Available via license: CC BY-NC-ND 4.0
Content may be subject to copyright.
Skiing Injuries in the US Pediatric
Population
An Analysis of National Injury Trends and Mechanisms
Between 2012 and 2022
Avanish Yendluri,
*
y||
BS, Eugene I. Hrabarchuk,
y||
BS, Kyle K. Obana,
z||
MD,
Nikan K. Namiri,
y||
MD, Kevin D. Plancher,
§||
MD, MPH, David P. Trofa,
z||
MD,
and Robert L. Parisien,
y||
MD
Investigation performed at the Department of Orthopaedic Surgery, Icahn School
of Medicine at Mount Sinai, New York, New York, USA
Background: While prevention protocols have been implemented, skiing-related musculoskeletal injuries and concussions con-
tinue to present to emergency departments in the United States. Previous literature has suggested the pediatric population may
constitute up to 40% of skiing-related injuries.
Purpose: To assess injury trends and the underlying mechanisms of skiing injuries in pediatric patients seen at emergency de-
partments in the United States.
Study Design: Descriptive epidemiology study.
Methods: The National Electronic Injury Surveillance System (NEISS) was queried for pediatric (age 18 years) skiing injuries
between January 1, 2012, and December 31, 2022. Injury mechanism, location, disposition, and diagnosis were recorded, and
the statistical sample weight assigned by NEISS by hospital was used to calculate national estimates (NEs). Injury trends were
evaluated with linear regression analysis.
Results: Overall, 2951 pediatric skiing injuries were included (NE = 123,386). The mean age of the patients was 12.4 63.5 years,
with 61.3% of the injuries occurring in male patients. Impact with the ground was the most common injury mechanism
(NE = 87,407; 70.8%). Fractures were the most common diagnosis (NE = 38,527, 31.2%), followed by strains/sprains
(NE = 22,562, 18.3%), contusions/abrasions (NE = 16,257, 13.2%), and concussions (NE = 12,449, 10.1%). The lower leg was
the most common fracture site (NE = 9509, 24.7%), followed by the shoulder (NE = 7131, 18.5%) and lower arm (NE = 5876,
15.3%). Analysis of annual injuries revealed no significant trend between 2012 and 2022 (P= .17), with fluctuations apparent
throughout the study period. Significant decreases were seen in strains/sprains (P\.01) and contusions/abrasions (P\.01),
but not in concussions (P= .57) or fractures (P= .70).
Conclusion: Impacts with the snow/ground made up 70.8% of all injuries. Fractures were the most common injury diagnosis,
followed by strains/sprains, with the lower leg being most frequently fractured. While strains/sprains and contusions/abrasions
showed a significant decline, there were no significant trends in fractures and concussions between 2012 and 2022.
Keywords: concussions; fractures; injuries; NEISS; pediatrics; skiing
Skiing is a popular winter sport, with an estimated 15 mil-
lion participants in the United States and approximately
200 million worldwide.
16,21
Participants across all age
groups with varying levels of experience engage in the
sport each year.
6
Although enjoyable, the sport presents
an inherent injury risk given the complex biomechanical
movements involved with navigating alpine slopes paired
with high-speed falls and collisions.
18,21
While skiing-related injuries were on the rise as the
sport grew in the early 2000s, recent studies have pointed
toward a decline in the past decade, especially given the
The Orthopaedic Journal of Sports Medicine, 12(6), 23259671241255704
DOI: 10.1177/23259671241255704
ÓThe Author(s) 2024
1
This open-access article is published and distributed under the Creative Commons Attribution - NonCommercial - No Derivatives License (https://creativecommons.org/
licenses/by-nc-nd/4.0/), which permits the noncommercial use, distribution, and reproduction of the article in any medium, provided the original author and source are
credited. You may not alter, transform, or build upon this article without the permission of the Author(s). For article reuse guidelines, please visit SAGE’s website at
http://www.sagepub.com/journals-permissions.
Original Research
rising popularity of snowboarding.
6,21,31
While prevention
protocols have been implemented,
5,14,16
skiing-related
musculoskeletal injuries and concussions continue to pres-
ent to emergency departments (EDs) in the United
States.
10,15
Furthermore, while the pediatric population
makes up approximately 20% of skiers, this demographic
makes up a large proportion of injuries,
3,15,21
with a study
by Hurt et al
15
reporting approximately 40% of injuries
being among youth skiers. Differences in anatomy, biome-
chanics, skill level, and coordination also result in distinc-
tive injury patterns among pediatric skiers compared with
adults.
