Factors affecting injury severity among recreational skiers and snowboarders: an epidemiology study

Comparison and analysis of skiing injuries at ski resorts in Chongli, China and Japan

PURPOSE

The rapid development of winter sports requires investigation on injuries in Chongli district, Zhangjiakou city, one of the ski sites of the 2022 Winter Olympics. Careful evaluation is required to observe which injuries are caused under what circumstances, and then we can make corresponding preventive measures and recommendations based on the results.

METHODS

In this retrospective study, the data of injury cases at ski resorts in China (Chongli district) and Japan were analyzed to provide a reference for the ongoing injury prevention at ski resorts. We collected data on injuries at Wanlong and Fulong ski resorts in Chongli district during the 2017-2018 and 2018-2019 ski seasons. We referred to the skiing injury report issued in February 2020 of a nationwide ski safety statistical service - Japan Ski Safety Association. The causes of injury and specific injured body parts were analyzed based on the data of Chinese and Japanese ski resorts. Statistical significance has been calculated using the Chi-square test.

RESULTS

During the 2019-2020 ski season in Japanese ski resorts, the number of reported injuries per 10,000 skiers was 0.93, of which 457 (17.3%) were over 50 years old, accounting for a large proportion of injuries, meanwhile in Chongli ski resort, the injury rate of skiers aged 50 and over was 7.1%. The knee joint (23.7% at Wanlong ski resort and 28.4% in Japanese ski resorts) was the most injured body part among Chongli and Japanese skiers. Among snowboarders, shoulder joint injury (17.7% in Japanese ski resorts) was the most common, and injury on hands and fingers (16.3% in Wanlong ski resorts) was the most common. Head injury rates are similar in Chongli, China and Japanese ski resorts (8.2% and 8.7%, respectively).

CONCLUSION

Our analysis demonstrated that injury data recorded among young skiers was higher in Chinese ski resorts (Chongli district) than that in Japanese ski resorts, and elderly skiers made up a larger proportion of skiing injuries in Japanese resorts. Thus, according to our research, the protection of knee joints, shoulder joints, and hands and fingers should be taken seriously. It should pay attention to the teaching of ski poles (for finger protection), and use protective devices such as knee pads, helmets, etc.

Clinical characteristics of patients with snow sports trauma transported to a trauma care center: A retrospective observational study

BACKGROUND

Snow sports are a popular recreational activity; however, the incidence of injury of snow sports can be high for skiers and snowboarders. Our hospital receives severe trauma cases from snow resorts and hospitals throughout the region. This study aimed to determine whether the risk of snow sports-related major trauma that requires emergency surgery under general anesthesia varies by the equipment and injury mechanism.

METHODS

This retrospective cohort study included patients with snow sports trauma referred to Gifu University Hospital, Japan between November 2010 and March 2020. We analyzed the need for emergency operation under general anesthesia within 24 h using Fisher's exact test. We identified 106 patients: (1) 90 in the snowboarders' group and 16 in the skiers' group or (2) 46 in the fall after jumping group (jumping group), 27 in the collide with other people and obstacle group (collision group), and 33 in the fall during gliding group (gliding group).

RESULTS

Snowboarders were nearly twice as likely as skiers to require emergency surgery under general anesthesia (44% vs. 25%; p = 0.236]. No significant associations were found between emergency surgery under general anesthesia and injury mechanism, but half of the patients in the jumping group required emergency surgery.

CONCLUSIONS

Snowboard as equipment and falls after jumping as a mechanism of injury tended to be associated with emergency surgery under general anesthesia, with no significant differences. In order to provide adequate resources for snow sports trauma, the cause of the patient's injury is strongly related to the urgency of the condition, and transport to a trauma center should be actively considered. Further studies are warranted with respect to the effects of personal protective equipment and skill level.

Collisions with another person while skiing and snowboarding: A 13-year national registry analysis

INTRODUCTION

Interindividual collisions while skiing or snowboarding occur regularly, they can be associated with severe injuries.

OBJECTIVE

To elucidate causes of accidents, injury patterns and potential risk factors for injury severity in interindividual collisions of skiers and snowboarders.

MATERIAL AND METHODS

Retrospective analysis of the Austrian Registry for Mountain Accidents within a 13-year timeframe (2005-2018) with regard to on- or off-piste collisions of skiers and snowboarders.

