erratum to: the pattern of acute injuries in patients from alpine skiing accidents has changed...

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Archives of Orthopaedic and TraumaSurgeryIncluding Arthroscopy and SportsMedicine ISSN 0936-8051Volume 133Number 10 Arch Orthop Trauma Surg (2013)133:1367-1373DOI 10.1007/s00402-013-1822-6

The pattern of acute injuries in patientsfrom alpine skiing accidents has changedduring 2000–2011: analysis of clinical andradiological data at a level I trauma center

Marius C. Wick, Christian Dallapozza,Markus Lill, Cecilia Grundtman, IrisE. Chemelli-Steingruber & MichaelRieger

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Arch Orthop Trauma Surg (2013) 133:1367–1373DOI 10.1007/s00402-013-1822-6

ORTHOPAEDIC SURGERY

The pattern of acute injuries in patients from alpine skiing accidents has changed during 2000–2011: analysis of clinical and radiological data at a level I trauma center

Marius C. Wick · Christian Dallapozza · Markus Lill · Cecilia Grundtman · Iris E. Chemelli‑Steingruber · Michael Rieger

Received: 4 November 2012 / Published online: 28 July 2013 © Springer-Verlag Berlin Heidelberg 2013

and vascular arterial injuries statistically significantly decreased (p < 0.05, respectively). However, extremity fractures, facial fractures, and vertebral fractures increased (p < 0.04, respectively). The number of cerebral hemor-rhages, thoracic injuries, and abdominal injuries remained unchanged (p = NS). The mean (SD) number of all ini-tial radiological examinations per victim statistically sig-nificantly decreased from 2.3 (0.7) in 2000 to 1.5 (0.6) in 2011, whereas the admissions for acute CT have signifi-cantly increased (p < 0.02; respectively).Conclusions Acute radiological evaluation in skiing acci-dents has changed during the last decade. The decrease in overall cerebral injuries might be a function of the increas-ing use of skiing helmets. A protection of the extremities, trunk, spine, and face, however, needs further improve-ments and their radiological assessment with CT warrants attention in skiing casualties.

Keywords Accidents · Computed tomography · Injuries · Radiology · Skiing

Introduction

Recreational alpine skiing is a very popular winter sport and a strong economic factor for tourism and sport equip-ment industries in many parts of the world. In addition, inju-ries from skiing accidents are also a major reason for acute trauma hospital admissions and victims from skiing acci-dents are routinely subjected to many radiological assess-ments, making them an important medical factor for hospi-tals and outpatient trauma centers in skiing areas as well as a socioeconomic factor for insurance companies [1, 2].

With the introduction of high-tech composite materials in skies and boots during the last decades, skiing equipment

Abstract Objectives During the last decade, many educational efforts and technological improvements have been made to protect skiing athletes from injuries. Whether these efforts have changed the pattern of acute injuries from skiing casu-alties has not yet been shown on a medical basis, which this longitudinal study examines.Methods All patients transferred to the Department of Radiology of our level I trauma center for acute emer-gency computed tomography (CT) after alpine skiing acci-dents from 2000 to 2011 were included. We hypothesized that only patients with clinical suspicion for injuries were admitted for acute CT.Results Of all acute patients after skiing accidents, 2,252 could be included. From 2000 to 2011, all cerebral injuries

M. C. Wick (*) · I. E. Chemelli-Steingruber · M. Rieger Department of Radiology, Innsbruck Medical University, Anichstrasse 35, 6020 Innsbruck, Austriae-mail: [email protected]

I. E. Chemelli-Steingruber e-mail: [email protected]

M. Rieger e-mail: [email protected]

C. Dallapozza · M. Lill Department for Trauma Surgery and Sports Medicine, Innsbruck Medical University, Innsbruck, Austriae-mail: [email protected]

M. Lill e-mail: [email protected]

C. Grundtman Laboratory of Autoimmunity, Division of Experimental Pathophysiology and Immunology, Biocenter, Innsbruck Medical University, Innsbruck, Austriae-mail: [email protected]

Author's personal copy

1368 Arch Orthop Trauma Surg (2013) 133:1367–1373

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has made technological and qualitative developments with both improvements in comfort of skiing for the general rec-reational skier and increased speed for professionals and the thrill-seeking amateur. Moreover, the development of carv-ing skies with novel binding technologies, fashionable skiing helmets as well as the production of artificial snow and icy slopes to prolong the skiing season from late autumn until late spring for mass tourism has also changed skiing indus-try. Many educational efforts have been made to protect skiing athletes from injuring themselves. Thus, the use of skiing helmets and back protectors has also become stand-ard equipment for almost every recreational skier. However, whether all these developments have decreased the number and severity of injuries from skiing accidents, the pattern of casualties, and/or the acute clinical and radiological manage-ment of patients admitted to the emergency unit from acute skiing accidents have not yet sufficiently been investigated on a medical basis over a long observation period.

