Dr Phil Vaughan 

Going for broke

Snowboarders are more prone to broken bones than skiers, and usually do it on their first go. So how can you avoid a visit to the fracture clinic? Dr Phil Vaughan finds out.
  
  


I lay on my back, looking up at the blue skies of Val d'Isere in France, winded from my latest snowboard tumble. I went through a mental check: back, OK, neck, OK, arms? - and was drawn to a throbbing pain in my right wrist that felt different from a normal impact pain. Alarm bells went off.

I gently pulled back my glove and noticed a depression in my wrist on the radius, the bone that runs from the crease of the elbow to the bottom of the thumb. It was a shape I recognised from my days working in A&E: I had a "dinner-fork" deformity - so-called because my wrist now resembled the shape of an upside down dinner fork. It was fractured.

My fall had come on the first full day of my snowboarding break, as I went down a relatively narrow, and extremely icy, piste. No snow for three weeks meant patches were bare and stony, which made snowboarding, especially for an intermediate like me, more difficult.

The three or four falls I'd sustained up until then were just falls on my back or my bum. This was different. As I neared the bottom of the increasingly crowded piste, I started to slow myself down by turning down the mountain and hit an icy patch.

But, instead of just falling backwards and landing on my bum, I'd stretched out my hand to cushion my fall and landed on it: a classic cause of a forearm fracture - and, as I was to learn, the classic fall for a snowboarder.

Once I realised my wrist was broken, I went into emergency mode: I was lying alone in the snow, a board attached to my feet - and I had to get down the piste. I kept my right hand held up, out of the way, and struggled to take the snowboard off with my left hand. My steps were tentative as I fought to balance the snowboard while cradling my arm and inching my way down the icy piste. As I caught up with my wife, who'd skied ahead and was waiting for me, I shouted, feebly at first: "It's broken." "What, your snowboard?" she called. "No." I was exasperated. "My bloody arm."

As with any forearm fracture, one of the most important things to do is to check the nerve and blood supply to the hand, which I did myself. Thankfully, I could move my thumb and fingers despite the swelling. I tested my sense of touch by tentatively prodding them, and I could tell the blood vessels were OK because my hand was a good colour - a healthy pink rather than a white pallor.

At the piste clinic and with a waiting time the NHS would be proud of - just 15 minutes - I was seen by the piste doctor, Dominique Arnaud.

But I wasn't the only one suffering. Next door, a fellow English bloke had fractured his collarbone earlier in the day by colliding with another snowboarder. Waiting outside was yet another boarder who'd torn the ligaments in his shoulder. We were all British, pointed out Dr Arnaud, all snowboarders, all had arrived the previous day and, unlike the French shunning the pistes for the lack of snow, had pushed ourselves on the ice.

When she showed me the x-rays, the fracture was obvious. The nature of a Colles'-style fracture, usually seen in the elderly, often means that the deformed wrist has to be manipulated back into its usual shape. Such a process requires an anaesthetic to allow the doctor to align the two segments of bone. As she injected the anaesthetic into the tissue around my fracture, I understood why the patients I'd treated winced. It actually hurt! Although pain free, I could feel the bones grind against each other as the Dr Arnaud manipulated the fracture and applied traction by pulling on my hand and thumb.

Post-manipulation, my arm was set in a plaster and then x-rayed to check the position was correct. The procedure was now over, but the real fun was just beginning. I had a plaster going from my wrist to above my elbow which set my forearm at right angles to my shoulder - great! In a perverse way it was comforting to learn that I'm not the only snowboarder who will fracture their arm this winter: wrist fractures account for a quarter of all snowboarding injuries and half of fractures. As Steve Bollen, consultant orthopaedic surgeon, and secretary of the British Orthopaedic Sports Trauma Association, explains: "You have to learn either to fall with your hands clenched in fists, and not land on them, or to just fall on your back - which is a difficult instinct."

In contrast to skiers, who have a greater risk of knee injuries, snowboarders suffer from far more upper limb injuries - with around three quarters of all injuries being wrist injuries, clavicle fractures, dislocated shoulders and neck and head injuries, according to Vladimir Bobic, consultant orthopaedic knee surgeon at the Royal Liverpool Hospital, and an authority on snowboarding injuries.

Doctors believe snowboarders are no more likely to injure themselves than skiers - the risk is around one in 400 - but research is limited. As Bobic admits: "As a snowboarder, I would say it's no more dangerous than skiing - but it probably is, in reality. Snowboarders tend to be more aggressive - they tend to hit skiers rather than the other way round, for instance." Certainly the most recent statistics from the French resorts point to snowboarding injuries being more serious, with 24% being fractures compared to just 5% for skiers.

Those most at risk are beginners: almost a quarter of all snowboarding accidents occur the very first time someone tries out a board, while almost half occur during the first season, according to research from the American Academy of Family Physicians. But intermediates also pose a danger. "Risks of injury are related to speed," says Dr Tom Crisp, a sports physician at the London Independent Hospital. "It's those people - normally young men - who can go fast, but do so beyond the limit of their control."

And piste conditions play a part. Snowboarding is particularly difficult when it's icy: with skiing, you can go into a snowplough and gradually grind to a halt before toppling over, whereas with snowboarding, if you catch an edge you just flip over.

All this makes the threat of getting injured seem extreme, but at least breaking a wrist doesn't appear to be as bad in the long-term as breaking a knee - the most common skiing injury. Then again, with boarding only becoming mainstream within the past seven years, it's perhaps too early to have identified potential long-term health consequences.

So what can you do to prevent becoming one of the estimated 35,000 Britons - out of 1.1m - who injure themselves while snowboarding or skiing each year? For Bobic tuition is imperative: "It's the most important thing. Instruction teaches you to fall properly and so makes you safer, but one day of group tuition isn't enough."

Proper boots and bindings are also important, and he recommends helmets - increasingly popular in America, where 10% of skiers and snowboarders now wear them, though you'd still be hard-pressed to see many on the European slopes.

For Bollen, protection doesn't stop there: "I personally wear as much protective armour as I can: wrist guards - which have been shown experimentally to have some effect, a helmet, and padded shorts, to protect the pelvis and coccyx, the bottom end of the spine."

I'll be trying the wrist guards next time. But, while proper tuition, good equipment and protective clothing can help to make snowboarding safer, perhaps it's the danger that attracts us and makes it so enjoyable.

 

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