RESULTS

A total of 30,503 collisions, involving 52,430 (85.9%) skiers and 8,576 (14.1%) snowboarders were analysed. Denominators are lacking, since total numbers of skiers and snowboarders were not available. Compared to skiers, snowboarders were younger (23 vs. 42 years; p<0.001), predominantly male (77.4% vs. 61.0%; p<0.001) and less often severely injured (46.8% vs. 26.2%; p<0.001). Most accidents occurred on slopes (>95%). Collisions involving two snowboarders occurred proportionally more often in terrain parks (4.1% of 1,664 injured snowboarders; p<0.001) and while one victim was standing or sitting (9.7%; p<0.001). Contusions/strains/sprains were most prevalent (>23%), as were head injuries (>12%). In skiers, chest, shoulder, hip, thigh and knee injuries occurred more often, leading to fractures, dislocations, concussions and internal injuries more frequently. In snowboarders, spine/back, elbow, forearm, wrist and lower leg injuries were more prevalent. Female gender and standing or sitting prior to the accident was a risk factor for being more severely injured in collisions involving i) two skiers (OR: 4.02 (3.79-4.26) and 3.91 (3.26-4.68)), ii) a skier and a snowboarder (OR: 4.50 (3.95-5.14) and 11.49 (8.04-16.41)) or iii) two snowboarders (OR: 2.85 (2.12-3.84) and 12.47 (6.17-25.20)). Wearing a helmet increased the risk when two skiers collided (OR: 1.10 (1.03-1.17)). In skier vs. snowboarder collisions, the skier had a higher risk of being injured more severely (OR: 7.93 (6.98-9.01)).

CONCLUSIONS

In interindividual collisions of skiers and snowboarders, injury patterns and preceding causes differ substantially. Skiers are more likely to be severely injured. Awareness of an increased risk of injury should be raised particularly while standing or sitting on the slope.

Gender differences in snowboarding accidents in Austria: a 2005-2018 registry analysis

OBJECTIVES

To elucidate gender differences in snowboarding accidents.

DESIGN

Retrospective registry analysis within the Austrian National Registry of Mountain Accidents.

SETTING

Snowboard-related emergencies between November 2005 and October 2018.

PARTICIPANTS

All injured snowboarders with documented injury severity and gender (3536 men; 2155 women).

PRIMARY AND SECONDARY OUTCOME MEASURES

Gender-specific analysis of emergency characteristics and injury patterns.

RESULTS

Over time, the number of mild, severe and fatal injuries per season decreased in men but not in women. Accidents most frequently were interindividual collisions (>80%) and occurred when heading downhill on a slope. Men more often suffered injuries to the shoulder (15.1% vs 9.2%) and chest (6.8% vs 4.4%), were involved in accidents caused by falling (12.9% vs 9.6%) or obstacle impact (4.3% vs 1.5%), while on slopes with higher difficulty levels (red: 42.6% vs 39.9%; black: 4.2% vs 2.5%), while snowboarding in a park (4.8% vs 2.1%) and under the influence of alcohol (1.6% vs 0.5%). Women more often sustained injuries to the back (10.2% vs 13.1%) and pelvis (2.9% vs 4.2%), on easier slopes (blue: 46.1% vs 52.4%) and while standing or sitting (11.0% vs 15.8%). Mild injuries were more frequent in women (48.6% vs 56.4%), severe and fatal injuries in men (36.0% vs 29.7% and 0.9% vs 0.4%). Male gender, age and the use of a helmet were risk factors for the combined outcome of severe or fatal injuries (OR (99% CI): 1.22 (1.00 to 1.48), 1.02 (1.02 to 1.03) and 1.31 (1.05 to 1.63)). When wearing a helmet, the relative risk (RR) for severe injuries increased while that for mild injuries decreased in male snowboarders only (RR (95% CI): 1.21 (1.09 to 1.34) and 0.88 (0.83 to 0.95)).

CONCLUSIONS

Snowboard injuries are proportionally increasing in women and the observed injury patterns and emergency characteristics differ substantially from those of men. Further gender-specific research in snowboard-related injuries should be encouraged.

TRIAL REGISTRATION NUMBER

NCT03755050.

