Snowboarding Accident Research Articles

Pelvic ring injuries after alpine ski and snowboard accidents.

The purpose of this study was to analyze the patient/injury characteristics and associated hospital course of patients sustaining traumatic pelvic ring injuries after alpine ski and snowboard accidents at a level one trauma center in the Rocky Mountain region. Patient/injury characteristics were obtained from patients presenting with pelvic ring injuries after alpine ski (n = 55) and snowboard (n = 9) accidents. Characteristics and outcomes analyzed included mechanism of injury, pelvic ring classification (Young-Burgess and Tile), hospital admission, physical therapy (PT) clearance, ambulation, length of stay, inpatient morphine milligram equivalents (MME), and discharges to rehabilitation facility. Snowboarders were more often younger, male, tobacco/substance users, and more likely to be injured by a fall from height than skiers. There were no differences in injury classification or hospital course outcomes between alpine sports. Most common injuries included lateral compression type 1 (LC1) injuries (37.5%), isolated pubic ramus fractures (31.3%), and isolated iliac wing fractures (15.6%). LC1 injuries were unstable in 50% of cases and associated with increased admissions (proportional difference: 47.5%, CI: 23.8-64.5%, p = 0.0002), longer time to PT clearance (median difference(MD): 1.0day, CI: 0-2.0, p = 0.03), longer LOS (MD: 2.0, CI: 0-2.0, p = 0.02), and increased inpatient MMEs (MD: 197.9 MME, CI: 30.0-420.0, p = 0.02), as compared to other pelvic ring injuries. The majority of pelvic ring injuries from alpine ski and snowboard accidents were LC1 injuries, half of which were unstable, resulting in longer hospital stays, time to PT clearance/ambulation, and opioid use.

First-time anterior shoulder dislocation after snowboard accidents in amateur athletes

Aim: The glenoid rim fractures, bony bankart lesions and/or tuberculum majus fractures that occurred due to snowboarding-related first-time shoulder dislocations may have differences specific to these athletes. Thus, we aimed to examine the characteristics of bone lesions in cases with snowboarding-related first-time shoulder dislocation.Materials and Methods: The cases diagnosed with first-time shoulder dislocation and received a closed reduction in the emergency department between 2018 and 2020 were examined retrospectively. 18 patients with snowboarding-related dislocation, and 24 patients with first-time shoulder dislocation by a different injury mechanism other than winter sports injury mechanism were included in the study. Those with snowboarding-related injuries were classified as Group A and other cases were classified as Group B. Comparison was made between the two groups.Results: The average age was 27.11 ± 6.14 years in Group A, and 26.17 ± 5.44 years in Group B (p:0.656). There were 12 men (M) and 6 women (W) in Group A, and 16 M and 8 W in the Group B (p:0.999). The two groups were similar in terms of Hill-Sachs lesion, tuberculum majus fracture, bony bankart lesion, and additional injury (p>0.05). In the snowboarders, a relationship was found between the injured side and the lead foot (p: 0.013). There was a significant difference between the injury mechanism and the presence of Hill-Sachs lesion in the snowboarders (p:0.033).Conclusion: The characteristics of bone lesions in snowboarding-related first-time shoulder dislocations may be similar to that of shoulder dislocations occurred by different mechanisms. In snowboarding, the direction of sliding may put the shoulder at a higher risk of dislocation for a particular side. For these athletes, the injury mechanism may be a factor affecting the formation of Hill-Sachs lesion.

Can an acute high-grade acromioclavicular joint separation be reduced and stabilized without surgery? A surgeon\u2019s experience

IntroductionWhile the management of Rockwood type III injuries is still a topic of debate, high-grade Rockwood type V injuries are mostly treated surgically, to anatomically reduce the acromioclavicular (AC) joint and to restore functionality. In this case report, we present a method for non-operative reduction and stabilization of a high-grade AC joint injury.CaseA 31-year-old male orthopaedic resident sustained a Rockwood type V injury during a snowboarding accident. His AC joint was reduced and stabilized with an AC joint brace for six weeks. The brace provided active clavicle depression and humeral elevation. After removal of the brace the AC joint showed a nearly anatomic reduction. Six-month follow-up weighted X-ray views showed an AC joint which had healed in a Rockwood type II position and the patient returned to full pre-injury function with a satisfying cosmetic appearance.ConclusionNon-operative reduction and stabilization of high-grade AC joint separations seems to be a valuable treatment option. A “closed reduction and external fixation” approach with the aid of a dedicated AC joint brace can reduce the AC joint and keep it in place until ligamentous consolidation occurs, thus improving AC joint stability and cosmetic appearance without surgical intervention.

