Skiing InjuriesAndrew Getzin, MD

Cayuga Medical CenterSports Medicine and Athletic Performance

www.cayugamed.org/sportsmedicine

Overview

• Statistics

• Head injuries

• Skier’s thumb

• Knee injuries

• Prevention

Injury Statistics

• 200 million skiers 70 million snowboarders in the world

• 2 injuries for every 1000 ski days

• Increased risk with newer skiers and those who try to ski slopes beyond their ability

Skiing Injuries in Children

Contusion

MCL sprain

Skier's thumb

Concussion

Tibia Fracture

Laceration

Facial

Hand Fracture

Other

Deibert, JBJS 1998A

Skiing Injuries in Adolescents

Contusion

Skier's Thumb

Hand Fracture

MCL Sprain

Laceration

ACL Sprain

Concussion

Shoulder

Other

Deibert, JBJS 1998A

Skiing Injuries in AdultsACL Sprain

MCL Sprain

Contusion

Skier's Thumb

Laceration

AC sprain

ShoulderDislocation

Other

Deibert, JBJS 1998A

Traumatic Brain injuries

• The leading cause of ski hospitalizations

• 50-88% of total deaths in skiers and snowboarders

• US Product Safety Commission estimates that 44% of these injuries could be eliminated with helmet use

• No increase risk for neck injuries

Cusimano and Kwok. JAMA 2010

Risk Factor for Head Injuries in Skiing

• Male gender• Youth• Low skill level• Use of rented equipment• Absence of a helmet

Which Skier’s with Head Injuries Need to be Seen by Medical Personnel?

• Almost all!• Any loss of consciousness• Memory problems• Headaches• Vomiting• Why take chances?

What is a Concussion?

• Mild traumatic brain injury• A disruption in normal brain function

due to a blow or jolt to the head• CT or MRI is normal• Invisible injury

Common Physical Symptoms• Headache• Nausea and vomiting• Clumsiness and poor balance• Dizziness and lightheadedness• Blurred vision and light sensitivity• Fatigue and lack of energy• Sleep disturbance• Symptoms often get worse before they get

better

Who Should Have a CT Scan?

• What are we looking for?– Intracranial bleed– Cerebral edema– Skull fracture

• <10% of patients with mTBI have CT abnormalities

• <1% require neurosurgical intervention• Radiation exposure, Cost

Principles of Concussion Treatment

• No cure for concussion, but treatment can help the person feel better and function better while symptomatic

• Early diagnosis and education is critical, and can improve outcome

• Rest early (7-10 days?) and then gradually increase activity

Skier’s thumb

• Skiing into a planted pole

• Disruption or sprain to the ulnar collateral ligament (MCP joint)

• Pain with opening and grabbing things

Skier’s Thumb: Exam

• Difficulty opposing pinky to thumb• Swelling and black and blue over thenar

eminence• Can’t hold an OK sign

Skier’s Radiology

Skier’s Thumb: Treatment

• Splint or cast 6-8 weeks• Ice, elevate, pain

medication• Rare cases need surgery

– Non-healing– Stenner’s lesion

Knee Injuries

• ACL injury– Often feel a pop– Usually can’t keep skiing– Requires surgery

• Medial Collateral ligament– Often can keep skiing– Non-surgical– brace

ACL Injuries

• Most common knee injury• 20% incidence in French ski team• 40% recurrence

Pujol, AJSM 2007

Phantom foot ACL Injury

Boot-Induced ACL Injury

ACL Awareness Training

• Serious knee injury reduced by 62% in patrollers and instructors who participated in awareness training

• Study involved 42 areas and encompassed 24% US skiers

• Can education benefit the novice skier?• http://www.vermontskisafety.com/

kneefriendly.php

Ettingler AJSM 1995

ACL Dos

• Arms forwards• Skies together• Hands over skis

ACL Don’ts

• Don’t straighten your legs when you fall• Don’t try to get up until you have stopped• Don’t land on your hand• Don’t jump unless you know how and where

to land

General Injury Prevention

• Take a lesson• When skiing, look uphill before you ski and

assess your surroundings• Prepare your body for ski season• Ease into the season: increase by <10%/week• www.ski-injury.com

Equipment Changes for Prevention

Multi-faceted approach with ski helmets

• Mountain bike use at resorts 80-90%• Incentives- discounted tickets or helmets• Include with all child and youth rental

packages• Insurance premiums to ski resorts• Education• Look at reduction in medical cost• Ski patrollers role models

Common Sense

• Sun Screen, only 65% of skiers• Warm clothes• Eye protection• Warm up or Warm

down

Hason and Sutherland, Curr Sports Med Reports 2010

Rule of 3s

• Never start a run after 3p• Take the 3rd day off• Beware above 3000 meters• Fewer than 3 drinks the day before skiing

ENJOY YOUR SKI SEASON