Managing risk in ski resorts: Environmental factors affecting actual and estimated speed on signposted groomed slopes in a cohort of adult recreational alpine skiers

Background

Certain weather conditions are clearly harmful, increasing the risk of injury of winter sports participants substantially. The objective of this study was to investigate actual speeds of skiers on signposted groomed slopes and to measure their skill to accurately estimate them with regard to environmental conditions such as visibility, sky cover, snow quality, wind and temperature.

Methods

The data were obtained from a sample of 421 adult recreational skiers taking ski courses. The Pearson correlation coefficient was used to explore the relationship between actual and estimated speed for all participants. Multiple linear regression analysis was used to measure the effect of environmental conditions on both the skiers’ actual speeds and their errors of estimation. Values of 0.05 or less were considered to indicate statistical significance.

Results

The Pearson correlation coefficient between estimated and actual speed was 0.90 (P < 0.001). Skiers underestimated their actual speed on average by 13.06 km/h or 24.1%. Visibility, quality of snow and wind speed were shown to significantly affect both actual maximum speed and estimated speed. Good visibility, grippy snow and calm wind were associated with both the highest actual maximum speed and the lowest ability to estimate it.

Conclusion

Certain environmental conditions are associated with the actual speed at which skiers travel and with their ability to estimate it. Visibility, quality of snow and wind speed seem to influence both actual speed and the ability to estimate it while sky cover and temperature do not. A reinforced understanding of skiing speed on signposted groomed slopes is useful to gain insight into crashes and the mechanisms of resulting injuries, to evaluate means of protection and to devise successful prevention policies in ski resorts.

[Role of ski injury treatment system between the ski resort medical station of Winter Olympics and the nearby medical care hospital]

OBJECTIVE

To make a retrospective analysis of the situation and process of treating skiers' injuries in the medical station of the Wanlong ski resort in Chongli and the nearest treatment hospital, and to provide a basis for the establishment and optimization of the treatment process between the medical station of the Winter Olympics ski resort and the nearest treatment hospital, and to gain experience for medical security of mass skiing.

METHODS

The data of all ski injuries in Chongli District were collected from the medical station of the Wanlong ski resort during the 2018-2019 snow season (November 2018 to April 2019) and the nearest treatment hospital during two periods (March 2019, and November 2019 to January 2020). The differences of injury causes, injury types, injury sites, and treatment effects of the injured skiers were analyzed.

RESULTS

A total of 755 cases of ski injuries were recorded in the medical station of Wanlong ski resort, the estimated incidence of injury was 2.02‰ per day. The nearest treatment hospital treated a total of 838 injured skiers from different ski resorts in Chongli District in the two periods. In the records of the ski resort medical station, the main causes of injury were technical defects and turnovers (53.6%). Knee joint injury rate was the highest (18.7%), followed by head and neck (12.9%) and lower limb (11.9%). The number of injuries on intermediate roads was the highest (40.0%), the greatest number of injuries (81.2%) occurred when the age of skiing was less than 5 years. In the records of the nearest treatment hospital, the injury types were fracture or fissure fracture, contusion and trauma, and muscle and soft tissue injury, accounting for 30.5%, 27.4%, and 21.2% respectively. 9.6% of the injured took the snow field ambulance to the hospital, and 50% of them suffered from fractures or fissure fractures.

CONCLUSION

The injury rate of skiing in the 2018-2019 snow season of the Wanlong ski resort in Chongli was higher than that reported by foreign literature. Severe trauma (including severe fractures and concussions) could occur and patients needed to be transferred to the nearest hospital for treatment. The ski resort medical station and the nearest treatment hospital should be strengthened with adequate medical staff and equipment, and promote cooperation in the timely referral of seriously injured patients, the organization and construction of ski patrols and the medical security of large-scale competitions, thus playing an important role in forming a grassroots network of medical security and treatment system for skiing.

What Are Kinematic and Kinetic Differences between Short and Parallel Turn in Alpine Skiing?