Numerical Reconstruction of Traumatic Brain Injury in Skiing and Snowboarding.

Proper evaluation of ski helmet designs and safety standards should rely on head impact conditions involved in skiing and snowboarding head injuries. To study these impacts, main crash scenarios involving head injuries are numerically replicated. Multibody models of skiers and snowboarders were developed to investigate five common crash scenarios involved in traumatic brain injury: forward and sideways skiing falls, snowboarding backward falls, collisions between users and collisions with obstacles. For each scenario, the influence of crash conditions on head impact (location, speed, linear and rotational accelerations) and risk of injury are evaluated. Crash conditions were initial velocity, user height, position and approach angle, slope steepness, obstacles, and snow stiffness. One thousand one hundred forty-nine crashes were simulated and three significant levels of impact conditions were discriminated over the investigated crash scenarios: 1) the smallest normal-to-slope impact velocities (6 km·h; 22 km·h) and peak linear accelerations (42g; 75g) were obtained during forward and sideways skiing falls; 2) snowboarding backward falls and collisions between users were associated with high normal-to-surface impact velocities (26 km·h; 32 km·h) and head accelerations (80g; 149g) above one published threshold for mild traumatic brain injury but below the pass/fail criteria of helmet standard tests; 3) collisions with obstacles were associated with high normal-to-surface impact velocities (19 km·h; 35 km·h) and the highest head accelerations (626g; 1885g). Current impact conditions of helmet standard evaluations consistently replicate collisions with obstacles, but need to be revised to better reflect other significant crash scenarios leading to traumatic brain injury.

Severe injuries associated with skiing and snowboarding: A national trauma data bank study.

Injuries after skiing and snowboarding accidents lead to an estimated 7,000 hospital admissions annually and present a significant burden to the health care system. The epidemiology, injury patterns, hospital resource utilization, and outcomes associated with these severe injuries need further characterization. The National Trauma Data Bank was queried for the period 2007 to 2014 for admissions with Injury Severity Score > 15 and International Classification of Diseases Codes-9th Revision codes 885.3 (fall from skis, n = 1,353) and 885.4 (fall from snowboard, n = 1,216). Demographics, emergency department data, diagnosis and procedure codes, and outcomes were abstracted from the database. Severe (Injury Severity Score > 15) ski-associated and snowboard-associated injuries differed with respect to age distribution (median age, 38; interquartile range, 19-59 for skiers and median age, 20; interquartile range, 16-25 for snowboarders; p < 0.001) and sex (78.9% and 86.4% males, respectively, p < 0.001). Traumatic brain injury was common for both sports (56.8% of skiers vs. 46.6% of snowboarders, p < 0.001). Injuries to the spine (28.9%), chest (37.6%), and abdomen (35.0%) were also common. Eighty percent of patients used emergency medical services (50% ambulance, 30% helicopter) with a median emergency medical services transport time of 84 minutes. 50.8% of patients required interhospital transport. 43.2% of injuries required surgical intervention (21.3% orthopedic, 12.5% neurosurgical, 10.5% thoracic, 7.8% abdominal). Median hospital length of stay was 5.0 days. 60.0% of patients required intensive care unit admission with median intensive care unit length of stay 3.0 days. Overall mortality was 4.0% for skiers and 1.9% for snowboarders. Severe injuries after ski and snowboard accidents are associated with significant morbidity and mortality. Differences in injury patterns, risk factors for severe injury, and resource utilization require further study. Increased resource allocation to alpine trauma systems is warranted. Prognostic/epidemiologic, level III.

Head impact in a snowboarding accident.

