1. Snowboarding Injuries Greak Peak Expo Oct 30, 2010 Jake D. Veigel, MD www.cayugamed.org/sportsmedicine

2. My Experience Residency training in Ogden, UT Sports medicine training at UMass

3. Objectives Briefly review history of snowboarding Review common injuries seen in snowboarding

4. History 1965 “the Snurfer” Sherman Poppen 1969 “the Winterstick” Dimitrije Milovich 1977 Jake Burton and Tom Sims 1998 snowboarding in Nagano Olympic games Fastest Growing winter sport

5. Who Rides? Age 25-34: 41 % Age 35-44: 14 % Age 45-54: 6 % Age 55-64: 3 % Age 65+: 2 %

6. Equipment The board The boots The bindings The body

7. Injuries Lower extremity – Both feet firmly attached to board (less twisting of legs/knees) – Snowboard shorter than skis (shorter lever arm) – Usually softer boots (less ankle protection, less force transmitted to knee) – Less ACL, more ankle injuries

8. Injuries Upper extremity injuries – No poles – Feet perpendicular to direction of movement – Can’t stabilize by moving leg out – Fall backward (heel side) or forward (toe side) without poles to break fall – Wrist and shoulder injuries instead of skier‟s thumb

9. Snowboarding Injuries Most common sites of injury: 23% wrist 17% ankle 16% knee 9% head 8% shoulder 8% trunk 4% elbow 7% other Young AFP 1999

10. Snowboarding Injuries 45% beginners 31% intermediate 23% expert

11. Upper Extremity Fractures (56%) > sprains (27%) > dislocations (10%) > contusions (6%) Fractures: radius (esp. distal) > carpal bones (esp. scaphoid) > clavicle > humerus > ulna Dislocations/subluxations: glenohumeral and acromioclavicular > elbow joints

12. Wrist injuries Wrist injury more common with a backward (heel side) fall – 75% of wrist fractures Shoulder injury more common with a forward (toe side) fall

13. 12 year old snowboarder

14. Treatment for Distal Radius Fractures Evaluate alignment Initially splinting Casting for 4-6 weeks Followed by protective splinting

15. Scaphoid Fracture Most common fractured bone in the wrist Peanut shaped bone that spans both row of carpal bones Does not require excessive force and often not extremely painful so can be delayed presentation

16. 21 year old snowboarder

17. Scaphoid Fracture Treatment Cast 6-12 weeks Short arm vs. long arm Follow patient every 2 weeks with x-ray CT and clinical evaluation to determine healing Consider surgery early

18. Wrist Injury Prevention Snowboarders with wrist guards ½ as likely to be seen for wrist injury Large proportion of snowboarders do not use any protective equipment Russell CJSM 2007 Neidfelt CJSM 2008

19. Snowboarding Ankle Injuries 2nd most commonly injured site 12-38% of snowboarding injuries vs. 5-6% of skiing injuries Leading leg (62-91%) > trailing leg Sprains 52%, fractures 44%

20. Snowboarder’s Fracture Fracture of the lateral process of the talus Rare injury before snowboarding: – <0.9% of ankle injuries – high energy trauma In snowboarding: – 2.3% of all injuries – 15% of ankle injuries – 34% of ankle fractures – 95% of talus fractures

22. Lateral process of the talus – Superior surface forms part of the ankle joint – Inferior surface forms part of the posterior subtalar joint – Fractures are usually intra-articular

24. Snowboarder’s Fracture Hawkins 1965 reported 13 cases of fractures of the lateral process of the talus MVA or fall from height Patients reported dorsiflexion and inversion at the time of injury

25. Snowboarder’s Fracture Dorsiflexion and inversion has been the commonly accepted mechanism In snowboarding: landing after an aerial maneuver

26. How it Happens? Funk AJSM 2003

27. Snowboarder’s Ankle Ride with knees slightly flexed and ankles dorsiflexed, especially when riding toeside Forward fall parallel to the direction of the board Leading leg rotates toward the front of the board everting the dorsiflexed ankle Board acts as a lever about the long axis of the foot, increasing torque

28. Snowboarder’s Fracture Three types A.Type 1, a chip fracture B.Type 2, simple C.Type 3, comminuted

29. Snowboarders Ankle? Anterolateral ankle pain, similar to an ankle sprain May be occult or inconspicuous on radiographs 40% missed at initial presentation May be seen better with CT or MR

30. Snowboarder’s Ankle Treatment Casting and nonweightbearing If type 2 or 3, then surgery if needed

31. Prognosis Early diagnosis important to decrease the risk of persistent pain from nonunion, malunion or subtalar osteoarthritis Even with treatment, approximately 25% have pain at follow up

32. Happy Riding