The number of patients admitted to the doctor as a result of skiing casualties is constantly high [3–5]. In the clinical routine of acute emergency responses, in addition to initial clinical examination including full man clinical scans with palpation and careful exploration, radiological evaluations are of major importance. Moreover, in clinical practice of acute evaluation of seemingly injured patients after skiing accidents, the use of computed tomography (CT) as one of the first-line radiological evaluations has gained momentum since the development of fast- and low-dose X-ray CT technology has been introduced and affordable scanners have become availa-ble in many hospitals, not only in level I trauma centers [6, 7].

Notwithstanding the general increasing use of imaging in medicine, there are considerable reasons to hypothesize that only patients with a clear clinical suspicion for inju-ries after skiing accidents underwent radiological assess-ments and are admitted for acute emergency CT. Thus, in combination with the clinical diagnosis and outcome, the results of the CT examinations could be used as sta-ble biomarkers for longitudinal injury characterization. At the Innsbruck Medical University Hospital, which is the primary level I trauma center in western Austria, a sta-tistically stable and continuous high number of hospital admissions during the winter seasons due to alpine skiing accidents (Dallapozza et al. unpublished data) offer the possibility to longitudinally investigate whether the pat-tern of skiing injuries has changed over the years, which this present study examines.

Materials and methods

The institutional review board waived informed consent for this retrospective study, which was approved by the regional ethics committee.

As mentioned, the main hypothesis of this study was that only patients with a clear clinical suspicion for injuries after skiing accidents underwent radiological assessments and those with a high suspicion for injuries were admitted for acute emergency CT. Therefore, an analysis of the radi-ological reports and clinical diagnoses in the whole collec-tive of patients who had CT as one of their first-day acute emergency injury evaluation should be a representative bio-marker for long-term injury characterizations.

Thus, using the study data, the aim of the study was two-fold: (1) injury characterization over the whole observation period and (2) investigation of the development of radio-logical assessments in skiing casualties over time.

Patients

We identified all inpatient and outpatient visits to the CT of the Department of Radiology of the Innsbruck Medi-cal University Hospital that were the results of a skiing accident emergency from 1st September 2000 to 31st May 2011. An annual skiing season was defined as the time between the 1st of September until the 31st of the follow-ing May. Acute casualties were only included if the ski-ing accident happened on the day of hospital admission. Patients from snowboarding accidents were not included.

Using full-text searches in the local electronic patient archives and electronic radiology files, we analyzed the clinical characteristics, hospital admissions, type of injury, radiological management, radiological diagnoses, and clinical outcomes of all skiing accident victims admitted for acute CT examinations during 2000–2011. Clinical data and information about accident mechanism, rescue, and transportation of victims were extracted from the local electronic patient files archive (Powerchart, Cerner, MO, USA), which records all diagnostic codes according to the International Classification of Diseases (ICD-10; 1997–pre-sent) for each patient at discharge. Patients who died during transportation or in the emergency room were not included in these analyses. One full day of hospital admission was defined as one overnight stay as an inpatient. Radiological information about each included case was reviewed from the clinical radiological archiving and communication sys-tem (J Vision, Tiani Medgraph AG, Austria; IMPAX, Agfa Healthcare NV., Mortsel, Belgium) and radiology reports.

Radiology

In 1999, whole-body CT protocol was introduced at our department together with the installation of a 4-detector row MDCT (LightSpeed Qx/i, General Electric Medical Systems, Milwaukee, WI, USA). In 2006, a 64-detector row MDCT scanner (LightSpeed VCT, General Electric Medical Systems, Milwaukee, WI, USA) was installed at


1369Arch Orthop Trauma Surg (2013) 133:1367–1373

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our emergency radiology unit. Since then, the “Innsbruck Emergency Algorithm”, which includes assessment of the neck and brain as a CT angiography during initial whole-body CT, was regularly used at our hospital in all clinical seemingly poly-traumatic patients [6, 7].

