Breaks of the Game

Despite his age, William Jacobson, 60, had no qualms last month when he joined the nation's 3,500,000 skiers. A recently retired California forester, he aimed to enjoy the outdoors even more than he had as a state employee. But as Jacobson, an advanced skier, whooshed down a slope at Sierra Ski Ranch, he lost control, hit a tree and broke his left elbow, shoulder blade and four ribs, which punctured a lung. Now incapacitated for at least two months, he has become an unhappy statistic--one of this year's roughly 100,000 injured U.S. skiers, more than a third of them with broken arms or legs.

From a strictly medical standpoint, skiing makes no sense. "The odds are not with the participant at all," says Orthopedist James Garrick, head of the University of Washington's division of sports medicine. Dr. Garrick is so concerned that he is participating in a conference on ski injuries to be held this week in Aspen, Colo. The agenda includes such abstruse topics as "Rotational Instability and Its Repair" and "The Biomechanics of Tibial Fractures in Skiing."

The engineering argot is appropriate. According to Garrick, the ski acts as a lever, accentuating the effects of any twisting motion on the leg. Even a slow fall on a beginner's slope can produce a fracture. In fact, it often does. "The typical ski injury," says Garrick, "involves a woman around 18 to 20 who is just beginning. As she makes a turn maneuver on a gentle slope, she goes down in a slow, twisting fall. She feels something snap; she has fractured the shaft of her tibia and fibula, the two bones of the lower leg."

Treatment for such an injury is relatively simple. As soon as the victim is down off the mountain, doctors can X-ray the leg and line up the broken bones. They can also set the leg without anaesthesia, since they usually see the patient before painful swelling begins. The patient should be able to get around on crutches within a few days, use a walking cast after six weeks, and walk without a cast, though with care, after another six.

Skimpy Second Aid. Many novices get hurt even before they hit the slopes. Though state safety codes have sharply reduced ski-lift mishaps, skiers manage to slip in icy parking lots, strain untrained muscles or fall off ski-lodge bar stools. One young woman recently hurt herself in the ski shop at Vail, Colo. Bending over to adjust the bindings on her rented skis, she ruptured her Achilles tendon and wound up in a cast for two months. Another girl suffered from annoying numbness in her legs whenever she skied. Dr. Arthur Ellison, a Williamstown, Mass., skier-orthopedist who runs a clinic at Vermont's Haystack Mountain, found that her tight ski pants were pressing on her leg nerves. He cured her "stretch-pants palsy" by making her wear a larger size.

On the mountain itself, the most common injuries used to be simple fractures of the lateral malleolus, or anklebone, and low-level spiral fractures of the tibia and fibula. But now that higher, more rigid ski boots are in style, doctors are encountering the more serious "boot-top fracture," in which the tibia and fibula are snapped well above the ankle. A simple ankle fracture takes six to eight weeks to knit properly; a simple boot-top break can require as long as 16 weeks.

Even so, skiing may be safer (fatalities are very rare) than staying home, where more than 4,000,000 Americans were disabled and 27,000 died in accidents last year. Moreover, for those who are hurt on the hill, emergency treatment is usually prompt and professional. The National Ski Patrol has 20,000 members trained in mountain rescue techniques, and all U.S. ski areas are policed by paid patrolmen or dedicated volunteers. As a result, most ski casualties are spotted, given first aid and whisked off the slopes in toboggans within minutes of a serious spill.

Unfortunately, second aid is often lacking. A few areas, like Vermont's Mount Snow, maintain well-equipped mini-hospitals at the foot of their lift lines, where doctors can X-ray and set simple fractures. But all too often good treatment stops at the bottom of a run, and injured skiers must either gamble on local physicians or limp to a distant city hospital. A Manhattan woman nearly lost the use of one leg after a Vermont hospital botched a simple break. A New York orthopedist later saved the leg with a complex operation, but only this month has the woman been able to board skis again--ten years later.

Safety in Skill. The obvious solution is prevention. Thus release bindings, designed to free the foot in a fall, are now installed on virtually every pair of skis sold or rented in the U.S. But such bindings may be useless if they are not properly adjusted and maintained. Many novice skiers fall too slowly to open the bindings. Some critics argue that women, who suffer twice as many ski injuries as men, are often too light to activate the release mechanism.

The best insurance for skiing safety is sheer skill. For raw beginners, the accident rate is twelve injuries per thousand "skier-days." After a mere week of instruction, the rate drops to five injuries per thousand skier-days. Schussing at the highest speeds on the steepest trails, expert skiers (including women) have the fewest accidents--only three per thousand days. Hard-core skiers have an added incentive: the $300 or more they invest in equipment and lessons. When good skiers get hurt, they usually ask the examining doctor to please slit their expensive pants down the seam so they can be resewed. Then they ask: "When can I start skiing again?"

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