Long-Term Incidence of Atrial Fibrillation and Stroke Among Cross-Country Skiers.

BACKGROUND: Studies have revealed a higher incidence of atrial fibrillation among well-trained athletes. We aim to investigate associations of endurance training with incidence of atrial fibrillation and stroke and to establish potential sex differences of such associations in a cohort of endurance trained athletes. METHODS: All Swedish skiers (208 654) completing 1 or more races in the 30 to 90 km cross-country skiing event Vasaloppet (1989-2011) and a matched sample (n=527 448) of nonskiers were followed until first event of atrial fibrillation or stroke. Cox regression was used to investigate associations of number of completed races and finishing time with incidence of atrial fibrillation and stroke. RESULTS: Female skiers in Vasaloppet had a lower incidence of atrial fibrillation than did female nonskiers (hazard ratio [HR], 0.55; 95% CI, 0.48-0.64), independent of finishing time and number of races. Male skiers had a similar incidence to that of nonskiers (HR, 0.98; 95% CI, 0.93-1.03). Skiers with the highest number of races or fastest finishing times had the highest incidence. Skiers of either sex had a lower incidence of stroke than did nonskiers (HR, 0.64; 95% CI, 0.60-0.67), independent of the number of races and finishing time. Skiers with atrial fibrillation had higher incidence of stroke than did skiers and nonskiers without atrial fibrillation (men: HR, 2.28; 95% CI, 1.93-2.70; women: HR, 3.51; 95% CI, 2.17-5.68; skiers with atrial fibrillation vs. skiers without atrial fibrillation). After diagnosis of atrial fibrillation, skiers with atrial fibrillation had a lower incidence of stroke (HR, 0.73; 95% CI, 0.50-0.91) and lower mortality compared with nonskiers with atrial fibrillation (HR, 0.57; 95% CI, 0.49-0.65). CONCLUSIONS: Female skiers in Vasaloppet had lower incidence of atrial fibrillation and stroke. Male skiers had similar incidence of atrial fibrillation and lower risk of stroke. Men with higher number of races and faster finishing times had the highest incidence of atrial fibrillation. After diagnosis of atrial fibrillation, skiers had lower incidence of stroke and death than did nonskiers with atrial fibrillation. This indicates that although on an individual level atrial fibrillation in well-trained individuals is associated with higher incidence of stroke, on population level, risk of stroke is low and that exercise should not be avoided.

Head injury trends and helmet use in skiers and snowboarders in Western Canada, 2008-2009 to 2012-2013: an ecological study.

This research explored associations between helmet use and head injuries in snowsports by investigating reported snowsport injuries in Western Canada from 2008-2009 to 2012-2013. The key finding was that increased helmet use (from 69% to 80%) was not associated with a reduction in reported head injuries. Over the study period, the average rate of reported head injuries was 0.2/1000 skier visits, with a statistically significant variation (P < 0.001). The line of best fit showed an non-significant upward trend (P = 0.13). Lacerations were the only subcategory of head injuries that decreased significantly with helmet use. A higher proportion of people who reported a head injury were wearing a helmet than for injuries other than to the head. Skiers were more likely to report a head injury when wearing a helmet than snowboarders (P < 0.001 cf. P = 0.22). There were significant differences in characteristics of helmet and non-helmet wearers. Helmet wearers were more likely to be: young adults (P < 0.001); beginner/novices (P = 0.004); and snowboarders (P < 0.001), but helmet wearing was not associated with gender (P = 0.191). Further research is needed to explore the possible reasons for the failure of helmets to reduce head injuries, for example, increased reporting of head injuries and increased risk-taking combined with over-rating of the helmets' protection.

Injury trends in alpine skiing and a snowboarding over the decade 2008-09 to 2017-18.

OBJECTIVES: This research explores snowsport injury trends in western Canadian resorts over the decade 2008-2018. DESIGN: Ecological study. METHODS: Injury and participation data on alpine skiing and snowboarding was provided by the Canada West Ski Areas Association for 2008-2018. Inclusion criteria were met by 29 of 52 resorts, resulting in the analysis of 107,540 injury reports via SPSS 24, using descriptive statistics and chi-squared analysis. RESULTS: Over the decade: there was a gradual decline in the injury rate, averaging 2.24 injuries per 1000 skier days. Male snowboarders accounted for 1/3 of all injured participants, females were 42% of all. Day-ticket holders were the most injured of all customer-types, with most injuries occurring as the result of falls on marked, green/easiest terrain. For skiers, injuries to lower limbs, and especially knees, were most common. For snowboarders, upper limb injuries, especially wrists, were most common. 12.8% of the injured population required emergency transport. Advanced slopes/terrain had the highest proportion requiring emergency transport. Fewer skiers experienced head injuries than snowboarders. Snowboarders experienced a higher proportion of serious injuries. CONCLUSIONS: Snowsport injuries are relatively rare when compared to other sports. Skiers were most prone to knee injuries and snowboarders to wrist injuries. Emergency transport was proportionally needed more from advanced slopes/terrain. Further research is needed into why and how participants make decisions around risk. Future injury prevention strategies should be evaluated in light of potential risk factors such as, social determinants of injury, fall mechanisms, changing participation patterns, age, snowsport discipline, and legal cannabis use.