Statistical analysis

Descriptive analysis investigated patient demographics, accident data, radiological examinations, and diagnoses. A summary variable recorded the number of admissions due to skiing accidents each year. This variable was the depend-ent variable in linear regression analysis, with the year of discharge as the independent variable and 95 % confidence intervals (CI). Spearman’s rank correlation coefficient was used to identify associations between the number of diag-noses and the length of hospital stays. Student’s t test com-pared groups. The level of significance was p ≤ 0.05. Data are given as mean ± standard deviation (SD). All statisti-cal analyses were performed using SPSS 11.6 for Windows (SPSS, Chicago, IL, USA).

Results

During 2000–2011, a total of 7,504 acute emergency patients [4,578 males (61 %)/2,926 females; mean (SD) age 35 (18)] were registered at the Radiology Department from recreational alpine skiing accidents (Table 1). Of those, 2,332 were admitted as supine patients (332 via the emer-gency room/shock room) and 5,047 could enter the hos-pital by themselves, walking. In 125 victims, the mode of admission has not been registered in the electronic patient files. The overall annual number of hospital admissions due to skiing accidents was stable over the whole observation period (Dallapozza et al. unpublished data; manuscript in preparation). During the whole observation period, a total of 87 individuals died due to a skiing accident either at the accident site, during transportation to the hospital, in the emergency room, or during hospitalization (2000–2001: 8 victims; 2001–2002: 5 victims; 2002–2003: 4 victims; 2003–2004: 10 victims; 2004–2005: 8 victims; 2005–2006: 13 victims; 2006–2007: 8 victims; 2007–2008: 7 victims; 2008–2009: 9 victims; 2009–2010: 7 victims; 2010–2011: 10 victims) [8].

Of all 7,504 patients, 2,252 (30 %) clinically seemingly severely injured patients [1,536 males (68 %)/716 females; mean (SD) age 38 (19)] required acute CT examinations at the day of admission and 1,892/2,252 (84 %) needed immediate inpatient admissions for a mean (SD) hospital stay of 6 (11) days (range 1–300). Of all study patients who needed immediate hospitalization, 590/1,892 (31 %) had to undergo surgery during their hospital stay. There was a

statistically significant correlation between number of inju-ries and length of hospital stays (r = 0.8, p < 0.03).

According to the clinical and radiological examinations at our hospital, all included patients had a mean (SD) of 2.3 (0.1) trauma-related ICD-9/ICD-10 diagnosis per indi-vidual. Statistically, the most frequent diagnosis per ski-ing accident victim was a rib fracture in 0.4 (0.1) cases per patient followed by cerebral concussion in 0.3 (0.1), facial abrasion in 0.18 (0.04), and facial fracture in 0.17 (0.1) (Table 1). In 0.12 (0.04) cases, skiing accident victims were diagnosed with a thoracic vertebral fracture and both (SD) in 0.08 cases with lumbar (0.03) or cervical (0.04) vertebral fractures (Table 1). The most frequent traumatic injuries of the extremities were tibia fractures in 0.05 (0.03) cases/ski-ing accident victim, followed by fractures of the humerus in 0.04 (0.03) cases and clavicula in 0.02 (0.04) (Table 1).

From 2000 to 2011, the number of patients diagnosed with extremity fractures, facial fractures, and vertebral fractures statistically significantly increased over the whole observation period (Fig. 1; p < 0.04, respectively). How-ever, the number of victims diagnosed with overall cerebral injuries including cerebral concussion (11 vs. 4 %) or vas-cular arterial injuries (1 vs. 0.5 %) statistically significantly decreased (Fig. 2; p < 0.05, respectively). The number of cerebral hemorrhage (Fig. 4), thoracic injuries and abdomi-nal injuries remained unchanged (p = NS; data not shown).

