Skiing injuries in Australia

Snow sports related head and spinal injuries: an eight-year survey from the neurotrauma centre for the Snowy Mountains, Australia

Neurotrauma from snow-sports related injuries is infrequently documented in the literature. In Australia no collective data has ever been published. The aim of this study is to document the injury pattern of snow sports related neurotrauma admissions to The Canberra Hospital, the regional trauma centre for the Snowy Mountains. A computerised hospital record search conducted between January 1994 and July 2002 revealed 25 head and 66 spinal injury admissions. The incidence of severe injuries requiring referral to tertiary trauma hospital was estimated to be 7.4 per 100,000 skier-days and for head and spinal injury 1.8 per 1,000,000 skier-days and 5.6 per 1,000,000 skier-days, respectively. Collision with a stationary object was disproportionately associated with head injury ( [Formula: see text] ) and falling forward with spinal injury ( [Formula: see text] ). Snowboarders tended to sustain cervical fractures more often than skiers ( [Formula: see text] ). The importance of helmet usage in buffering the impact of head-on collision and the proposition of having both feet fastened to a snowboard in leading to cervical injury were highlighted.

Head injury in athletes

HEAD INJURIES INCURRED during athletic endeavors have been recorded since games were first held. During the last century, our level of understanding of the types of cerebral insults, their causes, and their treatment has advanced significantly. Because of the extreme popularity of sports in the United States and worldwide, the implications of athletic head injury are enormous. This is especially true considering the current realization that mild traumatic brain injury (MTBI) or concussion represents a major health consideration with more long-ranging effects than previously thought. When considering athletic injuries, people who engage in organized sports, as well as the large number of people who engage in recreational activities, should be considered. There are 200 million international soccer players, a group increasingly recognized to be at risk for MTBI. The participation in contact sports of a large number of the population, especially youth, requires a careful and detailed analysis of injury trends and recommended treatment. There are numerous characteristics of this patient population that make management difficult, especially their implicit request to once again be subjected to potential MTBI by participating in contact sports. Recent research has better defined the epidemiological issues related to sports injuries involving the central nervous system and has also led to classification and management paradigms that help guide decisions regarding athletes' return to play. We currently have methods at our disposal that greatly assist us in managing this group of patients, including improved recognition of the clinical syndromes of MTBI, new testing such as neuropsychological assessment, radiographic evaluations, and a greater appreciation of the pathophysiology of concussive brain injury. The potential for long-term consequences of repetitive MTBI has been recognized, and we no longer consider the "dinged" states of athletic concussions to have the benign connotations they had in the past. We review the historical developments in the recognition and care of athletes with head injuries, the current theory of the pathophysiology and biomechanics of these insults, and the recommended management strategy, including return-to-play criteria.

Ski injuries in Scotland. A review of statistics from Cairngorm ski area winter 1993/94

Scottish skiing is a growth industry-nearly all acute ski injuries in Aviemore are managed initially by local general practitioners. This study set out to examine the nature and incidence of ski injuries in one Scottish ski resort, and to calculate the additional workload generated for the health centre, ambulance service and local hospital. During the study period, the winter ski season of 1993-94, a prospective study was made of the 486 acute ski injuries presenting to Aviemore Health Centre. Despite frequently poor weather conditions, the season's injury rate for Cairngorm was 2.43 per 1000 skier days which compares favourably with statistics from other ski centres world-wide. The anatomical pattern of injuries for both downhill skiing and snowboarding was similar to that of other countries. Knee injuries constituted nearly one third of all cases. 8% of injuries involved the ski lift machinery. 31% of casualties underwent radiographic examination, 17% needed hospital referral and 7% required admission to hospital. The management of acute ski injuries can be performed effectively in the primary care setting. It has significant benefits in rural areas by rationalising the use of ambulance and hospital services.

Shoulder injuries during alpine skiing

We retrospectively reviewed alpine skiing injuries at a destination ski resort during three seasons to characterize the incidence and types of shoulder injuries. A total of 3451 injuries in 3247 patients were reviewed. The overall injury rate was 4.44 injuries per 1000 skier-days. Injuries to the upper extremity represented 29.1% (N = 1004) of all alpine ski injuries. Injuries involving the shoulder complex (393 injuries in 350 patients) accounted for 39.1% of upper extremity injuries and 11.4% of all alpine skiing injuries. The rate of shoulder injury was 0.51 injuries per 1000 skier-days. Patients with shoulder injuries had a mean age of 35.4 years, and the male-to-female ratio of these patients was 3:1. Falls represented the most common mechanism of shoulder injury (93.9%) in addition to collisions with skiers (2.8%), pole planning (2.3%), and collisions with trees (1%). The most common shoulder injuries were rotator cuff strains (24.2%), anterior glenohumeral dislocations or subluxations (21.6%), acromioclavicular separations (19.6%), and clavicle fractures (10.9%). Less common shoulder injuries included greater tuberosity fractures (6.9%), trapezius muscle strains (6.4%), proximal humeral fractures (3.3%), biceps tendon strains (2.3%), glenoid fractures (1.5%), scapular fractures (1%), humeral head fractures (1%), sternoclavicular separations (0.5%), an acromial fracture (0.3%), a posterior glenohumeral dislocation (0.3%), and a biceps tendon dislocation (0.3%).