3,6,21
The purpose of this study was to assess injury trends
and the primary mechanisms underlying skiing injuries
in pediatric patients who visited US EDs between 2012
and 2022. Furthermore, we aimed to characterize injury
trends and distribution by diagnosis type. The hypotheses
were that (1) falls would contribute to a large portion of
skiing-related injuries in this population, with fractures
being the most common injury pattern and the lower
extremities being a frequent fracture site; and (2) injuries
would be decreasing due to the interventions implemented.
These findings will be invaluable in guiding the assess-
ment, treatment, and prevention of skiing-related injuries
in pediatric patients, especially those that require an ED
visit and work-up.
METHODS
NEISS Database
We queried the National Electronic Injury Surveillance
System (NEISS) database retrospectively for all skiing
injuries (NEISS product code 3283) in the pediatric
(18 years) population between 2012 and 2022. NEISS is
a publicly available, de-identified national database oper-
ated by the US Consumer Product Safety Commission.
ED visits are collected from a stratified probability sample
of approximately 100 US hospitals with a minimum of 6
beds and a 24-hour operating ED. The NEISS dataset
relies on a geographic sample of participating hospitals;
thus, there is likely a large variation in the number of
ski injuries based on location. The hospitals are grouped
into 5 strata: 4 represent hospital EDs of various sizes
and 1 represents EDs from children’s hospitals. A
statistical sample weight is assigned for each ED based
on the inverse of the probability of selection, thus allowing
for national estimates (NEs) of injuries to be calculated
across the United States using the NEISS cases. Several
epidemiological studies have utilized the NEISS database
to characterize sports injuries,
1,11,24,26,30,36
including those
from snow sports.
6,9,15,40
Institutional review board
approval was not required for this study, as only publicly
available data were included.
Data Extraction
There were 2991 cases of skiing-related injuries in pediat-
ric patients between January 1, 2012, and December 31,
2022. For each injury case, the patient’s demographic
information (eg, age, sex, and race), date of visit, diagnosis,
body area involved, and a visit narrative were available.
Each narrative was reported by the health care provider
to describe the injury and entered into the database by
a trained coder. The narrative for each case was reviewed
by 3 authors (A.Y., E.I.H., and K.K.O.), and the mechanism
of injury and affected body parts were identified. The
mechanism of injury was classified as impact with the
snow/ground, impact with an object (tree, rock, etc), impact
with another person, twisting motion, impact with ski
poles, impact with skis, injured while getting on/off ski
lift, other, or not specified in the narrative.
Exclusion Criteria
Injury cases were excluded if the patient was not a skier
(eg, a snowboarder injured after colliding with skier), if
the injury did not take place while skiing (eg, fall in the
ski lodge, head injury from a falling ski boot), or if there
was an injury mechanism or location that did not fit into
the categories as above.
Statistical Analysis
The data were analyzed using IBM SPSS Statistics Ver-
sion 28.0 (IBM Corp LLC). Descriptive statistics were per-
formed and reported as NEISS cases and NEs (calculated
using the statistical weights provided by the Consumer
Product Safety Commission for each case). Linear regres-
sion analysis was used to analyze the relationship between
*
Address correspondence to Avanish Yendluri, BS, Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, 5 East 98th Street,
9th Floor, New York, NY 10029, USA (email: avanish.yendluri@icahn.mssm.edu) (Twitter/X: @AvanishYendluri).
y
Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
z
Department of Orthopaedic Surgery, Columbia University Medical Center, New York, New York, USA.
§
Plancher Orthopaedics and Sports Medicine, New York, New York, USA.
||
Scientific Collaborative for Orthopaedic Research and Education (SCORE) Group.
Final revision submitted November 19, 2023; accepted December 6, 2023.
One or more of the authors has declared the following potential conflict of interest or source of funding: E.I.H. has received nonconsulting payments
from Bioventus and hospitality payments from AbbVie, AstraZeneca Pharmaceuticals, and Aesculap. K.D.P. has received education payments from
Gotham Surgical; nonconsulting fees from Bioventus and Linvatec; consulting fees from Anika Therapeutics, Flexion Therapeutics, Heron Therapeutics,
and Smith+Nephew; and hospitality payments from Aesculap Biologics. D.P.T. has received grant support from Arthrex and education payments from
Arthrex and Smith+Nephew. R.L.P. has received grant support and education payments from Arthrex. AOSSM checks author disclosures against the
Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating
thereto.
Ethical approval was not sought for the present study.
2Yendluri et al The Orthopaedic Journal of Sports Medicine
the year and annual skiing-related pediatric injuries
across the study period, with number of injuries as the
dependent variable and year as the independent variable.
