Snowboarding Injuries Research Articles

Trends in Emergency Department Reported Head and Neck Injuries Among Skiers and Snowboarders

Reports from the U.S. suggest increases in the proportion and rate of head and neck injuries in skiers and snowboarders. It is important to determine if the same is true in Canada. Skiers and snowboarders (< 18 years) presenting to 16 selected emergency departments from 1991 to 1999 were assigned one body region of injury in the following order: i) brain and spine-spinal cord, ii) head and neck, iii) face, iv) other body region (i.e., controls). Crude and adjusted (age, gender, helmet use and hospital admission) odds ratios indicating the proportion of head, brain, face, and neck injury relative to controls by calendar year were estimated. Injury rates were examined for 12 to 17 year olds over the last 4 years of the study. Compared with 1997-1999, there was a lower proportion of skier head injuries from 1991-93 (adjusted odds ratio (AOR) = 0.16; 95% Confidence Interval (CI) = 0.09-0.30) and from 1995-97 (AOR = 0.71; 95% CI = 0.49-1.04). The proportion of skier brain injuries was lower from 1993-95 (AOR = 0.69; 95% CI = 0.44-1.07) and from 1995-97 (AOR = 0.56; 95% CI: 0.35-0.91). In snowboarders, however, compared with 1997-99, there was evidence that although the proportion of head injuries was lower from 1991-93 (AOR = 0.19; 95% CI = 0.05-0.80), the opposite was true for facial injuries. For 12 to 17 year olds, skier brain and snowboarder head and neck injury rates increased from 1995-99. The results suggest that head and brain injuries in skiers and head and neck injuries in snowboarders may be increasing, particularly in adolescents.

Alpine Skiing and Snowboarding Injury of the Abdomen

Alpine Skiing and Snowboarding Injury of the Abdomen

Skiing, Snowboarding, and Sledding Injuries in a Northwestern State

Winter sports continue to be a popular form of recreation, but few studies have focused on serious injuries. The objectives of this study were to evaluate the major morbidity associated with downhill skiing, snowboarding, and sledding and to determine the incidence of serious injuries sustained while downhill skiing and snowboarding. State trauma registry data from the 1992-93 through 1998-99 ski seasons on all snow sports participants transported to tertiary trauma hospitals in Oregon were analyzed. Of 132 patients, 80% were male and 20% were female, with a mean age of 30.4 +/- 15.6 for skiers, 24.1 +/- 10.5 for snowboarders, and 18.8 +/- 11.9 for sledders. The mean Injury Severity Score was 12.3 +/- 7.6 for skiers, 10.3 +/- 7.4 for snowboarders, and 12.8 +/- 8.5 for sledders. Head injuries accounted for 55% of sledding injuries and 39% of all injuries. Skiers and snowboarders were less likely to have head injuries than sledders (odds ratio [OR] = 0.45; 95% CI, 0.21 to 0.98). A higher proportion of injuries sustained by snowboarders were due to falls from heights (29%) compared with injuries sustained by skiers or sledders (OR = 4.8; 95% CI, 1.6 to 13.7). Sledders were more likely to be injured during collisions than were skiers or snowboarders (OR = 16.7; 95% CI, 5.8 to 47.6). The incidence of serious skiing and snowboarding injuries was 6.4 injuries per million visits. There were 4 deaths (3%), 1 each from snowboarding and skiing (head injuries) and 2 from sledding (1 from head and 1 from head and thoracic injuries). Serious snow sports injuries are rare but potentially debilitating. Head injuries account for the majority of deaths and functional impairment.

Effect of helmet wear on the incidence of head/face and cervical spine injuries in young skiers and snowboarders

Purpose: To evaluate whether helmets increase the incidence and/or severity of cervical spine injury; decrease the incidence of head injury; and/or increase the incidence of collisions (as a reflection of...

Cervical Epidural Hematoma After Snowboarding Injury. Case Report.

