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Skiing And Snowboarding Medicine

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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
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12 January 2023 23:46:48
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