Head injury and helmet usage trends for alpine skiers and snowboarders in western Canada during the decade 2008-9 to 2017-18.

OBJECTIVES: This research explores snowsport head injury trends in western Canadian resorts over the decade 2008-2018. DESIGN: Ecological study. METHODS: Head-injury and participation data on alpine skiing and snowboarding (snowsports) was provided by the Canada West Ski Areas Association (CWSAA) for 2008-2018. Injury reports from the ski patrol of 52 western Canadian resorts were analysed. 29 resorts were included where there was both injury and participation data for at least 8 out of 10 seasons, resulting in analysis of 10,371 reports. Data was imported into SPSS 24 for analysis using descriptive statistics, chi-squared analysis, odds ratios and linear regression. RESULTS: Over the decade: the head injury rate was 0.205 injuries per thousand skier days. Head injuries were 9-10% of all injuries, significantly lower for skiers (8.3%) than snowboarders (10.9%). There were no significant differences in helmet-usage rates of injured and non-injured populations. 80.6% of injured participants wore a helmet, those wearing a helmet were 8% more likely to report a head injury than those not wearing a helmet. There was little variation in the proportion of head injuries reported as concussion, but a 50% reduction in ambulance or helicopter transport, a head-injury severity proxy. There was a significant relationship between the proportion of snowsport participants who were snowboarders and the head-injury rate. CONCLUSIONS: Head injuries remain a rare event. There has been a decline in the severity of reported head injuries which may be a function of a decline in the proportion of snowboarders in snowsports.

[Ski sport. Trend--pattern of injuries--prevention]. / Skisport. Aktuelle Entwicklung--Verletzungsmuster--Prävention.

Skiing is one of the most favoured winter sports, supported by the introduction of carving skis ten years ago. There's a close correlation between the design of the carving ski and a new skiing technique. Only a small number of persons is able to carve correctly. A special fitness program is necessary to be prepared adequately to the skills of carving. As proven by the latest injury statistics, the number of injuries has been declining over the last years. Due to the new skiing technique, injury patterns have changed. The most frequently affected injured region is still the knee joint. Prevention can be done by fitness training, watching instructional ski videos, and usage of well-fitting sports equipment. A new trend is the Telemark-technique, which shows different injury patterns than carving.

[The trend sport snowblading and its risks]. / Der Trendsport Snowblading und seine Risiken.

The study analysed the results of an examination of 3557 skiing, snowboarding and snowblading injuries treated at the Department of Trauma Surgery at the Klinikum Garmisch-Partenkirchen in winter seasons 99/00 through 02/03. In this study group, a total of 70 injuries occurred while snowblading. These injuries are compared to the remaining injuries resulting from skiing, carving or snowboarding accidents. This study intends to contribute to the tracking and recording of injuries occurring during snowblading, a sport that is popular but not yet well-addressed in medical literature. The results show that snowblading injuries are similar to those of skiing, but different from those attributable to snowboarding, particularly with regard to the affected parts of the body and injury patterns. Acrobatic jumps increase significantly the risk of fractures of the lower extremities. However, ruptures of ligaments, especially of the ACL, are seen more rarely in snowblading than in carving or conventional skiing. Distorsions, on the other hand, are observed significantly more often among snowbladers when compared with carvers and snowboarders. Release bindings for snowblades could reduce the risk of injuries.

The skier's knee.

Knee injuries in skiers have unique epidemiology and distinct mechanisms. Conversely, evaluation and treatment of the skier's knee is similar to evaluation and treatment of knee injuries in other athletes. A greater understanding of the epidemiology and mechanisms of knee injuries in skiers may aid arthroscopic clinicians and related researchers treating or investigating knee injuries in both skiers and in other athletes.

Avalanche safety practices in Utah.

