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

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.

Impact of anterior cruciate ligament surgery on the development of knee osteoarthritis: A systematic literature review and meta-analysis comparing non-surgical and surgical treatments

Introduction

Context: The development of knee osteoarthritis (OA) after anterior cruciate ligament (ACL) injury is now widely recognized. The impact of surgical or non-surgical management on the development of post-traumatic osteoarthritis is still debated in the medical community.Here, we present a meta-analysis comparing the impact of surgical or non-surgical management of ACL injuries on the development of knee OA.

Method

A systematic literature review was conducted using data from the PubMed, EMBASE, Medline, and Cochrane libraries from February to May 2019. Only randomized clinical trials published between 2005 and 2019 with a non-surgical group and a surgical group were included to explore the onset or progression of knee OA after ACL injury. Trials had to have at least one radiographic endpoint (Kellgren-Lawrence scoring system). Heterogeneity was assessed using the Cochrane's Q and I2 statistical methods.

Results

Only three randomized controlled trials met the inclusion criteria and were selected for meta-analysis. Of the 343 injured knees included in the studies, 180 underwent ACL reconstruction and 163 underwent non-surgical treatment. The relative risk of knee osteoarthritis was higher after surgery than after non-surgical treatment (RR 1.72, CI 95% [1.18-2.53], I2 ​= ​0%).

Conclusion

The results of this meta-analysis suggest a predisposition to knee osteoarthritis after ACL reconstruction surgery compared with non-surgical management. Due to the small number of good quality studies available, further well-conducted randomised studies are needed to confirm these findings.

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.

Clinical characteristics of patients with snow sports trauma transported to a trauma care center: A retrospective observational study

BACKGROUND

Snow sports are a popular recreational activity; however, the incidence of injury of snow sports can be high for skiers and snowboarders. Our hospital receives severe trauma cases from snow resorts and hospitals throughout the region. This study aimed to determine whether the risk of snow sports-related major trauma that requires emergency surgery under general anesthesia varies by the equipment and injury mechanism.

METHODS

This retrospective cohort study included patients with snow sports trauma referred to Gifu University Hospital, Japan between November 2010 and March 2020. We analyzed the need for emergency operation under general anesthesia within 24 h using Fisher's exact test. We identified 106 patients: (1) 90 in the snowboarders' group and 16 in the skiers' group or (2) 46 in the fall after jumping group (jumping group), 27 in the collide with other people and obstacle group (collision group), and 33 in the fall during gliding group (gliding group).

RESULTS

Snowboarders were nearly twice as likely as skiers to require emergency surgery under general anesthesia (44% vs. 25%; p = 0.236]. No significant associations were found between emergency surgery under general anesthesia and injury mechanism, but half of the patients in the jumping group required emergency surgery.

CONCLUSIONS

Snowboard as equipment and falls after jumping as a mechanism of injury tended to be associated with emergency surgery under general anesthesia, with no significant differences. In order to provide adequate resources for snow sports trauma, the cause of the patient's injury is strongly related to the urgency of the condition, and transport to a trauma center should be actively considered. Further studies are warranted with respect to the effects of personal protective equipment and skill level.

Relationship between Lower Extremity Fitness Levels and Injury Risk among Recreational Alpine Skiers: A Prospective Cohort Study

Background: Although the importance of physical fitness for injury prevention is recognized in sports medicine and rehabilitation, few studies have investigated this factor among recreational alpine skiers. Objective: To determine the effect of lower extremity fitness on the risk and severity of injury among recreational alpine skiers. Method: This prospective cohort study involved 117 recreational skiers at two alpine resorts during the 2021−2022 winter season. Anthropometric characteristics, skiing skills, and lower extremity agility (hexagon test), balance (Y-Balance Test), and endurance (60-s squat test) were assessed before the winter season. All of the participants were divided into an injured group and an uninjured group, based on whether an injury was recorded throughout the season. Results: In binary logistic regression, the hexagon test duration and composite Y-Balance Test score were significant injury risk factors (p < 0.05). Ordinal polytomous logistic regression revealed no significant factors for injury severity (p > 0.05). Conclusions: Recreational alpine skiers with inferior lower extremity agility or balance may have a higher injury risk and this must be considered when assessing individual risk. In the context of injury prevention, regular neuromuscular training and testing, including agility and balance aspects should be recommended to skiers.

