Ski Accident Research Articles

Beyond the Slopes and Highways: Endovascular Repair of Blunt Traumatic Aortic Injuries after Skiing versus Motor Vehicle Accidents.

Background: Blunt traumatic aortic injury (BTAI) is a potentially fatal condition, typically resulting from high-velocity trauma. To date, little is known about this type of injury among skiers, who form the largest patient cohort with aortic injuries in the alpine region of Tyrol, Austria. Methods: This retrospective, single-center study at the University Hospital of Innsbruck analyzed patients who underwent endovascular treatment for blunt traumatic aortic injury from 2005 to 2023. Patient data were extracted from electronic and digitalized medical history records. Subsequent analyses compared the baseline characteristics and clinical results of the skiing accident (SA) group to the motor vehicle accident (MVA) group. Results: A total of 48 BTAI patients receiving TEVAR were included, 25 (52%) from SAs versus 23 (48%) from MVAs, who were predominantly male (92% vs. 78.3%). Despite similar preoperative risk profiles and ASA Scores (1.44 vs. 1.74) and no marked differences in BTAI injury grades or the affected aortic zones, significant disparities emerged: the SA group experienced shorter median ICU stays (3 vs. 11 days, p = 0.0007), fewer concomitant injuries (5 vs. 7, p = 0.005), and lower Injury Severity Scores (ISSs) (29 vs. 33, p = 0.003) than their MVA counterparts. The presence of rib fractures alongside other thoracic injuries, such as lung injury, pneumothorax, or hemothorax, was strongly correlated with BTAI in patients following skiing accidents (OR = 128.5). Conclusions: The injury severities and locations of BTAI in SA patients were comparable to those in MVA patients, indicating similar mechanisms of thoracic trauma. However, the SA patients experienced fewer concurrent pelvic and extremity fractures, had less post-procedural morbidity, and required shorter ICU stays. The presence of rib fractures combined with other thoracic injuries strongly suggests BTAI. These indicators should lead to prompt imaging and appropriate therapy.

Characteristics of Fatal Accidents due to Exogenous Causes at Ski Resorts in Japan Over the Past 13 Years: A Retrospective Descriptive Study.

The characteristics of ski- and snowboard-related fatalities at Japanese ski resorts remain unknown. We aimed to analyze the characteristics of this in the current study. Using the Ski Resort Injury Report data for the 13-y period between the 2011-12 and 2022-23 seasons, we described the characteristics of fatal accidents due to exogenous causes. Eighty-four subjects (48 skiers and 36 snowboarders) were analyzed. Males accounted for 73 cases of all 84 fatalities (86.9%), including 44 skiers (91.7%) and 29 snowboarders (80.6%). Skiers aged ≥50 y and snowboarders aged 20-35 y had the highest number of fatal accidents (32 and 18 cases, respectively). Regarding location, 26 fatal accidents occurred on slopes, and 58 occurred out of slopes (skiers, 11 and 37 cases; snowboarders, 15 and 21 cases, respectively). Among skiers, head and neck trauma accounted for the cause of death in 13 cases (27.1%) and asphyxiation in 11 cases (22.9%). Among snowboarders, head and neck trauma accounted for the cause of death in 14 cases (38.9%) and asphyxiation in 14 cases (38.9%). Males, particularly those aged ≥50 among skiers and 20-35 among snowboarders, should be wary of the potential for injuries to the head, neck, and airway when skiing or snowboarding. In this study, traumatic deaths from crashing into trees and asphyxiation from deep snow immersion accidents accounted for approximately half of fatal ski accidents in Japan.

