Common Skiing and Snowboarding Injuries

Epidemiology of paediatric winter sports-related injuries in France: The WINTRAUMA-1 retrospective cohort study

AIM

To describe the epidemiology of injuries related to winter sports in patients younger than 15 years in France.

METHODS

We conducted a retrospective observational multicentre cohort study of patients younger than 15 years who were seen by mountain-community general practitioners for winter-sports injuries in 1999-2022.

RESULTS

Of the 108 619 patients (mean age, 11.4 ± 2.8 years), 76 724 (70.6%), 26 186 (24.1%) and 2132 (2.0%) were injured while skiing, snowboarding and sledding, respectively. Helmet use was noted in 50 164 (46.2%) patients and increased over time but remained low among sledders. A collision was the mechanism in 12.3% of patients overall and 32.1% of sledders. The most common injuries overall were wrist fractures (48.5%), head and trunk injuries (42.3%), and anterior cruciate ligament (ACL) tears (23.7%), with wrist fractures being more common in beginners (24.7%) and head/trunk injuries and ACL tears in advanced participants (18.3% and 2.6%, respectively). Only 3699 (3.4%) patients were admitted after the general-practitioner visit, notably for leg or ankle fractures (9.5%).

CONCLUSION

Winter sports-related injuries vary according to age, sex, skill level and sport. Admission rates are low but might be further decreased by better prevention. Protective measures should be tailored to each sport and individual.

Risk Factor Analysis of Ski and Snowboard Injuries During the 2023/2024 Winter Season: A Single, High-Volume Trauma Center Database Analysis

Background and Objectives: The objective of the study was to evaluate the epidemiology of slope-related accidents in a high-volume trauma center during the winter season. In addition, this study aims to analyze patient-related, equipment-related, and environment-related characteristics. Materials and Methods: A questionnaire containing 22 items was distributed to all adult patients admitted to the emergency department of the Brixen Hospital (Italy) during the 2023/24 winter season because of a ski/snowboard-related injury. Results: The final database included 579 questionnaires from 579 patients who ultimately entered the study: 285 were females and 294 were males. The analysis of risk factors for fractures revealed that patients with fractures were generally older (50.7 ± 16.0 years) compared to those without fractures (45.4 ± 17.2 years, p = 0.0021). Thirty-six percent of injuries were considered as joint sprain/ligament strain: patients in this group were younger (45.5 ± 16.2 years) compared to all patients (48.3 ± 17.3 years, p = 0.0151). Conclusions: In conclusion, this study identified significant risk factors associated with skiing and snowboarding injuries. Fractures were more common among older and more experienced skiers, particularly those who described themselves as experts. Ligamentous distortions were more common among younger and less experienced skiers. Fatigue is generally underestimated, and the general physical preparation is often lacking for sports like skiing and snowboarding. Additionally, the absence of significant correlations between weather conditions, snow quality, equipment type, and the difficulty of the slope with injury risk suggests that individual factors such as age and skill level are more critical determinants of injury risk than environmental or equipment-related factors.

Pediatric Snowboarding-Related Concussions and Musculoskeletal Injuries Decreased From 2012 to 2022

Purpose

To analyze mechanisms, diagnoses, and incidence of youth snowboarding-related injuries presenting to US emergency departments.

Methods

Data from the National Electronic Injury Surveillance System were analyzed for pediatric snowboarding injuries (≤18 years old) from 2012 to 2022. Data were collected for mechanism of injury, diagnosis, location of injury, and disposition. National estimates (NEs) were calculated using the statistical sample weight of the corresponding hospital assigned by the National Electronic Injury Surveillance System. Linear regressions were used to analyze injuries over time.

Results

In total, 3,036 (NEs = 120,140) pediatric snowboarding injuries were included in this study. Average age was 14.0 ± 2.7 years. The most common mechanism of injury was impact with the ground (NEs = 97,120, 80.8%). The most injured body parts were 719 wrists (NEs = 115,505, 96.1%), 580 heads (NEs = 22,258, 18.5%), and 381 shoulders (NEs = 17,269, 14.4%). The most common diagnoses were fractures (NEs = 48,886, 40.7%), strains/sprains (NEs = 22,948, 19.1%), and concussions (NEs = 12,553, 10.4%). Fractures primarily involved the wrist (NEs = 18,122, 37.1%), lower arm (NEs = 12,348, 25.3%), and shoulder (NEs = 9,073, 18.6%). From 2012 to 2022, there were average decreases of 1,051 overall injuries per year (P < .01), 299 fractures per year (P = .04), 298 strains/sprains per year (P < .01), and 143 concussions per year (P < .01). There were average decreases of 784 impact with ground injuries per year (P < .01), 161 not specified injuries per year (P < .01), and 42 impact with inanimate object injuries per year (P = .03) from 2012 to 2022.

