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Snowboarding injuries of the abdomen: comparison with skiing injuries
PERGAMON
Injury, Int J. Care Injured 30 (1999) 47±49
Snowboarding injuries of the abdomen: comparison with skiing injuries Taiichi Machida a, b, *, Kazuhiro Hanazaki b, Katsuhiko Ishizaka a, Manabu Nakamura a, Osamu Kobayashi a, Hitoshi Shibata a, Haruyoshi Nakafuji a, Jun Amano b a Department of Surgery, Iiyama Red Cross Hospital, Iiyama, Japan Second Department of Surgery, Shinshu University School of Medicine, Matsumoto 390-8692, Japan
b
Accepted 23 September 1998
Abstract A retrospective study was conducted to identify the characteristics of snowboarding injury of the abdomen in comparison with those of alpine skiing injuries. Between December 1988 and April 1997, 1579 patients were treated for snowboarding injuries and 9108 patients were treated after skiing accidents. 19 patients (1.2%) in snowboarding and 64 (0.7%) in skiing had abdominal injuries. The abdominal injury rate in snowboarders was signi®cantly higher than that in skiers. Snowboarders with abdominal injuries were similar to skiers with respect to epidemiology but the patterns of injury in the two groups showed several distinct dierences. Riding mistakes after jumping for the snowboarders (31.6%) was signi®cantly higher than that for the skiers (0%). The main organs involved in snowboarding and skiing injuries were kidney, liver and spleen. The incidence of solitary renal injury in snowboarding (68.4%) was signi®cantly higher than that in skiing (29.7%). # 1999 Published by Elsevier Science Ltd. All rights reserved.
1. Introduction
2. Patients and methods
Snowboarding became an ocial Olympic event at the Nagano Winter Olympic games in 1998. However, serious problems due to snowboarding injuries have been noted with the remarkable increase in the popularity of this sport. Indeed, the incidence of serious snowboarding injury has increased steadily compared with that due to alpine skiing [1]. Although there are many reports [2±11] of orthopaedic/musculo±skeletal snowboarding injuries, little has been reported about injuries to the abdomen. This paper concerns snowboarding injuries of the abdomen and compares them with those due to alpine skiing.
Between December 1988 and April 1997, 1579 patients were treated in the Iiyama Red Cross Hospital for snowboarding and 9108 for skiing injuries. Of these patients, 19 (1.2%) snowboarders and 64 (0.7%) skiers suered abdominal injuries. All patients were initially evaluated by emergency physicians using X-ray ®lm, computed tomography (CT) or ultrasonography (US) by emergency physicians. Patients with known or suspected abdominal injuries were examined subsequently by general surgeons.
* Corresponding author. Tel.: +81-253-37-2657; fax: +81-263-372721.
2.1. Statistics The data were analyzed using w 2 test and unpaired Student's t-test. A p value of <0.05 was considered signi®cant.
0020-1383/99/$19.00 # 1999 Published by Elsevier Science Ltd. All rights reserved. PII: S 0 0 2 0 - 1 3 8 3 ( 9 8 ) 0 0 2 1 0 - 1
48
T. Machida et al. / Injury, Int J. Care Injured 30 (1999) 47±49
Table 1 Clinical features of the patients between snowboarding and skiing injuries Snowboarders (n = 19)
Skiers (n = 64)
p value
16/13 20 210 [16±25]
50/14 2227 [10±61]
NS
0 (0%) (36.8%) (10.5%) (42.2%) (10.5%)
2 (3.1%) 27 (42.2%) 8 (12.5%) 19 (29.7%) 8 (12.5%)
NS NS NS NS NS
10 (52.6%) 8 (42.1%) 1 (5.3%)
25 (39.1%) 29 (45.3%) 10 (15.6%)
NS NS NS
10 (52.6%) 3 (15.8%) 1 2 6 (31.6%) 0 (0%)
37 (57.8%) 25 (39.1%) 8 17 0 (0%) 2 (3.1%)
NS p < 0.05
Male/female ratio Age (year) Time for injuries Before 10:00 10:00±12:00 12:00±14:00 14:00±16:00 After 16:00 Technical level Beginner Average Advanced Mechanism of injury Fall to snow Collision [Tree] [Another skier] Riding mistake after jumping Other unknown
7 2 8 2
p < 0.001 NS
Mean2standard deviation. NS: not signi®cant.
