Jump to content
We need you! See something you could improve? Make an edit and help improve WikSM for everyone.

Skiing And Snowboarding Medicine

From WikiSM
(Redirected from Skiing)


Other Names

  • Ski Medicine
  • Snowboarding Medicine
  • Skiing Medicine
  • Skiing Injuries
  • Snowboarding Injuries
  • Alpine Skiing
  • Alpine Snowboarding

Background

  • This page reviews injuries associated with alpine skiing and snowboarding

Epidemiology

  • Popularity
    • Estimated 11.5 million skiers, 8.2 million snowboarders in 2010[1]
  • General
    • Overall injury estimates are 1 to 5 per 1000 athlete days[2][3]
    • Snowboarders are more likely to sustain an acute injury than skiers[4]
    • Snowboarding injury rates appear to be increasing while skiing injuries are not[5]
    • Males are more commonly injured than females in both sports[6]
    • The average age of injured skiers is higher than snowboarders[7]
    • Skiers suffer more lower extremity injuries, snowboarders suffer more upper extremity injuries
  • Snowboarding
    • Lower extremity injuries trend towards the lumbar spine, pelvis, hip
    • Suffer more shoulder, neck, humerus, and abdominal injuries[8]
    • Higher risk for head injuries and concussions
    • Ankle injuries more common in snowboarding than skiing[9]
  • Skiing
    • Lower extremity injuries trend towards the knee
  • Severe injuries[10]
    • musculoskeletal injuries are the most common type of injury in snow sports
    • Severe injuries are more likely to affect the head, face, spine, chest, and abdomen
    • Severe injuries are more likely to occur on days with 5 cm or less of snowfall
    • More likely to occur from collisions rather than falls
  • Spine
    • Account for 1% to 17% of all injuries in alpine sports[11]

Introduction

  • More than 9 million active participants in 2017 and 2018[12]

Equipment

  • General
    • Helmet
    • Winter gear (gloves, jacket, hat, goggles, etc)
  • Skiing Equipment
    • Boots
    • Bindings
    • Skis
    • Poles
  • Snowboarding Equipment
    • Board
    • Boots
    • Bindings
  • Not commonly worn
    • Wrist guards
    • Knee brace

Affiliated Bodies

Clinical Setting

  • Typically, initial management occurs on the slope by ski patrol
  • From there, they may end up at clinic at the ski resort, nearby clinic or emergency department
    • Depends on triage and resource availability
  • Ski resorts
    • Large ski resorts often have their own xray and/or ultrasound, smaller or remote mountains are less likely
  • Ski Patrol
    • Must be adequately trained to treat a variety of medical conditions
    • Have confidence to provide care in emergency situations
    • Strongly encouraged are Basic Life Support, Advanced Cardiac Life Support, and Advanced Trauma Life Support
  • Providers
    • Should have some experience with analgesia
    • Procedural sedation for fracture and joint reduction
    • Familiarity with protocols for transport to higher level of care

Evaluation

  • Triage and Initial Evaluation
    • May occur on the slope or nearby medical facility
    • Primary and secondary survey, history characterizing mechanism
    • Strongly consider eFAST if intra-abdominal or chest injuries are suspected
    • IV access, pain management as indicated
    • Risk of hypothermia on slope outweighs most benefits of care and should not delay transportation down the mountain
    • Removal of all equipment is important, preferably by experienced personnel
  • Stabilization, Immobilization, and Transportation
    • Critical patients should be stabilized and transported to higher level of care as soon as possible[13]
    • Priority should also be given to open fractures or other obvious surgical injuries
    • If no limb or life threatening injuries are apparent, outpatient follow up can be arranged
    • Appropriate transportation depends on availability, weather and severity of injury
    • Joint dislocations or fracture reductions should be performed by trained personnel under appropriate anesthesia or analgesia
    • Injuries should be immobilized following reduction
    • Most injuries are non emergent, requiring immobilization, analgesia and close outpatient follow up

