Abstract
Background
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?
Methods
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.
Results
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.
Conclusion
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 of Evidence
Level III, prognostic study.
Introduction
Background
Skiing and snowboarding are increasingly popular sports in the United States, with the number of participants reaching 10.3 million during the 2018 to 2019 season [15]. Prior evidence has consistently shown that upper extremity fractures occur more frequently in snowboarders and lower extremity fractures occur more frequently in skiers [1, 4-7, 14, 20, 21]. Diaphyseal forearm factures (isolated radius, isolated ulna, and both-bone fractures) are an important subset of these injuries. They are often managed operatively and have a considerable proportion of complications such as malunion, compartment syndrome, and radioulnar synostoses [11, 16].
The efficacy of wrist guards in snow sports remains controversial. A recent systematic review showed they have a protective effect against wrist fractures but voiced concern about their theoretical potential to transfer energy proximally or distally and cause other upper extremity injuries [18]. A small case series suggested that they may act as a fulcrum, increasing force transmitted proximally, raising the forearm fracture risk [4].
Rationale
A thorough investigation on the possible correlation between wrist guards and diaphyseal forearm fractures has not been published. This correlation is important for effectively counseling patients on wrist guard use. More broadly, the frequency, common mechanisms of injury, and factors associated with diaphyseal forearm fractures in skiers and snowboarders have also not been well studied. A thorough analysis of this type could reveal additional points of intervention to reduce the risk of musculoskeletal injury in these hazardous sports.
Therefore, we asked: (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 odds of forearm fractures?
Patients and Methods
Study Design and Setting
This was an unmatched case-control study. The methodology of data collection has previously been described in detail [8-10]. Briefly, since 1972, the Department of Orthopedic Surgery at the University of Vermont has been operating an orthopaedic clinic at the base lodge of a major ski resort in Vermont. In 1972, a case-control study was initiated to describe injuries and factors associated with alpine sports. Since the 1972 to 1973 ski season, the clinic has been recording detailed clinical information and taking radiographs of injured skiers who present to the clinic and agree to participate in the study. Data collection for snowboarders began in 1988, when snowboarding was first allowed at the resort.
Injured patients complete a questionnaire on demographics, equipment type, experience level, skiing or snowboarding habits, and mechanism of injury. Uninjured skiers and snowboarders were randomly selected with a random number generator and completed the same questionnaires. For the questions pertaining to injury, control group participants answered the same questions corresponding to their most recent fall that did not result in an injury. The questions regarding speed (not moving, very slow, slow, moderately fast, and fast) were determined by the participant. Trail difficulty is defined as green circle (easiest), blue square (intermediate), black diamond (difficult), and double black diamond (most difficult).
Nonambulatory skiers and snowboarders who are injured on the mountain are brought directly to the clinic by ski patrol. Ambulatory skiers and snowboarders who are injured on the mountain are directed to the clinic if they inquire about medical aid. By conducting interviews of those leaving the resort, we previously reported that 27% of people with injuries do not present to the clinic [10]. No data were collected on those who presented to the clinic more than 48 hours after injury, those with injuries not requiring medical treatment such as minor abrasions or frostbite, and those who declined medical treatment. We have previously reported that 11% of eligible patients presenting to the clinic declined to participate in the study [10]. All data are uploaded to an electronic database, and physical radiographs are stored.
Participants
The inclusion criteria were all patients with diaphyseal forearm fractures from 1972 to 2018. This included isolated fractures of the radius or ulna as well as both-bone forearm fractures (AO 22A, B, C). Monteggia fractures (an ulnar fracture with concomitant radial head dislocation) and Galeazzi fractures (a radius fracture with a distal radioulnar joint dislocation) were excluded.
Radiographic Analysis
Radiographs for all identified patients were reviewed, and fractures were classified according to the AO classification system by two medical students, two orthopaedic surgery residents, and a fellowship-trained upper-extremity surgeon (ABS). Consensus of classification was achieved in all patients.