A novel framework for video-informed reconstructions of sports accidents: A case study correlating brain injury pattern from multimodal neuroimaging with finite element analysis

Ski racing is a high-risk sport for traumatic brain injury. A better understanding of the injury mechanism and the development of effective protective equipment remains central to resolving this urgency. Finite element (FE) models are useful tools for studying biomechanical responses of the brain, especially in real-world ski accidents. However, real-world accidents are often captured by handheld monocular cameras; the videos are shaky and lack depth information, making it difficult to estimate reliable impact velocities and posture which are critical for injury prediction. Introducing novel computer vision and deep learning algorithms offers an opportunity to tackle this challenge. This study proposes a novel framework for estimating impact kinematics from handheld, shaky monocular videos of accidents to inform personalized impact simulations. The utility of this framework is demonstrated by reconstructing a ski accident, in which the extracted kinematics are input to a neuroimaging-informed, personalized FE model. The FE-derived responses are compared with imaging-identified brain injury sites of the victim. The results suggest that maximum principal strain may be a useful metric for brain injury. This study demonstrates the potential of video-informed accident reconstructions combined with personalized FE modeling to evaluate individual brain injury. Statement of significanceReconstructing real-world sports accidents combined with finite element (FE) models presents a unique opportunity to study brain injuries, as it enables simulating complex loading conditions experienced in reality. However, a significant challenge lies in accurately obtaining kinematics from the often shaky, handheld video footage of such accidents. We propose a novel framework that bridges the gap between real-world accidents and video-informed injury predictions. By integrating video analysis, 3D kinematics estimation, and personalized FE simulation, we extract accurate impact kinematics of a ski accident captured from handheld shaky monocular videos to inform personalized impact simulations, predicting the injury pathology identified by multimodal neuroimaging. This study provides important guidance on how best to estimate impact conditions from video-recorded accidents, opening new opportunities to better inform the biomechanical study of head trauma with improved boundary conditions.

Injuries of the shoulder in winter sports

Skiing as asport has come along way from the first competitive event in Norway in 1767 to about 200million skiers today worldwide. With Germany alone recording around 8000 injuries annually, there is an increased need for awareness for winter-sport-related injuries and their management. According to the latest report by "Auswertungsstelle für Skiunfälle" (ASU, evaluation center for ski accidents), shoulder injuries alone account for more than 20% of injuries to all body regions (men 26.1% and women 13%). The most common injuries affecting the shoulder girdle are rotator cuff strains, glenohumeral dislocations, acromioclavicular dislocations and clavicle fractures. These injuries are primarily the result of four mechanisms: direct impact, axial load on an extended arm, resisted forced abduction of the arm, and external rotation forces resulting from afirmly planted ski pole in the grasp of askier during afall. In this article, we describe the three most common shoulder girdle injuries in winter sports along with their management and answer the most important questions for the athlete.

Traumatic brain injury in the elderly after a skiing accident: A retrospective cohort study in a level 1 emergency department in Switzerland.

BackgroundSkiing is a very popular sport worldwide, with increasing trends over the past decades. This study aimed to evaluate the importance of traumatic brain injury (TBI), especially in the elderly, after a ski accident, and to describe its short-term repercussions.MethodologyPatients were analyzed who were admitted to our neurotrauma center from 2012–2018 after a head trauma while skiing. Three different age groups were differentiated and analyzed for the severity of TBI depending on the initial Glasgow Coma Scale as the primary outcome and as secondary outcomes need and type of surgery, Glasgow Outcome Score, preexisting use of anticoagulant or antiplatelet drugs, time to presentation, and pattern of brain injury. TBI severity was adjusted to the time to initial medical consultation.ResultsNo significant difference in TBI severity was found when comparing the middle (>29–54) and older (≥54) age groups to the reference group <30 years (OR:0.45, p = 0.127; OR:0.46, p = 0.17). Acute subdural hemorrhage was present in 21.2% of the ≥55 group and 14.5% of the 30–54 age group, compared to 12.8% of the youngest group (p = <0.001). Overall, 39.4% of the patients in the ≥55 group and 8.1% of the 30–54 age group presented with chronic subdural hemorrhage, whereas none of the youngest patients did (p = <0.001).ConclusionNo differences were observed in terms of TBI severity between age groups after acute trauma. Nonetheless, a different pattern of head injury after TBI in older patients was demonstrated. Accordingly, the management differs for these TBIs compared to those of younger patients.

