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Skiing and snowboarding are part of an important adventure tourism industry in New Zealand. Winter sports carry an element of risk. Previous research suggests a risk of injury of 1.74 ski injuries per 1000 ‘skier days' and 3.55 snowboard injuries per 1000 ‘boarder days'.1 The demographics of ski and snowboarding injuries are well documented in other parts of the world suggesting a predominance of lower limb injuries in skiers and upper limb injuries in snow boarders.1,2In New Zealand, treatment for accidents and injuries is covered by the Accident Compensation Corporation (ACC) irrespective of nationality or domiciliary status in New Zealand. In 2007, ACC accepted claims for 11,633 snow sports injuries at a cost of around NZ$12 million.3Queenstown is a major hub for snow sports during winter months. Snowsports injuries sustained in this area are usually managed initially at the ski field or in medical centres in Queenstown. Injures requiring orthopaedic specialist assessment, are referred to the orthopaedic department in Southland Hospital, Invercargill. Severely injured patients can be transferred directly from the ski field to Southland Hospital for rapid assessment and treatment.The resident population of Queenstown is around 23,000 people.4 An increased population typical during winter months places increased strain on local emergency, medical services and orthopaedic services. Very little published data exists on the demographics of significant ski and snowboard-related injuries, and their acute orthopaedic inpatient assessment and treatment in New Zealand.The aims of this study were to report on the demographics, complexity and cost of ski and snowboard injuries presenting to a medium sized orthopaedic trauma unit during winter 2009.Methods Data collection for this prospective audit was undertaken using a pro forma designed by the author. A literature search for published articles on ski and snowboard injuries was performed prior to the study to help establish appropriate information regarding patient demographics, injury and treatment and to provide data for comparison. Patients admitted to the orthopaedic ward in Southland Hospital with ski or snowboard injuries were included in this study. Patient details were passed to the main author for inclusion in the study and these details were double checked against admission records to ensure all patients were identified for inclusion. Patients admitted in the semi-acute or chronic period, at least two weeks after injury were excluded. Demographic data, country of origin and injury date were collected. Referral Source and means of transport to Southland Hospital were recorded along with site of injury (spine/pelvis, upper limb or lower limb), including a written description and Radiographic means of acute investigation. Treatment was documented (conservative/operative) including a description. In-patient duration and complications associated with treatment initiated were also recorded. Cost analysis was calculated in terms of both case weights and actual cost based on hospital coding data. Case weights (CWs) are a financial currency used by District Health Boards in New Zealand to calculate the cost of admissions and are necessary when applying for funding, particularly for elective admissions not covered under ACC bulk funding. One case weight is equal to approximately NZ$4000. Mean, median and standard deviation have been calculated to allow interpretation of the spread of data and 95% confidence intervals have been calculated to test significance of data when comparing groups. P-values were also calculated using an unpaired t-test, withp<0.01 accepted as significant. There was no conflict of interest between the author and the study and no pecuniary interests. Ethical Approval has been sought for this study from the Southern Regional Ethics Committee.5 Results Eighty-eight patients were admitted with 92 injuries to Southland Hospital (Invercargill, New Zealand) for orthopaedic assessment and treatment of injuries sustained from skiing and snowboarding over 129 days from 8 June 2009 until 14 October 2009. One injury occurred in one patient heliskiing and all other injuries were sustained on local fields. There were no admissions for injuries sustained during telemark skiing. Thirty-six skiers and 52 snowboarders were admitted with 37 injuries and 55 injuries respectively over the season. Injured snowboarders were significantly younger than skiers. Injured male snow boarders were also significantly younger than male skiers. No significant difference was found between female skiers and snowboarders or between sexes generally. See Table 1. Table 1. Demographics of injured skiers/snowboarders Variables Ski(range) 95% CI Snowboard(range) 95% CI Both(range) P Admissions 36 52 88 Injuries 37 55 92 Sex Female Male 13 23 14 38 27 61 Median age (range) Female Male Both 29 (5-59) 39 (15-69) 32.5 (5-69) 24.4-40.5 33.7-48.6 32.3-43.6 25.5 (17-49) 26.5 (11-47) 26 (11-49) 23-32 23.7-28.7 24.4-28.7 28 (5-49) 27 (11-69) 27.5 (5-69) 0.249 <0.001a <0.001a a significant difference Thirty-two admissions (37.5%) were Australian comprising 18 skiers and 14 snowboarders, compared to 29 New Zealanders (31.8%) comprising 10 skiers and 19 snowboarders (Table 2). In total there were 11 different nationalities included in this study. Most admissions were made in July (30 [34%]) compared to the least in October (5 [6%]). Table 2. Country of origin of injured skiers/snowboarders Variables Skiers Snowboarders Both Country of origin New Zealand Australia UK & Ireland Europe USA/Canada Japan Other 10 18 3 2 2 1 0 19 14 11 4 2 0 2 29 32 14 6 4 1 2 Admission month June July August September October 5 9 18 4 0 6 21 10 10 5 11 30 28 14 5 The majority of patients were referred from either a general practice-led medical centre in Queenstown of Lakes District Hospital. Most patients were transported to Invercargill by ambulance. See Table 3. Eighty-eight admissions spent 292 inpatient days in hospital throughout the study period with a mean stay of 3.3 days and median stay of 2 days. There was no significant difference in in-patient stay between skiers and snowboarders. All patients had an X-ray and more than half had a CT scan. See Table 3. Table 3. Hospital admission details of injured skiers/snowboarders Variables Ski (95%CI) Snowboard (95%CI) Both P Referral source Ski field (%) MC LDH ED 3 (3.4) 15 (17) 18 (20.4) 0 0 16 (18.2) 35 (39.8) 1 (1.1) 3 (3.4) 31 (35.2) 53 (60.2) 1 (1.1) Transport to Invercargill Helicopter (%) Ambulance Personal 9 (10.2) 24 (27.3) 3 (3.4) 4 (4.5) 28 (31.8) 20 (22.7) 13 (14.8) 52 (59.1) 23 (26.1) Inpatient duration Median (range) 2.5 (1-12) (1.4-4.9) 2 (1-14) (2.2-3.8) 2 (1-14) 0.2331 Investigation X-ray (%) CT MRI Bone scan 36 (40.9) 17 (19.3) 0 1 (1.1) 52 (59.1) 33 (37.5) 0 0 88 (100) 46 (52.3) 0 1 (1.1) i No significant difference of inpatient duration between groups MC: medical centre LDH: Lakes District Hospital ED: Emergency Department (Southland Hospital) There was a predominance of lower limb injuries in skiers and upper limb injuries in snowboarders. Spinal injuries were more common in snowboarders than skiers. One death occurred following a cervical burst fracture in a snowboarder (Table 4). Table 4. Injury type by sport Variables Skiing Snowboarding Spine Cervical spine fracture Cervical spine soft tissue injury Thoracic spine fracture 1 level Thoracic spine fracture multiple levels Lumbar spine fracture 1 level Lumbar spine fracture multiple levels Pelvic fracture Total (%) 1 1 3 1 2 8 (21.6) 2 1 4 2 5 1 15 (27.3) Upper limb Clavicle fracture Complicated shoulder dislocation Proximal humerus fracture Mid shaft humerus fracture Distal/supracondylar humerus fracture Elbow dislocation Proximal ulna/radius fracture Mid shaft ulna/radius fracture Distal radius/ulna fracture Carpal dislocation including scaphoid injury Metacarpal fracture Phalangeal fracture Upper limb wound Total (%) 1 1 1 1 1 2 1 8 (21.6) 2 4 2 4 4 1 3 8 1 1 1 31 (56.4) Lower limb Dislocated hip Neck of femur fracture Sub-trochanteric fracture Supra-condylar femoral fracture Tibial plateau fracture Tibial shaft fracture Distal tibial fracture Ankle fracture Talus fracture (excluding lateral process) Lateral talar process fracture Calcaneal fracture Wound lower leg Total (%) 1 2 2 1 3 8 2 1 1 21 (56.7)

