In a 7-year review of 1,447 spine fractures, 202 (14%) were due to sporting or recreational causes, of which 84 (42%) were associated with paralysis. This high incidence of catastrophic injury is second only to motor vehicle accidents. Snowmobiling (10%), skiing (5%), tobogganing (5%) and ice hockey (3%) accounted for approximately one-quarter of these injuries. Snowmobile injuries rose steadily over this period, and the main contributing factors were alcohol, poor lighting, young age and inappropriate terrain. The skiing injuries occurred to novices and top class skiers alike, with one-third of those sustaining a fracture having associated paralysis. In view of the terrain and the speeds involved, this figure is unlikely to change. An alarming trend was the subtle increase in cervical fractures due to ice hockey, most of which were compression injuries with the neck in the neutral or slightly flexed position, and secondary to a collision with the boards. Being decked from behind contributed to the impact. The introduction of measures to reduce these injuries is mandatory, since cervical fractures secondary to ice hockey were associated with permanent paralysis in 67% of the cases. There are several points of initial management which require emphasis.
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