SKIING INJURIES IN CHILDREN AND ADOLESCENTS "

Transcription

1 SKIING INJURIES IN CHILDREN AND ADOLESCENTS " Athanasios Zacharopoulos Orthopaedic Depatrment General Hospital of Amfissa Greece

2 Children in sports The past decade has seen an explosion in the number of children participating in team and solo sports In 2011, only in USA, more than 46.5 million children played team sports.

3 Children in sports Benefits Physical Fitness Motor development Learn New Skills Improve Skills To Make Friends Build Self-Estimation Have Fun

4 Children are not small adults

5 Body size Smaller heads Closer to the ground Children in sports There are differences Unique impact characteristics (Hoshizaki, et al., 2012)

6 Body growth Children in sports There are differences there is a decrease in flexibility because of relative bone lengthening Tendons and ligaments are relatively stronger than the epiphyseal plate Fractures

7 Metabolic Children produce more heat Children in sports There are differences have a low sweating capacity Fatigue

8 Psychology Risky taking behavior Children in sports There are differences Excessive speed Collision

9 Parental influence Children in sports There are differences Risky taking behavior

10 Children in sports Three age groups: <11 years old (children) years old (adolescents - high school) years old (adolescents - college)

11 Children in sports There are differences between these three age groups (even into the same group) regarding: Maturity BMI Stage of puberty

12 Children are at high risk for injury in almost all the sports

13 Especially in skiing and boarding: per thousand skiers days (Meyers, et al., 2007) When in general population on the slopes the injury rate is 1-6 injuries/1000 skiers days

14 In skiing and boarding: Fatal Injuries per 1 million skiers days 14% of all fatal injuries occurred among child skiers (Xiang et al, 2004)

15 Our experience: Prospective case-control study during winter seasons

16 Parnassus Ski Resorts

17 Study Group From a total of 3488 injured: 856 injured (with 923 injuries) were under 18 years old Skier: 620 Snowboarder: ,40% 56% Children Adults 44% 27,60% Skier Snb

18 Study Group 3 subgroups: <11 (206 skiers, 17 snbs) (228 skiers, 88 snbs) (186 skiers. 131 snbs) Skier Snb 55,50% 33,20% 36,80% 37,30% 30,00% 7% <

19 Control Group From a total of 1290 uninjured (randomly selected) Skier: 183 Snowboarder: 51 uninjured 17 : 234 Study 72,40% 78,00% Control 27,60% 22,00% Skier Snb

20 Results: Overall rate of injuries: 8 Injuries per Thousand Skiers Days (IPTSD) ,2 5,6 4 0 Total Children Adults The overall rate of injuries for children and adolescents is higher than adults

21 Children skiers counted the 18% of the population on the slopes but sustaining the 25% of all the injuries.

22 Overall rate of injuries in Children: IPTSD 5,6 5,2 6,8 Total Ski Snb The injury rate in Snb is higher than Skiers

23 Overall rate of injuries in Children in Skiing: IPTSD 8,9 4,1 4,9 5,2 < Total The age subgroup of in skiing represent the higher incidence of injuries

24 Overall rate of injuries in Children in Snowboarding: IPTSD 8,9 5,6 7,7 6,8 < Total

25 Body Part injured Ski Snb 15,10% 10,10% 26,40% 63,90% 8,10% 8,90% 50,40% 17,10% Head Upper Limb Trunk Lower Limb Snb sustain mainly upper limb injuries while skiers lower limb injuries

26 Compared with adults Body Part injured Children Adults 41,20% 13,70% Head Upper Limb 39,40% 12,90% 8,30% 36,80% Trunk Lower Limb 11,50% 36,20% There are no differences between children and adults

27 Compared with adults Body part of the injured skiers Children Skier Adults Skier Head Upper Lim b Trunk Low er Lim b It is not observed statistical significant difference between children and adults skiers

28 Compared with adults Body part of the injured Boarders Children Snb Adults Snb 63,20% 46,60% 13,20% 15,20% 9,30% 9,50% 18,00% 25,10% Head Upper Limb Trunk Lower Limb Young snowboarders represent a significant higher incidence of upper limb injuries than adults

