Document Title: Deibert-JBJS-Jan98.shtml
Article Title: Skiing Injuries in Children, Adolescents, and Adults
Author: M.C. Deibert, M.D., D. D. Aronsson, M.D., R. J. Johnson, M.D., C. F. Ettlinger, M.S. and J. E. Shealy, Ph.D.
Publication: The Journal of Bone and Joint Surgery (American Edition)
Date: January 1998
Volume: 80, pages 25-32
Keywords: Alpine skiing, knee injuries, head injuries, CNS injuries, children, adults.

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Comments: This thought-provoking article discusses the injury epidemiology of alpine skiing, and covers knee injuries in the context of all the injuries associated with this sport. As Figure 2 shows, knee injuries rank at or near the top of injuries for skiers of all ages. Hand injuries are a concern too, as are head injuries. The authors point out two worrisome trends: an increase in head and spinal injuries (despite insufficient data to nail down statistical significance) and an increase in serious knee injuries (i.e. ACL tears). Although some trends are encouraging (e.g. fewer injuries overall, fewer broken bones, more skier hours between injuries), the increase in severe injuries (defined as injuries which can bring lifelong consequences, for example ACL tears and head injuries) is cause for concern. Although the change in lower-extremity injuries (i.e. drop in tibial fracture, but growth in ACL tears) is attributed primarily to the advent of stiff, high-backed ski boots, another aspect to keep in mind is the fundamental physical fact that kinetic energy increases with speed squared. Modern skis have ultra-slippery fluorocarbon-polymer bases and high-tech waxes, and ski resorts have brought out ever-more-challenging runs (e.g. more precipitous slopes). This, combined with the trend towards "extreme" sports, has resulted in alpine skiing involving higher speeds than ever before. It is not surprising, then, that Olympic skiers can reach speeds of about 100 kilometres per hour (62 miles per hour). A skier moving at this speed harbours 25 times (i.e. 5×5=25) as much kinetic energy as a cross-country skier moving at 20 kilometres per hour (which is still brisk). This Olympic skier, in an crash with a solid object, would incur injuries 25 times as severe as the cross-country skiier, would require 25 times as much distance to come to a full stop without colliding, and would have a correspondingly diminished reaction time (i.e. travels five times as far during the time in which it takes for the brain to register an occurrence and effectuate a response accordingly). A novice alpine skier moving at 60 kilometres per hour still carries nine times the kinetic energy of the aforementioned cross-country skier. In short, alpine (downhill) skiing is a high-risk sport because of the high speeds it typically involves.

Abstract

We prospectively gathered data on skiing injuries that had been sustained at the Sugarbush North ski area since 1972 and at the Sugarbush South ski area since 1981. The purpose of the current study was to document the overall rates of injury in children, adolescents, and adults participating in alpine skiing. We also sought to determine the ten most common injuries in each age-group. Finally, we analyzed short-term and long-term trends to determine if changes in equipment had had an effect on the frequency or pattern of injury. From the 1981–1982 to the 1993–1994 season, there were 2.79 injuries per 1000 skier days: 4.27 injuries in children, 2.93 in adolescents, and 2.69 in adults. During the last eight years of the study, the most common injuries were a contusion of the knee in children, a sprain of the ulnar collateral ligament of the thumb in adolescents, and a grade-III sprain of the anterior cruciate ligament in adults. The short-term trends revealed that, in children, the frequency of tibial fractures decreased 10 per cent while that of fractures of the upper extremity increased 8 per cent. The long-term trends showed that, in adults, the rate of tibial fractures decreased 89 per cent while that of injuries of the anterior cruciate ligament increased 280 per cent. The overall rate of injury decreased 43 per cent from the beginning of the study in 1972 to the end of the study in 1994; the decrease was 58 per cent in children, 45 per cent in adolescents, and 42 per cent in adults. Data on the types of equipment and the binding-release values were collected prospectively from injured skiers and from 2083 non-injured skiers. Of the fifty-nine skiers who sustained a spiral fracture of the tibia, forty-two (71 per cent) had binding-release values that were higher than the average for the uninjured group. We believe that the use of properly functioning modern equipment will decrease the rate of injury, particularly in children.

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