A 21-year-old man developed cervical spinal epidural hematoma one month after a snowboarding injury. He fell down while snowboarding and hit his occiput. Immediately after the injury, he suffered hypesthesic pain in the C-8 area associated with dull neck pain, which persisted for a month. Radiography of the cervical spine detected no pathological findings. The second attack of pain occurred when he was resting, followed by paraparesis and loss of urinary sensation within 24 hours. Emergent magnetic resonance (MR) imaging demonstrated an epidural hematoma at the levels of C-7 to T-2 which compressed the spinal cord. During the operation for removal of the hematoma, arterial rebleeding occurred from a small artery in the dural sac on the right C-8 root, which was thought to be responsible for the hematoma. The patient was discharged with no neurological deficits. Snowboarding-related injuries occur with higher frequency and involve greater risks compared to skiing-related injuries. Repeat MR imaging is strongly recommended to follow up any spinal injury, particularly in cases associated with focal neurological signs.

Spinal injuries in snowboarders: risk of jumping as an integral part of snowboarding.

The purpose of this study was to clarify the occurrence rate and characteristics of spinal injuries caused by snowboarding that were sustained at the Okumino skiing area in Gifu Prefecture, Japan, from 1988 to 2000. This study was a retrospective review of 13,490 cases of snowboard- or ski-related injury treated at Sumi Memorial Hospital over this period. A total of 7,188 patients sustained snowboard-related injuries, and 238 of these had spinal injuries caused by snowboarding (3.3%), whereas 6,302 patients sustained ski-related injuries, and 86 of these had spinal injuries caused by skiing (1.4%). Although there were no significant differences in the difficulty of slope, location of vertebral fracture, or spinal cord injury between snowboarders and skiers, the incidence of transverse process fractures was significantly higher in snowboard-related than in skiing-related injury (p < 0.05). In addition, there was a significantly higher incidence of spinal injury among beginner snowboarders than among beginner skiers (p = 0.04). Furthermore, intermediate or expert snowboarders were more likely to be injured because of jumping than beginners (p < 0.001), whereas about 70% of spinal injuries caused by skiing resulted from a simple fall. Spinal injuries sustained while snowboarding are increasing considerably in incidence and are characterized as complex injuries. We must educate young snowboarders of the risk of this sport, to prevent these serious injuries.

SKIING, SNOWBOARDING, AND SLEDDING INJURIES

This is a retrospective study of the serious skiing, snowboarding and sledding (inner tubing) injuries that occurred in Oregon from the 1992–1993 to the 1998–1999 ski seasons. Data were obtained from the Oregon Trauma Registry on all participants requiring transportation to tertiary trauma hospitals, for a total of 132 patients. Of these, 80% were male and 20% were female, with a mean age of 30.4 + 15.6 for skiers, 24.1 + 10.5 for snowboarders, and 18.8 + 11.9 for sledders. Collisions with fixed objects or other persons caused 28% of skiing, 16% of snowboarding and 85% of sledding injuries. Falls from a height comprised 9% of skiing, 29% of snowboarding, and 6% of sledding falls. (p < 0.001) Isolated falls caused 63% of the injuries in skiers and 55% of the injuries in snowboarders but only 9% of all injuries in sledders. (p < 0.001) Falls from a height comprised 9% of skiing, 29% of snowboarding, and 6% of sledding accidents. The mean Injury Severity Score (ISS) was 12.25 (SD 7.59) for skiers, 10.32 (SD 7.36) for snowboarders, and 12.76 (SD 8.46) for sledders. The types of injuries sustained did not differ significantly among sports although there was a trend toward more head injuries in sledders. Skiers sustained 38% head, 22% spine, 21% thoracic (including the chest, abdomen and pelvis), and 19% extremity injuries. Snowboarders had 29% head injuries, 32% spine, 29% thorax and 10% extremity injuries. In sledders, there were 53% head, 16% spine, 19% thorax, and 12% extremity injuries. The incidence of serious skiing and snowboarding injuries occurring in Oregon was estimated based on annual ski area visitation data at 6.4 injuries per million visits. There were a total of 4 deaths (3%), one each from snowboarding and skiing (head injuries), and two from sledding (one head and one thoracic injury). Fifteen patients were discharged with a GCS < 14 (11%). Eleven patients (8%), all with head and spine injuries, were discharged to rehabilitation or skilled nursing facilities, and 116 patients (88%) were discharged home. In conclusion, serious injuries due to these activities are a rare, but potentially debilitating occurrence. Head injuries account for the majority of deaths and functional impairment. Further research will be needed to identify potentially modifiable factors associated with serious injuries, and to determine in which situations helmets may be of greatest benefit.

