Recreational Skiing- and Snowboarding-Related Extremity Injuries: A Five-Year Tertiary Trauma Center Cohort.

INTRODUCTION: Skiing and snowboarding are widely recognized winter sports with a notable risk of sports-related injuries. Comprehensive knowledge of the injuries sustained during skiing and snowboarding is imperative for preventative strategies and for understanding the injury patterns and epidemiological characteristics from surgeons' standpoint, particularly orthopedic surgeons, given that all anatomical regions and systems are susceptible to harm when engaging in these activities. OBJECTIVE: Our research aims to investigate the injury patterns and epidemiological characteristics of individuals seeking medical attention at Erzincan University Faculty of Medicine Orthopedics and Traumatology Clinic, Erzincan, Turkey, after experiencing recreational skiing or snowboarding injuries. METHODS: During the period spanning from 2018 to 2023, a retrospective analysis was conducted on patients aged between 18 to 65 years who had sustained isolated extremity injuries while participating in recreational winter sports at the Ergan Mountain Ski Center. The causes of injuries were categorized into two types (skiing and snowboarding) based on the subjective description of the injury scene. The study employed the χ2 test for categorical variables and Student's t-test for continuous variables to conduct subgroup comparisons. RESULTS: The study results revealed that most patients, precisely 53.2%, sustained injuries in their lower extremities, whereas 46.8% sustained injuries in their upper extremities. The most frequently injured area of the patients presenting with skiing injury was the region around the knee (31.2%), followed by around the shoulder (21.6%) and the foot and ankle (14.9%). The anatomical region most injured among patients who sustained snowboarding injuries was the hand and wrist, accounting for 23.9% of cases. CONCLUSION: Skiing and snowboarding injuries vary anatomically. While individuals with limited experience are at a higher risk of sustaining injuries, no statistically significant disparity was observed regarding the specific body parts affected among individuals of varying skill levels. Recognizing these sports-related injuries, which are growing in young people, will encourage the use of personal protective equipment to avoid injuries, assure ski resorts' environmental safety, and reduce sports-related morbidity.

SalterHarris fractures in paediatric skiers and snowboarders.

The incidence of paediatric fractures among winter sport athletes is not adequately studied. Our objective was to categorize fractures that occurred in paediatric skiers and snowboarders at a single ski resort. X-rays of 756 skiers/snowboarders aged 3-17 diagnosed with a fracture were categorized using the Salter-Harris (SH) classification. SH fractures were seen in 158 (21%) patients, with 123 (77%) being Type II. There were no significant differences between patients with a SH fracture and patients with a non-SH fracture for age, sex, snowboarding or skiing, mechanism of injury, terrain or the resort conditions on the day of injury. The most common mechanism of injury was falling onto snow while collisions resulted in more severe injuries. Compared to fractures without growth plate involvement, a higher proportion of SH fractures were seen in the humerus, radius, fibula and thumb; a lower proportion of SH fractures were observed at the tibia and clavicle.

Pelvic ring injuries after alpine ski and snowboard accidents.

PURPOSE: 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. METHODS: 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. RESULTS: 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): 1.0 day, 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. CONCLUSION: 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.

Waxing activity as a potential source of exposure to per- and polyfluoroalkyl substances (PFAS) and other environmental contaminants among the US ski and snowboard community.

BACKGROUND: Skiers and snowboarders apply waxes and solvents to their equipment to enhance glide across the snow. Waxing results in exposures to per- and polyfluoroalkyl substances (PFAS) and particulate matter, which have been associated with adverse health effects among professional wax technicians in Scandinavia. However, little is known about exposure among people who participate at other levels of sport, including recreationally, in other regions. OBJECTIVE: We sought to characterize wax-related exposures among US skiers and snowboarders who participate across numerous levels of sport to expand scientific understanding of environmental health risks among this population. METHODS: We used an anonymous electronic survey to evaluate wax-related exposures among US cross-country and downhill skiers and snowboarders. Specifically, we assessed (Fang et al., 2020): duration of time involved with each sport in any role (Freberg et al., 2013), intensity of wax-related exposures based on time spent in waxing areas, wax use, and wax type (Rogowski et al., 2007), frequency of fluorinated wax application, and (Freberg et al., 2010) use of exposure interventions. RESULTS: Participants tended to be long-term winter sports enthusiasts (e.g., median downhill skiing duration: 31 years). Nearly all (92%) participants personally applied some wax to their skis/snowboards and most applied waxes containing PFAS (67%) and solvents (62%). Ski professionals waxed the most pairs of skis with fluorinated waxes annually (median (IQR): 20 (1, 100)), though individuals participating recreationally also applied fluorinated waxes regularly. Exposure interventions were not widely used. SIGNIFICANCE: Waxing activities may pose significant risk of exposure to PFAS and other environmental contaminants among the US ski and snowboard community. Efforts are needed to reduce these exposures through changes to wax use patterns and broader adoption of exposure reduction strategies.

