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PubMed2003

The hidden dangers of winter sliding.

One of the irresistible allures of freshly fallen snow is the urge to flop onto the ground and slide downhill. Generations of families have been coming together to go sledding for centuries. Unfortunately, this perceived innocuous activity has predictable injury patterns, many of which are preventable with minimal effort or expense. Catastrophic injuries, not infrequently involving younger children, also seem to be preventable with education of the parents and the general public. The current authors reviewed the available literature on sledding injuries and summarized the findings on injury patterns and the recommendations on injury prevention. Proposals for injury prevention and public education, several of which have been designed by national interest groups, are included.

Accident Prevention↗
PubMed2005

Lumbar chance fracture in an adult snowboarder: unusual mechanism of a chance fracture.

STUDY DESIGN: A case of a Chance fracture in an adult snowboarder following a fall is presented. The mechanism of this fracture is reported. OBJECTIVE: To increase awareness of the spinal injuries in snowboarders and to propose the mechanism of this unusual fracture. SUMMARY OF BACKGROUND DATA: Chance fractures rarely occur in adults and are very unusual in children. Nearly all of the reported cases are in conjunction with lap-type seat belt injuries. To the authors' knowledge, this is the first reported case of a lumbar Chance fracture in an adult snowboarder. METHODS: A 25-year-old snowboarder sustained an L1 Chance fracture following a fall backward. The patient was placed in a hyperextension cast, and the cast was changed to a thoracolumbar orthosis after 12 weeks. RESULTS: Complete bony union was obtained with body cast immobilization, and an excellent functional restoration was obtained. CONCLUSIONS: Chance fractures are horizontal splitting fractures of the posterior elements of the vertebrae, and the mechanism of the injury is that of a hyperflexion of the spine over a fulcrum. A Chance-type fracture can be seen in an adult snowboarder, when acute hyperflexion of the spine occurs following a fall backward.

Accidental Falls↗
PubMed2005

Sledding-related injuries among children requiring emergency treatment.

OBJECTIVES: The aims of the study were to describe sledding-related injuries among children requiring emergency treatment and assess the use of safety measures before and after these injuries. METHODS: This is a study of a consecutive series of patients treated for sledding-related injuries in the emergency department of a large, urban, academic children's hospital during a 5-year period. Follow-up contact with patients' families was made by telephone or mail within 2 months after the injury. RESULTS: One hundred sixty-eight children were treated for sledding-related injuries during the study period. Children ranged in age from 2 to 18 years (mean +/- SD, 9.1 +/- 3.8 years). The most common mechanism of injury was a collision with a stationary object (45.2%). The area of the body most commonly injured was the head/neck (53.6%). Soft tissue injuries were the most common type of injury (43.4%). Children 6 years or younger were more likely to sustain a head/neck injury (P < 0.001; relative risk [RR], 2.60; 95% confidence interval [CI], 1.46-4.64) and lacerations (P < 0.001; RR, 2.45; 95% CI, 1.58-3.82) than older children. Children 7 to 18 years were more likely to sustain an extremity injury (P < 0.005; RR, 1.39; 95% CI, 1.17-1.65), a fracture or dislocation (P < 0.05; RR, 1.31; 95% CI, 1.10-1.55), and a fall off a sled (P < 0.05, RR, 1.30; 95% CI, 1.08-1.55) than younger children. Children 7 to 18 years were also more likely to be admitted to the hospital (P < 0.05, RR, 1.39; 95% CI, 1.20-1.62) than younger children. Helmet use occurred in only 3.0% of the cases. No other safety equipment was used. Sixty-five percent of injuries occurred when adult supervision was present. After the injury, helmet use was reported to be 25.3%, representing a statistically significant increase (P < 0.001). Other safety measures implemented after the injury include change in behavior on the sled (59.5%) and change in location of sledding activity (19.2%). Only 1.0% of parents reported increased adult supervision after the injury event. CONCLUSIONS: More than 50% of sledding-related injuries were to the head/neck region, but only 3% of patients were wearing a helmet at the time of injury. A program to increase helmet use while sledding could have a significant impact on reducing head injuries. Because most injuries occurred when sledders struck a stationary object in their path, checking the sledding location for the presence of obstacles is also an important preventive measure.

Adolescent↗
PubMed2006

Sun-safety behaviors of skiers and snowboarders on the South Island of New Zealand.