Summary

Abstract

Aim

The aims of this study were to report on ski and snowboard injuries which required in-patient assessment and treatment, by investigating demographics, complexity and cost.

Method

A prospective study investigating the pattern of ski and snowboard injuries admitted to the Orthopaedic Department of Southland Hospital (Invercargill) during 2009. Patient demographics, injury characteristics, treatment and financial implications have all been examined.

Results

88 patients were admitted with 92 injuries over 129 days. Thirty-six skiers sustained 37 injuries compared to 55 injuries in 52 snowboarders. The median age of skiers was 32.5 years compared to 26 years for snowboarders, which represented a statistically significant difference. Thirty-two admissions were visitors from Australia, compared to 29 from New Zealand and 14 from Great Britain and Ireland. Fifty-two patients (59.1%) were transported to Invercargill by ambulance compared to 13 (14.8%) by helicopter. Twenty-five ski-related injuries were treated operatively (67.5%) compared with 37 snowboard-related injuries (67.3%). Twenty-three patients (26%) were admitted with spinal injuries including one C5 burst fracture which was ultimately fatal. A total of 124.46 case weights were generated by all 88 admissions representing a cost of almost $500,000.

Conclusion

Ski and snowboard injuries represent a significant workload and financial burden to a typical mid-sized district general hospital in New Zealand. There is little published data on the natural history of serious orthopaedic injuries related to skiing and snowboarding in New Zealand.

Author Information

A Gordon Burgess and Ridzwan Namazie, Orthopaedic Registrars, Southland Hospital, Invercargill

Acknowledgements

The authors thank Maree Jackson, Elective Services Southland Hospital for case weight data and data on elective and acute services.

Correspondence

Dr Gordon Burgess, Orthopaedic Registrar, Orthopaedic Outpatients, Christchurch Hospital, Private Bag 4710, Christchurch, New Zealand.

Correspondence Email

agburgess@hotmail.com

Competing Interests

None.

Langran M, Selvaraj S. Snow sports injuries in Scotland: a case-control study. British Journal of Sports Medicine 2002;36:135-140.Sacco DE, Sartorelli DH, Vane DW. Evaluation of alpine skiing and snowboarding in a northeastern state. Journal of Trauma-Injury Infection & Critical Care. 1998 Apr;44(4):654-9.ACC SnowSmart Website: http://www.snowsmart.co.nz/articles/view/150New Zealand Census 2006.http://www.stats.govt.nz/Census/2006CensusHomePage/QuickStats/AboutAPlace/SnapShot.aspx?id=2000070&type=ta&ParentID=1000014Lower South Regional Ethics Committee. Application number LRS/09/32/EXP.Siu TLT, Chandran KN, Newcombe RL, et al. Snow sports related head and spinal injuries: an eight year survey from the neurotrauma centre fro the Snowy Mountains, Australia. J Clin Neuroscience 2004;11(3):236-242.Statistics New Zealand. Visitor arrivals by country. http://search.stats.govt.nz/search?w=visitor+arrivals+by+countryGwynne Jones D. Non-resident orthopaedic admissions to Dunedin Hospital New Zealand: 1997 to 2004. 2005 N Z Med J 24 June 2005;118(1217). http://www.nzma.org.nz/journal/118-1217/1531/content.pdfSt John Southern Region. 17 York Place, Po Box 5055, Dunedin, New Zealand (contacted via Frankton base January 2010).Donald S, Chalmers D, Theis J-C. Are snowboarders more likely to damage their spines than skiers? Lessons learned from a study of spinal injuries from the Otago skifields in New Zealand. N Z Med J 24 June 2005;118(1217).http://www.nzma.org.nz/journal/118-1217/1530/content.pdf