The mean (SD) combined use of initial acute radiologi-cal examinations at day of admission, viz., plain radiogra-phy, sonography, magnetic resonance tomography (MRT), angiography, or CT per study patient has statistically sig-nificantly decreased from 2.3 (0.7) during the skiing sea-son 2000/2001 to 1.5 (0.6) during the season 2010/2011 (r = 0.83; p < 0.02; Fig. 3). Thus, a mean (SD) number of 1.7 (0.6) radiological techniques (including initial CT) have been performed at the first day of clinical presenta-tion in 2000–2011 (Table 1). These comprised a mean (SD) number of 1.4 (1.5) anatomical regions per victim assessed by conventional radiography, 1.0 (0.1) initial CTs, 0.1 (0.3) acute sonographies, 0.02 (0.1) magnetic resonance tomog-raphies, and 0.01 (0.1) conventional angiographies per victim.

The use of conventional radiography during initial clini-cal assessment has statistically significantly decreased from 2.6 (2) anatomical regions per patient during 2000/2001 to 0.7 (1.3) during 2010/2011 (r = 0.88; p < 0.01; Fig. 3), whereas the overall number of admissions for acute CT evaluation has statistically significantly increased (r = 0.92; Fig. 4; p < 0.01). In 923/2,252 victims (41 %), CT was the only radiological assessment during the first clinical evaluation. Moreover, only the low number of admissions for acute sonographies during emergency radio-logical evaluation has decreased over the whole observa-tion period (r = 0.71; p < 0.03; Fig. 3).



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Discussion

During the last 10 years, the development of novel skiing technologies, viz., short carving skis together with the pro-duction of comfortable boots and bindings that allow for an increased curve speed, has certainly changed the popu-larity of this sport and skiing technique in general [9]. In addition, developments in slope preparation with the over-all country’s production of artificial snow even before and long after the traditional skiing season have lead to icier, faster, and therefore seemingly more dangerous skiing tracks with an increased risk of injuries in cases of falls on the hard surface.

In skiing accidents, which have to be considered high-speed accident mechanisms, especially the head and neck area is endangered for blunt trauma since a sufficient protection of the cervical spine against hyperextension, hyperflexion, or rotational mechanisms in the case of falls, is mostly neglected among athletes due to the loss of both mobility and comfort in sports action. The same applies for the protection of the trunk and extremities. It needs to be mentioned, however, that a protection of the latter regions with “uncomfortable”, rigid, or specially cushioned equipment may lead to a reduced mobility and flexibility, which might again lead to an increased risk of falls.

Table 1 Demographic characteristics, clinical details, and radiology details of study population

SD standard deviationa All clinical seemingly injured skiing accident victims who required acute CT examinationsb Sampling of the 12 most frequent skiing injuries of study population during 2000–2011c Plain radiography, sonography, magnetic resonance tomography (MRT), angiography, or computed tomography (CT)

Details Numbers

Demographic characteristics

All skiing accident victims admitted to Innsbruck Medical University Hospital during 2000–2011 7,504

Mean age (SD) of all skiing accident victims in years 35 (18)

Gender of all skiing accident victim (male/female) 4,578 (61 %)/2,926

Admitted as supine patients 2,332

Clinical seemingly severely injured victims who required acute CT examinationa 2,252

Mean age (SD) of clinical seemingly injured skiing accident victims in yearsa 38 (19)

Gender of clinical seemingly severely injured victims (male/female)a 1,536 (68 %)/716

Immediate inpatient admissionsa 1,892

Mean (SD) duration of hospital stay in daysa 6 (11)

Surgical treatment during hospital staya 590

Injuriesa, b

Rib fracture 0.4 (0.1)

Cerebral concussion 0.3 (0.1)

Facial abrasion 0.18 (0.04)

Facial fracture 0.17 (0.1)

Thoracic vertebral fracture 0.12 (0.04)

Thoracic contusion 0.1 (0.04)

Lumbar vertebral fracture 0.08 (0.03)

Cervical vertebral fracture 0.08 (0.04)

Pneumothorax 0.06 (0.02)

Subarachnoidal hemorrhage 0.06 (0.03)

Kidney injury 0.05 (0.03)

Tibia fracture 0.05 (0.03)

Radiologya

Mean (SD) number of radiological techniques used per patient at admission during 2000–2011c 1.7 (0.6)

Victims initially only undergoing CT 923

Mean (SD) number of anatomical regions for conventional radiography per victim at admission during 2000–2011 1.4 (1.5)

Mean (SD) number of acute sonographies per victim as initial radiological investigation during 2000–2011 0.02 (0.1)

Mean (SD) number of acute angiographies per victim as initial radiological investigation during 2000–2011 0.01 (0.1)