AIMS: To study sun-protective behaviors among skiers and snowboarders on the South Island of New Zealand and to identify associations with personal characteristics or weather conditions. METHODS: Two hundred twenty-six skiers and snowboarders completed an interviewer-administered questionnaire during September and October 2002. Reported behaviors were used to derive a composite sun-protection index, which was used to divide the sample into "protected" and "unprotected" groups. Odds ratios of being unprotected were calculated by logistic regression. RESULTS: Forty-eight percent (95% CI 42-54%) of interviewees recalled being sunburned while skiing or snowboarding in the past. Sixty-eight percent (95% CI 62-74%) were unaware of any educational messages specific to sun protection while skiing or snowboarding. Women were more likely to be protected from the sun (OR 0.47; 95% CI 0.27-0.81). Having a skin type resistant to burning (OR 1.93; 95% CI 0.92-4.06) and reported awareness of education messages (OR 1.66; 95% CI 0.92-2.99) were associated with not using sun protection. CONCLUSIONS: Sunburn is common and sun protection not used by all. Men are less likely to report use of sun-protection measures. There is no evidence from this study that current strategies are effective in promoting skin protection while skiing or snowboarding.

Health Behavior↗
PubMedDate not supplied

Sledding accidents in children: potential for serious injury, risk of fatality.

Though a pastime rarely considered rough or dangerous, sledding is not risk-free. The presentation of several serious injuries to Rainbow Babies and Children's Hospital in Cleveland, Ohio, led us to examine our emergency department and admitting records to determine the incidence of neurological injury among children involved in sledding accidents. We discovered 24 children who had sustained brain or spine injuries as sequelae to sledding mishaps during a 5-year period. The ages ranged from 3 months to 15 years. Injuries included multiple skull fractures, 2 epidural hematomas, 1 subdural hematoma, 1 odontoid fracture and 1 anoxic brain injury. There was 1 death. Twenty-one of 24 patients incurred their injuries by colliding with fixed objects. Both improvised crafts and models intended for sledding were involved in the injuries. Only 3 sleds possessed steering capability. Eight of the 9 children who sustained a serious neurosurgical injury were supervised by an adult. Only 2 children had received instruction before sledding. The lack of awareness of the potential for injury together with the dearth of instruction and lack of control over a vehicle dashing down a hill studded with obstacles can change a carefree pastime into a hazardous activity.

Accidents↗
PubMedDate not supplied

Increased injury risk among first-day skiers, snowboarders, and skiboarders.

BACKGROUND: Inexperience predisposes skiers, snowboarders, and skiboarders to a higher risk of injury. HYPOTHESIS: Individuals on their very 1st day's experience of skiing, snowboarding, or skiboarding are at greater risk of injury. STUDY DESIGN: Case control study. METHODS: All individuals injured at the three largest ski areas in Scotland during the three winter seasons 1999-2000 through 2001-2002 were included. First-day participants were identified. Individual demographic details and snow sports-related parameters were recorded. Control data were collected from uninjured individuals. Factors associated with injury were explored in univariate and multivariate analyses. RESULTS: First-day participants were overrepresented in the injured population by a factor of 2.2. Participant age younger than 17 years or older than 26 years, snowboarding, taking professional instruction, and the use of rented or borrowed gear were all independently associated with increased injury risk among 1st-day participants. CONCLUSIONS: First-day participants are at increased risk of injury. Several independent risk factors for injury have been identified. CLINICAL RELEVANCE: First-day participants should be targeted in any future educational programs with emphasis on gear selection, use of protective gear, and the risks of exceeding the limits of their ability.

Adolescent↗
PubMed2006

Emergency department visits for sledding injuries in children in the United States in 2001/2002.

OBJECTIVES: To describe the characteristics of nonfatal sledding-related injuries in U.S. children resulting in emergency department (ED) visits in 2001/2002 and to explore the implications of these findings for injury prevention efforts. METHODS: A stratified probability sample of U.S. hospitals providing emergency services in the National Electronic Injury Surveillance System-All Injury Program was utilized for 2001/2002. ED visits resulting from injuries involving sleds, snow discs, snow tubes, and toboggans were analyzed for patients 19 years of age or younger. RESULTS: In 2001/2002, there were an estimated 57,866 ED visits for sledding-related injuries in the United States for all age groups. Of these, 41,272 (71%) occurred in patients 19 years of age or younger, 58% of whom were male. The highest number of injuries occurred in children between five and 14 years of age (74%), and the injuries were most often caused by falls or collisions (75%). The head or neck was the most frequently injured body region among those 0-9 years of age, while the extremities were injured most commonly among those 10-19 years of age. Head and neck injuries occurred in 56% (95% confidence interval [CI] = 32% to 81%) of children 0-4 years of age versus 19% (95% CI = 9% to 29%) of patients 15-19 years of age. Nine percent (95% CI = 6% to 12%) of patients sustained a traumatic brain injury. Three percent (95% CI = 1% to 5%) of patients required admission to the hospital. CONCLUSIONS: Sledding injuries resulting in ED visits predominantly affect children and are a source of measurable morbidity in this population. An increase in injury prevention efforts for this activity is warranted.

Adolescent↗
PubMed2006

Lift mechanics of downhill skiing and snowboarding.