Upper Extremity

  • General
    • Upper extremity injuries are more common in snowboarders

Shoulder/Arm

Elbow/ Forearm

Wrist/Hand

  • Distal Radius Fracture
    • Most common upper extremity fracture in snowboarders[16]
    • Usually sustained from falling onto and landing on an outstretched hand
    • More common in younger, inexperienced snowboarders[17]
  • Thumb UCL Injury
    • Often referred to as "skiers thumb", more common in skiers than snowboarders
    • Occurs from sudden valgus force on the thumb after a fall with the ski pole still in hand

Lower Extremity

(A) Anteroposterior radiograph of the left ankle joint of a 22-year-old female snowboarder taken during the initial visit (the day after injury, in which she twisted the ankle during snowboarding) showing a displaced type I fracture of the lateral process of the talus according to the Hawkins classification (arrow). (B) The fracture was not evident on a lateral radiograph.[18]
  • General
    • Lower extremity injuries are more common in skiers
    • Largely due to differences in equipment, overall stance, and fall mechanisms
    • Torsional forces in skiers place the knee at increased risk for ligamentous injury
    • Foot and ankle injuries are the most common lower extremity injuries in snowboarders[19]

Hip/Groin/Thigh

  • No common patterns are well characterized

Knee/Leg

Ankle/Foot

Non Musculoskeletal

Facial

  • General
    • More common in recreational skiers and snowboarders[21]
  • Facial fractures
    • Snowboarders have more maxillofacial fractures than skiers[22]
  • Dental injuries

Head

  • General[23]
    • Leading cause of death, critical injuries in skiing and snowboarding
    • Range from concussion to severe TBI
    • Fall is the primary cause of TBI
  • Concussion
    • Concussions are the most prevalent type of head injury in both skiing and snowboarding[24]
  • Severe head injury
    • Examples include subdural hematoma
    • Collision with an obstacle (tree, rock, lift pole), while the least frequent mechanism of injury, is associated with higher severity head injuries[25]
    • Skiers have higher rates of skull fractures than snowboarders[26]

Spine

Chest

Abdomen/ Pelvis

  • General
    • More common in snowboarding than skiing
    • In skiers, more likely a result of collision
    • In snowboarders, more likely a result of fall or jump[27]
  • Spleen
    • More common in snowboarding
    • Male more likely than female
  • Kidney
  • Pelvis
  • Liver
  • Gastrointestinal tract

Environmental

  • Acute Mountain Sickness
  • UV radiation[28]
    • Ambient exposure increases 2-3% for every 100 M of altitude gained
    • Snow reflection increase UV exposure by 40%
  • Hypothermia
    • More likely to occur in back country skiers than those at a resort[29]
  • Frostbite
  • Avalanche Safety
    • Important consideration for back-country skiers
    • Travel in groups of two, education can limit risk

Prevention

  • Beginners[10]
    • Proper education
    • Sport specific instruction
    • Education on risk awareness
  • Helmet
    • Officially endorsed by the AMA in 1997[30]
    • Helmet use has increased[31]
    • Helmet's reduce the risk and severity of head injuries in skiers and snowboarders[30]
    • Milan et al showed helmet use reduced severity scores in patients admitted to the ICU compared to those who were not helmetted[32]
  • Wrist guards
    • 5.6% of snowboarders with wrist injuries were wearing wrist injuries[33]
    • Wearing wrist guards appears to reduce wrist injuries by up to 50%[33]
    • Russell et al: one wrist injury was prevented for every 50 snowboarders wearing wrist guards[34]
  • Knee Bracing and ACL Injury Prevention
    • Those who don't use brace are 6.4 times more likely to sustain a knee injury[35]
    • In individuals with an ACL reconstructed knee, unbraced knees are 2.7 times more likely to sustain a knee injury
  • Ski Bindings
    • Rued et al: bindings failed in 78% of 498 ACL tears in recreational skiers, greater in females[36]
  • Bindings and Boots

