In the name of God

SnowSnow catastrophe condition: How much does it affect the

orthopedic injuries?

Mohsen Mardani-Kivi, M.D. Orthopedic

Department, Guilan University Of Medical

Sciences

SnowSnow catastrophe condition: How much does it affect the

orthopedic injuries?

Mohsen Mardani-Kivi, M.D. Orthopedic

Department, Guilan University Of Medical

Sciences

Background

• Iran is one of the most high risk natural disaster countries (6th place among all countries).

Background

• Natural disasters victimize 150,000 cases annually (3 million individuals in 20 years)

• Guilan 3 episodes of snow crisis in the last decade

Background

• Subtle knowledge +learning from the previous experiences more cost effective approaches for future catastrophes

Background

• During the snow crisis, the patternpattern and mechanismmechanism of injuries alter due to changing in traffic and increasing the slipping and falling risks.

The purpose of the study

• Since there is no such study about the incidence of snow related trauma in our country, the present study seeks to analyze the snow injuries in year 2014 for precaution and prevention of trauma in possible future catastrophes.

Methods and Materials:

Results

Results

Results

Results

Results

IcyIcy daysdays significantly resulted in moremore injuries than snowy days (P< 0.001).

Results

• The mean of fracture rate per day was 54.7 cases which were 4.5 4.5 times times more than a similar time in 2 years ago (11.6 fracture per day).

Results:• The incidence of all fractures in menmen

were significantly more than women (P<0.0001).

• Among those patients > 65 yrs Frequency of the lower limb lower limb fractures were more than upper ones years.

Results:

α. The number in parentheses are demonstrated the percentage of the injury in every anatomical site.β. MVA: motor-vehicle accident

 Mechanism of injury

Slipping (%)α Falling (%) MVAβ (%) Others (%) Overall

Upper limb 171 (76%) 15(7%) 14(6%) 26(11%) 226

Lower limb 62(71%) 10(12%) 9(10%) 6(7%) 87

Orthopedic 256(82%) 25(8%) 0(82%) 32(10%) 313

Head & neck 26(47%) 23(42%) 6(11%) 0(0%) 55

Trunk 3(23%) 10(77%) 0(0%) 0(0%) 13

Table1. Mechanism of injuries in anatomical sites

Results:

Discussion• Snow crisis and the increasing rate of

slipping in European studies:– Ralis et al.: reported an increase of

in fracture rate at four-day period after snow in Cardiff.• Elderly (especially women) • The upper limb fx (59% of cases)• the most common fx distal radius fx

2.6 times2.6 times

Discussion

• Ralis et al. – Results of 6 similar studies; – they concluded that there is an increase

(4.5 times4.5 times more than usual) in fractures rate

Discussion

• In Norway:– the frequency of fx unrelated to MVA in

snowy winter days were documented. – 39% of fx were due to slipping on the

ice or snow – 45% of those cases were suffered from

upper extremities fx

Why?!

• Ice formation: 1. The surface of ice is crinkled due to subsiding

snowflake.2. The following decrease in temperature at

night protects the snow from defrosting. 3. With increase in temperature in the next day,

the ice surface would thaw and again it would become frozen in the night.

This mechanism would form a smooth and plain layer of ice that increases the rate of slipping and falling.

Why?!

• On the other hand, in the first day of snow crises, a large percentage of people may stay at home, however as the time passes, people start to come out to the icy streets

• Lewis et al. – the peak days of trauma may happen at

the 6th day after snow.

Summary• Icy days: 3-6 days after snow• The most common mechanism:

SlippingSlipping• IcyIcy days > snowy days• menmen > women• UpperUpper > lower • Distal Raius Fx & Hip Fx

Take home message

Be careful for the IcyIcy days instead of Snowy days!

Any suggestions?