Hiroshi Sumi

The dangers of snowboarding: a 9-year prospective comparison of snowboarding and skiing injuries.

We studied 2,552 snowboarding injuries and 5048 skiing injuries sustained during 1988-97. The number of snowboarding injuries had been increasing year by year and was 6 times as many as skiing injuries (2.0 versus 0.35 per 1,000 visits). The types of snowboarding injuries included fractures (39%), lacerations (21%), dislocations (17%), and contusions (15%). Upper extremity injuries were more frequent than those in the lower extremity in snowboarders. The commonest fractures involved the radius (48%), clavicle (11%), humerus (11%), and ulna (7-8%). The shoulder joint was most commonly dislocated (55%) followed by the elbow (27%), acromioclavicular (10%), finger (4%), and hip joints. In snowboarding accidents, the rates of fractures and dislocations were higher than those in skiing in almost every part of the body. Severe injuries were commoner in snowboarding accidents. We recommend the use of appropriate equipment and instructions for beginners to prevent such injuries.

Wrist fractures from snowboarding: a prospective study for 3 seasons from 1998 to 2001.

ObjectivesTo elucidate the epidemiology and the mechanisms of snowboarding wrist injuries, especially distal radial fractures. DesignA prospective survey of snowboarders with distal radial fractures. ParticipantsFrom November 21, 1998, to April 22, 2001, we analyzed and interviewed 5110 injured snowboarders, and a total of 740 snowboarders with distal radial fractures were studied. On the basis of the medical records and radiographs, the severity of distal radial fracture was analyzed according to the AO classification. ResultsDistal radial fractures occurred at a rate of 0.31 per 1000 snowboarder visits and were assessed in 740 snowboarders in this study. Most of the injured snowboarders were either of beginner (42.0%) or intermediate level (48.1%). The most common events leading to an injury in snowboarding were falling (59.6%) and jumping (36.1%). Comminuted and articular fractures classified as AO types A3, B, and C, which required surgical treatment, made up 63.2% of distal radial fractures in snowboarders. The most remarkable differences between the first-time or beginner group and the intermediate or expert group were that the former had a significantly higher proportions of extra-articular fractures classified as AO type A (P < 0.05), and the latter were significantly more likely to have compression or complex intra-articular fractures such as AO type C (P < 0.05). Furthermore, first-time or beginner snowboarders were more likely to be injured because of a simple fall than were the intermediates or experts (P < 0.05). Over 60% of distal radial fractures classified as AO type C in the intermediate or expert group resulted from jumping. Furthermore, the side opposite to the snowboarders preferred direction of stance was more often affected. A high incidence of injury during opposite-side edging, which is used more frequently in snowboarding, was found in novice female snowboarders. ConclusionsThis study suggested several patterns in the nature of wrist injuries sustained while snowboarding, and these facts should be taken into consideration in the diagnosis of wrist injuries in snow-boarders.

Traumatic Spinal Cord Injuries From Snowboarding

Background Little information has yet been made available on the types and mechanisms of snowboard-related spinal cord injuries or their neurologic involvement. Purpose To review the cause and types of spinal cord injuries seen in snowboarders. Study Design Case series; Level of evidence, 4. Methods The subjects were 18 patients (mean age, 24.0 years) referred to the authors’ institution for neurologic deficits associated with spinal injuries between November 1, 1995, and April 9, 2005. The clinical features of these patients were reviewed with respect to epidemiologic factors, mechanism of injury, fracture pattern, and neurologic status. Results The 18 snowboarders with spinal cord injuries constituted a very homogeneous group. First, almost all patients (94.4%) were young men. Second, most of the patients were intermediate or expert boarders. Third, the most common cause of injury was a failure of intentional jumping (83.3%). Fourth, the most commonly affected site was the thoracolumbar junction (66.7%), and the most common type of fracture was an anterior dislocation fracture (66.7%). Finally, in the thoracolumbar group, most patients (83.3%) were classed as Frankel grade A or B. Conclusion It is fundamentally important that snowboarders, especially young men, be made aware of the spinal injury risk associated with jumping.

An Analysis of Hip Dislocations among Snowboarders and Skiers: A 10-year Prospective Study from 1992 to 2002

BACKGROUND We evaluated the types and mechanisms of hip dislocation sustained while snowboarding and skiing, a subject about which there have been few studies. METHODS In a prospective cohort study between 1992 and 2002, we studied 30 snowboarders and 8 skiers with hip dislocations. RESULTS The incidence of dislocation with or without fracture of the hip joint in snowboarders was five times higher than in skiers (0.45 per 100,000 visits for snowboarders vs. 0.09 for skiers). The most remarkable differences between skiing and snowboarding hip injuries were that in the former there was a significantly higher incidence of anterior hip dislocation (p < 0.05) and in the latter there was a significantly higher incidence of posterior hip dislocation (p < 0.05). Furthermore, the rate of type V hip dislocation (with fracture of the femoral head) was higher in snowboarders (9 of 30 cases [30.0%]) than in skiers (1 of 8 cases [12.5%]). CONCLUSION Hip dislocations are much more common in snowboarders than in skiers. Furthermore, the causes and types of hip dislocation differ between snowboarding and skiing.

