Tag Archives: Injury

Straight, No Chaser: Emergency Room Adventures – Trampoline Trauma

September 29, 2013Orthopedics/Bones, Trauma, Musculoskeletal SystemGymnastics, AAP, American Academy of Pediatrics, Australian Associated Press, Emergency department, health, Injury, Shopping, Sports, Trampoline, United States, WordPressJeffrey Sterling, MD

So I’m back in the emergency room with a little girl who looks like her forearm is going to fall off the rest of her upper extremity.
People love trampolines. Yet somehow the only time I seem to hear the word trampoline is when someone’s been hurt. I’m not the only one who’d vaporize them on site. The American Academy of Pediatrics recommends that trampolines never be used at home or in outdoor playgrounds because these injuries include head and neck contusions, fractures, strains and sprains, among other injuries.

So my patient had a (posteriorly) dislocated elbow, meaning she fell off the trampoline, landing on the back of the extended upper arm, pushing the upper arm bone (the humerus) in front of the elbow and forearm. This is how that looks.

So for the joy of bouncing on a trampoline, the child had to be put asleep so the elbow could be replaced into the appropriate position. This procedure is fraught with potential for complications, including a broken bone on the way back, as well as damage to the local nerves and arteries (brachial artery, median and ulnar nerves), which can become entrapped during the effort to relocate the bone into the elbow joint. Some limitation in fully bending the arm up and down (flexion and extension) is common after a dislocation, especially if prompt orthopedic and physical therapy follow-up isn’t obtained. This really is a high price to pay for the privilege of bouncing up and down.
So if you’re going to allow your kids to play on a trampoline, here are two tips shown to reduce injuries.

Find one of those nets that enclose the trampoline, and make sure the frame and hooks are completely covered with padding. This is meant to protect against getting impaled, scratched or thrown from the trampoline.
Keep the trampoline away from anything else, including trees and rocks. This works even better if the trampoline is enclosed as previously mentioned.

Think back to the little girl I had to care for and consider whether this predictable event (complete with the mental stress of being in a loud emergency room in pain, getting an IV started and being put to sleep) was worth the effort. As per routine, an ounce of prevention…
I welcome your questions or comments.
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Straight, No Chaser: Orthopedics Quick Tips – Learn How to Fall – The FOOSH injury

August 10, 2013Orthopedics/BonesWrist, Trauma, Colles' fracture, Emergency department, health, Injury, Orthopedic surgery, OrthopedicsJeffrey Sterling, MD

We use a lot a acronyms in the Emergency Room, many of which can’t be repeated in polite company. Orthopedics and Trauma seem to lend themselves to a few. There’s GTSBOOM (got the stuff beat out of me, which is an all too common occurrence) and there’s FOOSH. FOOSH stands for ‘fell on outstretched hand’.
I bring this up because you need to learn how to fall. FOOSH injuries predictably cause fractures of the distal radius and ulnar (the two bones of the forearm), usually down by the wrist. These injuries are incredibly common and avoidable. The most notable injury is the Colles fracture, which is a distal radius fracture. You’ll know you have it after a fall when your wrist assumes the typical ‘dinner-fork deformity’.
$colles-fracture1$
So next time you fall, try to make it a glancing blow and avoid placing the full weight of your body on those wrists. Try to land and roll when you hit – but be extra careful to avoid bumping your head by doing this. If you get this right, it could save you 6 weeks in a splint, cast or in some cases a trip to the operating room.

Straight, No Chaser: Back Pain to The Future

August 7, 2013Orthopedics/Bones, NeurologyWeight loss, Back pain, health, Human back, Injury, Pain, Pain management, United StatesJeffrey Sterling, MD

Over 40 million Americans suffer from various forms of chronic low back pain. We must work really hard.
Lower back pain is a tricky subject for an emergency physician. The lower back is a source of many life threatening emergencies, which I’ll discuss in a separate post, but for now, as always let’s give you some information to help prevent and address your routine back problems. Let’s start by understanding what the back’s trying to accomplish and how you help or hinder that process by your actions.
Remember the back is the major weight-bearing apparatus of the body and it connects the upper and lower body. It twists, turns, pulls and bends. It contains many vital nerves and muscles.
Let’s point at four situations that produce or exacerbate your back pain:
1. Bad form (born with or otherwise acquired):

Spinal problems you were born with can predispose you to and outright cause all manner of back difficulties. Any machine works better if well-built.
Obesity puts a significant strain on your back in various ways. Given that most people don’t build up their back muscles, sprains and chronic pain are quite easy when you’re front-loaded. Pregnancy produces a similar strain on your back.

2. Strains
Have you ever heard that it’s easier to lift with your legs than your back? Well, I’d never think so based on the habits of many patients, but it’s true. The lower extremities are much stronger than your back. One of the problems with back strains is once it gets weak, it gets worse. Muscle spasms, pain, more strains and protruding discs all become more likely.
3. Fractures
A broken back is no fun. A weakened back bone (vertebrae) may collapse on its own if diseased (e.g. cancer, age, arthritis, infection), it may become fractured or may be injured with significant trauma. Those with osteoporosis have this happen more commonly. These broken bones may compress spinal nerves. You may even get shorter.
4. Arthritis and Normal Deterioration (aging)
There are other forms of arthritis beside degenerative joint disease (osteoarthritis, which we all get as we age), but the resulting pain, warmth, redness, swelling and limitation in motion all forms lead to reduced function and pain that can continue for the remainder of one’s life.
Here are a few clues to help you hone in on whether your back pain requires emergency attention:

Direct blow to your back
Fever and new onset back pain
Loss of control of your bowel movements or bladder function
New onset back pain after age 65
Numbness and tingling in both of your legs
Nighttime back pain
Sudden sexual dysfunction
Weakness and/or loss of motion or sensation in your legs
Weight loss and new onset back pain
Work related back injuries

What can you do to prevent or reduce the pain at home?

Learn and practice good posture. Sit when you can. Keep your back straight and shoulders back. When you stand, find something upon which to prop one of your feet, like a stool (think Captain Morgan).

Learn the correct way to lift (bend at the knees, not at the back – every time). If you have pain, avoid bending, stretching and reaching if avoidable.
Wear low-heeled shoes whenever you can, ladies!
Learn how to stretch your back.

Maintain a healthy weight, and exercise to strengthen your abdomen and back (your core)
Sleep on your side. Try a pillow between your knees.
Walk. Did you know walking is the best (and easiest) exercise for your back?

I’ll be back later (no pun intended) with your questions and more.