and 1.38 cases respectively. The difference of injury rate in different months might have little to do with snowfall and more to do with passenger flow. In both the snow seasons, men accounted for more injuries than women, and injured skiers aged between 21 and 30 accounted for the largest proportion, reaching 36.8%. The main causes of injuries were falls (76.6%). The highest rate of injury was in the head and neck (17.9%), followed by the knee (17.4%) and wrist and fingers (13.3%). The most common types of injuries were contusion and trauma (29.5%) and joint and/or ligament injuries (22.2%). Children (2-12 years old) accounted for 12.7% of all the injured skiers. The rate of moderate to severe injuries (including fractures, concussions, etc.) was 34.8% among the injured patients over 50 years of age.

CONCLUSION

The snow resort should focus on injuries to children and elderly skiers and carry out targeted guidance and rescue work. In order to better ensure the medical safety of skiers, the ski resort medical station and nearby treatment hospitals should be equipped with a corresponding number of medical personnel and equipment, and the ski resort should further improve its safety management and rescue system.

Do Older Skiers Have Worse Outcomes After Anterior Cruciate Ligament Reconstruction Compared With Non-Skiers or Younger Skiers?

Background:

There remains a paucity of literature comparing clinical outcomes after anterior cruciate ligament reconstruction (ACLR) between skiers and non-skiers, particularly in older patient populations.

Purpose:

To compare clinical outcomes after ACLR between skiers and non-skiers, with a subanalysis based on age.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

A nested cohort of 128 patients from the Multicenter Orthopaedic Outcomes Network cohort who underwent primary ACLR completed a series of patient-reported outcomes pre- and postoperatively at 2 and 6 years including the Knee injury and Osteoarthritis Outcome Score (KOOS), Marx Activity Rating Scale, and subjective International Knee Documentation Committee (IKDC) score. Data including patient sex, age at surgery, graft type, and sport participation were analyzed. Patients were stratified by participation in skiing (skiers vs non-skiers) and by age subgroup (≤29, 30-39, and ≥40 years). Student t tests and analysis of variance were used to compare mean improvement between pre- and postoperative outcomes.

Results:

A total of 44 skiers (female, 59.1%; age, 35.3 ± 11.6 years) and 84 non-skiers (female, 34.5%; age, 27.7 ± 11.3 years) were included. ACLR was performed using allograft in 36.7% (22 skiers, 25 non-skiers), autograft in 58.6% (19 skiers, 56 non-skiers), or hybrid autograft-allograft in 4.7% (3 skiers, 3 non-skiers). Although both non-skiers and skiers demonstrated improvements in outcomes from baseline to 2 and 6 years, non-skiers demonstrated significantly less overall improvement from 2 to 6 years postoperatively in KOOS Symptoms (P = .01), KOOS Pain (P = .002), and KOOS Activities of Daily Living (P = .03) subscales compared with skiers. There were 15 skiers who were 29 years or younger (34.1%), 14 skiers between 30 and 39 years (31.8%), and 15 skiers 40 years or older (34.1%). Skiers 40 years and older demonstrated significantly greater mean improvement in KOOS Symptoms (P = .02) and KOOS Quality of Life (QoL) (P = .01) subscales at 2 years and KOOS QoL (P = .01) at 6 years postoperatively compared with skiers 29 years or younger.

Conclusion:

Compared with non-skiers, skiers demonstrated significantly greater mean improvements in KOOS scores between 2 and 6 years after ACLR. In addition, skiers 40 years or older showed greater improvement in KOOS QoL compared with younger skiers. This information can be used to counsel skiers, especially those older than 40 years, as to their expected outcomes after ACLR.

Ultrasound of sports injuries of the musculoskeletal system: gender differences

In recent years, women and girls are increasing their sport participation, and female sports are becoming more challenging. While more women and girls are participating in sports, there is still a lack of information about gender-specific lesions. We will therefore evaluate gender differences in sports injuries, analyzing the five sports and sporting activities that are most widespread in the western world: running, soccer, basketball, water sports, and winter sports. The ability to make correct ultrasonographic diagnoses in sports injuries is improving as the technology is advancing. Ultrasonography demonstrates tissue structure with two-dimensional grayscale images, while blood flow can be visualized with color and power Doppler. Furthermore, ultrasonography is the preferred imaging modality for studying soft-tissue lesions dynamically. High-quality diagnostic ultrasound cannot be performed without the knowledge of the underlying clinical background, and an understanding of gender-specific injuries and mechanisms of injuries is therefore important for assessing proper diagnostic and treatment guidelines tailored to phenotypic differences in professional and amateur athletes between male and female.