WRIST GUARDS FOR SNOWBOARDING

If you haven't already seen it, you should first of all read my information on wrist injuries in snowboarding before you work your way through this page.
 

Is there any evidence that wrist guards reduce the chances of breaking your wrist?


Snowboarding is not the only sport with a high rate of wrist injuries. Roller (in-line) skating is one such sport with a previously reported wrist injury rate of between 25 - 43%. Wrist guards are now worn by up to 33% of all skaters, with 54% of skaters wearing some form of protection (wrist, knee or elbow). It would seem that the wrist injury rate has now decreased amongst in line skaters. So, could wrist guards be the answer for snowboarders? The answer has come from three levels of evidence - laboratory based, epidemiological and randomised case/control studies.

The laboratory-based scientific studies that have been performed in this area are a bit bizarre – basically taking both arms off dead people, fitting one of them with a guard and leaving the other without and then seeing how much force it takes to break each wrist by simulating a fall. Four studies have now shown that, in the wrist with the guard on, one way or another more energy is needed to cause a fracture and that the fractures that do eventually occur are of a reduced severity.  So now you know what really happens when you leave your body to medical science…Although these studies provide some important information, it was still argued that these laboratory conditions are unlikely to be exact replicas of the situation on-piste when a snowboarder falls.

The next bit of evidence came from epidemiological studies. The biggest of these was the Colorado Snowboard Injury Survey. Collating information from over 7000 snowboard injuries, this study demonstrated that snowboarders wearing wrist guards were half as likely to injure their wrists as snowboarders not wearing guards. A more convincing piece of evidence still but not quite enough for some. What was really needed was a study where a group of snowboarders were taken and half (taken completely at random) were given guards and half were not. In addition, there must be no major differences between the two groups in terms of age, sex, ability etc. For guards to be truly effective, the number of wrist injuries would have to be significantly lower in the group wearing guards. This is called a randomised controlled trial and provides very strong evidence - one way or the other.



Well, we now have the benefit of three such trials and they all fortunately reached the same conclusion - that wearing  wrist guards reduces the risks of sustaining an injury to the wrist. RØnning et al in Norway took 5029 snowboarders and gave wrist guards to one half of the group. They demonstrated a significant reduction in wrist injuries in the group wearing guards. Machold et al did the same in Austria, this time with a group of 721 boarders. There were no wrist injuries in the group wearing guards but 9 serious wrist injuries in the group not wearing guards. Finally, O'Neill compared two groups of first-time snowboarders - 551 wearing guards that he had given them and 1800 who did not wear guards (acting as the control group). Once again, no wrist injuries were seen in the group wearing guards compared to 40 such injuries in the group without guards on.

Finally, the most recent paper on the topic is perhaps the most important of all. Russell, Hagel and colleagues published an overview of all the studies on wrist guards in snowboarding - what's known in the business as a systematic review. They conclude "Regardless of study design our analysis shows consistently that wrist guards significantly reduce the risk of wrist injuries". They also demonstrate that beginner snowboarders are the group who get the maximum benefit from wearing wrist guards.

So there you have it. There really is no escaping the significance of all these trials and studies which really do provide conclusive proof that wearing a wrist guard of some description protects against wrist injuries amongst snowboarders. There is a bit more to it than this though, as you can read below!


 

So if they work, why don't boarders wear guards?!


Good question! In most countries, less than 10% of all boarders wear guards. There are many reasons for this - boarders consider them to be uncool, too expensive, uncomfortable to wear etc. Snowboarding has always enjoyed a cool image and wearing guards would seem to go against this image. Having said that, in my opinion, nothing is more uncool than not being able to snowboard - which is the case if you break your wrist. Virtually without exception, every snowboarder I have treated in the last five years with a wrist fracture has said something along the lines of "...I'll definitely be getting some guards now...." (as they wince in agony until I get the morphine flowing...). What a pisser they had to endure pain and subsequent time away from the snow to learn the lesson. I did some research a while ago at my ski area asking just under 250 snowboarders who didn't wear guards the reasons why. The answers given (people could answer yes to more than one) are given below.

Reason for not wearing wrist guards
%
No need 32.8
Can't get hold of them 16.2
Too expensive 10.8
Don't like the look of them 2.5
Uncomfortable to wear 27.0
Won't protect against injury 8.3
Wasn't aware of them 22.1


To comment on a couple of these points, guards are now more widely available - see below for some recommendations and details. The final thorny issue which is not so easy is the "no need" argument. I accept that the absolute risk of an injury is very low. But, for the sake of £40 or so, do you really want to take the risk of injuring your wrist and being unable to snowboard, perhaps for a very long time....?
 

Don't wrist guards lead to injury further up the arm?