Pelvic ring injuries after alpine ski and snowboard accidents

PURPOSE

The purpose of this study was to analyze the patient/injury characteristics and associated hospital course of patients sustaining traumatic pelvic ring injuries after alpine ski and snowboard accidents at a level one trauma center in the Rocky Mountain region.

METHODS

Patient/injury characteristics were obtained from patients presenting with pelvic ring injuries after alpine ski (n = 55) and snowboard (n = 9) accidents. Characteristics and outcomes analyzed included mechanism of injury, pelvic ring classification (Young-Burgess and Tile), hospital admission, physical therapy (PT) clearance, ambulation, length of stay, inpatient morphine milligram equivalents (MME), and discharges to rehabilitation facility.

RESULTS

Snowboarders were more often younger, male, tobacco/substance users, and more likely to be injured by a fall from height than skiers. There were no differences in injury classification or hospital course outcomes between alpine sports. Most common injuries included lateral compression type 1 (LC1) injuries (37.5%), isolated pubic ramus fractures (31.3%), and isolated iliac wing fractures (15.6%). LC1 injuries were unstable in 50% of cases and associated with increased admissions (proportional difference: 47.5%, CI: 23.8-64.5%, p = 0.0002), longer time to PT clearance (median difference(MD): 1.0 day, CI: 0-2.0, p = 0.03), longer LOS (MD: 2.0, CI: 0-2.0, p = 0.02), and increased inpatient MMEs (MD: 197.9 MME, CI: 30.0-420.0, p = 0.02), as compared to other pelvic ring injuries.

CONCLUSION

The majority of pelvic ring injuries from alpine ski and snowboard accidents were LC1 injuries, half of which were unstable, resulting in longer hospital stays, time to PT clearance/ambulation, and opioid use.

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

Background

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

Methods

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

Results

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

Conclusion

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

Supplementary Information

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

Turbans vs. Helmets: A Systematic Narrative Review of the Literature on Head Injuries and Impact Loci of Cranial Trauma in Several Recreational Outdoor Sports

When in public, faith-based mandates require practising Sikh men to wear a turban which may not be covered by hats or caps. This makes it impossible for practising Sikhs to wear helmets and other protective headwear, mandatory in many countries and facilities for engagement in recreational pursuits (e.g., skiing) and on adventure outdoor recreation camps mandatorily run for school groups. The result is often social exclusion and ostracisation in the case of school children. Despite studies into the efficacy of protective helmets in some recreational outdoor activity settings, virtually nothing is known about the protective potential of turbans. This paper systematically reviews the extant literature on head injuries in several recreational outdoor activities and sports sectors (aerial, water, winter, wheeled and animal-based sports) and finds that the extant literature is of limited value when trying to understand the spatial distribution of trauma on the cranial surface. As the data do not permit to make inferences on the protective potential of turbans, future systematic, evidence-based epidemiological studies derived from hospital admissions and forensic examinations are required. Failure to do so perpetuates social exclusion and discrimination of religious grounds without an evidentiary basis for defensible public health measures.

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.

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.

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.

Epidemiology and injury patterns of aerial sports in Switzerland

BACKGROUND

Airborne sports have become more popular in recent years. The number of accidents has increased linearly as athletes take increasingly greater risks to experience the adventurous spirit of this kind of sports.

AIM

To investigate the variety of injuries in airborne sport accidents, as well as which acute treatment these patients receive, both before and after admission to a level-one-trauma center.

METHODS

We performed a retrospective chart analysis at a major level-one-trauma center in Switzerland for 235-patients who were admitted following airborne sports injuries between 2010 and 2017. Patients’ demographic data, injury patterns, emergency primary care procedures and intra-hospital care were recorded.

RESULTS

Overall, 718-injuries in 235-patients were identified; the spine was the most commonly affected region with 46.5% of injuries (n = 334/718) in 143-patients. In 69-patients (15.5%), the (non-spine) thorax was affected, followed by the lower and upper extremity, pelvis, head/face and abdominal injuries. Eleven-patients had to be intubated at the trauma site. Three patients were resuscitated after onset of pulseless-electrical-activity. Two-patients died in the resuscitation room. In 116-cases, surgery was indicated including 55-emergency surgeries. Another 19 patients (8.1%) were transferred to the intensive care unit.

CONCLUSION

Paragliders are most commonly affected, although the highest injury severities were identified for Building, Antenna, Span and Earth-jumping athletes. First responders, treating physicians and pilots should be aware of the risk for potentially serious and life-threatening injury with an in-hospital mortality of 0.9%.