U-SHAPED MICROVASCULAR FIBULA FLAP FOR MAXILLARY RECONSTRUCTION AFTER LE FORT I AVULSION

Our objective is to present the use of the U-shaped microvascular fibula flap (US-MFF) for posttraumatic maxillary reconstruction. The technique is indicated for full Le Fort I maxillary reconstruction. The fibula flap is cut into 3 segments. The first and third segments aim to reconstruct bilateral alveolar ridges as well as the zygomaticomaxillary buttresses. The middle segment is used to reconstruct the anterior maxilla. Flap is fixed with 2.0 mini plates and screws. A 20-year-old female patient involved in a jet ski accident presented full Le Fort I maxillary avulsion. Reconstruction was performed using the US-MFF technique. The procedure had no vascular complications and showed satisfactory stability. After 3 months, iliac free bone grafting was made to provide supplementary canine buttress width. The successful reconstruction of trauma victims is challenging, due to the extension of trauma and underlying social aspects. The US-MFF is a viable alternative for reconstructing extensive maxillary defects.

Reviewing my career as a hematologist-oncologist and a quality control specialist in clinical trials

After a long-term hospitalization following a ski accident in college, I decided to choose a specialty in hematology and oncology. In graduate school, after learning the basics of biostatistics and the methodology of clinical trials, I had the opportunity to go through a series of clinical trial tasks, from launching to writing a clinical study report, which led to the study drug approval. This has greatly motivated me to be actively involved in this field. At the Dana-Farber Cancer Institute, I studied outcomes research under a supervisor, and at a time of difficulty, my good role model, Dr. Stephanie Lee, had urged me, saying, "That which does not kill you makes you stronger." Subsequently, I devoted myself to the establishment of a data center for a Japanese pediatric leukemia/lymphoma study group, currently a subcommittee of the Japan Children's Cancer Group, and to develop an academic research organization for conducting ICH-GCP-compliant international clinical trials, including the originally developed EDC system. I was struggling in balancing work and parenting. Fortunately, I was supported by my encounters with respectable people.

Acquired Brain Injury-Induced Hyperphagia and Obesity, Successfully Treated With a GLP-1 Agonist

Background: Several Glucagon-like peptides 1 (GLP-1s) were approved since 2005 for the treatment of DM & obesity. Their usefulness in other conditions is not well studied. We present two cases of hyperphagia after TBI successfully treated with GLP-1 agonists. Clinical cases: Case 1: A 54-year-old female with a history of multiple traumatic brain injuries (multiple falls and a ski accident) complained of years of insatiable hunger leading to hyperphagia and over 20 pounds weight gain. With tremendous will-power, she avoided additional weight gain by adopting a strict meal-plan and increasing her water intake (10–12 liters a day) to relieve her hunger. She sipped so much water, that her sodium remained 123 - 133 mmol/L (ref: 135–146) with dilute urine. Initial tests revealed: IGF-1 315 ng/ml (52–328), FSH 77.5 mIU/ml (23–116.3), LH 24.3 mIU/ml (14.2–52.3), prolactin 17.1 ng.ml (10–54.7), estradiol 17 (<31), TSH 1.09mIU/ml (0.45–4.5), FT4 1.0 ng/dl(0.8–1.8), all within the normal limit for her age. Semaglutide 0.25mg/week was started and increased to 0.5mg/week. Within the first six months of treatment, she experienced 22 pounds of weight loss, hunger relief, less water sipping behavior, and more enjoyment of food. Her sodium rose to 137 mmol/L. Case 2: A 40-year-old female, s/p craniectomy and aneurysm clipping due to intracranial hemorrhage complicated by an ischemic stroke developed sudden, documented, 45-pound weight gain over thirteen months despite aggressive lifestyle modification attempts. Initial labs revealed: TSH 1.33 mIU/ml (0.45–4.5), FT4 1.22 ng/dl (0.8–1.8), midnight salivary cortisol 0.03 mcg/dl (<0.09), ruling out hypothyroidism and Cushing syndrome. Liraglutide 1.8mg/day was started and has resulted to date in 26 pounds (11.8% of maximum weight) by 9 months with an associated decrease in subjective hunger. Conclusion: Hyperphagia can be seen in brain injury, in response to some medications, and some genetic conditions, like Prader-Willi. The exact mechanisms are not clear am may be multifactorial. In the case of brain injury, proposed mechanisms include insatiable hunger due to ventromedial hypothalamic or brain stem dysfunction, or disinhibition and poor impulse control due to frontal lobe injury. GLP-1’s may act on the causal mechanism for increased hunger, or it may result in clinical improvement through a parallel pathway. More studies are warranted to investigate the application of GLP-1’s to hyperphagia.