There are numerous programs worldwide adapted for alpine ski beginners and they all share the same primary goal-inclusion of skiing beginners in alpine ski schools. The final elements of ski school taught in the parallel skiing technique are parallel turn and short turn. Synchronized analysis of kinetic and kinematic parameters of the parallel turn (PT) and short turn (ST) was conducted to determine the main biomechanical differences from a standpoint of foot pressure and lower limb angles. Both elements were performed by nine male ski instructors (age 33.4 ± 8.62, height 179.52 ± 5.98 cm, weight 78.6 ± 8.88 kg). Kinetic and kinematic analysis was conducted on 180 turns, 90 for each element. Differences in kinetic and kinematic parameters between parallel and short turns were tested by a paired t-test. The main findings of our study are determined differences in the ratio of pressure distribution on the inside and the outside foot and differences in kinematic parameters of the outside leg between elements. The mentioned analysis can provide an objective insight into the complexity of each element and provide guidelines for teaching process of those elements. This study determined the reasons for higher complexity of ST compared to PT based on the objective evaluation of biomechanical factors.

Sex differences in the knee orthopaedic injury patterns among recreational alpine skiers

Background

Although studies have reported the sex differences in injury patterns among recreational skiers, the findings are still conflicting. This study aims to analyse the sex differences of orthopaedic knee injuries that occurred during alpine skiing.

Methods

A total of 306 recreational alpine skiers (125 females and 181 males) who sustained knee surgeries between June 2016 and December 2018 participated in this study. Age, height, weight, and physical activity level of the patients were recorded. The orthopaedic knee injury patterns were analysed based on the diagnosis given by the physicians.

Results

Male skiers (17.13%) had a higher proportion of multiple knee ligament injuries than females (6.40%). The combined anterior cruciate ligament (ACL) and medial collateral ligament injury were the most common injury types in both females and males, with ACL injury being more prevalent for females (79.20%) than that in males (56.35%). The proportion of female skiers (17.6%) with vigorous-intensity activity level was significantly lower than that of males (30.9%). Female skiers had lower body height, body weight, and body mass index than male skiers (P <  0.001).

Conclusions

ACL injury is the most common orthopaedic injury among both female and male knee-injured recreational skiers. The proportion of females with an ACL injury is higher than that of males, but the proportion of multiple knee ligament injuries is lower than that of males. More male recreational skiers have vigorous-intensity activity level habits in daily life than females.

Injury patterns in a large-scale ski resort in the host city of 2022 Winter Olympic Games: a retrospective cross-sectional study

OBJECTIVES

The aims of the study are to describe the injury patterns among recreational skiers and snowboarders in China and to provide primary data to guide the reconstruction of regional healthcare facilities to deal with the increasing number of participants in snow sports.

DESIGN

Retrospective cross-sectional study.

METHODS

A retrospective study was performed in Wanlong Ski Resort in Chongli, China. Data of all injured skiers and snowboarders treated in the resort clinic during the 2018-2019 season were collected. Patients' information, including sex, age, equipment, skill level and injured body part, was analysed.

RESULTS

A total of 753 sports injuries were recorded. The estimated incidence of injury was 1.98 per 1000 skier days. 453 cases (60.2%) were associated with skiing. The mean age of skiers was older than snowboarders (35.1±14.5 vs 29.0±8.9, p<0.01). Injury not involving others constituted 67.9% of all injuries. The most common injured body part among skiers was lower extremity, contrary to injury in the upper extremity among snowboarders. Head and cervical injury was identified in 13.7% of skiers and 13.6% of snowboarders.

CONCLUSION

The incidence of skiing/snowboarding injury in China was similar to other countries. Injury pattern differed among different sports and causes of injury.

[Analysis of the mass skiers' injury in a large ski resort in Chongli, China]

OBJECTIVE

To make a retrospective analysis of the injuries of skiing population in a large ski resort in Chongli, China and provide a basis for predicting the rapidly increasing medical needs for ski injuries in the context of the 2022 Winter Olympic Games.

METHODS

The basic data of all injured skiers who were treated in a medical station of a large ski resort in Chongli during the snow season from November 2017 to March 2018 and from November 2018 to March 2019 were collected. The number of skiers, the number of injuries, the causes of injuries, the types of injuries and the locations of injuries were compared.

RESULTS

A total of 753 skiers were injured in two snow seasons, and the estimated average incidence of injury was 4.53 and 4.46 per 1 000 skier days at the resort respectively. The average daily injury rate per 1 000 skiers in November of the two snow seasons was relatively low, with 2.20 and 1.38 cases respectively. The difference of injury rate in different months might have little to do with snowfall and more to do with passenger flow. In both the snow seasons, men accounted for more injuries than women, and injured skiers aged between 21 and 30 accounted for the largest proportion, reaching 36.8%. The main causes of injuries were falls (76.6%). The highest rate of injury was in the head and neck (17.9%), followed by the knee (17.4%) and wrist and fingers (13.3%). The most common types of injuries were contusion and trauma (29.5%) and joint and/or ligament injuries (22.2%). Children (2-12 years old) accounted for 12.7% of all the injured skiers. The rate of moderate to severe injuries (including fractures, concussions, etc.) was 34.8% among the injured patients over 50 years of age.