Skiing and snowboarding related deep laceration injuries. A five-season cross-sectional analysis from a level-1 trauma centre in the Swiss Alps.

OBJECTIVES: Lacerations comprise 5.6-33.6% of skiing/snowboarding related injuries. This study aimed to investigate the mechanism of injury and the location of these lacerations and propose preventive measures. METHODS: After our state ethics committee approval, we retrospectively reviewed the medical records and surgical protocols of 46 patients (mean age (±SD) 34.6 (±15.3); 71.4% men) treated for severe skiing/snowboarding lacerations at our level-1 trauma centre between 2016 and 2021. Patients were asked to answer a questionnaire on their skiing experience, equipment used and the circumstances of the accident. RESULTS: Lacerations around the hip, thigh, and knee accounted for 94%. The latter was the most common location (45%). Although 91.3% of patients wore appropriate clothing and full standard protection equipment, it did not offer any extra-resistance against skiing/snowboarding's edges. Skiers were more affected (91.3%) than snowboarders (8.7%). The most common mechanism of injury was inadvertent release of the bindings (52.2%), followed by insufficient ski level for the slope (21.7%) and collisions (17.4%). Long-term trends demonstrated an increasing incidence. CONCLUSION: Identification of body areas at risk and the mechanisms of injury were the most significant findings of this work. These data encourage the development of specific injury prevention programs as the occurrence of these lesions tended to increase over the last few years. To reduce their incidence, we propose skiers to have their bindings regularly adjusted and manufacturers to develop cut-resistant skiwear. LEVEL OF EVIDENCE: IV.

Impact Performance Comparison of Advanced Snow Sport Helmets with Dedicated Rotation-Damping Systems.

Rotational acceleration of the head is a principal cause of concussion and traumatic brain injury. Several rotation-damping systems for helmets have been introduced to better protect the brain from rotational forces. But these systems have not been evaluated in snow sport helmets. This study investigated two snow sport helmets with different rotation-damping systems, termed MIPS and WaveCel, in comparison to a standard snow sport helmet without a rotation-damping system. Impact performance was evaluated by vertical drops of a helmeted Hybrid III head and neck onto an oblique anvil. Six impact conditions were tested, comprising two impact speeds of 4.8 and 6.2 m/s, and three impact locations. Helmet performance was quantified in terms of the linear and rotational kinematics, and the predicted probability of concussion. Both rotation-damping systems significantly reduced rotational acceleration under all six impact conditions compared to the standard helmet, but their effect on linear acceleration was less consistent. The highest probability of concussion for the standard helmet was 89%, while helmets with MIPS and WaveCel systems exhibited a maximal probability of concussion of 67 and 7%, respectively. In conclusion, rotation-damping systems of advanced snow sport helmets can significantly reduce rotational head acceleration and the associated concussion risk.

Ski and Snowboard - Related Orthopedic Injuries.

Participation in skiing and snowboarding continues to increase. Both sports are associated with unique equipment and movement patterns, placing athletes at risk for several characteristic injuries. Although the axial skeleton and extremities are at risk for injury in both sports, skiing and snowboarding are associated with distinctive injury patterns. This article summarizes the epidemiology, risk factors, and specific injuries associated with skiing and snowboarding to better educate orthopedic surgeons regarding diagnosis and treatment of athletes partaking in these sports.

Different injury patterns after snowboard in children and adolescents.