Conclusions

Pediatric snowboarding injuries demonstrated a large decline from 2012 to 2022. Fractures are the most common diagnosis, primarily affecting the wrist and shoulder. The head was the second most injured body part, and concussions were the third most common diagnosis.

Clinical Relevance

This study highlights decreasing injuries despite growing popularity of snowboarding, bringing to light the importance of protective equipment, on-site injury management, and implementation of clinics at resort bases.

Beyond the Slopes and Highways: Endovascular Repair of Blunt Traumatic Aortic Injuries after Skiing versus Motor Vehicle Accidents

Background: Blunt traumatic aortic injury (BTAI) is a potentially fatal condition, typically resulting from high-velocity trauma. To date, little is known about this type of injury among skiers, who form the largest patient cohort with aortic injuries in the alpine region of Tyrol, Austria. Methods: This retrospective, single-center study at the University Hospital of Innsbruck analyzed patients who underwent endovascular treatment for blunt traumatic aortic injury from 2005 to 2023. Patient data were extracted from electronic and digitalized medical history records. Subsequent analyses compared the baseline characteristics and clinical results of the skiing accident (SA) group to the motor vehicle accident (MVA) group. Results: A total of 48 BTAI patients receiving TEVAR were included, 25 (52%) from SAs versus 23 (48%) from MVAs, who were predominantly male (92% vs. 78.3%). Despite similar preoperative risk profiles and ASA Scores (1.44 vs. 1.74) and no marked differences in BTAI injury grades or the affected aortic zones, significant disparities emerged: the SA group experienced shorter median ICU stays (3 vs. 11 days, p = 0.0007), fewer concomitant injuries (5 vs. 7, p = 0.005), and lower Injury Severity Scores (ISSs) (29 vs. 33, p = 0.003) than their MVA counterparts. The presence of rib fractures alongside other thoracic injuries, such as lung injury, pneumothorax, or hemothorax, was strongly correlated with BTAI in patients following skiing accidents (OR = 128.5). Conclusions: The injury severities and locations of BTAI in SA patients were comparable to those in MVA patients, indicating similar mechanisms of thoracic trauma. However, the SA patients experienced fewer concurrent pelvic and extremity fractures, had less post-procedural morbidity, and required shorter ICU stays. The presence of rib fractures combined with other thoracic injuries strongly suggests BTAI. These indicators should lead to prompt imaging and appropriate therapy.

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.

Exploring the Epidemiology of Injuries in Athletes of the Olympic Winter Games: A Systematic Review and Meta-Analysis

This study sought to provide a comprehensive assessment of the incidence of sports injuries among athletes participating in the Olympic Winter Games and to investigate contributing factors. We gathered injury data from athletes participating in the recent four Olympic Winter Games, incorporating details on the sports event, sex, injury location, and type. Through a meta-analysis, we calculated the injury incidence rates for each sport and examined the influence of sex and the type of sport on these incidence rates. Out of 11,197 registered athletes, we documented 1,304 sports injuries. The sports events with the highest injury rates were freestyle skiing, snowboarding, alpine skiing, bobsleigh, and ice hockey, with the most frequent injury locations being the knees, thoracic/lumbar/back regions, and the wrist/hand/fingers. Contusions, hematomas, and bruises were the most prevalent injuries, followed by strains (including muscle rupture, tearing, or tendon rupture) and sprains (covering dislocations, subluxations, and ligament ruptures). In the Olympic Winter Games, events such as freestyle skiing, snowboarding, alpine skiing, bobsleigh, and ice hockey pose a particularly high risk. Predominant injury sites include the knee, spine/back, and wrist and hand, with injuries ranging from contusions and hematomas to strains and sprains. For effective injury prevention, it is crucial to emphasize proper medical resource allocation, specialized training for medical personnel, and meticulous venue maintenance.

