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Snowboarding Injuries Greak Peak Expo Oct 30, 2010. Jake D. Veigel, MD www.cayugamed.org/sportsmedicine. Residency training in Ogden, UT Sports medicine training at UMass. My Experience. Briefly review history of snowboarding Review common injuries seen in snowboarding. Objectives.

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snowboarding injuries greak peak expo oct 30 2010

Snowboarding InjuriesGreak Peak Expo Oct 30, 2010

Jake D. Veigel, MD

www.cayugamed.org/sportsmedicine

my experience
Residency training in Ogden, UT

Sports medicine training at UMass

My Experience
objectives
Briefly review history of snowboarding

Review common injuries seen in snowboarding

Objectives
history
1965 “the Snurfer” Sherman Poppen

1969 “the Winterstick” Dimitrije Milovich

1977 Jake Burton and Tom Sims

1998 snowboarding in Nagano Olympic games

Fastest Growing winter sport

History
who rides
Age 25-34: 41 %

Age 35-44: 14 %

Age 45-54: 6 %

Age 55-64: 3 %

Age 65+: 2 %

Who Rides?
equipment
The board

The boots

The bindings

The body

Equipment
injuries
Lower extremity

Both feet firmly attached to board (less twisting of legs/knees)

Snowboard shorter than skis (shorter lever arm)

Usually softer boots (less ankle protection, less force transmitted to knee)

Less ACL, more ankle injuries

Injuries
injuries1
Upper extremity injuries

No poles

Feet perpendicular to direction of movement

Can’t stabilize by moving leg out

Fall backward (heel side) or forward (toe side) without poles to break fall

Wrist and shoulder injuries instead of skier‟s thumb

Injuries
snowboarding injuries
Most common sites of injury:

23% wrist

17% ankle

16% knee

9% head

8% shoulder

8% trunk

4% elbow

7% other

Snowboarding Injuries

Young AFP 1999

snowboarding injuries1
45% beginners

31% intermediate

23% expert

Snowboarding Injuries
upper extremity
Fractures (56%) > sprains (27%) > dislocations (10%) > contusions (6%)

Fractures: radius (esp. distal) > carpal bones (esp. scaphoid) > clavicle > humerus > ulna

Dislocations/subluxations: glenohumeral and acromioclavicular > elbow joints

Upper Extremity
wrist injuries
Wrist injury more common with a backward (heel side) fall – 75% of wrist fractures

Shoulder injury more common with a forward (toe side) fall

Wrist injuries
treatment for distal radius fractures
Evaluate alignment

Initially splinting

Casting for 4-6 weeks

Followed by protective splinting

Treatment for Distal Radius Fractures
scaphoid fracture
Scaphoid Fracture
  • Most common fractured bone in the wrist
  • Peanut shaped bone that spans both row of carpal bones
  • Does not require excessive force and often not extremely painful so can be delayed presentation
scaphoid fracture treatment
Scaphoid Fracture Treatment
  • Cast 6-12 weeks
  • Short arm vs. long arm
  • Follow patient every 2 weeks with x-ray
  • CT and clinical evaluation to determine healing
  • Consider surgery early
wrist injury prevention
Wrist Injury Prevention
  • Snowboarders with wrist guards ½ as likely to be seen for wrist injury
  • Large proportion of snowboarders do not use any protective equipment

Russell CJSM 2007

Neidfelt CJSM 2008

snowboarding ankle injuries
2nd most commonly injured site

12-38% of snowboarding injuries vs. 5-6%of skiing injuries

Leading leg (62-91%) > trailing leg

Sprains 52%, fractures 44%

Snowboarding Ankle Injuries
snowboarder s fracture
Fracture of the lateral process of the talus

Rare injury before snowboarding:

<0.9% of ankle injuries

high energy trauma

In snowboarding:

2.3% of all injuries

15% of ankle injuries

34% of ankle fractures

95% of talus fractures

Snowboarder’s Fracture
snowboarder s fracture1
Hawkins 1965 reported 13 cases of fractures of the lateral process of the talus

MVA or fall from height

Patients reported dorsiflexion and inversion at the time of injury

Snowboarder’s Fracture
snowboarder s fracture2
Snowboarder’s Fracture
  • Dorsiflexion and inversion has been the commonly accepted mechanism
  • In snowboarding: landing after an aerial maneuver
how it happens
How it Happens?

Funk AJSM 2003

snowboarder s ankle
Ride with knees slightly flexed and ankles dorsiflexed, especially when riding toeside

Forward fall parallel to the direction of the board

Leading leg rotates toward the front of the board everting the dorsiflexed ankle

Board acts as a lever about the long axis of the foot, increasing torque

Snowboarder’s Ankle
snowboarder s fracture3
Three types

Type 1, a chip fracture

Type 2, simple

Type 3, comminuted

Snowboarder’s Fracture
snowboarders ankle
Anterolateral ankle pain, similar to an ankle sprain

May be occult or inconspicuous on radiographs

40% missed at initial presentation

May be seen better with CT or MR

Snowboarders Ankle?
prognosis
Early diagnosis important to decrease the risk of persistent pain from nonunion, malunion or subtalar osteoarthritis

Even with treatment, approximately 25% have pain at follow up

Prognosis