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SKI AND SNOWBOARD INJURIES

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  1. SKI AND SNOWBOARD INJURIES Outdoor Emergency Care, 4th Edition AAOS/NSP

  2. Statistics: (Scottish Snow Sports Safety Study) ** Skiers mainly injure Knee, then head/face, then limbs Outdoor Emergency Care, 4th Edition AAOS/NSP

  3. Statistics: (Scottish Snow Sports Safety Study) ** Skiers injure knees and snowboarders injure wrists Outdoor Emergency Care, 4th Edition AAOS/NSP

  4. Statistics: (Scottish Snow Sports Safety Study) ** Skiers sprain more and snowboarders fracture more Outdoor Emergency Care, 4th Edition AAOS/NSP

  5. Conclusion (Scottish Snow Sports Safety Study) • Injury rate in Scotland is 2.24 injuries per 1000 skier days • Over the four years of the study there was a trend toward less injury • Attributed this to increased use of helmets, wrist guards, awareness • No mention of skiers using knee braces for primary prevention of joint injury Outdoor Emergency Care, 4th Edition AAOS/NSP

  6. Outdoor Emergency Care, 4th Edition AAOS/NSP

  7. Statistics:(Geddes, R et al. Boarder Belly: splenic injuries reslting from ski and snowboarding accidents. Emergency Medicine Australia. April, 2005.17 (2): 157-162 • Ten year retrospective review on splenic injury in skiers and snowboarders (boarder belly). • Snowboarders are six times more likely to sustain splenic injury than skiers • Males 21 times more likely than females to sustain such injury • Most injury in snowboarders resulted from falls or jumps. Outdoor Emergency Care, 4th Edition AAOS/NSP

  8. Statistics:(1995 - U.S. Consumer Product Safety Commission) • Through the National Injury Information Clearinghouse the looked at head injury from skiing. • 42% of head injuries were concussions • 24% of head injuries were lacerations • CPSC estimates that each year more than 7,000 head injuries could be prevented or reduced in severity with helmet use. Outdoor Emergency Care, 4th Edition AAOS/NSP

  9. Statistics:Snowsport Deaths • Occurrence of death in USA from 1991-2004 is 469 • 58 snowboarders. 401 Skiers. • 1 death/ 1.4million skier days • Average 35 deaths per season • No decrease in mortality despite increased helmet use! Outdoor Emergency Care, 4th Edition AAOS/NSP

  10. Statistics: Final Conclusions • Skiers: lacerations, boot-top contusions, thumb injuries, and complex knee injuries. • Snowboarders: distal radius fractures, foot or ankle injuries • Serious injuries: equal rates of closed head injuries but snowboarders suffer more intra-abdominal injuries (boarder belly) • Snowboarders suffer from falls or jumps while skiers from collision. • Unique pattern of injuries. Accident prevention must focus on sport specific education and equipment design Outdoor Emergency Care, 4th Edition AAOS/NSP

  11. Common Recommendations • Make sure items such as bindings and boots are adjusted to fit properly. • Don't ski or snowboard beyond your ability. • Ski and snowboard in control, and follow the rules of the slopes. • Never ski or snowboard alone. • Get in shape before you hit the slopes • *Wear warm, close-fitting clothing. Loose clothing can become entangled in lifts, tow ropes and ski poles. Outdoor Emergency Care, 4th Edition AAOS/NSP

  12. Recommendations are helpful but is there any evidence on protective equipment- Helmets, wrist guards, knee braces? Outdoor Emergency Care, 4th Edition AAOS/NSP

  13. Helmets:Hagel, I et al. • Assumption that they are helpful is based on bicycle helmet data that does prove usefulness • Children have large head:body ratio • Could helmets exert excessive bending or twisting on the neck in simple falls Outdoor Emergency Care, 4th Edition AAOS/NSP

  14. Outdoor Emergency Care, 4th Edition AAOS/NSP

  15. Helmets:Hagel, I et al. • Conclusions: • Wearing helmet may reduce risk of head injury by 29-56% • Although not statistically significant, there was a trend toward helmet use causing an increase in neck injuries. • Limitations: • Snowsport participants that fell but were not injured as a result of wearing a helmet could not have been reported • Benefits of wearing a helmet may have been underestimated Outdoor Emergency Care, 4th Edition AAOS/NSP

  16. Helmets:Sulheim, et al. • Norwegian study in skiers and snowboarders • Methods • Case control study at 8 major alpine resorts during 2002 season • 3277 injured and 2992 non-injured controls interviewed • Multivariate logistic regression analysis Outdoor Emergency Care, 4th Edition AAOS/NSP

