1. Skiing Injuries Andrew Getzin, MD Cayuga Medical Center Sports Medicine and Athletic Performance www.cayugamed.org/sportsmedicine

2. Overview Statistics Head injuries Skier’s thumb Knee injuries Prevention

3. 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

4. Skiing Injuries in Children Deibert, JBJS 1998A

5. Skiing Injuries in Adolescents Deibert, JBJS 1998A

6. Skiing Injuries in Adults Deibert, JBJS 1998A

8. 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

9. Risk Factor for Head Injuries in Skiing Male gender Youth Low skill level Use of rented equipment Absence of a helmet

10. 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?

11. 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

12. 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

14. 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

15. 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

16. Skier’s thumb Skiing into a planted pole Disruption or sprain to the ulnar collateral ligament (MCP joint) Pain with opening and grabbing things

17. Skier’s Thumb: Exam Difficulty opposing pinky to thumb Swelling and black and blue over thenar eminence Can’t hold an OK sign

18. Skier’s Radiology

19. Skier’s Thumb: Treatment Splint or cast 6-8 weeks Ice, elevate, pain medication Rare cases need surgery – Non-healing – Stenner’s lesion

20. 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

21. ACL Injuries Most common knee injury 20% incidence in French ski team 40% recurrence Pujol, AJSM 2007

22. Phantom foot ACL Injury

23. Boot-Induced ACL Injury

24. 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/kneefriend ly.php http://www.vermontskisafety.com/kneefriend ly.php Ettingler AJSM 1995

25. ACL Dos Arms forwards Skies together Hands over skis

26. 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

27. 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

28. Equipment Changes for Prevention

29. 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

30. 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

31. Rule of 3s Never start a run after 3p Take the 3 rd day off Beware above 3000 meters Fewer than 3 drinks the day before skiing

32. ENJOY YOUR SKI SEASON