Description of Study Population
During the study period, there were 9,525,846 skier visits and 1,322,834 snowboarder visits. We found 21,784 skier injuries and 3567 snowboarder injuries in our database. From these data, we identified 84 patients with diaphyseal forearm fractures, one of which was a Monteggia fracture and was excluded. Of the 83 patients included in our analysis, 82% (68) were men or boys and 18% (15) were women or girls, with an overall median (interquartile range) age of 14 years (IQR 7 to 21). Thirty-eight patients were skiers (compared with 5402 uninjured controls) and 45 were snowboarders (549 uninjured controls). Compared with skier controls, injured skiers were younger (median 14 versus 30 years; p < 0.001), more frequently male (92% [35 of 38] versus 63% [3372 of 5382]; p < 0.001), but similar in self-reported skill level (8% [3 of 38] beginner versus 6% [183 of 3132]; p = 0.49) (Table 1). Compared with snowboarder controls, injured snowboarders were also younger (median 14 versus 24 years) but were similar in distribution of gender (73% [33 of 45] male versus 76% [417 of 546]; p = 0.65) and were more likely to self-report beginner skill level (18% [8 of 45] versus 3% [4 of 120]; p < 0.01). Because all variables were being investigated as possibly associated with the injury, injured participants and controls were not matched for any of these variables. To address confounding variables, we performed a multivariable analysis.
Table 1.
Demographics of study population
| Variable | Injured skiers (n = 38) | Uninjured skier controls (n = 5402) | p value |
| Seasons skied (or snowboarded) before this one, median (IQR) | 6 (5) | 10 (17) | < 0.01 |
| Average number of days skied/snowboarded each prior season, median (IQR) | 15 (33) | 15 (22) | 0.67 |
| Number of days skied (or snowboarded) this season, median (IQR) | 6 (17) | 7 (14) | 0.89 |
| How long have you skied (or snowboarded) today? Median (IQR) | 2 (3) | 3 (2) | 0.34 |
| Age at last birthday, median (IQR) | 14 (7) | 30 (24) | < 0.01 |
| How many ski/snowboard injuries have required physician attention? Median (IQR) | 0 (0) | 1 (2) | < 0.01 |
| Height in inches to nearest inch, median (IQR) | 63 (13) | 68 (7) | < 0.01 |
| Weight in pounds to nearest pound, median (IQR) | 112 (68) | 150 (50) | < 0.01 |
| Measured foot length in mm, median (IQR) | 235 (50) | 255 (35) | 0.01 |
| Total hours of ski/snowboard instruction, median (IQR) | 90 (492) | 15 (52) | 0.12 |
| Sex, % (n) | < 0.01 | ||
| Male | 92 (35) | 63 (3372 of 5382)a | |
| Female | 8 (3) | 37 (2010 of 5382)a | |
| Highest speed at which you normally ski or snowboard, % (n) | 0.55 | ||
| Slow | 9 (2 of 22)a | 10 (134 of 1328)a | |
| Moderately fast | 45 (10 of 22) | 56 (738 of 1328)a | |
| Fast | 45 (10 of 22)a | 34 (456 of 1328)a | |
| What type of slope do you normally ski or snowboard? % (n) | 0.08 | ||
| Gentle | 14 (3 of 22)a | 9 (115 of 1329)a | |
| Moderately steep | 28 (6 of 22)a | 51 (680 of 1329)a | |
| Steep | 60 (13 of 22)a | 41 (534 of 1329)a | |
| Estimate of own ability, % (n) | 0.49 | ||
| Beginner | 8 (3) | 6 (183 of 3132)a | |
| Higher level | 92 (35) | 94 (2949 of 3231)a | |
| Wrist guards, % (n) | > 0.99 | ||
| Yes | 0 (0 of 9)a | 1 (17 of 2452)a | |
| No | 100 (9 of 9)a | 99 (2435 of 2452)a |
| Variable | Injured snowboarders (n = 45) | Uninjured snowboarder controls (n = 549) | p value |
| Seasons skied (or snowboarded) before this one, median (IQR) | 2 (3) | 7 (9) | < 0.01 |
| Average number of days skied/snowboarded each prior season, median (IQR) | 11 (19) | 20 (25) | < 0.01 |