The Pvalue, regression coefficient (b), and 95% CI were
reported when the data were statistically significant
(P\.05).
RESULTS
There were 2991 cases of pediatric (age 18 years) skiing
injuries reported at US EDs between January 1, 2012,
and December 31, 2022. Forty injuries that did not involve
skiing (snowboarder injuries, injuries in ski lodge, or being
hit by skis or ski boots not while skiing) were excluded,
resulting in 2951 pediatric skiing injuries (NE = 123,386)
that were included in the analysis. The mean age of the
injured patients was 12.4 63.5 years, with most injuries
being among male (61.3%) and White (94.9%) patients
(Table 1).
Linear regression analysis of annual injuries revealed
no significant trend between 2012 and 2022 (P= .17)
(Figure 1). Rather, injuries fluctuated during the study
period. There was a slight increase from 2012 to 2013
and a slight decrease from 2013 to 2014, followed by larger
decreases of 28.5% from 2014 to 2015 and 33.4% from 2015
to 2016. Injuries increased slightly in 2017, then increased
by 51.8% from 2017 to 2018. Injuries then decreased in
2019 and 2020, followed by increases in 2021 and 2022.
The 13,268 injuries reported at US EDs in 2022 was the
highest in a single year nationally since 2014 and repre-
sented a 29.9% increase from 2021 (Figure 1).
Injury Mechanism
The most common mechanism of injury was impact with
the snow/ground, making up 70.8% (NE = 87,407) of inju-
ries (Table 2). Impact with an inanimate object and inju-
ries due to a twisting motion were the next most
common, followed by injuries while getting on/off the ski
chairlift. Collisions with other people made up 3.2% of inju-
ries. Impact with ski poles, impact with skis, and other
injuries made up a combined 3.2% of injuries.
Injury Diagnoses
Fractures were the most common primary injury diagnosis
(NE = 38,527; 31.2%), followed by strains/sprains, contu-
sions/abrasions, and concussions (Table 3). These 4 diagno-
ses made up over 70% of all national skiing injuries in
the pediatric population. Among pediatric skiers aged
TABLE 1
Characteristics of Skiing-Related Injuries
in the Pediatric Population, 2012 to 2022
a
Characteristic NEISS, n
NE, n
(% of Total
b
)
Sex
Male 1762 75,601 (61.3)
Female 1189 47,785 (38.7)
Race
White 2314 104,750 (84.9)
Black/African American 46 1011 (0.8)
Asian 68 2813 (2.3)
American Indian/Alaska Native 1 81 (0.1)
Native Hawaiian/Pacific Islander 1 8 (0.0)
Other 61 1562 (1.3)
Not specified 460 13,161 (10.7)
a
NE, national estimate; NEISS, National Electronic Injury Sur-
veillance System.
b
Total NE = 123,386.
Figure 1. National estimates for skiing-related pediatric injuries reported at US emergency departments between 2012 and 2022.
The Orthopaedic Journal of Sports Medicine Epidemiology of Pediatric Skiing Injuries 3
13 years, fractures made up 36.1% of all injuries, fol-
lowed by strains/sprains making up 16.1%. In contrast,
among the adolescent pediatric skiers (age, 14-18 years
old), fractures made up 24.6% of all injuries, followed
closely by strains/sprains at 21.3%.
Linear regression analysis of annual trends of the
4 most common injury diagnoses between 2012 and
2022 revealed significant decreases in strains/sprains
(P= .002; b=2270.76; 95% CI, 2407.91 to 2133.62)
and contusions/abrasions (P= .007; b=2208.53; 95%
CI, 2354.14 to 271.92). However, no significant decreases
in annual concussions (P= .57) or fractures (P= .70) were
observed between 2012 and 2022, demonstrating that
severe skiing-related head and musculoskeletal injuries
remained prevalent and continued to be reported at US
EDs (Figure 2).
The lower leg was the body part fractured most com-
monly (NE = 9509; 24.7%), followed by the shoulder, lower
arm, and wrist (Table 4).
Only 4.5% (NE = 5562) of injuries reported at EDs
required hospital admission, with 92% (NE = 113,515)
being treated and released and 0.5% (NE = 615) leaving
without treatment.