BACKGROUND: Snowboarding is a very common sport especially among young adults. Common injuries are hand, wrist, shoulder and ankle injuries. PURPOSE: of this study was to analyze different injury pattern in children and young adults comparing with adults. METHODS: Patients who were admitted for ambulant or stationary treatment as a result of injury practicing snowboard received a questionnaire and were divided into three groups (children, young adults and adults) according to their age. Between october 2002 and may 2007 1929 injured snowboard sportsmen were included in the study. Data such as location, date and time of accident as well as information about the slope were carried out. In addition snowboard skills were classified and patients were questioned whether they wore special protectors. RESULTS: 32.5% of injured patients were female (n = 626) and 67.5% male (n = 1303) with a mean age of patients of 21.9 (7-66) years. 13% of all patients were in group I (children), 19.2% in group II (young adults) and 67.8% in group III (adults).Most common injuries with 60% of all accidents were injuries of the hand wrist especially in children beginning with snowboard sports. Injuries on the regular track were most common followed by jumps in the kicker park and rails in the fun-park. 20.6% in group I, 13.6% in group II and 12.8% group III did not wear any protectors. CONCLUSION: Children and adolescents presented different injury patterns than adults. Young participants of up to 14 years of age are endangered especially during the first days of learning this sport. Further development of protectors with regard to biomechanical characteristics is important to achieve an optimal protective effect. LEVEL OF EVIDENCE: 2b.

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.

Accessory Anterolateral Talar Facet Syndrome After Treatment of Neglected Fracture of the Lateral Process of the Talus: A Case Report.

Fracture of the lateral process of the talus has often been missed or confused with lateral ankle sprain, and this can lead to long-term untreated cases of nonunion, malunion, and subtalar joint osteoarthritis. In a review of the published data, accessory anterolateral talar facet syndrome was not found after treatment of nonunion of the lateral process of the talus fracture. This report presents the case of a 40-year-old male snowboard instructor who suffered from a neglected fracture of the lateral process of the talus and was treated with open reduction using an iliac autogenous bone graft. Subsequently, partial resection of the anterior aspect of the process was required to treat the impingement syndrome that developed secondary to the united but enlarged lateral process. The patient resumed his activities a year after the second operation. We describe the consequences of misdiagnosis of the lateral process of the talus and its management.

Energy Expenditure and Muscular Recruitment Patterns of Riding a Novel Electrically Powered Skateboard.

Analysis of metabolic gas exchange and muscular output measures have enabled researchers to index activity intensity and energy expenditure for a myriad of exercises. However, there is no current research that investigates the physiological demands of riding electrically powered skateboards. The aim of this study was to measure the energetic cost and muscular trends of riding a novel electrically powered skateboard engineered to emulate snowboarding on dry-land. While riding the skateboard, eight participants (aged 21-37 years, 1 female) donned a portable breath-by-breath gas analyzer to measure energy expenditure (mean = 12.5, SD = 2 kcal/min), maximum heart rate (mean = 158, SD = 27 bpm), and metabolic equivalent (mean = 10.5, SD = 2 kcal/kg/h). By comparison, snowboarding has a metabolic equivalent (MET) of 8.0. Per the Compendium of Physical Activities guidelines, the predicted MET values for riding an electrically powered skateboard qualifies as vigorous-intensity activity. Four participants additionally wore a surface EMG embedded garment to record the percentage of maximum voluntary contraction (%MVC) of lower limb muscle groups. The inner quadriceps had the most pronounced mean peak muscle activation of 145%MVC during frontside and 164%MVC during frontside turns. EMG recordings showed 11.7%MVC higher utilization during backside turns compared to frontside turns while riding the electrically powered skateboard, which is similar to trends observed in alpine snowboarders. Therefore, electrically powered skateboards may be a promising technology for snowboarders and non-snowboarders alike to burn calories and increase physical activity year-round.

Unusual combination of elbow dislocation with a retained intraarticular fragment and trochlear fracture and ipsilateral distal radius fracture in an amateur snowboarder: A case report and review of literatures.

INTRODUCTION: The most common damage caused by snowboarding is wrist injury. However, Elbow injuries are relatively rare. In general, elbow dislocation with ipsilateral distal radius fracture is also very rare. PRESENTATION OF CASE: We present an 18-year-old right hand dominant male with distal radius extra-articular fracture and elbow fracture dislocation. Computed tomographic scan and Magnetic resonance image of elbow joint showed retained intra-articular fragment, trochlear fracture, and the humeral attachment site of lateral collateral ligament (LCL) with rupture. The ruptured LCL was repaired, and then, the distal radius fracture was fixed with a volar distal radius locking plate. At one year after surgery, the patient did not complain of any subjective symptoms or functional deficit. DISCUSSION: The injury mechanism would fall into the outstretched arm state, leading first to hyperextension of the wrist, resulting in fracture of the distal radius. The remaining force is then applied to the elbow joint by an external rotation and valgus moment arm, resulting in the rupture of the LCL of the elbow joint. In this state, the remaining force is transmitted through the olecranon to the trochlea as a shear force, resulting in osteochondral fracture and subsequent dislocation of the elbow joint. CONCLUSION: Combined injury of extremity from snowboarding is relatively rare, but we experienced a case of elbow dislocation combined with distal radius fracture caused by fall on outstretched hand on the snow surface during snowboarding in a young adult.