To effectively prevent sport traumatic brain injury (TBI), means of protection need to be designed and tested in relation to the reality of head impact. This study quantifies head impacts during a typical snowboarding accident to evaluate helmet standards. A snowboarder numerical model was proposed, validated against experimental data, and used to quantify the influence of accident conditions (speed, snow stiffness, morphology, and position) on head impacts (locations, velocities, and accelerations) and injury risk during snowboarding backward falls. Three hundred twenty-four scenarios were simulated: 70% presented a high risk of mild TBI (head peak acceleration >80g) and 15% presented a high risk of severe TBI (head injury criterion >1000). Snow stiffness, speed, and snowboarder morphology were the main factors influencing head impact metrics. Mean normal head impact speed (28±6km/h) was higher than equivalent impact speed used in American standard helmet test (ASTM F2040), and mean tangential impact speed, not included in standard tests, was 13.8 (±7km/h). In 97% of simulated impacts, the peak head acceleration was below 300g, which is the pass/fail criteria used in standard tests. Results suggest that initial speed, impacted surface, and pass/fail criteria used in helmet standard performance tests do not fully reflect magnitude and variability of snowboarding backward-fall impacts.

Evaluation of a treatment algorithm for acute traumatic osseous Bankart lesions resulting from first time dislocation of the shoulder with a two year follow-up

BackgroundStudies dealing with acute osseous Bankart lesions and corresponding treatment strategies are rare. The purpose of this study is to analyze the results after applying our treatment algorithm for acute glenoid rim fractures caused by first time traumatic anterior shoulder dislocations.Methods25 patients were included in this retrospective case series. All patients sustained a first time shoulder dislocation caused by ski or snowboard accidents. An osseous Bankart lesion was detected in all shoulders. Operative therapy was performed in patients with osseous defects of 5% or more, otherwise conservative therapy was initiated. Primary study outcome parameter was the Rowe score. Additionally, the outer rotation deficit and operative complications were analysed.Results12 patients showed a defect size of less than 5% and were treated conservatively. The average lesion size was 2%. For these patients, the Rowe score was excellent in 58%, good in 25%, and moderate in 17% of patients. Three patients (25%) complained about a feeling of instability. 13 patients had a lesion size of more than 5%, average 15%, and were treated operatively. The Rowe score for this group was excellent in 54%, good in 31%, and moderate results in 15% of patients. One patient (8%) complained about a feeling of instability, without recurrent dislocations. There were no statistically significant differences between both study groups (ROWE score: p = 0.98).ConclusionsApplying our treatment algorithm for acute osseous Bankart lesions consisting of a conservative strategy for small defect sizes and a surgical approach for medium-sized and large defects leads to encouraging mid-term results and a low rate of recurrent instability in active patients.

Head Trauma in Skiing and Snowboard Accidents in a Swiss Tertiary Referral Center: Prevalence and Severity over the Last Decade

Background/Aim: The Swiss Council for Accident Prevention recorded an average of 1P029 people injured per day because of skiing/snowboarding in Swiss Ski Resorts. Head trauma accounted for most severe injuries sustained. Recent statistics suggest increased usage of helmets (81% in 2011). The indicators of head trauma severity are examined and whether escalated helmet use has decreased the incidence and severity of head injuries over the past 10 years

Helmet use in winter sport activities—attitude and opinion of neurosurgeons and non-traumatic-brain-injury-educated persons

During the last winter season, some fatal sport injuries with severe traumatic brain injury (TBI) prompted major discussions about protective helmet use. Although ski helmets reportedly lead to a 60% decrease of risk to incur TBI, little is known about the distribution of helmet users and which factors are crucial for the decision to wear a helmet. Especially, it is unknown whether knowledge or experience concerning TBI in winter sports influences the use of helmets, as well as the attitude and opinion of people. Since treatment of TBI is a major field in neurosurgery, 55 neurosurgical departments (NS) in Germany, Switzerland and Austria were addressed and asked to answer anonymous questionnaires. A "non-trauma-educated" control cohort (NTP) was interviewed in ski resorts in Austria as well as sports equipment stores in Germany. Questionnaires were returned by 465 NS and 546 NTP. Half of NS and NTP wore helmets in winter sports. Although some interviewees showed cognitive dissonant behaviour, experience in TBI after ski or snowboard accidents significantly affected the decision to wear helmets. After the fatal ski accidents, and increased media coverage 15.4% NS and 13.2% NTP bought their helmet. Furthermore, incidence of helmet use in children was correlated with the actual use and disposition of their parents to make the use of helmet compulsory. This study indicates that brain-trauma education affects ones attitude and opinion concerning protective helmet use in winter sports. However, without neglecting educational measures, emotional arguments should be added in the promotion of helmets to make them a popular integral part of winter sport outfits.