Mean (SD) number of acute MRT per victim as initial radiological investigation during 2000–2011 0.01 (0.1)



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2000-2001 2001-2002 2002-2003 2003-2004 2004-2005 2005-2006 2006-2007 2007-2008 2008-2009 2009-2010 2010-2011

Skiing season

Mean number of vertebral fractures/skiing accident victim

Mean number of fractures of the extremities/skiing accident victim

Mean number of skull fractures/skiing accident victim

*

*

* * **

**

#

# #

##

0.25

0.2

0.15

0.1

0.05

0

n

Fig. 1 Mean numbers of diagnosed vertebral fractures, extremity fractures, or skull fractures per study patient, respectively, showing statisti-cally significant increases during 2000–2011. §, *, # p < 0.04, respectively

# # ##

## #

* * * * * * * *2000-2001 2001-2002 2002-2003 2003-2004 2004-2005 2005-2006 2006-2007 2007-2008 2008-2009 2009-2010 2010-2011

Skiing season

Mean number of vascular injuries/skiing accident victim during 2000-2011

Mean number of cerebral injuries/skiing accident victim during 2000-2011

Mean number of cerebral hemorrhage/skiing accident victim during 2000-2011

0.16

0.14

0.12

0.1

0.06

0.04

0.02

0.08n

Fig. 2 The mean number of cerebral hemorrhages remained unchanged during 2000–2011, whereas the mean numbers of overall cerebral injuries (including cerebral concussions) and vascular arte-

rial injuries per skiing accident victim, respectively, showed statisti-cally significant decreases. *, #p < 0.05, respectively



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In our study, we were able to demonstrate that the fre-quency of registered overall cerebral injuries, including the diagnosis of cerebral concussions, has markedly been reduced during the years 2000–2011. The observed decrease in overall cerebral injuries from 11 to 4 % of all diagnoses per victim might be at least partially a function of the increasing

use of skiing helmets. Nevertheless, sub-analysis of all cere-bral injuries showed that the number of cerebral hemorrhages has not changed during 2000–2011, indicating that the exter-nal forces on the head during a skiing accident have increased due to higher speed and accident victims might have even more severe intracerebral injuries without helmets.

2000-2001 2001-2002 2002-2003 2003-2004 2004-2005 2005-2006 2006-2007 2007-2008 2008-2009 2009-2010 2010-2011

Skiing season

Mean number of radiological modalities/skiing accident victim at hospital admission

Mean number of anatomical regions/skiing accident victim assessed by conventional radiography at hospital admission

Mean number of acute sonographies/skiing accident victim at hospital admission

* * * ** *

**

# # # # # # # # #

3

2.5

2

1.5

1

0.5

0

n

Fig. 3 Mean numbers of radiological modalities, anatomical regions assessed by conventional radiography, and acute sonographies per study patient, respectively, referred to the Innsbruck Medical University Hospital during 2000–2011. §p < 0.01; *p < 0.02; #p < 0.03

0

50

100

150

200

250

300

350

400

2000-2001 2001-2002 2002-2003 2003-2004 2004-2005 2005-2006 2006-2007 2007-2008 2008-2009 2009-2010 2010-2011

Skiing season

Total number of CT examinations due to skiing accidents

*

n

Fig. 4 Total annual numbers of acute computed tomographies (CT) of patients admitted to the Innsbruck Medical University Hospital due to skiing accidents during 2000–2011. *p < 0.01



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The overall numbers of extremity fractures, facial frac-tures, and vertebral fractures statistically significantly increased over the whole observation period, demonstrat-ing that a protection of the extremities, trunk, spine, and face needs further improvements and their potential inju-ries warrant diagnostic radiological attention in skiing casualties.

The use of different radiological methods in initial emergency investigations aims to accelerate clinical deci-sions and optimize patient care and prognosis. However, in some patients, the critical nature of emergency care (e.g., in unconscious people) does not always allow full radio-logical assessment (e.g., initial conventional radiographical evaluation or ultrasound), but often immediate whole-body CT, according to the “Innsbruck Emergency Algorithm” can be performed and diagnoses whole-body injuries at a glance, despite the potential downside of radiation [6, 7]. For individuals admitted after high-speed mechanisms such as skiing accidents victims, radiological examinations proved beneficial and are useful to avoid overlooking inju-ries. However, many clinically overt injuries and that do not require therapy are only diagnosed after radiological assessment. An over-expression of such diagnoses might partially influence the generality of our results.

