title: Epidemic of fractures during a period of snow and ice: has anything changed 33 years on?
abstract: We reproduced a frequently cited study that was published in the British Medical Journal (BMJ) in 1981 assessing the extent of 'snow-and-ice' fractures during the winter period.
  
  
  
  This study aims to provide an insight into how things have changed within the same emergency department (ED) by comparing the findings of the BMJ paper published 33 years ago with the present date.
  
  
  
  As per the original study, all patients presenting to the ED with a radiological evidence of fracture during three different 4-day periods were included. The three 4-day periods included 4 days of snow-and-ice conditions and two control 4-day periods when snow and ice was not present; the first was 4 days within the same year, with a similar amount of sunshine hours, and the second was 4 days 1 calendar year later.
  
  
  
  To identify the frequency, distribution and pattern of fractures sustained in snow-and-ice conditions compared to control conditions as well as comparisons with the index study 33 years ago.
  
  
  
  A total of 293 patients with fractures were identified. Overall, there was a 2.20 (CI 1.7 to 3.0, p <0.01) increase in risk of fracture during snow-and-ice periods compared to control conditions. There was an increase (p <0.01) of fractures of the arm, forearm and wrist (RR 3.2 (CI 1.4 to 7.6) and 2.9 (CI 1.5 to 5.4) respectively).
  
  
  
  While the relative risk was not of the magnitude 33 years ago, the overall number of patients presenting with a fracture during snow-and-ice conditions remains more than double compared to control conditions. This highlights the need for improved understanding of the impact of increased fracture burden on hospitals and more effective preventative measures.
authors.affiliation: University Hospital of Wales, Cardiff, UK Cardiff University, Cardiff, UK University Hospital Llandough, Penarth, UK.
authors.forename: Waheeb
authors.initials: W
authors.lastname: Al-Azzani
authors.affiliation: Cardiff University, Cardiff, UK.
authors.forename: Danial
authors.initials: D
authors.lastname: Adam Maliq Mak
authors.affiliation: University Hospital of Wales, Cardiff, UK Cardiff University, Cardiff, UK.
authors.forename: Paul
authors.initials: P
authors.lastname: Hodgson
authors.affiliation: Hywel Dda University Health Board, Llanelli, UK.
authors.forename: Rhodri
authors.initials: R
authors.lastname: Williams
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data*; D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology*; D006801:Humans; D007053:Ice; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D012306:Risk; D012621:Seasons; D012914:Snow; D006113:United Kingdom / Q000453:epidemiology; D055815:Young Adult
chemical_list: D007053:Ice
keywords: fracture; ice; incidence; snow; weather