March 10, 2023
On Friday, March 4, 2022, Brian D. Kim, M.D., a Mayo Clinic trauma surgeon and adult trauma medical director, became a trauma patient.
That day, he drove to Welch Village Ski and Snowboard Area in Welch, Minnesota, with two of his children. One of them snowboarded with a friend as part of a local ski club outing and the other skied with Dr. Kim.
It was late in the season for a Southeast Minnesota resort. As the weather recently had warmed and melted some snow, runs were choppy with ruts.
Dr. Kim, a 35-year snowboarder, started his last run of the day with his son, Mason, who was skiing. He snowboarded behind his son by approximately 30 yards when Mason slowed his pace. With momentum going, Dr. Kim passed his son, riding his typical goofy style with right foot in front. He looked back over his board at his son and planned to say, "Great run — almost down."
Right then, Dr. Kim snowboarded over a tiny hill, called a knuckle, catching the edge of his snowboard on a rut. He flipped over the front of the board in a somersault. He landed on his right shoulder on the knuckle's downside, with the board over his head. His right knee collided with his right elbow, driving his humerus into the humeral head and shattering his proximal humerus.
"I knew, based on pain, something was wrong with my shoulder," says Dr. Kim. "I tried pushing myself off the snow. My right arm gave out. That's when I knew it was bad."
He turned onto his back. Mason skied over, said he had seen his father upside down and asked if he was OK. Dr. Kim responded that he was not. He was hurt.
Post-injury
Dr. Kim removed his mitten to check his right hand and upper extremity. Although his hand moved and he felt a pulse, something was wrong. He could not shrug his shoulder.
He asked Mason to ski down the rest of the way and remove his gear at the rack. Dr. Kim says he somehow managed to stand and snowboarded down to his son.
Due to the injury, Dr. Kim found he was unable to remove his jacket before climbing into his vehicle. As he drove home, he rested his right arm on the console. He dropped off his son at home and drove to Mayo Clinic's emergency department (ED).
An orthopedic surgery resident assessed Dr. Kim in the ED and ordered X-rays. The X-ray technician, who had known Dr. Kim for years, showed him the images. The resident diagnosed Dr. Kim with a comminuted proximal humerus fracture.
ED personnel fitted Dr. Kim with a sling, and the orthopedic resident called William W. Cross III, M.D., a Mayo Clinic orthopedic trauma surgeon. Jonathan D. Barlow, M.D., another orthopedic surgeon with expertise in management of shoulder injuries, reviewed Dr. Kim's injury and discussed recommendations with Dr. Kim. The fracture involved the insertion of the rotator cuff. There were extensive discussions about the management options. They decided on nonoperative injury management with a plan for a shoulder immobilizer for three months.
With his immobilizer, Dr. Kim says he had to retrain himself in everyday tasks. He could only wear button-down shirts and stretchy V-neck T-shirts. Activities of daily living such as brushing teeth, showering and simply getting dressed were challenging without the use of his dominant arm and rotation of his shoulder. Although he could not perform surgery, he returned to work 10 days after the crash.
"I was going batty at home, just focusing on how badly it hurt," he says. "So, I returned to staff the surgical ICU, doing mostly mental work."
Dr. Kim relied on his partners to perform intubations and invasive lines. He could not operate or take acute care surgery and trauma call for three months.
"It took three months to raise my arm to put on a scrub top," Dr. Kim says. "Even then, it was extraordinarily painful. My partners were immensely supportive of me during this time. They allowed me the time to heal and come back when I was ready."
A look back
In retrospect, Dr. Kim says weather was not a factor in his crash.
"The weather was clear, a great day to be on the hill," he says. "The run was a blue — nothing scary. However, the snow was slow, slushy and sloppy."
He says this type of snow made snowboarding more dangerous for an edge catch. When he tumbled, tiredness also was not a factor, he explains.
"I was not fatigued," says Dr. Kim. "My son and I could have stayed out longer, but we had a drive home. I also wasn't doing anything aggressive."
Dr. Kim says he is grateful he was wearing a helmet.
"It could've been a different injury pattern had I landed on my head unprotected," he says. "If the impact had been on my axial spine, it also could have been a different injury," he says. "I'm thankful it was just my arm."
Dr. Kim is trying to maintain a realistic perspective on his injury. He does not expect the shoulder will ever be as it was before the injury.
"My care was excellent," he says. "I still have some rotator cuff issues that require stretches and strengthening. It's been nine months since my crash. I'm still not 100% — I'd say 90% — but there's a long tail to this recovery. I have a new appreciation for trauma patients' recoveries, especially from orthopedic injury.
Dr. Kim says he experienced a "little moment" psychologically on the same run with similar snow conditions as his injury day while snowboarding this season. Yet, he feels it was important for him to get back to snowboarding to move beyond the crash.
Snowboard safety insights
Dr. Kim says snowboard injuries have grown alongside the sport's expansion. He feels snowboard safety primarily comes down to rider experience and conditions. Learning to snowboard will lead to some falls, he says. He encourages reasonable expectations.
"You've gotta dust off the snow sometimes," he says. "My daughter skied first, then tried snowboarding. Before her first time, I told her she'd have a miserable day and fall often. It's a learned skill; there'll be some trials."
Dr. Kim has cared for patients with solid organ injury, hemorrhage, head injury and various orthopedic injuries following skiing and snowboarding.
His tips to avoid snowboarding injuries include:
- Awareness. Know your abilities and remain self-critical.
- Preparedness. Prepare according to your experience.
- Protectiveness. Safety gear such as adjusted bindings, helmets, goggles, wrist guards, a snowboard leash and pads can make a difference in a crash.
- Teachability. Listen to those mentoring you in the sport.
Dr. Kim suggests passing on these suggestions to patients who have experienced traumatic injury from snowboarding, as appropriate.
Lastly, when injured at a ski and snowboard resort, Dr. Kim suggests seeking on-site help.
"First responders are at a resort for a reason," he says. "My pride, embarrassment and interest in taking care of my son clouded my own decision-making about my injury and condition."
Though being ready for time on the hill is crucial, Dr. Kim acknowledges some injury factors are outside one's control.
"Injury doesn't discriminate," he says. "Trauma doesn't care. Honestly, the underprepared will suffer more than the properly prepared. And even the best prepared person can suffer trauma.
"I credit the trauma and orthopedic professionals as well as the physical therapists who cared for me. I am thankful to be in the state of recovery that I am."
For more information
Refer a patient to Mayo Clinic.