Head injuries in skiers and snowboarders in British Columbia.

At the Vancouver General Hospital Neurosurgical Service there have been a significant number of seriously brain injured snowboarders, seemingly out of proportion to the number of skiers. The purpose of this study was to determine whether snowboarders suffered more serious head injuries than skiers in the Vancouver catchment area. The British Columbia Trauma Registry was searched for patients incurring head injuries while skiing or snowboarding on British Columbia mountains during the period from January 1992 to December 1997. Patients were included if they were admitted to hospital and underwent neurosurgical consultation. A total of 40 skiers and 14 snowboarders met the above criteria. Of the skiers, 15% sustained a severe head injury by Glasgow Coma Score, another 30% sustaining moderate head injuries, while 29% of snowboarders had a severe injury and 36% a moderate injury. A concussion was present in 60% of the skiers and 21% of the snowboarders. Snowboarders suffered an intracranial hemorrhage in 71% of the cases compared to 28% of the skiers. A craniotomy was performed acutely in 10% of skiers and in 29% of snowboarders. Three deaths occurred as a direct result of head injury, one while snowboarding. All but one of the surviving skiers were able to return home, whereas four of 13 surviving snowboarders required additional inpatient rehabilitation or transfer to another acute hospital for ongoing care. Snowboarders suffer more significant head injuries compared to skiers in this series and are much more likely than skiers to require an intracranial procedure. In our opinion, this indicates that additional safety measures, in particular the use of mandatory helmets, should be considered by ski areas and their patrons.

Warning from Nagano: increase of vulvar hematoma and/or lacerated injury caused by snowboarding.

On the basis of the number of women snowboarders whose vulvar injuries we have recently treated, we believe that the cases of vulvar hematoma and lacerated injuries caused by snowboarding have been increasing. To analyze the causal relation between snowboarding and vulvar injuries, we investigated how women were injured during snowboarding. During the last three ski-ing seasons at the five hospitals near the ski resorts in Nagano Prefecture, Japan, the clinical charts of all patients with vulvar injuries during snowboarding were reviewed for the number of patients treated, the condition of the patients at diagnosis, and the characteristics of vulvar injuries. All patients were also asked by phone about how their vulvar injury was caused during snowboarding. The number of patients with vulvar injuries during the last three seasons was 16, 14, and 35, respectively. The types of vulvar injuries included hematoma in 33 (51%) patients, hematoma with lacerated injury in 17 (26%), and lacerated injury in the remaining 15 (23%). Of the 65 patients, 45 (69%) needed surgical treatment. Characteristically, 54 (88%) patients were injured when they tumbled onto the binding of the snowboard at the same time that one foot was left off the board and the binding was not turned down but left erect. It is important for women snowboarders to realize that in snowboarding there are dangers that may cause vulvar injuries. The prevention of such injuries requires that the binding should be turned down when the foot is left off the board and that snowboarders should try not to tumble onto the board.

What are the health hazards of snowboarding?