DISCUSSION
The study findings indicated that skiing-related injuries in
the pediatric population fluctuated between 2012 and
2022, with no significant linear trend. Furthermore, we
found that impact with the ground was the most common
mechanism of injury, with fractures being the most com-
mon injury diagnosis, frequently of the lower leg. Alarm-
ingly, despite increased awareness and increased use
of helmets and protective gear,
12,20,33,41
there was no
TABLE 2
Mechanism of Skiing-Related Injuries
in the Pediatric Population, 2012 to 2022
a
Mechanism of Injury NEISS, n NE, n (% of Total
b
)
Impact with snow/ground 2067 87,407 (70.8)
Impact with inanimate object 297 12,406 (10.1)
Twist 216 9157 (7.4)
Chairlift 141 5882 (4.8)
Impact with person 116 3954 (3.2)
Impact with ski pole 40 1740 (1.4)
Impact with ski 30 1144 (0.9)
Other 23 1107 (0.9)
Not specified 21 589 (0.5)
a
NE, national estimate; NEISS, National Electronic Injury Sur-
veillance System.
b
Total NE = 123,386.
TABLE 3
Most Common Skiing-Related Injury Diagnoses
in the Pediatric Population, 2012 to 2022
a
Diagnosis Raw, n NE, n (% of Total
b
)
Fracture 972 38,527 (31.22)
Strain/sprain 513 22,562 (18.29)
Contusion/abrasion 336 16,257 (13.18)
Concussion 321 12,449 (10.09)
Internal organ injury 260 9953 (8.07)
Laceration 148 6051 (4.90)
Dislocation 47 2323 (1.88)
Other 354 15,264 (12.37)
a
NE, national estimate.
b
Total NE = 123,386.
Figure 2. National estimates for the 4 most common skiing-related pediatric injury diagnoses reported at US emergency depart-
ments between 2012 and 2022.
4Yendluri et al The Orthopaedic Journal of Sports Medicine
significant decline in concussion and fracture-type injuries
between 2012 and 2022 according to study results.
The pediatric population may constitute 13% to 27% of
the overall skiing population worldwide, yet some studies
point to this demographic contributing to as much as
40% of skiing injuries seen in US EDs.
15,28
The available
literature also suggests that youth participants in snow
sports in the US may face a higher risk of injury compared
with adults.
40
Due to this notable injury burden among
pediatric skiers, it is important for further research to
determine which types of injuries are most common, their
long-term impact, and ways to mitigate injury rates to
maintain a healthy and active pediatric population moving
forward. Furthermore, given that musculoskeletal imma-
turity of children and adolescents plays a key role in the
burden of injury rates, identifying prevention strategies
and protocols will be imperative to protecting pediatric
skiers.
21
To our knowledge, this is the first study that
has evaluated the epidemiology of injury patterns in this
population.
A notable finding of this study was that skiing injuries
in pediatric patients who visited US EDs showed no signif-
icant linear trend between 2012 and 2022. Rather, fluctua-
tions in annual injuries were apparent over the study
period. These fluctuations may be attributable to fluctua-
tions in the popularity of skiing as well as variable weather
conditions affecting snowfall and snow quality each season.
The decrease seen between 2013 and 2016 may be a result
of decreasing participation as well as increasing implemen-
tation of onsite clinics at ski resorts to address minor inju-
ries that do not require a full ED work-up or visit.
27,31,40
Furthermore, the use of injury prevention programs with
safety training as well as emphasis of protective gear
may have contributed to this decrease.
4,20,22,31,40
The large
increase in 2018 may be attributable to the 2018 ski season
being the sixth busiest since 1978 despite decreasing
participation in preceding years.
23
The drop in pediatric
skiing injuries in 2020 likely was attributable to the
COVID-19 pandemic cutting the 2020 ski season short,
with many ski resorts closing during that period. The
reopening of ski resorts in 2021 and 2022 and return to
snow sports after the pandemic may have contributed to
the increase in injuries in 2021 and 2022 compared with
2020.
19,38,39
Some of the injuries experienced by the pediatric popu-
lation could be explained by increased risk-taking behavior
in this population. For example, some studies indicate that
riskier skiers are actually more likely to wear helmets com-
pared with those who are more cautious.
12,34
This could
explain the finding that while helmet usage and compli-
ance has been increasing among the pediatric population,
the rates of concussion have shown no significant down-
ward trend over the study period despite helmets offering
more protection if a skier were to fall.
29,34
Furthermore,
concussions have generally become a more prevalent ED
complaint driven primarily by increasing youth sports par-
ticipation and increasing concussion awareness.
25,41
The mechanism of injury was also of interest in the cur-
rent study. Impacts with the snow and ground were iden-
tified as the main mechanism of injury, making up 70%
of the data. Fractures were the most common injury, mak-
ing up 30% of the cases, and the lower extremity was the
most common site of fracture (25% of fractures). This is
in line with previous research showing that the lower
limb, particularly the knee, was most at risk of injury in
pediatric populations.
