Risk Factors in Snowboarders’ Wrist Fractures
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Transcript Risk Factors in Snowboarders’ Wrist Fractures
Risk
Factors in
Snowboarders’
Wrist
Fractures
Tracey J. Dickson, PhD
Background
Wrist injuries are the most common snowboard injury
(Bladin et al, 2004)
Wrist guards may assist in reducing wrist injuries (Russell et
al, 2007)
There is debate about whether wrist guards contribute to
upper arm injuries (Hagel et al, 2005)
There is some evidence that wrist guard design is a
contributing factor (Binet, ISSS, 2007)
Risk factors in skiing and
snowboarding from previous
research (Hagel, 2005)
Intrinsic risk factors
Ability (lower) and experience
Age (younger)
Previous instruction: unclear
what the impact is
Past injury (increased risk of
future injury)
Female sex (could be due to a
higher level of reporting rather
than higher level of injury)
Extrinsic risk factors
Activity (snowboarding vs
skiing)
Snowboarding aerials
This may change with twin
tip skis
Improper binding adjustment
Equipment ownership (rental
vs own)
No helmet
Slope characteristics
exceeding ability
No wrist guards
Research Design
Prospective case-control study
using a non-probability sample
Patients: Snowboarders
presenting with a snowboard
injury to 1 of 10 medical
centres and physiotherapy
clinics in mainland Australian
resorts and gateway
communities across the 2007
season
Data Collected
Using a self-completion,
anonymous single page
questionnaire
Demographics
Snowboarding experience
Levels of instruction
Protective equipment usage
Wrist guard design
Mechanism of injury
Type of injury
Resort location of injury
Case: those presenting with a
wrist fracture
Controls: all other
snowboarding injuries
Injury rates are not able to be
calculated due to study design
and also as skier day figures are
not available from the resorts
or snowsport industry
Results (1)
611 snowboarders
Reported 802 injuries (1.3 injuries per person):
Bruising (82.1%)
Fractures (38.2%)
Wrist, n=108 (17.7%)
Dislocations (7.2%)
Concussions (1.8%)
Age range: 8-57 (mean =22.1 yrs)
Significant difference between cases (younger) and controls (p<.000)
Gender
Females (38.7%)
Males (61.3%)
Results (2)
Experience
Less than 7 days (39.5%)
First day ever snowboarding (11.1%)
Significant difference between cases (less experienced) and controls (p<.014)
Protective Equipment
No protective equipment worn (49.6%)
Helmets (36.5%)
Wrist guards (22.6%)
Previous snowboard injury (46.5%)
Mean = 2.1 injuries
Mode = 0
Reasons for not wearing wrist
guards (n=473) (multiple responses possible)
List of reasons provided
I don’t see the need for wrist guards
Of these 12.9% experienced a wrist fracture
They are uncomfortable to wear
I can’t get hold of them
I think they will contribute to injuries
I don’t believe they will protect against injury
Of these 7.9% experienced a wrist fracture
They are too expensive
38.7%
27.7%
16.5%
14.2%
9.5%
7.5%
Resort location at time of injury
Location
On-piste (groomed) areas
Terrain park, slope-style and half pipes
Terrain park
Slope-style course
Half-pipe
During snowboarding lesson
67.3%
23.1%
18.4%
3.3%
1.4%
11.5%
Risk factors for wrist fractures
All
(n=611)
%
Cases: wrist
fracture (n=108)
%
Controls
(n=503)
%
Odds ratio (95%
confidence
interval)
Gender: Male
Female
61.3
38.7
57.0
43.0
62.2
37.8
.81
(.53 to 1.23)
Age:
22.2
77.8
45.8
54.2
17.1
82.9
4.10
(2.62 to 6.42)
Experience: 1st day
> 1 day
11.1
88.9
17.8
82.2
9.7
90.3
2.02
(1.13 to 3.59)
Experience: < 7 days
7 days or more
39.5
60.5
49.5
505.