Pediatric and adolescent injury in snowboarding.

To systematically review published literature on pediatric snowboard injuries, a literature search was performed in PubMed for "snowboard*". Studies must 1) have been primary research; 2) included at least 10 snowboarders; 3) included children and/or adolescents 4) reported specific injury outcomes, risk factors, or injury prevention program effectiveness. The overall injury rates ranged from 0.5 per 1,000 runs to 420 per 1,000 snowboarders. The most common injuries types were fractures, sprains and strains. Most injuries occurred to an upper extremity or the head. Falls and collisions were the most common mechanisms. Snowboarders who were younger, female, had less snowboard experience, or had a previous injury were at greater risk for injury. Wearing wrist guards had a protective effect. Injury rates varied by injury denominator and source of data. Injury prevention efforts should evaluate modifiable extrinsic risk factors, such as strategies to increase use of protective equipment.

Safety on the slopes: ski versus snowboard injuries in children treated at United States trauma centers.

PURPOSE: Skiing and snowboarding are popular winter sports. The purpose of this study was to determine differences in injury patterns and severity between children participating in these sports treated at trauma centers in the United States. METHODS: Ski and snowboard injuries in children <15 identified from the 2011-2015 National Trauma Data Bank were compared using t tests, chi squared tests, and multivariable analyses. Time trends were evaluated using the Cochran Armitage trend test. RESULTS: We identified 1613 injured snowboarders and 1655 skiers. Snowboarders were older (12 vs. 11years, p<.001) and more likely to be male (84 vs. 68%, p<.001). The proportion of ski to snowboard injuries increased over time (p<.001). Skiers had greater median ISS than snowboarders (5 vs. 4, p<.001) but similar severe injuries ISS ≥16 (9 vs. 8%, p=.31). Head injuries were more frequent among snowboarders (26 vs. 23%, p=.013). Helmet use was greater in skiers (46 vs. 34%, p<.001). Skiers were more likely to sustain face, chest, and lower extremity injuries. Snowboarders had more abdominal and upper extremity injuries (p<.05). Snowboarders were more likely to undergo CT (20 vs. 16%, p=.008), and skiers were more likely to undergo surgery (25 vs. 22% p=.021). Need for intensive care (12 vs. 13%, p=.43) and mortality (0.3 vs. 0.3%, p=.75) were similar. Median length of stay was greater for skiers (2 days vs. 1day, p<.001). CONCLUSION: Many children are treated at United States trauma centers for ski and snowboard injuries. One in 10 is severely injured. Different injury patterns between sports can be used to tailor prevention efforts. However, avoiding head injury and improving helmet use should be a priority for all children on the slopes. LEVEL OF EVIDENCE: III TYPE OF STUDY: Prognostic.

Effect of Helmet Use on Traumatic Brain Injuries and Other Head Injuries in Alpine Sport.

INTRODUCTION: Sport helmet effectiveness in preventing traumatic brain injury (TBI) has been repeatedly questioned. This study assesses the effect of helmet use on risk of TBI and other types of head injury (OTHI) in alpine sports. METHODS: From 2012 to 2014, data on the injured population were collected by physicians in on-mountain clinics in 30 French ski resorts, and interviews were conducted on the slope to sample a noninjured control population. Two sets of cases (1425 participants with TBI and 1386 with OTHI) were compared with 2 sets of controls (2145 participants without injury and 40,288 with an injury to a body part other than the head). The effect of helmet use on the risk of TBI and OTHI was evaluated with a multivariate logistic regression adjusted for age, sex, sport, skill level, crash type, and crash location. RESULTS: Using participants without injury as control, we found that helmet wearers were less likely to sustain any head injury (odds ratio [OR]TBI = 0.65; OROTHI = 0.42). When considering participants with an injury to another body part as control, the risk of OTHI was lower among helmet wearers (OROTHI: 0.61). However, no significant effect was found for the risk of TBI. Participants with low skill levels, those aged <26 and >50 years, snowboarders, and those involved in collision and in snowpark accidents were at higher risk of head injury. CONCLUSIONS: This study confirms the effectiveness of helmets in protecting users from head injuries but questions their effects on TBI, especially concussion.

Ski and snowboard school programs: Injury surveillance and risk factors for grade-specific injury.