Ski Accidents and Liability of Possessor or Owner of Artifact - Focusing on Concept and Defects of Artifact of Article 758 of Civil Act -

Ski Accidents and Liability of Possessor or Owner of Artifact - Focusing on Concept and Defects of Artifact of Article 758 of Civil Act -

Safety and Liability in the practice of Skiing: How Law and Cognitive Sciences shape the driving factor of Winter Tourism

Witnessing an injured skier being airlifted by helicopter from a winter ski resort is an unforgettable event, reminding us of the risks of snow-based winter sports, particularly alpine skiing. The world’s media attention for the ski accident suffered by Michael Schumacher for example, illustrated a collective concern for the safety of ski areas (Allen, 2014), showing how even the slightest inattention on the part of the skier, combined with the lack of optimal precautions of the ski area, may cause serious, and potentially fatal, injuries.

The Distribution of Social Costs of Ski Accidents through Tort Law: Limits of Fault-Based Liability in Practice – and Alternative Regimes

The Distribution of Social Costs of Ski Accidents through Tort Law: Limits of Fault-Based Liability in Practice – and Alternative Regimes

Real World Experience: The Role of the Nurse Informaticist

17 A Personal Sentinel Event: The Nurse’s Role in Preventing Vascular Complications Pamela Mahaffrey, DNP, ACNS-BC, RN Vascular complications DVT and PE are seen as preventable vascular complications. Keys to preventing these types of complications are ardent assessment and the implementation of appropriate VTE prophylaxis. This presentation will inspire and motivate nurses to assure timely assessments and interventions to prevent vascular complications during hospitalization and after a major trauma. A personal story regarding a traumatic ski accident resulting in multiple bone fractures and subsequent complications including stroke, brain surgery and DVTwill be reviewed. Abstract 18 Standardized Wound Care Education Program18 Standardized Wound Care Education Program

A Personal Sentinel Event: The Nurse's Role in Preventing Vascular Complications

17 A Personal Sentinel Event: The Nurse’s Role in Preventing Vascular Complications Pamela Mahaffrey, DNP, ACNS-BC, RN Vascular complications DVT and PE are seen as preventable vascular complications. Keys to preventing these types of complications are ardent assessment and the implementation of appropriate VTE prophylaxis. This presentation will inspire and motivate nurses to assure timely assessments and interventions to prevent vascular complications during hospitalization and after a major trauma. A personal story regarding a traumatic ski accident resulting in multiple bone fractures and subsequent complications including stroke, brain surgery and DVTwill be reviewed. Abstract 18 Standardized Wound Care Education Program18 Standardized Wound Care Education Program

Purtscher’s retinopathy after intramedullary nailing of a femoral shaft fracture in a 20-year old healthy female – report of a rare case and review of the literature

