This work done by 72 French doctors in the “Médecins de Montagne” skiing safety network studies the evolution of the rate of ACL ruptures since 1992. The study was done on 232 571 injuries including 21 303 ACL ruptures. Alpine skiing ACL ruptures, which have been increasing since 1992, represent 12.5% of accidents (3125 MDBI). A control group is analyzed each season through interviews at the bottom of the slopes in parking lots and random evaluations. We have ascertained that ACL ruptures represent 9.2% of total injuries in men, in comparison with 20% in women, over 24 years old. The case-control study, women versus men, stratified by age group, shows a remarkable ODDS ratio for adults (over 16 years old) with an extremely reduced confidence interval at 95% (3.26 < 3.41 < 3.56). The ISO adjustment charts do not currently take into account a major risk factor, the feminine sex. Among the possible preventive measures that can be taken for ACL ruptures in women is to evoke the decrease in adjustment values. There are no studies that prove the effectiveness of a decrease in adjustment values on the incidence of ACL ruptures, but there are corroborating arguments in favor of a positive action. The only risks of a decrease in the adjustment are extremely low, in particular that of inadvertent release. Different authors have demonstrated the possibility of a decrease in adjustment without inadvertent release. We suggest, beside the education of the skiers, in the prevention of the phantom foot, a 15% decrease in binding adjustment values for women over 25 years old, and 30% for beginners with less than 7 days of skiing.

This paper presents the study of the incidence of femur fractures and their epidemiological description in the French winter sports resorts. During the 1994, 1995, and 1996 seasons, 99.339 injuries were recorded by the 72 physicians of the “Médecins de Mon- tagne” Skiing Safety Network. These physicians are divided into 52 winter sports resorts. Their distribution is homogeneous across the entire French mountainous regions. During the 1994 season and in the Northern Alps region, we have studied the activity of the Hospital Rescue Service (SAMU in France) as well as a control group. The descriptive analysis confirms the increasing risk of femoral neck fractures among women over 55 and noted a lesser risk among female teenagers and young women. The incidence of femur fracture is 1.5/100 000 skiers per day or 65.769 MDBI (2.5/1000 skiers per day for all downhill injuries).

Because of concern with the difficulties encountered when removing rear entry ski boots from patients with lower limb injuries, an investigation was undertaken to determine if there are significant differences between the forces necessary to remove a rear entry boot and those necessary to take off a normal entry boot. This laboratory study used an articulated foot with an ankle joint. The angles of the ankle's joint were measured, and the pulling forces necessary to remove the foot from various models of usual and rear entry ski boots were recorded. Records were kept of several different people attempting to remove the boots. It was found that while it was possible to remove normal entry boots from the dummy's foot using reasonable force and without disturbing the foot's position, this was not the case with rear entry boots. In fact, according to the several different candidates, either extra forces were required or the position of the ankle joint had to be altered. Practice and training play a great part in this removal. It has been proven that a doctor trained in the methods of removing boots from the injured skier uses a lower pulling force than an engineer not familiar with such methods. Removing the boot without disturbing the ankle joint and using only reasonable force should be added to the existing standards concerning ski boots presently set by the industry.

No abstract

Avoriaz, a third generation ski-resort, located in the French Northern Alps, has been using, since the 1983/1984 winter season, a helicopter as a means of transportation for injured people. The Medical Center is located in the very heart of the resort and, moreover, in the very heart of a chair-lift network connecting 14 resorts. The helicopter is not used in every type of rescue, but it is used in about ¼ of them either for primary transportation for technical reasons or for secondary transportation. The use of the helicopter did not significantly increase the transportation costs but resulted in greater comfort both for the injured people, who were quickly rescued, and for the doctor. Indeed, because of quick transport, the doctor can take immediate care for the injured person who, consequently, does not get greatly chocked, suffer long, or suffer from cold.