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contact nzmj@nzma.org.nz

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Skiing and snowboarding are part of an important adventure tourism industry in New Zealand. Winter sports carry an element of risk. Previous research suggests a risk of injury of 1.74 ski injuries per 1000 ‘skier days' and 3.55 snowboard injuries per 1000 ‘boarder days'.1 The demographics of ski and snowboarding injuries are well documented in other parts of the world suggesting a predominance of lower limb injuries in skiers and upper limb injuries in snow boarders.1,2In New Zealand, treatment for accidents and injuries is covered by the Accident Compensation Corporation (ACC) irrespective of nationality or domiciliary status in New Zealand. In 2007, ACC accepted claims for 11,633 snow sports injuries at a cost of around NZ$12 million.3Queenstown is a major hub for snow sports during winter months. Snowsports injuries sustained in this area are usually managed initially at the ski field or in medical centres in Queenstown. Injures requiring orthopaedic specialist assessment, are referred to the orthopaedic department in Southland Hospital, Invercargill. Severely injured patients can be transferred directly from the ski field to Southland Hospital for rapid assessment and treatment.The resident population of Queenstown is around 23,000 people.4 An increased population typical during winter months places increased strain on local emergency, medical services and orthopaedic services. Very little published data exists on the demographics of significant ski and snowboard-related injuries, and their acute orthopaedic inpatient assessment and treatment in New Zealand.The aims of this study were to report on the demographics, complexity and cost of ski and snowboard injuries presenting to a medium sized orthopaedic trauma unit during winter 2009.Methods Data collection for this prospective audit was undertaken using a pro forma designed by the author. A literature search for published articles on ski and snowboard injuries was performed prior to the study to help establish appropriate information regarding patient demographics, injury and treatment and to provide data for comparison. Patients admitted to the orthopaedic ward in Southland Hospital with ski or snowboard injuries were included in this study. Patient details were passed to the main author for inclusion in the study and these details were double checked against admission records to ensure all patients were identified for inclusion. Patients admitted in the semi-acute or chronic period, at least two weeks after injury were excluded. Demographic data, country of origin and injury date were collected. Referral Source and means of transport to Southland Hospital were recorded along with site of injury (spine/pelvis, upper limb or lower limb), including a written description and Radiographic means of acute investigation. Treatment was documented (conservative/operative) including a description. In-patient duration and complications associated with treatment initiated were also recorded. Cost analysis was calculated in terms of both case weights and actual cost based on hospital coding data. Case weights (CWs) are a financial currency used by District Health Boards in New Zealand to calculate the cost of admissions and are necessary when applying for funding, particularly for elective admissions not covered under ACC bulk funding. One case weight is equal to approximately NZ$4000. Mean, median and standard deviation have been calculated to allow interpretation of the spread of data and 95% confidence intervals have been calculated to test significance of data when comparing groups. P-values were also calculated using an unpaired t-test, withp<0.01 accepted as significant. There was no conflict of interest between the author and the study and no pecuniary interests. Ethical Approval has been sought for this study from the Southern Regional Ethics Committee.5 Results Eighty-eight patients were admitted with 92 injuries to Southland Hospital (Invercargill, New Zealand) for orthopaedic assessment and treatment of injuries sustained from skiing and snowboarding over 129 days from 8 June 2009 until 14 