  17. Helmets:Sulheim, et al. • Results • 578 (17.6%) head injuries. • Helmet use reduced head injury by 60% even after adjusting for other factors like skill level, equipment, et cetera • The risk for head injury was higher in snowboarders Outdoor Emergency Care, 4th Edition AAOS/NSP

  18. Helmets:Macnab, et al. • Results • No difference in serious neck injury between groups (helmet vs non-helmet) • Failure to use helmet increase head injury (RR 2.24; 95% CI 1.23-4.12) Outdoor Emergency Care, 4th Edition AAOS/NSP

  19. Snowboarding Injury:Epidemiology • Results • Ratio of upper extremity injury to all types of injury was significantly higher in snowboarders than skiers by three times • Snowboarders fracture wrists and skiers fractures clavicles • Snowboarders dislocate elbows and skiers dislocate shoulders • In snowboarders, the left upper extremity was more frequently affected due to their orientation on the board Outdoor Emergency Care, 4th Edition AAOS/NSP

  20. Snowboarding:Wrist Guards • O’Neill et al. • Studied rate of injury in first time snowboarders • Compared 551 wore wrist guards and control was more than 1800; no wrist guards. Outdoor Emergency Care, 4th Edition AAOS/NSP

  21. Snowboarding:Wrist Guards • Results • 40 wrist injuries in Control (unguarded) and 0 injuries in experimental (guarded) in first timers • No higher rate of other upper extremity injury in guarded group • Should they have stopped and given everyone wrist guards? Outdoor Emergency Care, 4th Edition AAOS/NSP

  22. Snowboarding:Wrist Guards • Ronning et al. - Results • Significant difference between the two groups • Wrist guards were protective • More injuries if first-timers and those who rented equipment Outdoor Emergency Care, 4th Edition AAOS/NSP

  23. Statistics:Boarder Belly Outdoor Emergency Care, 4th Edition AAOS/NSP

  24. Skiing:Bindings • Very poor evidence for studies on bindings • Finch et al: • Review article based on 15 low level evidence studies • Bindings currently have one pivot point to release for rotational forces exerted on the ski from the front, but this does not account for rotational forces from the back • Adjustments, especially in children, tends to be inadequate • Suggests that a binding testing device should be used to optimize and standardize adjustments Outdoor Emergency Care, 4th Edition AAOS/NSP

  25. Skiing:Knee Braces • Oates et al: • Three groups of skiers: (1) No previous ACL injury- 4748 (2) ACL deficient- 138 (3) ACL reconstruction- 274 • Put them all in knee braces • Ligament deficient knees had 6.2x higher rate of injury than intact knees • Ligament reconstructed knees had 3.1x higher rate than intact • Injuries in intact knees were also less severe Outdoor Emergency Care, 4th Edition AAOS/NSP

  26. Skiing:Knee Braces • Kocher et al: • Cohort study of 180 ACL deficient skiers who were a mix of braced and non-braced knees • Unbraced knees had higher injury rates (P=0.005) • No evidence on knee braces for primary injury prevention Outdoor Emergency Care, 4th Edition AAOS/NSP

  27. Outdoor Emergency Care, 4th Edition AAOS/NSP

  28. Classic Injuries:Skier’s Thumb • Background • Skier’s thumb, aka gamekeepers thumb • Ski pole injuries and football injuries are now most common cause Outdoor Emergency Care, 4th Edition AAOS/NSP

  29. Classic Injuries:Skier’s Thumb • Presentation • Acute trauma or repeated stress typically results in ulnar collateral ligament tendonopathy or disruption • Leads to swelling, pain, tenderness and/or loss of stability Outdoor Emergency Care, 4th Edition AAOS/NSP

  30. Classic Injuries:Skier’s Thumb Outdoor Emergency Care, 4th Edition AAOS/NSP

  31. Classic Injuries:Skier’s Thumb Prevention Outdoor Emergency Care, 4th Edition AAOS/NSP

  32. Conclusions:General Skier, think knee sprain then ACL or ligament disruption Snowboarder think wrist fracture of left hand Outdoor Emergency Care, 4th Edition AAOS/NSP

  33. Conclusions:Skiing Injuries • If points to knee Think ACL tear or sprain and consider brace in future • If points to hand Think skier’s thumb and search and qualify avulsion fracture and/or ligament disruption • If points to arm Think clavicle fracture and/or shoulder dislocation Outdoor Emergency Care, 4th Edition AAOS/NSP

  34. Conclusions:Snowboard Injuries • If points to knee Think sprain • If points to hand/wrist Think distal radius fracture and give them a brace to use in future • If points to arm Think elbow dislocation • If points to foot/ankle Think snowboarder’s ankle • If points to abdomen Think boarder belly Outdoor Emergency Care, 4th Edition AAOS/NSP

