26 day or so) or to send the individual to a hospital for further diagnostic evaluation. There are similarities between injured astronauts and snowboarders in that both may be extremely limited in the available medical and diagnostic resources that can be provided. In order to address this challenge, NASA has reﬁned techniques of remote guidance ultrasound (US) technique to assist onboard non-physician care-providers to help make accurate and quick initial diagnoses aboard the International Space Station (ISS) [5–7]. While astro- nauts perform US on the ISS, doctors on earth are able to view and guide the US examination in real time. When provided with two-way voice and single-direction video communications, remote experts can immediately inter- pret the images and provide feed-back and remote guidance to the novice on-board users to obtain the best possible images and thus answer a clinical question at hand. These physicians can then decide whether an injured astronaut can be medically managed in space or needs to be brought back to earth for hospital care [8]. On mountain slopes this technology could also be utilized to advance the medical care of injured snowboarders. If remotely supported using such tele-ultrasound techniques, we propose that trained snow patrol teams or individual trainers could use a portable US machine to immediately diagnose injuries that previously required the delayed use of large radiographic machines for evaluation. Whether a hospital transfer was necessary might be decided depending on the mountain patrol or the trainer’s US diagnosis. If obvious pathology was detected then evac- uation should be expedited. If a less experienced operator was still suspicious of a negative examination or if an operator wished to conﬁrm their diagnosis, they could upload the US images and send them to the appropriate radiologic experts anywhere on the globe for consulta- tion. This article thus reviews the traumatic snowboard injuries that have been reported to-date and discusses the potential use of US technology as a diagnostic tool for mountainside determination of the extent of snowboard- ing injuries. Snowboarding injuries in elite and recreational riders A study of elite Norwegian snowboarders showed that overall injury risk is high and that the traumas suffered by these athletes are different from those seen among recrea- tional snowboarders. Speciﬁcally the elite group reported fewer wrist injuries but more knee and back traumas. A follow-up study was performed to conﬁrm these ﬁndings at the last race in March 2003 at the Federation Internationale de Ski Snowboard World Cup held in Switzerland. Acute injuries resulting in missed participation and traumas Curr Rev Musculoskelet Med (2009) 2:25–29 Fig. 1 Injury breakdown at the Federation Internationale de Ski Snowboard World Cup inﬂuencing performance were recorded during an interview. Exposure was reported as the number of runs in all disci- plines and the incidence rate was calculated as number of injuries per 1,000 runs [9]. At the Federation Internationale de Ski Snowboard World Cup, 258 elite snowboarders were interviewed after participating in a total number of 3,193 competition days in all disciplines. They reported suffering 158 injuries (some with more than one) with only 62 of these traumas occurring in the actual competitions. The most common injuries were located in the knee (n = 24; 18%), shoulder (n = 18; 13%), back (n = 17; 13%), and wrist (n = 11; 8%) (Fig. 1). The total competition exposure was estimated to be 46,879 runs based on the ﬁxed exposure factors estimated for each discipline. Therefore the calculated injury inci- dence rate was 1.3 traumas per 1,000 runs. One of the main difﬁculties in obtaining accurate data about recreational sports injuries is that they occur in a mobile population. Many of these participants often wait until they return home before having their injuries eval- uated [10]. The overall injury rate amongst recreational snowboarders is estimated to be 4–6 injuries per 1,000 snowboarder days, which is slightly higher than that seen in non-elite skiers. Over half (53%) of all injuries in the recreational snowboarder occur in the upper extremity [11]. Additionally, 15% of traumatic cases are head injuries, composed mostly of concussions. A review of 3,645 upper extremity injuries in snowboarders detailed the speciﬁc emerging trends in their traumas. A majority (21.6%) of these injuries occurred in the wrist, 16.2% in the shoulder, 4.1% in the hand, 3.8% in the elbow, and 2.7% in the forearm region. These upper extremity inju- ries are more common in beginners as advanced snowboarders are more likely to have complex and severe wrist fractures from extremely severe falls. Lower extremity trauma, although not as common as upper extremity injury, is also frequently seen. Of these the ankle accounts for 12–28%, the knee for 13–23%, and the foot for 1–3% [12].