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.

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.

Telemark skiing injuries: characteristics and risk factors

OBJECTIVE

To determine the types of injuries associated with telemark skiing and the effects of ability level, equipment, and terrain.

METHODS

A survey was mailed to a sample of North American telemark skiers.

RESULTS

Completed surveys were returned by 548 telemarkers (response rate = 74.5%). The mean age was 42.7 (+/- 9.3) years, and 69% were male. A total of 439 injury events resulted in 494 body injuries, reported by 285 skiers (52%). Lower-extremity injuries (n = 231) were more frequent than upper-extremity injuries (n = 187). Knee injuries were most common with 128 cases, followed by 80 thumb, 66 shoulder, and 44 ankle injuries. Surgery was required in 39 cases. Skiers suffering thumb injuries with sequela lasting greater than 3 months were 10.1 times less likely to have sought medical attention than skiers with other long-term injuries (p < 0.001). Injuries occurred more often at lift-served ski areas (74.2%) than in the backcountry (25.8% [p < 0.001, OR = 2.09]). There was no association between boot type and overall knee or ankle injury, but risk of severe ankle injury was increased in leather boots compared to plastic (OR = 8.0, CI = 1.05, 60.59). Release bindings were used by 27.9% of all skiers but were in use in only 18.7% of injury events, suggesting that release plates have a protective effect against injury (OR = 0.59, p < 0.001). In 66 of 82 injuries (80.5%) sustained while using release bindings, the bindings did not release.

CONCLUSIONS

The knee, thumb, shoulder, and ankle are most frequently injured telemark skiing. Injuries are more likely to occur at lift-served areas than in the backcountry. Thumb injuries are often ignored and may result in long-term sequela. Ankle injuries appear more severe in leather boots. Release bindings appear protective against injury, but they often do not release.

The epidemiology of skiing injuries in Antarctica

A retrospective analysis of all skiing injuries experienced by members of the British Antarctic Survey between 1989 and 1995 was undertaken to test the hypothesis that skiing was responsible for a disproportionate number and severity of injuries compared with other activities. Fifty-nine new consultations for skiing injuries were recorded. This represented 3.2% of all consultations (annual range 1.3-6.7%), or 9.7% of all consultations due to trauma. The mean incidence was 84.3/1000 population/year. The annual proportion and rate of consultation fluctuated but no overall trends were noted. The lower limb was the commonest site of injury (76.3%), with the ratio of lower limb: upper limb injuries being 6.4:1. The commonest single injury was an isolated medial collateral ligament knee sprain (23.7% of all consultations). Head injuries comprised 8.5% and ulnar collateral ligament thumb sprains 5.1%. Assessment of injury by the Injury Severity Score (ISS) showed that skiing injuries were significantly more likely to be non-trivial (ISS > 2) than work-related injuries [chi 2(1, N = 56) = 55.6, p < 0.001] or injuries of all causes [chi 2(1, N = 56) = 65.0, p < 0.001]. They were significantly more likely to need radiological investigation than all injuries [chi 2(1, N = 59) = 22.0, p < 0.001]. The most severe (ISS 13), survivable injury seen during the study period resulted from a skiing accident. This excess of non-trivial injury raises important management issues, particularly as the majority (81%) were recreational.

