Prevention of Head Injuries in Skiing

Prevention of Head Injuries in Skiing

Prevention of Head Injuries in Skiing Mechanisms, Experimental Study, and Prevention Sooyoung Oh Head of the Neurosurgery Section, Department of Surgery, Kantonsspital, Chur, Switzerland 174 figures and 13 tables, 1985 KARGDER Basel München Paris London NewYork New Delhi Singapore Tokyo Sydney

Cover illustration: C dpa, Deutsche Presse-Agentur GmbH, Frankfurt/Main National Library of Medicine, Cataloging in Publication Oh, Sooyoung Prevention of head injuries in skiing: mechanisms, experimental study, and prevention / Sooyoung Oh Basel; New York: Karger, 1985. - Bibliography: p. Includes index. 1. Athletic Injuries prevention & control 2. Head Injuries prevention & control 3. Skiing I. Title WE 706 036ρ ISBN 3-8055-3978-9 All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Copyright 1985 by S. Karger AG, P.O. Box, CH-4009 Basel (Switzerland) Printed in Switzerland by Thür AG Offsetdruck, Pratteln ISBN 3-8055-3978-9

Contents Preface VII 1 Introduction 1 Brief Description of the Sport of Skiing 1 The Risk of Accidents 2 Pilot and Vehicle in One 4 2 The Causes of Accidents 7 Slope Accidents 7 Free Fall 7 Collision with Another Skier 10 Injury Caused by Ski Equipment 14 Slipping or Sliding 16 Hit by Ski-Lift 19 Collision with Various Obstacles 22 Unknown Causes 30 Discussion 31 3 Case Reports and Statistical Data 32 Free Fall 32 Collision with Another Skier 39 Injury Caused by Ski Equipment 47 Slipping or Sliding 50 Hit by Ski-Lift 53 Collision with Various Obstacles 58 Unknown Causes 73 Alcohol 77 Combined Injuries (Head and Neck) 77 Statistical Data 81 4 Experimental Study 86 Physical Conditions of Skiing 86 Skull Injuries from the Application of Force 88

Contents VI Experimental Study of Depressed Skull Fracture 91 Experimental Procedure 91 Sites of Impact and Results 92 The Reaction to the Energy of Impact 97 Clinical and Experimental Study of the Morphology of the Depressed Fracture 102 Clinical Study 102 Experimental Morphological Study 104 Discussion 112 5 First Aid and Immediate Treatment 115 First Aid at Accident Site 115 Immediate Treatment 120 Conservative Therapy 121 Immediate Surgical Treatment 122 6 Prevention 125 Indirect Preventive Measures 125 Personal Aspects 125 Accidental Aspects 126 Natural Aspects 127 Technical Aspects 129 Traffic Aspects 129 Social Aspects 133 Discussion 136 Direct Preventive Measures: The Safety Helmet 136 History 137 Preventive Functions 139 Clinical Observation 141 Ideal Protection 144 Additional Advantages 145 Discussion 149 7 History of Skiing as a Sport 152 References 158 Subject Index 161

Preface Switzerland, a model country in so many ways, is also a model laboratory for studying injuries related to skiing. Though certainly not the only nation with a claim on Alpine terrain, Switzerland is more greatly dependent on the tourist industry than are France, Italy, Austria, and Germany. In certain Alpine areas of Switzerland, tourism may account for up to 80% of the economy. In this sense, snow is an important national resource, and skiing, apart from ranking as the nation's favorite sport, is an industry that has been cultivated with characteristic Swiss efficiency. Not surprisingly, Swiss ski resorts are known for their superior facilities, lift equipment, and slope conditions as well as for their outstanding scenery and the famous personalities frequently photographed there. The country is thus ideally styled for an `industrialized' recreational sport that depends on sophisticated personal equipment and well-organized transport installations, goes through fashions, and carries, as part of its popular appeal, an association of healthy physical exertion with an evening of relaxing in luxury. In the past decade, these very attractions have created a serious problem in skiing because the number of serious and fatal head accidents linked to this sport has increased to an alarming degree in Switzerland itself and in every other country with facilities for downhill skiing. This monograph, focused on head injuries and based on more than 10 years of experience in the Department of Neurosurgery at the Cantonal Hospital of Chur (Graubunden), documents the severity of accidents associated with skiing and explores their causes, covering both the obvious and some unexpected dangers of this sport. For such a project, Switzerland has again served as a good model: the small geographic area of this country combined with its dense population of locals and tourists makes it possible for a neurosurgical department, such as ours, to gather experience and statistics on a sufficient scale to permit some generalizations.

Preface VIII As the record of cases seen and treated by us clearly shows, even the best and most immediate medical treatment of the head injuries is not always adequate to save the accident victim or prevent life-long handicaps. Head injuries in skiing are serious mostly, and increasing in frequency nowadays. It is for these reasons that strategies for prevention have been kept at the forefront of concern throughout this work. Chur, January 1985 S.O.