Dual-energy CT characterization of winter sports injuries

CT is a readily available imaging modality for cross-sectional characterization of acute musculoskeletal injuries in trauma. Dual-energy CT provides several additional benefits over conventional CT, namely assessment for bone marrow edema, metal artifact reduction, and enhanced assessment of ligamentous injuries. Winter sports such as skiing, snowboarding, and skating can result in high speed and high energy injury mechanisms; dual-energy CT is well suited for the characterization of those injuries.

Injury patterns after skiing and snowboarding sports accidents

BACKGROUND

Alpine sports are associated with risk of serious injuries. To gain insight into factors that may help reduce injury severity, accident characteristics and injury patterns were analyzed in a cohort of injured skiers and snowboarders.

METHODS

All patients with Alpine sports-related injuries, reporting the injury to a leading medical assistance organization in the Netherlands in the period of 2013-2016, were contacted. Medical data were collected from the patients' files. Only ski and snowboard incidents were included. Injuries were classified according to the Abbreviated Injury Scale (AIS) and Injury Severity Scale (ISS). Data on the accident conditions, i.e. risk factors, were collected using retrospective patient-reported questionnaires. Risk factors for injuries with ISS≥9 were analysed by multivariate modelling.

RESULTS

Of the 1588 included patients, 421 patients filled out the questionnaire. Skiers (N.=1370) had more knee injuries (20.4% vs. 7.4%, P<0.001), femur fractures (5.3% vs. 0.5%, P=0.002) and lower leg fractures (27.5% vs. 11.5%, P<0.001) compared to snowboarders (N.=218). Skiers were also more seriously injured (ISS>9) (P=0.01). Injured snowboarders sustained more brain concussions (8.8% vs. 15.7%, P=0.003) and lower arm fractures (5.4% vs. 16.1%, P<0.001). Only 'a higher skills level' was borderline significant for predicting serious injury (OR: 4.0 95% CI: 0.86-18.50; P=0.08). No additional risk factors were identified.

CONCLUSIONS

Injury patterns after skiing and snowboarding accidents differ, injury severity differed not. Preventive measures should therefore aim to protect specific body parts depending on the type of Alpine sport. Experienced skiers and snowboarders may be more at risk for serious injuries.

Alpine Skiing Injuries

Context:

Alpine skiing is a popular sport worldwide but has significant risk for injury. The epidemiology of skiing-related injuries has been described, which has led to the identification of risk factors for specific types of injuries.

Evidence Acquisition:

Pertinent literature from peer-reviewed publications was reviewed.

Study Design:

Clinical review.

Level of Evidence:

Level 5.

Results:

The adoption of international standards for ski-boot-binding systems has changed the profile of skiing-related injuries over time, as has the widespread use of helmets. An understanding of mechanisms of injury, risk factors, and preventative measures may decrease the incidence of skiing-related injuries.

Conclusion:

Advances in standards for skiing equipment have been effective at decreasing both the frequency and severity of skiing-related injuries, but additional efforts are required to improve the safety of the sport.

Management of injuries in snowboarders: rehabilitation and return to activity

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

Cervical Spine Alignment in Helmeted Skiers and Snowboarders With Suspected Head and Neck Injuries: Comparison of Lateral C-spine Radiographs Before and After Helmet Removal and Implications for Ski Patrol Transport

OBJECTIVE

Current protocols for spine immobilization of the injured skier/snowboarder have not been scientifically validated. Observing changes in spine alignment during common rescue scenarios will help strengthen recommendations for rescue guidelines.

METHODS

Twenty-eight healthy volunteers (18 men, 10 women) age 47±17 (range 20-73) (mean ±SD with range) underwent a mock rescue in which candidate patrollers completing an Outdoor Emergency Care course performed spine immobilization and back boarding in 3 scenarios: 1) Ski helmet on, no c-collar; 2) helmet on, with c-collar; and 3) helmet removed, with c-collar. After each scenario, a lateral radiograph was taken of the cervical spine to observe for changes in alignment.

RESULTS

Compared with the control group (helmet on, no collar), we observed 9 degrees of increased overall (occiput-C7) cervical extension in the helmet on, with collar group (P < .001), and 17 degrees in the helmet off, with collar group (P < .001). There was increased extension at the occiput-C2 intersegment in the helmet on, with collar group (9 degrees, P < .001) and at both the occiput-C2 (9 degrees, P < .001) and C2-C7 (8 degrees, P < .001) intersegments in the helmet off, with collar group.

