Epidemiology of Lower Leg Fractures at a Colorado Ski Resort

Abstract

Category: Trauma; Ankle; Sports Introduction/Purpose: Lower extremity fractures are relatively common among winter sports participants. The purpose of this study is to evaluate the demographics, injury mechanisms and environmental features among patients evaluated for lower leg fractures at a high-volume Colorado ski resort during five consecutive ski seasons. Methods: We conducted a retrospective descriptive analysis of patients with lower leg fractures at the Denver Health Winter Park Medical Center during the 2012/13 to 2016/17 ski seasons. We included all fractures below the knee (excluding tibial plateau and isolated fibular head fractures) sustained by skiing or snowboarding. Chart review was performed on the patient cohort, confirming diagnosis and evaluating factors associated with these fractures. Results: There were 346 lower leg, ankle, and/or foot fractures (5.4% of all clinic visits) during the study period. The average age was 33.1 years (range 4-74) with the majority being male (60.7%) and mainly as a result of skiing (84.7%). The majority of fractures were sustained among skiers and snowboarders who self-identified as beginner or intermediate skill level (64.8%), and on easy (green) or intermediate (blue) runs (64.9%). The most common fractures sustained were complete tibia-fibula fractures (30.9%) and lateral malleolus fractures (27.5%). More than half (57.0%) of complete tibia-fibula fractures were classified and boot top (mid- shaft just above the ski boot) fractures. The most common type of lateral malleolus fractures was Danis-Weber B (72.0%) with only 5.4% being Weber C fractures. Foot fractures were rare with only 12 total cases (3.5%). Conclusion: Skiers are much more likely to sustain lower leg fractures compared to snowboarders. Men were much more likely than women to sustain lower leg fractures. Most fractures occurred in mild or moderately difficult ski runs relative to advanced runs. Fractures appear to be more common with advancing age. Complete tibia-fibula fractures were the most common fractures sustained in all riders with lateral malleolus fractures being the second most common. Foot fractures are very rare in this population. Given the frequency of these injuries, additional education around prevention may be warranted.