8,28
Previous research has shown
that, whereas adult injuries during skiing are more com-
mon than pediatric injuries, fractures of the lower leg spe-
cifically are more common in children than adults, which is
supported by the data in this study.
8
Furthermore, we
identified that one-third of injuries among pediatric skiers
aged 13 years and younger were fractures, while only one-
fourth of injuries among those aged 14 to 18 years were
fractures. This heightened fracture risk among the youn-
ger pediatric population likely is attributable to less con-
trol, a higher center of gravity, and the role of open
growth plates leading to weak points in the developing
bones of growing children.
17,32,35,37
Interestingly, there
was a decreasing incidence of contusions/abrasions and
strains/sprains. Previous studies have similarly shown
that lower extremity sprains/strains and contusions/abra-
sions are decreasing and have also pointed out that upper
extremity injuries are increasing.
16
This is thought to be
due the development of better binding mechanisms
between the ski and boot, which allow for better release
of the foot and ankle before impact.
13
Minor injuries such
as strains, sprains, contusions, and abrasions are likely
able to be addressed at an onsite or outpatient clinic or
with the use of protective gear, whereas more serious trau-
matic injuries such as fractures or concussions may be
taken by ski patrol directly to the hospital for ED evalua-
tion and additional imaging.
20,27,31
Another area of particular interest in the data is that
5% of injuries occurred due to chairlifts. Chairlifts can be
variable, from 2 seats to 6 seats or more per ride and can
also include gondolas and other standing forms of
TABLE 4
Location of Skiing-Related Fractures in the Pediatric
Population, 2012 to 2022
a
Body Area NEISS Cases, n NE, n (% of Total
b
)
Lower leg 255 9509 (24.7)
Shoulder 153 7131 (18.5)
Lower arm 144 5876 (15.3)
Wrist 79 3499 (9.1)
Upper leg 70 2634 (6.8)
Upper arm 54 1998 (5.2)
Finger 51 1556 (4.0)
Face 30 952 (2.5)
Spine 22 897 (2.3)
Elbow 17 880 (2.3)
Ankle 18 745 (1.9)
Hand 7 144 (0.4)
Other 53 2486 (6.5)
Not specified 19 219 (0.6)
a
NE, national estimate; NEISS, National Electronic Injury Sur-
veillance System.
b
Total NE for fractures = 38,527.
The Orthopaedic Journal of Sports Medicine Epidemiology of Pediatric Skiing Injuries 5
transportation. Given that chairlifts are a method used fre-
quently for accessing the top of the mountain, it is impor-
tant that future research is focused on determining how
to make this transportation safer, especially for pediatric
populations. Some studies have shown that skiing in
a larger group of friends or family can reduce risk of injury
by around 50%, especially compared with skiing alone.
7
This shows possible risk mitigation for pediatric injury
needs to fall onto parents and counselors chaperoning
these trips to reduce rates of injury. Finally, ski resort
chairlift models can have an impact on injury rates. One
study at a particular ski resort found that chairlift injuries
increased by 2-fold using only a 50% capacity increase to
chairlift systems across the resort.
2
As winter sports
become more popular and resorts increase lift capacities,
such factors as traffic patterns, lift functioning, and overall
snow accommodations will take further importance to pre-
vent increases to injury rates.
In a 2023 study, Hurt et al
15
identified a significant
decrease in skiing, snowboarding, and snowmobiling inju-
ries reporting at US EDs between 2009 and 2018, with
fractures being the most common diagnosis and boys being
injured more commonly. Warren et al
40
assessed pediatric
ski and snowboarding injuries from 2010 to 2022 and
reported fractures as the most common diagnosis, boys as
being injured more frequently, and injuries as decreasing
significantly between 2010 and 2020. Although they iden-
tified a significant decrease during the study period, they
also noted that ski/snowboarding injuries reported at US
EDs kept steady between 2017 and 2020. In our study,
we similarly identified fractures as the most common diag-
nosis and found pediatric skiing injuries to be more com-
mon among boys. However, we demonstrated no
significant trend in injuries between 2012 and 2022, which
contrasts the decline previously reported. This discrepancy
in injury trends may be due largely to the higher injury
rate between 2018 and 2022 compared with 2016 and
2017. Importantly, our study further identified that,
whereas fractures and concussions showed no significant
trend, strains/sprains and contusions/abrasions signifi-
cantly decreased. With 2022 representing the highest
number of pediatric skiing injuries since 2014, these find-
ings highlight the importance of continued injury preven-
tion efforts and may aid in injury assessment and
treatment by onsite ski clinics.
