Skiing

Skiing and snowboarding have become the most popular winter sports. They are fun and a great activity for the whole family. Skiing has been around for a long time, being first introduced as a sport in the Winter Olympics in the 1930’s. By comparison, snowboarding is a young sport, that became officially an Olympic sport in 1998.¹ However, they can both be dangerous and a single mistake that leads to an injury may be a moment away. Fortunately, most snowsport injuries are minor and can be treated with bracing, rest and NSAIDS. However, some injuries may require surgical intervention, with recovery varying from 3 to 6 months. 

Epidemiology – Statistics

No anatomic location is exempt from the risk of potential injury. However, it seems that the patterns of injury are a bit different between sports. Snowboarders are more likely to injure their wrist, whereas skiers are more likely to get an ACL injury.²

Snowboarders seem much more likely to sustain an acute injury overall, as compared to skiers.³ This is probably because of the more frequent falls sustained because of the inherent nature of the sport. Another reason is that ski equipment has been modified to prevent injuries.

Skis are programmed to come off at more appropriate times during a crash, whereas snowboards don’t come off. However, when it comes to a real serious injury, skiers are still at higher risk (US National Ski Areas Association). Skiing is all about racing, whereas snowboarding is all about tricks and manoeuvres.

As a result, a skier is more likely to experience a high-speed collision leading to a high-energy injury. On the contrary, a snowboarder sustains frequent falls at lower speed, that may lead to minor injuries.  

Knee injuries

Knee injuries are more common in skiers rather than in snowboarders, in major part due to differences in fall mechanism, general stance and equipment used.⁴ Skiers undergo much higher torsional forces, placing the knee at risk of ligamentous injury.²

ACL rupture typically occurs as a result of valgus load and internal rotation, after the inner side of the ski catches in the snow while going downhill and the boot fails to come off (slip catching).⁵ MCL tears and meniscal tears can also occur. Most ACL tears will require surgery (ACL reconstruction) in active individuals or athletes.

Although less commonly, experienced snowboarders that perform risky tricks and jumps can also get a serious knee injury. Fractures, such as tibial plateau, tibial plafond, or tibial shaft fractures (“boot-top fractures”) may also occur with both sports. Most of these typically require urgent surgical fixation. 

Foot & ankle injuries

Improvements in ski boots and bindings have significantly reduced foot & ankle injuries in skiers. Ankle sprains and fractures remain common in snowboarders.⁶ Snowboarders may also characteristically sustain a fracture of the lateral process of the talus, the so-called “snowboarder’s fracture”.⁷ A CT scan is warranted if there is a high degree of suspicion, as this fracture may easily be missed on plain radiographs. Metatarsal fractures are also common in snowboard, after a hard landing in a flat surface. If isolated, these fractures may be treated nonoperatively.⁷

Hand & wrist injuries

Wrist fractures are the most common fractures seen in snowboarders, even though they are commonly seen in skiers, too.⁸ They typically result from a fall on the outstretched hand. Many of these can be treated conservatively in a cast, but angulated, widely displaced fractures may need surgery.

Injuries to the thumb ulnar collateral ligament (UCL) are more commonly seen in skiers, and are known as “skier’s thumb”. They occur after a sudden valgus force to the thumb, such as when the skier falls to the ground with the ski pole still in hand. Treatment is based on the degree of the injury, with surgery reserved for unstable injuries.⁴ 

Shoulder injuries

Fractures are common in snow sports after a fall on the shoulder. Clavicle fractures may occur in both skiers and snowboarders. The frequently involve the midshaft of the clavicle and can be treated nonoperatively if stable and not widely displaced. Shortened and displaced fractures with skin tenting usually require surgery.

Proximal humerus fractures and AC joint injuries are also common. Shoulder dislocations may also occur in skiing and snowboarding. Dislocations should be reduced as soon as possible. Subsequent management will depend on factors such as age, history of recurrent dislocations, concomitant injuries.⁹

Head injuries

Head injuries can occur in skiing after a high-speed collision with an obstacle (tree, rock, lift pole, etc.), or in snowboarding from a failed landing after a jump. They may vary from a concussion to a severe traumatic brain injury.¹⁰ Head injuries are the leading cause of death and critical injury in skiing and snowboarding. It is critical to recognize early a serious head injury that necessitates transfer to a tertiary facility.  

Prevention

Lessons from expert instructors are extremely important before attempting to hit the slopes. The teacher will teach the beginner not only the correct technique, but also the correct use of the equipment. Malfunctioning or incorrectly fitted equipment, such as too loose or too tight bindings, or equipment that is not the correct size, or that is still unsuitable for the conditions or type of snow, can lead to serious and easily avoidable injuries.

The use of protective equipment, such as helmets, wristbands or knee guards, is also extremely important. Most injuries can be avoided by applying common sense. The skier or snowboarder should be well-hydrated, avoid skiing in conditions of physical fatigue, and always take into account the weather conditions and the condition of the piste (ice, powder, tricked-out spots, off-piste spots). Finally, children need adult supervision.

Finally, we should not forget that the more fit and prepared we are, the less likely we are to get injured. Especially important for skiing and snowboarding are certain muscle groups, which it is good to practice before the winter holidays. The quadriceps, hamstrings and gluteal muscles are extremely important. Core strength is equally essential.

References

1. Deady LH, Salonen D: Skiing and snowboarding injuries: a review with a focus on mechanism of injury. Radiol Clin North Am 2010;48:1113-1124.

2. Kim S, Endres NK, Johnson RJ, Ettlinger CF, Shealy JE: Snowboarding injuries: trends over time and comparisons with alpine skiing injuries. Am J Sports Med 2012;40:770-776.

3. Wijdicks CA, Rosenbach BS, Flanagan TR, Bower GE, Newman KE, Clanton TO, et al.: Injuries in elite and recreational snowboarders. Br J Sports Med 2014;48:11-17.

4. Owens BD, Nacca C, Harris AP, Feller RJ: Comprehensive Review of Skiing and Snowboarding Injuries. J Am Acad Orthop Surg 2018;26:e1-e10.

5. Bere T, Florenes TW, Krosshaug T, Koga H, Nordsletten L, Irving C, et al.: Mechanisms of anterior cruciate ligament injury in World Cup alpine skiing: a systematic video analysis of 20 cases. Am J Sports Med 2011;39:1421-1429.

6. Sachtleben TR: Snowboarding injuries. Curr Sports Med Rep 2011;10:340-344.

7. Helmig K, Treme G, Richter D: Management of injuries in snowboarders: rehabilitation and return to activity. Open Access J Sports Med 2018;9:221-231.

8. Matsumoto K, Miyamoto K, Sumi H, Sumi Y, Shimizu K: Upper extremity injuries in snowboarding and skiing: a comparative study. Clin J Sport Med 2002;12:354-359.

9. Weinstein S, Khodaee M, VanBaak K: Common Skiing and Snowboarding Injuries. Curr Sports Med Rep 2019;18:394-400.

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