CONCLUSION

The snow resort should focus on injuries to children and elderly skiers and carry out targeted guidance and rescue work. In order to better ensure the medical safety of skiers, the ski resort medical station and nearby treatment hospitals should be equipped with a corresponding number of medical personnel and equipment, and the ski resort should further improve its safety management and rescue system.

Snowboarders' Knowledge of the FIS Rules for Conduct on Ski Slopes

The objective of the present study is to assess snowboarders’ general perceptions of safety and knowledge of existing rules and both active and passive knowledge of the International Ski Federation (FIS) regulations in order to contribute to defining target groups for specific educational interventions in the field of injury prevention. Data were drawn from random interviews conducted with 918 snowboarders during the 2017–2018 winter season at five ski resorts located in the Spanish Pyrenees. To collect the data, a questionnaire assessing personal characteristics (gender, age, origin, and self-reported skill), general perception of safety, general request for rules, and knowledge of existing rules was used. Pearson’s Chi-squared tests were performed to compare characteristics between groups. The study revealed, for accident prevention purposes, a concerning lack of general knowledge of existing rules. Risk-inducing situations that could result in severe injuries were largely assessed incorrectly. The appropriate intuitive behavior increases with age and experience: youths and beginners are less able to implement the FIS rules than older and more experienced snowboarders. Stakeholders, such as parents, ski resorts, clubs or schools, should direct educational efforts at high-risk groups. Further research is needed to determine the causal relation between snowboard-related injuries and disregard of FIS rules.

Injury Prevention: Freestylers' Awareness of FIS Code of Conduct for Snow Parks

The objectives of the present study were to assess general perceptions of safety in snow parks (SPs), general knowledge of rules existence, and both active and passive awareness of the International Ski Federation (FIS) rules contained in its Code of Conduct for SPs in order to define target groups for injury prevention-specific education interventions. Data were drawn from 436 freestylers randomly interviewed. The study was conducted during the 2018-2019 winter season in the SP of a major winter resort located in the Spanish Pyrenees. A questionnaire assessing personal data (gender, age, gear used, self-reported skill, and frequency of use), general perceptions on safety, general request for rules, and awareness of existing rules in SPs was developed. Chi-square goodness-of-fit tests were used to compare characteristics between groups. It was revealed, for accident prevention purposes, a concerning general lack of knowledge of existing rules in SPs (63% of participants ignored them). Risk-inducing situations that could result in severe injuries, such as familiarity with the right progression in choosing features and/or stunts or with safety equipment, were largely assessed incorrectly (94% and 70% of participants, respectively). Appropriate intuitive behavior increases with experience: youths and beginners are less able to implement FIS rules than more experienced freestylers.

Effect of environmental conditions on injury rates at a Colorado ski resort

OBJECTIVE

To determine the effect of daily environmental conditions on skiing and snowboarding-related injury rates.

METHODS

Injury information was collected from a mountainside clinic at a large Colorado ski resort for the 2012/2013 through 2016/2017 seasons. Daily environmental conditions including snowfall, snow base depth, temperature, open terrain and participant visits were obtained from historical resort records. Snowpack and visibility information were obtained for the 2013/2014 through 2014/2015 seasons and included in a subanalysis. Negative binomial regression was used to estimate injury rate ratios (IRRs) and 95% CIs.

RESULTS

The overall injury rate among skiers and snowboarders was 1.37 per 1000 participant visits during 2012/2013 through 2016/2017. After adjustment for other environmental covariates, injury rates were 22% higher (IRR=1.22, 95% CI 1.14 to 1.29) on days with <2.5 compared with ≥2.5 cm of snowfall, and 14% higher on days with average temperature in the highest quartile (≥-3.1°C) compared with the lowest (<-10.6°C; IRR=1.14, 95% CI 1.03 to 1.26). Rates decreased by 8% for every 25 cm increase in snow base depth (IRR=0.92, 95% CI 0.88 to 0.95). In a subanalysis of the 2013/2014 and 2014/2015 seasons including the same covariates plus snowpack and visibility, only snowpack remained significantly associated with injury rates. Rates were 71% higher on hardpack compared with powder days (IRR=1.71, 95% CI 1.18 to 2.49) and 36% higher on packed powder compared with powder days (IRR 1.36, 95% CI 1.12 to 1.64).