| Number of days skied (or snowboarded) this season, median (IQR) | 5 (10) | 14 (25) | < 0.01 |
| How long have you skied (or snowboarded) today? Median (IQR) | 2 (2) | 3 (2) | 0.03 |
| Age at last birthday, median (IQR) | 14 (5) | 24 (12) | < 0.01 |
| How many ski/snowboard injuries have required physician attention? Median (IQR) | 0 (1) | 0 (1) | <.01 |
| Height in inches to nearest inch, median (IQR) | 65 (7) | 69 (6) | < 0.01 |
| Weight in pounds to nearest pound, median (IQR) | 125 (36) | 165 (44) | < 0.01 |
| Measured foot length in mm, median (IQR) | 250 (30) | 265 (35) | 0.33 |
| Total hours of ski/snowboard instruction, median (IQR) | 4 (10) | 2 (9) | 0.18 |
| Sex, % (n) | 0.65 | ||
| Male | 73 (33) | 76 (417 of 546)a | |
| Female | 27 (12) | 24 (129 of 546)a | |
| Highest speed at which you normally ski or snowboard, % (n) | < 0.01 | ||
| Slow | 22 (10 of 44)a | 2 (2 of 120)a | |
| Moderately fast | 57 (25 of 44)a | 58 (69 of 120)a | |
| Fast | 20 (9 of 44)a | 41 (49 of 120)a | |
| What type of slope do you normally ski or snowboard? % (n) | < 0.01 | ||
| Gentle | 25 (11 of 44)a | 3 (4 of 118)a | |
| Moderately steep | 52 (23 of 44)a | 64 (76 of 118)a | |
| Steep | 22 (10 of 44)a | 32 (38 of 118)a | |
| Estimate of own ability, % (n) | < 0.01 | ||
| Beginner | 18 (8) | 3 (4 of 120)a | |
| Higher level | 82 (37) | 97 (116 of 120)a | |
| Wrist guards, % (n) | 0.20 | ||
| Yes | 11 (3 of 28)a | 5 (25 of 478)a | |
| No | 89 (25 of 28)a | 95 (453 of 478)a |
Differences in total number of participants with complete data for each variable are due to missing data.
Primary and Secondary Study Outcomes
Our first goal was to determine the relative frequency and AO classifications of diaphyseal forearm fractures in skiers and snowboarders. We did this by determining the number of injuries per participant-day for each sport.
Our second study goal was to determine the mechanisms of diaphyseal forearm fractures in skiers and snowboarders. We did this by analyzing the most common mechanisms recorded for these injuries.
Our third study goal was to determine any participant factors that were associated with these injuries, which we accomplished by comparing the injured participants to uninjured controls in a multivariable analysis to identify the factors associated with injury.
Our final study goal was to determine whether wrist guards were associated with diaphyseal forearm fractures in skier and snowboarders, which we did by including wrist guard use in the above multivariable analysis. Data for wrist guard use were available for 83% of snowboarders and 45% of skiers in our study population. Participants with missing data were excluded from this portion of the analysis.
Ethical Approval
This study was approved by the institutional review board at the University of Vermont, Burlington, VT, USA (number 18-0668).
Statistical Analysis
We performed a univariable logistic regression analysis comparing injured participants to controls to identify any potential factors associated with injury. Any variable with a p value less than 0.10 was then included in our definitive multivariable logistic regression analysis. To minimize potential confounding of our results, we conducted separate analyses for skiers and snowboarders as these two sports were thought to be different enough that they would have different mechanisms and factors associated with injury. We used a chi-square test to assess the difference in proportions of skiers and snowboarders who sustained diaphyseal forearm fractures. The statistical analysis was conducted using SAS (SAS Institute).
