Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

Injury patterns and risk factors for orthopaedic trauma from snowboarding and skiing: a national perspective



Alpine skiing and snowboarding are both popular winter sports that can be associated with significant orthopaedic injuries. However, there is a lack of nationally representative injury data for the two sports.


The National Trauma Data Bank was queried for patients presenting to emergency departments due to injuries sustained from skiing and snowboarding during 2011 and 2012. Patient demographics, comorbidities, and injury patterns were tabulated and compared between skiing and snowboarding. Risk factors for increased injury severity score and lack of helmet use were identified using multivariate logistic regression.


Of the 6055 patients identified, 55.2 % were skiers. Sixty-one percent had fractures. Lower extremity fractures were the most common injury and occurred more often in skiers (p < 0.001). Upper extremity fractures were more common in snowboarders, particularly distal radius fractures (p < 0.001). On multivariate analysis, increased injury severity was independently associated with age 18–29, 60–69, 70+, male sex, a positive blood test for alcohol, a positive blood test for an illegal substance, and wearing a helmet. Lack of helmet use was associated with age 18–29, 30–39, smoking, a positive drug test for an illegal substance, and snowboarding.


Young adults, the elderly, and those using substances were shown to be at greater risk of increased injury severity and lack of helmet use. The results of this study can be used clinically to guide the initial assessment of these individuals following injury, as well as for targeting preventive measures and education.

Level of evidence

Prognostic Level III.

This is a preview of subscription content, log in to check access.

Fig. 1
Fig. 2
Fig. 3


  1. 1.

    Abu-Laban RB (1991) Snowboarding injuries: an analysis and comparison with alpine skiing injuries. CMAJ 145(9):1097–1103

  2. 2.

    Baker SP, O’Neill B, Haddon W Jr, Long WB (1974) The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma 14(3):187–196

  3. 3.

    Barnas C, Miller CH, Sperner G, Sperner-Unterweger B, Beck E, Hinterhuber H, Fleischhacker WW (1992) The effects of alcohol and benzodiazepines on the severity of ski accidents. Acta Psychiatr Scand 86(4):296–300

  4. 4.

    Baschera D, Hasler RM, Taugwalder D, Exadaktylos A, Raabe A (2015) Association between head injury and helmet use in alpine skiers: cohort study from a swiss level I trauma center. J Neurotrauma 32(8):557–562

  5. 5.

    Bissell BT, Johnson RJ, Shafritz AB, Chase DC, Ettlinger CF (2008) Epidemiology and risk factors of humerus fractures among skiers and snowboarders. Am J Sports Med 36(10):1880–1888

  6. 6.

    Burtscher M, Ruedl G, Nachbauer W (2013) Effects of helmet laws and education campaigns on helmet use in young skiers. Paediatr Child Health 18(9):471–472

  7. 7.

    Chapter 41 (2011) Senate and General Assembly of the State of New Jersey C.5:13–12

  8. 8.

    Cheng SL, Rajaratnam K, Raskin KB, Hu RW, Axelrod TS (1995) “Splint-top” fracture of the forearm: a description of an in-line skating injury associated with the use of protective wrist splints. J Trauma 39(6):1194–1197

  9. 9.

    Chow TK, Corbett SW, Farstad DJ (1996) Spectrum of injuries from snowboarding. J Trauma 41(2):321–325

  10. 10.

    Coury T, Napoli AM, Wilson M, Daniels J, Murray R, Milzman D (2013) Injury patterns in recreational alpine skiing and snowboarding at a mountainside clinic. Wilderness Environ Med 24(4):417–421

  11. 11.

    Cundy TP, Systermans BJ, Cundy WJ, Cundy PJ, Briggs NE, Robinson JB (2010) Helmets for snow sports: prevalence, trends, predictors and attitudes to use. J Trauma 69(6):1486–1490

  12. 12.

    Demetriades D, Martin M, Salim A, Rhee P, Brown C, Doucet J, Chan L (2006) Relationship between American College of Surgeons trauma center designation and mortality in patients with severe trauma (injury severity score >15). J Am Coll Surg 202(2):212–215

  13. 13.

