June 1, 2006
by Oral Health
With the popularity of snowmobiles, the incidence of facial fractures in those enjoying this recreational activity has increased due to a combination of factors including: alcohol use, night-time driving, immaturity of the driver, inappropriate use of helmets, and traveling on unknown terrain. In order to help decrease the rate of snowmobile related injuries, further education of snowmobile riders, and the elimination of those factors which are completely preventable is key to achieving a significant injury reduction.
Snowmobiling has become an extremely popular winter sport, and no longer is considered just a means of transportation during emergencies or through areas of snow covered terrain, inaccessible by automobile. It is not only an individual but a family recreational sport. With its increasing popularity also comes an increase in the number of injuries and death which has become a costly burden to society. Snowmobile accidents are the most severe winter recreational injury in Canada, surpassing snowboarding and skiing.
The snowmobiles, also known as snow machines, have become popular and powerful 400 kilogram self propelled vehicles with their engine in the front section. They move along with the use of centrally located cleated rubberized tracks, skis, belts or low pressured tires. The snowmobile can reach speeds of up to 190 km/h on a 60 horsepower engine. The sheer force and size of this vehicle is one of the factors why riders may be killed or severely injured while using them.
Between Canada and United States, there are over 4 million snowmobiles which are registered.1 It is estimated that over 360, 000 snowmobiles are in use in Ontario alone, which surpasses the rest of North America’s statistics.2 Each year in North America, the snowmobiling industry accounts for in excess of $9.4 billion of spending.1 However, the mortality related to snowmobiling in North America is high. It is believed that the fatality rate of 200 persons annually with an additional 14,000 emergency room visits for snowmobile related injuries are a gross underestimation.1 In Ontario alone, approximately 7000 people are injured in yearly snowmobile related accidents. Again this number is well underestimated as many injuries go unreported.3 It is inevitable that as the popularity of snowmobiling increases, so do the number of associated injuries and deaths.
RISK FACTORS AND MECHANISM OF INJURY
Many risk factors have been associated with snowmobile injury and death. Injuries and death are more likely to occur during the night or at dusk when the eyes are adjusting to the change of lighting conditions. In North America, February has been noted to be most dangerous in terms of injuries followed by January and then March. Weekends and holidays have also shown to have higher rates of associated mortality.4 The fatality resulting from a snowmobile crash may be due to excessive use of speed, inattention of the driver, carelessness, reckless driving, inexperienced drivers, and poor visibility.4 Alcohol is a major contributing factor with almost half of those who were seriously injured having a positive history of consuming alcohol prior to snowmobiling. Males far outweigh females with one estimate noting that four out of five injuries occur in men.2,4
Local statistics in Ontario show that 75% of snowmobiling fatalities occur off established trails. An impressive 74% of snowmobiling injuries involved alcohol consumption. A total of 37% of snowmobiling injuries involved excessive speed. Locally most snowmobiling injuries and deaths occurred most commonly among males, aged 20-34 (www.tbdhu.com).
The mechanism of injury and mortality during a snowmobile crash include: a direct hit with another object such as fencing/ wiring, trees, bridges, or other vehicles; rollovers; drowning after falling through the ice, and injury of passengers on the snowmobile or being towed behind the snowmobile.4-6 Injuries to the snowmobiler most often affect the extremities and/or the head, with the most common cause of death being caused by trauma to the head, neck or spinal cord, injury to internal organs, or drowning after the snowmobile falling through thin ice. Riders less than 20 years of age are more likely to be seriously injured.3,4,6,7
With respect to the facial region, reports have indicated a pattern of injury that involves both the hard and soft tissues. The distribution of facial fractures includes maxilla, dento-alveolar, mandible, zygoma, and nose (Fig. 1). Contact to the face is made many times either by the face hitting the front part of the snowmobile, especially the handle-bars, or more commonly by the face striking a stationary object, such as rock outcrops, fence post or barbed wire fencing (Figs. 2-4). Facial lacerations were often seen with these types of injury because of the barbs of the fences.6 Lack of helmet use and excessive speed has been shown to increase the severity of injury.5,8
The maxillofacial injuries associated with snowmobile collisions and accidents are usually complex and require a multidisciplinary approach, with the involvement of trauma teams consisting of general surgeons, orthopedic surgeons, oral and maxillofacial surgeons, ophthalmologists and dentists. Treatment consists of management using the acute trauma life support protocol developed by the American College of Surgeons. The facial fractures are repaired with open reductions where appropriate using rigid fixation techniques to promote a faster recovery.8 The dental injuries are treated emergently and then dealt with definitively once the patient’s condition permits.