Given that this study relied on ED visits through the
NEISS database, it likely underestimated the total number
of skiing injuries in the pediatric population. Many pediat-
ric skiing injuries are likely treated at ski clinics or may be
evaluated at urgent care clinics, pediatric offices, or in
orthopaedic offices. Thus, the NEISS dataset may consist
primarily of injuries that require a timely evaluation and
work-up, such as fractures. Importantly, while the use of
protective equipment has increased over time,
5
this study
shows that more serious injuries such as fractures and con-
cussions continue to remain prevalent with no significant
decline between 2012 and 2022. Thus, we recommend
increased utilization of protective gear, including helmets,
as well as implementation of safety lessons and concussion
prevention protocols especially for pediatric skiers.
Limitations
As this was a retrospective study that relied on informa-
tion provided by the NEISS dataset, limitations are inher-
ent. The classification of injury mechanisms depended on
the narrative reported by the ED clinician. There was var-
iability in the detail provided in these narratives that
might have resulted in misinterpretation of the contribut-
ing outcome. However, only 589 cases (0.48%) of pediatric
skiing injuries in this study were classified as ‘‘not speci-
fied.’’ Another limitation of this study is that the location
of injuries was not able to be considered. Thus, it was not
known what prevention measures were in place at the
ski resort, the helmet/protective gear usage rate, or the
onsite ski clinics or ski patrol available for a given case.
We attempted to mitigate such risks by using a large
national database dataset to mitigate low sample size
when assessing injury trends and distribution. However,
NEISS NEs are extrapolated from 100 EDs that serve as
a representative sample of all US EDs, and these estimates
may be off from pediatric skiing injuries nationally. Another
important limitation is that specific details regarding the
injury/fracture patterns as well as findings from imaging
are not known. Our analysis relied on NEISS coding for
the injured body part and injury diagnosis, which may not
always represent the true underlying injury. Finally, the
exact number of total pediatric skiers each year in the
United States over the study period is not known, and
this may have affected annual trends and interpretation
of preventive measures of safety initiatives.
CONCLUSION
Between 2012 and 2022, there was no significant trend in
pediatric skiing injuries reported at EDs in the United
States. Impact with the snow/ground was the most com-
mon injury mechanism, making up 70.8% of all injuries.
Fractures were the most common injury diagnosis followed
by strains/sprains, with the lower leg being fractured most
frequently. While strains/sprains and contusions/abrasions
reported at US EDs showed a significant decline, fractures
and concussions showed no significant trend over the study
period.
ORCID iD
Robert L. Parisien https://orcid.org/0000-0002-7562-8375
REFERENCES
1. Abed V, Hawk GS, Conley C, Akarakian R, Stone AV. Epidemiological
analysis of pediatric baseball and softball concussions in United
States emergency departments. Am J Emerg Med. 2023;69:143-
146. doi:10.1016/j.ajem.2023.04.025
2. Boris D, Makajic
´-Nikolic
´D, C
´irovic
´M, Petrovic
´N, Suknovic
´M. A ski
injury risk assessment model for ski resorts. J Risk Res.
