1. In the name of God

2. Snow Snow catastrophe condition: How much does it affect the orthopedic injuries? Mohsen Mardani-Kivi, M.D. Orthopedic Department, Guilan University Of Medical Sciences

14. Snow Snow catastrophe condition: How much does it affect the orthopedic injuries? Mohsen Mardani-Kivi, M.D. Orthopedic Department, Guilan University Of Medical Sciences

15. Background Iran is one of the most high risk natural disaster countries (6 th place among all countries).

16. Background Natural disasters victimize 150,000 cases annually (3 million individuals in 20 years) Guilan  3 episodes of snow crisis in the last decade

17. Background Subtle knowledge +learning from the previous experiences  more cost effective approaches for future catastrophes

18. Background pattern mechanismDuring the snow crisis, the pattern and mechanism of injuries alter due to changing in traffic and increasing the slipping and falling risks. Giladi AM, et al. Variation in the incidence of distal radius fractures in the U.S. Elderly as related to slippery weather conditions. Plast Reconstr Surg. 2014;133(2):321-32. Xu G, et al. Incidences, types, and influencing factors of snow disaster-asasociated injuries in Ningbo, China, 2008. Disaster Med Public Health Prep. 2012;6(4):363-9.

19. The purpose of the study Since there is no such study about the incidence of snow related trauma in our country, the present study seeks to analyze the snow injuries in year 2014 for precaution and prevention of trauma in possible future catastrophes.

20. A Retrospective Descriptive study Inclusion criteria: patients who were admitted due to snow related trauma in Rasht Poursina Hospital Exclusion criteria: incomplete medical files, superficial injuries (bruise, contusion, or laceration) and dislocations Patients were sub-categorized based on the day of admission (snowy day or icy days). The first 3 days after the snow  snowy days The 4 th to 7 th days after snow  icy days Methods and Materials :

21. Results

23. upper The most common fractures among upper extremities distal radius distal radius fx (124 cases, 32% of all fractures), forearm both bone fx (32 cases, 8%) humerus fracture (10 cases, 3%).

24. Results lower The most common fractures among lower extremities hip 45 cases of hip fx (12% of all) 44 cases of ankle fx (12% of all fractures) 11 cases of tibia fx (3%)

25. Results The frequency of injury Snowy days  124 injuries (32.4%) 41.3 fracture per day Icy days  259 injuries (67.6%) 64.6 fracture per day Icy days more Icy days significantly resulted in more injuries than snowy days (P< 0.001).

26. Results 4.5 timesThe mean of fracture rate per day was 54.7 cases which were 4.5 times more than a similar time in 2 years ago (11.6 fracture per day).

27. Results : menThe incidence of all fractures in men were significantly more than women (P<0.0001). lower limbAmong those patients > 65 yrs  Frequency of the lower limb fractures were more than upper ones years.

28. Results : α. The number in parentheses are demonstrated the percentage of the injury in every anatomical site. β. MVA: motor-vehicle accident Mechanism of injury Slipping (%) α Falling (%)MVA β (%)Others (%)Overall Upper limb171 (76%)15(7%)14(6%)26(11%)226 Lower limb62(71%)10(12%)9(10%)6(7%)87 Orthopedic256(82%)25(8%)0(82%)32(10%)313 Head & neck26(47%)23(42%)6(11%)0(0%)55 Trunk3(23%)10(77%)0(0%) 13 Table1. Mechanism of injuries in anatomical sites

29. Results : The most common mechanism of injury Slipping The rarest mechanism of injury Motor vehicle accident

30. Discussion Snow crisis and the increasing rate of slipping in European studies: – Ralis et al.: reported an increase of in fracture rate at four-day period after snow in Cardiff. Elderly (especially women) The upper limb fx (59% of cases) the most common fx  distal radius fx Ralis ZA. Epidemic of fractures during period of snow and ice. Br Med J. 1981;282(6264):603-52.6 times

31. Discussion Ralis et al. –Results of 6 similar studies; 4.5 times –they concluded that there is an increase (4.5 times more than usual) in fractures rate

32. Discussion In Norway: – the frequency of fx unrelated to MVA in snowy winter days were documented. –39% of fx were due to slipping on the ice or snow –45% of those cases were suffered from upper extremities fx

33. Why? ! Ice formation: 1.The surface of ice is crinkled due to subsiding snowflake. 2.The following decrease in temperature at night protects the snow from defrosting. 3.With increase in temperature in the next day, the ice surface would thaw and again it would become frozen in the night. This mechanism would form a smooth and plain layer of ice that increases the rate of slipping and falling.

34. Why? ! On the other hand, in the first day of snow crises, a large percentage of people may stay at home, however as the time passes, people start to come out to the icy streets Lewis et al. –the peak days of trauma may happen at the 6 th day after snow.

35. Summary Icy days: 3-6 days after snow SlippingThe most common mechanism: Slipping IcyIcy days > snowy days menmen > women UpperUpper > lower Distal Raius Fx & Hip Fx

36. Take home message Icy Be careful for the Icy days instead of Snowy days!

37. Any suggestions?