    Dickson TJ, Terwiel FA (2011) Snowboarding injuries in Australia: investigating risk factors in wrist fractures to enhance injury prevention strategies. Wilderness Environ Med 22(3):228–235

  14. 14.

    Franz T, Hasler RM, Benneker L, Zimmermann H, Siebenrock KA, Exadaktylos AK (2008) Severe spinal injuries in alpine skiing and snowboarding: a 6-year review of a tertiary trauma centre for the Bernese Alps ski resorts. Switz Br J Sports Med 42(1):55–58

  15. 15.

    Fukuda O, Takaba M, Saito T, Endo S (1076) Head injuries in snowboarders compared with head injuries in skiers. A prospective analysis of 1076 patients from 1994 to 1999 in Niigata, Japan. Am J Sports Med 29(4):437–440

  16. 16.

    Gaudio RM, Barbieri S, Feltracco P, Spaziani F, Alberti M, Delantone M, Trevisiol P, Righini F, Talarico A, Sanchioni R, Spagna A, Pietrantonio V, Zilio G, Dalla Valle R, Vettore G, Montisci M, Bortoluzzi A, Sacco A, Ramacciato G, Pasetti A, Mognato E, Ferronato C, Costola A, Ori C, Avato FM (2010) Impact of alcohol consumption on winter sports-related injuries. Med Sci Law 50(3):122–125

  17. 17.

    Gertzbein SD, Khoury D, Bullington A, St John TA, Larson AI (2012) Thoracic and lumbar fractures associated with skiing and snowboarding injuries according to the AO comprehensive classification. Am J Sports Med 40(8):1750–1754

  18. 18.

    Graves JM, Whitehill JM, Stream JO, Vavilala MS, Rivara FP (2013) Emergency department reported head injuries from skiing and snowboarding among children and adolescents, 1996–2010. Inj Prev 19(6):399–404

  19. 19.

    Helmet Usage and Safety Fact Sheet. National Ski Areas Association.

  20. 20.

    Hagel B, Pless IB, Goulet C (2005) The effect of wrist guard use on upper-extremity injuries in snowboarders. Am J Epidemiol 162(2):149–156

  21. 21.

    Hagel BE, Goulet C, Platt RW, Pless IB (2004) Injuries among skiers and snowboarders in Quebec. Epidemiology 15(3):279–286

  22. 22.

    Hagel BE, Pless IB, Goulet C, Platt RW, Robitaille Y (2005) Effectiveness of helmets in skiers and snowboarders: case-control and case crossover study. BMJ 330(7486):281

  23. 23.

    Hagel BE, Russell K, Goulet C, Nettel-Aguirre A, Pless IB (2010) Helmet use and risk of neck injury in skiers and snowboarders. Am J Epidemiol 171(10):1134–1143

  24. 24.

    Harlow T (1996) Factors predisposing to skiing injuries in Britons. Injury 27(10):691–693

  25. 25.

    Hasler RM, Berov S, Benneker L, Dubler S, Spycher J, Heim D, Zimmermann H, Exadaktylos AK (2010) Are there risk factors for snowboard injuries? A case-control multicentre study of 559 snowboarders. Br J Sports Med 44(11):816–821

  26. 26.

    Hasler RM, Dubler S, Benneker LM, Berov S, Spycher J, Heim D, Zimmermann H, Exadaktylos AK (2009) Are there risk factors in alpine skiing? A controlled multicentre survey of 1278 skiers. Br J Sports Med 43(13):1020–1025

  27. 27.

    Hayes JR, Groner JI (2008) The increasing incidence of snowboard-related trauma. J Pediatr Surg 43(5):928–930

  28. 28.

    Hubbard ME, Jewell RP, Dumont TM, Rughani AI (2011) Spinal injury patterns among skiers and snowboarders. Neurosurg Focus 31(5):E8

  29. 29.

    Ishimaru D, Ogawa H, Sumi H, Sumi Y, Shimizu K (2011) Lower extremity injuries in snowboarding. J Trauma 70(3):E48–E52

  30. 30.