The objective of our study was to evaluate incidence rates and profile of school program ski and snowboard-related injuries by school grade group using a historical cohort design. Injuries were identified via Accident Report Forms completed by ski patrollers. Severe injury was defined as those with ambulance evacuation or recommending patient transport to hospital. Poisson regression analysis was used to examine the school grade group-specific injury rates adjusting for risk factors (sex, activity, ability, and socioeconomic status) and accounting for the effect of clustering by school. Forty of 107 (37%) injuries reported were severe. Adolescents (grades 7-12) had higher crude injury rates (91 of 10 000 student-days) than children (grades 1-3: 25 of 10 000 student-days; grades 4-6: 65 of 10 000 student-days). Those in grades 1-3 had no severe injuries. Although the rate of injury was lower in grades 1-3, there were no statistically significant grade group differences in adjusted analyses. Snowboarders had a higher rate of injury compared with skiers, while higher ability level was protective. Participants in grades 1-3 had the lowest crude and adjusted injury rates. Students in grades 7-12 had the highest rate of overall and severe injuries. These results will inform evidence-based guidelines for school ski/snowboard program participation by school-aged children.

Head Injuries in Urban Environment Skiing and Snowboarding: A Retrospective Study on Injury Severity and Injury Mechanisms.

BACKGROUND AND AIM: During the last decade urban skiing and snowboarding has gained a lot of popularity. In urban skiing/snowboarding riders try to balance on handrails and jump off buildings. Previous studies in skiing and snowboarding accidents have mostly been conducted at hospitals located close to alpine terrain with big ski resort areas. The aim of this study is to evaluate the types and severity of traumatic brain injuries occurring in small, suburban hills and in urban environment, and to characterize injury patterns to find out the specific mechanisms of injuries behind. MATERIALS AND METHODS: This study included all patients admitted to the Helsinki University Hospital Trauma Unit from 2006 to 2015 with a head injury (ICD 10 S06-S07) from skiing or snowboarding accidents in Helsinki capital area. Head injuries that did not require a CT-scan, and injuries older than 24 hours were excluded from this study. RESULTS: There were a total of 72 patients that met the inclusion criteria Mean length of stay in hospital was 2.95 days. According to the AIS classification, 30% had moderate, 14% had severe, and 10% had critical head injuries. Patients who got injured in terrain parks or on streets where more likely to be admitted to ICU than those injured on slopes. Based on GOS score at discharge, 78% were classified as having a good recovery from the injury, 13% had a moderate disability, 5% had a severe disability and 3% of the injuries were fatal. There were no statistically significant differences in decreased GOS between the accident sites. CONCLUSION: Head injuries occurring in small suburban hills and in urban environments can be serious and potentially fatal. The profile and severity of skiing injuries in urban environments and small, suburban hills is comparable to those on alpine terrain.

Return to Sport-Specific Performance After Primary Anterior Cruciate Ligament Reconstruction: A Systematic Review.

BACKGROUND: Physicians counseling athletes on the prognosis of sport-specific performance outcomes after anterior cruciate ligament reconstruction (ACLR) depend on the published literature. However, critical appraisal of the validity and biases in these studies is required to understand how ACLR affects an athlete's ability to return to sport, the athlete's sport-specific performance, and his or her ability to achieve preinjury levels of performance. PURPOSE: This review identifies the published prognostic studies evaluating sport-specific performance outcomes after ACLR. A risk of bias assessment and summaries of return to sport and career longevity results are provided for each included study. STUDY DESIGN: Systematic review. METHODS: Electronic databases (Ovid MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, and PUBMED) were searched via a defined search strategy with no limits, to identify relevant studies for inclusion in the review. A priori defined eligibility criteria included studies measuring sport-specific performance within an athlete's sport, before and after primary ACLR. Reference lists of eligible studies were hand-searched for additional relevant studies. Data extraction was performed by use of a standardized spreadsheet. Each included study was assessed by use of 6 bias domains of the Quality in Prognosis Studies tool to critically appraise study participation, study attrition, prognostic factors, outcome measurement, confounders, and statistical analysis and reporting. Two authors independently performed each stage of the review and reached consensus through discussion. RESULTS: Fifteen pertinent prognostic studies evaluated sport-specific performance outcomes and/or return to play after ACLR for athletes participating in competitive soccer, football, ice hockey, basketball, Alpine ski, X-Games ski and snowboarding, and baseball. Twelve of these studies were considered to have a high level of bias. CONCLUSION: This review demonstrated that most high-performance or professional athletes returned to their preinjury level of sport after ACLR. The bulk of evidence suggests there was a measurable decrease in performance statistics, although this is highly sport-specific. A paucity of literature is available that addresses sport-specific performance in athletes after ACLR. This review has determined that the available literature is highly biased and must be read with caution. CLINICAL RELEVANCE: By better understanding the validity and biases in the published literature, physicians can provide more informed prognoses about return to sport-specific performance after ACLR while considering risk factors relevant to their patients. REGISTRATION: CRD42016046709 (International Prospective Register of Systematic Reviews, https://www.crd.york.ac.uk/prospero/ ).