           
O.M.G!!!  This is an old chestnut with very little actual basis in fact but it still rears its ugly head far too frequently! In 1995 (15+ years ago now), Cheng et al reported four cases where skaters (not snowboarders) wearing wrist guards sustained open forearm fractures immediately proximal to the wrist guard. They hypothesised that the guard could transfer the energy of impact from the hand to the mid-forearm level. Their report did not describe the splints each individual was using or if they were fitted properly. Whilst it may sound a cautionary note, very few other case reports have been forthcoming out of the many thousands of skating injuries occurring every year.

You also have to remember that inline skating and snowboarding are different sports. Skaters usually fall onto concrete surfaces (consequently with a more abrupt stop involved). I am only aware of two individual cases where snowboarders wearing guards have sustained upper arm fractures, possibly as a result of wearing a guard. This must be compared to the thousands of potential wrist injuries that guards have prevented or reduced in severity. Subsequent biomechanical studies do not support Cheng’s theory and, in fact, demonstrate that one of the protective effects of guards is to dissipate impact energy safely throughout the device without increasing the forces at any one spot.

I am very keen to hear from any other boarders who have broken their arms - at the upper level of the guard (i.e. not at the wrist itself) - whilst wearing wrist guards. The more details you can give about the accident, guard type, size etc the better. Please email me. I will get back in touch with you and this information will be used to collate a database so that this issue can continue to be looked at. So far, after four years of asking, only two snowboarders have come forward with such injuries. In neither case could you definitely pin the blame specifically on the wrist guard, it might have happened anyway. Even so, two injuries is not alot compared to the estimated 75,000 wrists that get broken every season as a result of snowboarding.

The July 15th 2005 issue of the American Journal of Epidemiology published a piece of research by Hagel and colleagues from Canada. They studied 19 ski areas to determine the protective effect of wrist guards on injury. They found that overall wearing wrist guards reduced the risk of a hand, wrist or forearm injury by 85%. This was a statistically significant finding (i.e. it didn't just happen by chance). They also found a non-significant finding of a possible increased risk of injury to the shoulder or upper arm as a consequence of wearing wrist guards. This result may have occurred by chance. Even if it didn't, it is still the case that a wrist fracture is a more severe injury than an injury to the shoulder or upper arm.

Even more recently than this, another paper that I have already mentioned (by Russell, Hagel and colleagues), after looking at all the studies on wrist guards in snowboarding (a so-called systematic review) has concluded that there is no proof of an increase in other arm or shoulder injuries amongst those boarders who wear wrist guards.

So I really think we can lay this one to rest once and for all..... until the next time someone emails me or writes it on a snowboard forum!

 

OK, so what about wrist fractures under the guards?

Of course, no wrist protection system could ever claim to prevent all wrist injuries from occurring - sometimes the forces are simply too great. In addition, some guards currently on the market have been seen to lead to unusual fractures directly under the guard itself. This has been most recently reported by the Medicins de Montagne group of doctors in the French Alps. At the ISSS meeting in 2005, they reported on a series of cases where boarders wearing very short and rigid guards (designed originally for in-line skaters) had sustained wrist fractures directly under the guard. The take home message is that not every guard is as good as you might hope it will be in every situation, although I would say that I personally think wearing one of these guards is better than wearing no guard at all.

Thanks to my good friend Dr Marc Binet from Avoriaz for the illustrative photo and x-ray below.

An example of a nasty fracture of the radius and ulna wrist bones occurring directly underneath a short, rigid wrist

Since posting these pictures, I have received a lot of emails from boarders who use these guards asking if they are still ok to use. My reply is that personally I would prefer a different system such as Flexmeter or Biomex (see below) but that short guards like those shown above are still likely to be better than no guards. It's your money and choice to decide to buy a different pair of guards.
 

The need for a standard for wrist guards


The real problem at the moment is the lack of a recognised standard for wrist guards - like there is for most other bits of protective equipment such as helmets. Standards ensure that the products can withstand certain forces under testing and give added reassurance that the product (in this case a wrist guard) may actually do what it claims it will! At the moment,  its very hard for us all to know which particular wrist guard is actually more likely to protect against injury. This is something that the ISSS recognises as an urgent problem. Fortunately, the pressure has begun to have an effect as the American ASTM organisation is now considering the setting of a standard for snowboarding wrist guards.  A recent study from the French Alps has provided some evidence to support what l have been suggesting for a couple of years now - namely, that to provide maximum protection a standalone snowboard wrist guard should:

  • Have a degree of flexibility in the guard material - rigid inserts may be more likely to cause the sort of fracture shown in the pictures above
  • Have protection situated along the back of the wrist (the most important spot), with or without protection on the palm side and
  • Extend some distance up the forearm and not be of the short stubby type used by inline skaters (this type of guard is designed to slide along concrete/tarmac surfaces. Quite different to a fall on snow)


In the next section of this page, I make some suggestions for guards currently on the market. My personal preferences would be the Flexmeter or Biomex systems - both of these have been designed by doctors active in the management of snow sports injuries and both have considerable data to support their effectiveness.