    Kim S, Endres NK, Johnson RJ, Ettlinger CF, Shealy JE (2012) Snowboarding injuries: trends over time and comparisons with alpine skiing injuries. Am J Sports Med 40(4):770–776

  31. 31.

    Kim S, Lee SK (2011) Snowboard wrist guards–use, efficacy, and design. A systematic review. Bull NYU Hosp Jt Dis 69(2):149–157

  32. 32.

    Levy AS, Hawkes AP, Hemminger LM, Knight S (2002) An analysis of head injuries among skiers and snowboarders. J Trauma 53(4):695–704

  33. 33.

    Levy AS, Smith RH (1999) Neurologic injuries in skiers and snowboarders. Semin Neurol 20(2):233–245

  34. 34.

    Macnab AJ, Smith T, Gagnon FA, Macnab M (2002) Effect of helmet wear on the incidence of head/face and cervical spine injuries in young skiers and snowboarders. Inj Prev 8(4):324–327

  35. 35.

    Mahmood B, Duggal N (2014) Lower extremity injuries in snowboarders. Am J Orthop (Belle Mead NJ) 43(11):502–505

  36. 36.

    Myles ST, Mohtadi NG, Schnittker J (1992) Injuries to the nervous system and spine in downhill skiing. Can J Surg 35(6):643–648

  37. 37.

    N (2013) National Trauma Data Bank Research Data Set Admission Year 2012 User Manual. American College of Surgeons

  38. 38.

    Nakaguchi H, Fujimaki T, Ueki K, Takahashi M, Yoshida H, Kirino T (1999) Snowboard head injury: prospective study in Chino, Nagano, for two seasons from 1995 to 1997. J Trauma 46(6):1066–1069

  39. 39.

    O’Neill DF (2003) Wrist injuries in guarded versus unguarded first time snowboarders. Clin Orthop Relat Res 409:91–95

  40. 40.

    Ogawa H, Sumi H, Sumi Y, Shimizu K (2010) Pelvic fractures resulting from snowboarding. Am J Sports Med 38(3):538–542

  41. 41.

    Provance AJ, Engelman GH, Carry PM (2012) Implications of parental influence on child/adolescent helmet use in snow sports. Clin J Sport Med 22(3):240–243

  42. 42.

    Ruedl G, Kopp M, Rumpold G, Holzner B, Ledochowski L, Burtscher M (2012) Attitudes regarding ski helmet use among helmet wearers and non-wearers. Inj Prev 18(3):182–186

  43. 43.

    Ruedl G, Pocecco E, Sommersacher R, Gatterer H, Kopp M, Nachbauer W, Burtscher M (2010) Factors associated with self-reported risk-taking behaviour on ski slopes. Br J Sports Med 44(3):204–206

  44. 44.

    Rughani AI, Lin CT, Ares WJ, Cushing DA, Horgan MA, Tranmer BI, Jewell RP, Florman JE (2011) Helmet use and reduction in skull fractures in skiers and snowboarders admitted to the hospital. J Neurosurg Pediatr 7(3):268–271

  45. 45.

    Russell K, Hagel B, Francescutti LH (2007) The effect of wrist guards on wrist and arm injuries among snowboarders: a systematic review. Clin J Sport Med 17(2):145–150

  46. 46.

    Russell K, Meeuwisse W, Nettel-Aguirre A, Emery CA, Wishart J, Romanow NT, Rowe BH, Goulet C, Hagel BE (2013) Characteristics of injuries sustained by snowboarders in a terrain park. Clin J Sport Med 23(3):172–177

  47. 47.

    Ruzic L, Tudor A (2011) Risk-taking behavior in skiing among helmet wearers and nonwearers. Wilderness Environ Med 22(4):291–296

  48. 48.

    Sakamoto Y, Sakuraba K (2008) Snowboarding and ski boarding injuries in Niigata, Japan. Am J Sports Med 36(5):943–948

  49. 49.

