Snowboarding: Defining the Injury Spectrum
abstract & commentary
Synopsis: Comparisons were made to data detailing injuries of patients hospitalized after downhill skiing accidents. Head injuries in snowboarding are generally less severe and upper extremity fracture is more common among snowboarders than skiers.
Source: Shorter NA, et al. Snowboarding injuries in children and adolescents. Am J Emerg Med 1999;17:261-263.
A recent paper from shorter and colleagues at Dartmouth-Hitchcock Medical Center adds to the growing body of literature detailing the range of injuries associated with snowboarding. Shorter et al extracted data retrospectively from the charts of admitted patients over a six-year period; the population (n = 27) included 13 patients presenting directly to Dartmouth-Hitchcock ED and 14 others received in transfer.
Most injuries resulted from falls, with at least 25% of injuries being a consequence of jumping; collisions did not generally result in serious injury. Head injury (12) and long bone fracture (12) were the most common types of injury; solid intra-abdominal organ injury (5) and vertebral fracture (3) followed. The head injuries were relatively minor (none required operative intervention), and 75% of the long bone fractures involved the upper extremity. Two of the three spinal fractures were lumbar burst fractures. Seven patients had multiple system injuries; there were no fatalities. Shorter et al proceeded to make comparisons to data published earlier by their group1 detailing injuries of patients hospitalized after downhill skiing accidents. Comparisons of hospital costs and lengths-of-stay are not valid due to time differences in data collection, but injury profiles may be, although evolution in equipment technology could be a confounding variable. Noteworthy comparisons included the following: head injuries in snowboarding are generally less severe, and upper extremity fracture is more common among snowboarders than skiers (although the reader must recall that the population included only admitted patients in both studies).
Comment by Richard A. Harrigan, MD, FACEP
This article appears nearly simultaneously with another describing spinal injuries in skiers and snowboarders.2 Although both articles offer insight into the spectrum of injury associated with this emerging sport, both suffer from serious methodological flaws. The paper by Shorter and colleagues does serve to raise our awareness of intra-abdominal and spinal injuries, but the reported incidences of the various injuries are not reliable. For example, a patient could be admitted for a fractured vertebra, yet also have an upper extremity fracture. The latter injury would be included in the database, and yet the (perhaps) numerous cases with lone upper, or lower, extremity fractures discharged to home would be excluded due to study design.
The paper appearing in the American Journal of Sports Medicine on spinal injuries2 found 34 spinal fractures in skiers and 22 in snowboarders (over two seasons); notably, jumping was again the primary mechanism of injury in snowboarders. The thoracolumbar spine was the predominant area of vertebral fracture. The flaw is the conclusion that the rate of spinal injuries is increased "fourfold" over that of skiers; the denominator is based on the estimate that 15% of users of the resort were snowboarders. This estimate is contrary to the referenced statement in the paper by Shorter et al that 25-75% of ski resort customers are now snowboarders. Incidence of disease should not be based on population estimates.
References
1. Shorter NA, et al. Skiing injuries in children and adolescents. J Trauma 1996;40:997-1001.
2. Tarazi F, et al. Spinal injuries in skiers and snowboarders. Am J Sports Med 1999;27:177-180.
43. Snowboarding injuries found in admitted patients appear to
a. be frequently fatal.
b. more frequently involve the lower extremity than the upper extremity.
c. be more commonly associated with collision rather than with falling.
d. frequently include head injuries requiring nonoperative
management.
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