Hand injuries on artificial ski slope

50 consecutive patients with injuries due to skiing on an artificial ski slope were seen in our emergency department over a 16-month period; 76% of these involved the hand or wrist. 52.5% of hand lesions were fractures and only one-third of the first ray injuries were sprains of the ulnar aspect of the MP joint. These data significantly differ from those known for skiing on snow.

Gamekeeper's thumb. Ligament localisation by echography

Twenty-one patients presenting clinically with a lesion of the ulnar collateral ligament complex of the metacarpo-phalangeal joint of the thumb underwent prospective diagnostic echography, in order to recognize the possible dislocation of the ligament over the adductor aponeurosis (Stener's lesion). Seven patients were treated surgically, the others conservatively. The accuracy of the echography was controlled by surgery and by the follow-up. We determined 15 true negatives, 4 true positives, 2 false positives, there was no false negative. Ultrasound imaging is a non-invasive, cost-effective diagnostic aid in differentiating the ruptured non-displaced ligament from the true Stener's lesion, solely requiring surgical repartir.

Snow skiing injuries in physically disabled skiers

This study, through retrospective review, examines the injury rate of selected disable skiing populations in general and as compared to able-bodied skiers in areas where comparison was possible. Data on disabled skiers gathered from instructional programs at multiple sites indicate that the disabled skier had a very low rate of injury occurrence. Where comparison could be make, it was found that there was no significant difference in overall injury rates between able-bodied and physically disabled skiers. Disabled skiers appear to sustain less severe injuries, and they do not show the trend in increasing injury rates that able-bodied skiers in this study show. In addition, the uphill transport of skiers with a disability who use sit- or mono-skis was examined in one large program and found to be efficient and exceedingly safe, with no injuries reported. A major limitation of this study is the inconsistency in methods of data collection and reporting. There is a need for further prospective studies in the general able-bodied and disabled skiing populations with direct comparisons of rate, location and severity of injury, type of disability, and experience level of the skier. We hope that this study will stimulate more ski areas to allow disabled skiers on their slopes, even it limited to participation in supervised, instructional programs.

Nordic (cross-country) skiing injuries in Australia

A retrospective study of 88 nordic skiing injuries from the 1984 and 1985 skiing seasons in Australia is presented. To our knowledge, this is the largest study to date of such injuries. These injuries are compared with alpine skiing injuries from the same medical clinic for the 1985 skiing season. There was a much lower incidence of injury from nordic skiing; however, when injuries did occur, they tended to be more serious than those of alpine skiing and frequently required immediate evacuation to hospital for treatment. As the nordic skier is relatively isolated from medical services, these findings need to be considered in the future planning of rescue services for such skiers.

Children's skiing injuries in Australia

Skiing is one of the most popular winter sports for adults and children in Australia. While much is known about the epidemiology of skiing trauma in adults, little has been written about the patterns of skiing injury in children in Australia. During the 1984 ski season, the injuries and risk factors of 149 children were compared with those of 1093 adults who were injured over the same period. Although Australian children were found to be possibly less prone to injury than were adults, they did sustain more serious injuries, in particular, fractures of the tibia. The significantly different associated risk factors that are thought to be responsible were the greater number of children who were injured in collisions and ski-lift accidents, and inadequate bindings on their skis. Such shortcomings are correctable; children require better boot-bindings and greater supervision on the ski-slopes.

Artificial ski slope injuries: a 1-year prospective study

Skiing is one of the fastest growing sports in the United Kingdom. A prospective study of 119 patients who sustained injuries while skiing on the Edinburgh artificial ski slope was performed. The ratio of injury of the arm to that of the leg was 4.2:1, which is the reverse of that found with snow skiing. In particular, thumb injuries accounted for 32 per cent of all injuries. Attention is drawn to the high incidence of damage to the ulnar collateral ligament of the metacarpophalangeal joint of the thumb, which is related to the construction of the 'snow slope' matting. The pattern of injury is described and the mechanisms of injury discussed.

Hypothermia among resort skiers: 19 cases from the Snowy Mountains

Even in relatively temperate environments, accidental hypothermia is a potentially lethal complication of exposure. We have reviewed our experience of accidental hypothermia among recreational alpine skiers at an Australian resort during the 1983 and 1984 seasons. There were 19 cases of accidental hypothermia, which occurred in 10 men and nine women who were aged between six and 47 years (mean age, 15.9 years) and who had rectal temperatures that ranged from less than 35 degrees C to 36 degrees C. The temperature at presentation to the Ski Injury Clinic was less than 35 degrees C in seven cases. One patient presented to the Clinic with a gastrointestinal haemorrhage in addition to hypothermia, and one was initially thought to be suffering from alcohol intoxication. Two patients were lost in the snow overnight. All patients were removed from the snow, changed into warm dry clothes where necessary, and their body temperatures allowed to return to normal spontaneously (17 patients), or were exposed to heat actively by means of inhaled, heated, humidified air (two severely obtunded patients). All patients responded satisfactorily. There were no deaths and no sequelae. We conclude that all skiers should be advised to wear effective thermal insulation, and to ski with a partner to ensure that adequate care is taken to prevent accidental hypothermia. Inhalational "warming" is effective in the treatment of hypothermia in obtunded patients.