First introduced in the 1920s with little success, snowboarding is now one of the fastest growing winter sports in the world. In the 1999-2000 season, 3.3 million snowboarders contributed about 13.5 million visits to US ski resorts, representing 27% of total days on the snow. Many resorts now have special areas set aside just for snowboarding. These areas, called pipelines, are wide semicylindrical “shoots” carved out of snow. They are up to several hundred feet long with high vertical walls that allow snowboarders to ride from side to side. They are designed for “jumps and bumps” (aerial maneuvers and acrobatics). The typical snowboarder is a male adolescent, although the age range is widening and the proportion of female snowboarders is increasing.1 ​,​, Table 1 Shoulder injuries associated with snowboarding9 Dislocation Acromioclavicular separation Fracture of the clavicle Rotator cuff strain Fracture of the proximal humerus View it in a separate window Table 2 Management of shoulder and elbow injuries associated with snowboarding7 Refer to an orthopedist if fracture involves the growth plate (Salter-Harris type III or higher) Perform a neurovascular examination before and after reduction of a dislocation Assess reduction of dislocation radiographically Consider surgical stabilization of dislocations in young patients involved in collision sports10 View it in a separate window HOW COMMON ARE INJURIES? With the increasing popularity of snowboarding, injuries—the predominant health hazard associated with the sport—are seen more often than in the past. About 27,000 injuries related to the sport occurred in the United States in 1994. While most injuries are treated by health care personnel close to ski resorts, primary care physicians often provide follow-up care and can be instrumental in the primary prevention of injuries. The reported injury rate varies from 3.5 per 1,000 snowboard days to more than 40 per 1,000 snowboard days.2,3 Mortality rates are low (0.2 per million snowboarding days).1 Recent cohort studies suggest that the rate4 and severity3 of injuries among snowboarders are higher than among alpine skiers of similar levels of ability. Forty-two percent of snowboard injuries, compared with only 16% of ski injuries, were considered emergent (defined as necessitating immediate medical intervention, including fractures, concussions with any loss of consciousness, dislocations, and lost teeth). Concussions and wrist fractures accounted for most of the difference in emergent injuries between the 2 groups.3

Upper extremity snowboarding injuries. Ten-year results from the Colorado snowboard injury survey.

A survey of snowboarding injuries was conducted over 10 seasons (1988 to 1998). A questionnaire evaluating 20 variables was used to collect data from 47 medical facilities near Colorado ski resorts. A total of 7430 snowboarding-related injuries were seen. A control group consisted of 3107 noninjured snowboarders. Most of those injured were 30 years of age or younger; 74% of injuries occurred in men and 26% in women; 39% of injured snowboarders were beginners and 61% were intermediate or experts. Men rode at more advanced levels than women. Injured snowboarders were more likely than noninjured snowboarders to be beginners. There were 3645 (49.06% of total) upper extremity injuries; 56.43% were fractures, 26.78% sprains, and 9.66% dislocations. The most common site of injury was the wrist (21.6% of all snowboarding injuries). Wrist fractures (except to the scaphoid) and sprains were more common in beginners, women, and younger age groups. Intermediate and expert men were more likely to sustain hand, elbow, and shoulder injuries, as well as more severe injuries. Falling was the predominant mechanism of upper extremity injuries. Snowboarders who wore protective wrist guards were half as likely to sustain wrist injuries as those who did not wear guards.

Neurologic injuries in skiers and snowboarders.

Neurologic injures are the leading cause of death and disability in skiing and snowboarding accidents, despite accounting for only a small fraction of injuries overall. Head injuries make up 3 to 15% of all skiing and snowboarding related injuries, spinal injuries account for 1 to 13%, and peripheral nerve injuries constitute less than 1% of reported injuries. Improvements in equipment and technology, especially advances in binding technology, have resulted in decreased injury rates on the slopes overall, but neurologic injury rates have not decreased, and in fact appear to be increasing as a percentage of overall injuries and in absolute numbers. With advances in technology and slope maintenance, skiers and boarders progress to higher skill levels and faster speeds more rapidly than ever before. Great efforts have been focused on reducing extremity injuries in skiers and snowboarders, but until recently very little attention has been given to neurologic injury prevention on the slopes. Hopefully with increased awareness and the growing popularity of ski/snowboard helmets, we will begin to see head injury rates (and maybe even spine injury rates) decrease among skiers and snowboarders.

Preventing snowboarding injuries – what is the evidence?

Snowboarding is quickly becoming a popular sport at alpine resorts. In contrast to alpine skiing, where injuries to the knee and thumb are most common, the wrist (and forearm) and ankle are the most frequently injured body regions for snowboarders. Unfortunately, the rapid international growth of the sport has not been matched by detailed epidemiological evaluation of the injuries specific to snowboarding or the countermeasures to prevent them. The aim of this paper is to critically review the literature describing injury prevention measures, or countermeasures, for snowboarding. In doing so, it provides an evaluation of the extent to which these countermeasures have been demonstrated to be effective or associated with the occurrence of new types of injuries. Few countermeasures specific for snowboarding were found to have been formally evaluated. The countermeasures to which some attention has been paid are boots, bindings, wrist guards, skill level and methods of falling. Skill level and the other injury countermeasures apply more generally across the sport. Recommendations for countermeasure implementation include: education for snowboarders, adherence to snow conduct and safety codes, preparing snowboarders for their activity and maintenance of parks and runs. Recommendations for improved data collections include: standardising and maintaining existing data collections, collecting information about equipment used by snowboarders and monitoring injury trends. Further biomechanical and epidemiological research needs to be undertaken on knee/ankle and wrist/forearm injuries. Evaluation of countermeasures needs to keep pace with the rapid developments in this field. Particular attention should be directed towards evaluations of the role of wristguards, boots/bindings, fall technique and lessons in preventing injuries. Given the rapidly increasing popularity of the sport, the need for the safety equipment to be evaluated would seem to be a priority, along with identification of the mechanisms of injury.