Lower extremity injuries in snowboarding

BACKGROUND In snowboarding, the upper extremity is known as the most common injury site and little information is available for lower extremity injuries. Here, we aim to discuss lower extremity injuries during snowboarding. METHODS We retrospectively analyzed the epidemiologic factors, injury types, and injury mechanisms for injured snowboarders (7,793 cases) between 2004-2005 and 2008-2009 seasons; information was gathered via questionnaires. Individuals were classified into a lower extremity injury group (961 cases) and a control group with other injuries (6,832 cases). RESULTS The incidence of lower extremity injuries in snowboarding was 0.16 per 1,000 participant days, accounting for 12.3% of all snowboarding injuries. The mean age of the lower extremity injury group and injured control group was 26.1 years ± 5.9 years and 25.1 years ± 5.6 years, respectively. Approximately 90% of snowboarders in both the groups were equipped with soft-shelled boots. Skilled snowboarders tended to sustain lower extremity injuries (p<0.0001). In lower extremity injuries, the most common injury type was lacerations/contusions (22.4%), resulting from collision with other snow sports participants. The most common fracture site was the ankle. Overall, in lower extremity injuries, the leading side was the most commonly injured (53.8%). CONCLUSIONS A typical lower extremity injury in snowboarding is lacerations/contusions caused by collision with other snow sport participants. Lower extremity injuries in snowboarding differ considerably from well-known upper extremity injuries in terms of injury types and mechanisms. The incidence of lower extremity injuries is high and deserves further attention.

Characteristics and risk factors of spinal fractures in recreational snowboarders attending an emergency department in Japan

Objective:The purpose of this study was to elucidate the characteristics of spinal fractures during recreational snowboarding and to determine the risk factors for these fractures. Design:Case series study. Setting:The Oku-mino ski area during the 7-year period between the 2005 to 2006 and 2011 to 2012 skiing seasons. Participants:Eight thousand seven hundred twenty-three snowboarders with injures. Interventions:Cases involved snowboarders with spinal fractures; controls were snowboarders without spinal fractures. Main Outcome Measures:The characteristics of spinal fractures were assessed using a standard form and patient records, including radiographs. Multivariate regression analysis was performed to investigate risk factors for spinal fractures, including age, type of slope, snow condition, accident cause, self-reported skill level, experience level, and the use of protective equipment. Results:Of 8723 snowboarders with injuries, 431 snowboarders presented with spinal fractures (4.9%). The most common spinal fracture was isolated transverse process fracture in the lumbar spine (33.2%, n = 143), followed by compression type fracture in the lumbar spine (25.1%, n = 108). Age (20-39 years), terrain slopes (half-pipe/box/kicker/rail), and jump-landing failure were associated with a significantly high risk of spinal fracture. Conclusions:Among the recreational snowboarders, isolated transverse process fracture in the lumbar spine was the most frequent spinal fracture. Age (20-39 year old), terrain slopes, and jump-landing failure were found to be risk factors for spinal fracture. Clinical Relevance:Identification of characteristics and risk factors for spinal fractures during snowboarding is useful information to create a preventive strategy for the fractures and make snowboarding a safer sport.

Comparison of Tibial Shaft Ski Fractures in Children and Adults

Objective:To examine whether child and adult skiers have different risk factors or mechanisms of injury for tibial shaft fractures. Design:Descriptive epidemiological study. Setting:Prospectively analyzed the epidemiologic factors, injury types, and injury mechanisms at Sumi Memorial Hospital. Patients:This study analyzed information obtained from 276 patients with tibial fractures sustained during skiing between 2004 and 2012. Main Outcome Measures:We focused on 174 ski-related tibial shaft fractures with respect to the following factors: age, gender, laterality of fracture, skill level, mechanism of fracture (fall vs collision), scene of injury (steepness of slope), snow condition, and weather. Fracture pattern was graded according to Arbeitsgemeinschaft für Osteosynthesefragen (AO) classification and mechanical direction [external (ER) or internal rotation (IR)]. Results:Tibial shaft fractures were the most common in both children (89.3%) and adults (47.4%). There were no significant differences in gender, side of fracture, mechanism of fracture, snow condition, or weather between children and adults. Skill levels were significantly lower in children than in adults (P < 0.0001). Type A fractures were more dominant in children (73 cases, 72.3%) than in adults (39 cases, 53.4%). There was significantly more ER in children than in adults (P < 0.0001). Among children, female patients had significantly more IR than ER; in contrast, among adults, women were injured by ER. Conclusions:We found significant differences in some of these parameters, suggesting that child and adult skiers have different risk factors or mechanisms of injury for tibial shaft fractures.

A Case of an Insufficiency Fracture of the Medial Proximal Tibia Secondary to Osteomalacia Associated with Long-Term Saccharated Ferric Oxide Administration

This article presents a case of insufficiency fracture of medial proximal tibia caused by long-term administration of saccharated ferric oxide (SFO) in a 77-year-old female. In this case, 2-year administration of SFO for iron deficit anemia induced hypophosphatemic osteomalacia and finally resulted in an insufficiency fracture of medial proximal tibia. Hypophosphatemia and pain due to the insufficiency fracture were recovered promptly by withdrawing SFO administration and rest. This case represented varus deformity of the knee associated with osteoarthritis, which may also cause the insufficiency fracture of medial proximal tibia in addition to osteomalacia due to long-term administration of SFO. Long-term SFO administration should be avoided because of a definitive risk of osteomalacia and fragile fracture.