Imaging of hand and wrist injuries in alpine skiing: common injury mechanisms, imaging findings, and treatment

Alpine skiing is associated with characteristic patterns of hand and wrist trauma, which together account for approximately 11% of all injuries in this sport. These injuries typically result from high-velocity falls, pole-related mechanisms, and collisions with infrastructure, including lift pylons and barriers. This review provides an overview of common hand and wrist injuries in alpine skiers, with emphasis on skiing-specific mechanisms, characteristic imaging findings, strengths and limitations of different imaging modalities, as well as clinically relevant implications. Although some of the described injury patterns and imaging considerations may also occur in other skiing disciplines and other sports, this review focuses specifically on alpine skiing. Discussed fractures include those of the fingers, base of the first metacarpal (Bennett and Rolando fractures), scaphoid, and distal radius. Soft-tissue injuries encompass frostbite and skiing-related injuries of ligaments, tendons, and volar plates. In most cases, conventional radiographs are the first-line imaging modality, while CT, MRI, and ultrasound are used selectively depending on the suspected injury pattern, particularly for detailed assessment of fractures, ligament integrity, and tendon injuries. An accurate evaluation of typical imaging patterns is essential for guiding treatment strategies and improving clinical outcomes. Delayed diagnosis may lead to prolonged recovery, chronic instability, post-traumatic osteoarthritis, and other secondary complications.