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Snowboarding Injuries Greak Peak Expo Oct 30, 2010

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

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  1. Snowboarding InjuriesGreak Peak Expo Oct 30, 2010 Jake D. Veigel, MD www.cayugamed.org/sportsmedicine

  2. Residency training in Ogden, UT Sports medicine training at UMass My Experience

  3. Briefly review history of snowboarding Review common injuries seen in snowboarding Objectives

  4. 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

  5. Age 25-34: 41 % Age 35-44: 14 % Age 45-54: 6 % Age 55-64: 3 % Age 65+: 2 % Who Rides?

  6. The board The boots The bindings The body Equipment

  7. 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

  8. 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

  9. 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

  10. 45% beginners 31% intermediate 23% expert Snowboarding Injuries

  11. 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

  12. 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

  13. 12 year old snowboarder

  14. Evaluate alignment Initially splinting Casting for 4-6 weeks Followed by protective splinting Treatment for Distal Radius Fractures

  15. 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

  16. 21 year old snowboarder

  17. 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

  18. 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

  19. 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

  20. 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

  21. 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

  22. Snowboarder’s Fracture • Dorsiflexion and inversion has been the commonly accepted mechanism • In snowboarding: landing after an aerial maneuver

  23. How it Happens? Funk AJSM 2003

  24. 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

  25. Three types Type 1, a chip fracture Type 2, simple Type 3, comminuted Snowboarder’s Fracture

  26. 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?

  27. Casting and nonweightbearing If type 2 or 3, then surgery if needed Snowboarder’s Ankle Treatment

  28. 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

  29. Happy Riding

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