3. Results Background features of the patients sustaining snowboarding and skiing injuries are recorded and compared in Table 1. The abdominal injury rate among snowboarders was signi®cantly higher than that among skiers ( p < 0.05). There were no signi®cant dierences in age, gender or time for injuries. Although not signi®cant, the incidence of injury in beginners sustaining a snowboarding injury was higher than in skiing. The most common mechanism of injury was falling in both groups. The incidence of collision was signi®cantly higher among skiers than among snowboarders. Riding mistakes after jumping were signi®cantly higher
among snowboarders than among skiers in whom this mechanism of injury did not occur. The abdominal organs in snowboarding injuries and treatments required are categorized and compared with those of skiing in Table 2. The main organs involved in snowboarding and skiing injuries were kidney, liver and spleen. The incidence of solitary renal injury in snowboarding was signi®cantly higher than in skiing. Two patients with skiing injuries had small bowel perforation and emergency surgery was needed; however, there were no small bowel injuries requiring surgery in snowboarders. All snowboarding injuries were solitary organ injuries except for 3 patients with contusion alone, 17.2% of skiing injuries injured twoorgans.
Table 2 Abdominal organs and treatment of snowboarding or skiing injuries
Solitary organ injury Contusion Kidney Spleen Liver Small bowel perforation Two-organ injuries Spleen + kidney Liver + kidney Spleen + liver Duration of admission
Snowboarders (n = 19)
Skiers (n = 64)
p value
3 (15.8%) conservative 13 (68.4%) conservative 1 (5.3%) splenectomy 2 (10.5%) conservative 0 (0%)
24 (37.4%) conservative 19 (29.7%) conservative 4 (6.3%) conservative 4 (6.3%) conservative 2 (3.1%) curative operation
p < 0.02 p < 0.01 NS NS NS
0 (0%)
11 (17.2%) 7 (10.9%); conservative in 6 and splenectomy in 1 3 (4.7%) conservative 1 (1.6%) conservative
p < 0.05
15 212 days (1±35)
17214 days (2±62)
NS
Mean2standard deviation. NS: not signi®cant. conservative: conservative treatment.
T. Machida et al. / Injury, Int J. Care Injured 30 (1999) 47±49
Surgical treatment was performed in one snowboarder (splenectomy for splenic injury) and in three skiers (two repair procedures for small bowel perforation and one splenectomy for splenic injury); the other patients in the two groups were treated nonoperatively. There was no signi®cant dierence in the mean length of hospital stay between snowboarders and skiers. There were no deaths in either group. 4. Discussion Snowboarders have a much greater tendency to injure the abdomen compared with skiers [1]. In general, snowboarders are younger, predominantly male, and less experienced than skiers [4]. More than half were beginners with less than one week's training or experience; one-®fth of the beginners' accidents occurred on the ®rst snowboarding day [10]. These tendencies were also apparent in patients with abdominal snowboarding injuries. However, the mechanism of abdominal injury between the snowboarders and skiers was dierent. Over 30% of the abdominal snowboarding injuries involved riding mistakes after jumping, while there were no skiing injuries caused by the same mechanism. A previous report [10] supports our ®nding that over 80% of patients with snowboarding injury made riding mistakes and that insucient training or instruction was the cause; rarely were the snow conditions to blame. In accordance with other reports [1, 7] on snowboarding injuries, most injuries occurred during the afternoon when snow conditions are often worse and when fatigue may aect both performance and judgement. Snowboarders with abdominal injuries were similar to skiers with respect to epidemiology, but the patterns of injury in the two groups showed several distinct dierences. In particularly, renal injuries occurred more commonly in snowboarders than in skiers. The manner of riding probably puts snowboarders at greater risk of falling backwards [5] and thus increase the risk of renal injury. Such injuries are comparatively less common in alpine skiing, probably because most accidents involve falling forwards [7]. In addition, when snowboarders fall backwards onto snow, they may be more likely to injure retroperitoneal organs compared with skiers. However, two abdominal-organ injury including the kidney occurred only in
49
skiers and was not found in snowboarders, although the reason for this is not clear. It is also unclear why small bowel perforation occurred only in skiers, but this injury may relate in part to abdominal contusion by the ski itself when the skier falls forward. Prall et al. [1] suggested that snowboarders were much more likely than skiers to injure the abdomen, particularly the spleen. On the contrary, the splenic injury rate among snowboarders appeared to be lower than among skiers in this series. Future analysis of more patients is therefore needed to elucidate the anatomical injury pattern. The absence of deaths among the two groups is notable. The increasing popularity of snowboarding may create a dierent pattern of abdominal injury and has implications for safety, especially in beginners. Riding mistakes after jumping may be a characteristic mechanism of abdominal snowboarding injuries. Snowboarders appear much more likely to injure the kidney compared with skiers.