The effect of wrist guards on bone strain in the distal forearm.

There are increasing epidemiologic and biomechanical data suggesting that wrist guards are effective in preventing wrist injuries in snowboarders and in-line skaters. However, there have been few studies designed to determine how they function. In this study we explored the load-sharing function of wrist guards at subfailure loading levels. To do so, we measured bone strain in the distal radius, distal ulna, and midshaft of the radius in cadaveric forearms with and without two types of commercially available wrist guards. We also measured construct stiffness and energy absorption during testing. Our most significant findings were that dorsal and volar distal radius bone strain were reduced with both wrist guards, and wrist guards increased energy absorption. We also found a reduction in dorsal distal ulnar bone strain, but only with the one guard in which the volar plate was elevated off the heel of the hand. In our loading configuration, wrist guards did not increase bone strain at the radial midshaft. These findings provide insight into how wrist guards protect the wrist: during low-energy falls they function partly by load-sharing, as well as by absorbing impact energy.

Fracture and dislocation of snowboarder's elbow.

This study focuses on the analysis of snowboarding versus skiing injuries, especially fracture, dislocation, or both, of the elbow, based on 7 years of medical records and roentgenograms of patients injured at a ski-snowboard area, Mt. Zao National Park, and demonstrates the precise characteristics of snowboard injury in the elbow region. A retrospective study of 1,445 injured snowboarders and 10,152 injured skiers was undertaken to assess both snowboarding and skiing injuries. Sixty-four cases of snowboarding injuries and 152 cases of skiing injuries were available for precise analysis of fracture, dislocation, or both, in the elbow region. Fractures, dislocations, or both, in the elbow were more frequently observed for snowboarders (30 of 64 cases, 46.9%) when compared with that for skiers (26 of 152 cases, 17.1%) (p < 0.001). The rate of dislocation with or without fracture of the elbow was also significantly higher for snowboarders (17 of 64 cases, 26.6%) than for skiers (8 of 152 cases, 5.3%, p < 0.001). Seventeen cases of elbow dislocation in snowboarding were all of the posterior type, which accompanied two coronoid process fractures and two radial neck fractures. Fractures of the coronoid process (five cases), radial head (one case), radial neck (five cases), olecranon (one case), proximal ulnar shaft (one case), and extension-type fracture of distal humerus (four cases) were the fracture types observed in the analysis. Posterior dislocation; fractures of coronoid process, radial neck, and radial head; and extension-type fracture of the distal humerus characterize the particular and frequent injury mechanism responsible for snowboarding trauma in the elbow region. Thus, snowboarding injury of the elbow is recognized as a severe injury and is characterized by a frequent risk of posterior dislocation, fracture, or both. The severity of elbow injuries in snowboarding mainly seems to be due to direct mechanical force on the elbow, receiving the full impact of falling down, combined with an outstretched hand and elbow extension, or with an outstretched hand and longitudinal thrust force, to the proximal radius and ulna and distal humerus.

Evaluation of skiing injuries by Injury Severity Score.

