Department of Orthopedics and Rehabilitation, Robert Larner M.D. College of Medicine, University of Vermont College of Medicine, Burlington, VT, USA.
Biomedical Statistics Research Core, University of Vermont, Burlington, VT, USA.
Clin Orthop Relat Res. 2022 Mar 1;480(3):562-570. doi: 10.1097/CORR.0000000000001982.
Skiing and snowboarding are popular sports that are associated with a high number of orthopaedic injuries. Diaphyseal forearm fractures are an important subset of these injuries. To our knowledge, factors associated with these injuries, the mechanisms that cause them, and their relative frequencies in skiers and snowboarders have not been described. In addition, it has been proposed that the use of wrist guards may increase the risk of sustaining a diaphyseal forearm fracture; therefore, we sought to explore the relationship between wrist guard use and diaphyseal forearm fractures.
QUESTIONS/PURPOSES: (1) What are the relative frequencies and types of diaphyseal forearm fractures in skiers and snowboarders? (2) What factors are associated with these injuries? (3) Is the use of wrist guards associated with an increased risk of forearm fractures?
This was an unmatched case-control study performed with an injury database from a university-run clinic at the base lodge of a major ski resort. Cases were injured skiers and snowboarders; controls were randomly selected uninjured skiers and snowboarders. Data were collected on the mechanism of injury; experience level; equipment; radiographs; skiing or snowboarding habits; and trail type, defined as green circle (easiest), blue square (intermediate), black diamond (difficult), and double black diamond (most difficult). From this database, we identified 84 patients with diaphyseal forearm fractures, one of which was a Monteggia fracture and was excluded. A logistic regression analysis was used to compare the injured and control groups to identify factors associated with diaphyseal forearm fractures, including wrist guard use.
When adjusted for participant days, diaphyseal forearm fractures were more common in snowboarders than skiers (0.03 injuries per 1000 person-days versus 0.004 per 1000 person-days). On multivariable analysis, factors associated with forearm fractures in skiers were younger age (odds ratio 1.08 [95% CI 1.05 to 1.14]; p < 0.01), being a man or boy (OR 11.9 [95% CI 2.5 to 57.2]; p < 0.01), lack of movement at the time of falling (OR 18.2 [95% CI 3.2 to 102.5]; p < 0.01), and skiing on green circle trails compared with black diamond trails (OR 3.6 [95% CI 1.4 to 12.5]; p = 0.04). Factors associated with forearm fractures in snowboarders were younger age (OR 1.08 [95% CI 1.02 to 1.15]; p = 0.01), decreased weight (OR 1.02 [95% CI 1.00 to 1.02]; p < 0.01), snowboarding on gentle terrain (OR 8.4 [95% CI 1.6 to 45.0]; p = 0.01), and snowboarding on groomed terrain compared with other (OR 7.2 [95% CI 1.9 to 28.0]; p < 0.01) or wet, heavy snow (OR 24.8 [95% CI 2.5 to 246.7]; p = 0.01). Wrist guard use was not associated with an increased odds of diaphyseal forearm fracture in skiers or snowboarders.
Diaphyseal forearm fractures occur more frequently in snowboarders than in skiers. Despite speculation in prior evidence that wrist guards may paradoxically increase the risk of sustaining these injuries, our study suggests that this is not the case and wrist guards are not unsafe to wear.
Level III, prognostic study.
滑雪和单板滑雪是受欢迎的运动，与大量骨科损伤有关。骨干前臂骨折是这些损伤的一个重要亚组。据我们所知，与这些损伤相关的因素、导致这些损伤的机制以及滑雪者和单板滑雪者中这些损伤的相对频率尚未描述。此外，有人提出使用腕部护具可能会增加发生骨干前臂骨折的风险；因此，我们试图探讨腕部护具使用与骨干前臂骨折之间的关系。
问题/目的：（1）滑雪者和单板滑雪者骨干前臂骨折的相对频率和类型是什么？（2）哪些因素与这些损伤有关？（3）使用腕部护具是否会增加前臂骨折的风险？
这是一项在大学滑雪胜地基地小屋的诊所运行的损伤数据库中进行的未匹配病例对照研究。病例为受伤的滑雪者和单板滑雪者；对照组为随机选择的未受伤的滑雪者和单板滑雪者。收集的资料包括损伤机制、经验水平、设备、射线照片、滑雪或单板滑雪习惯以及雪道类型，定义为绿圈（最简单）、蓝方（中等）、黑钻（困难）和双黑钻（最难）。从该数据库中，我们确定了 84 例骨干前臂骨折患者，其中 1 例为孟氏骨折，予以排除。使用逻辑回归分析比较受伤组和对照组，以确定与骨干前臂骨折相关的因素，包括腕部护具的使用。
调整参与者天数后，与滑雪者相比，单板滑雪者骨干前臂骨折更为常见（0.03 例/ 1000 人天，0.004 例/ 1000 人天）。多变量分析显示，与滑雪者前臂骨折相关的因素包括年龄较小（优势比 1.08 [95%置信区间 1.05 至 1.14]；p < 0.01）、男性或男孩（优势比 11.9 [95%置信区间 2.5 至 57.2]；p < 0.01）、摔倒时无运动（优势比 18.2 [95%置信区间 3.2 至 102.5]；p < 0.01）以及与黑钻雪道相比在绿圈雪道滑雪（优势比 3.6 [95%置信区间 1.4 至 12.5]；p = 0.04）。与单板滑雪者前臂骨折相关的因素包括年龄较小（优势比 1.08 [95%置信区间 1.02 至 1.15]；p = 0.01）、体重减轻（优势比 1.02 [95%置信区间 1.00 至 1.02]；p < 0.01）、在平缓地形上单板滑雪（优势比 8.4 [95%置信区间 1.6 至 45.0]；p = 0.01）以及与其他地形（优势比 7.2 [95%置信区间 1.9 至 28.0]；p < 0.01）或湿重雪地（优势比 24.8 [95%置信区间 2.5 至 246.7]；p = 0.01）相比在雪道上单板滑雪。在滑雪者或单板滑雪者中，腕部护具的使用与骨干前臂骨折的发生几率增加无关。
与滑雪者相比，单板滑雪者骨干前臂骨折更为常见。尽管先前的证据推测腕部护具可能会增加发生这些损伤的风险，但我们的研究表明并非如此，并且佩戴腕部护具是安全的。
III 级，预后研究。