  35. Objectives(1 of 5) • List the functions of the central nervous system. • Define the structure of the skeletal system as it relates to the nervous system. • Relate mechanism of injury to potential injuries of the head and spine. • State the signs and symptoms of a potential spinal injury. Outdoor Emergency Care, 4th Edition AAOS/NSP

  36. Objectives(2 of 5) • Describe the method of determining if a responsive patient may have a spinal injury. • Relate the airway emergency medical care techniques to the patient with a suspected spinal injury. • Describe how to stabilize the cervical spine. • List the steps in performing rapid extrication. Outdoor Emergency Care, 4th Edition AAOS/NSP

  37. Objectives(3 of 5) • Explain the rationale for immobilization of the entire spine when a cervical spine injury is suspected. • Explain the rationale for utilizing rapid extrication approaches only when they indeed will make the difference between life and death. • Demonstrate opening the airway in a patient with a suspected spinal cord injury. Outdoor Emergency Care, 4th Edition AAOS/NSP

  38. Objectives(4 of 5) • Demonstrate evaluating a responsive patient with a suspected spinal cord injury. • Demonstrate stabilization of the cervical spine. • Demonstrate the four-person log roll for a patient with a suspected spinal cord injury. • Demonstrate how to log roll a patient with a suspected spinal cord injury using two people. Outdoor Emergency Care, 4th Edition AAOS/NSP

  39. Objectives(5 of 5) • Demonstrate securing a patient to a long backboard. • Demonstrate the procedure for rapid extrication. • Demonstrate helmet removal techniques. Outdoor Emergency Care, 4th Edition AAOS/NSP

  40. Spinal Column Outdoor Emergency Care, 4th Edition AAOS/NSP

  41. Assessment of Spinal Injuries • Vehicle crashes (snowmobile, car, motorcycle) • Snow rider collisions with fixed objects • Snow rider collisions with other snow riders • Falls from heights • Blunt or penetrating trauma • Blunt trauma • Hangings • Diving accidents Outdoor Emergency Care, 4th Edition AAOS/NSP

  42. Questions to Ask Responsive Patients • Does your neck or back hurt? • What happened? • Where (specific location) does it hurt? • Can you feel me touching your fingers? Your toes? • Can you move your hands and feet? Outdoor Emergency Care, 4th Edition AAOS/NSP

  43. Assessment of Spinal Injuries • Assess DCAP-BTLS. • Avoid any excessive motion. • Assess strength in each extremity and compare. • Absence of pain does not rule out injury. • Ability to move or walk does not rule out injury. Outdoor Emergency Care, 4th Edition AAOS/NSP

  44. Signs and Symptoms of Spinal Injury • Pain or tenderness of spine • Deformity of spine • Tingling and/or weakness in the extremities • Loss of sensation or paralysis • Incontinence • Soft-tissue injuries to head, neck, back Outdoor Emergency Care, 4th Edition AAOS/NSP

  45. Emergency Medical Care • Follow BSI precautions. • Manage the airway. • Perform the jaw-thrust maneuver to open the airway. • Consider inserting an oropharyngeal airway. • Administer oxygen. • Stabilize the cervical spine. Outdoor Emergency Care, 4th Edition AAOS/NSP

  46. Stabilization of the Cervical Spine (1 of 3) • Hold patient’s head firmly with both hands. • Support the lower jaw. • Move to patient’s head to eyes-forward position. • Maintain position until patient is secured to backboard. Outdoor Emergency Care, 4th Edition AAOS/NSP

  47. Stabilization of the Cervical Spine (2 of 3) • Assess and monitor CMS functions. • Cervical collars do not replace manual stabilization. • Improperly fitted collars may be harmful. • Towel rolls and/or blanket rolls can be substituted for cervical collar. Outdoor Emergency Care, 4th Edition AAOS/NSP

  48. Stabilization of the Cervical Spine (3 of 3) • Do not force the head into a neutral, in-line position if the following develop: • Muscles spasms • Increase in pain • Numbness, tingling, or weakness • Compromised airway or breathing Outdoor Emergency Care, 4th Edition AAOS/NSP

  49. Preparation for Transport:Supine Patients(1 of 2) • Maintain in-line stabilization. • Assess and monitor distal CMS functions in each extremity. • Apply a cervical collar, sized appropriately. • Have other team members position immobilization device. • Log roll patient; quickly assess the back. Outdoor Emergency Care, 4th Edition AAOS/NSP

  50. Preparation for Transport:Supine Patients (2 of 2) • Center patient on device. • Secure upper torso to device. • Secure pelvis, legs, and feet. • Immobilize and secure the head. • Check and adjust all straps. • Reassess distal CMS functions. Outdoor Emergency Care, 4th Edition AAOS/NSP