# Distal Upper Limb Injuries in Skiing and Snowboarding: A Two-Season Study from a High-Volume Trauma Center in the Italian Dolomites

## TL;DR

This study examines wrist and hand injuries in skiers and snowboarders in the Italian Dolomites, finding that wrist fractures and thumb injuries are common and often linked to specific slope types and fall mechanisms.

## Contribution

The study provides new insights into the epidemiology and mechanisms of distal upper limb injuries in alpine sports, emphasizing the role of slope difficulty and fall techniques.

## Key findings

- Wrist fractures were more common on blue slopes, while UCL injuries were more frequent on red slopes.
- Female skiers had a higher incidence of complex forearm fractures.
- No patients reported using protective wrist or thumb supports.

## Abstract

Background and Objectives: Distal upper limb injuries are frequent in winter sports, but their functional impact is often underestimated. This study aimed to describe the epidemiology, mechanisms, and risk factors for injuries involving the forearm, wrist, hand, and fingers sustained during two consecutive winter seasons in the Italian Dolomites. Materials and Methods: All adult and willing patients presenting to the Emergency Department of Brixen Hospital after ski- or snowboard-related accidents between December 2023 and March 2025 completed a standardized 23-item questionnaire on demographics, experience level, environmental factors, equipment, and trauma mechanism. For the aim of this study only distal upper limb injuries were extracted and analyzed. Statistical analyses compared fracture versus non-fracture injuries, “good” versus “bad” fractures (AO classification and surgical complexity), and isolated ulnar collateral ligament (UCL) injuries. Results: A total of 195 patients were analyzed: 96 (49.2%) sustained a fracture and 33 (16.9%) presented with isolated UCL lesions. Fractures occurred more frequently on blue slopes (56.2% vs. 33.3%, p < 0.001), whereas non-fracture injuries predominated on red and off-piste slopes. Age, BMI, and skill level did not differ significantly between groups. Surgically classified complex distal forearm fractures were significantly more frequent in females (p < 0.005) but were not associated with environmental factors. UCL injuries occurred mainly on red slopes (54.5%) and were often related to pole entrapment during falls. None of the injured patients reported the use of protective wrist or thumb supports. Conclusions: Distal upper limb injuries are a common pattern of alpine sports trauma, with wrist fractures and skier’s thumb being predominant lesions. Low-speed falls on easy slopes are associated with wrist fractures, while UCL injuries are linked to intermediate slopes. Preventive strategies should include fall technique education, protective gloves, and improved pole ergonomics.