Downhill Skiing

Aka: Downhill Skiing, Downhill Skier, Snowboarding, Skiing, Snow Sports, Skier, Downhill Skiing Injury, Snowboarding Injury

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II. Mechanism: Injury

  1. Falls (75-85%)
  2. Collisions (11-20%)
  3. Lift Injuries (2-9%)

III. Risk Factors: Injury

  1. Age <20 years old and >40 years old
  2. Beginner Skier or Snowboarder
    1. Injuries are three times more common
    2. However expert skiers have more serious injuries (head injuries, Fractures, ligament injuries)
  3. Snow conditions
    1. Hard-packed snow (contrast with powder)
  4. Other factors
    1. Failing to take rest breaks (with secondary Fatigue or Dehydration)
    2. Skier or snowboarder participates in activities (and risks) above their ability
    3. Equipment failure (or improper)
    4. Failure to acclimitize to altitude
    5. Going off trail, to closed areas, or ignoring posted warnings

IV. Associated Conditions: Head and Torso Injuries

  1. Head Injury (7-18%)
    1. Most common cause of serious injury and death
  2. Chest Trauma
    1. Rib Fracture
    2. Pneumothorax
    3. Hemothorax
  3. Thoracolumbar spine injury
    1. Spinal Compression Fracture
    2. Spinous process Fracture
    3. Transverse process Fracture

V. Associated Conditions: Skiers (lower extremity injuries are more common)

  1. Knee Injury
    1. See Knee Injury in Downhill Skiing
    2. Medial Collateral Ligament Tear or MCL (25%)
    3. Anterior Cruciate Ligament Tear or ACL (25%)
    4. Meniscal tear
    5. Segond Fracture
    6. Reverse Segond Fracture
    7. Tibial Spine Avulsion (rare)
    8. Tibial Plateau Fracture
  2. Head Injury
  3. Facial Trauma
  4. Shoulder Injury
    1. Rotator Cuff Tear
    2. Anterior Shoulder Dislocation
    3. Acromioclavicular Separation (AC Separation)
    4. Clavicle Fracture
    5. Other strains and sprain
      1. Trapezius Strain
      2. Biceps Strain
      3. Sternoclavicular Separation
    6. Other Fractures (uncommon)
      1. Proximal Humerus Fracture
      2. Humeral Head Fracture
      3. Greater tuberosity Fracture
      4. Glenoid Fracture
      5. Scapular Fracture
      6. Acromial Fracture
  5. Thumb Injury
    1. Ulnar Collateral Ligament Sprain (Skier's Thumb)
      1. Occurs with fall on an Outstretched Hand (FOOSH) attached to a ski strap

VI. Associated Conditions: Snowboarders (upper extremity injuries are more common)

  1. Wrist Injury
    1. See Fall on Outstretched Hand (FOOSH)
  2. Shoulder Injury
    1. Acromioclavicular Separation (AC Separation)
    2. Anterior Shoulder Dislocation
    3. Clavicle Fracture
    4. Sternoclavicular Dislocation
    5. Rotator Cuff Tear
    6. Proximal Humerus Fracture
  3. Knee Injury
    1. See Knee Injury in Downhill Skiing
  4. Head Injury
  5. Facial Injury
  6. Ankle Injury
    1. Lateral talar process Fracture (32% of ankle injuries in snow boarders, typically on landing jump)
  7. Splenic Injury (uncommon)

VII. References

  1. Dolbec (2019) Crit Dec Emerg Med 33(1): 17-25

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