2020;23(12):1590-1602. doi:10.1080/13669877.2020.1749113
3. Chesler KC, Howell DR, Khodaee M, Pierpoint LA, Comstock RD,
Provance AJ. Are different aged youth skiers and snowboarders
6Yendluri et al The Orthopaedic Journal of Sports Medicine
experiencing different injury characteristics? Wilderness Environ
Med. 2023;34(1):45-54. doi:10.1016/j.wem.2022.10.010
4. Cusimano M, Luong WP, Faress A, Leroux T, Russell K. Evaluation of
a ski and snowboard injury prevention program. Int J Inj Contr Saf
Promot. 2013;20(1):13-18. doi:10.1080/17457300.2011.648677
5. Davey A, Endres NK, Johnson RJ, Shealy JE. Alpine skiing injuries.
Sports Health. 2019;11(1):18-26. doi:10.1177/1941738118813051
6. DeFroda SF, Gil JA, Owens BD. Epidemiology of lower extremity inju-
ries presenting to the emergency room in the United States: snow ski-
ing vs. snowboarding. Injury. 2016;47(10):2283-2287. doi:10.1016/j
.injury.2016.07.005
7. Delibas
ˇic
´B, Radovanovic
´S, Jovanovic
´MZ, Obradovic
´Z, Suknovic
´
M, Lojic
´R. A study on ski groups size and their relationship to the
risk of injury. Proc Inst Mech Eng P J Sports Eng Technol. Published
online August 15, 2022. doi:10.1177/17543371221118193
8. Ekeland A, Rødven A, Heir S. Injuries among children and adults in
alpine skiing and snowboarding. J Sci Med Sport. 2019;22 Suppl
1:S3-S6. doi:10.1016/j.jsams.2018.07.011
9. Galgano AC, Cohn JE, Licata JJ, Othman S, Stucker FJ, Bundrick P.
Slippery slopes: skiing-related facial trauma in adults. Craniomaxillo-
fac Trauma Reconstr. 2022;15(2):122-127. doi:10.1177/194338752
11020933
10. Graves JM, Whitehill JM, Stream JO, Vavilala MS, Rivara FP. Emer-
gency department reported head injuries from skiing and snow-
boarding among children and adolescents, 1996-2010. Inj Prev.
2013;19(6):399-404. doi:10.1136/injuryprev-2012-040727
11. Hager M, Leavitt J, Carballo C, Gratton A, Yon J. Surfing injuries:
a US epidemiological study from 2009-2020. Injury. 2023;54(6):
1541-1545. doi:10.1016/j.injury.2023.03.011
12. Haider AH, Saleem T, Bilaniuk JW, Barraco RD, Eastern Association
for the Surgery of Trauma Injury Control Violence Prevention Com-
mittee. An evidence-based review: efficacy of safety helmets in the
reduction of head injuries in recreational skiers and snowboarders.
J Trauma Acute Care Surg. 2012;73(5):1340-1347. doi:10.1097/
TA.0b013e318270bbca
13. Hermann A, Senner V. Knee injury prevention in alpine skiing. A tech-
nological paradigm shift towards a mechatronic ski binding. J Sci
Med Sport. 2021;24(10):1038-1043. doi:10.1016/j.jsams.2020.06.009
14. Hunter RE. Skiing injuries. Am J Sports Med. 1999;27(3):381-389.
doi:10.1177/03635465990270032101
15. Hurt J, Graf A, Dawes A, Toston R, Gottschalk M, Wagner E. Winter
sport musculoskeletal injuries: epidemiology and factors predicting
hospital admission. Eur J Orthop Surg Traumatol. 2023;33(5):1735-
1743. doi:10.1007/s00590-022-03322-y
16. Koehle MS, Lloyd-Smith R, Taunton JE. Alpine ski injuries and their
prevention. Sports Med. 2002;32(12):785-793. doi:10.2165/
00007256-200232120-00003
17. Levine RH, Thomas A, Nezwek TA, Waseem M. Salter-Harris Frac-
ture. In: StatPearls [Internet]. StatPearls Publishing; 2023.
18. Luppino FS, den Hollander-Gijsman ME, Dekker FW, Bartlema KA,
van Diepen M. Estimating skills level in recreational skiing: develop-
ment and validation of a practical multidimensional instrument.
Scand J Med Sci Sports. 2023;33(1):55-63. doi:10.1111/sms.14245
19. Maestro A, Varillas-Delgado D, Morencos E, et al. Injury incidence
increases after COVID-19 infection: a case study with a male profes-
sional football team. Int J Environ Res Public Health. 2022;19(16):
10267. doi:10.3390/ijerph191610267
20. Mecı
´as-Calvo M, Lago-Fuentes C, Mun
˜oz-Pe
´rez I, et al. Motives for
the use or not of protective equipment for the recreational practice of
skiing and snowboarding in Spanish winter stations. Healthcare
(Basel). 2021;9(12):1767. doi:10.3390/healthcare9121767
21. Meyers MC, Laurent CM Jr, Higgins RW, Skelly WA. Downhill ski inju-
ries in children and adolescents. Sports Med. 2007;37(6):485-499.
doi:10.2165/00007256-200737060-00003
22. Milan M, Jhajj S, Stewart C, Pyle L, Moulton S. Helmet use and injury
severity among pediatric skiers and snowboarders in Colorado. J
Pediatr Surg. 2017;52(2):349-353. doi:10.1016/j.jpedsurg.2016.11
.001
23. National Ski Areas Association. National Skier/Snowboarder Visits,
1978/79 to 2022/23. Lakewood, CO: National Ski Areas Association;
2023.
24. Obana KK, Hasegawa ME, Mueller JD, et al. Decreasing trend in
upper extremity surfing injuries presenting to United States emergency
departments – a 20-year analysis. Hawaii J Health Soc Welf.2023;
82(10):232-239.
