Skiing Safety Network !National results
Sitemsh congress JAPAN March 2016
Epidemiology of snow sports injuries in France
Dr MH Binet- Dr JD Laporte Medecins de Montagne France Skiing Safety Network !National results
Medecins de Montagne
• French Association
• 300 physicians practicing close to the slopes
• trained to take care of sports injuries and emergency medecine
• taking care more than 150.000 winter sports injuries each winter
• 94% of the patients are localy treated without hospitalisation. Skiing Safety Network !National results
The Skiing Safety Network of Medecins de Montagne
Studies each winter season : 1. injured popula on 2. control group Skiing Safety Network !National results
Method : Control Group
Randomized counting is conducted at the bottom of ski lifts in 12 ski resorts.
Interviews are conducted in parallel on the ski slopes and in car parks. Skiing Safety Network !
Method: The population at risk
Respect a breakdown of resorts according to : n The geographical distribution n The dimension and turnover n The type and the altitude n The specificities of the resorts Skiing Safety Network !National results
Method : Injured Popula on
DATA FORM • A standardized form has been used since 1992, for each injured skier.
• Record and data analysis are performed on same sofware for all par cipants
Skiing Safety Network !National results
Method : Incidence Rate
The incidence rate is calculated in rela on to a number of skiers per day or « skiers visits ». A skier day is a standard based on the number of ski passes sold.
Skiing Safety Network !National results
Method : MDBI
Results will be given in MDBI: MDBI = skier visit/ nb of injuries Higher the number is, lower the risk is. At the opposite if the number is small the risk is high. Skiing Safety Network !National results
Method Medecins de Montagne
The method has been validated by an independent na onal sta s cal ins tute – INVS: Ins tut de la veille sanitaire Skiing Safety Network !National results
419 809 winter sports injuries in the database since 1992.
• 8.7 millions of skiers and snowboarders in 2015 in France • 150 000 where injured while practicing winter sports • only 51 000 have been assisted by ski patrols Injuries by practice
Other sports 2,8% (Skiboard, Monoski, Skwal, Telemark) Sledge 1.7 %
Snowboard 24.0 %
N = 27336 Alpine ski 71.5 % Injuries for alpine skiers
Head injuries 2.1 % Luxations 3.3 % Wounds 6.4 % Others 1.4 % Muscle injuries 6.4 % Contusions 14.7 %
Cartilage damages 1.9 %
Fractures 16.7 %
N = 20033 Sprains 47.1 % Injuries for alpine skiers
Other knee sprains 20.5 % N = 19750 ACL 12.7 % Skier thumb 6.9 %
Forearm & wrist fractures 2.2%
Leg & ankle fractures 3.1 % Other injuries 38 % Dangerous locations (spine-thorax-abdomen) 16.6 % Injuries for snowboarders
Other knee sprains 6.2 % N = 5996 ACL 1.4 % Skier thumb 2.4 %
Forearm & wrist Fractures 31.8%
Leg & ankle Fractures 1.9% Other injuries 52.7 % Dangerous locations (spine-thorax-abdomen) 17.6 % Skiing Safety Network !National results
Incidence rate : MDBI : Mean days between injuries
MDBI 500
400
300
200
100
0 Skiing Safety Network !National results
Incidence rate : MDBI by type of prac ce
600
500
400
300
200
100
0 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Alpine skiing Snowboarding Results – All Injuries –By Experience Level
All Injuries
1 200
1 000
800 Beginner Intermediate 600 Advanced MDBI 400 All
200
0 Alpine Snowboard Skiboard
Beginner injury rates 2-3x higher than all injuries, 4-6x advanced Beginner in snowboarding less than 100 MDBI LIMB FRACTURE Evolution since 1975
80 70 60 Lower limb. 50 40 30
20 % of Fractures 10 0 1975 1980 1985 1990 1995 2000 2005 5 % of injuries LIMB FRACTURE Evolution since 1975
70 60
50 40
30 20 Upper limb.
% of Fractures 10 0 1975 1980 1985 1990 1995 2000 2005
16.1 % of injuries LIMB FRACTURE Evolu on since 1975
80 Upper Limb 70 60 50 40 30
% of Fractures 20 Lower limb 10 0 1970 1975 1980 1985 1990 1995 2000 2005 2010 2015 Skiing Safety Network !National results
Evolu on of 5 types of injuries occurring amongst skiers and snowboarders:
• ACL • MCL • Leg and ankle fractures • Wrist fractures • Skier thumb
Skiing Safety Network !National results
Alpine skiing: rela ve risks
25000
20000
15000
MDBI 10000
5000
0 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Acl MCL Leg&ankle fracture wrist fracture
ACL and MCL injury rates are higher than lower leg and wrist fracture Skiing Safety Network !National results
Alpine skiing: wrist fracture
25000
20000
15000
MDBI 10000
5000
0 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 years wrist fracture all injuries
The incidence of wrist fractures increased significantly during this period P<0.05 Skiing Safety Network !National results
Alpine skiing lower leg and ankle fracture
16000 14000 12000 10000 8000
MDBI 6000 4000 2000 0 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 years
Leg&ankle fracture all injuries
The incidence of lower leg fractures increased significantly during this period P<0.05 Skiing Safety Network !National results
Alpine skiing: thumb Skiing Safety Network !National results
Snowboarding: rela ve risks
45000 y = 45,108x + 962,05 40000 R² = 0,14929 35000 30000 25000 20000 15000 10000 5000 MDBI 0
ACL MCL Leg&Ankle fracture Wrist fracture years
The incidence of MCL and wrist fracture are higher than ACL or lower leg fracture Skiing Safety Network !National results
Snowboard: wrist fracture
2500 2000 1500 1000 500 MDBI 0
years Wrist fracture all injuries
The incidence of wrist fractures is slightly going down
Skiing Safety Network !National results
Snowboard: lower leg fractures
40000 35000 30000 25000 20000 15000 10000 5000 MDBI 0
Lower leg&ankle fracture all injuries years
The incidence of lower leg fractures was stable un l 2007 decreasing rapidly therea er.
Skiing Safety Network !National results
Discussion
• For alpine skiing, the increased incidence of lower leg and ankle fractures could be related to inconsistent ski binding se ngs. • The decrease of skier thumb could be linked with to the changes in ski pole design.
Skiing Safety Network !National results
Discussion
For snowboarding the lower overall incidence of injuries could be linked with the fact that beginners now account for a lower propor on of the control group compared to the earlier period. Skiing Safety Network !National results
Conclusion
Trends for alpine skiing: - Important decrease of skier thumb - Increased rate of lower leg and ankle fractures - ACL stable - MCL decreasing - High rate of female knee injuries Skiing Safety Network !National results
Conclusion
Trends for snowboarding: - Important decrease of the risk - Stable rate of wrist fractures - S ll very important rate of wrist injury in teenagers & beginners - Decreased rate of ACL & MCL injuries Thank you for your attention!