October 2009. One injury occurred in one patient heliskiing and all other injuries were sustained on local fields. There were no admissions for injuries sustained during telemark skiing. Thirty-six skiers and 52 snowboarders were admitted with 37 injuries and 55 injuries respectively over the season. Injured snowboarders were significantly younger than skiers. Injured male snow boarders were also significantly younger than male skiers. No significant difference was found between female skiers and snowboarders or between sexes generally. See Table 1. Table 1. Demographics of injured skiers/snowboarders Variables Ski(range) 95% CI Snowboard(range) 95% CI Both(range) P Admissions 36 52 88 Injuries 37 55 92 Sex Female Male 13 23 14 38 27 61 Median age (range) Female Male Both 29 (5-59) 39 (15-69) 32.5 (5-69) 24.4-40.5 33.7-48.6 32.3-43.6 25.5 (17-49) 26.5 (11-47) 26 (11-49) 23-32 23.7-28.7 24.4-28.7 28 (5-49) 27 (11-69) 27.5 (5-69) 0.249 <0.001a <0.001a a significant difference Thirty-two admissions (37.5%) were Australian comprising 18 skiers and 14 snowboarders, compared to 29 New Zealanders (31.8%) comprising 10 skiers and 19 snowboarders (Table 2). In total there were 11 different nationalities included in this study. Most admissions were made in July (30 [34%]) compared to the least in October (5 [6%]). Table 2. Country of origin of injured skiers/snowboarders Variables Skiers Snowboarders Both Country of origin New Zealand Australia UK & Ireland Europe USA/Canada Japan Other 10 18 3 2 2 1 0 19 14 11 4 2 0 2 29 32 14 6 4 1 2 Admission month June July August September October 5 9 18 4 0 6 21 10 10 5 11 30 28 14 5 The majority of patients were referred from either a general practice-led medical centre in Queenstown of Lakes District Hospital. Most patients were transported to Invercargill by ambulance. See Table 3. Eighty-eight admissions spent 292 inpatient days in hospital throughout the study period with a mean stay of 3.3 days and median stay of 2 days. There was no significant difference in in-patient stay between skiers and snowboarders. All patients had an X-ray and more than half had a CT scan. See Table 3. Table 3. Hospital admission details of injured skiers/snowboarders Variables Ski (95%CI) Snowboard (95%CI) Both P Referral source Ski field (%) MC LDH ED 3 (3.4) 15 (17) 18 (20.4) 0 0 16 (18.2) 35 (39.8) 1 (1.1) 3 (3.4) 31 (35.2) 53 (60.2) 1 (1.1) Transport to Invercargill Helicopter (%) Ambulance Personal 9 (10.2) 24 (27.3) 3 (3.4) 4 (4.5) 28 (31.8) 20 (22.7) 13 (14.8) 52 (59.1) 23 (26.1) Inpatient duration Median (range) 2.5 (1-12) (1.4-4.9) 2 (1-14) (2.2-3.8) 2 (1-14) 0.2331 Investigation X-ray (%) CT MRI Bone scan 36 (40.9) 17 (19.3) 0 1 (1.1) 52 (59.1) 33 (37.5) 0 0 88 (100) 46 (52.3) 0 1 (1.1) i No significant difference of inpatient duration between groups MC: medical centre LDH: Lakes District Hospital ED: Emergency Department (Southland Hospital) There was a predominance of lower limb injuries in skiers and upper limb injuries in snowboarders. Spinal injuries were more common in snowboarders than skiers. One death occurred following a cervical burst fracture in a snowboarder (Table 4). Table 4. Injury type by sport Variables Skiing Snowboarding Spine Cervical spine fracture Cervical spine soft tissue injury Thoracic spine fracture 1 level Thoracic spine fracture multiple levels Lumbar spine fracture 1 level Lumbar spine fracture multiple levels Pelvic fracture Total (%) 1 1 3 1 2 8 (21.6) 2 1 4 2 5 1 15 (27.3) Upper limb Clavicle fracture Complicated shoulder dislocation Proximal humerus fracture Mid shaft humerus fracture Distal/supracondylar humerus fracture Elbow dislocation Proximal ulna/radius fracture Mid shaft ulna/radius fracture Distal radius/ulna fracture Carpal dislocation including scaphoid injury Metacarpal fracture Phalangeal fracture Upper limb wound Total (%) 1 1 1 1 1 2 1 8 (21.6) 2 4 2 4 4 1 3 8 1 1 1 31 (56.4) Lower limb Dislocated hip Neck of femur fracture Sub-trochanteric fracture Supra-condylar femoral fracture Tibial plateau fracture Tibial shaft fracture Distal tibial fracture Ankle fracture Talus fracture (excluding lateral process) Lateral talar process fracture Calcaneal fracture Wound lower leg Total (%) 1 2 2 1 3 8 2 1 1 21 (56.7)

