WRIST INJURIES IN SNOWBOARDING
 

Introduction


Many studies have now demonstrated that snowboarding has a distinctly different pattern of injuries to alpine skiing - both in terms of the areas of the body that get injured and the types of injury sustained. Compared to skiers, snowboarders are far more likely to sustain an injury to the upper limb and less likely to injure the lower limb. The incidence of fractures (broken bones) is twice as high amongst snowboarders compared to skiers - (approximately 25% of all injuries in boarders are fractures compared to 12.5% in skiers). The reasons for these differences can be explained by the design of the equipment and the way it is used. When travelling on piste, snowboarders ride with both feet fixed firmly to the snowboard in non release bindings. The upper body is used to help generate turning forces on the board. In the event of a loss of balance and a subsequent fall, the instinctive reaction of a snowboarder is to outstretch a hand in order to try and break their fall. This mechanism is known as a 'FOOSH' amongst emergency department staff (standing for Fall Onto an Out Stretched Hand). As a result, the wrist is the single commonest site of injury amongst snowboarders - an area that is rarely injured whilst alpine skiing. It is important though - sustain a broken wrist and you won't be snowboarding for at least 6-8 weeks, if not longer. With more severe breaks, I'm not joking when I say you may never be able to snowboard again....

The severity of the break is determined by several factors - the speed and force of the impact and the exact position of your arm when you fall being three examples. Severe wrist fractures include those where:-
 

  • The bones have been pushed out of position (a 'displaced' fracture)
  • The bones have been pushed through the skin (an 'open' or 'compound' fracture)
  • The break goes through the line of the wrist joint (a so called 'intra-articular' fracture)
  • The wrist has been broken into many different fragments (known as a 'comminuted' fracture).
     

Unfortunately, these can occur in combination as well making the injury all the worse. Get all four of these together in the same injury and you're in deep poop - you can hang your snowboard boots up for a very long time..... Not only this, a severe injury like this may also affect your ability to work, write and function in general. You don't realise how many day to day tasks you need your wrist for until you injure it. So although overall they occur relatively infrequently, and the majority of snowboarders never injure their wrists, you should take the potential for these injuries seriously, especially if you are a beginner - the group at highest risk of all.


Displacement of the bone fragments is the commonest problem, because of the (often considerable) forces involved. Displaced fractures are easy to recognise because of the so-called 'dinner fork' deformity that results (see pictures above). These injuries require manipulation under anaesthetic (MUA - basically what this entails is that under general or local anaesthesia the bones are pushed and pressed until they go back into the correct position) and/or the insertion of orthopaedic metalwork (this needs a general anaesthetic!) to realign the damaged joint. As I have already mentioned, in the longer term they can lead to the premature development of osteoarthritis with chronic pain and disability.
 

Wrist fractures and snowboarding - the statistics

The latest data from our own Scottish Snow Sports Safety Study and other studies from across the globe indicate that 25% of all snowboard injuries affect the wrist joint - far and away the commonest area to be injured (the shoulder being the next most common site of injury - 12% of all injuries). 70% of all wrist injuries were fractures (broken bones). The latest statistics (based on 38500 snowboarding injuries from 1998-2004 treated by the French Medicins de Montagne group) show that a wrist fracture occurs once every 1135 days snowboarding. For teenagers, the risk is much higher as a wrist fracture in this group occurs once every 500 days. So even though its the most common injury you can still see that the absolute risk is very low. Beginner snowboarders are also at higher risk, especially those trying snowboarding for the very first time. 43% of the wrist injury group were boarding for the very first time compared to only 12% of the uninjured control population. Similarly, experienced boarders were less likely to injure their wrist - by a factor of 2.5.

At present the evidence is that at the most around 10% of all snowboarders world wide currently wear wrist guards - in Scotland the figure is less than this, but I'm working on it. Watch the video clip below for an example of a typical snowboard scenario resulting in a wrist fracture .....turn up the sound for the full effect! 

 

 

Increased risk of wrist injury amongst beginner snowboarders

 

So why are beginner snowboarders at greater risk of wrist injury?  And who cares some might argue!

My rationale is that one of the first things a novice snowboarder must learn is the ability to maintain a stable stance – not easy, with both feet fixed in non-release bindings to a relatively narrow board. It would be logical to assume that beginner snowboarders are the least likely to have mastered this basic skill. Consequently, they are also more likely to lose balance and fall. When balance is lost, snowboarders (unlike skiers) cannot ‘step out’ a leg in order to recover the lost balance, as both feet are firmly attached to the board. The instinctive protective reaction in the event of the subsequent snowboard fall is to outstretch a hand to break the landing, thus placing the upper limb at risk of injury. I believe that this combination of inherent instability and a tendency to fall onto an outstretched hand, places beginner snowboarders at a higher risk of injury. Injuries to beginners (especially those on their very first day) are important because for snow sports to survive we have to encourage new people to take them up and an injury early on is unlikely to inspire someone to come back.

In conclusion, I am firmly of the opinion that wrist guards should be part of the standard kit for a beginner snowboard and am working to try and convince others of this! Given the choice, wrist guards are of far more use (and cheaper!) than a helmet.

Learning to fall properly


One of the simplest way to try and reduce the risks of injury to the upper limb in general and the wrist joint in particular is to learn to fall properly. More and more snowboard instructors are teaching boarders techniques to try and reduce the risks of upper limb injury.  Whilst no study has ever proven (or indeed can ever prove) that doing this will reduce the risk of injury it does make sense and is unlikely to do any photographs demonstrating these manoeuvres were kindly supplied by journalist Daniel Elkan, with the assistance of Mike, instructor with the SMT Snowboard School in Mayrhofen.

Falling forwards



Falling backwards

 

For information on wrist guards for snowboarding, the evidence for their effectiveness and some recommendations for specific models, click here to visit my wrist guard page.

 

References


1. Schieber RA et al. In-line skating injuries. Epidemiology and recommendations for prevention. Sports Med. 1995 June; 19(6): 427-32

2. Idzikowski JR, Janes PC, Abbott PJ. Upper extremity snowboarding injuries. Ten-year results from he Colorado Snowboard Injury Survey. Am J Sports Med. 28(6): 825-832, 2001

3. Sasaki K, Takagi M, Ida H et al. Severity of upper limb injuries in snowboarding. Arch Orthop Trauma Surg 1999; 119: 292-295


 

 



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