Telemark skiing injuries: a three-year study

Telemark skiing is an increasingly popular wilderness activity. Little is known, however, about the injuries incurred during modern telemark skiing. To determine the incidence and types of these injuries we carried out a prospective analysis of injured telemarkers over three ski seasons from November 1994 through May 1997 at the Mount Hood Meadows ski area medical clinic in Oregon. Injured telemark skiers presenting to the clinic were asked to fill out a one-page survey, and a diagnosis was provided by the clinic physician or nurse. During the 1995-1996 and 1996-1997 ski seasons, skiers were counted at the ski lifts to determine the proportion of telemark skiers, alpine skiers, and snowboarders using the lifts. Using these proportions and the total ticket sales for the year, the number of downhill skiers, snowboarders, and telemarkers over the season were estimated, and injury rates were calculated. During the three ski seasons, 33 injuries were identified in 28 injured telemarkers. Of the study participants, 75% (21) were male. The average age was 33.1 years. Self-described intermediate and advanced telemarkers accounted for 74% of the injured. In 96% of the injuries, the skier was performing a telemark turn. Powder snow or heavy, wet snow conditions were reported most often. Lower-extremity injuries were most common, accounting for 42.5% (14) of the total. Seven of the lower-extremity injuries were ankle injuries, and four were knee injuries. Upper-extremity injuries comprised 24.2% (8) and head and facial injuries 21.2% (7) of the total. The least number of injuries occurred in the spine, 12.1% (4). Release plates were used by 8 of 28 skiers and only released in two instances. Telemark skiers comprised 0.9% of skiers counted at the lifts during the 1995-1996 season and 1.8% in 1996-1997. Injury rates/1000 skier days in 1995-1996 were 3.3 (95% CI: 3.27, 3.35) for downhill skiers, 4.1 (95% CI: 3.32, 5.22) for telemark skiers, and 6.8 (95% CI: 6.54, 7.00) for snowboarders. Injury rates/1000 skier days in 1996-1997 were 3.1 (95% CI: 3.05, 3.15) for downhill skiers, 1.7 (95% CI: 1.44, 2.11) for telemark skiers, and 5.6 (95% CI: 5.39, 5.78) for snowboarders. We conclude that telemark skiers comprise only a small proportion of skiers at a lift-served area. Lower-extremity injuries were most common, followed by upper-extremity and head and facial injuries. Injury rates for telemarkers are comparable to those for alpine skiers.

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%).

Spectrum of injuries from snowboarding

OBJECTIVE

To examine and compare the types, frequency, and associated risk factors of injuries sustained in snowboarders with downhill skiers.

DESIGN

Prospectively administered survey.

MATERIALS AND METHODS

All snowboarders and skiers who presented to a rural hospital emergency department in California during one winter season were asked to answer a survey eliciting information regarding participants' demographics, previous experience, equipment use and circumstances surrounding their injury.

MEASUREMENTS AND MAIN RESULTS

An overall response rate of 87.4% yielded examination of 355 injured snowboarders. Victims tended to be male (81%) with a mean age of 19.8. Snowboarders were more likely to injure the upper limb than skiers (58% vs. 32%, respectively, p < 0.001) but less likely to injure the lower extremities (16% vs. 35%, p < 0.001). Wrist injuries were most common. Nonorthopedic injuries were less common but potentially life threatening. The data also suggest that aerial maneuvers are associated with increased risk of injury to the head, face, spine, and abdomen and that collisions are associated with more severe injury. Snow conditions had no apparent effect on the type, location, or severity of injury and the reported use of alcohol and drugs was low (7%). It was estimated that snowboarders comprised 20 to 25% of participants on the slope but represented 45% of emergency department visits.

CONCLUSIONS

There exists a wide spectrum of injuries from snowboarding, ranging from common extremity injuries to potentially life-threatening nonorthopedic trauma.

Trends in public hospital injury admission rates, Victoria, July 1987 to June 1993

Admissions to Victorian public hospitals because of injury for the six years from July 1987 to June 1993 were analysed to ascertain the frequencies, rates and trends over time in rates. This information is important for epidemiological purposes, to determine priorities for injury prevention and, as baseline data, to monitor the success of interventions. The major causes of injury, and their rates, did not change markedly. Falls or transport-related injuries were still the major cause of hospitalisation. The mean annual all-age frequency over the six years was 67,902, an all-age, all-cause rate of 1620 per 100,000. The highest frequencies of injury occurred in the young age groups, 15-19, 20-24 and 25-29 years, but the highest rates occurred in the over-60 age groups. The all-age, all-cause injury rate increased significantly at 39 per 100,000 per year (2.4 per cent per year), notwithstanding the decreasing rate of transport-related injury of 17 per 100,000 per year (7.5 per cent). Significant increases were also observed for injuries from falls in all age groups and intentional self-inflicted injuries. For the 15-24 years age group, transport-related injury rates declined by 35 per 100,000 per annum but intentional injury rates were increasing. In the over-65 years age group, rates of injury from falls were increasing by 3.3 per cent per annum. The benefits of investment in prevention of transport-related injury are apparent. With high rates, frequencies and increases over time for many injury causes, similar resources for prevention of other causes of injury are justified and necessary.