References [1] Prall JA, Winston KR, Brennan R. Severe snowboarding injuries. Injury 1995;26:539±42. [2] Chissell HR, Feagin JA, Jr, Warme WJ, Lambert KL, King P, Jhonson L. Trends in ski and snowboard injuries. Sports Med. 1996;22:141±5. [3] Warme WJ, Feagin JA, Jr, King P, Lambert KL, Cunningham RR. Ski injury statistics, 1982 to 1993, Jackson hole ski resort. Am. J. Sports Med. 1995;23:597±600. [4] Sutherland AG, Holmes JD, Myers S. Diering injury patterns in snowboarding and alpine skiing. Injury 1996;27:423±5. [5] Pino EC, Colville MR. Snowboard injuries. Am. J. Sports Med. 1989;17:778±81. [6] Ganong RB, Heneveld EH, Beranek SR, Fry P. Snowboarding injuries. Phys. Sportsmed. 1992;20:114±22. [7] Abu-Laban RB. Snowboarding injuries: an analysis and comparison with alpine skiing injuries. CMAJ 1991;145:1097±103. [8] Pigozzi F, Santori N, Di Salvo V, Parisi A, Di-Luigi L. Snowboarding traumatology: an epidemiological study. Orthopedics 1997;20:505±9. [9] Biasca N, Battaglia H, Simmen HP, Disler P, Trentz O. An overview of snowboarding injuries. Unfallchirurg 1995;98:33±9. [10] Zollinger H, Gorschewsky O, Cathrein P. Injuries in snowboarding: a prospective study. Sportverletz Sportschaden 1994;8:31±7. [11] Bladin C, Giddings P, Robinson M. Australian snowboard injury data base study: a four-year prospective study. Am. J. Sports Med. 1993;21:701±4.
Injury, Int J. Care Injured 30 (1999) 47±49
Snowboarding injuries of the abdomen: comparison with skiing injuries Taiichi Machida a, b, *, Kazuhiro Hanazaki b, Katsuhiko Ishizaka a, Manabu Nakamura a, Osamu Kobayashi a, Hitoshi Shibata a, Haruyoshi Nakafuji a, Jun Amano b a Department of Surgery, Iiyama Red Cross Hospital, Iiyama, Japan Second Department of Surgery, Shinshu University School of Medicine, Matsumoto 390-8692, Japan
b
Accepted 23 September 1998
Abstract A retrospective study was conducted to identify the characteristics of snowboarding injury of the abdomen in comparison with those of alpine skiing injuries. Between December 1988 and April 1997, 1579 patients were treated for snowboarding injuries and 9108 patients were treated after skiing accidents. 19 patients (1.2%) in snowboarding and 64 (0.7%) in skiing had abdominal injuries. The abdominal injury rate in snowboarders was signi®cantly higher than that in skiers. Snowboarders with abdominal injuries were similar to skiers with respect to epidemiology but the patterns of injury in the two groups showed several distinct dierences. Riding mistakes after jumping for the snowboarders (31.6%) was signi®cantly higher than that for the skiers (0%). The main organs involved in snowboarding and skiing injuries were kidney, liver and spleen. The incidence of solitary renal injury in snowboarding (68.4%) was signi®cantly higher than that in skiing (29.7%). # 1999 Published by Elsevier Science Ltd. All rights reserved.
1. Introduction
2. Patients and methods
Snowboarding became an ocial Olympic event at the Nagano Winter Olympic games in 1998. However, serious problems due to snowboarding injuries have been noted with the remarkable increase in the popularity of this sport. Indeed, the incidence of serious snowboarding injury has increased steadily compared with that due to alpine skiing [1]. Although there are many reports [2±11] of orthopaedic/musculo±skeletal snowboarding injuries, little has been reported about injuries to the abdomen. This paper concerns snowboarding injuries of the abdomen and compares them with those due to alpine skiing.
