Emergency radiology of severe acute injury in extreme alpine summer sports: a pictorial essay.

Abstract

Extreme alpine summer sports are increasingly popular and expose participants to high-energy trauma in remote mountain environments. This pictorial essay reviews the emergency radiology of severe acute injuries associated with down-hill mountain biking, rock climbing, paragliding, BASE jumping, canyoning, and rafting, with emphasis on mechanism-based imaging interpretation. Injury patterns differ across disciplines but are largely determined by velocity, fall height, landing posture, impact surface, axial loading, torsional forces, and water-related hazards. Down-hill mountain biking commonly produces extremity, thoracic, craniofacial, abdominal, and spinal injuries after high-speed crashes or handlebar impact. Rock climbing and paragliding frequently involve falls from height and hard landings, leading to thoracolumbar fractures, pelvic trauma, calcaneal or ankle injuries, and, in severe cases, neurologic compromise or visceral injury. BASE jumping is associated with high-velocity landing trauma, particularly involving the lower limbs, pelvis, and spine. Canyoning and rafting combine blunt trauma with environmental risks such as submersion, aspiration, hypothermia, and drowning-related complications. In high-energy trauma or polytrauma, whole-body computed tomography is the cornerstone of emergency assessment, enabling rapid evaluation of head, spine, chest, abdomen, and pelvis. Radiography remains useful for isolated appendicular injuries, whereas magnetic resonance imaging is essential for spinal cord, ligamentous, marrow, and selected soft-tissue injuries. Awareness of sport-specific mechanisms helps radiologists optimize image selection, maintain an appropriate search pattern, recognize injuries that may coexist after axial loading, and communicate urgent findings promptly. A mechanism-oriented approach may improve diagnostic accuracy, guide multidisciplinary management, and reduce missed injuries in patients presenting after alpine summer extreme sports trauma.