Summary

Abstract

Aim

The aims of this study were to report on ski and snowboard injuries which required in-patient assessment and treatment, by investigating demographics, complexity and cost.

Method

A prospective study investigating the pattern of ski and snowboard injuries admitted to the Orthopaedic Department of Southland Hospital (Invercargill) during 2009. Patient demographics, injury characteristics, treatment and financial implications have all been examined.

Results

88 patients were admitted with 92 injuries over 129 days. Thirty-six skiers sustained 37 injuries compared to 55 injuries in 52 snowboarders. The median age of skiers was 32.5 years compared to 26 years for snowboarders, which represented a statistically significant difference. Thirty-two admissions were visitors from Australia, compared to 29 from New Zealand and 14 from Great Britain and Ireland. Fifty-two patients (59.1%) were transported to Invercargill by ambulance compared to 13 (14.8%) by helicopter. Twenty-five ski-related injuries were treated operatively (67.5%) compared with 37 snowboard-related injuries (67.3%). Twenty-three patients (26%) were admitted with spinal injuries including one C5 burst fracture which was ultimately fatal. A total of 124.46 case weights were generated by all 88 admissions representing a cost of almost $500,000.

Conclusion

Ski and snowboard injuries represent a significant workload and financial burden to a typical mid-sized district general hospital in New Zealand. There is little published data on the natural history of serious orthopaedic injuries related to skiing and snowboarding in New Zealand.

Author Information

A Gordon Burgess and Ridzwan Namazie, Orthopaedic Registrars, Southland Hospital, Invercargill

Acknowledgements

The authors thank Maree Jackson, Elective Services Southland Hospital for case weight data and data on elective and acute services.

Correspondence

Dr Gordon Burgess, Orthopaedic Registrar, Orthopaedic Outpatients, Christchurch Hospital, Private Bag 4710, Christchurch, New Zealand.

Correspondence Email

agburgess@hotmail.com

Competing Interests

None.

Langran M, Selvaraj S. Snow sports injuries in Scotland: a case-control study. British Journal of Sports Medicine 2002;36:135-140.Sacco DE, Sartorelli DH, Vane DW. Evaluation of alpine skiing and snowboarding in a northeastern state. Journal of Trauma-Injury Infection & Critical Care. 1998 Apr;44(4):654-9.ACC SnowSmart Website: http://www.snowsmart.co.nz/articles/view/150New Zealand Census 2006.http://www.stats.govt.nz/Census/2006CensusHomePage/QuickStats/AboutAPlace/SnapShot.aspx?id=2000070&type=ta&ParentID=1000014Lower South Regional Ethics Committee. Application number LRS/09/32/EXP.Siu TLT, Chandran KN, Newcombe RL, et al. Snow sports related head and spinal injuries: an eight year survey from the neurotrauma centre fro the Snowy Mountains, Australia. J Clin Neuroscience 2004;11(3):236-242.Statistics New Zealand. Visitor arrivals by country. http://search.stats.govt.nz/search?w=visitor+arrivals+by+countryGwynne Jones D. Non-resident orthopaedic admissions to Dunedin Hospital New Zealand: 1997 to 2004. 2005 N Z Med J 24 June 2005;118(1217). http://www.nzma.org.nz/journal/118-1217/1531/content.pdfSt John Southern Region. 17 York Place, Po Box 5055, Dunedin, New Zealand (contacted via Frankton base January 2010).Donald S, Chalmers D, Theis J-C. Are snowboarders more likely to damage their spines than skiers? Lessons learned from a study of spinal injuries from the Otago skifields in New Zealand. N Z Med J 24 June 2005;118(1217).http://www.nzma.org.nz/journal/118-1217/1530/content.pdf

