Snowboarding was popularized in the 1980s and became an Olympic sport in 1998.

Snowboarding is one of the fastest growing sports worldwide, and there are >6 million riders in the United States.

Snowboarders ride on slopes shared with skiers at winter resorts as well as on terrain parks, on half-pipes, and in the backcountry.

Standard equipment includes a snowboard, bindings, and snowboard boots ( Fig. 79.1 ).

Snowboarding equipment.

Snowboard bindings and boots fix the feet to the board and transfer energy forces to the board.

Snowboards are made of fiberglass with a wood or foam core.

Most riders wear soft boots, which are comfortable and allow increased movement.

Hard boots are also available, which have a hard plastic shell similar to ski boots and are designed for increased control and precision of movements.

Additional safety equipment includes helmets, wrist guards, goggles as well as hip and knee pads.

Alpine-style races (parallel or giant slalom)

Half-/super-pipe

Snowboard cross—multiple riders race simultaneously through a course of ramps and jumps

Big-air events—riders jump for maximum height with aerial maneuvers

Slopestyle—snowboarders race through an obstacle course full of rails and tables

Both feet are positioned nearly perpendicular to the long axis of the board and direction of movement ( Fig. 79.2 ). This prevents the board from acting independently as a lever and applying torque on the knee, which occurs in skiing.

Snowboard stance.

Riders move with one shoulder and leg leading the way down the slope (see Fig. 79.2 ). This creates a partial blind side, increasing the risk of collision. Catching the toe or heel edge of the board on snow can cause falls forward onto riders’ hands and knees or backward onto the occiput and sacrum, respectively. Approximately 75% of lower extremity injuries involve the lead foot.

The overall injury rate is approximately 5 per 1000 snowboarder days.

Falls are the most common mechanism of injury, followed by jumps/landings and collisions.

Collisions with stationary objects or other skiers/snowboarders account for only about 10% of injuries; 4%–8% of snowboarding injuries involve chairlifts.

Flexible snowboard boots provide less support than ski boots, making snowboarders more susceptible to ankle injuries.

Compared with skiing, upper extremity injuries, particularly in novice riders and children, are more prevalent.

Wrist injuries are 10 times more common in snowboarders than in skiers because of frequent falls backward onto an outstretched arm and hyperextended wrist.

Head injury rates are three times higher in snowboarders than in skiers. Head and spinal injuries are common and are related to the popularity of aerial acrobatics and jumping.

Snowboarders are 2.5 times more likely to sustain a fracture than skiers.

It is estimated that approximately half of all injuries occur in beginner snowboarders and that >50% of injured beginners have never received formal instruction.

Fast skill advancement and progression to aerials and jumping put numerous riders at risk of serious injury. During competitions, snowboard cross has the highest risk of severe injuries.

Snowboarding often appeals to those seeking risky behavior. Recreational drug use, alcohol, sleep deprivation, using personal music players, as well as a rider’s perception of these risk factors, can contribute to injury.

Additional risk factors include riding on hard, icy, or slushy terrain as well as poor visibility/inclement weather.

Snowboarders reach out with their arms to aid in balance and to brace falls, thus making upper extremity injuries very common. Backward falls cause twice as many fractures as forward falls.

The shoulder is vulnerable, particularly in advanced riders (acromioclavicular joint separations, shoulder subluxations/dislocations, and clavicle fractures).

Elbow fractures and dislocations occur frequently, particularly in children.

Early detection of forearm intraosseous membrane injuries is essential as delayed diagnoses lead to poor outcomes.

Wrist injuries occur frequently, particularly in children and beginners; one-fourth of all snowboarding injuries involve the wrist, and approximately 75% of these are fractures.

Distal radius fractures are particularly common, with approximately two-thirds being intra-articular or comminuted fractures requiring surgical intervention.

Wrists are often used for speed control as well as pivoting and trick maneuvers. A majority of wrist fractures sustained by novice riders are a result of falls, whereas most wrist fractures seen in advanced riders are caused by jumping.

Head injuries encountered in snowboarding include skull fractures, concussions, cerebral contusions, diffuse axonal injury, subdural (most common), epidural, and intracerebral hematomas.

The incidence of traumatic brain injuries among adolescents is increasing.

Traumatic brain injury is the leading cause of severe injury and death among snowboarders.

Collisions with stationary objects (e.g., trees or lift poles) account for approximately half of head injuries.

Acute subdural hematomas are more common in beginners, while fractures, epidural hematomas, and neurologic injuries are seen more often in intermediate and expert riders.

Spinal injuries constitute 2%–4% of all snowboarding injuries and are a major cause of permanent disability.

Most spinal injuries involve compression, burst, or transverse process fractures.

Half-pipe and “big-air” events are associated with an increased frequency of spinal injuries. Axial loads are transmitted to the spine when landing aerials and jumping in a flexed position. Spinal cord injuries usually occur at the thoracolumbar junction and involve an anterior fracture/dislocation.

Snowboarders usually sustain injuries to the chest, including rib fractures and pneumothorax, as a result of collisions or falls while jumping.

Blunt abdominal trauma, including liver lacerations, renal contusions, and splenic injuries, are also common in snowboarders, usually after falling from great heights while jumping.

The typical mechanism of splenic injury is a snowboarder’s own flexed and adducted lead elbow being thrust into his or her abdomen upon hitting the ground with an outstretched hand.

Contrast-enhanced computed tomography (CT) is best for rapid and accurate diagnosis of intra-abdominal injuries, and a follow-up CT is important when clinical examinations suggest possible delayed splenic rupture. These injuries can be life threatening, and plain radiographs detect an ominous sign such as pneumopertioneum in only 30% of patients with visceral rupture. Ultrasound can be used when CT is not available or in patients who are hemodynamically unstable.

Abdominal injuries may be initially overlooked because of concomitant distracting upper extremity injuries, head trauma, or when riders are under the influence of alcohol and/or drugs.

Ankle injuries make up approximately 15%–20% of all snowboarding injuries, with half of these being fractures, primarily involving the lateral process of the talus (LPT).

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  Approximately one-third of ankle fractures in snowboarders involve the LPT.

  
  
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  This fracture is frequently seen in riders wearing soft boots that allow increased ankle flexibility.

Snowboarders are also at a risk of malleolar bursitis and pseudotumor of the ankle.

Malleolar bursitis develops as a result of repetitive friction from stiff snowboard boots, while pseudotumors occur due to compression of soft tissues between the lateral malleolus and snowboard boot.

Only 6% of snowboarding injuries involve the knee. Anterior cruciate ligament (ACL) injuries are infrequent and are primarily seen in advanced snowboarders landing flat after a jump or riding in the terrain park. Novice riders are at a risk of ACL injury while getting on and off lifts because this action requires one leg free for self-propulsion.

The incidence of hip dislocations in snowboarders is five times higher than in skiers.