See Also

References

  1. ↑ Kim S, Endres NK, Johnson RJ, Ettlinger CF, Shealy JE: Snowboarding injuries: Trends over time and comparisons with alpine skiing injuries. Am J Sports Med 2012;40(4):770-776.22268231
  2. ↑ Kim S, Endres NK, Johnson RJ, et al. Snowboarding injuries: trends over time and comparisons with alpine skiing injuries. Am. J. Sports Med. 2012; 40: 770–6.
  3. ↑ Davey A, Endres NK, Johnson RJ, Shealy JE. Alpine skiing injuries. Sports Health. 2019; 11:18–26.
  4. ↑ Wijdicks CA, Rosenbach BS, Flanagan TR, et al. Injuries in elite and recreational snowboarders. Br. J. Sports Med. 2014; 48:11–7.
  5. ↑ Owens BD, Nacca C, Harris AP, Feller RJ. Comprehensive review of skiing and snowboarding injuries. J. Am. Acad. Orthop. Surg. 2018; 26:e1–10.
  6. ↑ DeFroda SF, Gil JA, Owens BD. Epidemiology of lower extremity injuries presenting to the emergency room in the United States: snow skiing vs. snowboarding. Injury. 2016; 47:2283–7.
  7. ↑ Pierpoint LA,KerrZY,Grunwald G, et al. Effect of environmental conditions on injury rates at a Colorado ski resort. Inj. Prev. 2019. pii: injuryprev-2019-043275.
  8. ↑ Basques BA, Gardner EC, Samuel AM, et al. Injury patterns and risk factors for orthopaedic trauma fromsnowboarding and skiing: a national perspective. Knee Surg. Sports Traumatol. Arthrosc. 2018; 26:1916–26.
  9. ↑ Bailly N, Afquir S, Laporte JD, et al. Analysis of injury mechanisms in head injuries in skiers and snowboarders. Med. Sci. Sports Exerc. 2017; 49:1–10.
  10. ↑ 10.0 10.1 10.2 deRoulet A, Inaba K, StrumwasserA, et al. Severe injuries associatedwith skiing and snowboarding: a national trauma data bank study. J. Trauma Acute Care Surg. 2017; 82:781–6.
  11. ↑ Franz T, HaslerRM, Benneker L, et al. Severe spinal injuries in alpine skiing and snowboarding: a 6-year review of a tertiary trauma centre for the Bernese Alps ski resorts, Switzerland. Br. J. Sports Med. 2008; 42:55–8.
  12. ↑ National Ski Areas Association. Active domestic skiers/snowboarders, 1996/97 to 2017/18. [cited 2019 September 1]. Available from: http://www.nsaa.org/media/341889/Number_of_participants_by_equipment.pdf.
  13. ↑ Britt LD, Burgess J. Initial assessment and resuscitation of the trauma patient. In: Cameron JL, Cameron AM, editors. Current Surgical Therapy. Philadelphia (PA): Elsevier, Inc; 2017. p. 1115–20.
  14. ↑ Ishimaru D, Matsumoto K, Ogawa H, et al. Characteristics and risk factors of spinal fractures in recreational snowboarders attending an emergency department in Japan. Clin. J. Sport Med. 2016; 26:405–10.
  15. ↑ Crellin CHK, McCarty E. Shoulder injuries. In: Madden CC, Putukian M, McCarthy EC, Young CC, editors. Netter's Sports Medicine. Philadelphia (PA): Elsevier; 2017. p. 367–81.
  16. ↑ Seleznev A, Shah NV, Desai R, et al. Trends of snowboarding-related fractures that presented to emergency departments in the United States, 2010 to 2016. Ann. Transl. Med. 2018; 6:200.
  17. ↑ Abu-Laban RB. Snowboarding injuries: an analysis and comparison with alpine skiing injuries. CMAJ. 1991; 145:1097–103.
  18. ↑ Funasaki, Hiroki, et al. "Arthroscopic reduction and internal fixation for fracture of the lateral process of the talus." Arthroscopy techniques 4.1 (2015): e81-e86.
  19. ↑ Davidson TM, Laliotis AT. Snowboarding injuries, a four-year study with comparison with alpine ski injuries. West. J. Med. 1996; 164:231–7.
  20. ↑ Helmig K, Treme G, Richter D.Management of injuries in snowboarders: rehabilitation and return to activity. Open Access J. Sports Med. 2018; 9:221–31.