BackgroundPurtscher’s retinopathy is a sight threatening, occlusive microvasculopathy associated with trauma, it is rarely reported after long bone fractures.Case presentationA 20-year-old female sustained a femoral shaft fracture (AO 32-A2.3) in a ski accident colliding with a snowgun and was treated with intramedullary nailing one hour after the accident. 14 hours after surgery the patient complained of loss of vision in both eyes and was therefore referred to a neurologist, furthermore an MRI scan of the brain was performed. Neither showed any pathological findings. The patient was finally transferred to an ophthalmology department. After slit lamp examination and funduscopy Purtscher’s retinopathy was diagnosed. Treatment was started right after diagnosis and 5 days after the onset of symptoms. The patient was administered intravenous haemo-rheologic therapy for five days as well as low molecular heparine in therapeutic dose and Vasonit® 400 mg bid orally.At follow-up 4 weeks and 6 months later visual acuity had improved after 4 weeks before that exam. At final follow-up the symptoms had almost resolved completely and uncorrected visual acuity (UCVA) and best corrected visual acuity had improved from originally 0.25 decimal in both eyes to 0.8 decimal UCVA and BCVA in both eyes.ConclusionsPatients suffering from perioperative loss of vision have to be referred for ophthalmological and neurological assessment as soon as possible. History of trauma and visual loss can point to the diagnosis of Purtscher’s retinopathy.

Assessing Economic Damages in Personal Injury and Wrongful Death Litigation: The State of Colorado

AbstractThis article presents the legal framework for the assessment of economic damages in the state of Colorado. Special attention is given to the statutes, case law, and procedural rules that govern the estimation of damages in personal injury and wrongful death actions including medical malpractice and ski accidents. Also included are an overview of the jury instructions and the role of the forensic economic expert in the assessment of economic damages.

Management of Deep Vein Thrombosis of the Upper Extremity

Case 1: A 34-year-old previously healthy male office manager was admitted with acute onset of heaviness, pain, and functional impairment of his right arm. The arm was cyanotic and massively swollen (Figure 1). For the past weeks, he reported transient paresthesia of his right arm during overhead activities and was unable to perform repetitive or strenuous arm exercise. He had a fracture of the right clavicle after a ski accident 5 years previously. The fracture was managed conservatively. There was no personal or family history of thrombosis. Conventional phlebography confirmed axillary and subclavian vein thrombosis (Figure 2, top), and treatment with intravenous unfractionated heparin was started. Figure 1. Clinical presentation of case 1 with massive swelling and cyanosis of the right arm (left). One day after pharmacomechanical thrombolysis, signs of thrombosis have markedly improved (right). Figure 2. Baseline digital subtraction venogram from case 1 with extensive filling defects in the axillary subclavian veins (top). Control venogram after 15 hours of pharmacomechanical thrombectomy confirmed resolution of filling defects and restored venous flow (middle). Positional venography obtained during abduction of the right arm confirmed the venous thoracic outlet syndrome with residual stenosis of the subclavian vein at the costoclavicular junction (white arrow, bottom). Case 2: A 55-year-old man with lung cancer presented with swelling, heaviness, and pain in his left arm 1 week after completion of chemotherapy administered via a left-sided indwelling central venous catheter. Axillary and subclavian vein thrombosis was confirmed by ultrasonography. Low-molecular-weight heparin (LMWH) was initiated, and the catheter was removed 3 days later because it was no longer functional. At 1 week, pain and functional impairment had not improved, and the circumference of the left upper arm had increased by 2 cm. Case 3: A 65-year-old woman with metastatic ovarian cancer presented with swelling of the face and both arms, headache, …

Ureteral injury after percutaneous iliosacral fixation: a case report and literature review

We report a case of right ureter injury in an 11-year-old girl after a percutaneous iliosacral screwing with non–computer-assisted fluoroscopic guidance. The indication was a pelvic ring fracture, C1-1 in the Tile modified AO classification (J Am Acad Orthop Surg. 1996;4:143-151). The mechanism was a ski accident. A percutaneous iliosacral screwing was performed to stabilize the right iliac wing fracture. Twelve days after the initial trauma, a right ureter tear was highlighted, just opposite the fourth lumbar vertebra. Uneventful spontaneous healing of the ureteral injury site occurred following double J-stent catheterization.