Results
What Is the Relative Frequency and Types of Diaphyseal Forearm Fractures in Skiers and Snowboarders?
After adjusting for the number of participant-days, forearm fractures were more common among snowboarders than skiers (0.03 injuries per 1000 person-days versus 0.004 per 1000 person-days). They accounted for 0.2% (38 of 21,784) of skiing injuries and 1.3% (45 of 3567) of snowboarding injuries. The most common facture types were AO 22-A2 (45% [37 of 83] simple isolated radius fractures) and AO 22-A3 (42% [35 of 83] simple both-bone fractures) (Table 2).
Table 2.
Number of fracture types by AO classification
| AO classification | Combined | Skiers | Snowboarders | |
| A1 | Simple ulna fracture | 2 | 1 | 1 |
| A2 | Simple radius fracture | 37 | 16 | 21 |
| A3 | Simple both bone fracture | 35 | 15 | 20 |
| B1 | Wedge ulna fracture | 5 | 3 | 2 |
| B2 | Wedge radius fracture | 3 | 2 | 1 |
| B3 | One bone wedge, other simple or wedge | 1 | 1 | 0 |
What Factors Are Associated with These Injuries?
In the skier group, factors associated with injury included younger age (odds ratio 1.08 [95% confidence interval 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 (easiest) compared with black diamond trails (more difficult) (OR 3.6 [95% CI 1.4 to 12.5]; p = 0.04) (Table 3). For snowboarders, factors associated with injury included 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 snow compared with other snow types (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 (Table 4).
Table 3.
Multivariable model for risk factors for diaphyseal forearm fractures in skiers
| Description | Comparison | Odds ratio (95% CI) | p value |
| Trail most frequently skied (or snowboarded) during the day of injury | Easiest vs more difficult | 3.6 (1.0-12.5) | 0.04 |
| Intermediate vs easiest | 0.4 (0.1-1.2) | 0.11 | |
| Most difficult vs easiest | 6.7 (0.7-68.9) | 0.11 | |
| Sex | Male vs female | 11.9 (2.5-57.2) | < 0.01 |
| Participant speed at time of accident (self-reported) | Fast vs slow | 2.0 (0.5-7.4) | 0.30 |
| Moderately fast vs slow | 2.1 (0.6-6.7) | 0.23 | |
| Not moving vs slow | 18.2 (3.2-102.5) | < 0.01 | |
| Very slow vs slow | 0.4 (0.0-4.8) | 0.50 | |
| Younger age (per year) | 1.08 (1.05-1.14) | < 0.01 |
Table 4.
Multivariable model for risk factors for diaphyseal forearm fractures in snowboarders
| Description | Comparison | Odds ratio (95% CI) | p value |
| Slope normally skied or snowboarded (self-reported) | Gentle vs moderately steep | 8.4 (1.6-45.0) | 0.01 |
| Steep vs gentle | 0.18 (0.03-1.06) | 0.04 | |
| Snow conditions at site of accident (self-reported) | Packed powder/groomed vs exposed ground | 1.4 (0.32-6.52) | 0.65 |
| Packed powder/groomed vs frozen granular/corn | 2.38 (0.53-10.5) | 0.14 | |
| Packed powder/groomed vs hard packed/ice | 1.94 (0.51-7.40) | 0.34 | |
| Packed powder/groomed vs other | 7.2 (1.9-28) | < 0.01 | |
| Packed powder/groomed vs powder | 3.91 (0.59-25.8) | 0.16 | |
| Packed powder/groomed vs wet heavy | 24.8 (2.5-246.7) | 0.01 | |
| Younger age (per year) | 1.08 (1.02-1.15) | 0.01 | |
| Decreased weight (per pound) | 1.02 (1.00-1.02) | < 0.01 |
Is the Use of Wrist Guards Associated with an Increased Odds of Forearm Fractures?