The increased use of whole-body CT and simultane-ous decrease of ultrasound [despite the efforts to establish sonography as standard in the emergency room (FAST)] and conventional radiography during the observation period cannot have only been due to the faster availabil-ity of the CT machine at the emergency unit but might be mainly a result of the increasing awareness of the supe-rior efficacy of CT in markedly minimizing the possibility of overlooking covert injuries, as shown before by Wick and Rozycki [6, 10]. In the clinical routine of the emer-gency department, the referring physician initiates the type and frequency of radiological examinations. The observed statistically insignificant peak of CT examinations during season 2006/2007 (Fig. 2) might be in part explained by the installation of a fast 64-detector row MDCT scanner at our emergency radiology unit in 2006 and the following increased initial use of the novel technology because of its new possibilities, e.g., CT-angiographies or three-dimen-sional reconstructions of fractures. Nevertheless, overall the numbers of admissions for acute CT evaluations have statistically significantly increased already before and further more after the installation of the 64-detector row MDCT scanner in 2006. The use of the appropriate radio-logical technique is sometimes also limited by other fac-tors, e.g., critically compromised condition of the victim, lack of time, need for rapid surgical intervention, avoid-ance of radiation in children, lack of knowledge amongst referring physicians about the existence of certain CT

algorithms, and limited technical experience of some radiologists. It should also be mentioned that the Inns‑bruck Medical University Hospital is a primary level I trauma institution and the possibility that seriously injured patients were more likely to be transferred to our trauma center than patients at minor risk must be considered. In addition, also injured patients themselves, even after minor accidents, are more likely to visit our technologically and personally highly equipped emergency center than other smaller hospitals in the area, limiting the generality of our results. Patients who died during transportation or in the emergency room were not included in these analyses. However, the number of fatal skiing casualties was rela-tively small compared to the overall number of skiing inju-ries so that the final cohort size is large enough to absorb a small number of fatalities without significantly altering the study results [8].

In conclusion, our study based on the results of an analysis of a very large cohort demonstrate that patients from skiing accidents are at great risk of multiple trauma and radiological examinations, especially CT, are of great importance for accurate emergency diagnosis. Moreover, the acute emergency radiological evaluation in patients admitted from skiing accidents has changed during the last decade and skiing accident victims need full-body diagnos-tic radiological attention in their casualties.

References

1. Hunter RE (1999) Skiing Injuries. Am J Sports Med 27:381–389 2. Hentschel S, Hader W, Boyd M (2001) Head injuries in skiers and

snowboarders in British Columbia. Can J Neurol Sci 28:42–46 3. Burtscher M, Nachbauer W (1999) Verletzungsrisiko österrei-

chischer Skiläufer im Vergleich der Verletzungsmuster von Nor-mal- und Carvingskifahrern, In: Österreichisches Kuratorium für Alpine Sicherheit. Sicherheit im Bergland, Innsbruck, pp 107–115

4. Johnson RJ, Ettlinger CF, Shealy JF, Meader C (1997) Impact of super sidecut skis on the epidemiology of skiing injuries. Sport-verletz Sportschaden 11:150–152

5. Langran M, Selvaraj S (2002) Snow sports injuries in Scotland: a case-control study. Br J Sports Med 36:135–140

6. Wick MC, Weiss RJ, Lill M, Jaschke W, Rieger M (2010) The “Innsbruck Emergency Algorithm” avoids the underdiagnosis of blunt cervical vascular injuries. Arch Orthop Trauma Surg 130:1269–1274

7. Wick MC, Weiss RJ, Hohlrieder M, Tecklenburg K, Jaschke W, Rieger M (2009) Radiological aspects of injuries in avalanche victims. Injury 40:93–98

8. Source: Kuratorium für Alpine Sicherheit; www.alpinesicherheit.at 9. Natri A, Beynnon BD, Ettlinger CF, Johnson RJ, Shealy JE

(1999) Alpine ski bindings and injuries. Current findings. Sports Med 28:35–48

10. Rozycki GS, Ochsner MG, Jaffin JH, Champion HR (1993) Pro-spective evaluation of surgeons’ use of ultrasound in the evalua-tion of trauma patients. J Trauma 34:516–527


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erratum to: the pattern of acute injuries in patients from alpine skiing accidents has changed...

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