The goal of this study was to evaluate the Injury Severity Score (ISS) in an alpine area. Hafjell Alpine Centre was the 1994 Winter Olympic Alpine arena in Lillehammer. A total of 2,044,484 lift transportations and 183 injuries were registered in the two winter seasons 1991 and 1992. The injury rate was 1.8 injuries per 1000 skier days. The mean ISS was 3.6 per injury for this particular alpine area. Thirty-six per cent of the injured were women and 35.5% were between 15 and 19 years of age. There was no difference in mean ISS between male and female skiers, but mean ISS was higher in adolescents than in the other age groups. Injuries to the knee represented the single most frequently injured body region, but injuries to the abdomen had the highest mean ISS. Alpine skiers suffered more severe injuries than telemark and snowboard skiers. Severe injuries (ISS > 16) were recorded when unexpected objects, such as a grooming machine, a net, a root, etc., appeared on the slope. The Abbreviated Injury Scale (AIS) and ISS give us additional information about the condition of the slopes, and their use as a tool in preventing skiing injuries is recommended.

Risk of injuries in snow boarding

Survey of a group of injured snowboarders and analysis of their sustained injuries and risk factors in comparison to experience level and equipment. 55% of all injuries occurred within the first 7 days of learning how to ride the snowboard. The affected body region of 36% of all injuries and 53% of the severe injuries was the wrist. The primary mechanism of injury was through low-velocity falls on hard or icy snow, essentially a loss of balance with backward fall onto out-stretched arms leading to hyperextension and trauma to the wrist.

Spinal injuries in skiers and snowboarders.

Spinal injuries are among the most devastating injuries associated with recreational sports. Snowboarding spinal injury patterns have not been described. During two seasons (1994 to 1995 and 1995 to 1996), 34 skiers and 22 snowboarders suffered serious spinal injuries (fracture or neurologic deficit or both) at two ski areas in British Columbia, Canada. Ski patrol records, the Provincial Trauma Database, and hospital records were reviewed. Injury rates were based on computerized lift-ticket data and a population estimate of 15% snowboarders (ski patrol observation). The incidence of spinal injury among skiers was 0.01 per 1000 skier-days, and among snowboarders was 0.04 per 1000 snowboarder-days. Mean age was 34.5 years for skiers and 22.4 years for snowboarders. Seventy percent of the skiers were men, whereas all of the snowboarders were men. Jumping (intentional jump > 2 meters) was the cause of injury in 20% of skiers and 77% of snowboarders. Neither age nor sex accounted for any significant portion of this difference. The rate of spinal injuries among snowboarders is fourfold that among skiers. Although jumping is the primary cause of injury, it is an intrinsic element of snowboarding. Until research defines effective injury-prevention strategies, knowledge of the risk of snowboarding should be disseminated and techniques for safe jumping should be taught.

The downside of snowboarding

PREVIEWDepending on where you live, you may never have treated a snowboarding injury. However, some of your patients (or maybe your own children) may return from a vacation in the Rockies sporting a snowboarding injury and needing immediate treatment or follow-up care. How familiar are you with the injury patterns specific to this increasingly popular sport? Read on for an introduction to the world of snowboarding and helpful guidelines on how to recognize and treat common snowboarding injuries.

Skiing and snowboarding injuries in the children and adolescents of Southern Alberta.

To identify injuries and profile the characteristics of injured skiers and snowboarders younger than 18 years of age in Southern Alberta, Canada. Case-series over one year. Injured skiers and snowboarders younger than 18 years of age presenting to the ski patrol members at each of seven ski areas in Southern Alberta. Information on injured individuals reporting to the ski patrol at the involved areas was documented on a standardized injury reporting form. Anonymous information was then copied and sent to the University of Calgary Sport Medicine Centre, where the data were analyzed. Proportions of injured skiers and snowboarders with specific characteristics or participating in specific environmental conditions are presented. There were a total of 832 (60.0%) injury reports filed for skiers and 557 (40.1%) for snowboarders, reflecting 1,635 separate injuries. Head injuries were the most frequently reported (19.1% of all regional injuries). The most commonly injured region was the knee among skiers (n = 213; 22.8%) and the wrist among snowboarders (n = 173; 27.8%). Lower extremity injuries in skiers and upper extremity injuries in snowboarders were most common. Younger male skiers and snowboarders reported high proportions of head, neck, and back injuries. The lower extremity in skiers and the upper extremity in snowboarders were most susceptible to injury. A cause for concern is the high proportion of head injuries reported for both male skiers and snowboarders of younger age groups. Further study into protective equipment design and function is required.