Wrist guard use was not associated with diaphyseal forearm fractures in skiers or snowboarders in the multivariable analysis.
Discussion
Skiing and snowboarding are increasingly popular winter sports and are associated with high numbers of injuries, with generally greater numbers of upper extremity injuries in snowboarders [12]. Diaphyseal forearm fractures can cause major functional impairment, and operative treatment is often performed to restore proper alignment and rotation of the forearm, especially in patients with both-bone fractures [16]. Therefore, identifying factors associated with forearm fractures in skiers and snowboarders, especially the efficacy of wrist guards, could aid participants, resorts, and clinicians in reducing the number of injuries.
Limitations
This study has several limitations. Patient recall bias could have introduced error; however, we only included participants who presented to the clinic within 48 hours of their injury to minimize this effect. Selection bias is also a concern because we have reported that 27% of patients with injuries at the resort do not report to the clinic [12]. However, these missed injuries might represent a greater proportion of minor injuries because patients with forearm fractures, particularly those with both-bone fractures, are more likely to have a deformed or angulated fracture and would likely seek immediate medical attention. Therefore, we do not believe this limitation should change the interpretation of our study. The rarity of diaphyseal forearm fractures compared with other injury types in this patient population introduces statistical fragility into the data and makes a multivariable assessment of factors associated with injury challenging. Statistical fragility occurs when there are not many observations for a given variable in an analysis, so just a few more cases may drastically change the results. Our wide confidence intervals in our multivariate analysis demonstrate how just a few more participants with a certain risk factor could change our results. This effect is especially notable when assessing uncommon factors. For example, our study found that not moving at the time of injury was associated with dia-physeal forearm fractures. This does not make sense clinically; therefore, we manually analyzed the data and discovered there were two participants who were struck by other skiers while standing still and sustained diaphyseal forearm fractures. When compared with uninjured controls, this gave us a p value of 0.001. This highlights the importance of taking statistical fragility into account when appropriate and not blindly trusting p value cutoffs. This finding should therefore be disregarded when analyzing our results; however, this does raise the question of what types of injuries occur when a participant is struck by another. We also recognize that some of the injuries we reported as isolated radial shaft fractures may have been underdiagnosed Galeazzi subluxations that were not radiographically apparent. However, we do not believe this drastically impacts the interpretation of our study, as this this is not a major finding with clinical impact.
What Is the Relative Frequency and Types of Diaphyseal Forearm Fractures in Skiers and Snowboarders?
Forearm fractures were more common in snowboarders than in skiers, which is consistent with prior studies that showed snowboarders are more likely to sustain upper extremity injuries than skiers [1, 19]. This may be because snowboarders have both feet fixed to the board, requiring them to break a fall with their arms [2]. However, this effect is less pronounced in forearm fractures than in wrist fractures. In a previous study on the same population used in the current one, we found the odds of sustaining a wrist fracture to be much higher in snowboarders than skiers [17]. Physicians can use this information to help counsel patients on the risks of skiing and snowboarding. In addition, the most common fractures in our study were simple, isolated radial shaft fractures, which are generally very rare injuries. Although some of these fractures may have been underdiagnosed Galeazzi subluxations, future studies could assess the frequency of these fractures in other snow sports populations to determine whether skiing and snowboarding are a unique mechanism for these uncommon fractures.
What Factors Are Associated with These Injuries?
We found that younger age was associated with increased odds of forearm fracture. We suggest that older participants might be more cautious or more experienced. The association of younger age with injury is consistent with the result of our previous study in wrist fractures [17]. Men and boys had higher odds of forearm fracture than women and girls did in our series, which is consistent with past studies that have shown upper extremity injuries in alpine sports are more common in men than women [13, 19]. However, in past work with the same patient population, we reported that being a woman was associated with an increased odds of wrist fractures in snowboarders [17]. It is unknown why being a man is a factor associated with forearm fractures and being a woman is a factor associated with wrist fractures. In this study, most injuries occurred in boys and men aged 10 to 20 years (Fig. 1).