CONCLUSION

Ski helmet removal and c-collar application each leads to increased extension of the cervical spine. In the absence of other clinical factors, our recommendation is that helmets should be left in place and c-collars not routinely applied during ski patrol rescue.

Concussion Among Youth Skiers and Snowboarders: A Review of the National Trauma Data Bank From 2009 to 2010

OBJECTIVE

There are limited data regarding concussion among youth skiers and snowboarders. The objective of this study was to examine the frequency of concussion among helmeted and unhelmeted youth skiers and snowboarders presenting to trauma centers.

METHODS

Subjects 18 years or younger with a ski- or snowboard-related injury were studied using data from the National Trauma Data Bank from 2009 to 2010. We further selected those with head/neck injuries and stratified based on helmet status. Concussive injuries were identified from International Classification of Diseases, 9th Revision codes. Severity analysis was based on the Glasgow Coma Scale and Injury Severity Score.

RESULTS

A total of 1001 subjects met inclusion criteria with 678 subjects having documented helmet status. Subjects 12 years or younger were more likely to use helmets compared to 13-18 year-olds (odds ratio, 2.21; 95% confidence interval [95% CI], 1.52-3.21). Skiers were more likely to use helmets compared to snowboarders (odds ratios, 1.60; 95% CI, 1.16-2.19). Snowboarders had a greater likelihood of concussion (estimated-β, 2.1; 95% CI, 1.48-2.85) after adjusting for helmet status and age. There was no significant difference in the frequency of concussion among helmeted compared to unhelmeted subjects. Imputing missing values for helmets status had no effect on outcome for concussion. We found no difference in injury severity among helmeted compared to unhelmeted subjects.

CONCLUSIONS

Among youth skiers and snowboarders who present to trauma centers with a head injury, the likelihood of that injury involving a concussion was not associated with helmet use.

Changes in Skiing and Snowboarding Injury Epidemiology and Attitudes to Safety in Big Sky, Montana, USA: A Comparison of 2 Cross-sectional Studies in 1996 and 2013

Background

Despite a risk of harm, the past 20 years have seen dramatically increased participation in snow sports such as skiing, and particularly, snowboarding. This period has also seen revolutions in piste maintenance and paradigm developments in the use of safety equipment. Consequently, the numbers and characteristics of injury may be very different from those traditionally quoted.

Purpose

To compare and evaluate the injury patterns among skiers and snowboarders in a North American ski resort in 1996 and 2013.

Study Design

Cross-sectional study; Level of evidence, 3.

Methods

Questionnaire-based cross-sectional studies were carried out independently in a North American ski resort between the dates of March 6 and April 11 in both 1996 and 2013. Demographic data and information about incident circumstances were collected from injured patients who visited the local on-site clinic. Data were compared statistically to assess for significant changes in injury characteristics between the 2 time periods.

Results

The 1996 report consisted of 148 injured participants, and the 2013 study included 156 participants. Results from 2013 demonstrated significant increases in helmet use, the number of snowboarders injured, and shoulder injuries. Injury was also more likely in those aged 46 to 55 years, those never having had professional instruction, or those with rented equipment. Significant reductions were seen in those injured with other people close by and in the 36- to 45-year age group. Overall, the knee was the most commonly injured body part in both periods (1996: 31%, n = 38; 2013: 33%, n = 36), although upper limb injuries were predominant in snowboarders.

Conclusion

Snow sports injury characteristics of patients presenting to a ski resort medical clinic have changed between 1996 and 2013. These findings can be used to further inform safety recommendations and areas to target with further research.

Review of snowboarding injuries

Snowboarding is a popular sport and can lead not only to various injuries including wrist fracture, closed head injury and acromioclavicular injuries but also to others such as scaphoid fracture or ulna collateral ligament injury which is often difficult to diagnose. Having a high suspicion for specific injuries from known injury patterns associated with snowboarding may help earlier diagnosis which can result in better outcomes for the patient. The severity of injuries will vary depending on the individual’s skill level and their use of protective equipment. Preventive methods for injuries among snowboarders may need to be devised based on differences in skill levels. This review focuses on injuries associated with the use of snowboards, draws comparisons with skiing injuries and suggests strategies for injury prevention.

