The Skiers' Boot Top Fracture: Rising Incidence, Characteristics, Treatment

Among the bony injuries sustained as a result of skiing accidents fractures of the tibio-fibular complex predominate.These fractures may vary considerably as to their localization, the form and extension of the fracture line, and the degree of displacement.Thcy may be located in the ankle region or they may affect the tibial shaft or the region of the knee.Of the ankle injuries, the simple fracture of the external malleolus with a spiral fracture line beginning at the level of the ankle joint and extending cephalad and laterally is met so often in skiers that it is sometimes called "the ski fracture" (Biitzntv 1957, Moritz 1959, Ellison, Carroll, Haddon & Wolf 1962, Spadeiiian 1968).The "Bosworth" fracture in which the proximal fragment of the fibula becomes impacted with its distal end behind the posterolateral ridge of the tibia (Bosworth 1947) is also held to be more or less characteristic for skiers.This latter fracture is, however, seen less often and so are fractures of the tibial malleolus and bimalleolar fractures.All these bony injuries in the ankle region, of course, result from a sudden thrust of the talus against the malleoli.Although they are often seen in skiers, they are in no way exclusive to the sport, but are also met as a result of a variety of other activities.The tibial shaft fractures, met in skiers, may be divided into spiral and transverse fractures, the fracture line reflecting the direction of the forces causing the injury.Spiral fractures of the tibio-fibular complex, which are sometimes comminuted with "butterfly" fragments, occur as the result of the same rotational force also responsible for the majority of ankle injuries.Such forces are likely to arise during down-hill skiing when the skier for some reason or other is unable to complete a turn and falls in the direction of his original motion.