For the PDF of this article,
contact nzmj@nzma.org.nz

View Article PDF

Skiing and snowboarding are part of an important adventure tourism industry in New Zealand. Winter sports carry an element of risk. Previous research suggests a risk of injury of 1.74 ski injuries per 1000 ‘skier days' and 3.55 snowboard injuries per 1000 ‘boarder days'.1 The demographics of ski and snowboarding injuries are well documented in other parts of the world suggesting a predominance of lower limb injuries in skiers and upper limb injuries in snow boarders.1,2In New Zealand, treatment for accidents and injuries is covered by the Accident Compensation Corporation (ACC) irrespective of nationality or domiciliary status in New Zealand. In 2007, ACC accepted claims for 11,633 snow sports injuries at a cost of around NZ$12 million.3Queenstown is a major hub for snow sports during winter months. Snowsports injuries sustained in this area are usually managed initially at the ski field or in medical centres in Queenstown. Injures requiring orthopaedic specialist assessment, are referred to the orthopaedic department in Southland Hospital, Invercargill. Severely injured patients can be transferred directly from the ski field to Southland Hospital for rapid assessment and treatment.The resident population of Queenstown is around 23,000 people.4 An increased population typical during winter months places increased strain on local emergency, medical services and orthopaedic services. Very little published data exists on the demographics of significant ski and snowboard-related injuries, and their acute orthopaedic inpatient assessment and treatment in New Zealand.The aims of this study were to report on the demographics, complexity and cost of ski and snowboard injuries presenting to a medium sized orthopaedic trauma unit during winter 2009.Methods Data collection for this prospective audit was undertaken using a pro forma designed by the author. A literature search for published articles on ski and snowboard injuries was performed prior to the study to help establish appropriate information regarding patient demographics, injury and treatment and to provide data for comparison. Patients admitted to the orthopaedic ward in Southland Hospital with ski or snowboard injuries were included in this study. Patient details were passed to the main author for inclusion in the study and these details were double checked against admission records to ensure all patients were identified for inclusion. Patients admitted in the semi-acute or chronic period, at least two weeks after injury were excluded. Demographic data, country of origin and injury date were collected. Referral Source and means of transport to Southland Hospital were recorded along with site of injury (spine/pelvis, upper limb or lower limb), including a written description and Radiographic means of acute investigation. Treatment was documented (conservative/operative) including a description. In-patient duration and complications associated with treatment initiated were also recorded. Cost analysis was calculated in terms of both case weights and actual cost based on hospital coding data. Case weights (CWs) are a financial currency used by District Health Boards in New Zealand to calculate the cost of admissions and are necessary when applying for funding, particularly for elective admissions not covered under ACC bulk funding. One case weight is equal to approximately NZ$4000. Mean, median and standard deviation have been calculated to allow interpretation of the spread of data and 95% confidence intervals have been calculated to test significance of data when comparing groups. P-values were also calculated using an unpaired t-test, withp<0.01 accepted as significant. There was no conflict of interest between the author and the study and no pecuniary interests. Ethical Approval has been sought for this study from the Southern Regional Ethics Committee.5 Results Eighty-eight patients were admitted with 92 injuries to Southland Hospital (Invercargill, New Zealand) for orthopaedic assessment and treatment of injuries sustained from skiing and snowboarding over 129 days from 8 June 2009 until 14 October 2009. One injury occurred