Emergency Abdominopelvic Injuries

The presentation of traumatic abdominopelvic injuries in sport can range from initially benign appearing to hemorrhagic shock. A high clinical suspicion for injury, knowledge of the red flags for emergent further evaluation, and familiarity with the initial stabilization procedures are necessary for sideline medical providers. The most important traumatic abdominopelvic topics are covered in this article. In addition, the authors outline the evaluation, management, and return-to-play considerations for the most common abdominopelvic injuries, including liver and splenic lacerations, renal contusions, rectus sheath hematomas, and several others.

Biomechanical evaluation of Back injuries during typical snowboarding backward falls

To prevent spinal and back injuries in snowboarding, back protector devices (BPDs) have been increasingly used. The biomechanical knowledge for the BPD design and evaluation remains to be explored in snowboarding accident conditions. This study aims to evaluate back-to-snow impact conditions and the associated back injury mechanisms in typical snowboarding backward falls. A previously validated snowboarder multi-body model was first used to evaluate the impact zones on the back and the corresponding impact velocities in a total of 324 snowboarding backward falls. The biomechanical responses during back-to-snow impacts were then evaluated by applying the back-to-snow impact velocity to a full human body finite element model to fall on the snow ground of three levels of stiffness (soft, hard, and icy snow). The mean values of back-to-snow normal and tangential impact velocities were 2.4 m/s and 7.3 m/s with maximum values up to 4.8 m/s and 18.5 m/s. The lower spine had the highest normal impact velocity during snowboarding backward falls. The thoracic spine was found more likely to exceed the limits of flexion-extension range of motions than the lumbar spine during back-to-snow impacts, indicating a higher injury risk. On the hard and icy snow, rib cage and vertebral fractures were predicted at the costal cartilage and the posterior elements of the vertebrae. Despite the possible back injuries, the back-to-snow impact force was always lower than the force thresholds of the current BPD testing standard. The current work provides additional biomechanical knowledge for the future design of back protections for snowboarders.

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.

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.

Estimating skills level in recreational skiing: Development and validation of a practical multidimensional instrument

Skiing and snowboarding are both popular recreational alpine sports, with substantial injury risk of variable severity. Although skills level has repeatedly been associated with injury risk, a validated measure to accurately estimate the actual skills level without objective assessment is missing. This study aimed to develop a practical validated instrument, to better estimate the actual skills level of recreational skiers, based on the criteria of the Dutch Skiing Federation (DSF), and covering five different skill domains. A sample of Dutch recreational skiers (n = 84) was asked to fill in a questionnaire reflecting seven, a priori chosen predictors by expert opinion, to ski downhill and to be objectively evaluated by expert assessors. The instrument was developed to have a multidimensional character and was validated according to the TRIPOD guideline (Transparent reporting of a multivariable prediction model for individual prognosis or diagnosis). The sample reported an overall incorrect self-reported estimation of their skills, compared with the observed skill score. The instrument showed good calibration and underwent multiple validation methods. The estimated skills score showed to be closer to the observed scores, than self-reportage. Our study provides a practical, multidimensional, and validated instrument to estimate the actual skills level. It proved to better reflect the actual skills levels compared with self-reportage among recreational skiers.

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.

Slippery Slopes: Skiing-Related Facial Trauma in Adults

Study Design:

Retrospective, observational, cross-sectional study.

Objective:

To determine the incidence of skiing-related facial trauma and to identify their patterns in terms of potential risk factors, mechanism of injury, anatomical location, and degree of severity.

Methods:

Data was collected using the National Electronic Injury Surveillance System and included snow skiing-related incidents during the years 2009 to 2018. Specifically, injuries limited to the facial region including the head, face, eye(s), mouth, neck or ear(s) were reported. Patients with fractures were further classified by the study variables. Descriptive statistics were used to classify continuous variables while chi-square analysis was used to compare categorical variables.

Results:

A total of 514 (n = 514) patients met the inclusion criteria within the study period. The majority of injuries were due to concussions (59%), followed by lacerations (18%), fractures (11%), contusions (11%) and dental injuries (1%). Of the fractures seen, the majority were nasal (30%) and cervical spine (30%), followed by midface (27%), mandible (9%) and skull (4%). In our population, head injuries were more common in females (80%) than in males (60%), whereas, mouth injuries were more common in males (8%) than females (1%) [χ2 = 30.2, p < 0.001].

Conclusions:

Skiing-related craniofacial trauma remains a significant mechanism of injury. Our data illustrates a need to correlate these injuries to the use of personal protective equipment. Furthermore, this data calls for the strict implementation of such equipment and the development of safety protocols to further prevent deleterious injury.