Wrist guards should be compulsory for school-aged snowboarders.

1. Wrist guards should be compulsory for school-aged snowboarders. Research presentation ACRRM 5th Scientific Forum Dr Graham Slaney

2. Outline • Background • Study objective • Study design • Results • Conclusion

3. Mt Buller Medical Centre • Mt Buller - one of Australia’s busiest ski resorts • 300 000 skier days per season on average • Services all the local medical needs for Mt Buller in winter • About 2500 patients per season • 100-120 wrist fractures per season • 2 doctors, 3 nurses, 1 radiographer • Ski patrol services ski slopes

4. Background - Wrist injuries • Snowboarders have 2.4 times as many fractures as skiers1 • Upper limb injuries account for 50%2 • 56% of upper limb injuries are fractures3 • Wrist fractures alone account for nearly a fifth of all injuries in snowboarders • Impact rather than torsional4 • Possibility of force transfer more proximate5 1. Bladdin (1993) 2. Young (1999) 3. Idzikowski (2000) 4. Pino (1989) 5. Hagel (2005)

5. Study Objective To ascertain the association: • between wrist guard use and wrist fracture in snowboarders in Australia • between wearing wrist guards and the severity of wrist and elbow injury

6. Study design • Case control study 2004 and 2005 ski seasons • Cases - snowboarder seen at clinic with fractured wrist (n = 119) • Controls - snowboarder seen at clinic for any reason other than fractured wrist (n = 375) • Questionnaire about wrist guard use and snow sport behaviour • Clinic staff recorded details of injury • Logistic regression used to determine adjusted odds ratios

7. Characteristics associated with Wrist Fracture

8. Study Results - Wrist Fracture • Adjusting for significant variables • Odds of having worn wrist guards lower in snowboarders with wrist fracture (cases) • Adjusted OR = 0.58; 95% CI, 0.32–1.04;P = 0.07 • Wearing wrist guards in Australia reduces wrist fracture injury by about 42%

9. Study Results - Elbow Injury 15 elbow injuries amongst the 494 snowboarders • 5 soft tissue • 4/86 wearing wrist guards • 1/391 not wearing wrist guards • adjusted OR, 17.6; P = 0.01 • 10 elbow fracture or dislocation • 3/86 wearing wrist guards • 7/391 not wearing wrist guards • adjusted OR, 1.84; P = 0.39 Wrist guards protective of overall injury severity

10. Conclusions Snowboarders wearing wrist guards: • Elbows protected – important new finding • Reduce wrist fracture injury in Australia by about 42% • Data consistent with international literature (52% to 87%)6 • Novices strongly recommended • Mandatory for School-aged children 6. Russell (2007)

11. Acknowledgements • Thanks to my supervisors Phil Weinstein & Judith Finn • Thanks to the staff at the Mt Buller Medical Centre • Thanks to the patients for participating in the study and completing the forms • Thanks to my 15 year old daughter, Caitlin

12. References 1. Bladin C, Giddings P, Robinson M. (1993) Australian snowboard injury data base study. A four year prospective study. The American Journal of Sports Medicine 21(5) 701-704 2. Young CC, Niedfelt MW. (1999) Snowboarding injuries. American Family Physician 59(1):131-136. • Idzikowski JR, Janes pc, Abbott PJ. (2000) Upper extremity snowboard injuries. Ten year results from the Colorado snowboard injury survey. The American Journal of Sports Medicine 28(6):825-32 • Pino EC, Colville MR. (1989) Snowboard injuries. The American Journal of Sports Medicine 17(6):778-781 • Hagel B, Pless IB, Goulet C. The effect of wrist guard use on upper-extremity injuries in snowboarders. Am J Epidemiol 2005; 162: 149-156. • Russell K, Hagel B, Francescutti LH. The effect of wrist guards on wrist and arm injuries among snowboarders: a systematic review. Clin J Sport Med 2007; 17: 145-150.