PREVENTION AND RECOMMENDATIONS
The recreational use of snowmobiles may result in serious but often avoidable injuries. Such trauma is often caused by human factors and is thus potentially preventable. Provincial laws govern the use of snowmobiles with respect to minimum age requirements for operation, registration of snowmobiles, wearing of helmets, speed limits and use of the public road system. Unfortunately however, these laws cannot stop those riders who choose to snowmobile on private areas of land. In addition there is not enough police manpower to patrol private trails. As a result Ontario has tried to help ameliorate this problem by teaming up with snowmobile club members through a program called STOP (Snowmobile Trail Officer Patrol) program.
In some jurisdictions legislation regulating snowmobile use is strict in its implementation and leaves little doubt in terms of interpretation. The excessive speeds and reckless driving, poor decisions and alcohol consumption have been the main factors for injuries during sledding. Similar to Canada, the consumption of alcohol is strictly forbidden for snowmobile riders in Finland. The outfits that hire snowmobiles as rentals are allowed to make customers undergo a breathalyzer test prior to allowing the rental of their equipment. In addition the wearing of a helmet is now mandatory in Finland,8 where a great many tourists also engage in snowmobile tours (Fig. 5).
Local snowmobile clubs are good candidates to help try, improve safety and improve driver awareness of the dangers of snowmobiling. Driver awareness is the key to prevention. The use of helmets for example can help to substantially reduce the number of injuries.9 Education and enforcement campaigns that are age appropriate and are targeted to the specific risk groups would be more effective in reducing snowmobile related injuries (Table 1).
Bruce R. Pynn, MSc, DDS, FRCDC, Oral and Maxillofacial Surgeon, Pterosaur Healthcare Inc., Thunder Bay, ON.
Tania P. Pynn, RN, BScN, MHS, Public Health Nurse, Thunder Bay District Health Unit Thunder Bay, ON.
George K.B. Sndor, MD, DDS, PhD, FRCDC, FRCSC, FACS. Professor, Oral and Maxillofacial
Surgery and Anaesthesia, University of Toronto, Coordinator of Pediatric Oral and Maxillofacial Surgery, The Hospital for Sick Children and Bloorview Kid’s Rehab Centre.
1.Pierz, J. J. (2003, April). Snowmobile Injuries in North America. Clinical Orthopaedics and Related Research, 2003; 409: 29-36.
2.Beirness, D. J., Mayhew, D. R., & Simpson, H. M. Alcohol involvement in snowmobile fatalities in Canada. Retrieved April 1, 2006, from http://www.normie.ca/alcohol.html
3.Rowe, B. H., Caverson, R., Therrien, S., Bota, G., Giesbrecht, N., & Smythe, C. Snowmobilers in a Northeastern Ontario Community: A survey of characteristics, injury profiles, and strategies for injury prevention. Sudbury General Hospital and Addiction Research Foundation 1993.
4.Sy, M. L., & Corden, T. E. (2005). The perils of snowmobiling. Wisconsin Medical Journal, 2005; 104: 32-34.
5.Nayci, A., Stavlo, P. L., Zarroug, A. E., Zietlow, S. P., Moir, C. R., & Rodeberg, D. A. Snowmobile injuries in children and adolescents. Mayo Clinic Proceedings 2006; 81: 39-44.
6.Rigg, B. M. (May 1977). Facial Fractures and Snowmobile Accidents. The Canadian Journal of Surgery 1977; 20 : 275-277.
7.Stewart, R. L., & Black, G. B. Snowmobile trauma: 10 years’ experience at Manitoba’s tertiary trauma centre. Canadian Medical Association 2004; 47: 90-94.
8.Pynn, BR, Green, RA, Dowhos, WW: Oral and maxillofacial surgery: Responding to trauma. Ontario Dentist 2003: 80(7) 23-28,
9.Koskinen K. Snowmobile traumas in Finnish Lapland: Injuries to head, face and neck. Arctic Med Res 1994; 53 Suppl 3: 5-7.