PURPOSE: This study is conducted to develop a simplified mathematical model to describe the lift mechanics of downhill skiing and snowboarding, where the lift contributions due to both the transiently trapped air and the compressed solid phase (snow crystals) are determined. To our knowledge, this is the first time that anyone has attempted to realistically estimate the relative contribution of the transiently trapped air to the total lift in skiing and snowboarding. METHODS: The model uses Shimizu's empirical relation to predict the local variation in Darcy permeability due to the compression of the solid phase. The forces and moments on the skier or snowboarder are used to predict the angle of attack of the planing surface, the penetration depth at the leading edge, and the shift in the center of pressure for two typical snow types, fresh and wind-packed snow. We present numerical solutions for snowboarding and asymptotic analytic solutions for skiing for the case where there are no edging or turning maneuvers. The force and moment balance are then used to develop a theory for control and stability in response to changes in the center of mass as the individual shifts his/her weight. RESULTS: Our model predicts that for fine-grained, windpacked snow that when the velocity (U) of the snowboarder or skier is 20 m.s, approximately 50% of the total lift force is generated by the trapped air for snowboarding and 40% for skiing. For highly permeable fresh powder snow, the lift contribution from the pore air pressure drops substantially. CONCLUSION: This paper develops a new theoretical framework for analyzing the lift mechanics and stability of skis and snowboards that could have important applications in future ski and snowboard design.

Air↗
PubMed2006

[Incidence- and reaction-related predictors of the acute and posttraumatic stress disorder in disaster workers].

OBJECTIVES: This recent study assesses the correlation of incidence- and reaction-related variables to predict acute and posttraumatic stress disorder in rescue workers after the catastrophe of Kaprun (2000) in Austria, Europe. METHODS: In a prospective longitudinal study, 250 emergency medical personnel, crisis intervention teams and police officers were assessed using the Acute Stress Disorder Scale (ASD), the Posttraumatic Stress Diagnostic Scale (PDS) and an incidence- and reaction-related questionnaire 6 weeks and 6 months after their mission. RESULTS: After 6 weeks, 7.3 % of the emergency medical personnel, 22.2 % of the crisis intervention team workers and 25.7 of police officers suffered from ADS. At 6 months after the disaster, 6.3 % of all rescue workers showed PTSD. The incidence-related predictors of PTSD assessed in the study were duration of the mission and early arrival at the site. Uncertainty about the help given was found to be a reaction-related predictor. CONCLUSIONS: This study provides further support for the usefulness of incidence- and reaction-related factors to predict acute and posttraumatic stress disorder in rescue workers. These results will aid in the development of special prevention strategies for rescue workers.

Adult↗
PubMed1976

Modeling of the human leg in ski injuries.

This study establishes that the human lower extremity-ski system has a fundamental frequency of approximately 1 Hz. The fundamental mode dominates the system response when loading times are short compared to the first natural frequency. Consequently, the use of a single degree of freedom approximation and the use of impulse criteria can provide important insights into the problem of skiing injuries. Specifically, the sport of snow skiing develops forces with frequency content in the static, transition, and impulse regions of the leg-ski response spectrum. Therefore, ski release bindings must be designed to safely and effectively couple the leg to the ski throughout this loading environment. An important means of evaluating possible binding designs is by simulating their characteristics in a computer model. The model will apply realistic loading histories to the ski or binding, will evaluate the strain in the bones and ligaments of the lower extremity, and will determine the release point of the binding. The program presented in this discussion is one stage in the development of this total system capability.

Ankle Joint↗
PubMed2004

Snowmobile trauma: 10 years' experience at Manitoba's tertiary trauma centre.

INTRODUCTION: According to the literature, the increased recreational use of the snowmobile has resulted in an increasing number of musculoskeletal injuries. We wished to examine whether previously described risk factors continue to be associated with snowmobile trauma and to identify previously unrecognized risks and specific patterns of injury. METHODS: We carried out a chart review of all snowmobile-related injuries over a 10-year period at the Health Sciences Centre in Winnipeg, the only level 1 trauma centre serving the Province of Manitoba, with particular attention to the risk factors of suboptimal lighting, excessive speed and alcohol consumption. RESULTS: We identified 480 injuries in 294 patients, and 81 (27.6%) of these patients died. Collisions accounted for 72% of the injury mechanisms. Of the injuries sustained, 31% occurred on roads. Excessive speed was a risk factor in 54% of patients, suboptimal lighting in 86% and a blood alcohol level greater than 0.08 in 70%. Musculoskeletal injuries accounted for 57% of those recorded. There were also brachial plexus injuries (3%) and knee dislocations (2%). To our knowledge, this is the largest study detailing injury associated with recreational use of snowmobiles in Canada. CONCLUSIONS: Because snowmobile trauma is caused principally by human errors, it is potentially preventable. Efforts aimed at prevention must focus on the driver, who controls the common risk factors. The danger of snowmobiling while intoxicated must be emphasized. Trail-side monitoring is likely to be ineffective, as the majority of accidents do not occur on designated snowmobile trails.

Adult↗