29 45,40% 40,60% Type of injuries 34,10% 24,60% 29,00% Children Skier Children Sb 4,80% 4,80% 1,00% 1,50% 2,90% 0,70% 8,50% 1,40% 0,70% Abration Laceration Contusion Dislocation Fractur e Concussion Ligam ent Sprain Contusions and ligament sprains are the most common injuries in skiers Fractures are the second most common injuries in Snb s

30 Compared with adults Injury types in Skiing 45,40% 37% 37,70% 34,10% Children Skier Adults Skier 8,60% 6,30% 4,80% 4,80% 1,00% 3,70% 8,50% 5,60% 1,10% 1,40% Abration Laceration Contusion Ligam ent Sprain Dislocation Fractur e Concussion Young skiers sustained more contusions, more fractures and less dislocations than adults

31 Compared with adults Injury types in Snb 41,70% 40,60% 23,50% Children Sb Adults Sb 24,60% 29,00% 14,30% 6,40% 6,50% 6,60% 1,50% 2,90% 0,70% 0,70% 1,00% Abra tion Lace ration Contus ion Ligament Spra in Dislocation Fracture Concussion Young snowboarders sustained more fractures and less dislocations than adults

32 Head Injuries 36,80% Children 8,30% 36,20% Adults 11,50% Head Upper Limb Trunk 41,20% Lower Limb 39,40% 13,70% 12,90% 13,7% of all the injuries in children and 12,9%% in adults are head injuries

33 Compared with adults Head Injuries Mean Days Between Injuries (MDBI) Total Skier Snb children adults Children skier sustain higher prevalence of head injuries than adults

34 Compared with adults Head Injuries 9% of head injuries in skiing are concussions (the same with adults).

35 Compared with adults Head Injuries 19% Concussion in Snb 12% Children Adults Children boarders sustain more concussions than adults

36 Compared with adults Upper Limb Injuries in Skiing 10,10% Children Adults 3,60% 1,10% 1,00% 1,00% 2,40% 2,40% 0,90% 1,20% 0,50% 6,30% 4,50% 5,40% 4,80% 4,80% 4,10% Clavicle Shoulder Humerus Elbow Forearm Wrist Thumb Hand Children sustain less shoulder but more forearm and wrist injuries than adults

37 Compared with adults Upper Limb Injuries in Snb Children Adults 36,20% 4,30% 4,90% 14,30% 8,60% 1,60% 4,20% 3,90% 1,20% 2,70% 1,90% 13,30% 2,10% 0,40% 6,20% 5,30% Clavicle Shoulder Humerus Elbow Forearm Wrist Thumb Hand The same happens in snowboard.

38 Wrist Injuries 41,20% Children Adults 39,40% Head 8,30% 13,70% Upper Limb Wrist 12,90% Trunk 11,50% 14,70% 22,10% Lower Limb 8,60% 27,60% 15% of all the injuries in children and 9% in adults are wrist injuries

39 Wrist Injuries 1104 Mean Days Between Injuries (MDBI) Total Skier Snb Children snowboarders have seven times more the possibility to sustain a wrist injury than skiers

40 Compared with adults Wrist Injuries Mean Days Between Injuries (MDBI) 5355 children adults Total Skier Snb Children sustain higher prevalence of wrist injuries than adults

41 Wrist Injuries Wrist injuries in boarding 2,30% 14% 19,50% 9% < Adults As age increases the prevalence of wrist injuries is higher

42 Wrist Injuries 55% of all wrist injuries in young boarders are fractures (the same with adults).

43 The main problem in alpine sports (especially in skiing) Knee Injuries

44 Knee Injuries Children Adults 36,50% 7,70% 14,90% Head Upper Limb Trunk 36,40% 11,70% 12,20% Low er Limb Knee 13,10% 27,80% 12,60% 27,10% 27.8% of all the injuries in children and 27.1% in adults are knee injuries

45 Knee Injuries in children Mean Days Between Injuries (MDBI) Total Skier Snb Children skiers have the double the possibility to sustain a knee injury than snowboarders

46 Compared with adults Mean Days Between Injuries (MDBI) children adults Total Skier Snb Children skier sustain higher prevalence of knee injuries than adults

47 Type of knee injuries in children Skier 68,40% Snb 62,50% 27,10% 33,30% 4,50% 4,20% Contusion Ligament Sprain Other Ligament sprains are the most common knee injuries