    Salminen S, Pohjola J, Saarelainen P, Sakki A, Roine R (1996) Alcohol as a risk factor for downhill skiing trauma. J Trauma 40(2):284–287

  50. 50.

    Scher I, Richards D, Carhart M (2005) Head contact after catching an edge: an examination of snowboarding helmets. In: 16th International Society of Skiing Safety Conference, Niigata, Japan, pp 17–23

  51. 51.

    Scott MD, Buller DB, Andersen PA, Walkosz BJ, Voeks JH, Dignan MB, Cutter GR (2007) Testing the risk compensation hypothesis for safety helmets in alpine skiing and snowboarding. Inj Prev 13(3):173–177

  52. 52.

    Shealy J, Ettlinger C, Johnson R (2000) Rates and modalities of death in the US: snowboarding and skiing differences-1991/92 through 1998/99, vol 1397. ASTM Special Technical Publication

  53. 53.

    Shealy JE, Johnson RJ, Ettlinger CF (2006) Do helmets reduce fatalities or merely alter the patterns of death? In: Moritz EF, Haake S (eds) The Engineering of Sport 6. Springer, New York, pp 163–167

  54. 54.

    Sherker S, Finch C, Kehoe EJ, Doverty M (2006) Drunk, drowsy, doped: skiers’ and snowboarders’ injury risk perceptions regarding alcohol, fatigue and recreational drug use. Int J Inj Contr Saf Promot 13(3):151–157

  55. 55.

    Shorter NA, Jensen PE, Harmon BJ, Mooney DP (1996) Skiing injuries in children and adolescents. J Trauma 40(6):997–1001

  56. 56.

    Staebler MP, Moore DC, Akelman E, Weiss AP, Fadale PD, Crisco JJ 3rd (1999) The effect of wrist guards on bone strain in the distal forearm. Am J Sports Med 27(4):500–506

  57. 57.

    Stenroos A, Handolin L (2014) Incidence of recreational alpine skiing and snowboarding injuries: six years experience in the largest ski resort in Finland. Scand J Surg 104(2):127–131

  58. 58.

    Sulheim S, Holme I, Ekeland A, Bahr R (2006) Helmet use and risk of head injuries in alpine skiers and snowboarders. JAMA 295(8):919–924

  59. 59.

    Sulheim S, Holme I, Rodven A, Ekeland A, Bahr R (2011) Risk factors for injuries in alpine skiing, telemark skiing and snowboarding–case-control study. Br J Sports Med 45(16):1303–1309

  60. 60.

    Wakahara K, Matsumoto K, Sumi H, Sumi Y, Shimizu K (2006) Traumatic spinal cord injuries from snowboarding. Am J Sports Med 34(10):1670–1674

  61. 61.

    Wasden CC, McIntosh SE, Keith DS, McCowan C (2009) An analysis of skiing and snowboarding injuries on Utah slopes. J Trauma 67(5):1022–1026

  62. 62.

    Wijdicks CA, Rosenbach BS, Flanagan TR, Bower GE, Newman KE, Clanton TO, Engebretsen L, Laprade RF, Hackett TR (2014) Injuries in elite and recreational snowboarders. Br J Sports Med 48(1):11–17

  63. 63.

    Yamauchi K, Wakahara K, Fukuta M, Matsumoto K, Sumi H, Shimizu K, Miyamoto K (2010) Characteristics of upper extremity injuries sustained by falling during snowboarding: a study of 1918 cases. Am J Sports Med 38(7):1468–1474

Download references

Author information

Correspondence to Jonathan N. Grauer.

Additional information

IRB approval

This study received approval from our institution’s Human Investigations Committee.



See Table 6.

Table 6 International Classification of Disease, Ninth Revision (ICD-9) codes for each injury location

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Basques, B.A., Gardner, E.C., Samuel, A.M. et al. Injury patterns and risk factors for orthopaedic trauma from snowboarding and skiing: a national perspective. Knee Surg Sports Traumatol Arthrosc 26, 1916–1926 (2018).

Download citation


  • Skiing
  • Snowboarding
  • Helmet
  • Fracture
  • Alcohol
  • Drugs