Jaykar Panchmatia and Fares Haddad highlight how boarding injuries differ from those incurred by skiers
Snowboarding has changed beyond recognition since its inception in the 1960s. In 1998 the activity was recognised as an Olympic sport at the Winter Olympic Games in Nagano, Japan, no doubt adding to its fastgrowing popularity: between 1998 and 2002 a sports participation survey in the United States recorded an increase in snowboarding take-up of more than 300% (1) .
Although previous studies have attempted to identify risk factors for snowboarding injuries, figures have varied widely, ranging from 0.1 to 6 injuries per 1,000 snowboarding days (2) . These discrepancies can be put down to differences in data collection, the experience of snowboarders involved in the studies, the technical difficulty of the slopes included, and the injuries treated at centres conducting the studies.
All athletes and sports support professionals with an interest in snowboarding should be aware of the unique pattern of injuries arising from this popular sport; in particular it is important to appreciate that the injuries encountered are very different from those seen in skiers (3) .
Snowboarders are most likely to sustain injuries to the upper limb. Sacco et al found that 24% of snowboarders admitted to a level 1 trauma centre in Vermont had upper-limb injuries, and among these, 78% had sustained fractures (2) .
Wrist injuries are particularly common; of the 6,200 snowboarding injuries treated in US emergency departments in 2002, 17.9% were wrist injuries. Injuries further up the arm and shoulder accounted for 16.6% and 14.7% respectively (4) .
The reason for the preponderance of upper-limb injuries is that snowboarders tend to fall in an anterior-posterior position, using an outstretched hand to break their fall. Some academics have advocated wrist protectors, but this is controversial: other authors have suggested that the use of wrist protectors will make the wearer more prone to injuries further up the arm as a result of the transfer of energy upon impact to other areas (5, 6, 7) .
Lower-limb injuries are less common among snowboarders than skiers, as there are fewer torsional (twisting) stresses on the lower limb. So for example, Sacco et al found that while the classic damage to a cruciate ligament accounted for 45% of all ski injuries admitted to a level 1 trauma centre in Vermont, this injury affected 13% of all snowboarders at the same unit (2) .
Again, most injuries are fractures. Sacco et al established that fractures of the femur and ankle were equally prevalent (8%). Snowboarders tend to sustain more ankle injuries than skiers these days, probably because tougher ski boots offer greater ankle protection than the softer snowboarding boots (8) .
Prime among these injuries is the notorious ‘snowboarder’s ankle’: a fracture of the lateral process of the talus, resulting from forced dorsiflexion and inversion of the ankle. Early diagnosis and management by an orthopaedic surgeon is essential to ensure a good outcome (9) .
Yamakawa et al have reported that 3.3% of all snowboarding injuries are spinal injuries (10) . The findings of this study support earlier studies showing that snowboarders are more prone to spinal injuries than skiers. The types of spinal injury also differ between the two sports, with transverse process fractures being significantly more common among snowboarders (11) . Only 17 out of the 238 snowboarders treated for spinal injuries in Yamakawa et al’s study had cord injuries, the rest sustained fractures. Of these, 94.1% fractured at a single vertebral level; and 69.4% of fractures affected the lumbar spine.
The most common breaks were anterior compression fractures followed by transverse process fractures. Cord injuries tended to be located in the cervical area. Yamakawa et al postulate that jumping is largely responsible for both the variety and relatively high incidence of fractures among snowboarders. Typically the upper body is twisted, which puts shear force through the spine when the boarder makes a poor landing. Snowboarders are also more likely to fall backwards, resulting in axial loading, which again predisposes them to spinal injuries.
According to Chow et al, head injuries account for approximately 13.6% of all snowboarding injuries. A substantial proportion of these were concussions, lacerations and abrasions (7) . Nonetheless, head injuries are a significant cause of morbidity, leading various authors to recommend the use of helmets. Abdominal and thoracic injuries are rare, but both can be severe. Falling backwards carries the risk of renal injury, and the spleen is also a vulnerable site for snowboarders (12) .
It is rare for snowboarders to be killed. Sacco et al reported a single death of a 15-year-old patient with a brain-stem injury and a cervical spine dislocation. This is equivalent to 0.000000231 deaths per snowboarder day.
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