OBJECTIVE: Avalanche fatalities occur on a yearly basis in Utah. The purpose of this study was to assess avalanche safety practices of different backcountry users in Utah and to identify groups that can be targeted for avalanche safety education. METHODS: We surveyed 353 winter backcountry users to determine the percentage of participants in each group who were traveling with one or more partners; the percentage who were carrying avalanche transceivers, shovels, probes, or AvaLungs; and the percentage who had taken an avalanche safety course. A measure of minimum safe practice was defined as 1) traveling with a partner, 2) carrying an avalanche transceiver, and 3) carrying a shovel. Participants in this study were backcountry skiers, snowboarders, snowshoers, snowmobilers, and out-of-bounds resort skiers/snowboarders traveling in the Wasatch and Uinta Mountains of Utah during the winter of 2005-06. RESULTS: The percentage of backcountry recreationists traveling with one or more partners was not significantly different (P=.0658) among backcountry skiers, snowboarders, snowshoers, snowmobilers, and out-of-bounds resort skiers/snowboarders. These groups did, however, differ in the percentage who carried avalanche transceivers (P<.0001), shovels (P<.0001), probes (P<.0001), and AvaLungs (P=.0020), as well as in the percentage who had taken an avalanche safety course (P<.0001) and the percentage who were carrying out minimum safe practices (P<.0001). Backcountry skiers showed the highest level of avalanche preparedness, with 98% carrying avalanche transceivers, 98% carrying shovels, 77% carrying probes, 86% having taken an avalanche safety course, and 88% carrying out minimum safe practices. Out of bounds snowboarders were the least prepared with 9% carrying avalanche transceivers, 9% carrying shovels, 7% carrying probes, 33% having taken an avalanche safety course, and 2% carrying out minimum safe practices. CONCLUSIONS: There are significant differences in the avalanche safety practices of the various groups of backcountry travelers in Utah. Backcountry skiers and snowboarders were the most prepared, while snowmobilers, snowshoers, and out-of-bounds skiers/snowboarders were relatively less prepared.

[Snowboarding. History--injuries--risks--new materials--tournament on-site services--prevention]. / Snowboarden Geschichte -- Verletzungen -- Risiken -- Materialneuigkeiten -- Wettkampfbetreuung -- Prävention.

Since the 1998 Olympic Winter Games in Nagano, snowboarding has been established as a popular winter sport for youth and adults. The most frequently affected body region reported in many studies on snowboarding injuries are the wrists accounting for more than 50% of severe injuries, especially in beginners. Wrist braces are effective in protecting snowboarding beginners against wrist injuries. Male snowboarders up to the age of 16 and female snowboarders over the age of 25 have a higher risk of injury. Snowboarders should not use ski boots and should be careful with rented equipment. Systems providing body and limb protection and also snowboard-specific helmets can reduce the injury risk for alpine racers, freestylers, and also freeriders. Snowboard training is important to prevent injuries especially for beginners, and icy slopes should be avoided.

[Effect of equipment on current ski injuries, their development in the last 20 years and their prevention]. / Influenza degli attrezzi sulla traumatologia da sci attuale, sulla sua evoluzione negli ultimi 20 anni e sulla prevenzione.

Ski injuries depend from many factors which involve the skier and his behavior, the environment, especially the weather and slopes conditions, but first of all, the typical equipment, skis, boots and bindings. These materials have undergone a great technical improvement in recent years which allowed a significant decrease of ski injuries, first of all of the typical lower leg fracture, the so called "boot fracture". Nevertheless alpine skiers are exposed to conditions not encountered in other sports. The ski and the stiff plastic ski boot combine to form an extension to the human anatomy, which subjects the lower extremities to loads not normally encountered in other activities. The velocity of the skier combine with the equipment used to expose to a risk of injury that by type, severity and incidence is unusual. The more frequent ski injury in the last 15 years involve the knee and his ligaments. These lesions often involve the medial and lateral compartment and the anterior cruciate ligament (ACL, more than 65% of all knee lesions) and the etiology is related to both the boot and bindings characteristics. Many studies have shown the direct relationship between injuries of the lower extremity and equipment (the so called LEER-injuries, near 46% of all lesions in US studies) and also the importance of a proper binding setting for a lower risk. Ski boots are indicated as the primary cause of the ACL tears but, at this moment, for this lesion 4 mechanisms are described.(ABSTRACT TRUNCATED AT 250 WORDS)

Evaluation of alpine skiing and snowboarding injury in a northeastern state.