Cervical Spine Alignment in Helmeted Skiers and Snowboarders With Suspected Head and Neck Injuries: Comparison of Lateral C-spine Radiographs Before and After Helmet Removal and Implications for Ski Patrol Transport.

OBJECTIVE: Current protocols for spine immobilization of the injured skier/snowboarder have not been scientifically validated. Observing changes in spine alignment during common rescue scenarios will help strengthen recommendations for rescue guidelines. METHODS: Twenty-eight healthy volunteers (18 men, 10 women) age 47±17 (range 20-73) (mean ±SD with range) underwent a mock rescue in which candidate patrollers completing an Outdoor Emergency Care course performed spine immobilization and back boarding in 3 scenarios: 1) Ski helmet on, no c-collar; 2) helmet on, with c-collar; and 3) helmet removed, with c-collar. After each scenario, a lateral radiograph was taken of the cervical spine to observe for changes in alignment. RESULTS: Compared with the control group (helmet on, no collar), we observed 9 degrees of increased overall (occiput-C7) cervical extension in the helmet on, with collar group (P < .001), and 17 degrees in the helmet off, with collar group (P < .001). There was increased extension at the occiput-C2 intersegment in the helmet on, with collar group (9 degrees, P < .001) and at both the occiput-C2 (9 degrees, P < .001) and C2-C7 (8 degrees, P < .001) intersegments in the helmet off, with collar group. CONCLUSION: Ski helmet removal and c-collar application each leads to increased extension of the cervical spine. In the absence of other clinical factors, our recommendation is that helmets should be left in place and c-collars not routinely applied during ski patrol rescue.

[Epidemiological data of Hungarian skiers' and snowboarders' medical problems]. / A magyar alpesi sízok és hódeszkázók egészségkárosodásainak összehasonlító statisztikai elemzése.

INTRODUCTION AND AIM: There are no high mountains or any advantageous circumstances for winter sports in Hungary, yet within the 10 million population there are about half a million people (the exact number is 550,000) who tend to go for skiing or snowboarding abroad. Authors compared the injury statistical data with results described in the international literature in order to develop conclusions about the differences in the injury patterns and frequency between the Hungarian ones' and those found in countries with plenty of winter sport possibilities. METHOD: Authors analysed the winter sport injury cases of an insurance company. All the injury happened abroad and the assistance provider of the insurance company has managed the patient treatment and repatriation. Three winter seasons (12 months) data was analysed from the point of view of injuries frequency at different body parts and areas. Due to the fact that only limited information was available a simple statistical method was applied. RESULTS: Of 222 cases 90.5% were ski-related injury and 8.6% were snowboard injury. As for the skiers, the upper limb injuries accounted for 21.9%, the truncal region for 24.4% and the lower limb for 55.8%. Among snowboarders the upper limb injuries accounted for 36.9%, the truncal region for 37% and the lower limb for 26.1%. The most frequent was the knee (36.8%), the wrist (12.4) and the shoulder (11.4) injury. Skier's thumb injury was only 1.5%. The most common snowboard injury was the wrist trauma (31.6%), the head/neck/face was accounted 15.8% of all the injuries. And the ankle was injured in 10.5% of all the cases. The head/neck and the knee injury often combined with injuries of some other body part. 29 patients (13%) had to be repatriated, the most frequent reason for the repatriation was the injury of the lower limb. CONCLUSIONS: The Hungarian sportsmen's injury patterns do not always follow data described in the international literature, but they correspond to data of countries with similar geographical situation. The injury rate of knee and of the shoulder displays same data, the injury rate of the wrist was more frequent than in the international data, and this is true both for skiers and the snowboarders. The Hungarians' injury of the truncal region (mainly the head) was more frequent, but on the other hand the general injury rate of other body parts proved to be a lower number. It seems that the frequent use of the protective equipment and the preventive measures applied by the Hungarians are mirrored in the lower injury figures. Orv. Hetil., 2017, 158(16), 618-624.