Rehabilitation and Recovery Training After Snowboard Accidents

Rehabilitation and Recovery Training After Snowboard Accidents

When the Rules Do not Work: Head Injury Without Loss of Consciousness

p t r. Joshua Easter: Today’s case is a 24-year-old man ho presented to the Emergency Department (ED) with nkle pain and headache after a snowboarding accident he day prior. The patient recalled that he was snowoarding down a slope and caught the opposite edge of is snowboard on the snow, causing him to fall backards, and he hit his helmeted head against the snow. he patient stated that he did not lose consciousness, and e was able to recall the details of the event. He noted mmediate onset of pain in his left ankle, but he was able o bear weight on the slope. About an hour after the ccident, he noticed that he had bitten his tongue and had mild occipital headache; however, he was still able to ontinue snowboarding for 3 more hours. The headache, escribed as mild in nature, persisted until his presentaion to the ED the next day. He denied nausea, vomiting, ethargy, or focal weakness. The pain in his ankle was escribed as severe, sharp, and exacerbated by flexion of he ankle. He denied knee pain or other discomfort. Dr. Jonathan Edlow: Patients with head injury may e unreliable in reporting the details of the injury, paricularly whether there was loss of consciousness. Was his episode witnessed? Dr. Easter: The patient’s snowboarding companion, ho accompanied him in the ED, confirmed that there as no loss or alteration of consciousness after the imact. The companion also confirmed that this was a round-level fall and that the patient appeared normal fter the incident. No abnormal motor activity was noted. Dr. Shamai Grossman: Can you further describe the atient’s headache? Dr. Easter: The headache was dull, generalized, and eveloped gradually in the hours after his accident. There ere no exacerbating or alleviating factors. On examit

Clinical presentation of a traumatic cervical spine disc rupture in alpine sports: a case report

Isolated non-skeletal injuries of the cervical spine are rare and frequently missed. Different evaluation algorithms for C-spine injuries, such as the Canadian C-spine Rule have been proposed, however with strong emphasis on excluding osseous lesions. Discoligamentary injuries may be masked by unique clinical situations presenting to the emergency physician. We report on the case of a 28-year-old patient being admitted to our emergency department after a snowboarding accident, with an assumed hyperflexion injury of the cervical spine. During the initial clinical encounter the only clinical finding the patient demonstrated, was a burning sensation in the palms bilaterally. No neck pain could be elicited and the patient was not intoxicated and did not have distracting injuries. Since the patient described a fall prevention attempt with both arms, a peripheral nerve contusion was considered as a differential diagnosis. However, a high level of suspicion and the use of sophisticated imaging (MRI and CT) of the cervical spine, ultimately led to the diagnosis of a traumatic disc rupture at the C5/6 level. The patient was subsequently treated with a ventral microdiscectomy with cage interposition and ventral plate stabilization at the C5/C6 level and could be discharged home with clearly improving symptoms and without further complications.This case underlines how clinical presentation and extent of injury can differ and it furthermore points out, that injuries contracted during alpine snow sports need to be considered high velocity injuries, thus putting the patient at risk for cervical spine trauma. In these patients, especially when presenting with an unclear neurologic pattern, the emergency doctor needs to be alert and may have to interpret rigid guidelines according to the situation. The importance of correctly using CT and MRI according to both – standardized protocols and the patient's clinical presentation – is crucial for exclusion of C-spine trauma.

