To Wear a Helmet When Air boarding

During a weekend in the Swiss mountains our patient decided to try airboarding as an alternative to regular sledding. Helmets were not mandatory so he chose not to wear one. After a number of successful runs he lost control and careened head-first into a wall of iced snow. He was unconscious for roughly 2 minutes. Medical staff arrived at the scene quickly and he was immobilized according to advanced trauma life support (ATLS) procedures and airlifted to our hospital. On initial examination he presented a flattened right midface with excoriations from the right tragus to his nose, bony steps to be palpated around both orbits and significant occlusal discrepancy. A bodycheck showed no evidence of further injuries, but his personal history included an old midface fracture as a child with consecutive mandibular dysmorphy which accentuates the slight displacement of the midface.