Between December 1988 and April 1997, 1579 patients were treated in the Iiyama Red Cross Hospital for snowboarding and 9108 for skiing injuries. Of these patients, 19 (1.2%) snowboarders and 64 (0.7%) skiers suered abdominal injuries. All patients were initially evaluated by emergency physicians using X-ray ®lm, computed tomography (CT) or ultrasonography (US) by emergency physicians. Patients with known or suspected abdominal injuries were examined subsequently by general surgeons.
* Corresponding author. Tel.: +81-253-37-2657; fax: +81-263-372721.
2.1. Statistics The data were analyzed using w 2 test and unpaired Student's t-test. A p value of <0.05 was considered signi®cant.
0020-1383/99/$19.00 # 1999 Published by Elsevier Science Ltd. All rights reserved. PII: S 0 0 2 0 - 1 3 8 3 ( 9 8 ) 0 0 2 1 0 - 1
48
T. Machida et al. / Injury, Int J. Care Injured 30 (1999) 47±49
Table 1 Clinical features of the patients between snowboarding and skiing injuries Snowboarders (n = 19)
Skiers (n = 64)
p value
16/13 20 210 [16±25]
50/14 2227 [10±61]
NS
0 (0%) (36.8%) (10.5%) (42.2%) (10.5%)
2 (3.1%) 27 (42.2%) 8 (12.5%) 19 (29.7%) 8 (12.5%)
NS NS NS NS NS
10 (52.6%) 8 (42.1%) 1 (5.3%)
25 (39.1%) 29 (45.3%) 10 (15.6%)
NS NS NS
10 (52.6%) 3 (15.8%) 1 2 6 (31.6%) 0 (0%)
37 (57.8%) 25 (39.1%) 8 17 0 (0%) 2 (3.1%)
NS p < 0.05
Male/female ratio Age (year) Time for injuries Before 10:00 10:00±12:00 12:00±14:00 14:00±16:00 After 16:00 Technical level Beginner Average Advanced Mechanism of injury Fall to snow Collision [Tree] [Another skier] Riding mistake after jumping Other unknown
7 2 8 2
p < 0.001 NS
Mean2standard deviation. NS: not signi®cant.
3. Results Background features of the patients sustaining snowboarding and skiing injuries are recorded and compared in Table 1. The abdominal injury rate among snowboarders was signi®cantly higher than that among skiers ( p < 0.05). There were no signi®cant dierences in age, gender or time for injuries. Although not signi®cant, the incidence of injury in beginners sustaining a snowboarding injury was higher than in skiing. The most common mechanism of injury was falling in both groups. The incidence of collision was signi®cantly higher among skiers than among snowboarders. Riding mistakes after jumping were signi®cantly higher
among snowboarders than among skiers in whom this mechanism of injury did not occur. The abdominal organs in snowboarding injuries and treatments required are categorized and compared with those of skiing in Table 2. The main organs involved in snowboarding and skiing injuries were kidney, liver and spleen. The incidence of solitary renal injury in snowboarding was signi®cantly higher than in skiing. Two patients with skiing injuries had small bowel perforation and emergency surgery was needed; however, there were no small bowel injuries requiring surgery in snowboarders. All snowboarding injuries were solitary organ injuries except for 3 patients with contusion alone, 17.2% of skiing injuries injured twoorgans.
Table 2 Abdominal organs and treatment of snowboarding or skiing injuries
Solitary organ injury Contusion Kidney Spleen Liver Small bowel perforation Two-organ injuries Spleen + kidney Liver + kidney Spleen + liver Duration of admission
Snowboarders (n = 19)
Skiers (n = 64)
p value
3 (15.8%) conservative 13 (68.4%) conservative 1 (5.3%) splenectomy 2 (10.5%) conservative 0 (0%)
24 (37.4%) conservative 19 (29.7%) conservative 4 (6.3%) conservative 4 (6.3%) conservative 2 (3.1%) curative operation
p < 0.02 p < 0.01 NS NS NS
0 (0%)
11 (17.2%) 7 (10.9%); conservative in 6 and splenectomy in 1 3 (4.7%) conservative 1 (1.6%) conservative
p < 0.05
15 212 days (1±35)
17214 days (2±62)
NS
Mean2standard deviation. NS: not signi®cant. conservative: conservative treatment.