in one patient heliskiing and all other injuries were sustained on local fields. There were no admissions for injuries sustained during telemark skiing. Thirty-six skiers and 52 snowboarders were admitted with 37 injuries and 55 injuries respectively over the season. Injured snowboarders were significantly younger than skiers. Injured male snow boarders were also significantly younger than male skiers. No significant difference was found between female skiers and snowboarders or between sexes generally. See Table 1. Table 1. Demographics of injured skiers/snowboarders Variables Ski(range) 95% CI Snowboard(range) 95% CI Both(range) P Admissions 36 52 88 Injuries 37 55 92 Sex Female Male 13 23 14 38 27 61 Median age (range) Female Male Both 29 (5-59) 39 (15-69) 32.5 (5-69) 24.4-40.5 33.7-48.6 32.3-43.6 25.5 (17-49) 26.5 (11-47) 26 (11-49) 23-32 23.7-28.7 24.4-28.7 28 (5-49) 27 (11-69) 27.5 (5-69) 0.249 <0.001a <0.001a a significant difference Thirty-two admissions (37.5%) were Australian comprising 18 skiers and 14 snowboarders, compared to 29 New Zealanders (31.8%) comprising 10 skiers and 19 snowboarders (Table 2). In total there were 11 different nationalities included in this study. Most admissions were made in July (30 [34%]) compared to the least in October (5 [6%]). Table 2. Country of origin of injured skiers/snowboarders Variables Skiers Snowboarders Both Country of origin New Zealand Australia UK & Ireland Europe USA/Canada Japan Other 10 18 3 2 2 1 0 19 14 11 4 2 0 2 29 32 14 6 4 1 2 Admission month June July August September October 5 9 18 4 0 6 21 10 10 5 11 30 28 14 5 The majority of patients were referred from either a general practice-led medical centre in Queenstown of Lakes District Hospital. Most patients were transported to Invercargill by ambulance. See Table 3. Eighty-eight admissions spent 292 inpatient days in hospital throughout the study period with a mean stay of 3.3 days and median stay of 2 days. There was no significant difference in in-patient stay between skiers and snowboarders. All patients had an X-ray and more than half had a CT scan. See Table 3. Table 3. Hospital admission details of injured skiers/snowboarders Variables Ski (95%CI) Snowboard (95%CI) Both P Referral source Ski field (%) MC LDH ED 3 (3.4) 15 (17) 18 (20.4) 0 0 16 (18.2) 35 (39.8) 1 (1.1) 3 (3.4) 31 (35.2) 53 (60.2) 1 (1.1) Transport to Invercargill Helicopter (%) Ambulance Personal 9 (10.2) 24 (27.3) 3 (3.4) 4 (4.5) 28 (31.8) 20 (22.7) 13 (14.8) 52 (59.1) 23 (26.1) Inpatient duration Median (range) 2.5 (1-12) (1.4-4.9) 2 (1-14) (2.2-3.8) 2 (1-14) 0.2331 Investigation X-ray (%) CT MRI Bone scan 36 (40.9) 17 (19.3) 0 1 (1.1) 52 (59.1) 33 (37.5) 0 0 88 (100) 46 (52.3) 0 1 (1.1) i No significant difference of inpatient duration between groups MC: medical centre LDH: Lakes District Hospital ED: Emergency Department (Southland Hospital) There was a predominance of lower limb injuries in skiers and upper limb injuries in snowboarders. Spinal injuries were more common in snowboarders than skiers. One death occurred following a cervical burst fracture in a snowboarder (Table 4). Table 4. Injury type by sport Variables Skiing Snowboarding Spine Cervical spine fracture Cervical spine soft tissue injury Thoracic spine fracture 1 level Thoracic spine fracture multiple levels Lumbar spine fracture 1 level Lumbar spine fracture multiple levels Pelvic fracture Total (%) 1 1 3 1 2 8 (21.6) 2 1 4 2 5 1 15 (27.3) Upper limb Clavicle fracture Complicated shoulder dislocation Proximal humerus fracture Mid shaft humerus fracture Distal/supracondylar humerus fracture Elbow dislocation Proximal ulna/radius fracture Mid shaft ulna/radius fracture Distal radius/ulna fracture Carpal dislocation including scaphoid injury Metacarpal fracture Phalangeal fracture Upper limb wound Total (%) 1 1 1 1 1 2 1 8 (21.6) 2 4 2 4 4 1 3 8 1 1 1 31 (56.4) Lower limb Dislocated hip Neck of femur fracture Sub-trochanteric fracture Supra-condylar femoral fracture Tibial plateau fracture Tibial shaft fracture Distal tibial fracture Ankle fracture Talus fracture (excluding lateral process) Lateral talar process fracture Calcaneal fracture Wound lower leg Total (%) 1 2 2 1 3 8 2 1 1 21 (56.7)