CONCLUSIONS

Environmental conditions, particularly snowfall and snowpack, have a significant impact on injury rates. Injury prevention efforts should consider environmental factors to decrease injury rates in skiers and snowboarders.

The use of medication and alcohol in recreational downhill skiers: Results of a survey including 816 subjects in Tyrol

OBJECTIVE

The aim of this study was to collect data on the medication and alcohol use in recreational downhill skiers.

DESIGN

Cross-sectional study.

METHODS

The study was conducted during the 2014 winter season in different ski resorts in Tyrol, Austria. Participants were asked to complete a brief survey including questions about basic anthropometric data (age, stature, weight) the use of medication (yes/no) and alcohol intake on the skiing day or the day before (yes/no).

RESULTS

In total, 816 persons with an age between 6-87 years were surveyed. In general, 22% of the male and 20% of the female recreational downhill skiers reported the use of medication. In the age group >40 years, half of the respondents were taking medication on a regular basis. 30% of males and 16% of females reported to consume alcohol on the skiing day whereas more than 50% drank alcohol on the evening before skiing the next day. 63% of those under medication concomitantly consumed alcohol.

CONCLUSIONS

The findings confirm a high prevalence of medication use and alcohol consumption in recreational downhill skiers. Even more importantly, 63% of skiers under medication concomitantly consumed alcohol. Considering the fact that only a small amount of alcohol can already affect motor and cognitive skills, it may be strongly assumed that the risk for skiing injuries is increased with alcohol consumption. Side effects of simultaneous intake of drugs and alcohol may include hypotension, vertigo and collapse which are thought to be associated with increased risks of skiing falls and injuries.

Snowsport experience, expertise, lower limb injury and somatosensory ability

OBJECTIVES

Previous research demonstrates that a history of ankle injuries increases the risk of overall future injuries, and that somatosensory scores are correlated to sport performance. This research explores the relationship between lower limb somatosensory scores in snowsport participants and ankle injury history; and the relationship between lower limb somatosensory scores and Instructor qualification.

DESIGN AND METHODS

Experienced snowsport participants who were recruited through a western Canadian snowsport school completed a questionnaire that included their ankle injury history, the Identification of Functional Ankle Instability (idFAI), the Cumberland Ankle Instability Tool (CAIT), and their current instructor qualification level, as a proxy for sport performance. Lower limb somatosensory was assessed using the active movement extent discrimination assessment (AMEDA) method.

RESULTS

Of the 75 participants, 55% reported at least one previous ankle injury. An independent sample t-test did not show any significant difference in somatosensory scores of those with an ankle injury history (x¯=.66, SD=.05) or not (x¯=.66, SD=.05). Nor was there any difference between those with a functionally unstable ankle (i.e. CAIT<24 and idFAI>11) and all others [x¯=.66, SD=.04 cf. x¯=.66, SD=.05; t(67)=.54, p=.78]. An ANOVA exploring the relationship between Instructor Qualification and somatosensory scores was significant at p<.05 [F(4, 68)=4.0, p=.006].

CONCLUSIONS

The results did not reveal any significant difference in perceived functional instability and somatosensory scores, which contrasts with previous research. The sport performance finding is consistent with previous work examining the relationship between somatosensory scores and sport performances. Further research is needed to explore if the dynamic snowsport working environment impacts ankle instability and somatosensory scores.

Hospital-Treated Snow Sport Injury in Victoria, Australia: A Summary of 2003-2012

INTRODUCTION

To determine the incidence rate and changes over time for ice and snow sports injury in Victoria, Australia, from 2003 to 2012 and describe the most common types and causes of these injuries.

METHODS

Retrospective data from the Victorian Injury Surveillance Unit describing hospital admissions and emergency department presentations were extracted for the 10-year period of 2003 to 2012 for all ice- and snow-related injury. Descriptive injury data and participation-adjusted trend analyses using log-linear regression modelling of data (statistical significance, P<0.05) from the Exercise, Recreation and Sport Survey 2003 to 2010 are presented.

