Abstract
Comparison of Tibial Shaft Ski Fractures in Children and Adults
Alpine skiing is a popular winter sport but is also a risk for tibial fractures in both adults and children. The current study investigated whether children and adults have different mechanisms of injury or risk factors for sustaining tibial shaft fractures while skiing. This descriptive epidemiological study collected data from 2004 to 2012 from Sumi Memorial Hospital in Japan, a catchment hospital for 13 ski resorts. Variables examined for each case included age, sex, laterality of fracture, skill level, mechanism of fracture, scene of injury, snow condition, and weather. Fractures were classified according to the Arbeitsgemeinschaft fur Osteosynthesefragen (AO) grading system.
The investigators ultimately included 276 patients with tibial fractures, 122 were children (44.2%) and 154 were adults (55.8%). Tibial plateau and distal tibial fractures were more common in adults than in children. Tibial shaft fractures were the most common tibial fracture in both children (89.3%) and adults (47.4%). Of the tibial shaft fractures, spiral type fractures were the most common in children and adults. Tibial shaft fractures in the pediatric population were 72.3% type A fractures (simple fractures) and only 7% type C fractures (multifragmentary or complex). In contrast, tibial shaft fractures within the adult population were 53.4% type A and 19.2% type C. External rotation was a more common mechanism of injury in children versus the adult population. Finally, children were more likely to be beginners and injure themselves on flat terrain. There was no statistically significant difference in sex, snow condition, or weather between pediatric and adult tibial fractures.
Although this study does have limitations such as being a single hospital study, self-reported skill levels, and interobserver and intraobserver difference in AO classification, it provides insight into the differences of injury mechanism for a tibial shaft fracture in children versus adults. Beginner-level children are more likely to sustain a simple, spiral tibial shaft fracture due to external rotation while skiing on flat, gentle terrain. This information can be used to improve awareness, determine binding settings, and guide future ski instruction.
(Clin J Sport Med. 2014;24:380–384). T Hamada, K Matsumoto, D Ishimaru, et al.
Prepared by Justine Macneil, University of Utah Wilderness Medicine Fellow, Salt Lake City, UT, USA.