Differing injury patterns in snowboarding and alpine skiing

This is a study of all people presenting to ski patrollers with ski and snowboard injuries during the 1995 season. There were 476 casualties of whom 396 were skiers and 57 were snowboarders. Information was collected retrospectively on the mechanism, region and injury, and also personal details of the casualties. The information was compared with the numbers of ski and snowboard injuries for the 1994 season. Injuries due to snowboarding increased in frequency, from 4 per cent in 1994 to 11 per cent in 1995. Snowboarders were younger, predominantly male, and were more often beginners than were skiers. They most commonly sustained ligament strains, dislocations and fractures, with the hand and forearm and shoulder most affected. Skiers sustained more ligament strains and soft tissue bruising, particularly of the knee and thumb. Snowboarders sustain a different pattern of injuries compared with skiers, and this has important implications for preventing accidents in the instruction of novices.

Severe skiing injuries: a retrospective analysis of 361 patients including mechanism of trauma, severity of injury, and mortality

All ski accident patients requiring an inhospital treatment at our institute from 1984 to 1992 (n = 2,053) were analyzed retrospectively. The incidence, pattern, and severity of the injuries, as well as the 30-day mortality comparing two time slots (1984 to 1988 and 1989 to 1992) were analyzed for the 361 cases classified as "serious" injuries according to the following definitions and groupings: group 1, multiple trauma (Injury Severity Score > or = 18) and patients with multiple fractures (n = 179; group 2, abdominal or thoracic single trauma (Abbreviated Injury Scale (AIS) score > or = 2, n = 58); and group 3, isolated head injuries (AIS score > or = 2, n = 124). Serious injuries were observed in 19% in the first period compared to 16% in the second period (not significant). Two hundred thirty-eight of 361 patients injured themselves by just falling, while 117 collided with some sort of obstacle like other skiers (45), trees or rocks (27), posts, pylons, barriers (20), and moving objects (25) such as piste machines, ski lifts, automobiles, and in one case a helicopter. Six skiers were caught on the ski run by an avalanche. Comparing the two time periods, trauma circumstances did not change significantly. The number of most severe head injuries (AIS score > or = 4) increased from 11.6 to 19.3% (p < 0.05). The overall mortality increased from 2 to 7% (p < 0.05). Group 2 had the best prognosis with no mortality, while group 3 was rated worst with 8%. Skiing remains a major source of serious trauma in winter resort areas.(ABSTRACT TRUNCATED AT 250 WORDS)

Changing injury pattern of acute anterior cruciate ligament tears treated at Tampere University Hospital in the 1980s

During the years 1980-1989, 450 patients with an acute anterior cruciate ligament (ACL) rupture were treated at the University Hospital of Tampere, Finland. ACL ruptures were diagnosed by arthroscopy or open surgery. The data were analyzed in terms of patient age, sex, injury etiology, injury type and sports activity to determine the trends in the 1980s. The number of ACL tears seen in the Hospital increased by 247% over this period. Sixty-three percent of the patients were male (mean age 33 years) and 37% female (mean age 39 years), and there were no changes in the sex and age distribution in 1980s. The most common injury type was the isolated ACL rupture (51%), followed by a combination injury of the ACL and medial collateral ligament (38%). Isolated ACL ruptures in the 1980s increased 6.5 times. Sports accounted for 54% of all injuries without any sign of change in their relative proportion in 1980s. The most common sports causing the rupture were soccer (29%), downhill skiing (20%), cross-country skiing (12%) and volleyball (12%). From 1980 to 1989, there was a decrease (2 times) in ACL injuries sustained in cross-country skiing and a substantial (30 times) increase in ACL injuries sustained in downhill skiing.

Skier's thumb: a literature review

Skier's thumb is defined as an acute injury to the ulnar collateral ligament of the metacarpophalangeal joint of the thumb. This review details the history, aetiology, epidemiology, anatomy, diagnosis, surgical and conservative treatment regimes, rehabilitation and current advances in the prevention of skier's thumb. It emphasises the importance of accurate diagnosis of skier's thumb, and appropriate referral of grade three ruptures for surgery. The need for research by physiotherapists which examines this common soft tissue injury is highlighted throughout the review.