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.