  21. ↑ Tuli T, Haechl O, Berger N, et al. Facial trauma: how dangerous are skiing and snowboarding? J. Oral Maxillofac. Surg. 2010; 68:293–9.
  22. ↑ Gassner R, Vasquez Garcia J, LejaW, Stainer M. Traumatic dental injuries and Alpine skiing. Endod. Dent. Traumatol. 2000; 16:122–7.
  23. ↑ Ackery A,Hagel BE, Provvidenza C, Tator CH. An international review of head and spinal cord injuries in alpine skiing and snowboarding. Inj. Prev. 2007; 13: 368–75.
  24. ↑ Haider AH, Saleem T, Bilaniuk JW, Barraco RD, Eastern Association for the Surgery of Trauma Injury Control Violence Prevention Committee. An evidence-based review: efficacy of safety helmets in the reduction of head injuries in recreational skiers and snowboarders. J. Trauma Acute Care Surg. 2012; 73: 1340–7.
  25. ↑ Bailly N, Afquir S, Laporte JD, et al. Analysis of injury mechanisms in head injuries in skiers and snowboarders. Med. Sci. Sports Exerc. 2017; 49:1–10.
  26. ↑ Fukuda O, Takaba M, Saito T, Endo S. Head injuries in snowboarders compared with head injuries in skiers. A prospective analysis of 1076 patients from 1994 to 1999 in Niigata, Japan. Am. J. Sports Med. 2001; 29:437–40.
  27. ↑ Geddes R, Irish K. Boarder belly: splenic injuries resulting from ski and snowboarding accidents. Emerg. Med. Australas. 2005; 17:157–62.
  28. ↑ Rigel EG, Lebwohl MG, Rigel AC, Rigel DS. Ultraviolet radiation in alpine skiing: magnitude of exposure and importance of regular protection. Arch. Dermatol. 2003; 139:60–2.
  29. ↑ Zafren K, Giesbrecht GG, Danzl DF, et al. WildernessMedical Society practice guidelines for the out-of-hospital evaluation and treatment of accidental hypothermia: 2014 update. Wilderness Environ. Med. 2014; 25(Suppl. 4):S66–85.
  30. ↑ 30.0 30.1 Haider AH, Saleem T, Bilaniuk JW, Barraco RD; Eastern Association for the Surgery of Trauma Injury Control/Violence Prevention Committee: An evidence-based review: Efficacy of safety helmets in the reduction of head injuries in recreational skiers and snowboarders. J Trauma Acute Care Surg 2012;73(5):1340-1347.23117389
  31. ↑ Hasler RM, Baschera D, Taugwalder D, Exadaktylos AK, Raabe A: Cohort study on the association between helmet use and traumatic brain injury in snowboarders from a Swiss tertiary trauma center. World Neurosurg 2015;84(3):805-812.26004699
  32. ↑ Milan M, Jhajj S, Stewart C, Pyle L, Moulton S: Helmet use and injury severity among pediatric skiers and snowboarders in Colorado. J Pediatr Surg 2017;52(2):349-353.27876383
  33. ↑ 33.0 33.1 Idzikowski JR, Janes PC, Abbott PJ: Upper extremity snowboarding injuries: Ten-year results from the Colorado snowboard injury survey. Am J Sports Med 2000;28(6):825-832.11101105
  34. ↑ Russell K, Hagel B, Francescutti LH: The effect of wrist guards on wrist and arm injuries among snowboarders: A systematic review. Clin J Sport Med 2007;17(2):145-150.17414485
  35. ↑ Kocher MS, Sterett WI, Briggs KK, Zurakowski D, Steadman JR: Effect of functional bracing on subsequent knee injury in ACL-deficient professional skiers. J Knee Surg 2003;16(2):87-92.12741421
  36. ↑ Ruedl G, Helle K, Tecklenburg K, Schranz A, Fink C, Burtscher M: Factors associated with self-reported failure of binding release among ACL injured male and female recreational skiers: A catalyst to change ISO binding standards? Br J Sports Med 2016;50(1):37-40.26702016
Created by:
John Kiel on 30 December 2022 14:39:57
Authors:
Last edited:
12 January 2023 23:46:48
Category:
Retrieved from "https://wikism.org/w/index.php?title=Skiing_And_Snowboarding_Medicine&oldid=18582"