Skiing-Over-the-Edge-1-Robert-Foxford

SKIING OVER
THE EDGE
ROBERT FOXFORD MD/FRCPC/DIP.SPORTMED
MCGILL UNIVERSITY HEALTH CENTRE, MONTREAL

CONFLICT OF INTEREST
Faculty - Dr. Robert Foxford
Relationship with commercial
interests – none
Speaker Honorarium – none
Consulting fees - none

SKIING OVER THE
EDGE
3
2.5
2
1.5
1
0.5
0
Moguls
Aerials
Halfpipe
Slopestyle
Alpine

SKIING OVER THE EDGE
ACL
1.6
1.4
1.2
1
0.8
0.6
men
women
0.4
0.2
0
Slopestyle
Halfpipe

SKIING OVER THE EDGE
AGE OF 1 ST ACL REPAIR
In Slopestyle, youngest was age 15.
Oldest to first ACL was 26.
Mean age was 20.6 years of age.
4 of 15 had first ACL repair prior to age 20.

SKIING OVER THE EDGE

SKIING OVER THE EDGE
LONG TERM ACL
CONSEQUENCES
ACL seldom injured alone.
Is OA a certainty?
50% post ACL or meniscus will have functional
impairment and pain within 10 – 20 years.
What if multiple injury/surgery?
Do we emphasize this enough when discussing
return to activity with our patients?
In new disciplines, discussion is with patient,
parent, coach, AND sponsor and agent.

SKIING OVER THE
EDGE
3
2.5
2
1.5
1
0.5
0
Moguls
Aerials
Halfpipe
Slopestyle

SKIING OVER THE EDGE
HALFPIPE CRASH

SKIING OVE THE EDGE
CONCUSSION
5
4.5
4
3.5
3
2.5
2
1.5
1
0.5
0
Slopestyle
Halfpipe
Men
Women

SKIING OVER THE
EDGE
3
2.5
2
1.5
1
0.5
0
Moguls
Aerials
Halfpipe
Slopestyle

SKIING OVER THE EDGE
FRACTURES
2.5
2
1.5
1
Men
Women
0.5
0
Slopestyle
Halfpipe

SKIING OVER THE EDGE
SERIOUS INJURY
Only one paralyzing injury in the history of Moguls
competition, none in aerials, but one intracranial
bleed with subsequent disability.
In 2005, there were 5 moguls and aerials athletes
competing with spinal fractures on the Canadian
team, 4 cervical (single level stabilization), and
one thoracic (2 level stabilization).
One partial pancreatic resection secondary to
intra-abdominal bleed in Slopestyle athlete.
Deaths, Sarah Burke Halfpipe, Nik Zoricic Ski Cross,
two US athletes in training secondary to
avalanche January 2015.

SKIING OVER THE EGDE
SPORT INJURIES AND ILLNESS
IN THE SOCHI 2014 OLYMPIC
WINTER GAMES
Hot off the press January 28, 2015.
Soligard, Steffen, Palmer-Green, Aubry, Grant, Meeuwisse,
Mountjoy, Budgett, Engebretson.
Produced data from the Injury Surveillance System since
Beijing 2008.
Data mirros FIS data and other current data.
Large % of injuries occur with contact with the ground.
16% of total injuries caused > 7 days lost training/comp.

SKIING OVER THE EDGE
IOC STUDY
Highest rates:
1. Aerials
2. Snowboard Slopestyle
3. Ski Slopestyle
4. Ski Halfpipe
5. Moguls.
6. Alpine
7. Snowboard Halfpipe

SKIING OVER THE EDGE
HOW IS IT MANAGED?
No regulations exist on size of pipe, or jumps. Ski
centres may build as they wish.
Some ski centres have removed their terrain parks
due to high injury rates and insurance costs.
Most now require special passes to enter,
mandatory helmets, and some a test.
Regular inspections requried by licencing
agencies, in Quebec, Ministre du Loisir et du Sport.
Rule changes: FIS added snow to the knoll of
Aerials sites to prevent flat landings.
FIS mandates local medical and physio presence
at all events, but this is not always enforced.

SKIING OVER THE EDGE
NIH STUDY 2010
5 year study of two large western ski centres
Terrain park injuries more severe than slopes.
More often male, non-beginner, age 13 – 24.
More likely to involve head and back.
More likely to require hospital transfer.
Snowboard injuries involved head/neck, chest
and upper extremity vs. slope involving lower
extremity.
The fixed leg position on a snowboard restricts
lower body movement, and may lead to more
impact into the chest and abdomen.

SKIING OVER THE EDGE
OTHER COSTS
Long term orthopedic disability (eg: knee OA
from).
Long term cognitive disability (eg: early dementia
as a result of multiple concussions).
Surgical/Anesthetic risks (anesthetic reactions,
anaphylaxis, rare death).
Accumulative radiation exposure (Multiple CT
scans, studies suggest 1/450 CT result in a life
tumor in paediatric population).

SKIING OVER THE EDGE

SKIING OVER THE EDGE
SLOPESTYLE CRASH

SKIING OVER THE EDGE
SLOPESTYLE CRASH

SKIING OVER THE EDGE
RADIATION RISKS
Testicles, ovaries, thyroid, breast high risk.
CXR = 0.01 mSv (same as 7 hour flight).
Brain CT = 2.0 mSv.
Chest CT = 7mSv.
Abdo CT = 8mSv.
Abdo/Pelvis = 14 mSv (= 2.7 years of back ground
radiation).
“Athletes are not healthy adults, they are well
stressed”.
AND well radiated!

SKIING OVER THE EDGE
TAKE HOME MESSAGE
New disciplines have higher injury rates.
New disciplines have more serious injuries.
These athletes are more likely to have long term
health consequences.
What is our duty to the patient? Are we heroes or
zeroes for getting an athlete back rapidly to the
sport that injured them in the first place.
Should CASEM be more involved in setting policies
toward sport safety at other levels? Are position
statements enough???