BACKGROUND: To demonstrate the injury patterns of Alpine skiing and snowboarding in a northeastern state and evaluate potential risk factors. METHODS: The medical records of a single pediatric and adult Level I trauma center were evaluated from January 1, 1990, through December 31, 1995. All admissions with injuries caused by Alpine skiing or snowboarding were reviewed. Those patients arriving from two local ski resorts, all of whose injuries are referred to the institution for care, were separated out for consideration. Age, sex, type of injury, date of injury, Injury Severity Score, operations performed, and outcome (including mortality) were evaluated. In addition, resort utilization for the study period was obtained from the two resorts included in the evaluation. Mortality data was obtained from the Vermont office of the Chief Medical Examiner for the same time period. RESULTS: For the 6-year period of the study approximately 2,978,000 skier and snowboarder days were recorded at the study sites. Approximately 447,000 of those days were attributed to snowboarders (15%). In all, 279 patients were admitted for injuries (0.01%), 238 were related to Alpine skiing (incidence 0.01%) and 40 to snowboarding (incidence 0.01%). Snowboarders were statistically younger (20 years; range, 4-44 years) than skiers (29 years; range, 6-70 years) (p < 0.001) and had a significantly lower Injury Severity Score (15 in snowboarders vs. 27 in skiers, p < 0.03). Two female patients were injured snowboarding and 68 female patients were injured skiing. Eight percent of injured snowboarders and 16% of injured skiers sustained multiple injuries (p < 0.01). Injury patterns were significantly different. Upper extremity injuries were almost exclusively found in snowboarders (24% vs. 7%, p < 0.003), whereas cruciate ligament injuries occurred far more commonly in skiers (45% vs. 4%, p < 0.001 Lower extremity injuries in general were more common in skiers (78% vs. 38%, p < 0.001). Central nervous system injuries, including head and spine, were evenly distributed over the two groups, although the snowboarders with central nervous system injuries were younger. In addition, splenic injuries were more common in snowboarders (13% vs. 2%, p < 0.01). Snowboarding accidents were far more common in December, March, and April than other months. Fifty-one patients sustained abdominal or chest injuries and only two of these required operative intervention (two splenectomies). Other operative interventions were limited to extremity injuries, injuries of the spine, or placement of an intracranial pressure monitor. There were no fatalities recorded in this population, although over the 6.5 years, there were 25 deaths related to alpine skiing and one to snowboarding in the State (incidence 0.0000009 skier days). Victims tended to be male: 96% of the skiers and the one snowboarder. The predominant cause of death was blunt head trauma followed by blunt chest trauma. Helmets were not worn by those sustaining head injuries or fatalities. Spine injuries were recorded only in extremely young snowboarders and skiers out of control. CONCLUSION: Snowboarders and Alpine skiers are equally prone to injury. Snowboarding accidents are typically less severe and show significantly different injury patterns than skiing accidents. Abdominal and chest injuries in this population are generally amenable to nonoperative management. Prevention programs are best targeted at safe skiing and snowboarding practices, not skiing or snowboarding in poor conditions, use of helmets for skiers, and restraint of snowboard use in very young children.

Trends in skiing injury type and rates in Australia. A review of 22,261 injuries over 27 years in the Snowy Mountains.

OBJECTIVE: To show the trends in the rate and type of skiing injuries in Australia. DESIGN: A retrospective analysis of skiing injuries in the Snowy Mountains from 1962 to 1988. SETTING: All injuries were seen and treated at the Ski Injury Clinic in Perisher Valley. PATIENTS: A total of 22,261 injuries were seen over this 27 year period (data for 1963, 1964, 1966, 1977, 1978, 1981 and 1982 were missing). INTERVENTIONS: Injured skiers were treated at the Clinic with a small number sent to main centres for tertiary care. MAIN OUTCOME MEASURES: The overall injury rate (1962-1988) and the specific injury rate for six subgroups of injuries (1974-1988) were calculated. RESULTS: The overall injury rate declined dramatically over this period. The incidence of tibial fractures, ankle injuries and lacerations also declined. Upper body injuries continue to rise although this trend was not statistically significant. There was a statistically significant increase in knee injuries. CONCLUSIONS: The trends reported here are similar to those overseas except that the incidence of thumb injuries has not changed in Australia. The changes in the rates of lacerations, and tibial and ankle injuries can be related to improvements in ski bindings and boots.

Occurrence and trends in ski injuries in Norway.

OBJECTIVES: To provide an overview of ski injuries in Norway and to describe the changes between 1990 and 1996. METHODS: All ski injuries (7966) treated at four hospitals providing health care to a defined population of about 11% of the Norwegian population were registered prospectively from 1990 to 1996. For this study, 6462 injuries sustained in cross country skiing, downhill skiing, telemark skiing, and snowboarding were selected for further analysis. RESULTS: The relative distribution of ski injuries by type of skiing changed significantly from 1990 to 1996 (p<0.001). Injuries from snowboarding showed the highest relative increase, and those sustained during downhill skiing showed a decline. The proportion of fractures in all types of skiing increased during the study period (p=0.001). The proportion of injuries to knee/lower leg decreased and the proportion to the forearm/wrist/hand increased during the study period (p=0.03). The mean age of the injured skiers differed significantly among the different types of skiing activity (p<0.001): cross country skiers were the oldest followed by telemark skiers, downhill skiers, and snowboarders. CONCLUSIONS: Ski injury surveillance results in early detection of changes in temporal injury trends, allowing timely adjustment of injury prevention strategies. Injuries from snowboarding are on the increase in Norway, warranting more effective injury prevention measures.