48 Compared with adults Children Skier 68,40% Adults Skier 76,40% 27,10% 19,40% 4,50% 4,20% Contusion Ligament Sprain Other There are not differences in injury types in skiing

49 Knee injury types in skiing 76,40% 66,20% 68,30% 71,40% < Adults As age increases the prevalence of knee ligament sprains is higher

50 Knee injury types in skiing 62,10% 75,60% Male Female 30,60% 23,20% 7,30% 1,20% Contusion Ligament Sprain Other Female skiers sustain a significantly higher prevalence of knee ligament injuries than males p<0,005

51 Knee injury types in skiing Male Female 80% 70% 77,80% 73,50% 79% 63,20% 60,60% 62,50% < Adults in all ages

52 Risk factors Age Gender Ability Experience Hours of skiing Company Equipment

53 Risk factor: Age Conclusion Age is a risk factor for injury in the subgroups of years in skiing

54 Risk factor: Age 47,50% Age distribution in skiing 33,20% 36,80% 36,10% 30% Study 16,40% Control < The age subgroup of years in skiing sustain the highest prevalence of injuries (p<0.005)

55 Risk factor: Gender Conclusion Gender is a risk factor for an injury in age subgroup (females) in skiing and in (males) in boarding

56 Risk factor: Ability Conclusion Beginners skiers (especially in the subgroup of years) and moderate and expert snowboarders had the highest risk for injuries

57 Risk factor: Experience Conclusion 1 st day young skiers (<11) are at high risk of sustaining an injury. The same happen to the more experienced snowboarders

58 Risk factor: Hours of skiing Conclusion Fatigue may play a role in injuries for young skiers

59 Risk factor: Hours of skiing Study Skier Control Skier 66,00% 43,30% 43,90% 31,90% 10,00% 2,80% 2,10% 0,00% 0-2 hours 2-4 hours 4-6 hours >6 hours Fatigue is a relative risk factor for an injury in young skiers

60 Risk factor: Company Conclusion School groups may be risk factor for injuries for young skiers and boarders

61 Risk factor: Company Skier Snb 54,10% 24,80% 42,00% 27,80% 31,60% 5,40% 1,50% 12,70% Alone School Family Instructor Groups/Friends Skiers are more often injured when are skiing with an instructor and snowboarders with friends

62 Risk factor: Company in skiing Study Skier Control Skier 1,50% 6,50% 24,80% 6,50% 43,50% 42,00% 43,50% 31,60% Alone School Groups/Friends Family Instructor But only skiing with friends (school groups) is a risk factor for an injury in young skiers

63 Risk factor: Equipment Conclusion Rented equipment is a risk factor for injury among young (<11) skiers

64 Cause of injury 77,10% 75,00% 15,00% 14,20% 2,80% 2,10% 4,00% 1,30% 3,30% 5,40% Skier Snb Ow n fall/mistake Jumb Equipment failure Bad snow conditions Collision Most injuries occurred during free riding

65 Cause of injury Collisions in Skiing 18% 14,90% 13,90% 13% < Adults As the age increases the possibility for a skier to sustain a collision decreases

66 Cause of injury Jumps in Snb 18,70% 22,70% 6,20% 9,30% < Adults As the age increases the possibility for a snowboarder to get injured because of a jump increases also

67 Conclusions Children are not small adults. The overall rate of injuries for children and adolescents is higher than adults Children sustain more fractures than adults

68 Conclusions Children skier sustain more head injuries than adults, but young snowboarders sustain more concussions Children skier have the double and Snb the triple the possibility to sustain a wrist injury than adults

69 Conclusions Knee (mainly ligament related) injuries are more common among children and adolescents, especially in alpine skiing in all age groups, than adults. Female sustain a higher prevalence of knee ligament injuries than males in both sports.

70 Conclusions The target groups are in skiing: the age 15-17, the beginners and the 1 st day skiers and in snowboard: the age 11-14, the moderate and more experienced snowboarders. Fatigue and rented equipment may play a role in knee injuries for young skiers.

71 Conclusions Targeting also on the school groups can lead to the decrease of these injuries in both sports.

72 Can you show me the way for safe skiing? Thank you for your attention