Fig. 1.
This graph shows the number of diaphyseal forearm fractures, stratified by patient age and gender. A color image accompanies the online version of this article.
One surprising factor associated with an increased odds of fracture was the lack of movement at the time of falling compared with uninjured controls. This seems counterintuitive because higher-speed falls are associated with increased forces, which would predispose patients to more serious injury. However, on further inspection of the data, we found that the two participants who were injured while not moving were struck by another skier or snowboarder, and this finding is likely a result of statistical fragility in our data as discussed previously. However, this does suggest that skier or snowboarder collisions can result in substantial injuries.
Is the Use of Wrist Guards Associated with an Increased Odds of Forearm Fractures?
A recent systematic review has shown that wrist guard use protects against wrist fractures in skiing and snowboarding [18]. However, it is unclear whether wrist guards transmit force to other areas of the upper extremity, increasing the risk of injury higher up the arm [17, 18]. A case report evaluated four inline skaters who sustained both-bone forearm fractures while wearing wrist guards [3]. The authors theorized that the rigid plastic insert in the wrist guard transmitted the force away from the wrist to the forearm, with the length of the splint acting as a lever multiplying the force, resulting in both-bone fracture [3].
In this study, after controlling for confounding variables such as age, gender, speed, and trail type, wrist guard use was not associated with diaphyseal forearm fractures. In addition, our previous work on the same patient population did not show a protective effect of wrist guards against wrist fractures, unlike a review by Russell et al. [18]. Wrist guard use is low in alpine sports (0.49% of controls wore them), so sustaining an injury while wearing them is a rare event. This makes studying their effects on injuries difficult. However, the lack of association between wrist guard use and forearm fractures in our study provides evidence that wrist guards do not increase the odds of these injuries. To investigate this question more definitively would be difficult; a very large sample size would be needed because of the rarity of the injury. Biomechanical studies could potentially evaluate this effect; however, an effect observed in a lab does not necessarily translate to clinical practice. Therefore, we suggest that wrist guards are not unsafe to use in snow sports and do not increase the odds of diaphyseal forearm fractures.
Conclusion
Forearm fractures are rare yet important upper extremity injuries in skiers and snowboarders. They are more common in snowboarders than in skiers. Factors associated with forearm fractures in skiers after controlling for potential confounding variables such as age, gender, speed, and trail types were younger age, being a man or boy, not moving at the time of falling, and skiing on green trails compared with black trails. Factors associated with forearm fractures in snowboarders after controlling for trail and snow type, age, and weight, were snowboarding on gentle terrain compared with moderately steep terrain; snowboarding on groomed snow versus other or wet, heavy snow types; decreased weight; and younger age. Wrist guard use was not associated with increased odds of diaphyseal forearm fractures after controlling for age, gender, speed, and trail type, and therefore are not unsafe to use.
Acknowledgment
We thank Zachary Ehret MD and Nicole Jedrzynski MD for assisting with data entry.
Footnotes
Each author certifies that there are no commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article related to the author or any immediate family members.
All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research® editors and board members are on file with the publication and can be viewed on request.
Ethical approval for this study was obtained from the University of Vermont, Burlington, VT, USA (number 18-0668).
This work was performed at the University of Vermont, Burlington, VT, USA.
Contributor Information
Ryan Caldwell, Email: Ryan.Caldwell@uvmhealth.org.
Michael DeSarno, Email: Michael.DeSarno@uvm.edu.
Ethan Blackburn, Email: ethanblackburn@gmail.com.
Adam B. Shafritz, Email: Adam.Shafritz@uvmhealth.org.
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