Fatalities on Austrian Ski Slopes During a 5-year period

While the mean injury rate from snow sports in Austria is low (less than 2 injuries per 1000 skier days), there is little information about fatalities on Austrian ski slopes. The purpose of this study was to evaluate incidence and causes of fatalities among recreational skiers and snowboarders over a 5-season period on Austrian ski slopes. All traumatic and nontraumatic fatal ski accidents from the 2005-2006 through the 2009-2010 winter season were compiled by members of the Federal Ministry of the Interior. Data on age, gender, nationality, gear used, altitude, accident cause, primary cause of death, and helmet use were collected. The number of fatalities was related to a million skier days during this 5-year period. In total, 207 fatalities were registered during this time period. An overall incidence of 0.79 deaths per million skier days was calculated. Mean age was 50.9 ± 17.7 years. More than 85% of all fatalities occurred in males and 93.1% in skiers. Mean altitude was 1706.1 ± 517.7 m above sea level. In total, 52.7% were nontraumatic deaths, with the majority (73%) attributed to cardiac arrest. Regarding traumatic deaths, 41.2% died after a fall, 18.6% after collision with another skier, and 35.1% after an impact with a solid object. Head injury was the primary cause of death in 46.4% of traumatic deaths. Death is a rare event in recreational winter sports on Austrian ski slopes. Nevertheless, awareness of potential risk factors and common dangers may impact snow riders' behavior and help reduce the incidence of on-slope fatalities.

Physical work capacity required to avoid ski accidents examined using the equations of ski-skier system motion

Alpine skiing is a dangerous sport. According to Japanese legal precedent in ski accident cases, the skier has an obligation to foresee and avoid any dangers in skiing. The purposes of this study were 1) to identify the human physical work capacity required to avoid a ski accident using the equations of the ski-skier motions and 2) to study ski accidents from point of the human physical capacity or condition. To undertake this study, the power to control the velocity in skiing was calculated using the equation of ski-skier system motion. The calculated power, for example, to control the ski-skier system velocity of 15m/s was 3933.0 (W), with an air resistance coefficient of 0.5, θ was 30 degrees and the weight was 65.0kg. On the other hand, the maximum anaerobic powers (Pmax) and the wingate powers (P40) (which was the explosive capacity) of 12 subjects were measured using a bicycle ergometer. Furthermore, the vertical jump power (VJP) in each subject was measured using a force platform. As an example of these measurement results, the average of the Pmax was 862.9 (W). From these results, it was thought to be difficult to avoid ski accident completely using only the human physical work capacity.

Supernumerary phantom limbs in spinal cord injury

Case report and review of supernumerary phantom limbs in patients suffering from spinal cord injury (SCI). SCI rehabilitation centre. After a ski accident, a 71-year-old man suffered an incomplete SCI (level C3; AIS C, central cord syndrome), with a C3/C4 dislocation fracture. From the first week after injury, he experienced a phantom duplication of both upper limbs that lasted for 7 months. The supernumerary limbs were only occasionally related to painful sensation, specifically when they were perceived as crossed on his trunk. Although the painful sensations were responsive to pain medication, the presence of the illusory limb sensations were persistent. During neurological recovery, the supernumerary limbs gradually disappeared. A rubber hand illusion paradigm was used twice during recovery to monitor the patient's ability to integrate visual, tactile and proprioceptive stimuli. Overall, the clinical relevance of supernumerary phantom limbs is not clear, specific treatment protocols have not yet been developed, and the underlying neural mechanisms are not fully understood. Supernumerary phantom limbs have been previously reported in patients with (sub)cortical lesions, but might be rather undocumented in patients suffering from traumatic SCI. For the appropriate diagnosis and treatment after SCI, supernumerary phantoms should be distinguished from other phantom sensations and pain syndromes after SCI.