In summary then, I think you can see that I (and my colleagues around the world) are very pro wrist guards! But we have our reasons - not the least of which is that we hate seeing so many young snowboarders with such painful injuries. I particularly hate seeing beginners injured because for snow sports to survive we have to encourage new people to take them up and an injury early on is unlikely to inspire someone to come back. I personally think that guards should be a routine part of a beginner snowboard hire package. I am also working to make information available at each ski area to make snowboarders aware of wrist guards and what they can do. It will take time, but it has happened before when other equipment advances proved beneficial. Once people realise that they can reduce the risk of injury, hopefully we will continue to see more guards being worn on the slopes and less “dinner fork” wrists in our patrol and casualty rooms. Time will tell…

 

Some recommendations for wrist guards


Flexmeter

Developed by ISSS member Dr Marc Binet from Avoriaz in France, the Flexmeter has a wide range of products including stand alone guards and integrated glove/guard systems. It is based on the premise that most wrist fractures result from hyperextension (the wrist getting forced backwards). The Flexmeter specifically prevents this happening using flexible Dupont materials. The very latest data for them is based on a 3 year case-control study at 3 ski areas in France where two groups of beginners were studied - one group wearing Flexmeters and the others wearing no guards. 2% of the group with guards on sustained a wrist injury compared to 11% in the group with no guards (this is a statistically significant result). Importantly, in the group wearing Flexmeters, there were no injuries seen above the guard on the arm. Flexmeter studies continue to be performed and hopefully will lead to more information in due course.

To find out more, visit the Flexmeter website. In the UK, you can buy Flexmeters online from Alpsgear. (www.alpsgear.co.uk). Current prices are £35.99 for the single wrist guards, £40.99 for the double system and £59.99 - £79.99 for the Flexmeter gloves (depending on size).

To buy Flexmeters in other countries, follow these links:

USA - www.flexmeters.com
France - http://www.skimeter.com/fr/flex/fr_flexmeter.php
Germany - www.flexmeter.de
Netherlands - www.flexmeter.nl (for the English version, click here)

The YouTube video below has been produced by the UK importers of Flexmeters.

Biomex

The Biomex Protection system has been developed in St Moritz by another respected ISSS member, Dr Georg Ahlbaumer - himself a keen snowboarder. Its design has been integrated into the Level range of gloves with such products as the Half Pipe GTX Biomex gloves and the Fly GTX gloves. You can visit the Biomex Protection website here.

I receive a lot of emails from boarders who have different guards from Flexmeters or Biomex asking if their guards are ok or not. If you have any other kind of wrist guard, my personal feeling remains that on balance it is likely to be far better than wearing no wrist guards at all. But if you had the choice and the money to spend, then I would recommend one of the two systems mentioned above or something similar.

 

References


1. Schieber RA et al. In-line skating injuries. Epidemiology and recommendations for prevention. Sports Med. 1995 June; 19(6): 427-32

2. Schieber RA et al. Risk factors for injuries from in-line skating and the effectiveness of safety gear. NEJM. 1996 Nov 28; 335(22): 1630-5

3. Warda L et al. An observational study of protective equipment use among in-line skaters. Inj Prev 1998 4(3): 198-202

4. Lewis LM et al Do wrist guards protect against fractures? Ann Emerg. Med 1997 29(6):766-769

5. Greenwald RM et al. Dynamic impact response of human cadaveric forearms using a wrist brace. Am J Sports Med 1998 26(6):825-30

6. Staebler MP et al. The effect of wrist guards on bone strain in the distal forearm. Am J Sports Med 1999 27(4): 500-506

7. Cheng SL et al. “Splint top” fracture of the forearm: A description of an in-line skating injury associated with the use of protective wrist splints. J. Trauma 1995 39(6): 1194-1197

8. Idzikowski JR, Janes PC, Abbott PJ. Upper extremity snowboarding injuries. Ten-year results from the Colorado Snowboard Injury Survey. Am J Sports Med. 28(6): 825-832, 2001

9. Rønning R, Rønning I, Gerner T et al. The efficacy of wrist in preventing snowboarding injuries. Am J Sports Med. 29(5): 581-585, 2001

10. Machold W, Kwasny O, Eisenhardt P et al. Reduction of severe wrist injuries in snowboarding by an optimized wrist protection device: A prospective randomized trial. J Trauma. 52(3): 517-520, 2001

11. Sasaki K, Takagi M, Ida H et al. Severity of upper limb injuries in snowboarding. Arch Orthop Trauma Surg 1999; 119: 292-295

12. O'Neill DF. Wrist injuries in guarded versus unguarded first time snowboarders. Clin Orthop. 2003; 1(409): 91-95

13. Hagel BE et al. The effect of wrist guard use on upper-extremity injuries in snowboarders. Am J Epidemiology. 2005; 162(2): 149-156

14. Russell, K et al. The effect of wrist guards on wrist and arm injuries amongst snowboarders: A systematic review. Clin J Sports Med. 2007; 17:145-150



 

 



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