Curr Rev Musculoskelet Med (2009) 2:25–29 Speciﬁc upper extremity traumatic snowboarding injuries that have been reported are as follows. Distal radius fractures occur in those who are less experienced and are not usually wearing wrist guards. This injury typically occurs when the outstretched hand is used in an attempt to break a fall. Scapholunate dissociation presents as pain in the dorsal aspect of the wrist, also after falling onto an outstretched hand. Shoulder dislocation, which accounts for 8–16% of snowboarding injuries, commonly occurs from falling forward (toward the toe edge) on a snowboard. Other less common injuries to the shoulder include rotator cuff strains or tears, glenohumeral sub- luxations and dislocations, acromioclavicular separations, and clavicular fractures. Elbow injuries account for 2–5% of injuries and include contusions, sprains, strains, frac- tures, and dislocations. These elbow injuries likewise usually result from a drop onto an outstretched arm. Forearm injuries, although uncommon, can be seen after a severe fall. These include Monteggia fractures/disloca- tions (fracture of the proximal ulna with associated dislocation of the proximal radius) and Galeazzi fracture/ dislocations (fracture of the radius at the junction of the mid and distal one-third associated with dislocation of the distal radioulnar joint) [12]. Speciﬁc lower extremity snowboarding trauma that has been reported is as follows. A fracture of the lateral process of the talus (LPT) has been known as the ‘‘snowboarder’s fracture’’ [13] and is reported to represent 15% of all ankle snowboarding injuries. This previously rare injury has become more common, and typically occurs when a snowboarder lands hard from a jump with his body weight too far over the toe edge of the board. Ankle ligamentous sprains are commonly seen (most are of the lateral ankle ligaments) and half of all the injuries to the ankle are sprains. Knee injuries, although more common in skiers, include cruciate and collateral ligament injuries from fall- ing at high speed, collisions, and while chair lift uploading and unloading. Anterior cruciate ligament (ACL) sprains occur while medial collateral ligament (MCL) injuries are not often seen in snowboarding given the positioning of the feet on the board [12]. There are a number of non-extremity traumas that have also been associated with snowboarding. Spinal injuries account for signiﬁcant injuries (0.004/1,000 snowboarding days) and are commonly related to falls or errors while jumping and landing [4]. Chest injuries account for 1–6% of all snowboarding injuries and include rib fractures (55.2%), rib contusions (37.5%), sternal fractures (3.1%), pneumothorax/hemothorax (3.1%), and pneumomediastinum (1.1%). Abdominal injuries account for 2–7% of injuries and occur from falling (53%), errors occurring during jumping (32%), and collisions (16%) [12]. 27 The potential of ultrasound use in the diagnosis of snowboarding injuries We believe the vast majority of all reported snowboarding injuries could be assessed and accurately diagnosed mountainside utilizing portable US imaging. The use of US to supplement the physical examination of the injured patient is becoming increasingly accepted as an additional basic ‘‘sense’’ to complement inspection, auscultation, and palpation. An US enhanced initial assessment can address serious life-threatening pathology of the airway, respira- tory, and circulatory systems, and completely complements the primary survey of the Advanced Trauma Life Support Course [14]. However, given the medical complexity of abdominal and thoracic trauma, and the catastrophic con- sequences a misdiagnosis of visceral injury or organ system instability, we believe the initial mountainside use of US in the hands of non-physicians should be limited to the evaluation of extremity trauma. Such injuries have been studied extensively using musculoskeletal US techniques, accurately showing the extent and speciﬁc location of the injury [4]. While it is impossible to document the speciﬁcs of each sonographic evaluation for all the extremity snowboard injuries reported, three examples follow which show its potential use close to the scene of the accident. Case reports Case 1 The ﬁrst case shows the US probe placement and the resultant sonographic image seen in a patient suffering a fracture of the left second metacarpal bone (Fig. 2). Fig. 2 US probe placement and the resultant sonographic image seen in a patient suffering a fracture of the left second metacarpal bone