RESULTS

Overall, there were 7387 ice- and snow-related injuries, with a significant increase in hospital-treated snowboard injuries and a (nonsignificant) decline in hospital-treated ski injuries over the 10 years. Skiing (39%) and snowboarding (37%) had the highest incidence of hospital-treated injury, with males aged 15 to 24 years injured most frequently in both sports. Falls were the most common cause of injury in both skiing (68%) and snowboarding (78%).

CONCLUSIONS

Patterns of snow sports injury in Australia during 2003 to 2012 remain similar to findings of national studies conducted decades earlier. More importantly, however, Australian injury patterns are comparable to international statistics and thus may be generalizable internationally. Head injuries, although infrequent, are associated with great injury severity due to a high frequency of hospitalization. Furthermore, research into the use of personal protective equipment and other injury prevention measures among Australian participants, particularly by young, male snowboarders, is required. Given the similar injury patterns, injury prevention measures implemented internationally could reasonably translate to an Australian setting.

Characteristics and Risk Factors of Spinal Fractures in Recreational Snowboarders Attending an Emergency Department in Japan

OBJECTIVE

The purpose of this study was to elucidate the characteristics of spinal fractures during recreational snowboarding and to determine the risk factors for these fractures.

DESIGN

Case series study.

SETTING

The Oku-mino ski area during the 7-year period between the 2005 to 2006 and 2011 to 2012 skiing seasons.

PARTICIPANTS

Eight thousand seven hundred twenty-three snowboarders with injures.

INTERVENTIONS

Cases involved snowboarders with spinal fractures; controls were snowboarders without spinal fractures.

MAIN OUTCOME MEASURES

The characteristics of spinal fractures were assessed using a standard form and patient records, including radiographs. Multivariate regression analysis was performed to investigate risk factors for spinal fractures, including age, type of slope, snow condition, accident cause, self-reported skill level, experience level, and the use of protective equipment.

RESULTS

Of 8723 snowboarders with injuries, 431 snowboarders presented with spinal fractures (4.9%). The most common spinal fracture was isolated transverse process fracture in the lumbar spine (33.2%, n = 143), followed by compression type fracture in the lumbar spine (25.1%, n = 108). Age (20-39 years), terrain slopes (half-pipe/box/kicker/rail), and jump-landing failure were associated with a significantly high risk of spinal fracture.

CONCLUSIONS

Among the recreational snowboarders, isolated transverse process fracture in the lumbar spine was the most frequent spinal fracture. Age (20-39 year old), terrain slopes, and jump-landing failure were found to be risk factors for spinal fracture.

CLINICAL RELEVANCE

Identification of characteristics and risk factors for spinal fractures during snowboarding is useful information to create a preventive strategy for the fractures and make snowboarding a safer sport.

Surgical risks associated with winter sport tourism

Background

Mass tourism during winter in mountain areas may cause significant clustering of body injuries leading to increasing emergency admissions at hospital. We aimed at assessing if surgical safety and efficiency was maintained in this particular context.

Methods

We selected all emergency admissions of open surgery performed in French hospitals between 2010 and 2012. After identifying mountain areas with increasing volume of surgical stays during winter, we considered seasonal variations in surgical outcomes using a difference-in-differences study design. We computed multilevel regressions to evaluate whether significant increase in emergency cases had an effect on surgical mortality, complications and length of stay. Clustering effect of patients within hospitals was integrated in analysis and surgical outcomes were adjusted for both patient and hospital characteristics.

Results

A total of 381 hospitals had 559,052 inpatient stays related to emergency open surgery over 3 years. Compared to other geographical areas, a significant peak of activity was noted during winter in mountainous hospitals (Alps, Pyrenees, Vosges), ranging 6-77% volume increase. Peak was mainly explained by tourists’ influx (+124.5%, 4,351/3,496) and increased need for orthopaedic procedures (+36.8%, 4,731/12,873). After controlling for potential confounders, patients did not experience increased risk for postoperative death (ratio of OR 1.01, 95%CI 0.89-1.14, p = 0.891), thromboembolism (0.95, 0.77-1.17, p = 0.621) or sepsis (0.98, 0.85-1.12, p = 0.748). Length of stay was unaltered (1.00, 0.99-1.02, p = 0.716).