Summary

Abstract

Aim

The aims of this study were to report on ski and snowboard injuries which required in-patient assessment and treatment, by investigating demographics, complexity and cost.

Method

A prospective study investigating the pattern of ski and snowboard injuries admitted to the Orthopaedic Department of Southland Hospital (Invercargill) during 2009. Patient demographics, injury characteristics, treatment and financial implications have all been examined.

Results

88 patients were admitted with 92 injuries over 129 days. Thirty-six skiers sustained 37 injuries compared to 55 injuries in 52 snowboarders. The median age of skiers was 32.5 years compared to 26 years for snowboarders, which represented a statistically significant difference. Thirty-two admissions were visitors from Australia, compared to 29 from New Zealand and 14 from Great Britain and Ireland. Fifty-two patients (59.1%) were transported to Invercargill by ambulance compared to 13 (14.8%) by helicopter. Twenty-five ski-related injuries were treated operatively (67.5%) compared with 37 snowboard-related injuries (67.3%). Twenty-three patients (26%) were admitted with spinal injuries including one C5 burst fracture which was ultimately fatal. A total of 124.46 case weights were generated by all 88 admissions representing a cost of almost $500,000.

Conclusion

Ski and snowboard injuries represent a significant workload and financial burden to a typical mid-sized district general hospital in New Zealand. There is little published data on the natural history of serious orthopaedic injuries related to skiing and snowboarding in New Zealand.

Author Information

A Gordon Burgess and Ridzwan Namazie, Orthopaedic Registrars, Southland Hospital, Invercargill

Acknowledgements

The authors thank Maree Jackson, Elective Services Southland Hospital for case weight data and data on elective and acute services.

Correspondence

Dr Gordon Burgess, Orthopaedic Registrar, Orthopaedic Outpatients, Christchurch Hospital, Private Bag 4710, Christchurch, New Zealand.

Correspondence Email

agburgess@hotmail.com

Competing Interests

None.

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