AANS Neurosurgeon | Volume 28, Number 3, 2019

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The Potential for Peripheral Nerve Lacerations in Skiing

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Acknowledgement: William Holden (M2, UVM-Larner College of Medicine), Victor A. Wiacek (College Alpine Skier, Babson College)

Elite alpine ski racers are their own breed. Day after day during the winter months, they train on ice-covered slopes, going up to 95 miles per hour to try and be the best in the world. However, in one instant their dreams of breaking records can be reduced to hopes of simply skiing another day. Traumatic injuries among world-class skiers is thought to be as high as 36.7 per 100 athletes per season.1,2 For example, Lindsey Vonn, who is a well-known, world-class Olympic alpine ski racer, has suffered countless injuries while training or competing ranging – from knee fractures and ACL tears to acute facet dysfunction in her spine.3

Ski edges are the metal strips that run along the sides of skis and their sharpness is a major contributing factor to a skier’s performance. The sharper the edge is, the less resistance it has when cutting into the snow. This increases a skier’s speed and provides grip on snow and ice, allowing them to maintain control on difficult terrain. Elite alpine ski racers are able to reach speeds up to 95 miles per hour because they utilize their edges to maintain fast “lines” into turns and then to accelerate out of them.

However, properly maintained ski edges can easily slice through ski clothing, causing laceration-type injuries. A 40-year study looking at over 20,000 recreational skiers in the USA found lacerations to be the third most common skiing injury.4 Two poignant examples:

  • In 2007, Norwegian skier Aksel Lund Svindal, the world cup overall champion at the time, crashed while training in Beaver Creek, Colorado and suffered a 6-inch laceration on his left gluteal muscle.5
  • In 2015, the six-time Olympic medalist, Bode Miller, sustained a deep laceration from his own skis during a crash on the Super-G, which severed his hamstring tendon.6

Although the laceration injuries of Svindal and Miller avoided any major peripheral nerves, laceration of peripheral nerves such as the median nerve and peroneal nerve by striking the outer ski edge, have been reported.7 

Closing day at Stowe Mountain Resort in Vermont in 2018, displayed the expected East Coast spring skiing conditions – ice with a mix of rocks jutting out from the withering ski trials. As I was gliding down the slope, I heard a crash. Looking over, I saw that my friend had caught an edge and wiped out. When I reached him, I noticed that he had a large laceration on his forearm. The crash forced his leg to rise into the air, causing his ski edge to slice through his jacket and arm. Skiing in places like Vermont ends up having very similar snow conditions to that of downhill ski racers – icy, harsh and unforgiving. When skiing on these types of conditions, it is important to maintain sharp ski edges. For both recreational and elite alpine skiers, properly maintained ski edges are razor sharp.

The research team at the University of Vermont Medical Center believes that the use of machine edge-sharpening systems may be one contributing factor to the increasing prevalence of ski laceration injuries. We identified and questioned elite amateur alpine skiers within the New England region to explore this theory and found that the pressure to go faster has pushed most athletes to utilize machine-sharpening systems. Many of these athletes even bought their own personal sharpening systems so that they can sharpen their skis every day. Although no skiers sustained peripheral nerve injuries, many skiers did sustain laceration-type injuries from their own skis that nearly damaged their peripheral nerves in their distal upper extremity and lower extremity, specifically between the top of the ski boot and the waist.8

The treatment paradigm for this type of injury remains the same no matter the etiology and requires primary acute end-to-end anastomosis. Efforts by neurosurgeons should focus on promoting and improving preventive methods. We hope our work will help foster collaboration with neurosurgeons around the nation and the Federation de International de ski (the international governing organization of alpine ski racing) to begin creating a database of laceration injuries to identify the most common locations of lacerations. Through this data we will be able to work with ski clothing manufacturers, recreational and competitive, to improve current cut proof clothing to help prevent serious peripheral nerve injuries.

On February 3, 2019, Victor Wiacek, an elite ski racer at Babson College, was racing Giant Slalom in West Mountain, N.Y., during an Eastern Collegiate Ski Conference race. He had just used a tuning machine to sharpen his skis the day prior. In the flattest and lowest-speed section of the course he caught an edge, his ski came off and slid across the outside of his left thigh.

The ski cut through his quadriceps muscle, part of the hamstring, severed the iliotibial band and came within 1 cm of his femur. The femoral artery and nerve were not injured. Treatment consisted of sewing together muscle tissue and blood vessels before stitching and stapling the skin.

Six months after his injury, Wiacek has resumed all of his normal activities, including kitesurfing, running, biking and strength training. He plans to be back racing on the slopes this coming season.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

References

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1. Florenes, T. W., Bere, T., Nordsletten, L., Heir, S., & Bahr, R. (2009). Injuries among male and female World Cup alpine skiers. British Journal of Sports Medicine, 43(13), 973-978.

2. Haaland, B., Steenstrup, S. E., Bere, T., Bahr, R., & Nordsletten, L. (2015). Injury rate and injury patterns in FIS World Cup Alpine skiing (2006–2015): Have the new ski regulations made an impact? British Journal of Sports Medicine, 50(1), 32-36.

3. (2018, January 31). Lindsey Vonn’s injury history. Retrieved from https://olympics.nbcsports.com/2018/01/31/lindsey-vonn-injury-history/

4. Davey, A., Endres, N. K., Johnson, R. J., & Shealy, J. E. (2018). Alpine Skiing Injuries. Sports Health: A Multidisciplinary Approach, 11(1), 18-26.

5. (n.d.). Norwegian skier Aksel Lund Svindal may need more surgery after frightening crash on Tuesday. Retrieved from https://www.espn.com/espn/wire/_/section/skiing/id/3134088

6. Associated Press. (2019, May 22). Injuries leave Bode Miller unsure of his professional future. Retrieved from https://www.chicagotribune.com/sports/olympics/chi-injuries-leave-bode-miller-unsure-of-his-professional-future-20150206-story.html

7. Match, R. M. (1978). Laceration of the median nerve from skiing. The American Journal of Sports Medicine, 6(1), 22-25.

8. Holden W, Limoges N, Endres NK & Jewell RP. (2019). Lacerations in alpine ski racing: A preliminary report.” Manuscript in Preparation.

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