T. Machida et al. / Injury, Int J. Care Injured 30 (1999) 47±49
Surgical treatment was performed in one snowboarder (splenectomy for splenic injury) and in three skiers (two repair procedures for small bowel perforation and one splenectomy for splenic injury); the other patients in the two groups were treated nonoperatively. There was no signi®cant dierence in the mean length of hospital stay between snowboarders and skiers. There were no deaths in either group. 4. Discussion Snowboarders have a much greater tendency to injure the abdomen compared with skiers [1]. In general, snowboarders are younger, predominantly male, and less experienced than skiers [4]. More than half were beginners with less than one week's training or experience; one-®fth of the beginners' accidents occurred on the ®rst snowboarding day [10]. These tendencies were also apparent in patients with abdominal snowboarding injuries. However, the mechanism of abdominal injury between the snowboarders and skiers was dierent. Over 30% of the abdominal snowboarding injuries involved riding mistakes after jumping, while there were no skiing injuries caused by the same mechanism. A previous report [10] supports our ®nding that over 80% of patients with snowboarding injury made riding mistakes and that insucient training or instruction was the cause; rarely were the snow conditions to blame. In accordance with other reports [1, 7] on snowboarding injuries, most injuries occurred during the afternoon when snow conditions are often worse and when fatigue may aect both performance and judgement. Snowboarders with abdominal injuries were similar to skiers with respect to epidemiology, but the patterns of injury in the two groups showed several distinct dierences. In particularly, renal injuries occurred more commonly in snowboarders than in skiers. The manner of riding probably puts snowboarders at greater risk of falling backwards [5] and thus increase the risk of renal injury. Such injuries are comparatively less common in alpine skiing, probably because most accidents involve falling forwards [7]. In addition, when snowboarders fall backwards onto snow, they may be more likely to injure retroperitoneal organs compared with skiers. However, two abdominal-organ injury including the kidney occurred only in
49
skiers and was not found in snowboarders, although the reason for this is not clear. It is also unclear why small bowel perforation occurred only in skiers, but this injury may relate in part to abdominal contusion by the ski itself when the skier falls forward. Prall et al. [1] suggested that snowboarders were much more likely than skiers to injure the abdomen, particularly the spleen. On the contrary, the splenic injury rate among snowboarders appeared to be lower than among skiers in this series. Future analysis of more patients is therefore needed to elucidate the anatomical injury pattern. The absence of deaths among the two groups is notable. The increasing popularity of snowboarding may create a dierent pattern of abdominal injury and has implications for safety, especially in beginners. Riding mistakes after jumping may be a characteristic mechanism of abdominal snowboarding injuries. Snowboarders appear much more likely to injure the kidney compared with skiers.
References [1] Prall JA, Winston KR, Brennan R. Severe snowboarding injuries. Injury 1995;26:539±42. [2] Chissell HR, Feagin JA, Jr, Warme WJ, Lambert KL, King P, Jhonson L. Trends in ski and snowboard injuries. Sports Med. 1996;22:141±5. [3] Warme WJ, Feagin JA, Jr, King P, Lambert KL, Cunningham RR. Ski injury statistics, 1982 to 1993, Jackson hole ski resort. Am. J. Sports Med. 1995;23:597±600. [4] Sutherland AG, Holmes JD, Myers S. Diering injury patterns in snowboarding and alpine skiing. Injury 1996;27:423±5. [5] Pino EC, Colville MR. Snowboard injuries. Am. J. Sports Med. 1989;17:778±81. [6] Ganong RB, Heneveld EH, Beranek SR, Fry P. Snowboarding injuries. Phys. Sportsmed. 1992;20:114±22. [7] Abu-Laban RB. Snowboarding injuries: an analysis and comparison with alpine skiing injuries. CMAJ 1991;145:1097±103. [8] Pigozzi F, Santori N, Di Salvo V, Parisi A, Di-Luigi L. Snowboarding traumatology: an epidemiological study. Orthopedics 1997;20:505±9. [9] Biasca N, Battaglia H, Simmen HP, Disler P, Trentz O. An overview of snowboarding injuries. Unfallchirurg 1995;98:33±9. [10] Zollinger H, Gorschewsky O, Cathrein P. Injuries in snowboarding: a prospective study. Sportverletz Sportschaden 1994;8:31±7. [11] Bladin C, Giddings P, Robinson M. Australian snowboard injury data base study: a four-year prospective study. Am. J. Sports Med. 1993;21:701±4.