{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,30]],"date-time":"2026-08-30T12:08:55Z","timestamp":1788091735893,"version":"build-2803163510"},"reference-count":10,"publisher":"BMJ","issue":"9","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2016,6,6]]},"published-print":{"date-parts":[[2016,9]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>\n                      We reproduced a frequently cited study that was published in the\n                      <jats:italic>British Medical Journal<\/jats:italic>\n                      (\n                      <jats:italic>BMJ<\/jats:italic>\n                      ) in 1981 assessing the extent of \u2018snow-and-ice\u2019 fractures during the winter period.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>\n                      This study aims to provide an insight into how things have changed within the same emergency department (ED) by comparing the findings of the\n                      <jats:italic>BMJ<\/jats:italic>\n                      paper published 33\u2005years ago with the present date.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>As per the original study, all patients presenting to the ED with a radiological evidence of fracture during three different 4-day periods were included. The three 4-day periods included 4\u2005days of snow-and-ice conditions and two control 4-day periods when snow and ice was not present; the first was 4\u2005days within the same year, with a similar amount of sunshine hours, and the second was 4\u2005days 1 calendar year later.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Primary and secondary outcome measures<\/jats:title>\n                    <jats:p>To identify the frequency, distribution and pattern of fractures sustained in snow-and-ice conditions compared to control conditions as well as comparisons with the index study 33\u2005years ago.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 293 patients with fractures were identified. Overall, there was a 2.20 (CI 1.7 to 3.0, p &lt;0.01) increase in risk of fracture during snow-and-ice periods compared to control conditions. There was an increase (p &lt;0.01) of fractures of the arm, forearm and wrist (RR 3.2 (CI 1.4 to 7.6) and 2.9 (CI 1.5 to 5.4) respectively).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>While the relative risk was not of the magnitude 33\u2005years ago, the overall number of patients presenting with a fracture during snow-and-ice conditions remains more than double compared to control conditions. This highlights the need for improved understanding of the impact of increased fracture burden on hospitals and more effective preventative measures.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2015-010582","type":"journal-article","created":{"date-parts":[[2016,9,14]],"date-time":"2016-09-14T20:57:57Z","timestamp":1473886677000},"page":"e010582","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":32,"title":["Epidemic of fractures during a period of snow and ice: has anything changed 33\u2005years on?"],"prefix":"10.1136","volume":"6","author":[{"given":"Waheeb","family":"Al-Azzani","sequence":"first","affiliation":[{"name":"University Hospital of Wales, Cardiff, UK"},{"name":"Cardiff University, Cardiff, UK"},{"name":"University Hospital Llandough, Penarth, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danial","family":"Adam Maliq Mak","sequence":"additional","affiliation":[{"name":"Cardiff University, Cardiff, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Hodgson","sequence":"additional","affiliation":[{"name":"University Hospital of Wales, Cardiff, UK"},{"name":"Cardiff University, Cardiff, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rhodri","family":"Williams","sequence":"additional","affiliation":[{"name":"Hywel Dda University Health Board, Llanelli, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2016,9,14]]},"reference":[{"key":"2025121408125876000_6.9.e010582.1","doi-asserted-by":"publisher","DOI":"10.1136\/ip.6.1.16"},{"key":"2025121408125876000_6.9.e010582.2","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2010.12.012"},{"key":"2025121408125876000_6.9.e010582.3","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.282.6264.603"},{"key":"2025121408125876000_6.9.e010582.4","doi-asserted-by":"crossref","first-page":"589","DOI":"10.1016\/S0140-6736(88)91383-9","article-title":"Snow-and-ice fracture in the UK, a preventable epidemic","volume":"1","author":"Ralis","year":"1988","journal-title":"Lancet"},{"key":"2025121408125876000_6.9.e010582.5","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1186\/1865-1380-7-17","article-title":"Fracture prevalence during an unusual period of snow and ice in the Netherlands","volume":"7","author":"van den Brand","year":"2014","journal-title":"Int J Emerg Med"},{"key":"2025121408125876000_6.9.e010582.6","unstructured":"NHSWales. 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