Favourable changes of the risk-benefit ratio in alpine skiing

During the past five decades recreational alpine skiing has become increasingly safer. The numerous annual media reports on ski injuries have to be interpreted on the basis of the tremendous numbers of skiers. These favourable changes seem primarily be due to the introduction of short carving skis, more rigid and comfortable ski boots, the use of protective gear like helmets, and the optimized preparation of ski slopes. The associated health benefits from skiing, especially arising from its association with a healthier life style, and possibly also from effects related to hypoxia preconditioning and increasing subjective vitality by natural elements clearly outweigh the health hazards. Technical improvements will likely help further reducing the injury risk. At least hypothetically, each individual skier could help to prevent injuries by the development of an appropriate physical fitness and responsible behaviour on ski slopes thereby optimizing the risk-benefit ratio of alpine skiing.

Is reconstruction the best management strategy for anterior cruciate ligament rupture? A systematic review and meta-analysis comparing anterior cruciate ligament reconstruction versus non-operative treatment

AIMS

The purpose of this study was to determine the optimal clinical and cost-effective strategy for managing people following ACL rupture.

METHODS

A systematic review of the published (AMED, CINAHL, MEDLINE, EMBASE, PubMed, psycINFO and the Cochrane Library) and unpublished literature (OpenGrey, the WHO International Clinical Trials Registry Platform, Current Controlled Trials and the UK National Research Register Archive) was conducted on April 2013. All randomised and non-randomised controlled trials evaluating clinical or health economic outcomes of isolated ligament reconstruction versus non-surgical management following ACL rupture were included. Methodological quality was assessed using the PEDro appraisal tool. When appropriate, meta-analysis was conducted to pool data.

RESULTS

From a total of 943 citations, sixteen studies met the eligibility criteria. These included 1397 participants, 825 who received ACL reconstruction versus 592 who were managed non-surgically. The methodological quality of the literature was poor. The findings indicated that whilst reconstructed ACL offers significantly greater objective tibiofemoral stability (p<0.001), there appears limited evidence to suggest a superiority between reconstruction versus non-surgical management in functional outcomes. There was a small difference between the management strategies in respect to the development of osteoarthritis during the initial 20 years following index management strategy (Odds Ratio 1.56; p=0.05).

CONCLUSIONS

The current literature is insufficient to base clinical decision-making with respect to treatment opinions for people following ACL rupture. Whilst based on a poor evidence, the current evidence would indicate that people following ACL rupture should receive non-operative interventions before surgical intervention is considered.

Knee Injuries in Downhill Skiers: A 6-Year Survey Study

BACKGROUND

Knee injuries account for approximately one third of injuries in skiers. Researchers have proposed several mechanisms of knee injury in skiers. However, the frequencies of these mechanisms have varied in different studies.

PURPOSE

To identify the most common knee injury mechanisms in recreational downhill skiers and to assess injury frequencies across several demographics.

STUDY DESIGN

Descriptive epidemiology study.

METHODS

Over 6 ski seasons, 541 patients with acute knee injuries completed a survey. Patients selected 1 of 6 injury classifications; age, sex, height, weight, years of experience, ability level, and ski binding release were also recorded.

RESULTS

The overall injury distribution was valgus-external rotation (32.9%), phantom foot (22.5%), hyperextension (19.0%), boot induced (7.8%), collision (2.2%), and other (15.6%). The phantom foot mechanism was most common in ages 30 to 40 years (36.3% of all injuries within this mechanism; P < .01). Children and adults showed no significant difference in distribution of injury mechanism. Of 80 youth skiers, valgus-external rotation was most common (35.4%), followed by phantom foot (25.3%). Adult and youth skiers who identified as "advanced" skiers had a higher prevalence of valgus-external rotation than did less experienced skiers (51.5% of total valgus injuries; P < .01). Bindings released in 19.3% in adults and 53.7% in youths (P < .01) during injury. Female skiers comprised 60.0% of total respondents, but only 39.7% of injuries occurred in female children (P < .01).

CONCLUSION

Valgus-external rotation is the most common injury mechanism for recreational skiers in general. Previous studies have suggested that the phantom foot injury is the most common injury, but in this series, it was the second most common, representing 22.5% of injuries in this study. Individuals between the ages of 30 and 40 years showed an increased risk for the phantom foot mechanism, and the prevalence of injuries was significantly higher for females compared with males in this cohort (P < .01). Children and adults appear to have similar mechanisms for ski-related knee injuries, with valgus-external rotation being most common and advanced skiers having the highest frequency of this mechanism. Binding release was more likely to occur in youth skiers.