Epidemiology and Short-Term Hospital Outcomes of Skiing- and Snowboarding-Related Tibial Shaft Fractures Compared With Other Mechanisms of Injury.

Background Tibial shaft fractures are common long-bone injuries associated with significant healthcare utilization. While winter sports such as skiing and snowboarding are recognized etiologies of lower-extremity trauma, literature regarding tibial shaft fractures following such activities remains scarce. The biomechanics associated with skiing and snowboarding may differ from other traumatic mechanisms of injury (MOIs), potentially resulting in distinct injury patterns that influence hospital outcomes and resource utilization. The purpose of this study was to characterize the epidemiology of skiing- and snowboarding-related tibial shaft fractures and evaluate the influence of this MOI on short-term hospital outcomes.  Methods This retrospective cohort study identified 12,996 patients with tibial shaft fractures from 2017 to 2018 in the American College of Surgeons National Trauma Data Bank (NTDB), using International Classification of Diseases, Tenth Revision (ICD-10) diagnostic codes, including 232 skiing/snowboarding patients and 12,764 patients injured through other mechanisms. Patients with multiple tibial shaft fracture ICD-10 diagnosis codes or subsequent encounter codes were excluded. Skiing and snowboarding injuries were compared with all other MOIs, and 1:1 propensity score matching on age, sex, comorbidities, insurance type, injury characteristics, and hospital factors was used to reduce confounding. Hospital outcomes, including time to discharge, measured with length of stay (LOS), were evaluated in the matched cohort using appropriate comparative tests and Cox proportional hazards regression with four covariate sets: (1) demographics and injury severity score (ISS), (2) fracture characteristics, (3) payment and hospital factors, and (4) all prior covariates plus selected comorbidities and acute compartment syndrome (ACS). Results Skiing and snowboarding were associated with a higher hazard of discharge in Models 1-3 (HRs of 1.40, 1.77, and 1.48; all p < 0.001), suggesting shorter LOS compared with patients injured through other MOIs. However, this association was no longer statistically significant in Model 4 (HR 1.08, 95% CI 0.93-1.24, p = 0.302). Longer LOS was associated with increasing age, higher ISS, open fractures, diabetes, alcohol use disorder, substance abuse, and ACS (all p < 0.001). Segmental fractures were associated with longer LOS (HR 0.82, p < 0.001), whereas spiral, oblique, and transverse fractures were associated with shorter LOS relative to comminuted fractures (all p < 0.001).  Conclusion Skiing- and snowboarding-related tibial shaft fractures initially appeared to be associated with shorter LOS. However, after adjustment for patient, injury, and hospital characteristics, this MOI was no longer independently associated with time to discharge. While this MOI does not appear to independently drive short-term hospital outcomes, these findings suggest, but do not establish, that skiing- and snowboarding-related tibial shaft fractures represent a distinct lower-risk injury profile characterized by younger age, lower injury severity, fewer open fractures, fewer comorbidities, and more favorable discharge disposition.