Conclusion

Surgical outcomes are not compromised during winter in French mountain areas despite a substantial influx of major emergencies.

Skiing and snowboarding injury prevention

Skiing and snowboarding are popular recreational and competitive sport activities for children and youth. Injuries associated with both activities are frequent and can be serious. There is new evidence documenting the benefit of wearing helmets while skiing and snowboarding, as well as data refuting suggestions that helmet use may increase the risk of neck injury. There is also evidence to support using wrist guards while snowboarding. There is poor uptake of effective preventive measures such as protective equipment use and related policy. Physicians should have the information required to counsel children, youth and families regarding safer snow sport participation, including helmet use, wearing wrist guards for snowboarding, training and supervision, the importance of proper equipment fitting and binding adjustment, sun safety and avoiding substance use while on the slopes.

Accident prevention on ski slopes - Perceptions of safety and knowledge of existing rules

Increases in the numbers of people participating in snow sports raise safety concerns. Despite declining numbers of skiing injuries among recreational skiers, collisions resulting in severe injuries appear to be on the rise. Skiers' risk of injury depends on a considerable number of different factors but only a few studies have investigated risk-taking behaviour and knowledge of proper skiing behaviour. To promote safe skiing the International Ski Federation (FIS) introduced regulations in 1967. We investigated participants' familiarity with the FIS regulations on the ski slopes in relation to age, skiing ability and country of origin. Random interviews were conducted with 1450 recreational skiers at 17 ski resorts in Tyrol, an Austrian province. A questionnaire assessing skiers' knowledge of existing rules, their intuitive behaviour in given situations and perceptions of safety was developed. The study revealed that beginners, young skiers and those who were not local residents displayed insufficient knowledge. Risk-inducing situations that could result in collisions, such as moving upwards during carving, were largely assessed incorrectly. Appropriate intuitive behaviour increases with experience, and beginners are less able to implement FIS regulations than more experienced skiers. Ski resorts, the media and schools should direct educational efforts toward these high-risk groups. More research is needed to determine the causal connection between skiing injuries and disregard of the FIS Rules.

A prospective study of snowkiting injuries

BACKGROUND

Snowkiting is becoming an increasingly popular extreme sport; however, its injury rates and patterns are unknown to date.

PURPOSE

The authors surveyed the injuries in a group of snowkiters over 1 season.

STUDY DESIGN

Descriptive epidemiology study.

METHODS

The study was conducted over the course of 1 winter season ranging from November 2009 until March 2010; 80 snowkiters were surveyed prospectively. All participants were recruited through contacts with snowkite schools, snowkiting-related web portals, or Internet-based social networks.

RESULTS

During 3929 hours of snowkiting recorded, 33 injuries occurred, of which 60.6% were mild; 21.2%, moderate; and 18.2%, severe. The calculated injury rate was 8.4 injuries per 1000 hours of exposure. Most frequently injured body sites were the back (30.3%), knee (24.2%), shoulder (21.2%), and head (21.2%). Upper extremity injuries included 2 shoulder dislocations, a clavicle fracture, and a dislocation fracture of the radial head. Injuries to the lower extremity included 3 knee sprains and 1 anterior cruciate ligament rupture. The most common injury causes were riding errors (75.8%), wind gusts (36.4%), and poor snow conditions (27.3%). When compared with experts (5.1 injuries per 1000 hours of exposure), beginners (20.8 injuries per 1000 hours of exposure) had a significantly increased risk of getting injured (odds ratio [OR] 4.11; 95% confidence interval [CI], 1.34-12.64; P = .008). Athletes who used snowboards for snowkiting purposes were injured almost 3 times more frequently than their colleagues using skis (11.7 vs 4.1 injuries per 1000 hours of exposure; OR 2.85; 95% CI, 1.23-6.57; P = .010). The quick-release system (97.5%), helmet (92.5%), kite leash (83.8%), spine protector (51.3%), and shoulder protectors (20.0%) were the most commonly used protective/safety equipment.

CONCLUSION

Snowkiting can be considered a sport carrying a high risk of injury. More caution in assessing local snow conditions and wind gust occurrences is recommended as well as considering using the help and advice of a professional instructor when beginning this action-packed sport. Injury prevention strategies should also include the further improvement of currently available safety equipment.