37.5
62.5
1.64
(1.07 to 2.49)
Wrist guard usage: No
Yes
77.4
22.6
90.7
9.3
86.9
13.1
1.48
(0.74 to 2.98)
88.9
11.1
74.0
26.0
2.80
(1.49 to 5.28)
< 16 years
16 years+
Reason for being in area: holidays
Live for season or permanent
A risk ‘profile’ for wrist fractures
Risk profile
< 16 years of age; on holidays;
1st day of snowboarding ever
All others
Cases: wrist
fracture
(n=108)
%
Controls
(n=503)
%
9.3
90.7
1.2
98.8
Odds ratio (95%
confidence
interval)
8.45
(3.00 to 23.80)
i.e. a young kid who is on holidays visiting the snow, who is participating
in their first day snowboarding ever, were 8 times more likely to
experience a wrist fracture than all others (though wide CI)
Investigating wrist guard design
Length
Short
Long
Stiffness
Soft
Stiff (some flex)
Rigid (no flex)
Protection
Palm-side only
Back of wrist only
Both sides
Position
Built into
glove/mitten
Inside
glove/mitten
Outside
glove/mitten
Wrist guard design
Cases
(n=17)
%
Controls
(n=110)
%
Chi-squared
p value
Length: Short
Long
88
12
67
33
.079
Stiffness: Soft
Stiff (some flex)
Rigid (no flex)
10
45
45
6
55
39
.501
Protection: Palm-side only
Back of wrist only
Both sides
65
5
30
37
4
59
.017
Position:Built into glove/mitten
Inside glove/mitten
Outside glove/mitten
5
47
47
8
44
48
.873
Wrist guard design cont’d
The only aspect of wrist guard design where there was a
significant difference was palm-side vs both sides (p = .000)
Of the 17 wrist fractures incurred while wearing wrist guards:
Palm-side only wrist guards accounted for 65% of wrist fractures
while wearing wrist guards
Short, palm-side designs (52.9%), OR = 3.13 (CI 0.80 to 12.19)
Long, palm-side designs (11.8%)
cf Short, both –side designs ( ), OR=0.41 (CI 0.08 to 2.09)
Nobody wearing a long, back -of-wrist or both-sides designs
experienced a wrist fracture
Conclusion
Based on a small sample, this Australian study supports
previous research that age, experience (intrinsic factors) and
wrist guard usage (extrinsic factor) are risk factors in
snowboarding wrist fractures
The data also suggests that wrist guard design (short, palm-
side) and being a visitor to the alpine region (i.e. tourist) are risk
factors
The compounding effects of risk factors is demonstrated in that
tourists who are <16 years of age, on their first day of
snowboarding are more than 8 times more likely to break their
wrist
What’s next?
Further co-ordinated research needs to be conducted:
Into the impact of wrist guard design on wrist injuries, e.g.
Length of wrist guard in relation to injury position (measure,
photograph)
The availability and design of wrist guards in rental shops
The snowsport safety and wrist guard usage messages in resorts,
magazines, TV shows, shops, online (e.g blogs, Youtube, Facebook)
Improved snowsport safety messages (targetting their
communication channels and in their language) need to be
developed to reach the at-risk populations (especially young,
first-time participants, tourists) about:
The benefits of wrist guard usage
What to look for in wrist guard designs
Acknowledgements
Drs Mark Zagorksi and Mark Binet for advice on the
questionnaire design
Dr Mark Zagorski for assistance in data collection
Ms Margot Hurrell for data entry and feedback on results
Contact:
Tracey J. Dickson, PhD
Senior Research Fellow
Centre for Tourism Research
University of Canberra
Australia
[email protected]
References
Bladin C, McCrory P, and Pogorzelski A. Snowboarding injuries:
current trends and future directions. Sports Medicine (Auckland,
N.Z.). 2004;34(2):133-9.
Hagel BE. Skiing and snowboarding injuries. Medicine And Sport
Science. 2005;48:74-119.
Hagel BE, Pless IB, and Goulet C. The effect of wrist guard use on
upper-extremity injuries in snowboarders. American Journal Of
Epidemiology. 2005;162(2):149-56.
Russell K, Hagel BE, and Francescutti LH. The effect of wrist
guards on wrist and arm injuries among snowboarders: a
systematic review. Clinical Journal Of Sport Medicine: Official
Journal Of The Canadian Academy Of Sport Medicine.
2007;17(2):145-50.