Fulminant Thoracic Sarcoma Masked by Hemothorax

A 15-year-old female was admitted to the hospital with dyspnea and thoracic pain 1 month after trauma caused by a snowboarding accident. The patient was hit by another snowboarder and landed on the left hemithorax. She suffered immediate pain. The pain decreased gradually, but increasing dyspnea developed 2 weeks prior to admission. No evidence of other illness symptoms was recorded. Chest x-ray (Fig. 1) revealed left pleural effusion. Blood tests revealed a hemoglobin level of 9.9 gm/dl but were otherwise normal. Pleural drainage was performed based on clinical suspicion of traumatic hemothorax, and 2700 ml of blood-stained fluid was drained, with subsequent satisfactory radiological examination (Fig. 1) and immediate patient recovery. One month later, the patient was readmitted to the hospital with low hemoglobin (10.5 g/dl) and weight loss (7% of body mass). Except for a slight contusion to the left hemithorax at home, no other anamnestic event or new symptoms were recorded. After chest x-ray and CT scan (Fig. 2), the patient was operated on with the intention of performing hematoma debridement and lung decortication because of hemothorax. During thoracotomy, a cauliflower-like tumor filling the whole thoracic cavity and infiltrating the chest wall was found. There was minimal blood content in the thoracic cavity. Intraoperative biopsy diagnosis indicated “highly malignant neoplasm of unknown origin.” Taking into account extensive infiltration of the thoracic wall, the decision to abandon curative resection was made, and additional biopsies were taken before the thoracotomy was closed. The patient received four units of red blood cell concentrates after the operation. Histological examination revealed primitive neuroendocrine tumor, which belongs to the Ewing sarcoma family.1–3 The patient was subsequently treated with chemotherapy (ifosfamid, vincristin, doxorubicin, and cyclofosfamid) and died 8 months later from progressive disease. REFERENCES 1. Hadithi M, van Boxem TJ, Giaccone G, et al. Exercise-induced spontaneous hemothorax insinuates trauma; yet unmasks a lament disorder. Neth J Med. 2001;59:292–294. 2. Varsano S, Edelstein E, Gendel B, et al. Bilateral and unilateral spontaneous massive hemothorax as a presenting manifestation of rare tumors. Respiration. 2003;70:214–218. 3. Eroglu A, Kurkcuoglu IC, Karaoglanoglu N, et al. Extraskeletal Ewing sarcoma of the diaphragm presenting with hemothorax. Ann Thorac Surg. 2004;78:715–717.

Fixation of Transverse Fractures of the Sternum and Sacrum With the Locking Compression Plate System

Transverse fractures of the sternum or sacrum each present specific surgical challenges. Here, we report the successful use of a locking compression plate system in a 69-year-old woman with a displaced segmental fracture of the sternum following a motor vehicle accident and a 15-year-old girl with a low transverse fracture of the sacrum (S3-S4) as a result of a snowboarding accident. In both cases, the system provided adequate fixation to allow healing in the 2 fractures, despite the poor bone quality (sternal case) and the thin bone stock (sacral case).

Aneurysmal Bone Cyst of the Atlas: Successful Treatment through Selective Arterial Embolization: Case Report

Aneurysmal bone cysts (ABCs) are benign and expansile osteolytic lesions that can occur in any location in the spine, including the craniovertebral junction. Aggressive resection followed by bone grafting has been the mainstay of treatment, with selective arterial embolization as a presurgical adjunct. Complete excision of these lesions at the craniovertebral junction is associated with high surgical morbidity. We report a case of successful treatment of an ABC of the atlas in a child with selective arterial embolization alone. A 10-year-old girl presented with persistent neck pain after a snowboarding accident. Computed tomography and magnetic resonance imaging of the cervical spine revealed an expansile cystic mass involving the right lateral mass of C1. Digital subtraction angiography revealed a tumor blush, which, along with the cystic appearance of the lesion, was consistent with an ABC. The arterial feeders to the lesion were selectively embolized with polyvinyl alcohol particles. Three sessions of embolization were required to eradicate the blood supply to the lesion completely. Complete surgical resection of ABCs at the craniovertebral junction can be associated with high morbidity secondary to the highly vascular and destructive nature of these lesions. The case discussed here demonstrates the viability of selective arterial embolization as a primary and stand-alone modality of treatment.

Snowboardverletzungen

This retrospective study includes 59 people treated at our trauma centre for snowboard accidents that happened in the 1989 winter season. 22 People were severely injured. 2 people died due to a polytrauma. One fracture of the cervical vertebrate column was followed by complete hemiplegia. Reasons for these accidents were a lack of knowledge how to behave outside the marked alpine regions, as well as lack of technical equipment and theoretical education.