25. Obana KK, Mueller JD, Saltzman BM, et al. Targeting rule implemen-
tation decreases concussions in high school football: a national
concussion surveillance study. Orthop J Sports Med. 2021;9(10):
23259671211031191. doi:10.1177/23259671211031191
26. Onor GI, Thome AP, Lemme NJ, Brown KE, Daniels AH. Epidemiol-
ogy of ankle dislocations in the United States: 2009 to 2018. RI
Med J (2013). 2023;106(7):26-30.
27. Patrick E, Cooper JG, Daniels J. Changes in skiing and snowboard-
ing injury epidemiology and attitudes to safety in Big Sky, Montana,
USA: a comparison of 2 cross-sectional studies in 1996 and 2013.
Orthop J Sports Med. 2015;3(6):2325967115588280. doi:10.1177/
2325967115588280
28. Provance AJ, Daoud AK, Tagawa A, Rhodes J. Pediatric and adoles-
cent injury in skiing. Res Sports Med. 2018;26(sup1):150-165.
doi:10.1080/15438627.2018.1438282
29. Ruedl G, Pocecco E, Sommersacher R, et al. Factors associated with
self-reported risk-taking behaviour on ski slopes. Br J Sports Med.
2010;44(3):204-206. doi:10.1136/bjsm.2009.066779
30. Sandler CB, Green CK, Scanaliato JP, Sandler AB, Dunn JC, Parnes
N. Comparison of volleyball-related injuries at US emergency depart-
ments between high school and collegiate athletes: a 10-year NEISS
database study. Orthop J Sports Med. 2023;11(6):23259671
231180534. doi:10.1177/23259671231180534
31. Seleznev A, Shah NV, Desai R, et al. Trends of snowboarding-related
fractures that presented to emergency departments in the United
States, 2010 to 2016. Ann Transl Med. 2018;6(11):200. doi:10
.21037/atm.2018.04.32
32. Singh V, Garg V, Parikh SN. Management of physeal fractures:
a review article. Indian J Orthop. 2021;55(3):525-538. doi:10.1007/
s43465-020-00338-6
33. Sorenson TJ, Borad V, Schubert W. A nationwide study of skiing and
snowboarding-related facial trauma. Craniomaxillofac Trauma
Reconstr. 2022;15(1):28-33. doi:10.1177/1943387521997237
34. Sulheim S, Holme I, Ekeland A, Bahr R. Helmet use and risk of head
injuries in alpine skiers and snowboarders. JAMA. 2006;295(8):919-
924. doi:10.1001/jama.295.8.919
35. Summers Z, Teague WJ, Hutson JM, Palmer CS, Jowett HE, King
SK. The spectrum of pediatric injuries sustained in snow sports. JPediatr
Surg. 2017;52(12):2038-2041. doi:10.1016/j.jpedsurg.2017.08.038
36. Twomey-Kozak J, Boadi P, Rodriguez K, et al. Estimates of golf-
related upper extremity injuries in the United States: a 10-year epide-
miology study (2011-2020). Sports Health. 2024;16(3):440-447.
doi:10.1177/19417381231168832
37. Valerio G, Galle
`F, Mancusi C, et al. Pattern of fractures across pedi-
atric age groups: analysis of individual and lifestyle factors. BMC
Public Health. 2010;10:656. doi:10.1186/1471-2458-10-656
38. Valle EA, Cobourn AP, Trivitt SJ, Hendrikx J, Johnson JD, Fiore DC.
Perceptions among backcountry skiers during the COVID-19 pan-
demic: avalanche safety and backcountry habits of new and estab-
lished skiers. Wilderness Environ Med. 2022;33(4):429-436. doi:10
.1016/j.wem.2022.08.005
39. Vincent HK, Patel S, Zaremski JL. Impact of COVID on sports injury
patterns, changes in mental well-being, and strategies to prepare for
future pandemics in sport. Curr Sports Med Rep. 2022;21(6):196-
204. doi:10.1249/JSR.0000000000000966
40. Warren A, Dea M, Barron IG, Zapata I. Ski and snowboard injury pat-
terns in the United States from 2010 to 2020 in pediatric patients.
Injury. 2023;54(8):110899. doi:10.1016/j.injury.2023.110899
41. Zhang AL, Sing DC, Rugg CM, Feeley BT, Senter C. The rise of con-
cussions in the adolescent population. Orthop J Sports Med.
2016;4(8):2325967116662458. doi:10.1177/2325967116662458
The Orthopaedic Journal of Sports Medicine Epidemiology of Pediatric Skiing Injuries 7
